2025-06-19T16:08:25-05:00 2024-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-10-01 390832914 Stoughton Hospital Association STOU 6088736611 900 Ridge Street Stoughton WI 53589 Michelle Abey CFO 6088736611 2025-06-18 1 0 Kim Hunwardsen CPA P00484560 6122536500 2025-06-18 2023 2025-03-06 01:10:19Z Christopher Brabant 900 Ridge Street Stoughton WI 53589 104907722 0 X www.stoughtonhealth.com X 1924 WI Provide quality health care to meet the changing health care needs of the communities we serve. 12 10 446 66 0 0 771522 286551 66775300 70166112 1701572 4182997 87897 91788 69336291 74727448 0 0 0 0 26876935 29444800 0 0 205348 30346302 31280475 57223237 60725275 12113054 14002173 103696247 140900878 14749918 34787732 88946329 106113146 X The mission of Stoughton Hospital is to provide safe, quality health care with exceptional personalized service. 0 0 49629303 70166112 Stoughton Hospital Association is an acute care, critical access hospital, fully accredited by DNV, licensed by the state of Wisconsin and a member of the Wisconsin Hospital Association and Rural Wisconsin Health Cooperative. The Hospital provides inpatient and outpatient services to its patients. Inpatient services include medical/surgical, telemetry, intensive care, inpatient rehabilitative care (commonly referred to as swing bed) and geriatric psychiatry care. In 2024, there were 3,599 inpatient days. In addition to inpatient services, the Hospital provides a variety of outpatient services including emergency room care, urgent care, medical imaging (including in-house MRI services), surgical services, ambulatory infusion center, occupational health, and rehabilitation services. In 2024, there were approximately 91,739 outpatient visits.To fulfill its mission of community service, the Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Revenue from services to these patients is recorded in the accounting system at the established rates, but the Hospital does not pursue collection of the amounts. The resulting adjustments are recorded as adjustments to patient service revenue, depending on the timing of the charity determination.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as revenue. The estimated cost of providing these services was $200,000 for each of the years ended September 30, 2024 and 2023, which was determined based on an average ratio of cost to gross charges related to the services provided. Additionally, the Hospital extends discounts to uninsured patients. The estimated costs of providing services related to the discounts was $286,000 and $208,000 for the years ended September 30, 2024 and 2023, which was determined based on an average ratio of cost to gross charges related to the services provided.In addition, the Hospital provides services to other patients under certain government-reimbursed public aid programs. Such programs pay providers amounts which are less than established charges for the services provided to the recipients, and for some services the payments are less than the cost of rendering the services provided.The Hospital also commits significant time and resources to endeavors and critical services which meet otherwise unfulfilled community needs. Many of these activities are sponsored with the knowledge that they will not be self-supporting or financially viable. 49629303 1 1 0 1 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 70 0 1 446 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 WI X Michelle Abey 6088732267 900 Ridge Street Stoughton WI 53589 Dr Ashish Rawal Medical Staff Rep 41.00 X 838157 0 42639 Dr Aaron Schwaab Chief of Staff 41.00 X 467383 0 42220 Daniel DeGroot President/CEO 40.00 X 394007 0 12626 Deborah Dahlke Nurse Anesthetist 40.00 X 293672 0 35015 Charles Smith Nurse Anesthetist 40.00 X 277114 0 41210 Kristine Nikolai Nurse Anesthetist 40.00 X 281193 0 36745 Michelle Abey CFO/ VP Financial Services 40.00 X 192599 0 38251 Teresa Lindfors-Chief Strategy & Bus Dev Officer(until 2/24) 40.00 X 192973 0 7691 Pauline Cass Pharmacy Manager 40.00 X 163051 0 37331 Amy Hermes Chief Nursing Officer 40.00 X 177642 0 17813 Thomas Kostecki Pharmacist 40.00 X 156884 0 30530 Christopher Schmitz VP HR, Facility Operations 40.00 X 164522 0 17582 Donna Olson Chair 2.00 X X 0 0 0 Tim Rusch Vice Chair 2.00 X X 0 0 0 Glenn Kruser Secretary/Treasurer(as of 11/23) 2.00 X X 0 0 0 Steve Staton Secretary/Treasurer(until 11/23) 2.00 X X 0 0 0 Matt Kinsella Director - Class IV - SSM 1.00 X 0 0 0 Kyle Nondorf - Director Class IV - SSM Alternate 1.00 X 0 0 0 Dawit Tesfasilassie Director - Class IV - SSM 1.00 X 0 0 0 Kris Krentz Director 1.00 X 0 0 0 Nick Probst Director 1.00 X 0 0 0 Sue Vanderbilt Director 1.00 X 0 0 0 Cindy McGlynn Director (as of Nov 23) 1.00 X 0 0 0 Steve Peotter Director (as of Nov 23) 1.00 X 0 0 0 Tom Fendrick Director (until Nov 23) 1.00 X 0 0 0 3599197 0 359653 40 0 1 0 Southern WI Emergency Association 1446 N Randall Ave Janesville WI 53545 Emergency physicians 4767962 Shared Imaging Services 915 17th Street Prairie du Sac WI 53578 Nuclear medicine and ultrasound 1736606 Stoughton Hospital Imaging LLC 900 Ridge Street Stoughton WI 53589 MRI scans 1435815 Beam Healthcare SC 25 W Main St Fl 5 Madison WI 53703 Hospital physician services 1325707 Eppstein Uhen Architects Inc 333 E Chicago St Milwaukee WI 53202 Architecture 872946 22 5000 267796 13755 286551 Patient Service Revenue 621110 68181149 68181149 Joint Venture Earnings 900003 525356 525356 1459607 1459607 70166112 3444447 3444447 480994 389206 91788 91788 91788 30490308 39310 29713842 77226 776466 -37916 738550 738550 74727448 70166112 0 4274785 X 2797126 1614049 1183077 21102196 17777796 3195060 129340 726867 611678 110857 4332 3187493 2616592 552955 17946 1631118 1326544 295682 8892 211099 125 210974 70545 63845 6700 17661 17661 14017172 11541247 2469115 6810 589297 589222 75 1599203 838257 734066 26880 398136 382889 15247 34705 17277 17393 35 208683 91067 116089 1527 365179 365179 3159758 2522008 636883 867 263647 263647 Medical Supplies 8776791 8763646 13145 Repairs and Maintenance 1063897 758580 305317 Food Costs 399616 382857 14925 1834 Medicaid Taxes 95014 95014 10072 1851 8111 110 60725275 49629303 10890624 205348 1355 1355 45980975 54769834 9490 7898 7605291 8916193 23945 16761 120086 61622 920255 854602 677280 2105622 89807328 43409811 27505908 46397517 14991752 20732719 1329607 1604963 30000 4530303 5401792 103696247 140900878 3720101 4131106 112905 25213 8638463 22444151 41894 25243 2236555 8162019 14749918 34787732 X 86102997 102105717 2843332 4007429 88946329 106113146 103696247 140900878 X 14002173 2002432 1 1162211 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 4104 0 1 13557 17661 0 Part II-B, Line 1: The Hospital incurred travel expenses to speak with legislators. Other activities include payment to the National Rural Health Association for dues with $101 attributable to lobbying expense, membership dues to the Wisconsin Hospital Association with $3,211 attributable to lobbying expense, quarterly dues paid to the Rural Wisconsin Health Collaborative with $2,027 attributable to lobbying expense, membership dues to the American Hospital Association with $8,196 attributable to lobbying expenses, and dues paid to the American Academy of Sleep Medicine with $22 attributable to lobbying expenses. 0 1 X 2374776 2374776 44680119 26595954 18084165 792149 775343 16806 20515241 14401268 6113973 21445043 1637246 19807797 46397517 Deferred Compensation 604553 Estimated third party payor settlements 770830 Construction Payable 5019369 Operating lease liability 1053705 Finance lease liability 713562 8162019 X Part IV, Line 2b: The Hospital is the fiscal intermediary for Stoughton Wellness Coalition. Stoughton Wellness Coalition promotes healthy lifestyle choices and prevents youth substance use. Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 180.000000000000 1 1 1 0 1 1 486000 486000 0.00800 4617376 2593462 2023914 0.03330 5103376 2593462 2509914 0.04130 573953 23211 550742 0.00910 310320 310320 0.00510 2473417 1498363 975054 0.01610 82528 82528 0.00140 3440218 1521574 1918644 0.03170 8543594 4115036 4428558 0.07300 142244 142244 0.00230 89 89 0.00000 11626 11626 0.00020 14205 14205 0.00020 168164 168164 0.00270 1 2151901 537975 14159914 14147320 12594 X 1 1 1 1 Stoughton Hospital Association 900 Ridge Street Stoughton WI 53589 www.stoughtonhealth.com 1046 X X X X Stoughton Hospital Association 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X Part V, Page 8 X http://healthydane.org X 1 21 1 Part V, Page 8 0 1 X 150.000000000000 180.000000000000 X X X X 1 1 X X X 1 X http://stoughtonhealth.com/fa/ X http://stoughtonhealth.com/fa/ X http://stoughtonhealth.com/fa/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Stoughton Hospital Association Part V, Section B, Line 5: Stoughton Health worked jointly with the three Dane County area health systems - Unity Point Health Meriter, SSM Health, UW Health, along with Group Health Cooperative and Public Health Madison and Dane County. The group was called the Healthy Dane Collaborative (HDC). To provide a complete overview of the health behaviors and perceptions of Dane County residents as possible, the HDC reviewed population health data and gathered feedback through community focus groups, input sessions, surveys, and interviews. The community health needs assessment (CHNA) included significant input from the community and a detailed examination of public health data using a health equity lens. Community input was collected through a community health survey that was made available in English, Spanish, and Hmong and through virtual and in-person community input sessions and key informant interviews. The main source of secondary data was from healthydane.org. which utilizes data from the National Cancer Institute, the Environmental Protection Agency, U.S. Census Bureau, the U.S. Dept. of Education, as well as other national, state, and regional sources. This assessment also included data and findings from the 2021 Dane County Youth Assessment (DCYA). Qualitative Data included 10 Key Informant Interviews with individuals knowledgeable of broad or specific community health needs, 9 focus groups with diverse groups, 879 completed surveys, 186 provider surveys to gather their perspective on needs, and review of the DCYA taken by almost 27,000 students in grades 7-12th. Community Partners engaged included: Oregon Youth Center, Children's Mental Health Collaborative, Oceanhawk Counseling, Stoughton Area Resource Team (START), and Neighborhood Free Health Clinic in our immediate service area. The public health department continued to serve as a partner through the hospitals' CHNA process. Stoughton Hospital Association Part V, Section B, Line 6a: Unity Point Health Meriter, SSM Health, and UW Health Stoughton Hospital Association Part V, Section B, Line 6b: Group Health Cooperative of South Central WisconsinPublic Health Madison and Dane County Stoughton Hospital Association Part V, Section B, Line 11: The 2021 Community Health Needs Assessment was completed and approved in fiscal year 2022. Stoughton Health selected three key areas to focus on over the next three years: - Behavioral Health (includes Mental Health and Substance Misuse) - Chronic Disease - InjuriesThe following actions were taken during fiscal year 2024 to address the needs in the CHNA.To address Behavioral Health which is comprised of the subcategories, Mental Health and Substance Misuse, the hospital has partnered with Neighborhood Free Health Clinic, police, EMS, Journey Mental Health, Tellurian, Dane County Behavioral Health Services, Ocean Hawk Counseling, Stoughton Wellness Coalition, Oregon CARES, Building a Safer Evansville (BASE), LGBTQ+, local churches and other networks. Working with the Stoughton School District, we continue to support the screening of middle school students for mental health and substance abuse risk factors and therapy is provided for identified students. That program will be expanding into the high school. We continue to treat acute mental health disorders in adults 55 years and over through the Geriatric Psychiatry Inpatient program. In addition, multiple free yoga, meditation, forgiveness, dementia screenings, and physical activity classes were offered to encourage interaction and involvement to improve mental health. The hospital supports and participated with National Alliance for Mental Health (NAMI), offered mental health first aid training, and implemented a stigma-free media campaign via social media, flyers, banners, and website interaction. The hospital also supports and participates with the Wisconsin Alzheimer's Association and offered multiple dementia educational classes. To address substance misuse, multiple hospital employees are on the boards and involved with three local coalitions. Oregon CARES, Building a Safer Evansville (BASE) and the Stoughton Wellness Coalition (SWC). All have a focus on reducing youth substance use and promoting healthy life style choices. The hospital provided collaboration and support for alcohol free events, participated and promoted medication drop offs that happen twice a year, supported advocacy and policy change. We offered free Narcan training and installation of free Narcan stations at various locations in Stoughton. Hundreds of Medication lock boxes and deterra kits were handed out at events and available to patients in our Emergency Department/Urgent Cares, Day Surgery and Medical Surgical Departments. Through the work of our local coalitions, lock boxes are also distributed to community partners such as senior centers, EMS, assisted living and many events in the Oregon and Stoughton Communities. Stoughton Hospital continues participation in prescription drug monitoring through the emergency department. To address chronic conditions, community classes were offered including focus on nutrition, physical activity, and Healthy Living with Diabetes. The hospital provided multiple screenings and consultations to improve individual health. We offered heart health talks, healthy eating and how to shop at grocery stores, all of which were highly attended. We continue to offer and promote free podcasts covering a variety of health topics to improve chronic conditions. In addition, tobacco cessation resources are promoted and are on-line. Stoughton Hospital Association also participates and supports many Dane and Rock County community efforts and requests such as runs/walks, educational presentations, health fairs, screenings and more to improve the health of the community. Partnership continues with the Neighborhood Free Health Clinic, Senior Centers and Stoughton Hospital Foundation, to provide medication vouchers for those in need of financial assistance.To address Injuries Stoughton Hospital implemented a Parkinson's class twice a week, Balance Classes in Oregon and Stoughton Communities and offered multiple Strong Bodies class series, all to support decreasing falls. Our Safe@Home Program was also expanded to teach children how to be safe at home alone and our Safe Sitter, a babysitting class, were expanded. While Reproductive Justice was identified as a top health need, Stoughton Hospital reviewed its ability to make a difference and selected the above three primary areas of focus for FY2022-2024. We will continue to provide confidential sexual and reproductive health care in an inclusive, stigma-free environment for people of all ages, gender identities, gender expressions, and sexual orientations through our Emergency, Urgent Care and Specialty Services. We continue to promote the First Breath Program (tobacco cessation program for pregnant women) through the Wisconsin Women's Health Foundation. We provide nutrition education for parents to improve children's health and well-being. Hospital education and classes continued to be offered primarily virtual/zoom. Stoughton Hospital Association Part V, Section B, Line 13h: The size of a patient's family is used in determining eligibility for any discounts. Stoughton Hospital Association Part V, Section B, Line 16j: A summary of the financial assistance policy is provided at our intake process, on our website, through brochures, and patient billing statements. The financial counselor helps those in need become aware of and apply for Stoughton Hospital's Financial Assistance Program. Schedule H, Part V, Section B, Line 7a: https://stoughtonhealth.com/community-health-needs/ Schedule H, Part V, Section B, Line 10a: https://stoughtonhealth.com/community-health-needs/ 5 1 - Ortho Team Clinic 2 Science Court Suite 102 Madison WI 53711 Orthopedic Clinic 2 - Stoughton Rehab & Sports Med Clinic 2300 US Highway 51-138 Stoughton WI 53589 Outpatient rehab 3 - Oregon Rehab & Sports Medicine Clinic 990 Janesville Street Oregon WI 53575 Outpatient rehab & urgent care 4 - Community Health and Wellness Center 3162 County Highway B Stoughton WI 53589 Community screenings, health and wellness information and classes 5 - McFarland Urgent Care 5614 US-51 McFarland WI 53558 Urgent Care Part I, Line 3c: The size of a patient's family is used in determining eligibility for any discounts. Part I, Line 6a: The community benefit report is available at the Association annual meeting in November which is open to the public. Hard copies of the report are available at the Hospital and can be downloaded from the Stoughton Hospital website at https://stoughtonhealth.com/wp-content/uploads/Stoughton-Health-Annual-Report-2024-2.pdf. The report is also shared with local media, employees and at presentations that are done throughout the communities we serve. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost to charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, health professions education, line 7f, and cash and in-kind contributions, line 7i are reported based on estimates of employees' time and actual expenses recorded from the events in the general ledger and compiled in the CBISA software. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part II, Community Building Activities: Stoughton Health dedicates many staff hours and monetary resources to community building activities through board leadership and participation in multiple Chamber of Commerces throughout the communities Stoughton Health serves. We are active with our region and the county's disaster planning groups including the Dane County Inter-hospital Communications and Disaster Planning Committee. The organization participates in the community's semi-annual medication disposal and sharps collection programs, Stoughton Community Leadership Development Program, and multiple staff are active in local civic groups including Lions, Rotary and Kiwanis. Stoughton Health is the Fiscal Agent for the Stoughton Wellness Coalition (SWC), which is dedicated to reducing youth substance abuse and promoting healthy lifestyle choices. There are two staff who are on the Board of SWC. Additional staff participate on the Boards of Stoughton Free Health Clinic, which serves uninsured or underinsured, and START, a Stoughton non-profit that provides emergency assistance to families in need. Stoughton Health continues to be involved in Workforce Development, providing mentoring and job shadowing for college and high school students as well as other career development opportunities including Area Health Education Center (AHEC). Stoughton Health also participates in the state WSHHRA Board and other meetings which focus on pending health professional shortages. In addition, members of leadership actively participate in the Wisconsin Hospital Association. Part III, Line 2: The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: Approximately 25% of the Hospital's bad debt expense is attributable to patients eligible under the Organization's financial assistance policy. This is the approximate percentage of applications denied or not returned due to insufficient information. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 12 and 13 of the attached audited financial statements. Part III, Line 8: Stoughton Hospital Association is a critical access hospital. The Hospital provides services to Medicare patients regardless if there is a shortfall or surplus. Healthcare and individual's health is important to the Hospital. The Medicare shortfall is considered a community benefit. Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the Medicare services would have resulted in a loss.Medicare fee schedule revenue $ 735,762Medicare estimated costs of care relating to payments (1,698,429)Net (Shortage) $ (962,666) Part III, Line 9b: It is the policy of Stoughton Hospital Association that each patient receives care regardless of the ability to pay. During the collection process, patients may still request financial assistance information and complete the information. There are no collection efforts while an individual is in the process of applying for charity care. The patient can qualify for financial assistance and have any collection issues reversed by the Hospital if they show a need for the care based upon the Hospital's policy. The Hospital will not pursue extraordinary collection activities on patients for at least 120 days from the date of the first statement and provides patients 240 days to apply for assistance. Part VI, Line 2: Stoughton Hospital Association is involved with multiple coalitions (BASE, SWC, Oregon CARES, and Oregon Area Wellness Coalition) who also conduct community surveys. The coalitions are made up of representatives from the Area School Districts, Public Health, City, Chamber, Senior Center, Police/EMS, youth, ministry, and library - all who have strong connections in the community and share data, partner with strategic plans and support healthcare issues together. Many of our hospital leaders are involved with civic organizations, senior centers, transportation initiatives, chambers, youth centers, free health clinic and more. This involvement provides a strong pulse on the health care needs of the communities we serve. Part VI, Line 3: Stoughton Hospital provides a financial counselor who acts as a patient advocate and helps those in need become aware of and apply for Stoughton Hospital's financial assistance (community care) program. The counselor also assists patients in identifying and providing information regarding other state, county, or federal programs they may qualify for. Patients have access to learn about the Hospital's community care program through our financial policy which is made available to all patients through the intake process and on our website, brochures, and patient billing statements. Stoughton Hospital's caregivers also identify patients in need as they register or after they receive care and determine specific patients who may have difficulty with payment. Our counselors help patients understand what programs they could be eligible for and provide information regarding application and registration for these programs. Part VI, Line 4: Stoughton Hospital Association is a general acute care hospital located in Stoughton, Wisconsin. The Hospital serves the southern Dane and northern Rock County communities. Its primary service area is made up of Stoughton, Edgerton, Oregon, Evansville and also includes surrounding areas which are a blend of small towns and rural communities. The 2023 population of the service area mentioned was approximately 60,586. In 2023, approximately 5.1% of the stated service area population had income below the federal poverty level for a single person. Part VI, Line 5: Stoughton Hospital is a 35-bed independent, critical access non-profit community hospital governed by a 12-member Board of Directors with 8 directors residing in our primary service area who are neither employees nor contractors of our organization and voluntarily provide their service along with two directors from our affiliate system - SSM Health Care of Wisconsin. Stoughton Hospital has an open medical staff with privileges provided to qualified physicians who are independent or employed by the various health systems in our area. Stoughton Hospital provides a continuum of health care services including, but not limited to, acute care (medical-surgical and inpatient geriatric psychiatry) and outpatient care (emergency and urgent care services, physical rehabilitation, medical imaging, home health) as well as offering or supporting numerous community health education classes, health fairs and support groups. Any surplus funds are reinvested back into Stoughton Health for further health service, technology, building and community education upgrades. Our mission is to provide safe, quality healthcare with exceptional personalized service and one of our values and strategic goals is to provide benefit to the communities we serve through our services, financial stewardship, promotion of wellness and provision of charity and community care. Part VI, Line 6: The Hospital signed a master agreement and affiliation agreement with SSM Healthcare of Wisconsin (SSM Wisconsin). As part of this affiliation, SSM Wisconsin has the right to appoint two directors to the Hospital's twelve-member Board of Directors. The agreement also specifies certain board resolutions that must be approved by the SSM Wisconsin board members. In the event of liquidation, dissolution or sale of the Hospital, SSM Wisconsin would receive 40 percent of the net proceeds. Part VI, Line 7, Reports Filed With States WI 1 X X 0 0 0 0 0 0 0 0 0 Dr Ashish Rawal Medical Staff Rep 738132 0 99572 0 453 0 11494 0 35801 0 885452 0 0 0 Dr Aaron Schwaab Chief of Staff 391089 0 75600 0 694 0 13872 0 33003 0 514258 0 0 0 Daniel DeGroot President/CEO 375046 0 16968 0 1993 0 12198 0 5084 0 411289 0 0 0 Deborah Dahlke Nurse Anesthetist 283842 0 8848 0 982 0 12026 0 27159 0 332857 0 0 0 Charles Smith Nurse Anesthetist 263587 0 11534 0 1993 0 11013 0 34367 0 322494 0 0 0 Kristine Nikolai Nurse Anesthetist 263434 0 16461 0 1298 0 11150 0 29765 0 322108 0 0 0 Michelle Abey CFO/ VP Financial Services 182436 0 9710 0 453 0 8114 0 33801 0 234514 0 0 0 Teresa Lindfors-Chief Strategy & Bus Dev Officer(until 2/24) 181373 0 10906 0 694 0 7691 0 3420 0 204084 0 0 0 Pauline Cass Pharmacy Manager 159290 0 3308 0 453 0 6736 0 33715 0 203502 0 0 0 Amy Hermes Chief Nursing Officer 166122 0 10222 0 1298 0 7210 0 13817 0 198669 0 0 0 Thomas Kostecki Pharmacist 150419 0 4791 0 1674 0 6545 0 26758 0 190187 0 0 0 Christopher Schmitz VP HR, Facility Operations 154528 0 9541 0 453 0 6729 0 13853 0 185104 0 0 0 A Wisconsin Health and Educational Facilities Authority 391337855 000000000 2012-10-01 5605000 Refund bonds issued 2/10/99; 4/30/03; 10/14/09 0 0 0 B Wisconsin Health and Educational Facilities Authority 391337855 000000000 2015-09-10 10000000 Renovation and equip for ER, urgent care, day surgery, lab & capital improv 0 0 0 C Wisconsin Health and Educational Facilities Authority 391337855 000000000 2018-11-06 3500000 Medical Imaging Renovation Project 0 0 0 D Wisconsin Health and Educational Facilities Authority 391337855 000000000 2023-10-31 15165000 Construction of the Outpatient Center 0 0 0 A 5307821 5605000 41714 5563286 2012 1 0 1 1 B 4167647 10000000 113222 1017856 8868922 2017 0 0 1 1 C 2071362 3500000 3500000 2019 0 0 1 1 D 15165000 165000 15000000 2023 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: Wisconsin Health and Educational Facilities Authority Date the Rebate Computation was Performed: 10/18/2023 Michelle Abey CFO/VP Financial Services Employee tuition reimbursement program X 25000 16761 0 0 1 16761 Form 990, Part VI, Section A, line 1a The Executive Committee has a minimum of four members and consists of the Chair, Vice Chair, the Secretary-Treasurer and one Class IV director. The Executive Committee has power to transact all regular business of the hospital during the period between the meetings of the Board of Directors subject to any prior limitation imposed by the Board of Directors; provided that no action may be taken by the Executive Committee if such action would require either supermajority or Special Member approval. Class IV members consist of two members appointed by the Special Member. The Special Member is SSM Healthcare of Wisconsin, Inc. The Alternate Member attends board meetings in the event one of the Special Members is unable to attend. Form 990, Part VI, Section A, line 6 Stoughton Hospital Association has members who are residents of Stoughton and surrounding communities who are 18 years of age or older. SSM Healthcare of Wisconsin, Inc. is a special member. Also, all members of the Medical Staff are members and two members of the Medical Staff are members of the Governing Board. Form 990, Part VI, Section A, line 7a Stoughton Hospital Association has four classes of board members. Class I board members consist of six members who are elected by the members for terms of 3 years. Class II board members consist of 2 members appointed by the Medical Staff for a term of 1 year. Class III board members consist of 2 members appointed by the Board of Directors for successive terms at the discretion of the Board of Directors. Class III board members may serve no more than 7 consecutive years. Class IV board members consist of 2 members appointed by the Special Member. Class IV board members may be appointed for unlimited successive terms. Form 990, Part VI, Section A, line 7b SSM Healthcare of Wisconsin, Inc. is the Special Member of Stoughton Hospital Association. Amendment or restatement of the Articles of Incorporation or Bylaws, approval of the appointment of the CEO in the event of a vacancy, approval of the sale of all or substantially all assets, approval of the sale or long-term lease of real estate comprising the corporation's campus, approval of any merger or consolidation, and dissolution of the corporation require approval by the Special Member. Form 990, Part VI, Section B, line 11b The Form 990 is sent via e-mail to the Board members requesting they review the Form 990 prior to filing. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c A questionnaire requesting information about possible conflicts of interest is distributed annually to Board Members and key management employees. These are completed, signed, and returned to Administration. The completed forms are reviewed by the CEO & CFO. A summary of disclosures is presented to the Governance Committee of the Board of Directors. The Hospital may enter into contracts or transact business with one or more of its directors, officers, or with any corporation, firm, association, trust company, organization, or other entity in which any one or more of its directors or officers are directors, officers, trustees, beneficiaries, stockholders, or financially or otherwise interested. No such contracts or business transactions shall be void or voidable because of such relationships or interests or because such director or directors, officer or officers, are present at the meeting of the Board of Directors or a committee thereof which authorizes, approves or ratifies such contracts or business transactions or because his or their votes are counted for such purpose if (1) the fact of such relationship or interest is disclosed or known to the Board of Directors or committee which authorizes, approves or ratifies the contracts or business transactions by a vote or consent sufficient for the purpose without counting the votes or consents of such interested directors or officers and (2) the contracts or business transactions are fair to the corporation. Interested directors or officers may be counted in determining the presence of a quorum at a meeting of the Board of Directors or a committee thereof which authorizes, approves, or ratifies such contracts or business transactions. Form 990, Part VI, Section B, line 15a The CEO's compensation and evaluation is completed by the Executive Committee of the Governing Board. The Executive Committee obtains market compensation data and independent surveys annually and adjusts the CEO's compensation based upon this review and achievement of goals. The compensation process and decision is documented and was last completed in FY 2024. The CFO's compensation is determined based upon market studies. The Human Resource Department reviews the market data with the CEO. Form 990, Part VI, Section C, line 19 The Hospital holds a publicized annual meeting the last Monday in November and uses this venue to provide updates to the community about changes in governing documents and financial results. The conflict of interest policy is available to the public upon request. The financial statements are required to be attached to the public disclosure copy of the 990. Form 990, Part IX, line 11g Purchased Services: Program service expenses 11,411,357. Management and general expenses 1,683,018. Fundraising expenses 0. Total expenses 13,094,375. Professional Fees: Program service expenses 129,397. Management and general expenses 583,941. Fundraising expenses 6,810. Total expenses 720,148. Payment Processing Fees: Program service expenses 493. Management and general expenses 202,156. Fundraising expenses 0. Total expenses 202,649. Form 990, Part XI, line 9: Change in interest in net assets of the Foundation 1,162,211. Partners of Stoughton Hospital 900 Ridge Street Stoughton WI 53589 391836242 Provide support to Stoughton Hospital Association WI 501(c)(3) Line 7 Stoughton Hospital Association 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0