2024-11-13T10:48:17-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 382780429 DICKINSON COUNTY HEALTHCARE SYSTEM DICK 7153875511 1721 SOUTH STEPHENSON AVENUE IRON MOUNTAIN MI 49801 JEANETTE WOJTALEWICZ INTERIM CFO 7153875511 2024-11-11 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-11 2023 2024-10-15 13:58:12Z MARSHFIELD MEDICAL CENTER-DICKINSON BRIAN HOERNEMAN MD 1000 N OAK AVENUE MARSHFIELD WI 54449 142072739 0 X WWW.DCHS.ORG X 1990 MI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 768 25 0 0 1801176 335795 118204998 141398231 5003367 115964 2186854 222749 127196395 142072739 0 0 0 0 55864389 67873453 0 0 0 66781131 74380215 122645520 142253668 4550875 -180929 80915306 64236890 57151834 54025114 23763472 10211776 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 135088795 141140058 DICKINSON COUNTY HEALTHCARE SYSTEM (DCHS) INCLUDES A 49-BED, GENERAL MEDICAL AND SURGICAL HOSPITAL LOCATED IN IRON MOUNTAIN, MICHIGAN AND PRIMARY CARE CLINICS IN IRON MOUNTAIN, KINGSFORD AND NORWAY, MICHIGAN AND FLORENCE, WISCONSIN. DCHS SERVES COMMUNITIES IN MICHIGAN'S CENTRAL UPPER PENINSULA AND NORTHERN WISCONSIN BY PROVIDING A BROAD RANGE OF HIGH QUALITY ACUTE CARE INCLUDING INPATIENT, OUTPATIENT, DIAGNOSTIC, AND SPECIALTY SERVICES. 135088795 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 768 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 MI X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 X MARK BUGHER CHAIR - PART YEAR 1.00 9.00 X X 0 24924 0 COLLEEN HOERNEMAN CHAIR 1.00 9.00 X X 0 6500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 13000 0 RUWAN DISSANAYAKE MD SECRETARY - PART YEAR 1.00 50.00 X X 0 370856 24157 JOHN BALTUS SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 1.00 54.00 X 0 3125033 382007 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 1.00 54.00 X 0 848741 40127 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO - PART YEAR 1.00 54.00 X 0 1053823 21091 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 515015 29993 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 56.00 X 0 536206 43230 MARGARET MINERICK BOARD MEMBER - PART YEAR 1.00 1.00 X 0 0 0 DAVID HOLMES BOARD MEMBER 1.00 0.00 X 0 0 0 CATHY BUKOWSKI MCHS CFO - PART YEAR 1.00 54.00 X 0 725840 23393 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 116564 0 AMANDA SHELAST PRESIDENT MMC-DICKINSON 50.00 0.00 X 331019 0 7605 ERIN DEPREKEL MD PHYSICIAN 50.00 0.00 X 252656 0 1325 BRIAN DONAHUE VP OF FINANCE/CFO MMC-DICKINSON 50.00 0.00 X 270832 0 7541 MARYAM HAMIDI MD PHYSICIAN 50.00 0.00 X 280086 0 1018 ERIC JOHNSON MD PHYSICIAN 50.00 0.00 X 419197 0 17603 DAVID VIAU MD PHYSICIAN 50.00 0.00 X 352049 0 4451 1905839 7336502 603541 51 0 1 0 SOUND PHYSICIANS OF MICHIGAN PO BOX 742936 LOS ANGELES CA 90074 MEDICAL SERVICES 3681516 GUNDLACH CHAMPION INC PO BOX 490 IRON MOUNTAIN MI 49801 CONSTRUCTION 2792685 UP REHAB SERVICES 841 W WASHINGTON STREET SUITE 500 MARQUETTE MI 49855 MEDICAL SERVICES 2038672 SUMMIT SURGICAL 1711 S STEPHENSON AVENUE SUITE 350 IRON MOUNTAIN MI 49801 MEDICAL SERVICES 1046999 CROTHALL FACILITIES MANAGEMENT 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 PROFESSIONAL SERVICES 635342 65 282741 53054 335795 NET PATIENT SERVICE REVENUE 621110 139482462 139482462 INTERCOMPANY REVENUE 621110 829742 829742 MISC OTHER OPERATING REVENUE 621110 827854 827854 CAFETERIA REVENUE 621110 258173 258173 141398231 115163 115163 222749 0 222749 222749 222749 801 0 801 801 801 142072739 141140058 0 596886 X 338624 338624 54913255 52654153 2259102 1373307 1296865 76442 7950049 7493299 456750 3298218 3104023 194195 99753 99753 75687 75687 19345903 17921545 1424358 108741 107741 1000 1712333 1660504 51829 2539873 2508624 31249 2748866 2391703 357163 208707 181518 27189 2002326 2002326 4066246 4066246 121209 121209 MEDICAL SUPPLIES 32540183 32221994 318189 BAD DEBT EXPENSE 3281914 3281914 MI MEDICAID ACCESS TAX 2565669 2565669 EQUIP. REPAIRS & MAINT. 983961 944688 39273 1978844 564774 1414070 142253668 135088795 7164873 0 12813353 9185243 520000 960000 10659 21583137 2094670 3985634 5886791 1460030 626753 50192718 9358312 36732537 40834406 360 882581 899270 1036676 503085 1901358 3235653 80915306 64236890 14279077 10160011 101014 856933 1861386 1644593 39449484 38900361 1460873 2463216 57151834 54025114 X 23763472 10202589 9187 23763472 10211776 80915306 64236890 X -180929 118 -13370885 X 0 1 X 1 1 1 X 3076700 3076700 23288442 2170397 21118045 293075 10041 283034 23022031 6981314 16040717 512470 196560 315910 40834406 OPERATING LEASE - BUILDING 1622785 OPERATING LEASE - EQUIP 1594518 OTHER ASSETS 18350 3235653 CAPITAL LEASES PAYABLE 806944 RESERVE MALPRACTICE CLAIMS 50000 LT OPERATING LEASE PAYABLE 1606272 2463216 X 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, 2023 OR DECEMBER 31, 2022. 1 1 1 X 1 X 1 1 1 0 1 1 15613 15613 0.00010 17505484 10185662 7319822 0.05270 17521097 10185662 7335435 0.05280 9312 9312 0.00010 113327 113327 0.00080 122639 122639 0.00090 17643736 10185662 7458074 0.05370 4429 4429 0.00000 670 670 0.00000 5099 5099 0.00000 1 927469 20160357 23777193 -3616836 X 1 0 1 1 MARSHFIELD MEDICAL CENTER - DICKINSON 1721 SOUTH STEPHENSON AVENUE IRON MOUNTAIN MI 49801 X X X MARSHFIELD MEDICAL CENTER - DICKINSON 1 0 1 1 X X X X X X X X X 23 1 1 1 1 X HTTPS://TINYURL.COM/2EUJ4PHC X 1 23 1 HTTPS://TINYURL.COM/2XJB6NMR 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X 1 X HTTPS://WWW.DCHS.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.DCHS.ORG/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.DCHS.ORG/FINANCIAL-ASSISTANCE/ X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 2: EFFECTIVE FEBRUARY 1, 2022, DICKINSON COUNTY HEALTHCARE SYSTEM (DCHS), JOINED MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) AND ITS SUBSIDIARIES WITH THE CLOSING OF AN AFFILIATION AGREEMENT. MCHS HOSPITALS, INC., A SUBSIDIARY OF MCHS, BECAME THE SOLE MEMBER OF DCHS THROUGH A MEMBER SUBSTITUTION. MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 5: PRIMARY DATA COLLECTION BEGAN WITH A COMMUNITY HEALTH SURVEY IN AUGUST 2021. THE SAMPLE FOR THE 2021 COMMUNITY HEALTH SURVEY OF UPPER PENINSULA ADULTS WAS PURCHASED FROM MARKETING SYSTEMS GROUP. THE SAMPLE WAS ADDRESS-BASED AND DRAWN FROM A DATABASE MATCHED TO THE UNITED STATES POSTAL SERVICE'S DELIVERY SEQUENCE FILE. WITHIN EACH UPPER PENINSULA COUNTY, 1,700 ADDRESSES WERE RANDOMLY SELECTED. PACKETS CONTAINING A COVER LETTER, SURVEY, AND POSTAGE-PAID PRE-ADDRESSED RETURN ENVELOPE WERE PREPARED AND MAILED TO THE ENTIRE SAMPLE OF 23,800 ADDRESSES IN AUGUST 2021. THE PACKET INCLUDED INSTRUCTIONS FOR ACCESSING AN ONLINE VERSION OF THE SAME SURVEY, WHICH WAS BETTER UTILIZED IN 2021 THAN IN 2017 HOUSEHOLDS THAT RETURNED COMPLETED SURVEYS EARLY QUALIFIED FOR A PRIZE DRAWING CONSISTING OF EIGHT $50 GROCERY GIFT CARDS. NO REMINDERS WERE SENT. DICKINSON COUNTY HAD A SURVEY RESPONSE RATE OF 15% IN 2021, WHICH WAS DOWN COMPARED TO THE 2017 RESPONSE RATE OF 20.7%. DATA ANALYSIS WAS CONDUCTED BY KELLY KAMM, PHD FROM THE DEPARTMENT OF KINESIOLOGY AND INTEGRATIVE PHYSIOLOGY, MICHIGAN TECHNOLOGICAL UNIVERSITY IN HOUGHTON, AND ROBERT S. VAN HOWE, MD, MS, THE PROVISIONAL MEDICAL DIRECTOR FOR THE WESTERN U.P. HEALTH DEPARTMENT AND THE DICKINSON-IRON DISTRICT HEALTH DEPARTMENT. ALL ANALYSES WERE COMPLETED IN SAS, VERSION 9.4 (CARY, NORTH CAROLINA). SURVEY DATA WERE ASSESSED FOR COMPLETENESS AND CONSISTENCY. MMC-DICKINSON RECOGNIZES THAT HEALTH IS DETERMINED BY MORE THAN HEALTH CARE. TO FURTHER UNDERSTAND THE CONDITIONS THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS, A SERIES OF QUESTIONS RELATED TO SOCIAL DETERMINANTS OF HEALTH (SDOH) WERE INCLUDED AND FURTHER ANALYZED. COMMUNITY BENEFITS WORKGROUP (CBW)-DICKINSON IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH PRIORITIES THROUGH A COMPREHENSIVE PROCESS THAT INCLUDED INPUT FROM MULTI-SECTOR COMMUNITY PARTNERS AND ORGANIZATION LEADERSHIP. DIRECT COMMUNITY INPUT WAS GATHERED AND FOCUSED ON UNDERSTANDING THE PRIORITIES OF THE UNDERSERVED IN THE COMMUNITY. THE CBWDICKINSON IS COMMITTED TO ADDRESSING HEALTH INEQUITIES AND CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) USING A HEALTH EQUITY LENS. THE CBW-DICKINSON SEEKS TO ADDRESS "TYPES OF UNFAIR HEALTH DIFFERENCES CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGES THAT ADVERSELY AFFECT A GROUP OF PEOPLE". (ATTAINING HEALTH EQUITY. CDC. RETRIEVED FROM: HTTPS://WWW.CDC.GOV/NCCDPHP/DCH/PROGRAMS/HEALTHYCOMMUNITIESPROGRAM/OVERVIEW /HEALTHEQUITY.HTM) MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 6A: YES, THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- ASPIRUS IRON RIVER HOSPITAL - ASPIRUS IRONWOOD HOSPITAL - ASPIRUS KEWEENAW HOSPITAL - ASPIRUS ONTONAGON HOSPITAL - BARAGA COUNTY MEMORIAL HOSPITAL - BELLIN HEALTH HOSPITAL AND CLINICS - HELEN NEWBERRY JOY HOSPITAL - MACKINAC STRAITS HEALTH SYSTEM - MUNISING MEMORIAL HOSPITAL/BAYCARE MEDICAL CENTER - MYMICHIGAN MEDICAL CENTER- SAULT - OSF ST. FRANCIS HOSPITAL - SCHOOLCRAFT MEMORIAL HOSPITAL - U.P. HEALTH SYSTEMS- BELL - U.P HEALTH SYSTEMS- MARQUETTE - U.P HEALTH SYSTEMS- PORTAGE - WAR MEMORIAL HOSPITAL MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 6B: YES, THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BCBS FOUNDATION OF MICHIGAN - CHIPPEWA COUNTY HEALTH DEPARTMENT - COPPER COUNTY COMMUNITY MENTAL HEALTH - DICKINSON-IRON DISTRICT HEALTH DEPARTMENT - GOGEBIC COUNTY COMMUNITY MENTAL HEALTH - GREAT LAKES RECOVERY CENTER - KEWEENAW BAY INDIAN COMMUNITY - MARQUETTE COUNTY HEALTH DEPARTMENT - MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES - MICHIGAN HEALTH ENDOWMENT FUND - MICHIGAN TECHNOLOGICAL UNIVERSITY - NORTHCARE NETWORK - NORTHERN MICHIGAN CENTER FOR RURAL HEALTH - NORTHPOINTE BEHAVIOR HEALTH SYSTEM - PATHWAYS COMMUNITY MENTAL HEALTH - PORTAGE HEALTH FOUNDATION - PUBLIC HEALTH OF DELTA AND MENOMINEE COUNTIES - SUPERIOR HEALTH FOUNDATION - UPPER GREAT LAKES FAMILY HEALTH CENTER - UPPER PENINSULA HEALTH CARE SOLUTIONS - UPPER PENINSULA HEALTH GROUP - UPPER PENINSULA HEALTH PLAN - WESTERN UP HEALTH DEPARTMENT - WESTERN UP PLANNING AND DEVELOPMENT REGION MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE UPCHNA, DICKINSON COUNTY CHA, UNITED WAY DATA, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MARSHFIELD MEDICAL CENTER IN DICKINSON ARE:- ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - HEALTH EQUITY - CHRONIC DISEASE PREVENTION AND MANAGEMENT - TOBACCO AND VAPING - ACCESSIBILITY AND AFFORDABILITY TO HEALTHCARE AND SERVICE PROGRAMS HEALTH PRIORITY 1: ALCOHOL AND SUBSTANCE USE GOAL 1: PREVENT ALCOHOL AND SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION -STRATEGY: PREVENT ALCOHOL AND SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING INDIVIDUAL AND/OR ENVIRONMENTAL PREVENTION STRATEGIES. GOAL 2: REDUCE COMMUNITY AND SOCIAL IMPACTS OF ALCOHOL AND SUBSTANCE MISUSE - STRATEGY 1: SERVE COMMUNITIES AND INDIVIDUALS THROUGH RECOVERY COACH SERVICES. - STRATEGY 2: SUPPORT COMMUNITY LED RECOVERY EFFORTS. HEALTH PRIORITY 2: BEHAVIORAL HEALTH GOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES. - STRATEGY 1: ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL-EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH. - STRATEGY 2: PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS. - STRATEGY 3: SUPPORT COMMUNITY WIDE, INDIVIDUAL, AND ENVIRONMENTAL STRATEGIES THAT SUPPORT MENTAL WELLNESS, SOCIAL CONNECTIONS, AND ENGAGEMENT. HEALTH PRIORITY 3: HEALTH EQUITY GOAL 1: ADVANCE HEALTH EQUITY BY FOCUSING ON COMMUNITY-BASED HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH - STRATEGY 1: ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES. - STRATEGY 2: INCREASE ACCESS TO COMMUNITY-BASED RESOURCES, SERVICES, AND SUPPORT WITH A FOCUS ON HEALTH EQUITY. AS THESE PRIORITIES ARE ADDRESSED, INTENTIONAL EFFORTS WILL BE MADE TO ENSURE APPROPRIATE RESOURCES ARE PROVIDED, AND UNFAIR AND UNJUST OBSTACLES ARE ELIMINATED FOR ALL PEOPLE AND COMMUNITIES TO REACH THEIR OPTIMAL HEALTH. DUE TO THE INTERCONNECTED NATURE OF THESE HEALTH PRIORITIES, MMC-DICKINSON CHOSE TO FOCUS ON OVERARCHING PRIORITIES TO ADDRESS ALL IDENTIFIED HEALTH NEEDS. 16 1 - MMC-DICKINSON BARK RIVER CENTER 2845 US RTE 2 BARK RIVER MI 49807 CARDIOLOGY AND DIAGNOSTIC SERVICES 2 - MMC-DICKINSON FAMILY MEDICINE 1711 S STEPHENSON AVE SUITE 125 IRON MOUNTAIN MI 49801 FAMILY PRACTICE 3 - MMC-DICKINSON NORWAY FAMILY MED N1667 US-8 NORWAY MI 49870 FAMILY PRACTICE 4 - MMC-DICKINSON NORWAY FAM & GERIATRIC CEN 500 MAIN ST NORWAY MI 49870 FAMILY PRACTICE & GERIATIC 5 - MMC-DICKINSON HEMATOLOGY ONCOLOGY 1711 S STEPHENSON AVENUE SUITE 315 IRON MOUNTAIN MI 49801 HEMATOLOGY/ONCOLOGY CLINIC 6 - MMC-DICKINSON INT MEDICINE & NEPHROLOGY 1711 S STEPHENSON AVE SUITE 225 IRON MOUNTAIN MI 49801 INTERNAL MEDICINE/NEPHROLOGY 7 - MMC-DICKINSON OBSTETRICS & GYNECOLOGY 1721 S STEPHENSON AVENUE IRON MOUNTAIN MI 49801 OB/GYN 8 - MMC-DICKINSON ORTHOPEDICS 1711 S STEPHENSON AVE SUITE 100 IRON MOUNTAIN MI 49801 ORTHOPEDIC PRACTICE 9 - MMC-DICKINSON PODIATRY SERVICES 225 WEST H STREET IRON MOUNTAIN MI 49801 PODIATRY SERVICES 10 - MMC-DICKINSON PRIMARY CARE 1711 S STEPHENSON AVE SUITE 210 IRON MOUNTAIN MI 49801 PRIMARY CARE 11 - MMC-DICKINSON SURGERY AND ENDOSCOPY 1711 S STEPHENSON AVE SUITE 305 IRON MOUNTAIN MI 49801 SURGERY & ENDOSCOPY 12 - MMC-DICKINSON UROLOGY 1711 S STEPHENSON AVENUE SUITE 320 IRON MOUNTAIN MI 49801 UROLOGY SERVICES 13 - MMC-DICKINSON FLORENCE CENTER 1010 OLIVE AVE FLORENCE WI 54121 FAMILY CLINIC 14 - MMC-DICKINSON REGIONAL HEART CARE CLINIC 1711 S STEPHENSON AVENUE SUITE 315 IRON MOUNTAIN MI 49801 HEART CARE 15 - MMC-DICKINSON SLEEP MEDICINE CENTER 1100 S CARPENTER AVENUE KINGSFORD MI 49802 SLEEP DISORDER 16 - MMC-DICKINSON WOUND HEAL&HYPERBARIC MED 1707 S STEPHENSON AVE IRON MOUNTAIN MI 49801 WOUND CARE/HYPERBARIC 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: MARSHFIELD MEDICAL CENTER-DICKINSON (MMC-DICKINSON), IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT; ENRICHES LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY, ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES. THE HEALTH SYSTEM WAS REQUIRED TO IMPLEMENT A FINANCIAL IMPROVEMENT PLAN BECAUSE OF SIGNIFICANT CHALLENGES IN THE HEALTHCARE INDUSTRY. DESPITE THIS, COMMUNITY-BUILDING ACTIVITIES CONTINUED, AND STRONGER, LOCAL CONNECTIONS WERE MADE. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE: ECONOMIC DEVELOPMENT:HOSPITAL STAFF INCLUDING MANAGEMENT PARTICIPATED IN THE DICKINSON CHAMBER OF COMMERCE AND DICKINSON AREA ECONOMIC DEVELOPMENT ALLIANCE. MMC-DICKINSON HAS BEEN VERY SUPPORTIVE OF DICKINSON AREA ECONOMIC DEVELOPMENT ALLIANCE'S SMALL BUSINESS RETENTION & GROWTH COMMITTEE. THE COMMITTEE HAS CREATED AN INITIATIVE CALLED LOYAL TO LOCAL. LOYAL TO LOCAL HAS IS A CAMPAIGN TO RAISE AWARENESS OF THE IMPACT OF SMALL BUSINESSES ON OUR COMMUNITY AND ENCOURAGES CUSTOMERS TO SUPPORT LOCAL BUSINESSES BEFORE ORDERING ONLINE OR GOING OUTSIDE THE AREA FOR SERVICES AND ITEMS. COMMUNITY SUPPORT:MMC-DICKINSON STAFF ACTIVELY PARTICIPATED IN SEVERAL LOCAL ORGANIZATIONS SUCH AS THE EMERGENCY OPERATIONS COMMITTEE AND INCIDENT COMMAND GROUP, LOCAL EMERGENCY PLANNING COMMITTEE, AND DICKINSON CHAMBER OF COMMERCE. STAFF, INCLUDING MANAGEMENT, ARE INVOLVED IN PLANNING, COORDINATING, AND IMPLEMENTING VARIOUS COLLABORATIVE EFFORTS AND INITIATIVES IN THE COMMUNITY. MMC-DICKINSON SUPPORTED THE UNITED WAY OF DICKINSON COUNTY, THE LOCAL FARMER'S MARKET, YMCA, DOWNTOWN PUMPKIN WALK, THE MEDICAL CARE ACCESS COALITION AND THE U.P. HOSPICE FOUNDATION. ADDITIONALLY, MMC-DICKINSON STAFF PROVIDE ATHLETIC TRAINING SUPPORT TO A NUMBER OF SCHOOL DISTRICTS WITHIN THE COUNTY AT VARIOUS SPORTING EVENTS YEAR-ROUND. MMC-DICKINSON PARTICIPATES IN A COLLABORATIVE EFFORT WITH OTHER AREA HOSPITALS TO PROVIDE BLOOD DRIVES TO SUPPLY THE REGIONAL BLOOD BANK WITH BLOOD PRODUCTS. MMC-DICKINSON PROVIDES A COMMUNITY THANKSGIVING DINNER THAT IS OPEN TO ANYONE WITHOUT CHARGE. COALITION BUILDING:MMC-DICKINSON STAFF PARTICIPATED IN COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY BY ADDRESSING MENTAL/BEHAVIORAL HEALTH, ALCOHOL AND OTHER DRUGS ABUSE, AND HEALTHY LIVING. THESE COMMUNITY GROUPS INCLUDED THE DICKINSON-IRON COUNTY COLLABORATIVE, DICKINSON-IRON GREAT START COLLABORATIVE, COMMUNITIES THAT CARE, FLORENCE COUNTY AODA/MENTAL HEALTH TASK FORCE, CHILD ADVOCACY AND CHILD ABUSE PREVENTION NETWORK, AND LOCAL CHAPTER OF THE ROTARY CLUB. COMMUNITY HEALTH IMPROVEMENT ADVOCACY:MMC-DICKINSON SUPPORTED SWIM LESSONS FOR ALL THIRD-GRADE STUDENTS FOR THE SURROUNDING SCHOOLS AND HOMESCHOOLED STUDENTS. EACH CLASS RECEIVED FIVE 40-MINUTE LESSONS AT THE LOCAL YMCA, WITH TRANSPORTATION TO AND FROM THE LESSON. 350 CHILDREN PARTICIPATED IN 2023. HAVING ONE OF ONLY A FEW CERTIFIED SANE NURSES IN THE REGION, MMC-DICKINSON HAS PROVIDED EDUCATION AND ADVOCACY ON ISSUES SUCH AS HUMAN TRAFFICKING, DOMESTIC VIOLENCE, CHILD SAFETY, AND MANDATORY REPORTING. MMC-DICKINSON PROVIDED RECOVERY COACH SERVICES FOR PATIENTS AND COMMUNITY MEMBERS SEEKING SUPPORT OR ALREADY IN RECOVERY FROM AN ADDICTION TO ALCOHOL AND/OR OTHER SUBSTANCES. WORKFORCE DEVELOPMENT:MMC-DICKINSON COLLABORATED WITH AREA HIGH SCHOOLS TO OFFER PROGRAMS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL CAREERS, AND OBSERVATIONAL JOB EXPERIENCES FOR HIGH SCHOOL GRADUATES. HOSPITAL STAFF WERE INVITED TO HEALTH OCCUPATIONS CLASS OFFERED AT THE DICKINSON-IRON TECH SCHOOL TO EDUCATE AND SHARE INFORMATION ABOUT HEALTH PROFESSIONS WITH HIGH SCHOOL STUDENTS. MMC-DICKINSON FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, RESPIRATORY THERAPY, MEDICAL ASSISTANTS, LAB, AND IMAGING. MMC-DICKINSON SUPPORTED THE UPPER PENINSULA ASSOCIATION FOR BEHAVIOR ANALYSIS ANNUAL CONFERENCE WHICH PROVIDED AN OPPORTUNITY FOR REGIONAL PRACTITIONERS TO GAIN NECESSARY CONTINUING EDUCATION CREDIT. OTHER:MMC-DICKINSON STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS. EXAMPLES INCLUDED: - EDUCATION ON FALL PREVENTION AND EXERCISE WITH THE ADRC - PRENATAL CHILD BIRTHING AND BREASTFEEDING SUPPORT CLASSES - PROVIDED A FREE, VIRTUAL DIABETES PREVENTION PROGRAM LED BY CDC-CERTIFIED LIFESTYLE COACHES TO EMPOWER PARTICIPANTS TO PREVENT OR DELAY THE ONSET OF TYPE 2 DIABETES 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 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 65% AND 61% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2023 AND DECEMBER 31, 2022, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2023 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 VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-DICKINSON USES RELIABLE-SECONDARY DATA AND REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, AND DIRECT COMMUNITY INVOLVEMENT TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THE INFORMATION PROVIDED BY THESE SOURCES POINTS TO AREAS OF NEED. MMC-DICKINSON COLLABORATES CLOSELY WITH MARSHFIELD CLINIC HEALTH SYSTEM'S CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA) TO ASSESS, DEVELOP, AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH OF THE LOCAL COMMUNITY. CCHA'S PRIORITY AREAS INCLUDE SUBSTANCE USE PREVENTION, YOUTH BEHAVIORAL HEALTH, HEALTH EQUITY, AND BUILDING COMMUNITY CAPACITY FOR HEALTH IMPROVEMENT. THIS WORK REQUIRES CONTINUAL ASSESSMENT OF THE NEEDS OF THE COMMUNITY WHICH REINFORCES MMC-DICKINSON'S CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. MMC-DICKINSON UTILIZES OUR COMMUNITY CONNECTIONS TEAM AND FINDHELP, AN ELECTRONIC DATABASE OF COMMUNITY RESOURCES AVAILABLE IN AN AREA, TO ASSESS NEEDS AND THEN CONNECT INDIVIDUALS TO THOSE RESOURCES. ADDITIONALLY, THERE ARE PROCESSES IN PLACE AT MMC-DICKINSON TO ESTABLISH ONGOING DIRECT ENGAGEMENT WITH THE LOCAL HEALTH DEPARTMENT, NUMEROUS COMMUNITY-HEALTH-FOCUSED ORGANIZATIONS, COMMUNITY CHAMBERS, BOARDS OF ECONOMIC DEVELOPMENT, YOUTH-FOCUSED ORGANIZATIONS AND OTHER HEALTH IMPROVING ORGANIZATIONS. DIRECT COLLABORATION WITH, AND REQUESTS FROM, THESE GROUPS FURTHER KNOWLEDGE OF THE COMMUNITY AND ITS NEEDS. PART VI, LINE 3: FINANCIAL 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.UNCOMPENSATED CARE PACKETS ARE GIVEN TO PATIENTS IN EVERY CLINIC AND DEPARTMENT OF THE FACILITY WHERE A PATIENT IS UNINSURED, INQUIRES ABOUT ASSISTANCE OR EXPRESSES HARDSHIP. COPIES OF THESE DOCUMENTS ARE ALSO AVAILABLE IN THE LOBBIES OF ALL CLINICS AND DEPARTMENTS OF THE FACILITY IN BROCHURE STANDS AS WELL AS POSTED IN EXAM ROOMS. THEY ARE ALSO GIVEN TO ALL INPATIENTS WITH THEIR INPATIENT ADMISSION PAPERWORK TO OFFER SUPPORT IF NEEDED OR QUESTIONS. PART VI, LINE 4: MMC-DICKINSON SERVICE AREA IS NOT DEFINED BY COUNTY BORDERS BUT SERVES THOSE IN HIGH NEED AREAS WITH LIMITED RESOURCES. MMC-DICKINSON FOCUSES ON SERVING THOSE THAT ARE UNDERSERVED AND LIVING IN RURAL AREAS OF THE SERVICE AREA. DICKINSON COUNTY IS IN THE CENTRAL UPPER PENINSULA OF MICHIGAN BORDERING WISCONSIN. THE COUNTY IS COMPRISED OF THREE CITIES (IRON MOUNTAIN, KINGSFORD, AND NORWAY) AND SEVEN TOWNSHIPS (BREEN, BREITUNG, FELCH, NORWAY, SAGOLA, WAUCEDAH, AND WEST BRANCH) SPANNING OVER A TOTAL OF 777 SQUARE MILES.IN 2021, DICKINSON COUNTY HAS A POPULATION TOTALING 25,787. APPROXIMATELY 24% OF DICKINSON COUNTY RESIDENTS ARE 65 YEARS OR OLDER, WHILE 19.8% OF THE COUNTY'S RESIDENTS ARE 18 YEARS OR YOUNGER. THE COUNTY IS PRIMARILY WHITE, ACCOUNTING FOR 96% OF THE POPULATION. ALMOST 95% OF RESIDENTS HAVE ARE A HIGH SCHOOL GRADUATE OR HIGHER AND 26% PERCENT OF RESIDENTS HOLD A BACHELOR'S DEGREE OR HIGHER. IN 2019, 38.4% OF DICKINSON COUNTY RESIDENTS WERE BELOW THE ALICE THRESHOLD AND STRUGGLED TO MAKE ENDS MEET. THE MEDIAN HOUSEHOLD INCOME FROM 2016-2020 IS $51,704. PART VI, LINE 5: MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) PROMOTES THE HEALTH OF COMMUNITIES THROUGH ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), A DEPARTMENT WITHIN MCHS SOLELY DEDICATED TO POPULATION HEALTH. CCHA IS GOVERNED BY THE MCHS COMMUNITY HEALTH/COMMUNITY BENEFITS STEERING COMMITTEE WHICH IS TASKED WITH PROVIDING OVERSIGHT AND GUIDANCE ON SYSTEM COMMUNITY HEALTH AND COMMUNITY BENEFIT STRATEGY. THE COMMITTEE IS MADE UP OF INTERNAL EMPLOYEES WHO REPRESENT VARIOUS DIFFERENT DEPARTMENTS AND ROLES WITHIN THE HEALTH SYSTEM. THIS STRONG FOCUS ON COMMUNITY HEALTH IS FURTHER SUPPORTED BY THE MARSHFIELD CLINIC HEALTH SYSTEM BOARD OF DIRECTORS WHICH CONSISTS OF 24 MEMBERS, 11 OF THOSE MEMBERS ARE PHYSICIAN DIRECTORS AND 13 ARE INDEPENDENT DIRECTORS WHO RESIDE WITHIN THE SERVICE AREA AND ARE NOT EMPLOYEES OF THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES THROUGH ACCESSIBLE, AFFORDABLE, AND COMPASSIONATE HEALTH CARE. MCHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY LIVING OUT THIS MISSION INCLUDING PROVIDING SEVERAL SERVICES WHICH WOULD NOT OTHERWISE BE AVAILABLE IN A RURAL SETTING SUCH AS, MCHS PROVIDERS PRACTICING MORE THAN 170 SPECIALTIES AND EMERGENCY ROOMS THAT ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. MCHS TRAINS AND EDUCATES HEALTHCARE PROFESSIONALS THROUGH A VARIETY OF INTERNSHIP PROGRAMS AND PARTNERS REGULARLY WITH LOCAL HIGH SCHOOLS AND COLLEGES TO DISCUSS CAREER, INTERNSHIP, AND VOLUNTEER OPPORTUNITIES FOR STUDENTS. MCHS ACCEPTS FINANCIAL ASSISTANCE AND PAYMENT PLANS ARE AVAILABLE; MCHS ALSO PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (E.G. MEDICARE, MEDICAID). A VARIETY OF HEALTH PROGRAMMING IS PROVIDED TO THE COMMUNITY AT NO COST SUCH AS HEALTH SCREENINGS AT LOCAL EVENTS, TRAININGS, AND PREVENTION PROGRAMMING. MCHS STAFF ARE ACTIVELY INVOLVED IN THEIR LOCAL COMMUNITY AND LEND NOT ONLY THEIR EXPERTISE BUT OFTENTIMES LEADERSHIP AS WELL TO MANY ORGANIZATIONS SUCH AS UNITED WAY, YMCA, CHAMBER OF COMMERCE, ETC. STAFF FROM MCHS HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF SUBSTANCE MISUSE, BEHAVIORAL HEALTH, AND HEALTH EQUITY. MCHS SUPPORTS SEVERAL FREE CLINICS BY PROVIDING SERVICES LIKE IMAGING AT NO-COST AND ROUTINELY DONATES SUPPLIES TO COMMUNITY-BASED HEALTH ORGANIZATIONS SUCH AS VACCINES, LAB EQUIPMENT, AND TECHNOLOGY. PART VI, LINE 6: MMC-DICKINSON IS PART OF MARSHFIELD CLINIC HEALTH SYSTEM, INC., 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. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. MARSHFIELD CLINIC HEALTH SYSTEM SERVES RURAL COMMUNITIES AND COLLECTIVELY PROMOTES HEALTH BY REDUCING BARRIERS TO ACCESSING CARE. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE THAT WOULDN'T OTHERWISE BE AVAILABLE THROUGH ITS 60 LOCATIONS AND 11 HOSPITALS IN COMMUNITIES ACROSS NORTHERN, CENTRAL AND WESTERN WISCONSIN AND IN MICHIGAN. MCHS PRIMARY OPERATIONS INCLUDE MARSHFIELD CLINIC; MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, PARK FALLS, AND IRON MOUNTAIN (MICHIGAN); MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, DIVISION OF EDUCATION 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 COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. 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. THIS COLLABORATION HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. PART VI, LINE 7, REPORTS FILED WITH STATES MI X X 1 1 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 0 1225308 0 450000 0 1449725 0 361730 0 20277 0 3507040 0 264534 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO - PART YEAR 0 206266 0 152673 0 694884 0 9900 0 11191 0 1074914 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 0 741668 0 73943 0 33130 0 9900 0 30227 0 888868 0 0 CATHY BUKOWSKI MCHS CFO - PART YEAR 0 571918 0 9200 0 144722 0 9900 0 13493 0 749233 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 349775 0 148993 0 37438 0 9900 0 33330 0 579436 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 466567 0 21085 0 27363 0 9900 0 20093 0 545008 0 0 ERIC JOHNSON MD PHYSICIAN 357997 0 18000 0 43200 0 0 0 17603 0 436800 0 0 0 RUWAN DISSANAYAKE MD SECRETARY - PART YEAR 0 240464 0 114060 0 16332 0 3614 0 20543 0 395013 0 0 DAVID VIAU MD PHYSICIAN 342049 0 10000 0 0 0 0 0 4451 0 356500 0 0 0 AMANDA SHELAST PRESIDENT MMC-DICKINSON 283154 0 27006 0 20859 0 6124 0 1481 0 338624 0 0 0 MARYAM HAMIDI MD PHYSICIAN 253244 0 0 0 26842 0 0 0 1018 0 281104 0 0 0 BRIAN DONAHUE VP OF FINANCE/CFO MMC-DICKINSON 210822 0 60010 0 0 0 0 0 7541 0 278373 0 0 0 ERIN DEPREKEL MD PHYSICIAN 252656 0 0 0 0 0 0 0 1325 0 253981 0 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, LINES 4A-B LINE 4A: IN 2023, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $614,466, WILLIAM MELMS, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $610,615, AND CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $82,431. 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 - $275,424 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 SAMANTHA KLEBE, DO WILLIAM MELMS, MD BRIAN HOERNEMAN, MD EDWARD FERNANDEZ, MD CATHY BUKOWSKI A DICKINSON COUNTY HEALTHCARE SYSTEM 382780429 NONEAVAIL 2004-08-03 5000000 SEE SUPPLEMENTAL INFO 0 0 0 B UNITED STATES DEPARTMENT OF AGRICULTURE 720564834 NONEAVAIL 2021-10-05 16900000 SEE SUPPLEMENTAL INFO 0 0 0 A 2835797 5042506 50050 4949950 2006 0 0 1 1 B 601393 16900000 400000 9535520 6964480 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 1 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 B 0 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: DICKINSON COUNTY HEALTHCARE SYSTEM (F) DESCRIPTION OF PURPOSE: CONSTRUCT AN ADDITION TO THE HOSPITAL FACILITY, RENOVATE EXISTING HOSPITAL FACILITY SPACE AND RELATED EQUIPMENT. SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: UNITED STATES DEPARTMENT OF AGRICULTURE (F) DESCRIPTION OF PURPOSE: PURCHASE MAJOR MEDICAL EQUIPMENT AND RETIRE OTHER PRIVATE DEBT. PART II, LINE 3, COLUMN A: THE TOTAL PROCEEDS EXCEEDS THE ISSUE PRICE DUE TO INVESTMENT EARNINGS. FORM 990, PART V, LINE 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO DICKINSON COUNTY HEALTHCARE SYSTEM SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS COLLEEN HOERNEMAN AND BRIAN HOERNEMAN, MD HAVE A FAMILY RELATIONSHIP. 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 DICKINSON COUNTY HEALTHCARE SYSTEM. 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 DICKINSON COUNTY HEALTHCARE SYSTEM. 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 DICKINSON COUNTY HEALTHCARE SYSTEM. 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 THE 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 DICKINSON COUNTY HEALTHCARE SYSTEM 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 AMANDA SHELAST 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 DICKINSON COUNTY HEALTHCARE SYSTEM, 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 IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 17,921,545. MANAGEMENT AND GENERAL EXPENSES 1,424,358. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,345,903. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTION 307,372. EQUITY INCOME FROM UPHP 305,547. EQUITY INCOME FROM UPMC 16,196. NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS -14,000,000. 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