2022-11-09T09:05:21-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2021-01-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 CATHY BUKOWSKI INTERIM CFO 7152341515 2022-11-04 1 CATHY BUKOWSKI 999009999 DAVID LOWENTHAL P00378651 3122071040 2022-11-04 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z MARSHFIELD MEDICAL CENTER-RICE LAKE SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 162577564 0 X WWW.LAKEVIEWMEDICAL.COM X 1919 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 5 0 250 0 0 830235 7018010 42744024 152497729 11734 2865118 1001 3441 43586994 162384298 610318 295 0 0 17149038 70820452 0 0 0 18885320 80210516 36644676 151031263 6942318 11353035 137256294 74199891 56057719 50999235 81198575 23200656 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 121186680 295 152160254 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. 121186680 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 8 5 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X CATHY BUKOSWKI INTERIM CFO 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 X MARK BUGHER CHAIR 1.00 9.00 X X 0 23500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 8500 0 RUWAN DISSANAYAKE MD SECRETARY 1.00 50.00 X X 0 486599 52360 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 2088402 310931 COLLEEN HOERNEMAN BOARD MEMBER 1.00 1.00 X 0 3000 0 NARAYANA MURALI MD BOARD MEMBER/MCHS CSO 1.00 54.00 X 0 783446 55354 GORDON EDWARDS MCHS CFO/COO 1.00 54.00 X 0 849211 54294 JERARD JENSEN MCHS GENERAL COUNSEL 1.00 54.00 X 0 844246 59187 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 1.00 54.00 X 0 668017 50987 BRADLEY GROSETH CHIEF ADMIN OFFICER MMC-RICE LAKE 50.00 0.00 X 371851 0 58964 371851 5754921 642077 1 0 1 0 0 156801 6861209 7018010 NET PATIENT SERVICE REVENUE 621110 151808267 151808267 CAFETERIA REVENUE 621110 337475 337475 MISC OTHER OPERATING REVENUE 621110 294991 294991 INTERCOMPANY REVENUE 621110 56411 56411 WELLNESS REVENUE 621110 585 585 152497729 28931 28931 3029453 193266 2836187 2836187 2836187 VENDING REVENUE 722515 3441 3441 3441 162384298 152160254 0 3206034 295 295 57090744 56015901 1074843 2823323 2755562 67761 7711364 7613135 98229 3195021 3145226 49795 5875103 5714735 160368 5882 5882 519210 410855 108355 51749 51749 1896180 1869941 26239 393510 392585 925 1345348 1345348 4195924 4195924 13277 13277 MEDICAL SUPPLIES 29641152 29640433 719 I/C PURCHASED SERVICES 28168837 0 28168837 BAD DEBT EXPENSE 4984644 4984644 0 WI MEDICAID ACCESS TAX 1900076 1900076 0 1219624 1136994 82630 151031263 121186680 29844583 0 X 30382647 5890930 438316 393557 0 0 43286392 19916086 0 0 0 0 0 0 1763332 2137557 0 0 109873087 64015977 60920665 45857110 0 0 0 0 0 0 0 0 464942 4651 137256294 74199891 1892259 3017558 4853 4853 12534688 8247515 0 0 0 0 0 0 41166996 39729309 0 0 458923 0 56057719 50999235 X 81198575 23200656 81198575 23200656 137256294 74199891 X 11353035 -69350954 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4503454 4503454 70941370 28963404 41977966 557940 2490669 -1932729 30231887 29470515 761372 3638436 3091389 547047 45857110 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, 2021 OR DECEMBER 31, 2020. 1 1 X 1 X 1 X 1 1 1 0 1 1 653163 0 653163 0.00450 20032944 12292758 7740186 0.05300 0 0 20686107 12292758 8393349 0.05750 105875 585 105290 0.00070 18851 0 18851 0.00010 0 0 0 0 0 0 124726 585 124141 0.00080 20810833 12293343 8517490 0.05830 1 1776029 0 29682810 32128970 -2446160 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 21 1 1 1 1 X HTTPS://TINYURL.COM/YV9TYSST X 1 21 1 HTTPS://TINYURL.COM/MRNEUV33 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: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RICE LAKE) COMPLETED THE 2021 CHNA IN PARTNERSHIP WITH BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS), WISCONSIN DIVISION OF PUBLIC HEALTH, UNIVERSITY OF WISCONSIN-EAU CLAIRE, WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC), ADRC OF BARRON, RUSK, AND WASHBURN COUNTIES, AND THE OTHER HEALTHCARE SYSTEMS IN THE COMMUNITY. IN ADDITION TO ANALYZING DEMOGRAPHIC INFORMATION, THE GROUP COLLECTED SECONDARY DATA THROUGH BOTH AN ONLINE AND PAPER SURVEY CONCERNING DISEASE, DEATH, DISABILITY, INJURY AND COMMUNITY OPINIONS. THE SURVEY WAS TRANSLATED TO SOMALI AND SPANISH TO INCLUDE FEEDBACK FROM UNDER SERVED POPULATIONS IN THE COUNTY. MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEMS- CUMBERLAND HEALTHCARE- 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)- WISCONSIN DIVISION OF PUBLIC HEALTH-WESTERN REGION OFFICE- UNIVERSITY OF WISCONSIN-EAU CLAIRE- WESTERN INDIANHEAD TECHNICAL COLLEGE (WITC)- AGING AND DISABILITY RESOURCE CENTER OF BARRON, RUSK, AND WASHBURN COUNTIES- 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 - CHRONIC DISEASE - SOCIAL DETERMINANTS OF HEALTHHEALTH PRIORITY 1: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE YOUTH SUBSTANCE USE - SUPPORT ALCOHOL AND OTHER DRUG (AOD) PREVENTION CURRICULUMS IN SCHOOL AND/OR AFTERSCHOOL SETTINGS. GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 2: BEHAVIORAL HEALTH GOAL 1: DECREASE SUICIDE RATES FOR HIGH-RISK POPULATIONS - ENHANCE COMMUNITY MEMBER'S SKILLS TO SUPPORT MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION. - SUPPORT SUICIDE PREVENTION COMMUNITY AWARENESS EVENTS. GOAL 2: IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS - ENHANCE SCHOOL CAPACITY TO PROVIDE HIGH QUALITY SOCIAL, EMOTIONAL ASSESSMENT, SUPPORT AND LEARNING. GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 3: CHRONIC DISEASE GOAL 1: IMPROVE ACCESS TO HEALTHY FOODS - INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCALLY GROWN FOOD AND ADDRESS FOOD INSECURITY. GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO CHRONIC DISEASE PREVENTION EFFORTS. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY 4: SOCIAL DETERMINANTS OF HEALTH GOAL 1: INCREASE KNOWLEDGE AND AWARENESS OF HEALTH EQUITY. - CONDUCT AN ORGANIZATION AND COMMUNITY ASSESSMENT OF HEALTH DISPARITIES AND HEALTH EQUITY AND DEVELOP A WORKPLAN TO ADDRESS THOSE GAPS. GOAL 2: IMPROVE HEALTH OUTCOMES BY CONNECTING CLINICAL PRACTICE TO COMMUNITY EFFORTS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH BARRIERS. - SUPPORT AND CONNECT PATIENTS AND COMMUNITY MEMBERS TO RESOURCES TO ADDRESS SOCIALLY DETERMINED NEEDS. GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO ADVANCING HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH. - PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. THROUGH THE ASSESSMENT PROCESS, OTHER COMMUNITY HEALTH PRIORITIES WERE IDENTIFIED THAT WILL NOT BE ADDRESSED IN THIS PLAN. THE FOLLOWING WAS CONSIDERED WHILE PRIORITIZING COMMUNITY HEALTH NEEDS; OTHER ORGANIZATIONS ADDRESSING THE SPECIFIC NEED, THE ABILITY OF MMC-RICE LAKE TO IMPACT CHANGE, AVAILABILITY OF RESOURCES, AS WELL AS READINESS OF THE COMMUNITY FOR INTERVENTIONS. THE FOLLOWING HEALTH PRIORITIES WILL NOT BE ADDRESSED BY MMC-RICE LAKE FOR REASONS INDICATED: - COMMUNICABLE DISEASE PREVENTION & CONTROL: INSTEAD OF LEADING THIS CHARGE COMMUNITY WIDE, STAFF PARTICIPATE IN NUMEROUS COVID-19 WORKGROUPS ACROSS REGIONAL COUNTY AREAS. - ORAL HEALTH: STAFF FROM MMC-RICE LAKE DOES NOT PROVIDE RELATED SERVICES, HOWEVER THE FAMILY HEALTH CENTER OF MARSHFIELD DENTAL CENTER, DOES LEAD THESE EFFORTS LOCALLY, REGIONALLY AND NATIONALLY. ONE OF THE FAMILY HEALTH CENTER DENTAL LOCATIONS IS IN RICE LAKE. PART V, LINE 13A: THE FINANCIAL ASSISTANCE POLICY LINK PROVIDED HAS BEEN UPDATED AFTER THE YEAR ENDED DECEMBER 31, 2021 AND NOW REFLECTS A FAMILY INCOME LIMIT FOR FREE CARE OF 100%. AS OF DECEMBER 31, 2021, THE FAMILY INCOME LIMIT FOR FREE CARE WAS 200%. 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.THE FINANCIAL ASSISTANCE POLICY LINK PROVIDED HAS BEEN UPDATED AFTER THE YEAR ENDED DECEMBER 31, 2021 AND NOW REFLECTS A FAMILY INCOME LIMIT FOR FREE CARE OF 100%. AS OF DECEMBER 31, 2021, THE FAMILY INCOME LIMIT FOR FREE CARE WAS 200%. 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: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RICE LAKE) LOCATED IN RICE LAKE, WISCONSIN PARTICIPATED IN VARIOUS COMMUNITY BUILDING ACTIVITIES WITH THE PURPOSE TO IMPROVE THE HEALTH OF THE COMMUNITY, INCLUDING ADDRESSING SOCIAL DETERMINATES OF HEALTH AND HEALTH INEQUITIES. DUE TO COVID-19, MANY COMMUNITY BUILDING ACTIVITIES WERE LIMITED OR CANCELED DURING THIS REPORTING PERIOD, HOWEVER STAFF PARTICIPATED IN REGIONAL COMMUNITY GROUPS COORDINATING EFFORTS TO ADDRESS COVID-19. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED: COALITION BUILDING: MARSHFIELD MEDICAL CENTER-RICE LAKE STAFF PARTICIPATED IN MORE THAN 5 DIFFERENT 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:MMC-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. 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 60% AND 55% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2021 AND DECEMBER 31, 2020, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2021 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 INCLUDES (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: MARSHFIELD MEDICAL CENTER-RICE LAKE ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES BY CONDUCTING STANDARD CHNA PRACTICES, INCLUDING: - COMPLETION OF KEY INFORMANT INTERVIEWS WITH COMMUNITY LEADERS ABOUT THE COMMUNITY'S HEALTH NEEDS - REVIEW OF PUBLICLY AVAILABLE COMMUNITY HEALTH DATA (I.E. COUNTY HEALTH RANKINGS)- PARTICIPATION IN COMMUNITY HEALTH COMMITTEES AND BOARDS (I.E. THRIVE STEERING COMMITTEE) 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: 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 THE NORTHERN REGION OF 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 45,244 IN 2019 AND 65.9% OF THE RESIDENTS LIVING IN A RURAL AREAS. THE RACIAL MAKE-UP OF BARRON COUNTY IS 94.6% WHITE, 0.7% ASIAN, 2.5% HISPANIC OR LATINO, 1.2% TWO OR MORE RACES, 1.6% BLACK OR AFRICAN AMERICAN, AND 0.7% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $52,703 COMPARED TO THE STATE AVERAGE OF $61,747 WITH THE POVERTY RATE OF 10.7%. THE EDUCATION LEVEL OF BARRON COUNTY RESIDENTS IS LOWER THAN THE STATEWIDE AVERAGE. ACCORDING TO THE LATEST CENSUS ESTIMATES, 90% OF BARRON RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO 92.2% STATEWIDE. LIKEWISE, 20.6% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 30.1% STATEWIDE. PART VI, LINE 5: MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-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. WAS FORMED. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. THE HEALTH SYSTEM TODAY IS AN INTEGRATED SYSTEM SERVING WISCONSIN AND BEYOND, WITH MORE THAN 12,000 EMPLOYEES INCLUDING OVER 1,400 PROVIDERS COMPRISING MORE THAN 170 SPECIALTIES AND SUBSPECIALTIES. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE TO MORE THAN TWO MILLION RESIDENTS THROUGH OVER 60 LOCATIONS IN 40 WISCONSIN COMMUNITIES IN NORTHERN, CENTRAL AND WESTERN WISCONSIN. PRIMARY OPERATIONS INCLUDE: MARSHFIELD CLINIC; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, WESTON, PARK FALLS AND MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. THE HEALTH SYSTEM DEEPLY BELIEVES IN PROMOTING COMMUNITY HEALTH THROUGH BUILDING AND SUSTAINING STRONG INTERNAL AND EXTERNAL PARTNERSHIPS AND COLLABORATIONS. FOR THIS REASON, THE HEALTH SYSTEM AND ITS AFFILIATED ENTITIES WORK TOGETHER INTERNALLY AND EXTERNALLY WITH COMMUNITY PARTNERS, STAKEHOLDERS AND RESIDENTS TO IMPROVE COMMUNITY HEALTH. UNIQUE TO THE HEALTH SYSTEM IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILD BRIDGES BETWEEN THE HEALTH SYSTEM AND AREAS 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 1754423 0 5000 0 328979 0 280404 0 30527 0 2399333 0 248642 GORDON EDWARDS MCHS CFO/COO 0 757620 0 10000 0 81591 0 21816 0 32478 0 903505 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 0 782228 0 0 0 62018 0 21816 0 37371 0 903433 0 0 NARAYANA MURALI MD BOARD MEMBER/MCHS CSO 0 740814 0 0 0 42632 0 21816 0 33538 0 838800 0 0 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 0 609735 0 10000 0 48282 0 21816 0 29171 0 719004 0 0 RUWAN DISSANAYAKE MD SECRETARY 0 348045 0 96819 0 41735 0 20245 0 32115 0 538959 0 0 BRADLEY GROSETH CHIEF ADMIN OFFICER MMC-RICE LAKE 315212 0 10000 0 46639 0 21816 0 37148 0 430815 0 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 - $284,113 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: NARAYANA MURALI, MD RUWAN DISSANAYAKE, MD JERARD JENSEN GORDON EDWARDS WILLIAM MELMS, MD 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/COO 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 -69,350,954. MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 0 VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 0 FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) LINE 7 N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 0 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) LINE 7 MCHS 0 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI N/A 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1