ASPIRUS MERRILL HOSPITAL & CLINICS INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ASPIRUS MERRILL HOSPITAL & CLINICS INC (EIN 39-0808503)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-13
- IRS object ID
- 201332259349301978
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-13T10:54:48-07:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390808503 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HEALTH CENTER OF MERRILL | BusinessNameLine1 |
| Business Name Line2 | WISCONSIN INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOOD | NameControl |
| Phone | 7155365511 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 SOUTH CENTER AVENUE | AddressLine1 |
| City | MERRILL | City |
| State | WI | State |
| ZIP Code | 54452 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mary Krueger | Name |
| Title | President | Title |
| Date Signed | 2013-08-13 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Mary Krueger | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 S Center Ave | AddressLine1 |
| City | Merrill | City |
| State | WI | State |
| ZIP Code | 54452 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 26687999 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.ministryhealth.org/GSHC/home.nws | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | GOOD SAMARITAN HEALTH CENTER'S MISSION AS A CATHOLIC HOSPITAL IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR. WE PROVIDE ACUTE HEALTH CARE SERVICES TO THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 247 | TotalNbrEmployees |
| Total Nbr Volunteers | 131 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 19600 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 22421 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 26506008 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 25812840 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 381567 | InvestmentIncomePriorYear |
| Investment Income Current Year | 696013 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 187219 | OtherRevenuePriorYear |
| Other Revenue Current Year | 156725 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27094394 | TotalRevenuePriorYear |
| Total Revenue Current Year | 26687999 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 14464681 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 15032874 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10515831 | OtherExpensePriorYear |
| Other Expenses Current Year | 10762433 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 24984512 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25797307 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2109882 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 890692 | RevenuesLessExpensesCY |
| Total Assets BOY | 35239551 | TotalAssetsBOY |
| Total Assets EOY | 35156905 | TotalAssetsEOY |
| Total Liabilities BOY | 3287805 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2596726 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 31951746 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 32560179 | NetAssetsOrFundBalancesEOY |
| Mission Description | GOOD SAMARITAN HEALTH CENTER'S MISSION AS A CATHOLIC HOSPITAL IS TO FURTHER THE HEALING MINISTRY OF JESUS BY CONTINUALLY IMPROVING THE HEALTH AND WELL-BEING OF ALL PEOPLE, ESPECIALLY THE POOR. WE PROVIDE ACUTE HEALTH CARE SERVICES TO THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 21061828 | Expense |
| Revenue | 25857737 | Revenue |
| Description | THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY ROOM AND ANCILLARY SERVICES REGARDLESS OF AN INDIVIDUALS ABILITY TO PAY OR METHOD OF PAYMENT. THE HOSPITAL ALSO PROVIDES EDUCATIONAL PROGRAMS AND SERVICES ON HEALTH CARE ISSUES TO THE COMMUNITY IT SERVES. SEE SCHEDULE H FOR FURTHER DETAILS. | Description |
| Total Program Service Expense | 21061828 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 41 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 247 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Jeff Badger VP Corp Fin Trs | NamePerson |
| Telephone Number | 7155365511 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4941 Kirschling Ct | AddressLine1 |
| City | Stevens Point | City |
| State | WI | State |
| ZIP Code | 54481 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Denis McCarthy | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Robyn Schertz | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Shannon M Murray | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Mary Krueger | |||||||
| President | 1.00 | X | 0 | 381867 | 40444 | X | |
| Randy Waskin | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Jane Deau | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Barb Haffemann | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Sister Maria Vinton | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Kevin A Cohrs | |||||||
| Vice Chairman | 1.00 | X | 0 | 0 | 0 | X | |
| Susan Ryman | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Val Mindak | |||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | X | |
| Michael Ravn | |||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | X | |
| Kristine McGarigle | |||||||
| VP-Patient Care | 40.00 | 0 | 194505 | 32211 | X | ||
| Jeffrey Martin | |||||||
| CEO | 4.00 | 0 | 804211 | 45600 | X | ||
| Eric D Barnes | |||||||
| AnesthesiaDirector | 40.00 | 236657 | 0 | 6908 | X | ||
| David Burnett | |||||||
| CRNA | 40.00 | 214143 | 0 | 29303 | X | ||
| Steven Gasper | |||||||
| CRNA | 40.00 | 208868 | 0 | 26301 | X | ||
| James L Mason | |||||||
| PharmacyDirector | 40.00 | 129761 | 0 | 22270 | X | ||
| Kathryn S Horst | |||||||
| ClinicalPharmacist | 40.00 | 132881 | 0 | 10988 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 922310 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1380583 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 214025 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Shared Medical Services Inc - HD MRI Imaging | |||||
| PO Box 330 | Cottage Grove | WI | 535270330 | MRI Medical Services | 253994 |
| Medical Staffing Solutions | |||||
| PO Box 101 | Rice Lake | WI | 54868 | Medical Staff | 183336 |
| Marshfield Clinic - Merrill Center | |||||
| 1205 ODay Street | Merrill | WI | 54452 | Medical Staff | 711786 |
| Dept of Health Services | |||||
| Drawer 296 | Milwaukee | WI | 53293 | X-ray Registration | 125684 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Federated Campaigns | 500 | FederatedCampaigns |
| Related Organizations | 6950 | RelatedOrganizations |
| Government Grants | 14971 | GovernmentGrants |
| Total Contributions | 22421 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Program Service - Rents | 531120 | 89966 | 89966 |
| Program Service | 900099 | 25722874 | 25722874 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 25812840 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 742537 | TotalRevenueColumn |
| Exclusion | $742,537 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5675 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5675 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5675 | TotalRevenueColumn |
| Exclusion | $5,675 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -46524 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -46524 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -46524 | TotalRevenueColumn |
| Exclusion | -$46,524 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Misc Other Income | 900099 | 14573 | 14573 | |
| Interest Received Pt Acct | 900099 | 12568 | 12568 | |
| Cafeteria | 722210 | 106153 | $106,153 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17756 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17756 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 151050 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26687999 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25857737 | RelatedOrExemptFunctionIncome |
| Exclusion | $807,841 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2000 | Total |
| Program Services | 2000 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11618897 | Total |
| Program Services | 10666953 | ProgramServices |
| Management And General | 951944 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 586343 | Total |
| Program Services | 575192 | ProgramServices |
| Management And General | 11151 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2193720 | Total |
| Program Services | 1936017 | ProgramServices |
| Management And General | 257703 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 633914 | Total |
| Program Services | 611030 | ProgramServices |
| Management And General | 22884 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18311 | Total |
| Management And General | 18311 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1670 | Total |
| Management And General | 1670 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16193 | Total |
| Program Services | 16193 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1004112 | Total |
| Program Services | 933799 | ProgramServices |
| Management And General | 70313 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 295 | Total |
| Management And General | 295 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1515383 | Total |
| Program Services | 1448507 | ProgramServices |
| Management And General | 66876 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 465281 | Total |
| Program Services | 459155 | ProgramServices |
| Management And General | 6126 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 583211 | Total |
| Program Services | 581483 | ProgramServices |
| Management And General | 1728 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29564 | Total |
| Program Services | 26687 | ProgramServices |
| Management And General | 2877 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49367 | Total |
| Program Services | 34027 | ProgramServices |
| Management And General | 15340 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1132140 | Total |
| Program Services | 1129070 | ProgramServices |
| Management And General | 3070 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 126057 | Total |
| Program Services | 126007 | ProgramServices |
| Management And General | 50 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MHC EXECUTIVE SERVICES | 347639 | 28863 | 318776 |
| PHARMACEUTICALS | 631868 | 631868 | |
| BAD DEBT | 1298957 | 1298957 | |
| PURCHASE SERVICES | 3198787 | 1581927 | 1616860 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343598 | Total |
| Program Services | 273050 | ProgramServices |
| Management And General | 70548 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25797307 | Total |
| Program Services | 21061828 | ProgramServices |
| Management And General | 4735479 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 444070 | BOY |
| EOY | 381758 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5016215 | BOY |
| EOY | 1220458 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2943854 | BOY |
| EOY | 3848604 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 542401 | BOY |
| EOY | 518123 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44284 | BOY |
| EOY | 38419 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 26497390 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20371914 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6116529 | BOY |
| EOY | 6125476 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19398344 | BOY |
| EOY | 22392893 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 733854 | BOY |
| EOY | 631174 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35239551 | BOY |
| EOY | 35156905 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2834061 | BOY |
| EOY | 2596726 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 453744 | BOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3287805 | BOY |
| EOY | 2596726 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31951746 | BOY |
| EOY | 32560179 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31951746 | BOY |
| EOY | 32560179 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35239551 | BOY |
| EOY | 35156905 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 890692 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -282259 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $3,796 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3796 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i | Identifier |
| Return Reference | Part II-B, Line 1i - Other Activities Description | ReturnReference |
| Explanation | Good Samaritan Health Center of Merrill WI Inc belongs to a number of trade associations (WHA, CHA, AHA, RWHC). These associations are paid annual dues and a percentage of the dues are related to lobbying done by the trade association. Lobby percentages range between 3 - 24% of the annual amounts. The amount reported on (1i) represents the sum of all trade association dues related to lobby expense. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 83511 | InvestmentCostOrOtherBasis |
| Book Value | 83511 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 7742106 | InvestmentCostOrOtherBasis |
| Depreciation | 5760730 | Depreciation |
| Book Value | 1981376 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 573603 | InvestmentCostOrOtherBasis |
| Depreciation | 533115 | Depreciation |
| Book Value | 40488 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 9068708 | InvestmentCostOrOtherBasis |
| Depreciation | 7731446 | Depreciation |
| Book Value | 1337262 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 9029462 | InvestmentCostOrOtherBasis |
| Depreciation | 6346623 | Depreciation |
| Book Value | 2682839 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6125476 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XI, Line 8 | Identifier |
| Return Reference | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | ReturnReference |
| Explanation | MARKET ADJUSTMENTS $ -238661 EHR FUNDING $ -43598 | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 577456 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 577456 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02360 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3484076 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2382000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1102076 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04500 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4061532 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2382000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1679532 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06860 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 67246 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 67246 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26537 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 26537 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 50248 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 50248 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00210 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 144031 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 144031 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4205563 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2382000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1823563 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07450 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1072 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1072 | NetCommunityBuildingExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 10832 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10832 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11904 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11904 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,229,000 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 10563000 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11568265 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1005265 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 0 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Good Samaritan Health Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 S Center Ave | AddressLine1 |
| City | Merrill | City |
| State | WI | State |
| ZIP Code | 54452 | 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 | Good Samaritan Health Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | 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 |
|---|---|---|---|---|
| Bone & Joint Clinic | ||||
| 100 Eagle Dr | Merrill | WI | 54452 | Physical & Occupational Therapy |
| Menard Center | ||||
| 503 South Center Ave | Merrill | WI | 54452 | Physical & Occupational & Speech Therapy |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | While there is growing agreement in the United States about what constitutes a non-profit hospital's 'community benefit', this is a work in progress. The organization provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. Our hospital, like most rural hospitals, was created and is maintained in order to provide care locally-care that without our hospital, would not be available locally.Certain specialized services available include: -Emergency Room and Walk In Services-Oncology Program-Swing Bed Facilities-Lab Testing and Ancillary Diagnostics (Ultrasound, Radiology, Mammography, etc.) | |
| Part V - Explanation of Number of Facility Type | Physical and Occupation Therapy Rehabilitation Clinic | |
| Part VI - States Where Community Benefit Report Filed | WI | |
| Part VI - Affilated Health Care System Roles and Promotion | 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 has a foundation which is included within the operations of the organization. The foundation provides programs and cash donations which help support the mission of the organization and the affiliated health care system.. The Foundation made donations to local charitable organizations. They included cash donations to Merrill Food Pantry to replenish the shelves as needed, St Vincent DePaul Outreach Power on Program, Comunidad Hispana for various programs and assistance for the local Hispanic population, and local schools to help promote a healthy lifestyle. | |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | The organization strives to further its exempt purposes by the following: (1) The organization's governing board consists primarily of persons who reside within the primary service area. They are not employees of the organization. (2) As mentioned, the organization provides several services which are not otherwise available being in a rural setting. (3) Based on the organization's mission, emergency rooms are made available to all patients regardless of the ability to pay. (4) The organization also participates in the education and training of healthcare professionals through internship programs.The hospital participates in government-sponsored health programs (Medicare, Medicaid, CHAMPUS, Tricare).The hospital offers volunteer opportunities to the community. There are 131 volunteers that serve the hospital as needed.Various financial programs are available to patients of Good Samaritan Health Center. They include discounted and/or free care depending on individual circumstances. The facility also offers payment plans for those self pay patients.Good Samaritan Health Center is a critical access hospital that has in patient and swing beds. They also provide emergency and walk in services. As a critical access hospital, the organization serves as a critical point in stabilizing patients for transport to other facilities. | |
| Part VI - Community Building Activities | 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. The organization provides various community health education programs. They include Health Promotion and Wellness, school health education programs, child safety programs, advanced health directive education and various support groups. The organization also provides various clinical services to the community. They include diabetes education, prostate and various other screenings, and school and athletic exams. The organization also provided job shadowing and mentoring opportunities for the community. | |
| Part VI - Community Information | The city of Merrill is located in southern Lincoln County located in the northern portion of Wisconsin. Merrill serves as the county seat and is the largest city in the county. The population of Lincoln county as of the 2010 census data was 28,743. According to the 2010 census data there were 9,661 people living in Merrill, consisiting of 4175 households and 2516 families. The population density of the city of Merrill was 1334.9 people per square mile. The population consisted of 96.3% White, 2.00% Hispanic, 0.50% African American, 0.40% Native American, 0.60% Asian, 0.20% Other. Of the 4175 households in Merrill, 27.70% of those had children under 18 years old living at home. The 4175 households are categorized as 43% were married couples living together, 12.4% had a female householder with no husband present, and 39.70% were non-families. 35% of the households consisted of individuals and 17.40% had someone 65 and older living alone. The age of the population is widely spread. 23.9% were under 18, 7.30% were 18-24, 24.90% were 25-44, 24.50% were 45-64, and 19.40% were 65 and older. The median income for a household was $39,783 and the median income for a family was $53,388. The per capita income for the city was $21,516. The largest industry in Merrill is manufacturing (28.90%). Education, health, and social services (17.80%) and retail trade (15.30%) are the next largest industries in Merrill. Roughly 10.70% of families and 12.40% of the population were below the poverty line. That includes 10.80% of those under 18 years old and 16.30% of those 65 and older.The unadjusted seasonal unemployment rate for Lincoln County as of September 2011 was 9.30%, compared to a state unemployment rate of 6.80% and a national unemployment rate of 8.80%. | |
| Part VI - Patient Education of Eligibility for Assistance | MHC has financial counselors located at every hospital. If a patient indicates they are unable to pay their bill at any point during pre-service, admission, discharge or billing process, the financial counselors will assist the patient in either securing a funding source (grants, COBRA coverage, Disability benefits, Medicaid, VA, etc) if eligible or assist them in completing a financial assistance application. | |
| Part VI - Needs Assessment | 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 V, Line 15e - Other Collection Actions Against a Patient | We make every effort to determine patient's eligibility for assistance prior to billing. If patient is uncooperative or unresponsive, the patient account may be referred to a collection agency for further billing effort. If patient does indicate inability to pay, we will stop collection efforts and work with patient to complete a financial assistance application. We do not file liens, lawsuits, or report to credit agency, until all determination efforts have been exhausted. | Number of Hospital Faciltiy - 0 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | 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 made 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 offices so no additional time is spent on collection efforts. | |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | 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 (IE 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 4 - Bad Debt Expense | 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 COLLECTIONS 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. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY 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 I, Line 7, Column F - Explanation of Bad Debt Expense | Bad debt expense of $1,298,957 is excluded from the total operating expenses of $25,797,307 when calculating percentage of total expenses in Part 1, Line 7, Column F and Part II, Lines 1-10, Column F. | |
| Part I, Line 7 - Explanation of Costing Methodology | 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. | |
| Part I, Line 6a - Related Organization Community Benefit Report | As part of Ministry Health Care, Inc., the organization files an annual community benefit report on its webpage. The report can be viewed by visiting www.ministryhealth.org/MinistryHealth/Community.nws. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Bonus Filing OrgBonusFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Steven Gasper | |||||||||||
| 203108 | 5760 | 3705 | 22596 | 235169 | |||||||
| Mary Krueger | |||||||||||
| 212404 | 88601 | 80862 | 24716 | 15728 | 422311 | ||||||
| Kristine McGarigle | |||||||||||
| 136984 | 37730 | 19791 | 14450 | 17761 | 226716 | ||||||
| Jeffrey Martin | |||||||||||
| 422518 | 208046 | 173647 | 29556 | 16044 | 849811 | ||||||
| James L Mason | |||||||||||
| 129428 | 333 | 2682 | 19588 | 152031 | |||||||
| Eric D Barnes | |||||||||||
| 222220 | 77 | 4391 | 2517 | 243565 | 14360 | ||||||
| David Burnett | |||||||||||
| 201128 | 135 | 4123 | 25180 | 243446 | 12880 | ||||||
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990 PART XI Question 2b - AUDIT | Ministry Health Care Inc engages the services of McGladrey & Pullen to do a consolidated audit of it's health care facilities and related foundations. While Good Samaritan Health Center of Merrill WI Inc does not have its own individual audit, it is part of the consolidated audit performed. | |
| FORM 990 PART IX LINE 24 - OTHER EXPS | EXECUTIVES ARE EMPLOYED BY MINISTRY HEALTH CARE INC (39-1490371) AND THEIR SALARIES AND BENEFITS ARE ALLOCATED TO INDIVIDUAL FACILITIES BASED ON HOURS DEDICATED. GOOD SAMARITAN HEALTH CENTER REIMBURSES THE CORPORATE OFFICE FOR ITS SHARE AND THESE EXPENSES ARE INCLUDED ON FORM 990, PART IX, LINE 24D UNDER MHC EXECUTIVE SERVICES. PLEASE SEE FORM 990 PART VII SECTION A AND SCHEDULE J FOR ADDITIONAL DISCLOSURES REGARDING EXECUTIVE COMPENSATION. | |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The Ministry Web Page is available to the public for inspection with a good deal of information regarding whom Ministry Health Care is and the entities included along with our mission. The Articles of Incorporation, Bylaws, Conflicts policy, and financial statements are not included on any web page. However, if an inquiry is made for any documents, they are shared as appropriate | Form 990, Part VI, Line 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The Ministry Board of Directors has a compensation committee that is assisted by an independent outside 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, Line 15b |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | The Board members complete each year a Board of Directors Conflict of Interest & Insider Transaction Policy Questionnaire. A standard annual refresher is completed each year in the fall. Any significant reported items are corrected promptly through the Ministry Corporate Compliance Officer and local administrator. | Form 990, Part VI, Line 12c |
| Form 990, Part VI, Line 11: Form 990 Review Process | The Form 990 is completed through joint efforts of the shared finance function with review and guidance of legal council when deemed necessary and corporate oversight. The 990 will be presented at the next Board meeting, however due to timing constraints the Form could not be presented before filing. | Form 990, Part VI, Line 11 |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | Ministry Health Care, Inc has certain reserved powers. Those reserved powers include to define the philosophy and mission, establish long-range goals and strategic plans, initiate and approve all amendments to the Articles of Incorporation and Bylaws, appoint or terminate, after consulting the Board of Directors, the President and require regular evaluation, to initiate and approve long-term borrowing of money and others forms of long term indebtedness, to approve all capital and operating budgets either individually or as part of the consolidated budget, approve the selection and retention of an independent auditing firm, and the selection or retention of general legal counsel. | Form 990, Part VI, Line 7b |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | Ministry Health Care, Inc has the reserved powers to appoint and remove, with or without cause, the directors, authorize vacancies, and determine the number of directors. | Form 990, Part VI, Line 7a |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | Ministry Health Care, Inc has certain reserves and influential powers over all of its wholly owned healthcare facilities. Good Samaritan Health Center is one of Ministry Health Cares owned facilities | Form 990, Part VI, Line 6 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Good Samaritan Health Center Foundation | ||||||||||
| 601 S Center Ave | Merrill | WI | 54452 | 391627755 | To support the mission of Good Samaritan Health Center | WI | 501(c)(3) | 11-I | N/A | true |
| Ministry Health Care | ||||||||||
| 11925 West Lake Park Drive Suite 1 | Milwaukee | WI | 53224 | 391490371 | Mgmnt support for integrtd hlthcre systm | WI | 501(c)(3) | 11-O | N/A | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| Ministry Health Care | ||
| o | 1613589 | COST |
| Ministry Health Care | ||
| n | 1614215 | PAY RECORDS |
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