2024-11-13T10:33:30-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 JEANETTE WOJTALEWICZ INTERIM CFO 7152341515 2024-11-11 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-11 2023 2024-10-15 13:58:12Z MARSHFIELD MEDICAL CENTER-RICE LAKE BRIAN HOERNEMAN MD 1000 N OAK AVENUE MARSHFIELD WI 54449 152637755 0 X WWW.MARSHFIELDCLINIC.ORG X 1919 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 250 0 0 3112261 17616 135851022 152615794 156503 -2959 0 0 139119786 152630451 2000 0 0 0 72848499 63918603 0 0 0 80543870 83692640 153394369 147611243 -14274583 5019208 104854905 100153915 41121516 40057118 63733389 60096797 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 116719978 0 152225041 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT 40-BED COMMUNITY HOSPITAL LOCATED IN RICE LAKE, WISCONSIN THAT PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE AND HOME HEALTH SERVICES. 116719978 1 1 0 0 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 0 0 0 0 0 0 0 1 0 1 0 1 X 0 0 0 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 X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 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 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 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 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 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 56.00 X 0 536206 43230 JOHN BALTUS SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 DAVID HOLMES BOARD MEMBER 1.00 0.00 X 0 0 0 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 MARGARET MINERICK BOARD MEMBER - PART YEAR 1.00 1.00 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 0 7336502 563998 0 0 1 0 VAYA WORKFORCE SOLUTIONS LLC PO BOX 713427 CHICAGO IL 60677 PROFESSIONAL SERVICES 2033210 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD AND ENVIRONMENTAL 1797052 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 FOOD AND ENVIRONMENTAL 1526105 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 PROFESSIONAL SERVICES 997149 STERIS CORP LOCKBOX 771652 CHICAGO IL 60677 CONSTRUCTION SERVICES 702388 35 12618 4998 17616 NET PATIENT SERVICE REVENUE 621110 152024390 152024390 CAFETERIA REVENUE 621110 390753 390753 INTERCOMPANY REVENUE 621110 145741 145741 MISC OTHER OPERATING REVENUE 621110 54910 54910 152615794 3709 3709 636 7304 -6668 -6668 -6668 152630451 152225041 0 387794 51877858 50398116 1479742 1396853 1346079 50774 7735914 7513824 222090 2907978 2809446 98532 1300 1300 6221546 6209937 11609 1972 696 1276 1147312 1001580 145732 123992 123077 915 2037530 2019224 18306 456800 441566 15234 1199715 1199715 4684519 4684519 I/C PURCHASED SERVICES 31137471 2351411 28786060 MEDICAL SUPPLIES 29601031 29597444 3587 BAD DEBT EXPENSE 4363397 4363397 WI MEDICAID ACCESS TAX 1698212 1698212 1017843 961735 56108 147611243 116719978 30891265 0 X 5998247 6011 0 3344 29520913 33936520 2862118 2491451 125832770 62161103 66453539 63671667 20088 44922 104854905 100153915 2944754 13498726 284382 -7716 37890451 26548194 1929 17914 41121516 40057118 X 63733389 60096797 63733389 60096797 104854905 100153915 X 5019208 -8655800 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3788469 3788469 80871576 32680953 48190623 57020 42023 14997 36696044 26523390 10172654 4419661 2914737 1504924 63671667 OPERATING LEASE PAYABLE LONG-TERM 17914 17914 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 X 1 X 1 X 1 1 1 0 1 1 103768 0 103768 0.00070 19996112 2469591 17526521 0.12240 0 0 20099880 2469591 17630289 0.12310 65760 1250 64510 0.00050 2378 0 2378 0.00000 0 0 0 0 0 0 68138 1250 66888 0.00050 20168018 2470841 17697177 0.12360 1 1526753 0 22495863 39082853 -16586990 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - RICE LAKE 1700 W STOUT STREET RICE LAKE WI 54868 82 X X X MARSHFIELD MEDICAL CENTER - RICE LAKE 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://TINYURL.COM/Y2UENJ9C X 1 23 1 HTTPS://TINYURL.COM/Y2CZJRC5 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 5: DIRECT COLLABORATION WITH LOCAL COMMUNITY PARTNERS INCLUDED TWO THRIVE STEERING COMMITTEE CHA/CHIP PLANNING MEETINGS IN AUGUST 2022 AND DECEMBER 2022. TO ACHIEVE COMPLIANCE, MMC-RICE LAKE COMPLETED A ONE-YEAR CHNA/IS IN 2021 WITH A COMMUNITY HEALTH ASSESSMENT SURVEY AND KEY INFORMANT INTERVIEWS. TO ALIGN WITH BARRON COUNTY HEALTH DEPARTMENT AND THE THRIVE STEERING COMMITTEE, MMC-RICE LAKE UTILIZED THE COMMUNITY HEALTH SURVEY DATA, KEY INFORMANT INTERVIEW DATA, TWO PLANNING MEETINGS, AND THE ADDITION OF THE COMMUNITY AFFIRMATION SURVEY TO COMPLETE THE 2022 MMC-RICE LAKE CHNA.THE SURVEY COLLECTED 250 RESPONSES BETWEEN MARCH AND APRIL 2021 FROM BARRON COUNTY RESIDENTS. OVERALL, RESPONDENTS TENDED TO BE WHITE, FEMALE AND BETWEEN THE AGES OF 35-44 AND 55-64. OF SURVEY RESPONDENTS, 6.76% WERE RETIRED AND 7.43% WORK PART TIME. THIS SURVEY DATA WAS UTILIZED IN THE 2021 MMC-RICE LAKE CHNA AND 2022 MMC-RICE LAKE CHNA.PRIMARY DATA COLLECTION FOR AN AFFIRMATION SURVEY WAS COMPLETED IN JANUARY 2022. THE PURPOSE OF THE SURVEY WAS TO MEET THE NEED OF THE BARRON COUNTY CHA AND OTHER HEALTH SYSTEMS CHNA/IS. AN ELECTRONIC SURVEY WAS WIDELY DISTRIBUTED BY BARRON COUNTY PUBLIC HEALTH AND THE THRIVE STEERING COMMITTEE, WHICH INCLUDED MMC-RICE LAKE.THE SURVEY COLLECTED 361 RESPONSES BETWEEN DECEMBER 2021 AND JANUARY 2022 FROM BARRON COUNTY RESIDENTS.FOR THIS ASSESSMENT KEY INFORMANT INTERVIEWS WERE CONDUCTED VIA WEBEX (VIDEO CONFERENCING PLATFORM) AND TELEPHONE TO OBSERVE COVID-19 PANDEMIC SAFETY PROTOCOLS. THREE INDIVIDUALS COMPLETED AN INTERVIEW AND RESULTING INSIGHTS WERE COMPILED INTO A SUMMARY REPORT. MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEM NORTHLAND- AMERY HOSPITAL AND CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)- AGING AND DISABILITY RESOURCE CENTER OF BARRON, RUSK, AND WASHBURN COUNTIES- UNIVERSITY OF WISCONSIN-EAU CLAIRE- WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC)- CUMBERLAND HEALTHCARE- RICE LAKE AREA FREE CLINIC- NORTHLAKES COMMUNITY CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE BARRON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY, KEY INFORMANT INTERVIEW SUMMARY, HEALTHIEST WISCONSIN 2020, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MARSHFIELD MEDICAL CENTER IN RICE LAKE ARE: - ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - HEALTH EQUITYHEALTH PRIORITY: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE ALCOHOL & SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION.- PREVENT ALCOHOL AND SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING INDIVIDUAL AND/OR ENVIRONMENTAL PREVENTION STRATEGIES.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: BEHAVIORAL HEALTH GOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES.- ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH.- PROVIDE EDUCATIONAL MATERIALS (USING A VARIETY OF PLATFORMS) TO INCREASE CAREGIVER MENTAL HEALTH AND WELLBEING. - PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS.- ENHANCE COMMUNITY MEMBERS' SKILLS TO SUPPORT MENTAL WELLNESS PROMOTION AND SUICIDE PREVENTION.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: HEALTH EQUITYGOAL 1: ADVANCE HEALTH EQUITY BY FOCUSING ON COMMUNITY-BASED HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH.- ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES.GOAL 2: REDUCE HEALTH DISPARITIES RELATED TO PHYSICAL, SOCIAL, ECONOMIC AND/OR COMMUNITY CONDITIONS.- INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCAL GROWN FOOD AND ADDRESS FOOD INSECURITY.GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO IMPROVING EQUITABLE ACCESS TO RESOURCES AND SUPPORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-RICE LAKE FOR REASONS INDICATED:- INJURY & VIOLENCE PREVENTION: INJURY AND VIOLENCE ARE IMPORTANT AREAS OF FOCUS. INSTEAD OF LEADING THIS CHARGE, MMC-RICE LAKE STAFF PARTICIPATE IN A VARIETY OF COMMUNITY GROUPS SUPPORTING THIS AREA INCLUDING, BARRON-WASHBURN COUNTY CAREGIVER COALITION AND COMMUNITY CONNECTIONS TO PROSPERITY (CCP). EMBRACE INC. (A DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCY THAT PROVIDES SAFE SHELTER AND SUPPORTIVE SERVICES FOR SURVIVORS), AGING AND DISABILITY RESOURCE CENTER (ADRC) OF BARRON, RUSK, AND WASHBURN COUNTIES, AND BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEAD AND HAVE EXPERTISE IN THIS AREA. - COMMUNICABLE DISEASE PREVENTION & CONTROL: THIS IS AN IMPORTANT AREA OF FOCUS, AND MMC-RICE LAKE HAS SYSTEMS AND PROCESSES IN PLACE TO PREVENT AND REDUCE THE SPREAD OF COMMUNICABLE DISEASES. THE HOSPITAL WILL NOT TAKE THE LEAD ON THIS AREA IN COMMUNITY OUTREACH AS THIS IS AN AREA THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEADS AND HAS EXPERTISE IN.- ORAL HEALTH: MARSHFIELD CLINIC RICE LAKE DENTAL CENTER ADDRESSES THE COMMUNITY NEED FOR ORAL HEALTH BY SERVING PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS. WHILE MMC-RICE LAKE ADDRESSES ORAL HEALTH IT IS NOT LISTED AS ONE OF THE TOP HEALTH PRIORITIES. PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. PART II, COMMUNITY BUILDING ACTIVITIES: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RICE LAKE), 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: COMMUNITY SUPPORT:MMC-RICE LAKE STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS. EXAMPLES INCLUDED: -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 -PRENATAL CHILD BIRTHING AND BREASTFEEDING SUPPORT CLASSES -NATIONAL NIGHT OUT IN CAMERON AND RICE LAKE -PARTICIPATION IN THE EMERGENCY PREPAREDNESS SUBCOMMITTEE -PROVIDED LIFE JACKETS AND BIKE HELMETS AT THE BARRON COUNTY FAIR, MEASURED FOR CORRECT FIT, AND PROVIDED SAFETY EDUCATION. ENVIRONMENTAL IMPROVEMENTS:MMC-RICE LAKE PROVIDES A MEDICATION DISPOSAL KIOSK IN THE CLINIC PHARMACY OPENED TO THE PUBLIC TO ENCOURAGE SAFE DISPOSAL OF MEDICATION IN THE COMMUNITY. MMC-RICE LAKE COLLECTED 90.45 POUNDS OF MEDICATION IN 2023. MMC-RICE LAKE SUPPORTS HARM REDUCTION METHODS RELATED TO USED SHARPS, BY ACCEPTING USED SHARPS FROM ANYONE IN THE COMMUNITY REGARDLESS OF PATIENT STATUS. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: MMC-RICE LAKE IMPLEMENTS A HOSPITAL VOLUNTEER PROGRAM, HOSPITAL VOLUNTEERS HOST EVENTS TO FINANCE THE MMC RICE LAKE SCHOLARSHIP PROGRAM OPEN TO HIGH SCHOOL SENIORS IN THE COMMUNITY. MMC-RICE LAKE OFFERS A MEDICAL ASSISTANT TRAINING PROGRAM. MMC-RICE LAKE IMPLEMENTS A HIGH SCHOOL INTERNSHIP WHERE STUDENTS ROTATE THROUGH MULTIPLE HOSPITAL DEPARTMENTS COMPLETING FULL-DAY OBSERVATIONS AND CONTRIBUTE VOLUNTEER SERVICE. COALITION BUILDING:MMC-RICE LAKE STAFF PARTICIPATED IN MULTIPLE COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY INCLUDING THE BARRON COUNTY COMMUNITY COALITION, COMMUNITY CONNECTIONS TO PROSPERITY, COMMUNITY CONNECTIONS TO PROSPERITY MENTAL HEALTH ACTION TEAM (MHAT), BARRON COUNTY THRIVE CHRONIC DISEASE COMMITTEE, AND BARRON COUNTY THRIVE STEERING COMMITTEE. COMMUNITY HEALTH IMPROVEMENT ADVOCACY:MMC-RICE LAKE 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-RICE LAKE COLLABORATED WITH AREA HIGH SCHOOLS TO OFFER PROGRAMS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL CAREERS. MMC-RICE LAKE FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT-NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, AND MEDICAL RESIDENTS AND INTERNS. OTHER:MMC-RICE LAKE SUPPORTED THE BARRON COUNTY FAIR, 5K TURKEY TROT RUN/WALK, RICE LAKE AREA SCHOOL DISTRICT, RICE LAKE CHAMBER, THE ROTARY CLUB OF RICE LAKE, THE ADRC OF BARRON AND RUSK COUNTY, BENJAMIN'S HOUSE EMERGENCY SHELTER, AND CAMERON MIDDLE SCHOOL STUDENT COUNCIL. 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 ANDIDENTIFIES 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 DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFFAGAINST 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 III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-RICE LAKE USES RELIABLE SECONDARY DATA 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-RICE LAKE 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-RICE LAKE'S CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. MMC-RICE LAKE 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-RICE LAKE 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: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE.INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: MMC-RICE LAKE IS A 40-BED COMMUNITY HOSPITAL IN RICE LAKE WISCONSIN. MMC-RICE LAKE OFFERS A 24/7 EMERGENCY DEPARTMENT, AMBULANCE SERVICES, FULL SCOPE OF GENERAL AND ORTHOPEDIC SURGERY SERVICES, COMPREHENSIVE OUTPATIENTS CANCER CARE SERVICES, AND INPATIENT AND OUTPATIENT PHYSICAL THERAPY, REHABILITATION AND OCCUPATIONAL THERAPY. BARRON COUNTY IS LOCATED IN NORTHWESTERN WISCONSIN. THE COUNTY IS COMPRISED OF FOUR CITIES (BARRON, CHETEK, CUMBERLAND, AND RICE LAKE), SIX VILLAGES (ALMENA, CAMERON, DALLAS, HAUGEN, NEW AUBURN, PRAIRIE FARM, AND TURTLE LAKE), AND 25 TOWNSHIPS WITH A TOTAL POPULATION OF 46,719 IN 2021; APPROXIMATELY 65.9% OF WHICH IS RURAL.THE CITY OF RICE LAKE IS WHERE MARSHFIELD MEDICAL CENTER-RICE LAKE IS LOCATED AND HAD A TOTAL POPULATION OF 8,939 IN 2021. RICE LAKE IS LOCATED ABOUT 100 MILES EAST OF MINNEAPOLIS, MN AND ABOUT 60 MILES NORTH OF EAU CLAIRE, WI. THE RACIAL MAKE-UP OF BARRON COUNTY IS 94.9% WHITE, 0.7% ASIAN, 3.0% HISPANIC OR LATINO, 1.4% TWO OR MORE RACES, 1.8% BLACK OR AFRICAN AMERICAN, AND 1.3% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $52,346 COMPARED TO THE STATE AVERAGE OF $63,293 WITH THE POVERTY RATE OF 10%. THE EDUCATION LEVEL OF BARRON COUNTY RESIDENTS IS LOWER THAN THE STATEWIDE AVERAGE. ACCORDING TO THE LATEST CENSUS ESTIMATES, 90.6% OF BARRON RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO 92.6% STATEWIDE. LIKEWISE, 20.6% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 30.8% STATEWIDE. 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, TRAINING, 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-RICE LAKE 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 WI 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 RUWAN DISSANAYAKE MD SECRETARY - PART YEAR 0 240464 0 114060 0 16332 0 3614 0 20543 0 395013 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: WILLIAM MELMS, MD RUWAN DISSANAYAKE, MD SAMANTHA KLEBE, DO BRIAN HOERNEMAN, MD EDWARD FERNANDEZ, MD CATHY BUKOWSKI FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 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 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. 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 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. 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 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. 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 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. 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 ENSURE 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 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE 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. FROM 990, PART X, LINE 20: LAKEVIEW MEDICAL CENTER INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS -8,655,800. 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