WAGNER COMMUNITY MEMORIAL HOSPITAL: Form 990, tax year 2009
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- Organization
- WAGNER COMMUNITY MEMORIAL HOSPITAL (EIN 46-0226283)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201141339349302564
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-13T10:57:00-05:00 | 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 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1 |
| City | SIOUX FALLS | City |
| State | SD | State |
| ZIP Code | 571175125 | 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 | 460226283 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wagner Community Memorial Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WAGN | NameControl |
| Phone | 6053843611 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Bryan Slaba | Name |
| Title | CEO | Title |
| Phone | 6053843611 | Phone |
| Date Signed | 2011-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Laurie Hanson | Name |
| Phone | 6053391999 | Phone |
| Date Prepared | 2011-05-13 | 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 | Bryan Slaba | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 Third Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 7877984 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1947 | YearFormation |
| State Legal Domicile | SD | StateLegalDomicile |
| Activity Or Mission Description | To provide healthcare services. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 78 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 303526 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 930609 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5892851 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 6901908 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 23754 | InvestmentIncomePriorYear |
| Investment Income Current Year | 30440 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 16102 | OtherRevenuePriorYear |
| Other Revenue Current Year | 14652 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6236233 | TotalRevenuePriorYear |
| Total Revenue Current Year | 7877609 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 2688 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 2565572 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3336694 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3378956 | OtherExpensePriorYear |
| Other Expenses Current Year | 3971601 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5944528 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7310983 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 291705 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 566626 | RevenuesLessExpensesCY |
| Total Assets BOY | 7175456 | TotalAssetsBOY |
| Total Assets EOY | 8125154 | TotalAssetsEOY |
| Total Liabilities BOY | 3919190 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4100156 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3256266 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4024998 | NetAssetsOrFundBalancesEOY |
| Mission Description | Wagner Community Memorial Hospital's mission is to provide care and treatment of the sick; provide care and support of the aged, disabled, and indigent; and to provide for those in need of hospitalization regardless of race, color, creed, or ability to pay. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6312157 | Expense |
| Revenue | 6901908 | Revenue |
| Description | It is the objective and purpose to provide care and treatment of the sick, to provide care and support of the aged, disabled and indigent and to provide for those in need of hospitalization, regardless of race, color, creed or ability to pay. WCMH is a 20 bed critical access hospital equipped with extensive advanced services, including areas for Medical/Surgical, Pediatric, Intensive/Coronary Care, Swing Bed/Long Term Care. The clinic is adjacent to the hospital making it convenient to see hospital patients, share laboratory services and other diagnostic equipment. Outreach services include OB/GYN, Pediatrics, Orthopedic Surgery, General Surgery, Urology, Podiatry, ENT & Audiology. The people of the community truly believe in having access to care and support their local medical providers. During the 2009-10 fiscal year WCMH provided more than $623,643 of free care to our patients who were unable to afford payment. The facility serves as the inpatient unit for the local Indian Health Services clinic and works collaboratively with the IHS physicians and leaders to care for the Native American population. WCMH experienced 1218 Inpatient days, 707 Swing Bed days, 1,839 Emergency Department visits, 1,640 Urgent Care visits and 1,350 clinic visits.WCMH provides Community Health Improvement Services which include: Community CPR classes, sponsorship to the Dakota Smiles Mobile Dental Program, Blood Pressure screenings at area events, assisting with community disasters and award scholarships to the local high school graduates.eEmergency/eStroke Services-are a two way video link to emergency-trained specialists to assist local providers in cases of trauma, heart attacks, stroke and other critical situations. These services assist rural hospitals by having specialists available for consultation, streamline emergency transport when needed, diagnose and begin treatment earlier and keep patients nearby home. Approximately $10,257 was expensed for this service, with no charge to the patients.Patient Satisfaction is monitored through Press Ganey services. The organization is proud to report our scores have continually improved and have seen an overall satisfaction approval from our patients in all areas. WCMH strives to provide a high quality of healthcare for the community and is very proud of the physicians and staff whose expertise and compassion allows that achievement. | Description |
| Total Program Service Expense | 6312157 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| 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 | 0 | TaxExemptBonds |
| 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 | 13 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 78 | 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 |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Lisa Weisser | NamePerson |
| Telephone Number | 6053843611 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 513 3rd Street SW | AddressLine1 |
| City | Wagner | City |
| State | SD | State |
| ZIP Code | 573800280 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Jan Coleman | |||||||
| Board President (Thru 9/09) | 0.50 | X | X | 0 | 0 | 0 | |
| Ken Thaler | |||||||
| Board President (Started 9/09) | 0.50 | X | X | 0 | 0 | 0 | |
| David Kotab | |||||||
| Board Vice President | 0.50 | X | X | 0 | 0 | 0 | |
| Elden Ridgeway | |||||||
| Board Secretary | 0.50 | X | X | 0 | 0 | 0 | |
| Jean Pirner | |||||||
| Board Treasurer | 0.50 | X | X | 0 | 0 | 0 | |
| Merle Bartunek | |||||||
| Director | 0.50 | X | X | 0 | 0 | 0 | |
| Dorothy Holzbauer | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Joan Wagner | |||||||
| Director (Thru 9/09) | 0.50 | X | 0 | 0 | 0 | ||
| Ann Freier-Metzger | |||||||
| Director | 0.50 | X | 0 | 0 | 0 | ||
| Dave Andrews | |||||||
| Director (Started 9/09) | 0.50 | X | 0 | 0 | 0 | ||
| Bill Frei | |||||||
| Director (Started 9/09) | 0.50 | X | 0 | 0 | 0 | ||
| Daryl Dusharm | |||||||
| Director (9/09 Thru 3/10) | 0.50 | X | 0 | 0 | 0 | ||
| Bryan Slaba | |||||||
| CEO/Administrator | 40.00 | X | 79681 | 0 | 19801 | ||
| Ahmed H Dessouki | |||||||
| Physician | 40.00 | 188183 | 0 | 15904 | X | ||
| Robert Hubley | |||||||
| Physician | 40.00 | 179043 | 0 | 11656 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 446907 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 47361 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Avera Sacred Heart Hospital | |||||
| 501 S Summit Street | Yankton | SD | 57078 | Management Services, CEO and IT Services | 386305 |
| Dr Jeffery Pinter | |||||
| 27952 323rd Avenue | Winner | SD | 57580 | Physician ER Coverage | 243880 |
| Avera Sacred Heart Rural Health | |||||
| 501 S Summit Street | Yankton | SD | 57078 | Contract Physician Labor | 141982 |
| Wagner Building and Supply | |||||
| 39379 SD Hwy 46 | Wagner | SD | 57380 | Construction/Remodel | 138009 |
| Dr Gary A Bubak | |||||
| 29778 398th Avenue | Wagner | SD | 57380 | Physician ER Coverage | 125525 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Government Grants | 924974 | GovernmentGrants |
| All Other Contributions | 5635 | AllOtherContributions |
| Total Contributions | 930609 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Service Rev | 622110 | 6744344 | 6744344 |
| Apartment Revenue | 900099 | 100101 | 100101 |
| Other Revenue | 900099 | 36975 | 36975 |
| Patient Int Revenue | 900099 | 20488 | 20488 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 6901908 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28629 | TotalRevenueColumn |
| Exclusion | $28,629 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14652 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14652 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14652 | TotalRevenueColumn |
| Exclusion | $14,652 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2186 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 375 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1811 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1811 | TotalRevenueColumn |
| Exclusion | $1,811 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7877609 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6901908 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $45,092 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2688 | Total |
| Program Services | 2688 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2882185 | Total |
| Program Services | 2443280 | ProgramServices |
| Management And General | 438905 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45253 | Total |
| Program Services | 38465 | ProgramServices |
| Management And General | 6788 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 233713 | Total |
| Program Services | 198656 | ProgramServices |
| Management And General | 35057 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 175543 | Total |
| Program Services | 149212 | ProgramServices |
| Management And General | 26331 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42000 | Total |
| Management And General | 42000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 384459 | Total |
| Program Services | 263475 | ProgramServices |
| Management And General | 120984 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43961 | Total |
| Management And General | 43961 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24501 | Total |
| Program Services | 3336 | ProgramServices |
| Management And General | 21165 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30435 | Total |
| Program Services | 12556 | ProgramServices |
| Management And General | 17879 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 108946 | Total |
| Program Services | 105506 | ProgramServices |
| Management And General | 3440 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30988 | Total |
| Program Services | 24044 | ProgramServices |
| Management And General | 6944 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29887 | Total |
| Program Services | 22073 | ProgramServices |
| Management And General | 7814 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 172634 | Total |
| Program Services | 172634 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 442051 | Total |
| Program Services | 442051 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44871 | Total |
| Program Services | 44871 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 1529422 | 1476751 | 52671 |
| Bad Debt Expense | 528776 | 528776 | |
| Repairs and Maintenance | 246435 | 241246 | 5189 |
| Equipment Lease and Ren | 134099 | 125005 | 9094 |
| ACS Fees | 106179 | 106179 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71957 | Total |
| Program Services | 17532 | ProgramServices |
| Management And General | 54425 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7310983 | Total |
| Program Services | 6312157 | ProgramServices |
| Management And General | 998826 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 993900 | BOY |
| EOY | 1267479 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15000 | BOY |
| EOY | 8201 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1482625 | BOY |
| EOY | 1377552 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60415 | BOY |
| EOY | 70226 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54622 | BOY |
| EOY | 66638 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8432391 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3959665 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3800122 | BOY |
| EOY | 4472726 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 757969 | BOY |
| EOY | 841404 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10803 | BOY |
| EOY | 20928 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7175456 | BOY |
| EOY | 8125154 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 740209 | BOY |
| EOY | 630979 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13180 | BOY |
| EOY | 37000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3165801 | BOY |
| EOY | 3432177 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3919190 | BOY |
| EOY | 4100156 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3069644 | BOY |
| EOY | 3671277 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 186622 | BOY |
| EOY | 353721 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3256266 | BOY |
| EOY | 4024998 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7175456 | BOY |
| EOY | 8125154 | 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 | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4246 | OtherCostOrOtherBasis |
| Book Value | 4246 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5735113 | OtherCostOrOtherBasis |
| Depreciation | 2619012 | Depreciation |
| Book Value | 3116101 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2420847 | OtherCostOrOtherBasis |
| Depreciation | 1312180 | Depreciation |
| Book Value | 1108667 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 272185 | OtherCostOrOtherBasis |
| Depreciation | 28473 | Depreciation |
| Book Value | 243712 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4472726 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| Interest in Pooled Investment Fund | 804148 | F |
| Interest in Net Assets of Avera Health Foundation | 37256 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 841404 | TotalOfBookValueSecurities |
| Total Revenue | 7877609 | TotalRevenue |
| Total Expenses | 7310983 | TotalExpenses |
| Excess Or Deficit For Year | 566626 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 22653 | NetUnrealizedGLOnInvestments |
| Other | $179,453 | OtherAmount |
| Total Adjustments | 202106 | TotalAdjustments |
| Excess Or Deficit Per FS | 768732 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 8079715 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 22653 | NetUnrealizedGainsInvestments |
| Other Revenues | 179453 | OtherRevenues |
| Revenue Not Rptd F990 | 202106 | RevenueNotRptdF990 |
| Revenue Subtotal | 7877609 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 7877609 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7310983 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7310983 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7310983 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | The Hospital has adopted the provisions of FASB Accounting Standards Codification Topic 740-10 (previously Financial Interpretation No. 48, Accounting for Uncertainty in Income Taxes), on July 1, 2009. The implementation of this standard had no impact on the financial statements. As of both the date of adoption, and as of June 30, 2010, the unrecognized tax benefit accrual was zero. The Hospital will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense if incurred. The Hospital is no longer subject to Federal tax examinations by tax authorities for years before 2007. |
| Part XI, Line 8 - Other Adjustments: | Change in Interest in Net Assets of Avera Health Foundation: 179453. | |
| Part XII, Line 2d - Other Adjustments: | Change in Net Assets of Avera Health Foundation: 179453. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| 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 | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 55 | PersonsServed |
| Total Community Benefit Expense | 37579 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19073 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 18506 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 984368 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1302337 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -317969 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 55 | PersonsServed |
| Total Community Benefit Expense | 1021947 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1321410 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -299463 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8171 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8171 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4058 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4058 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 614930 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 83369 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 531561 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07270 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5666 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5666 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 632825 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 83369 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 549456 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07520 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 55 | PersonsServed |
| Total Community Benefit Expense | 1654772 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1404779 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 249993 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07770 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 26 | PersonsServed |
| Total Community Building Expense | 110443 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 101064 | DirectOffsettingRevenue |
| Net Community Building Expense | 9379 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 16311 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 16311 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 834 | PersonsServed |
| Total Community Building Expense | 407 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 407 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 16 | NumberOfActivitiesOrPrograms |
| Persons Served | 860 | PersonsServed |
| Total Community Building Expense | 127161 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 101064 | DirectOffsettingRevenue |
| Net Community Building Expense | 26097 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $176,342 | BadDebtExpenseAmount |
| Amount Attributable To | 73358 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2842593 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2835910 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 6683 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Critical Access HospitalCriticalAccessHospital | Er24 HoursEr24Hours | OtherOther |
|---|---|---|---|---|---|---|---|---|
| Wagner Community Memorial Hospital | ||||||||
| PO Box 280 | Wagner | SD | 57380 | X | X | X | X | |
| Community Villa | ||||||||
| 208 Grant Avenue SE | Wagner | SD | 57380 | Subsidized Independent Living Facility | ||||
| Westside Estates | ||||||||
| 315 Birch Avenue SW | Wagner | SD | 57380 | Subsidized Independent Living Facility | ||||
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: Lines 7a and 7b were determined using the ratio of patient care costs to charges calculated by WCMH's general ledger accounting system. Lines 7e, 7f and 7i were obtained utilizing the actual general ledger system. Line 7g was obtained from the Medicare cost report. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: The expenses of the Rural Health Clinic total $613,218. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: Bad debt expense of $528,776 was subtracted from total operating expense. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: a) The cost-to-charge ratio was calculated using Worksheet 2.b) Bad debt recoveries and discounts applied during the collection process are rare, but when they do occur they are posted against the bad debt account.c) WCMH applied the poverty level percentage from the U.S. Census Bureau for its service area to the total amount sent to collections during the fiscal year ended June 30, 2010 to determine an estimate of eligible charity care reported as bad debt. d) Footnote from Financial Statement: The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Management also reviews accounts to determine if classification as charity care is appropriate. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: Medicare allowable cost of care was calculated from the medicare cost report for the fiscal year ending 6/30/2010. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: All services provided at the Wagner Community Memorial Hospital & Clinic are expected to be paid in full after receiving the bill of services. Medicare, Medicaid and Commercial Insurance will be sent at the request of the patient provided we have the correct insurance information. Any co-insurance or deductibles must be paid at the time of services or other arrangements need to be made before discharge. - A statement will be sent out monthly to the responsible party allowing them to pay in full or make arrangements to pay in full. Arrangements must be confirmed in writing.- An interest charge of 1% monthly may be charged to all services 90 days old or older.- Patients may receive a final notice if no payment agreement has been made for services 90 days or older.- Patients may receive a final notice if no payment agreement has been made after third party payors have made payment.-Following the final notice, patient accounts may be turned over to Small Claims Court or to a Collection Agency. This may result in additional fees that will be charged to the account.-All account collections are treated the same, and the policy does not outline any provisions for the collection pratices to be followed for patients who are known to qualify for charity care or financial assistance. However, a review may be made either at the request of the patient or hospital staff to determine if the account may qualify for Charity Care. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Through constant communication with patients and providers, primary and specialists, as well as state and federal governmental health agency, WCMH strives to consistently investigate, analyze, and determine the greatest needs of our community. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: WCMH has a written charity care policy. First reference is given to the patient upon admission. A second reference as to the patient qualifying/needing financial assistant and contact information accompanies the third request for payment. If neither notice is acted upon and the account continues to be unpaid a patient advocate will try to contact the patient if it is believed they may qualify for financial assistance. If the patient expresses interest in financial assistance the patient advocate determines if any other opportunities are available for the patient. If the only option available is WCMH's charity care, the proper documentation is completed. The amount of reduction a patient may receive is based on a sliding scale point system. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Wagner is a rural community located in southern Charles Mix County of South Dakota which has many health disparities with unmet needs. If one looks at the county as a whole, the average individual income is $39,438 with the median family income at $53,800. Inhabitants below the poverty level total 31%. County education demographics include 72.75% of residents having a high school degree and 13.72% holding a Bachelor's Degree in comparison to the national average of 80.4% and 24.4%, accordingly. According to the US Census Bureau Fact Finder most recent data, 28.3% of residents in the county are of American Indian descent, almost all members of the Yankton Sioux Tribe. All of Charles Mix County is considered medically underserved by HRSA and the SD Department of Health. The county is also considered a health professional shortage area with few providers and many miles in between these rural communities. Wagner provides the only local hospital facility since Indian Health Services (IHS) closed their facility in 1992. In 2008, the IHS emergency room closed putting a burden on the Wagner facility until a new clinic was built by the Wagner Hospital. There are only a few rural health clinics available in addition to the IHS clinic and the newly built VA facility. Many clinics provide only primary care services and are often staffed by Physician Assistants. If more specialized care is needed, patients must travel to either Yankton, South Dakota, which is about 115 miles round trip or they drive the 280 round trip miles to Sioux Falls, which is the area's tertiary care hub with all types of specialty care available. In addition to the shortage of quality health care services, residents of Southern Charles Mix County also suffer from many chronic health conditions. The percent of the population over 65 years of age is almost double the national average in more than half of the county. The disability status of the county's inhabitants is consistent with, if not higher than, the national average of 19.3% in a majority of the communities. Gaps exist among socioeconomic groups in the rate of diabetes and its associated complications in South Dakota as well as throughout the United States. Certain racial and ethnic communities including American Indians, as well as economically disadvantaged or older people, suffer disproportionately compared to other populations. Diabetes prevalence for adults located in Central SD surpasses South Dakota and U.S. percentages. The American Indian population in Wagner and Lake Andes is between 34-42% as compared to the national average of 0.9%. American Indian population in the nearby towns of Marty and Ravinia are 90% and 80%, respectively. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: WCMH owns two elderly and disabled independent living facilities. The facilities are both rent subsidized and combined have a total of 26 units. WCMH was also able to recruit and retain a PA-C to assist with the needs of the area. Fourteen different healthcare career fairs were sponsored and presented by WCMH throughout southern Charles Mix County. | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: WCMH is a community hospital with an open board selected from associates, all of which are community members and can not be WCMH employees. All providers who wish to obtain privileges at WCMH are encouraged and welcome to use the appointment/reappointment privileging application process. In 2010 WCMH lead the establishment of the Southern Charles Mix County Healthcare Consortium (SCMCHC). The mission of the consortium is to determine the greatest needs of the area maximizing resources of the eight member facilities and agencies to address the determined needs. SCMCHC has applied for a USDA-RD planning grant to accomplish this task which includes the completion of an independent needs assessment. WCMH uses surplus funds to fund building improvements to enhance services to its patients. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: N/A | AffiliatedHealthCareSystem |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bryan Slaba | |||||||||||||
| 79183 | 0 | 282 | 0 | 216 | 0 | 2405 | 0 | 18051 | 0 | 100137 | 0 | 0 | 0 |
| Ahmed H Dessouki | |||||||||||||
| 188183 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15904 | 0 | 204087 | 0 | 0 | 0 |
| Robert Hubley | |||||||||||||
| 179043 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 11656 | 0 | 190699 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Supplemental Information | Identifier |
| Return Reference | Part III | ReturnReference |
| Explanation | Form 990, Part VII, Section A, Line 5 & Form 990, Schedule J, Part II: Bryan Slaba, CEO/Administrator, is paid by Avera Sacred Heart Hospital, 501 Summit Street, Yankton, SD 57078. Dr. Robert Hubley, Physician, is paid by Avera Sacred Heart Hospital, 501 Summit Street, Yankton, SD 57078. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part III, line 2 | New Program Services | eEmergency and eStroke Services were added during the fiscal year ending June 30, 2010. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee consists of the President, as Chairman, and two other members of the board of directors appointed by the President. The executive committee will have power to transact all regular business of the Hospital during the interim between the meetings of the board of directors provided any action taken does not conflict with the policies and expressed wishes of the board of directors, and that it shall refer all matters of major importance to the board of directors. | |
| Form 990, Part VI, Section A, line 3 | Sevices provided by the CEO are through a management agreement with Avera Sacred Heart Health Services in Yankton, South Dakota. | |
| Form 990, Part VI, Section A, line 6 | There is only one class of member. Any individual, partnership, corporation or association having legal entity, who has contributed $25 or more to the Corporation with request of membership at the time of donation, shall be a member thereof and each member shall have one vote at all meetings of the members of the corporation. Membership of any individual who shall become deceased shall revert by request to that individual's next of kin or according to his will. Any member who has contributed $50 or more shall have the right to transfer such membership to his or her spouse. Said transfer to be approved by the Board of Directors. The basis for membership is on non-refundable contributions. | |
| Form 990, Part VI, Section A, line 7a | Only one class of member exists. At the annual meeting, members approve the minutes of the last annual meeting, elect board members of the Wagner Community Memorial Hospital, and vote on other business that may be properly brought before the members. | |
| Form 990, Part VI, Section A, line 7b | The Board of Directors may adopt amendments at any regular or special meeting of the Board and the same shall be effective until the next regular or special meeting of the members, at which time, the same will be ratified or rejected, and, if ratified, the same shall be binding as incorporated by-laws of the corporation. | |
| Form 990, Part VI, Section B, line 11 | The CEO will review the 990. After the form 990 has been reviewed, it will be forwarded to the members of the Governing Body for their review. It will be presented at a board meeting, and filed subsequent to that. | |
| Form 990, Part VI, Section B, line 15 | Avera Sacred Heart Health Services and Wagner Community Memorial Hospital Compensation Committee use comparability data to determine appropriate compensation of the CEO based on experience and performance. Wagner Community Memorial Hospital uses comparability data and demographic data to determine the appropriate compensation of its key employees. | |
| Form 990, Part VI, Section C, line 19 | Documents are made available upon request. |
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