CUMBERLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CUMBERLAND MEMORIAL HOSPITAL INC (EIN 39-0831153)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-11
- IRS object ID
- 201221329349300032
- 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 H
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-11T08:23:58-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPLFLI 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 | 54702 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390831153 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED | BusinessNameLine1 |
| Business Name Line2 | CARE UNIT INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CUMB | NameControl |
| Phone | 7158222741 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANGIE MARTENS | Name |
| Title | CFO | Title |
| Phone | 7158222741 | Phone |
| Date Signed | 2012-05-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| Phone | 7158323407 | Phone |
| Date Prepared | 2012-05-10 | 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 | ANGIE MARTENS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 20116922 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CUMBERLANDHEALTHCARE.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. IS COMMITTED TO CREATING A HEALTHIER COMMUNITY THROUGH PROVIDING AN ARRAY OF HIGH-QUALITY ACUTE CARE, AMBULATORY, AND SKILLED NURSING FACILITY SERVICES TO RESIDENTS OF THE SERVICE AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 299 | TotalNbrEmployees |
| Total Nbr Volunteers | 127 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 148581 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 91978 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 19770180 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19963622 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 70279 | InvestmentIncomePriorYear |
| Investment Income Current Year | 36229 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 19989040 | TotalRevenuePriorYear |
| Total Revenue Current Year | 20091829 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5018 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1368 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12407206 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13147355 | 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 | 7075566 | OtherExpensePriorYear |
| Other Expenses Current Year | 7247443 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 19487790 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20396166 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 501250 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -304337 | RevenuesLessExpensesCY |
| Total Assets BOY | 16586783 | TotalAssetsBOY |
| Total Assets EOY | 16282101 | TotalAssetsEOY |
| Total Liabilities BOY | 6379899 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6379554 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10206884 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9902547 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE PRIMARY FUNCTION OF CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. (CMH-ECU) IS THE PROVISION OF HIGH QUALITY COMMUNITY-BASED HEALTH CARE TO ALL PEOPLE WITHOUT REGARD TO DISABILITY, RACE, CREED, COLOR, NATIONAL ORIGIN OR ABILITY TO PAY. QUALITY CARE ENCOMPASSES CURATIVE, RESTORATIVE, SUPPORTIVE AND PREVENTATIVE ASPECTS. IN PROVIDING THIS CARE, THE RIGHTS, DIGNITY AND PRIVACY OF THE PATIENT/RESIDENT WILL BE HELD IN HIGHEST REGARD. QUALITY HEALTH CARE CAN BEST BE PROVIDED BY FOSTERING A QUALITY WORK ENVIRONMENT TO ATTRACT AND RETAIN COMPETENT AND CARING EMPLOYEES. CMH-ECU ACCEPTS A LEADERSHIP ROLE IN THE COMMUNITY IN ASSESSING NEEDS, INSTITUTING CHANGES TO MEET THOSE NEEDS, AND PLANNING WITH OTHER AGENCIES FOR CONTINUITY AND COMPREHENSIVE HEALTH CARE IN A COST EFFECTIVE MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14669368 | Expense |
| Revenue | 17300208 | Revenue |
| Description | CUMBERLAND MEMORIAL HOSPITAL-EXTENDED CARE UNIT, INC. IS AN INDEPENDENT, NONPROFIT, COMMUNITY-BASED FACILITY THAT SERVES NORTHWEST WISCONSIN. CUMBERLAND MEMORIAL HOSPITAL BECAME A CRITICAL ACCESS HOSPITAL ON AUGUST 19, 2005, LICENSED FOR 25 ACUTE CARE BEDS (INCLUDING 3 IN THE BIRTHPLACE), AND 10 PSYCHIATRIC BEDS. AMONG THE MANY KINDS OF SERVICES PROVIDED ARE SURGERY, RADIOLOGY, LABORATORY, EMERGENCY ROOM, BEHAVIORAL HEALTH, THERAPY, AND NURSERY. ACUTE CARE DAYS TOTALED 1,763 IN 2011, SWING BED DAYS TOTALED 1,079, NEWBORN DAYS TOTALED 129, AND BEHAVIORAL HEALTH DAYS TOTALED 1,896. DURING FISCAL YEAR 2011, CUMBERLAND MEMORIAL HOSPITAL PROVIDED 63 INPATIENT AND 392 OUTPATIENT SURGERIES ALONG WITH 247 SCOPE PROCEDURES. THERE WERE ALSO 2,796 EMERGENCY ROOM VISITS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3188940 | Expense |
| Revenue | 2492905 | Revenue |
| Description | CUMBERLAND EXTENDED CARE UNIT, A 50 BED SKILLED NURSING HOME, IS DEDICATED TO MEETING THE PHYSICAL, MENTAL, EMOTIONAL, AND SPIRITUAL NEEDS OF THE RESIDENTS AND FAMILIES SERVED. TOTAL NURSING HOME DAYS IN FISCAL YEAR 2011 WERE 15,683. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 131510 | Expense |
| Revenue | 170509 | Revenue |
| Description | THE LAKEWOOD REGENCY APARTMENTS ARE ATTACHED TO THE CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT. THESE SPACIOUS APARTMENTS WERE DESIGNED AS A COMFORTABLE AND CONVENIENT LIVING CHOICE FOR SENIORS KEEPING SOCIAL INTEREST AND PERSONAL SAFETY IN MIND. THE OCCUPANCY PERCENTAGE FOR 2011 WAS APPROXIMATELY 85%. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 17989818 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 0 | 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 | 35 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 299 | 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 | 4 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | 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
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANGIE MARTENS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7158222741 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| CHARLES CHRISTENSEN | |||||||
| CHAIRMAN | 2.00 | X | X | 2925 | 0 | 0 | |
| TOM LINGEN MD | |||||||
| TRUSTEE | 1.00 | X | 2625 | 0 | 0 | ||
| RAY HALL | |||||||
| TRUSTEE | 1.00 | X | 2925 | 0 | 0 | ||
| CANDY COTONE | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 2925 | 0 | 0 | |
| ANN HENDRICKS | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| JOSEPH LESCHISIN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MATT GORES | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MARTIN PETERS | |||||||
| TREASURER | 1.00 | X | X | 2850 | 0 | 0 | |
| DEB KUNFERMAN | |||||||
| CEO | 40.00 | X | 233086 | 0 | 8195 | ||
| MARY ANN CLARK | |||||||
| NURSING HOME ADMINISTRATOR | 40.00 | X | 112933 | 0 | 16649 | ||
| ANGIE MARTENS | |||||||
| CFO | 40.00 | X | 75227 | 0 | 3287 | ||
| DR CHARLES MAYO II | |||||||
| CHIEF PSYCHIATRIST | 40.00 | 239250 | 0 | 44729 | X | ||
| RICHARD NERBUN | |||||||
| PHARMACIST | 40.00 | 114464 | 0 | 32784 | X | ||
| JEFFREY KUEHN | |||||||
| CRNA | 40.00 | 199845 | 0 | 34951 | X | ||
| DONALD FULLERTON | |||||||
| CRNA | 40.00 | 185384 | 0 | 41177 | X | ||
| LAURIE POLUBINSKY | |||||||
| PHYSICIAN | 40.00 | 241914 | 0 | 11000 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1416353 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 192772 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 |
|---|---|---|---|---|---|
| CUMBERLAND CLINIC | |||||
| 1475 WEBB STREET | CUMBERLAND | WI | 54829 | ER PHYSICIANS | 644837 |
| ABM JANITORIAL SERVICES | |||||
| 75 REMITTANCE DRIVE SUITE 3011 | CHICAGO | IL | 606753011 | HOUSEKEEPING | 217088 |
| SHARED MEDICAL | |||||
| 2020 W NEWTON ST | RICE LAKE | WI | 54868 | RADIOLOGY | 204557 |
| DMS IMAGING | |||||
| 11600 96TH AVENUE NORTH | MAPLE GROVE | MN | 55369 | MRI | 158749 |
| UNIVERSAL HOSPITAL SERVICES | |||||
| 7700 FRANCE AVE SOUTH 275 | EDINA | MN | 55435 | RADIOLOGY | 156041 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 5263 | GovernmentGrants |
| All Other Contributions | 86715 | AllOtherContributions |
| Total Contributions | 91978 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL REVENUE | 621990 | 17300208 | 17300208 |
| NURSING HOME REVENUE | 623000 | 2492905 | 2492905 |
| APARTMENT REVENUE | 623990 | 170509 | 170509 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19963622 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32636 | TotalRevenueColumn |
| Exclusion | $32,636 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9899 | TotalRevenueColumn |
| Exclusion | $9,899 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 18787 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 25093 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -6306 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6306 | TotalRevenueColumn |
| Exclusion | -$6,306 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 20091829 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19963622 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $36,229 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1368 | Total |
| Program Services | 1368 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 720112 | Total |
| Program Services | 276738 | ProgramServices |
| Management And General | 443374 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9245177 | Total |
| Program Services | 8846798 | ProgramServices |
| Management And General | 398379 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 220191 | Total |
| Program Services | 213787 | ProgramServices |
| Management And General | 6404 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2289804 | Total |
| Program Services | 2102271 | ProgramServices |
| Management And General | 187533 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 672071 | Total |
| Program Services | 616276 | ProgramServices |
| Management And General | 55795 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24728 | Total |
| Management And General | 24728 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76777 | Total |
| Management And General | 76777 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1904467 | Total |
| Program Services | 1874397 | ProgramServices |
| Management And General | 30070 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118539 | Total |
| Management And General | 118539 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1903672 | Total |
| Program Services | 1686651 | ProgramServices |
| Management And General | 217021 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101739 | Total |
| Management And General | 101739 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 564790 | Total |
| Management And General | 564790 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 977170 | Total |
| Program Services | 977170 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102765 | Total |
| Management And General | 102765 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 671702 | 671702 | |
| REPAIRS & MAINTENACE | 350386 | 309380 | 41006 |
| MEDICAID ASSESSMENTS | 290101 | 290101 | |
| DUES, SUBSCRIPTIONS, & | 113001 | 86319 | 26682 |
| EQUIPMENT RENT & LEASES | 47606 | 36860 | 10746 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20396166 | Total |
| Program Services | 17989818 | ProgramServices |
| Management And General | 2406348 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 692691 | BOY |
| EOY | 443379 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4413368 | BOY |
| EOY | 4951837 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2911908 | BOY |
| EOY | 2980767 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 351724 | BOY |
| EOY | 338989 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 52675 | BOY |
| EOY | 67059 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19168493 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11754881 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7778706 | BOY |
| EOY | 7413612 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385711 | BOY |
| EOY | 86458 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16586783 | BOY |
| EOY | 16282101 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1544899 | BOY |
| EOY | 1889554 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4835000 | BOY |
| EOY | 4490000 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6379899 | BOY |
| EOY | 6379554 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10206884 | BOY |
| EOY | 9902547 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10206884 | BOY |
| EOY | 9902547 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16586783 | BOY |
| EOY | 16282101 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -304337 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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 | $1,700 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1700 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
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 | CUMBERLAND MEMORIAL HOSPITAL, INC. PAYS AN ANNUAL ASSOCIATION MEMBERSHIP TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. WHA HAS NOTIFIED CMH THAT APPROXIMATELY $1,700 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 | 295897 | OtherCostOrOtherBasis |
| Book Value | 295897 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11460025 | OtherCostOrOtherBasis |
| Depreciation | 6334799 | Depreciation |
| Book Value | 5125226 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7412571 | OtherCostOrOtherBasis |
| Depreciation | 5420082 | Depreciation |
| Book Value | 1992489 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7413612 | TotalOfBookValueLandBuildings |
| Total Revenue | 20091829 | TotalRevenue |
| Total Expenses | 20396166 | TotalExpenses |
| Excess Or Deficit For Year | -304337 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | -304337 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 20115988 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 24159 | OtherRevenues |
| Revenue Not Rptd F990 | 24159 | RevenueNotRptdF990 |
| Revenue Subtotal | 20091829 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 20091829 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20420325 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 24159 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 24159 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20396166 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20396166 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE FACILITY IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE FACILITY IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FACILITY 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 THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE FACILITY'S POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED JUNE 30, 2011 AND 2010, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE FACILITY IN THE FINANCIAL STATEMENTS. THE FACILITY RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2011 OR 2010. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIETARY REVENUE NETTED AGAINST DIETARY EXPENSES 24,159. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | DIETARY EXPENSES NETTED AGAINST DIETARY REVENUE 24,159. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 150.000000000000 | 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 | 180950 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 180950 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00920 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4301748 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4120662 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 181086 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00920 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4482698 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4120662 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 362036 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01840 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 142700 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 142700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00720 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 16500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 166200 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 166200 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00840 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4648898 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4120662 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 528236 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02680 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $399,732 | BadDebtExpenseAmount |
| Amount Attributable To | 31979 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5459281 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5608615 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -149334 | 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 | CUMBERLAND MEMORIAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1110 7TH AVENUE | AddressLine1 |
| City | CUMBERLAND | City |
| State | WI | State |
| ZIP Code | 54829 | 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 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
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 |
|---|---|---|---|---|
| CUMBERLAND EXTENDED CARE UNIT | ||||
| 1110 7TH AVENEUE | CUMBERLAND | WI | 54829 | SKILLED NURSING FACILITY |
| LAKEWOOD REGENCY APARTMENTS | ||||
| 1110 7TH AVENEUE | CUMBERLAND | WI | 54829 | SENIOR LIVING APARTMENTS |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 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 SERVICES REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.PART I, LINE 7, COL. F: THE CALCULATED PERCENT OF TOTAL EXPENSES EXCLUDES BAD DEBT EXPENSE TOTALING $671,702. | ||
| PART II: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S 'COMMUNITY BENEFIT,' THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: PSYCHIATRIC SERVICES, AMBULANCE SERVICES, BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. | ||
| PART III, LINE 4: THE 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. 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. PATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE FACILITY BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON PATIENT ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT. THE FACILITY DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO THE PATIENT 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 PATIENT ACCOUNTS RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. | ||
| PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT EXPENSE BECAUSE SERVICES PROVIDED TO MEDICARE BENEFICIARIES ARE TYPICALLY PROVIDED TO ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, 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.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT. | ||
| PART III, LINE 9B: THE PATIENT IS ASKED TO FILL OUT A CHARITY CARE APPLICATION DURING THE COLLECTION PROCESS PRIOR TO SENDING TO A COLLECTION AGENCY. IF THE PAPERWORK IS NOT RECEIVED THE ACCOUNT IS HANDLED THROUGH THE NORMAL COLLECTION PROCESS. | ||
| PART VI, LINE 2: THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITY THROUGH SURVEYS AND BY RECOGNIZING WHY CERTAIN PATIENTS ARE REFERRED OUT OF THE AREA. THE ORGANIZATION THEN ATTEMPTS TO GET SPECIALISTS IN THE IDENTIFIED AREAS INTO THE FACILITY TO SEE PATIENTS AND MEET THEIR NEEDS. THE ORGANIZATION IS ALSO PARTICIPATING IN A COUNTY-WIDE HEALTHCARE NEEDS ASSESSMENT PROGRAM AND PLANS TO USE THE INFORMATION FROM THIS PROGRAM IN THE FUTURE TO MEET THE NEEDS OF THE COMMUNITY. | ||
| PART VI, LINE 3: IF A PATIENT IS IDENTIFIED AS UNINSURED, HOSPITAL STAFF WORKS WITH THE PATIENT OR THEIR FAMILY TO DETERMINE IF THEY ARE ELIGIBLE FOR ANY TYPE OF GOVERNMENT PROGRAM OR QUALIFY FOR THE HOSPITAL'S CHARITY CARE PROGRAM. | ||
| PART VI, LINE 4: THE ORGANIZATION SERVES THE COMMUNITIES OF CUMBERLAND, WI AND ALMENA, WI AND SURROUNDING COMMUNITIES WITHIN A 20 MILE RADIUS. APPROXIMATELY 11.9% OF THE PERSONS RESIDING IN THE COMMUNITY LIVE BELOW POVERTY LEVEL. THE MEDIAN HOUSEHOLD INCOME IS $42,601. PERSONS 65 YEARS OR OLDER MAKE UP 18.2% OF THE POPULATION AND PERSONS UNDER AGE 18 MAKE UP 22.1% OF THE POPULATION. | ||
| PART VI, LINE 6: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. OUR ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. WE ALSO PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PROVIDE SERVICE AT SPORTING EVENTS. THE ORGANIZATION ALSO PROVIDES AMBULANCE AND EMERGENCY MEDICAL TECHNICIAN COVERAGE AT COMMUNITY EVENTS, PARTICIPATES IN THE BARRON COUNTY FREE CLINIC, AND SPONSORS A WOMEN'S EXPO EACH YEAR. SURPLUS FUNDS ARE INVESTED BACK INTO THE FACILITY AND ITS EQUIPMENT TO ENSURE THE NEEDED SERVICES ARE CONTINUED TO BE PROVIDED IN THIS COMMUNITY. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DEB KUNFERMAN | |||||||||||||
| 183086 | 0 | 50000 | 0 | 0 | 0 | 7000 | 0 | 1195 | 0 | 241281 | 0 | 0 | 0 |
| DR CHARLES MAYO II | |||||||||||||
| 239250 | 0 | 0 | 0 | 0 | 0 | 7459 | 0 | 37270 | 0 | 283979 | 0 | 0 | 0 |
| JEFFREY KUEHN | |||||||||||||
| 199845 | 0 | 0 | 0 | 0 | 0 | 8208 | 0 | 26743 | 0 | 234796 | 0 | 0 | 0 |
| DONALD FULLERTON | |||||||||||||
| 185384 | 0 | 0 | 0 | 0 | 0 | 5787 | 0 | 35390 | 0 | 226561 | 0 | 0 | 0 |
| LAURIE POLUBINSKY | |||||||||||||
| 241914 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11000 | 0 | 252914 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF CUMBERLAND | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 396005423 | IssuerEIN |
| CUSIP Number | 230849FE6 | CUSIPNumber |
| Date Issued | 2008-10-23 | DateIssued |
| Issue Price | 5166566 | IssuePrice |
| Description Of Purpose | REMODELING PROJECT | 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) |
|---|---|---|
| Amount Retired | 2021303 | AmountRetired |
| Total Proceeds | 5166566 | TotalProceeds |
| Amount In Reserve Fund | 517000 | AmountInReserveFund |
| Issuance Costs From Proceeds | 103400 | IssuanceCostsFromProceeds |
| Capital Expenditures | 2524863 | CapitalExpenditures |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | 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 |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | 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 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER REVIEWED THE RETURN. THE BOARD MEMBERS OF CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. WERE THEN NOTIFIED WHEN FORM 990 WAS AVAILABLE FOR REVIEW AND GIVEN AN OPPORTUNITY TO COMMENT BEFORE SUBMISSION TO THE IRS. | |
| CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT,INC. REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. OFFICERS AND KEY EMPLOYEES OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SIGN A CODE OF CONDUCT STATEMENT. IN THE CODE OF CONDUCT STATEMENT IT MENTIONS THE CONFLICT OF INTEREST. | FORM 990, PART VI, SECTION B, LINE 12C | |
| EFFECTIVE JULY 1, 2008, WAGE SCALES WERE SET FOR ALL NON-UNION EMPLOYEES. THESE SCALES WOULD INCLUDE ALL HIGHLY COMPENSATED EMPLOYEES. THE SCALES WERE SET BASED ON AN AREA SURVEY OF 6 OTHER HEALTHCARE FACILITIES. IT WAS THE GOAL OF THE CUMBERLAND MEMORIAL HOSPITAL-EXTENDED CARE UNIT, INC. TO SET SCALES THAT RAN AT ABOUT THE MIDLEVEL OF ALL FACILITIES SURVEYED FOR MOST POSITIONS. THESE SCALES ARE EVALUATED ON A YEARLY BASIS USING THE SALARY SURVEY TOOL AVAILABLE THROUGH THE ST. CROIX VALLEY EMPLOYER'S ASSOCIATION. THE ONLY TIME AN EMPLOYEE HOURLY WAGE MAY EXIST OUTSIDE OF THE SCALE IS IF THE EMPLOYEE IS AT THE TOP OF THE SCALE YET THEIR MERIT INCREASE OF UP TO 1% FOR THE YEAR BRINGS THEM TO A WAGE OUTSIDE OF THE SCALE. THE CEO, OFFICERS AND KEY EMPLOYEE'S SALARY ARE APPROVED BY THE BOARD OF DIRECTORS (THOSE WITHOUT CONFLICT) ANNUALLY AND THE CEO APPROVES ALL OTHER EMPLOYEES' SALARIES ANNUALLY ALSO. DOCUMENTATION IS MAINTAINED IN PERSONNEL FILES. | FORM 990, PART VI, SECTION B, LINE 15 | |
| CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 18 | |
| CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| OVERSIGHT OF THE AUDIT AND INDEPENDENT ACCOUNTANT | CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT INC.'S ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND ANY QUESTIONS OR CONCERNS REGARDING THEM ARE ADDRESSED BY THE INDEPENDENT ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XI, LINE 2C |
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