2020-07-28T14:20:18-05:00 2019-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-10-01 390799566 Tomah Memorial Hospital TOMA 6083722181 501 Gopher Drive Tomah WI 54660 Joseph Zeps Chief Financial Officer 6083722181 2020-07-27 1 Kim Hunwardsen CPA P00484560 6122536500 2020-07-27 216.147.181.49 2020-07-27 12:34:39 CD P 5755687E6BF8D8D10BDE3B83E6631EF3D64C584D EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2020-11-19 02:30:22Z X Philip J Stuart 501 Gopher Drive Tomah WI 54660 98012958 0 X www.tomahhospital.org X 1948 WI To promote and provide quality health care to patients in a hospital setting 10 9 465 73 0 0 858518 487772 59186341 61171337 2762298 1133817 -36449 -102615 62770708 62690311 0 0 0 0 28660797 30961037 116400 97000 121295 29486948 30519450 58264145 61577487 4506563 1112824 111844534 114912986 50166608 51439146 61677926 63473840 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 46857255 58236724 Tomah Memorial Hospital 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, 2019 are as follows:(Continued on Schedule O)* 1,209 inpatient discharges* 3,411 inpatient days* 17,799 emergency room and urgent care visits* 1,865 surgical and endoscopic procedures* 15,331 radiology procedures (including CT and MRI)* 73,849 laboratory tests* 40,578 rehabilitative services proceduresIn furtherance of its charitable mission, the Hospital provided approximately $786,943 of free and discounted care to area residents (cost of care approximately $403,000), and wrote off $3.29 million of uncollectible accounts (cost equal to approximately $1.69 million). Additionally, based on its most recently completed community benefits survey, the Hospital incurred approximately $2.66 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 2019 approximated $2.52 million. Additional details regarding the hospice program and the Warrens Walk-In Clinic can be found below. 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. 4123280 2363217 The 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, 2019, the Hospice program experienced 11,005 program days and 2,182 hospice residence days. 666861 571396 The 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, 2019, the clinic accommodated 4,146 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 2019, 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. 51647396 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 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 14 0 1 465 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Joseph Zeps 6083740307 501 Gopher Drive Tomah WI 54660 Oak Moser Chair 1.00 X X 0 0 0 Tom Bramwell Vice Chair 1.00 X X 0 0 0 Spencer Stephens Secretary 1.00 X X 0 0 0 Patty Clark Treasurer 1.00 X X 0 0 0 John Laufenberg Director 1.00 X 0 0 0 Keith Laugen Director 1.00 X 0 0 0 Penny Precour-Berry Director 1.00 X 0 0 0 Greg Gaardner Director - as of Jan 2019 1.00 X 0 0 0 John Robertson III MD President of Medical Staff 41.00 X 589667 0 0 Jeff Cavaness MD Director - as of Jan 2019 1.00 X 0 0 0 Terrie Gaarder Director - until Jan 2019 1.00 X 0 0 0 Jill McMullen MD - Pres of Medical Staff - until Jan 2019 41.00 X 0 0 0 Philip J Stuart Administrator 40.00 X 0 0 0 Joseph Zeps Chief Financial Officer 40.00 X 183023 0 36032 Tracy Myhre CNO 40.00 X 156284 0 35040 James Piper CRNA Certified Registered Nurse 40.00 X 320794 0 20990 Kelly Thayer APNP Nurse Practitioner 40.00 X 171797 0 18058 Todd Chapman Pharmacist 40.00 X 195064 0 7788 Gerald Fushianes PA-C Physician Assistant 40.00 X 156576 0 35082 Laura Miller APNP Nurse Practitioner 40.00 X 157247 0 17512 1930452 0 170502 32 0 1 0 Gundersen Lutheran Health Systems 1900 South Ave LaCrosse WI 54601 Contracted ER physicians/dietician 2023402 Monroe Clinic 515 22nd Avenue Monroe WI 53566 Electronic Health Implementation Fees 2013077 Tomah Orthopedics 321 Butts Avenue Tomah WI 54660 Contracted orthopedic surgeon services 1355175 Mayo Clinic Health System 201 W Center St Rochester MN 55902 Contracted hospitalist/pathology service 1272608 Medical X-Ray Consultants 900 W Clairemont Avenue Eau Claire WI 54701 Contracted radiologist services 1226936 25 12513 16313 458946 487772 Patient service revenue 622110 60974801 60974801 196536 196536 61171337 534996 534996 57113 79159 -22046 -22046 -22046 35842309 35243488 598821 598821 598821 Loss on Extinguishment of Debt 900099 -80569 -80569 -80569 62690311 61171337 0 1031202 X 1034755 796362 238393 47232 47232 22681932 19227705 3435701 18526 634970 525083 109372 515 4932232 4119111 809166 3955 1629916 1454534 174083 1299 353678 353678 26740 26740 68224 68224 97000 97000 9764233 8450195 1314038 198052 902 197150 2556951 1297475 1259476 462390 447055 15335 147478 98245 49233 146997 119537 27460 186244 158565 27679 3871227 3406618 464609 178390 178390 Medical Supplies 7202423 7183946 18477 Bad Debt Expense 3293086 3293086 Repairs and Maintenance 1162003 698656 463347 901334 144699 756635 61577487 51647396 9808796 121295 5604296 2429990 665606 706862 9168612 8938405 940410 1112414 467479 1033020 102558184 31412613 35326769 71145571 59042846 27452262 8816 0 619700 2094462 111844534 114912986 4039870 4502902 39189554 45771974 6937184 1164270 50166608 51439146 X 59315737 61339767 1096887 811362 1265302 1322711 61677926 63473840 111844534 114912986 X 1112824 676658 6432 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1265302 38025 32246 12862 1322711 1150962 31647 93995 11302 1265302 1048289 38192 75358 10877 1150962 952450 34130 72113 10404 1048289 869600 102541 -9919 9772 952450 0.00000 1.00000 0.00000 0 0 1821831 1821831 73488877 20107515 53381362 25688942 10892405 14796537 1558534 412693 1145841 71145571 Construction accounts payable 1164270 1164270 X 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. X X 1 McDonald Schaefer 2810 Crossroads Dr Suite 4000 Madison WI 53718 Professional fundraising services 0 481945 97000 384945 481945 97000 384945 WI 1 1 X 1 X 1 X 1 1 1 0 1 1 361 403000 403000 0.00690 1 8098 16878542 15006998 1871544 0.03210 1 3615 8891961 8105633 786328 0.01350 2 12074 26173503 23112631 3060872 0.05250 988095 584482 403613 0.00690 16 58000 58000 0.00100 3 4361 5054126 2934613 2119513 0.03640 3 4377 6100221 3519095 2581126 0.04430 5 16451 32273724 26631726 5641998 0.09680 0 3293086 434687 13542998 13611442 -68444 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 18 1 1 1 1 X See Part V, Page 8 X 1 18 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 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 DepartmentOtto Bremer TrustTrempealeau County Health DepartmentVernon County Health Department Tomah Memorial Hospital Part V, Section B, Line 11: The following needs were identified during the most recent CHNA: -Alcohol and illegal drug use -Healthcare access and cost -Mental health -ObesityThe Hospital has implemented programs and formed partnerships to address all items identified as community health needs in the most recent CHNA. -The Hospital's Community Outreach Department has developed various educational programs offered to local businesses and industry regarding substance abuse, and partners with various non-profits as well as the local school district to offer additional education and resources regarding alcohol and drug use.-The Hospital continues to work collaboratively with local clinics to assist in recruiting primary care and specialty physicians to the area. This includes recruiting physicians to work directly with the Hospital (as opposed to one of the local healthcare systems).-The Hospital participates in various workgroups with the local health department to promote mental health, including offering education and providing resources to the local school district and various community events.-The Hospital offers various community events/education regarding healthy eating and exercise programs. All of the initiatives noted above continue to be refined and tailored to the unique population and needs of Monroe County, WI. The Hospital is committed to providing for the health and wellness of the various communities it serves, and is continuously seeking out partnerships with area organizations to collaborate on health and wellness initiatives. 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: tomahhealth.org/images/compass-now-2018-monroe-county_final.pdf Part V, line 10a, Implementation Strategy website: Tomahhealth.org/images/CHNA_Response_-_Implementation_2020.pdf Part V, line 16a, FAP website: tomahhealth.org/patients-guests/general-hospital-and-billing-information Part V, line 16a, FAP Application website: tomahhealth.org/patients-guests/general-hospital-and-billing-information Part V, line 16a, FAP Plain Language Summary website: tomahhealth.org/patients-guests/general-hospital-and-billing-information 1 1 - Hospice Touch Serenity House 601 Straw Street Tomah WI 54660 Hospice residence Part I, Line 6a: Annual Community Benefit reporting process, which is released to the public via a written report distributed to member hospitals as well as the WHA'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 WHA 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 I, Ln 7 Col(f): The amount of bad debt removed from total expenses to determine the percentage was $3,293,086. Part III, Line 2: Accounts are not written off to bad debt until all forms of payment have been applied to the account such as insurance, discounts, and contractual allowances, and the remaining balance is the personal portion due. A payment received on an account previously written off to bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. 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 13.2% (per US Census Bureau QuickFacts for Monroe County, WI, estimates as of 7/1/19). Part III, Line 4: The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements. Part III, Line 8: Tomah Memorial Hospital follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. 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. 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 Memorial Hospital 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 Lutheran), 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.tomahhospital.org. Part VI, Line 3: Tomah Memorial Hospital 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. 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 14.3% Medicaid, 38.2% Medicare, 7.7% military, 3.6% self-pay, and 36.2% 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 Memorial Hospital'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 John Robertson III MD President of Medical Staff 589667 0 0 0 0 0 0 0 0 0 589667 0 0 0 Joseph Zeps Chief Financial Officer 175143 0 2550 0 5330 0 7656 0 29655 0 220334 0 0 0 Tracy Myhre CNO 150422 0 3190 0 2672 0 6663 0 29613 0 192560 0 0 0 James Piper CRNA Certified Registered Nurse 314819 0 3782 0 2193 0 9852 0 12416 0 343062 0 0 0 Kelly Thayer APNP Nurse Practitioner 156972 0 2254 0 12571 0 6919 0 12380 0 191096 0 0 0 Todd Chapman Pharmacist 178899 0 3529 0 12636 0 7788 0 1230 0 204082 0 0 0 Gerald Fushianes PA-C Physician Assistant 153683 0 2218 0 675 0 6706 0 29527 0 192809 0 0 0 Laura Miller APNP Nurse Practitioner 149173 0 2179 0 5895 0 6374 0 11911 0 175532 0 0 0 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. Part I, Question 3: Tomah Memorial Hospital does not pay compensation to the Administrator directly. The Administrator 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 Administrator. The Board of Directors also approves the Organization's contract with the Management Company. A Wisconsin Health and Educational Facilities Authority 391337855 000000000 2017-11-09 35000000 Construction of replacement facility 0 0 0 B Wisconsin Health and Educational Facilities Authority 391337855 000000000 2017-11-09 13000000 Construction of replacement facility 0 0 0 A 35735486 35000000 0 0 1 1 B 13000000 13000000 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Schedule K, Part II, Line 3, Bond B: The issue price includes $735,486 in interest, realized gains, and unrealized gains earned on the bond proceeds during the construction phase. Cindy Lambert Family member of Chief Financial Officer 47232 Compensation and benefits as an employee 0 Form 990, Part VI, Section A, line 1 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 Philip J. Stuart, Administrator of Tomah Memorial Hospital, is employed by HealthTechS3, an unrelated management company. The Administrator has the responsibility of supervising the management, administration and operation of the Organization. HealthTechS3 was compensated $331,034 for Philip'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 Administrator, 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 is 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 three years from 7/1/19 through 6/30/22 with an out clause on 6/30/21 provided 120 days notice is given. The Administrator 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 and was last completed in fiscal year 2019. 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 8,277,195. Management and general expenses 570,641. Fundraising expenses 0. Total expenses 8,847,836. Professional Fees: Program service expenses 173,000. Management and general expenses 743,397. Fundraising expenses 0. Total expenses 916,397. Form 990, Part XI, line 9: Net change in fair value of beneficial interest in perpetual trust 6,432. Pederson Trust Fund for the Benefit of Tomah Memorial Hospital 321 Butts Avenue 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