WAGNER COMMUNITY MEMORIAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- WAGNER COMMUNITY MEMORIAL HOSPITAL (EIN 46-0226283)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-01-23
- IRS object ID
- 201320239349300132
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-01-23T15:14:54-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH STREET PO BOX 5125 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 571175125 | 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 | 460226283 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wagner Community Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WAGN | NameControl |
| Phone | 6053843611 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Bryan Slaba | Name |
| Title | CEO | Title |
| Phone | 6053843611 | Phone |
| Date Signed | 2013-01-23 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Laurie Hanson | Name |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | Phone |
| Date Prepared | 2013-01-23 | DatePrepared |
| 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 | Bryan Slaba | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8416886 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1947 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | To provide healthcare services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 104 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 454381 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 95684 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7342022 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8280711 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 55025 | InvestmentIncomePriorYear |
| Investment Income Current Year | 25939 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 14502 | OtherRevenuePriorYear |
| Other Revenue Current Year | 14552 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7865930 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8416886 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2133 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3535003 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4023085 | 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 | 4361941 | OtherExpensePriorYear |
| Other Expenses Current Year | 4568007 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7899077 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8591092 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -33147 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -174206 | RevenuesLessExpensesCY |
| Total Assets BOY | 10546961 | TotalAssetsBOY |
| Total Assets EOY | 11738938 | TotalAssetsEOY |
| Total Liabilities BOY | 5866459 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7111938 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4680502 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4627000 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Wagner Community Memorial Hospital's mission is to provide care and treatment of the sick; provide care and support of the aged, disabled, and indigent; and to provide for those in need of hospitalization regardless of race, color, creed, or ability to pay. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7438258 | Expense |
| Revenue | 8295263 | Revenue |
| Description | WCMH is a 20 bed critical access hospital equipped with extensive advanced services, including areas for Medical/Surgical, Pediatric, Intensive/Coronary Care, and Swing Bed/Long Term Care. The clinic is adjacent to the hospital making it convenient to see hospital patients, and share laboratory services and other diagnostic equipment. Outreach services include OB/GYN, Pediatrics, Orthopedic Surgery, General Surgery, Urology, Podiatry, ENT & Audiology. The people of the community truly believe in having access to care and support their local medical providers. The facility serves as the inpatient unit for the local Indian Health Services clinic and works collaboratively with the IHS physicians and leaders to care for the Native American population. WCMH experienced 839 Inpatient days, 568 Swing Bed days, 1805 Emergency Department visits, 751 Urgent Care visits and 1594 clinic visits. | Description |
| Total Program Service Expense | 7438258 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 26 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 104 | 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 | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Lisa Weisser | NamePerson |
| Telephone Number | 6053843611 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 3rd Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 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 |
|---|---|---|---|---|---|---|---|
| Ken Thaler | |||||||
| Board President | 0.50 | X | X | 0 | 0 | 0 | |
| David Kotab | |||||||
| Board Vice President | 0.50 | X | X | 0 | 0 | 0 | |
| Elden Ridgeway | |||||||
| Board Secretary | 0.50 | X | X | 0 | 0 | 0 | |
| Jean Pirner | |||||||
| Board Treasurer | 0.50 | X | X | 0 | 0 | 0 | |
| Merle Bartunek | |||||||
| Director | 0.50 | X | X | 0 | 0 | 0 | |
| Dorothy Holzbauer | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Ann Freier-Metzger | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Bill Frie | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Dave Andrews | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Bryan Slaba | |||||||
| CEO/Administrator | 40.00 | X | 116385 | 0 | 6069 | ||
| Robert Hubley til August 2011 | |||||||
| Physician | 40.00 | 162019 | 0 | 19694 | X | ||
| Ahmed Dessouki til May 2011 | |||||||
| Physician | 40.00 | 116150 | 0 | 7524 | X | ||
| Dr Uzma Mian | |||||||
| Physician | 40.00 | 128355 | 0 | 4165 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 522909 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 37452 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Avera Sacred Heart Hospital | |||||
| 501 S Summit Street | Yankton | SD | 57078 | Management and IT Services | 296573 |
| Dr Jeffery Pinter | |||||
| 27952 323rd Avenue | Winner | SD | 57580 | Physician Labor | 247280 |
| Linde Healthcare Staffing | |||||
| 3668 South Geyer Road | St Louis | MO | 63127 | Physician Labor | 213446 |
| Avera Sacred Heart Rural Health | |||||
| 501 S Summit Street | Yankton | SD | 57078 | Contract Physician Labor | 151974 |
| Dr Gary A Bubak | |||||
| 29778 398th Avenue | Wagner | SD | 57380 | Physician Labor | 119625 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 91698 | GovernmentGrants |
| All Other Contributions | 3986 | AllOtherContributions |
| Total Contributions | 95684 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Fees | 621110 | 8110290 | 8110290 |
| Apartment Revenue | 900099 | 104340 | 104340 |
| Other Revenue | 900099 | 65873 | 65873 |
| Patient Interest Reven | 900099 | 208 | 208 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8280711 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25191 | TotalRevenueColumn |
| Exclusion | $25,191 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14552 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14552 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14552 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14552 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 748 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 748 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 748 | TotalRevenueColumn |
| Exclusion | $748 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8416886 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8295263 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $25,939 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126430 | Total |
| Management And General | 126430 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114626 | Total |
| Program Services | 114626 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3260696 | Total |
| Program Services | 2761352 | ProgramServices |
| Management And General | 499344 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47436 | Total |
| Program Services | 40218 | ProgramServices |
| Management And General | 7218 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259422 | Total |
| Program Services | 219945 | ProgramServices |
| Management And General | 39477 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214475 | Total |
| Program Services | 181838 | ProgramServices |
| Management And General | 32637 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17733 | Total |
| Management And General | 17733 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54800 | Total |
| Management And General | 54800 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1045359 | Total |
| Program Services | 989449 | ProgramServices |
| Management And General | 55910 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34992 | Total |
| Management And General | 34992 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 346305 | Total |
| Program Services | 287624 | ProgramServices |
| Management And General | 58681 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51730 | Total |
| Program Services | 21354 | ProgramServices |
| Management And General | 30376 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 157164 | Total |
| Program Services | 157164 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13365 | Total |
| Program Services | 13365 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34278 | Total |
| Program Services | 31022 | ProgramServices |
| Management And General | 3256 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 186042 | Total |
| Program Services | 184902 | ProgramServices |
| Management And General | 1140 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 776029 | Total |
| Program Services | 776029 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44697 | Total |
| Program Services | 44679 | ProgramServices |
| Management And General | 18 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Medical Supplies | 703207 | 703207 | |
| Bad Debt | 522967 | 522967 | |
| Repairs and Maintenance | 366173 | 360316 | 5857 |
| ACS Fees | 109344 | 109344 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103822 | Total |
| Program Services | 28201 | ProgramServices |
| Management And General | 75621 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8591092 | Total |
| Program Services | 7438258 | ProgramServices |
| Management And General | 1152834 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 719839 | BOY |
| EOY | 413554 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 15360 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1480843 | BOY |
| EOY | 2077129 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 69645 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 104278 | BOY |
| EOY | 187554 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77627 | BOY |
| EOY | 118126 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13209997 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4772088 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7429462 | BOY |
| EOY | 8437909 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 714508 | BOY |
| EOY | 399797 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20404 | BOY |
| EOY | 19864 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10546961 | BOY |
| EOY | 11738938 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1220937 | BOY |
| EOY | 769122 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4639501 | BOY |
| EOY | 6336520 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6021 | BOY |
| EOY | 6296 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5866459 | BOY |
| EOY | 7111938 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4679746 | BOY |
| EOY | 4626244 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 756 | BOY |
| EOY | 756 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4680502 | BOY |
| EOY | 4627000 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10546961 | BOY |
| EOY | 11738938 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -174206 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 120704 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4247 | OtherCostOrOtherBasis |
| Book Value | 4247 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9752882 | OtherCostOrOtherBasis |
| Depreciation | 3162224 | Depreciation |
| Book Value | 6590658 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3248352 | OtherCostOrOtherBasis |
| Depreciation | 1573565 | Depreciation |
| Book Value | 1674787 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 204516 | OtherCostOrOtherBasis |
| Depreciation | 36299 | Depreciation |
| Book Value | 168217 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8437909 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Tenant Security Deposits | Description |
| Amount | $6,296 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6296 | TotalOfAmounts |
| Total Revenue | 8416886 | TotalRevenue |
| Total Expenses | 8591092 | TotalExpenses |
| Excess Or Deficit For Year | -174206 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -38440 | NetUnrealizedGLOnInvestments |
| Other | $159,144 | OtherAmount |
| Total Adjustments | 120704 | TotalAdjustments |
| Excess Or Deficit Per FS | -53502 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8014623 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -38440 | NetUnrealizedGainsInvestments |
| Other Revenues | -363823 | OtherRevenues |
| Revenue Not Rptd F990 | -402263 | RevenueNotRptdF990 |
| Revenue Subtotal | 8416886 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8416886 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 8068125 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 8068125 | ExpensesSubtotal |
| Other Expenses Not Included | 522967 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 522967 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 8591092 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | The Hospital 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 Hospital 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. |
| Part XI, Line 8 - Other Adjustments: | Change in interest in net assets of Avera Health Foundation 159,144. | |
| Part XII, Line 2d - Other Adjustments: | Change in interest in net assets on Avera Health Foundation 159,144. Bad debt expense -522,967. | |
| Part XIII, Line 4b - Other Adjustments: | Bad debt expense 522,967. |
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 |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| 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 | 125400 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 125400 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01550 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1311638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 919341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 392297 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04860 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1437038 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 919341 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 517697 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06410 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 1796 | PersonsServed |
| Total Community Benefit Expense | 14766 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 200 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14566 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5237 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5237 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2008703 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 442201 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1566502 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19420 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3188 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3188 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 1796 | PersonsServed |
| Total Community Benefit Expense | 2031894 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 442401 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1589493 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19700 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 10 | NumberOfActivitiesOrPrograms |
| Persons Served | 1796 | PersonsServed |
| Total Community Benefit Expense | 3468932 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1361742 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2107190 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.26110 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 1389 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1389 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 34137 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 34137 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 35526 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 35526 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00440 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $522,967 | BadDebtExpenseAmount |
| Amount Attributable To | 470670 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3134944 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3103904 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 31040 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | 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 | Wagner Community Memorial Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 280 | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 57380 | 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 | Wagner Community Memorial Hospital | 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 | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| 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 | 1 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Community Villa | ||||
| 208 Grant Avenue SE | Wagner | SD | 57380 | Subsidized Elderly/Disabled Independent |
| Westside Estates | ||||
| 315 Birch Avenue SW | Wagner | SD | 57380 | Subsidized Elderly/Disabled Independent |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 6a: Wagner Community Memorial Hospital is included in the community benefit report that is submitted to Avera Health by Avera Sacred Heart. It is available through the website and requested mailing, and is filed with the Catholic Health Association. | |
| Part I, Line 7: Line is 7a calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity. Lines 7e, 7f and 7i were obtained utilizing the actual general ledger system. Lines 7b and 7g were obtained from the Medicare cost report. | |
| Part I, Line 7g: The rural health clinic expense totalled $958,196 | |
| Part I, L7 Col(f): Bad debt expense of $522,967 was subtracted from total operating expense. | |
| Part II: Line 7 includes donations to support Boys & Girls club activities, as well as area schools' After Prom programs. Also, vascular screening tests were donated to the Wagner Chamber of Commerce. | |
| Part III, Line 4: a) Bad debt recoveries and discounts applied during the collection process are rare, but when they do occur they are posted against the bad debt account.b) WCMH estimated the amount on line 3 of $324,612 by taking bad debt expense at cost multiplied by 90%. Of the accounts sent to collection, only 5% are collected. The primary area served by WCMH has a Native American population of 42%. 67% of all bad debt are related to Native Americans, all of whom would qualify under the financial assistance policy. It is estimated that a minimum of an additional 23% of patients would qualify under the financial assistance policy based on the overall poverty level of the area served.c) Footnote from Financial Statement: Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary, for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely.For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates, if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. | |
| Part III, Line 8: Medicare allowable cost of care was calculated from the medicare cost report for the fiscal year ending 6/30/2012. | |
| Part V, Section B, Line 19d: All patients are charged gross charges initially. As of year end, a policy had not been approved by management to determine the amounts generally billed discount under the Prospective or Look-back Method.The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | Wagner Community Memorial Hospital |
| Part V, Section B, Line 20: The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | Wagner Community Memorial Hospital |
| Part V, Section B, Line 21: The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | Wagner Community Memorial Hospital |
| Part VI, Line 2: Through constant communication with patients, primary and specialty providers, and state and federal governmental health agencies, WCMH strives to consistently investigate, analyze, and determine the greatest needs of our community. | |
| Part VI, Line 3: WCMH has a written charity care policy. First reference to the policy is given to the patient upon admission. A second reference is attached to the third request for payment along with contact information. If neither notice is acted upon and the account continues to be unpaid a patient advocate will try to contact the patient if it is believed they may qualify for financial assistance. If the patient expresses interest in financial assistance, the patient advocate determines if any other opportunities are available for the patient. If the only option available is WCMH's charity care, the proper documentation is completed. The amount of reduction a patient may receive is based on a sliding scale point system.The Hospital is in the process of updating policies and procedures to meet the provisions of the new 501(r). They will be using the proposed regulations as a guideline for making changes to current policies. | |
| Part VI, Line 4: Wagner is a rural community located in southern Charles Mix County of South Dakota which has many health disparities with unmet needs. If one looks at the county as a whole, the average individual income is $17,403 with the median family income at $35,808. Inhabitants below the poverty level total 24%. County education demographics include 80.7% of residents having a high school degree and 15.5% holding a Bachelor's Degree in comparison to the national average of 85% and 27.9%. According to the US Census Bureau Fact Finder most recent data, 31.7% of residents in the county are of American Indian descent, almost all members of the Yankton Sioux Tribe. All of Charles Mix County is considered medically underserved by HRSA and the SD Department of Health. The county is also considered a health professional shortage area with few providers and many miles in between these rural communities. Wagner provides the only local hospital facility since Indian Health Services (IHS) closed their facility in 1992. In 2008, the IHS emergency room closed putting a burden on the Wagner facility. There are only a few rural health clinics available in addition to the IHS clinic and the newly built VA facility. Many clinics provide only primary care services and are often staffed by mid-level providers. If more specialized care is needed, patients must travel to either Yankton, South Dakota, which is about 115 miles round trip or they drive the 280 round trip miles to Sioux Falls, which is the area's tertiary care hub with all types of specialty care available. In addition to the shortage of quality health care services, residents of Southern Charles Mix County also suffer from many chronic health conditions. The percent of the population over 65 years of age is almost double the national average in more than half of the county. The disability status of the county's inhabitants is consistent with, if not higher than, the national average of 19.3% in a majority of the communities. Gaps exist among socioeconomic groups in the rate of diabetes and its associated complications in South Dakota as well as throughout the United States. Certain racial and ethnic communities including American Indians, as well as economically disadvantaged or older people, suffer disproportionately compared to other populations. Diabetes prevalence for adults located in Central SD surpasses South Dakota and U.S. percentages. The American Indian population in Wagner and Lake Andes is between 40-53% as compared to the national average of 0.9%. American Indian population in the nearby towns of Marty and Ravinia are 97% and 66%, respectively. | |
| Part VI, Line 5: WCMH is a community hospital with an open board selected from associates, all of whom are community members and can not be WCMH employees. All providers who wish to obtain privileges at WCMH are encouraged and welcome to use the appointment/reappointment privileging application process. In 2010, WCMH lead the establishment of the Southern Charles Mix County Healthcare Consortium (SCMCHC). The mission of the consortium is to determine the greatest needs of the area maximizing resources of the eight member facilities and agencies to address the determined needs. SCMCHC has applied for a USDA-RD planning grant to accomplish this task which includes the completion of an independent needs assessment. WCMH uses surplus funds to fund building improvements to enhance services to its patients.WCMH provides Community Health Improvement Services which include: Community CPR classes, sponsorship to the Dakota Smiles Mobile Dental Program, Blood Pressure screenings at area events, assisting with community disasters and award scholarships to the local high school graduates. Fourteen different healthcare career fairs were sponsored and presented by WCMH throughout southern Charles Mix County. | |
| Part VI, Line 6: WCMH is a managed facility of Avera Health. Avera Health and the Hospital work cooperatively to enhance healthcare throughout the community served by the Hospital. As a managed facility, WCMH is able to participate in Avera e-CARE services. These services include Avera e-ICU, e-Emergency, e-Pharmacy and e-Consult. These services allow rural patients to be cared for at their local hospitals, provide rural hospitals access to immediate specialty care and support, and help reduce health care costs and travel.WCMH also has access to "back office" support services, such as legal consultation, quality benchmarking, coding, computer services, contract negotiations, administrative consultation, group purchasing, human resource assistance and many other services. Avera Health is able to provide these services to WCMH at a cost below that which the Hospital could otherwise achieve. In turn, local caregivers are able to devote more resources to patient and resident care. Avera Health and WCMH dedicate resources to endeavors that make a positive difference to improve the health of the communities they serve. These activities include leadership development and training for community members, economic development, physical improvements in the community, contributions to nonprofit community organizations, nonprofit event sponsorships, donated medical supplies, community health education and support groups, health screenings, flu-shot clinics, community health education and various other activities. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bryan Slaba | |||||||||||||
| 115886 | 0 | 0 | 0 | 499 | 0 | 4888 | 0 | 1886 | 0 | 123159 | 0 | 0 | 0 |
| Robert Hubley til August 2011 | |||||||||||||
| 161775 | 0 | 0 | 0 | 244 | 0 | 7919 | 0 | 12245 | 0 | 182183 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Form 990, Part VII, Section A, Line 5 & Form 990, Schedule J, Part II: Bryan Slaba, CEO/Administrator, is paid by Avera Sacred Heart Hospital, 501 Summit Street, Yankton, SD 57078. Dr. Robert Hubley, Physician, is paid by Avera Sacred Heart Hospital, 501 Summit Street, Yankton, SD 57078. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Uzma Mian | NamePerson |
| Purpose Of Loan | Comm needs loan | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $100,000 | OriginalPrincipalAmount |
| Balance Due | 69645 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 69645 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Vicki Thaler | |||
| Family relationship with Ken Thaler, board member. | 48251 | Employee Compensation | 0 |
| Marcia Podzimek | |||
| Family relationship with Dorothy Holzbaur, board member. | 49948 | Employee Compensation | 0 |
| Deborah Hubley | |||
| Family relationship with Robert Hubley, highest compensated employee. | 16428 | Employee Compensation | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the President, as Chairman, and two other members of the Board of Directors appointed by the President. The Executive Committee will have power to transact all regular business of the hospital during the interim between the meetings of the Board of Directors provided any action taken does not conflict with the policies and expressed wishes of the Board of Directors, and that it shall refer all matters of major importance to the Board of Directors. | |
| Form 990, Part VI, Section A, line 3 | Services provided by the CEO are through a management agreement with Avera Sacred Heart Health Services in Yankton, South Dakota. | |
| Form 990, Part VI, Section A, line 6 | There is only one class of member. Any individual, partnership, corporation or association having legal entity, who has contributed $25 or more to the Corporation with request of membership at the time of donation, shall be a member thereof and each member shall have one vote at all meetings of the members of the corporation. Membership of any individual who shall become deceased shall revert by request to that individual's next of kin or according to his will. Any member who has contributed $50 or more shall have the right to transfer such membership to his or her spouse. Said transfer to be approved by the Board of Directors. The basis for membership is on non-refundable contributions. | |
| Form 990, Part VI, Section A, line 7a | Only one class of member exists. At the annual meeting, members approve the minutes of the last annual meeting, elect board members of the Wagner Community Memorial Hospital, and vote on other business that may be properly brought before the members. | |
| Form 990, Part VI, Section A, line 7b | The Board of Directors may adopt amendments at any regular or special meeting of the Board and the same shall be effective until the next regular or special meeting of the members, at which time, the same will be ratified or rejected, and, if ratified, the same shall be binding as incorporated by-laws of the corporation. | |
| Form 990, Part VI, Section B, line 11 | The CEO will review the 990. After the form 990 has been reviewed, it will be forwarded to the members of the Governing Body for their review. It will be presented at a board meeting, and filed subsequent to that. | |
| Form 990, Part VI, Section B, line 12c | Directors and Management Officials are required to complete annual conflict of interest questionnaires which are monitored and tracked. The questionnaires are reviewed by the Board for any possible conflicts with any noted conflicts being brought to management's attention. Inquiries of conflicts are also reviewed at the monthly Board meetings. After a conflict is deemed to exist, the Board determines the level of participation of the potential conflicting member. | |
| Form 990, Part VI, Section B, line 15a | Avera Sacred Heart Health Services and Wagner Community Memorial Hospital Compensation Committee use comparability data to determine appropriate compensation of the CEO based on experience and performance. The compensation amount is approved annually by the Board of Directors. | |
| Form 990, Part VI, Section C, line 19 | Documents are made available upon request. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -38,440. Change in interest in net assets of Avera Health Foundation 159,144. Total to Form 990, Part XI, Line 5: 120,704. | Changes in Net Assets or Fund Balances: |
Comments