2024-08-26T08:22:50-05:00 2023-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 391027536 BLACK RIVER MEMORIAL HOSPITAL INC BLAC 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 HOLLY WINN CFO 7152845361 2024-08-20 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-08-20 2023 2024-08-08 14:25:15Z CARL SELVICK 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 76590792 0 X WWW.BRMH.NET X 1966 WI TO HELP PATIENT'S IMPROVE THEIR LIVES THROUGH COMPASSIONATE, COMMUNITY-BASED CARE. 9 8 402 42 10024 2401 16291 7340236 62950055 65639252 726789 1618356 35699 16502 63728834 74614346 4000 5000 0 0 36947920 34686206 0 0 0 28426692 29918221 65378612 64609427 -1649778 10004919 89753789 100100495 29743779 28162399 60010010 71938096 X BLACK RIVER MEMORIAL HOSPITAL, INC.'S MISSION IS TO HELP PATIENT'S IMPROVE THEIR LIVES THROUGH COMPASSIONATE, COMMUNITY-BASED CARE. 0 1 43516388 5000 58706422 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PRIMARY, AND MENTAL HEALTH CARE TO ALL PEOPLE IN NEED OF CARE. AMONG THE INPATIENT AND OUTPATIENT SERVICES PROVIDED ARE DIAGNOSTIC IMAGING, REHABILITATION SERVICES, RESPIRATORY CARE, SURGICAL SERVICES, INFUSION THERAPY, LAB SERVICES, PHARMACY SERVICES, 24-HOUR EMERGENCY ROOM AND MANY OTHERS. IN 2023, THE HOSPITAL PROVIDED 3,594 INPATIENT DAYS OF CARE TO ADULTS, PEDIATRICS, SWING BED, AND NURSERY INPATIENTS AS WELL AS 10,254 EMERGENCY ROOM AND 32,175 OUTPATIENT SERVICES TO THOSE IN NEED OF CARE. THE HOSPITAL ALSO SERVES AS A VITAL LINK TO THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS IN AN EFFORT TO ENHANCE THE HEALTH AND WELFARE OF THE PEOPLE IN ITS AREA. IN ITS EFFORT TO ATTAIN THIS GOAL THE HOSPITAL PROVIDES:-FREE AND REDUCED-COST CARE TO THOSE WITH A DEMONSTRATED NEED-CARE TO THOSE COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH MAY NOT COVER THE CHARGES OR COST OF SERVICES PROVIDED-HEALTH EDUCATION AND OUTREACH PROGRAMS TO ALL MEMBERS OF THE COMMUNITY AT LITTLE OR NO COST TO THE PARTICIPANTSCHARITY CARE GIVEN TO PERSONS UTILIZING OUR HOSPITAL AMOUNTED TO A TOTAL OF $471,715 IN TOTAL CHARGES. IN ADDITION, WE FURNISH CARE TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH PAY AT RATES LESS THAN CHARGES. DISCOUNTS TO THESE PROGRAMS FOR HOSPITAL SERVICES AMOUNTED TO $17,109,974.BLACK RIVER MEMORIAL HOSPITAL, INC. ALSO CONDUCTED NUMEROUS EDUCATIONAL AND SUPPORTIVE ACTIVITIES TO ENCOURAGE THE GOOD HEALTH AND WELFARE OF THE MEMBERS OF THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE:-FACILITIES FOR MEETINGS AND SUPPORT PERSONNEL, INCLUDING LEADERSHIP FOR A GRIEF SUPPORT GROUP AND THE PERS-DISCONTINUED 2023 (A PERSONAL EMERGENCY RESPONSE SYSTEM AVAILABLE AT NOMINAL COSTS TO AREA RESIDENTS), DIABETES EDUCATION GROUP AND A NEWLY FORMED CANCER SUPPORT GROUP.-PROVIDING ASSISTANCE TO HEALTH EDUCATORS BY SPONSORING INTERNSHIPS FOR STUDENT NURSES, RADIOLOGICAL, REHABILITATION, AND LABORATORY TECHNICIAN STUDENTS.-PROVIDING CHILDBIRTH EDUCATIONAL CLASSES-PROVIDING LEADERSHIP TO STATE AND REGION-WIDE HEALTH ORGANIZATIONS INCLUDING THE WISCONSIN HOSPITAL ASSOCIATION, HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION, NURSE EXECUTIVES, HEALTH EDUCATORS, PERINATAL CARE ASSOCIATION AND THE WISCONSIN HEALTHCARE PUBLIC RELATIONS AND MARKETING SOCIETY TO FURTHER HEALTHCARE GOALS OUTSIDE OF OUR DIRECT SERVICE AREA.OTHER SERVICES WE PROVIDE INCLUDE GRIEF SUPPORT GROUP. COALITIONS WE SUPPORT ARE: BREASTFEEDING COALITION, BLACK RIVER AREA SAFETY COUNCIL, TOGETHER FOR JACKSON COUNTY KIDS, AND JACKSON IN ACTION. BLACK RIVER MEMORIAL HOSPITAL'S WOUND CARE CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY MAY 2021 AND PERFORMED 5,941 OUTPATIENT PROCEDURES IN 2023. 1735579 0 3315509 BLACK RIVER HEALTHCARE CLINIC OPENED TO BRMH EMPLOYEES IN JUNE AND THE GENERAL PUBLIC IN JULY 2020. BLACK RIVER HEALTHCARE CLINIC IS AN INTEGRATED CLINIC OFFERING BEHAVIORAL HEALTH AND PRIMARY CARE SERVICES. IN 2023, BEHAVIORAL HEALTH VISITS WERE 2,354 AND PRIMARY CARE VISITS WERE 5,861. 362528 0 216736 OTHER HOME-BASED SERVICES OFFERED INCLUDE BLACK RIVER MEMORIAL HOSPITAL'S HOMECARE AND HOSPICE PROGRAMS THAT PROVIDE COMPREHENSIVE HEALTHCARE SERVICES IN THE MOST COMFORTABLE SETTING-THE PATIENT'S HOME. THESE SERVICES WERE DISCONTINUED IN MAY 2023. 257686 0 1136980 BLACK RIVER MEMORIAL HOSPITAL'S INFUSION CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY IN AUGUST 2021 WHICH INCLUDE INTRODUCING CHEMOTHERAPY TO OUR SERVICE MIX FOR THE FIRST TIME. INFUSION VISITS IN 2023 WERE 1,410. 51007 0 64054 HOME-BASED SERVICES:BLACK RIVER MEMORIAL HOSPITAL'S HOME-BASED SERVICES GIVE PATIENTS WITH LIFE-LIMITING OR TERMINAL ILLNESSES THE OPPORTUNITY TO LIVE WITH DIGNITY DURING THE LAST STAGE OF THEIR LIFE. HOSPICE SERVICES WERE DISCONTINUED IN MAY 2023. 0 0 2032986 OTHER PROGRAMS. 308693 0 3234020 45923188 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 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 0 0 0 0 1 39 0 402 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X HOLLY WINN 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 DR CAROL MARTIN CHIEF OF STAFF/DIRECTOR 38.00 X X 402550 0 70148 ALEX BRADLEY CHOWN CHAIRPERSON 5.00 X X 0 0 0 MICHELE SEVERSON VICE CHAIRPERSON 4.00 X X 0 0 0 MICHELLE GREENDEER-RAVE TREASURER 4.00 X X 0 0 0 WALLACE APLAND III DIRECTOR 4.00 X 0 0 0 CHRISTINE HOVELL DIRECTOR (THRU 10/2023) 4.00 X 0 0 0 TIMOTHY KUNES DIRECTOR 4.00 X 0 0 0 KATHERINE POTTER DIRECTOR 4.00 X 0 0 0 TIMOTHY TRANBERG DIRECTOR 4.00 X 0 0 0 DR THOMAS WALKER DIRECTOR 4.00 X 0 0 0 HOLLY WINN CFO 40.00 X 304702 0 61085 CARL SELVICK CEO 40.00 X 351138 0 24616 ESTEBAN MILLER MD CMO 42.00 X 388736 0 71628 SMITA RAJASEKARAN MD PHYSICIAN 34.00 X 364255 0 66663 JOSEPH AHN DR PHYSICIAN 40.00 X 371607 0 62727 CASEY TOTTEN MD PHYSICIAN 40.00 X 366363 0 42798 RICHARD MINNIHAN MD PHYSICIAN 34.00 X 300466 0 52055 2849817 0 451720 62 0 1 0 WIPFLI 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 REVENUE CYCLE CODING/BILLING/AUDIT 4399147 R1 RCM 29586 NETWORK PLACE 29586 CHICAGO IL 60673 REVENUE CYCLE CODING/BILLING/AUDIT 1545664 BLACK RIVER ANESTHESIA ASOCIATES 812 WESTWIND DRIVE BLACK RIVER FALLS WI 54615 CRNA/ANESTHESIA PROFESSIONAL SERVICE 506266 CHIPPEWA VALLEY ORTHOPEDICS 1200 OAKLEAF WAY STE A ALTOONA WI 547202245 ORTHOPEDIC SURGICAL SERVICES 278417 DUDLEY ANESTHESIA SC 607 L HAUSER RD ONALASKA WI 54650 CRNA/ANESTHESIA PROFESSIONAL SERVICE 198634 7 7299614 40622 7340236 HOSPITAL PATIENT SERVICE REVENUE 621400 58862963 58862963 CLINIC REVENUE 621400 3315509 3315509 INFUSION REVENUE 621400 1136980 1136980 HOMECARE PATIENT REVENUE 621400 1095507 1095507 HOSPICE PATIENT REVENUE 621400 216736 216736 1011557 844992 10024 156541 65639252 1827849 1827849 39400 0 39400 39400 39400 948231 818722 1240047 736399 -291816 82323 -209493 -209493 -22898 -22898 -22898 74614346 65472687 10024 1791399 X 5000 5000 1214239 1214239 24925002 19973218 4951784 786467 647058 139409 5970771 4648982 1321789 1789727 1371090 418637 364583 364583 7168 7168 56242 56242 11329823 5314139 6015684 287011 287011 736718 262591 474127 1785140 78 1785062 556064 534553 21511 128601 85286 43315 685902 509607 176295 3147969 2338857 809112 216000 216000 MEDICAL SUPPLIES AND PH 5495370 5481444 13926 BAD DEBT EXPENSE 3243553 3243553 EQUIPMENT RENTAL & MAIN 646680 610152 36528 FOOD EXPENSE 402481 402481 828916 495099 333817 64609427 45923188 18686239 0 0 808821 20508911 9944278 10785924 10637367 856802 1030127 461382 403628 71296893 44961170 28861865 26335723 24880040 47272773 3398865 3667778 89753789 100100495 5596089 5207643 223909 0 20422740 19458800 3501041 3495956 29743779 28162399 X 59989247 71938096 20763 0 60010010 71938096 89753789 100100495 10004919 1923167 0 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 7168 7168 0 PART II-B, LINE 1: BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR BLACK RIVER MEMORIAL, INC. PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A FEW 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, CLINICAL EDUCATION, PROVIDER PRIVILEGING AND CREDENTIALING SERVICES, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT 19.1% OR 4,660.40 OF THE FEES PAID BY BLACK RIVER MEMORIAL, INC WENT TO LOBBYING EFFORTS. BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE WHA PROVIDES SUPPORT SERVICES FOR A NUMBER OF MEMBERS WHICH INCLUDE BUT ARE NOT LIMITED TO QUALITY AND SAFETY DATA REPORTING AND RESOURCES, DATA REPOSITORY, AND EDUCATION. THEY ALSO HOST MULTIPLE COUNCILS FOR THEIR MEMBERS. THE WHA DETERMINED THAT 16.7% OR $2,508.01 OF THE MEMBERSHIP DUES PAID WENT TO LOBBYING. 511499 511499 42021234 22181160 19840074 28255532 22780010 5475522 508628 508628 26335723 DEFERRED COMPENSATION PLAN LIABILITY 2280724 THIRD-PARTY REIMBURSMENT PROGRAMS 550000 OPERATING LEASE LIABILITY 665232 3495956 73237718 1923167 1923167 71314551 56242 3243553 3299795 74614346 61309632 0 61309632 56242 3243553 3299795 64609427 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 3,243,553. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 3,243,553. 1 1 X 1 X 1 X 1 1 0 1 1 270348 270348 0.00440 10354758 8724503 1630255 0.02660 10625106 8724503 1900603 0.03100 12426 12426 0.00020 103415 103415 0.00170 19484029 7720934 11763095 0.19170 12592 12592 0.00020 19612462 7720934 11891528 0.19380 30237568 16445437 13792131 0.22480 703 703 0.00000 18891 18891 0.00030 9453 9453 0.00020 19316 19316 0.00030 48363 48363 0.00080 0 858934 929467 11580108 11652341 -72233 X 1 1 1 1 BLACK RIVER MEMORIAL HOSPITAL INC 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 WWW.BRMH.NET 1037 X X X X BLACK RIVER MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X WWW.BRMH.NET/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 22 1 WWW.BRMH.NET/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: IN 2023, CONTINUING THE FOUNDATIONAL WORK FROM THE 2021 CHNA AND SUBSEQUENT CHIP PRIORITIZATION AND IMPLEMENTATION IN 2022, ONGOING COMMUNITY TASK FORCE, COALITIONS, AND AGENCY MEETINGS WITH HOSPITAL REPRESENTATION WORKED TO ADDRESS GLOBAL COMMUNITY HEALTH PRIORITIES AND THE BRMH IDENTIFIED FOCUS AREAS. SOME OF THESE GROUPS INCLUDED THE JACKSON COUNTY CHILDCARE NETWORK, JACKSON COUNTY RESILIENCY ALLIANCE, JACKSON COUNTY CRISIS COLLABORATION, JACKSON COUNTY WORKFORCE CONNECTIONS, JACKSON COUNTY CHRONIC DISEASE COALITION, JACKSON COUNTY HOMELESS COALITION, SERVANT-LED COMMUNITY-TRANSPORTATION, AND COMMUNITY SUPPORT WORKER PROGRAM IMPLEMENTATION. MANY OF THESE CROSS-AGENCY GROUPS HAD A FOCUS ON THE BRMH IDENTIFIED PRIORITIES: 1. FAMILY AND COMMUNITY RESOURCE AWARENESS AND ACCESS, 2. MENTAL HEALTH SUICIDE AND SELF-HARM, AND 3. MENTAL HEALTH ACCESS, AND 4. HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY. ROUTINE MEETINGS WITH THE PUBLIC HEALTH DEPARTMENT OCCURRED REGARDING INTER-RELATIONSHIPS OF EACH AGENCIES CHIP PRIORITIES. THE FOCUS OF THESE MEETINGS WAS TO IDENTIFY APPROACHES AND RESOURCES BEING ORGANIZED TO ADDRESS HEALTH PRIORITIES TO ENABLE CROSS AGENCY PROMOTION AND TO PREVENT DUPLICATION OF EFFORT. MULTIAGENCY CAMPAIGNS, OF WHICH PUBLIC HEALTH WAS A PART, WERE ORGANIZED TO INCREASE COMMUNITY AWARENESS OF JACKSON COUNTIES HEALTH PRIORITIES. THIS ENABLED MULTIPLE VEHICLES OF COMMUNICATION TO REACH VARIED SEGMENTS OF THE POPULATION. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE CHNA WAS COMPLETED WITH THE HO-CHUNK NATION AND JACKSON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: IN 2023, THE COMMUNITY HEALTH NEEDS PRIORITIES WERE ADDRESSED IN THE FOLLOWING MANNER: MENTAL HEALTH: SUICIDE AND SELF-HARMGOAL ONE: DELIVER COMPASSIONATE, HIGH-QUALITY EMERGENCY CARE DURING TIMES OF A MENTAL HEALTH CRISIS.- TACTICS: WE CONTINUED TO OFFER EMERGENT BEHAVIORAL HEALTH SERVICES ON DEMAND VIA TELEHEALTH WITHIN OUR EMERGENCY DEPARTMENT (ED) DURING TIMES OF CRISIS, INCLUDING CONNECTING PATIENTS WITH INPATIENT PSYCHIATRY CARE WHEN NECESSARY. THE REFERRAL PROCESS FOR MENTAL HEALTH SERVICES WAS ENHANCED TO ENSURE THAT PATIENTS PRESENTING IN THE EMERGENCY DEPARTMENT DURING A MENTAL HEALTH CRISIS HAVE PROPER FOLLOW-UP WITH AN APPROPRIATE PROVIDER. THIS INCLUDED WORKING WITH PRIMARY CARE PROVIDERS WHO MAY BE INVOLVED IN THEIR CARE. WE CONTINUED TO REVIEW AND UPDATE LOCAL OFFERINGS AND PATIENT RESOURCES AS PART OF THEIR EMERGENCY VISIT TO HELP REDUCE THE RISK OF PATIENTS NEEDING EMERGENCY CARE. WE EMPHASIZED 211 AS THE REGIONAL RESOURCE WITH THE MOST CURRENT INFORMATION. GOAL TWO: HELP TO DEVELOP AND INCREASE PARTICIPATION IN LOCAL EDUCATIONAL OPPORTUNITIES AND CAMPAIGNS AIMED AT BRINGING AWARENESS TO SUICIDE AND SELF-HARM.- TACTICS: - WE CONTINUED TO SUPPORT LOCAL EVENTS THROUGH GUEST SPEAKERS, MONETARY CONTRIBUTIONS, IN-KIND DONATIONS, AND BROCHURES ABOUT SERVICE OFFERINGS TO HELP INCREASE ATTENDANCE AND THE OVERALL IMPACT OF THE EVENT. THIS IS EVIDENCED BY CBISA RECORDED DATA. - THE BRMH WEBSITE PROVIDES RESOURCES WHICH INCLUDE A GUIDED MENTAL HEALTH JOURNAL AND INFORMATION ON MENTAL HEALTH SERVICES. - THE BRMH COMMUNITY DISTRIBUTED MOMENTUM MAGAZINE INCLUDED CONTENT RELATED TO MENTAL HEALTH AWARENESS IN ADDITION TO SOCIAL AND MEDICAL CHANNELS AIMED TO INCREASE AWARENESS OF SUICIDE AND ASKING FOR HELP. - A MENTAL WELLNESS WALK-A-THON WAS HELD IN SEPTEMBER OF 2023 IN COLLABORATION WITH COMMUNITY PARTNERS TO INCREASE LOCAL AWARENESS OF MENTAL WELLNESS AND PROMOTE ASKING FOR HELP. THIS EVENT WAS WELL ATTENDED AND WELL RECEIVED AND WILL BE CONTINUED IN 2024. MENTAL HEALTH: ACCESSGOAL ONE: INCREASE THE EFFICIENCY OF CARE ACROSS ALL BEHAVIORAL HEALTH SERVICE OFFERINGS BY OPTIMIZING OPERATIONS, EXPANDING SERVICES, AND ALIGNING SERVICES TO IDENTIFIED PATIENT NEEDS.- TACTICS: A COLLABORATION AND AGREEMENT FOR BEHAVIORAL HEALTH TELEHEALTH SERVICE WERE COMPLETED FOR A LICENSED CLINICAL SOCIAL WORKER IN THE RURAL HEALTH CLINIC. - RECRUIT EFFORTS INCLUDED A HIGH-QUALITY BEHAVIORAL HEALTH PROVIDER WITH SPECIALIZATIONS BEYOND WHAT IS CURRENTLY OFFERED TO PATIENTS. CHANGING CMS REGULATIONS ENABLED THE EXPANSION OF RECRUITMENT TO INCLUDE LICENSED FAMILY MARRIAGE COUNSELOR PROFESSIONALS. OPERATIONAL EFFICIENCY AND CARE COORDINATION PLANNING WERE IMPLEMENTED TO OPTIMIZE PROVIDER SCHEDULES AND INCREASE ACCESS TO PATIENTS IN NEED OF MENTAL HEALTH SERVICES. GOAL TWO: DEVELOP STRATEGIC PARTNERSHIPS WITH LOCAL ENTITIES CENTERED AROUND THE GOAL OF DELIVERING HIGH-QUALITY BEHAVIORAL HEALTH SERVICES TO UNDERSERVED POPULATIONS.- TACTICS: IN COLLABORATION WITH AREA SCHOOL DISTRICTS, THE FEASIBILITY OF LAUNCHING A SCHOOL-BASED MENTAL HEALTH PROGRAM WAS EXPLORED. A NEEDS ASSESSMENT FOR PROGRAM DESIGN WAS CONDUCTED TO REVIEW CURRENT OFFERINGS, AND AN EXPANSION OF SERVICES WAS PLANNED FOR 2024. - WE CONTINUED TO OFFER EMERGENT BEHAVIORAL HEALTH SERVICES ON DEMAND VIA TELEHEALTH WITHIN OUR EMERGENCY DEPARTMENT (ED) DURING TIMES OF CRISIS, INCLUDING CONNECTING PATIENTS WITH INPATIENT PSYCHIATRY CARE IF NECESSARY. - WE CONTINUED TO ENHANCE AND PROMOTE OUR FINANCIAL ASSISTANCE PROGRAM THROUGH ONE-ON-ONE CONVERSATIONS WITH PATIENTS AND OTHER EXTERNAL COMMUNICATION TOOLS TO HELP ENSURE FINANCES ARE NOT A BARRIER TO RECEIVING NECESSARY MENTAL HEALTH SERVICES. THE FINANCIAL ASSISTANCE POLICY WAS UPDATED TO ENABLE INCREASED ACCESS BASED ON INCOME LEVEL.MENTAL HEALTH: HEALTHCARE ACCESS, AFFORDABILITY, AND AVAILABILITYGOAL ONE: INCREASE THE EFFICIENCY OF CARE DELIVERY ACROSS EVERY SERVICE LINE OFFERED AT BRMH. - TACTICS: - ALL CLINICAL DEPARTMENTS IDENTIFIED OPPORTUNITIES TO INCREASE EFFICIENCY AND PATIENT-CENTEREDNESS IN ALL SERVICE LINES BY EVALUATING STAFFING RATIOS AND INTEGRATING CMS-REPORTED DATA INTO OPERATIONS AND THE QAPI COMMITTEE. - HOMECARE AND HOSPICE SERVICE LINES WERE RE-DESIGNED. DURABLE MEDICAL EQUIPMENT STORE AND OUTPATIENT THERAPY SERVICES IN THE HOME EXPANDED TO SERVE MORE PATIENTS THAN UNDER A HOME CARE MODEL. TELEHEALTH OFFERINGS TO MEET COMMUNITY NEEDS AND INCREASE ACCESS TO SPECIALTY SERVICES, INCLUDING BEHAVIORAL HEALTH, CONTINUE TO BE IN PLACE, ASSISTING WITH ACUTE MENTAL HEALTH EVALUATION AND PLACEMENT WHEN NEEDED. FURTHER EVALUATION AND PLANNING FOR TELESTROKE AND A TELEHEALTH INTENSIVE CARE UNIT WERE INITIATED. - ONGOING FORMAL AND INFORMAL STRATEGIC PARTNERSHIPS WITH REGIONAL FACILITIES TO HELP KEEP HIGH-QUALITY HEALTHCARE LOCAL CONTINUE TO OCCUR THROUGH EXECUTIVE PLANNING MEETINGS FOR LOCAL AND REGIONAL HEALTHCARE. THESE OCCUR AT STATE AND REGIONAL LEVELS. - THE REFERRAL PROCESS WAS ENHANCED TO OPTIMIZE THE USE OF EMR AND DISPLAY MEANINGFUL RESULTS TO ENABLE MONITORING AND FOLLOW-UP TO ENSURE A PATIENT PRESENTING IN THE EMERGENCY DEPARTMENT (ED) HAS PROPER FOLLOW-UP WITH AN APPROPRIATE PROVIDER- IN COLLABORATION WITH AREA SCHOOL DISTRICTS, THE FEASIBILITY OF LAUNCHING A SCHOOL-BASED MENTAL HEALTH PROGRAM WAS EXPLORED. A NEEDS ASSESSMENT FOR PROGRAM DESIGN WAS CONDUCTED TO REVIEW CURRENT OFFERINGS AND THE EXPANSION OF PROGRAMMING TO SCHOOLS IN 2024.GOAL TWO: INCREASE THE AFFORDABILITY OF HIGH-QUALITY, LOCAL CARE BY BEING A GOOD STEWARD OF LOCAL RESOURCES AND CAPTURING MORE EXTERNAL FUNDING OPPORTUNITIES.- TACTICS: - CONTINUED WORK WITH A DONOR-CENTERED FOUNDATION THAT FOCUSES ON SECURING STATE AND FEDERAL GRANTS TO HELP FUND THE DELIVERY OF CRITICAL SERVICE LINES AND VALUE-ADDED EXPERIENCES FOR PATIENTS AND THEIR LOVED ONES. - THE ORGANIZATION'S PARTICIPATION IN THE FEDERAL 340B DRUG PRICING PROGRAM WAS ENHANCED AND EXPANDED TO CONTINUALLY INCREASE THE ACCESS AND AFFORDABILITY OF COMPREHENSIVE HEALTHCARE SERVICES TO THE COMMUNITY. - INCREASE THE AFFORDABILITY AND LONG-TERM ACCESS TO LOCAL HEALTHCARE BY FOCUSING ON VARIOUS SUSTAINABLE ENERGY INITIATIVES ACROSS OUR FACILITIES TO HELP REDUCE OPERATIONAL EXPENSES AND CONTRIBUTE TO THE RESPONSIBLE STEWARDSHIP OF LOCAL RESOURCES. A PLAN WAS DEVELOPED, AND WORK BEGAN ON ENERGY-SAVING INITIATIVES WITH COST SAVINGS ALREADY RECOGNIZED IN 2023. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL WILL CONSIDER THE OTHER DEBTS OF THE PATIENT. A PATIENT'S HOSPITAL BILL THAT IS LARGE IN COMPARISON TO THE PATIENT'S INCOME IS ALSO CONSIDERED FOR CATASTROPHIC CARE. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16J: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. 1 1 - BLACK RIVER MEMORIAL HOSPITAL HOME-BASED 311 COUNTY RD A BLACK RIVER FALLS WI 54615 HOME HEALTH AGENCY OFFICE, HOSPICE PROGRAM OFFICE, DME SERVICES PART I, LINE 6A: BLACK RIVER MEMORIAL HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S DATABASE AND WEBSITE. PART I, LINE 7: 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 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 BLACK RIVER MEMORIAL HOSPITAL, INC. INCLUDE THE OPERATION OF THE HOSPITAL'S CLINIC, INPATIENT NURSING UNIT AND EMERGENCY ROOM, AS WELL AS THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE SUBSIDIZED INPATIENT UNIT INCLUDES THE MEDICAL/SURGICAL, OBSERVATION, OB AND HOSPITALIST NURSING UNITS. THE HOSPITAL INPATIENT UNIT DEPARTMENT AND EMERGENCY ROOM OPERATES 24-HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED STAFF INCLUDING HOSPITALIST PHYSICIANS, REGISTERED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT NURSING UNIT COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF JACKSON COUNTY, WISCONSIN. JACKSON COUNTY IS A LARGE COUNTY IN WISCONSIN AND OFTEN SIGNIFICANT TRAVEL AND EFFORTS ARE NEEDED TO PROVIDE THESE SERVICES TO PATIENTS IN THE MOST COMFORTABLE SETTING WHICH IS THEIR HOMES. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF BLACK RIVER MEMORIAL HOSPITAL, INC. AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF BLACK RIVER MEMORIAL HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY 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 FORM 990 PURPOSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,243,553. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PROVIDES FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND SAME DAY APPOINTMENTS THROUGH THE BLACK RIVER HEALTHCARE CLINIC, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH THERAPY, SURGICAL SERVICES, AND WOMEN'S HEALTH. WE DISCONTINUED OUR HOMECARE AND HOSPICE PROGRAMS IN MAY 2023 AND BEGAN CCM AND TCM 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: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: BLACK RIVER MEMORIAL HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY 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 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF JACKSON COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND COMMUNITY CARE POLICIES, BLACK RIVER MEMORIAL HOSPITAL, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S COMMUNITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE COMMUNITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES. PART VI, LINE 2: EVERY THREE YEARS, BRMH CONSIDERS OUR COMMUNITY'S MOST PRESSING HEALTH NEEDS BY CONDUCTING A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE 2022 ASSESSMENT WAS COMPLETED BY A GROUP OF HOSPITAL EMPLOYEES AND INCLUDES QUANTITATIVE AND QUALITATIVE DATA THAT SERVE TO GUIDE BOTH OUR COMMUNITY BENEFIT AND STRATEGIC PLANNING. THROUGH OUR CHNA, BRMH HAS IDENTIFIED THE GREATEST HEALTH NEEDS IN OUR HOSPITAL'S COMMUNITIES ENABLING BRMH TO ENSURE OUR RESOURCES ARE APPROPRIATELY DIRECTED TOWARD OUTREACH, PREVENTION, EDUCATION, AND WELLNESS OPPORTUNITIES WHERE THE GREATEST IMPACT CAN BE ACHIEVED. OUR TOP THREE NEEDS ARE BEHAVIORAL HEALTH CARE (INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDER), OBESITY, AND DEMENTIA/ALZHEIMER'S CARE. PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S PATIENT FINANCIAL ADVOCATES EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE PATIENT FINANCIAL ADVOCATE EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERS THE FINANCIAL ASSISTANCE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGER CARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR BLACK RIVER MEMORIAL HOSPITAL, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 30-MILE RADIUS OF THE HOSPITAL. THIS AREA INCLUDES JACKSON COUNTY AND PARTS OF EAU CLAIRE, MONROE, LA CROSSE, TREMPEALEAU, WOOD, ADAMS, AND CLARK COUNTIES. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE ALMA CENTER, BLAIR, HIXTON, HUMBIRD, MELROSE, MERRILLAN, SPARTA, OSSEO, TOMAH, NEILLSVILLE, AND WHITEHALL. BLACK RIVER MEMORIAL HOSPITAL, INC. IS THE ONLY HOSPITAL LOCATED IN JACKSON COUNTY, WISCONSIN. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS AS WELL AS THE HO-CHUNK NATION (A LOCAL TRIBAL NATION WITH A LARGE PORTION OF ITS POPULATION RESIDING IN JACKSON COUNTY, WISCONSIN). THE HO-CHUNK NATION ALSO IS ABLE TO ACCESS CARE AT THE HOSPITAL AT REDUCED RATES THROUGH A REGULATION KNOWN AS THE "MEDICARE-LIKE PAYMENTS RULE." THE HOSPITAL ALSO IS A SUPPLIER OF HEALTH CARE SERVICES TO FIVE STATE OPERATED INSTITUTIONS WHICH ARE OPERATED BY THE WISCONSIN DEPARTMENT OF CORRECTIONS. THE STATE OF WISCONSIN ALSO REIMBURSES THE HOSPITAL AT RATES BELOW THE GENERAL PUBLIC TO REDUCE COSTS PASSED ON TO TAXPAYER IN THE STATE. PART VI, LINE 5: AS A COMMUNITY-OWNED HOSPITAL, BLACK RIVER MEMORIAL HOSPITAL, INC. CONTINUES TO BE PROACTIVELY INVOLVED WITH AREA COMMUNITY MEMBERS THROUGH A VARIETY OF EDUCATIONAL FORUMS, SUPPORT GROUPS, WELLNESS AND SAFETY FAIRS, DIABETES FAIR, HO-CHUNK HEALTH FAIR, KIDS' SAFETY CAMP, PRE-NATAL AND BREASTFEEDING CLASSES. OTHER SUPPORT GROUPS NOT ONLY INCLUDE DIABETES AND BEREAVEMENT, BUT WE OFFER A BETTER BREATHERS SUPPORT GROUP AND A BETTER SLEEPERS SUPPORT GROUP. THERE ARE A NUMBER OF LOCAL ORGANIZATIONS THAT ARE REPRESENTED OR FACILITATED BY HOSPITAL STAFF INCLUDING: JACKSON IN ACTION, GREATER BLACK RIVER AREA SAFETY COUNCIL, JACKSON COUNTY HEALTHCARE ALLIANCE, JACKSON COUNTY TOBACCO COALITION, TOGETHER FOR JACKSON COUNTY KIDS, JACKSON COUNTY EMERGENCY MANAGEMENT PLANNING WORKFORCE, AND MANY OTHERS. THE HOSPITAL WELCOMES MEDICAL STUDENTS FOR INTERNSHIPS AND CLINICALS. THE HOSPITAL ALSO PARTICIPATES IN THE MEALS ON WHEELS PROGRAM BY DELIVERING MEALS TO LOCAL SENIORS WHO ARE HOME BOUND. THE HOSPITAL ALSO PROVIDES SUPPORT AND SPONSORSHIP TO THE RED CROSS BLOODMOBILE SEVERAL TIMES A YEAR. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X 0 0 0 0 0 0 0 0 0 DR CAROL MARTIN CHIEF OF STAFF/DIRECTOR 399502 0 1500 0 1548 0 19800 0 50348 0 472698 0 0 0 ESTEBAN MILLER MD CMO 386408 0 1500 0 828 0 19800 0 51828 0 460364 0 0 0 JOSEPH AHN DR PHYSICIAN 371247 0 0 0 360 0 19800 0 42927 0 434334 0 0 0 SMITA RAJASEKARAN MD PHYSICIAN 362177 0 1250 0 828 0 17500 0 49163 0 430918 0 0 0 CASEY TOTTEN MD PHYSICIAN 366039 0 0 0 324 0 19800 0 22998 0 409161 0 0 0 CARL SELVICK CEO 347617 0 0 0 3521 0 19800 0 4816 0 375754 0 0 0 HOLLY WINN CFO 303154 0 0 0 1548 0 18558 0 42527 0 365787 0 0 0 RICHARD MINNIHAN MD PHYSICIAN 299926 0 0 0 540 0 0 0 52055 0 352521 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-02-01 24000000 HOSPITAL ADDITIONS AND RENOVATIONS; REFUNDING OF 2005 BOND SERIES 0 0 0 A 4410971 24000000 10163311 146704 13689985 2019 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART III, LINE 3 HOMECARE AND HOSPICE PROGRAMS WERE DISCONTINUED IN MAY 2023. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION HAS AMENDED THEIR ORGANIZING DOCUMENTS TO REFLECT A SIGNIFICANT CHANGE TO REMOVE MEMBERS. PRIOR TO 07/01/2023 THE ORGANIZATION HAD TWO CLASSES OF MEMBERSHIP INCLUDING INDIVIDUAL AND GROUP MEMBERSHIP. THE MEMBERS POWERS ARE FURTHER DESCRIBED IN SCHEDULE O. BY REMOVING THE ROLE AND FUNCTION OF MEMBERS IN THE ORGANIZATION WHICH WILL NOW HAVE NO MEMBERS, THOSE POWERS CEASED ON 07/01/2023. FORM 990, PART VI, SECTION A, LINE 6 FROM 01/01 THROUGH 06/30/2023 THE FOLLOWING WAS IN EFFECT. ON 07/01/2023 THE BYLAWS AND ARTICLES WERE AMENDED TO NO LONGER HAVE MEMBERS. MEMBERSHIP OF BLACK RIVER MEMORIAL HOSPITAL, INC. CONSISTS OF TWO CLASSES, INDIVIDUAL AND GROUP AS FOLLOWS: INDIVIDUAL MEMBERSHIP-ANY ADULT RESIDING WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS HE OR SHE RESIDES WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES. A FAMILY CONTRIBUTION, OR ONE BY EITHER SPOUSE INDIVIDUALLY, ENTITLES BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIP IN THE CORPORATION. GROUP MEMBERSHIP-ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHICH HAS CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR THE CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS THE ORGANIZATION IS IN EXISTENCE. SUCH ORGANIZATIONS SHALL DESIGNATE ANNUALLY, IN WRITING, ONE PERSON TO ACT ON ITS BEHALF AT MEETINGS OF MEMBERS. MEMBERSHIP SHALL TERMINATE IF THE MEMBER RELINQUISHES MEMBERSHIP OR IF THE MEMBER CEASES TO EXIST. NEW MEMBERS MAY BE ANY ADULT RESIDING WITHIN, OR ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION HAVING AN ESTABLISHED BUSINESS ADDRESS WITHIN, THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO DID NOT CONTRIBUTE TO THE 1965 CAMPAIGN FOR THE HOSPITAL BUILDING MAY THEREAFTER BECOME A LIFE MEMBER AS PROVIDED IN 1 OR 2 ABOVE BY CONTRIBUTING TWENTY DOLLARS ($20.00) OR MORE TO THE CORPORATION, EXCEPT AS OF JUNE 1, 2001, A FAMILY CONTRIBUTION SHALL NO LONGER ENTITLE BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIPS IN THE CORPORATION. WHENEVER A NEW INDIVIDUAL MEMBERSHIP IS CREATED, ONE INDIVIDUAL SHALL BE IDENTIFIED AS THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A FROM 01/01 THROUGH 06/30/2023 THE FOLLOWING WAS IN EFFECT. ON 07/01/2023 THE BYLAWS AND ARTICLES WERE AMENDED TO NO LONGER HAVE MEMBERS. THE MEMBERS SHALL ELECT MEMBERS OF THE BOARD OF DIRECTORS. EACH MEMBER IS ENTITLED TO ONE VOTE, AND EACH GROUP MEMBER SHALL, BEFORE THE START OF THE MEETING, DESIGNATE IN WRITING TO THE SECRETARY OF THE CORPORATION THE PERSON ENTITLED TO VOTE FOR THE GROUP MEMBER. FORM 990, PART VI, SECTION A, LINE 7B FROM 01/01 THROUGH 06/30/2023 THE FOLLOWING WAS IN EFFECT. ON 07/01/2023 THE BYLAWS AND ARTICLES WERE AMENDED TO NO LONGER HAVE MEMBERS. THE MEMBERS OF BLACK RIVER MEMORIAL HOSPITAL, INC. HAVE THE AUTHORITY TO VOTE ON ALL MATTERS PRESENTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS OF BLACK RIVER MEMORIAL HOSPITAL, INC. RECEIVED A COPY OF THE 990 FOR REVIEW PRIOR TO THE FILING OF THEIR RETURN. MEMBERS OF THE BOARD WILL DO A FORMAL REVIEW OF THE FORM AFTER FILING. THE HOSPITAL'S CHIEF OFFICERS REVIEWED THE RETURN IN DETAIL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. ANY ISSUES WHICH MAY ARISE ARE DISCUSSED AND HANDLED APPROPRIATELY. ANY MEMBER OF THE BOARD OF DIRECTORS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON ANY POTENTIAL CONFLICTED ISSUES. A SIMILAR PROCESS IS USED BY THE BOARD OF DIRECTORS FOR THE REVIEW OF CONFLICTS OF INTEREST WITH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILAR SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN THE SAME REVENUE CATEGORY OR GEOGRAPHICAL AREA). THE COMPENSATION OF ADMINISTRATIVE LEVEL EMPLOYEES IS REVIEWED BY THE CEO AND APPROVED IN THE BUDGET BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 BLACK RIVER MEMORIAL HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SUMMARIZED FINANCIAL STATEMENT DATA IS ALSO AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION'S WEBSITE AND THE HOSPITAL'S ANNUAL REPORT, WHICH IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FORM 990, PART IX, LINE 11G RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 860,923. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 860,923. ANESTHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 838,726. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 838,726. MRI/CT/NUCLEAR MED SERVICES: PROGRAM SERVICE EXPENSES 709,355. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 709,355. PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 438,095. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 438,095. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 262,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 262,143. OTHER: PROGRAM SERVICE EXPENSES 2,204,897. MANAGEMENT AND GENERAL EXPENSES 6,015,684. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,220,581.