BURNETT MEDICAL CENTER INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- BURNETT MEDICAL CENTER INC (EIN 39-0938661)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-09
- IRS object ID
- 201101299349301215
- Schema version
- 2009v1.7
- 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
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-09T09:53:42-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | 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 | 3703 OAKWOOD HILLS PARKWAY | AddressLine1 |
| City | EAU CLAIRE | City |
| State | WI | State |
| ZIP Code | 54701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390938661 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Burnett Medical Center Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BURN | NameControl |
| Phone | 7154635353 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 West Saint George Avenue/PO Box | AddressLine1 |
| Address Line2 | 99 | AddressLine2 |
| City | Grantsburg | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHARLIE FAUGHT | Name |
| Title | CFO | Title |
| Phone | 7154635353 | Phone |
| Date Signed | 2011-05-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HOLLY POKRANDT CPA | Name |
| Phone | 7158323407 | Phone |
| Date Prepared | 2011-05-06 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHARLIE FAUGHT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 West Saint George Avenue/PO Box | AddressLine1 |
| Address Line2 | 99 | AddressLine2 |
| City | Grantsburg | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19879623 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | burnettmedicalcenter.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1957 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF BURNETT MEDICAL CENTER IS TO PROVIDE COMPASSIONATE, COMPREHENSIVE, COMMUNITY HEALTHCARE THAT EXCEEDS OUR CUSTOMER'S EXPECTATIONS. OUR MISSION, AS WELL AS OUR VISION AND VALUES, SERVES AS A GUIDELINE FOR DAILY DECISION MAKING AND REPRESENTS THE PRINCIPLES AND PRACTICES THAT WE CONSTANTLY APPLY. THE COMFORT AND CARE OF OUR PATIENTS IS A MAJOR FOCUS OF OURS. WE WANT TO BE THE HEALTHCARE PROVIDER OF "CHOICE" - PROVIDING EXPERT AND COST EFFECTIVE CARE IN A "HOMETOWN" ATMOSPHERE. ANOTHER OBJECTIVE OF OURS IS TO PROVIDE EDUCATION THAT WILL INCREASE HEALTH AWARENESS. PART OF OUR MISSION IS TO CONTINUALLY PUT THE "CARE" IN HEALTHCARE. MORE HEALTHCARE INFORMATION IS NOW AVAILABLE FROM OUR WEB SITe, which also provides patient education resources for those we serve. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 265 | TotalNbrEmployees |
| Total Nbr Volunteers | 18 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 26503 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 34261 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 18485403 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19808573 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31025 | InvestmentIncomePriorYear |
| Investment Income Current Year | 35319 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 18542931 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19878153 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10630603 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10574825 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8640741 | OtherExpensePriorYear |
| Other Expenses Current Year | 9729163 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 19271344 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20303988 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -728413 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -425835 | RevenuesLessExpensesCY |
| Total Assets BOY | 26296201 | TotalAssetsBOY |
| Total Assets EOY | 25646452 | TotalAssetsEOY |
| Total Liabilities BOY | 18259524 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18023884 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8036677 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7622568 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission of Burnett Medical Center is to provide compassionate, comprehensive community healthcare. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11758634 | Expense |
| Revenue | 12032078 | Revenue |
| Description | Burnett Medical Center, located in rural northwest Wisconsin is a 17 bed critical access hospital that provides the following services throughout a three county region:Acute Care has 40+ employees who also work in obstetrics, the operating room, the emergency room, and post anesthesia recovery. We provide general inpatient medical and surgical care, as well as a large volume of outpatient services which include: OP surgery, chemotherapy, blood transfusion, IV therapy as examples. All of the RN staff is ACLS accredited and the entire staff is certified in CPR. The goal of the nursing staff is to provide excellent patient care, close to home, near family and friends.We also provide a full range of services from a 24/7 ER to cardiac rehab, and we provide other therapeutic and diagnostic services via Radiology, Lab, Physical Therapy, and Occupational Therapy.During FY 2010 in a total of 2,000 patient days we served 517 patients in our inpatient and swing bed programs and also had 46 births. We performed 826 surgical procedures, saw 5,054 patients in emergency and urgent care, and provided services for over 12,270 other outpatient visits. Gross hospital revenue of $157,280 was provided as charity care to 51 different patients for 195 episodes of care.Since June of 2004, Burnett Medical Center has been participating in the level 1 heart attack program developed by Abbott Northwestern Hospital and the Minneapolis Heart Institute. The Level 1 Heart Attack Program is an innovative approach to treating patients suffering from a heart attack. The key ingredient for success is speed in treatment. The goal is to treat and transport patients within 120 minutes, meaning 120 minutes from the time a patient enters the emergency room at Burnett Medical Center until the first balloon is inflated or stent placed at Abbott Northwestern Hospital (ABNW).Because rural hospitals do not have the capability to do angioplasty, it is important to move a heart attack patient to the nearest hospital that has a heart catheterization lab. The Level 1 Program has a definite protocol to move these patients quickly during that 'golden hour' when angioplasty is the most successful.Burnett Medical Center is one of 30 hospitals in Minnesota and Wisconsin participating in the Level 1 Program. Clearly, the Level 1 Program is advantageous to residents of Burnett County, knowing that cardiovascular disease is the leading cause of death for men and women in the United States. This team approach gives patients the advantage of time which translates to better outcomes and decreased mortality. Burnett Medical Center's medical and nursing staff have been trained for this program and are prepared and pleased to provide quick access to efficient cardiac care through the Level 1 Heart Attack Program. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3211236 | Expense |
| Revenue | 3218993 | Revenue |
| Description | The Continuing Care Center of Burnett Medical Center offers 46 semi-private and 4 private room accommodations and a full range of health and personal care services. Physical, occupational, and speech therapy are available, as well as nutritional services, recreational activities, and social services. Additionally, adult day care and respite care is available. The goal of the Continuing Care Center's staff is to provide necessary health services while maintaining an atmosphere of hope, harmony, humor, and a 'home' away from home.We strive to enhance the quality of residents' life via a venue for community-based volunteers sharing their time and talent with our residents, such as musical bands, Rotary Club sponsored functions, etc.During FY2010 we had over 18,400 resident days serving about 120 different residents. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3086881 | Expense |
| Revenue | 4557502 | Revenue |
| Description | Burnett Medical Center Clinic is located just off Highway 70 in Grantsburg and is now part of our new expanded facility. The clinic is staffed by 23 employees including (5) Physicians, (1) Physician Assistant, (2) Certified Nurse Practitioners, and (1) Certified Nurse Midwife.We are pleased to offer our patients a range of services including: Physicals (Including Well Child Checks, Pre-operative, DOT, etc.), obstetrical exams, health status assessments, diagnosis and treatment of common, acute and chronic health conditions, immunizations, family planning, diabetic education, women's health, colonoscopy procedures, fracture care, vasectomies, routine laboratory testing, EKG's, and Holter monitoring. Additionally, the clinic laboratory is a certified collection site for urine drug screening.Hours of operation have been expanded to allow people increased access, including working families with school-age children, people that work varying shifts, etc. Our providers have collaborative relationships with area industries, including the local school systems. This allows Burnett Medical Center to provide educational opportunities to employees of these industries, including bloodborne pathogens training, health education to school children, and participation in employee health fairs. BMC providers participate in the local Rotary group and in County Coalitions to reduce prescription drug abuse and improve awareness of wellness activities in the area. We also sponsor an annual 5K event that raises funds for a local charity while promoting healthy lifestyles-this year is our 6th annual!Over 20,000 primary care clinic visits were provided during FY 2010. Clinic gross revenue of $27,040 was provided as charity care to 47 different patients in 206 visits. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 18056751 | 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 |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 |
| 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 | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 7 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 265 | 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 |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Charlie Faught | NamePerson |
| Telephone Number | 7154635353 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 WEST SAINT GEORGE AVE | AddressLine1 |
| City | GRANTSBURG | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| jim richison | |||||||
| dIRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| JOHN SAUERBERG | |||||||
| PRESIDENT | 0.50 | X | 0 | 0 | 0 | X | |
| ADAM BENSON | |||||||
| VICE PResident | 0.50 | X | 0 | 0 | 0 | X | |
| William Hunt | |||||||
| director | 0.50 | X | 0 | 0 | 0 | ||
| CRAIG SELANDER | |||||||
| Secretary/Treasurer | 0.50 | X | 0 | 0 | 0 | X | |
| JoLouise McNally | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Marilyn Kooiker | |||||||
| diRECTOR | 0.50 | X | 0 | 0 | 0 | ||
| CHARLIE FAUGHT | |||||||
| CFO | 40.00 | 128700 | 0 | 25814 | X | ||
| Gordon Lewis | |||||||
| CEO | 40.00 | 162660 | 0 | 34566 | X | ||
| Timothy Novick | |||||||
| Physician | 36.00 | 268590 | 0 | 18959 | X | ||
| James franzel | |||||||
| physician | 34.00 | 206389 | 0 | 16653 | X | ||
| Adeola Jolayemi | |||||||
| physician | 40.00 | 213201 | 0 | 4406 | X | ||
| Vesna Radivojevic | |||||||
| physician | 40.00 | 170864 | 0 | 11370 | X | ||
| julie Andersson | |||||||
| physician Assistant | 0.40 | 120131 | 0 | 13487 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1270535 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 125255 | 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 (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Dr Blaise Vitale | |||||
| 257 West Saint george Avenue | Grantsburg | WI | 54840 | Clinic and ER Services | 316112 |
| BNB Enterprises | |||||
| 27165 John Stone Road | webster | WI | 54893 | CRNA Services | 288025 |
| Anton Mentele | |||||
| 257 West Saint george Avenue | grantsburg | WI | 54840 | crNA Services | 233235 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| All Other Contributions | 34261 | AllOtherContributions |
| Total Contributions | 34261 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Hospital patient servi | 621990 | 12032078 | 12032078 |
| Clinic patient service | 621110 | 4557502 | 4557502 |
| Nursing home resident | 623000 | 3218993 | 3218993 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19808573 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36039 | TotalRevenueColumn |
| Exclusion | $36,039 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 750 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1470 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -720 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -720 | TotalRevenueColumn |
| Exclusion | -$720 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19878153 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19808573 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $35,319 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 356395 | Total |
| Management And General | 356395 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8351747 | Total |
| Program Services | 7463038 | ProgramServices |
| Management And General | 888709 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49885 | Total |
| Program Services | 42330 | ProgramServices |
| Management And General | 7555 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1239465 | Total |
| Program Services | 1104648 | ProgramServices |
| Management And General | 134817 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 577333 | Total |
| Program Services | 509879 | ProgramServices |
| Management And General | 67454 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222499 | Total |
| Management And General | 222499 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23546 | Total |
| Management And General | 23546 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53025 | Total |
| Management And General | 53025 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2845067 | Total |
| Program Services | 2746013 | ProgramServices |
| Management And General | 99054 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74675 | Total |
| Management And General | 74675 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2190430 | Total |
| Program Services | 2056214 | ProgramServices |
| Management And General | 134216 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36315 | Total |
| Management And General | 36315 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1137987 | Total |
| Program Services | 1137987 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71270 | Total |
| Program Services | 56146 | ProgramServices |
| Management And General | 15124 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1323026 | Total |
| Program Services | 1323026 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96346 | Total |
| Management And General | 96346 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad debt Expense | 982196 | 982196 | |
| Repairs & Maintenance | 463394 | 454390 | 9004 |
| Nursing Home Bed Assess | 115985 | 115985 | |
| Dues & Subscriptions | 53910 | 25407 | 28503 |
| Minor Equipment | 39492 | 39492 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20303988 | Total |
| Program Services | 18056751 | ProgramServices |
| Management And General | 2247237 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -14742 | BOY |
| EOY | -45408 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2509105 | BOY |
| EOY | 2743488 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2886383 | BOY |
| EOY | 2860043 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 470703 | BOY |
| EOY | 463828 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 277018 | BOY |
| EOY | 350446 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25164322 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8322501 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17286608 | BOY |
| EOY | 16841821 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1524601 | BOY |
| EOY | 1559471 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 558012 | BOY |
| EOY | 130232 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 241758 | BOY |
| EOY | 231013 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 556755 | BOY |
| EOY | 511518 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26296201 | BOY |
| EOY | 25646452 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1659914 | BOY |
| EOY | 1814883 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16486265 | BOY |
| EOY | 16069837 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113345 | BOY |
| EOY | 139164 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18259524 | BOY |
| EOY | 18023884 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8036677 | BOY |
| EOY | 7622568 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8036677 | BOY |
| EOY | 7622568 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26296201 | BOY |
| EOY | 25646452 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $2,177 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2177 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | Burnett Medical Center, Inc. pays annual association memberships to the american hospital association and wisconsin hospital association. These dues are primarily for access to educational materials and staff training and development. A small portion of the annual dues were used in conjunction with lobbying activities with the goal of improving the overall healthcare environment. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50000 | OtherCostOrOtherBasis |
| Book Value | 50000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19594998 | OtherCostOrOtherBasis |
| Depreciation | 5618872 | Depreciation |
| Book Value | 13976126 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5244152 | OtherCostOrOtherBasis |
| Depreciation | 2703629 | Depreciation |
| Book Value | 2540523 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 275172 | OtherCostOrOtherBasis |
| Book Value | 275172 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16841821 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| 457(B) Plan Payable | $131,702 |
| Flexible Spending acocunt Liability | $7,462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 139164 | TotalOfAmounts |
| Total Revenue | 19878153 | TotalRevenue |
| Total Expenses | 20303988 | TotalExpenses |
| Excess Or Deficit For Year | -425835 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 5112 | NetUnrealizedGLOnInvestments |
| Other | $6,614 | OtherAmount |
| Total Adjustments | 11726 | TotalAdjustments |
| Excess Or Deficit Per FS | -414109 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 19878153 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 19878153 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 19878153 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20303988 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20303988 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20303988 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | Schedule D Part XIV: Income Taxes The Medical Center and Foundation are nonprofit corporations as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and are exempt from federal taxes on related income pursuant to Section 501(a) of the Code. The Medical Center and Foundation are also exempt from state taxes on related income. The Medical Center adopted ASC Topic 740-10, Accounting for uncertainty in income taxes, during 2010. ASC Topic 740-10 requires companies to determine 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 Medical Center recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits in 2010 and 2009. Federal returns for the years ended September 30, 2009, 2008, and 2007, remain subject to examination by the Internal Revenue Service. The return for the year ended September 30, 2010, is not yet due and has not yet been filed as of the report date. |
| Part XI, Line 8 - Other Adjustments: | Change in Interest in net assets of Foundation: 6614. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 108064 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 108064 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00560 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4758811 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4043306 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 715505 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03700 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4866875 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4043306 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 823569 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04260 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17474 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5531 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11943 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17474 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5531 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11943 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4884349 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4048837 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 835512 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04320 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $575,845 | BadDebtExpenseAmount |
| Amount Attributable To | 230340 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5742532 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5702144 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 40388 | 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 |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Burnett Medical Center Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 West Saint George Avenue | AddressLine1 |
| City | Grantsburg | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Nursing Home, Rural Health Clinic | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: The calculated percent of total expenses excluded bad debt expense of $982,196. The expenses recognized in the table were calculated using the cost-to-charge ratio from the medicare cost report. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: The calculated percent of total expenses excluded bad debt expense. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Accounts Receivable and Credit PolicyThe cost-to-charge ratio was calculated using the medicare cost report.Accounts receivable are uncollateralized patient obligations that are stated at the amount management expects to collect from outstanding balances. The obligations are primarily from local residents, most of whom are insured under third-party payer agreements. The Medical Center bills third-party payers on the patients' behalf, or if a patient is uninsured, the patient is billed directly. Once claims are settled with the primary payer, any secondary insurance is billed, and patients are billed for copay and deductible amounts that are the patients' responsibility. Payments on accounts receivable are applied to the specific claim identified on the remittance advice or statement. The Medical Center does not have a policy to charge interest on past due accounts. The carrying amounts of 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 reduction of gross revenue and a credit to accounts receivable. In addition, management provides for probable uncollectible amounts, primarily uninsured patients and amounts patients are personally responsible for, through a charge to operations and a credit to a valuation allowance based on its assessment of historical collection likelihood and the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to accounts receivable. Accounts receivable are recorded in the accompanying balance sheets net of contractual adjustments and an allowance for uncollectible accounts. The audited financial statements do not include a separate footnote regarding bad debt expense. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The Medical Center has been designated as a Critical Access Hospital and therefore did not recognize a shortfall from the Medicare program. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: Patients receive our Community Care application when they present for services. They are encouraged to review the application and submit the required information to apply for potential coverage. If they have questions or need help with the application they may meet with our Financial Counselor and/or our Business Office Manager. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: We have used marketing and demographic data for both our Primary and Secondary Service Areas as supplied by proprietary sources from both Thomson Reuters Market Expert and the Minnesota Hospital Association. Such market-based analysis provides estimates and projections for the medical needs of those that live within our service area. We then look at the availability of existing healthcare providers and services to determine what gaps may exist, and how we can best be a part of addressing unmet need in partnership with both public and private providers of healthcare services. The results of this review and analysis become a fundamental basis for the development of goals and objectives in our Strategic Plan. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: A sign is posted near registration areas informing patients of our community care program. Patients are also told about the program by registration staff and our financial counselor. If the patient feels they will need assistance they are encouraged to submit the community care application. Patients are also informed of the program during the collection process and encouraged to apply if their situation qualifies. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Based on 2009 estimates, Burnett County has a population of 15,884, which represents our primary service area. Burnett Medical Center, a 17 bed federally designated Critical Access Hospital, is the sole hospital in Burnett County. Located in rural Northwest Wisconsin, Burnett County covers over 820 square miles, or 19.1 persons per square mile (compared to Wisconsin's 98.8 per square mile). Burnett County is one of Wisconsin's poorer counties as 14.1% live below the poverty level compared to a state average of 10.5% with a median income of $41,276 which is about 21% below the state median income of $52,103. Demographically our over 65 year old population represents over one in five, or 22.1% of the population, compared to the state average of 13.5%. According to the US Census, while the county population is comprised of predominately white persons at 92.5%, our next largest population is American Indian at 5.0% (compared to 1% overall for the state). In our secondary service areas in the neighboring counties of Polk County in Wisconsin and Pine County in Minnesota, we see similarities. Based on Census bureau data, their comparisons show them to have far fewer persons per square mile, and are relatively lower than their respective state averages for median household income, the 65+ years of age population, and greater than state average of both white persons and American Indians.Despite our rural location in Northwest Wisconsin, we are in a relatively competitive market as residents from both our primary and secondary service areas have access to ten hospitals (in either Wisconsin or Minnesota) within 50 miles of Burnett Medical Center's geographic location in Grantsburg, Wisconsin Finally, we take our role in providing a health care safety net seriously for all, including the uninsured, as evidenced by our 24/7 emergency department which provides emergent, urgent, and primary care to all that present to the emergency department. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: In response to the growing trend of illegal use of prescription drugs by the youth of our nation and community, Burnett Medical Center partnered with the Burnett County Coalition for Healthy Living in sponsoring prescription drug disposal as part of the National Take Back Day in Burnett County. The Coalition will be hosting five drop-off sites throughout Burnett County: Burnett County Government Center Grantsburg Village Hall St. Croix Tribal Clinic in Hertel St. Croix Tribal Hall in Danbury A & H Senior Citizen's CenterThis effort will bring awareness to the need for proper disposal of prescription drugs, and will inform the community that a pill drop box is located and accessible for the proper disposal of drugs at the Burnett County Sheriff's Department entrance 24/7. We have provided information on this initiative at our website, to highlight this growing national healthcare concern for adolescents and it is intended to advance the general knowledge of the issue. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: As a sole community rural hospital we take pride in being close to those we serve. We benefit from the community in its involvement in knowing of our services and in promoting our mission throughout the communities served. For example our governing body is composed of seven community volunteers from throughout Burnett County, that reside in our primary service area, none of which are employees, contractors, nor family members.We enjoy the continued support of our community with the establishment of a healthcare Foundation which provides philanthropic support to fulfilling the hospital's mission.In order to ensure continued and ready access to qualified healthcare providers, we take pride in having an open medical staff model that extends medical staff privileges to all qualified providers in our community.When we have surplus funds, those funds are used for improvements in patient care and quality, as evidenced by our recent $15M renovation and early adoption of the electronic medical record.Advocacy of the communities healthcare needs are done locally by members of the Board speaking with local officials on relevant issues that may affect the hospital. Additionally, the organization's CEO serves as a member of the Wisconsin Hospital Association's Board of Directors which advocates for initiatives for community, state and national efforts for improving the overall health of the population and continued ready access to quality healthcare for all.Mindful of the need for support of various methods of insurance, we are proud of our participation in such governmentally-sponsored healthcare programs such as Medicare, Medicaid and TRICARE. | OtherInformation |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHARLIE FAUGHT | |||||||||||||
| 115500 | 0 | 13200 | 0 | 0 | 0 | 4620 | 0 | 21194 | 0 | 154514 | 0 | 0 | 0 |
| Gordon Lewis | |||||||||||||
| 154660 | 0 | 8000 | 0 | 0 | 0 | 6186 | 0 | 28380 | 0 | 197226 | 0 | 0 | 0 |
| Timothy Novick | |||||||||||||
| 253021 | 0 | 0 | 0 | 15569 | 0 | 7350 | 0 | 11609 | 0 | 287549 | 0 | 0 | 0 |
| James franzel | |||||||||||||
| 206151 | 0 | 0 | 0 | 238 | 0 | 6579 | 0 | 10074 | 0 | 223042 | 0 | 0 | 0 |
| Adeola Jolayemi | |||||||||||||
| 213079 | 0 | 0 | 0 | 122 | 0 | 1494 | 0 | 2912 | 0 | 217607 | 0 | 0 | 0 |
| Vesna Radivojevic | |||||||||||||
| 170864 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11370 | 0 | 182234 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|
| Burnett County | |||||
| 396005675 | 2007-03-23 | 7000000 | To refinance and provide funds for building renovation and expansion | 0 | 0 |
| Village of Grantsburg | |||||
| 396006277 | 2007-04-10 | 5000000 | To provide funds for building renovation and expansion | 0 | 0 |
| Village of Siren | |||||
| 396008452 | 2007-04-25 | 4850000 | to provide funds for building renovation and expansion | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Total ProceedsTotalProceeds | Amount UnspentAmountUnspent | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 7000000 | 126304 | 140000 | 5338460 | 2008 | 1 | 0 | 0 | 1 |
| 5000000 | 100000 | 4900000 | 2008 | 0 | 0 | 1 | 1 | |
| 4850000 | 97000 | 4753000 | 2008 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Each person, business, corporation or organization who has contributed and paid one hundred dollars or more to Burnett Medical Center, Inc."the Corporation" shall be a lifetime member of the Corporation. Each person, business, corporation or organization is entitled to hold a maximum of one membership certificate. A husband and wife, or two or more related persons, may hold a membership as joint tenants, however, only one vote per membership shall be permitted. | |
| Form 990, Part VI, Section A, line 7a | The duties of the members of Burnett Medical Center, Inc. "the Corporation" shall be: the formulation and development of the overall purposes; objectives and philosophy of the Corporation; the election of members of the Board of Directors of the Corporation; the removal of members of the Board of Directors of the Corporation; the changing of the number of directors constituting the Board of Directors; the amendment, restatement, or modification of the Articles of Incorporation or Bylaws of the Corporation; and the approval of the sale, lease, or other disposition of all, or substantially all of the assets and property of the Corporation or its merger with another Corporation. | |
| Form 990, Part VI, Section B, line 11 | The board of directors for Burnett Medical Center, Inc. reviewed and approved the FYE 2010 Form 990 prior to filing. | |
| Form 990, Part VI, Section B, line 12c | Burnett Medical Center, Inc. has a conflict of interest policy. The purpose of this policy is to protect the interest of BMC when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director of BMC. It is expected that such persons shall exercise the utmost good faith in all transactions touching upon their duties at Burnett Medical Center and its property. All members of the board complete a disclosure form upon appointment, and review and sign it annually thereafter. This statement establishes the duty of an interested party to disclose the existence of his or her financial interest and must disclose all material facts. After any such disclosure, he/she shall leave the governing board meeting while the determination of a conflict of interest is discussed and voted upon by the remaining board members. If the Board has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis of such belief and afford the member an opportunity to explain the alleged failure to disclose. If members fail to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. | |
| Form 990, Part VI, Section B, line 15 | Burnett Medical Center Inc.'s Executive Compensation Policy is designed with the goal of providing remuneration that is fair, reasonable and competitive. The hospital board may establish a compensation committee or may act as a committee of the whole in executive session. The committee oversees the total compensation packages to ensure that they are competitive with other healthcare organizations, reflect job responsibilities and requirements and are fair, equitable and consistently managed. The committee meets as often as it deems appropriate to carry out its responsibilities. In general, BMC positions total executive compensation at the median of the market. The board of directors uses contemporaneous data including executive compensation data from the wisconsin hospital association as a guide when approving the compensation of the administrator and chief financial officer. The policy is meant to be flexible so that compensation can be above or below the median based on experience, performance, size and complexity of organization, and business need to attract and retain executive talent. | |
| Form 990, Part VI, Section C, line 19 | Burnett Medical Center, Inc. makes it financial statements and governing documents available to the public on a per request basis. | |
| Form 990, Part XI, Line 2C | Burnett Medical Center, Inc. does not have a specific committee which assumes the responsibility for oversight of the audit. The entire board of directors is responsible for the selection of the independent accountant. The process has not changed from the prior year. | Oversight of the audit |
| Form 990, Part VI, Section A, Line 3 | Burnett Medical Center, Inc. entered into a five year agreement for management services with Brim Healthcare, Inc. effective February 1, 2007. Both the chief executive officer and chief financial officer of Burnett Medical Center, Inc. are employees of Brim Healthcare, Inc. | Management Company |
| Form 990, schedule K, Part II, Line 4 | The remaining unspent proceeds were spent in fiscal year end 2011 towards the purchase of an electronic medical records system as approved by the lender and bond trustee. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Burnett medical Center Foundation Inc | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 257 West Saint George Avenue | AddressLine1 |
| City | Grantsburg | City |
| State | WI | State |
| ZIP Code | 54840 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263129839 | EIN |
| Primary Activities | Foundation | PrimaryActivities |
| Legal Domicile State | WI | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 170(b)(1)(A)(vi) | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| 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 | 0 | 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 |