2023-10-31T11:59:29-05:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 390929538 ST JOSEPH'S HEALTH SERVICES INC STJO 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 ROBIN NELSON FINANCE ADMINISTRATOR 6084898000 2023-10-27 1 ROBIN NELSON 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2023-10-17 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GUNDERSEN ST JOSEPH'S HOSPITAL AND CLINICS ROBIN NELSON PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 37108668 0 X WWW.GUNDERSENHEALTH.ORG/ST-JOSEPHS X 1949 WI WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. 12 4 228 10 0 0 1763788 1855323 32548429 35082962 11211 41673 449753 128710 34773181 37108668 0 0 0 0 16205219 17585276 0 0 0 13384510 14007456 29589729 31592732 5183452 5515936 60670818 60769251 31287406 26336821 29383412 34432430 X WE WILL DISTINGUISH OURSELVES THROUGH PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. 1 1 22135177 0 29342913 ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW INCOME PATIENTS. THE ORGANIZATION OPERATES A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING ACUTE CARE SERVICES TO THE HILLSBORO, WISCONSIN AREA. INPATIENT SERVICES INCLUDE ACUTE CARE FOR MEDICAL, SURGICAL, SWING BED, AND HOSPICE PATIENTS. ST. JOSEPH'S HEALTH SERVICES, INC. ALSO PROVIDES DIAGNOSTIC SERVICES TO PATIENTS, SUCH AS X-RAY, LAB, AND THERAPY SERVICES. THE HOSPITAL HAD 1,554 TOTAL INPATIENT DAYS DURING THE FISCAL YEAR. OF THOSE PATIENT DAYS 585 WERE RELATED TO ACUTE INPATIENT SERVICES AND 969 DAYS OF CARE PROVIDED TO HOSPICE AND SWING BED PATIENTS. THE HOSPITAL'S SWING BED PROGRAM PROVIDES CARE TO PATIENTS NEEDING EITHER SKILLED NURSING OR REHABILITATIVE PROGRAMS IN THE HOSPITAL SETTING. THE SWING BED PROGRAM IS A VITAL SERVICE TO THE COMMUNITY AS THERE CURRENTLY IS NO SKILLED NURSING FACILITY IN HILLSBORO, WISCONSIN, AND THIS PROGRAM ALLOWS MANY PATIENTS THE OPPORTUNITY TO BE CARED FOR IN THEIR COMMUNITY.ST. JOSEPH'S HEALTH SERVICES ALSO PROVIDES VARIOUS OUTPATIENT SERVICES INCLUDING EMERGENCY AND URGENT CARE SERVICES; DIAGNOSTIC PROCEDURES, SUCH AS X-RAYS, CT SCANS, MRI'S, AND LABORATORY TESTING; SURGICAL PROCEDURES; AND THERAPY PROGRAMS INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH, AND RESPIRATORY THERAPY SERVICES ARE AMONG THE MANY SERVICES PROVIDED BY THE HOSPITAL.ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITH MINIMAL OR NO CHARGE. IN ADDITION, ST. JOSEPH'S IS A PROVIDER UNDER THE WISCONSIN MEDICAID PROGRAM. UNDER THIS PROGRAM, THE ORGANIZATION IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES. (SEE ADDITIONAL INFORMATION ON THE COST OF PROVIDING THESE SERVICES INCLUDED IN SCHEDULE H OF THE FORM 990.)ST. JOSEPH'S PROVIDES THE MEALS FOR THE SENIOR MEAL SITE COMMUNITY MEMBERS. THESE MEALS ARE DELIVERED TO THE MEMBERS HOME. WE OFFERS ADULT FITNESS IN OUR REHABILITATION GYM, HOME MONITORING EQUIPMENT SO PATIENT'S CAN SAFELY GO HOME TO RECOVER. ST. JOSEPH'S IS VERY INVOLVED IN THE CARE OF THE SCHOOL AGE CHILDREN IN OUR SERVICE AREA. THROUGH CONTRACTS WITH THE AREA SCHOOLS WE PROVIDE THEM WITH NURSES, ATHLETIC TRAINERS, SOCIAL WORKER, AND BEHAVIORAL HEALTH THERAPISTS. WE PROVIDE ALL THE TRAINING, CME, AND EDUCATION TO SUPPORT THESE PROVIDERS IN THE SCHOOL SYSTEM. CHANGES TO THE PROGRAM: THE HOSPITAL ADDED PAIN MANAGEMENT SERVICES 1 DAY/MONTH - UROLOGY SERVICES OFFERED 3 DAYS/MONTH - CHIROPRACTIC SERVICES OFFERED 2 DAYS/WEEK - VASCULAR SURGERY SERVICES OFFERED 1 DAY/MONTHDUE TO RESTRICTIONS DURING COVID WE HAD TO TEMPORARILY SUSPEND OUR COMMUNITY OUTREACH EVENTS. MANY OF THE COVID RESTRICTIONS HAVE BEEN LIFTED NOW IN THE HEALTH CARE INDUSTRY SO WE ARE STARTING UP THOSE PROGRAMS AGAIN INCLUDING, STRONG BODIES, CRP TRAINING, ADVANCED DIRECTIVES SEMINARS, SCRUB CLUB FOR MIDDLE SCHOOL STUDENTS, BLOOD DRIVES, EMPLOYEE EVENTS TO INCREASE VITALITY AT WORK, EDUCATIONAL VAPING ASSEMBLIES FOR LOCAL SCHOOLS, CAREER DAYS, ETC. WE ARE ADDING MORE AND MORE EVENTS IN THE COMMUNITY TO ADDRESS THE HEALTH OF OUR COMMUNITY. 4324451 0 5732597 ST. JOSEPH'S HEALTH SERVICES, INC. ALSO OPERATES THREE CLINICS LOCATED IN HILLSBORO, ELROY, AND WONEWOC, WISCONSIN. DURING THE FISCAL YEAR THESE THREE CLINICS PROVIDED A TOTAL OF 15,990 VISITS TO PATIENTS. ALL THREE OF THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL AND UNDERSERVED AREAS OF THE COUNTRY BY HEALTH CARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FURTHER DISTANCES FOR QUALITY HEALTHCARE. PATIENTS OF THE CLINICS ARE ALSO ELIGIBLE TO QUALIFY UNDER ST. JOSEPH'S HEALTH SERVICES FINANCIAL ASSISTANCE POLICY AS IT IS THE GOAL OF THE ORGANIZATION TO PROVIDE QUALITY HEALTHCARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 26459628 1 1 0 1 0 0 0 0 0 0 1 0 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 1 0 0 0 0 0 0 1 1 0 0 0 1 60 0 228 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 4 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ROBIN NELSON 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 MIKE MCKEE SECRETARY 0.80 40.00 X X 0 270756 67960 KRISTIE MCCOIC ADMINISTRATOR 50.00 X 0 178958 50605 SCOTT LARSON PHARMACIST 50.00 X 204844 0 22311 DANA MEYERS BOARD DIRECTOR 0.80 X 0 174669 48086 RACHEL ALBRECHT MBA TREASURER/ADMIN DIRECTOR (THRU NOV) 0.80 40.00 X X 0 151435 46902 ROBIN NELSON FINANCE ADMINISTRATOR 50.00 X 0 143981 46533 CHRIS SHANNON NURSE 50.00 X 128839 0 43666 CALEB VANDEHEI NURSE 50.00 X 134452 0 34147 DENISE KROES NURSE 50.00 X 139100 0 27017 JESSICA THOMPSON NURSE PRACTITIONER 50.00 X 127823 0 34408 STACIE CHRISTENSEN BOARD DIRECTOR 0.80 X 0 111515 40276 THEA FRONK DIRECTOR OF IP SERVICES 50.00 X 102552 0 41729 HOLLY BOISON BOARD DIRECTOR 0.80 X 0 100712 37947 ASHLEY THAYER DIRECTOR OF OP SERVICES 50.00 X 119521 0 7811 JIM MLSNA CHAIR 0.80 X X 0 0 0 ANN BRADNAU HYNEK VICE CHAIR 0.80 X X 0 0 0 NATALIE ADAMS BOARD DIRECTOR 0.80 X 0 0 0 KATHY KLOCK BOARD DIRECTOR (THRU MAY) 0.80 X 0 0 0 MIKE RORAFF BOARD DIRECTOR 0.80 X 0 0 0 957131 1132026 549398 7 0 1 0 GUNDERSEN HEALTH SYSTEM 1900 SOUTH AVE LA CROSSE WI 54601 HEALTH & ADMIN SERVICES 7117836 CD SMITH CONSTRUCTION INC PO BOX 1006 FOND DU LAC WI 54936 CONSTRUCTION 662837 KRISTINE LADIKA 27349 COUNTY HWY V WONEWOC WI 53968 CRNA SERVICES 547808 WIESER BROTHERS INC 200 TWILITE STREET LACRESCENT MN 55947 CONSTRUCTION 435855 SHARED IMAGING SERVICES 944 WATER ST SAUK CITY WI 53583 ULTRASOUND & NUCLEAR MEDICINE SERVICES 173993 6 420600 1434723 1855323 NET PATIENT SERVICE REVENUE 621400 27686574 27686574 PHARMACY REVENUE 456110 7337476 7337476 58912 51460 7452 35082962 39173 39173 2500 0 2500 2500 2500 DIETARY/CAFETERIA 722514 127350 127350 INSURANCE PROCEEDS 900099 1000 1000 360 360 128710 37108668 35075510 0 177835 271228 271228 13779876 11945942 1833934 338555 296258 42297 2394959 2077811 317148 800658 652809 147849 1153476 1153476 18200 18200 2828942 2735664 93278 68578 68578 702716 415122 287594 3532 3532 327857 317909 9948 35758 26423 9335 36276 22101 14175 812217 649774 162443 2465882 1972706 493176 77158 77158 PHARMACY EXPENSE 1722459 1722459 PROVISION FOR BAD DEBTS 1501408 1501408 MEDICAL SUPPLIES 1388142 1387795 347 REPAIRS AND MAINTENANCE 620855 620744 111 244000 111171 132829 31592732 26459628 5133104 0 1150 1150 20612012 21533624 4147826 4713021 492820 497789 338499 231160 41810739 8900390 33800266 32910349 107623 107851 1170622 774307 60670818 60769251 2343987 1774648 55493 24370481 23718141 4572938 788539 31287406 26336821 X 29025778 33709831 357634 722599 29383412 34432430 60670818 60769251 X 5515936 -466918 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4416 4416 0 PART II-B, LINE 1: ST. JOSEPH'S HEALTH SERVICES, 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, HOWEVER, A PORTION OF THE ANNUAL DUES PAID TO THE WHA WAS USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ST. JOSEPH'S HEALTH SERVICES, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION 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 IMPROVE HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. THESE EFFORTS ALSO INCLUDE LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. 1203574 1203574 31820020 4754250 27065770 7608985 4136230 3472755 1178160 9910 1168250 32910349 3RD PARTY SETTLEMENTS PAYABLE 621279 DUE FROM GLAS 118864 ASSET RETIREMENT OBLIGATION 48396 788539 X PART X, LINE 2: THE SYSTEM HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 0 1 0 468377 468377 0.01480 4750000 3312269 1437731 0.04550 5218377 3312269 1906108 0.06030 103368 39414 63954 0.00200 38835 38835 0.00120 15862830 9147653 6715177 0.21260 6515 6515 0.00020 16011548 9187067 6824481 0.21600 21229925 12499336 8730589 0.27630 3625 3625 0.00010 3625 3625 0.00010 1 776776 388388 7488265 7637579 -149314 X 1 1 1 1 ST JOSEPH'S HEALTH SERVICES INC PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 HTTP://WWW.GUNDERSENHEALTH.ORG/ST-JOSE 1005 X X X X PROVIDER BASED PHYSICIAN CLINICS ST JOSEPH'S HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X 1 22 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 5: IN PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ST. JOSEPH'S HEALTH SERVICES, INC. GATHERED INFORMATION IN THREE WAYS:- A RANDOM HOUSEHOLD SURVEY- CONVENIENCE SAMPLING OF IDENTIFIED GROUPS- AN ANALYSIS OF COUNTY HEALTH RANKINGS DATA- INPUT FROM COUNTY STAKEHOLDERS. ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- TRI-COUNTY MEMORIAL HOSPITAL- GUNDERSEN LUTHERAN HEALTH CENTER- MAYO CLINIC HEALTH SYSTEM- TOMAH MEMORIAL HOSPITAL- VERNON MEMORIAL HEALTHCARE ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS:- GREAT RIVERS UNITED WAY- LA CROSSE COMMUNITY FOUNDATION- LA CROSSE COUNTY HEALTH DEPARTMENT- MONROE COUNTY HEALTH DEPARTMENT- VERNON COUNTY HEALTH DEPARTMENT- TREMPEALEAU COUNTY HEALTH DEPARTMENT- HOUSTON COUNTY PUBLIC HEALTH DEPARTMENT ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 11: 1. MENTAL HEALTHA. CONTINUED EXPANSION AND DEVELOPMENT OF OUR SCHOOL-BASED BEHAVIORAL HEALTH PROGRAM. HAVE SECURED MULTIPLE GRANTS TO COVER THE COST OF RECRUITMENT AND STAFFING.B. FOCUSED OUR MARKETING EFFORTS ON PUSHING THE IMPORTANCE OF THE LITTLE THINGS THAT MAKE US HEALTHY (HAVING CONNECTIONS, DINING WITH FRIENDS, DANCING WITH THE KIDS)2. POVERTY/LIVABLE WAGES/SOCIOECONOMIC DISPARITIESA. FOUNDING MEMBER OF HILLSBORO CHAMBER OF COMMERCE.B. ESTABLISHED OUR HUNGERCARE PROGRAM TO PROVIDE FREE BOXES OF FOOD TO COMMUNITY MEMBERS WHO ARE FOOD INSECURE.C. WORKING ON THE DEVELOPMENT OF A SCHOOL-BASED SNACK CLOSET PROGRAM TO PROVIDE OUR YOUTH WITH CONSISTENT ACCESS TO HEALTHY SNACKS DURING SCHOOL.D. PROMOTION OF FINANCIAL ASSISTANCE PROGRAM.3. CHILDCAREA. PARTICIPATING IN THE PARTNER-UP PROGRAM. B. PROVIDED GRANT WRITING SUPPORT TO A LOCAL COMMUNITY GROUP LOOKING TO BUILD A NEW DAYCARE.4. SAFE & AFFORDABLE HOUSINGA. CONTINUED TO COLLABORATE WITH LOCAL COUNTY HEALTH DEPARTMENTS TO EXPAND ACCESS TO THEIR WELL WATER AND RADON TESTING PROGRAMS.5. MOBILITY & TRANSPORTATION ACCESSA. WE DO NOT HAVE AN OFFICIAL PLAN TO ADDRESS THIS NEED AS IT IS NOT IN OUR AREA OF EXPERTISE BUT IT IS IMPACTING THE ABILITY FOR PATIENTS TO MAKE APPOINTMENTS. WE HAVE BEGUN TO EXPLORE THE ISSUE BUT IT IS COMPLEX AND THERE ARE LIMITING FACTORS INCLUDING STAFFING, COSTS, LIABILITY AND INSURANCE.THE FULL REPORT AND PLAN IS ACCESSIBLE HERE: HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/22471 PART V, SECTION B LINE 7A: HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/PART V, SECTION B LINE 7B:HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/PART V, SECTION B LINE 10:HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 3 1 - ST JOSEPH'S HEALTH SERVICES-HILLSBORO 400 WATER AVENUE HILLSBORO WI 54634 PHYSICIAN CLINIC 2 - ST JOSEPH'S HEALTH SERVICES-ELROY 1705 OMAHA STREET ELROY WI 53929 PHYSICIAN CLINIC 3 - ST JOSEPH'S HEALTH SERVICES-WONEWOC 301 RAILROAD STREET WONEWOC WI 53968 PHYSICIAN CLINIC PART I, LINE 3C: CATASTROPHIC CARE ASSISTANCE:FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME.DISCOUNTED CARE:FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL. POVERTY LEVEL.1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE.2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE.3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE.4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE.FREE CARE:A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT:PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING:1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY.2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES.3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY.4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS 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 ORGANIZATION'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 ST. JOSEPH'S HEALTH SERVICES, INC. INCLUDE THE OPERATION OF THE INPATIENT UNIT, EMERGENCY ROOM, AND RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF ST. JOSEPH'S HEALTH SERVICES, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR 990 PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. ST. JOSEPH'S HEALTH SERVICES, 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, BUT NOT LIMITED TO: DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, AND WOMEN'S SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. 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. PART III, LINE 4: THE ORGANIZATION IS PART OF THE GUNDERSEN HEALTH SYSTEM'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT (IMPLICIT PRICE CONCESSIONS) EXPENSE IS LOCATED IN FOOTNOTE #2, PAGES 10, 11, 18 AND 19. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE 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, SURGICAL, 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 ST. JOSEPH'S HEALTH SERVICES, 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, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (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: THE ORGANIZATION FOLLOWS GUNDERSEN HEALTH SYSTEM'S GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. PART VI, LINE 2: THE HOSPITAL REVIEWS THE UTILIZATION OF SERVICES THAT ARE CURRENTLY AVAILABLE AT THE HOSPITAL. AN EVALUATION OF THE AREA DEMOGRAPHIC IS USED TO DETERMINE WHAT NEW SERVICES MAYBE APPROPRIATE TO PROVIDE. PART VI, LINE 3: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE AT ALL CHECK IN AREAS OF OUR HOSPITAL AND CLINICS. INFORMATION IS INCLUDED WITH THE BILLING STATEMENT. AVAILABLE ON THE HOSPITAL'S WEBSITE, OR BY CALLING THE PATIENT ACCOUNTS DEPARTMENT. PART VI, LINE 4: WE HAVE A 30 MILE SERVICE THAT INCLUDES THE SEVERAL COUNTIES, VERNON, SAUK, MONROE, JUNEAU AND RICHLAND. OUR PATIENT POPULATION IS MADE UP LARGELY OF MEDICARE & MEDICAID PATIENTS. PART VI, LINE 5: DRIVE THROUGH VACCINATION CLINICS WERE HELD IN EACH OF OUR LOCAL COMMUNITIES, HILLSBORO, ELROY, AND WONEWOC TO FACILITATE EASY ACCESS FOR FLU AND COVID VACCINES. WE PROVIDE THE MEALS FOR THE COMMUNITY MEMBERS SIGNED UP FOR THE MEAL SITE. PART VI, LINE 6: THROUGH THE HOSPITAL'S AFFILIATION WITH GUNDERSEN HEALTH SYSTEM SPECIALTY CARE SERVICES ARE PROVIDED AT OUR HILLSBORO LOCATION BRINGING CARE TO OUR LOCAL PATIENTS CLOSE TO HOME. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 MIKE MCKEE SECRETARY 0 270131 0 625 0 0 0 40054 0 27906 0 338716 0 0 KRISTIE MCCOIC ADMINISTRATOR 0 175546 0 903 0 2509 0 26361 0 24244 0 229563 0 0 SCOTT LARSON PHARMACIST 198287 0 6142 0 415 0 8244 0 14067 0 227155 0 0 0 DANA MEYERS BOARD DIRECTOR 0 154752 0 14527 0 5390 0 25614 0 22472 0 222755 0 0 RACHEL ALBRECHT MBA TREASURER/ADMIN DIRECTOR (THRU NOV) 0 141471 0 289 0 9675 0 22658 0 24244 0 198337 0 0 ROBIN NELSON FINANCE ADMINISTRATOR 0 143842 0 139 0 0 0 21713 0 24820 0 190514 0 0 CHRIS SHANNON NURSE 100402 0 24625 0 3812 0 5495 0 38171 0 172505 0 0 0 CALEB VANDEHEI NURSE 104711 0 29741 0 0 0 5559 0 28588 0 168599 0 0 0 DENISE KROES NURSE 126916 0 12184 0 0 0 5703 0 21314 0 166117 0 0 0 JESSICA THOMPSON NURSE PRACTITIONER 111838 0 883 0 15102 0 4357 0 30051 0 162231 0 0 0 STACIE CHRISTENSEN BOARD DIRECTOR 0 110831 0 684 0 0 0 16767 0 23509 0 151791 0 0 SCHEDULE J, PART 1, LINE 3 A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. ANGIE NOVY SISTER OF OFFICER 42921 SALARY 0 DORIS SKEMP MOTHER OF OFFICER 10580 SALARY 0 FORM 990, PART III, LINE 2 PAIN MANAGEMENT SERVICES 1 DAY/MONTH - UROLOGY SERVICES OFFERED 3 DAYS/MONTH - CHIROPRACTIC SERVICES OFFERED 2 DAYS/WEEK - VASCULAR SURGERY SERVICES OFFERED 1 DAY/MONTH FORM 990, PART III, LINE 3 DUE TO RESTRICTIONS DURING COVID WE HAD TO TEMPORARILY SUSPEND OUR COMMUNITY OUTREACH EVENTS. MANY OF THE COVID RESTRICTIONS HAVE BEEN LIFTED NOW IN THE HEALTH CARE INDUSTRY SO WE ARE STARTING UP THOSE PROGRAMS AGAIN INCLUDING, STRONG BODIES, CRP TRAINING, ADVANCED DIRECTIVES SEMINARS, SCRUB CLUB FOR MIDDLE SCHOOL STUDENTS, BLOOD DRIVES, EMPLOYEE EVENTS TO INCREASE VITALITY AT WORK, EDUCATIONAL VAPING ASSEMBLIES FOR LOCAL SCHOOLS, CAREER DAYS, ETC. WE ARE ADDING MORE AND MORE EVENTS IN THE COMMUNITY TO ADDRESS THE HEALTH OF OUR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 4 GUNDERSEN AND BELLIN HEALTH SYSTEMS, INC. (BELLIN), EACH A WISCONSIN NONPROFIT, NON-STOCK CORPORATION, ENTERED INTO A COMBINATION AGREEMENT DATED JULY 29, 2022 (THE AGREEMENT), TO ALIGN THEIR RESPECTIVE OPERATIONS AND TO FORM A SINGLE NONPROFIT HEALTH SYSTEM THROUGH THE CREATION OF BELLIN GUNDERSEN HEALTH SYSTEM, INC., A WISCONSIN NONPROFIT, NON-STOCK CORPORATION (BELLIN GUNDERSEN). ON DECEMBER 1, 2022, UPON CONSUMMATION OF THE ALIGNMENT OF THE TWO SYSTEMS (THE AFFILIATION), BELLIN GUNDERSEN BECAME THE SOLE CORPORATE MEMBER OF BOTH BELLIN AND GUNDERSEN. BELLIN AND GUNDERSEN AND THEIR RESPECTIVE AFFILIATES ARE EXPECTED TO MAINTAIN THEIR RESPECTIVE CORPORATE EXISTENCE. IN DECEMBER 2022, THE BYLAWS OF GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. WERE AMENDED AND RESTATED TO UPDATE THE SOLE CORPORATE MEMBER TO BELLIN GUNDERSEN HEALTH SYSTEM, INC. THE BYLAWS WERE ALSO UPDATED TO SPECIFY THE POWERS RETAINED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. THE CHIEF EXECUTIVE OFFICER OF BELLIN GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. RETAINS AUTHORITY TO APPROVE ANY SIGNIFICANT CHANGES TO THE CORPORATION. SUBJECT TO THE RESERVED POWERS SPECIFIED IN THE BYLAWS, THE AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY ITS BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF ST. JOSEPH'S HEALTH SERVICES, INC. IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER AND UNDER THE TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT FIVE MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF ST. JOSEPH'S HEALTH SERVICES, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST-COMPENSATED EMPLOYEES TO COMPLETE ITS ANNUAL DISCLOSURE QUESTIONNAIRE. THESE QUESTIONNAIRES ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. ALL NOTED CONFLICTS ARE DISCLOSED ANNUALLY TO THE BOARD AND ANY MEMBERS OF THE BOARD WITH CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON THOSE ISSUES. THE ORGANIZATION ALSO NOTES AND DOCUMENTS IF ANY BUSINESS OWNED BY BOARD MEMBERS OR EMPLOYEES DO BUSINESS WITH THE ORGANIZATION TO ENSURE THAT COMPETITIVE BIDS ARE SOUGHT FOR SERVICES. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ST. JOSEPH'S HEALTH SERVICES, INC. RELIED ON IT'S AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSON LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990 IS MADE AVAILABLE TO THE PUBLIC AT ITS MAIN BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. FORM 990 INCLUDES MUCH OF THE INFORMATION CONTAINED WITHIN THE ORGANIZATION'S GOVERNING DOCUMENTS. CONFLICTS OF INTEREST ARE ALSO NOTED ON FORM 990. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS THEY ARE REQUIRED TO BE ATTACHED TO THE FORM 990. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION -466,918. FORM 990, PART IV, LINE 12B AND PART XII, LINE 2: THE ORGANIZATION WAS INCLUDED IN A SHORT YEAR CONSOLIDATED AUDIT FOR THE 11-MONTH PERIOD JANUARY 1, 2022 THROUGH NOVEMBER 30, 2022. THE ANSWERS FOR PART IV, LINE 12B AND PART XII, LINES 2A-2C HAVE BEEN ANSWERED YES EVEN THOUGH THE FORM 990 COVERS THE 12-MONTH PERIOD JANUARY 1, 2022 THROUGH DECEMBER 31, 2022. THE REASON FOR THIS CHANGE IS DUE TO A MERGER WITH THE BELLIN GUNDERSEN HEALTH SYSTEM. THE ACTIVITY OF DECEMBER 2022 WILL BE INCLUDED IN A CONSOLIDATED AUDIT FOR THE PERIODS OF DECEMBER 2022 - SEPTEMBER 2023 AS ALL THE RELATED PARTIES LISTED IN SCHEDULE R WILL BE TRANSITIONING TO THAT YEAR END. 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