2026-07-15T17:03:47-05:00 2025-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2024-10-01 390832914 Stoughton Hospital Association STOU 6088736611 900 Ridge Street Stoughton WI 53589 Michelle Abey CFO 6088736611 2026-07-07 1 1 Kim Hunwardsen CPA P00484560 6122536500 2026-07-07 2024 2025-03-06 01:10:19Z Christopher Brabant 900 Ridge Street Stoughton WI 53589 110768231 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 10 463 49 0 0 286551 1583492 70166112 77876964 4182997 2691358 91788 49726 74727448 82201540 0 0 0 0 29444800 34215217 0 0 208570 31280475 35338301 60725275 69553518 14002173 12648022 140900878 141670688 34787732 21965401 106113146 119705287 X The mission of Stoughton Hospital is to provide safe, quality health care with exceptional personalized service. 1 0 57017878 77876964 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 2025, there were 4,581 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, rehabilitation services, (Statement continued on Schedule O)breast care services, cardiology, foot care, health screenings, lab, podiatry, sleep disorder services, vein treatment services and wound care services.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 $259,000 for the year ended September 30, 2025, 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 $443,000 for the year ended September 30, 2025, 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 57017878 1 1 0 1 0 0 0 0 1 0 1 0 0 1 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 1 0 0 0 0 1 1 0 0 0 1 104 0 1 463 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 Tim Rusch Chair 2.00 X X 0 0 0 Sue Vanderbilt Vice Chair 2.00 X X 0 0 0 Glenn Kruser Secretary/Treasurer 2.00 X X 0 0 0 Matt Kinsella Director - Class IV - SSM 1.00 X 0 0 0 Kris Krentz Director 1.00 X 0 0 0 Cindy McGlynn Director 1.00 X 0 0 0 Donna Olson Director 1.00 X 0 0 0 Steve Peotter Director 1.00 X 0 0 0 Nick Probst Director 1.00 X 0 0 0 Dr Ashish Rawal Medical Staff Rep 41.00 X 850290 0 47042 Dr Aaron Schwaab Chief of Staff 41.00 X 471062 0 40397 Dawit Tesfasilassie Director - Class IV - SSM 1.00 X 0 0 0 Kyle Nondorf - Director Class IV- SSM Alternate until Nov 1.00 X 0 0 0 Daniel DeGroot President/CEO - until Dec 40.00 X 442921 0 13528 Michelle Abey CFO/ VP Financial Services 40.00 X 231952 0 38988 Christopher Brabant President/CEO as of Nov 40.00 X 23902 0 2415 Amy Hermes CNO Vice President of Patient Services 40.00 X 202254 0 19543 Christopher Schmitz VP HR, Facility Operations 40.00 X 193943 0 19717 Deborah Dahlke Nurse Anesthetist 40.00 X 307153 0 37931 Kristine Nikolai Nurse Anesthetist 40.00 X 266911 0 33859 Charles Smith Nurse Anesthetist 40.00 X 293264 0 34652 Michael Berger Nurse Anesthetist 40.00 X 258077 0 12016 Mary Schneider Nurse Anesthetist 40.00 X 175467 0 6177 Teresa Lindfors Former Key Employee 0.00 X 222674 0 5891 3939870 0 312156 47 1 1 0 Southern WI Emergency Association 1446 N Randall Ave Janesville WI 53545 Emergency physicians 4764068 JP Cullen & Sons Inc PO Box 5957 Janesville WI 53547 General Contractor 2769517 Shared Imaging Services 915 17th Street Prairie Du Sac WI 53578 Nuclear medicine and ultrasound 1745430 Stoughton Hospital Imaging LLC 900 Ridge Street Stoughton WI 535891896 MRI Scans 1479590 Beam Healthcare SC 25 W Main St Fl 5 Madison WI 53703 Hospital physician services 1342153 20 351949 1231543 200000 1583492 Patient Service Revenue 621110 75894988 75894988 Joint Venture Earnings 900003 461109 461109 1520867 1520867 77876964 2602729 2602729 543145 493419 49726 49726 49726 28127256 34645 27835783 237489 291473 -202844 88629 88629 82201540 77876964 0 2741084 X 2740305 1713486 1026819 24702335 20871872 3694186 136277 869601 737170 127751 4680 4024010 3356775 646494 20741 1878966 1550257 319313 9396 266983 920 266063 60278 54818 5460 17808 17808 15551935 12916546 2634526 863 771313 195 771043 75 2003011 1065275 914511 23225 512087 495047 17040 75548 18396 56534 618 194619 83336 110528 755 690347 690347 4165900 3305963 859072 865 322022 322022 Medical Supplies 8841164 8823644 17520 Repairs and Maintenance 1385758 990161 391143 4454 Food Costs 383175 363023 19030 1122 Medicaid Taxes 74249 74249 22104 17657 4408 39 69553518 57017878 12327070 208570 1355 1715 54769834 41282319 7898 11776 8916193 8404418 16761 7183 61622 40272 854602 955273 2105622 1131385 100643209 43296920 46397517 57346289 20732719 23479579 1604963 1816072 30000 6707 5401792 7187700 140900878 141670688 4131106 4749194 25213 39708 22444151 12833740 25243 40551 8162019 4302208 34787732 21965401 X 102105717 115964701 4007429 3740586 106113146 119705287 140900878 141670688 X 12648022 1137928 -1 -193808 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 3550 0 1 14258 17808 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 $102 attributable to lobbying expense, membership dues to the Wisconsin Hospital Association with $3,307 attributable to lobbying expense, quarterly dues paid to the Rural Wisconsin Health Collaborative with $2,396 attributable to lobbying expense, membership dues to the American Hospital Association with $8,441 attributable to lobbying expenses, and dues paid to the American Academy of Sleep Medicine with $12 attributable to lobbying expenses. 0 1 X 2447096 2447096 69948249 28668233 41280016 1926110 204697 1721413 22442684 12614199 9828485 3879070 1809791 2069279 57346289 Other Receivables 105885 Interest in net assets of Stoughton Hospital Foundation, Inc. 3672604 Right of Use Assets 3021551 Accrued interest receivable 91388 Estimated Third Party Payor Settlement 296272 7187700 Deferred Compensation 553488 Construction Payable 76415 Right of Use Liabilities 3672305 4302208 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 259000 259000 0.00370 4086267 2370072 1716195 0.02470 4345267 2370072 1975195 0.02840 652514 34613 617901 0.00890 555568 555568 0.00800 2994376 2269152 725224 0.01040 121584 121584 0.00170 4324042 2303765 2020277 0.02900 8669309 4673837 3995472 0.05740 77880 77880 0.00110 3888 3888 0.00010 18190 18190 0.00030 35861 35861 0.00050 135819 135819 0.00200 1 3000067 750017 15798167 15817773 -19606 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 24 1 1 1 1 X Part V, Page 8 X http://healthydane.org X 1 24 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 continues to work 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 is called the Healthy Dane Collaborative (HDC). To provide as complete of an 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. To understand community health needs, HDC gathered input from the community and looked at public health data. They talked with people in person and online and held focus groups led by young people. They also spoke with doctors, nurses, and other health workers to learn about the challenges their patients face. They looked at data from many sources to better understand the health problems and barriers people face. Most of the data came from healthydane.org, which uses information from the National Cancer Institute, the Environmental Protection Agency, the U.S. Census Bureau, the U.S. Department of Education, and other important sources. 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 community health needs assessment (CHNA) we completed in fiscal year 2025. The Hospital identified four priority needs.1. Chronic Conditions2. Injury & Safety3. Mental Health & Substance Use4. Reproductive JusticeThe CHNA identified Reproductive Justice as a community need. After careful review, the hospital did not prioritize this area in its implementation strategy due to limited capacity to provide maternal and early childhood services. Instead, Stoughton Health chose to focus on needs where it has the strongest resources and ability to effectively serve the community and recognized that other Dane County hospitals may be better positioned to address this need.In the current tax year, Stoughton Hospital Association, doing business as Stoughton Health, implemented a wide range of actions aligned with the health needs identified from its most recent CHNA. These actions focused on our priority areas of Chronic Conditions, Injury & Safety, and Mental Health & Substance Use, which were selected based on community input, internal capacity, and community resources. Actions taken include:Chronic Conditions The hospital provided ongoing community wellness offerings, including health risk screenings, two 6 week Healthy Living with Diabetes workshops and educational classes focused on nutrition, exercise, blood pressure, and other cardiac rehab focused classes. In addition, continual and multiple offerings of Parkinson's Exercise and StrongBodies classes helped support physical activity and chronic condition management. Stoughton Health also provided free blood pressure cuffs to libraries for self-monitoring and free yoga sessions in the communities served. Injury & SafetyStoughton Health continued to offer a variety of community injury prevention programs. Over 125 children completed the Safe Sitter and Safe@Home programs. Multiple balance classes, poling in the parks and fall prevention workshops with senior partners were coordinated, Eight blood drives were held during the year for employees and the community. Free car seat checks and the Wisconsin Elder Abuse Hotline were promoted. In addition, free compression-only CPR training sessions were provided to over 50 community members to improve emergency response capacity.Mental Health & Substance UseFour dementia screenings and multiple educational talks on dementia with high participation were offered. Stoughton Health hosts a monthly Memory Cafe and continues to collaborate with partners on dementia-friendly community initiatives. A program was hosted at the hospital in collaboration with the Stoughton Senior Center, featuring Dr. Zorba Paster, and over 90 people attended. In addition, Stoughton Health provided free fidgets to police departments in Oregon and Stoughton, and financial support was provided to the National Alliance for Mental Illness. To address substance use, two free medication disposal events were offered that collected over 600 pounds of medication and sharps. In collaboration with the Stoughton Wellness Coalition, over 300 prescription lock boxes, disposable Deterra medication bags and refrigerator locks were handed out at multiple events. Multiple staff from Stoughton Health assist in the annual Reality Maze event at the Stoughton High School going through scenarios with 9th grade students on consequences of substance use. These efforts represent tangible implementation strategies to address the CHNA priorities and reflect the hospital's commitment to measurable community health improvement. Evaluation of participation and outcomes from these initiatives continues to direct future planning. 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/ 6 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 6 - Cottage Grove Urgent Care 110 W Limestone Pass 103 Cottage Grove WI 53527 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/about-us/hospital-publications/. 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 total loss from Medicare services would have increased by $149,790.Medicare fee schedule revenue $ 749,417Medicare estimated costs of care relating to payments (899,207)Net (Shortage) $ (149,790) 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: In addition to the 2025-2027 Stoughton Hospital CHNA reported on Part V, the 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 2024 population of the service area mentioned was approximately 61,055. In 2024, approximately 5.0% 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) as well as offering or supporting numerous community health education classes, health fairs and support groups. Any surplus funds are reinvested back into our Hospital 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 1 0 0 0 0 0 0 0 0 Dr Ashish Rawal Medical Staff Rep 759005 0 90595 0 690 0 13056 0 38642 0 901988 0 0 0 Dr Aaron Schwaab Chief of Staff 392372 0 78000 0 690 0 9542 0 35511 0 516115 0 0 0 Daniel DeGroot President/CEO - until Dec 426470 0 12641 0 3810 0 13099 0 5084 0 461104 0 0 0 Deborah Dahlke Nurse Anesthetist 295629 0 9202 0 2322 0 12552 0 29549 0 349254 0 0 0 Charles Smith Nurse Anesthetist 275187 0 14267 0 3810 0 11301 0 27521 0 332086 0 0 0 Kristine Nikolai Nurse Anesthetist 245110 0 19973 0 1828 0 10892 0 27137 0 304940 0 0 0 Michelle Abey CFO/ VP Financial Services 220320 0 11182 0 450 0 8333 0 34319 0 274604 0 0 0 Michael Berger Nurse Anesthetist 254809 0 2853 0 415 0 10357 0 4536 0 272970 0 0 0 Teresa Lindfors Former Key Employee 40655 0 0 0 182019 182019 1660 0 4801 0 229135 182019 0 0 Amy Hermes CNO Vice President of Patient Services 184022 0 16942 0 1290 0 8204 0 14553 0 225011 0 0 0 Christopher Schmitz VP HR, Facility Operations 182021 0 11232 0 690 0 7914 0 14804 0 216661 0 0 0 Mary Schneider Nurse Anesthetist 170673 0 3504 0 1290 0 6177 0 1674 0 183318 0 0 0 Part I, Line 4a Teresa Lindfors, key employee through February 2024, received severance in the amount of $181,771. because her position was eliminated in March 2024. 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 2018-11-06 3500000 Medical Imaging Renovation Project 0 0 0 C Wisconsin Health and Educational Facilities Authority 391337855 000000000 2023-10-31 15165000 Construction of the Outpatient Center 0 0 0 A 5581913 5605000 41714 5563286 2012 1 0 1 1 B 2570176 3500000 3500000 2019 0 0 1 1 C 3033000 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 A 0 0 1 0 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 0 1 0 0 0 1 A 1 B 1 C 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 7183 0 0 1 7183 X 1 200000 Assessment of expert 1 0 1 0 Part I, Column (b): The organization reports the number of contributions in column (b). Form 990, Part III, line 2 Cottage Grove Urgent Care opened in October 2024. 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 2025. 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 12,702,470. Management and general expenses 1,826,063. Fundraising expenses 0. Total expenses 14,528,533. Professional Fees: Program service expenses 207,401. Management and general expenses 560,808. Fundraising expenses 863. Total expenses 769,072. Payment Processing Fees: Program service expenses 6,675. Management and general expenses 247,655. Fundraising expenses 0. Total expenses 254,330. Form 990, Part XI, line 9: Change in interest in net assets of the Foundation -193,808. 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 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0