2025-11-04T12:59:35-06:00 2024-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2024-01-01 382780429 DICKINSON COUNTY HEALTHCARE SYSTEM DICK 7153875511 1721 SOUTH STEPHENSON AVENUE IRON MOUNTAIN MI 49801 NICHOLAS OLSON EVP, CFO 6053331000 2025-11-04 1 0 JESS WAGENER P01622613 3128792000 2024 2025-03-06 01:10:19Z MARSHFIELD MEDICAL CENTER-DICKINSON BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 144260925 0 X WWW.MARSHFIELDCLINIC.ORG X 1990 MI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 25 0 0 335795 13290 141398231 143829504 115964 174437 222749 236052 142072739 144253283 0 0 0 0 67873453 71749356 0 0 0 74380215 82988473 142253668 154737829 -180929 -10484546 64236890 78971909 54025114 45252542 10211776 33719367 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 138087862 0 143829504 DICKINSON COUNTY HEALTHCARE SYSTEM (DCHS) INCLUDES A 49-BED, GENERAL MEDICAL AND SURGICAL HOSPITAL LOCATED IN IRON MOUNTAIN, MICHIGAN AND PRIMARY CARE CLINICS IN IRON MOUNTAIN, KINGSFORD AND NORWAY, MICHIGAN AND FLORENCE, WISCONSIN. DCHS SERVES COMMUNITIES IN MICHIGAN'S CENTRAL UPPER PENINSULA AND NORTHERN WISCONSIN BY PROVIDING A BROAD RANGE OF HIGH QUALITY ACUTE CARE INCLUDING INPATIENT, OUTPATIENT, DIAGNOSTIC, AND SPECIALTY SERVICES. 138087862 1 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 1 1 1 1 1 0 0 0 MI X NICHOLAS OLSON EVP CFO 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 COLLEEN HOERNEMAN CHAIR 1.00 10.00 X X 0 5500 0 MARK BRADLEY VICE CHAIR 1.00 6.00 X X 0 5500 0 JOHN BALTUS SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID HOLMES BOARD MEMBER 1.00 1.00 X 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 51.00 X 0 592054 42454 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 1.00 54.00 X X 0 1584168 39013 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 703503 36357 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 972510 0 AMANDA SHELAST PRESIDENT MMC-DICKINSON 50.00 0.00 X 0 311795 9224 SUSAN TURNEY MD FORMER MCHS CEO 0.00 0.00 X 0 2241715 0 CATHY BUKOWSKI FORMER MCHS CFO 0.00 0.00 X 0 631969 0 0 7048714 127048 0 1 1 0 GUNDLACH CHAMPION INC PO BOX 490 IRON MOUNTAIN MI 49801 CONSTRUCTION 5648467 SOUND PHYSICIANS OF MICHIGAN PO BOX 742936 LOS ANGELES CA 90074 MEDICAL SERVICES 5421778 UP REHAB SERVICES 841 W WASHINGTON STREET SUITE 500 MARQUETTE MI 49855 MEDICAL SERVICES 3050819 LOCUMSMART LLC PO BOX 736389 DALLAS TX 75373 MEDICAL SERVICES 2951784 SUMMIT SURGICAL 1711 S STEPHENSON AVE SUITE 350 IRON MOUNTAIN MI 49801 MEDICAL SERVICES 1865731 81 11804 1486 13290 NET PATIENT SERVICE RE 621110 143209663 143209663 CAFETERIA REVENUE 722310 313588 313588 MISC OTHER OPERATING R 621110 306253 306253 143829504 162400 162400 236052 0 236052 236052 236052 19679 7642 12037 12037 12037 144253283 143515916 0 724077 X 311795 311795 58430372 57393824 1036548 1546625 1497809 48816 8032773 7838761 194012 3427791 3321826 105965 30000 30000 24282 24282 17504161 15663117 1841044 163451 163412 39 1231020 1208569 22451 1790806 1594059 196747 2778325 2381287 397038 121944 99315 22629 1797164 1797164 3952286 3952286 MEDICAL SUPPLIES 34173851 34097429 76422 INTERCOMPANY P/S 12765469 580094 12185375 MI MEDICAID ACCESS TAX 5514082 5514082 EQUIP REPAIRS & MAINT 798411 711512 86899 343221 273316 69905 154737829 138087862 16649967 0 9185243 5536756 960000 1180000 10659 0 2094670 20767647 5886791 6508674 626753 775823 49781009 9471672 40834406 40309337 360 -643 899270 702015 503085 266534 3235653 2925766 64236890 78971909 10160011 4060864 856933 848092 1644593 15200360 38900361 23139094 2463216 2004132 54025114 45252542 X 10202589 33710180 9187 9187 10211776 33719367 64236890 78971909 X -10484546 33992137 X 0 1 X 1 1 1 X 3076700 3076700 32446433 3423976 29022457 32270 9159 23111 12930912 5687609 7243303 1294694 350928 943766 40309337 0 CAPITAL LEASES PAYABLE 881323 RESERVE MALPRACTICE CLAIMS 50000 OPERATING LEASE PAYABLE LT 1072809 2004132 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, 2024 OR DECEMBER 31, 2023. 1 1 X 1 X 1 X 1 1 1 0 0 8378 0 8378 0.00010 12862685 7247413 5615272 0.03630 0 0 12871063 7247413 5623650 0.03640 5545744 0 5545744 0.03580 1243 0 1243 0.00000 26321837 21832680 4489157 0.02900 0 0 3334 0 3334 0.00000 31872158 21832680 10039478 0.06480 44743221 29080093 15663128 0.10120 0 0 653 0 653 0.00000 418 0 418 0.00000 683 0 683 0.00000 0 0 148 0 148 0.00000 0 0 0 0 0 0 1902 1902 0.00000 1 5250164 0 13457358 17104896 -3647538 X 1 0 1 1 MARSHFIELD MEDICAL CENTER - DICKINSON 1721 SOUTH STEPHENSON AVENUE IRON MOUNTAIN MI 49801 WWW.MARSHFIELDCLINIC.ORG 1060000028 X X X MARSHFIELD MEDICAL CENTER - DICKINSON 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X SEE SUPPLEMENTAL INFO X 1 23 1 SEE SUPPLEMENTAL INFO 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 5: PRIMARY DATA COLLECTION BEGAN WITH A COMMUNITY HEALTH SURVEY IN AUGUST 2021. THE SAMPLE FOR THE 2021 COMMUNITY HEALTH SURVEY OF UPPER PENINSULA ADULTS WAS PURCHASED FROM MARKETING SYSTEMS GROUP. THE SAMPLE WAS ADDRESS-BASED AND DRAWN FROM A DATABASE MATCHED TO THE UNITED STATES POSTAL SERVICE'S DELIVERY SEQUENCE FILE. WITHIN EACH UPPER PENINSULA COUNTY, 1,700 ADDRESSES WERE RANDOMLY SELECTED. PACKETS CONTAINING A COVER LETTER, SURVEY, AND POSTAGE-PAID PRE-ADDRESSED RETURN ENVELOPE WERE PREPARED AND MAILED TO THE ENTIRE SAMPLE OF 23,800 ADDRESSES IN AUGUST 2021. THE PACKET INCLUDED INSTRUCTIONS FOR ACCESSING AN ONLINE VERSION OF THE SAME SURVEY, WHICH WAS BETTER UTILIZED IN 2021 THAN IN 2017 HOUSEHOLDS THAT RETURNED COMPLETED SURVEYS EARLY QUALIFIED FOR A PRIZE DRAWING CONSISTING OF EIGHT $50 GROCERY GIFT CARDS. NO REMINDERS WERE SENT. DICKINSON COUNTY HAD A SURVEY RESPONSE RATE OF 15% IN 2021, WHICH WAS DOWN COMPARED TO THE 2017 RESPONSE RATE OF 20.7%. DATA ANALYSIS WAS CONDUCTED BY KELLY KAMM, PHD FROM THE DEPARTMENT OF KINESIOLOGY AND INTEGRATIVE PHYSIOLOGY, MICHIGAN TECHNOLOGICAL UNIVERSITY IN HOUGHTON, AND ROBERT S. VAN HOWE, MD, MS, THE PROVISIONAL MEDICAL DIRECTOR FOR THE WESTERN U.P. HEALTH DEPARTMENT AND THE DICKINSON-IRON DISTRICT HEALTH DEPARTMENT. ALL ANALYSES WERE COMPLETED IN SAS, VERSION 9.4 (CARY, NORTH CAROLINA). SURVEY DATA WERE ASSESSED FOR COMPLETENESS AND CONSISTENCY. MMC-DICKINSON RECOGNIZES THAT HEALTH IS DETERMINED BY MORE THAN HEALTH CARE. TO FURTHER UNDERSTAND THE CONDITIONS THAT AFFECT A WIDE RANGE OF HEALTH, FUNCTIONING, AND QUALITY-OF-LIFE OUTCOMES AND RISKS, A SERIES OF QUESTIONS RELATED TO SOCIAL DETERMINANTS OF HEALTH (SDOH) WERE INCLUDED AND FURTHER ANALYZED. COMMUNITY BENEFITS WORKGROUP (CBW)-DICKINSON IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH PRIORITIES THROUGH A COMPREHENSIVE PROCESS THAT INCLUDED INPUT FROM MULTI-SECTOR COMMUNITY PARTNERS AND ORGANIZATION LEADERSHIP. DIRECT COMMUNITY INPUT WAS GATHERED AND FOCUSED ON UNDERSTANDING THE PRIORITIES OF THE UNDERSERVED IN THE COMMUNITY. THE CBW-DICKINSON IS COMMITTED TO ADDRESSING HEALTH INEQUITIES AND CONDUCTED THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) USING A HEALTH EQUITY LENS. THE CBW-DICKINSON SEEKS TO ADDRESS "TYPES OF UNFAIR HEALTH DIFFERENCES CLOSELY LINKED WITH SOCIAL, ECONOMIC, OR ENVIRONMENTAL DISADVANTAGES THAT ADVERSELY AFFECT A GROUP OF PEOPLE". (ATTAINING HEALTH EQUITY. CDC. RETRIEVED FROM: HTTPS://WWW.CDC.GOV/NCCDPHP/DCH/PROGRAMS/HEALTHYCOMMUNITIESPROGRAM/OVERVIEW /HEALTHEQUITY.HTM) MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- ASPIRUS IRON RIVER HOSPITAL - ASPIRUS IRONWOOD HOSPITAL - ASPIRUS KEWEENAW HOSPITAL - ASPIRUS ONTONAGON HOSPITAL - BARAGA COUNTY MEMORIAL HOSPITAL - BELLIN HEALTH HOSPITAL AND CLINICS - HELEN NEWBERRY JOY HOSPITAL - MACKINAC STRAITS HEALTH SYSTEM - MUNISING MEMORIAL HOSPITAL/BAYCARE MEDICAL CENTER - MYMICHIGAN MEDICAL CENTER- SAULT - OSF ST. FRANCIS HOSPITAL - SCHOOLCRAFT MEMORIAL HOSPITAL - U.P. HEALTH SYSTEMS- BELL - U.P. HEALTH SYSTEMS- MARQUETTE - U.P. HEALTH SYSTEMS- PORTAGE - WAR MEMORIAL HOSPITAL MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BCBS FOUNDATION OF MICHIGAN - CHIPPEWA COUNTY HEALTH DEPARTMENT - COPPER COUNTY COMMUNITY MENTAL HEALTH - DICKINSON-IRON DISTRICT HEALTH DEPARTMENT - GOGEBIC COUNTY COMMUNITY MENTAL HEALTH - GREAT LAKES RECOVERY CENTER - KEWEENAW BAY INDIAN COMMUNITY - MARQUETTE COUNTY HEALTH DEPARTMENT - MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES - MICHIGAN HEALTH ENDOWMENT FUND - MICHIGAN TECHNOLOGICAL UNIVERSITY - NORTHCARE NETWORK - NORTHERN MICHIGAN CENTER FOR RURAL HEALTH - NORTHPOINTE BEHAVIOR HEALTH SYSTEM - PATHWAYS COMMUNITY MENTAL HEALTH - PORTAGE HEALTH FOUNDATION - PUBLIC HEALTH OF DELTA AND MENOMINEE COUNTIES - SUPERIOR HEALTH FOUNDATION - UPPER GREAT LAKES FAMILY HEALTH CENTER - UPPER PENINSULA HEALTH CARE SOLUTIONS - UPPER PENINSULA HEALTH GROUP - UPPER PENINSULA HEALTH PLAN - WESTERN UP HEALTH DEPARTMENT - WESTERN UP PLANNING AND DEVELOPMENT REGION MARSHFIELD MEDICAL CENTER - DICKINSON PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE UPCHNA, DICKINSON COUNTY CHA, UNITED WAY DATA, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MARSHFIELD MEDICAL CENTER IN DICKINSON ARE:- ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - HEALTH EQUITY - CHRONIC DISEASE PREVENTION AND MANAGEMENT - TOBACCO AND VAPING - ACCESSIBILITY AND AFFORDABILITY TO HEALTHCARE AND SERVICE PROGRAMS HEALTH PRIORITY 1: ALCOHOL AND SUBSTANCE USE GOAL 1: PREVENT ALCOHOL AND SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION -STRATEGY: PREVENT ALCOHOL AND SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING INDIVIDUAL AND/OR ENVIRONMENTAL PREVENTION STRATEGIES. GOAL 2: REDUCE COMMUNITY AND SOCIAL IMPACTS OF ALCOHOL AND SUBSTANCE MISUSE - STRATEGY 1: SERVE COMMUNITIES AND INDIVIDUALS THROUGH RECOVERY COACH SERVICES. - STRATEGY 2: SUPPORT COMMUNITY LED RECOVERY EFFORTS. HEALTH PRIORITY 2: BEHAVIORAL HEALTH GOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES. - STRATEGY 1: ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL-EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH. - STRATEGY 2: PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS. - STRATEGY 3: SUPPORT COMMUNITY WIDE, INDIVIDUAL, AND ENVIRONMENTAL STRATEGIES THAT SUPPORT MENTAL WELLNESS, SOCIAL CONNECTIONS, AND ENGAGEMENT. HEALTH PRIORITY 3: HEALTH EQUITY GOAL 1: ADVANCE HEALTH EQUITY BY FOCUSING ON COMMUNITY-BASED HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH - STRATEGY 1: ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES. - STRATEGY 2: INCREASE ACCESS TO COMMUNITY-BASED RESOURCES, SERVICES, AND SUPPORT WITH A FOCUS ON HEALTH EQUITY. AS THESE PRIORITIES ARE ADDRESSED, INTENTIONAL EFFORTS WILL BE MADE TO ENSURE APPROPRIATE RESOURCES ARE PROVIDED, AND UNFAIR AND UNJUST OBSTACLES ARE ELIMINATED FOR ALL PEOPLE AND COMMUNITIES TO REACH THEIR OPTIMAL HEALTH. DUE TO THE INTERCONNECTED NATURE OF THESE HEALTH PRIORITIES, MMC-DICKINSON CHOSE TO FOCUS ON OVERARCHING PRIORITIES TO ADDRESS ALL IDENTIFIED HEALTH NEEDS. LINE 7A CHNA REPORT URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2024-26%20MMC-D%20CHNA.PDF LINE 10A IMPLEMENTATION STRATEGY URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2024-26%20MMC-D%20IS.PDF PART V, LINE 16A, FAP WEBSITE: WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE-DICKINSON PART V, LINE 16B, FAP APPLICATION WEBSITE: WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE-DICKINSON PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE-DICKINSON 16 1 - MMC-DICKINSON FAMILY MEDICINE 1711 S STEPHENSON AVE SUITE 125 IRON MOUNTAIN MI 49801 FAMILY PRACTICE 2 - MMC-DICKINSON ORTHOPEDICS 1711 S STEPHENSON AVE SUITE 100 IRON MOUNTAIN MI 49801 ORTHOPEDIC PRACTICE 3 - MMC-DICKINSON OBSTETRICS & GYNECOLOGY 1721 S STEPHENSON AVENUE IRON MOUNTAIN MI 49801 OB/GYN 4 - MMC-DICKINSON SURGERY AND ENDOSCOPY 1711 S STEPHENSON AVE SUITE 305 IRON MOUNTAIN MI 49801 SURGERY & ENDOSCOPY 5 - MMC-DICKINSON FLORENCE CENTER 1010 OLIVE AVE FLORENCE WI 54121 FAMILY CLINIC 6 - MMC-DICKINSON UROLOGY 1711 S STEPHENSON AVENUE SUITE 320 IRON MOUNTAIN MI 49801 UROLOGY SERVICES 7 - MMC-DICKINSON REGIONAL HEART CARE CLINIC 1711 S STEPHENSON AVENUE SUITE 315 IRON MOUNTAIN MI 49801 HEART CARE 8 - MMC-DICKINSON PRIMARY CARE 1711 S STEPHENSON AVE SUITE 210 IRON MOUNTAIN MI 49801 PRIMARY CARE 9 - MMC-DICKINSON HEMATOLOGY ONCOLOGY 1711 S STEPHENSON AVENUE SUITE 315 IRON MOUNTAIN MI 49801 HEMATOLOGY/ONCOLOGY CLINIC 10 - MMC-DICKINSON PODIATRY SERVICES 225 WEST H STREET IRON MOUNTAIN MI 49801 PODIATRY SERVICES 11 - MMC-DICKINSON WOUND HEAL&HYPERBARIC MED 1707 S STEPHENSON AVE IRON MOUNTAIN MI 49801 WOUND CARE/HYPERBARIC 12 - MMC-DICKINSON NORWAY FAMILY MED N1667 US-8 NORWAY MI 49870 FAMILY PRACTICE 13 - MMC-DICKINSON NORWAY FAM & GERIATRIC CEN 500 MAIN ST NORWAY MI 49870 FAMILY PRACTICE & GERIATIC 14 - MMC-DICKINSON INT MEDICINE & NEPHROLOGY 1711 S STEPHENSON AVE SUITE 225 IRON MOUNTAIN MI 49801 INTERNAL MEDICINE/NEPHROLOGY 15 - MMC-DICKINSON SLEEP MEDICINE CENTER 1100 S CARPENTER AVENUE KINGSFORD MI 49802 SLEEP DISORDER 16 - MMC-DICKINSON BARK RIVER CENTER 2845 US RTE 2 BARK RIVER MI 49807 CARDIOLOGY AND DIAGNOSTIC SERVICES PART I, LINE 7: COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND LINE 7G (SUBSIDIZED HEALTH SERVICES) IS CALCULATED USING A COST ACCOUNTING SYSTEM. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO THE ORGANIZATION. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO THE ORGANIZATION, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY THE ORGANIZATION THROUGH PHYSICIAN PRACTICES. FOR CY 2024, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $4,489,157. PART II, COMMUNITY BUILDING ACTIVITIES: MMC-DICKINSON, IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT; ENRICHES LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY. THE HEALTH SYSTEM CONTINUED 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-DICKINSON STAFF PARTICIPATE ON THE BOARD OF DIRECTORS FOR THE DICKINSON CHAMBER OF COMMERCE AND THE DICKINSON AREA ECONOMIC DEVELOPMENT ALLIANCE.COMMUNITY SUPPORT:MMC-DICKINSON STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS INCLUDING: - HOSTS BLOOD DRIVES TO PROVIDE BLOOD AND BLOOD PRODUCTS TO THE REGIONAL BLOOD BANK. - HOSTS A MONTHLY COMMUNITY EDUCATION SERIES AT THE YMCA COVERING TOPICS SUCH AS CARDIOVASCULAR HEALTH, SLEEP HEALTH AND HYGIENE, AND CONDITIONS SUCH AS OSTEOARTHRITIS AND SEPSIS. - PROVIDED INFORMATION ABOUT MEN'S MENTAL HEALTH AND MENTAL HEALTH RESOURCES. - PROVIDED BIOMETRIC HEALTHCARE SCREENINGS TO COMMUNITY MEMBERS.ENVIRONMENTAL IMPROVEMENTS:MMC-DICKINSON STAFF: - PARTICIPATED IN THE DEA NATIONAL DRUG TAKE BACK DAY, PROPERLY DISPOSING OF UNWANTED, UNUSED, AND EXPIRED MEDICATIONS. - DISTRIBUTED DRUG DISPOSAL POUCHES TO HELP DISPOSE OF MEDICATIONS PROPERLY AND KEEP THEM OUT OF THE COMMUNITY.COALITION BUILDING: MMC-DICKINSON STAFF PARTICIPATED IN COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY INCLUDING THE CHILD ADVOCACY AND CHILD ABUSE PREVENTION NETWORK, PEDIATRIC FOCUS MEETINGS, AND ACUTE-CARE FOCUS MEETINGS.COMMUNITY HEALTH IMPROVEMENTS ADVOCACY: MMC-DICKINSON - SUPPORTED SWIM LESSONS FOR ALL THIRD-GRADE STUDENTS AT THE YMCA. - PROVIDED EDUCATION AND ADVOCACY ON ISSUES SUCH AS HUMAN TRAFFICKING, DOMESTIC VIOLENCE, CHILD SAFETY, AND MANDATORY REPORTING. - PROVIDED RECOVERY COACH SERVICES FOR PATIENTS AND COMMUNITY MEMBERS SEEKING SUPPORT OR ALREADY IN RECOVERY FROM AN ADDICTION TO ALCOHOL AND/OR OTHER SUBSTANCES.WORKFORCE DEVELOPMENT: MMC-DICKINSON - COLLABORATED WITH AREA HIGH SCHOOLS TO OFFER PROGRAMS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL CAREERS, OBSERVATIONAL JOB EXPERIENCES FOR HIGH SCHOOL GRADUATES, AND ATTEND CAREER DAYS. - ATTENDED HEALTH OCCUPATIONS CLASS OFFERED AT THE DICKINSON-IRON TECH SCHOOL TO EDUCATE AND SHARE INFORMATION ABOUT HEALTH PROFESSIONS. - FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, RESPIRATORY THERAPY, MEDICAL ASSISTANTS, LAB, AND IMAGING. - SUPPORTED THE UPPER PENINSULA ASSOCIATION FOR BEHAVIOR ANALYSIS ANNUAL CONFERENCE WHICH PROVIDED AN OPPORTUNITY FOR REGIONAL PRACTITIONERS TO GAIN NECESSARY CONTINUING EDUCATION CREDIT.OTHER COMMUNITY BUILDING:MMC-DICKINSON - 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. - PROVIDED A COMMUNITY THANKSGIVING DINNER THAT IS OPEN TO ANYONE WITHOUT CHARGE. - SPONSORED THE UNITED WAY OF DICKINSON COUNTY. - SPONSORED THE DOWNTOWN PUMPKIN WALK. - SPONSORED A FIRST AID AND TEEN TENT AT THE GUS MACKER TOURNAMENT. - SPONSORED THE PINE MOUNTAIN SKI JUMP TOURNAMENT AND PROVIDED MEDICAL OVERSIGHT AND ATHLETIC TRAINER SUPPORT AT THE EVENT. - PROVIDED SPORTS MEDICINE COVERAGE TO THE REGIONAL AND STATE HOCKEY TOURNAMENT. - COLLECTED SOCKS FOR DONATION TO THE SALVATION ARMY. - PROVIDES MEDICAL OVERSIGHT AND ATHLETIC TRAINER SUPPORT AT LOCAL HIGH SCHOOL SPORTING EVENTS. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 62% AND 65% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2024 AND DECEMBER 31, 2023, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2024 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-DICKINSON USES RELIABLE THIRD-PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, AND DIRECT COMMUNITY INVOLVEMENT TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THE INFORMATION PROVIDED BY THESE SOURCES' POINTS TO AREAS OF NEED.MMC-DICKINSON COLLABORATES CLOSELY WITH MARSHFIELD CLINIC HEALTH SYSTEM'S CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA) TO ASSESS, DEVELOP, AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH OF THE LOCAL COMMUNITY. CCHA'S STRATEGIC AREAS OF FOCUS INCLUDE SUBSTANCE USE, BEHAVIORAL HEALTH, HEALTH EQUITY, AND BUILDING COMMUNITY CAPACITY FOR HEALTH IMPROVEMENT. THIS WORK REQUIRES CONTINUAL ASSESSMENT OF THE NEEDS OF THE COMMUNITY WHICH REINFORCES MMC-DICKINSON'S CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE STRATEGIC AREAS REPRESENT COMPLEX CHALLENGES COMMUNITIES EXPERIENCE EVERY DAY, AND CCHA IS COMMITTED TO IMPROVING. MMC-DICKINSON UTILIZES THE CENTER FOR COMMUNITY HEALTH ADVANCEMENT'S COMMUNITY CONNECTIONS TEAM AND FINDHELP, A SOCIAL NEEDS PLATFORM THAT INCLUDES AN ELECTRONIC DATABASE OF COMMUNITY RESOURCES AVAILABLE IN AN AREA, TO ASSESS NEEDS AND THEN CONNECT INDIVIDUALS TO THOSE RESOURCES. ADDITIONALLY, THERE ARE PROCESSES IN PLACE AT MMC-DICKINSON TO ESTABLISH ONGOING DIRECT ENGAGEMENT WITH THE LOCAL HEALTH DEPARTMENT, NUMEROUS COMMUNITY-HEALTH-FOCUSED ORGANIZATIONS, COMMUNITY CHAMBERS, BOARDS OF ECONOMIC DEVELOPMENT, YOUTH-FOCUSED ORGANIZATIONS AND OTHER HEALTH IMPROVING ORGANIZATIONS. DIRECT COLLABORATION WITH, AND REQUESTS FROM, THESE GROUPS FURTHER KNOWLEDGE OF THE COMMUNITY AND ITS NEEDS. PART VI, LINE 3: FINANCIAL COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE.UNCOMPENSATED CARE PACKETS ARE GIVEN TO PATIENTS IN EVERY CLINIC AND DEPARTMENT OF THE FACILITY WHERE A PATIENT IS UNINSURED, INQUIRES ABOUT ASSISTANCE OR EXPRESSES HARDSHIP. COPIES OF THESE DOCUMENTS ARE ALSO AVAILABLE IN THE LOBBIES OF ALL CLINICS AND DEPARTMENTS OF THE FACILITY IN BROCHURE STANDS AS WELL AS POSTED IN EXAM ROOMS. THEY ARE ALSO GIVEN TO ALL INPATIENTS WITH THEIR INPATIENT ADMISSION PAPERWORK TO OFFER SUPPORT IF NEEDED OR QUESTIONS. PART VI, LINE 4: MMC-DICKINSON SERVICE AREA IS NOT DEFINED BY COUNTY BORDERS BUT SERVES THOSE IN HIGH NEED AREAS WITH LIMITED RESOURCES. MMC-DICKINSON FOCUSES ON SERVING THOSE THAT ARE UNDERSERVED AND LIVING IN RURAL AREAS OF THE SERVICE AREA. DICKINSON COUNTY IS IN THE CENTRAL UPPER PENINSULA OF MICHIGAN BORDERING WISCONSIN. THE COUNTY IS COMPRISED OF THREE CITIES (IRON MOUNTAIN, KINGSFORD, AND NORWAY) AND SEVEN TOWNSHIPS (BREEN, BREITUNG, FELCH, NORWAY, SAGOLA, WAUCEDAH, AND WEST BRANCH) SPANNING OVER A TOTAL OF 777 SQUARE MILES. IN 2021, DICKINSON COUNTY HAS A POPULATION TOTALING 25,787. APPROXIMATELY 24% OF DICKINSON COUNTY RESIDENTS ARE 65 YEARS OR OLDER, WHILE 19.8% OF THE COUNTY'S RESIDENTS ARE 18 YEARS OR YOUNGER. THE COUNTY IS PRIMARILY WHITE, ACCOUNTING FOR 96% OF THE POPULATION. ALMOST 95% OF RESIDENTS HAVE ARE A HIGH SCHOOL GRADUATE OR HIGHER AND 26% PERCENT OF RESIDENTS HOLD A BACHELOR'S DEGREE OR HIGHER. IN 2019, 38.4% OF DICKINSON COUNTY RESIDENTS WERE BELOW THE ALICE THRESHOLD AND STRUGGLED TO MAKE ENDS MEET. THE MEDIAN HOUSEHOLD INCOME FROM 2016-2020 IS $51,704. PART VI, LINE 5: MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) PROMOTES THE HEALTH OF COMMUNITIES THROUGH ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), A DEPARTMENT WITHIN MCHS SOLELY DEDICATED TO COMMUNITY HEALTH. CCHA IS GOVERNED BY THE ENTERPRISE WIDE 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 CHILD SAFETY EDUCATION, SUPPORT GROUPS, AND PRESENTATIONS ON A VARIETY OF HEALTH TOPICS. 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. PART VI, LINE 6: MMC-DICKINSON IS PART OF MARSHFIELD CLINIC HEALTH SYSTEM, INC., AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN AND RESEARCH AND EDUCATION PROGRAMS. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. MARSHFIELD CLINIC HEALTH SYSTEM SERVES RURAL COMMUNITIES AND COLLECTIVELY PROMOTES HEALTH BY REDUCING BARRIERS TO ACCESSING CARE. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE THAT WOULDN'T OTHERWISE BE AVAILABLE THROUGH ITS 60 LOCATIONS AND 11 HOSPITALS IN COMMUNITIES ACROSS NORTHERN, CENTRAL AND WESTERN WISCONSIN AND IN MICHIGAN. MCHS PRIMARY OPERATIONS INCLUDE MARSHFIELD CLINIC LOCATIONS; 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. CCHA LIVES OUR MISSION THROUGH COLLECTIVE IMPACT, COLLABORATIVE PARTNERSHIPS, AND INNOVATION TO ADDRESS POLICY, SYSTEMS AND ENVIRONMENT TO ADVANCE HEALTH, ESPECIALLY IN RURAL COMMUNITIES. CCHA COLLABORATES WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THIS COLLABORATION HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. PART VI, LINE 7, REPORTS FILED WITH STATES MI 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD FORMER MCHS CEO 0 0 0 0 0 2241715 0 0 0 0 0 2241715 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 0 1043925 0 516277 0 23966 0 8625 0 30388 0 1623181 0 0 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 0 0 0 0 0 972510 0 0 0 0 0 972510 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 476625 0 201334 0 25544 0 8625 0 27732 0 739860 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 338138 0 225978 0 27938 0 8625 0 33829 0 634508 0 0 CATHY BUKOWSKI FORMER MCHS CFO 0 0 0 0 0 631969 0 0 0 0 0 631969 0 0 AMANDA SHELAST PRESIDENT MMC-DICKINSON 0 309506 0 1048 0 1241 0 8625 0 599 0 321019 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 2024, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $1,879,544 AND CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $631,969. 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 - $362,171 A UNITED STATES DEPARTMENT OF AGRICULTURE 720564834 NONEAVAIL 2021-10-05 16900000 SEE SUPPLEMENTAL INFO 0 0 0 A 1699640 16900000 400000 9535520 6964480 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: UNITED STATES DEPARTMENT OF AGRICULTURE (F) DESCRIPTION OF PURPOSE: PURCHASE MAJOR MEDICAL EQUIPMENT AND RETIRE OTHER PRIVATE DEBT. FORM 990, PART V, LINE 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO DICKINSON COUNTY HEALTHCARE SYSTEM SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS COLLEEN HOERNEMAN AND BRIAN HOERNEMAN, MD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF DICKINSON COUNTY HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF DICKINSON COUNTY HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF DICKINSON COUNTY HEALTHCARE SYSTEM. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE EXECUTIVE MANAGEMENT TEAM. AN EXTERNAL ACCOUNTING FIRM REVIEWS AND SIGNS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO INSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 DICKINSON COUNTY HEALTHCARE SYSTEM DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 15,663,117. MANAGEMENT AND GENERAL EXPENSES 1,841,044. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,504,161. FORM 990, PART XI, LINE 9: EQUITY INCOME FROM UPHP -17,341. EQUITY INCOME FROM UPMC 12,057. NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 33,997,421. FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) LINE 7 N/A 0 MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 0 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 0 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) LINE 7 MCHS 0 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 DICKINSON HOSPITALS FOUNDATION 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 386093161 PHILANTHROPY MI 501(C)(3) LINE 7 DCHS 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 1 SECURITY HEALTH PLAN OF WISCONSIN INC L 998451 COST