2025-08-13T11:24:17-05:00 2024-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-10-01 390799566 Tomah Memorial Hospital TOMA 6083722181 501 Gopher Drive Tomah WI 54660 Joseph Zeps Chief Financial Officer 6083722181 2025-08-12 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-08-12 2023 2025-03-06 01:10:19Z Tomah Health Derek Daly 501 Gopher Drive Tomah WI 54660 102227085 0 X www.tomahhospital.org X 1948 WI To promote and provide quality health care to patients in a hospital setting 8 7 538 31 0 0 2492713 298403 81522472 90324234 2073655 2319545 -9750 -1704 86079090 92940478 0 0 0 0 37656300 42246291 0 0 39342 41223970 44707224 78880270 86953515 7198820 5986963 129590553 140787498 45260023 47534632 84330530 93252866 X The mission of Tomah Memorial Hospital, Inc. is to promote and provide quality health care based on customer needs and expectations. In fulfillment of its mission, Tomah Memorial Hospital is committed to view its customers and employees through a holistic approach without consideration to economic status, gender, ethnic origin or personal limitations. 0 0 69483066 87647430 Tomah Health has provided for the health and well-being of the residents of Tomah and the surrounding communities for nearly sixty-five years. The Hospital provides a broad spectrum of health and wellness services to the community, including general medical/surgical and swing bed inpatient care, diagnostic laboratory, and radiology services, general and specialty surgical services, 24-hour emergency care services, obstetric services, rehabilitative services, occupational health and wellness programs, and a community outreach program. Key volume indicators for the fiscal year ended September 30, 2024 are as follows:(Continued on Schedule O)* 1,229 inpatient discharges* 3,540 inpatient days* 23,124 emergency room and urgent care visits* 2,093 surgical and endoscopic procedures* 20,681 radiology procedures (including CT and MRI)* 106,683 laboratory tests* 57,087 rehabilitative services proceduresIn furtherance of its charitable mission, the Hospital provided approximately $521 thousand of free and discounted care to area residents (cost of care approximately $211 thousand) and wrote off $3.78 million of uncollectible accounts (cost equal to approximately $1.52 million). Additionally, based on its most recently completed community benefits survey, the Hospital incurred approximately $2.43 million in net losses related to providing care for individuals with health insurance provided by either the Medicaid program or other governmental insurance programs. The Hospital subsidizes several programs that are deemed vital services for the community, including in-home hospice and palliative care services, a hospice residence, a walk-in clinic located in the rural community of Warrens, WI, and a dedicated community outreach department that provides health and wellness services to area employers and the Tomah community. Subsidies for these programs for fiscal 2024 approximated $3.08 million. Additional details regarding the hospice program and the Warrens Walk-In Clinic can be found below in 4b and 4c. In addition to providing high quality healthcare services, the Hospital encourages employees to become actively involved in community organizations and projects that provide other benefits to local communities. The Hospital provides many free services to the community, including health and wellness presentations to area school children, CPR and AED training to various organizations, wellness fairs devoted to women and senior citizens, and meeting space to various non-profit and civic organizations. 4778002 2237783 Hospice ProgramThe Hospital provides in-home, inpatient, and residential hospice care to residents of Tomah and the surrounding communities. Residential care is provided via the operation of an eight-bed hospice house located off campus. Despite subsidizing the financial losses incurred by the program, the services are deemed vital to the community and represent a necessary component of patient care. For the year ended September 30, 2024, the Hospice program experienced 9,061 program days and 1,365 hospice residence days 974648 439021 Warrens Walk-In ClinicThe Hospital began operating an off-site walk-in care clinic several years ago to better serve the needs of the residents of Warrens, Wisconsin. For the fiscal year ended September 30, 2024, the clinic accommodated 2,752 patient visits. The clinic provides residents with a close-to-home, low-cost option for healthcare services (including basic laboratory tests and x-ray capabilities) related to minor injuries and illnesses, and all services provided are supported by the Hospital's Emergency Department. Despite incurring a negative gross contribution margin during 2024, the Hospital's Board of Directors believes the clinic is an important asset to the residents of Warrens and remains committed to supporting it until it achieves a sustainable level of financial performance. 75235716 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 6 0 1 538 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Joseph Zeps 6083778681 501 Gopher Drive Tomah WI 54660 Michelle Masters Nurse Practitioner 36.00 X 291425 0 37092 Gerald Fushianes Physician Assistant 36.00 X 265727 0 38423 Joseph Zeps Chief Financial Officer 40.00 X 259868 0 37019 Tracy Myhre CNO 40.00 X 222762 0 36645 Laura Miller Nurse Practitioner 30.00 X 227793 0 18973 Todd Chapman Pharmacy Director 40.00 X 220374 0 8843 Kelly Thayer Nurse Practitioner 40.00 X 196921 0 20083 Greg Gaardner Chair 1.00 X X 0 0 0 Keith Laugen Vice Chair (until Jan 24) 1.00 X X 0 0 0 B Scott Nicol - Secretary then Vice Chair (as of Jan 24) 1.00 X X 0 0 0 Deb Buswell Treasurer 1.00 X X 0 0 0 Sue Playter Mubarak-Director the Secretary (as of Jan 24) 0.50 X X 0 0 0 Diana Gerke Director 0.50 X 0 0 0 Tiffany Casper DO Director 0.50 X 0 0 0 Beth Arity Director 0.50 X 0 0 0 Wes Revels Director 0.50 X 0 0 0 Jennifer Drexler DO Director (until Jan 24) 0.50 X 0 0 0 Todd Torkelson Director (until Jan 24) 0.50 X 0 0 0 Robert Holness MD Director (until Jan 24) 0.50 X 0 0 0 Derek Daly CEO 40.00 X 0 0 0 1684870 0 197078 33 0 1 0 Gundersen Lutheran Health Systems 1900 South Ave LaCrosse WI 54601 Contracted ER physicians/dietician 4222620 Novus 501 Gopher Dr Tomah WI 54660 Contracted CRNA Services 2451020 Medical X-ray Consultants 900 W Clairemont Avenue Eau Claire WI 54701 Contracted radiologist 1553151 Pinnacle Orthopedics 501 Gopher Dr Tomah WI 54660 Contracted orthopedic surgeon 1457250 Mayo Clinic Health System 201 W Center St Rochester MN 55902 Contracted hospitalists 1242224 15 20674 3275 274454 298403 Patient Service Revenue 621110 89944221 89944221 380013 380013 90324234 1817708 1817708 7965 9669 -1704 -1704 -1704 9679479 99296 9276938 0 402541 99296 501837 501837 92940478 90324234 0 2317841 X 596755 279792 316963 266532 266532 32560861 28153271 4376576 31014 958742 829765 128058 919 5488525 4734135 749193 5197 2374876 2040857 331807 2212 938321 938321 10575 10575 86481 86481 2897 2897 14731874 13499196 1232678 285916 285916 2364360 1143858 1220502 569886 569886 191538 150006 41532 245183 189492 55691 1167024 1038651 128373 6271117 5581294 689823 201124 201124 Medical Supplies 14956806 14953804 3002 Repairs & Maint 1943740 1348730 595010 740382 252426 487956 86953515 75235716 11678457 39342 25357331 34991823 9916775 10617921 1318834 1479917 2273522 2025123 84119358 31260377 55499384 52858981 33926690 37473205 1298017 1340528 129590553 140787498 4290574 5936995 10909225 10391832 29125342 28364403 934882 2841402 45260023 47534632 X 80625242 90152562 3705288 3100304 84330530 93252866 129590553 140787498 X 5986963 2737946 197427 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2897 0 0 0 2897 0 Part II-B, Line 1: Dues paid to the American Hospital Association where 32% of the annual dues $9,055 were attributable to lobbying. 1596177 38871 254563 21106 1868505 1489183 45183 80673 18862 1596177 1508753 61894 -63467 17997 1489183 1335008 35758 154311 16324 1508753 1322711 31230 -1818 17115 1335008 0.00000 1.00000 0.00000 0 0 2005488 2005488 56429023 14786920 41642103 24252813 16061579 8191234 1432034 411878 1020156 52858981 Estimated Third Party Payor 2448500 Capital Lease Obligation 392902 2841402 X 95875851 2737946 197427 2935373 92940478 0 92940478 86953515 0 86953515 0 86953515 Part V, Line 4: Permanently restricted net assets are restricted to the Hospice endowment fund and the beneficial interest in a perpetual trust. The interest earned can be used for hospice expenditures. Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Net change in fair value of beneficial interest in a perpetual trust 197,427. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 209 211000 211000 0.00240 1 12698 30326173 28170857 2155316 0.02480 1 7682 29423584 29144732 278852 0.00320 3 20589 59960757 57315589 2645168 0.03040 24 128735 128735 0.00150 3 3157 5752650 2676804 3075846 0.03540 3 3181 5881385 2676804 3204581 0.03690 6 23770 65842142 59992393 5849749 0.06730 1 3768462 482363 16977093 17014675 -37582 X 1 1 1 1 Tomah Memorial Hospital 501 Gopher Drive Tomah WI 54660 www.tomahhealth.org 1023 X X X Warrens Walk-In Clinic - provider based Tomah Memorial Hospital 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X See Part V, Page 8 X 1 21 1 See Part V, Page 8 0 1 X 100.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 Tomah Memorial Hospital Part V, Section B, Line 5: The Hospital participates in a collaborative community health needs assessment project with other area healthcare providers and county health departments. A new assessment is performed once every three years, and the process is coordinated by the Great Rivers United Way. The collaboration conducted a region-wide assessment via surveys, focus groups, and a detailed review of county and state demographic information. The assessment was used to identify and prioritize the health needs of Monroe County. The results of the assessment are used to affirm existing programs, develop new strategies, and ultimately improve the overall health of the community. Tomah Memorial Hospital Part V, Section B, Line 6a: Gundersen Health System (including LaCrosse, Hillsboro, and Whitehall locations)Mayo Health System (including LaCrosse and Sparta locations)Vernon Memorial Healthcare Tomah Memorial Hospital Part V, Section B, Line 6b: Great Rivers United WayHouston County (MN) Health DepartmentLaCrosse Community FoundationLaCrosse County Health DepartmentMonroe County Health DepartmentTrempealeau County Health DepartmentVernon County Health Department Tomah Memorial Hospital Part V, Section B, Line 11: The 2021-2023 CHNA identified many of the same issues that were covered in the previous CHNA, with the top five concerns centered on mental health, alcohol and other drug abuse, nutrition, childcare, and wages and poverty. Significant implementation strategies/actions in FY2024 include the following:- Continued partnership with the Monroe County Mental Health coalition to improve access to mental wellness services and reduce stigma associated with accessing those services.- Provision of Adverse Childhood Experiences & Trauma Informed Care to support individuals involved with traumatic events.- Developed a suboxone clinic to provide medically assisted treatment to individuals struggling with opioid addiction, as well as coordinating the provision of this service with local law enforcement and judiciary officials.- Partnership with Coulee Recovery Center to provide patients with assistance on finding rehab services, as well as the availability of a Peer Recovery Coaching program for patients presenting with a substance use disorder.- Continued partnership with the Monroe County Nutrition Coalition to improve the nutrition of Monroe County residents and reduce diabetes health disparities.- Membership on the Tomah Area School District's Wellness Committee to encourage staff and students to improve nutrition habits.- Formally planning for a future food forest project, whereby food produced naturally in the forest can be paired with health community cooking classes.- Provided educational offerings to help new parents and siblings with the process of bringing new life into the world, including online classes to address prepared childbirth, hydrotherapy, and breastfeeding.- Continued offering of the SafeSitter babysitting class to help students learn the responsibility of babysitting as well as staying at home alone.- Continued coordination sponsorship of community health and wellness events including Health Aging Expo, Women's Health Night, and Men's Health Night.- Continued review of the Hospital's wage and benefit package to ensure all Hospital employees are compensated at a level that provides for a liveable wage.- Use of Hospital classroom space for area educational events (e.g basic cooking skills, healthy eating) and support groups (cancer survivors, Parkinson's support)- Partnered with area nursing school to offer free foot care clinics to elderly and disabled in the Tomah area.More details on the Hospital's most recent CHNA implementation strategies can be found on the Hospital's website (www.tomahhealth.org). Tomah Memorial Hospital Part V, Section B, Line 16j: Brochures containing information about financial assistance are available to patients. The Hospital's website contains information regarding community care and financial assistance. Contact information regarding community care and financial assistance is included on billing statements. Summary and contact information is also included in the emergency room, waiting rooms, and business office. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Part V, line 7a, Community Health Needs Assessment website: https://www.tomahhealth.org/about-us/community-health-needs-assessment Part V, line 10a, Implementation Strategy website: https://www.tomahhealth.org/about-us/community-health-needs-assessment/ Part V, line 16a, FAP website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ Part V, line 16a, FAP Application website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ Part V, line 16a, FAP Plain Language Summary website: https://www.tomahhealth.org/patients-visitors/billing-insurance/general-hospital-billing-info/ 2 1 - Hospice Touch Serenity House 601 Straw Street Tomah WI 54660 Hospice residence 2 - Tomah Health Occupational Health Service 1401 Town Line Road Tomah WI 54660 Occupational Health Facility Part I, Line 6a: The Annual Community Benefit report is released to the public via a written report distributed to member hospitals as well as the Wisconsin Hospital Association's website. This reporting initiative attempts to quantify the amount of community benefits provided by the Hospital, and includes figures related to community care write-offs, bad debt write-offs, Medicare and Medicaid shortfalls, and programs operated at a loss.The Organization also prepares a quarterly newsletter that is distributed to the public via a mass-mailing. The quarterly newsletter is intended to provide the communities the Hospital serves information regarding Hospital operations, financial results, and programs/initiatives intended to fulfill the Hospital's commitment to community. The newsletter also contains financial highlights from the Wisconsin Hospital Association community benefit report. Current and prior editions of the newsletter are available on the Hospital's website. Part I, Line 7: The methodology for determining charity care and Medicaid/Tricare shortfalls at cost was as follows: a cost to charge ratio was computed using totals from the Hospital's audited financial statements; this ratio was applied to charity care charges, and gross Medicaid/Tricare revenue. Actual reimbursement received from Medicaid/Tricare was then compared to the estimated cost (computed by multiplying the CCR by gross charges) to determine the shortfall. All other items were based on actual program expenses. Also worth noting that the methodology used for charity care/Tricare/Medicaid is the same as the methodology used by the Wisconsin Hospital Association in compiling their annual community benefit report. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the Organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy is determined by using the percentage of residents with income below the poverty level in Tomah, WI. The percentage was 12.8% per the US Census Bureau QuickFacts for Monroe County, WI, estimates as of 7/1/24. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on pages 13 and 14 of the audited financial statements. Part III, Line 8: Tomah Memorial Hospital follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall would be excluded from the Hospital's community benefit report. The Hospital had a Medicare shortage for fiscal year 2024. Providing services to Medicare patients is essential to these patients and the community and increases their access to healthcare services, which is a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by The Centers for Medicaid and Medicare services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the total loss from Medicare services would have increased by $1,188,137.Medicare fee schedule revenue $ 747,738Medicare estimated costs of care relating to payments (1,935,875)Net (Shortage) $ (1,188,137) Part III, Line 9b: Tomah Health attempts to screen all elective/scheduled patients prior to the receipt of service regarding community care eligibility and works with patient financial services staff to identify emergent/unscheduled patients who may be eligible for community care (generally after receipt of service). Patients without insurance are offered a 42.5% discount. Patients that express an interest in community care assistance, are in the process of applying for community care assistance or waiting on a determination of community care assistance will not have collection efforts imposed on their accounts. After a determination of community care assistance is made, any personal portion due by the patient will follow the same collection procedures as other patients. Part VI, Line 2: Tomah Health currently operates on a three-year strategic planning cycle. At the beginning of each cycle, a strategic planning retreat is held during which an analysis is conducted of the services the Hospital currently provides and areas of need that should be addressed by the Hospital. The retreat is open to all Hospital staff, Hospital Board Members, and members of the Hospital's medical staff. The Hospital's medical staff is comprised primarily of physicians employed by other area healthcare providers (e.g. Mayo, Gundersen Health System), and as such their input into the strategic planning process allows the Hospital to work collaboratively with other hospitals and health systems in assessing the needs of the community. The strategic planning process is facilitated by a representative of HealthTechS3 (contracted management organization), and the three-year plan that is adopted by the Hospital's governance serves as a blueprint for ensuring the Hospital is addressing the needs of the community.In addition to the formal strategic planning process, the Hospital engages in ongoing discussions with various stakeholders (area businesses, physicians, patients, and community members) regarding the services offered at the Hospital, and Hospital leadership evaluates all suggestions offered for improving the many ways in which the Hospital serves its community.Finally, the Hospital participated in a collaborative community health needs assessment project with other area healthcare providers and county health departments. The final report and the Hospital's implementation plan are published on the Hospital's website at www.tomahhealth.org. Part VI, Line 3: Tomah Health makes available brochures containing information about financial assistance to all patients seen in the emergency room/urgent care areas, and any patient that registers for a non-emergent service is questioned by admissions or nursing staff regarding any concerns they might have about the cost of their Hospital services. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Additionally, a review is conducted of all accounts that become delinquent to ensure that an attempt to contact the patient has been made by Hospital staff. Part VI, Line 4: Tomah Memorial Hospital, Inc. d/b/a Tomah Health is a 25-bed Critical Access Hospital located in Tomah, Wisconsin. The Hospital's primary service area consists of Tomah, WI, and the outlying communities of Camp Douglas, Warrens, Oakdale, and Wilton. Tomah is located in rural western Wisconsin, and as such a significant portion of the Hospital's patient base is comprised of agricultural workers and members of the Amish community. Additionally, Tomah's proximity to two military installations results in a large portion of services provided to members of the military and their families. The Hospital's payer mix is comprised of approximately 13.8% Medicaid, 39.9% Medicare, 14.3% military, 1.9% self-pay, and 30.1% commercial insurance. The reimbursement challenges associated with providing a high percentage of services to Medicaid/Medicare recipients and the uninsured has required the Hospital to operate at a high level of efficiency, ensuring that all services provided represent an excellent value to area community members. Although the Hospital has benefited from the additional reimbursement afforded through the Critical Access Hospital program, competition for market share with other area healthcare providers requires Hospital leadership to continually reevaluate service offerings and business lines for appropriateness given the healthcare needs of the community. Part VI, Line 5: Tomah Health's Board of Directors is comprised of community members that represent both a cross section of industry expertise (banking, manufacturing, attorneys, physicians, small business, etc.) as well as an appreciation of the healthcare needs of the community. The Hospital generally budgets for a targeted operating margin of between 1% and 3% each year. This target was established by the Hospital's Board of Directors and is believed to represent an appropriate balance between fulfilling the Hospital's charitable purpose and achieving financial results that allow for continued reinvestment in staff and equipment to remain competitive.The Hospital operates a fully staffed Community Health Initiatives Department dedicated to improving the health of the community through wellness education and preventative healthcare strategies. This Department maintains an active presence in the community, sponsoring such events as an annual Women's Health Night, an annual Senior Health and Safety Expo, and various other educational programs in area schools and businesses. Part VI, Line 7, Reports Filed With States WI X X X 0 0 0 0 0 0 0 1 0 Michelle Masters Nurse Practitioner 290548 0 0 0 877 0 9724 0 28511 0 329660 0 0 0 Gerald Fushianes Physician Assistant 264126 0 0 0 1601 0 11056 0 28518 0 305301 0 0 0 Joseph Zeps Chief Financial Officer 254424 0 4595 0 849 0 9651 0 28646 0 298165 0 0 0 Tracy Myhre CNO 214721 0 5917 0 2124 0 9278 0 28604 0 260644 0 0 0 Laura Miller Nurse Practitioner 223181 0 4061 0 551 0 6763 0 12982 0 247538 0 0 0 Todd Chapman Pharmacy Director 209280 0 10434 0 660 0 8843 0 1278 0 230495 0 0 0 Kelly Thayer Nurse Practitioner 187915 0 6385 0 2621 0 7873 0 13451 0 218245 0 0 0 Part I, Line 3 Tomah Memorial Hospital does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, HealthTechS3, and is considered a common law employee of the management company. The Hospital Board of Directors uses some of the processes described in Part I, Question 3 to help determine appropriate compensation for the CEO. The Board of Directors also approves the Organization's contract with the Management Company. Part I, Line 7 Bonuses are provided based on production and performance. The Board of Directors has authority to determine if a bonus should be granted or denied. A Wisconsin Health and Educational Facilities Authority 391337855 000000000 2017-11-09 13000000 Construction of replacement facility 0 0 0 A 2436225 13000000 13000000 2019 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: Wisconsin Health and Educational Facilities Authority Date the Rebate Computation was Performed: 08/22/2023 Steve Loging Family member of CNO, Tracy Myhre 143344 Employee compensation 0 Jessye Buswell Family member of Director, Deb Buswell 123188 Employee compensation 0 Form 990, Part VI, Section A, line 1a The Executive Committee includes the Corporation's officers and Chairmen of Standing Committees. The Executive Committee has power to transact all regular business of the Corporation during the period between the meetings of the Board of Directors subject to any prior limitation imposed by the Articles of Incorporation, these Bylaws, or the Board, and with the understanding that all matters of major importance will be referred to the Board of Directors. The Chairman of the Board presides as Chairman of Executive Committee and the Treasurer presides in the Chairman's absence. Actions of the Executive Committee are subjected to approval or disapproval at the next regular Board of Directors meeting except for those actions taken pursuant to delegation by the Board of Directors. Form 990, Part VI, Section A, line 3 Derek Daly, CEO of Tomah Memorial Hospital, is employed by HealthTechS3, an unrelated management company. This position has the responsibility of supervising the management, administration and operation of the organization. HealthTechS3 was compensated $482,208 for Derek's services provided to Tomah Memorial Hospital. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is provided to the Board before it is filed. The CEO, CFO, and Executive/Finance Committee review the draft in detail. Form 990, Part VI, Section B, line 12c All members of the Board and Administration team are covered by the conflict of interest policy. Potential conflicts are contracts or transactions between the Hospital and a Director or another corporation, firm, association, or entity in which there is a material financial interest. The Hospital administration reviews annual statements for potential conflicts. If the Hospital Administration determines there is a conflict, the person involved must abstain from voting on any matter related to the conflict. Form 990, Part VI, Section B, line 15 The Administrator and CEO positions are employed by HealthTechS3. The Board approves the contract on a three-year period with two one-year renewal clauses. Comparability data is used during this process and the decision is documented. The contract was renewed for five years from 7/1/22 through 6/30/27 with an out clause on 6/30/25 provided 120 days notice is given. The CEO makes recommendations to the Finance/Executive Committee of the Board for other officers. Comparability data is used during this process and the decisions are documented. This is an annual process completed each fiscal year. Form 990, Part VI, Section C, line 19 The Organization's governing documents and conflict of interest policy are not available to the general public. Financial statements are available through the Organization's bond issuer on the internet, and the Organization presents an annual report to the community, open to the general public, in which a financial report is presented. Additionally, an annual financial report is included in the quarterly mailings the Organization sends to all community members. Form 990, Part IX, line 11g Purchased services: Program service expenses 13,499,196. Management and general expenses 558,509. Fundraising expenses 0. Total expenses 14,057,705. Professional fees: Program service expenses 0. Management and general expenses 674,169. Fundraising expenses 0. Total expenses 674,169. Form 990, Part XI, line 9: Net change in fair value of beneficial interest in perpetual trust 197,427. Pederson Trust Fund for the Benefit of Tomah Memorial Hospital 501 Gopher Dr Tomah WI 54660 396173790 Support Tomah Memorial Hospital WI 501(c)(3) Line 12b, II Tomah Memorial Hospital 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0