2015-08-17T16:19:53-05:00 2014-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2013-10-01 421017512 UPLAND HILLS HEALTH INC UPLA 6089308000 800 COMPASSION WAY DODGEVILLE WI 53533 ARTHUR K PUSTINA VICE PRESIDENT OF FINANCE 6089308000 2015-08-17 1 PAUL M TRACZEK CPA P01368830 7158323407 2015-08-14 2013 2016-04-25 22:37:26Z LISA SCHNEDLER 800 COMPASSION WAY DODGEVILLE WI 53533 48738320 0 X WWW.UPLANDHILLSHEALTH.ORG X 1974 WI AS A HEALTH CARE ORGANIZATION, UPLAND HILLS HEALTH, INC.'S MISSION IS TO CONSISTENTLY MEET OR EXCEED THE EXPECTATIONS OF THOSE WE SERVE, AND OF THOSE WE HOPE TO SERVE, IN A COST-EFFECTIVE MANNER. TO LEAD A PARTNERSHIP WITH THE COMMUNITIES AND OUR MEDICAL STAFF, REFLECTING ADDITIONAL EMPHASIS ON HEALTH EDUCATION, CONTINUING MEDICAL EDUCATION, REHABILITATION, AND THE PREVENTION OF ILLNESS OR INJURY. TO APPROACH THE PATIENT AS A WHOLE PERSON RATHER THAN A SET OF SYMPTOMS OR A DISEASE STATE, FOCUSING ON THE CLINICAL AND EMOTIONAL WELL-BEING OF PATIENTS AND THEIR FAMILIES, AND PROVIDING CARE IN AN ENVIRONMENT COMMITTED TO IMPROVING PATIENT SAFETY. TO PARTICIPATE IN THE PROVISION OF HEALTH SERVICES TO THE POOR, MINORITIES, DISABLED, AND OTHER UNDER SERVED PERSONS IN OUR COMMUNITIES. 9 7 498 70 16712 0 144008 41810 46205256 47073919 660704 507075 218429 251838 47228397 47874642 107800 98415 0 0 25673353 25809191 0 0 0 19179704 19147754 44960857 45055360 2267540 2819282 83233305 86116219 32585908 32325371 50647397 53790848 X UPLAND HILLS HEALTH, INC.'S MISSION IS TO PROVIDE THE IDEAL PATIENT EXPERIENCE. 0 0 33694677 98415 40639615 UPLAND HILLS HEALTH, INC. (UPLAND HILLS) PROVIDES HIGH QUALITY, COST EFFECTIVE, PRIMARY HOSPITAL CARE TO ALL PEOPLE IN NEED OF CARE. AMONG THE HOSPITAL INPATIENT AND OUTPATIENT SERVICES PROVIDED ARE DIAGNOSTIC IMAGING, REHABILITATION SERVICES, DIALYSIS, RESPIRATORY CARE, SURGICAL SERVICES, CARDIAC MONITORED CARE, LAB SERVICES, PHARMACY SERVICES, 24-HOUR EMERGENCY ROOM, OBSTETRICAL SERVICES, REGIONAL CLINIC SERVICES, AND MANY OTHERS. UPLAND HILLS ALSO PROVIDES ADDITIONAL SERVICES TO THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS IN AN EFFORT TO ENHANCE THE HEALTH AND WELFARE OF THE PEOPLE IN ITS AREA. DURING FISCAL YEAR 2014, UPLAND HILLS HEALTH HOSPITAL PROVIDED 2,882 DAYS OF INPATIENT CARE, 562 DAYS OF SWING BED CARE, OVER 9,700 EMERGENCY ROOM AND URGENT CARE PATIENT VISITS, OVER 1,900 CLINIC PATIENT VISITS, AND PERFORMED OVER 33,000 OTHER OUTPATIENT PROCEDURES AND SERVICES FOR PATIENTS IN NEED OF MEDICAL CARE.IN ITS EFFORT TO ATTAIN THIS MISSION AND GOAL, AND TO BE A PARTNER IN THE COMMUNITY, UPLAND HILLS PROVIDES:- HEALTH EDUCATION AND OUTREACH PROGRAMS TO ALL MEMBERS OF THE COMMUNITY AT LITTLE OR NO COST TO THE PARTICIPANTS.- DIABETES SELF-MANAGEMENT CLASSES - CLASSES ARE RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION AS QUALITY SELF-MANAGEMENT CLASSES AND ARE TAUGHT BY A REGISTERED DIETICIAN WHO IS SPECIALLY TRAINED IN DIABETES EDUCATION.- PROGRAMS FOR NEW AND EXPECTANT PARENTS - CHILDBIRTH EDUCATION, PRE-DELIVERY CONFERENCE, SIBLING CLASS, BREASTFEEDING SUPPORT AND BREASTFEEDING SUPPLIES.- INDOOR FITNESS WALKING IS AVAILABLE AT THE HOSPITAL FACILITY FOR COMMUNITY MEMBERS DURING COLD OR INCLEMENT WEATHER.- SAFE SITTER BABYSITTING TRAINING - MEDICALLY ACCURATE BABYSITTING PREPARATION CLASS DESIGNED FOR BOYS AND GIRLS AGES 11 TO 13. THE PROGRAM TEACHES SITTERS HOW TO HAVE FUN WITH CHILDREN AS WELL AS HOW TO RECOGNIZE A MEDICAL EMERGENCY AND KNOW THE APPROPRIATE ACTION TO TAKE. STUDENTS ALSO LEARN INFANT AND CHILD CPR. THE COST OF PROVIDING CHARITY CARE TO PERSONS UTILIZING OUR HOSPITAL AMOUNTED TO APPROXIMATELY $554,000 IN 2014. IN ADDITION, UPLAND HILLS FURNISHES CARE TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH PAY AT RATES LESS THAN CHARGES. DISCOUNTS TO THESE PROGRAMS FOR HOSPITAL SERVICES AMOUNT TO $30,699,121. UPLAND HILLS ALSO PROVIDES ASSISTANCE TO THE FREE CLINIC LOCATED IN DODGEVILLE, WISCONSIN ON AN ANNUAL BASIS.UPLAND HILLS ALSO OPERATES A THERAPY AND WELLNESS CENTER TO PROVIDE FITNESS AND WELLNESS OPPORTUNITIES TO EMPLOYEES AND THE PUBLIC. THE THERAPY AND WELLNESS CENTER HOUSES MODERN EQUIPMENT, INCLUDING CARDIO WORKOUT MACHINES, CIRCUIT TRAINING, AND FREE WEIGHTS. WELLNESS CLASSES AND MASSAGE THERAPY ARE OFFERED TO COMPLEMENT YOUR WELLNESS GOALS. CLASSES INCLUDE YOGA, ABS AND TONE, SENIOR STRENGTH BUILDING, BODY BOOST, MORNING CARDIO MIX, CIRCUIT TRAINING, PILATES, AND ZUMBA(R). UPLAND HILLS HOSPITAL HAS ALSO PROVIDED DIALYSIS SERVICES TO LOCAL RESIDENTS SINCE 2008. THE HOSPITAL REVIEWED THE POTENTIAL PROGRAM OPERATIONS OF THE DIALYSIS CENTER AND HEALTHCARE NEEDS IN THE COMMUNITY AND NOTED THAT THE DIALYSIS CENTER IS BUDGETED TO RUN IN A NET LOSS POSITION, HOWEVER IT WAS DETERMINED THAT THIS IS A NEEDED HEALTHCARE SERVICE FOR RESIDENTS OF THE DODGEVILLE, WISCONSIN COMMUNITY AND THE SURROUNDING AREAS AND SO THE BOARD OF DIRECTORS APPROVED THAT DIALYSIS SERVICES SHOULD BE SUPPLEMENTED AND PROVIDED BY UPLAND HILLS TO FURTHER ITS MISSION IN THE COMMUNITY. 2281076 3972863 UPLAND HILLS HEALTH, INC. (UPLAND HILLS) ALSO SERVES THE COMMUNITY BY OPERATING A 44-BED SKILLED NURSING FACILITY KNOWN AS THE "NURSING AND REHABILITATION CENTER." THE PRIMARY ACTIVITY OF THE NURSING AND REHABILITATION CENTER IS TO PROVIDE SKILLED AND INTERMEDIATE CARE FOR THE AGED AND DISABLED OF THE SURROUNDING AREA. THE CENTER PROVIDED 14,747 DAYS OF RESIDENT CARE IN FISCAL YEAR 2014. THE CENTER OFFERS SKILLED NURSING CARE IN BOTH SHORT-TERM REHABILITATION PROGRAMS AND LONG-TERM CARE RESIDENT PROGRAMS. SOME OF THE SPECIALIZED CARE SERVICES OFFERED INCLUDE IV THERAPY CARE, WOUND CARE, PAIN MANAGEMENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY. THE CENTER OPERATES IN CONJUNCTION WITH UPLAND HILLS HOSPITAL TO PROVIDE A SMOOTH TRANSITION FOR PATIENTS NEEDING EXTENDED REHABILITATION OR LONG-TERM CARE SERVICES. THE COMBINATION AND COORDINATION OF FACILITIES ALSO ALLOWS THE ORGANIZATION TO SHARE MANY DEPARTMENTS AND SERVICES IN UPLAND HILLS CONSTITUTED EFFORT TO PROVIDE HIGH QUALITY AND LOW COST CARE TO THE COMMUNITY. 1542296 1531600 UPLAND HILLS HEALTH, INC.'S HOSPICE PROGRAM GIVES THOSE PATIENTS WITH LIFE-LIMITING OR TERMINAL ILLNESSES THE OPPORTUNITY TO LIVE PAIN-FREE AND WITH DIGNITY DURING THE LAST STAGE OF THEIR LIFE. TOTAL HOSPICE DAYS OF SERVICE PROVIDED TO PATIENTS IN FISCAL YEAR 2014 WERE 5,726.UPLAND HILLS HEALTH, INC.'S HOMECARE PROGRAM PROVIDES COMPREHENSIVE HEALTHCARE SERVICES IN THE MOST COMFORTABLE SETTING-THE PATIENT'S HOME. IN FISCAL YEAR 2014 THERE WERE 5,720 TOTAL HOMECARE VISITS PROVIDED TO PATIENTS. 37518049 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 46 0 498 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X ARTHUR K PUSTINA 6089308000 800 COMPASSION WAY DODGEVILLE WI 53533 PEG KOEHLER DIRECTOR 2.50 X 0 0 0 KATHRYN DALSING MD DIRECTOR 2.50 X 0 0 0 JOHN THRONSON DIRECTOR 2.50 X 0 0 0 TODD BURCHILL DIRECTOR 2.50 X 0 0 0 LINDA TAPLIN STATZ DIRECTOR 2.50 X 0 0 0 JODY VANDERLOO PRESIDENT 2.50 X X 0 0 0 BRAD LAUFENBERG VICE PRESIDENT 2.50 1.00 X X 0 0 0 JIM MASSEY SECRETARY 2.50 X X 0 0 0 TED GREENHECK TREASURER 2.50 X X 0 0 0 LISA SCHNEDLER PRESIDENT AND CEO 51.00 1.00 X 122014 0 26111 ARTHUR K PUSTINA VP OF FINANCE 53.80 1.00 X 139459 0 17204 BARBARA HOSTETLER PHYSICIAN 41.80 X 419480 0 42210 ADAM DACHMAN PHYSICIAN 38.60 X 396573 0 21500 JEFF PIERCE CRNA 44.80 X 273242 0 42261 BRENTON JENKINS PHYSICIAN 30.30 X 294040 0 2982 ROBERT SCHMUS PHYSICIAN 26.70 X 296930 0 16118 1941738 0 168386 16 0 1 0 MADISON EMERGENCY PHYSICIANS SC INC 1221 JOHN Q HAMMONS DRIVE MADISON WI 537444966 EMERGENCY ROOM COVERAGE 2058536 SHARED IMAGING SERVICES INC PO BOX 45686 MADISON WI 537445686 X-RAY SCAN SERVICES 815445 RURAL WISCONSIN HEALTH COOPERATIVE ITN 880 INDEPENDENCE LANE PO BOX 490 SAUK CITY WI 535830490 COMPUTER SUPPORT 590073 RURAL WISCONSIN HEALTH COOPERATIVE 880 INDEPENDENCE LANE PO BOX 490 SAUK CITY WI 535830490 AUDIOLOGY HOURS & SUPPLIES, EDUCATION, A 441284 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI SERVICES 386595 10 11121 18364 12325 41810 PATIENT SERVICE REVENUE 621990 46160790 46144078 16712 CAFETERIA & NUTRITION 722210 183527 183527 MASSAGE/ACUPUNCTURE 621990 89240 89240 FITNESS CENTER 624100 71995 71995 LIFELINE 621990 57507 57507 510860 510860 47073919 423477 423477 48 48 705048 518885 186163 186163 186163 357739 70604 298640 46153 59099 24451 83550 83550 65675 0 65675 65675 47874642 46144078 16712 1672042 X 98415 98415 462644 462644 19508633 16579153 2929480 442554 376099 66455 4044992 3437583 607409 1350368 1123410 226958 140471 140471 23560 23560 11571 11571 5025847 4460097 565750 223661 11271 212390 1076727 541655 535072 241454 241454 1401997 1401997 229723 198518 31205 47751 47751 3238728 3238728 254630 81216 173414 MEDICAL SUPPLIES 3505752 3505752 REPAIRS & MAINTENANCE 1498071 723794 774277 PROVISION FOR BAD DEBTS 1090410 1090410 EQUIPMENT RENTAL & LEAS 657604 501995 155609 479797 100205 379592 45055360 37518049 7537311 0 1794310 1254386 5420854 5526947 4829091 1097895 946374 1016813 587240 552394 68945304 35155608 34998736 33789696 17814 18083 33231865 41115001 72600 72600 1334421 1672404 83233305 86116219 3794128 3788605 174821 282321 27310000 26780000 327598 243575 31172 2398 948189 1228472 32585908 32325371 X 50614397 53790848 33000 0 50647397 53790848 83233305 86116219 X 2819282 20212 303957 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6539 6539 0 PART II-B, LINE 1: UPLAND HILLS HEALTH, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS, HOWEVER A PORTION OF THE ANNUAL DUES WERE USED IN CONJUCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. UPLAND HILLS HEALTH, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, UPLAND HILLS HEALTH, INC. PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE WHA, AHA, AND RWHC DETERMINED THAT APPROXIMATELY $6,539 OF THE FEES PAID BY UPLAND HILLS HEALTH, INC. IN 2014 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. 213859 1088 214947 213277 1000 1504 1922 213859 210220 2000 1057 213277 208412 1016 792 210220 75366 131000 2046 208412 0.00000 0.97880 0.02120 0 1 1 194076 194076 46877883 18838760 28039123 20366045 15613109 4752936 1507300 703739 803561 33789696 BOARD-DESIGNATED FOR CAPITAL IMPROVEMENTS 39027507 F UNDER BOND INDENTURE AGREEMENTS 1850063 F STATE OF WI UNEMPLOYMENT FUNDING 237431 F 41115001 SECURITY DEPOSITS 63440 DEFERRED COMPENSATION PLAN LIABILITY 638532 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 526500 1228472 X PART V, LINE 4: UPLAND HILLS HEALTH, INC.'S ENDOWMENT CONSISTS OF TWO FUNDS HELD BY UPLAND HILLS HEALTH FOUNDATION, INC. THESE FUNDS WERE ESTABLISHED TO PROVIDE INCOME FOR THE FOUNDATION TO HELP SUPPORT SPECIFIC PROGRAMS OF UPLAND HILLS HEALTH, INC. PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, UPLAND HILLS HEALTH, INC. ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UPLAND HILLS HEALTH, INC. HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2014 OR 2013. FEDERAL TAX RETURNS FOR TAX YEARS ENDED SEPTEMBER 30, 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 1 0 1 1 549156 549156 0.01250 4785216 2246791 2538425 0.05770 5334372 2246791 3087581 0.07020 24431 24431 0.00060 224241 224241 0.00510 1240610 1168495 72115 0.00160 100535 100535 0.00230 1589817 1168495 421322 0.00960 6924189 3415286 3508903 0.07980 397 397 0.00000 397 397 0 461267 230634 18957266 19301596 -344330 X 1 1 1 CRESTRIDGE ASSISTED LIVING LLC ASSISTED LIVING FACILITY 0.49000 1 1 UPLAND HILLS HEALTH INC 800 COMPASSION WAY DODGEVILLE WI 53533 WWW.UPLANDHILLSHEALTH.ORG 1056 X X X X UPLAND HILLS HEALTH INC 1 1 X X X X X X X X X 12 1 0 1 X SEE SCHEDULE H, PART V, SECTION B, LINE 5 X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 UPLAND HILLS HEALTH, INC. PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONSIDERED INFORMATION OBTAINED FROM INTERVIEWS WITH STAKEHOLDERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. SEVENTEEN KEY STAKEHOLDERS PARTICIPATED IN THE INTERVIEW PROCESS. THE SEVENTEEN STAKEHOLDERS REPRESENT PUBLIC HEALTH EXPERTS; INDIVIDUALS FROM HEALTH OR OTHER DEPARTMENTS AND AGENICES; LEADERS OR REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS; AND OTHER COMMUNITY MEMBERS. THE CHNA ALSO CONSIDERED MULTIPLE OTHER DATA SOURCES, INCLUDING SECONDARY DATA SOURCES REGARDING DEMOGRAPHICS, HEALTH STATUS INDICATORS, AND MEASURES OF HEALTHCARE ACCESS. UPLAND HILLS HEALTH, INC. PART V, SECTION B, LINE 5D: A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.UPLANDHILLSHEALTH.ORG UPLAND HILLS HEALTH, INC. PART V, SECTION B, LINE 7: WE HAVE NOT ADDRESSED ALL OF THE NEEDS IN THE PRESENT PLAN. IT BECAME EVIDENT TO US THAT THE PLAN WAS OVERLY AMBITIOUS AND SO WE HELD A SERIES OF TOWN HALL MEETINGS IN EACH OF THE COMMUNITIES WE SERVE TO BETTER DEFINE OUR FOCUS TO THREE ITEMS. WE WILL USE THE INPUT FROM THESE MEETINGS IN FORMULATING OUR NEXT PLAN, WHICH WILL BEGIN IN THE FALL OF 2015. UPLAND HILLS HEALTH, INC. PART V, SECTION B, LINE 14G: THE POLICY WAS OFFERED TO ALL PRIVATE PAY PATIENTS IN THE EMERGENCY DEPARTMENT. 7 UPLAND HILLS NURSING AND REHAB CENTER 800 COMPASSION WAY DODGEVILLE WI 53533 SKILLED NURSING FACILITY UPLAND HILLS HEALTH CENTER 800 COMPASSION WAY DODGEVILLE WI 53533 OUTPATIENT CLINIC UPLAND HILLS HEALTH CLINIC - HIGHLAND 551 N MAIN STREET HIGHLAND WI 53543 OUTPATIENT CLINIC UPLAND HILLS HEALTH CLINIC - MONTFORT 202 W US HIGHWAY 18 MONTFORT WI 53569 OUTPATIENT CLINIC UPLAND HILLS HEALTH CLINIC - SPRING GREE 156 W JEFFERSON ST SPRING GREEN WI 53588 OUTPATIENT CLINIC UHH THERAPY CLINIC - BARNEVELD 103 QUAIL RIDGE DRIVE BARNEVELD WI 53507 OUTPATIENT PHYSICAL THERAPY CLINIC UHH THERAPY CLINIC - LANDS' END 1 LANDS END LANE DODGEVILLE WI 53533 LANDS END EMPLOYEE OUTPATIENT PHYSICAL THERAPY CLINIC PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT UPLAND HILLS HEALTH, INC. INCLUDE THE OPERATION OF THE DIALYSIS CENTER. SEE PART III, LINE 4A FOR A DESCRIPTION OF THE DIALYSIS SERVICES OFFERED. IT IS THE GOAL OF UPLAND HILLS HEALTH, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,090,410. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. UPLAND HILLS HEALTH, INC. PROVIDES SIGNIFICANT AMOUNTS OF CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. UPLAND HILLS HEALTH, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, HOSPICE, HOME CARE, RENAL DIALYSIS, INFUSION SERVICES, SWING BED SERVICES, NURSING HOME SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, AND WOMENS' SERVICES, AND MANY OTHERS. PART III, LINE 2: THE COSTING METHOD AND CALCULATIONS USED ON FORM 990 ARE BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE UPLAND HILLS HEALTH, INC. ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF PATIENT REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, UPLAND HILLS HEALH, INC. ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), UPLAND HILLS HEALTH, INC. RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGEON PROFESSIONAL SERVICES, OUTPATIENT PHYSICAL THERAPY SERVICES PROVIDED TO NURSING HOME RESIDENTS, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGERY, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT UPLAND HILLS HEALTH, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2014, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND CHARITY CARE POLICIES, UPLAND HILLS HEALTH, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. PART VI, LINE 2: UPLAND HILLS HEALTH, INC. ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH THE HOSPITAL'S MISSION IN THE COMMUNITY. UPLAND HILLS HEALTH, INC. ALSO REVIEWS STATISTICS IN THE HOSPITAL, NURSING HOME, CLINIC, HOME HEALTH, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE HOSPITAL ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND IT'S PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY.DURING FISCAL YEAR 2013 UPLAND HILLS HEALTH, INC. COMPLETED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO BETTER UNDERSTAND THE HEALTH NEEDS OF THE COMMUNITY AND TO DEVELOP AN EFFECTIVE IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY NEEDS. DURING THE CURRENT FISCAL YEAR, EFFORTS HAVE BEEN MADE TO FOCUS ON THE ISSUES THAT WERE IDENTIFIED IN THE CHNA. PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR UPLAND HILLS HEALTH, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE DODGEVILLE, MONTFORT, HIGHLAND, COBB, EDMUND, RIDGEWAY, LINDEN, AND MINERAL POINT, WISCONSIN, AMONG MANY OTHERS. UPLAND HILLS HEALTH, INC. IS THE ONLY HOSPITAL LOCATED IN IOWA COUNTY, WISCONSIN. THE HOSPITAL PROVIDES A SIGNFICANT PORTION OF ITS PATIENT SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS, ESPECIALLY THOSE BENEFICIARIES WHO RESIDE IN THE HOSPITAL'S LONG-TERM CARE FACILITY, OR PATIENTS WHO RECEIVE HOME HEALTH, HOSPICE, OR DIALYSIS SERVICES FROM UPLAND HILLS HEALTH, INC. IN 2014, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 53 PERCENT OF THE GROSS PATIENT SERVICE REVENUE PROVIDED BY THE HOSPITAL DURING THE YEAR. PART VI, LINE 5: UPLAND HILLS HEALTH, INC. FURTHERS ITS EXEMPT PURPOSE OF PROMOTING THE HEALTH OF THE COMMUNITY IN MANY WAYS, EXAMPLES OF WHICH INCLUDE THE OVERSIGHT BY A COMMUNITY BOARD, THE SPONSORSHIP OF HEALTH EVENTS, THE ESTABLISHMENT OF A SCHOLARSHIP PROGRAM FOR LOCAL STUDENTS SEEKING DEGREES IN HEALTH-RELATED PROFESSIONS, AND PROVISION OF SERVICES FREE OF CHARGE FOR PATIENTS OF THE FREE CLINIC. PART VI, LINE 6: UPLAND HILLS HEALTH, INC. MAINTAINS AN AFFILIATION AGREEMENT WITH SSM HEALTHCARE OF WISCONSIN, INC. SSM HEALTHCARE OF WISCONSIN, INC. OPERATES ST. MARY'S HOSPITAL IN MADISON, WISCONSIN AS WELL BEING AFFILIATED WITH OTHER AREA COMMUNITY HOSPITALS LOCATED NEAR MADISON, WISCONSIN. ST. MARY'S AND THE SSM HEALTHCARE SYSTEM IS A MULTI-SPECIALTY HEALTH SYSTEM. UPLAND HILLS HEALTH, INC. COLLABORATES WITH SSM HEALTHCARE TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES SERVED AND THE REGION. AS NOTED PREVIOUSLY IN THE FORM 990, TWO REPRESENTATIVES FROM SSM HEALTHCARE HAVE ROLES ON THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. THE AFFILIATION HELPS ENHANCE ACCESSIBILITY OF HEALTH CARE SERVICES OFFERED AT UPLAND HILLS HEALTH, INC. AND MAKES AVAILABLE ADDITIONAL EXPERTISE AND SERVICES WHEN NEEDED TO PROVIDE ACCESS TO EXPANDED SERVICES FOR AREA RESIDENTS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 COMMUNITY CONNECTIONS FREE CLINIC INC 201 S IOWA STREET DODGEVILLE WI 53533 721619112 501(C)(3) 81939 COST MEDICAL SERVICES & SUPPLIES TO PROVIDE ACCESS TO ADDITIONAL HEALTHCARE SERVICES TO THOSE IN NEED IN THE COMMUNITY. UPLAND HILLS HEALTH FOUNDATION INC 800 COMPASSION WAY DODGEVILLE WI 53533 260596045 501(C)(3) 16476 FMV MONETARY SUPPORT 2 0 PART I, LINE 2: UPLAND HILLS HEALTH, INC. HAS A BOARD APPROVED POLICY ON CHARITABLE GIVING FROM UPLAND HILLS TO THE COMMUNITY FOR PURPOSES THAT FURTHER THE MISSION OF THE ORGANIZATION. GRANTS TO THE COMMUNITY CONNECTIONS FREE CLINIC ARE IN SUPPORT OF THIS MISSION TO PROVIDE ACCESS TO HEALTHCARE SERVICES TO THOSE IN NEED IN THE COMMUNITY AND SURROUNDING AREAS. EACH YEAR, UPLAND HILLS PROVIDES AN AMOUNT THAT IS APPROVED IN THE ANNUAL OPERATING BUDGET BY THE BOARD OF DIRECTORS AND THIS ALLOTED AMOUNT IS GIVEN TO THE FREE CLINIC TO REFER PATIENTS IN NEED OF ADDITIONAL SERVICES TO UPLAND HILLS TO BE PROVIDED FREE OF CHARGE. THE ORGANIZATION MONITORS THE AMOUNTS PROVIDED DURING THE YEAR AND ENSURES THAT THE CLINIC IS MADE AWARE OF REMAINING AVAILABLE ALLOCATED AMOUNTS. IF A TIME OF NEED IS DETERMINED FOR THE FREE CLINIC TO RECEIVE ADDITIONAL SERVICES BEYOND THE BUDGETED AMOUNT, THIS WOULD BE APPROVED BY THE BOARD OF DIRECTORS UNDER THE CHARITABLE GIVING POLICY OF UPLAND HILLS HEALTH, INC. PATIENTS OF THE FREE CLINIC MAY ALSO QUALIFY FOR ADDITIONAL SERVICES UNDER THE HOSPITAL'S CHARITY CARE POLICY AT FREE OR REDUCED RATES DEPENDING ON INDIVIDUAL NEEDS. THESE TWO POLICIES ALLOW UPLAND HILLS THE ABILITY TO PROVIDE A CONTINUUM OF CARE TO THOSE IN NEED. X X X 0 0 0 0 0 0 0 0 0 ARTHUR K PUSTINA VP OF FINANCE 131860 0 2199 0 5400 0 5340 0 11864 0 156663 0 0 0 BARBARA HOSTETLER PHYSICIAN 400887 0 16748 0 1845 0 25116 0 17094 0 461690 0 0 0 ADAM DACHMAN PHYSICIAN 346536 0 49071 0 966 0 16500 0 5000 0 418073 0 0 0 JEFF PIERCE CRNA 262716 0 9806 0 720 0 27500 0 14761 0 315503 0 0 0 BRENTON JENKINS PHYSICIAN 291630 0 0 0 2410 0 0 0 2982 0 297022 0 0 0 ROBERT SCHMUS PHYSICIAN 253175 0 38698 0 5057 0 10000 0 6118 0 313048 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 977104K98 2006-10-03 20825012 CONSTRUCTION & RENOVATION OF HOSPITAL FACILITIES 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VN93 2006-10-03 10300000 CONSTRUCTION & RENOVATION OF HOSPITAL FACILITIES 0 0 0 A 3305000 20825012 1351698 9340920 414461 9717934 2009 0 1 1 1 B 750000 10300000 225810 10074190 2009 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 1 0 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/15/2010 FORM 990, PART VI, SECTION A, LINE 2 LINDA TAPLIN STATZ AND TODD BURCHILL ARE MEMBERS OF THE BOARD OF DIRECTORS AND REPRESENT SSM HEALTHCARE OF WISCONSIN. THESE INDIVIDUALS ARE EMPLOYEES OF SSM HEALTHCARE OF WISCONSIN AND SERVE ON THE BOARD AT UPLAND HILLS HEALTH, INC. AS A PART OF THE AFFILIATION AGREEMENT BETWEEN UPLAND HILLS HEALTH, INC. AND SSM WISCONSIN, INC. (A NON-PROFIT CORPORATION WHICH OPERATES ST. MARY'S HOSPITAL IN MADISON, WISCONSIN.) FORM 990, PART VI, SECTION A, LINE 6 SSM HEALTHCARE OF WISCONSIN, INC., UNDER THE TERMS OF THE AFFILIATION AGREEMENT DATED SEPTEMBER 21, 2011, HOLDS A 17.39% EQUITY INTEREST IN UPLAND HILLS HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A SSM HEALTHCARE OF WISCONSIN, INC. CAN APPOINT TWO MEMBERS TO THE UPLAND HILLS HEALTH, INC. BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS BY THE BOARD SHALL REQUIRE BOTH THE APPROVING VOTE OF A MAJORITY OF THE ENTIRE BOARD AND THE APPROVAL OF SSM HEALTHCARE OF WISCONSIN, INC.: (I) APPROVAL OF ANY AMENDMENT OR RESTATEMENT AFFECTING ARTICLE TWELVE OF THE ARTICLES OF INCORPORATION. (II) APPROVAL OF ANY AMENDMENT OR RESTATEMENT AFFECTING SECTION 1.4, SECTION 2.2, SECTION 2.6, SECTION 3.7, SECTION 5.2, OR ARTICLE X OF THE CORPORATE BYLAWS OF UPLAND HILLS HEALTH, INC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE AND THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C UPLAND HILLS HEALTH, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO COMPLETE AN ANNUAL DISCLOSURE STATEMENT. THESE STATEMENTS ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. IF BOARD MEMBERS HAVE CONFLICTS THAT ARE NOTED, THESE MEMBERS ARE ASKED TO ABSTAIN FROM VOTING ON THOSE MATTERS. CONFLICTS NOTED BY EMPLOYEES ARE REVIEWED BY THE BOARD OF DIRECTORS TO ENSURE THAT ALL TRANSACTIONS ARE CONDUCTED AT ARMS LENGTH. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS AN ESTABLISHED PROCESS TO REVIEW THE COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES AND TO DEFINE COMPENSATION PRACTICES. COMPARATIVE DATA FROM WAGE SURVEYS, AREA LABOR ADJUSTMENTS, AND MARKET RATES IN OTHER AREA FACILITIES ARE USED IN DETERMINING COMPENSATION. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES ANY EXCEPTIONS TO ACROSS-THE-BOARD RAISES AND STANDARD NEW HIRE WAGES. DURING THE REVIEW PROCESS, DECISIONS AFFECTING COMPENSATION AND CONTRACTS ARE ONLY REVIEWED AND APPROVED BY INDIVIDUALS WHO DO NOT HAVE NOTED CONFLICTS. THE DECISIONS AND DELIBERATION ARE ALSO DOCUMENTED FOR KEY EMPLOYEES AND EXECUTIVES (WHICH MAINLY INCLUDE THE HIGHLY COMPENSATED EMPLOYEES OF THE ORGANIZATION) IN THE MINUTES OF THE BOARD OF DIRECTORS UPON APPROVAL BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 UPLAND HILLS HEALTH, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G EMERGENCY ROOM PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,045,427. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,045,427. IMAGING SERVICES PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,224,451. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,224,451. LAB PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 290,345. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 290,345. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 899,874. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 899,874. ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 565,750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 565,750. FORM 990, PART XI, LINE 9: INCREASE IN EQUITY OF INVESTMENTS IN UNCONSOLIDATED AFFILIATES 303,957. FORM 990, PART XII, LINE 2C, SELECTION OF INDEPENDENT ACCOUNTANT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS BY AN INDEPENDENT ACCOUNTANT. THE BOARD OF DIRECTORS OF UPLAND HILLS HEALTH, INC. ALSO APPROVES THE SELECTION OF THE INDEPENDENT AUDITORS AND HISTORICALLY HAS USED A PROCESS OF SOLICITATION OF SEALED BIDS FROM INDEPENDENT AUDIT FIRMS WITH HEALTHCARE AUDIT EXPERIENCE EVERY FIVE YEARS SO THAT THE AUDIT FIRM REVIEW IS DONE ON A REGULAR BASIS. THIS PROCESS AND PROCEDURES HAVE NOT CHANGED IN THE CURRENT YEAR. FORM 990, PART VI, SECTION B, LINE 16B: UPLAND HILLS HEALTH, INC. DOES NOT HAVE A WRITTEN POLICY REGARDING THE EVALUATION OF PARTICIPATION IN JOINT VENTURE ARRANGEMENTS; HOWEVER, ALL POTENTIAL JOINT VENTURE ARRANGEMENTS ARE REVIEWED BY UPLAND HILLS HEALTH, INC.'S LEGAL COUNSEL PRIOR TO PARTICIPATION. THE LEGAL COUNSEL REVIEWS POTENTIAL JOINT VENTURE ARRANGEMENTS FOR COMPLIANCE WITH THE UPLAND HILLS HEALTH, INC. CORPORATE BY-LAWS AND ALSO REVIEWS FOR COMPLIANCE WITH APPLICABLE FEDERAL TAX LAW TO ENSURE THE SAFEGUARDING OF THE ORGANIZATION'S TAX EXEMPT STATUS. UPON LEGAL COUNSEL CONSENT, UPLAND HILLS HEALTH, INC. WILL PROCEED WITH A FORMAL WRITTEN AGREEMENT FOR ALL JOINT VENTURE ARRANGEMENTS. UPLAND HILLS HEALTH HOLDINGS LLC 800 COMPASSION WAY DODGEVILLE WI 53533 800809494 PARTNERSHIP FOR DURABLE MEDICAL EQUIPMENT PROVIDED TO PATIENTS WI 171418 288840 N/A UPLAND HILLS HEALTH FOUNDATION INC 800 COMPASSION WAY DODGEVILLE WI 53533 260596045 FOUNDATION TO PROVIDE CONTRIBUTIONS & SUPPORT FOR UPLAND HILLS HEALTH, INC. WI 501(C)(3) LINE 7 N/A 0 UPLAND HILLS HOMETOWN MEDICAL EQUIPMENT LLC 305 E BUSINESS HWY 151 SUITE C PLATTEVILLE WI 53818 680656862 PARTNERSHIP FOR DURABLE MEDICAL EQUIPMENT PROVIDED TO PATIENTS WI N/A RELATED 171418 288840 0 0 0.30000 CRESTRIDGE ASSISTED LIVING LLC 1402 PANKRANTZ STREET SUITE 110 MADISON WI 53704 391913656 ASSISTED LIVING WI N/A RELATED 132539 120453 0 0 0.49000 0 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 CRESTRIDGE ASSISTED LIVING LLC D 2664875 CASH PAID UPLAND HILLS HEALTH FOUNDATION INC B 66000 CASH PAID