BURNETT MEDICAL CENTER INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- BURNETT MEDICAL CENTER INC (EIN 39-0938661)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-14
- IRS object ID
- 201341349349304899
- 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 K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T14:30:27-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390938661 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BURNETT MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BURN | NameControl |
| Phone | 7154635353 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 WEST SAINT GEORGE AVENUE | AddressLine1 |
| City | GRANTSBURG | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHARLIE FAUGHT | Name |
| Title | CFO | Title |
| Phone | 7154635353 | Phone |
| Date Signed | 2013-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| PTIN | P00449155 | PTIN |
| Phone | 7158323407 | Phone |
| Date Prepared | 2013-05-14 | DatePrepared |
| 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 | CHARLES FAUGHT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 WEST SAINT GEORGE AVENUE | AddressLine1 |
| City | GRANTSBURG | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22016320 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | BURNETTMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF BURNETT MEDICAL CENTER IS TO PROVIDE COMPASSIONATE, COMPREHENSIVE, COMMUNITY HEALTHCARE THAT EXCEEDS OUR CUSTOMER'S EXPECTATIONS. OUR MISSION, AS WELL AS OUR VISION AND VALUES, SERVES AS A GUIDELINE FOR DAILY DECISION MAKING AND REPRESENTS THE PRINCIPLES AND PRACTICES THAT WE CONSTANTLY APPLY. THE COMFORT AND CARE OF OUR PATIENTS IS A MAJOR FOCUS OF OURS. WE WANT TO BE THE HEALTHCARE PROVIDER OF "CHOICE" - PROVIDING EXPERT AND COST EFFECTIVE CARE IN A "HOMETOWN" ATMOSPHERE. ANOTHER OBJECTIVE OF OURS IS TO PROVIDE EDUCATION THAT WILL INCREASE HEALTH AWARENESS. PART OF OUR MISSION IS TO CONTINUALLY PUT THE "CARE" IN HEALTHCARE. MORE HEALTHCARE INFORMATION IS NOW AVAILABLE FROM OUR WEB SITE, WHICH ALSO PROVIDES PATIENT EDUCATION RESOURCES FOR THOSE WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 275 | TotalNbrEmployees |
| Total Nbr Volunteers | 11 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 72665 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 109997 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 20223455 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 20915637 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 19262 | InvestmentIncomePriorYear |
| Investment Income Current Year | 22315 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 20315382 | TotalRevenuePriorYear |
| Total Revenue Current Year | 21047949 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10855720 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10951133 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9786908 | OtherExpensePriorYear |
| Other Expenses Current Year | 9512968 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20642628 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20464101 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -327246 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 583848 | RevenuesLessExpensesCY |
| Total Assets BOY | 24268848 | TotalAssetsBOY |
| Total Assets EOY | 24595241 | TotalAssetsEOY |
| Total Liabilities BOY | 16965800 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 16655581 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7303048 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7939660 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF BURNETT MEDICAL CENTER IS TO PROVIDE COMPASSIONATE, COMPREHENSIVE COMMUNITY HEALTHCARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11914708 | Expense |
| Revenue | 12825669 | Revenue |
| Description | BURNETT MEDICAL CENTER, LOCATED IN RURAL NORTHWEST WISCONSIN IS A 17 BED CRITICAL ACCESS HOSPITAL THAT PROVIDES THE FOLLOWING SERVICES THROUGHOUT A THREE COUNTY REGION:ACUTE CARE HAS 50+ EMPLOYEES WHO ALSO WORK IN OBSTETRICS, OPERATING ROOM, EMERGENCY ROOM, AND POST ANESTHESIA RECOVERY. WE PROVIDE GENERAL INPATIENT MEDICAL AND SURGICAL CARE, AS WELL AS A LARGE VOLUME OF OUTPATIENT SERVICES WHICH INCLUDE: OP SURGERY, CHEMOTHERAPY, BLOOD TRANSFUSION, IV THERAPY AS EXAMPLES. ALL OF THE RN STAFF IS ACLS ACCREDITED AND THE ENTIRE STAFF IS CERTIFIED IN CPR. THE GOAL OF THE NURSING STAFF IS TO PROVIDE EXCELLENT PATIENT CARE, CLOSE TO HOME, NEAR FAMILY AND FRIENDS.WE ALSO PROVIDE A FULL RANGE OF SERVICES FROM A 24/7 EMERGENCY ROOM TO CARDIAC REHABILITATION, AND WE PROVIDE OTHER THERAPEUTIC AND DIAGNOSTIC SERVICES VIA RADIOLOGY, LAB, PHYSICAL THERAPY, AND OCCUPATIONAL THERAPY.DURING FY 2012 IN A TOTAL OF 1,828 PATIENT DAYS WE SERVED 478 PATIENTS IN OUR INPATIENT AND SWING BED PROGRAMS AND ALSO HAD 43 BIRTHS. WE PERFORMED 718 SURGICAL PROCEDURES, SAW 4,755 PATIENTS IN EMERGENCY AND URGENT CARE, AND PROVIDED SERVICES FOR OVER 18,459 OTHER OUTPATIENT VISITS. GROSS HOSPITAL REVENUE OF $188,481 WAS PROVIDED AS CHARITY CARE TO 48 DIFFERENT PATIENTS FOR 224 EPISODES OF CARE.SINCE JUNE OF 2004, BURNETT MEDICAL CENTER HAS BEEN PARTICIPATING IN A PROGRAM DEVELOPED BY ABBOTT NORTHWESTERN HOSPITAL AND THE MINNEAPOLIS HEART INSTITUTE. THE LEVEL 1 HEART ATTACK PROGRAM IS AN INNOVATIVE APPROACH TO TREATING PATIENTS SUFFERING FROM A HEART ATTACK. THE KEY INGREDIENT FOR SUCCESS IS SPEED IN TREATMENT. THE GOAL IS TO TREAT AND TRANSPORT PATIENTS WITHIN 120 MINUTES, MEANING 120 MINUTES FROM THE TIME A PATIENT ENTERS THE EMERGENCY ROOM AT BURNETT MEDICAL CENTER UNTIL THE FIRST BALLOON IS INFLATED OR STENT PLACED AT ABBOTT NORTHWESTERN HOSPITAL (ABNW).BECAUSE RURAL HOSPITALS DO NOT HAVE THE CAPABILITY TO DO ANGIOPLASTY, IT IS IMPORTANT TO MOVE A HEART ATTACK PATIENT TO THE NEAREST HOSPITAL THAT HAS A HEART CATHETERIZATION LAB. THE LEVEL 1 PROGRAM HAS A DEFINITE PROTOCOL TO MOVE THESE PATIENTS QUICKLY DURING THAT "GOLDEN HOUR" WHEN ANGIOPLASTY IS THE MOST SUCCESSFUL.BURNETT MEDICAL CENTER IS ONE OF 30 HOSPITALS IN MINNESOTA AND WISCONSIN PARTICIPATING IN THE LEVEL 1 PROGRAM. CLEARLY, THE LEVEL 1 PROGRAM IS ADVANTAGEOUS TO RESIDENTS OF BURNETT COUNTY, KNOWING THAT CARDIOVASCULAR DISEASE IS THE LEADING CAUSE OF DEATH FOR MEN AND WOMEN IN THE UNITED STATES. THIS TEAM APPROACH GIVES PATIENTS THE ADVANTAGE OF TIME WHICH TRANSLATES TO BETTER OUTCOMES AND DECREASED MORTALITY. BURNETT MEDICAL CENTER'S MEDICAL AND NURSING STAFF HAVE BEEN TRAINED FOR THIS PROGRAM AND ARE PREPARED AND PLEASED TO PROVIDE QUICK ACCESS TO EFFICIENT CARDIAC CARE THROUGH THE LEVEL 1 HEART ATTACK PROGRAM. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2916409 | Expense |
| Revenue | 4702807 | Revenue |
| Description | BURNETT MEDICAL CENTER CLINIC IS LOCATED JUST OFF HIGHWAY 70 IN GRANTSBURG AND IS PART OF OUR EXPANDED FACILITY. THE CLINIC IS STAFFED BY 24 EMPLOYEES INCLUDING (5) PHYSICIANS, (1) PHYSICIAN ASSISTANT, (2) CERTIFIED NURSE PRACTITIONERS, AND (1) CERTIFIED NURSE MIDWIFE.WE ARE PLEASED TO OFFER OUR PATIENTS A RANGE OF SERVICES INCLUDING: PHYSICALS (INCLUDING WELL CHILD CHECKS, PRE-OPERATIVE, DOT, ETC.), OBSTETRICAL EXAMS, HEALTH STATUS ASSESSMENTS, DIAGNOSIS AND TREATMENT OF COMMON, ACUTE, AND CHRONIC HEALTH CONDITIONS, IMMUNIZATIONS, FAMILY PLANNING, DIABETIC EDUCATION, WOMEN'S HEALTH, COLONOSCOPY PROCEDURES, FRACTURE CARE, VASECTOMIES, ROUTINE LABORATORY TESTING, EKG'S, AND HOLTER MONITORING. ADDITIONALLY, THE CLINIC LABORATORY IS A CERTIFIED COLLECTION SITE FOR URINE DRUG SCREENING.HOURS OF OPERATION HAVE BEEN EXPANDED TO ALLOW PEOPLE INCREASED ACCESS, INCLUDING WORKING FAMILIES WITH SCHOOL-AGE CHILDREN, PEOPLE THAT WORK VARYING SHIFTS, ETC. OUR PROVIDERS HAVE COLLABORATIVE RELATIONSHIPS WITH AREA INDUSTRIES, INCLUDING THE LOCAL SCHOOL SYSTEMS. THIS ALLOWS BURNETT MEDICAL CENTER TO PROVIDE EDUCATIONAL OPPORTUNITIES TO EMPLOYEES OF THESE INDUSTRIES, INCLUDING BLOODBORNE PATHOGENS TRAINING, HEALTH EDUCATION TO SCHOOL CHILDREN, AND PARTICIPATION IN EMPLOYEE HEALTH FAIRS. BMC PROVIDERS PARTICIPATE IN THE LOCAL ROTARY GROUP AND IN COUNTY COALITIONS TO REDUCE PRESCRIPTION DRUG ABUSE AND IMPROVE AWARENESS OF WELLNESS ACTIVITIES IN THE AREA. WE ALSO SPONSOR AN ANNUAL 5K EVENT THAT RAISES FUNDS FOR A LOCAL CHARITY WHILE PROMOTING HEALTHY LIFESTYLES - THIS YEAR IS OUR 7TH ANNUAL!OVER 17,000 PRIMARY CARE CLINIC VISITS WERE PROVIDED DURING FY 2012. CLINIC CHARGES OF $23,023 WAS PROVIDED AS CHARITY CARE TO 48 DIFFERENT PATIENTS IN 197 VISITS. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3341880 | Expense |
| Revenue | 3387161 | Revenue |
| Description | THE CONTINUING CARE CENTER OF BURNETT MEDICAL CENTER OFFERS 46 SEMI-PRIVATE AND 4 PRIVATE ROOM ACCOMMODATIONS AND A FULL RANGE OF HEALTH AND PERSONAL CARE SERVICES. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY ARE AVAILABLE, AS WELL AS NUTRITIONAL SERVICES, RECREATIONAL ACTIVITIES, AND SOCIAL SERVICES. ADDITIONALLY, ADULT DAY CARE AND RESPITE CARE IS AVAILABLE. THE GOAL OF THE CONTINUING CARE CENTER'S STAFF IS TO PROVIDE NECESSARY HEALTH SERVICES WHILE MAINTAINING AN ATMOSPHERE OF HOPE, HARMONY, HUMOR, AND A "HOME" AWAY FROM HOME.WE STRIVE TO ENHANCE THE QUALITY OF RESIDENTS' LIVES VIA A VENUE FOR COMMUNITY-BASED VOLUNTEERS SHARING THEIR TIME AND TALENT WITH OUR RESIDENTS, SUCH AS MUSICAL BANDS, ROTARY CLUB SPONSORED FUNCTIONS, ETC.DURING FY 2012 WE HAD 18,001 RESIDENT DAYS SERVING ABOUT 100 DIFFERENT RESIDENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 18172997 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 6 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 275 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CHARLIE FAUGHT | NamePerson |
| Telephone Number | 7154635353 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 WEST SAINT GEORGE AVE | AddressLine1 |
| City | GRANTSBURG | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES RICHINSION II | |||||||
| VICE PRESIDENT | 0.50 | X | X | 0 | 0 | 0 | |
| ADAM BENSON | |||||||
| PRESIDENT | 0.50 | X | X | 0 | 0 | 0 | |
| TIM GERBER | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| MARILYN KOOIKER | |||||||
| SECRETARY/TREASURER | 0.50 | X | X | 0 | 0 | 0 | |
| JOLOUISE MCNALLY | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| PAT TAYLOR | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| RANDY CAREY | |||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| CHARLES FAUGHT | |||||||
| CFO | 40.00 | X | 127130 | 0 | 5729 | ||
| GORDON LEWIS | |||||||
| CEO | 40.00 | X | 187599 | 0 | 6374 | ||
| TIMOTHY NOVICK | |||||||
| PHYSICIAN | 36.00 | 298221 | 0 | 12676 | X | ||
| ADEOLA JOLAYEMI | |||||||
| PHYSICIAN | 40.00 | 210141 | 0 | 2668 | X | ||
| VESNA RADIVOJEVIC | |||||||
| PHYSICIAN | 40.00 | 173013 | 0 | 11947 | X | ||
| MELINDA DEYE | |||||||
| NURSE PRACTITIONER | 31.00 | 125226 | 0 | 1726 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1121330 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 41120 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| DR BLAISE P VITALE MD SC | |||||
| 257 WEST SAINT GEORGE AVENUE | GRANTSBURG | WI | 54840 | CLINIC AND ER SERVICES | 310835 |
| BNB ENTERPRISES | |||||
| 27165 JOHN STONE RD | WEBSTER | WI | 54893 | CRNA SERVICES | 226255 |
| ANTON MENTELE | |||||
| 923 BURGS PARK DRIVE | SHELL LAKE | WI | 54871 | CRNA SERVICES | 220160 |
| SURGERY CLINIC OF SPOONER | |||||
| N 6142 LITTLE VL ROAD | SPOONER | WI | 54801 | SURGICAL SERVICES | 170000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Related Organizations | 21357 | RelatedOrganizations |
| Government Grants | 87000 | GovernmentGrants |
| All Other Contributions | 1640 | AllOtherContributions |
| Total Contributions | 109997 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL PATIENT SERVI | 621990 | 12825669 | 12825669 |
| CLINIC PATIENT SERVICE | 621110 | 4702807 | 4702807 |
| NURSING HOME RESIDENT | 623000 | 3387161 | 3387161 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 20915637 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25662 | TotalRevenueColumn |
| Exclusion | $25,662 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 965004 | Securities |
| Other | 20 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 968371 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -3367 | Securities |
| Other | 20 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3347 | TotalRevenueColumn |
| Exclusion | -$3,347 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21047949 | TotalRevenueColumn |
| Related Or Exempt Function Income | 20915637 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $22,315 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 373952 | Total |
| Management And General | 373952 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8600992 | Total |
| Program Services | 7529072 | ProgramServices |
| Management And General | 1071920 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1388680 | Total |
| Program Services | 1224130 | ProgramServices |
| Management And General | 164550 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587509 | Total |
| Program Services | 512880 | ProgramServices |
| Management And General | 74629 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8979 | Total |
| Management And General | 8979 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14035 | Total |
| Management And General | 14035 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56013 | Total |
| Management And General | 56013 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2614288 | Total |
| Program Services | 2492012 | ProgramServices |
| Management And General | 122276 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74830 | Total |
| Management And General | 74830 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2148571 | Total |
| Program Services | 2029292 | ProgramServices |
| Management And General | 119279 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50336 | Total |
| Management And General | 50336 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1080986 | Total |
| Program Services | 1080986 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93926 | Total |
| Program Services | 68682 | ProgramServices |
| Management And General | 25244 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1464512 | Total |
| Program Services | 1464512 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72902 | Total |
| Management And General | 72902 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 1037018 | 1037018 | |
| REPAIRS & MAINTENANCE | 499845 | 490080 | 9765 |
| MEDICAID BED ASSESSMENT | 174208 | 174208 | |
| DUES & SUBSCRIPTIONS | 78440 | 27393 | 51047 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44079 | Total |
| Program Services | 42732 | ProgramServices |
| Management And General | 1347 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20464101 | Total |
| Program Services | 18172997 | ProgramServices |
| Management And General | 2291104 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -23486 | BOY |
| EOY | 163323 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2332770 | BOY |
| EOY | 3683770 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3024925 | BOY |
| EOY | 3080975 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 530105 | BOY |
| EOY | 551396 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 610974 | BOY |
| EOY | 439899 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25739186 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11204429 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15723059 | BOY |
| EOY | 14534757 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1578246 | BOY |
| EOY | 1589542 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 220268 | BOY |
| EOY | 209524 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 271987 | BOY |
| EOY | 342055 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24268848 | BOY |
| EOY | 24595241 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1182281 | BOY |
| EOY | 1272348 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15633066 | BOY |
| EOY | 15177056 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 150453 | BOY |
| EOY | 206177 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16965800 | BOY |
| EOY | 16655581 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7292531 | BOY |
| EOY | 7867490 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10517 | BOY |
| EOY | 72170 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7303048 | BOY |
| EOY | 7939660 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24268848 | BOY |
| EOY | 24595241 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 583848 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 52764 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $3,494 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3494 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | BURNETT MEDICAL CENTER, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIPS TO THE AMERICAN HOSPITAL ASSOCIATION AND WISCONSIN HOSPITAL ASSOCIATION. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A SMALL PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50000 | OtherCostOrOtherBasis |
| Book Value | 50000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19731994 | OtherCostOrOtherBasis |
| Depreciation | 7140756 | Depreciation |
| Book Value | 12591238 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5957192 | OtherCostOrOtherBasis |
| Depreciation | 4063673 | Depreciation |
| Book Value | 1893519 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14534757 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| 457(B) PLAN PAYABLE | $198,715 |
| FLEXIBLE SPENDING ACCOUNT LIABILITY | $7,462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 206177 | TotalOfAmounts |
| Total Revenue | 21047949 | TotalRevenue |
| Total Expenses | 20464101 | TotalExpenses |
| Excess Or Deficit For Year | 583848 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -8889 | NetUnrealizedGLOnInvestments |
| Other | $61,653 | OtherAmount |
| Total Adjustments | 52764 | TotalAdjustments |
| Excess Or Deficit Per FS | 636612 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 21047949 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 21047949 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 21047949 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20464101 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20464101 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20464101 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | SCHEDULE D PART XIV: INCOME TAXES IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE MEDICAL CENTER ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAX AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE MEDICAL CENTER RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR THE YEARS ENDED SEPTEMBER 30, 2009, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE MEDICAL CENTER'S POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF SEPTEMBER 30, 2012 AND 2011, THERE WERE NO MATERIAL TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES, RECORDED BY THE MEDICAL CENTER IN THE FINANCIAL STATEMENTS. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION: 61,653. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 122591 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 122591 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4776800 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4003444 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 773356 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03980 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4899391 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4003444 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 895947 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04610 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20922 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4198 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16724 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20922 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4198 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16724 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4920313 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4007642 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 912671 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04700 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $601,070 | BadDebtExpenseAmount |
| Amount Attributable To | 240000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6239647 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6220267 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 19380 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BURNETT MEDICAL CENTER INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 WEST SAINT GEORGE AVENUE | AddressLine1 |
| City | GRANTSBURG | City |
| State | WI | State |
| ZIP Code | 54840 | 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 | BURNETT MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | 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 |
|---|---|---|---|---|
| BURNETT MEDICAL CENTER CLINIC | ||||
| 257 WEST SAINT GEORGE AVENUE | GRANTSBURG | WI | 54840 | PROVIDER BASED RURAL HEALTH CLINIC |
| THE CONTINUING CARE CENTER OF BURNETT | ||||
| MEDICAL CENTER 257 W ST GEORGE AVE | GRANSTBURG | WI | 54840 | SKILLED NURSING FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST HOSPITAL REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY USED FOR NURSING HOME SERVICES IS BASED ON MEDICARE COST REPORTING METHODS. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 601070. | ||
| PART II: WE ARE CLOSE TO THE COMMUNITIES WE SERVE. IN RESPONSE TO THE GROWING TREND OF ILLEGAL USE OF PRESCRIPTION DRUGS BY THE YOUTH OF OUR NATION AND COMMUNITIES SERVED, BURNETT MEDICAL CENTER CONTINUES TO PARTNER WITH THE BURNETT COUNTY COALITION FOR HEALTHY LIVING IN SPONSORING PRESCRIPTION DRUG DISPOSAL AS PART OF THE NATIONAL TAKE BACK DAY IN BURNETT COUNTY. THE COALITION HOSTS FIVE DROP-OFF SITES THROUGHOUT BURNETT COUNTY: BURNETT COUNTY GOVERNMENT CENTER GRANTSBURG VILLAGE HALL ST. CROIX TRIBAL CLINIC IN HERTEL ST. CROIX TRIBAL HALL IN DANBURY A & H SENIOR CITIZEN'S CENTERTHIS EFFORT CONTINUES TO BRING AWARENESS TO THE NEED FOR PROPER DISPOSAL OF PRESCRIPTION DRUGS, AND INFORMS THE COMMUNITY THAT A PILL DROP BOX IS LOCATED AND ACCESSIBLE FOR THE PROPER DISPOSAL OF DRUGS AT THE BURNETT COUNTY SHERIFF'S DEPARTMENT ENTRANCE OF THE BURNETT COUNTY 24/7. WE CONTINUE TO PROVIDE TIMELY INFORMATION ON THIS INITIATIVE AT OUR WEBSITE, TO HIGHLIGHT THIS GROWING NATIONAL HEALTHCARE CONCERN FOR ADOLESCENTS AND IT IS INTENDED TO ADVANCE THE GENERAL KNOWLEDGE OF THE ISSUE. | ||
| PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICYTHE COSTING METHOD USED IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF CHARITY CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE MEDICAL CENTER. THE MEDICAL CENTER ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE MEDICAL CENTER. THE COST OF BAD DEBT AMOUNTS IS CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REFLECTS THE COST OF SERVICES PROVIDED TO UNINSURED COMMUNITY MEMBERS AND DEDUCTIBLES OR COINSURANCE AMOUNTS FOR INSURED PATIENTS WHO ARE UNABLE TO PAY FOR A PORTION OF SERVICES.MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE | ||
| PART III, LINE 8: THE MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND THEREFORE DID NOT RECOGNIZE A SHORTFALL FROM THE MEDICARE PROGRAM.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. | ||
| PART III, LINE 9B: PATIENTS RECEIVE OUR COMMUNITY CARE APPLICATION WHEN THEY PRESENT FOR SERVICES. THEY ARE ENCOURAGED TO REVIEW THE APPLICATION AND SUBMIT THE REQUIRED INFORMATION TO APPLY FOR POTENTIAL COVERAGE. IF THEY HAVE QUESTIONS OR NEED HELP WITH THE APPLICATION THEY MAY MEET WITH OUR FINANCIAL COUNSELOR AND/OR OUR BUSINESS OFFICE MANAGER. | ||
| PART V, SECTION B, LINE 19D: THE MEDICAL CENTER DETERMINES THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS USING AN INCOME-BASED SLIDING FEE BASED ON FEDERAL POVERTY GUIDELINES. IF AN INDIVIDUAL IS AT 150% OR LESS OF THE FEDERAL POVERTY GUIDELINES, THEN THEY GENERALLY RECEIVE FREE CARE. IF THE INDIVIDUAL EARNS BETWEEN 150% AND 200% OF THE FEDERAL POVERTY GUIDELINES, THEN THEY RECEIVE A DISCOUNTED PRICE BASED ON A SLIDING FEE SCALE. | BURNETT MEDICAL CENTER, INC. | |
| PART VI, LINE 2: WE HAVE USED MARKETING AND DEMOGRAPHIC DATA FOR BOTH OUR PRIMARY AND SECONDARY SERVICE AREAS AS SUPPLIED BY PROPRIETARY SOURCES FROM BOTH THOMSON REUTERS MARKET EXPERT AND THE MINNESOTA HOSPITAL ASSOCIATION. SUCH MARKET-BASED ANALYSIS PROVIDES ESTIMATES AND PROJECTIONS FOR THE MEDICAL NEEDS OF THOSE THAT LIVE WITHIN OUR SERVICE AREA. WE THEN LOOK AT THE AVAILABILITY OF EXISTING HEALTHCARE PROVIDERS AND SERVICES TO DETERMINE WHAT GAPS MAY EXIST, AND HOW WE CAN BEST BE A PART OF ADDRESSING UNMET NEEDS IN PARTNERSHIP WITH BOTH PUBLIC AND PRIVATE PROVIDERS OF HEALTHCARE SERVICES. THE RESULT OF OUR REVIEW AND ANALYSIS BECOMES A FUNDAMENTAL BASIS FOR THE DEVELOPMENT OF GOALS AND OBJECTIVES IN OUR STRATEGIC PLAN. FURTHER, WE ARE IN THE INITIAL STAGES OF CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AS REQUIRED UNDER THE PATIENT PROTECTION AND ACCOUNTABLE CARE ACT. WE AWAIT THE RESULTS OF OUR APPLICATION TO THE STATE OF WISCONSIN FOR A $5,000 MINI-GRANT TO ASSIST US IN CONDUCTING THE CHNA. ONCE COMPLETED THE CHNA RESULTS WILL FORM A BASIS FOR HOW TO BEST ADDRESS THESE IDENTIFIED COMMUNITY NEEDS, IN CONJUNCTION WITH MARKETING AND DEMOGRAPHIC DATA. | ||
| PART VI, LINE 3: PATIENTS ARE TOLD ABOUT OUR COMMUNITY CARE PROGRAM BY OUR FINANCIAL COUNSELOR, REGISTRATION STAFF, PATIENT ACCOUNT REPRESENTATIVES AND BUSINESS OFFICE MANAGER. IN ADDITION, WE HAVE SIGNS POSTED BY BOTH OUR CLINIC AND EMERGENCY ROOM REGISTRATION AREAS INFORMING OUR PATIENTS OF THE COMMUNITY CARE PROGRAM AVAILABLE AT OUR FACILITY. IF THE PATIENT FEELS THEY WILL NEED ASSISTANCE WITH THEIR MEDICAL BILLS, THEY ARE ENCOURAGED TO APPLY FOR THE COMMUNITY CARE PROGRAM WITH ALL THE REQUIRED INFORMATION. PATIENTS ALSO HAVE ACCESS TO THE COMMUNITY CARE APPLICATION INFORMATION ON OUR WEBSITE, FOR EASIER ACCESS FOR OUR PATIENTS. | ||
| PART VI, LINE 4: BURNETT MEDICAL CENTER (BMC) IS THE ONLY HOSPITAL IN BURNETT COUNTY. WHILE WE SERVE THE ENTIRE COUNTY, AND ADJOINING COUNTIES IN BOTH WISCONSIN AND MINNESOTA, GRANTSBURG, WISCONSIN IS THE PRIMARY SERVICE AREA OF BMC. BASED ON 2012 ESTIMATES, BURNETT COUNTY HAS A POPULATION OF 15,382 WHICH IS ABOUT A .5% REDUCTION FROM THE PREVIOUS ESTIMATES. BURNETT MEDICAL CENTER, A 17 BED FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL, IS THE SOLE HOSPITAL IN BURNETT COUNTY. FURTHER, BURNETT COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA/POPULATION (ID NUMBER 03764), HAVING BEEN SO DESIGNATED ON JUNE 28, 1984. LOCATED IN RURAL NORTHWEST WISCONSIN, BURNETT COUNTY COVERS OVER 820 SQUARE MILES (OR ABOUT 70% THE SIZE OF THE STATE OF RHODE ISLAND), WITH A POPULATION DENSITY OF OR 18.8 PERSONS PER SQUARE MILE (COMPARED TO 105 PER SQUARE MILE IN WISCONSIN). BURNETT COUNTY IS ONE OF THE POORER COUNTIES IN WISCONSIN WITH NEARLY ONE IN FIVE PERSONS (17.8%) LIVING BELOW THE POVERTY LEVEL COMPARED TO A STATE AVERAGE OF 12.0% WITH A MEDIAN INCOME OF $40,686 WHICH IS WELL BELOW THE STATE MEDIAN INCOME OF $51,374. DEMOGRAPHICALLY OUR OVER 65 YEARS OLD POPULATION REPRESENTS NEARLY ONE IN FOUR, OR 23.8% OF THE POPULATION, AND APPROACHING NEARLY DOUBLE THE WISCONSIN STATE AVERAGE OF 13.9%. ACCORDING TO THE US CENSUS, WHILE THE COUNTY POPULATION IS COMPRISED OF PREDOMINATELY WHITE PERSONS AT 91.8%, OUR NEXT LARGEST POPULATION IS AMERICAN INDIAN AT 4.7% (COMPARED TO 1.1% OVERALL FOR THE STATE). IN OUR SECONDARY SERVICE AREAS IN THE NEIGHBORING COUNTIES OF POLK COUNTY IN WISCONSIN AND PINE COUNTY IN MINNESOTA, WE SEE SIMILARITIES. BASED ON CENSUS BUREAU DATA, THEIR COMPARISONS SHOW THEY TOO HAVE FAR FEWER PERSONS PER SQUARE MILE, AND ARE RELATIVELY LOWER THAN THEIR RESPECTIVE STATE AVERAGES FOR MEDIAN HOUSEHOLD INCOME, THE 65+ YEARS OF AGE POPULATION, AND GREATER THAN STATE AVERAGE OF BOTH WHITE PERSONS AND AMERICAN INDIANS.DESPITE OUR RURAL LOCATION IN NORTHWEST WISCONSIN, WE ARE IN A RELATIVELY COMPETITIVE MARKET AS RESIDENTS FROM BOTH OUR PRIMARY AND SECONDARY SERVICE AREAS HAVE ACCESS TO TEN HOSPITALS (IN EITHER WISCONSIN OR MINNESOTA) WITHIN 50 MILES OF THE BURNETT MEDICAL CENTER GEOGRAPHIC LOCATION IN GRANTSBURG, WISCONSIN.FINALLY, WE TAKE OUR ROLE IN PROVIDING A HEALTH CARE SAFETY NET SERIOUSLY FOR ALL, INCLUDING THE UNINSURED, AS EVIDENCED BY OUR 24/7 EMERGENCY DEPARTMENT WHICH PROVIDES EMERGENT, URGENT, AND PRIMARY CARE TO ALL THAT PRESENT TO THE EMERGENCY DEPARTMENT. | ||
| PART VI, LINE 5: AS A SOLE COMMUNITY RURAL HOSPITAL WE TAKE PRIDE IN BEING CLOSE TO THOSE WE SERVE. WE SHARE WITH THE COMMUNITY VIA PRINT AND RADIO MEDIA, AS WELL AS A GROWING USE OF OUR WEBSITE AND OTHER SOCIAL MEDIA CONTENT OUTLETS KNOWLEDGE OF OUR SERVICES AND SHARING AND PROMOTING OUR MISSION THROUGHOUT THE COMMUNITIES SERVED. WE LEARN DIRECTLY FROM THOSE WE SERVE BY OUR GOVERNING STRUCTURE WHICH IS COMPOSED OF SEVEN UNPAID COMMUNITY VOLUNTEERS FROM THROUGHOUT BURNETT COUNTY, THAT RESIDE IN OUR PRIMARY SERVICE AREA, NONE OF WHICH ARE EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS.WE ENJOY THE CONTINUED SUPPORT OF OUR COMMUNITY WITH THE ESTABLISHMENT OF A HEALTHCARE FOUNDATION WHICH PROVIDES PHILANTHROPIC SUPPORT TO FULFILLING THE HOSPITAL'S MISSION.IN ORDER TO ENSURE CONTINUED AND READY ACCESS TO QUALIFIED HEALTHCARE PROVIDERS, WE TAKE PRIDE IN HAVING AN OPEN MEDICAL STAFF MODEL THAT EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN OUR COMMUNITY.WHEN WE HAVE SURPLUS FUNDS, THOSE FUNDS ARE USED FOR IMPROVEMENTS IN PATIENT CARE AND QUALITY, AS EVIDENCED BY OUR RECENT RENOVATIONS TO OUR LONG TERM CARE CENTER AND OUR RADIOLOGY DEPARTMENT. WE ALSO HAVE CONTINUED INVESTMENTS AS AN EARLY ADOPTER OF ELECTRONIC MEDICAL RECORDS, SUCCESSFULLY MEETING STAGE ONE MEANINGFUL USE GOALS.ADVOCACY OF THE COMMUNITIES HEALTHCARE NEEDS ARE DONE LOCALLY BY MEMBERS OF THE BOARD SPEAKING WITH LOCAL OFFICIALS ON RELEVANT ISSUES THAT MAY AFFECT THE HOSPITAL. ADDITIONALLY, THE ORGANIZATION'S CEO SERVES AS A MEMBER OF THE WISCONSIN HOSPITAL ASSOCIATION'S BOARD OF DIRECTORS WHICH ADVOCATES FOR INITIATIVES FOR COMMUNITY, STATE AND NATIONAL EFFORTS FOR IMPROVING THE OVERALL HEALTH OF THE POPULATION AND CONTINUED READY ACCESS TO QUALITY HEALTHCARE FOR ALL.MINDFUL OF THE NEED FOR SUPPORT OF VARIOUS METHODS OF INSURANCE, WE ARE PROUD OF OUR PARTICIPATION IN SUCH GOVERNMENTALLY-SPONSORED HEALTHCARE PROGRAMS SUCH AS MEDICARE, MEDICAID, AND TRICARE. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GORDON LEWIS | |||||||||||||
| 158109 | 0 | 29000 | 0 | 490 | 0 | 645 | 0 | 5729 | 0 | 193973 | 0 | 0 | 0 |
| TIMOTHY NOVICK | |||||||||||||
| 281045 | 0 | 0 | 0 | 17176 | 0 | 0 | 0 | 12676 | 0 | 310897 | 0 | 0 | 0 |
| ADEOLA JOLAYEMI | |||||||||||||
| 184995 | 0 | 25000 | 0 | 146 | 0 | 0 | 0 | 2668 | 0 | 212809 | 0 | 0 | 0 |
| VESNA RADIVOJEVIC | |||||||||||||
| 172856 | 0 | 0 | 0 | 157 | 0 | 0 | 0 | 11947 | 0 | 184960 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | GORDON LEWIS AND CHARLES FAUGHT WERE EMPLOYEES OF HEALTHTECH, LLC PROVIDING MANAGEMENT SERVICES TO THE FACILITY THROUGH JANUARY 31, 2011. EFFECTIVE FEBRUARY 1, 2011, GORDON LEWIS AND CHARLES FAUGHT BECAME EMPLOYEES OF THE MEDICAL CENTER. SALARIES AND BENEFITS FOR THE CALENDAR YEAR 2011 REFLECT COMPENSATION FROM BOTH HEALTHTECH, LLC AND BURNETT MEDICAL CENTER, INC. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|
| BURNETT COUNTY | ||||||
| 396005675 | 2007-03-23 | 7000000 | TO REFINANCE AND PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION | 0 | 0 | 0 |
| VILLAGE OF GRANTSBURG | ||||||
| 396006277 | 2007-04-10 | 5000000 | TO PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION | 0 | 0 | 0 |
| VILLAGE OF SIREN | ||||||
| 396008452 | 2007-04-25 | 4850000 | TO PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| 698413 | 7000000 | 140000 | 5464764 | 1395236 | 2008 | 1 | 0 | 1 | 1 |
| 494686 | 5000000 | 100000 | 4900000 | 2008 | 0 | 0 | 1 | 1 | |
| 479845 | 4850000 | 97000 | 4753000 | 2008 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | EACH PERSON, BUSINESS, CORPORATION OR ORGANIZATION WHO HAS CONTRIBUTED AND PAID ONE HUNDRED DOLLARS OR MORE TO BURNETT MEDICAL CENTER, INC."THE CORPORATION" SHALL BE A LIFETIME MEMBER OF THE CORPORATION. EACH PERSON, BUSINESS, CORPORATION OR ORGANIZATION IS ENTITLED TO HOLD A MAXIMUM OF ONE MEMBERSHIP CERTIFICATE. A HUSBAND AND WIFE, OR TWO OR MORE RELATED PERSONS, MAY HOLD A MEMBERSHIP AS JOINT TENANTS, HOWEVER, ONLY ONE VOTE PER MEMBERSHIP SHALL BE PERMITTED. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DUTIES OF THE MEMBERS OF BURNETT MEDICAL CENTER, INC. "THE CORPORATION" SHALL BE: THE FORMULATION AND DEVELOPMENT OF THE OVERALL PURPOSES; OBJECTIVES AND PHILOSOPHY OF THE CORPORATION; THE ELECTION OF MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION; THE REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION; THE CHANGING OF THE NUMBER OF DIRECTORS CONSTITUTING THE BOARD OF DIRECTORS; THE AMENDMENT, RESTATEMENT, OR MODIFICATION OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; AND THE APPROVAL OF THE SALE, LEASE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL OF THE ASSETS AND PROPERTY OF THE CORPORATION OR ITS MERGER WITH ANOTHER CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF DIRECTORS FOR BURNETT MEDICAL CENTER, INC. REVIEWED AND APPROVED THE FY 2012 FORM 990 PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | BURNETT MEDICAL CENTER, INC. (BMC) HAS A CONFLICT OF INTEREST POLICY. THE PURPOSE OF THIS POLICY IS TO PROTECT THE INTEREST OF BMC WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF BMC. IT IS EXPECTED THAT SUCH PERSONS SHALL EXERCISE THE UTMOST GOOD FAITH IN ALL TRANSACTIONS TOUCHING UPON THEIR DUTIES AT BURNETT MEDICAL CENTER AND ITS PROPERTY. ALL MEMBERS OF THE BOARD COMPLETE A DISCLOSURE FORM UPON APPOINTMENT, AND REVIEW AND SIGN IT ANNUALLY THEREAFTER. THIS STATEMENT ESTABLISHES THE DUTY OF AN INTERESTED PARTY TO DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST DISCLOSE ALL MATERIAL FACTS. AFTER ANY SUCH DISCLOSURE, HE/SHE SHALL LEAVE THE GOVERNING BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING BOARD MEMBERS. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS OF SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF MEMBERS FAIL TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, BMC SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. | |
| FORM 990, PART VI, SECTION B, LINE 15 | BURNETT MEDICAL CENTER INC.'S EXECUTIVE COMPENSATION POLICY IS DESIGNED WITH THE GOAL OF PROVIDING REMUNERATION THAT IS FAIR, REASONABLE AND COMPETITIVE. THE HOSPITAL BOARD MAY ESTABLISH A COMPENSATION COMMITTEE OR MAY ACT AS A COMMITTEE OF THE WHOLE IN EXECUTIVE SESSION. THE COMMITTEE OVERSEES THE TOTAL COMPENSATION PACKAGES TO ENSURE THAT THEY ARE COMPETITIVE WITH OTHER HEALTHCARE ORGANIZATIONS, REFLECT JOB RESPONSIBILITIES AND REQUIREMENTS AND ARE FAIR, EQUITABLE AND CONSISTENTLY MANAGED. THE COMMITTEE MEETS AS OFTEN AS IT DEEMS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES. IN GENERAL, BMC POSITIONS TOTAL EXECUTIVE COMPENSATION AT THE MEDIAN OF THE MARKET. THE BOARD OF DIRECTORS USES CONTEMPORANEOUS DATA INCLUDING EXECUTIVE COMPENSATION DATA FROM THE WISCONSIN HOSPITAL ASSOCIATION AS A GUIDE WHEN APPROVING THE COMPENSATION OF THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER. THE POLICY IS MEANT TO BE FLEXIBLE SO THAT COMPENSATION CAN BE ABOVE OR BELOW THE MEDIAN BASED ON EXPERIENCE, PERFORMANCE, SIZE AND COMPLEXITY OF ORGANIZATION, AND BUSINESS NEED TO ATTRACT AND RETAIN EXECUTIVE TALENT. | |
| FORM 990, PART VI, SECTION C, LINE 19 | BURNETT MEDICAL CENTER, INC. MAKES IT FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -8,889. CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION: 61,653. TOTAL TO FORM 990, PART XI, LINE 5: 52,764. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | BURNETT MEDICAL CENTER, INC. DOES NOT HAVE A SPECIFIC COMMITTEE WHICH ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | OVERSIGHT OF THE AUDIT |