Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
HUDSON HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
405 STAGELINE ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
HUDSON, WI54016
D Employer identification number

39-0804125
E Telephone number

G Gross receipts $ 51,156,083
F Name and address of principal officer:
DOUGLAS E JOHNSON
405 STAGELINE ROAD
HUDSON,WI54016
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HUDSONHOSPITAL.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1950
M State of legal domicile: WI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 10
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 423
6 Total number of volunteers (estimate if necessary) ............. 6 160
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 668,392 111,274
9 Program service revenue (Part VIII, line 2g) ......... 49,973,456 49,921,798
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 186,275 14,566
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 329,534 319,660
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 51,157,657 50,367,298
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 16,025 2,985
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 29,620,422 31,123,066
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 17,875,680 18,213,087
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 47,512,127 49,339,138
19 Revenue less expenses. Subtract line 18 from line 12....... 3,645,530 1,028,160
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 68,750,038 69,924,323
21 Total liabilities (Part X, line 26)............. 28,349,627 28,219,328
22 Net assets or fund balances. Subtract line 21 from line 20..... 40,400,411 41,704,995
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: CARING FOR THE HEALTH OF OUR COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 43,506,501 including grants of $ 2,985 ) (Revenue $ 50,241,458 )
SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet43,506,501
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
Yes
 
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
423
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
No
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
No
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
No
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
10
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletDOUGLAS E JOHNSON - CHIEF FINANCIAL OFFICER405 STAGELINE ROADHUDSONWI54016 (715) 531-6013
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) SUSAN GILBERT........................................................................
DIRECTOR
 1.00
.......................   		X           0 0 0
(2) BILL GOLD MD........................................................................
DIRECTOR - CHAIR
 1.00
.......................   		X           0 0 0
(3) DENNIS HARTUNG MD........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(4) STEVE KIRBY........................................................................
DIRECTOR - VICE CHAIR
 1.00
.......................   		X           0 0 0
(5) RUTH MISENKO........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(6) PAUL SCOTT MD........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(7) MIKE SELLMAN........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(8) DIANA VANCE-BRYAN........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(9) GREG YOUNG MD........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(10) LINDA ZEITS........................................................................
DIRECTOR
 .50
.......................   		X           0 0 0
(11) MARIAN M FURLONG........................................................................
DIRECTOR & PRESIDENT
 47.50
.......................2.50 		X   X       0 297,817 52,536
(12) BURKE KEALEY MD........................................................................
DIRECTOR
 .50
.......................44.50 		X           0 410,969 96,052
(13) BROCK D NELSON........................................................................
DIRECTOR & SECRETARY
 .50
.......................54.50 		X           0 586,029 181,857
(14) SCOTT A SCHNUCKLE........................................................................
DIRECTOR
 .50
.......................49.50 		X           0 425,791 109,191
(15) STEVE MUELLERLEILE........................................................................
VP - PLANNING & DEVELOPMEN
 40.00
.......................   		    X       210,180 0 41,354
(16) ANN RIPLEY........................................................................
VP - OPERATIONS, COMPLIANCE
 55.00
.......................   		    X       167,484 0 35,644
(17) KARA A FEDIE........................................................................
NURSE ANESTHETIST
 40.00
.......................   		        X   217,982 0 34,440
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) KEITH W LARSON........................................................................
NURSE ANESTHETIST
 68.00
.......................   		        X   208,458 0 33,133
(19) CHERYLL A MARTINY-JORGENSEN........................................................................
SUPERVISOR - ANESTHESIA
 60.00
.......................   		        X   217,430 0 45,271
(20) JEFFREY L REICHEL........................................................................
NURSE ANESTHETIST
 40.00
.......................   		        X   227,479 0 40,263
(21) DANIELLE L TANSKI........................................................................
NURSE ANESTHETIST
 40.00
.......................   		        X   230,473 0 15,702


















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,479,486 1,720,606 685,443
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet24
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MCGOUGH CONSTRUCTION CONW 5870 PO BOX 1450MINNEAPOLISMN554855970 CONSTRUCTION 2,073,558
ZAPPA BROTHERS INC715 SIXTH STREETHUDSONWI54016 CONSTRUCTION 477,470
COMPUTERIZED MEDICAL IMAGING719 W HAMILTON AVE SUITE BEAU CLAIREWI54701 RADIOLOGY SERVICES 254,769
A M N HEALTHCARE ALLIED INCPO BOX 281939ATLANTAGA303841939 STAFFING 201,026
HUDSON PHYSICIANS403 STAGELINE RDHUDSONWI54016 PHYSICIAN SERVICES 197,913
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet13
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 20,000
e Government grants (contributions)1e 7,621
f All other contributions, gifts, grants, and
similar amounts not included above1f 		83,653
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 111,274
Program Service RevenueAmt Business Code
2a PATIENT SERVICE 623990 49,617,790 49,617,790    
b GIFT SHOP 453220 154,518 154,518    
c DIETARY 722210 148,019 148,019    
d OTHER HEALTH CARE 623990 1,471 1,471    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 49,921,798
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 14,566     14,566
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 1,108,445  
b Less: rental expenses 788,785  
c Rental income or (loss) 319,660  
d Net rental income or (loss).......MediumBullet 319,660 319,660    
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 50,367,298 50,241,458 0 14,566
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 2,985 2,985
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 454,662   454,662  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 26,856,691 24,219,699 2,636,992  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 416,678 377,140 39,538  
9 Other employee benefits ....... 2,030,655 1,837,968 192,687  
10 Payroll taxes ........... 1,364,380 1,234,916 129,464  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 74,563   74,563  
c Accounting ........... 1,500   1,500  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 2,257,259 1,753,847 503,412  
12 Advertising and promotion .... 305,506 3,613 301,893  
13 Office expenses ....... 380,134 89,637 290,497  
14 Information technology ...... 135,101 72,897 62,204  
15 Royalties ..        
16 Occupancy ........... 1,036,298 595,429 440,869  
17 Travel ............ 59,520 24,355 35,165  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 10,252 1,006 9,246  
20 Interest ........... 717,775 717,775    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 2,843,550 2,779,482 64,068  
23 Insurance .............. 217,480 343 217,137  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL & OFFICE SUPPLY 8,102,513 8,080,247 22,266  
b EQUIPMENT & MAINTENANCE 1,537,594 1,367,601 169,993  
c TAXES & ASSESSMENTS 305,481 305,481    
d OTHER EXPENSE 116,647 3,618 113,029  
e All other expenses 111,914 38,462 73,452  
25 Total functional expenses. Add lines 1 through 24e 49,339,138 43,506,501 5,832,637 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 23,887,319 2 24,486,368
3 Pledges and grants receivable, net ........... 95,503 3 150,133
4 Accounts receivable, net ............. 6,326,203 4 6,224,462
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 942,593 8 938,126
9 Prepaid expenses and deferred charges .......... 336,804 9 323,866
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 61,181,928
b Less: accumulated depreciation ..... 10b 28,700,625 31,964,416 10c 32,481,303
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 ..... 2,702,604 13 2,826,733
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 2,494,596 15 2,493,332
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 68,750,038 16 69,924,323
Liabilities 17 Accounts payable and accrued expenses ......... 6,958,760 17 7,923,991
18 Grants payable .................   18  
19 Deferred revenue ................ 375 19 576
20 Tax-exempt bond liabilities ............. 20,365,487 20 19,469,761
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 1,025,005 25 825,000
26 Total liabilities. Add lines 17 through 25......... 28,349,627 26 28,219,328
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 38,065,504 27 39,137,627
28 Temporarily restricted net assets ........... 2,253,217 28 2,485,678
29 Permanently restricted net assets ........... 81,690 29 81,690
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 40,400,411 33 41,704,995
34 Total liabilities and net assets/fund balances ........ 68,750,038 34 69,924,323
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
50,367,298
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
49,339,138
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
1,028,160
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
40,400,411
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
276,424
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
41,704,995
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
HUDSON HOSPITAL INC
  		Employer identification number

39-0804125
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
HUDSON HOSPITAL INC
  		Employer identification number

39-0804125
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
HUDSON HOSPITAL INC
  		Employer identification number

39-0804125
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
0
j
Total. Add lines 1c through 1i ...............................
0
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
PART II-B, LINE 1: HUDSON HOSPITAL, INC. PAYS FOR CERTAIN CORPORATE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 81,690 81,690 81,690 81,690 81,690
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ...... 81,690 81,690 81,690 81,690 81,690
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   12,143,402 12,143,402
b Buildings ................   31,376,037 18,108,267 13,267,770
c Leasehold improvements ............        
d Equipment ................   15,054,552 9,982,447 5,072,105
e Other .................   2,607,937 609,911 1,998,026
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 32,481,303
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
THIRD-PARTY PAYOR SETTLEMENTS 825,000








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 825,000
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 51,156,083
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 0
3 Subtract line 2e from line 1..................... 3 51,156,083
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b -788,785
c Add lines 4a and 4b....................... 4c -788,785
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 50,367,298
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 50,127,923
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 788,785
e Add lines 2a through 2d...................... 2e 788,785
3 Subtract line 2e from line 1..................... 3 49,339,138
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 49,339,138
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: HUDSON HOSPITAL, INC. HOLDS $81,690 OF PERMANENTLY RESTRICTED ASSETS RELATED TO HUDSON HOSPITAL, INC.'S BENEFICIAL INTEREST IN THE NET ASSETS OF HUDSON HOSPITAL FOUNDATION, INC., A RELATED ORGANIZATION OF HUDSON HOSPITAL, INC.
PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL PROPERTY EXPENSE -788,785.
PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL PROPERTY EXPENSE 788,785.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		  506 281,416 0 281,416 0.560 %
b Medicaid (from Worksheet 3,
column a) .... 		  4,524 4,964,942 4,769,081 195,861 0.390 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		  5,030 5,246,358 4,769,081 477,277 0.950 %
Other Benefits
 33 19,063 842,362 63,853 778,509 1.550 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		2 111 181,291 0 181,291 0.360 %
g Subsidized health services
(from Worksheet 6) .. 		7 14,046 2,116,585 0 2,116,585 4.220 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		8 157 39,183 0 39,183 0.080 %
j Total. Other Benefits .. 50 33,377 3,179,421 63,853 3,115,568 6.210 %
k Total. Add lines 7d and 7j . 50 38,407 8,425,779 4,832,934 3,592,845 7.160 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development 2   22,071 0 22,071 0.040 %
3 Community support 3   5,921 0 5,921 0.010 %
4 Environmental improvements 1   17,769 0 17,769 0.040 %
5 Leadership development and training for community members            
6 Coalition building 1 203 10,939 0 10,939 0.020 %
7 Community health improvement advocacy 2   4,269 0 4,269 0.010 %
8 Workforce development            
9 Other            
10 Total 9 203 60,969   60,969 0.120 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
945,307
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
11,289,971
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
11,289,971
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
 
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
12 WESTERN WISCONSIN CANCER CENTER
  		MEDICAL ONCOLOGY AND RADIATION 23.700 % 0 % 0 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 HUDSON HOSPITAL INC
405 STAGELINE ROAD
HUDSON,WI54016
WWW.HUDSONHOSPITAL.ORG
STATE OF WI 		X X     X   X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HUDSON HOSPITAL INC
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If "Yes," indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 3: AS PART OF THE DATA COLLECTION PROCESS FOR THE MOST RECENT CHNA THAT WAS CONDUCTED IN 2012, REPRESENTATIVES FROM COMMUNITY HOSPITAL CONSULTING CONDUCTED INTERVIEWS WITH TWENTY (20) STAKEHOLDERS FROM MARCH 14, 2012 - APRIL 6, 2012. INTERVIEWS WERE CONDUCTED WITH PEOPLE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY INCLUDING:- PEOPLE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.- FEDERAL, TRIBAL, REGIONAL, STATE OR LOCAL HEALTH DEPARTMENTS OR AGENCIES WITH INFORMATION RELEVANT TO THE HEALTH NEEDS OF COMMUNITY SERVED.- LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED.THE COUNTIES REPRESENTED INCLUDED WASHINGTON, DAKOTA, ST. CROIX AND RAMSEY. THE GOAL OF THE INTERVIEWS WAS TO GATHER OPINIONS AND PERCEPTIONS ON CURRENT HEALTH CARE ISSUES FACED IN THE COUNTIES SERVED AND/OR POPULATIONS REPRESENTED. FOR A FULL DETAILED LIST OF INSTITUTIONS AND PERSONS, PLEASE SEE THE 2012 HEALTHPARTNERS CHNA LOCATED AT OUR WEBSITE: HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 4: NEEDS ASSESSMENT IN CONJUNCTION WITH OTHER HOSPITALS OTHER HOSPITAL FACILITIES INCLUDED IN THE 2012 HEALTHPARTNERS CHNA WERE:- WESTFIELDS HOSPITAL, NEW RICHMOND, WI.- REGIONS HOSPITAL, ST. PAUL, MN.- LAKEVIEW HOSPITAL, STILLWATER, MN.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 7: UNADDRESSED IDENTIFIED NEEDS "INCREASE ACCESS TO DENTAL SERVICES" WAS IDENTIFIED AS THE SIXTH PRIORITY IN THE COMMUNITIES SERVED BY REGIONS, HUDSON HOSPITAL (HOSPITAL), LAKEVIEW AND WESTFIELDS. WHILE THIS IS A CONCERN IN THE COMMUNITY, THE TEAM DECIDED TO FOCUS THEIR EFFORTS ON THE OTHER FIVE PRIORITIES BECAUSE HEALTHPARTNERS DENTAL GROUP, A DIVISION OF GROUP HEALTH PLAN, INC., A STAFF MODEL HMO, IS CURRENTLY THE LEADING DENTAL CARE PROVIDER TO UNINSURED PEOPLE IN MINNEAPOLIS/ST. PAUL.WESTFIELDS DECIDED NOT TO PRIORITIZE "INCREASE ACCESS TO DENTAL CARE" FOR THE FOLLOWING REASONS: 1) DENTAL CARE IS NOT A CORE SERVICE LINE FOR THE HOSPITALS AND 2) HEALTHPARTNERS ALREADY PLACES SIGNIFICANT EMPHASIS ON DENTAL CARE SERVICES WITH ACCESS THROUGH ITS DENTAL PRACTICES AND FREE DENTAL CLINICS. THUS, THE NEED IS BEING ADDRESSED BY THE PARENT ORGANIZATION.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 14G: THE HOSPITAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN 2013, THE HOSPITAL PROVIDED $281,416 IN FINANCIAL ASSISTANCE. THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. TO INFORM AND EDUCATE PATIENTS ON ITS FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, THE HOSPITAL HAS DEVELOPED A FINANCIAL COUNSELING PROGRAM. WHEN A PATIENT VISITS THE HOSPITAL EMERGENCY DEPARTMENT OR IS ADMITTED, BASIC INFORMATION ABOUT INSURANCE STATUS IS REQUESTED. IF A PATIENT DOES NOT HAVE HEALTH INSURANCE, THE PATIENT FINANCIAL SERVICES DEPARTMENT IS CONTACTED TO MEET OR FOLLOW-UP WITH THE PATIENT. ALL PATIENTS WITHOUT INSURANCE AUTOMATICALLY QUALIFY FOR A DISCOUNT OF 20%, REGARDLESS OF INCOME. IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY ARE ELIGIBLE FOR FURTHER DISCOUNTS, THEY WILL BE REQUESTED TO PROVIDE ADDITIONAL INFORMATION. ENROLLMENT ASSISTANCE, INFORMATION, AND REFERRAL SERVICES ARE AVAILABLE TO HELP SECURE A PAYMENT SOURCE FOR UNINSURED AND UNDERINSURED PATIENTS. PATIENT FINANCIAL SERVICES, ADMINISTERED BY THE HOSPITAL BUSINESS OPERATIONS, HELPS PATIENTS ENROLL IN GOVERNMENT PROGRAMS, FIND OTHER SOURCES OF PAYMENT, OR ACCESS SERVICES BEYOND MEDICAL CARE. FINANCIAL INFORMATION (PAYMENT, BILLING AND INSURANCE COVERAGE) AND FINANCIAL ASSISTANCE OPPORTUNITIES ARE NOTED ON THE HOSPITAL WEB SITE, ON ALL BILLING STATEMENTS, AND IN THE PATIENT INFORMATION GUIDE, DISTRIBUTED TO ALL NEW PATIENTS. IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS A STAFF SOCIAL WORKER AND A CASE MANAGER TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 20D: THE HOSPITAL OFFERS A STANDARDIZED AND UNIFORM APPROACH TO OFFERING A DISCOUNT FOR THE UNINSURED. THE DISCOUNT IS 50% FOR ALL ELIGIBLE PATIENTS, REGARDLESS OF INCOME. THE HOSPITAL USES FPG FAMILY INCOME LIMIT OF 300% TO DETERMINE ELIGIBILITY FOR ADDITIONAL DISCOUNTED CARE ABOVE AND BEYOND THE 50%.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 3: AS PART OF THE DATA COLLECTION PROCESS FOR THE MOST RECENT CHNA THAT WAS CONDUCTED IN 2012, REPRESENTATIVES FROM COMMUNITY HOSPITAL CONSULTING CONDUCTED INTERVIEWS WITH TWENTY (20) STAKEHOLDERS FROM MARCH 14, 2012 - APRIL 6, 2012. INTERVIEWS WERE CONDUCTED WITH PEOPLE WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY INCLUDING:- PEOPLE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.- FEDERAL, TRIBAL, REGIONAL, STATE OR LOCAL HEALTH DEPARTMENTS OR AGENCIES WITH INFORMATION RELEVANT TO THE HEALTH NEEDS OF COMMUNITY SERVED.- LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED.THE COUNTIES REPRESENTED INCLUDED WASHINGTON, DAKOTA, ST. CROIX AND RAMSEY. THE GOAL OF THE INTERVIEWS WAS TO GATHER OPINIONS AND PERCEPTIONS ON CURRENT HEALTH CARE ISSUES FACED IN THE COUNTIES SERVED AND/OR POPULATIONS REPRESENTED. FOR A FULL DETAILED LIST OF INSTITUTIONS AND PERSONS, PLEASE SEE THE 2012 HEALTHPARTNERS CHNA LOCATED AT OUR WEBSITE: HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 4: NEEDS ASSESSMENT IN CONJUNCTION WITH OTHER HOSPITALS OTHER HOSPITAL FACILITIES INCLUDED IN THE 2012 HEALTHPARTNERS CHNA WERE:- WESTFIELDS HOSPITAL, NEW RICHMOND, WI.- REGIONS HOSPITAL, ST. PAUL, MN.- LAKEVIEW HOSPITAL, STILLWATER, MN.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 7: UNADDRESSED IDENTIFIED NEEDS "INCREASE ACCESS TO DENTAL SERVICES" WAS IDENTIFIED AS THE SIXTH PRIORITY IN THE COMMUNITIES SERVED BY REGIONS, HUDSON HOSPITAL (HOSPITAL), LAKEVIEW AND WESTFIELDS. WHILE THIS IS A CONCERN IN THE COMMUNITY, THE TEAM DECIDED TO FOCUS THEIR EFFORTS ON THE OTHER FIVE PRIORITIES BECAUSE HEALTHPARTNERS DENTAL GROUP, A DIVISION OF GROUP HEALTH PLAN, INC., A STAFF MODEL HMO, IS CURRENTLY THE LEADING DENTAL CARE PROVIDER TO UNINSURED PEOPLE IN MINNEAPOLIS/ST. PAUL.WESTFIELDS DECIDED NOT TO PRIORITIZE "INCREASE ACCESS TO DENTAL CARE" FOR THE FOLLOWING REASONS: 1) DENTAL CARE IS NOT A CORE SERVICE LINE FOR THE HOSPITALS AND 2) HEALTHPARTNERS ALREADY PLACES SIGNIFICANT EMPHASIS ON DENTAL CARE SERVICES WITH ACCESS THROUGH ITS DENTAL PRACTICES AND FREE DENTAL CLINICS. THUS, THE NEED IS BEING ADDRESSED BY THE PARENT ORGANIZATION.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 14G: THE HOSPITAL SERVES ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN 2013, THE HOSPITAL PROVIDED $281,416 IN FINANCIAL ASSISTANCE. THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. TO INFORM AND EDUCATE PATIENTS ON ITS FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, THE HOSPITAL HAS DEVELOPED A FINANCIAL COUNSELING PROGRAM. WHEN A PATIENT VISITS THE HOSPITAL EMERGENCY DEPARTMENT OR IS ADMITTED, BASIC INFORMATION ABOUT INSURANCE STATUS IS REQUESTED. IF A PATIENT DOES NOT HAVE HEALTH INSURANCE, THE PATIENT FINANCIAL SERVICES DEPARTMENT IS CONTACTED TO MEET OR FOLLOW-UP WITH THE PATIENT. ALL PATIENTS WITHOUT INSURANCE AUTOMATICALLY QUALIFY FOR A DISCOUNT OF 20%, REGARDLESS OF INCOME. IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY ARE ELIGIBLE FOR FURTHER DISCOUNTS, THEY WILL BE REQUESTED TO PROVIDE ADDITIONAL INFORMATION. ENROLLMENT ASSISTANCE, INFORMATION, AND REFERRAL SERVICES ARE AVAILABLE TO HELP SECURE A PAYMENT SOURCE FOR UNINSURED AND UNDERINSURED PATIENTS. PATIENT FINANCIAL SERVICES, ADMINISTERED BY THE HOSPITAL BUSINESS OPERATIONS, HELPS PATIENTS ENROLL IN GOVERNMENT PROGRAMS, FIND OTHER SOURCES OF PAYMENT, OR ACCESS SERVICES BEYOND MEDICAL CARE. FINANCIAL INFORMATION (PAYMENT, BILLING AND INSURANCE COVERAGE) AND FINANCIAL ASSISTANCE OPPORTUNITIES ARE NOTED ON THE HOSPITAL WEB SITE, ON ALL BILLING STATEMENTS, AND IN THE PATIENT INFORMATION GUIDE, DISTRIBUTED TO ALL NEW PATIENTS. IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS A STAFF SOCIAL WORKER AND A CASE MANAGER TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE.
HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 20D: THE HOSPITAL OFFERS A STANDARDIZED AND UNIFORM APPROACH TO OFFERING A DISCOUNT FOR THE UNINSURED. THE DISCOUNT IS 50% FOR ALL ELIGIBLE PATIENTS, REGARDLESS OF INCOME. THE HOSPITAL USES FPG FAMILY INCOME LIMIT OF 300% TO DETERMINE ELIGIBILITY FOR ADDITIONAL DISCOUNTED CARE ABOVE AND BEYOND THE 50%.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
Yes
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)MARIAN M FURLONGDIRECTOR & PRESIDENT (i)
(ii)		 0
244,033 		0
53,784 		0
0 		0
20,952 		0
31,584 		0
350,353 		0
0
(2)BURKE KEALEY MDDIRECTOR (i)
(ii)		 0
381,369 		0
29,600 		0
0 		0
49,887 		0
46,165 		0
507,021 		0
0
(3)BROCK D NELSONDIRECTOR & SECRETARY (i)
(ii)		 0
457,118 		0
128,911 		0
0 		0
140,570 		0
41,287 		0
767,886 		0
0
(4)SCOTT A SCHNUCKLEDIRECTOR (i)
(ii)		 0
306,826 		0
87,416 		0
31,549 		0
68,222 		0
40,969 		0
534,982 		0
21,066
(5)STEVE MUELLERLEILEVP - PLANNING & DEVELOPMEN (i)
(ii)		 177,521
0 		32,659
0 		0
0 		6,504
0 		34,850
0 		251,534
0 		0
0
(6)ANN RIPLEYVP - OPERATIONS, COMPLIANCE (i)
(ii)		 145,951
0 		21,533
0 		0
0 		5,153
0 		30,491
0 		203,128
0 		0
0
(7)KARA A FEDIENURSE ANESTHETIST (i)
(ii)		 217,982
0 		0
0 		0
0 		3,571
0 		30,869
0 		252,422
0 		0
0
(8)KEITH W LARSONNURSE ANESTHETIST (i)
(ii)		 208,458
0 		0
0 		0
0 		0
0 		33,133
0 		241,591
0 		0
0
(9)CHERYLL A MARTINY-JORGENSENSUPERVISOR - ANESTHESIA (i)
(ii)		 217,430
0 		0
0 		0
0 		3,571
0 		41,700
0 		262,701
0 		0
0
(10)JEFFREY L REICHELNURSE ANESTHETIST (i)
(ii)		 227,479
0 		0
0 		0
0 		3,301
0 		36,962
0 		267,742
0 		0
0
(11)DANIELLE L TANSKINURSE ANESTHETIST (i)
(ii)		 230,473
0 		0
0 		0
0 		0
0 		15,702
0 		246,175
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS: BROCK D. NELSON $ 41,192 SCOTT A. SCHNUCKLE 10,097 -------- TOTAL $ 51,289
PART I, LINE 6 HUDSON HOSPITAL, INC. (THE HOSPITAL) OFFICERS, DIRECTORS AND HIGHEST COMPENSATED EMPLOYEES ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY THE HOSPITAL. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM REGIONS, GHI OR THE HOSPITAL MANAGEMENT INCENTIVE PROGRAMS, WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. VICE PRESIDENT, DIRECTOR, MANAGER, OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE BUT ARE NOT LIMITED TO PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, EMPLOYEE AND/OR LEADERSHIP DEVELOPMENT, CARE DELIVERY, PATIENT EDUCATION, SIX AIMS, MARKET SHARE, STRATEGIC CAPABILITIES, FINANCIAL PERFORMANCE (NET MARGIN), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET MARGIN THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT.
990, SCH. J, PART II - PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTOR: SCOTT A. SCHNUCKLE $ 21,066 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S.
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number
39-0804125
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY
  		39-1337855 97710B6E7 10-03-2012 20,513,711 REFUNDING OF SERIES 2002 BONDS X     X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 1,043,949      
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 20,513,711      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . .        
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . . . . 20,513,711      
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . . X              
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?   X            
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
7 Does the bond issue meet the private security or payment test? . . . . . X              
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . . 		X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . .   X            
If you checked "No rebate due" in line 2c, provide in
Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K, PART III, LINES 3B, 3C & 3D HUDSON HOSPITAL USES INTERNAL LEGAL COUNSEL TO REVIEW ANY MANAGEMENT OR SERVICE CONTRACTS RELATING TO THE FINANCED PROPERTY. IF IT ENCOUNTERS UNUSUAL OR COMPLEX CONTRACTS IT WILL ENGAGE BOND COUNSEL OR OTHER OUTSIDE COUNSEL.
SCHEDULE K, PART V SINCE 12/31/2012 HUDSON HOSPITAL HAS UNDERTAKEN ESTABLISHING SUCH WRITTEN PROCEDURES.
Schedule K (Form 990) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Return Reference Explanation
990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS I. ORGANIZATION AND GOVERNANCE HUDSON HOSPITAL, INC. (HOSPITAL), A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT ORGANIZATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS (HEALTHPARTNERS), AN INTEGRATED SYSTEM OF HEALTH FINANCING, CARE DELIVERY, AND SUPPORT SERVICES PROVIDING HEALTH PLAN SERVICES TO OVER 1,165,000 MEMBERS AND DELIVERING CARE TO OVER 4,500,000 PATIENT ENCOUNTERS, PRIMARILY IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND IMPROVING AFFORDABILITY - ALL AT THE SAME TIME. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ENTITIES - INCLUDING FIVE HOSPITALS AND THEIR RELATED FOUNDATIONS, TWO HEALTH MAINTENANCE ORGANIZATIONS, FOUR NON-PROFIT PHYSICIAN GROUPS, HOME CARE, TRANSITIONAL CARE, MEDICAL EQUIPMENT, A THIRD PARTY ADMINISTRATOR THAT SERVES SELF INSURED EMPLOYERS, AND MANY MORE. A COMPLETE LISTING OF ALL HEALTHPARTNERS ORGANIZATIONS, FOR WHICH HPI IS THE PARENT ORGANIZATION AND THE REPORTING RELATIONSHIP BETWEEN EACH OF THOSE ORGANIZATIONS, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF THE HOSPITAL. GHI IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE HOSPITAL IS THE SOLE CORPORATE MEMBER OF HUDSON HOSPITAL FOUNDATION, INC., A FOUNDATION WHOSE PURPOSE IS TO SUPPORT THE HOSPITAL. HEALTHPARTNERS AND THE HOSPITAL ALSO PARTNER WITH OTHER PLANS, CARE PROVIDERS AND NON-PROFIT ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION; TO INCREASE ACCESS, CREATE AND DISSEMINATE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY AND COLLABORATE ON SYSTEM IMPROVEMENTS. THE HOSPITAL CONTINUES TO WORK IN PARTNERSHIP WITH OTHER HEALTHPARTNERS ORGANIZATIONS, HUDSON PHYSICIANS - WESTERN WISCONSIN MEDICAL ASSOCIATES (WWMA), AND THE COMMUNITY TO ALSO PROMOTE COMMUNITY HEALTH THROUGH CLINICAL INITIATIVES, EDUCATION AND OUTREACH, AND COMMUNITY HEALTH IMPROVEMENT EFFORTS SUCH AS HEALTHIER TOGETHER - ST. CROIX COUNTY. THE HOSPITAL CONTINUES TO BE AN INTEGRAL PART OF THE HUDSON COMMUNITY AND SURROUNDING AREA. THE HOSPITAL HAS BEEN A VITAL AND NECESSARY COMMUNITY RESOURCE SINCE 1953. IN 2011, 2012 AND 2013 THE NATIONAL RURAL HEALTH ASSOCIATION RANKED THE HOSPITAL IN THE TOP 100 CRITICAL ACCESS HOSPITALS IN AMERICA. THE JOINT COMMISSION AWARDED THE HOSPITAL FULL ACCREDITATION. THIS RECOGNITION IS A RESULT OF THE HOSPITAL'S ATTENTION TO QUALITY AND PATIENT SAFETY. PROGRAMS AND SERVICES INCLUDE: - A REGIONALLY POPULAR BIRTH CENTER, RANKED IN THE TOP 3% OF BIRTHING UNITS (TOP 50 HOSPITALS) NATIONWIDE FOR EXCEPTIONAL CARE DELIVERY; - 24/7 EMERGENCY CENTER (WITH MEDICAL HELICOPTER TRANSPORT SERVICE) STAFFED BY FULL-TIME, BOARD-CERTIFIED EMERGENCY MEDICINE PHYSICIANS; - GROWING SPECIALTY CLINICS - INCLUDING EXPANDED PEDIATRIC SPECIALTY SERVICES TO INCLUDE HEMATOLOGY AND ONCOLOGY (IN PARTNERSHIP WITH CHILDREN'S HOSPITALS & CLINICS AND HUDSON PHYSICIANS PEDIATRICIANS); - INTERNAL MEDICINE CLINIC, EXPANDED TO 2 PROVIDERS; - A HOSPITAL MEDICINE PROGRAM; - THE CANCER CENTER OF WESTERN WISCONSIN (CCWW) IN COLLABORATION WITH FIVE OTHER HOSPITALS AND TWO MEDICAL PROVIDER GROUPS. IT IS LOCATED ON THE WESTFIELDS HOSPITAL CAMPUS, A HOSPITAL WITHIN THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS, CCWW PROVIDES COORDINATED CLINICAL CARE AND AFFORDS PATIENTS REGIONAL ACCESS TO THE AREA'S ONLY RADIATION THERAPY CENTER. THE HOSPITAL PROVIDES CLINICAL CARE, INFUSION THERAPY, CANCER PREVENTION EDUCATION AND SUPPORT LOCALLY. OTHER SERVICES INCLUDE MEDICAL IMAGING, LABORATORY SERVICES, PHARMACY, REHABILITATION, SURGERY, CANCER CARE, HEART AND VASCULAR CARE, NEUROLOGY, ORTHOPEDICS, SLEEP HEALTH, EYE CARE AND MORE. THE HOSPITAL'S CAMPUS IS DESIGNED WITH THE LATEST TECHNOLOGY AND AMENITIES TO SUPPORT WHOLE HEALTH AND HEALING FOR PATIENTS AND THEIR FAMILIES - INCLUDING A NATIONALLY ACCLAIMED AND INTERNATIONALLY RECOGNIZED HEALING ARTS PROGRAM. THE PROGRAM, IN COLLABORATION WITH THE PHIPPS CENTER FOR THE ARTS, IS ONE OF THE MOST COMPREHENSIVE HOSPITAL ARTS PROGRAM IN THE REGION WITH OVER 200 ORIGINAL PIECES OF ART ON DISPLAY AT ANY GIVEN TIME. THE PROGRAM'S MISSION IS TO BRING THE CREATIVE AND VISUAL ARTS TO PATIENTS, GUESTS AND STAFF TO WELCOME DIVERSION FROM OFTENTIMES CHALLENGING HEALTH EXPERIENCES. BEST CARE, BEST EXPERIENCE ACTIVITIES, INCLUDING PROMISES TO PATIENTS AND PROMISES TO EACH OTHER CONTINUED IN SUPPORT OF A CULTURE OF EXCELLENCE - ONE OF RESPECT, ACCOUNTABILITY FOR EXCELLENCE, AND EMPLOYEE ENGAGEMENT AND INVOLVEMENT. ALL EMPLOYEE SURVEY PARTICIPATION WAS 81% WITH EMPLOYEE ENGAGEMENT INDEX OF 83% IN 2013. A PATIENT'S WILLINGNESS TO RECOMMEND IS A LEADING INDICATOR OF SUCCESSFUL CUSTOMER SERVICE. THE HOSPITAL'S INPATIENT SCORES REMAIN HIGH AT THE 89TH PERCENTILE NATIONAL RANKING (TOP BOX: "WOULD DEFINITELY RECOMMEND") AMONG PRESS GANEY HOSPITALS OF COMPARABLE SIZE. PRESS GANEY IS ONE OF THE COUNTRY'S LARGEST HOSPITAL DATA BASES OF PATIENT SATISFACTION SURVEY DATA. II. BENEFITS TO PATIENTS AND THE COMMUNITY IN 2013 THE HOSPITAL AIMS TO BE THE PREMIER PARTNER IN THE COMMUNITY'S QUEST FOR HEALTH AND HAPPINESS. WORKING IN PARTNERSHIP WITH EACH OTHER, THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS, HUDSON PHYSICIANS (WWMA), AND THE COMMUNITY, THE HOSPITAL ACCOMPLISHED A GREAT DEAL IN 2013. ADVANCEMENTS WERE MADE IN SUPPORT OF THE TRIPLE AIM: TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. THE HOSPITAL CONTINUED TO GROW ITS REPUTATION FOR EXCELLENT CLINICAL OUTCOMES AND SERVICE. HIGHLIGHTS INCLUDE: - CONTINUED PARTICIPATION IN THE AMERICAN HOSPITAL ASSOCIATION'S PARTNERS FOR PATIENTS NATIONAL INITIATIVE TO PREVENT 1.8 MILLION INJURIES TO PATIENTS IN THE HOSPITAL SAVING MORE THAN 60,000 LIVES OVER THREE YEARS. FOCUS AREAS FOR THE HOSPITAL ARE REDUCING CATHETER-ASSOCIATED URINARY TRACT INFECTIONS, FALL PREVENTION, AND READMISSION/CARE TRANSITIONS. THE RESULTS FOR 2013 ARE; 0 CATHETER-ASSOCIATED INFECTIONS, 0 FALL WITH HARM AND A 1.1% INCREASE IN READMISSIONS FROM THE PRIOR YEAR. - EXPANDED THE PROVIDERS PRACTICING IN THE INTERNAL MEDICINE CLINIC BY ADDING ONE PROVIDER AND HOSPITALIST PROGRAM WITH TWO ADDITIONAL PROVIDERS. - CONTINUED OPTIMIZATION OF EPIC THE ELECTRONIC HEALTH RECORD (EHR) SYSTEM TO IMPROVE HEALTHPARTNERS' REGIONAL NETWORK AND ADVANCE QUALITY AND EXPERIENCE FOR PATIENTS, CLINICIANS AND MEDICAL STAFF, AND REDUCE HEALTH CARE COSTS. AS PART OF THE HEALTHPARTNERS FAMILY OF CARE, RECOGNIZED FOR BEING THE "MOST WIRED" IN THE HOSPITAL & HEALTH NETWORK'S (H&HN) MAGAZINE. THE HOSPITAL ALSO ACHIEVED THE HIMSS ANALYTICS STAGE 6 DESIGNATION (OF SEVEN) - ONE OF ONLY 10% OF HOSPITALS IN THE U.S. - ADOPTING ELECTRONIC MEDICAL RECORDS (EMRS), CREATING A PAPERLESS PATIENT RECORD ENVIRONMENT, AND IMPLEMENTING TECHNOLOGY SOLUTIONS THAT IMPROVE PATIENT SAFETY AND QUALITY OF CARE. - TELEMEDICINE INCORPORATED IN OUR EMERGENCY CENTER, CONNECTING OUR EMERGENCY PHYSICIANS FOR A REALTIME CONSULT WITH REGIONS HOSPITAL SPECIALISTS WITH A BURN DOCTOR, NEUROLOGIST FOR ACUTE STROKE PATIENTS, TRAUMA DOCTORS AND ER TO ER. - THE HOSPITAL WAS RECOGNIZED FOR QUALITY AND SAFETY AND DELIVERING THE BEST CARE FOR CERTAIN CONDITIONS 95 PERCENT OF THE TIME OR MORE IN THE JOINT COMMISSION'S TOP PERFORMER ON KEY QUALITY MEASURES REPORT. THIS REPRESENTS THE TOP 33 PERCENT OF ALL JOINT COMMISSION ACCREDITED HOSPITALS REPORTING PERFORMANCE DATA FOR 2013. THE HOSPITAL WAS RECOGNIZED FOR HIGH QUALITY SURGICAL CARE.
FORM 990, PART III, LINE 4A - STRATEGIC EFFORTS TO FOCUS ON THESE KEY QUALITY MEASURES, ACHIEVED 11 MONTHS OF "PERFECT-ARE" IN 2013 ON ALL CORE MEASURES: SURGICAL CARE IMPROVEMENT PROJECT OR SCIP, CHRONIC HEART FAILURE OR CHF, AND PNEUMONIA. - SOCIAL SERVICES LED AN EFFORT TO INCREASE COMMUNICATION AND COLLABORATION WITH ST. CROIX COUNTY'S MOBILE CRISIS PROGRAM WHICH ASSISTS PATIENT'S RECEIVING SERVICES ON CAMPUS IN THE CLINIC, EMERGENCY CENTER AND INPATIENT AREAS. - EXPANDED HEALTHPARTNERS ONLINE PATIENT SERVICES FOR THE SPECIALTY CLINICS AND THE ROBERTS CLINIC TO GIVE PATIENTS THE OPTION OF ACCESSING TEST RESULTS OR IMMUNIZATION RECORDS, EMAILING A PROVIDER, AND PAYING BILLS ONLINE. - DURING EARTH WEEK, AN EDUCATIONAL BOOTH WAS CREATED TO EDUCATE THE COMMUNITY AND EMPLOYEES WHAT CAN BE RECYCLED IN HUDSON. APPROXIMATELY 50 PEOPLE STOPPED AND LEARNED MORE ABOUT RECYCLING. OVER 60 EMPLOYEES COMPLETED A SUSTAINABLE TRANSPORTATION SURVEY WHERE 4 WERE INTERESTED IN CARPOOLING. - THE HOSPITAL'S SUSTAINABILITY EFFORTS WERE RECOGNIZED WITH STATE AND NATIONAL ENVIRONMENTAL ACHIEVEMENT AWARDS WINNING THE GREEN PROFESSIONAL LEVEL IN THE WI GREEN MASTER'S PROGRAM AND PRACTICE GREENHEALTH'S WITH DISTINCTION AWARDS FOR OUR COMPREHENSIVE SUSTAINABILITY PROGRAM INCLUDING ENERGY EFFICIENCY, WASTE MINIMIZATION, SECTOR LEADING SUSTAINABLE FOOD SERVICE, ENVIRONMENTALLY PREFERRED PURCHASING AND OTHER INITIATIVES. - CONTINUED SUCCESS WITH THE SURGICAL CARE IMPROVEMENT PROJECT (SCIP) IMPLEMENTED IN 2010 - NATIONAL PATIENT SAFETY INITIATIVE TO REDUCE PATIENT INFECTION RATES. ACCORDING TO THE NATIONAL HEALTHCARE SAFETY NETWORK (NHSN), THE HOSPITAL REPORTS SOME OF THE LOWEST SURGICAL INFECTION RATES IN THE REGION WITH A RATE OF 0.7% COMPARED TO THE NATIONAL AVERAGE OF 1.9%. - MEDICATION WASTE PROGRAM CREATED TO ENSURE BEST PRACTICES FOR COLLECTION OF HAZARDOUS WASTE USED IN THE HOSPITAL IN SUPPORT OF A SUSTAINABLE AND ECO-FRIENDLY ENVIRONMENT. - THE HOSPITAL COMMUNITY GARDENS YIELDED OVER 150 POUNDS OF FRESH PRODUCE THIS YEAR - WITH 66 PLOTS TENDED BY GARDENERS FROM THE COMMUNITY, AND STAFF, INCLUDING OUR OWN NUTRITION SERVICES GARDEN FEEDING HOSPITAL PATIENTS AND STAFF. MASTER GARDENER SITES WERE DEDICATED FOR THE HUDSON COMMUNITY FOOD SHELF. - SUPPORTING COMMUNITIES AND PURCHASING LOCALLY-RAISED BEEF, PORK AND FRESH PRODUCE IS AN INITIATIVE BY THE HOSPITAL GREEN TEAM, IN PARTNERSHIP WITH NUTRITION SERVICES, AND ANOTHER GREAT EXAMPLE OF THE COMMITMENT TO SUSTAINABILITY. - ADDITION OF MANY NEW HEALTH CARE PROVIDERS TO THE CAMPUS TEAM, INCLUDING SPECIALISTS IN ENT, INTERNAL MEDICINE, PEDIATRIC HEMATOLOGY/ONCOLOGY, OPHTHALMOLOGY, GENERAL SURGERY, THE HOSPITALIST PROGRAM, OB/GYN AND FAMILY MEDICINE. - EXPERIENCED A 4.3% INCREASE IN SURGICAL VOLUMES OVER 2012 VOLUMES. - RECORD-SETTING 673 BABIES WERE BORN IN THE BIRTH CENTER - MARKING THE HIGHEST NUMBER OF BIRTHS IN A SINGLE YEAR SINCE HUDSON'S FOUNDING IN 1953. - THE BIRTH CENTER NURSING STAFF CONTINUES TO RANK AMONG THE BEST IN THE NATION - 99TH PERCENTILE FOR FRIENDLINESS AND ATTITUDE ACCORDING TO PRESS GANEY SURVEY DATA (1,800 HOSPITAL DATABASE). WHILE 2013 BROUGHT NEW CHALLENGES, THE HOSPITAL PROACTIVELY IMPLEMENTED CHANGES TO ENSURE A SOUND FUTURE FOR THE ORGANIZATION. IT WAS A YEAR FOCUSED ON GROWTH, EXCEPTIONAL PATIENT CARE, AND CLEAR ATTENTION TO QUALITY AND SAFETY. THE HOSPITAL PROVIDED MORE SPECIALTIES AND RECRUITED ADDITIONAL PHYSICIANS TO MEET THE NEEDS OF ITS GROWING COMMUNITIES, IMPLEMENTED NEW TECHNOLOGIES, CONTINUED ITS SUSTAINABLE JOURNEY, AND DELIVERED SERVICES IN MORE EFFICIENT AND EFFECTIVE WAYS TO BRING GREATER VALUE TO PATIENTS AND THEIR FAMILIES. CHARITABLE TRADITION CONTINUED AS THE HOSPITAL REACHED OUT TO THOSE IN NEED OF ITS SERVICES. STAFF ENGAGED IN COMMUNITY PARTNERSHIPS WITH SCHOOLS, BUSINESSES, AGENCIES, AND OTHER HEALTH PROVIDERS INVESTED IN COMMUNITY HEALTH, EDUCATION, ECONOMIC DEVELOPMENT, AND CULTURE. THESE PROGRAMS AND PARTNERSHIPS EMBODY THE HOSPITAL'S MISSION OF "CARING FOR THE HEALTH OF OUR COMMUNITY." THE HOSPITAL AND ST. CROIX COUNTY PUBLIC HEALTH CONTINUED TO CO-FACILITATE HEALTHIER TOGETHER - ST. CROIX COUNTY, THE COUNTYWIDE COMMUNITY HEALTH IMPROVEMENT INITIATIVE. SINCE JUNE 2008, THEY HAVE WORKED TOGETHER TO BETTER UNDERSTAND CURRENT AND FUTURE HEALTH CARE NEEDS OF ST. CROIX COUNTY. THE PROCESS INVOLVES ASSESSING, PRIORITIZING AND ADDRESSING HEALTH NEEDS IN THE REGION. HEALTHIER TOGETHER IS A STRATEGIC, COUNTY-WIDE, COMMUNITY-BASED APPROACH FOR CREATING AND MAINTAINING HEALTHY COMMUNITIES. A STEERING COMMITTEE OF 20+ MEMBERS REPRESENTING DIVERSE ORGANIZATIONS FROM ACROSS THE COUNTY PROVIDES OVERSIGHT AND GUIDANCE. THEY WORK TOGETHER TO BETTER ALIGN EFFORTS AMONG COMMUNITY PARTNERS AND CREATE A MORE STRATEGIC FRAMEWORK FOR LOCAL HEALTH IMPROVEMENT ACTIVITIES. FROM THE 2009 COUNTY-WIDE COMMUNITY NEEDS ASSESSMENT (EXECUTIVE SUMMARY AND FULL REPORT ARE PUBLICLY AVAILABLE ON THE WEBSITE), THE TOP 5 HEALTH PRIORITIES WERE IDENTIFIED FOR THE PURPOSE OF EDUCATING AND MOBILIZING AREA ORGANIZATIONS, PLANNING ACTIONS TO IMPROVE PUBLIC HEALTH AND QUALITY OF LIFE, AND GARNERING RESOURCES FOR HEALTH IMPROVEMENT INITIATIVES. THE TOP FIVE HEALTH PRIORITIES FOR 2009-2014 ARE: 1. ACCESS TO PRIMARY AND PREVENTIVE HEALTH SERVICES; 2. OVERWEIGHT, OBESITY, AND LACK OF PHYSICAL ACTIVITY; 3. ADEQUATE AND APPROPRIATE NUTRITION; 4. ALCOHOL AND OTHER SUBSTANCE USE AND ADDICTION; 5. TOBACCO USE AND EXPOSURE. COMMUNITY BENEFIT OPERATIONS IN SUPPORT OF THE COALITION WORK DONE IN 2010 (COMMUNITY FORUM, WORKSHOPS, LEADERSHIP ORIENTATION AND CONTINUED CAPACITY BUILDING), THE TASK FORCES AND WORK GROUPS COMPLETED THEIR ACTION, IMPLEMENTATION AND EVALUATION PLANNING AND THE HEALTHIER TOGETHER - ST. CROIX COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN WAS RELEASED JUNE 2011. IN 2013, THE PLAN CONTINUED TO BE IMPLEMENTED AND THE HOSPITAL REMAINS COMMITTED TO PLAN SUCCESS. THE HOSPITAL HAS PROVIDED A SIGNIFICANT AMOUNT OF INTELLECTUAL, IN-KIND AND FINANCIAL RESOURCES TO THIS INITIATIVE SINCE IT BEGAN. COSTS ASSOCIATED WITH DEDICATED STAFF, PROGRAM OPERATIONS, RESOURCE EXPENSES, TRAINING, TRAVEL, WHA SURVEY COMPLETION, HEALTHIER TOGETHER CO-FACILITATION, FUNDRAISING FOR COMMUNITY BENEFIT PROGRAMS, AND OTHER PROGRAM EXPENSES TOTALED $98,768. THIS INVESTMENT REFLECTS THE HOSPITAL'S COMMITMENT TO COMMUNITY HEALTH IMPROVEMENT AND ITS COMMUNITY BENEFIT PROGRAM AND REPORTING PROCESS. THE 2013 ANNUAL COMMUNITY BENEFIT REPORT IS PUBLICALLY AVAILABLE ON THE HOSPITAL'S WEBSITE AND THE SUMMARY OF WHAT HAS BEEN ACHIEVED THROUGH THE WORK OF HEALTHIER TOGETHER-ST. CROIX COUNTY CAN BE FOUND AT: HTTP://WWW.HEALTHIERTOGETHERSTCROIX.ORG/WP-CONTENT/UPLOADS/2013/07/14HH FROM JANUARY TO JULY 2012, HEALTHPARTNERS ENGAGED THE RESOURCES OF COMMUNITY HOSPITAL CONSULTING (CHC CONSULTING) TO CONDUCT A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ON BEHALF OF REGIONS HOSPITAL, LAKEVIEW MEMORIAL HOSPITAL, THE HOSPITAL, AND WESTFIELDS HOSPITAL. THE "COMMUNITIES" ASSESSED INCLUDED DAKOTA, RAMSEY, WASHINGTON AND ST. CROIX COUNTIES. THE PURPOSE OF THE ASSESSMENT, ASIDE FROM MEETING FEDERAL GOVERNMENT AND REGULATORY REQUIREMENTS (PATIENT PROTECTION AND AFFORDABLE CARE ACT AND INTERNAL REVENUE SERVICE NOTICE 2011-52), WAS TO IDENTIFY THE MAIN COMMUNITY HEALTH PRIORITIES THAT HEALTHPARTNERS AND ITS RESPECTIVE HOSPITALS SHOULD SEEK TO ADDRESS. IT WAS CONCLUDED THAT THE FIVE PRIORITIZED HEALTH NEEDS CURRENTLY OF PARAMOUNT CONCERN TO THE COMMUNITIES SERVED BY THESE HOSPITALS ARE: 1. INCREASE ACCESS TO MENTAL HEALTH; 2. PROMOTE POSITIVE BEHAVIORS TO REDUCE OBESITY (NUTRITION/PHYSICAL ACTIVITY); 3. INCREASE ACCESS TO PRIMARY AND PREVENTIVE CARE; 4. IMPROVE SERVICE INTEGRATION; AND 5. PROMOTE CHANGE IN UNHEALTHY LIFESTYLES (TOBACCO/ALCOHOL/SUBSTANCE ABUSE)
FORM 990, PART III, LINE 4A THESE PRIORITIES CORRELATE VERY WELL WITH THE FIVE TOP HEALTH PRIORITIES IDENTIFIED IN THE ST. CROIX COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2009 AND THE WORK BEING DONE THROUGH THE HEALTHIER TOGETHER - ST. CROIX COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN (2009-2014). OCTOBER AND NOVEMBER 2013, THE HOSPITAL PARTICIPATED IN A COUNTY WIDE SURVEY TO PRIORITIZE THE HEALTH PRIORITIES IDENTIFIED IN 2009. THROUGH AN ONLINE SURVEY, 434 PEOPLE RESPONDED AND FELT THE FOLLOWING PRIORITIES WERE CRITICAL TO SUSTAIN AND BUILD UPON EXISTING COMMUNITY-WIDE EFFORTS TO ENSURE CONTINUED COMMUNITY HEALTH IMPROVEMENT. 1. OVERWEIGHT, OBESITY, AND LACK OF PHYSICAL ACTIVITY 2. ACCESS TO PRIMARY AND PREVENTIVE HEALTH SERVICES 3. ADEQUATE AND APPROPRIATE NUTRITION IN 2014, IMPLEMENTATION PLANS WILL BE CREATED TO CONTINUE THE HEALTH IMPROVEMENT ACTIVITIES THROUGH HEALTHIER TOGETHER-ST. CROIX COUNTY. EACH HOSPITAL, USING CHNA FINDINGS, HAS DESIGNED A COMMUNITY BENEFIT IMPLEMENTATION PLAN TO IDENTIFY HOSPITAL-SPECIFIC ACTIVITIES, PROGRAMS, AND SERVICES WHICH DIRECTLY ADDRESS THE HEALTH CONCERNS, AND ARE INTENDED TO POSITIVELY IMPACT THE COMMUNITIES IT SERVES. THE HOSPITAL'S DEVOTION TO THE HEALTH OF THE COMMUNITY STARTS WITH PROVIDING EXCEPTIONAL MEDICAL CARE TO EACH PATIENT AND EXTENDS TO FAMILIES AND ORGANIZATIONS THROUGHOUT THE REGION. THROUGH ITS COMMUNITY BENEFIT PROGRAM, THE HOSPITAL OFFERED SPECIAL HELP AND SUPPORT TO INDIVIDUALS OR FAMILIES EXPERIENCING FINANCIAL HARDSHIP AND TO EFFORTS OR ORGANIZATIONS STRIVING TO IMPROVE THE QUALITY OF LIFE FOR ALL. TOTAL 2013 COMMUNITY BENEFIT CONTRIBUTION EQUALED $3,653,814 WHICH REPRESENTS 7.1% OF NET REVENUE. THIS FIGURE IS REPORTED AT COST PER THE CATHOLIC HEALTH ASSOCIATION (CHA) COMMUNITY BENEFIT REPORTING GUIDELINES AND IN ACCORDANCE WITH WISCONSIN HOSPITAL ASSOCIATION (WHA) REPORTING REQUIREMENTS. FINANCIAL ASSISTANCE AND HEALTHCARE ACCESS FOR LOW-INCOME INDIVIDUALS FINANCIAL ASSISTANCE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. THE HOSPITAL PROVIDED $281,416 IN FREE OR DISCOUNTED CARE TO 506 LOW INCOME AND UNINSURED PATIENTS. FINANCIAL ASSISTANCE REPRESENTS ABOUT 0.56% OF THE HOSPITAL'S TOTAL OPERATING EXPENSES. CARE FOR MEDICAID PATIENTS. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES, TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES ARE BELOW THE COST OF CARE PROVIDED. THE EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR 4,524 PATIENTS TOTALED $195,861. SUBSIDIZED HEALTH SERVICES THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2013, LOSS ON SERVICES FOR HOSPITAL INPATIENT AND OUTPATIENT HEALTH SERVICES INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, ONCOLOGY, PROGRAMS FOR CHANGE, EMERGENCY DEPARTMENT, LABOR & DELIVERY, AND REGIONAL BLOOD BANK TOTALED $2,116,585. COMMUNITY HEALTH IMPROVEMENT SERVICES OVER 19,000 PEOPLE BENEFITED FROM THE FOLLOWING PROGRAMS OR ACTIVITIES, WHICH WERE CARRIED OUT AND SUPPORTED BY THE HOSPITAL IN 2013 FOR THE EXPRESS PURPOSE OF IMPROVING COMMUNITY HEALTH: COMMUNITY HEALTH EDUCATION - OVER 9,900 PEOPLE ATTENDED EDUCATIONAL PROGRAMS, CLASSES, SPECIAL EVENTS, HEALTH FAIRS OR SUPPORT GROUPS TAUGHT OR HOSTED BY MEDICAL AND CLINICS STAFF AND CAMPUS PARTNERS OR WERE HOSPITAL FITNESS CENTER MEMBERS (1:1 EDUCATION AND FITNESS TRAINING). TOTAL COMMUNITY HEALTH EDUCATION EXPENSES TOTALED $410,484. - CLASSES INCLUDED ADVANCED DIRECTIVES, BREASTFEEDING, BABY SIGN LANGUAGE, BABYSITTING CLASSES, FAMILY/PARENTING/SIBLING EDUCATION, HEART DISEASE, MEDICATION SAFETY, MENTAL HEALTH AND DEPRESSION, NUTRITION/WEIGHT MANAGEMENT, SCHOOL-BASED HEALTH EDUCATION, WORKFORCE DEVELOPMENT, HAND HYGIENE, EFFECTS OF SMOKING, HEALTHY EATING AND PORTION CONTROL, CAREER DAY, ETC. IN ADDITION, 255 PEOPLE ATTENDED 15 FREE HEALTH SEMINARS ON RELEVANT HEALTH TOPICS. OVER 90 CPR/AED AND FIRST AID TRAINING CLASSES WERE OFFERED TO 883 PARTICIPANTS, AS YOUNG AS 6TH GRADE. - SPECIAL HEALTH EDUCATION PROGRAMS AND EVENTS WERE PRESENTED TO AREA YOUTH (ANNUAL BIKE SAFETY CLINIC, NUTRITION EDUCATION & GAMES PRESENTATION ETC.) 122 PARTICIPANTS ENJOYED AN EVENING OF ZEN - A HOLISTIC APPROACH TO BETTER HEALTH (MEDITATION, YOGA AND NUTRITION TIPS) OFFERED THROUGHOUT THE YEAR. - COMMUNITY-BASED HEALTH FAIRS INCLUDING THE UNIVERSITY OF WISCONSIN STUDENT HEALTH FAIR AND THE YMCA SENIOR HEALTH FAIR ATTRACTED OVER 200 PEOPLE, WHO LEARNED ABOUT PROGRAM FOR CHANGE (EFFECTS OF ALCOHOL AND BINGE DRINKING - HOSPITAL ALCOHOL AND SUBSTANCE ABUSE TREATMENT PROGRAM), ADVANCED DIRECTIVES AND LIVING WILLS, RECREATION THERAPY - THE BENEFITS OF MOTION AND MOVEMENT, AND MEDICATION SAFETY. - SUPPORT GROUPS FACILITATED BY STAFF INCLUDED CANCER, NEW PARENT, SMOKING CESSATION, CELIAC, WEIGHT LOSS AND WELLNESS. OVER 500 PEOPLE PARTICIPATED. OTHER SUPPORT GROUPS OFFERED ON CAMPUS BY COMMUNITY PARTNERS INCLUDED CARDIOVASCULAR DISEASE, DIABETES, AND PARKINSON'S DISEASE. - HEALTH RESOURCE CENTER (HRC) OPERATES AT A COST OF $18,160. OVER 1,200 PEOPLE UTILIZED MATERIALS OR SERVICES. THE HRC IS A LENDING LIBRARY WHERE PATIENTS, THEIR FAMILY AND FRIENDS, STAFF AND COMMUNITY MEMBERS CAN ACCESS HEALTH AND WELLNESS INFORMATION FROM PRINT RESOURCES, INTERNET SITES, ORGANIZED EVENTS, AND STAFF ASSISTANCE FROM A REGISTERED NURSE. OVER 1200 BOOKS AND MAGAZINES ARE CHECKED OUT ANNUALLY. WELLNESS CLASSES ARE COORDINATED BY THE HRC AND ARE OPEN TO THE COMMUNITY AT NO OR LOW COST. - THE FITNESS CENTER, AN ON-SITE COMMUNITY FITNESS CENTER USED BY 75 COMMUNITY MEMBERS INCLUDING PHASE 3 CARDIAC REHAB PROGRAM PARTICIPANTS, WAS AVAILABLE FOR USE. OPERATING COSTS OF $25,796 INCLUDED DEDICATED STAFF TIME TO ADMINISTER FITNESS AND EDUCATION PROGRAMS, SPACE USAGE, AND REDUCED FACILITY MEMBERSHIP FEES. COMMUNITY BASED CLINICAL SERVICES THE HOSPITAL HOSTED NUMEROUS BLOOD DRIVES (225 DONORS) IN SUPPORT OF THE AMERICAN RED CROSS THROUGHOUT THE YEAR AT A COST OF $3,776 FOR STAFFING, PLANNING AND ADVERTISING THEM. HEALTH CARE SUPPORT SERVICE - IN 2013, OVER 8,800 PEOPLE REALIZED THE BENEFIT OF HEALTH CARE SUPPORT SERVICES AVAILABLE INCLUDING TRANSLATION/INTERPRETER SERVICES, VAN TRANSPORTATION, CRISIS INTERVENTION AND COUNSELING SERVICES, AND LIFELINE HOME MONITORING SYSTEM, TO NAME A FEW. - THE HOSPITAL'S GOOD SAMARITAN FUND, SUPPORTED BY HUDSON HOSPITAL FOUNDATION AND EMPLOYEE GIVING, DONATED $3,369 TO HELP 47 INDIVIDUALS RECEIVING CARE ON THE HEALTH CAMPUS. FUNDS SUPPORTED URGENT AND EMERGENT NEEDS RELATED TO THEIR HEALTH INCLUDING DURABLE EQUIPMENT, NON-NARCOTIC PRESCRIPTION DRUGS, GAS CARDS, CLOTHING, ETC. - ENROLLMENT ASSISTANCE, INFORMATION AND REFERRAL SERVICES WERE AVAILABLE TO HELP SECURE A PAYMENT SOURCE FOR UNINSURED AND UNDERINSURED PATIENTS. PATIENT FINANCIAL SERVICES, ADMINISTERED BY THE BUSINESS OPERATIONS, OVERSEES THE FINANCIAL ASSISTANCE PROGRAM AND, ALONG WITH SUPPORT FROM DEPARTMENT STAFF, HELPS PATIENTS ENROLL IN GOVERNMENT PROGRAMS, FIND OTHER SOURCES OF PAYMENT, OR ACCESS SERVICES BEYOND MEDICAL CARE. IN 2013, THE HOSPITAL SPENT $45,093 IN STAFF TIME TO ASSIST 637 PATIENTS TO ENROLL IN PUBLIC MEDICAL PROGRAMS; $58,670 IN STAFF TIME TO GUIDE OR REFER 2,498 PEOPLE TO COMMUNITY SERVICES/PUBLIC HEALTH ASSISTANCE; AND $196,277 IN STAFF TIME TO GUIDE OR REFER 4,537 PATIENTS TO FINANCIAL ASSISTANCE. - PROGRAMS FOR CHANGE, THE HOSPITAL'S OUTPATIENT CHEMICAL ADDICTION TREATMENT AND RECOVERY CARE PROGRAM, OFFERED PARENTS AND FAMILY MEMBERS THE OPPORTUNITY TO PARTICIPATE IN EDUCATIONAL LECTURES, GROUP DISCUSSION, AND FAMILY TREATMENT GROUPS FREE OF CHARGE IN SUPPORT OF THEIR LOVED ONE. THE HOSPITAL PROVIDED $3,304 IN STAFF TIME TO SUPPORT THE 21 ATTENDEES. - VAN TRANSPORTATION AND PHARMACY DELIVERY SERVICES WERE AVAILABLE TO COMMUNITY RESIDENTS WITHIN A 15-MILE RADIUS UPON REQUEST. OPERATING COSTS FOR THE PROGRAM TOTALED $17,294. OVER 1,000 RESIDENTS TOOK ADVANTAGE OF THE SERVICES. HEALTH PROFESSIONS EDUCATION THE HOSPITAL'S STAFF PROVIDED CLINICAL TRAINING FOR 72 NURSES AND NURSING STUDENTS AND 29 HEALTH PROFESSIONALS INCLUDING EMS FROM SEVENTEEN INSTITUTIONS AT A COST OF $181,291. IN ADDITION, THE HOSPITAL VOLUNTARILY PARTICIPATED IN THE WISCONSIN NURSE RESIDENCY PROGRAM (WNRP). THE PROGRAM IS A STRUCTURED LEARNING EXPERIENCE FOR NEWLY LICENSED REGISTERED NURSES DESIGNED TO PROMOTE EFFECTIVE TRANSITION INTO PROFESSIONAL PRACTICE. THREE NURSES, PAIRED WITH EXPERIENCED HOSPITAL NURSES ACTING AS COACH/SUPPORT PERSON, COMPLETED THE 12-MONTH PROGRAM.
FORM 990, PART III, LINE 4A CASH DONATIONS & GRANTS THE HOSPITAL'S FINANCIAL CONTRIBUTION IN THE FORM OF CASH DONATIONS AND GRANTS TO OTHER TAX-EXEMPT COMMUNITY ORGANIZATIONS FOR SPONSORSHIPS OR MEMBERSHIP DUES INCLUDING HUDSON RELAY FOR LIFE, HUDSON ROTARY, HUDSON CHAMBER, TWIN CITIES HEART WALK, ETC. TOTALED $7,619. IN-KIND DONATIONS IN-KIND SERVICES PROVIDED INCLUDED STAFF HOURS SPENT IN SUPPORT OF BOARD OR COMMITTEE WORK INCLUDING: HUDSON ROTARY CLUB, ST. CROIX ECONOMIC DEVELOPMENT CORPORATION, ST. CROIX COUNTY SUBSTANCE ABUSE ADVISORY COMMITTEE, UW-RIVER FALLS CHANCELLOR ADVISORY COUNCIL, ST. CROIX VALLEY VISUAL ARTS COUNCIL, CANCER CENTER OF WESTERN WISCONSIN, ST, CROIX VALLEY YMCA, AND WISCONSIN HOSPITAL ASSOCIATION IN ADDITION, MD MISSION TRIP SUPPLIES; SPECIAL EVENTS PLANNING (HEART WALK, NAMIWALK, HUDSON RELAY FOR LIFE); AND OVERHEAD EXPENSES OF SPACE PROVIDED TO NOT-FOR-PROFIT COMMUNITY GROUPS FOR MEETINGS. COMMUNITY-BUILDING ACTIVITIES THE HOSPITAL IS AN ENERGETIC MEMBER OF THE LOCAL, STATE AND REGIONAL COMMUNITIES. THE HOSPITAL SUPPORTS INDIVIDUALS, ORGANIZATIONS, EVENTS AND PROGRAMS; IT LIVES OUT ITS COMMITMENT TO IMPROVE THE HEALTH OF THE COMMUNITY. KNOWING MUCH MORE CAN BE ACCOMPLISHED TOGETHER, THE HOSPITAL'S COMMUNITY BENEFIT PROGRAM BUILT VALUABLE CONNECTIONS WITH INDIVIDUALS AND ORGANIZATIONS FROM PUBLIC, PRIVATE AND NONPROFIT SECTORS TO SHARE SKILLS AND ASSETS. THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT INCLUDING THE TOBACCO COALITION, HEALTHWATCH OF ST. CROIX COUNTY, WEST CENTRAL REGIONAL TRAUMA ADVISORY COUNCIL (RTAC), THE HEALING ARTS PROGRAM, HUDSON CHAMBER, SOMERSET MIDDLE SCHOOL CAREER ACADEMIC AND PERSONAL AND SOCIAL SKILLS (CAPS) CLASS, AND LEADERSHIP HUDSON - A PROGRAM DEDICATED TO PROMOTING AND DEVELOPING DYNAMIC BUSINESS AND COMMUNITY LEADERS. THE HOSPITAL CONTINUED ON ITS ECO-FRIENDLY JOURNEY "HEALTH CARE WITHOUT HARM" (2008 COMMITMENT) USING SUSTAINABLE BUSINESS PRACTICES AND ESTABLISHING GREEN PURCHASING POLICIES IN ORDER TO PROVIDE HEALTH CARE THAT'S HEALTHY. GREEN INITIATIVES INCLUDED THE RECYCLING PROGRAM, COMMUNITY SHARPS DISPOSAL SITE, REDUCTION OF ENERGY AND WATER CONSUMPTION, CREATION AND EXPANSION OF THE COMMUNITY GARDEN - THE HOSPITAL IN SUPPORT OF HEALTHIER TOGETHER INITIATIVES, AND THE FOSTERING OF HEALING ENVIRONMENTS INCLUDING THE COMMUNITY LABYRINTH. IMPLEMENTING SUSTAINABLE BUSINESS PRACTICES HAS MADE THE HOSPITAL A MODEL WITHIN THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS. NUTRITION SERVICES CONTINUED ITS WORK IN SUPPORT OF THE HOSPITAL'S "HEALTHY FOOD IN HEALTH CARE" PLEDGE (2010). THE PLEDGE IS A COMMITMENT TO INCREASE OFFERINGS OF FRUITS AND VEGETABLES, REDUCE FATS AND SWEETENED FOODS, TAKE STEPS TO ENCOURAGE CURRENT VENDORS TO PROCURE LOCAL FOOD, AND WORK DIRECTLY WITH LOCAL FARMS. THE HOSPITAL IS SHARING BEST PRACTICES AND ENCOURAGING OTHER HOSPITALS IN THE FAMILY TO INCREASE LOCAL PURCHASING. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY SUPPORTED AGRICULTURE AND SERVES AS A DISTRIBUTION SITE FOR LOCALLY GROWN FRESH, ORGANIC PRODUCE FOR STAFF AND COMMUNITY.
FORM 990, PART VI, SECTION A, LINE 6 AS OF JANUARY 1, 2009, THE CORPORATE MEMBERS OF THE HOSPITAL ARE GROUP HEALTH PLAN, INC. AND RH-WISCONSIN, INC. THESE SAME ENTITIES ARE ALSO THE CORPORATE MEMBERS OF WESTFIELDS HOSPITAL, INC., A CRITICAL ACCESS HOSPITAL IN NEW RICHMOND, WISCONSIN. GROUP HEALTH PLAN, INC. AND RH-WISCONSIN, INC. ARE PART OF THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS.
FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN THIRTEEN (13) PERSONS APPOINTED AS FOLLOWS (AMENDED BYLAWS, ART. II, SECT. 2): - SEVEN (7) COMMUNITY DIRECTORS NOMINATED BY THE BOARD'S NOMINATING COMMITTEE AND APPOINTED BY RH-WISCONSIN, INC. - THREE (3) DIRECTORS APPOINTED BY GROUP HEALTH PLAN, INC., ONE OF WHOM MAY BE A PHISICIAN AND ONE OF WHOM MAY BE THE CHIEF EXECUTIVE OFFICER OF REGIONS HOSPITAL - ONE (1) DIRECTOR WHO IS A MEMBER OF THE ACTIVE MEDICAL STAFF OF THE HOSPITAL AND APPOINTED BY WESTERN WISCONSIN MEDCIAL ASSOCIATES, S.C. OR BY THE LARGEST ACTIVE PRIMARY CARE PHYSICIAN GROUP SERVING THE HOSPITAL. - ONE (1) DIRECTOR SHALL BE THE HOSPITAL'S CHIEF OF STAFF - ONE (1) DIRECTOR SHALL BE A PHYSICIAN NOMINATED BY THE BOARD'S NOMINATING COMMITTEE AND APPOINTED BY RH-WISCONSIN, INC.
FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S CORPORATE MEMBERS - RH-WISCONSIN, INC. AND GROUP HEALTH PLAN, INC. - JOINTLY APPROVE THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS OR INITIATE THESE ACTIONS DIRECTLY (AMENDED BYLAWS, ART. III, SECT. 1): - AMENDMENT OF THE ARTICLES, BYLAWS OR OTHER GOVERNING DOCUMENTS - APPROVAL OF THE ADDITION OR DELETION OF MAJOR SERVICE LINES - SALE, LEASE, MORTGAGE OR PLEDGE OF ANY REAL ESTATE OR INTEREST THEREIN, OR OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS - ADOPTION OF AMENDMENT OF A STRATEGIC PLAN, AND CAPITAL AND OPERATING BUDGETS - APPROVAL OF UNBUDGETED CAPITAL EXPENDITURES - APPROVAL OF BORROWING OR LENDING OF FUNDS IN EXCESS OF ONE MILLION DOLLARS - MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY AND TRANSFER OR CONTRIBUTION OF ASSETS AND FUNDS TO SEPARATE ENTITIES - ESTABLISHMENT OR DIVESTITURE OF ENTITIES OF WHICH THE HOSPITAL HAS AN EQUITY OR MANAGEMENT INTEREST, OR ESTABLISMENT OF ANY SIGNIFICANT AND CONTINUING RELATIONSHIP WITH ANY ENTITY - APPOINTMENT AND REMOVAL OF THE HOSPITAL'S PRESIDENT AND CHAIR OF THE BOARD OF DIRECTORS - DISSOLUTION AND DISTRIBUTION OF ASSETS
FORM 990, PART VI, SECTION B, LINE 11 THE HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND HEALTHPARTNERS, INC.'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. ONCE THAT REVIEW PROCESS HAS BEEN COMPLETED, IT IS THE POLICY OF THE HOSPITAL TO MAKE AVAILABLE TO THE FINANCE AND AUDIT COMMITTEE OF IT'S BOARD OF DIRECTORS, AND TO IT'S BOARD OF DIRECTORS, A COPY OF THE 990 PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED TO THE FINANCE AND AUDIT COMMITTEE AND THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE COMMITTEE MEETING. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN COMMITTEE MINUTES OF THE MEETING. THESE MINUTES ARE PRESENTED TO THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C AS REQUIRED BY THE BYLAWS OF THE HOSPITAL, THE BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTEREST. THE GENERAL COUNSEL WILL SUMMARIZE THE FINDINGS FOLLOWING REVIEW OF THE QUESTIONNAIRE AND SUBMIT A REPORT TO THE CHAIR AND HOSPITAL PRESIDENT. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL'S OFFICERS, DIRECTORS AND HIGHLY COMPENSATED EMPLOYEES ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY THE HOSPITAL. REGIONS, GHI AND THE HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE HOSPITAL'S OFFICERS, DIRECTORS AND HIGHLY COMPENSATED EMPLOYEES. EVERY THREE YEARS, UNDER THE DIRECTION OF THE GHI BOARD OF DIRECTORS' COMPENSATION COMMITTEE (COMPENSATION COMMITTEE), A TOTAL COMPENSATION MARKET REVIEW IS COMPLETED. THE REVIEW INCLUDES ALL COMPONENTS OF COMPENSATION; BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE DIRECTION OF THE COMPENSATION COMMITTEE, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION COMMITTEE. FOR THE CHIEF EXECUTIVE OFFICER AND CERTAIN OTHER POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED. IN ALL CASES, COMMITTEE MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMPENSATION COMMITTEE MEMBERS' INDEPENDENCE, STAFF IS NOT IN ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2 STATEMENTS. THE BOARD OF DIRECTORS HAS DELEGATED TO THE COMPENSATION COMMITTEE THE ACCOUNTABILITY TO CONDUCT AN ANNUAL PERFORMANCE EVALUATION AND TO DETERMINE THE COMPENSATION OF THE PRESIDENT BASED ON THE PERFORMANCE REVIEW AND THE MARKET COMPARABILITY DATA, APPROVED BY THE COMPENSATION COMMITTEE. THE BOARD HAD DELEGATED TO THE CEO (WITH AUTHORITY TO FURTHER DELEGATE) THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL OTHER OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMPENSATION COMMITTEE. ANY EXCEPTIONS NEED TO BE APPROVED BY THE COMPENSATION COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE HOSPITAL. THE HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE WISCONSIN SECRETARY OF STATE'S OFFICE. THE HOSPITAL'S CONFLICT OF INTEREST POLICY CAN BE VIEWED THROUGH THE HUDSON HOSPITAL.ORG WEBSITE.
990, PART VII, SEC. A, LINE 1A, COL. B: AVERAGE HOURS-RELATED ORGANIZATIONS DIRECTORS AND OFFICERS OF THE HOSPITAL ARE EMPLOYED AND COMPENSATED BY GROUP HEALTH PLAN, INC., REGIONS HOSPITAL, OR THE HOSPITAL. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS.
FORM 990, PART XI, LINE 9: INCREASE IN INTEREST IN NET ASSETS OF HUDSON HOSPITAL FOUNDATION 332,460. TRANSFER OF NET ASSETS TO HUDSON HOSPITAL FOUNDATION, INC. -174,306. TRANSFER OF NET ASSETS FROM HUDSON HOSPITAL FOUNDATION, INC. 118,265. ROUNDING 5.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HUDSON HOSPITAL INC
 
Employer identification number

39-0804125
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTHPARTNERS INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1693838 		HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4   N/A
Yes
 
(2) HPI - RAMSEY

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1793333 		CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC
 
Yes
 
(3) GROUP HEALTH PLAN INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0797853 		STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC
 
Yes
 
(4) HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1670163 		HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I GROUP HEALTH PLAN INC
 
Yes
 
(5) CAPITOL VIEW TRANSITIONAL CARE CENTER

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-2011453 		POST HOSPITALIZATION PATIENT CARE MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
Yes
 
(6) REGIONS HOSPITAL

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0956618 		HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
Yes
 
(7) REGIONS HOSPITAL FOUNDATION

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1888902 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY
 
Yes
 
(8) RHSC INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1891928 		HEALTHCARE STAFFING MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC
 
Yes
 
(9) RH-WISCONSIN

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
20-2287016 		CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY
 
Yes
 
(10) PHYSICIANS NECK AND BACK CLINICS

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
27-0684883 		SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC
 
Yes
 
(11) HUDSON HOSPITAL FOUNDATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1279567 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC
 
Yes
 
(12) WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
26-3616590 		PROVIDE MEDICAL TRANSPORT SERVICES WI 501(C)(3) 509(A)(3) TYPE II RH-WISCONSIN
 
Yes
 
(13) LAKEVIEW MEMORIAL HOSPITAL FOUNDATION

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1386635 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM
 
Yes
 
(14) LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0811697 		HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) STILLWATER HEALTH SYSTEM
 
Yes
 
(15) STILLWATER MEDICAL GROUP

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
83-0379473 		PHYSICIANS GROUP MN 501(C)(3) 509(A)(2) STILLWATER HEALTH SYSTEM
 
Yes
 
(16) STILLWATER HEALTH SYSTEM

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
30-0221189 		CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY
 
Yes
 
(17) WESTFIELDS HOSPITAL INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-0808442 		HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN & GROUP HEALTH PLAN INC
 
Yes
 
(18) WESTFIELDS HOSPITAL FOUNDATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1770913 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 509(A)(3) TYPE I WESTFIELDS HOSPITAL INC
 
Yes
 
(19) RAMSEY INTEGRATED HEALTH SERVICES

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1503090 		IN-HOME PATIENT CARE MN 501(C)(3) 509(A)(2) HPI - RAMSEY
 
Yes
 
(20) PARK NICOLLET HEALTH SERVICES

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
36-3465840 		CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) TYPE III HEALTHPARTNERS INC
 
Yes
 
(21) PARK NICOLLET FOUNDATION

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
23-7346465 		GRANTS TO SERVE THE COMMUNITY MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES
 
Yes
 
(22) PARK NICOLLET METHODIST HOSPITAL

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-0132080 		HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
Yes
 
(23) PARK NICOLLET INSTITUTE

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-0961862 		HEALTHCARE RESEARCH MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
Yes
 
(24) PARK NICOLLET HEALTH CARE PRODUCTS

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
01-0638901 		HEALTHCARE PRODUCTS MN 501(C)(3) 509(A)(3) TYPE II PARK NICOLLET HEALTH SERVICES
 
Yes
 
(25) PARK NICOLLET CLINIC

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-0834920 		HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
Yes
 
(26) PNMC HOLDINGS

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-1741792 		HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET CLINIC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTHPARTNERS ADMINISTRATORS INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1629390 		THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC
  		C       Yes  
(2) HEALTHPARTNERS ASSOCIATES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
52-2365151 		MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
  		C       Yes  
(3) HEALTHPARTNERS SERVICES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683568 		MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
  		C       Yes  
(4) HEALTHPARTNERS VENTURES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1838197 		DEVELOP HEALTHCARE BUSINESS OPPORTUNITIES MN HEALTHPARTNERS INC
  		C       Yes  
(5) HEALTHPARTNERS INSURANCE COMPANY

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683523 		MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC
  		C       Yes  
(6) DENTAL SPECIALTIES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
45-1297583 		DENTAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC
  		C       Yes  
(7) HEALTHPARTNERS CENTRAL MINNESOTA CLINICS

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1236798 		MEDICAL CLINIC STAFFING AND MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
  		C       Yes  
(8) PARK NICOLLET ENTERPRISES

6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
41-1656735 		REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES
  		C       Yes  
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) HUDSON HOSPITAL FOUNDATION INC

 B 174,306 CASH AMOUNT
(2) HUDSON HOSPITAL FOUNDATION INC

 C 118,265 CASH AMOUNT
(3) HUDSON HOSPITAL FOUNDATION INC

 M    
(4) HUDSON HOSPITAL FOUNDATION INC

 N    
(5) HUDSON HOSPITAL FOUNDATION INC

 O    
(6) HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES

 L 672,443 CASH AMOUNT
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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