TRI-COUNTY MEMORIAL HOSPITAL INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- TRI-COUNTY MEMORIAL HOSPITAL INC (EIN 39-0704510)
- Tax period
- 2024-10-01 to 2025-09-30
- Filed
- 2026-08-13
- IRS object ID
- 202632259349302283
- Schema version
- 2024v5.1
- 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
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-08-13T17:02:52+00:00 | ReturnTs |
| Tax Period End | 2025-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST RANDOLPH DRIVE SUITE 5500 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606016436 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390704510 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TRI- | BusinessNameControlTxt |
| Phone | 7155384361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL COENEN | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 7155384361 | PhoneNum |
| Signature | 2026-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RILEY KOBRICK | PreparerPersonNm |
| PTIN | P02401884 | PTIN |
| Phone | 3126651000 | PhoneNum |
| Preparation | 2026-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANIEL COENEN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,144,967 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1937 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 287 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $405,533 | PYContributionsGrantsAmt |
| CY Contributions Grants | $694,212 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,327,868 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,062,277 | CYProgramServiceRevenueAmt |
| PY Investment Income | $63,117 | PYInvestmentIncomeAmt |
| CY Investment Income | $116,978 | CYInvestmentIncomeAmt |
| PY Other Revenue | $133,952 | PYOtherRevenueAmt |
| CY Other Revenue | $271,500 | CYOtherRevenueAmt |
| PY Total Revenue | $39,930,470 | PYTotalRevenueAmt |
| CY Total Revenue | $45,144,967 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,181,432 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,777,085 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $24,703,254 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,435,114 | PYOtherExpensesAmt |
| CY Other Expenses | $16,653,195 | CYOtherExpensesAmt |
| PY Total Expenses | $36,212,199 | PYTotalExpensesAmt |
| CY Total Expenses | $42,537,881 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,718,271 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,607,086 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $67,930,969 | TotalAssetsBOYAmt |
| Total Assets EOY | $75,180,360 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $47,005,382 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $51,647,687 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $20,925,587 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $23,532,673 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $32,841,944 | ExpenseAmt |
| Grant | $1,181,432 | GrantAmt |
| Revenue | $43,607,395 | RevenueAmt |
| Desc | TRI-COUNTY MEMORIAL HOSPITAL, INC. ("TRI-COUNTY") PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW INCOME PATIENTS. THE ORGANIZATION OPERATES A CRITICAL ACCESS HOSPITAL AND PROVIDES INPATIENT ACUTE CARE AND SWING BED SERVICES, ALONG WITH AN EMERGENCY DEPARTMENT, WHICH IS OPEN TWENTY-FOUR HOURS PER DAY, AND OTHER OUTPATIENT SERVICES. VISITING SPECIALISTS FROM AN AFFILIATED ORGANIZATION, GUNDERSEN CLINIC, LTD., PERFORM OUTPATIENT GASTROENTEROLOGY, ORTHOPEDIC, AND OPHTHALMIC SURGICAL PROCEDURES AT THE FACILITY AS WELL. TRI-COUNTY ALSO OPERATES AN ASSISTED LIVING FACILITY, THREE RURAL HEALTH CLINICS, AND AN AMBULANCE SERVICE. THE CRITICAL ACCESS HOSPITAL HAD 852 INPATIENT ACUTE DAYS, 54 RESPITE DAYS, 3277 SWING BED DAYS, 660 SURGICAL OPERATIONS, AND 8616 ER VISITS IN THE PERIOD OCTOBER 1 THROUGH SEPTEMBER 30, 2025. CONSISTENT WITH THE MISSION OF TRI-COUNTY, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO ARE EITHER UNDERINSURED OR CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID HOSPITAL SERVICES, ARE ALSO CONSIDERED PART OF TRI-COUNTY'S BENEFIT PROVIDED TO THE COMMUNITY, SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN THE COSTS OF PROVIDING CARE. PATIENTS WHO MEET CERTAIN CRITERIA FOR CHARITY CARE, GENERALLY BASED ON FEDERAL POVERTY GUIDELINES, ARE PROVIDED CARE AT A SIGNIFICANTLY REDUCED RATE, DETERMINED BASED ON QUALIFYING CRITERIA AS DEFINED IN TRI-COUNTY'S CHARITY CARE POLICY, AND FROM APPLICATIONS COMPLETED BY PATIENTS AND THEIR FAMILIES. THE AMOUNT OF HOSPITAL AND CLINIC CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THIS POLICY DURING 2025 TOTALED $1,181,432. IN ADDITION, DISCOUNTS TO THE MEDICAID PROGRAM FOR HOSPITAL AND CLINIC SERVICES AMOUNTED TO $5,209,289. BENEFITS FOR SERVING THE COMMUNITY ALSO INCLUDE UNPAID COSTS OF TREATING THE ELDERLY, HEALTH SCREENINGS, COMMUNITY EDUCATION THROUGH SEMINARS AND CLASSES, AND OTHER HEALTH-RELATED SERVICES. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $539,468 | ExpenseAmt |
| Revenue | $454,882 | RevenueAmt |
| Desc | TRI-COUNTY ALSO OPERATES AN ASSISTED LIVING FACILITY LOCATED DIRECTLY EAST ACROSS THE STREET OF TRI-COUNTY HOSPITAL. THIS CARE IS PROVIDED TO RESIDENTS IN AN EFFORT BY TRI COUNTY TO PROVIDE A CONTINUUM OF CARE FOR PATIENTS OF THE SURROUNDING COMMUNITIES. SERVICES OFFERED AND PROVIDED TO RESIDENTS INCLUDE ASSISTANCE WITH THE ACTIVITIES OF DAILY LIVING, MEAL PREPARATION, LAUNDRY SERVICES, APARTMENT MAINTENANCE SERVICES, DAILY RECREATIONAL ACTIVITIES, AMONG MANY SERVICE OFFERINGS. RESIDENTS OF THE ASSISTED LIVING FACILITY ALSO HAVE ACCESS TO NURSING STAFF IN THE EVENT OF AN EMERGENCY TWENTY-FOUR HOURS A DAY PROVIDED BY TRI-COUNTY'S NURSING SERVICES STAFF. SOME OF THE RESIDENTS SERVED ARE LOW-INCOME PATIENTS, WHICH ARE SUBSIDIZED THROUGH THE WISCONSIN FAMILY CARE PROGRAM, WHICH OFTEN REIMBURSES TRI-COUNTY AT COST OR BELOW THE TRUE COST OF CARING FOR THESE RESIDENTS. DESPITE RECEIVING REIMBURSEMENT AT AMOUNTS BELOW COST, TRI-COUNTY CONTINUES THIS SERVICE AS IT FURTHERS ITS MISSION IN THE COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $33,381,412 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 287 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANIEL COENEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7155384361 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| BETH LISOWSKI | |||||||||
| BOARD OF DIRECTORS, CHAIRMAN (BEG 1.1.25) | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DENNIS STEPHENSON | |||||||||
| BOARD OF DIRECTORS, CHAIRMAN (END 12.31.24) | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KATHLEEN KLOCK | |||||||||
| BOARD OF DIRECTORS, SECRETARY, (END 12.31.24) | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARILU BINTZ MD | |||||||||
| BOARD OF DIRECTORS, SECRETARY, (BEG 1.1.25) | 2.0 | 0.0 | Yes (X) | Yes (X) | $0 | $261,160 | $38,627 | ||
| RON GUZA | |||||||||
| BOARD OF DIRECTORS, TREASURER | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| VICKIE BAKALARS | |||||||||
| BOD, VICE CHAIRMAN, CLINICAL OPERATIONS DIRECTOR | 2.0 | 48.0 | Yes (X) | Yes (X) | $0 | $157,306 | $49,437 | ||
| KIMBERLY BREIDENBACH | |||||||||
| BOARD OF DIRECTORS, MD | 2.0 | 48.0 | Yes (X) | $0 | $376,827 | $71,967 | |||
| LAURA KLOSS | |||||||||
| BOD, CLINICAL OPERATIONS DIRECTOR, (BEG 1.1.25) | 2.0 | 48.0 | Yes (X) | $0 | $156,831 | $50,305 | |||
| MARLYS KOLSTAD | |||||||||
| BOARD OF DIRECTORS | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| THERESE BINFET | |||||||||
| BOD, CLINICAL OPERATIONS DIRECTOR | 2.0 | 48.0 | Yes (X) | $0 | $184,133 | $49,695 | |||
| TIM HOLTAN | |||||||||
| BOARD OF DIRECTORS (BEG 1.1.25) | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| DANIEL COENEN | |||||||||
| ADMINISTRATOR | 28.0 | 22.0 | Yes (X) | $0 | $165,449 | $47,722 | |||
| JOHN CEELEN | |||||||||
| CHIEF FINANCIAL OFFICER | 1.0 | 49.0 | Yes (X) | $0 | $728,316 | $54,052 | |||
| KRISTY MILLERING | |||||||||
| FINANCE ADMINISTRATOR | 18.0 | 32.0 | Yes (X) | $0 | $131,354 | $42,400 | |||
| SCOTT RATHGABER MD | |||||||||
| CEO | 1.0 | 49.0 | Yes (X) | $0 | $1,324,275 | $73,275 | |||
| CARLA SENDELBACH | |||||||||
| RN, ACUTE HOSPITAL - TRI-COUNTY | 36.0 | 0 | $152,457 | $0 | $44,920 | Yes (X) | |||
| GANESH RAM | |||||||||
| PA - TRI COUNTY ER | 50.0 | 0 | $203,135 | $0 | $28,563 | Yes (X) | |||
| JASMINE FOLKEDAHL | |||||||||
| RN, ACUTE HOSPITAL (WEO) - TRI-COUNTY | 36.0 | 0 | $168,334 | $0 | $40,238 | Yes (X) | |||
| KATHLEEN CAIN | |||||||||
| MANAGER, PHARMACY | 50.0 | 0 | $200,688 | $0 | $45,691 | Yes (X) | |||
| WADE BERTELSEN | |||||||||
| RN, ACUTE HOSPITAL - TRI-COUNTY | 36.0 | 0 | $156,491 | $0 | $47,347 | Yes (X) | |||
| JONI OLSON | |||||||||
| ADMINISTRATOR | 0.0 | 0.0 | $0 | $169,390 | $41,223 | Yes (X) | |||
| STEVE LITTLE | |||||||||
| FORMER CHIEF FINANCIAL OFFICER | 0.0 | 0.0 | $0 | $209,856 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $881,105 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,864,897 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $725,462 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 31 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| KRAUS ANDERSON CONSTRUCTION CO | |||||
| 501 SOUTH EIGHTH STREET | MINNEAPOLIS | MN | 55404 | CONSTRUCTION SERVICES | $4,149,769 |
| NEI ELECTRIC | |||||
| 4815 WHITE BEAR PARKWAY | WHITE BEAR LAKE | MN | 55110 | ELECTRICAL | $392,493 |
| STAFFENCY | |||||
| 221 W COLLEGE AVE FLOOR 2 | APPLETON | WI | 54911 | REHAB PROVIDERS | $318,357 |
| SHARED MEDICAL TECHNOLOGY INC | |||||
| 202 WEST NEWTON STREET | RICE LAKE | WI | 54868 | IMAGING SERVICES | $156,990 |
| BAND BOX CLEANERS & LAUNDRY | |||||
| PO BOX 299 | TOMAH | WI | 54660 | LAUNDRY SERVICE | $147,402 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $671,664 | GovernmentGrantsAmt |
| All Other Contributions | $22,548 | AllOtherContributionsAmt |
| Total Contributions | $694,212 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $30,092,604 | $30,092,604 |
| PHARMACY REVENUE | 456110 | $13,355,932 | $13,355,932 |
| ASSISTED LIVING REVENUE | 623000 | $454,882 | $454,882 |
| OTHER PROGRAM SERVICES REVENUE | 900099 | $158,859 | $158,859 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,062,277 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,978 | TotalRevenueColumnAmt |
| Exclusion | $116,978 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,536 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,536 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,536 | TotalRevenueColumnAmt |
| Exclusion | $20,536 | ExclusionAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DIETARY | Desc |
| Business | 722514 | BusinessCd |
| Total Revenue Column | $250,964 | TotalRevenueColumnAmt |
| Exclusion | $250,964 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $250,964 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,144,967 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,062,277 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $388,478 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,181,432 | TotalAmt |
| Program Services | $1,181,432 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,345,167 | TotalAmt |
| Program Services | $17,520,977 | ProgramServicesAmt |
| Management And General | $1,824,190 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,802,115 | TotalAmt |
| Program Services | $1,706,743 | ProgramServicesAmt |
| Management And General | $95,372 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,473,072 | TotalAmt |
| Program Services | $2,208,395 | ProgramServicesAmt |
| Management And General | $264,677 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,082,900 | TotalAmt |
| Program Services | $977,353 | ProgramServicesAmt |
| Management And General | $105,547 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,174,860 | TotalAmt |
| Program Services | $22,008 | ProgramServicesAmt |
| Management And General | $1,152,852 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,769 | TotalAmt |
| Management And General | $1,769 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,700 | TotalAmt |
| Management And General | $39,700 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,283 | TotalAmt |
| Management And General | $6,283 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,163,286 | TotalAmt |
| Program Services | $2,040,581 | ProgramServicesAmt |
| Management And General | $122,705 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,854 | TotalAmt |
| Program Services | $465 | ProgramServicesAmt |
| Management And General | $94,389 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497,179 | TotalAmt |
| Program Services | $311,936 | ProgramServicesAmt |
| Management And General | $185,243 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,979 | TotalAmt |
| Program Services | $23,399 | ProgramServicesAmt |
| Management And General | $3,580 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $430,263 | TotalAmt |
| Program Services | $175,504 | ProgramServicesAmt |
| Management And General | $254,759 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,461 | TotalAmt |
| Program Services | $58,137 | ProgramServicesAmt |
| Management And General | $1,324 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $849,559 | TotalAmt |
| Management And General | $849,559 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,594,417 | TotalAmt |
| Program Services | $996,236 | ProgramServicesAmt |
| Management And General | $2,598,181 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,238 | TotalAmt |
| Management And General | $96,238 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & EQUIPMENT | $5,613,261 | $5,613,261 | |
| PROVISIONS FOR BAD DEBT | $1,204,106 | $1,204,106 | |
| REPAIRS AND MAINTENANCE | $258,395 | $126,243 | $132,152 |
| DIETARY FOOD EXPENSE | $243,595 | $239,036 | $4,559 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $298,990 | TotalAmt |
| Program Services | $179,706 | ProgramServicesAmt |
| Management And General | $119,284 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,537,881 | TotalAmt |
| Program Services | $33,381,412 | ProgramServicesAmt |
| Management And General | $9,156,469 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,397 | BOYAmt |
| EOY | $24,954 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,330,550 | BOYAmt |
| EOY | $14,637,992 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,269,204 | BOYAmt |
| EOY | $10,671,388 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $645,805 | BOYAmt |
| EOY | $765,462 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,991 | BOYAmt |
| EOY | $63,979 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $59,926,246 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,072,341 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,193,089 | BOYAmt |
| EOY | $47,853,905 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $402,933 | BOYAmt |
| EOY | $1,162,680 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,930,969 | BOYAmt |
| EOY | $75,180,360 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,991 | BOYAmt |
| EOY | $3,606,483 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,398 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,920,833 | BOYAmt |
| EOY | $37,832,292 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,501,973 | BOYAmt |
| EOY | $1,449,761 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,183,187 | BOYAmt |
| EOY | $8,759,151 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,005,382 | BOYAmt |
| EOY | $51,647,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,925,587 | BOYAmt |
| EOY | $23,532,673 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,925,587 | BOYAmt |
| EOY | $23,532,673 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,930,969 | BOYAmt |
| EOY | $75,180,360 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,607,086 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $6,283 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,283 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS (TRI-COUNTY) PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PAID PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE AHA AND WHA HAVE NOTIFIED TRI-COUNTY THAT APPROXIMATELY $3,923 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. TRI-COUNTY IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND PROVIDE BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES A SMALL AMOUNT OF LOBBYING ON THE PART OF THE MEMBER HOSPITALS. THE RWHC DETERMINED THAT APPROXIMATELY $2360 OF THE FEES PAID BY TRI-COUNTY IN FISCAL YEAR 2024 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $380,696 | OtherCostOrOtherBasisAmt |
| Book Value | $380,696 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $49,821,988 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,219,030 | DepreciationAmt |
| Book Value | $43,602,958 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,042,973 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,426,304 | DepreciationAmt |
| Book Value | $3,616,669 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $680,589 | OtherCostOrOtherBasisAmt |
| Depreciation | $427,007 | DepreciationAmt |
| Book Value | $253,582 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $47,853,905 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| FEDERAL INCOME TAXES | |
| DUE TO RELATED PARTY | $7,691,026 |
| OPERATING LEASE OBLIGATIONS | $37,906 |
| PENSION | $1,030,219 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $8,759,151 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $0 | TotalRevenuePerForm990Amt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTE | FormAndLineReferenceDesc |
| Explanation | THE SYSTEM AND MOST OF ITS SUBSIDIARIES ARE CLASSIFIED AS TAX-EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTIONS 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES ON RELATED INCOME, PURSUANT TO SECTION 501(A) OF THE CODE. THESE ORGANIZATIONS ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES TO THE EXTENT THEY HAVE UNRELATED BUSINESS INCOME. THE SYSTEM HAS NO MATERIAL UNCERTAIN TAX POSITIONS. CERTAIN SUBSIDIARIES ARE SUBJECT TO FEDERAL AND STATE INCOME TAXES. SOME OF THESE CORPORATIONS HAVE ACCUMULATED NET OPERATING LOSS CARRYFORWARDS THAT ARE AVAILABLE TO OFFSET FUTURE TAXABLE INCOME, IF ANY, AND HAVE BEEN FULLY RESERVED. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $625,901 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $625,901 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01514 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,487,307 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,253,041 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,234,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02986 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,113,208 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,253,041 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,860,167 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04500 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,499 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,499 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00018 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $787,709 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $454,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $332,827 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00805 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $64,302 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $64,302 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00156 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $859,510 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $454,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $404,628 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00979 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,972,718 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,707,923 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,264,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05479 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,120 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,120 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $90 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $90 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $8,210 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,210 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $638,176 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $319,088 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,549,090 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,663,118 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$114,028 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18601 LINCOLN STREET | AddressLine1Txt |
| City | WHITEHALL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54773 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.GUNDERSENHEALTH.ORG/TRI-COUNTY | WebsiteAddressTxt |
| State License | 1019 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-COUNTY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 24 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ | OwnWebsiteURLTxt |
| Other Website URL | HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 25 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 3E | |
| SCHEDULE H, PART V, SECTION B, LINE 3 FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DOES NOT DIRECTLY DESCRIBE THE EXISTING HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THAT ARE AVAILABLE TO RESPOND TO THE HEALTH NEEDS OF THE COMMUNITY, AS THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH OTHER HOSPITALS LISTED IN QUESTION 4 BELOW. HOWEVER, GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS PREPARED AN IMPLEMENTATION STRATEGY, AS AN ADDENDUM TO THE CHNA, WHICH SPECIFICALLY DESCRIBES THE EXISTING HEALTH CARE FACILITIES AND RESOURCES THAT ARE AVAILABLE WITHIN THE COMMUNITY. |
| SCHEDULE H, PART V, SECTION B, LINE 5 FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. DETAILS LISTED ON THE CHNA AVAILABLE AT HTTPS://GUNDERSEN.WIDEN.NET/S/XQLVNJBSD7/TCM-COMMUNITY-HEALTH-IMPROVEMENT-PLAN-2026-2028 |
| SCHEDULE H, PART V, SECTION B, LINE 6A FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: - GUNDERSEN LUTHERAN MEDICAL CENTER - MAYO CLINIC HEALTH SYSTEM - LA CROSSE - MAYO CLINIC HEALTH SYSTEM - SPARTA - TOMAH MEMORIAL HOSPITAL - GUNDERSEN ST. JOSEPH'S HOSPITAL - VERNON MEMORIAL HEALTHCARE |
| SCHEDULE H, PART V, SECTION B, LINE 6B FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS: - GREAT RIVERS UNITED WAY - OTTO BREMER FOUNDATION - LA CROSSE COMMUNITY FOUNDATION - LA CROSSE COUNTY HEALTH DEPARTMENT - MONROE COUNTY HEALTH DEPARTMENT - VERNON COUNTY HEALTH DEPARTMENT - TREMPEALEAU COUNTY HEALTH DEPARTMENT - HOUSTON COUNTY PUBLIC HEALTH DEPARTMENT |
| SCHEDULE H, PART V, SECTION B, LINE 11 FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. THE CHNA NOTED AREAS OF NEED IN HEALTH, COMMUNITY, EDUCATION, AND ECONOMICS. HEALTH AREAS INCLUDE CHRONIC DISEASE, MENTAL HEALTH AND/OR SUBSTANCE ABUSE. GTCHC IS ADDRESSING THESE NEEDS BY COLLABORATING WITH SEVERAL LOCAL AGENCIES TO PROMOTE EXERCISE AND NUTRITION, BY COLLABORATING WITH LOCAL SCHOOLS TO ADDRESS YOUTH RESILIENCE AND BULLYING. ADDITIONAL ACTIVITIES DESIGNED TO IMPROVE COMMUNITY HEALTH INCLUDE BLOOD PRESSURE BOOTHS AT COMMUNITY EVENTS, A 5K RUN AND 3K RUN/WALK EVENT, AND THE SMARTEST LOSER PROGRAM. THE CHNA NOTED COMMUNITY NEEDS IN THE AREAS OF ADVERSE CHILDHOOD EXPERIENCES, VIOLENCE, AND ENVIRONMENT. PLANNED ACTIVITIES TO ADDRESS COMMUNITY NEEDS INCLUDE HOSTING A FAMILY FUN NIGHT, PARTICIPATING IN LOCAL PARADES, AND HAVING A BOOTH AT THE DAIRY BREAKFAST. TO ADDRESS THE EDUCATION NEEDS OF ACADEMIC READINESS, YOUTH RESILIENCE, AND WORKFORCE READINESS, GTCHC PLANS TO HOST A HEALTH ACADEMY PROGRAM WITH WHITEHALL SCHOOLS AND A REACH OUT AND READ PROGRAM. GTCHC SUPPORTS THE LOCAL ECONOMY BY SUPPORTING LOCAL FOOD PANTRY'S AND PROVIDING STABLE EMPLOYMENT FOR MANY PEOPLE. THE AREAS OF GREATEST FOCUS FOR THE 2026-2028 PERIOD ARE MENTAL HEALTH, FOOD SECURITY AND NUTRITION, AND GENERAL ACCESS TO CARE. THE AREAS NOT BEING ADDRESS AT THIS TIME ARE: SUBSTANCE ABUSE AND DENTAL HEALTH, HOWEVER, THE HOPE IS WITH GENERAL ACCESS TO CARE, WE WILL BE ABLE TO PROVIDE SUPPORT IN THESE AREAS AS WELL. |
| SCHEDULE H, PART V, SECTION B, LINE 13 FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. A CATASTROPHIC CARE DISCOUNT IS AVAILABLE FOR PATIENTS WITH INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. |
| SCHEDULE H, PART V, SECTION B, LINE 16 FACILITY , 1 | FACILITY , 1 - TRI-COUNTY MEMORIAL HOSPITAL, INC.:. THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE ORGANIZATION'S WEBSITE AND AT EVERY REGISTRATION POINT THERE IS A POSTER ABOUT PROGRAMS THAT EXIST TO HELP PATIENTS PAY FOR THEIR CARE. ALL PATIENTS WHO HAVE SELF-PAY BALANCES (EITHER UNINSURED OR SELF-PAY AFTER INSURANCE) ARE MADE AWARE OF AVAILABLE ASSISTANCE VIA STATEMENT MESSAGES AND COURTESY NOTICES. PHONE CALLS TO FOLLOW UP WITH PATIENTS ARE ALSO MADE IN CASES WHERE MAIL IS RETURNED AS UNDELIVERABLE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| GUNDERSEN TRI-COUNTY WHITEHALL CLINIC | ||||
| 18606 ERVIN STREET | WHITEHALL | WI | 54773 | PROVIDER BASED RURAL HEALTH CLINIC |
| GUNDERSEN TRI-COUNTY INDEPENDENCE CLINIC | ||||
| 35791 OSSEO ROAD | INDEPENDENCE | WI | 54747 | CLINIC |
| GUNDERSEN TRI-COUNTY BLAIR CLINIC | ||||
| 420 SOUTH PETERSON AVE | BLAIR | WI | 54616 | PROVIDER BASED RURAL HEALTH CLINIC |
| EMPLIFY HEALTH MONDOVI CLINIC | ||||
| 250 WI-37 | MONDOVI | WI | 54755 | PROVIDER BASED RURAL HEALTH CLINIC |
| SUNRISE SENIOR LIVING | ||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | RESIDENTIAL CARE APARTMENT COMPLEX |
Supplemental Information Detail SupplementalInformationDetail (21 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | CATASTROPHIC CARE ASSISTANCE: FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME. DISCOUNTED CARE: FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL POVERTY LEVEL. 1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE. 2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE. 3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE. 4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE. FREE CARE: A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT: PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING: 1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY. 2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES. 3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY. 4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS |
| SCHEDULE H, PART I, LINE 7F | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24(B), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,204,106 |
| SCHEDULE H, PART I, LINE 6A COMMUNITY BENEFIT REPORT PREPARED BY RELATED ORGANIZATION | TRI-COUNTY PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON THE WHA'S WEBSITE. |
| SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES | SUBSIDIZED HEALTH SERVICES AT GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS INCLUDE THE SUNRISE ASSISTED LIVING FACILITY. THE ASSISTED LIVING SERVICES ARE OPERATED TO PROVIDE A CONTINUUM OF CARE FOR ELDERLY AND DISABLED PERSONS WHO NEED ADDITIONAL CARE IN BOTH LONG-TERM AND SHORT-TERM PROGRAMS. THE ASSISTED LIVING SERVICES RECEIVE A LARGE PORTION OF THEIR PROGRAM REVENUES FROM GOVERNMENT PAY SOURCES SUCH AS THE WISCONSIN MEDICAID AND FAMILY CARE PROGRAMS, WHICH OFTEN REIMBURSE THE ORGANIZATION AT COSTS WELL BELOW THE COST OF PROVIDING CARE TO THE PATIENTS; HOWEVER, WITHOUT THIS PROGRAM, THESE RESIDENTS WOULD NEED TO TRAVEL TO FACILITIES OUTSIDE OF THEIR COMMUNITY TO FIND THE NEEDED MEDICAL SERVICES. (SEE ALSO PART III, LINES 4B AND 4C, FOR A FURTHER DESCRIPTION OF THE ASSISTED LIVING SERVICES PROVIDED.) |
| SCHEDULE H, PART I, LINE 7 BAD DEBT EXPENSE EXCLUDED FROM FINANCIAL ASSISTANCE CALCULATION | 1204106 |
| SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY USED TO CALCULATE FINANCIAL ASSISTANCE | THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. |
| SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES | GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS SUPPORTS MANY PROGRAMS THAT ARE OFFERED AT NOMINAL CHARGE OR FREE TO THE COMMUNITY AT LARGE. THESE PROGRAMS INCLUDE BUT ARE NOT LIMITED TO AN ANNUAL FITNESS RUN/WALK, SEMI-ANNUAL BLOOD DRIVES, MONTHLY SUPPORT GROUP FOR SUFFERERS OF DYSPHAGIA, AND PERIODIC PRESENTATIONS ON NUTRITION EDUCATION. THE COST TO PROVIDE THESE SERVICES IS OUTLINED IN THE COMMUNITY BENEFITS SCHEDULE. |
| SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE - METHODOLOGY USED TO ESTIMATE AMOUNT | THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE CONSOLIDATED FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. |
| SCHEDULE H, PART III, LINE 3 BAD DEBT EXPENSE METHODOLOGY | 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 THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. |
| SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE - FINANCIAL STATEMENT FOOTNOTE | THE ORGANIZATION IS PART OF THE GUNDERSEN HEALTH SYSTEM'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGE 9. |
| SCHEDULE H, PART III, LINE 8 COMMUNITY BENEFIT & METHODOLOGY FOR DETERMINING MEDICARE COSTS | GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND, AS SUCH, A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN INCLUDES ONLY A PORTION OF THE TOTAL GROSS MEDICARE REVENUE TRI-COUNTY RECEIVES AND DOES NOT CONSIDER ALL OF THE CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST OR URGENT CARE PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHOD AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT TRI-COUNTY PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF TREMPEALEAU COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES, WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHO ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. |
| SCHEDULE H, PART III, LINE 9B COLLECTION PRACTICES FOR PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE | THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. |
| SCHEDULE H, PART V, SECTION B, LINE 16A FAP WEBSITE | - TRI-COUNTY MEMORIAL HOSPITAL, INC.: LINE 16A URL: HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/; |
| SCHEDULE H, PART V, SECTION B, LINE 16B FAP APPLICATION WEBSITE | - TRI-COUNTY MEMORIAL HOSPITAL, INC.: LINE 16B URL: HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/; |
| SCHEDULE H, PART V, SECTION B, LINE 16C FAP PLAIN LANGUAGE SUMMARY WEBSITE | - TRI-COUNTY MEMORIAL HOSPITAL, INC.: LINE 16C URL: HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE/; |
| SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT | IN ADDITION, GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS MAINTAINS A PATIENT ADVISORY COMMITTEE OF COMMUNITY MEMBERS WHO MEET QUARTERLY, PROVIDE INPUT, AND ARE INVOLVED IN PROPOSED CHANGES TO CERTAIN ASPECTS OF THE ORGANIZATION'S OPERATIONS. THE ORGANIZATION IS ALSO AN ACTIVE MEMBER OF THE COMMUNITY. BY COLLABORATING WITH LOCAL LAW ENFORCEMENT, LOCAL SCHOOL DISTRICTS, AND OTHER ORGANIZATIONS AND PARTICIPATING IN VARIOUS COMMUNITY EVENTS, GUNDERSEN TRI-COUNTY IS ABLE TO REMAIN KNOWLEDGEABLE ABOUT THE COMMUNITY'S HEALTH NEEDS. ADDITIONALLY, MUCH OF GUNDERSEN TRI-COUNTY'S MANAGEMENT PARTICIPATES IN ROUNDTABLES OR OTHER PROFESSIONAL NETWORKING ACTIVITIES IN ORDER TO REMAIN KNOWLEDGEABLE ABOUT CURRENT HEALTHCARE ISSUES. |
| SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE ORGANIZATION'S WEBSITE AND AT EVERY REGISTRATION POINT THERE IS A POSTER ABOUT PROGRAMS THAT EXIST TO HELP PATIENTS PAY FOR THEIR CARE. ALL PATIENTS WHO HAVE SELF-PAY BALANCES (EITHER UNINSURED OR SELF-PAY AFTER INSURANCE) ARE MADE AWARE OF AVAILABLE ASSISTANCE VIA STATEMENT MESSAGES AND COURTESY NOTICES. PHONE CALLS TO FOLLOW UP WITH PATIENTS ARE ALSO MADE IN CASES WHERE MAIL IS RETURNED AS UNDELIVERABLE. |
| SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION | GUNDERSEN TRI-COUNTY HOSPITAL AND CLINICS, A FEDERALLY-DESIGNATED, CRITICAL ACCESS HOSPITAL, ALONG WITH ITS NURSING HOME, ASSISTED LIVING, AND THREE FEDERALLY DESIGNATED RURAL HEALTH CLINICS, SERVES THE CENTRAL AREA OF TREMPEALEAU COUNTY, WISCONSIN, AND PRIMARILY THE ZIP CODES OF WHITEHALL (54773), MONDOVI (54755), AND BLAIR (54616). AS AN AFFILIATE HOSPITAL OF THE GUNDERSEN LUTHERAN HEALTH SYSTEM OF LA CROSSE, WI, TRI-COUNTY ALSO SUPPORTS A GUNDERSEN-CONTRACTED INDUSTRIAL IN-PLANT EMPLOYEE AND DEPENDENTS PRIMARY CARE MEDICAL CLINIC IN NEARBY ARCADIA, AS WELL AS FEDERALLY DESIGNATED SKILLED NURSING FACILITY/NURSING FACILITIES IN WHITEHALL, PIGEON FALLS, AND BLAIR. TREMPEALEAU COUNTY IS SERVED BY TWO HOSPITALS, INCLUDING TRI-COUNTY IN WHITEHALL AND MAYO CLINIC HEALTH SYSTEM OAKRIDGE HOSPITAL IN OSSEO. THE PRIMARY CORE PART OF THIS SERVICE AREA CONTAINS A U.S. HEALTH AND HUMAN SERVICES (HHS) PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) OF THE GEOGRAPHICAL AREA TYPE, THE "CENTRAL TREMPEALEAU SERVICE AREA," COMPRISED OF CHIMNEY ROCK TOWNSHIP (RUSSELL, WI); BURNSIDE TOWNSHIP (INDEPENDENCE, WI); LINCOLN TOWNSHIP (WHITEHALL, WI); PIGEON TOWNSHIP (PIGEON FALLS, WI); AND PRESTON TOWNSHIP (BLAIR, WI). THIS PRIMARY CARE HPSA IS FLANKED ON THE EAST, NORTHEAST, AND SOUTH BY SIMILAR PRIMARY CARE GEOGRAPHIC AREA HPSAS FOR MONDOVI (NORTHERN HALF OF BUFFALO COUNTY), AUGUSTA/OSSEO SERVICE AREA (PARTS OF TREMPEALEAU, EAU CLAIRE, AND JACKSON COUNTIES), AND GALESVILLE/TREMPEALEAU (SOUTHERN HALF OF TREMPEALEAU COUNTY), RESPECTIVELY. TRI-COUNTY SERVES PATIENTS FROM ALL OF THESE AREAS. |
| SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH | A NUMBER OF MEMBERS OF TRI-COUNTY'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. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS TO BETTER MEET THE DEMANDS AND REQUESTS OF PATIENTS. TRI-COUNTY PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, TRI-COUNTY BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. TRI-COUNTY, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: PRIMARY HEALTH CARE AND DIAGNOSIS, DIAGNOSTIC RADIOLOGY, EMERGENCY SERVICES, URGENT CARE, SKILLED NURSING, INFUSION SERVICES, SWING BED SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH PATHOLOGY, SURGICAL SERVICES, WOMEN'S SERVICES, AND ASSISTED LIVING SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. |
| SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM | THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. |
| SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE | GrantTypeTxt |
| Recipient | 736 | RecipientCnt |
| Cash Grant | $1,181,432 | CashGrantAmt |
| Valuation Method Used | COST | ValuationMethodUsedDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS | FormAndLineReferenceDesc |
| Explanation | WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN "INABILITY TO PAY", A TRI-COUNTY MEMORIAL HOSPITAL REVENUE CYCLE REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A FINANCIAL HARDSHIP APPLICATION (FHA) AND EXPLICIT INSTRUCTIONS FOR ITS COMPLETION ALONG WITH A REQUEST FOR ANY DOCUMENTS NECESSARY TO VERIFY POTENTIAL PATIENT ASSETS AND LIABILITIES. AFTER RECEIPT OF THE PACKET IT IS THEN REVIEWED AS COMPILED AND PUT ONTO A SLIDING POVERTY DETERMINATION SCALE. AN ANNUAL COMPLIANCE AUDIT IS COMPLETED TO ENSURE ALL POLICY STANDARDS ARE BEING FOLLOWED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARILU BINTZ MD | ||||||||||||||
| BOARD OF DIRECTORS, SECRETARY, (BEG 1.1.25) | $0 | $109,201 | $0 | $100,000 | $0 | $51,959 | $0 | $36,295 | $0 | $2,332 | $0 | $299,787 | $0 | $0 |
| VICKIE BAKALARS | ||||||||||||||
| BOD, VICE CHAIRMAN, CLINICAL OPERATIONS DIRECTOR | $0 | $155,710 | $0 | $0 | $0 | $1,596 | $0 | $22,779 | $0 | $26,658 | $0 | $206,743 | $0 | $0 |
| THERESE BINFET | ||||||||||||||
| BOD, CLINICAL OPERATIONS DIRECTOR | $0 | $181,921 | $0 | $0 | $0 | $2,212 | $0 | $26,028 | $0 | $23,667 | $0 | $233,828 | $0 | $0 |
| KIMBERLY BREIDENBACH | ||||||||||||||
| BOARD OF DIRECTORS, MD | $0 | $345,356 | $0 | $27,000 | $0 | $4,471 | $0 | $48,300 | $0 | $23,667 | $0 | $448,794 | $0 | $0 |
| LAURA KLOSS | ||||||||||||||
| BOD, CLINICAL OPERATIONS DIRECTOR, (BEG 1.1.25) | $0 | $149,379 | $0 | $0 | $0 | $7,452 | $0 | $23,341 | $0 | $26,964 | $0 | $207,136 | $0 | $0 |
| STEVE LITTLE | ||||||||||||||
| FORMER CHIEF FINANCIAL OFFICER | $0 | $209,856 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $209,856 | $0 | $0 |
| JOHN CEELEN | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $598,104 | $0 | $129,468 | $0 | $744 | $0 | $29,147 | $0 | $24,905 | $0 | $782,368 | $0 | $0 |
| SCOTT RATHGABER MD | ||||||||||||||
| CEO | $0 | $1,278,368 | $0 | $0 | $0 | $45,907 | $0 | $48,300 | $0 | $24,975 | $0 | $1,397,550 | $0 | $0 |
| DANIEL COENEN | ||||||||||||||
| ADMINISTRATOR | $0 | $133,985 | $0 | $0 | $0 | $31,464 | $0 | $23,568 | $0 | $24,154 | $0 | $213,171 | $0 | $0 |
| KRISTY MILLERING | ||||||||||||||
| FINANCE ADMINISTRATOR | $0 | $130,279 | $0 | $0 | $0 | $1,075 | $0 | $18,798 | $0 | $23,602 | $0 | $173,754 | $0 | $0 |
| WADE BERTELSEN | ||||||||||||||
| RN, ACUTE HOSPITAL - TRI-COUNTY | $150,318 | $0 | $4,579 | $0 | $1,594 | $0 | $22,559 | $0 | $24,788 | $0 | $203,838 | $0 | $0 | $0 |
| KATHLEEN CAIN | ||||||||||||||
| MANAGER, PHARMACY | $195,436 | $0 | $4,858 | $0 | $394 | $0 | $27,921 | $0 | $17,770 | $0 | $246,379 | $0 | $0 | $0 |
| JASMINE FOLKEDAHL | ||||||||||||||
| RN, ACUTE HOSPITAL (WEO) - TRI-COUNTY | $163,312 | $0 | $4,906 | $0 | $116 | $0 | $23,737 | $0 | $16,501 | $0 | $208,572 | $0 | $0 | $0 |
| GANESH RAM | ||||||||||||||
| PA - TRI COUNTY ER | $201,636 | $0 | $0 | $0 | $1,499 | $0 | $28,229 | $0 | $334 | $0 | $231,698 | $0 | $0 | $0 |
| CARLA SENDELBACH | ||||||||||||||
| RN, ACUTE HOSPITAL - TRI-COUNTY | $142,636 | $0 | $5,912 | $0 | $3,909 | $0 | $21,730 | $0 | $23,190 | $0 | $197,377 | $0 | $0 | $0 |
| JONI OLSON | ||||||||||||||
| ADMINISTRATOR | $0 | $165,292 | $0 | $0 | $0 | $4,098 | $0 | $23,561 | $0 | $17,662 | $0 | $210,613 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 3 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION | A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. |
| SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II, PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTUTE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN FOR CALENDAR YEAR 2024: JOHN CEELEN |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2022-02-02 | BondIssuedDt |
| Issue Price | $40,000,000 | IssuePriceAmt |
| Purpose | (SEE STATEMENT) | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,079,167 | RetiredAmt |
| Total Proceeds | $40,000,000 | TotalProceedsAmt |
| Capitalized Interest | $1,613,870 | CapitalizedInterestAmt |
| Capital Expenditures | $38,386,130 | CapitalExpendituresAmt |
| Substantial Completion | 2024 | SubstantialCompletionYr |
| Refunding Tax Exempt Bonds | false | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Engage Bond Counsel Research | false | EngageBondCounselResearchInd |
| Private Bus Use By Others | 0 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.0 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropPct |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Term Of Hedge | 0 | TermOfHedgePct |
| Superintegrated Hedge | false | SuperintegratedHedgeInd |
| Hedge Terminated | false | HedgeTerminatedInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Term Of GIC | 0 | TermOfGICPct |
| Regulatory Safe Harbor Stsfd | false | RegulatorySafeHarborStsfdInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE K, PART I, COLUMN (F) | FormAndLineReferenceDesc |
| Explanation | PROCEEDS OF THE BONDS WERE USED TO FINANCE (I) THE ACQUISITION, CONSTRUCTION, RENOVATION, REMODELING AND EQUIPPING OF CERTAIN HOSPITAL, MEDICAL CLINIC, ADMINISTRATIVE AND RELATED HEALTH CARE FACILITIES OF THE CORPORATION, INCLUDING CONSTRUCTION OF A 68,000 SQUARE FOOT REPLACEMENT HOSPITAL AND RENOVATION OF AN EXISTING MEDICAL CLINIC AND (II) CAPITALIZED INTEREST RELATING THERETO. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, LINE 15A | COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THE CEO AND KEY EXECUTIVES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD SUPPORTED BY MARKET DATA FROM SURVEYS AND AN INDEPENDENT CONSULTANTS REPORT. THE COMPENSATION IS DETERMINED BY MEMBERS OF THE EXECUTIVE COMMITTEE WITHOUT CONFLICT AND IS DOCUMENTED. CEO COMPENSATION: CEO PRESENTS RESULTS OF PERFORMANCE OBJECTIVES TO THE EXECUTIVE COMMITTEE IN JANUARY OF EACH YEAR. THE CHAIR APPLIES A FORMULA TO THE RESULTS AND COMES UP WITH A RECOMMENDATION. THE CHAIR FACILITIES GETTING APPROVAL FROM OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. |
| FORM 990, PART VI, LINE 15B | SENIOR LEADERS: COMPENSATION IS DETERMINED BY A RELATED ORGANIZATION. COMPENSATION FOR THOSE WHO REPORT TO THE CEO IS TAKEN TO THE EXECUTIVE COMMITTEE FOR DISCUSSION/APPROVAL. |
| FORM 990, PART VI, LINE 3 DELEGATION OF MANAGEMENT DUTIES | AS AN AFFILIATE OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TRI-COUNTY WILL ROUTINELY DELEGATE VARIOUS MANAGEMENT OR SUPPORT FUNCTIONS TO RELATED ENTITIES. FOR EXAMPLE, THE CEO AND CFO OF TRI-COUNTY ARE EMPLOYED BY THE HOME OFFICE OF THE PARENT ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. SEVERAL MEMBERS OF THE BOARD OF DIRECTORS ARE ALSO EMPLOYEES OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. AND ITS AFFILIATED ORGANIZATIONS, WHICH ARE ALSO TAX-EXEMPT ORGANIZATIONS. |
| FORM 990, PART VI, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS | THE ARTICLES OF INCORPORATION OF TRI-COUNTY PROVIDE FOR TWO CLASSES OF MEMBERSHIP IN THE CORPORATION. THE FIRST CLASS OF MEMBERSHIP IS A CORPORATE MEMBER CLASS, AND THE SOLE MEMBER OF THIS CLASS IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE SECOND CLASS OF MEMBERSHIP IS A PUBLIC MEMBERSHIP, WHICH IS MADE UP OF PERSONS OVER THE AGE OF 18 WHO ARE INTERESTED IN PROMOTING AIMS, PURPOSES, AND WELFARE OF TRI-COUNTY. |
| FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODY | THE ARTICLES OF INCORPORATION OF TRI-COUNTY PROVIDE FOR TWO CLASSES OF MEMBERSHIP. ONE CLASS IS HELD BY A SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., WHICH MAY APPOINT SEVEN OF THE TWELVE MEMBERS OF THE BOARD OF DIRECTORS. GUNDERSEN ALSO HAS THE RESERVE RIGHT TO APPROVE OR DISAPPROVE OF THE OTHER FIVE MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERS | APPROVAL OF TRI-COUNTY'S OPERATING BUDGET AND PLAN, CAPITAL EXPENDITURES GREATER THAN $10,000, ADDITIONAL INDEBTEDNESS OVER $10,000, DISAFFILIATION, AND AMENDMENTS OR CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS IS SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS OF ITS MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. |
| FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY | THE FORM 990 IS REVIEWED BY THE ACCOUNTING MANAGER AND PRINCIPAL OFFICER. IT WILL BE MADE AVAILABLE FOR ALL BOARD MEMBERS BEFORE FILING. |
| FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY | GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES, INC. (GLAS) ANNUALLY REQUIRES EXECUTIVE LEADERSHIP (VICE PRESIDENTS AND ABOVE), BOARD MEMBERS, MEDICAL GOVERNORS AND FOUNDATION BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED DISCLOSURE STATEMENTS ARE REVIEWED BY A CONFLICT OF INTEREST REVIEW PANEL WHICH INCLUDES REPRESENTATIVES FROM LEGAL, COMPLIANCE, MEDICAL LEADERSHIP, HUMAN RESOURCES AND SUPPLY CHAIN. INDIVIDUALS REPORTING A POTENTIAL CONFLICT OF INTEREST ARE SENT A RESOLUTION THANKING THEM FOR THEIR SERVICE TO THE ORGANIZATION, ADVISING THEM OF ANY RESTRICTIONS RELATED TO THEIR CONFLICT (I.E. INDIVIDUALS WITH A RELATIONSHIP TO ANOTHER ORGANIZATION ARE ADVISED THAT THEY MUST ABSTAIN FROM DECISION MAKING THAT WOULD DIRECTLY AND SOLELY IMPACT GLAS) AND REMINDING THEM OF THEIR CONFIDENTIALITY OBLIGATIONS WITH RESPECT TO GLAS' HEALTHCARE, EMPLOYMENT AND PROPRIETARY INFORMATION. |
| FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC | TRI-COUNTY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. |
| FORM 990, PART VIII, LINE 2F OTHER PROGRAM SERVICE REVENUE | - TOTAL REVENUE: , RELATED OR EXEMPT FUNCTION REVENUE: , UNRELATED BUSINESS REVENUE: , REVENUE EXCLUDED FROM TAX UNDER SECTIONS 512, 513, OR 514: ; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| BELLIN GUNDERSEN HEALTH SYSTEM INC | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 920504278 | SUPPORT ORG | WI | 501(C)(3) | TYPE III-FI | NA | false |
| GUNDERSEN LUTHERAN HEALTH SYSTEM INC | ||||||||||
| 1836 SOUTH AVE | LA CROSSE | WI | 54601 | 391866425 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BGHS | false |
| GUNDERSEN LUTHERAN MEDICAL CENTER INC | ||||||||||
| 1910 SOUTH AVE | LA CROSSE | WI | 54601 | 390813416 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| GUNDERSEN CLINIC LTD | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391028657 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| GUNDERSEN LUTHERAN ADMINISTRATIVE SERVICES INC | ||||||||||
| 1910 SOUTH AVE | LA CROSSE | WI | 54601 | 391606449 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | GLHS | false |
| GUNDERSEN LUTHERAN MEDICAL FOUNDATION INC | ||||||||||
| 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391249705 | FOUNDATION | WI | 501(C)(3) | 7 | GLHS | false |
| HARMONY COUMMUNITY HEALTHCARE INC | ||||||||||
| 815 MAIN AVE | SOUTH HARMONY | MN | 55939 | 410711606 | HEALTHCARE | MN | 501(C)(3) | 10 | GLHS | false |
| TWEETEN LUTHERAN HEALTHCARE CENTER INC | ||||||||||
| 125 FIFTH AVE SE | SPRING GROVE | MN | 55974 | 411565003 | HEALTHCARE | MN | 501(C)(3) | 10 | GLHS | false |
| TRI STATE AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391965415 | MEDICAL TRANSPORT | WI | 501(C)(3) | 3 | GLHS | false |
| TRI-STATE REGIONAL AMBULANCE INC | ||||||||||
| 235 CAUSEWAY BOULEVARD | LA CROSSE | WI | 54603 | 391962965 | MEDICAL TRANSPORT | WI | 501(C)(3) | 10 | GLHS | false |
| LUTHERAN REAL ESTATE HOLDING CORPORATION | ||||||||||
| 1910 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391480826 | HOUSING | WI | 501(C)(3) | TYPE III-FI | GLHS | false |
| COMMUNITY HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391586700 | INDEPENDENT LIVING | WI | 501(C)(3) | 10 | LREH CORP | false |
| LUTHERAN HOUSING OF LA CROSSE INC | ||||||||||
| 1900 SOUTH AVENUE | LA CROSSE | WI | 54601 | 391751934 | INDEPENDENT LIVING | WI | 501(C)(3) | 10 | LREH CORP | false |
| ST JOSEPH'S HEALTH SERVICES INC | ||||||||||
| 400 WATER AVE | HILLSBORO | WI | 54634 | 390929538 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| ST JOSEPH MEMORIAL FOUNDATION INC | ||||||||||
| 400 WATER AVE | HILLSBORO | WI | 54634 | 391455787 | FOUNDATION | WI | 501(C)(3) | TYPE I | STJ HLTH SVC | false |
| TRI-COUNTY MEMORIAL FOUNDATION INC | ||||||||||
| 18601 LINCOLN STREET | WHITEHALL | WI | 54773 | 300093022 | FOUNDATION | WI | 501(C)(3) | TYPE I | TCH | Yes (true) |
| MEMORIAL HOSPITAL OF BOSCOBEL | ||||||||||
| 205 PARKER STREET | BOSCOBEL | WI | 53805 | 390845590 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| PALMER LUTHERAN HEALTH CENTER INC | ||||||||||
| 112 JEFFERSON STREET | WEST UNION | IA | 52175 | 421320763 | HEALTHCARE | IA | 501(C)(3) | 3 | GLHS | false |
| MOUNDVIEW MEMORIAL HOSPITALS AND CLINICS | ||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 390944012 | HEALTHCARE | WI | 501(C)(3) | 3 | GLHS | false |
| MEMORIAL HEALTHCARE FOUNDATION INC | ||||||||||
| 402 WEST LAKE STREET | FRIENDSHIP | WI | 53934 | 391775074 | FOUNDATION | WI | 501(C)(3) | TYPE I | MDV HOSP | false |
| SAINT ELIZABETH'S HOSPITAL OF WABASHA INC | ||||||||||
| 1200 FIFTH GRANT BLVD WEST | WABASHA | MN | 55981 | 410693877 | HEALTHCARE | MN | 501(C)(3) | 3 | GLHS | false |
| BELLIN HEALTH SYSTEMS INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512904 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BGHS | false |
| LAKE MICHIGAN HEALTH SERVICES INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 391512903 | SUPPORT ORG | WI | 501(C)(3) | TYPE II | BHS | false |
| BELLIN COLLEGE INC | ||||||||||
| 3201 EATON ROAD | GREEN BAY | WI | 54311 | 391620530 | EDUCATION | WI | 501(C)(3) | 2 | BHS | false |
| BELLIN PSYCHIATRIC CENTER INC | ||||||||||
| PO BOX 23725 | GREEN BAY | WI | 54301 | 391657627 | HEALTHCARE | WI | 501(C)(3) | 3 | BHS | false |
| BELLIN MEMORIAL HOSPITAL INC | ||||||||||
| 744 SOUTH WEBSTER AVE | GREEN BAY | WI | 54301 | 390884478 | HEALTHCARE | WI | 501(C)(3) | 3 | BHS | false |
| THE BELLIN HEALTH FOUNDATION INC | ||||||||||
| PO BOX 23400 | GREEN BAY | WI | 54301 | 391809171 | FOUNDATION | WI | 501(C)(3) | 7 | BHS | false |
| OCONTO HOSPITAL & MEDICAL CENTER INC | ||||||||||
| 820 ARBUTUS AVENUE | OCONTO | WI | 54153 | 061745397 | HEALTHCARE | WI | 501(C)(3) | 3 | BMH | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Address Line1ForeignAddress/AddressLine1Txt | Address Line2ForeignAddress/AddressLine2Txt | CityForeignAddress/CityNm | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GUNDERSEN EDGE LLC | ||||||||||||||||
| 921783811 | OTHER | WI | NA | C CORPORATION | false | |||||||||||
| BEL-REGIONAL HOME MEDICAL INC | ||||||||||||||||
| 391504766 | DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS | WI | NA | C CORPORATION | false | 617 S ROOSEVELT | GREEN BAY | WI | 54301 | |||||||
| GUNDERSEN ENVISION LLC | ||||||||||||||||
| 264706546 | RENEWABLE ENERGY | WI | NA | C CORPORATION | false | 1836 SOUTH AVENUE | LA CROSSE | WI | 54601 | |||||||
| BG ASSURANCE COMPANY | ||||||||||||||||
| SELF INSURANCE | NA | C CORPORATION | false | 20 GENESIS CLOSE | PO BOX 30600 | GEORGE TOWN | GRAND CAYMAN | CJ | KY11203 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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