CUMBERLAND MEMORIAL HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- CUMBERLAND MEMORIAL HOSPITAL INC (EIN 39-0831153)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-01-10
- IRS object ID
- 201120129349300477
- 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 I
- Schedule J
- Schedule K
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-01-10T16:11:03-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | 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 | 2009-07-01 | 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 | DEB KUNFERMAN | Name |
| Title | CEO | Title |
| Phone | 7158222741 | Phone |
| Date Signed | 2011-01-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Holly Pokrandt CPA | Name |
| Phone | 7158323407 | Phone |
| Date Prepared | 2010-12-28 | 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 | DEB kunferman | 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 | 19992810 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| 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 provision of 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 | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 301 | TotalNbrEmployees |
| Total Nbr Volunteers | 122 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 111157 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 148581 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 20137039 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19770180 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 57828 | InvestmentIncomePriorYear |
| Investment Income Current Year | 70279 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 20306024 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19989040 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2542 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5018 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11987124 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12407206 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6950085 | OtherExpensePriorYear |
| Other Expenses Current Year | 7075566 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 18939751 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19487790 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1366273 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 501250 | RevenuesLessExpensesCY |
| Total Assets BOY | 16551731 | TotalAssetsBOY |
| Total Assets EOY | 16586783 | TotalAssetsEOY |
| Total Liabilities BOY | 6846097 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6379899 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 9705634 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10206884 | NetAssetsOrFundBalancesEOY |
| 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 | 14081527 | Expense |
| Revenue | 16923884 | 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 1,961 in 2010, swing bed days totaled 688, newborn days totaled 108, and behavioral health days totaled 2,215. During fiscal year 2010, Cumberland Memorial Hospital provided 54 inpatient and 423 outpatient surgeries along with 259 scope procedures. There were also 2,696 emergency room visits. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3117173 | Expense |
| Revenue | 2677361 | 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 2010 were 16,833. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 147693 | Expense |
| Revenue | 168935 | 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 2010 was approximately 80%. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 17346393 | 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 | 1 | 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 40 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 301 | 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 |
| Taxable Distributions | 0 | TaxableDistributions |
| Distribution To Donor | 0 | DistributionToDonor |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | 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 (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| charles christensen | ||||||||
| Chairman | 2.00 | X | 5250 | 0 | 0 | |||
| keith lIndquist | ||||||||
| secretary | 1.00 | X | 3075 | 0 | 0 | |||
| joseph vinopal jr | ||||||||
| Former trustee | 1.00 | X | 1200 | 0 | 0 | |||
| tom lingen md | ||||||||
| TRUSTEE | 1.00 | X | 2475 | 0 | 0 | |||
| Martin Peters | ||||||||
| Treasurer | 1.00 | X | 2700 | 0 | 0 | |||
| Ray Hall | ||||||||
| TRUSTEE | 1.00 | X | 2475 | 0 | 0 | |||
| CANDY COTONE | ||||||||
| VICE chairman | 1.00 | X | 4250 | 0 | 0 | |||
| Deb Kunferman | ||||||||
| CEO | 40.00 | 223060 | 0 | 7534 | X | |||
| Mary Ann Clark | ||||||||
| Nursing Home Administrat | 40.00 | 102762 | 0 | 12565 | X | |||
| Angie Martens | ||||||||
| CFO | 40.00 | 70072 | 0 | 2123 | X | |||
| Dr Charles mayo II | ||||||||
| Chief psychiatrist | 40.00 | 232140 | 0 | 31190 | X | |||
| Richard Nerbun | ||||||||
| Pharmacist | 40.00 | 105990 | 0 | 22942 | X | |||
| JEFFreY KUEHN | ||||||||
| CRNA | 40.00 | 191456 | 0 | 26313 | X | |||
| DONALD FULLERTON | ||||||||
| CRNA | 40.00 | 171606 | 0 | 29694 | X | |||
| Benjamin Brenna | ||||||||
| Director of Rehab Servic | 40.00 | 105800 | 0 | 27399 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1224311 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 159760 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | 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 |
|---|---|---|---|---|---|
| Vonasek & Schieffer | |||||
| 2019 22 1/2 Ave PO Box 557 | Rice Lake | WI | 54868 | General contractor | 1051849 |
| Shared Medical | |||||
| 2020 W Newton St | Rice Lake | WI | 54868 | Radiology | 207908 |
| ABM Janitorial Services | |||||
| 75 Remittance Drive Suite 3011 | Chicago | IL | 606753011 | Housekeeping | 146331 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 116220 | GovernmentGrants |
| All Other Contributions | 32361 | AllOtherContributions |
| Total Contributions | 148581 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Hospital Revenue | 621990 | 16923884 | 16923884 |
| Nursing home revenue | 623000 | 2677361 | 2677361 |
| apartment Revenue | 623990 | 168935 | 168935 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19770180 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61572 | TotalRevenueColumn |
| Exclusion | $61,572 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11054 | TotalRevenueColumn |
| Exclusion | $11,054 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1423 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3770 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -2347 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -2347 | TotalRevenueColumn |
| Exclusion | -$2,347 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19989040 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19770180 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $70,279 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5018 | Total |
| Program Services | 5018 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 707230 | Total |
| Program Services | 274216 | ProgramServices |
| Management And General | 433014 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8764880 | Total |
| Program Services | 8434044 | ProgramServices |
| Management And General | 330836 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219059 | Total |
| Program Services | 213572 | ProgramServices |
| Management And General | 5487 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2068651 | Total |
| Program Services | 1918890 | ProgramServices |
| Management And General | 149761 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 647386 | Total |
| Program Services | 596789 | ProgramServices |
| Management And General | 50597 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21377 | Total |
| Management And General | 21377 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78165 | Total |
| Management And General | 78165 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2178283 | Total |
| Program Services | 2162060 | ProgramServices |
| Management And General | 16223 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105756 | Total |
| Management And General | 105756 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1981892 | Total |
| Program Services | 1810926 | ProgramServices |
| Management And General | 170966 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98697 | Total |
| Management And General | 98697 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 520285 | Total |
| Management And General | 520285 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 854058 | Total |
| Program Services | 854058 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 98827 | Total |
| Management And General | 98827 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Provision for bad debts | 556652 | 556652 | |
| Repairs & Maintenace | 319188 | 285430 | 33758 |
| Dues, Subscriptions, & | 108700 | 92286 | 16414 |
| Nursing hoMe assessment | 90000 | 90000 | |
| Equipment Rent & Leases | 63686 | 52452 | 11234 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19487790 | Total |
| Program Services | 17346393 | ProgramServices |
| Management And General | 2141397 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 329103 | BOY |
| EOY | 692691 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1139435 | BOY |
| EOY | 2161936 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3195054 | BOY |
| EOY | 2911908 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 352260 | BOY |
| EOY | 351724 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90149 | BOY |
| EOY | 52675 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19590952 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 11812246 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7332265 | BOY |
| EOY | 7778706 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3721496 | BOY |
| EOY | 2251432 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 391969 | BOY |
| EOY | 385711 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16551731 | BOY |
| EOY | 16586783 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1628097 | BOY |
| EOY | 1544899 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36000 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5170000 | BOY |
| EOY | 4835000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12000 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6846097 | BOY |
| EOY | 6379899 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9705634 | BOY |
| EOY | 10206884 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9705634 | BOY |
| EOY | 10206884 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16551731 | BOY |
| EOY | 16586783 | 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 | $1,656 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1656 | 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 | 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 $1,656 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 | 11438152 | OtherCostOrOtherBasis |
| Depreciation | 6073328 | Depreciation |
| Book Value | 5364824 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7856903 | OtherCostOrOtherBasis |
| Depreciation | 5738918 | Depreciation |
| Book Value | 2117985 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7778706 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CD's, Savings Accounts, | Description |
| Book Value | 2251432 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 2251432 | TotalOfBookValueProgramRelated |
| Total Revenue | 19989040 | TotalRevenue |
| Total Expenses | 19487790 | TotalExpenses |
| Excess Or Deficit For Year | 501250 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 501250 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 20011234 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 22194 | OtherRevenues |
| Revenue Not Rptd F990 | 22194 | RevenueNotRptdF990 |
| Revenue Subtotal | 19989040 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 19989040 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19509984 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 22194 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 22194 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19487790 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19487790 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XII, Line 2d - Other Adjustments: | Dietary Revenue netted against dietary expenses: 22194. |
| Part XIII, Line 2d - Other Adjustments: | Dietary expenses netted against dietary revenue: 22194. |
| Part X, Line 2 - The Facility is a nonprofit corporation as described in Section 501(c)(3) of the Internal Revenue 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. In order to account for any uncertain tax positions, ASC Topic 740-10, Accounting for Uncertainty in Income Taxes, requires an organization to assess whether it is more likely than not that a tax position will be sustained upon examination of the technical merits or 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 recorded no assets or liabilities for uncertain tax positions or unrecognized tax benefits. Federal returns for the years ended June 30, 2009, 2008, and 2007, remain subject to examination by the Internal Revenue Service. The return for the year ended June 30, 2010, is not yet due and has not yet been filed. |
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 | 160856 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 160856 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00850 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3454089 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3346339 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 107750 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 418074 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 266158 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 151916 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00800 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4033019 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3612497 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 420522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02220 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40940 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 40940 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13250 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13250 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 54190 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 54190 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4087209 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3612497 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 474712 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02510 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $335,485 | BadDebtExpenseAmount |
| Amount Attributable To | 16774 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5252970 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5407446 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -154476 | 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 | 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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: The calculated percent of total expenses excludes bad debt expense totaling $556,652. The expenses recognized in the table were calculated using the cost-to-charge ratio from the medicare cost report. | CostingMethodUsed |
| Bad Debt Footnote | Part III, Line 4: The cost-to-charge ratio was calculated using the medicare cost report.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. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The short fall should be treated as a community benefit expense because the hospital professionals offer classes to the community aimed at maintaining and improving the general health of the population. The cost to charge ratio was calculated using the medicare cost report. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: The patient is asked to fill out a charity care application prior to sending to a collection agency. If the paperwork is not received the account is handled through the normal collection process. | DebtCollectionPolicy |
| Needs Assessment | 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. | NeedsAssessment |
| Patient Education Assistance | 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. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: The organization serves the communities of Cumberland, WI and Almena, WI and surrounding communities within a 20 mile radius. There are three other hospitals located in the rural area that the organization serves. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: 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. | CommunityBuildingActivities |
| Other Information | 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. Surplus funds are invested back into the facility and its equipment to ensure the needed services are continued to be provided in this community. | OtherInformation |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Scholarships given out to employees to continue their education. | TypeOfGrant |
| Number Of Recipients | 2 | NumberOfRecipients |
| Amount Of Cash Grant | 5018 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Other Information: | Identifier |
| Return Reference | Part IV: | ReturnReference |
| Explanation | All full and part-time employees are eligible to apply for the continuing education program. The employee must have worked at Cumberland Memorial Hospital & Extended Care Unit Inc. (CMH-ECU) at least two years prior to start of coursework and the course must be fulfilled while employed at CMH-ECU. The course must be job related or directly related to a position needed by CMH-ECU. The employee must earn a grade of "B" or better and submit documentation including transcripts detailing grade received for coursework and receipt for the course and textbooks. The maximum scholarship to each employee shall not exceed $3,000 lifetime. The Human Resources Director will make a determination of approval of the scholarship application forms. | Explanation |
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 (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Deb Kunferman | |||||||||||||
| 169460 | 0 | 50000 | 0 | 3600 | 0 | 6591 | 0 | 943 | 0 | 230594 | 0 | 0 | 0 |
| Dr Charles mayo II | |||||||||||||
| 232140 | 0 | 0 | 0 | 0 | 0 | 7145 | 0 | 24045 | 0 | 263330 | 0 | 0 | 0 |
| JEFFreY KUEHN | |||||||||||||
| 191456 | 0 | 0 | 0 | 0 | 0 | 7844 | 0 | 18469 | 0 | 217769 | 0 | 0 | 0 |
| DONALD FULLERTON | |||||||||||||
| 171606 | 0 | 0 | 0 | 0 | 0 | 5346 | 0 | 24348 | 0 | 201300 | 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 |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
| Bond Counsel Routinely Engaged | 0 | BondCounselRoutinelyEngaged |
| 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 | Cumberland Memorial Hospital & Extended Care Unit, Inc.'s board members reviewed the Form 990 at the board meeting prior to submission. Once all the questions regarding the Form 990 were addressed, the 990 was approved by board members for submission to the IRS. | |
| Form 990, Part VI, Section B, line 12c | 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 15 | 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 C, line 18 | Cumberland Memorial Hospital & Extended Care Unit, Inc. makes its Form 990 available to the public upon request. | |
| Form 990, Part VI, Section C, line 19 | 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 XI, line 2c | 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. | Oversight of the Audit and independent accountant |
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