2021-11-29T13:57:39-06:00 2020-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH MINNEAPOLIS MN 55402 990 2020-10-01 461495343 MARSHFIELD CLINIC HEALTH SYSTEM INC MARS 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 GORDON T EDWARDS COO/CFO 7153875511 2021-11-29 1 GORDON EDWARDS 999009999 MONROE J GIERL P01413237 6123055000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 65474971 0 X WWW.MARSHFIELDCLINIC.ORG/HEALTH-SYSTEM X 2012 WI SEE SCHEDULE O. WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 24 13 11822 0 0 0 173688 740363 227881831 63557762 2930082 1155996 0 0 230985601 65454121 856705 59733 0 0 147671036 38546337 0 0 0 107238122 28805229 255765863 67411299 -24780262 -1957178 945887022 563033323 596698689 219894629 349188333 343138694 X WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 67411299 59733 63557762 SEE SCHEDULE O.MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) WAS INCORPORATED IN OCTOBER 2012 AS PART OF A PROSPECTIVE REORGANIZATION OF MARSHFIELD CLINIC AND ITS AFFILIATED ENTITIES INTO AN INTEGRATED HEALTHCARE SYSTEM. THE REORGANIZATION WAS IMPLEMENTED UPON RECEIPT OF AN INTERNAL REVENUE SERVICE (IRS) DETERMINATION LETTER RECOGNIZING MCHS AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3) IN 2014. MCHS AS A STANDALONE ENTITY HOUSES CERTAIN ADMINISTRATIVE FUNCTIONS THAT SUPPORT THE SYSTEM AS A WHOLE. 67411299 1 1 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1168 0 1 11822 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 X 24 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CATHY BUKOWSKI VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 MARK BUGHER CHAIR 9.00 1.00 X X 32500 0 0 MARK BRADLEY VICE CHAIR 4.00 2.00 X X 8500 0 0 RICHARD LEINENKUGEL TREASURER 4.00 0.00 X X 8500 0 0 ALPA SHAH MD SECRETARY 4.00 39.00 X X 0 243252 16822 EDWARD FERNANDEZ MD BOARD MEMBER 3.00 54.00 X 0 638528 53594 NEELAKANTAN NAMBOODIRI MD BOARD MEMBER 2.00 53.00 X 0 360247 42309 SUSHMA THAPPETA MD BOARD MEMBER 2.00 52.00 X 0 473522 50100 NICHOLAS BODMER MD BOARD MEMBER 2.00 52.00 X 0 722268 49225 KENT RAY DO BOARD MEMBER 3.00 53.00 X 0 335197 52460 JAYANTH VEDRE MD BOARD MEMBER 2.00 52.00 X 0 732731 52454 DAVID JUNKER MD BOARD MEMBER 2.00 52.00 X 0 707478 53937 TIMOTHY WENGERT MD BOARD MEMBER 2.00 52.00 X 0 341720 41537 MATTHEW THOMAS MD BOARD MEMBER 3.00 55.00 X 0 633405 47244 ELVIS PETER MD BOARD MEMBER 3.00 52.00 X 0 871834 52460 BILL FONTI BOARD MEMBER 2.00 0.00 X 5000 0 0 GEORGE BROWN MD BOARD MEMBER 2.00 0.00 X 6000 0 0 LEAH BRASH BOARD MEMBER 4.00 0.00 X 7000 0 0 MICHAEL LUEBKE BOARD MEMBER 4.00 1.00 X 29000 0 0 CHUCK NASON BOARD MEMBER 4.00 1.00 X 4750 0 0 BERNIE PATTERSON BOARD MEMBER 2.00 0.00 X 7500 0 0 DAVID SHORE BOARD MEMBER 4.00 0.00 X 9500 0 0 JANET LINDEMANN MD BOARD MEMBER 4.00 0.00 X 8500 0 0 FRITZ WENZEL BOARD MEMBER 4.00 0.00 X 9500 0 0 TERRY FRANKLAND BOARD MEMBER 4.00 1.00 X 15000 0 0 NARAYANA MURALI MD MCHS CHIEF STRATEGY OFFICER 50.00 5.00 X 1082372 0 50238 JULIE BRUSSOW MCHS HEALTH PLAN CEO 50.00 5.00 X 562370 0 38964 JERARD JENSEN MCHS GENERAL COUNSEL 50.00 5.00 X 986292 0 46087 GORDON EDWARDS MCHS CFO/COO 50.00 5.00 X 1003980 0 50671 SUSAN TURNEY MD MCHS CEO 50.00 5.00 X 2834416 0 291778 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 50.00 5.00 X 607112 0 45361 PAULA PRITZL MCHS CHIEF HR OFFICER 50.00 0.00 X 255411 0 42739 JEANNE SCINTO CHIEF TRANSFORMATION OFFICER 50.00 5.00 X 484078 0 46040 7967281 6060182 1124020 1023 0 1 0 TRIAGE LLC PO BOX 3291 OMAHA NE 68103 MEDICAL SVCS 4171244 XTEND HEALTHCARE LLC 90 VOLUNTEER DRIVE SUITE 150 HENDERSONVILLE TN 37075 PROFESSIONAL SVCS 3004131 ATWATER SOLUTIONS LLC PO BOX 611 DEVON PA 19333 PROFESSIONAL SVCS 2327329 CHANGE HEALTHCARE SOLUTIONS LLC 22423 NETWORK PLACE CHICAGO IL 60673 PROFESSIONAL SVCS 1554089 ELEKTA INC PO BOX 404199 ATLANTA GA 30384 PROFESSIONAL SVCS 1415667 89 56890 683473 740363 INTERCOMPANY REVENUE 561000 62106019 62106019 CONTRACT REVENUE 561000 1451743 1451743 63557762 801207 801207 375639 18336 2514 357303 -2514 354789 354789 65454121 63557762 0 1155996 20423 20423 39310 39310 2655805 2655805 23650826 23650826 2964377 2964377 7538051 7538051 1737278 1737278 575466 575466 219948 219948 257449 257449 4192084 4192084 1066062 1066062 1454482 1454482 9980654 9980654 1594003 1594003 196423 196423 1925 1925 245 245 5120178 5120178 1849803 1849803 MEDICAL SUPPLIES 1650617 1650617 DUES, SUB., LICENSES 439145 439145 RECRUITMENT EXPENSES 115124 115124 TAXES 78259 78259 13362 13362 67411299 67411299 0 0 19115286 15968170 244683 264229 0 0 376167389 6044082 0 0 0 0 10161300 10161300 48 0 9596414 11935946 195958143 127945268 66007059 68012875 71396974 126452159 99793808 128687419 289937067 195318498 3301138 0 165856 188645 945887022 563033323 596356569 219559993 0 0 222804 204333 0 0 0 0 0 0 119316 130303 0 0 596698689 219894629 X 349188333 343138694 0 0 349188333 343138694 945887022 563033323 X -1957178 10310316 -14402777 X 0 1 X 1 1 1 X X 3 MARSHFIELD CLINIC INC 390452970 3 1 0 0 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE 390837206 3 1 0 0 FLAMBEAU HOSPITAL INC 390973724 3 1 0 0 3 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 FORM 990, PART IV, SECTION A, LINE 6 THE COMMUNITY ENGAGEMENT DEPARTMENT PROVIDES SUPPORTS TO VARIOUS LOCAL NONPROFIT ORGANIZATIONS. FORM 990, PART IV, SECTION D, LINE 3: SUPPORTING ORGANIZATIONS HAVE A SIGNIFICANT VOICE IN THE ORGANIZATION'S INVESTMENT POLICIES AND USE OF ITS INCOME OR ASSETS BY VIRTUE OF THE OVERLAP OF BOARD AND EXECUTIVE OVERSIGHT. FORM 990, PART IV, SECTION E, LINE 3A: MCHS HAS THE RIGHT TO APPOINT, ELECT OR APPROVE/DISAPPROVE MEMBERS OF MOST OF THE SUPPORTED ORGANIZATIONS' BOARDS. IN THE CASE OF MARSHFIELD CLINIC, INC., MCHS DOES NOT ELECT OR APPOINT, BUT THE 11 MEMBERS OF THE MARSHFIELD CLINIC BOARD ARE ALSO MEMBERS OF THE MCHS BOARD. FORM 990, PART IV, SECTION E, LINE 3B: THERE IS EITHER BOARD OVERLAP OR EXECUTIVE OVERLAP IN EACH OF THE AFFILIATED ORGANIZATIONS. EXECUTIVE LEADERS FROM EACH SUPPORTED ORGANIZATION REPORT TO MCHS EXECUTIVES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 246757 0 1 10692 257449 0 FORM 990, PART II-B: WHERE ITS EXPERIENCE MAY BE HELPFUL, MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) MAY OFFER RECOMMENDATIONS CONCERNING LEGISLATION OR REGULATIONS BEING CONSIDERED. IN ADDITION, IT MAY ANALYZE AND TAKE POSITIONS ON ISSUES THAT HAVE A RELATIONSHIP TO THE ORGANIZATION'S OPERATIONS. OCCASIONALLY STAFF MEMBERS WILL SEND MAIL TO MEMBERS OF CONGRESS AND THEIR STAFF. MCHS IS ALSO A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. TOTAL DUES PAID BY MCHS ARE REPORTED ON LINE 1-I. 77550 77550 8776103 1648206 7127897 288227 184031 104196 186807682 126109147 60698535 8581 3884 4697 68012875 LTD PTNSHP COMM INV 128687419 F 128687419 INVESTMENT IN HHJV -92559 F INVESTMENT IN SHP 195411057 F 195318498 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, 2020 OR SEPTEMBER 30, 2019. 1 TOWN OF BOULDER JUNCTION PO BOX 616 BOULDER JUNCTION WI 54512 396018408 501(C)(3) 15000 GENERAL SUPPORT 1 0 PATIENT COST CHARITABLE BENEFIT 70 39310 N/A PART I, LINE 2: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) PROVIDES ASSISTANCE (PRIMARILY CONTRIBUTIONS) TO A VARIETY OF ORGANIZATIONS, ALL OF WHICH ARE 501(C)(3). MCHS MAKES DETERMINATIONS ON GRANTS AND OTHER ASSISTANCE BASED ON THE RECIPIENT ORGANIZATION'S MISSION, REPUTATION AND THE ORGANIZATION'S INTENDED USE OF FUNDS. X X 1 1 X X X X X 0 1 0 1 1 1 1 0 0 SUSAN TURNEY MD MCHS CEO 1736862 0 647870 0 449684 0 270161 0 21617 0 3126194 0 241400 0 NARAYANA MURALI MD MCHS CHIEF STRATEGY OFFICER 747104 0 272924 0 62344 0 21519 0 28719 0 1132610 0 0 0 GORDON EDWARDS MCHS CFO/COO 747640 0 210274 0 46066 0 21519 0 29152 0 1054651 0 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 772789 0 171649 0 41854 0 21519 0 24568 0 1032379 0 0 0 ELVIS PETER MD BOARD MEMBER 0 822562 0 16976 0 32296 0 21519 0 30941 0 924294 0 0 JAYANTH VEDRE MD BOARD MEMBER 0 453471 0 247174 0 32086 0 21519 0 30935 0 785185 0 0 NICHOLAS BODMER MD BOARD MEMBER 0 543822 0 146402 0 32044 0 21519 0 27706 0 771493 0 0 DAVID JUNKER MD BOARD MEMBER 0 607352 0 67830 0 32296 0 21519 0 32418 0 761415 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 379670 0 224420 0 34438 0 21519 0 32075 0 692122 0 0 MATTHEW THOMAS MD BOARD MEMBER 0 568029 0 21276 0 44100 0 21519 0 25725 0 680649 0 0 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 548327 0 43847 0 14938 0 21519 0 23842 0 652473 0 0 0 JULIE BRUSSOW MCHS HEALTH PLAN CEO 441747 0 104090 0 16533 0 21519 0 17445 0 601334 0 0 0 JEANNE SCINTO CHIEF TRANSFORMATION OFFICER 446280 0 31291 0 6507 0 21519 0 24521 0 530118 0 0 0 SUSHMA THAPPETA MD BOARD MEMBER 0 344668 0 116268 0 12586 0 21519 0 28581 0 523622 0 0 NEELAKANTAN NAMBOODIRI MD BOARD MEMBER 0 325439 0 7075 0 27733 0 21519 0 20790 0 402556 0 0 KENT RAY DO BOARD MEMBER 0 315879 0 6522 0 12796 0 21519 0 30941 0 387657 0 0 TIMOTHY WENGERT MD BOARD MEMBER 0 320340 0 6442 0 14938 0 21519 0 20018 0 383257 0 0 PAULA PRITZL MCHS CHIEF HR OFFICER 238198 0 12815 0 4398 0 19158 0 23581 0 298150 0 0 0 ALPA SHAH MD SECRETARY 0 228274 0 4535 0 10443 0 16822 0 0 0 260074 0 0 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, LINE 4B 457(F) PLAN ALPA SHAH, MD - $7,000 EDWARD FERNANDEZ, MD - $10,000 NEELAKANTAN NAMBOODIRI, MD - $5,000 SUSHMA THAPPETA, MD - $10,000 NICHOLAS BODMER, MD - $10,000 KENT RAY, DO - $10,000 JAYANTH VEDRE, MD - $10,000 DAVID JUNKER, MD - $10,000 TIMOTHY WENGERT, MD - $10,000 MATHEW THOMAS, MD - $10,000 ELVIS PETER, MD - $10,000 NARAYANA MURALI, MD - $10,000 JULIE BRUSSOW - $10,000 JERARD JENSEN - $10,000 GORDON EDWARDS - $10,000 SUSAN TURNEY, MD - $278,676 WILLIAM MELMS, MD - $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. A WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97710BZ54 2012-06-13 107540304 ACQUISITION, CONSTRUCTION, & RENOVATION 0 0 0 B WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97712DUG9 2016-10-05 316977541 SEE PART VI 0 0 0 C WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97712DA71 2017-09-13 328044486 REFUNDING OF SERIES 2017A BONDS 0 0 0 D WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 977121DQ5 2018-09-26 100000000 SEE PART VI 0 0 0 A 2645000 107298259 1440312 106487947 0 0 1 1 B 7735000 316990839 6038 2672884 102907260 211404657 2017 1 0 1 1 C 6615000 328044486 3044486 325000000 1 0 1 1 D 50000000 100000000 737000 99263000 0 0 0 1 A 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 1 1 0.00560 0.00000 0.00560 0 1 0.00340 1 1 C 0 1 1 1 1 1 0.01210 0.00000 0.01210 0 1 0.00490 1 1 D 0 1 1 1 1 1 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 1 B 0 1 1 0 1 0 0 1 C 0 1 1 0 0 0 0 1 D 0 1 1 0 1 0 0 1 A 1 B 1 C 1 D 1 PART II, LINE 3: COLUMN A: PART II, LINE 3: THE DIFFERENCE BETWEEN PART II, LINE 3 AND PART I (E) IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART IV, LINE 2C: THE REBATE COMPUTATION PERFORMED AS OF 02/15/2017 CONFIRMED THAT NO REBATE WAS DUE ON THE BONDS. COLUMN B: PART I(F): THE BONDS WERE ISSUED TO REIMBURSE THE BORROWER FOR COSTS ASSOCIATED WITH ITS NEW MONEY PROJECT AS WELL AS TO REISSUE THE SERIES 2012 BONDS (ISSUED ON 4/13/12), REFUND THE SERIES 2006B BONDS (ISSUED ON 1/31/06) REFINANCE A LINE OF CREDIT BY JP MORGAN CHASE BANK, N.A. (DRAWN ON 2/16/16) LINE OF CREDIT ISSUED ON (4/1/12), REFUND VARIOUS USDA LOANS AND PAY THE CHIPPEWA LEASE (ISSUED JULY 14, 2006). PART II, LINE 3: THE DIFFERENCE BETWEEN PART II, LINE 3 AND PART I (E) IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART IV, LINE 2B: THE CURRENT REFUNDING PORTION OF THE BONDS MET THE 6 MONTH EXCEPTION TO REBATE. COLUMN C: PART I(F): THE SERIES 2017A TAXABLE BONDS WERE ISSUED ON 06/30/2017. PART IV, LINE 2B: THE 2017BC BONDS MET THE 6 MONTH EXCEPTION TO REBATE. COLUMN D: PART I(F): THE BONDS WERE ISSUED TO FINANCE OR REIMBURSE THE BORROWER FOR COSTS ASSOCIATED WITH THE ACQUISITION, CONSTRUCTION, RENOVATION, AND EQUIPPING OF THE PROJECT AS WELL AS TO PAY ISSUANCE COSTS. PART IV, LINE 2B: ALL PROCEEDS OF THE BONDS WERE EXPENDED WITHIN 6 MONTHS OF THE ISSUE DATE, AND HAVE THUS MET THE REQUIREMENTS OF THE 6 MONTH EXCEPTION TO REBATE. A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 NONEAVAIL 2019-09-30 52700000 SEE PART VI 0 0 0 B WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712D6Y7 2020-06-30 318530787 SEE PART VI 0 0 0 A 1620000 53167458 334352 20023192 32809913 0 0 0 1 B 318531490 1197766 1726605 99783072 215606416 217630 1 0 0 1 A 0 1 1 1 1 1 0 0 1 B 0 1 1 1 1 1 0 0 1 A 0 1 0 0 1 0 0 1 B 0 1 1 0 0 0 0 1 A 1 B 1 JULIE KOPLITZ FAMILY RELATIONSHIP 26769 COMPENSATION 0 JUSTIN KOPLITZ FAMILY RELATIONSHIP 39740 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS BERNIE PATTERSON AND CHUCK NASON HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS RICHARD LEINENKUGEL AND MARK BRADLEY HAVE A FAMILY RELATIONSHIP. 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 MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) 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 XI, LINE 9: EQUITY INCOME FROM SECURITY HEALTH PLAN -14,443,655. EQUITY INCOME FROM MC HHJV LLV -24,914. NET ASSET TRANSFERS WITH RELATED ORGS 65,792. SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 1 FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 MCHS HOSP 0 LAKEVIEW MEDICAL CENTER INC 1700 W STOUT ST RICE LAKE WI 54868 390837206 HOSPITAL WI 501(C)(3) 3 MCHS HOSP 0 MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) 3 MCHS 1 VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) 12-TYPE III N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) 7 N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) 3 MCHS 1 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) 7 MCHS 1 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 THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI N/A RELATED 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 MCHS FOUNDATION INC C 56890 COST SECURITY HEALTH PLAN OF WISCONSIN INC S 100000 COST LAKEVIEW MEDICAL CENTER INC OF RICE LAKE P 496489 COST SECURITY HEALTH PLAN OF WISCONSIN INC P 833412 COST MCHS HOSPITALS INC P 2441452 COST THE DIAGNOSTIC & TREATMENT CENTER LLC S 65792 COST FORM 990, PART V, LINE 1: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A 501(C)3 ORGANIZATION), IS THE PARENT ORGANIZATION OF THE FOLLOWING ORGANIZATIONS: MARSHFIELD CLINIC, INC. SECURITY HEALTH PLAN OF WISCONSIN, INC. MCHS HOSPITALS, INC. MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION, INC.