THEDACARE MEDICAL CENTER-SHAWANO INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- THEDACARE MEDICAL CENTER-SHAWANO INC (EIN 39-0807068)
- Tax period
- 2010-05-01 to 2011-04-30
- Filed
- 2012-03-13
- IRS object ID
- 201200739349300300
- Schema version
- 2010v3.4
- 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 G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-13T05:19:55-05:00 | Timestamp |
| Tax Period End Date | 2011-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | PO BOX 12237 | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 543072237 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807068 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHAWANO MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SHAW | NameControl |
| Phone | 9205262111 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 NORTH BARTLETTE STREET | AddressLine1 |
| City | SHAWANO | City |
| State | WI | State |
| ZIP Code | 54166 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KENNETH MONGER | Name |
| Title | CFO | Title |
| Phone | 7155267310 | Phone |
| Date Signed | 2012-03-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TERRI REXRODE CPA MST | Name |
| Phone | 9206620016 | Phone |
| Date Prepared | 2012-03-07 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KENNETH MONGER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 NORTH BARTLETTE STREET | AddressLine1 |
| City | SHAWANO | City |
| State | WI | State |
| ZIP Code | 54166 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 41996845 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SHAWANOMED.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1932 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | THE HOSPITAL OPERATES A 25-BED ACUTE CARE FACILITY AND PROVIDES COMPREHENSIVE MEDICAL, SURGICAL, EMERGENCY, AND OUTPATIENT SERVICES TO THE RESIDENTS OF SHAWANO COUNTY AND THE SURROUNDING AREA. THE HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL (CAH) UNDER MEDICARE AND MEDICAID REGULATIONS. THE CAH DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS FOR BOTH MEDICARE AND MEDICAID, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 434 | TotalNbrEmployees |
| Total Nbr Volunteers | 57 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 146759 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 68243 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 40614827 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 41241240 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 393455 | InvestmentIncomePriorYear |
| Investment Income Current Year | 586486 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 25684 | OtherRevenuePriorYear |
| Other Revenue Current Year | 16929 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 41180725 | TotalRevenuePriorYear |
| Total Revenue Current Year | 41912898 | 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 | 20252893 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22226754 | 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 | 20006848 | OtherExpensePriorYear |
| Other Expenses Current Year | 21212242 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 40259741 | TotalExpensesPriorYear |
| Total Expenses Current Year | 43438996 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 920984 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1526098 | RevenuesLessExpensesCY |
| Total Assets BOY | 56771383 | TotalAssetsBOY |
| Total Assets EOY | 59043182 | TotalAssetsEOY |
| Total Liabilities BOY | 15710901 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18340958 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 41060482 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 40702224 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE HIGH-QUALITY HEALTH CARE SERVICES IN A HEALING ENVIRONMENT. WE EMPOWER OUR PATIENTS AND COMMUNITY TO GET WELL AND STAY HEALTHY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37834298 | Expense |
| Revenue | 41241240 | Revenue |
| Description | SHAWANO MEDICAL CENTER, INC. OPERATES A 25-BED ACUTE CARE FACILITY, WHICH PROVIDES LOCAL COMPREHENSIVE MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, AND HOSPICE SERVICES TO THE COMMUNITY. THE HOSPITAL PROVIDED CHARITY CARE TO 593 PATIENTS AT REDUCED OR NO-CHARGE FOR SERVICES FURNISHED UNDER THE HOSPITAL'S COMMUNITY CARE POLICY AGGREGATING $1,338,597. THE COST OF THESE SERVICES WAS $741,204. ALSO, UNCOMPENSATED HEALTHCARE COSTING $1,513,308 WAS PROVIDED TO 5,421 PATIENTS WHO WERE CLASSIFIED AS BAD DEBTS BECAUSE PATIENTS DID NOT PAY FOR ALL OR PART OF THE HEALTHCARE SERVICES PROVIDED. IN ADDITION, THE HOSPITAL PROVIDES AN IMPORTANT COMMUNITY BENEFIT BY PROVIDING CRITICAL HEALTHCARE LOCALLY. WITHOUT THE HOSPITAL, THIS CARE WOULD NOT BE AVAILABLE LOCALLY. THE HOSPITAL ALSO PROVIDED HEALTH EDUCATION PROGRAMS AND INFORMATION TO THE COMMUNITY AT AN AGGREGATE COST OF $44,505 | Description |
| Total Program Service Expense | 37834298 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | 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 | 1 | 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 | 1 | 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 | 1 | 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 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 434 | 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 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
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENNETH MONGER CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7155267310 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 NORTH BARTLETTE STREET | AddressLine1 |
| City | SHAWANO | City |
| State | WI | State |
| ZIP Code | 54166 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| LARRY KLEMENT | |||||||||
| PRESIDENT BOARD OF TRUSTEE | 2.00 | X | X | 0 | 0 | 0 | |||
| DICK KOEPPEN | |||||||||
| VICE PRESIDENT BOARD OF TR | 2.00 | X | X | 0 | 0 | 0 | |||
| JERRY HENTGES | |||||||||
| SECRETARY BOARD OF TRUSTEE | 2.00 | X | X | 0 | 0 | 0 | |||
| PAULA WEGNER | |||||||||
| TREASURER BOARD OF TRUSTEE | 2.00 | X | X | 0 | 0 | 0 | |||
| DR AMY SLAGLE | |||||||||
| CHIEF OF STAFF | 2.00 | X | 0 | 0 | 0 | ||||
| DR PETER KEENAN | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| GAIL MOESCH | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| JIM MEYER | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| RICK KANE | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| TIM OLSON | |||||||||
| CFO - THEDACARE | 2.00 | X | 0 | 412160 | 100567 | X | |||
| BRIAN BURMEISTER | |||||||||
| SR VP - THEDACARE | 2.00 | X | 0 | 284915 | 61721 | X | |||
| DR MICHAEL WILLIAMS | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 366050 | 20111 | ||||
| DOROTHY J ERDMANN | |||||||||
| ADMINISTRATOR/CEO | 40.00 | X | 0 | 0 | 0 | ||||
| KENNETH S MONGER | |||||||||
| ASST. ADMIN/CFO | 40.00 | X | 92212 | 0 | 6556 | ||||
| DR JEFFREY L MINIKEL | |||||||||
| PHYSICIAN | 40.00 | 542940 | 0 | 15044 | X | ||||
| KSHAMATA SHALINI MD | |||||||||
| PHYSICIAN | 40.00 | 175250 | 0 | 13865 | X | ||||
| DR RICHARD SARNWICK | |||||||||
| PHYSICIAN | 35.00 | 191487 | 0 | 25668 | X | ||||
| DR ANN TOUSIGNANT | |||||||||
| PHYSICIAN | 40.00 | 276528 | 0 | 25363 | X | ||||
| ROBERT L OSMER | |||||||||
| PHYSICIAN | 32.00 | 335103 | 0 | 20773 | X | ||||
| VINCENT D STUDER | |||||||||
| FORMER CFO | 0.00 | 119236 | 0 | 16381 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1732756 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1063125 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 306049 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BELLIN MEMORIAL HOSPITAL | |||||
| 744 S WEBSTER AVE POBOX 23400 | GREEN BAY | WI | 54305 | ER PHYSICIAN SERVICES | 2254970 |
| MCKESSON DRUG DC #8175 | |||||
| 3003 AIRPORT ROAD | LACROSSE | WI | 54603 | PHARMACEUTICALS | 1318121 |
| THEDACARE | |||||
| PO BOX 8025 | APPLETON | WI | 549128025 | CRNA CONTRACTOR LABOR FEES | 845769 |
| UNIVERSAL HOSPITAL SDS 12-0940 | |||||
| PO BOX 86 | MINNEAPOLIS | MN | 55486 | BIOMEDICAL SERVICES AND IV DUMP RENTALS | 744387 |
| SHAWANO MUNICPAL UTILITIES | |||||
| 122 N SAWYER STREET | SHAWANO | WI | 54166 | UTILITIES | 546143 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 29 | NumberOfContractorsGT100K |
| Related Organizations | 26054 | RelatedOrganizations |
| All Other Contributions | 42189 | AllOtherContributions |
| Total Contributions | 68243 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUES | 621400 | 40148287 | 40148287 |
| OTHER HOSPITAL SERVICE | 621400 | 652968 | 652968 |
| DIETARY SERVICES | 621400 | 236419 | 236419 |
| REHAB SERVICES | 621400 | 203566 | 203566 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 41241240 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 261159 | TotalRevenueColumn |
| Exclusion | $261,159 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 77268 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 76594 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 674 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 674 | TotalRevenueColumn |
| Exclusion | $674 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 323239 | Securities |
| Other | 2088 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 323239 | Securities |
| Other | 2088 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 325327 | TotalRevenueColumn |
| Exclusion | $325,327 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 23608 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 7353 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16255 | TotalRevenueColumn |
| Exclusion | $16,255 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 41912898 | TotalRevenueColumn |
| Related Or Exempt Function Income | 41241240 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $603,415 | ExclusionAmount |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1643024 | Total |
| Management And General | 1643024 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15739125 | Total |
| Program Services | 15155758 | ProgramServices |
| Management And General | 583367 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 332394 | Total |
| Program Services | 313795 | ProgramServices |
| Management And General | 18599 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3311036 | Total |
| Program Services | 3046530 | ProgramServices |
| Management And General | 264506 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1201175 | Total |
| Program Services | 1057034 | ProgramServices |
| Management And General | 144141 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 185003 | Total |
| Management And General | 185003 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68712 | Total |
| Management And General | 68712 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52759 | Total |
| Program Services | 40065 | ProgramServices |
| Management And General | 12694 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 157133 | Total |
| Program Services | 17819 | ProgramServices |
| Management And General | 139314 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 814429 | Total |
| Program Services | 736741 | ProgramServices |
| Management And General | 77688 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51709 | Total |
| Program Services | 43923 | ProgramServices |
| Management And General | 7786 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125782 | Total |
| Program Services | 87518 | ProgramServices |
| Management And General | 38264 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 583280 | Total |
| Program Services | 530785 | ProgramServices |
| Management And General | 52495 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3275851 | Total |
| Program Services | 2978520 | ProgramServices |
| Management And General | 297331 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187145 | Total |
| Program Services | 170302 | ProgramServices |
| Management And General | 16843 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 5083589 | 4648063 | 435526 |
| PROFESSIONAL CONTRACTED | 3031286 | 3031286 | |
| BAD DEBT EXPENSE (PATIE | 2482939 | 2482939 | |
| CONTRACT LABOR | 2345818 | 2345818 | |
| CONTRACTED SERVICES | 1295458 | 1295458 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1471349 | Total |
| Program Services | 1147402 | ProgramServices |
| Management And General | 323947 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43438996 | Total |
| Program Services | 37834298 | ProgramServices |
| Management And General | 5604698 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 975 | BOY |
| EOY | 1125 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5058546 | BOY |
| EOY | 11362104 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4628559 | BOY |
| EOY | 4693324 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1149776 | BOY |
| EOY | 1045802 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 291204 | BOY |
| EOY | 135814 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 60496217 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 31943317 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30945135 | BOY |
| EOY | 28552900 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14678894 | BOY |
| EOY | 13243611 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18294 | BOY |
| EOY | 8502 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56771383 | BOY |
| EOY | 59043182 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3356196 | BOY |
| EOY | 7413846 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11963756 | BOY |
| EOY | 10783164 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 390949 | BOY |
| EOY | 143948 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15710901 | BOY |
| EOY | 18340958 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40449038 | BOY |
| EOY | 40487466 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 611444 | BOY |
| EOY | 214758 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41060482 | BOY |
| EOY | 40702224 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56771383 | BOY |
| EOY | 59043182 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1526098 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1167840 | 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 Consolidated | X | FinancialStatementConsolidated |
| 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) |
|---|---|---|
| Other Activities | 1 | OtherActivities |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | THE ORGANIZATION HAS INDIRECT LOBBYING ACTIVITIES THROUGH THE PAYMENT OF WISCONSIN HOSPITAL ASSOCIATION (WHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) DUES. THE DUES PAID DURING 2010 WERE WHA - $18,522; AHA - $10,066. LOBBYING EXPENSES WERE APPROXIMATELY 15% OF THE DUES (WHA - $2,778; AHA $1,510). | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1574028 | OtherCostOrOtherBasis |
| Book Value | 1574028 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37749268 | OtherCostOrOtherBasis |
| Depreciation | 16732591 | Depreciation |
| Book Value | 21016677 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1092925 | OtherCostOrOtherBasis |
| Depreciation | 572284 | Depreciation |
| Book Value | 520641 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19987204 | OtherCostOrOtherBasis |
| Depreciation | 14638442 | Depreciation |
| Book Value | 5348762 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 92792 | OtherCostOrOtherBasis |
| Book Value | 92792 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28552900 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST RATE SWAP AGREEMENTS | Description |
| Amount | $143,948 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 143948 | TotalOfAmounts |
| Total Revenue | 41912898 | TotalRevenue |
| Total Expenses | 43438996 | TotalExpenses |
| Excess Or Deficit For Year | -1526098 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 980786 | NetUnrealizedGLOnInvestments |
| Other | $187,054 | OtherAmount |
| Total Adjustments | 1167840 | TotalAdjustments |
| Excess Or Deficit Per FS | -358258 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 41989492 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 76594 | OtherRevenues |
| Revenue Not Rptd F990 | 76594 | RevenueNotRptdF990 |
| Revenue Subtotal | 41912898 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 41912898 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 43515590 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 76594 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 76594 | ExpensesNotRptdF990 |
| Expenses Subtotal | 43438996 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 43438996 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES 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 TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSET OR LIABILITY FOR UNCERTAIN TAX POSITION IN 2011 OR 2010. FEDERAL AND STATE INCOME TAX RETURNS FOR 2010, 2009, AND 2008 REMAIN SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 76,594. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 76,594. | |
| PART XI, LINE 8 - OTHER: INTEREST RATE SWAP AGREEMENT ADJUSTMENT: 187,040 DECREASE IN TEMPORARILY RESTRICTED NET ASSETS: 396,686 NET ASSESTS RELEASED FROM RESTRICTION: 396,700 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF BENEFIT | NameOfEvent1 |
| Gross Receipts Event1 | 14940 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 14940 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 5471 | OtherDirectExpensesEvent1 |
| Name Of Event2 | VARIOUS AUXILIARY | NameOfEvent2 |
| Gross Receipts Event2 | 8668 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 8668 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 1882 | OtherDirectExpensesEvent2 |
| Other Direct Expenses Other Events | 0 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 23608 | GrossReceiptsTotal |
| Gross Revenue Total Events | 23608 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 7353 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 7353 | DirectExpenseSummaryEvents |
| Net Income Summary | 16255 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 300.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 275.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 741204 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 741204 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8049066 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7321793 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 727273 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8790270 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7321793 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1468477 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03590 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 28330 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 28330 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 46500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 46500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2840 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2840 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 77670 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 77670 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8867940 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7321793 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1546147 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03780 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 400 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 400 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1650 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1650 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5200 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5200 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8250 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8250 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,374,846 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 12989227 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12860679 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 128548 | 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 | SHAWANO MEDICAL CENTER INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 309 N BARTLETTE STREET | AddressLine1 |
| City | SHAWANO | City |
| State | WI | State |
| ZIP Code | 54166 | 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 | SHAWANO MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation |
|---|
| 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 $ 2482939. |
| PART II: COMMUNITY BUILDING AND COMMUNITY HEALTH PROMOTIONS STRESS THE GOALS SET BY HEALTHIEST WISCONSIN 2010. THESE INCLUDE SPORTS MEDICINE SERVICES FOR YOUTH SPORTS, SUPPORT FOR WALKING AND BIKING EVENTS, FREE EDUCATIONAL PROGRAMS INCLUDING A REGULAR DIABETES PROGRAM, HEALTH FAIRS, SUPPORT OF THE RURAL HEALTH INITIATIVE (A RURAL FARM/OUTREACH PROGRAM), A GENEROUS INCOME-BASED PAYMENT PROGRAM (COMMUNITY CARE), SUPPORT OF TECHNICAL AND COLLEGE HEALTH CARE PROGRAMS. |
| PART III, LINE 4: THERE IS NOT A BAD DEBT EXPENSE FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE RATIONALE FOR INCLUDING OTHER BAD DEBT AMOUNTS IN COMMUNITY BENEFIT: PATIENTS ARE TRULY UNABLE TO PAY OUT-OF-POCKET LIABILITY BUT DID NOT COMPLETE THE PROCESS. IF THEY HAVE COMPLETED THE PAPERWORK, THEY WOULD HAVE QUALIFIED FOR CHARITY CARE.PART I, LINE 7: COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED ABOVE WAS OBTAINED FROM THE 2011 MEDICARE COST REPORT "COST TO CHARGE" RATIO.SCHEDULE H, PART I, LINE 7 COLUMN (F): THE AMOUNT OF BAD DEBT REMOVED FROM THE DENOMINATOR IN CALCULATING THE PERCENTAGES WAS $2,482,939 |
| PART III, LINE 8: THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS UNDER REVENUE RULING 69-645 STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY IMPLYING THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT.THE ELDERLY ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH HEALTHCARE ACCESS. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE SERVICES, CMS WOULD HAVE THE BURDEN OF PROVIDING THESE SERVICES. THE PATIENTS WOULD HAVE A VERY LONG TRAVEL TIME IF THEY HAD TO GO TO OTHER FACILITIES.COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED ABOVE WERE DERIVED FROM THE MEDICARE COST REPORT. |
| PART III, LINE 9B: THE WRITTEN DEBT COLLECTION POLICY COVERS PRACTICES THAT WILL BE FOLLOWED FOR PATIENTS WHO ARE KNOW TO QUALIFY FOR FINANCIAL ASSISTANCE OR DISCOUNTED RATES. |
| PART VI, LINE 2: SHAWANO MEDICAL CENTER, IN COOPERATION WITH THE SHAWANO COUNTY DEPARTMENT OF PUBLIC HEALTH, CONDUCTS HEALTH ASSESSMENTS OF THE COMMUNITY EVERY THREE YEARS. THE MOST RECENT WAS COORDINATED WITH THE HEALTHIEST WISCONSIN 2010 PROJECT. THE ASSESSMENT INVOLVES INPUT FROM A MULTI-DISCIPLINARY COMMUNITY TEAM AND FOCUS GROUPS. SHAWANO COUNTY DEPARTMENT OF PUBLIC HEALTH ORGANIZED THE DATA AND HELPED THE COMMITTEE SET PRIORITIES. |
| PART VI, LINE 3: NEW PATIENTS TO OUR FACILITY ARE PROVIDED WITH 1. BROCHURE THAT ADDRESSES FREQUENTLY ASKED QUESTIONS ABOUT PATIENT INSURANCE AND FINANCIAL ARRANGEMENTS. THE BROCHURE COVERS OUR CHARITY CARE PROGRAM REQUIREMENTS AND ALSO INVITES PATIENTS TO CONTACT OUR PATIENT FINANCIAL COUNSELOR TO HELP IDENTIFY OTHER PROGRAMS FEDERAL, STATE OR LOCAL GOVERNMENT THAT PATIENTS MAY BE ELIGIBLE FOR. 2. CHARITY CARE PROGRAM APPLICATIONS ARE AVAILABLE TO ALL PATIENTS AT THE TIME OF REGISTRATION. 3. YEARLY A NOTICE OF AVAILABILITY OF COMMUNITY CARE FINANCIAL ASSISTANCE FOR THE UN-INSURED AND UNDER-INSURED IS PUBLISHED IN LOCAL AND SURROUNDING NEWSPAPERS. NOTICE IS PUBLISHED IN ACCORDANCE WITH REGULATION 42CFR 124.504 NOTICE OF AVAILABILITY OF UNCOMPENSATED SERVICES. |
| PART VI, LINE 4: THE SHAWANO MEDICAL CENTER SERVICE AREA INCLUDES ABOUT 35,000 IN SHAWANO, MENOMINEE AND WAUPACA COUNTIES. PRIMARY SERVICE AREA INCLUDES SHAWANO, GRESHAM, CLINTONVILLE, KESHENA; SECONDARY SERVICE AREA INCLUDES BONDUEL, CECIL, MARION; TERTIARY SERVICE AREA INCLUDES TIGERTON, NEOPOST, AND GILLETT. THERE ARE NO OTHER HOSPITALS IN THE SERVICE AREA. A. THE EMERGENCY DEPARTMENT HANDLES OVER 20,000 VISITS PER YEAR B. ABOUT 400 BABIES ARE BORN AT SMC ANNUALLY. C. SMC IS A CRITICAL-ACCESS HOSPITAL D. SHAWANO MEDICAL CENTER SERVES MEDICALLY UNDERSERVED AREAS INCLUDING WESTERN SHAWANO COUNTY (60.0) AND MENOMINEE COUNTY (60.0). (MUA APPLIES TO AREAS WITH A SCORE OF 62 OR LESS FOR PRIMARY CARE SERVICES PER THE US DEPARTMENT TO HEALTH & HUMAN SERVICES). E. IN SHAWANO COUNTY, 11% OF THE POPULATION LIVES BELOW THE POVERTY LEVEL. COUNTY, 31.7% LIVES BELOW THE POVERTY LEVEL. |
| PART VI, LINE 6: A.OUR BOARD OF TRUSTEES IS COMPRISED OF RESIDENTS WHO LIVE IN THE AREA BUT ARE NOT EMPLOYEES OF SMC. ADMINISTRATORS SERVE AS AD HOC MEMBERS ON THE BOARD.B.SMC HAS AN OPEN CAMPUS FOR PHYSICIANS; PRIVILEGES ARE EXTENDED TO PHYSICIANS FROM THEDACARE PHYSICIANS, BELLINHEALTH, AURORA HEALTH, MENOMINEE TRIBAL CLINIC AND OTHER AREA CLINICS.C.SURPLUS FUNDS HAVE BEEN USED FOR TECHNOLOGICAL IMPROVEMENTS INCLUDING AN IN-HOUSE MRI, SURGICAL EQUIPMENT (INCLUDING ORTHOPEDIC SURGICAL SUPPLIES), AND A COMPREHENSIVE ELECTRONIC MEDICAL RECORD UPGRADE. |
| PART VI, LINE 7: SHAWANO MEDICAL CENTER, INC. ENTERED INTO A DEFINITIVE AFFILIATION AGREEMENT WITH THEDACARE, INC. ON JANUARY 30, 2011. AS PART OF A LARGER FAMILY, SHAWANO MEDICAL CENTER IS IN THE PROCESS OF ALIGNING WITH THEDACARE TO PROMOTE A HEALTHIER SHAWANO COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIM OLSON | |||||||||||||
| 0 | 322102 | 0 | 67348 | 0 | 22710 | 0 | 87350 | 0 | 13217 | 0 | 512727 | 0 | 0 |
| BRIAN BURMEISTER | |||||||||||||
| 0 | 219678 | 0 | 48120 | 0 | 17117 | 0 | 48147 | 0 | 13574 | 0 | 346636 | 0 | 0 |
| DR MICHAEL WILLIAMS | |||||||||||||
| 0 | 366050 | 0 | 0 | 0 | 0 | 0 | 7266 | 0 | 12845 | 0 | 386161 | 0 | 0 |
| DR JEFFREY L MINIKEL | |||||||||||||
| 537641 | 0 | 0 | 0 | 5299 | 0 | 0 | 0 | 15044 | 0 | 557984 | 0 | 0 | 0 |
| KSHAMATA SHALINI MD | |||||||||||||
| 85375 | 0 | 62097 | 0 | 27778 | 0 | 4073 | 0 | 9792 | 0 | 189115 | 0 | 0 | 0 |
| DR RICHARD SARNWICK | |||||||||||||
| 189826 | 0 | 0 | 0 | 1661 | 0 | 5580 | 0 | 20088 | 0 | 217155 | 0 | 0 | 0 |
| DR ANN TOUSIGNANT | |||||||||||||
| 273948 | 0 | 0 | 0 | 2580 | 0 | 5394 | 0 | 19969 | 0 | 301891 | 0 | 0 | 0 |
| ROBERT L OSMER | |||||||||||||
| 316977 | 0 | 15000 | 0 | 3126 | 0 | 0 | 0 | 20773 | 0 | 355876 | 0 | 0 | 0 |
| VINCENT D STUDER | |||||||||||||
| 42659 | 0 | 0 | 0 | 76577 | 0 | 2328 | 0 | 14053 | 0 | 135617 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4A | ReturnReference |
| Explanation | VINCENT D. STUDER $38,786.80, DR. KSHAMATA SHALINI $27,518.40. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF SHAWANO WISCONSIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 390807068 | IssuerEIN |
| Date Issued | 2006-10-02 | DateIssued |
| Issue Price | 6000000 | IssuePrice |
| Description Of Purpose | SEE SCHEDULE K SUPPLEMENTAL INFORMATION | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 6000000 | TotalProceeds |
| Capital Expenditures | 6000000 | CapitalExpenditures |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 0 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Post Issuance Compliance Procdrs | 0 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K, PART 1, LINE A | Identifier |
| Return Reference | DESCRIPTION OF PURPOSE | ReturnReference |
| Explanation | FINANCE THE EXPANSION, IMPROVEMENT AND EQUIPPING OF THE HOSPITAL FACILITY, SPECIFICALLY INCLUDING THE ADDITION OF ATTACHED CLINIC FACILITY FOR HOSPITAL BASED PHYSICIANS AND RENOVATIONS OF OUTPATIENT SURGICAL FACILITIES. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DR AMY SLAGLE | |||
| MEDICAL STAFF PRESIDENT - BOARD OF TRUSTEES | 378142 | PATIENT REFERRALS | 0 |
| REINHARTS FOODS | |||
| JERRY HENTGES, A BOD MEMBER IS ALSO A MANAGER AT REINHARTS FOODS | 167783 | FOOD SUPPLIES | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | ON 1/30/11 THEDA CARE BECAME THE SOLE CORPORATE MEMBER OF SHAWANO MEDICAL CENTER. | |
| FORM 990, PART VI, SECTION A, LINE 6 | OUR BOARD OF TRUSTEES IS COMPRISED OF RESIDENTS WHO LIVE IN THE AREA BUT ARE NOT EMPLOYEES OF SMC. ADMINISTRATORS SERVE AS AD HOC MEMBERS ON THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 6 | ON 1/30/11 THEDA CARE BECAME THE SOLE CORPROATE MEMBER OF SHAWANO MEDICAL CENTER, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | OUR BOARD OF TRUSTEES IS COMPRISED OF RESIDENTS WHO LIVE IN THE AREA BUT ARE NOT EMPLOYEES OF SMC. ADMINISTRATORS SERVE AS AD HOC MEMBERS O THE BOARD. ON 1/31/11, THEDA CARE BECAME THE SOLE CORPORATE MEMBER AND THEY CAN ELECT AND REMOVE TRUSTEES. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING MUST BE COMPLETED ONLY BY THE MEMBER: MERGE OR CONSOLIDATE THE CORPORATION, SELL, LEASE, TRANSFER OR DISPOSE OF MATERIAL ASSETS, CAUSE THE ORGANIZATION TO ENTER INTO JOINT VENTURES OR AFFILIATIONS, AMEND THE ARTICLES OR BYLAWS, DEVELOP AND APPROVE THE CAPITAL AND OPERATING ANNUAL BUDGETS, AUTHORIZE AND MAKE CAPITAL EXPENDITURES, APPROVE THE STRATEGIC PLANS FROM YEAR TO YEAR, DEVELOP AND APPROVE THE SAFETY AND QUALITY PLAN, APPROVE THE DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, HIRE AND TERMINATE THE PRESIDENT AND CEO, BORROW OR INCUR DEBT, APPOINT AUDITORS AND LEGAL COUNSEL, AND RETAIN INVESTMENT ADVISORS AND ESTABLISH INVESTMENT POLICIES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF DIRECTORS (BOD) IS GIVEN AN ELECTRONIC COPY FOR REVIEW. THE BOD HAS DELEGATED THE DETAIL REVIEW OF THE FORM 990 TO THE MANAGEMENT OF THE HOSPITAL. | |
| ANNUAL CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND SIGNED BY EACH MEMBER OF THE BOARD OF TRUSTEES. CONFLICTS OF INTEREST DISCLOSED BY A MEMBER ARE REVIEWED BY THE ENTIRE BOARD OF TRUSTEES FOR APPROPRIATENESS AND RESOLUTION. | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION FOR THE CEO IS REVIEWED AND APPROVED BY THE GOVERNING BODY. SURVEYS ARE UTILIZED TO DETERMINE BOTH CEO AND OTHER KEY EMPLOYEES' COMPENSATION. DOCUMENTATION IS KEPT WITH RESPECT TO THE DELIBERATION AND DECISIONS. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE ORGANIZATION HAS DEEMED THAT ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. | FORM 990, PART VI, SECTION C, LINE 19 | |
| DETAIL OF HOURS WORKED FOR A RELATED ORGANIZATION | TIM OLSON WORKED 40 HOURS FOR A RELATED ORGANIZATION. BRIAN BURMEISTER WORKED 40 HOURS FOR A RELATED ORGANIZATION. DR. MICHAEL WILLIAMS WORKED 40 HOURS FOR A RELATED ORGANIZATION. | FORM 990, PART VII |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 980,786. INTEREST RATE SWAP AGREEMENT ADJUSTMENT 187,040. DECREASE IN TEMPORARILY RESTRICTED NET ASSETS -396,686. NET ASSETS RELEASED FROM RESTRICTION 396,700. TOTAL TO FORM 990, PART XI, LINE 5: 1,167,840. | FORM 990, PART XI, LINE 5: |
| AUDITED FINANCIAL STATEMENTS | THE COMBINED FINANCIAL STATEMENTS OF SHAWANO MEDICAL CENTER, INC. AND AFFILIATE ARE AUDITED BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS FOR THE HOSPITAL IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITOR. | FORM 990, PART XII, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SHAWANO MEDICAL CENTER FOUNDATION INC | |||||||||||
| 309 N BARTLETTE STREET | SHAWANO | WI | 54166 | 391539117 | SUPPORT | WI | 11D | LINE 11D, III-O | N/A | 0 | |
| THEDACARE | |||||||||||
| 122 EAST COLLEGE AVENUE | APPLETON | WI | 54911 | 391509362 | FUNCTIONALLY INTEGRATED | WI | 501(C)(3) | LINE 3 | N/A | 0 | |
| APPLETON MEDICAL CENTER | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390824015 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE | |
| THEDA CLARK MEDICAL CENTER | |||||||||||
| PO BOX 8025 | APPLETON | WI | 54912 | 390830664 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE | |
| APPLETON MEDICAL CENTER FOUNDATION | |||||||||||
| 1818 N MEADE | APPLETON | WI | 54911 | 391459276 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE | |
| THEDA CLARK FOUNDATION | |||||||||||
| 130 SECOND STREET | NEENAH | WI | 54956 | 391550056 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE | |
| WOLF RIVER FOUNDATION | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 200049796 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE | |
| COMMUNITY HOSPICE FOUNDATION | |||||||||||
| 1818 N MEADE | APPLETON | WI | 54911 | 391511977 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE | |
| GEORGE PEABODY FOUNDATION | |||||||||||
| PO BOX 2553 | APPLETON | WI | 54912 | 391702534 | FOUNDATION | WI | 501(C)(3) | LINE 7 | 0 | THEDACARE | |
| NEW LONDON FAMILY MEDICAL CENTER | |||||||||||
| 1405 MILL STREET | NEW LONDON | WI | 54961 | 390869788 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE | |
| RIVERSIDE MEDICAL CENTER INC | |||||||||||
| 800 RIVERSIDE DRIVE | WAUPACA | WI | 54891 | 390871113 | HOSPITAL | WI | 501(C)(3) | LINE 3 | 0 | THEDACARE | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHAWANO MEDICAL CENTER FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 15000 | AmountInvolved |