2023-11-13T09:44:45-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2022-01-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 CATHY BUKOWSKI CFO 7152341515 2023-11-08 1 CATHY BUKOWSKI 999009999 0 DAVID LOWENTHAL P00378651 3122071040 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARSHFIELD MEDICAL CENTER-RICE LAKE SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 139119786 0 X WWW.MARSHFIELDCLINIC.ORG X 1919 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 9 6 0 250 0 0 7018010 3112261 152497729 135851022 2865118 156503 3441 0 162384298 139119786 295 2000 0 0 70820452 72848499 0 0 0 80210516 80543870 151031263 153394369 11353035 -14274583 74199891 104854905 50999235 41121516 23200656 63733389 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 119542148 2000 135448256 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT 40-BED COMMUNITY HOSPITAL LOCATED IN RICE LAKE, WISCONSIN THAT PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE AND HOME HEALTH SERVICES. 119542148 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 X MARK BUGHER CHAIR 1.00 9.00 X X 0 26500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 9500 0 RUWAN DISSANAYAKE MD SECRETARY 1.00 50.00 X X 0 528556 54315 JOHN BALTUS TREASURER 1.00 0.00 X X 0 0 0 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 1.00 54.00 X 0 3048492 315344 COLLEEN HOERNEMAN BOARD MEMBER 1.00 2.00 X 0 7500 0 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 829413 57055 MARGARET MINERICK BOARD MEMBER 1.00 1.00 X 0 1000 0 GORDON EDWARDS MCHS CFO/COO - PART YEAR 1.00 54.00 X 0 829645 31752 KATHY BRESSLER MCHS COO 1.00 54.00 X 0 370779 16874 JERAD JENSEN MCHS GENERAL COUNSEL 1.00 54.00 X 0 1058880 65255 BRADLEY GROSETH PRESIDENT MMC-RICE LAKE 50.00 0.00 X 360557 0 64540 360557 6710265 605135 1 0 1 0 0 12490 3099771 3112261 NET PATIENT SERVICE REVENUE 621110 135170418 135170418 CAFETERIA REVENUE 621110 402766 402766 INTERCOMPANY REVENUE 621110 140577 140577 MISC OTHER OPERATING REVENUE 621110 137261 137261 135851022 51123 51123 104585 104585 795 0 795 795 795 139119786 135448256 0 559269 2000 2000 59846736 58798551 1048185 2756116 2695399 60717 7146862 7048765 98097 3098785 3049493 49292 950 950 5249044 5229825 19219 1559 84 1475 345061 318291 26770 80244 80244 2130290 2126690 3600 483081 469615 13466 790181 790181 4474418 4474418 I/C PURCHASED SERVICES 32485939 0 32485939 MEDICAL SUPPLIES 27333643 27331168 2475 BAD DEBT EXPENSE 4422898 4422898 0 WI MEDICAID ACCESS TAX 1896412 1896412 0 850150 808114 42036 153394369 119542148 33852221 0 X 5890930 5998247 393557 0 19916086 29520913 2137557 2862118 124639788 58186249 45857110 66453539 4651 20088 74199891 104854905 3017558 2944754 4853 0 8247515 284382 39729309 37890451 0 1929 50999235 41121516 X 23200656 63733389 23200656 63733389 74199891 104854905 X -14274583 54807316 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3788469 3788469 80274908 30788825 49486083 75418 50421 24997 36081332 24604689 11476643 4419661 2742314 1677347 66453539 OTHER LIABILITIES 1929 1929 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 OR DECEMBER 31, 2021. 1 1 X 1 X 1 X 1 1 1 0 1 1 539655 0 539655 0.00360 20340981 18284068 2056913 0.01380 0 0 20880636 18284068 2596568 0.01740 92955 1822 91133 0.00060 1182 0 1182 0.00000 0 0 0 0 2000 0 2000 0.00000 96137 1822 94315 0.00060 20976773 18285890 2690883 0.01800 1 1603950 0 22424818 29577459 -7152641 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - RICE LAKE 1700 W STOUT STREET RICE LAKE WI 54868 82 X X X MARSHFIELD MEDICAL CENTER - RICE LAKE 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://TINYURL.COM/Y2UENJ9C X 1 22 1 HTTPS://TINYURL.COM/4SYUAJMW 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 5: DUE TO TIMING OF NUMEROUS CIRCUMSTANCES, DIRECT COLLABORATION WITH LOCAL COMMUNITY PARTNERS WAS LIMITED TO TWO THRIVE STEERING COMMITTEE CHA/CHIP PLANNING MEETINGS IN AUGUST 2022 AND DECEMBER 2022. TO ACHIEVE COMPLIANCE, MMC-RICE LAKE COMPLETED A ONE-YEAR CHNA/IS IN 2021 WITH A COMMUNITY HEALTH ASSESSMENT SURVEY AND KEY INFORMANT INTERVIEWS. TO ALIGN WITH BARRON COUNTY HEALTH DEPARTMENT AND THE THRIVE STEERING COMMITTEE, MMC-RICE LAKE UTILIZED THE COMMUNITY HEALTH SURVEY DATA, KEY INFORMANT INTERVIEW DATA, TWO PLANNING MEETINGS, AND THE ADDITION OF THE COMMUNITY AFFIRMATION SURVEY TO COMPLETE THE 2022 MMC-RICE LAKE CHNA.THE SURVEY COLLECTED 250 RESPONSES BETWEEN MARCH AND APRIL 2021 FROM BARRON COUNTY RESIDENTS. OVERALL, RESPONDENTS TENDED TO BE WHITE, FEMALE AND BETWEEN THE AGES OF 35-44 AND 55-64. OF SURVEY RESPONDENTS, 6.76% WERE RETIRED AND 7.43% WORK PART TIME. THIS SURVEY DATA WAS UTILIZED IN THE 2021 MMC-RICE LAKE CHNA AND 2022 MMC-RICE LAKE CHNA.PRIMARY DATA COLLECTION FOR AN AFFIRMATION SURVEY WAS COMPLETED IN JANUARY 2022. THE PURPOSE OF THE SURVEY WAS TO MEET THE NEED OF THE BARRON COUNTY CHA AND OTHER HEALTH SYSTEMS CHNA/IS. AN ELECTRONIC SURVEY WAS WIDELY DISTRIBUTED BY BARRON COUNTY PUBLIC HEALTH AND THE THRIVE STEERING COMMITTEE, WHICH INCLUDED MMC-RICE LAKE.THE SURVEY COLLECTED 361 RESPONSES BETWEEN DECEMBER 2021 AND JANUARY 2022 FROM BARRON COUNTY RESIDENTS.FOR THIS ASSESSMENT KEY INFORMANT INTERVIEWS WERE CONDUCTED VIA WEBEX (VIDEO CONFERENCING PLATFORM) AND TELEPHONE TO OBSERVE COVID-19 PANDEMIC SAFETY PROTOCOLS. THREE INDIVIDUALS COMPLETED AN INTERVIEW AND RESULTING INSIGHTS WERE COMPILED INTO A SUMMARY REPORT. MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEM NORTHLAND- AMERY HOSPITAL AND CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)- AGING AND DISABILITY RESOURCE CENTER OF BARRON, RUSK, AND WASHBURN COUNTIES- UNIVERSITY OF WISCONSIN-EAU CLAIRE- WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC)- CUMBERLAND HEALTHCARE- RICE LAKE AREA FREE CLINIC- NORTHLAKES COMMUNITY CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE BARRON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY, KEY INFORMANT INTERVIEW SUMMARY, HEALTHIEST WISCONSIN 2020, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MARSHFIELD MEDICAL CENTER IN RICE LAKE ARE: - ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - HEALTH EQUITYHEALTH PRIORITY: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE ALCOHOL & SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION.- PREVENT ALCOHOL AND SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING INDIVIDUAL AND/OR ENVIRONMENTAL PREVENTION STRATEGIES.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: BEHAVIORAL HEALTH GOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES.- ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH.- PROVIDE EDUCATIONAL MATERIALS (USING A VARIETY OF PLATFORMS) TO INCREASE CAREGIVER MENTAL HEALTH AND WELLBEING. - PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS.- ENHANCE COMMUNITY MEMBERS' SKILLS TO SUPPORT MENTAL WELLNESS PROMOTION AND SUICIDE PREVENTION.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: HEALTH EQUITYGOAL 1: ADVANCE HEALTH EQUITY BY FOCUSING ON COMMUNITY-BASED HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH.- ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES.GOAL 2: REDUCE HEALTH DISPARITIES RELATED TO PHYSICAL, SOCIAL, ECONOMIC AND/OR COMMUNITY CONDITIONS.- INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCAL GROWN FOOD AND ADDRESS FOOD INSECURITY.GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO IMPROVING EQUITABLE ACCESS TO RESOURCES AND SUPPORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-RICE LAKE FOR REASONS INDICATED:- INJURY & VIOLENCE PREVENTION: INJURY AND VIOLENCE ARE IMPORTANT AREAS OF FOCUS. INSTEAD OF LEADING THIS CHARGE, MMC-RICE LAKE STAFF PARTICIPATE IN A VARIETY OF COMMUNITY GROUPS SUPPORTING THIS AREA INCLUDING, BARRON-WASHBURN COUNTY CAREGIVER COALITION AND COMMUNITY CONNECTIONS TO PROSPERITY (CCP). EMBRACE INC. (A DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCY THAT PROVIDES SAFE SHELTER AND SUPPORTIVE SERVICES FOR SURVIVORS), AGING AND DISABILITY RESOURCE CENTER (ADRC) OF BARRON, RUSK, AND WASHBURN COUNTIES, AND BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEAD AND HAVE EXPERTISE IN THIS AREA. - COMMUNICABLE DISEASE PREVENTION & CONTROL: THIS IS AN IMPORTANT AREA OF FOCUS, AND MMC-RICE LAKE HAS SYSTEMS AND PROCESSES IN PLACE TO PREVENT AND REDUCE THE SPREAD OF COMMUNICABLE DISEASES. THE HOSPITAL WILL NOT TAKE THE LEAD ON THIS AREA IN COMMUNITY OUTREACH AS THIS IS AN AREA THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEADS AND HAS EXPERTISE IN.- ORAL HEALTH: MARSHFIELD CLINIC RICE LAKE DENTAL CENTER ADDRESSES THE COMMUNITY NEED FOR ORAL HEALTH BY SERVING PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS. WHILE MMC-RICE LAKE ADDRESSES ORAL HEALTH IT IS NOT LISTED AS ONE OF THE TOP HEALTH PRIORITIES. PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. PART II, COMMUNITY BUILDING ACTIVITIES: IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT, WE ENRICH LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY-BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY, AND BY ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES. DUE TO LINGERING IMPACTS OF COVID-19, DECREASED STAFFING AND CAPACITY, MANY COMMUNITY-BUILDING ACTIVITIES REMAINED LIMITED DURING THIS REPORTING PERIOD. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED: COALITION BUILDING: MARSHFIELD MEDICAL CENTER-RICE LAKE STAFF PARTICIPATED IN MULTIPLE COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY. THESE ARE THE BARRON COUNTY COMMUNITY COALITION, COMMUNITY CONNECTIONS TO PROSPERITY, COMMUNITY CONNECTIONS TO PROSPERITY MENTAL HEALTH ACTION TEAM (MHAT), BARRON COUNTY THRIVE CHRONIC DISEASE COMMITTEE, AND BARRON COUNTY THRIVE STEERING COMMITTEE. WORKFORCE DEVELOPMENT: MARSHFIELD MEDICAL CENTER-RICE LAKE COLLABORATED WITH AREA HIGH SCHOOLS TO OFFER PROGRAMS FOR HIGH SCHOOL STUDENTS INTERESTED IN MEDICAL CAREERS AS WELL AS OBSERVATIONAL JOB EXPERIENCES FOR HIGH SCHOOL GRADUATES. MMC-RICE LAKE FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT-NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, AND MEDICAL RESIDENTS AND INTERNS.ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY:MARSHFIELD MEDICAL CENTER-RICE LAKE COLLABORATED WITH COMMUNITY ORGANIZATIONS AND GROUPS FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY. EXAMPLES INCLUDED: - PARTICIPATION IN VARIOUS HEALTH DEPARTMENT DRIVEN GROUPS FOCUSED ON ADDRESSING THE IMPACTS OF COVID-19. - PROVIDE PERMANENT MEDICATION DISPOSAL BOXES AT HOSPITAL PHARMACY.- PARTICIPATION IN THE EMERGENCY PREPAREDNESS SUBCOMMITTEE. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS ANDIDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFFAGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 61% AND 60% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2022 AND DECEMBER 31, 2021, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2022 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO-CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: ALL MARSHFIELD MEDICAL CENTER FACILITIES ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES THEY SERVE BY CONDUCTING STANDARD CHNA PRACTICES, INCLUDING: -REVIEW OF COMMUNITY PARTNERS' REPORTS (I.E. UNITED WAY) -REVIEW OF PUBLICLY AVAILABLE COMMUNITY HEALTH DATA (I.E. COUNTY HEALTH RANKINGS) -COMPLETION OF KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS ABOUT THE COMMUNITY'S HEALTH NEEDS -COMPLETION OF COMMUNITY CONVERSATIONS WITH COMMUNITY MEMBERS -PARTICIPATION IN COMMUNITY HEALTH COMMITTEES AND BOARDS PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE.INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RICE LAKE) IS A 40-BED COMMUNITY HOSPITAL IN RICE LAKE, WISCONSIN. MMC-RICE LAKE OFFERS A 24/7 EMERGENCY DEPARTMENT, AMBULANCE SERVICES, FULL SCOPE OF GENERAL AND ORTHOPEDIC SURGERY SERVICES, COMPREHENSIVE OUTPATIENTS CANCER CARE SERVICES, AND INPATIENT AND OUTPATIENT PHYSICAL THERAPY, REHABILITATION AND OCCUPATIONAL THERAPY. BARRON COUNTY IS LOCATED IN NORTHWESTERN WISCONSIN. THE COUNTY IS COMPRISED OF FOUR CITIES (BARRON, CHETEK, CUMBERLAND, AND RICE LAKE), SIX VILLAGES (ALMENA, CAMERON, DALLAS, HAUGEN, NEW AUBURN, PRAIRIE FARM, AND TURTLE LAKE), AND 25 TOWNSHIPS WITH A TOTAL POPULATION OF 46,719 IN 2021 (APPROXIMATELY 65.9% OF WHICH IS RURAL). THE CITY OF RICE LAKE IS WHERE MMC-RICE LAKE IS LOCATED AND HAD A TOTAL POPULATION OF 8,939 IN 2021. RICE LAKE IS LOCATED ABOUT 100 MILES EAST OF MINNEAPOLIS, MN AND ABOUT 60 MILES NORTH OF EAU CLAIRE, WISCONSIN.THE RACIAL MAKE-UP OF BARRON COUNTY IS 94.9% WHITE, 0.7% ASIAN, 3.0% HISPANIC OR LATINO, 1.4% TWO OR MORE RACES, 1.8% BLACK OR AFRICAN AMERICAN, AND 1.3% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $52,346 COMPARED TO THE STATE AVERAGE OF $63,293 WITH THE POVERTY RATE OF 10%. THE EDUCATION LEVEL OF BARRON COUNTY RESIDENTS IS LOWER THAN THE STATEWIDE AVERAGE. ACCORDING TO THE LATEST CENSUS ESTIMATES, 90.6% OF BARRON RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO 92.6% STATEWIDE. LIKEWISE, 20.6% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 30.8% STATEWIDE. PART VI, LINE 5: MARSHFIELD MEDICAL CENTER-RICE LAKE FURTHERED ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY WITH THE FOLLOWING: -REPRESENTATION ON THE COMMUNITY CONNECTIONS TO PROSPERITY (CCP) COALITION. THE MISSION OF THE COALITION IS TO HELP INDIVIDUALS, ORGANIZATIONS AND AGENCIES UNDERSTAND AND DEEPLY APPRECIATE THE IMMENSE POWER OF POVERTY. -REPRESENTATION AND FACILITATION OF THE MENTAL HEALTH ACTION TEAM (MHAT) DEVELOPED FROM THE CCP COALITION. THE MISSION OF THIS ACTION TEAM IS TO EDUCATE AND REDUCE STIGMA OF MENTAL ILLNESS, WHICH WILL INCREASE AWARENESS AND REDUCE THE POTENTIALLY DEBILITATING CONSEQUENCES OF MENTAL ILLNESS (INCLUDING POVERTY, SUBSTANCE ABUSE, HOMELESSNESS AND MANY CHRONIC HEALTH CONDITIONS). PART VI, LINE 6: MARSHFIELD CLINIC WAS FOUNDED IN 1916 BY SIX PHYSICIANS PRACTICING IN MARSHFIELD, A RURAL CENTRAL WISCONSIN CITY. AT ITS INCEPTION, CLINIC FOUNDERS SAW RESEARCH AND EDUCATION AS CRITICAL TO THEIR PRACTICE OF HEALTH CARE AND THAT REMAINS SO TODAY. THE CLINIC BECAME A 501(C)(3) NONPROFIT ORGANIZATION IN 1992 AND IN 2014, MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS), WAS FORMED. MCHS TODAY IS AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN, AND RESEARCH AND EDUCATION PROGRAMS. MCHS PRIMARY OPERATIONS INCLUDE: MARSHFIELD CLINIC; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, IRON MOUNTAIN, PARK FALLS, AND MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION.UNIQUE TO MCHS IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILDS BRIDGES BETWEEN THE HEALTHCARE SYSTEM AND THE PLACES IN THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. THE CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THE CCHA INCLUDES HOSPITAL STAFF WHO ARE CLOSELY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY (IS) IN THEIR RESPECTIVE COUNTIES. THIS HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. 0 1 0 0 0 0 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 0 1812322 0 910520 0 325650 0 287565 0 27779 0 3363836 0 258588 JERAD JENSEN MCHS GENERAL COUNSEL 0 801522 0 202859 0 54499 0 23031 0 42224 0 1124135 0 0 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO 0 784186 0 5000 0 40227 0 23031 0 34024 0 886468 0 0 GORDON EDWARDS MCHS CFO/COO - PART YEAR 0 560115 0 166037 0 103493 0 9150 0 22602 0 861397 0 0 RUWAN DISSANAYAKE MD SECRETARY 0 398039 0 103133 0 27384 0 21612 0 32703 0 582871 0 0 BRADLEY GROSETH PRESIDENT MMC-RICE LAKE 329753 0 5000 0 25804 0 23031 0 41509 0 425097 0 0 0 KATHY BRESSLER MCHS COO 0 285062 0 25000 0 60717 0 8769 0 8105 0 387653 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $219,744 THE FOLLOWING INDIVIDUALS PARTICATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A DISTRIBUTION OR HAVE AN AMOUNT VEST IN THE PLAN. UNDER THE PLAN, AMOUNTS DO NOT VEST UNTIL TWO YEARS AFTER SEPARATION FROM THE ORGANIZATION: RUWAN DISSANAYAKE, MD JERARD JENSEN GORDON EDWARDS WILLIAM MELMS, MD BRADLEY GROSETH FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO INSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART VII, SECTION A: COMPENSATION REPORTED FOR BRADLEY GROSETH HAS BEEN PAID BY A RELATED ORGANIZATION AND COMMON PAYMASTER, MARSHFIELD CLINIC HEALTH SYSTEM, (EIN 46-1495343). SINCE ALL SERVICES PERFORMED BY THIS INDIVIDUAL WERE FOR LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE, THE COMPENSATION HAS BEEN REPORTED IN COLUMN D AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH PAYROLL FILING REQUIREMENTS. FROM 990, PART X, LINE 20: LAKEVIEW MEDICAL CENTER INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 54,807,316. 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