SAINT ELIZABETHS HOSPITAL OF WABASHA INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SAINT ELIZABETHS HOSPITAL OF WABASHA INC (EIN 41-0693877)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-06
IRS object ID
201322189349300827
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-06T10:50:57-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 217AddressLine1
CityAUSTINCity
StateMNState
ZIP Code55912ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410693877EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SAINT ELIZABETH'S HOSPITAL OF WABASHA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSAINNameControl
Phone6515655553Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11200 GRANT BLVD WESTAddressLine1
CityWABASHACity
StateMNState
ZIP Code55981ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTOM CROWLEYName
TitlePRESIDENTTitle
Phone6515655553Phone
Date Signed2013-07-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSHERRI WESSELSName
PTINP00888088PTIN
Phone5074347000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTOM CROWLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11200 GRANT BLVD WESTAddressLine1
CityWABASHACity
StateMNState
ZIP Code55981ZIPCode
FieldValueIRS element (for citing)
Gross Receipts25635586GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.STELIZABETHSWABASHA.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1955YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees408TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year365265ContributionsGrantsPriorYear
Contributions Grants Current Year538961ContributionsGrantsCurrentYear
Program Service Revenue Prior Year23663601ProgramServiceRevenuePriorYear
Program Service Revenue CY25017636ProgramServiceRevenueCY
Investment Income Prior Year40136InvestmentIncomePriorYear
Investment Income Current Year76082InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year24069002TotalRevenuePriorYear
Total Revenue Current Year25632679TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year14309260SalariesEtcPriorYear
Salaries Etc Current Year14917446SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8780475OtherExpensePriorYear
Other Expenses Current Year9055810OtherExpensesCurrentYear
Total Expenses Prior Year23089735TotalExpensesPriorYear
Total Expenses Current Year23973256TotalExpensesCurrentYear
Revenues Less Expenses Prior Year979267RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1659423RevenuesLessExpensesCY
Total Assets BOY20076430TotalAssetsBOY
Total Assets EOY21247779TotalAssetsEOY
Total Liabilities BOY3707192TotalLiabilitiesBOY
Total Liabilities EOY3543062TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16369238NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY17704717NetAssetsOrFundBalancesEOY
Mission DescriptionOUR MISSION AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense21175404Expense
Revenue25017636Revenue
DescriptionSINCE 1898 ST. ELIZABETH'S HAS BEEN SERVING THE HEALTHCARE NEEDS OF EASTERN MINNESOTA AND WESTERN WISCONSIN RESIDENTS, AND IS A MEMBER OF MINISTRY HEALTH CARE AND SPONSORED BY THE SISTERS OF THE SORROWFUL MOTHER. SINCE MAY, 1992, ST. ELIZABETH'S HAS BEEN A CRITICAL ACCESS HOSPITAL AND IS MEDICARE CERTIFIED FOR 25 ACUTE CARE/SWING BEDS. WE OFFER A BROAD RANGE OF ACUTE CARE, DIAGNOSTIC, EDUCATIONAL, EMERGENCY, AND SURGICAL SERVICES TO RESIDENTS WITHIN OUR SERVICE AREA. IN FY 2012, ST. ELIZABETH'S HAD 1,238 ACUTE CARE DAYS, 593 SWING BED DAYS, AND 23,508 OUTPATIENT ENCOUNTERS. ADDITIONALLY, ST. ELIZABETH'S IS CURRENTLY LICENSED FOR 100 NURSING HOME BEDS AND 45 ASSISTED LIVING APARTMENTS. ALL NURSING HOME BEDS ARE MEDICARE CERTIFIED. IN FY 2012, WE HAD 35,891 NURSING HOME DAYS AND 17,040 APARTMENT DAYS.Description
Total Program Service Expense21175404TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109685NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees408NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHN WOLFENamePerson
Telephone Number6515655553TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11200 GRANT BLVD WAddressLine1
CityWABASHACity
StateMNState
ZIP Code55981ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
SISTER BARBARA HOLLWECK
DIRECTOR0.50X000
BRIAN KELLY MD
DIRECTOR0.50X000
DONALD JACOBY
CHAIR0.50X000
THOMAS CROWLEY
PRESIDENT40.00X269191058613X
STEVEN SEDLMAYR
VICE CHAIR0.50X000
JEREMY SOLBERG MD
DIRECTOR0.50X000
RICHARD ZABEL
SECRETARY/TREASURER0.50X000
REBECCA LUCKSTEIN
DIRECTOR0.50X000
MIKE EBERSOLD MD
DIRECTOR0.50X000
JOHN WOLFE
CFO40.00152537024247X
JONI LOMMEN
VP - CLINICAL SERVICES40.00162248023969X
JOHN HUST
CRNA40.00182500014287X
DR JOHN PETERSON
PSYCHIATRIST40.00154724010924X
KURT HENN
PHARMACIST40.00119120024182X
JAMES ROOT
VP HUMAN RESOURCES40.00121414011516X
KATHY LEUDERS
DON40.0010795508153X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1269689TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation175891TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ENHANCEMED MEDICAL PROFESSIONAL SERVICES
PO BOX 4004ROCHESTERMN55903E.R. COVERAGE211578
MAYO CLINIC HEALTH SYSTEMS
500 W GRANT STREETLAKE CITYMN550411143LAB SERVICES147092
MAYO MEDICAL LABORATORIES
PO BOX 9146ROCHESTERMN554809146LAB SERVICES132928
NORTHERN SHARED MEDICAL SERVICES INC
PO BOX 330COTTAGE GROVEWI53527MOBILE MRI SERVICES122450
PATRICIA P PEYLA CRNA MS
68034 COUNTY ROAD 76WABASHAMN55981CRNA SERVICES117425
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants23733GovernmentGrants
All Other Contributions515228AllOtherContributions
Total Contributions538961TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT & RESIDENT6230002482798224827982
OTHER OPERATING623000189654189654
FieldValueIRS element (for citing)
Total Program Service Revenue25017636TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column71489TotalRevenueColumn
Exclusion$71,489ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other7500Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other2907Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other4593Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4593TotalRevenueColumn
Exclusion$4,593ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column25632679TotalRevenueColumn
Related Or Exempt Function Income25017636RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$76,082ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total690805Total
Management And General690805ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10686463Total
Program Services9946478ProgramServices
Management And General739985ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total457462Total
Program Services466139ProgramServices
Management And General-8677ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2311423Total
Program Services2071759ProgramServices
Management And General239664ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total771293Total
Program Services680688ProgramServices
Management And General90605ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1673235Total
Program Services1205649ProgramServices
Management And General467586ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total498320Total
Program Services498320ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total118229Total
Program Services111342ProgramServices
Management And General6887ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total69602Total
Program Services69602ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1394093Total
Program Services1394093ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total78644Total
Management And General78644ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES1708684168751221172
PURCHASED SERVICES1161919827259334660
DRUGS887352887352
BAD DEBT EXPENSE585000585000

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total880732Total
Program Services744211ProgramServices
Management And General136521ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23973256Total
Program Services21175404ProgramServices
Management And General2797852ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1659150BOY
EOY1652714EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4779219BOY
EOY5208904EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY396457BOY
EOY404054EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1300BOY
EOY-3083EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis30549152LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19560878LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11257541BOY
EOY10988274EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1910109BOY
EOY2824802EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY72654BOY
EOY172114EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20076430BOY
EOY21247779EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2221473BOY
EOY2261540EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY71883BOY
EOY74583EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1029321BOY
EOY951980EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY384515BOY
EOY254959EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3707192BOY
EOY3543062EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16369238BOY
EOY17704717EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16369238BOY
EOY17704717EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20076430BOY
EOY21247779EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1659423ReconcilationRevenueExpenses
Reconcilation Other Changes-323944ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$344GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB344TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis22023OtherCostOrOtherBasis
Book Value22023BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17660353OtherCostOrOtherBasis
Depreciation10222387Depreciation
Book Value7437966BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12866776OtherCostOrOtherBasis
Depreciation9338491Depreciation
Book Value3528285BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings10988274TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionINVESTMENTS BY BOARD FOR CAPITAL PURPOSESDescription
Book Value2824802BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities2824802TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD-PARTY PAYORS$200,000
ASSET RETIREMENT OBLIGATION$54,959
FieldValueIRS element (for citing)
Total Of Amounts254959TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationPER NOTE 2 OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDING SEPTEMBER 30, 2012, MINISTRY AND ITS AFFILIATES, EXCEPT NHP AND NHIC, ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. NHP AND NHIC ACCOUNT FOR TAXES USING THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE ESTIMATED FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES. MINISTRY RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUBSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. EXAMPLES OF TAX POSITIONS FOR MINISTRY'S NOT-FOR-PROFIT CORPORATIONS INCLUDE THEIR TAX-EXEMPT STATUS AND VARIOUS POSITIONS RELATED TO THE POTENTIAL SOURCES OF UNRELATED BUSINESS TAXABLE INCOME (UBIT). THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50 PERCENT LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense76175TotalCommunityBenefitExpense
Net Community Benefit Expense76175NetCommunityBenefitExpense
Percent Of Total Expense0.00320PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5376491TotalCommunityBenefitExpense
Direct Offsetting Revenue4521357DirectOffsettingRevenue
Net Community Benefit Expense855134NetCommunityBenefitExpense
Percent Of Total Expense0.03570PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5452666TotalCommunityBenefitExpense
Direct Offsetting Revenue4521357DirectOffsettingRevenue
Net Community Benefit Expense931309NetCommunityBenefitExpense
Percent Of Total Expense0.03890PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served100PersonsServed
Total Community Benefit Expense21526TotalCommunityBenefitExpense
Direct Offsetting Revenue648DirectOffsettingRevenue
Net Community Benefit Expense20878NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served2PersonsServed
Total Community Benefit Expense31808TotalCommunityBenefitExpense
Net Community Benefit Expense31808NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9460543TotalCommunityBenefitExpense
Direct Offsetting Revenue8714062DirectOffsettingRevenue
Net Community Benefit Expense746481NetCommunityBenefitExpense
Percent Of Total Expense0.03110PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served850PersonsServed
Total Community Benefit Expense26263TotalCommunityBenefitExpense
Net Community Benefit Expense26263NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served952PersonsServed
Total Community Benefit Expense9540140TotalCommunityBenefitExpense
Direct Offsetting Revenue8714710DirectOffsettingRevenue
Net Community Benefit Expense825430NetCommunityBenefitExpense
Percent Of Total Expense0.03440PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served952PersonsServed
Total Community Benefit Expense14992806TotalCommunityBenefitExpense
Direct Offsetting Revenue13236067DirectOffsettingRevenue
Net Community Benefit Expense1756739NetCommunityBenefitExpense
Percent Of Total Expense0.07330PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense2456TotalCommunityBuildingExpense
Net Community Building Expense2456NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense10245TotalCommunityBuildingExpense
Net Community Building Expense10245NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense7256TotalCommunityBuildingExpense
Net Community Building Expense7256NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense9247TotalCommunityBuildingExpense
Net Community Building Expense9247NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense29204TotalCommunityBuildingExpense
Net Community Building Expense29204NetCommunityBuildingExpense
Percent Of Total Expense0.00120PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$585,000BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare5794980AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5847578CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-52598MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST ELIZABETH HOSPITAL OF WABASHA INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11200 GRANT BLVD WESTAddressLine1
CityWABASHACity
StateMNState
ZIP Code55981ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST ELIZABETH'S HOSPITAL OF WABASHA INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
ST ELIZABETH NURSING HOME
1200 GRANT BLVD WESTWABASHAMN55981NURSING HOME
ST ELIZABETH ASSISTED LIVING APARTMENT
1200 GRANT BLVD WESTWABASHAMN55981RESIDENTIAL HOUSING W/SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: IT IS THE POLICY OF THE ORGANIZATION TO PROVIDE MEDICALLY NECESSARY HEALTH CARE SERVICES TO PEOPLE IN THE COMMUNITIES IT SERVES, REGARDLESS OF THEIR ABILITY TO PAY. COMMUNITY CARE FINANCIAL ASSISTANCE IS GRANTED BASED UPON THE PATIENT'S INABILITY TO PAY AND TO INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED OR MEDICALLY INDIGENT. COMMUNITY CARE WORKS IN COLLABORATION WITH OTHER FINANCIAL (BOTH PUBLIC AND PRIVATE) ASSISTANCE PROGRAMS. THIS IS TO ENSURE HOLISTIC WELLNESS OF PATIENTS BY FACILITATING KNOWLEDGE OF AVAILABLE SERVICES AND PROGRAMS FOR HEALTH WHILE PRACTICING GOOD STEWARDSHIP OF FUNDS. KEY CRITERIA UTILIZED TO DETERMINE ELIGIBILITY FOR COMMUNITY CARE FINANCIAL ASSISTANCE IS FAMILY SIZE, FEDERAL POVERTY INCOME GUIDELINES AND AVAILABLE ASSETS. THE AVAILABLE ASSET TEST INCLUDES CONSIDERATION OF THE AMOUNT OF EQUITY IN A HOME, AUTOMOBILES, AND SAVINGS ACCOUNTS WHICH ARE CONSIDERED PART OF TOTAL ALLOWABLE INCOME WHEN ASSESSING AGAINST THE FEDERAL POVERTY GUIDELINES.
PART I, LINE 6A: ST ELIZABETH'S IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED MINISTRY HEALTH CARE, INC. WHICH CONSISTS OF A NUMBER OF HEALTH CARE FACILITIES LOCATED THROUGHOUT CENTRAL AND NORTH CENTRAL WISCONSIN AND WESTERN MINNESOTA. THE CONSOLIDATED COMMUNITY BENEFITS REPORT IS AVAILABLE ON MINISTRY HEALTH CARE'S WEBSITE.
PART I, LINE 7: AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BOTH ON A COST ACCOUNTING SYSTEM AND A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. DETAIL FOR EACH PROGRAM/ACTIVITY IS MAINTAINED AND DETERMINED AT THE DEPARTMENT LEVEL. CHARITY CARE AND MEANS-TESTED PROGRAMS ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO CONSISTENT WITH WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PRIOR YEAR COST REPORT SETTLEMENTS ARE EXLCUDED FROM A SHORTFALL CALCULATION IN ORDER TO GET A TRUE FISCAL YEAR SHORTFALL AMOUNT.
PART I, LINE 7G: PROGRAMS THAT ARE CONSIDERED SUBSIDIZED HEALTH SERVICES OF ST. ELIZABETH'S AND INCLUDED ON PART I, LINE 7G ARE NURSING HOME, APARTMENTS, CARDIAC REHAB, DIABETES MANAGEMNT, AND MENTAL HEALTH.
PART I, L7 COL(F): BAD DEBT EXPENSE THAT WAS SUBTRACTED FROM TOTAL EXPENSE TO OBTAIN THE % OF COMMUNITY BENEFIT TO TOTAL EXPENSE AMOUNTED TO $585,000.
PART II: COMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT, WHILE NOT DIRECTLY RELATED TO HEALTH CARE, PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL PROBLEMS. THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF THE ORGANIZATION. COSTS FOR THESE ACTIVITIES INCLUDE CASH, IN-KIND DONATIONS, AND EXPENDITURES FOR THE DEVELOPMENT OF A VARIETY OF COMMUNITY HEALTH PROGRAMS AND PARTNERSHIPS. SAINT ELIZABETH'S HAS SPONSORED A NUMBER OF COMMUNITY-WIDE EDUCATIONAL OPPORTUNITIES, INLCUDING WOMEN'S WELLNESS, EDUCATIONAL LECTURES TO OUTSIDE ORGANIZATIONS, AND SENIOR WELLNESS BY SPONSORING A PROGRAM CALLED "FIT CITY SENIORS". CPR EDUCATION IS ALSO OFFERRED TO THE OVERALL COMMUNITY, AND SAINT ELIZABETH'S ALSO SPONSORS AN ALZHEIMER'S SUPPORT GROUP.
PART III, LINE 4: NO FOOTNOTE EXISTS IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. BAD DEBT EXPENSE IS RECORDED IN A CONSISTENT MANNER WITH THE ORGANIZATION'S COLLECTION POLICIES. BAD DEBT EXPENSE INCLUDES ACCOUNTS WHICH ARE WRITTEN OFF AND ESTIMATES MADE ON LIVE ACCOUNTS BASED ON HISTORICAL PAYMENT TRENDS AND ACCOUNT MODELING. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH TREATING THEM SHOULD BE TREATED AS COMMUNITY BENEFIT. FOR 2012, WE HAVE INCLUDED $0 ON PART III, LINE 3 AS WE WEREN'T ABLE TO QUANTIFY THESE AMOUNTS. THE ORGANIZATION DOES HAVE A PRESUMPTIVE ELIGIBILITY PROGRAM IN PLACE TO HELP IDENTIFY INDIGENT PATIENTS AND MINIMIZE THE INSTANCES OF WHEN THEY BECOME A BAD DEBT. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY CARE CAN BE BURDENSOME, PARTICULARLY FOR SMALL BALANCES. THE ORGANIZATION CONTINUES SERVING PATIENTS EVEN AFTER THE PATIENTS HAVE GENERATED SIGNIFICANT BAD DEBT WHICH IS EVIDENCE THAT THE CARE IS GIVEN FOR COMMUNITY BENEFIT MOTIVATIONS.
PART III, LINE 8: THE SHORTFALL ASSOCIATED WITH MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT FOR SEVERAL REASONS. FIRST, IRS REV. RUL. 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. SECOND, FOR-PROFIT SPECIALTY HOSPITALS HAVE BEEN CARVING OUT CERTAIN HIGH-MARGIN SERVICES (I.E. CARDIAC, ORTHOPEDICS, AND ONCOLOGY), LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS INDICATES THAT MEDICARE LOSSES CAN BE A RESULT OF RENDERING THESE LOWER-MARGIN SERVICES (WHICH BENEFIT THE COMMUNITY) RATHER THAN INEFFICIENT OPERATIONS. LASTLY, THE COMMUNITY WHICH THE ORGANIZATION SERVES HAS MEDICARE AS THE LARGEST PAYER. THE ORGANIZATION MUST ACCEPT THESE PATIENTS REGARDLESS OF WHETHER THEY MAKE A SURPLUS OR DEFICIT FROM PROVIDING SUCH SERVICES. IF THE MEDICARE PARTICIPATION IS PREMISED ON THIS FACT, THEN PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH IS A COMMUNITY BENEFIT. THE DEMOGRAPHIC OF THE COMMUNITY IS ALSO AN AGING AND UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, CMS WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY.
PART III, LINE 9B: THE ORGANIZATION HAS A DEBT COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY OR MAY QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE PROGRAM. SUFFICIENT FINANCIAL COUNSELING SUPPORT IS AVAILABLE TO PATIENTS SO THEY CAN EASILY ACCESS PATIENT FINANCIAL SERVICE REPRESENTATIVES AND HAVE THEIR QUESTIONS ANSWERED, AND GAIN AN UNDERSTANDING OF THE REASONS WHY THEY OWE A BALANCE. ACCOUNTS ARE DESIGNATED AS CHARITY CARE IN THE BUSINESS OFFICE SO NO ADDITIONAL TIME IS SPENT ON COLLECTION EFFORTS.
PART V, SECTION B, LINE 19D: WE ESTIMATE THAT THE AVERAGE DISCOUNT PROVIDED TO INSURANCE COMPANIES IS 10%, WHICH IS THE SMALLEST DISCOUNT AVAILABLE UNDER OUR FAP. WE ARE IN THE PROCESS OF IMPLEMENTING A MORE FORMAL PROCESS TO ENSURE THAT WE APPROPRIATELY LIMIT OUR CHARGES TO THOSE WHO QUALIFY FOR FINANCIAL ASSISTANCE.ST. ELIZABETH'S HOSPITAL OF WABASHA, INC
PART VI, LINE 2: THE ORGANIZATION PERFORMS COMMUNITY NEEDS ASSESSMENTS AS NEEDED. PLANNING WORKGROUPS CONSISTING OF COMMUNITY PARTNERS ARE FORMED TO DEFINE THE COMMUNITY AND ITS NEEDS THROUGH REVIEW OF HEALTH PEOPLE INITIATIVES, CENSUS DOCUMENTS, AND LOCAL GOVERNMENT HEALTH AND WELFARE AGENCIES. CONSIDERING OTHER COMMUNITY RESOURCES/ASSETS, DATA COLLECTION METHODS ARE USED TO IDENTIFY PARTICULAR PROBLEMS OR SUBGROUPS AND AREAS KNOWN TO HAVE HIGH POVERTY RATES AND TO BE UNDERSERVED. THE DATA IS ANALYZED AND PRIORITIES ARE SET BASED ON TRENDING INFORMATION WHICH MAY TARGET A SPECIFIC NEED. WHEN A NEED IS IDENTIFIED, THE HOSPITAL DEVELOPS A PLAN TO IMPLEMENT A PROGRAM EITHER THROUGH COMMUNITY COLLABORATION OR INDIVIDUALLY. OUTCOMES FROM THE PROGRAMS ARE MEASURED AND CONSIDERED IN SUBSEQUENT COMMUNITY NEEDS ASSESSMENTS. COMMUNITY BENEFIT PLANS ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE INCORPORATED INTO THE ORGANIZATION'S STRATEGY AND POLICY DEVELOPMENT. FOR EXAMPLE, SENIOR LEADERS ARE REQUIRED TO PROVIDE DIRECT SERVICE TO THE POOR HOURS AS PART OF THEIR PERFORMANCE GOALS.
PART VI, LINE 3: THE ORGANIZATION GOES TO GREAT LENGTHS IN ORDER TO INFORM AND EDUCATE PATIENTS/PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE CHARITY CARE POLICY AND APPLICATION IS POSTED ON THE ORGANIZATION'S WEBSITE. ADMISSIONS, SOCIAL SERVICES, AND OTHER KEY AREAS CONTAIN SUMMARY INFORMATION OF THE CHARITY CARE POLICY. AS PART OF THE INTAKE/DISCHARGE PROCESS, PATIENTS ARE PROVIDED WITH A COPY OF THE POLICY AND OTHER INFORMATION FOR FINANCIAL ASSISTANCE. IF DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, OR UPON DISCHARGE IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S COMMUNITY CARE PROGRAM. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF COMMUNITY CARE FINANCIAL ASSISTANCE CAN BE INITIATED BY ANY MEMBER OF THE HOSPITAL'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR COMMUNITY CARE FINANCIAL ASSISTANCE. THE CHARITY CARE POLICY WAS ALSO TRANSLATED INTO DIALECTS PREVALENT IN THE COMMUNITY IN ORDER TO REACH OUT TO THOSE THAT MAY SPEAK ANOTHER LANGUAGE (SPANISH). PATIENT REGISTRATION STAFF AND FINANCIAL COUNSELORS ARE PROVIDED WITH SCRIPTS TO FOLLOW WHEN INTERACTING WITH PATIENTS. AS PART OF THE CHARITY CARE PROCESS, PATIENTS MUST REGISTER WITH THE COUNTY PUBLIC ASISTANCE TO SEE IF THEY MAY QUALIFY UNDER ANY OTHER FEDERAL OR STATE PROGRAMS.
PART VI, LINE 4: SAINT ELIZABETH'S SERVES THE RESIDENTS OF ALL AGES IN WABASHA COUNTY, MINNESOTA AND BUFFALO AND PEPIN COUNTY IN WISCONSIN. 62% OF OUR PATIENTS RESIDE IN WABASHA COUNTY, WHICH IS OUR PRIMARY SERVICE AREA. COMMUNITIES SERVED WITHIN THIS SERVICE AREA INCLUDE: WABASHA, KELLOGG, PLAINVIEW, READS LANDING, MINNIESKA, AND THEILMANN. THE TOTAL POPULATION OF WABASHA COUNTY IS 21,731. WABASHA COUNTY'S POPULATION INCREASED 9.5% FROM 1990 TO 2000. OUR SECONDARY SERVICE AREA INCLUDES SURROUNDING COMMUNITIES IN MINNESOTA AND THE COMMUNITIES OF ALMA, NELSON, PEPIN, ARKANSAW, MAIDEN ROCK IN BUFFALO, PEPIN, AND PIERCE COUNTIES OF WESTERN WISCONSIN. 15% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER; 4% LACK HEALTH INSURANCE; AND 10% LIVE AT OR BELOW THE POVERTY LEVEL. ALL PATIENTS ARE CARED FOR REGARDLESS OF GENDER, AGE, RELIGION, RACE OR FINANCIAL STATUS. 60% OF ACUTE CARE VOLUME IS FROM MEDICARE AND 7% IS MEDICAID. THE REMAINING 33% OF PAYER MIX IS DIVIDED AMONG MANAGED CARE, COMMERCIAL INSURANCE, SELF-PAY, AND CHARITY CARE.
PART VI, LINE 6: THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED MINISTRY HEALTH CARE, INC. THE MISSION OF MINISTRY AS A CATHOLIC HEALTH CARE SYSTEM IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL BEING OF ALL PEOPLE, ESPECIALLY THE POOR, IN THE COMMUNITIES SERVED. MINISTRY SUPPORTS SUCH NON-HOSPITAL FACILITIES AS THE AGAPE COMMUNITY CENTER. AS A COMMUNITY CENTER, IT HAS THE UNIQUE ADVANTAGE OF WELCOMING YOUTH, ADULTS, FAMILIES AND SENIORS INTO THE FACILITY THROUGH A BROAD RANGE OF EDUCATIONAL, SOCIAL, RECREATIONAL, CULTURAL, HEALTH AND LIFE-LONG LEARNING OPPORTUNITIES IN AN IMPOVERISHED PORTION OF MILWAUKEE. OUR CATHOLIC IDENTITY EXPECTS LEADERS TO INITIATE AND SUPPORT EFFORTS TO REACH OUT TO THE POOR AND VULNERABLE PEOPLE, ESPECIALLY WHERE NO ONE ELSE WANTS TO GO. HEALTH CARE CAN BECOME VERY BUREAUCRATIC AND BURDENED WITH OVERSIGHT OF FINANCES, REGULATORY REQUIREMENTS AND STRATEGIC PLANNING. OUR FOCUS ON THESE ISSUES MAY CAUSE US TO LOSE TOUCH WITH THOSE FOR WHOM WE HAVE A PRIMARY RESPONSIBILITY-THOSE WHO ARE POOR AND VULNERABLE. TITHING OF TIME ALLOWS US TO LOOK INTO THE FACE OF THE POOR, HEAR THE VOICE OF THE POOR, AND HELP US BETTER UNDERSTAND THE DAILY CHALLENGES AND BARRIERS THEY FACE. AS AN AFFILIATED HEALTH SYSTEM, ALL LEADERS WITH DIRECT REPORTS ARE REQUIRED TO PROVIDE SERVICE TO THE POOR. THIS ALSO INCLUDES PHYSICIAN LEADERS AND HOURLY SUPERVISORY STAFF. THE ORGANIZATION ALSO PARTICIPATES IN THE MINISTRY HEALTH CARE FUND WHICH PROVIDES MONIES FOR SPECIAL PROJECTS WITHIN THE COMMUNITIES WE SERVE. ALL ORGANIZATIONS SPONSORED OR CO-SPONSORED BY MINISTRY HEALTH CARE, INC. SET ASIDE MONIES EACH YEAR TO ASSIST WITH THE NEEDS OF THE COMMUNITY AND THE POOR. AS THE MINISTRY HEALTH CARE FUND, THESE DOLLARS ARE FUNNELED BACK INTO OUR COMMUNITIES FOR A VARIETY OF PROGRAMS AND SERVICES THROUGH A COMMUNITY ASSETS AND NEEDS ASSESSMENT PROCESS. THE ORGANIZATION HAS A FOUNDATION WHICH IS NOT INCLUDED WITHIN THE OPERATIONS OF THE ORGANIZATION. THE FOUNDATION PROVIDES PROGRAMS AND CASH DONATIONS WHICH HELP SUPPORT THE MISSION OF THE ORGANIZATION. DURING FY 2011, ST. ELIZABETH'S RECEIVED JUST OVER $472,000 TO HELP FUND VARIOUS CAPITAL EXPENDITURES THROUGHOUT THE YEAR.
MNREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
THOMAS CROWLEY
1676850399850615210435200150930327804000
JOHN WOLFE
103298023263025976073260169210176784000
JONI LOMMEN
108810025681027757019878040910186217000
JOHN HUST
1751240007376013178011090196787000
DR JOHN PETERSON
1382240001650001048404400165648000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS REVIEWED AT A REGULARLY SCHEDULED BOARD MEETING, PRIOR TO THE 990 BEING FILED WITH THE IRS. THE CFO PRESENTS TO THE BOARD, AND INCLUDES A GENERAL OVERVIEW OF THE 990, AS WELL AS SOME OF THE CHANGES NOW IMPLEMENTED AS PART OF THE REVISED 990 FORM.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, EACH BOARD MEMBER IS REQUIRED TO COMPLETE A "CONFLICT AND DUALITY OF INTEREST QUESTIONNAIRE" WHICH ASKS IF THEY, OR MEMBERS OF THEIR FAMILY, HAVE AFFILIATIONS OR INTERESTS THAT MIGHT POSSIBLY CONSTITUTE OR BE PERCEIVED TO CONSTITUTE A CONFLICT OR DUALITY OF INTEREST. WE HAVE NEVER HAD A MEMBER INDICATE SUCH A RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 15THE MINISTRY HEALTH CARE BOARD OF DIRECTORS HAS A COMPENSATION COMMITTEE THAT IS ASSISTED BY AN INDEPENDENT CONSULTING FIRM, SULLIVAN COTTER. SULLIVAN COTTER, IN PARTNERSHIP WITH THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, REVIEWS MARKET DATA FOR COMPENSATION AND BENEFITS AND COMPARABILITY DATA ON EVERY MINISTRY HEALTH CARE EXECUTIVE.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -23,944. FIN 47 CUMMULATIVE EFFECT -300,000. TOTAL TO FORM 990, PART XI, LINE 5: -323,944.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MINISTRY HEALTH CAREBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111925 WEST LAKE PARK DRIVE SUITE 10AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53224ZIPCode
FieldValueIRS element (for citing)
EIN391490371EIN
Primary ActivitiesCORP OFFICE/PARENT CO OF ST ELIZABETH'S AND SEVERAL WI HEALTHCARE FACILITIESPrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 11-D,TYPE III-OPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE R, PAGE 1, PART II, COLUMN (E)ReturnReference
ExplanationLINE 11-D,TYPE III-OExplanation

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