2024-11-15T14:49:28-06:00 2023-12-31 466029223 KEVIN SMITH 12800 CORPORATE HILL DRIVE ST LOUIS MO 63131 990 2023-01-01 390806265 WAUPUN MEMORIAL HOSPITAL WAUP 9209265519 620 WEST BROWN STREET WAUPUN WI 53963 STEPHANIE KING VP FINANCE 9209265519 2024-11-15 0 3149947800 2024-11-14 2023 2024-10-15 13:58:12Z SUE ANDERSON 620 WEST BROWN STREET WAUPUN WI 53963 59986891 0 0928 X WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/WAUPUN-MEMO X 1049 WI THE MISSION OF WAUPUN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH, AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. 13 10 0 82 19895 0 76967 60292 65763727 59588022 -8999 -4487 117216 343064 65948911 59986891 63548 65373 0 0 20792564 24224984 0 0 0 36483469 25114003 57339581 49404360 8609330 10582531 87097613 93064323 5111773 441196 81985840 92623127 X THE MISSION OF WAUPUN MEMORIAL HOSPITAL IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH, AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH. 0 0 44721180 65373 59588022 SINCE IT WAS FOUNDED IN 1872 BY CATHOLIC SISTERS, SSM HEALTH (SSMH) HAS EXISTED TO MEET THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. SSMH IS A CATHOLIC, NOT-FOR-PROFIT HEALTH SYSTEM SERVING THE COMPREHENSIVE HEALTH NEEDS OF COMMUNITIES ACROSS THE MIDWEST THROUGH ONE OF THE LARGEST INTEGRATED DELIVERY SYSTEMS IN THE NATION. WITH CARE DELIVERY SITES IN ILLINOIS, MISSOURI, OKLAHOMA, AND WISCONSIN, SSMH INCLUDES 23 ACUTE CARE HOSPITALS, ONE CHILDREN'S HOSPITAL, MORE THAN 650 PHYSICIAN OFFICES AND OTHER OUTPATIENT AND VIRTUAL CARE SERVICES, 12 POST-ACUTE FACILITIES, COMPREHENSIVE HOME CARE AND HOSPICE SERVICES, A PHARMACY BENEFIT COMPANY, AND AN ACCOUNTABLE CARE ORGANIZATION. THE HEALTH SYSTEM EMPLOYS NEARLY 40,000 PEOPLE AND IS AFFILIATED WITH 13,900 PHYSICIANS MAKING IT ONE OF THE LARGEST EMPLOYERS IN EVERY COMMUNITY IT SERVES. IN THE TRADITION OF ITS FOUNDING SISTERS, SSMH STRIVES TO FULFILL ITS MISSION BY PROVIDING EXCEPTIONAL HEALTH CARE TO EVERYONE WHO COMES TO ITS HOSPITALS, REGARDLESS OF THEIR ABILITY TO PAY. ABOUT WAUPUN MEMORIAL HOSPITAL:WAUPUN MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN WAUPUN, WISCONSIN, AND PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO WAUPUN AND THE SURROUNDING RURAL AREAS. WAUPUN MEMORIAL HOSPITAL FEATURES A TWO-STORY PROVIDER CLINIC, CONSOLIDATING ALL ITS PROVIDER SERVICES INTO ONE FACILITY WITH A DIRECT CONNECTION TO THE LARGER RESOURCES OF THE HOSPITAL. A STATE-OF-THE-ART SURGERY AREA FEATURES THREE HIGH-TECH OPERATING ROOMS, AN ENDOSCOPY PROCEDURE ROOM, 11 PRE/POSTOPERATIVE PATIENT ROOMS, FOUR POST ANESTHESIA RECOVERY ROOMS AND CENTRALIZED STERILE PROCESSING AREA. THE HOSPITAL'S STAFF OF ASSOCIATES AND VOLUNTEERS IS DEDICATED TO PROVIDING SERVICES IN THE AREAS OF LABORATORY, CARDIOPULMONARY, REHABILITATION, RADIOLOGY, ULTRASOUND, MRI, SURGICAL, EMERGENCY, OUTPATIENT DIALYSIS, MEDICAL/SURGICAL SERVICES, INTENSIVE CARE AND OBSTETRICS.IN 2018, WAUPUN MEMORIAL HOSPITAL RECEIVED CERTIFICATION OF ITS CARDIAC REHAB PROGRAM BY THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION (AACVPR). WMH WAS RECOGNIZED FOR ITS COMMITMENT TO IMPROVING THE QUALITY OF LIFE BY ENHANCING STANDARDS OF CARE. AACVPR PROGRAM CERTIFICATION IS THE ONLY PEER-REVIEW ACCREDITATION PROCESS DESIGNED TO REVIEW INDIVIDUAL PROGRAMS FOR ADHERENCE TO STANDARDS AND GUIDELINES DEVELOPED AND PUBLISHED BY AACVPR AND OTHER PROFESSIONAL SOCIETIES. EACH PROGRAM IS REVIEWED BY THE AACVPR PROGRAM CERTIFICATION COMMITTEE AND CERTIFICATION IS AWARDED BY THE AACVPR BOARD OF DIRECTORS. AACVPR-CERTIFIED PROGRAMS ARE RECOGNIZED AS LEADERS IN THE FIELD OF CARDIOVASCULAR AND PULMONARY REHABILITATION BECAUSE THEY OFFER THE MOST ADVANCED PRACTICES AVAILABLE. WAUPUN MEMORIAL HOSPITAL ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS, PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM QUANTIFIABLE UNCOMPENSATED CARE:THIS SECTION INCLUDES A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE QUANTIFIED AS UNCOMPENSATED CARE:TRADITIONAL CHARITY CARE $782,903UNPAID COST OF MEDICAID $154,150TOTAL QUANTIFIABLE UNCOMPENSATED CARE $937,054 44721180 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 WI X BRADLEY REACH 6082416949 1808 W BELTLINE HWY MADISON WI 53713 DOUG CRONIN PT YR DIRECTOR 1.00 1.00 X 0 0 0 KATHY DUCHAC PT YR DIRECTOR, VICE CHAIR 1.00 1.00 X X 0 0 0 SCOTT HANSFIELD PT YR DIRECTOR 1.00 1.00 X 0 0 0 JAN HARMSEN PT YR DIRECTOR, CHAIR 1.00 1.00 X X 0 0 0 KATHLEEN HENDRICKS PT YR DIRECTOR 1.00 1.00 X 0 0 0 DAVID HOPP PT YR DIRECTOR 1.00 1.00 X 0 0 0 AMY MOHR PT YR DIRECTOR 1.00 1.00 X 0 0 0 BREANNA NAGEL PT YR DIRECTOR, CHIEF OF STAFF REPRESENTATIVE 1.00 1.00 X 0 0 0 ROBERT NAGLE PT YR DIRECTOR 1.00 1.00 X 0 0 0 BRITTANY PAGE PT YR DIRECTOR 1.00 1.00 X 0 0 0 KAREN REYNOLDS PT YR DIRECTOR 1.00 1.00 X 0 0 0 RHEA EMMER DIRECTOR 1.00 4.00 X 0 0 0 PENG HER DIRECTOR 1.00 4.00 X 0 0 0 MARK HOLZMAN DIRECTOR 1.00 4.00 X 0 0 0 JOAN KARSTON DIRECTOR 1.00 4.00 X 0 0 0 KATIE KENNEDY DIRECTOR 1.00 4.00 X 0 0 0 PATTI LEITZEN FYE DIRECTOR 1.00 4.00 X 0 0 0 JENNIFER MASKEL DIRECTOR, PHYSICIAN 1.00 40.00 X 0 142795 14024 WAYNE MATZKE DIRECTOR, VICE CHAIR 1.00 4.00 X X 0 0 0 THEODORE MILLER DIRECTOR 1.00 4.00 X 0 0 0 OLIVIA OTTE DIRECTOR 1.00 4.00 X 0 0 0 MATTHEW POGODZINSKI DIRECTOR, PHYSICIAN 1.00 40.00 X 0 755367 62067 WESLEY SPARKMAN DIRECTOR, CHAIR 1.00 4.00 X X 0 0 0 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT 1.00 55.00 X X 0 1428914 540322 DEANN THURMER PT YR DIRECTOR, PRESIDENT/CNO-WAUPUN MEMORIAL HOSP 40.00 0.00 X 0 407420 137142 RANDY COMBS TREASURER, CFO AT SSM HEALTH 1.00 55.00 X 0 2182354 1238074 DOUGLAS LONG SECRETARY, CHIEF LEGAL OFFICER AT SSM HEALTH 1.00 55.00 X 0 1425239 777013 STEVE SMOOT VICE PRESIDENT, COO AT SSM HEALTH 1.00 55.00 X 0 2054358 1204489 THOMAS KIRSCHBAUM ASSISTANT SECRETARY 1.00 45.00 X 0 532265 210384 0 8928712 4183515 0 0 1 0 CD SMITH CONSTRUCTION INC 125 CAMELOT DRIVE FOND DU LAC WI 54935 CONSTRUCTION SERVICES 713586 TRIMEDX HOLDINGS LLC 5451 LAKEVIEW PARKWAY S DR INDIANAPOLIS IN 46268 CLINICAL ENGINEERING SERVICES 579171 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 454800 J F AHERN CO 855 MORRIS ST FOND DU LAC WI 54936 FIRE PROTECTION SERVICES 379869 KASCHAK ROOFING INC 2301 W PURDUE ST MILWAUKEE WI 53209 CONSTRUCTION SERVICES 351096 10 1000 34579 24713 60292 NET PATIENT SERVICE RE 622110 59397961 59397961 340B PHARMACY REVENUE 456110 21110 21110 168951 168951 59588022 -4487 -4487 187855 0 187855 187855 187855 CAFETERIA REVENUE 722210 135314 135314 MOBILE MEALS 624200 19895 19895 155209 59986891 59588022 19895 318682 65373 65373 19240734 18790243 450491 955453 933083 22370 2732396 2668421 63975 1296401 1266048 30353 29282 29282 16160 36 16124 3500839 3500839 754970 740889 14081 1446234 1446234 1188632 1188632 56366 49747 6619 4143 3338 805 6757451 2872413 3885038 2749711 2749711 238240 118229 120011 MEDICAL SUPPLIES & EQUI 8121476 8119313 2163 LICENSES, DUES & SUBSCR 94400 72737 21663 BANK FEES 51296 770 50526 104803 105842 -1039 49404360 44721180 4683180 0 337154 355906 5074383 6669268 11903 31712 2353 51432426 18369051 32643374 33063375 305454 375013 48722992 52569049 87097613 93064323 4137326 296492 974447 144704 5111773 441196 X 81680386 92248114 305454 375013 81985840 92623127 87097613 93064323 X 10582531 -6 54762 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 2063 2063 0 PART II-B, LINE 1: THE ORGANIZATION PAID DUES TO VARIOUS NATIONAL & STATE HOSPITAL ASSOCIATIONS AND A PORTION OF THESE DUES WAS ALLOCATED TO LOBBYING ACTIVITIES. 190000 190000 38759183 11628363 27130820 813475 569565 243910 11453067 6171123 5281944 216701 216701 33063375 DUE FROM AFFILIATES 52172573 ESTIMATED THIRD PARTY SETTLMENT 396476 52569049 THIRD PARTY PAYOR 144704 144704 X PART X, LINE 2: WAUPUN MEMORIAL HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, SSM HEALTH (SSMH). SSMH EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2023 OR 2022. 1 1 X 1 X 1 X 1 1 1 0 1 1 782903 0 782903 0.01580 5051293 4897142 154151 0.00310 502858 535603 0 0.00000 6337054 5432745 937054 0.01890 48370 0 48370 0.00100 196363 0 196363 0.00400 0 0 0 0 123602 0 123602 0.00250 368335 368335 0.00750 6705389 5432745 1305389 0.02640 0 0 0 0 5000 0 5000 0.00010 2263 0 2263 0.00000 0 0 0 0 0 0 0 0 0 0 7263 7263 0.00010 1 1549780 0 4772916 8682391 -3909475 X 1 1 1 1 WAUPUN MEMORIAL HOSPITAL 620 WEST BROWN STREET WAUPUN WI 53963 WWW.SSMHEALTH.COM/LOCATIONS/WISCONSIN/ 1031 X X X WAUPUN MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES X 1 22 1 SSMHEALTH.COM/RESOURCES/ABOUT/COMMUNITY-HEALTH/COMMUNITY-HEALTH-NEEDS-ASSES 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE X SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE X SSMHEALTH.COM/RESOURCES/PATIENTS-VISITORS/PAY-MY-BIL/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: THE HOSPITAL FACILITIES ANALYZED SEVERAL HEALTH NEEDS OF THE COMMUNITY AND HAVE PRIORITIZED THOSE OF MOST CONCERN. THE PRIORITIZATION OF THE TOP SIGNIFICANT COMMUNITY HEALTH NEEDS IS DESCRIBED IN THE CHNA. WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT IS COMPRISED OF FIVE DIFFERENT DATA COLLECTION METHODS TO INCLUDE PRIMARY, SECONDARY, QUALITATIVE, AND QUANTITATIVE DATA. ONCE IT WAS COLLECTED, IT WAS ORGANIZED INTO FIVE HEALTH FOCUS AREAS. COMMUNITY HEAL TH SURVEY THE COMMUNITY HEALTH SURVEY CONDUCTED BY JKV RESEARCH, LLC., PROVIDES PRIMARY, QUANTITATIVE DATA COLLECTED FROM FOND DU LAC COUNTY RESIDENTS. THE DATA PROVIDES AN OVERVIEW OF BEHAVIORAL AND LIFESTYLE HABITS AS WELL AS PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS EXISTING WITHIN THE FOND DU LAC COUNTY ADULT POPULATION. THE SURVEY WAS MAILED OUT TO A RANDOM SAMPLE AND 674 ADULTS PARTICIPATED. AGGREGATE DATA FROM SIX SCHOOL DISTRICTS IN FOND DU LAC COUNTY IS INCLUDED IN THE COMMUNITY HEAL TH SURVEY REPORT TO PROVIDE STUDENT DATA WHEN AVAILABLE. PUBLIC INPUT SURVEY THE PRIORITY HEALTH ISSUES SURVEY WAS CONDUCTED TO PROVIDE AN OUTLET FOR THE COMMUNITY AT LARGE TO PROVIDE ADDITIONAL INPUT AND VOICE THEIR CONCERNS REGARDING THE MOST PRESSING COUNTY HEALTH ISSUES. THE SURVEY WAS AVAILABLE IN HARD COPY AT THE HEALTH DEPARTMENT AND ONLINE ON THE HEALTH DEPARTMENT'S WEBSITE. THE SURVEY WAS AVAILABLE TO TAKE IN ENGLISH AND SPANISH. RESIDENTS WERE ENCOURAGED TO REVIEW KEY FINDINGS FROM THE 2020 COMMUNITY HEALTH SURVEY BEFOREHAND TO PROVIDE ADDITIONAL FEEDBACK. A TOTAL OF 284 FOND DU LAC COUNTY RESIDENTS COMPLETED THE SURVEY. THE HEAL TH FOCUS AREAS RANKED MOST CONSISTENTLY IN THE TOP FIVE BY RESPONDENTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEALTH, FOOD SECURITY AND NUTRITION AND INFECTIOUS DISEASE. KEY INFORMANT INTERVIEWS A TOTAL OF 37 KEY INFORMANT INTERVIEWS WERE CONDUCTED TO PROVIDE FURTHER QUALITATIVE DATA REGARDING COMMUNITY NEEDS. KEY INFORMANTS IDENTIFIED WERE CONSIDERED COMMUNITY EXPERTS WHO CAN PROVIDE VALUABLE INSIGHT ON PRESSING HEAL TH ISSUES IN THE FOND DU LAC COUNTY COMMUNITY. THE TOP HEAL TH FOCUS AREAS RANKED MOST CONSISTENTLY BY KEY INFORMANTS WERE: MENTAL HEALTH, ALCOHOL AND OTHER DRUG USE, SOCIAL DETERMINANTS OF HEALTH, CHRONIC DISEASE, ORAL HEALTH AND FOOD SECURITY AND NUTRITION. COMMUNITY CONVERSATIONS NEW FOR THE 2021 COMMUNITY HEAL TH ASSESSMENT WAS DATA COLLECTED FROM COMMUNITY CONVERSATIONS THESE CONVERSATIONS WERE ORGANIZED BY MEMBERS OF THE SSM HEALTH GREATER FOND DU LAC REGION, FOND DU LAC COUNTY HEAL TH DEPARTMENT AND OTHER ENTITIES THAT SERVED AS HOST LOCATIONS FOR THESE EVENTS. THE PURPOSE OF THESE COMMUNITY CONVERSATIONS WAS TO FURTHER ENGAGE THE PUBLIC AND PROVIDE AN OPPORTUNITY FOR VARIOUS POPULATIONS TO VOICE THEIR INPUT THAT MAY OTHERWISE HAVE NOT BEEN HEARD. 16 COMMUNITY CONVERSATIONS WERE HELD ACROSS THE COUNTY, PROVIDING FURTHER INFORMATION REGARDING THE HEALTH NEEDS OF RESIDENTS IN FOND DU LAC COUNTY. TOP NEEDS IDENTIFIED FROM COMMUNITY CONVERSATIONS INCLUDE: ACCESS TO RESOURCES, MENTAL HEALTH, TRANSPORTATION, ACCESS TO CARE AND RACISM. HIGHLIGHTS AND THEMES FROM THESE CONVERSATIONS CAN BE FOUND THROUGHOUT THE REPORT. SECONDARY DATA SECONDARY DATA WAS COLLECTED FROM LOCAL, STATE, AND NATIONAL HEALTH SOURCES TO SUPPLEMENT THE COMMUNITY HEALTH SURVEY AND OTHER DATA COLLECTION INFORMATION LISTED ABOVE. THIS DATA HELPED BUILD A COMMUNITY HEALTH PROFILE FOR FOND DU LAC COUNTY AND ALLOWED THIS REPORT TO BE COMPARABLE TO OTHER COUNTIES AS WELL AS STATE AND NATIONAL BENCHMARKS. THE SECONDARY DATA COLLECTED IS INCLUDED IN THROUGHOUT THE HEALTH FOCUS AREA AND THE DEFINITION OF COMMUNITY PROFILES. WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: HOSPITALS INCLUDED IN THE CHNA WERE AGNESIAN HEALTHCARE (ST. AGNES HOSPITAL), WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER. WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: WAUPUN MEMORIAL HOSPITAL CONDUCTED THEIR CHNA IN COLLABORATION WITH HEALTHY FOND DU LAC COUNTY AND THE FOND DU LAC COUNTY HEALTH DEPARTMENT. WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL IDENTIFIED VARIOUS HEALTH NEEDS IN THE 2021 CHNA. IN ORDER TO MAKE MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENCY, THE HOSPITAL WILL PLACE PRIMARY FOCUS ON THE FOLLOWING KEY PRIORITIES:- MENTAL HEAL TH - CHRONIC DISEASE - SUBSTANCE USEMENTAL HEALTH ACCORDING TO THE WORLD HEALTH ORGANIZATION, THE DEFINITION OF HEAL TH IS A "STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY." MENTAL HEALTH IS SOMETHING WE ALL HAVE, AND IT VARIES IN ITS DEGREE FROM TIME TO TIME. IF THERE IS A SIGNIFICANT IMPACT ON OUR THINKING, FEELING AND/OR BEHAVIOR, TREATMENT, SERVICES OR INTERVENTION MAY BE REQUIRED. IN GENERAL, THE SOONER ONE GETS TREATMENT, THE BETTER THE OUTCOME. HAVING AN UNTREATED MENTAL DISORDER CAN CREATE SERIOUS PROBLEMS SUCH AS INCREASING THE CHANCE OF RISKY BEHAVIORS, DRUG OR ALCOHOL ADDICTION, AND IN EXTREME CASES, DEATH. IT ALSO CAN RUIN RELATIONSHIPS, CAUSE PROBLEMS AT WORK, AND MAKE IT DIFFICULT TO OVERCOME SERIOUS ILLNESSES. MENTAL HEALTH WAS IDENTIFIED AS THE NUMBER ONE PRIORITY TO ADDRESS AS A RESULT OF THE 2021 CHNA. MENTAL HEALTH NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO CHALLENGES, BARRIERS OR NEEDS RELATED TO PROVIDER AVAILABILITY, AFFORDABILITY, TRANSPORTATION, INSURANCE, STIGMA, SUBSTANCE USE, CULTURALLY SENSITIVE AND DIVERSE PROVIDERS AND SERVICES, STRESS, AND SUICIDE. ADDITIONALLY, STATISTICS SHOW:- 20 DEATHS BY SUICIDE REPORTED IN FOND DU LAC COUNTY IN 2020- 1 IN 5 ADULTS REPORTED TO HAVE A MENTAL HEALTH CONDITION IN THE PAST THREE YEARS- 1 IN 5 YOUTH REPORTED THEY ALWAYS OR NEARLY ALWAYS FELT SAD, BLUE OR DEPRESSED- 44% UNSERVED CHILDREN WITH MENTAL ILLNESS IN FOND DU LAC COUNTY- 79% ADULTS REPORT TO HAVE THEIR MENTAL HEALTH CONDITION UNDER CONTROL (DOWN FROM 96% IN 2017)IN ORDER TO DECREASE THE NUMBER OF DEATHS BY SUICIDE IN FOND DU LAC COUNTY, AS WELL AS INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES, THE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES:- EXPAND TRAININGS FOR QUESTION, PERSUADE, REFER (QPR), MENTAL HEALTH FIRST AID FOR ADULTS (MHFA), YOUTH MENTAL HEALTH FIRST AID (YMHFA). EXPLORE ADDITIONAL TRAININGS AND PROGRAMS FOR SUICIDE PREVENTION AND MENTAL HEALTH - POTENTIAL NEW PARTNERS AND COLLABORATIONS: BUSINESSES AND EMPLOYERS - INCREASE MEANS FOR DATA COLLECTION, MONITORING AND EVALUATION OF MENTAL HEALTH NEEDS, WITH COMMUNITY PARTNERS SUCH AS DCP, AND PUBLIC SAFETY DEPARTMENTS- RESEARCH UNIVERSAL AND INDIVIDUAL SCREENING TOOLS FOR BEHAVIORAL AND MENTAL HEALTH NEEDS ACROSS THE LIFESPAN AND DEVELOP A PLAN TO ASSESS AND EXPAND SBIRT AT THE RIPON COMMUNITY HOSPITAL - INCREASE MENTAL HEALTH/BEHAVIORAL HEAL TH SERVICES AND ACCESS TO THEM - INCREASE MENTAL HEALTH RESOURCES AND NAVIGATION TOOLS - DEVELOP MORE UNIVERSAL APPROACH TO SAFETY PLANNING ACROSS THE COUNTRY - DECREASE STIGMA, CAMPAIGNS, AWARENESS, TIC, ACES, BUILD COMMUNITYCHRONIC DISEASE CHRONIC DISEASES ARE ILLNESSES THAT LAST A LONG TIME, DO NOT GO AWAY ON THEIR OWN, ARE RARELY CURED, AND OFTEN RESULT IN DISABILITY LATER IN LIFE. MULTIPLE HEAL TH CONDITIONS ARE CLASSIFIED AS CHRONIC DISEASES SUCH AS HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, HEART DISEASE, OBESITY, DIABETES, ASTHMA AND MORE. NUTRITION AND PHYSICAL ACTIVITY ARE IMPORTANT TO MAINTAIN AND IMPROVE OVERALL HEALTH AND BOTH PLAY A PROMINENT ROLE IN OBESITY PREVENTION AND CONTROL. AS ESTABLISHED IN THE U.S. DIETARY GUIDELINES, GOOD NUTRITION INCLUDES MEETING NUTRIENT RECOMMENDATIONS YET KEEPING CALORIES UNDER CONTROL. PHYSICAL ACTIVITY MEANS ANY BODILY ACTIVITY THAT ENHANCES OR MAINTAINS PHYSICAL FITNESS AND OVERALL HEALTH. OBESITY IS ONE OF THE MOST CRITICAL HEALTH ISSUES OF OUR TIME AND IS A COMPLEX HEALTH ISSUE RESULTING FROM MANY INTERACTING CAUSES AND FACTORS IN OUR SOCIETY, BEHAVIOR, AND GENETICS. OBESITY IS ALSO ASSOCIATED WITH POORER MENTAL HEALTH OUTCOMES AND REDUCES QUALITY OF LIFE. THE BURDEN OF OBESITY AND OTHER DIET-RELATED CHRONIC DISEASES ARE VAST, AND RATES CONTINUE TO RISE. CHANGES AT THE COMMUNITY LEVEL, SUCH AS POLICIES, SYSTEMS, AND ENVIRONMENT, ARE MORE LIKELY TO BE EFFECTIVE, AL THOUGH THEY MAY BE MORE DIFFICULT TO ACHIEVE. ACCORDING TO FOND DU LAC COMMUNITY MEMBERS RESPONSES THROUGHOUT THE ASSESSMENT, COMMON BARRIERS AND CHALLENGES TO CHRONIC DISEASES AND RELATED HEALTH BEHAVIORS INCLUDED, BUT NOT LIMITED TO, ACCESS AND AFFORDABILITY TO HEALTHY FOODS, AWARENESS OF NUTRITIOUS FOOD AND COOKING HEALTHY MEALS, ACCESS TO INDOOR AND OUTDOOR RECREATION, ACCESS AND AFFORDABILITY OF HEALTHCARE SERVICES. INSURANCE, STIGMA, TRANSPORTATION, AND CULTURAL COMPETENCIES. ADDITIONALLY, STATISTICS SHOW:- HEART DISEASES IS THE NUMBER ONE CAUSE OF DEATH AMONG ADULTS- 75% (3 IN 4) ADULTS WERE CLASSIFIED AS AT LEAST OVERWEIGHT- ABOUT 1 IN 3 YOUTH WERE CLASSIFIED AS AT LEAST OVERWEIGHT - 52% OF ADULTS REPORTED MEETING AEROBIC PHYSICAL ACTIVITY GUIDELINES- 23% OF ADULTS REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY- 17% OF YOUTH REPORTED EATING THE RECOMMENDED SERVINGS OF FRUIT PER DAY - 4,920 (6%) HOUSEHOLDS REPORTED THEY WENT HUNGRY BECAUSE THEY COULDN'T AFFORD ENOUGH FOODIN ORDER TO IMPROVE RESIDENTS' WEIGHT, PHYSICAL ACTIVITY, NUTRITION, AND INCREASE BREASTFEEDING, THE HOSPITAL HAS IMPLEMENTED THE FOLLOWING ACTION ITEMS:- RESEARCH AND IDENTIFY CHRONIC DISEASE PREVENTION AND SELF-MANAGEMENT CLASSES- INCREASE TRAIL USAGE, ENHANCE BIKE AND PEDESTRIAN MASTER PLANS- IMPLEMENT A PHYSICAL ACTIVITY CAMPAIGN- INCREASE SCHOOLS PARTICIPATING IN SAFE ROUTES TO SCHOOL - IDENTIFY EXISTING EFFORTS AND ASSESS IMPACT- INCREASE SNAP USAGE - INCREASE ACCESS TO AND AFFORDABILITY OF FRUITS AND VEGETABLES - ASSESS CURRENT FOOD FORESTS OR COMMUNITY/SHARED GARDENS AND INCREASE VALUE/IMPACT - INCREASE HEALTH PROMOTION PROGRAMS OFFERED TO LOW-INCOME HOUSING RESIDENTS - INCREASE NUMBER OF CHILDCARE CENTERS AND BUSINESS CENTERS WHO HAVE ADOPTED THE TEN STEPS TO BREASTFEEDING-FRIENDLY TOOLKIT (PROMOTE SUPPORT FOR BREASTFEEDING MOTHERS IN THE WORKPLACE, EARLY CHILDHOOD EDUCATION SETTINGS, AND THROUGHOUT THE COMMUNITYSUBSTANCE USE ALCOHOL AND OTHER DRUG USE MEANS ANY USE OF A SUBSTANCE THAT RESULT IN NEGATIVE CONSEQUENCES. THIS INCLUDES A BROAD ARRAY OF MOOD-ALTERING SUBSTANCES SUCH AS ALCOHOL, TOBACCO, PRESCRIPTION SUBSTANCES, AND ILLEGAL SUBSTANCES LIKE METHAMPHETAMINE AND HEROIN. NEGATIVE CONSEQUENCES OR UNHEALTHY USES INCLUDE BUT ARE NOT LIMITED TO, OPERATING A MOTOR VEHICLE WHILE INTOXICATED, DRINKING WHILE PREGNANT, ALCOHOL DEPENDENCE, FETAL ALCOHOL SPECTRUM DISORDER, ALCOHOL-RELATED HOSPITALIZATIONS, AND MORE. SUBSTANCE USE WAS IDENTIFIED AS THE NUMBER THREE PRIORITY TO ADDRESS IN THE 2022-2024 CHIP. SUBSTANCE USE NEEDS IN FOND DU LAC COUNTY MAY INCLUDE, BUT IS NOT LIMITED TO BARRIERS, CHALLENGES AND NEEDS RELATED TOBACCO, VAPING, DRUGS (NARCOTICS, MARIJUANA, ETC.), PRESCRIPTION MEDICATIONS, AND ALCOHOL USE, MENTAL HEALTH AND ACCESS TO CARE. THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT, SUBSTANCE USE WAS CONSISTENTLY RANKED AS A TOP PRIORITY. ADDITIONALLY, STATISTICS SHOW:- 25 OPIOID RELATED DEATHS IN FOND DU LAC COUNTY IN 2020, OVER DOUBLE THE DEATHS FROM 2019 - 74% OF ADULTS REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 22% OF YOUTH REPORTED DRINKING ALCOHOL IN THE PAST MONTH - 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTH- 37% OF ADULTS REPORTED BINGE DRINKING ALCOHOL IN THE PAST MONTHTHE HOSPITAL'S ACTION PLAN INCLUDES THE FOLLOWING INITIATIVES TO DECREASE UNDERAGE DRINKING AND BINGE DRINKING, AND DECREASE MISUSE OF OPIOIDS/PRESCRIPTION MEDICATION:- INCREASE FESTIVALS EVALUATED ANNUALLY USING THE COMMUNITY EVENTS BEST PRACTICES TOOLKIT- INCREASE NUMBER OF LAW ENFORCEMENT AGENCIES COMPLETING ANNUAL COMPLIANCE CHECKS- DECREASE ALCOHOL OUTLET DENSITY - AWARENESS AND EDUCATION CAMPAIGN- INCREASE NUMBER OF NARCAN TRAININGS AND KITS DISTRIBUTED - SYRINGE SERVICES PROGRAM- PRESCRIPTION MEDICATION PRESCRIBING PRACTICES AND PAIN MANAGEMENT - PRESCRIPTION MEDICATION DISPOSALTHE HOSPITAL HAS NO PLANS TO DISCONTINUE OTHER COMMUNITY BENEFIT EFFORTS ADDRESSING THE REMAINING CHNA-IDENTIFIED NEEDS. WAUPUN MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: PATIENTS AND THEIR GUARANTOR'S INCOME IS USED IN DETERMINING INCOME LEVEL FOR FREE OR DISCOUNTED CARE. PART I, LINE 3C: PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF THE HOSPITAL; HOWEVER THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO COMMERCIALLY INSURED [OR MEDICARE] PATIENTS. IN SUCH CASES, OTHER FACTORS MAY BE CONSIDERED IN DETERMINING THEIR ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES, INCLUDING: * BANK ACCOUNTS, INVESTMENTS AND OTHER ASSETS* EMPLOYMENT STATUS AND EARNING CAPACITY* AMOUNT AND FREQUENCY OF BILLS FOR HEAL TH CARE SERVICES * OTHER FINANCIAL OBLIGATIONS AND EXPENSES * GENERALLY, FINANCIAL RESPONSIBILITY WILL BE NO MORE THAN 25% OF GROSS FAMILY INCOME. THE HOSPITAL MAY UTILIZE PREDICTIVE ANALYTICAL SOFTWARE OR OTHER CRITERIA TO ASSIST IN MAKING A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IN SITUATIONS WHERE THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE BUT HAS NOT PROVIDED THE NECESSARY DOCUMENTATION TO MAKE A DETERMINATION. THIS PROCESS IS CALLED "PRESUMPTIVE ELIGIBILITY." PART I, LINE 6A: SSM HEALTH CARE CORPORATION, 46-6029223 PART I, LINE 7: THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B, AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H, AND 71 ARE REPORTED AT COST AS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE CALCULATION OF SCHEDULE H, PART I, LINE 7, COLUMN F UTILIZES 990, PART IX, LINE 25, COLUMN A, WHICH DOES NOT INCLUDE BAD DEBT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: WAUPUN MEMORIAL HOSPITAL PARTICIPATES IN A WIDE ARRAY OF COMMUNITY AND CIVIC ORGANIZATIONS IN THE PROMOTION OF HEAL TH CARE AND COMMUNITY BUILDING ACTIVITIES. SPECIFIC ACTIVITIES REPORTED IN PART II OF SCHEDULE H INCLUDE THE FOLLOWING: ENVIRONMENTAL IMPROVEMENTS: SHARPS CONTAINERS ARE SUPPLIED TO OUR PATIENTS AND CUSTOMERS THROUGHOUT THE COMMUNITY FREE OF CHARGE, WITH FULL CONTAINERS ABLE TO BE DROPPED OFF AT ALL FACILITY SITES FOR DISPOSAL. PART III, LINE 2: AS A RESULT OF NEW ACCOUNTING GUIDANCE, BAD DEBT IS NO LONGER AN EXPENSE, BUT IS INCLUDED AS A REDUCTION IN NET PATIENT REVENUE. PART III, LINE 3: FOR FINANCIAL STATEMENT PURPOSES, SSM HEALTH HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. THEREFORE, THERE IS NO AMOUNT REPORTED ON PART III, LINE 3 FOR THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER SSM HEALTH'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: WAUPUN MEMORIAL HOSPITAL IS PART OF THE SSM HEALTH CONSOLIDATED AUDIT. THE FOOTNOTE THAT REFERENCES THE TREATMENT OF UNCOLLECTIBLE ACCOUNTS AND IMPLICIT PRICE CONCESSIONS IN THE DECEMBER 31, 2023 CONSOLIDATED AUDIT IS CONTAINED ON PAGE 13 AND 14 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST WAS BASED ON THE MEDICARE PRINCIPLES USED IN COMPLETING THE MEDICARE COST REPORT. ALL COST REPORTED CAME FROM THE MEDICARE COST REPORT. SSM HEALTH ACCEPTS ALL MEDICARE PATIENTS WITH THE KNOWLEDGE THAT THERE MAY BE SHORTFALLS AND OPERATES TO PROMOTE THE HEAL TH OF THE COMMUNITY. SSM HEALTH BELIEVES THAT ANY MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE MEDICARE DOES NOT FULLY COMPENSATE HOSPITALS FOR THE COST OF PROVIDING HOSPITAL CARE TO MEDICARE BENEFICIARIES, AS MEDICARE ALLOWED COST IS LESS THAN ACTUAL COST. PART III, LINE 9B: WAUPUN MEMORIAL HOSPITAL HAS ESTABLISHED A WRITTEN CREDIT AND COLLECTION POLICY AND PROCEDURES. THE BILLING AND COLLECTION POLICIES AND PRACTICES REFLECT THE MISSION AND VALUES OF SSM HEAL TH, INCLUDING OUR SPECIAL CONCERN FOR PEOPLE WHO ARE POOR AND VULNERABLE. WAUPUN MEMORIAL HOSPITAL EMBRACES ITS RESPONSIBILITY TO SERVE THE COMMUNITIES IN WHICH IT PARTICIPATES BY ESTABLISHING SOUND BUSINESS PRACTICES. WAUPUN MEMORIAL HOSPITAL'S BILLING AND COLLECTION PRACTICES WILL BE FAIRLY AND CONSISTENTLY APPLIED. ALL STAFF AND VENDORS ARE EXPECTED TO TREAT ALL PATIENTS CONSISTENTLY AND FAIRLY REGARDLESS OF THEIR ABILITY TO PAY. THEY RESPOND TO PATIENTS IN A PROMPT AND COURTEOUS MANNER REGARDING ANY QUESTIONS ABOUT THEIR BILLS AND PROVIDE NOTIFICATION OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. ALL UNINSURED PATIENTS WILL BE PROVIDED A STANDARD DISCOUNT FOR MEDICALLY NECESSARY INPATIENT AND OUTPATIENT SERVICES, INCLUDING SERVICES PROVIDED AT OFF-CAMPUS OUTPATIENT SITES. THE HOSPITAL DETERMINED THE AMOUNT OF THE DISCOUNT BASED ON THE LOCAL MANAGED CARE MARKET, APPLICABLE STATUTORY REQUIREMENTS AND OTHER RELEVANT LOCAL CIRCUMSTANCES. THE RATE MUST BE NO LESS THAN THE LOWEST EFFECTIVE DISCOUNT RATE AND NO GREATER THAN THE HIGHEST EFFECTIVE DISCOUNT RATE FOR THE CURRENT MANAGED CARE CONTRACTS OF THE HOSPITAL. UNINSURED PATIENTS MAY ALSO QUALIFY FOR AN ADDITIONAL DISCOUNT BASED UPON FINANCIAL NEED UNDER THE SYSTEM FINANCIAL ASSISTANCE POLICY. ALL ACCOUNTS DUE FROM THE PATIENT WILL RECEIVE A STATEMENT AFTER DISCHARGE OR AFTER FINAL ADJUDICATION FROM PATIENT'S INSURANCE. GENERALLY THE PATIENT WILL RECEIVE 4 MONTHS (120 DAYS) OF IN-HOUSE COLLECTION EFFORTS (INCLUDING EARLY OUT VENDORS) AND 12 MONTHS OF BAD DEBT COLLECTION EFFORTS. THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO DETERMINE FAP ELIGIBILITY INCLUDING: 1. THE FINANCIAL ASSISTANCE SUMMARY WILL BE INCLUDED WITH EACH BILLING STATEMENT 2. EXTRAORDINARY COLLECTION ACTIVITY (ECAS) MAY NOT OCCUR UNTIL BAD DEBT PLACEMENT AND ONLY AFTER 120 DAYS. 3. ECAS MUST BE SUSPENDED IF A GUARANTOR SUBMITS A FAP APPLICATION DURING THE APPLICATION PERIOD. 4. REASONABLE MEASURES MUST BE TAKEN TO REVERSE ECAS IF THE APPLICATION IS APPROVED WHICH MAY INCLUDE REFUNDING ANY PAYMENTS MADE IN EXCESS OF AMOUNTS OWED AS AN FAP-ELIGIBLE INDIVIDUAL. 5.BAD DEBT VENDORS WILL GAIN WRITTEN APPROVAL FROM SSM PRIOR TO ENGAGING IN ECAS. SSM WILL REVIEW THE ACCOUNTS AND VERIFY SATISFACTORY COMPLETION OF REASONABLE EFFORTS DURING THE NOTIFICATION AND APPLICATION PERIOD. A WAIVER IS NOT CONSIDERED REASONABLE EFFORTS. OBTAINING A SIGNED WAIVER THAT AN INDIVIDUAL DOES NOT WISH TO APPLY FOR FAP ASSISTANCE OR RECEIVE FAP APPLICATION INFORMATION WILL NOT MEET THE REQUIREMENT TO MAKE "REASONABLE EFFORTS" TO DETERMINE WHETHER THE INDIVIDUAL IS FAP-ELIGIBLE BEFORE ENGAGING IN ECAS. ALL OUTSIDE COLLECTION AGENCIES MUST COMPLY WITH STATE AND FEDERAL LAWS, COMPLY WITH THE ASSOCIATION OF CREDIT AND COLLECTION PROFESSIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY AND COMPLY WITH WAUPUN MEMORIAL HOSPITAL'S COLLECTION AND FINANCIAL ASSISTANCE POLICIES. PART VI, LINE 2: SSM HEALTH (SSMH) PARTICIPATES IN COMMUNITY BENEFIT ACCORDING TO OUR VISION. THROUGH OUR PARTICIPATION IN THE HEALING MINISTRY OF JESUS CHRIST, COMMUNITIES, ESPECIALLY THOSE THAT ARE ECONOMICALLY, PHYSICALLY, AND SOCIALLY MARGINALIZED, WILL EXPERIENCE IMPROVED HEALTH IN MIND, BODY, SPIRIT AND ENVIRONMENT. IN THE TRADITION OF OUR FOUNDERS, THE FRANCISCAN SISTERS OF MARY, CARING FOR THOSE IN GREATEST NEED REMAINS OUR ORGANIZATIONAL PRIORITY. TODAY OUR SYSTEM BOARD MONITORS COMMUNITY BENEFIT EFFORTS, AND VIEWS ACHIEVEMENT OF OUR VISION AS A PRIMARY RESPONSIBILITY. THE PURPOSE OF SSM'S COMMUNITY BENEFIT PROGRAM IS TO ASSESS AND ADDRESS COMMUNITY HEAL TH NEEDS. MAKING OUR COMMUNITIES HEALTHIER IN MEASURABLE WAYS IS ALWAYS OUR GOAL. TO FULFILL THIS COMMITMENT, SSM'S COMMUNITY BENEFIT IS DIVIDED INTO TWO PARTS: 1) COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND 2) COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA). THE CHNA IS AN ASSESSMENT AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS AND THE ADOPTION AND IMPLEMENTATION OF STRATEGIES TO ADDRESS THOSE NEEDS. A CHNA IS CONDUCTED EVERY THREE YEARS BY EACH HOSPITAL ACCORDING TO THE FOLLOWING STEPS: *ASSESS AND PRIORITIZE COMMUNITY HEAL TH NEEDS: GATHER CHNA DATA FROM SECONDARY SOURCES; OBTAIN INPUT FROM STAKEHOLDERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY THROUGH INTERVIEWS AND FOCUS GROUPS; USE DATA TO SELECT TOP HEALTH PRIORITIES; AND COMPLETE WRITTEN CHNA. *DEVELOP, ADOPT, AND IMPLEMENT STRATEGIES TO ADDRESS TOP-HEALTH PRIORITIES: ESTABLISH STRATEGIES TO ADDRESS PRIORITIES; COMPLETE STRATEGIC IMPLEMENTATION PLAN; OBTAIN REGIONAL/DIVISIONAL BOARD APPROVAL; AND INTEGRATE STRATEGIES INTO OPERATIONAL PLAN. *MAKE CHNA WIDELY AVAILABLE TO THE PUBLIC: PUBLISH CHNA AND SUMMARY DOCUMENT ON HOSPITAL'S WEBSITE. *MONITOR, TRACK, AND REPORT PROGRESS ON TOP HEALTH PRIORITIES: COLLECT DATA AND EVALUATE PROGRESS; REPORT TO REGIONAL/DIVISIONAL BOARD EVERY SIX MONTHS AND SYSTEM BOARD EVERY YEAR; SHARE FINDINGS WITH COMMUNITY STAKEHOLDERS; AND SEND RESULTS TO FINANCE FOR SUBMISSION TO THE INTERNAL REVENUE SERVICE (IRS). SYSTEM OFFICE STAFF AND LEADERS OVERSEE AND MONITOR SSMH'S COMMUNITY BENEFIT PROGRAM, AND ENSURE REPORTING IS IN COMPLIANCE WITH IRS REGULATIONS. IN COLLABORATION WITH COMMUNITY STAKEHOLDERS AND PARTNER ORGANIZATIONS, SSM HEAL TH CARE CORPORATION ALSO IDENTIFIES NEEDS BASED ON ASSESSMENTS AND RESEARCH, AND SSMH FACILITIES ALSO INVOLVE CASE MANAGERS AND CARE TEAM STAFF TO PINPOINT CRITICAL HEALTH ISSUES IN THE COMMUNITY. ALL HOSPITAL CHNAS ARE COMPLETED, APPROVED, AND INTEGRATED INTO THE ORGANIZATION'S STRATEGIC PLAN. WE CONTINUE TO MONITOR AND ASSESS THE PROGRESS OF OUR LOCAL EFFORTS IN THE SPIRIT OF CARING FOR OTHERS AND IMPROVING COMMUNITY HEALTH. PART VI, LINE 3: EACH ENTITY PROVIDING MEDICAL SERVICE SHALL PROVIDE INFORMATION TO THE PUBLIC REGARDING ITS CHARITY CARE POLICIES AND THE QUALIFICATION REQUIREMENTS FOR EACH OF ITS FACILITIES. WHEN STANDARD SYSTEM NOTICES AND COMMUNICATION REGARDING CHARITY CARE ARE AVAILABLE, THESE MUST BE USED. MODIFICATIONS TO THE STANDARD MAY BE MADE TO COMPLY WITH STATE AND LOCAL LAWS, AS WELL AS REFLECT CULTURALLY SENSITIVE TERMINOLOGY FOR THE POLICY. ALL NOTICES ARE EASY TO UNDERSTAND BY THE GENERAL PUBLIC, CULTURALLY APPROPRIATE AND AVAILABLE IN THOSE LANGUAGES THAT ARE PREVALENT IN THE COMMUNITY. THEY PROVIDE INFORMATION ABOUT: * THE PATIENT'S RESPONSIBILITY FOR PAYMENT, * THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM PUBLIC PROGRAMS AND ENTITY CHARITY CARE AND PAYMENT ARRANGEMENTS,* THE ENTITY'S CHARITY POLICY AND APPLICATION PROCESS, AND * WHO TO CONTACT TO GET ADDITIONAL INFORMATION OR FINANCIAL COUNSELINGTHE FOLLOWING TYPES OF NOTICES TO THE PUBLIC ARE PROVIDED: *SIGNS IN THE EMERGENCY DEPARTMENT, OUTPATIENT AND INPATIENT REGISTRATION AND PUBLIC WAITING AREAS.*BROCHURES OR FLIERS PROVIDED AT TIME OF REGISTRATION AND AVAILABLE IN THE FINANCIAL COUNSELING AREAS. *NOTICES SENT WITH OR ON PATIENT BILLS OR COMMUNICATIONS SENT TO PATIENTS AND GUARANTORS RELATED TO MEDICAL SERVICES. *APPLICATIONS PROVIDED TO UNINSURED PATIENTS AT THE TIME OF REGISTRATION. THE APPLICATION FOR CHARITY CARE, TOGETHER WITH ANY INSTRUCTIONS, MUST CLEARLY STATE THE POLICIES REGARDING CHARITY CARE, INCLUDING EXCLUDED SERVICES, ELIGIBILITY CRITERIA AND DOCUMENTATION REQUIREMENTS. INFORMATION ABOUT THE ENTITY'S CHARITY POLICIES IS ALSO PROVIDED TO PUBLIC AGENCIES. PART VI, LINE 4: WAUPUN MEMORIAL HOSPITAL DEFINES ITS COMMUNITY AS AN AREA SIMILAR TO ITS PRIMARY SERVICE DELIVERY AREA. THE PRIMARY SERVICE AREA FOR THE HOSPITAL INCLUDES PART OF WAUPUN AND THE BRANDON AREA IN FOND DU LAC COUNTY, AND PART OF WAUPUN AND FOX LAKE AREA IN DODGE COUNTY. THE HOSPITAL'S SECONDARY SERVICE AREA INCLUDES THE RIPON AREA, PART OF FOND DU LAC COUNTY, AND COMMUNITIES IN DODGE AND GREEN LAKE COUNTIES, SUCH AS MAYVILLE, BEAVER DAM, RANDOLPH, MARKESAN AND MARQUETTE, AND A SMALL PORTION OF COLOMBIA COUNTY.APPROXIMATELY 75% OF THE HOSPITAL'S PATIENT POPULATION COMES FROM THE PRIMARY SERVICE AREA, AND ANOTHER 15% FROM THE SECONDARY SERVICE AREA. WAUPUN MEMORIAL HOSPITAL IS LOCATED IN WAUPUN, WISCONSIN. THE WAUPUN MEMORIAL HOSPITAL SERVICE AREA INCLUDES PORTIONS OF DODGE AND GREEN LAKE COUNTIES. GREEN LAKE COUNTY HAS A POPULATION OF 18,913 PEOPLE. DODGE COUNTY HAS A POPULATION OF 87,715 PEOPLE. BOTH COUNTIES INCLUDE VAST RURAL COMMUNITIES, SUPPORT A LARGE INDUSTRIAL WORKFORCE, AND COMPARED TO FOND DU LAC COUNTY HAVE MORE INDIVIDUALS LIVING IN POVERTY. SOME OF THE LARGE FACTORIES EMPLOY A CONSIDERABLE HISPANIC AND SPANISH SPEAKING POPULATION, ARE ALSO MORE PERSONS IN POVERTY IN DODGE AND GREEN LAKE COUNTIES COMPARED TO FOND DU LAC COUNTY. WAUPUN IS ALSO HOME TO THREE PRISON SYSTEMS, WAUPUN CORRECTIONAL INSTITUTION, DODGE CORRECTIONAL INSTITUTION AND JOHN C BURKE CORRECTIONAL CENTER. DODGE CORRECTIONAL INSTITUTION'S OPERATIONAL CAPACITY IS 1,165 PEOPLE, AND FOR THE YEAR 2020 SAW 5,821 PEOPLE IN THEIR FACILITY. WAUPUN CORRECTIONAL INSTITUTION HAS AN OPERATIONAL CAPACITY OF 1,290 PEOPLE. ADDITIONAL DEMOGRAPHIC AND STATISTICAL DATA ON THE HOSPITAL'S SERVICE AREA CAN BE FOUND THROUGHOUT THE CHNA. PART VI, LINE 5: WAUPUN MEMORIAL HOSPITAL PARTICIPATES IN A WIDE ARRAY OF COMMUNITY PROGRAMS THROUGHOUT THE AREA TO FURTHER ITS EXEMPT PURPOSE OF PROMOTING THE HEAL TH OF THE COMMUNITY. THE COMMUNITY INITIATIVES BUILD ON THE STRENGTHS OF OUR COMMUNITIES AND SYSTEMS TO IMPROVE THE QUALITY OF LIFE AND TO CREATE A SENSE OF HOPE. COMMUNITY BENEFIT INITIATIVES BUILD COMMUNITY CAPACITY AND INDIVIDUAL EMPOWERMENT THROUGH COMMUNITY ORGANIZING, LEADERSHIP DEVELOPMENT, PARTNERSHIPS, AND COALITION BUILDING. OUR COMMUNITY HEAL TH PROGRAMS PROVIDE COMPASSIONATE AND COMPETENT CARE WHILE THEY PROMOTE HEAL TH IMPROVEMENT BY REACHING DIRECTLY INTO THE COMMUNITY TO ENSURE THAT LOW-INCOME AND UNDER-SERVED PERSONS CAN ACCESS HEAL TH CARE SERVICES. IN RESPONSE TO THE GLOBAL CORONAVIRUS PANDEMIC, WAUPUN MEMORIAL HOSPITAL WORKED RELENTLESSLY TO RESPOND TO COMMUNITY NEEDS BY DEVELOPING AND IMPLEMENTING STRATEGIES TO ADDRESS SOCIAL NEEDS OF THOSE SERVED, PROVIDING SCREENING & TESTING SERVICES, PERSONAL PROTECTIVE EQUIPMENT AND EDUCATION THROUGHOUT THE COMMUNITY, AS WELL AS TREATMENT FOR THOSE WHO PRESENTED WITH COVID-19. WAUPUN MEMORIAL HOSPITAL PROMOTES GRASSROOTS ADVOCACY AND ENGAGES PERSONS OF INFLUENCE TO AFFECT SOCIAL AND PUBLIC POLICY CHANGE IN ORDER TO PROMOTE COMMUNITY HEALTH. WAUPUN MEMORIAL HOSPITAL ALSO FURTHERS ITS EXEMPT PURPOSE WITH THE FOLLOWING ACTIVITIES: *OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY, *HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, *ENGAGES IN THE TRAINING AND EDUCATION OF HEAL TH CARE PROFESSIONALS, *PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS *ALL SURPLUS FUNDS GENERATED BY SSMH ENTITIES ARE REINVESTED IN IMPROVING OUR PATIENT CARE DELIVERY SYSTEM. PART VI, LINE 6: WAUPUN MEMORIAL HOSPITAL IS A 501(C)(3) ORGANIZATION AND IS A MEMBER OF THE INTEGRATED HEAL TH CARE SYSTEM KNOW AS SSM HEALTH. SSM HEALTH (SSMH) IS A CENTRALLY MANAGED, FULLY INTEGRATED HEAL TH CARE DELIVERY SYSTEM WITH ITS HEADQUARTERS BASED IN ST. LOUIS, MISSOURI. SSM HEALTH CARE CORPORATION (SSMHCC) (DOING BUSINESS AS SSMH) IS THE PRINCIPAL NOT-FOR-PROFIT CORPORATION AND HAS BEEN ESTABLISHED AS THE PARENT CORPORATION. SSMH OWNS AND OPERATES 22 ADULT HOSPITALS, ONE PEDIATRIC HOSPITAL, THIRTEEN POST-ACUTE CARE FACILITIES, A NATIONAL PHARMACY BENEFIT MANAGEMENT COMPANY (PBM), AN EXTENSIVE NETWORK OF PHYSICIAN PRACTICE OPERATIONS, AND OTHER HEAL TH CARE BUSINESSES. SSMH'S HOSPITAL OPERATIONS ARE LOCATED PRIMARILY IN MISSOURI, WISCONSIN, OKLAHOMA AND ILLINOIS, AND ITS RELATED BUSINESSES PROVIDE HEALTH RELATED SERVICES IN 50 STATES. SSMH'S MISSION STATEMENT IS AS FOLLOWS: THROUGH OUR EXCEPTIONAL HEAL TH CARE SERVICES, WE REVEAL THE HEALING PRESENCE OF GOD. SSMHCC AND MOST OF ITS AFFILIATED SUBSIDIARY CORPORATIONS HAVE BEEN GRANTED EXEMPTION FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). CERTAIN SUBSIDIARIES OF SSMH ARE FOR-PROFIT ENTITIES THAT ARE TAXABLE UNDER THE IRC. SSMH IS SPONSORED BY SSM HEAL TH MINISTRIES, AN INDEPENDENT NINE-MEMBER BODY COMPOSED OF TWO FRANCISCAN SISTERS OF MARY, ONE SISTER OF ST. AGNES, ONE JESUIT PRIEST, AND FIVE LAY PERSONS WHO COLLECTIVELY HOLD CERTAIN RESERVED POWERS OVER SSMH. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 LIVING HOPE FOOD PANTRY 740 W STATE STREET FOX LAKE WI 53933 813450246 501(C)(3) 5828 0 CHARITABLE SUPPORT MORAINE PARK FOUNDATION 235 N NATIONAL AVE FOND DU LAC WI 54936 510188166 501(C)(3) 10000 0 CHARITABLE SUPPORT ST KATHERINE DREXEL SHELTER - ST VINCENT DE PAUL FOND DU LAC COUNTY 358 N PETERS AVE FOND DU LAC WI 54936 390824875 501(C)(3) 10000 0 CHARITABLE SUPPORT 3 0 PART I, LINE 2: THE PROCEDURES USED TO MONITOR THE USE OF GRANT FUNDING VARIES BASED ON THE GRANT RECIPIENT. GRANTS TO RELATED ENTITIES ARE MONITORED DIRECTLY BY THE ORGANIZATION WHEREBY THE RECIPIENT REPORTS ON THE SPECIFIC USE OF THE FUNDING. FOR GRANTS TO UNRELATED ENTITIES, THE ORGANIZATION UTILIZES THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY (CBISA) TO TRACK, STORE AND REPORT A WIDE RANGE OF INFORMATION RELATED TO GRANTS AND OVERALL COMMUNITY IMPACT. X 0 0 0 1 0 0 0 0 0 0 0 RANDY COMBS TREASURER, CFO AT SSM HEALTH 0 1242308 0 669269 0 270777 0 1203989 0 34085 0 3420428 0 669269 STEVE SMOOT VICE PRESIDENT, COO AT SSM HEALTH 0 1173646 0 737192 0 143520 0 1164125 0 40364 0 3258847 0 878090 DOUGLAS LONG SECRETARY, CHIEF LEGAL OFFICER AT SS 0 759270 0 495539 0 170430 0 753634 0 23379 0 2202252 0 495539 SUE ANDERSON DIRECTOR, REGIONAL PRESIDENT 0 765767 0 330759 0 332388 0 520449 0 19873 0 1969236 0 386663 MATTHEW POGODZINSKI DIRECTOR, PHYSICIAN 0 753607 0 0 0 1760 0 19050 0 43017 0 817434 0 0 THOMAS KIRSCHBAUM ASSISTANT SECRETARY 0 388964 0 99618 0 43683 0 172359 0 38025 0 742649 0 99618 DEANN THURMER PT YR DIRECTOR, PRESIDENT/CNO-WAUPUN 0 317834 0 58132 0 31454 0 111051 0 26091 0 544562 0 84873 JENNIFER MASKEL DIRECTOR, PHYSICIAN 0 142370 0 0 0 425 0 10628 0 3396 0 156819 0 0 PART I, LINE 1A AN INDIVIDUAL LISTED ON PART VII, SECTION A, RECEIVED TAX INDEMNIFICATION/GROSS UP PAYMENTS IN 2023, WHICH WAS INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 3 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, PRESIDENT, IS COMPENSATED BY A RELATED ORGANIZATION THAT UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B PENSION RESTORATION PLAN: SSM HEALTH (SSMH) PROVIDES THIS SUPPLEMENTAL DEFINED BENEFIT NONQUALIFIED RETIREMENT PLAN TO ANY EMPLOYEE WHO IS A PARTICIPANT IN THE SSMH QUALIFIED DEFINED BENEFIT PLAN WHO EARNS OVER THE INTERNAL REVENUE SERVICE COMPENSATION LIMIT. THE PLAN "RESTORES" THE BENEFITS TO THESE EMPLOYEES THAT WOULD HAVE BEEN PROVIDED UNDER THE SSMH QUALIFIED PLAN IF THE REGULATIONS DID NOT IMPOSE COMPENSATION LIMITS. AN INDIVIDUAL CAN TAKE A DISTRIBUTION FROM THE PLAN AT (1) AGE 65 OR OLDER IF THE INDIVIDUAL IS STILL EMPLOYED BY SSMH OR (2) AGE 55 OR OLDER IF THE INDIVIDUAL IS NO LONGER EMPLOYED BY SSMH. NO INDIVIDUALS LISTED ON PART VII OF FORM 990 RECEIVED DISTRIBUTIONS FROM THE PLAN IN 2023. CAPITAL ACCUMULATION PLAN: SSMH PROVIDES THIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO EXECUTIVE LEVEL EMPLOYEES. THE ORGANIZATION CONTRIBUTED A PERCENTAGE OF THE EMPLOYEE'S BASE SALARY INTO THEIR CHOICE OF A SELECT LIST OF INVESTMENTS. THE DEPOSITS AND EARNINGS OF THE PLAN ARE OWNED BY SSMH AND ARE TAX-DEFERRED UNTIL A DISTRIBUTION IS MADE TO THE EMPLOYEE. IN ADDITION, THE PLAN HAS SPECIAL SAFEGUARDS IN PLACE TO PROTECT THE FUNDS FROM CONTINGENCIES, OTHER THAN INSOLVENCY. FOR CONTRIBUTIONS MADE TO THE PLAN IN 2014 OR AFTER, THE DISTRIBUTION WILL OCCUR AFTER THE COMPLETION OF FOUR PLAN YEARS FOR ALL EXECUTIVES THAT ARE STILL ACTIVELY EMPLOYED ON THE DISTRIBUTION DATE. ANY ACTIVE PARTICIPANT 65 YEARS OR OLDER WILL RECEIVE THE CONTRIBUTION IN THE CURRENT YEAR. THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DEFERRALS FROM THIS PLAN IN 2023: DEANN THURMER - $29,866 JENNIFER MASKEL - $2,131 RANDY COMBS - $261,633 DOUGLAS LONG - $161,287 STEVE SMOOT $249,972 SUE ANDERSON - $153,458 THOMAS KIRSCHBAUM - $37,511 THE FOLLOWING INDIVIDUALS LISTED ON PART VII OF THE FORM 990 RECEIVED DISTRIBUTIONS FROM THIS PLAN IN 2023. ALL DISTRIBUTIONS RECEIVED FROM THE PLAN IN THE CURRENT YEAR WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE COMPENSATION. DEANN THURMER - $26,741 STEVE SMOOT - $140,898 SUE ANDERSON - $132,843 FORM 990, PART V, LINE 1A: ALL APPLICABLE 1099 AND 1096 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED ORGANIZATION, SSM HEALTH CARE CORPORATION, EIN 46-6029223. FORM 990, PART V, LINE 2A: ALL APPLICABLE W-2 AND W-3 IRS TAX FORMS ARE REPORTED AND FILED BY A RELATED ORGANIZATION, AGNESIAN HEALTHCARE INC, EIN 39-0807236. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS AGNESIAN HEALTHCARE INC. AGNESIAN HEALTHCARE INC IS A NONPROFIT 501 (C)(3) ORGANIZATION. BOTH WAUPUN MEMORIAL HOSPITAL AND AGNESIAN HEALTHCARE INC ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS SSM HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND TO APPOINT AND REMOVE THE APPOINTED DIRECTORS AND THE EX OFFICIO DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION; B. TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; C. TO APPOINT AND REMOVE THE DIRECTORS; D. TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; E. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS; M. TO APPROVE THE STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION; N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; O. TO AUTHORIZE AND APPROVE BORROWING MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION; P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO SSMHCC OR TO ANY OTHER ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY SSMHCC, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF SSMHCC AS DETERMINED BY SSMHCC; Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN SSMHCC, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO SSMHCC WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NONCONTROLLED SUBSIDIARY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE PARENT ORGANIZATION, SSM HEALTH CARE CORPORATION (SSM). THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SSM PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST AND INSIDER TRANSACTION POLICY THAT REQUIRES EACH DIRECTOR, PRINCIPAL OFFICER, TRUSTEE OR COMMITTEE MEMBER TO DISCLOSE ON A ANNUAL BASIS TO THE DESIGNATED AUTHORITY A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DESIGNATED AUTHORITY ENSURES THAT ALL STATEMENTS ARE COMPLETED, REVIEWS THEM FOR CONFLICTS, AND SUBMITS TO THE BOARD FOR REVIEW ANY CONFLICT OF INTEREST DISCLOSURE STATEMENTS THAT DISCLOSE ACTUAL OR POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 A RELATED ORGANIZATION UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE YEAR-END AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND UNAUDITED QUARTERLY CONSOLIDATED FINANCIAL STATEMENTS FOR THE SSM HEALTH SYSTEM ARE MADE AVAILABLE TO THE PUBLIC ON SSM HEALTH'S WEBSITE. THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE ON THE MISSOURI SECRETARY OF STATE'S WEBSITE. COPIES OF THE FORM 990 AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARY NET ASSETS - SPECIAL PURPOSE 69,559. GENERAL LEDGER OFFSET -14,797. 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