2024-11-13T12:48:01-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 JEANETTE WOJTALEWICZ INTERIM CFO 7157622484 2024-11-11 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-11 2023 2024-10-15 13:58:12Z MARSHFIELD MEDICAL CENTER-PARK FALLS BRIAN HOERNEMAN MD 1000 N OAK AVENUE MARSHFIELD WI 54449 41270632 0 X WWW.MARSHFIELDCLINIC.ORG X 1961 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 125 0 0 774357 108070 40267702 41160485 3066 2077 0 0 41045125 41270632 1000 0 0 0 22902889 20443952 0 0 0 16604722 16955672 39508611 37399624 1536514 3871008 13266431 33331476 705168 1575762 12561263 31755714 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 28944976 41102148 FLAMBEAU HOSPITAL, INC. IS A NOT-FOR-PROFIT 25-BED COMMUNITY HOSPITAL LOCATED IN PARK FALLS, WISCONSIN THAT PROVIDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, HOSPICE, HOME HEALTH AND OTHER OUTPATIENT SERVICES. 28944976 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 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 0 7336502 563998 0 0 1 0 MIRON CONSTRUCTION CO INC PO BOX 1372 GREEN BAY WI 54305 CONSTRUCTION 8966675 LOCUMSMART LLC PO BOX 736389 DALLAS TX 75373 MEDICAL SERVICES 746930 VAYA WORKFORCE SOLUTIONS LLC PO BOX 713427 CHICAGO IL 60677 PROFESSIONAL SERVICES 721011 BURLINGTON HEALTHCARE PROVIDERS INC W329 N4476 LAKELAND DR STE 140 NASHOTAH WI 53058 MEDICAL SERVICES 631005 OMNICELL INC PO BOX 204650 DALLAS TX 75320 CONSTRUCTION 420226 16 10293 97777 108070 NET PATIENT SERVICE REVENUE 621110 40884132 40884132 MISC OTHER OPERATING REVENUE 621110 216666 216666 CAFETERIA REVENUE 621110 59687 59687 41160485 727 727 1350 0 1350 1350 1350 41270632 41102148 0 60414 16347373 15963907 383466 387081 374465 12616 2765199 2700755 64444 944299 917126 27173 5200 5200 1774113 1766793 7320 1242 516 726 365542 359325 6217 14180 14180 751897 751897 100389 96207 4182 557 557 542094 542094 I/C PURCHASED SERVICES 8551035 640740 7910295 MEDICAL SUPPLIES 3063184 3062905 279 BAD DEBT EXPENSE 1357358 1357358 EQUIP. REPAIRS & MAINT. 307955 307781 174 120926 88370 32556 37399624 28944976 8454648 0 X 387239 950 36961 22228 7315719 16392282 511691 577479 9926 0 19262760 2986266 4886236 16276494 118659 62043 13266431 33331476 346722 1283673 94270 46738 264176 245351 705168 1575762 X 12561263 20633555 11122159 12561263 31755714 13266431 33331476 X 3871008 15323443 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 621000 621000 3002501 1170005 1832496 15580447 1773417 13807030 58812 42844 15968 16276494 ASSET RETIREMENT OBLIGATION 201213 OPERATING LEASE PAYABLE LT 44138 245351 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 43855 43855 0.00120 3907913 2580112 1327801 0.03680 3951768 2580112 1371656 0.03800 54092 54092 0.00150 54092 54092 0.00150 4005860 2580112 1425748 0.03950 1469 1469 0.00000 209 209 0.00000 1678 1678 0.00000 1 607418 4983391 7471587 -2488196 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - PARK FALLS 98 SHERRY AVENUE PARK FALLS WI 54552 1028 X X X X MARSHFIELD MEDICAL CENTER - PARK FALLS 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X HTTPS://TINYURL.COM/MSVJMRW5 X 1 21 1 HTTPS://TINYURL.COM/34UWZWRD 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTPS://MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X HTTPS://MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X HTTPS://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 - PARK FALLS PART V, SECTION B, LINE 5: COMMUNITY BENEFITS WORKGROUP (CBW)-PARK FALLS IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH PRIORITIES THROUGH A COMPREHENSIVE PROCESS THAT INCLUDED INPUT FROM COMMUNITY PARTNERS AND ORGANIZATION LEADERSHIP. THE MMC-PARK FALLS CHNA AND COMMUNITY HEALTH PRIORITIZATION PROCESS WAS LED BY THE CBW-PARK FALLS. THE CHIEF ADMINISTRATIVE OFFICER (CAO) OF MMC-PARK FALLS CHAIRED THE CBW-PARK FALLS, WHICH INCLUDED LOCAL LEADERSHIP. ALL MEMBERS WERE CHOSEN FOR THEIR COMMITMENT TO GUIDE COMMUNITY BENEFITS EFFORTS AND DESIRE TO IMPROVE HEALTH IN THE PRICE COUNTY COMMUNITIES. THE CHNA INCLUDED PRIMARY AND SECONDARY DATA. PRIMARY DATA INCLUDED A COUNTY-WIDE SURVEY AND COMMUNITY CONVERSATIONS. SECONDARY DATA WAS COMPILED INTO A DATA PACKET, WHICH INCLUDED DATA FROM VARIOUS SOURCES. BOTH PRIMARY AND SECONDARY DATA COLLECTION METHODS WERE UTILIZED, AND VARIOUS EFFORTS WERE MADE TO CONNECT WITH SEVERAL DIFFERENT DEMOGRAPHIC GROUPS TO DEVELOP A THOROUGH UNDERSTANDING OF HEALTH ISSUES FACING MEMBERS OF PRICE COUNTY COMMUNITY. COMMUNITY HEALTH ASSESSMENT SURVEY:PRIMARY DATA COLLECTION BEGAN WITH A COMMUNITY HEALTH SURVEY IN MARCH 2021. AN ELECTRONIC SURVEY WAS WIDELY DISTRIBUTED BY CHNA PARTNERSHIP TO PRICE COUNTY RESIDENTS. AN ABBREVIATED HARDCOPY VERSION OF THE ELECTRONIC COMMUNITY HEALTH SURVEY WAS CREATED FOR RESIDENTS WITH LIMITED ACCESS TO THE INTERNET AND LIMITED HEALTH LITERACY. THE SURVEY ASKED RESIDENTS TO EVALUATE FOURTEEN HEALTH NEEDS BASED ON THE WISCONSIN DEPARTMENT OF HEALTH SERVICES HEALTH PLAN, HEALTHY PEOPLE. COUNTY HEALTH RANKINGS AND ROADMAPS TAKE ACTION MODEL, HEALTHIEST WISCONSIN 2020, AND INCLUDED: MENTAL HEALTH, SUBSTANCE USE, ALCOHOL MISUSE, CHRONIC DISEASE PREVENTION AND MANAGEMENT, OBESITY, PHYSICAL ACTIVITY, INJURY AND VIOLENCE PREVENTION, HEALTHY NUTRITION, HEALTHY GROWTH AND DEVELOPMENT, COMMUNICABLE DISEASE PREVENTION AND CONTROL, TOBACCO USE AND EXPOSURE, ORAL HEALTH, REPRODUCTIVE AND SEXUAL HEALTH, AND ENVIRONMENTAL AND OCCUPATIONAL HEALTH. THE MMC-PARK FALLS CHNA PARTNERS 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. THE SURVEY COLLECTED 305 RESPONSES BETWEEN MARCH THROUGH APRIL 2021 FROM PRICE COUNTY RESIDENTS. OVERALL, RESPONDENTS TENDED TO BE WHITE, FEMALE AND BETWEEN THE AGES OF 55-64. 12.75% OF SURVEY RESPONDENTS ARE RETIRED, AND LESS THAN 2% OF SURVEY RESPONDENTS SAID THEY WERE UNEMPLOYED, DISABLED. KEY INFORMANT INTERVIEWS:KEY INFORMANT INTERVIEWS ARE IN-DEPTH, QUALITATIVE INTERVIEWS WITH INDIVIDUALS WHO KNOW WHAT IS GOING ON IN A COMMUNITY OR SPECIFIC POPULATION GROUP. THE PURPOSE OF THESE INTERVIEWS IS TO COLLECT INFORMATION FROM A WIDE RANGE OF INDIVIDUALS WHO HAVE FIRST-HAND KNOWLEDGE ABOUT THE COMMUNITY AND/OR POPULATION GROUPS. THESE INDIVIDUALS CAN INCLUDE FOR EXAMPLE, RESIDENTS, PROFESSIONALS, ELECTED OFFICIALS AND FAITH LEADERS. FOR THIS ASSESSMENT KEY INFORMANT INTERVIEWS WERE CONDUCTED VIA WEBEX VIDEO CONFERENCING PLATFORM TO OBSERVE COVID-19 PANDEMIC SAFETY PROTOCOLS. THE CBW-PARK FALLS IDENTIFIED A LIST OF 20 POTENTIAL KEY INFORMANTS ACROSS PRICE COUNTY TO INVITE TO COMPLETE AN INTERVIEW. 10 INDIVIDUALS COMPLETED AN INTERVIEW AND RESULTING INSIGHTS WERE COMPILED INTO A SUMMARY REPORT. MARSHFIELD MEDICAL CENTER - PARK FALLS PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED JOINTLY WITH THE PRICE COUNTY HEALTH DEPARTMENT. MARSHFIELD MEDICAL CENTER - PARK FALLS PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE PRICE 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-PARK FALLS ARE: - ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - CHRONIC DISEASE - SOCIAL DETERMINANTS OF HEALTHHEALTH PRIORITY 1: ALCOHOL AND SUBSTANCE USE GOAL 1: REDUCE YOUTH SUBSTANCE USE - SUPPORT ALCOHOL AND OTHER DRUG (AOD) PREVENTION CURRICULUMS IN SCHOOL AND/OR AFTERSCHOOL SETTINGS. - SUPPORT COMMUNITY WIDE ENVIRONMENTAL STRATEGIES, PREVENTION, AND/OR POLICY TO ADDRESS UNDERAGE ALCOHOL USE. GOAL 2: REDUCE COMMUNITY IMPACT RELATED TO SUBSTANCE MISUSE - SUPPORT WORKPLACE DRUG PREVENTION AND RECOVERY EFFORTS. GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 2: BEHAVIORAL HEALTH GOAL 1: DECREASE SUICIDE RATES FOR HIGH-RISK POPULATIONS - ENHANCE COMMUNITY MEMBER'S SKILLS TO SUPPORT MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION. - SUPPORT SUICIDE PREVENTION COMMUNITY AWARENESS EVENTS. GOAL 2: IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS - ENHANCE SCHOOL CAPACITY TO PROVIDE HIGH QUALITY SOCIAL, EMOTIONAL ASSESSMENT, SUPPORT AND LEARNING. GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 3: CHRONIC DISEASE GOAL 1: IMPROVE ACCESS TO HEALTHY FOODS - INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCALLY GROWN FOOD AND ADDRESS FOOD INSECURITY. GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO CHRONIC DISEASE PREVENTION EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 4: SOCIAL DETERMINANTS OF HEALTH GOAL 1: INCREASE KNOWLEDGE AND AWARENESS OF HEALTH EQUITY. - CONDUCT AN ORGANIZATION AND COMMUNITY ASSESSMENT OF HEALTH DISPARITIES AND HEALTH EQUITY AND DEVELOP A WORKPLAN TO ADDRESS THOSE GAPS. GOAL 2: IMPROVE HEALTH OUTCOMES BY CONNECTING CLINICAL PRACTICE TO COMMUNITY EFFORTS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH BARRIERS. - SUPPORT AND CONNECT PATIENTS AND COMMUNITY MEMBERS TO RESOURCES TO ADDRESS SOCIALLY DETERMINED NEEDS. GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO ADVANCING HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. THROUGH THE ASSESSMENT PROCESS, OTHER COMMUNITY HEALTH PRIORITIES WERE IDENTIFIED THAT WILL NOT BE ADDRESSED IN THIS PLAN. THE FOLLOWING WAS CONSIDERED WHILE PRIORITIZING COMMUNITY HEALTH NEEDS; OTHER ORGANIZATIONS ADDRESSING THE SPECIFIC NEED, THE ABILITY OF MMC-PARK FALLS TO IMPACT CHANGE, AVAILABILITY OF RESOURCES, AS WELL AS READINESS OF THE COMMUNITY FOR INTERVENTIONS. THE FOLLOWING HEALTH PRIORITIES WILL NOT BE ADDRESSED BY MMC-PARK FALLS FOR REASONS INDICATED: - COMMUNICABLE DISEASE PREVENTION & CONTROL: INSTEAD OF LEADING THIS CHARGE, STAFF PARTICIPATE IN THE NORTHCENTRAL WISCONSIN HEALTHCARE EMERGENCY READINESS COALITION IN ADDITION TO NUMEROUS COVID-19 WORKGROUPS ACROSS REGIONAL COUNTY AREAS. - ORAL HEALTH: STAFF FROM MMC-PARK FALLS DOES NOT PROVIDE RELATED SERVICES, HOWEVER THE FAMILY HEALTH CENTER OF MARSHFIELD DENTAL CENTER, DOES LEAD THESE EFFORTS LOCALLY, REGIONALLY AND NATIONALLY. ONE OF THE FAMILY HEALTH CENTER DENTAL LOCATIONS IS IN PARK FALLS. 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 - PARK FALLS (MMC-PARK FALLS), 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:MMC-PARK FALLS MANAGEMENT STAFF SIT ON THE YMCA STEERING COMMITTEE FOR THE PARK FALLS COMMUNITY. COMMUNITY SUPPORT:MMC-PARK FALLS STAFF PROVIDE RECIPES WEEKLY AT THE MARKET AS A FORM OF NUTRITION EDUCATION TO HELP PEOPLE LEARN HOW TO USE LOCALLY GROWN PRODUCE. MMC-PARK FALLS STAFF PARTICIPATE IN THE PRICE COUNTY TRANSPORTATION COORDINATING COMMITTEE WHOSE PURPOSE IS TO EVALUATE TRANSPORTATION OPTIONS IN THE PRICE COUNTY AREA AND ADVOCATE FOR IMPROVEMENTS IN TRANSPORTATION, ESPECIALLY RELATED TO ACCESS OF CARE. MMC-PARK FALLS STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS. EXAMPLES INCLUDED: -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 COALITION BUILDING:MMC-PARK FALLS STAFF PARTICIPATED IN COMMUNITY COALITIONS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE COALITIONS ARE THE PRICE COUNTY AODA/MENTAL HEALTH COALITION, PRICE COUNTY COORDINATION TRANSPORTATION COMMITTEE, PRICE COUNTY HEALTH & WELLNESS COALITION, NORTH CENTRAL WISCONSIN HEALTHCARE EMERGENCY READINESS COALITION AND NORTHWOODS TOBACCO FREE COALITION. COMMUNITY HEALTH IMPROVEMENT ADVOCACY:-MMC-PARK FALLS STAFF COLLABORATED WITH PRICE COUNTY AODA/MENTAL HEALTH COALITION AND PRICE COUNTY PUBLIC HEALTH TO CONDUCT BI-ANNUAL PRESCRIPTION DRUG TAKE-BACK EVENTS. -MMC-PARK FALLS STAFF PARTICIPATED IN THE NORTH CENTRAL WISCONSIN HEALTHCARE EMERGENCY READINESS COALITION WHICH COORDINATES STRATEGIES TO DELIVER MEDICAL CARE TO ALL POPULATIONS DURING EMERGENCIES AND OTHER EVENTS AND PARTICIPATED ON THE WI HEALTHCARE EMERGENCY READINESS COALITION ADVISORY BOARD. -MMC-PARK FALLS STAFF PARTICIPATED IN THE PRICE COUNTY TRAFFIC SAFETY COMMITTEE WHOSE PURPOSE IS TO EVALUATE TRAFFIC SAFETY AND ADVOCATE FOR OR IMPLEMENT CHANGES TO IMPROVE TRAFFIC SAFETY. -MMC-PARK FALLS STAFF PARTICIPATED IN THE PRICE COUNTY LOCAL EMERGENCY PLANNING BOARD WHOSE PURPOSE IS TO PLAN AND PREPARE FOR EMERGENCIES AND ADVOCATE FOR OR IMPLEMENT CHANGES TO IMPROVE SAFETY. WORKFORCE DEVELOPMENT: -MMC-PARK FALLS STAFF COLLABORATED WITH LOCAL AREA HIGH SCHOOLS TO OFFER PRESENTATIONS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL AND HEALTHCARE CAREERS. MMC-PARK FALLS FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, MEDICAL RESIDENTS, AND INTERNS. -MMC-PARK FALLS PROVIDED LAB SUPPLIES TO NORTHERN TECHNICAL COLLEGE LAB TECH PROGRAM. OTHER:MMC-PARK FALLS SUPPORTED THE PARK FALLS LIONS CLUB, THE PHILLIPS YOUTH BASEBALL PROGRAM, AND THE PARK FALLS AREA CHAMBER OF COMMERCE. MMC-PARK FALLS STAFF HELPED COORDINATE THE BACK-TO-SCHOOL SUPPLY DRIVE TO SUPPORT AREA SCHOOLS. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 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-PARK FALLS 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-PARK FALLS 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-PARK FALLS' CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. MMC-PARK FALLS 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-PARK FALLS 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-PARK FALLS IS A 25-BED CRITICAL ACCESS HOSPITAL IN PARK FALLS, WISCONSIN. 24-HOUR CARE IS PROVIDED FOR IN-PATIENT AND OUT-PATIENT SERVICES, EMERGENCY AMBULANCE SERVICES, AND HOME HEALTH & HOSPICE SERVICES TO RESIDENTS IN PRICE COUNTY AND NORTHERN WISCONSIN. PRICE COUNTY IS LOCATED IN NORTH CENTRAL WISCONSIN BETWEEN HAYWARD AND MINOCQUA. PRICE COUNTY IS COMPRISED OF TWO CITIES (PARK FALLS AND PHILLIPS), 17 TOWNS (INCLUDING PRENTICE), AND THREE VILLAGES. PRICE COUNTY HAD A TOTAL POPULATION OF 14,050 IN 2021 AND IS A 100% RURAL COUNTY WITH ON AVERAGE 11.3 PERSONS PER SQUARE MILE. THERE WERE 17.3% OF RESIDENTS UNDER 18 YEARS, 27.9% WHO WERE 65 YEARS AND OVER, AND 48.3% WHO WERE FEMALE. THE RACIAL MAKE-UP OF PRICE COUNTY WAS 93.5% WHITE ALONE NOT HISPANIC OR LATINO, 2.3% HISPANIC OR LATINO, 0.7% ASIAN ALONE, 0.6% BLACK OR AFRICAN AMERICAN, 1.0% AMERICAN INDIAN AND ALASKA NATIVE ALONE, AND 1.4% TWO OR MORE RACES. THERE WERE 1.7% OF PRICE COUNTY RESIDENTS WHO WERE NOT BORN IN THE UNITED STATES. PRICE COUNTY HAS 10.7% OF INDIVIDUALS WITH A DISABILITY WHO ARE UNDER THE AGE OF 65 YEARS, WHICH IS A HIGHER PERCENTAGE THAN FOR WISCONSIN AND THE UNITED STATES. IN PRICE COUNTY, THE HIGH SCHOOL GRADUATION RATE WAS 92.4%. RESIDENTS WHO HAVE A BACHELOR'S DEGREE OR HIGHER WERE AT 16.1%, WHICH IS LOWER THAN IN WISCONSIN AND THE UNITED STATES. IN 2021, THE MEDIUM HOUSEHOLD INCOME WAS $52,052 WITH 11.7% OF THE POPULATION BELOW THE POVERTY LINE. 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-PARK FALLS 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: RUWAN DISSANAYAKE, MD SAMANTHA KLEBE, DO WILLIAM MELMS, MD BRIAN HOERNEMAN, MD EDWARD FERNANDEZ, MD CATHY BUKOWSKI FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING FLAMBEAU HOSPITAL, 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 FLAMBEAU HOSPITAL INC 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 FLAMBEAU HOSPITAL, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR FLAMBEAU HOSPITAL, 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 FLAMBEAU HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBER OF THE BOARD OF DIRECTORS OF FLAMBEAU HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF FLAMBEAU HOSPITAL, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETE 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, COMMITTE 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 FLAMBEAU HOSPITAL, INC. DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART X, LINE 20: FLAMBEAU HOSPITAL, 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 ASSETS RELEASED FROM RESTRICTION 11,137,978. NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 4,185,465. 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