2023-11-13T13:16:15-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 391157876 BEAVER DAM COMMUNITY HOSPITALS INC BEAV 9208877181 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 CATHY BUKOWSKI CFO 9208877181 2023-11-08 1 CATHY BUKOWSKI 999009999 1 DAVID LOWENTHAL P00378651 3122071040 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARSHFIELD MEDICAL CENTER-BEAVER DAM SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARHSFIELD WI 54449 109493216 0 X WWW.BDCH.COM X 1972 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 9 6 0 300 2911615 0 2600168 464168 97034288 92181233 4214542 3565569 3048637 1049855 106897635 97260825 200 0 0 0 60586155 73399622 0 0 0 46150681 53624307 106737036 127023929 160599 -29763104 189592696 174370887 67246840 53665511 122345856 120705376 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 115157296 0 88725596 BEAVER DAM COMMUNITY HOSPITALS, INC. (BDCH) IS A NOT-FOR-PROFIT 60-BED COMMUNITY HOSPITAL LOCATED IN BEAVER DAM, WISCONSIN THAT PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES. THERE ARE MEDICAL/SURGICAL, TELEMETRY, INTENSIVE CARE, OBSTETRICS, AND NURSERY UNITS ON THE INPATIENT FLOORS. THERE IS AN EMERGENCY ROOM, URGENT CARE, SURGERY CENTER, REHABILITATION CENTER, PAIN CLINIC, OUTPATIENT MEDICAL ONCOLOGY CLINIC, MEDICAL IMAGING, PHARMACY DEPARTMENT AND A WOUND CENTER. BDCH ALSO OPERATES A 115-BED NURSING HOME AND PROVIDES HOME HEALTH AND HOSPICE SERVICES. 115157296 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 X 68 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 1 1 X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 X SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 1.00 54.00 X 0 3048492 315344 MARK BUGHER CHAIR 1.00 9.00 X X 0 26500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 9500 0 RUWAN DISSANAYAKE MD SECRETARY 1.00 50.00 X X 0 528556 54315 JOHN BALTUS TREASURER 1.00 0.00 X X 0 0 0 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 COLLEEN HOERNEMAN BOARD MEMBER 1.00 2.00 X 0 7500 0 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 829413 57055 MARGARET MINERICK BOARD MEMBER 1.00 1.00 X 0 1000 0 GORDON EDWARDS MCHS CFO/COO - PART YEAR 1.00 54.00 X 0 829645 31752 KATHY BRESSLER MCHS COO 1.00 54.00 X 0 370779 16874 JERARD JENSEN MCHS GENERAL COUNSEL 1.00 54.00 X 0 1058880 65255 ANGELIA FOSTER PRESIDENT MMC - BEAVER DAM 50.00 0.00 X 333943 0 54937 333943 6710265 595532 1 0 1 0 A1 EXCEL HOSPITALIST GROUP LLC W200N5300 BEECHCRAFT RD MENOMONEE FALLS WI 53051 MEDICAL SERVICES 512326 DIRECT MANAGEMENT COMPANY LLC 1600 N HIGH POINT MIDDLETON WI 53562 PROFESSIONAL SERVICES 412848 INFINITY HEALTHCARE PHYSICIANS SC 7032 COLLECTION CENTER DR CHICAGO IL 60693 MEDICAL SERVICES 105520 3 464168 464168 NET PATIENT SERVICE REVENUE 621110 85602303 85602303 MISC OTHER OPERATING REVENUE 621110 3115101 3115101 RETAIL TRADE 621110 2218608 2218608 DAYCARE REVENUE 621110 785932 8192 777740 CAFETERIA REVENUE 621110 459289 459289 92181233 1200294 1200294 3613303 2563448 1049855 1049855 -84733 1134588 11752176 282042 9665011 3932 2087165 278110 2365275 2365275 97260825 88725596 2911615 5159446 56402536 54932666 1469870 5039753 4959339 80414 8974480 8784763 189717 2982853 2897509 85344 -49976 -49976 15225 15225 23537 23537 6477853 6440893 36960 77440 44883 32557 1987338 1948824 38514 1418291 1364241 54050 3473851 3455924 17927 288226 282898 5328 1592 130 1462 1138784 1138784 8170319 8170319 -125852 -125852 MEDICAL SUPPLIES 14740941 14740706 235 I/C PURCHASED SERVICES 9863219 9863219 BAD DEBT EXPENSE 3066063 3066063 WI MEDICAID ACCESS TAX 1653478 1653478 1403978 1401728 2250 127023929 115157296 11866633 0 X 9539767 6967007 2520994 2371407 4160199 4160199 13580901 13264415 0 0 0 0 0 0 2757969 2834001 899323 111750 180373875 109869773 70653407 70504102 37230648 32893047 46251161 39636511 487 3209 700000 762222 1297840 863017 189592696 174370887 9124970 3606961 0 0 244147 602623 47625799 46014499 171317 191525 0 7243841 0 0 2836766 3249903 67246840 53665511 X 118185657 116545177 4160199 4160199 122345856 120705376 189592696 174370887 X -29763104 -13867100 41989724 X 0 1 X 1 1 1 X 0 1 X 4687282 4687282 89862794 41242173 48620621 83053418 65867993 17185425 2770381 2759607 10774 70504102 LTD PTNSHP COMM INV 39636511 F 39636511 ACCRUED PENSION LIABILITY 2485329 OTHER PAYROLL LIABILITY 265360 OPERATING LEASE PAYABLE LONG-TERM 499214 3249903 X PART IV, LINE 2B: SECURITY DEPOSITS ARE PAID TO BDCH BY RESIDENTS OF THE NURSING HOME UPON ENTERING INTO A RENTAL AGREEMENT AND ARE DUE BACK TO TENANTS UPON TERMINATION OF THEIR RENTAL AGREEMENT. THESE FUNDS ARE TRACKED SEPARATELY FROM BDCH'S FUNDS AND BELONG TO THE RESIDENTS. PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 OR DECEMBER 31, 2021. 1 1 X 1 X 1 X 1 1 1 0 1 1 644133 0 644133 0.00520 15578600 15470056 108544 0.00090 0 0 16222733 15470056 752677 0.00610 110245 0 110245 0.00090 5200 0 5200 0.00000 0 0 0 0 135634 0 135634 0.00110 251079 251079 0.00200 16473812 15470056 1003756 0.00810 0 1394139 0 12166962 19367184 -7200222 X 0 1 1 MARSHFIELD MEDICAL CENTER - BEAVER DAM 707 S UNIVERSITY AVENUE BEAVER DAM WI 53916 WWW.BDCH.COM 199 X X X MARSHFIELD MEDICAL CENTER-BEAVER DAM 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://TINYURL.COM/YC5WH6AK X 1 22 1 HTTPS://TINYURL.COM/MURDM7SE 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER-BEAVER DAM PART V, SECTION B, LINE 5: WHEN MARSHFIELD MEDICAL CENTER-BEAVER DAM (MMC-BEAVER DAM) CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE HOSPITAL ENGAGED A DIVERSE GROUP OF PEOPLE AND ORGANIZATIONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITIES IT SERVED. THE MMC-BEAVER DAM COMMUNITY HEALTH NEEDS PRIORITIZATION PROCESS WAS LED BY THE MMC-BEAVER DAM CHNA WORKGROUP (CHNA WORKGROUP). MEMBERS OF THE CHNA WORKGROUP INCLUDED SENIOR LEADERSHIP FROM MMC-BEAVER DAM, MMC-BEAVER DAM COMMUNITY HEALTH STAFF, DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT. THE MMC-BEAVER DAM STAFF COORDINATING THE CHNA PROCESS HAS 12+ YEARS OF EXPERIENCE WORKING AT A LOCAL PUBLIC HEALTH DEPARTMENT AND HAS PREVIOUSLY COORDINATED CHNA PROCESSES. ADDITIONALLY, MMC-BEAVER DAM PARTICIPATED IN A REGIONAL CHNA PROCESS AS PART OF THE DODGE-JEFFERSON HEALTHIER COMMUNITIES PARTNERSHIP (DJHCP) AS IT HAS EVERY THREE YEARS SINCE THE MID-1990S. DATA COLLECTED AND USED FOR THE MMC-BEAVER DAM CHNA WAS OBTAINED THROUGH THE DJHCP CHNA PROCESS.DIRECT COMMUNITY INPUT WAS GATHERED THROUGH A COMMUNITY HEALTH SURVEY AND WAS THE MAJORITY OF THE PRIMARY DATA REVIEWED FOR THE MOST RECENT CHNA. AN ELECTRONIC (ONLINE) SURVEY WAS WIDELY DISTRIBUTED BY MMC-BEAVER DAM AND COMMUNITY PARTNERS TO DODGE COUNTY COMMUNITY MEMBERS (THOSE WHO LIVE AND/OR WORK IN DODGE COUNTY). AN ABBREVIATED HARDCOPY VERSION OF THE ELECTRONIC COMMUNITY HEALTH SURVEY WAS CREATED FOR RESIDENTS WITH LIMITED ACCESS TO THE INTERNET AND LIMITED HEALTH LITERACY. PAPER SURVEYS WERE DISTRIBUTED BY UNITED WAY OF DODGE COUNTY AND CHURCH HEALTH SERVICES AND THROUGH THE DODGE COUNTY INTERAGENCY GROUP. A TOTAL OF 430 DODGE COUNTY COMMUNITY MEMBERS PARTICIPATED IN THE SURVEY, OF WHICH APPROXIMATELY 275 PARTICIPANTS RESPONDED TO THE MAJORITY OF THE HEALTH NEEDS QUESTIONS. SURVEY RESPONDENTS REPRESENTED A RANGE OF RESIDENTS WITH A VARIETY OF INCOME AND EDUCATION LEVELS, AGES AND HOUSEHOLD SIZE. MARSHFIELD MEDICAL CENTER-BEAVER DAM PART V, SECTION B, LINE 6A: THROUGH THE DJHCP: WATERTOWN REGIONAL MEDICAL CENTER AND FORT HEALTHCARE. MARSHFIELD MEDICAL CENTER-BEAVER DAM PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S): -WATERTOWN DEPARTMENT OF PUBLIC HEALTH-JEFFERSON COUNTY HEALTH DEPARTMENT-DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT-GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION -ROCK RIVER COMMUNITY CLINIC MARSHFIELD MEDICAL CENTER-BEAVER DAM PART V, SECTION B, LINE 11: A NUMBER OF HEALTH AREAS WERE IDENTIFIED THROUGH THE MOST RECENT CHNA: -ALCOHOL MISUSE-SUBSTANCE USE-MENTAL HEALTH -OBESITY-CHRONIC DISEASE PREVENTION AND MANAGEMENT-TRANSPORTATION ACCESS-ACCESS TO TECHNOLOGY/WI-FI/BROADBAND-QUALITY, AFFORDABLE CHILDCARE/AFTER-SCHOOL CARE -NUTRITION INSECURITYDUE TO THE INTERCONNECTED NATURE OF SEVERAL HEALTH AREAS, THE MMC-BEAVER DAM CHNA WORKGROUP CHOSE TO COMBINE MANY COMMUNITY HEALTH AREAS AND LIVING CONDITIONS INTO THE IDENTIFIED HEALTH PRIORITIES OF:-ALCOHOL AND SUBSTANCE USE-BEHAVIORAL HEALTH-CHRONIC DISEASE-SOCIAL DETERMINANTS OF HEALTHHEALTH PRIORITY: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE YOUTH SUBSTANCE USE-STRATEGY 1: SUPPORT COMMUNITY WIDE ENVIRONMENTAL STRATEGIES, PREVENTION, AND/OR POLICY TO ADDRESS UNDERAGE ALCOHOL USE.GOAL 2: REDUCE COMMUNITY IMPACT RELATED TO SUBSTANCE USE AND MISUSE-STRATEGY 1: SUPPORT COMMUNITY WIDE ENVIRONMENTAL STRATEGIES, PREVENTION AND/OR POLICY TO ADDRESS SUBSTANCE USE.-STRATEGY 2: SUPPORT COMMUNITY LED RECOVERY EFFORTS TO REDUCE SUBSTANCE USE-STRATEGY 3: SUPPORT WORKPLACE DRUG PREVENTION AND RECOVERY EFFORTS.GOAL 3: ENGAGE IN COMMUNITY EFFORTS-STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY: BEHAVIORAL HEALTHGOAL 1: DECREASE SUICIDE RATES FOR HIGH RISK POPULATIONS-STRATEGY 1: ENHANCE COMMUNITY MEMBER'S SKILLS TO SUPPORT MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION.-STRATEGY 2: PROMOTE PROTECTIVE FACTORS THAT BUILD SENSE OF BELONGING.-STRATEGY 3: SUPPORT SUICIDE PREVENTION COMMUNITY AWARENESS EVENTS.GOAL 2: IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS-STRATEGY 1: INCREASE AVAILABILITY OF MENTAL HEALTH SERVICES.-STRATEGY 2: ENHANCE COMMUNITY CAPACITY TO ADDRESS HIGH RISK YOUTH NEEDS THROUGH AFTERSCHOOL CARE OPTIONS.-STRATEGY 3: ENHANCE SCHOOL CAPACITY TO PROVIDE HIGH QUALITY SOCIAL, EMOTIONAL ASSESSMENT, SUPPORT, AND LEARNING.GOAL 3: ENGAGE IN COMMUNITY EFFORTS-STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY: CHRONIC DISEASEGOAL 1: IMPROVE ACCESS TO HEALTHY FOODS-STRATEGY 1: INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCALLY GROWN FOOD AND ADDRESS FOOD INSECURITY.GOAL 2: REDUCE RATES OF PREVENTABLE CHRONIC CONDITIONS WITH FOCUS ON OBESITY/DIABETES-STRATEGY 1: ENHANCE PROGRAMMING TO IMPACT CHRONIC DISEASE SELF-MANAGEMENT AND PREVENTION WITH A FOCUS ON OBESITY AND DIABETES.-STRATEGY 2: PROVIDE EDUCATION AND SKILL BUILDING OPPORTUNITIES.GOAL 3: ENGAGE IN COMMUNITY EFFORTS-STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY: SOCIAL DETERMINANTS OF HEALTH (SDOH)GOAL 1: INCREASE KNOWLEDGE AND AWARENESS OF HEALTH EQUITY-STRATEGY 1: CONDUCT AN ORGANIZATIONAL (INTERNAL) AND COMMUNITY ASSESSMENT (EXTERNAL) ASSESSMENT OF HEALTH DISPARITIES AND HEALTH EQUITY AND DEVELOP A WORK PLAN TO ADDRESS THOSE GAPS.GOAL 2: IMPROVE HEALTH OUTCOMES BY CONNECTING CLINICAL PRACTICE TO COMMUNITY EFFORTS TO ADDRESS SDOH BARRIERS-STRATEGY 1: SUPPORT AND CONNECT PATIENTS AND COMMUNITY MEMBERS TO RESOURCES TO ADDRESS SOCIALLY DETERMINED NEEDS. GOAL 3: IMPROVE HEALTH OUTCOMES BY IMPROVING LIVING CONDITIONS TO ADDRESS SDOH BARRIERS-STRATEGY 1: ENGAGE IN COMMUNITY CAPACITY BUILDING IN THE PHYSICAL, SOCIAL, AND/OR ECONOMIC ENVIRONMENT.GOAL 4: ENGAGE IN COMMUNITY EFFORTS-STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH NEEDS NOT ADDRESSEDTHROUGH THE ASSESSMENT PROCESS, THE CHNA WORKGROUP IDENTIFIED OTHER COMMUNITY HEALTH NEEDS THAT WERE NOT PRIORITIZED. THE CHNA WORKGROUP CONSIDERED OTHER ORGANIZATIONS ADDRESSING THE SPECIFIC NEED, THE ABILITY OF MMC-BEAVER DAM TO IMPACT CHANGE, AVAILABILITY OF RESOURCES, AS WELL AS READINESS OF THE COMMUNITY FOR INTERVENTIONS. AFTER CONSIDERATION, THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-BEAVER DAM FOR REASONS INDICATED: -ORAL HEALTH: MMC-BEAVER DAM IS WORKING TO GROW PARTNERSHIPS WITH LOCAL SERVICES THAT PROVIDE LOW-COST ORAL HEALTHCARE. FOR THE 2022 CHNA, THIS HEALTH NEED WAS NOT PRIORITIZED BY THE CHNA WORKGROUP. THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, AND THE FACT THAT MMC-BEAVER DAM IS NOT CURRENTLY EQUIPPED TO MEET THIS NEED. -ACCESS TO AND AFFORDABILITY OF CARE: MMC-BEAVER DAM CONTINUES TO MAKE PROGRESS TOWARDS INCREASING ACCESS AND REDUCING COST OF HIGH-QUALITY CARE. FOR THE 2022 CHNA, THIS HEALTH NEED WAS NOT PRIORITIZED BY THE CHNA WORKGROUP. THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, THE VERY BROAD NATURE OF THIS NEED, IN THAT IT IS NOT EASILY DEFINED AND NOT EASILY MEASURED.-POVERTY/LOW WAGE JOBS: MMC-BEAVER DAM'S CAPACITY TO ADDRESS SOCIOECONOMIC LEVELS OF DODGE COUNTY RESIDENTS IS VERY LIMITED. HOWEVER, OTHER ORGANIZATIONS IN THE COUNTY, INCLUDING THE UNITED WAY, ARE ADDRESSING THIS ISSUE. BY SHARING RESOURCES TO THOSE WHO NEED IT, MMC-BEAVER DAM IS COLLABORATING WITH THE AGENCIES WHO ARE WELL EQUIPPED TO ADDRESS SOCIOECONOMIC STRESSORS THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, THE VERY BROAD NATURE OF THIS NEED, IN THAT IT IS NOT EASILY DEFINED AND NOT EASILY MEASURED.-STRESS THAT ACCOMPANIES POVERTY: SIMILAR TO ADDRESSING POVERTY AND LOW-WAGE JOBS, MMC-BEAVER DAM'S CAPACITY TO ADDRESS STRESS DUE TO SOCIOECONOMIC STATUS IS LIMITED. HOWEVER, TO ATTEMPT TO ALLEVIATE STRESS, MMC-BEAVER DAM IS COMMITTED TO STRENGTHENING THE COMMUNITY TIES WITH OTHER AGENCIES BY PROVIDING REFERRALS TO SUCH AGENCIES AND IS CONTINUALLY WORKING TO INCREASE ACCESS TO LOW-COST SERVICES. 6 1 - HILLSIDE MANOR 803 S UNIVERSITY AVENUE BEAVER DAM WI 53916 SKILLED NURSING FACILITY 2 - REMEMBRANCE HOME 1810 NORTH SPRING STREET BEAVER DAM WI 53916 DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY 3 - EAGLES WINGS 408 STONE STREET BEAVER DAM WI 53916 DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY 4 - BEAVER DAM REFERENCE LAB 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 REFERENCE LAB 5 - HILLSIDE HOMECARE AND HOSPICE 709 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 HOME HEALTH AGENCY 6 - STONE TERRACE RETIREMENT LIVING CENTER 819 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 RESIDENTIAL CARE APARTMENT COMPLEX PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. PART II, COMMUNITY BUILDING ACTIVITIES: IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT, WE ENRICH LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY-BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY, AND BY ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES. DUE TO LINGERING IMPACTS OF COVID-19, DECREASED STAFFING AND CAPACITY, MANY COMMUNITY-BUILDING ACTIVITIES REMAINED LIMITED DURING THIS REPORTING PERIOD. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED:COALITION BUILDING: MARSHFIELD MEDICAL CENTER-BEAVER DAM (MMC-BEAVER DAM) STAFF PARTICIPATED IN MULTIPLE COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY SUCH AS DREAM UP DODGE COUNTY CHILDCARE TASKFORCE, DODGE COUNTY INTERAGENCY, ALLIANCE FOR SUBSTANCE ABUSE PREVENTION (ASAP) DODGE COUNTY, BEAVER DAM DEI TASKFORCE, PLAYGROUND MOVEMENT BEAVER DAM, BEAVER DAM PARKS & PLACEMAKING COMMITTEE, ACTIVE WISCONSIN, AND WISCONSIN PUBLIC HEALTH ASSOCIATION. ECONOMIC DEVELOPMENT:THE PRESIDENT OF MMC-BEAVER DAM SITS ON THE BOARD OF DIRECTORS FOR THE BEAVER DAM AREA CHAMBER OF COMMERCE. THE CHIEF NURSING OFFICER SITS ON THE MORAINE PARK TECHNICAL COLLEGE SCHOOL OF NURSING BOARD. COMMUNITY OUTREACH STAFF PARTICIPATE IN THE BEAVER DAM, FOX LAKE, HORICON, JUNEAU AND WAUPUN CHAMBERS OF COMMERCE REPRESENTING MMC-BEAVER DAM ACTIVELY ENGAGING IN CHAMBER ACTIVITIES THAT SUPPORT ECONOMIC DEVELOPMENT OF THE COMMUNITIES MMC-BEAVER DAM SERVES. COMMUNITY SUPPORT: IN 2022, MMC-BEAVER DAM HELD A 100-YEAR CELEBRATION EVENT. THE EVENT WAS FREE TO COMMUNITY MEMBERS AND MANAGED BY MMC-BEAVER DAM STAFF. HIGHLIGHTS INCLUDED LOCAL HEALTHCARE HISTORY, ACTIVITIES AND FREE HEALTH SCREENINGS. IN TOTAL 154 COMMUNITY MEMBERS RECEIVED FREE HEALTH SCREENINGS. THE HEALTH SCREENINGS OFFERED WERE DERMATOLOGY, DIABETES, BLOOD PRESSURE, SLEEP APNEA, BALANCE, POSTURE AND EYE. MMC-BEAVER DAM CREATED A COMMUNITY HEALTH GRANT PROGRAM IN 2021. THE INTENT OF THE PROGRAM IS TO SUPPORT LOCAL NOT-FOR-PROFIT ORGANIZATIONS ACTIVELY WORKING TO DEVELOP NEW IDEAS OR ENHANCE EXISTING PROJECTS THAT IMPROVE THE HEALTH OF RESIDENTS OF DODGE COUNTY AND BEYOND. PRIORITIES IDENTIFIED BY THE CHNA AND IS INCLUDE ALCOHOL AND SUBSTANCE ABUSE, BEHAVIORAL HEALTH, CHRONIC DISEASE PREVENTION AND SOCIAL DETERMINANTS OF HEALTH. GRANTS, FROM $1,000-$10,000, WERE AVAILABLE.STAFF ALSO SUPPORTED THE BEAVER DAM CHAMBER OF COMMERCE AND THE DOWNTOWN BEAVER DAM FARMERS MARKET WITH ASSISTANCE TO SETUP AND ACCEPT SNAP/EBT AT THE LOCAL FARMERS MARKET. MMC-BEAVER DAM PROVIDED MARKET MATCH FUNDS FOR THE MARKET IN 2022.ENVIRONMENTAL IMPROVEMENTS: MMC-BEAVER DAM PROVIDED SHARPS DISPOSAL IN THE HOSPITAL THAT WAS OPEN TO THE PUBLIC TO ENCOURAGE SAFE DISPOSAL OF SHARPS IN THE COMMUNITY. A MEDICATION DISPOSAL RECEPTACLE WAS AVAILABLE IN THE MMC-BEAVER DAM PHARMACY STARTING IN JANUARY 2022. LEADERSHIP DEVELOPMENT AND LEADERSHIP TRAINING FOR COMMUNITY MEMBERS: MMC-BEAVER DAM PARTNERS WITH LEADERSHIP BEAVER DAM, A TRAINING PROGRAM TO DEVELOP COMMUNITY LEADERS COORDINATED BY THE BEAVER DAM CHAMBER OF COMMERCE. MMC-BEAVER DAM HOSTS THE COHORT ONCE A YEAR TO TEACH PARTICIPANTS ABOUT THE HEALTH CARE INDUSTRY AND WHAT IMPACT MMC-BEAVER DAM HAS LOCALLY. MMC-BEAVER DAM STAFF ALSO CONDUCTED "AWAKEN YOUR WHY" WORKSHOPS FOR COMMUNITY MEMBERS. WORKSHOPS PROVIDE AN OPPORTUNITY TO BEGIN TO EXPLORE WHAT ONE'S PURPOSE IS. PARTICIPANTS ACTIVELY PARTICIPATE IN ENGAGING ACTIVITIES TO HELP THEM DISCOVER THEIR GIFTS AND THEN BEGIN TO UNDERSTAND HOW THEY CAN USE THESE GIFTS AND LIVE LIFE WITH GREATER PURPOSE. ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY: MMC-BEAVER DAM STAFF PARTICIPATED AS BOARD SECRETARY AND AN ANNUAL CONFERENCE PLANNING COMMITTEE MEMBER FOR THE WISCONSIN PUBLIC HEALTH ASSOCIATION (WPHA). WPHA'S ADVOCACY PRIORITIES INCLUDED EARLY CHILDHOOD EDUCATION, CRIMINAL JUSTICE REFORM, INCOME STABILITY AND EMPLOYMENT, AND HOUSING. MMC-BEAVER DAM STAFF ALSO PARTICIPATE IN THE COUNCIL OF ADVOCATES WITH THE WI BIKE FED WORKING TO ADVANCE BIKING INITIATIVES THROUGHOUT THE STATE. MMC-BEAVER DAM STAFF ALSO PARTICIPATED ON THE BEAVER DAM PARKS & PLACEMAKING COMMITTEE WHOSE MAIN TASK FOR 2022 WAS UPDATING THE CITY'S COMPREHENSIVE OUTDOOR RECREATION PLAN. WORKFORCE DEVELOPMENT: MMC-BEAVER DAM MENTORED AN MPH STUDENT INTERN AND AREA HEALTH EDUCATION CENTER COMMUNITY HEALTH INTERNSHIP PROGRAM STUDENT INTERN IN 2022. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS 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 DEDUCTIBLES AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT 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. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 61% AND 60% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2022 AND DECEMBER 31, 2021, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2022 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: ALL MARSHFIELD MEDICAL CENTER FACILITIES ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE BY CONDUCTING STANDARD CHNA PRACTICES, INCLUDING: -REVIEW OF COMMUNITY PARTNERS' REPORTS (I.E. UNITED WAY) -REVIEW OF PUBLICLY AVAILABLE COMMUNITY HEALTH DATA (I.E. COUNTY HEALTH RANKINGS) -COMPLETION OF KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS ABOUT THE COMMUNITY'S HEALTH NEEDS -COMPLETION OF COMMUNITY CONVERSATIONS WITH COMMUNITY MEMBERS -PARTICIPATION IN COMMUNITY HEALTH COMMITTEES AND BOARDS PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE. INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA.THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: MMC-BEAVER DAM SERVES RURAL DODGE COUNTY. DODGE COUNTY IS LOCATED IN SOUTH-EASTERN REGION OF WISCONSIN. KNOWN FOR ITS LAKES, STREAMS AND SMALL TOWNS, DODGE COUNTY, WISCONSIN OFFERS A PEACEFUL RURAL ENVIRONMENT LOCATED WITHIN AN HOUR DRIVE OF MILWAUKEE, MADISON AND FOX VALLEY METROPOLITAN AREAS. THE COUNTY IS COMPRISED OF FOUR CITIES, BEAVER DAM, MAYVILLE, JUNEAU (COUNTY SEAT) AND HORICON. OTHER MAJOR CITIES, A PORTION OF WHICH IS IN DODGE COUNTY, INCLUDE WATERTOWN, HARTFORD, WAUPUN AND COLUMBUS. DODGE COUNTY IS ALSO HOME TO OVER 30 VILLAGES AND TOWNSHIPS. THERE IS A GROWING SPANISH-SPEAKING POPULATION IN DODGE COUNTY. MANY ARE EMPLOYED IN THE AGRICULTURE SECTOR, WORKING ON FARMS OR FACTORIES, OR IN SEASONAL JOBS, WHICH PRESENT UNIQUE HEALTH CHALLENGES AND BARRIERS. THERE IS AN AMISH COMMUNITY IN COLUMBIA COUNTY ON THE BORDER OF DODGE COUNTY. THIS COMMUNITY IS WIDESPREAD OVER SEVERAL TOWNSHIPS AND CONSISTS OF SMALL TO MEDIUM-SIZED AMISH FARMSTEADS AND INDIVIDUAL HOMES. WHEN IN NEED OF MEDICAL CARE, MMC-BEAVER DAM IS OFTEN THE CLOSEST LOCATION FOR THESE FAMILIES. THERE ARE TWO OTHER HOSPITALS ADJACENT TO DODGE COUNTY. WAUPUN MEMORIAL HOSPITAL, LOCATED IN WAUPUN AND WATERTOWN REGIONAL MEDICAL CENTER, LOCATED IN WATERTOWN. THE TWO ADJACENT HOSPITALS, ALONG WITH THREE ADJACENT LOCAL PUBLIC HEALTH DEPARTMENTS, DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT, WATERTOWN DEPARTMENT OF PUBLIC HEALTH, AND JEFFERSON COUNTY HEALTH DEPARTMENT, COORDINATED WITH MMC-BEAVER DAM ON COMMUNITY HEALTH-RELATED ASSESSMENTS AND IMPLEMENTATION ACTIVITIES. PART VI, LINE 5: MARSHFIELD MEDICAL CENTER- BEAVER DAM FURTHERED ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY WITH THE FOLLOWING REPRESENTATION: -BEAVER DAM AREA CHAMBER OF COMMERCE BOARD -BEAVER DAM ROTARY -LION'S CLUB INTERNATIONAL -BEAVER DAM AREA COMMUNITY THEATRE BOARD -SOUTHEASTERN WISCONSIN WORKFORCE DEVELOPMENT BOARD ADDITIONAL INITIATIVES SUPPORTED BY MMC-BEAVER DAM INCLUDE: -RECOVERY MEALS PROGRAM TO ASSIST FOOD/NUTRITION-INSECURE PATIENTS IN GETTING ACCESS TO HEALTHY FOODS UPON DISCHARGE -SUPPORTED CHURCH HEALTH SERVICES, A LOCAL ORGANIZATION COMMITTED TO PROVIDING HEALTH SERVICES TO LOW-INCOME PATIENTS WITHOUT INSURANCE -HARVESTED AND DISTRIBUTED FRESH HYDROPONIC LETTUCE TO AREA FOOD PANTRIES -PROVIDED FREE VIRTUAL HEALTHY COOKING DEMONSTRATIONS -PROVIDED MEALS ON WHEELS AND FOOT CLINICS -OFFERED LACTATION CONSULTANT SERVICES -PROVIDED FREE HEALTH SCREENINGS -SUPPORTED LOCAL HOT MEAL PROGRAM WITH TIME -OFFERED TRANSPORTATION TO PATIENTS WITHOUT ACCESS PART VI, LINE 6: MARSHFIELD CLINIC WAS FOUNDED IN 1916 BY SIX PHYSICIANS PRACTICING IN MARSHFIELD, A RURAL CENTRAL WISCONSIN CITY. AT ITS INCEPTION, CLINIC FOUNDERS SAW RESEARCH AND EDUCATION AS CRITICAL TO THEIR PRACTICE OF HEALTH CARE AND THAT REMAINS SO TODAY. THE CLINIC BECAME A 501(C)(3) NONPROFIT ORGANIZATION IN 1992 AND IN 2014, MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS), WAS FORMED. MCHS TODAY IS AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN, AND RESEARCH AND EDUCATION PROGRAMS. MCHS PRIMARY OPERATIONS INCLUDE: MARSHFIELD CLINIC; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, IRON MOUNTAIN, PARK FALLS, AND MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION.UNIQUE TO MCHS IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILDS BRIDGES BETWEEN THE HEALTHCARE SYSTEM AND THE PLACES IN THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. THE CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THE CCHA INCLUDES HOSPITAL STAFF WHO ARE CLOSELY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY (IS) IN THEIR RESPECTIVE COUNTIES. THIS HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. 0 1 0 0 0 0 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 0 1812322 0 910520 0 325650 0 287565 0 27779 0 3363836 0 258588 JERARD JENSEN MCHS GENERAL COUNSEL 0 801522 0 202859 0 54499 0 23031 0 42224 0 1124135 0 0 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO 0 784186 0 5000 0 40227 0 23031 0 34024 0 886468 0 0 GORDON EDWARDS MCHS CFO/COO - PART YEAR 0 560115 0 166037 0 103493 0 9150 0 22602 0 861397 0 0 RUWAN DISSANAYAKE MD SECRETARY 0 398039 0 103133 0 27384 0 21612 0 32703 0 582871 0 0 ANGELIA FOSTER PRESIDENT MMC - BEAVER DAM 308940 0 3750 0 21253 0 23031 0 31906 0 388880 0 0 0 KATHY BRESSLER MCHS COO 0 285062 0 25000 0 60717 0 8769 0 8105 0 387653 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $219,744 THE FOLLOWING INDIVIDUALS PARTICATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A DISTRIBUTION OR HAVE AN AMOUNT VEST IN THE PLAN. UNDER THE PLAN, AMOUNTS DO NOT VEST UNTIL TWO YEARS AFTER SEPARATION FROM THE ORGANIZATION: RUWAN DISSANAYAKE, MD JERARD JENSEN GORDON EDWARDS WILLIAM MELMS, MD ANGELIA FOSTER FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING BEAVER DAM COMMUNITY HOSPITALS, INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR BEAVER DAM COMMUNITY HOSPITALS, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR BEAVER DAM COMMUNITY HOSPITALS, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF BEAVER DAM COMMUNITY HOSPITALS, INC. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF BEAVER DAM COMMUNITY HOSPITALS, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF BEAVER DAM COMMUNITY HOSPITALS, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO INSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 BEAVER DAM COMMUNITY HOSPITALS, INC. DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART VII, SECTION A: COMPENSATION REPORTED FOR ANGELIA FOSTER HAS BEEN PAID BY A RELATED ORGANIZATION AND COMMON PAYMASTER, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. SINCE ALL SERVICES PERFORMED BY THIS INDIVIDUAL WERE FOR BEAVER DAM COMMUNITY HOSPITALS INC, THE COMPENSATION HAS BEEN REPORTED IN COLUMN D AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH PAYROLL FILING REQUIREMENTS. FORM 990, PART X, LINE 20: BEAVER DAM COMMUNITY HOSPITALS, INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 43,007,641. EQUITY INCOME IN AFFILIATES -1,017,917. 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