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Nonprofiteer
← MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC

Form 990 for tax year 2022

Filed by MOUNDVIEW MEMORIAL HOSPITAL & CLINICS INC.

Totals

Total revenue
$29,396,243
Total expenses
$29,053,572
Contributions and grants received
$596,964
Grants paid
$551,107
Program service revenue
$28,523,764
Investment income
$67,633
Other revenue
$207,882
Total assets, end of year
$19,154,587
Total liabilities, end of year
$2,121,251
Net assets or fund balances, end of year
$17,033,336
Program services expenses (Part IX)
$25,093,319
Management and general expenses
$3,960,253
Fundraising expenses
$0
Program service expenses (Part III)
$25,093,319

Program services were 86.4% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $40,503

  • 1e · Government grants (contributions)

    $556,432

  • 1f · All other contributions, gifts and grants

    $29

  • 2a · Program service revenue: NET PATIENT SERVICE REVENUE

    total $18,771,761 · related or exempt $18,771,761

  • 2b · Program service revenue: PHARMACY

    total $9,691,066 · related or exempt $9,691,066

  • 2c · Program service revenue: MEDICAL BUILDING RENT

    total $52,046 · related or exempt $52,046

  • 2f · All other program service revenue

    total $8,891 · related or exempt $8,891

  • 3 · Investment income

    total $155,019 · excluded $155,019

  • 6a · Gross rents

    real property $17,983

  • 6b · Less rental expenses

    real property $12,316

  • 6c · Rental income or loss

    real property $5,667

  • 6d · Net rental income or loss

    total $5,667 · excluded $5,667

  • 7b · Less cost or other basis and sales expenses

    securities $84,001 · other assets $3,385

  • 7c · Gain or loss

    securities -$84,001 · other assets -$3,385

  • 7d · Net gain or loss

    total -$87,386 · excluded -$87,386

  • 11a · Other revenue: E.H.R INCENTIVE

    total $65,803 · related or exempt $65,803

  • 11b · Other revenue: CAFETERIA

    total $22,607 · excluded $22,607

  • 11d · All other revenue

    total $113,805 · excluded $113,805

  • 11e · Other revenue, total

    $202,215

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $551,107 · program services $551,107

  • 5 · Compensation of officers, directors and key employees

    total $222,331 · management and general $222,331

  • 7 · Other salaries and wages

    total $7,501,201 · program services $6,311,557 · management and general $1,189,644

  • 8 · Pension plan contributions

    total $116,956 · program services $94,860 · management and general $22,096

  • 9 · Other employee benefits

    total $1,121,807 · program services $888,772 · management and general $233,035

  • 10 · Payroll taxes

    total $509,432 · program services $409,740 · management and general $99,692

  • 11b · Fees: legal

    total $117,380 · management and general $117,380

  • 11c · Fees: accounting

    total $42,850 · management and general $42,850

  • 11d · Fees: lobbying

    total $2,985 · management and general $2,985

  • 11g · Fees: other

    total $8,863,144 · program services $7,291,330 · management and general $1,571,814

  • 12 · Advertising and promotion

    total $54,962 · program services $1,593 · management and general $53,369

  • 13 · Office expenses

    total $526,452 · program services $389,085 · management and general $137,367

  • 14 · Information technology

    total $21,698 · program services $21,698

  • 16 · Occupancy

    total $361,327 · program services $326,718 · management and general $34,609

  • 17 · Travel

    total $42,859 · program services $39,118 · management and general $3,741

  • 19 · Conferences, conventions and meetings

    total $23,111 · program services $14,464 · management and general $8,647

  • 20 · Interest

    total $2,134 · program services $1,921 · management and general $213

  • 22 · Depreciation, depletion and amortization

    total $659,129 · program services $593,216 · management and general $65,913

  • 23 · Insurance

    total $58,504 · program services $574 · management and general $57,930

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $7,267,808 · program services $7,267,808

  • 24b · Other expenses: BAD DEBT EXPENSE

    total $333,503 · program services $333,503

  • 24c · Other expenses: EQUIPMENT REPAIRS AND M

    total $300,647 · program services $286,405 · management and general $14,242

  • 24d · Other expenses: PHARMACY DRUGS AND VACC

    total $218,949 · program services $218,949

  • 24e · All other expenses

    total $133,296 · program services $50,901 · management and general $82,395

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,176 · end of year $875

  • 2 · Savings and temporary cash investments

    beginning of year $11,776,826 · end of year $9,233,752

  • 4 · Accounts receivable

    beginning of year $2,254,866 · end of year $2,492,118

  • 8 · Inventories for sale or use

    beginning of year $587,479 · end of year $635,752

  • 9 · Prepaid expenses and deferred charges

    beginning of year $106,584 · end of year $59,090

  • 10a · Land, buildings and equipment: cost or other basis

    $8,847,300

  • 10b · Land, buildings and equipment: accumulated depreciation

    $3,177,170

  • 10c · Land, buildings and equipment, net

    beginning of year $5,556,443 · end of year $5,670,130

  • 14 · Intangible assets

    beginning of year $760,833 · end of year $744,167

  • 15 · Other assets

    beginning of year $683,138 · end of year $318,703

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,063,000 · end of year $1,349,717

  • 19 · Deferred revenue

    beginning of year $3,183 · end of year $41,076

  • 23 · Secured mortgages and notes payable

    beginning of year $111,687 · end of year $226,262

  • 25 · Other liabilities

    beginning of year $3,858,810 · end of year $504,196

  • 27 · Net assets without donor restrictions

    beginning of year $16,064,689 · end of year $16,500,336

  • 28 · Net assets with donor restrictions

    beginning of year $625,976 · end of year $533,000

Mission and programs · 2022

Mission

WE WILL DISTINGUISH OURSELVES THROUGH EXCELLENCE IN PATIENT CARE, EDUCATION, AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE.

Activities or mission (Part I)

WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF.

  • THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSED FOR 25 BEDS. DURING FISCAL YEAR 2022, THE HOSPITAL HAD 375 ACUTE INPATIENT DAYS AND 750 SWING-BED DAYS. THE HOSPITAL ALSO HAD 7,022 EMERGENCY ROOM/URGENT CARE AND 8,447 CLINIC VISITS.

    Expenses $17,741,790 · Grants $551,107 · Revenue $18,898,501

  • THE HOSPITAL ALSO HAS AN OUTPATIENT PHARMACY THAT IS THE ONLY IN IT'S COUNTY (ADAMS, WI), AND IN 2022 FILLED 95,969 PRESCRIPTIONS.

    Expenses $7,351,529 · Revenue $9,691,066

As filed on the 2022 return.

Listed in Part VII

  • Richard Sternhagen

    CHAIR

    Total calculated
    $0
    Hours/week
    2.5 + 1 related

  • Paul Fisch

    VICE CHAIR

    Total calculated
    $52,144
    From this org
    $0
    From related orgs
    $46,800
    Other
    $5,344
    Hours/week
    2.5 + 40 related

  • Sarah Rossman

    SECRETARY

    Total calculated
    $159,615
    From this org
    $0
    From related orgs
    $150,665
    Other
    $8,950
    Hours/week
    2.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $148,119 related
    Bonus
    $0 + $1,617 related
    Other
    $0 + $929 related
    Deferred
    $0 + $6,008 related
    Nontaxable benefits
    $0 + $2,942 related
    Filer's total
    $0 + $159,615 related

  • Stephanie Carroll

    BOARD TRUSTEE/MD HOSPITALIST

    Total calculated
    $329,295
    From this org
    $0
    From related orgs
    $297,599
    Other
    $31,696
    Hours/week
    2.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $293,496 related
    Bonus
    $0 + $4,103 related
    Other
    $0
    Deferred
    $0 + $6,103 related
    Nontaxable benefits
    $0 + $25,593 related
    Filer's total
    $0 + $329,295 related

  • Bryan Erdmann

    BOARD TRUSTEE/COO

    Total calculated
    $356,744
    From this org
    $0
    From related orgs
    $316,306
    Other
    $40,438
    Hours/week
    2.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $304,833 related
    Bonus
    $0 + $601 related
    Other
    $0 + $10,872 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $28,238 related
    Filer's total
    $0 + $356,744 related

  • Roxanne Potts

    BOARD TRUSTEE/CLINICAL OPS. DIRECTOR

    Total calculated
    $183,946
    From this org
    $0
    From related orgs
    $157,034
    Other
    $26,912
    Hours/week
    2.5 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $150,022 related
    Bonus
    $0 + $591 related
    Other
    $0 + $6,421 related
    Deferred
    $0 + $5,418 related
    Nontaxable benefits
    $0 + $21,494 related
    Filer's total
    $0 + $183,946 related

  • Karen Miller

    BOARD TRUSTEE

    Total calculated
    $0
    Hours/week
    2.5

  • Joe Theisen

    BOARD TRUSTEE

    Total calculated
    $0
    Hours/week
    2.5

  • Frank Perez-Guerra

    CEO

    Total calculated
    $222,331
    From this org
    $0
    From related orgs
    $190,450
    Other
    $31,881
    Hours/week
    40 + 1 related

    Schedule J breakdown matched by us

    Base
    $0 + $185,365 related
    Bonus
    $0 + $519 related
    Other
    $0 + $4,566 related
    Deferred
    $0 + $7,737 related
    Nontaxable benefits
    $0 + $24,144 related
    Filer's total
    $0 + $222,331 related

  • Lisa Peters

    EMERGENCY DEPARTMENT MANAGER

    Total calculated
    $145,544
    From this org
    $111,016
    From related orgs
    $0
    Other
    $34,528
    Hours/week
    40

  • Brad Shaw

    IMPATIENT PHARMACY MANAGER

    Total calculated
    $153,224
    From this org
    $149,983
    From related orgs
    $0
    Other
    $3,241
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $149,279
    Bonus
    $488
    Other
    $216
    Deferred
    $1,800
    Nontaxable benefits
    $1,441
    Filer's total
    $153,224

  • Deena Kedrowski

    OUTPATIENT PHARMACY MANAGER

    Total calculated
    $190,685
    From this org
    $157,736
    From related orgs
    $0
    Other
    $32,949
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $156,521
    Bonus
    $183
    Other
    $1,032
    Deferred
    $4,926
    Nontaxable benefits
    $28,023
    Filer's total
    $190,685

  • Preston Pietrzak

    PHARMACIST

    Total calculated
    $151,497
    From this org
    $134,759
    From related orgs
    $0
    Other
    $16,738
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $134,520
    Bonus
    $23
    Other
    $216
    Deferred
    $4,083
    Nontaxable benefits
    $12,655
    Filer's total
    $151,497

  • David Brown

    PHARMACIST

    Total calculated
    $147,537
    From this org
    $146,362
    From related orgs
    $0
    Other
    $1,175
    Hours/week
    40

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
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.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

  • MOUNDVIEW MEMORIAL FOUNDATION

    $551,107

    TRANSFER OF ASSETS HELD IN CHARITIES AND DONATIONS TO FOUNDATION FOR DISBURSEMENT TO LOCAL NON-PROFITS FOR VARIOUS AID/PROGRAMS IN THE COMMUNITY

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • BEL-REGIONAL HOME MEDICAL INC

    C · DURABLE MEDICAL EQUIPMENT, RETAIL PHARMACY, FITNESS · WI

  • BELLIN INVESTMENTS INC

    C · OTHER · WI

  • GUNDERSEN ENVISION LLC

    C · RENEWABLE ENERGY · WI

Provenance

Return type
form_990
Tax year
2022
Filed
17 October 2023
IRS schema version
2022v5.0
Source object
202302969349300870

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