LAKEVIEW MEDICAL CENTER INC OF RICE LAKE: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- LAKEVIEW MEDICAL CENTER INC OF RICE LAKE (EIN 39-0837206)
- Tax period
- 2020-10-01 to 2020-12-31
- Filed
- 2021-11-24
- IRS object ID
- 202123289349300327
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-24T20:29:32-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 S 7TH ST STE 4200 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390837206 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKEVIEW MEDICAL CENTER INC | BusinessNameLine1Txt |
| Business Name Line2 | OF RICE LAKE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 7152341515 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1700 W STOUT STREET | AddressLine1Txt |
| City | RICE LAKE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54868 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GORDON T EDWARDS | PersonNm |
| Person Title | COO/CFO | PersonTitleTxt |
| Phone | 7152341515 | PhoneNum |
| Signature | 2021-11-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | GORDON | PersonFirstNm |
| Person Last | EDWARDS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MONROE J GIERL | PreparerPersonNm |
| PTIN | P01413237 | PTIN |
| Phone | 6123055000 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SUSAN TURNEY MD CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 N OAK AVENUE | AddressLine1Txt |
| City | MARSHFIELD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54449 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $43,586,994 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAKEVIEWMEDICAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1919 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | SEE SCHEDULE O.WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 250 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,122,342 | PYContributionsGrantsAmt |
| CY Contributions Grants | $830,235 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $148,204,540 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $42,744,024 | CYProgramServiceRevenueAmt |
| PY Investment Income | $16,635 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,734 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,176 | PYOtherRevenueAmt |
| CY Other Revenue | $1,001 | CYOtherRevenueAmt |
| PY Total Revenue | $149,348,693 | PYTotalRevenueAmt |
| CY Total Revenue | $43,586,994 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,317,843 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $610,318 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $60,235,769 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,149,038 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $67,353,062 | PYOtherExpensesAmt |
| CY Other Expenses | $18,885,320 | CYOtherExpensesAmt |
| PY Total Expenses | $128,906,674 | PYTotalExpensesAmt |
| CY Total Expenses | $36,644,676 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $20,442,019 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,942,318 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $142,587,331 | TotalAssetsBOYAmt |
| Total Assets EOY | $137,256,294 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $59,944,906 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $56,057,719 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $82,642,425 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $81,198,575 | NetAssetsOrFundBalancesEOYAmt |
| Mission | WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $29,205,014 | ExpenseAmt |
| Grant | $610,318 | GrantAmt |
| Revenue | $42,745,025 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $29,205,014 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CATHY BUKOWSKI VP OF FINANCE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7153875511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 N OAK AVENUE | AddressLine1Txt |
| City | MARSHFIELD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54449 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| MARK BUGHER | |||||||||
| CHAIR | 1.00 | 9.00 | Yes (X) | Yes (X) | $0 | $32,500 | $0 | ||
| MARK BRADLEY | |||||||||
| VICE CHAIR | 1.00 | 5.00 | Yes (X) | Yes (X) | $0 | $8,500 | $0 | ||
| CHUCK NASON | |||||||||
| SECRETARY | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $4,750 | $0 | ||
| JOHN BALTUS | |||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUSAN SUTTER | |||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN TURNEY MD | |||||||||
| BOARD MEMBER/MCHS CE | 1.00 | 54.00 | Yes (X) | $0 | $2,834,416 | $291,778 | |||
| RUWAN DISSANAYAKE MD | |||||||||
| BOARD MEMBER | 1.00 | 50.00 | Yes (X) | $0 | $492,987 | $47,500 | |||
| NARAYANA MURALI MD | |||||||||
| BOARD MEMBER/MCHS CS | 1.00 | 54.00 | Yes (X) | $0 | $1,082,372 | $50,238 | |||
| WILLIAM MELMS MD | |||||||||
| CHIEF MEDICAL OFFICER | 1.00 | 54.00 | $0 | $607,112 | $45,360 | Yes (X) | |||
| JERARD JENSEN | |||||||||
| MCHS GENERAL COUNSEL | 1.00 | 54.00 | $0 | $986,292 | $46,087 | Yes (X) | |||
| GORDON EDWARDS | |||||||||
| MCHS CFO/COO | 1.00 | 54.00 | $0 | $1,003,980 | $50,671 | Yes (X) | |||
| NED WOLF | |||||||||
| FORMER LMC CEO | 0.00 | 0.00 | $0 | $307,946 | $1,539 | Yes (X) | |||
| CINDY ARTS-STRENKE | |||||||||
| FORMER LMC COO | 0.00 | 50.00 | $0 | $252,607 | $38,276 | Yes (X) | |||
| STEVEN KULICK | |||||||||
| FORMER CHIEF EXP. OFF. | 0.00 | 0.00 | $0 | $471,868 | $12,843 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $8,085,330 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $584,292 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $830,235 | GovernmentGrantsAmt |
| Total Contributions | $830,235 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SVC REV | 621110 | $42,603,233 | $42,603,233 |
| CAFETERIA REV | 621110 | $78,711 | $78,711 |
| MISC OTHER OP REV | 621110 | $48,428 | $48,428 |
| INTERCOMPANY REV | 621110 | $11,260 | $11,260 |
| WELLNESS REV | 621110 | $2,392 | $2,392 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $42,744,024 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,734 | TotalRevenueColumnAmt |
| Exclusion | $11,734 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | VENDING REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,001 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,001 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,001 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $43,586,994 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $42,745,025 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $11,734 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,318 | TotalAmt |
| Program Services | $610,318 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,132,399 | TotalAmt |
| Program Services | $13,810,343 | ProgramServicesAmt |
| Management And General | $322,056 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $646,464 | TotalAmt |
| Program Services | $633,697 | ProgramServicesAmt |
| Management And General | $12,767 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,677,534 | TotalAmt |
| Program Services | $1,653,338 | ProgramServicesAmt |
| Management And General | $24,196 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $692,641 | TotalAmt |
| Program Services | $685,013 | ProgramServicesAmt |
| Management And General | $7,628 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,858,952 | TotalAmt |
| Program Services | $1,697,325 | ProgramServicesAmt |
| Management And General | $161,627 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,033 | TotalAmt |
| Program Services | $100,800 | ProgramServicesAmt |
| Management And General | $6,233 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,171 | TotalAmt |
| Program Services | $103,171 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,293 | TotalAmt |
| Program Services | $155,354 | ProgramServicesAmt |
| Management And General | $1,939 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,244 | TotalAmt |
| Program Services | $98,220 | ProgramServicesAmt |
| Management And General | $24 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,257 | TotalAmt |
| Program Services | $341,257 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,002,939 | TotalAmt |
| Program Services | $1,002,939 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $7,038,571 | $7,038,203 | $368 |
| I/C PURCHASED SERVICES | $6,901,947 | $0 | $6,901,947 |
| BAD DEBT EXPENSE | $616,947 | $616,947 | |
| WI MEDICAID ACCESS TAX | $414,947 | $414,947 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,019 | TotalAmt |
| Program Services | $243,142 | ProgramServicesAmt |
| Management And General | $877 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,644,676 | TotalAmt |
| Program Services | $29,205,014 | ProgramServicesAmt |
| Management And General | $7,439,662 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,730,302 | BOYAmt |
| EOY | $30,382,647 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $143,095 | BOYAmt |
| EOY | $438,316 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,232,061 | BOYAmt |
| EOY | $43,286,392 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,478 | BOYAmt |
| EOY | $1,763,332 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,836 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $110,538,696 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $49,618,031 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,692,807 | BOYAmt |
| EOY | $60,920,665 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,500 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $352,252 | BOYAmt |
| EOY | $464,942 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,587,331 | BOYAmt |
| EOY | $137,256,294 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,107 | BOYAmt |
| EOY | $1,892,259 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,853 | BOYAmt |
| EOY | $4,853 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,440,940 | BOYAmt |
| EOY | $12,534,688 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,039,111 | BOYAmt |
| EOY | $41,166,996 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $345,895 | BOYAmt |
| EOY | $458,923 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,944,906 | BOYAmt |
| EOY | $56,057,719 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,642,425 | BOYAmt |
| EOY | $81,198,575 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,642,425 | BOYAmt |
| EOY | $81,198,575 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $142,587,331 | BOYAmt |
| EOY | $137,256,294 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,942,318 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$8,386,168 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,503,454 | OtherCostOrOtherBasisAmt |
| Book Value | $4,503,454 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $70,941,370 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,642,709 | DepreciationAmt |
| Book Value | $46,298,661 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $427,997 | OtherCostOrOtherBasisAmt |
| Depreciation | $278,045 | DepreciationAmt |
| Book Value | $149,952 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,217,033 | OtherCostOrOtherBasisAmt |
| Depreciation | $22,771,725 | DepreciationAmt |
| Book Value | $8,445,308 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,448,842 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,925,552 | DepreciationAmt |
| Book Value | $1,523,290 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $60,920,665 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED COMPENSATION | Desc |
| Amt | $458,923 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $458,923 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2020 OR SEPTEMBER 30, 2019. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $249,376 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $249,376 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00680 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,526,601 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,143,336 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,383,265 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06500 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,775,977 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,143,336 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,632,641 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07180 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,918 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,392 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $40,526 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,321 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,321 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,239 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,392 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $49,847 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,828,216 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,145,728 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,682,488 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07320 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $252,085 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,420,613 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,604,029 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,183,416 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARSHFIELD MEDICAL CENTER - RICE LAKE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1700 W STOUT STREET | AddressLine1Txt |
| City | RICE LAKE | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54868 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 82 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARSHFIELD MEDICAL CENTER - RICE LAKE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.LAKEVIEWMEDICAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.LAKEVIEWMEDICAL.COM | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 5: | MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) COMPLETED THE 2018 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 UNDERSERVED POPULATIONS IN THE COUNTY. |
| PART V, LINE 6A: | THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEMS- CUMBERLAND HEALTHCARE - AMERY HOSPITAL AND CLINIC |
| PART V, 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 |
| PART V, LINE 11: | MARSHFIELD MEDICAL CENTER-RICE LAKE WILL IMPLEMENT MANY STRATEGIES TO COLLABORATE WITH COMMUNITY AND MARSHFIELD CLINIC HEALTH SYSTEM PARTNERS. COMMUNITY CHANGE IS A LONG-TERM PROCESS THAT NO ONE ORGANIZATION CAN ACCOMPLISH ALONE, THEREFOR PARTNERSHIPS ARE ESSENTIAL FOR SUCCESS. THE FOLLOWING WERE IDENTIFIED BY THE COMMUNITY HEALTH ASSESSMENT:- SUBSTANCE ABUSE - MENTAL HEALTH - CHRONIC DISEASE DUE TO THE INTERCONNECTED NATURE OF THE TOP IDENTIFIED HEALTH PRIORITIES, MMC-RL CHOSE TO COMBINE A NUMBER OF HEALTH PRIORITIES AND ARE AS FOLLOWS ALONG WITH THE GOALS AND STRATEGIES IDENTIFIED TO ACHIEVE THEM. ALCOHOL AND SUBSTANCE ABUSECOMMUNITY-BASED GOALS ARE TO REDUCE UNDERAGE AND EXCESSIVE ALCOHOL CONSUMPTION AND OPIOID RELATED DEATHS AND HARM. STRATEGY 1: SUPPORT IMPLEMENTATION OF AN ALCOHOL AND OTHER DRUG ABUSE (AODA) PREVENTION CURRICULUM- MMC-RL WILL PARTNER WITH LOCAL ORGANIZATIONS TO SUPPORT THE IMPLEMENTATION OF AN AODA PREVENTION CURRICULUM TO REDUCE UNDERAGE ALCOHOL CONSUMPTION AND/OR PREVENT SUBSTANCE USE AND ABUSE. STRATEGY 2: SUPPORT LOCAL POLICY RELATED TO UNDERAGE DRINKING PREVENTION- MMC-RL WILL PARTNER WITH LOCAL ORGANIZATION(S) TO SUPPORT THE IMPLEMENTATION OF A NEW OR IMPROVED POLICY RELATED TO UNDERAGE DRINKING PREVENTION. STRATEGY 3: ENGAGE IN AODA PREVENTION COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN THE BARRON COUNTY COMMUNITY COALITION (BC3) THAT ADDRESSES AODA. BEHAVIOR HEALTH COMMUNITY-BASED GOALS ARE TO DECREASE SUICIDE RATES AND IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS. STRATEGY 1: SUPPORT COMMUNITY TRAINING RELATED TO MENTAL HEALTH AND SUICIDE PREVENTION- MMC-RL WILL SUPPORT LOCAL COMMUNITY ORGANIZATION(S) IN PROVIDING QPR TRAININGS TO 500 BARRON COUNTY RESIDENTS. STRATEGY 2: SUPPORT COMMUNITY EDUCATIONAL EVENT(S) RELATED TO MENTAL HEALTH AND/OR SUICIDE PREVENTION- MMC-RL WILL PARTNER WITH AT LEAST ONE COMMUNITY ORGANIZATION TO HOST EDUCATIONAL EVENT(S) WHERE THE DOCUMENTARY, THE RIPPLE EFFECT, WILL BE VIEWED. STRATEGY 3: DEVELOP AODA AND MENTAL HEALTH RESOURCE APP.- MMC-RL WILL ASSIST IN THE DEVELOPMENT OF AN APP FOCUSED ON PROVIDING COMMUNITY MEMBERS, SPECIFICALLY YOUTH ACCESS TO INFORMATION ABOUT EXISTING AODA AND MENTAL HEALTH SERVICES AND RESOURCES. STRATEGY 4: ENGAGE IN MENTAL HEALTH COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN COMMUNITY CONNECTIONS TO PROSPERITY (CCP): MENTAL HEALTH ACTION TEAM THAT ADDRESSES MENTAL HEALTH.CHRONIC DISEASE COMMUNITY-BASED GOALS ARE TO IMPROVE ACCESS TO HEALTHY FOODS AND PHYSICAL ACTIVITY, IMPROVE SELF-MANAGEMENT OF CHRONIC CONDITIONS AND REDUCE TOBACCO USE. STRATEGY 1: PROVIDE A YEARLY PRIMARY PREVENTION STRATEGY THAT SUPPORTS CARE DELIVERY EFFORTS RELATED TO CHRONIC DISEASE MANAGEMENT - MMC-RL WILL PARTICIPATE ALONG WITH CUMBERLAND HEALTHCARE AND MAYO CLINIC HEALTH SYSTEM IN HOLDING KNOW YOUR NUMBERS EVENTS OPEN TO THE COMMUNITY THAT SCREEN RESIDENTS FOR CHRONIC DISEASE RISK FACTORS. STRATEGY 2: PROVIDE SELF-MANAGEMENT EDUCATION OF PRE-DIABETES THROUGH THE NATIONAL DIABETES PREVENTION PROGRAM- MMC-RL WILL IMPROVE REFERRALS/ACCESS TO MMC-RL NATIONAL DIABETES PREVENTION PROGRAM (DPP) STRATEGY 3: IMPROVE ACCESS TO HEALTHY CHOICES- MMC-RL WILL IMPLEMENT AN EDUCATIONAL CAMPAIGN REGARDING SUGAR SWEETENED BEVERAGES STRATEGY 4: ENGAGE IN CHRONIC DISEASE PREVENTION COMMUNITY GROUPS- MMC-RL STAFF WILL ACTIVELY ENGAGE IN THRIVE: BARRON COUNTY CHRONIC DISEASE PREVENTION COALITION THAT ADDRESSES CHRONIC DISEASETHE FOLLOWING HEALTH PRIORITIES WILL NOT BE ADDRESSED BY MMC-RL FOR REASONS INDICATED: - INJURY & VIOLENCE PREVENTION: INJURY AND VIOLENCE ARE IMPORT AREAS OF FOCUS. INSTEAD OF LEADING THIS CHARGE, MMC-RL 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, MMC-RL 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-RL ADDRESSES ORAL HEALTH IT IS NOT LISTED AS ONE OF THE TOP HEALTH PRIORITIES. - REPRODUCTIVE & SEXUAL HEALTH: WHILE MMC-RL DOES PROVIDE THIS SERVICE, COMMUNITY LEAD INITIATIVES ARE BEST LEAD BY THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) AND OTHER AGENCIES WITH EXPERTISE IN THE AREA. - ENVIRONMENTAL & OCCUPATIONAL HEALTH: WHILE MMC-RL DOES HAVE A VIBRANT OCCUPATIONAL HEALTH DEPARTMENT, 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. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: | MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) 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 DID PARTICIPATE IN REGIONAL COMMUNITY GROUPS COORDINATING EFFORTS TO ADDRESS COVID-19. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED: - COALITION BUILDING: MMC-RL STAFF PARTICIPATED IN MORE THAN TEN DIFFERENT COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY. A LIST OF COALITIONS AND COLLABORATIONS ARE LISTED IN MMC-RL CHNA AND IS DOCUMENTS ON THEIR MAIN HOSPITAL WEBSITE. - COMMUNITY SUPPORT: MMC-RL STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS. EXAMPLES INCLUDED: QUESTION, PERSUADE, AND REFER (QPR) TRAINING; VIRTUAL COMMUNITY SHOWING OF THE FILM SUICIDE: THE RIPPLE EFFECT - WORKFORCE DEVELOPMENT: MMC-RL 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-RL 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-RL 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 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 AND IDENTIFIES 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 OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 55% AND 41% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2020 AND SEPTEMBER 30, 2019, RESPECTIVELY. |
| PART III, LINE 8: | THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2020 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. THIS MEDICARE SHORTFALL LISTED ON LINE 7 IS NOT CURRENTLY TREATED AS COMMUNITY BENEFIT, HOWEVER, REPRESENTS SERVICES THAT ARE ESSENTIAL TO VARIOUS UNDERSERVED POPULATIONS IN 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(MMC-RL) ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES BY CONDUCTING STANDARD CHNA PRACTICES, INCLUDING: - REVIEW OF COMMUNITY PARTNERS' REPORTS (I.E. UNITED WAY) - 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: | MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) SERVES BARRON COUNTY. 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 45,164 AND A POPULATION PERCENT CHANGE OF -1.5% IN 2018. WITH 65.9% OF BARRON COUNTY RESIDENTS LIVING IN A RURAL AREA. THE COUNTY IS BORDERED BY DUNN, CHIPPEWA, RUSK, WASHBURN, BURNETT, AND POLK COUNTIES. THE RACIAL MAKE-UP OF BARRON COUNTY IS 93.3% CAUCASIAN, 0.7% ASIAN, 2.6% HISPANIC OR LATINO, 1.3% TWO OR MORE RACES, 1.4% BLACK OR AFRICAN AMERICAN, AND 1.0% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $49,257 COMPARED TO THE STATE AVERAGE OF $56,759. THE NUMBER OF ALICE (ASSET LIMITED, INCOME CONSTRAINED, EMPLOYED) HOUSEHOLDS IN BARRON COUNTY IS HIGHER THAN THE STATE AVERAGE AT 31% AND 25.8% COMPARATIVELY WITH THE POVERTY RATE OF 13% WHICH IS HIGHER THAN THE STATE AVERAGE OF 11%. THE UNEMPLOYMENT RATE IN BARRON COUNTY IS 3.5% WHICH IS SLIGHTLY HIGHER THAN THE STATE AVERAGE OF 3.3%. 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 91.7% STATEWIDE. LIKEWISE, 19.5% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 29% STATEWIDE. |
| PART VI, LINE 5: | MARSHFIELD MEDICAL CENTER-RICE LAKE (MMC-RL) 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 MORE THAN 60R 50 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 CLINIC OPERATES SEVERAL DENTAL CLINICS IN NORTHERN, CENTRAL AND WESTERN WISCONSIN, PROVIDING GENERAL FAMILY DENTISTRY AND DENTAL HYGIENE SERVICES TO MORE THAN 60,000 UNIQUE PATIENTS PER YEAR. THESE CENTERS WERE LAUNCHED THROUGH A COLLABORATION INCLUDING MARSHFIELD CLINIC, FAMILY HEALTH CENTER OF MARSHFIELD, INC., AND FEDERAL AND STATE AGENCIES, TO ADDRESS THE NEED FOR DENTAL CARE IN UNDERSERVED AREAS. THE CENTERS SERVE ALL PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS - UNINSURED/UNDERINSURED, PRIVATE PAY AND COMMERCIAL INSURANCE. 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 BUILDS 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
| Total501c3 Org | 0 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE | GrantTypeTxt |
| Recipient | 40 | RecipientCnt |
| Cash Grant | $610,318 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) PROVIDES EMERGENCY AND MEDICALLY NECESSARY HEALTH CARE SERVICES FOR FREE OR AT DISCOUNTED RATES TO PATIENTS WHO MEET CERTAIN ELIGIBILITY CRITERIA. PATIENTS SEEKING FINANCIAL ASSISTANCE APPLY BY COMPLETING A FINANCIAL ASSISTANCE APPLICATION. FREE CARE IS AVAILABLE FOR PATIENTS WITH INCOME AND EXCESS ASSET VALUES AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | Yes (1) | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN TURNEY MD | ||||||||||||||
| BOARD MEMBER/MCHS CE | $0 | $1,736,862 | $0 | $647,870 | $0 | $449,684 | $0 | $270,161 | $0 | $21,617 | $0 | $3,126,194 | $0 | $241,400 |
| NARAYANA MURALI MD | ||||||||||||||
| BOARD MEMBER/MCHS CS | $0 | $747,104 | $0 | $272,924 | $0 | $62,344 | $0 | $21,519 | $0 | $28,719 | $0 | $1,132,610 | $0 | $0 |
| GORDON EDWARDS | ||||||||||||||
| MCHS CFO/COO | $0 | $747,640 | $0 | $210,274 | $0 | $46,066 | $0 | $21,519 | $0 | $29,152 | $0 | $1,054,651 | $0 | $0 |
| JERARD JENSEN | ||||||||||||||
| MCHS GENERAL COUNSEL | $0 | $772,789 | $0 | $171,649 | $0 | $41,854 | $0 | $21,519 | $0 | $24,568 | $0 | $1,032,379 | $0 | $0 |
| WILLIAM MELMS MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $548,327 | $0 | $43,847 | $0 | $14,938 | $0 | $21,519 | $0 | $23,841 | $0 | $652,472 | $0 | $0 |
| RUWAN DISSANAYAKE MD | ||||||||||||||
| BOARD MEMBER | $0 | $356,702 | $0 | $103,989 | $0 | $32,296 | $0 | $21,519 | $0 | $25,981 | $0 | $540,487 | $0 | $0 |
| STEVEN KULICK | ||||||||||||||
| FORMER CHIEF EXP. OFF. | $0 | $153,586 | $0 | $0 | $0 | $318,282 | $0 | $5,429 | $0 | $7,414 | $0 | $484,711 | $0 | $0 |
| NED WOLF | ||||||||||||||
| FORMER LMC CEO | $0 | $23,093 | $0 | $0 | $0 | $284,853 | $0 | $866 | $0 | $673 | $0 | $309,485 | $0 | $0 |
| CINDY ARTS-STRENKE | ||||||||||||||
| FORMER LMC COO | $0 | $216,873 | $0 | $22,042 | $0 | $13,692 | $0 | $18,255 | $0 | $20,021 | $0 | $290,883 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE ORGANIZATION MAY OCCASIONALLY REIMBURSE OR PROVIDE A HOUSING ALLOWANCE FOR KEY EXECUTIVES IN ORDER TO ASSIST WITH RELOCATING TO THE AREA. THE ORGANIZATION MAY ALSO CONTRIBUTE TO OR REIMBURSE FOR HEALTH AND SOCIAL CLUB DUES AS DEEMED NECESSARY IN ORDER TO SUPPORT A BUSINESS NEED. |
| 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, LINES 4A-B | SEVERANCE NED WOLF - $277,000 STEVEN KULICK - $291,923 457(F) PLAN SUSAN TURNEY, MD - $278,676 RUWAN DISSANAYAKE, MD - $10,000 NARAYANA MURALI, MD - $10,000 WILLIAM MELMS, MD - $10,000 JERARD JENSEN - $10,000 GORDON EDWARDS - $10,000 NED WOLF - $2,500 CINDY ARTS-STRENKE - $10,000 |
| PART I, LINE 5 | SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. |
| PART I, LINE 6 | SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2: | 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 MEMBER 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 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 ORGS -8,386,168. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MARSHFIELD CLINIC INC | |||||||||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | 390452970 | MEDICAL SVCS | WI | 501(C)(3) | 3 | MCHS | 0 | |
| VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL | |||||||||||
| 1700 W STOUT ST | RICE LAKE | WI | 54868 | 391329084 | SUPPORT ORG | WI | 501(C)(3) | 12-TYPE III | 0 | N/A | |
| 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) | 3 | MCHS HOSP | 0 | |
| MARSHFIELD CLINIC HEALTH SYSTEM INC | |||||||||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | 461495343 | SUPPORT ORG | WI | 501(C)(3) | 12-TYPE III | 0 | N/A | |
| FAMILY HEALTH CENTER OF MARSHFIELD INC | |||||||||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | 391681547 | COM HLTH CTR | WI | 501(C)(3) | 7 | 0 | N/A | |
| MCHS HOSPITALS INC | |||||||||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | 810977948 | HOSPITAL | WI | 501(C)(3) | 3 | MCHS | 0 | |
| MCHS FOUNDATION INC | |||||||||||
| 1000 N OAK AVE | MARSHFIELD | WI | 54449 | 812822823 | PHILANTHROPY | WI | 501(C)(3) | 7 | 0 | N/A | |
| BEAVER DAM COMMUNITY HOSPITALS INC | |||||||||||
| 707 S UNIVERSITY AVE | BEAVER DAM | WI | 53916 | 391157876 | HOSPITAL | WI | 501(C)(3) | 3 | MCHS HOSP | 0 | |
| MEMORIAL HOSPITAL INC | |||||||||||
| N3708 RIVER AVE | NEILLSVILLE | WI | 54456 | 390806828 | HOSPITAL | WI | 501(C)(3) | 3 | MCHS HOSP | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE DIAGNOSTIC & TREATMENT CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3401 CRANBERRY BLVD | AddressLine1Txt |
| City | WESTON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54476 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200691634 | EIN |
| Primary Activities | MEDICAL SVCS | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | RELATED | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |