2013-08-13T10:54:48-07:00 2012-09-30 990 2011-10-01 390808503 GOOD SAMARITAN HEALTH CENTER OF MERRILL WISCONSIN INC GOOD 7155365511 601 SOUTH CENTER AVENUE MERRILL WI 54452 Mary Krueger 2013-08-13 2011 2016-02-24 21:20:13Z Mary Krueger 601 S Center Ave Merrill WI 54452 26687999 false false 0928 X http://www.ministryhealth.org/GSHC/home.nws X 1950 WI 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. 12 11 247 131 0 19600 22421 26506008 25812840 381567 696013 187219 156725 27094394 26687999 4000 2000 0 14464681 15032874 0 0 10515831 10762433 24984512 25797307 2109882 890692 35239551 35156905 3287805 2596726 31951746 32560179 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. false false 21061828 25857737 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. 21061828 true true false true false false false false false false true false false false false false false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false true true true false false true 41 0 true 247 true false false false false false false false false false false false 0 false false false false false false false false false false false X 12 11 false false false false true true true true true false false false false true true true true true true true false false WI X X Jeff Badger VP Corp Fin Trs 7155365511 4941 Kirschling Ct Stevens Point WI 54481 X Denis McCarthy 1.00 X 0 0 0 Robyn Schertz 1.00 X 0 0 0 Shannon M Murray 1.00 X 0 0 0 Mary Krueger 1.00 X X 0 381867 40444 Randy Waskin 1.00 X 0 0 0 Jane Deau 1.00 X 0 0 0 Barb Haffemann 1.00 X 0 0 0 Sister Maria Vinton 1.00 X 0 0 0 Kevin A Cohrs 1.00 X X 0 0 0 Susan Ryman 1.00 X 0 0 0 Val Mindak 1.00 X X 0 0 0 Michael Ravn 1.00 X X 0 0 0 Kristine McGarigle 40.00 X 0 194505 32211 Jeffrey Martin 4.00 X 0 804211 45600 Eric D Barnes 40.00 X 236657 0 6908 David Burnett 40.00 X 214143 0 29303 Steven Gasper 40.00 X 208868 0 26301 James L Mason 40.00 X 129761 0 22270 Kathryn S Horst 40.00 X 132881 0 10988 922310 1380583 214025 6 false true false 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 4 500 6950 14971 22421 Program Service - Rents 531120 89966 89966 Program Service 900099 25722874 25722874 25812840 742537 742537 0 0 5675 5675 5675 5675 -46524 -46524 -46524 -46524 0 0 0 Misc Other Income 900099 14573 14573 Interest Received Pt Acct 900099 12568 12568 Cafeteria 722210 106153 106153 17756 17756 151050 26687999 25857737 807841 0 2000 2000 0 0 0 0 11618897 10666953 951944 586343 575192 11151 2193720 1936017 257703 633914 611030 22884 0 18311 18311 1670 1670 0 0 16193 16193 1004112 933799 70313 295 295 1515383 1448507 66876 465281 459155 6126 0 583211 581483 1728 29564 26687 2877 0 49367 34027 15340 0 0 1132140 1129070 3070 126057 126007 50 MHC EXECUTIVE SERVICES 347639 28863 318776 PHARMACEUTICALS 631868 631868 BAD DEBT 1298957 1298957 PURCHASE SERVICES 3198787 1581927 1616860 343598 273050 70548 25797307 21061828 4735479 0 444070 381758 5016215 1220458 0 2943854 3848604 0 0 0 542401 518123 44284 38419 26497390 20371914 6116529 6125476 19398344 22392893 0 0 0 733854 631174 35239551 35156905 2834061 2596726 453744 3287805 2596726 X 31951746 32560179 31951746 32560179 35239551 35156905 X 890692 -282259 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 3796 3796 false false Part II-B, Line 1i Part II-B, Line 1i - Other Activities Description 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. 83511 83511 7742106 5760730 1981376 573603 533115 40488 9068708 7731446 1337262 9029462 6346623 2682839 6125476 Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances MARKET ADJUSTMENTS $ -238661 EHR FUNDING $ -43598 true true X true X true X true true false false true true 577456 577456 0.02360 3484076 2382000 1102076 0.04500 4061532 2382000 1679532 0.06860 67246 67246 0.00270 26537 26537 0.00110 50248 50248 0.00210 144031 144031 0.00590 4205563 2382000 1823563 0.07450 1072 1072 10832 10832 0.00040 11904 11904 0.00040 true 1229000 10563000 11568265 -1005265 X true true 1 0 Good Samaritan Health Center

601 S Center Ave Merrill WI 54452

X X X X Good Samaritan Health Center 1 true true 200.0000 true 400.0000 true X X X X X X true true X X X X X X true X false X X X X true X false false 2 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 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. Number of Hospital Faciltiy - 0 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. 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. X X X X false true false false false false false false false false 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 14360 77 4391 2517 243565 David Burnett 201128 12880 135 4123 25180 243446 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 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 15b 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 12c 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 11 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 7b 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 7a 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 6 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 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 false false true false false false false false true false false true true true true true false false Ministry Health Care o 1613589 COST Ministry Health Care n 1614215 PAY RECORDS