2024-08-07T10:14:33-05:00 2023-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-10-01 390799566 Tomah Memorial Hospital TOMA 6083722181 501 Gopher Drive Tomah WI 54660 Joseph Zeps Chief Financial Officer 6083722181 2024-08-06 1 1 Kim Hunwardsen CPA P00484560 6122536500 2024-08-06 2022 2024-08-08 14:25:15Z Tomah Health Derek Daly 501 Gopher Drive Tomah WI 54660 93791576 0 X www.tomahhospital.org X 1948 WI To promote and provide quality health care to patients in a hospital setting 10 9 518 38 0 0 1389768 2492713 74726031 81522472 615485 2073655 22140 -9750 76753424 86079090 0 0 0 0 35298055 37656300 0 0 37312 37589205 41223970 72887260 78880270 3866164 7198820 124121322 129590553 46871425 45260023 77249897 84330530 X The mission of Tomah Memorial Hospital, Inc. is to promote and provide quality health care based on customer needs and expectations. In fulfillment of its mission, Tomah Memorial Hospital is committed to view its customers and employees through a holistic approach without consideration to economic status, gender, ethnic origin or personal limitations. 0 0 62994731 78717489 Tomah Health has provided for the health and well-being of the residents of Tomah and the surrounding communities for nearly sixty-five years. The Hospital provides a broad spectrum of health and wellness services to the community, including general medical/surgical and swing bed inpatient care, diagnostic laboratory, and radiology services, general and specialty surgical services, 24-hour emergency care services, obstetric services, rehabilitative services, occupational health and wellness programs, and a community outreach program. Key volume indicators for the fiscal year ended September 30, 2023 are as follows:(Continued on Schedule O)* 1,056 inpatient discharges* 3,200 inpatient days* 21,610 emergency room and urgent care visits* 1,978 surgical and endoscopic procedures* 18,733 radiology procedures (including CT and MRI)* 96,673 laboratory tests* 53,270 rehabilitative services proceduresIn furtherance of its charitable mission, the Hospital provided approximately $564,989 of free and discounted care to area residents (cost of care approximately $250,000) and wrote off $2.86 million of uncollectible accounts (cost equal to approximately $1.26 million). Additionally, based on its most recently completed community benefits survey, the Hospital incurred approximately $3.81 million in net losses related to providing care for individuals with health insurance provided by either the Medicaid program or other governmental insurance programs. The Hospital subsidizes several programs that are deemed vital services for the community, including in-home hospice and palliative care services, a hospice residence, a walk-in clinic located in the rural community of Warrens, WI, and a dedicated community outreach department that provides health and wellness services to area employers and the Tomah community. Subsidies for these programs for fiscal 2023 approximated $2.66 million. Additional details regarding the hospice program and the Warrens Walk-In Clinic can be found below in 4b and 4c. In addition to providing high quality healthcare services, the Hospital encourages employees to become actively involved in community organizations and projects that provide other benefits to local communities. The Hospital provides many free services to the community, including health and wellness presentations to area school children, CPR and AED training to various organizations, wellness fairs devoted to women and senior citizens, and meeting space to various non-profit and civic organizations. 4293430 2130601 Hospice ProgramThe Hospital provides in-home, inpatient, and residential hospice care to residents of Tomah and the surrounding communities. Residential care is provided via the operation of an eight-bed hospice house located off campus. Despite subsidizing the financial losses incurred by the program, the services are deemed vital to the community and represent a necessary component of patient care. For the year ended September 30, 2023, the Hospice program experienced 8,382 program days and 1,657 hospice residence days. 1171458 674382 Warrens Walk-In ClinicThe Hospital began operating an off-site walk-in care clinic several years ago to better serve the needs of the residents of Warrens, Wisconsin. For the fiscal year ended September 30, 2023, the clinic accommodated 2,968 patient visits. The clinic provides residents with a close-to-home, low-cost option for healthcare services (including basic laboratory tests and x-ray capabilities) related to minor injuries and illnesses, and all services provided are supported by the Hospital's Emergency Department. Despite incurring a negative gross contribution margin during 2023, the Hospital's Board of Directors believes the clinic is an important asset to the residents of Warrens and remains committed to supporting it until it achieves a sustainable level of financial performance. 68459619 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 9 0 1 518 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Joseph Zeps 6083740307 501 Gopher Drive Tomah WI 54660 Greg Gaardner Chair 1.00 X X 0 0 0 Keith Laugen Vice Chair 1.00 X X 0 0 0 Spencer Stephens Secretary (Until Jan 23) 1.00 X X 0 0 0 B Scot Nicol-Director Until Jan 23/Secretary as of Jan 23) 1.00 X X 0 0 0 John Laufenberg Treasurer (Until Jan 23) 1.00 X X 0 0 0 Deb Buswell-Director Until Jan 23/Treasurer as of Jan 23) 1.00 X X 0 0 0 Diana Gerke Director (as of Jan 23) 1.00 X 0 0 0 Penny Precour-Berry Director (until Jan 23) 1.00 X 0 0 0 Sue Playter Mubarak Director 1.00 X 0 0 0 Jeffrey Cavaness MD Director (until Jan 23) 1.00 X 0 0 0 Robert Holness MD Director 1.00 X 0 0 0 Tiffany Casper DO Director (as of Jan 23) 1.00 X 0 0 0 Beth Arity Director (as of Jan 23) 1.00 X 0 0 0 Wes Revels Director (as of Jan 23) 1.00 X 0 0 0 Derek Daly CEO 40.00 X 0 0 0 Joseph Zeps Chief Financial Officer 40.00 X 225309 0 43550 Tracy Myhre CNO 40.00 X 197204 0 42373 Kelly Thayer APNP Nurse Practitioner 40.00 X 179730 0 20485 Laura Miller APNP Nurse Practitioner 40.00 X 176788 0 18919 Gerald Fushianes PA-C Physician Assistant 40.00 X 243774 0 41175 Michelle Masters APNP DNP Emergency Medicine, Urgent 40.00 X 208389 0 41772 Todd Chapman Pharmacist 40.00 X 213678 0 7010 1444872 0 215284 43 0 1 0 Gundersen Lutheran Health Systems 1900 South Ave LaCrosse WI 54601 Contracted ER physicians/dietician 4788458 Novus 501 Gopher Dr Tomah WI 54660 Contracted CRNA Services 3009179 Tomah Orthopedics 501 Gopher Dr Tomah WI 54660 Contracted orthopedic surgeon services 1486245 Medical X-ray Consultants 900 W Clairemont Avenue Eau Claire WI 54701 Contracted radiologist 1385797 Mayo Clinic Health System 201 W Center St Rochester MN 55902 Contracted hospitalist/pathology service 1230309 20 18789 372851 2101073 2492713 Patient Service Revenue 621110 81188835 81188835 333637 333637 81522472 1182264 1182264 9750 -9750 -9750 -9750 8573001 21126 7702736 0 870265 21126 891391 891391 86079090 81522472 0 2063905 X 561298 261542 299756 231760 231760 28536996 24957560 3550488 28948 872474 764508 107073 893 5405010 4711868 687701 5441 2048762 1779470 267262 2030 847136 847136 64591 64591 102015 102015 13295459 12232155 1063304 232745 232745 2271976 1038839 1233137 618090 618090 140749 118515 22234 209860 185290 24570 1207472 1074650 132822 6089326 5419500 669826 215022 215022 Medical Supplies 13489467 13487926 1541 Repairs & Maint 1774246 1143381 630865 665816 219543 446273 78880270 68459619 10383339 37312 27930423 25357331 62110 0 10690383 9916775 1140332 1318834 2662142 2273522 82259599 26760215 58379131 55499384 22594625 33926690 662176 1298017 124121322 129590553 3353634 4290574 359953 0 11410507 10909225 29864995 29125342 1882336 934882 46871425 45260023 X 75593482 80625242 1656415 3705288 77249897 84330530 124121322 129590553 X 7198820 -110105 -8082 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1489183 45183 80673 18862 1596177 1508753 61894 -63467 17997 1489183 1335008 35758 154311 16324 1508753 1322711 31230 -1818 17115 1335008 1265302 38025 32246 12862 1322711 0.00000 1.00000 0.00000 0 0 1811831 1811831 55133427 11966796 43166631 24011374 14473797 9537577 1302967 319622 983345 55499384 Estimated third-party payor settlements 375000 Finance lease liability 559882 934882 X 85960903 -110105 -8082 -118187 86079090 0 86079090 78880270 0 78880270 0 78880270 Part V, Line 4: Permanently restricted net assets are restricted to the Hospice endowment fund and the beneficial interest in a perpetual trust. The interest earned can be used for hospice expenditures. 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 consolidated 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. Part XI, Line 2d - Other Adjustments: Net change in fair value of beneficial interest in a perpetual trust -8,082. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 228 250000 250000 0.00320 1 10011 31303812 28258177 3045635 0.03860 1 6392 16749119 15984860 764259 0.00970 3 16631 48302931 44243037 4059894 0.05150 15 50655 50655 0.00060 3 3172 5464888 2804983 2659905 0.03370 3 3187 5515543 2804983 2710560 0.03430 6 19818 53818474 47048020 6770454 0.08580 1 2856838 388530 17664717 17720344 -55627 X 1 1 1 1 Tomah Memorial Hospital 501 Gopher Drive Tomah WI 54660 www.tomahhealth.org 1023 X X X Warrens Walk-In Clinic - provider based Tomah Memorial Hospital 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Part V, Page 8 X 1 21 1 See Part V, Page 8 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 Tomah Memorial Hospital Part V, Section B, Line 5: The Hospital participates in a collaborative community health needs assessment project with other area healthcare providers and county health departments. A new assessment is performed once every three years, and the process is coordinated by the Great Rivers United Way. The collaboration conducted a region-wide assessment via surveys, focus groups, and a detailed review of county and state demographic information. The assessment was used to identify and prioritize the health needs of Monroe County. The results of the assessment are used to affirm existing programs, develop new strategies, and ultimately improve the overall health of the community. Tomah Memorial Hospital Part V, Section B, Line 6a: Gundersen Health System (including LaCrosse, Hillsboro, and Whitehall locations)Mayo Health System (including LaCrosse and Sparta locations)Vernon Memorial Healthcare Tomah Memorial Hospital Part V, Section B, Line 6b: Great Rivers United WayHouston County (MN) Health DepartmentLaCrosse Community FoundationLaCrosse County Health DepartmentMonroe County Health DepartmentTrempealeau County Health DepartmentVernon County Health Department Tomah Memorial Hospital Part V, Section B, Line 11: The 2021-2023 CHNA identified many of the same issues that were covered in the previous CHNA, with the top five concerns centered on mental health, alcohol and other drug abuse, nutrition, childcare, and wages and poverty. Significant implementation strategies/actions include the following: Continued partnership with the Monroe County Mental Health coalition to improve access to mental wellness services and reduce stigma associated with accessing those services.- Provision of Adverse Childhood Experiences & Trauma Informed Care to support individuals involved with traumatic events.- Developed a suboxone clinic to provide medically assisted treatment to individuals struggling with opioid addiction, as well as coordinating the provision of this service with local law enforcement and judiciary officials.- Partnership with Coulee Recovery Center to provide patients with assistance on finding rehab services, as well as the availability of a Peer Recovery Coaching program for patients presenting with a substance use disorder.- Continued partnership with the Monroe County Nutrition Coalition to improve the nutrition of Monroe County residents and reduce diabetes health disparities.- Membership on the Tomah Area School District's Wellness Committee to encourage staff and students to improve nutrition habits.- Partnership with area clinics to offer a 10-week Pilot Produce Prescription Program to encourage health nutrition habits.- Formally planning for a future food forest project, whereby food produced naturally in the forest can be paired with health community cooking classes.- Provided educational offerings to help new parents and siblings with the process of bringing new life into the world, including online classes to address prepared childbirth, hydrotherapy, and breastfeeding.- Continued offering of the SafeSitter babysitting class to help students learn the responsibility of babysitting as well as staying at home alone.- Continued coordination sponsorship of community health and wellness events including Health Aging Expo, Women's Health Night, and Men's Health Night.- Continued review of the Hospital's wage and benefit package to ensure all Hospital employees are compensated at a level that provides for a liveable wage.More details on the Hospital's most recent CHNA implementation strategies can be found on the Hospital's website (www.tomahhealth.org). Tomah Memorial Hospital Part V, Section B, Line 16j: Brochures containing information about financial assistance are available to patients. The Hospital's website contains information regarding community care and financial assistance. Contact information regarding community care and financial assistance is included on billing statements. Summary and contact information is also included in the emergency room, waiting rooms, and business office. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Part V, line 7a, Community Health Needs Assessment website: https://www.tomahhealth.org/about-us/community-health-needs-assessment Part V, line 10a, Implementation Strategy website: https://www.tomahhealth.org/wp-content/uploads/2023/01/2022-Annual-Community-Report-4.pdf Part V, line 16a, FAP website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ Part V, line 16a, FAP Application website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ Part V, line 16a, FAP Plain Language Summary website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ 2 1 - Hospice Touch Serenity House 601 Straw Street Tomah WI 54660 Hospice residence 2 - Tomah Health Occupational Health Service 1401 Town Line Road Tomah WI 54660 Occupational Health Facility Part I, Line 6a: The Annual Community Benefit report is released to the public via a written report distributed to member hospitals as well as the Wisconsin Hospital Association's website. This reporting initiative attempts to quantify the amount of community benefits provided by the Hospital, and includes figures related to community care write-offs, bad debt write-offs, Medicare and Medicaid shortfalls, and programs operated at a loss.The Organization also prepares a quarterly newsletter that is distributed to the public via a mass-mailing. The quarterly newsletter is intended to provide the communities the Hospital serves information regarding Hospital operations, financial results, and programs/initiatives intended to fulfill the Hospital's commitment to community. The newsletter also contains financial highlights from the Wisconsin Hospital Association community benefit report. Current and prior editions of the newsletter are available on the Hospital's website. Part I, Line 7: The methodology for determining charity care and Medicaid/Tricare shortfalls at cost was as follows: a cost to charge ratio was computed using totals from the Hospital's audited financial statements; this ratio was applied to charity care charges, and gross Medicaid/Tricare revenue. Actual reimbursement received from Medicaid/Tricare was then compared to the estimated cost (computed by multiplying the CCR by gross charges) to determine the shortfall. All other items were based on actual program expenses. Also worth noting that the methodology used for charity care/Tricare/Medicaid is the same as the methodology used by the Wisconsin Hospital Association in compiling their annual community benefit report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy is determined by using the percentage of residents with income below the poverty level in Tomah, WI. The percentage was 13.6% per the US Census Bureau QuickFacts for Monroe County, WI, estimates as of 7/1/23. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on pages 14 and 15 of the audited financial statements. Part III, Line 8: Tomah Memorial Hospital follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall would be excluded from the Hospital's community benefit report. The Hospital had a Medicare shortage for fiscal year 2023, not including services reimbursed on a fee schedule. 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 been $1,239,565.Medicare fee schedule revenue $ 656,947Medicare estimated costs of care relating to payments (1,896,512)Net (Shortage) $ (1,239,565)Providing services to Medicare patients is essential to these patients and the community and increases their access to healthcare services, which is a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by The Centers for Medicaid and Medicare services. Part III, Line 9b: Tomah Health attempts to screen all elective/scheduled patients prior to the receipt of service regarding community care eligibility and works with patient financial services staff to identify emergent/unscheduled patients who may be eligible for community care (generally after receipt of service). Patients without insurance are offered a 42.5% discount. Patients that express an interest in community care assistance, are in the process of applying for community care assistance or waiting on a determination of community care assistance will not have collection efforts imposed on their accounts. After a determination of community care assistance is made, any personal portion due by the patient will follow the same collection procedures as other patients. Part VI, Line 2: Tomah Health currently operates on a three-year strategic planning cycle. At the beginning of each cycle, a strategic planning retreat is held during which an analysis is conducted of the services the Hospital currently provides and areas of need that should be addressed by the Hospital. The retreat is open to all Hospital staff, Hospital Board Members, and members of the Hospital's medical staff. The Hospital's medical staff is comprised primarily of physicians employed by other area healthcare providers (e.g. Mayo, Gundersen Health System), and as such their input into the strategic planning process allows the Hospital to work collaboratively with other hospitals and health systems in assessing the needs of the community. The strategic planning process is facilitated by a representative of HealthTechS3 (contracted management organization), and the three-year plan that is adopted by the Hospital's governance serves as a blueprint for ensuring the Hospital is addressing the needs of the community.In addition to the formal strategic planning process, the Hospital engages in ongoing discussions with various stakeholders (area businesses, physicians, patients, and community members) regarding the services offered at the Hospital, and Hospital leadership evaluates all suggestions offered for improving the many ways in which the Hospital serves its community.Finally, the Hospital participated in a collaborative community health needs assessment project with other area healthcare providers and county health departments. The final report and the Hospital's implementation plan are published on the Hospital's website at www.tomahhealth.org. Part VI, Line 3: Tomah Health makes available brochures containing information about financial assistance to all patients seen in the emergency room/urgent care areas, and any patient that registers for a non-emergent service is questioned by admissions or nursing staff regarding any concerns they might have about the cost of their Hospital services. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Additionally, a review is conducted of all accounts that become delinquent to ensure that an attempt to contact the patient has been made by Hospital staff. Part VI, Line 4: Tomah Memorial Hospital, Inc. d/b/a Tomah Health is a 25-bed Critical Access Hospital located in Tomah, Wisconsin. The Hospital's primary service area consists of Tomah, WI, and the outlying communities of Camp Douglas, Warrens, Oakdale, and Wilton. Tomah is located in rural western Wisconsin, and as such a significant portion of the Hospital's patient base is comprised of agricultural workers and members of the Amish community. Additionally, Tomah's proximity to two military installations results in a large portion of services provided to members of the military and their families. The Hospital's payer mix is comprised of approximately 16.6% Medicaid, 41.4% Medicare, 9.4% military, 2.0% self-pay, and 30.6% commercial insurance. The reimbursement challenges associated with providing a high percentage of services to Medicaid/Medicare recipients and the uninsured has required the Hospital to operate at a high level of efficiency, ensuring that all services provided represent an excellent value to area community members. Although the Hospital has benefited from the additional reimbursement afforded through the Critical Access Hospital program, competition for market share with other area healthcare providers requires Hospital leadership to continually reevaluate service offerings and business lines for appropriateness given the healthcare needs of the community. Part VI, Line 5: Tomah Health's Board of Directors is comprised of community members that represent both a cross section of industry expertise (banking, manufacturing, attorneys, physicians, small business, etc.) as well as an appreciation of the healthcare needs of the community. The Hospital generally budgets for a targeted operating margin of between 1% and 3% each year. This target was established by the Hospital's Board of Directors and is believed to represent an appropriate balance between fulfilling the Hospital's charitable purpose and achieving financial results that allow for continued reinvestment in staff and equipment to remain competitive.The Hospital operates a fully staffed Community Health Initiatives Department dedicated to improving the health of the community through wellness education and preventative healthcare strategies. This Department maintains an active presence in the community, sponsoring such events as an annual Women's Health Night, an annual Senior Health and Safety Expo, and various other educational programs in area schools and businesses. Part VI, Line 7, Reports Filed With States WI X X X 0 0 0 0 0 0 0 1 0 Gerald Fushianes PA-C Physician Assistant 241983 0 250 0 1541 0 7092 0 35233 0 286099 0 0 0 Joseph Zeps Chief Financial Officer 224569 0 0 0 740 0 9467 0 35361 0 270137 0 0 0 Michelle Masters APNP DNP Emergency Medicine, Urgent 207572 0 0 0 817 0 7689 0 35226 0 251304 0 0 0 Tracy Myhre CNO 194789 0 500 0 1915 0 8290 0 35319 0 240813 0 0 0 Todd Chapman Pharmacist 213268 0 0 0 410 0 7010 0 1278 0 221966 0 0 0 Kelly Thayer APNP Nurse Practitioner 177291 0 0 0 2439 0 7193 0 14534 0 201457 0 0 0 Laura Miller APNP Nurse Practitioner 176275 0 0 0 513 0 5626 0 14065 0 196479 0 0 0 Part I, Line 3 Tomah Memorial Hospital does not pay compensation to the Administrator directly. The Administrator is compensated by an unrelated management company, HealthTechS3, and is considered a common law employee of the management company. The Hospital Board of Directors uses some of the processes described in Part I, Question 3 to help determine appropriate compensation for the Administrator. The Board of Directors also approves the Organization's contract with the Management Company. Part I, Line 7 Bonuses are provided based on production and performance. The Board of Directors has authority to determine if a bonus should be granted or denied. A Wisconsin Health and Educational Facilities Authority 391337855 000000000 2017-11-09 13000000 Construction of replacement facility 0 0 0 A 1908721 13000000 13000000 2019 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Steve Loging Family member of CNO, Tracy Myhre 120222 Employee compensation 0 Jessye Buswell Family member of Director, Deb Buswell 111538 Employee compensation 0 Form 990, Part VI, Section A, line 1a The Executive Committee includes the Corporation's officers and Chairmen of Standing Committees. The Executive Committee has power to transact all regular business of the Corporation during the period between the meetings of the Board of Directors subject to any prior limitation imposed by the Articles of Incorporation, these Bylaws, or the Board, and with the understanding that all matters of major importance will be referred to the Board of Directors. The Chairman of the Board presides as Chairman of Executive Committee and the Treasurer presides in the Chairman's absence. Actions of the Executive Committee are subjected to approval or disapproval at the next regular Board of Directors meeting except for those actions taken pursuant to delegation by the Board of Directors. Form 990, Part VI, Section A, line 3 Philip J. Stuart, Administrator of Tomah Memorial Hospital, was employed by HealthTechS3, an unrelated management company until his retirement in September 2022. Derek Daly was hired as CEO in August 2022 and was also employed by HealthTechS3. These positions have the responsibility of supervising the management, administration and operation of the Organization. HealthTechS3 was compensated $567,995 for Philip and Derek's services provided to Tomah Memorial Hospital. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is provided to the Board before it is filed. The CEO, CFO, and Executive/Finance Committee review the draft in detail. Form 990, Part VI, Section B, line 12c All members of the Board and Administration team are covered by the conflict of interest policy. Potential conflicts are contracts or transactions between the Hospital and a Director or another corporation, firm, association, or entity in which there is a material financial interest. The Hospital administration reviews annual statements for potential conflicts. If the Hospital Administration determines there is a conflict, the person involved must abstain from voting on any matter related to the conflict. Form 990, Part VI, Section B, line 15 The Administrator and CEO positions are employed by HealthTechS3. The Board approves the contract on a three-year period with two one-year renewal clauses. Comparability data is used during this process and the decision is documented. The contract was renewed for five years from 7/1/22 through 6/30/27 with an out clause on 6/30/25 provided 120 days notice is given. The CEO makes recommendations to the Finance/Executive Committee of the Board for other officers. Comparability data is used during this process and the decisions are documented. This is an annual process completed each fiscal year. Form 990, Part VI, Section C, line 19 The Organization's governing documents and conflict of interest policy are not available to the general public. Financial statements are available through the Organization's bond issuer on the internet, and the Organization presents an annual report to the community, open to the general public, in which a financial report is presented. Additionally, an annual financial report is included in the quarterly mailings the Organization sends to all community members. Form 990, Part IX, line 11g Purchased services: Program service expenses 12,232,155. Management and general expenses 448,226. Fundraising expenses 0. Total expenses 12,680,381. Professional fees: Program service expenses 0. Management and general expenses 615,078. Fundraising expenses 0. Total expenses 615,078. Form 990, Part XI, line 9: Net change in fair value of beneficial interest in perpetual trust -8,082. Pederson Trust Fund for the Benefit of Tomah Memorial Hospital 501 Gopher Dr Tomah WI 54660 396173790 Support Tomah Memorial Hospital WI 501(c)(3) Line 12b, II Tomah Memorial Hospital 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0