2020-08-17T11:33:33-05:00 2019-09-30 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2018-10-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE % CATHY BUKOWSKI VP OF FINANC LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 GORDON T EDWARDS COO/CFO 7152241515 2020-08-14 true Holly K Moen P01800653 6123055000 2020-08-13 199.206.0.5 41438720202305000005 2020-08-17 P EA4B65EE71D42BE71D1FFD4325509DD549A18899 0AD48136B8CA164DDEFA78FE78BBACDA039E3F98 2018 2020-09-23 17:36:50Z SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 146035085 false X WWW.LAKEVIEWMEDICAL.COM X 1919 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 11 8 0 250 0 0 7146 34516 91617589 142960710 244415 348904 0 2752 91869150 143346882 350 1310967 0 0 31264547 66163991 0 0 0 45241336 61971722 76506233 129446680 15362917 13900202 96586658 106412465 46662520 44212059 49924138 62200406 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. false false 107093866 1310967 142963462 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. 107093866 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false true true false false false false false false false false false false false false false true false false false true X 0 0 true 0 false false false false false false false false false false false false X 11 8 false false false false true true true true true false false true true true true true true true true false WI X CATHY BUKOWSKI VP OF FINANC 7153875511 1000 N Oak Avenue Marshfield WI 54449 Sue Tindell Chair 1.0 0.0 X X 0 0 0 Carol Hakala Vice Chair 1.0 0.0 X X 0 0 0 Brittany Nielsen Secretary 1.0 0.0 X X 0 0 0 Mark Nymo MD Board Member 1.0 0.0 X 0 0 0 Tom Lundquist MD Board Member 1.0 40.0 X 0 223184 53402 Scott Polenz Board Member 1.0 40.0 X 0 263697 51695 Craig Fowler Board Member 1.0 0.0 X 0 0 0 Dan Ringwelski Board Member 1.0 0.0 X 0 0 0 Brenda Kupferschmidt Board Member 1.0 0.0 X 0 0 0 Bob Berg Board Member 1.0 0.0 X 0 0 0 Neelakantan Namboodiri MD Board Member 1.0 42.0 X 0 361550 48101 Bradley Groseth Chief Admin Officer 40.0 0.0 X 0 297246 31214 Narayana Murali MD MCHS Chief Strategy Officer 1.0 46.0 X 0 854715 55886 Jerard Jensen MCHS General Counsel 1.0 44.0 X 0 874226 53928 Gordon Edwards MCHS CFO/COO 1.0 44.0 X 0 702259 57140 Susan Turney MD MCHS CEO 1.0 46.0 X 0 2454892 291090 Steven Kulick Chief Experience Officer 1.0 44.0 X 0 225580 11227 Ned Wolf Former LMC CEO 0.0 40.0 X 0 366846 57835 Cindy Arts-Strenke Former LMC COO 0.0 40.0 X 0 202476 47172 Daniel Ramsey Former MCHS COO 0.0 0.0 X 0 557013 456 0 7383684 759146 0 true true false None 0 15427 19089 0 34516 Net Patient Service Revenue 621110 141199407 141199407 Intercompany Revenue 621110 995221 995221 Cafeteria Revenue 621110 467804 467804 Misc Other Operating Revenue 621110 236767 236767 Wellness Revenue 621110 61511 61511 142960710 230686 230686 0 0 94649 94649 0 0 0 2709345 2427 2579535 14019 129810 -11592 118218 118218 0 0 0 0 0 0 0 0 0 Vending Revenue 900099 2752 2752 2752 143346882 142963462 348904 0 1310967 1310967 0 0 316747 316747 0 52745284 52041850 703434 4302488 4217688 84800 5884349 5760486 123863 2915123 2866310 48813 0 0 0 0 0 2367 2367 2371145 1808437 562708 237 237 1006547 935886 70661 376839 278061 98778 0 976093 949872 26221 447930 433863 14067 0 0 1530962 1530962 0 3707378 3707378 140684 140684 Medical Supplies 27385238 27381226 4012 I/C Purchased Services 20213878 20213878 WI Medicaid Access Tax 1431788 1431788 Equipment Repairs 1028301 1028231 70 1352335 1267573 84762 129446680 107093866 22352814 0 X 9776678 9751637 138369 139926 0 0 20097080 32936780 0 0 0 0 0 0 1181989 2006031 104555 69879 105931294 44852541 62523061 61078753 0 0 2268395 0 0 0 0 0 496531 429459 96586658 106412465 2394746 1356132 0 0 0 0 0 0 0 0 0 0 43771243 42426468 0 0 496531 429459 46662520 44212059 X 49924138 62200406 0 0 0 0 49924138 62200406 96586658 106412465 X 13900202 18276 14790 -1657000 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false 0 4503454 4503454 0 70930710 22710718 48219992 0 427997 252220 175777 0 26620291 20117189 6503102 0 3448842 1772414 1676428 61078753 0 DEFERRED COMPENSATION 429459 429459 X Form 990 Sch D 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. BASED ON AN ANALYSIS PREPARED BY THE SYSTEM, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE ORGANIZATION AT SEPTEMBER 30, 2019 OR 2018. true true true X true X true true true false true true 517570 517570 0.00400 9865836 4064833 5801003 0.04530 10383406 4064833 6318573 0.04930 255018 57978 197040 0.00150 9316 9316 0.00010 264334 57978 206356 0.00160 10647740 4122811 6524929 0.05090 4416 4416 4416 4416 true 462161 34778160 41528964 -6750804 X true true None 1 1 MARSHFIELD MEDICAL CENTER - RICE LAKE 1700 W STOUT STREET RICE LAKE WI 54868 82 X X X MARSHFIELD MEDICAL CENTER - RICE LAKE 1 false false true X X X X X X X X X 18 true true true true X www.lakeviewmedical.com X true 18 true www.lakeviewmedical.com false true X 200. 400. X X X X X true true X X X true X See Supplemental Information X See Supplemental Information X See Supplemental Information X X X X X X true X false X X X X true X false false Form 990 Sch H 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. Form 990 Sch H Part V Line 6a The CHNA was conducted with the following hospital facility(s): - Mayo Clinic Health Systems - Cumberland Healthcare - Amery Hospital and Clinic Form 990 Sch H 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 Form 990 Sch H 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 Abuse Community-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 disease The 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. FORM 990 Sch H PART V LINE 16A-C THE FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY) AND THE FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE AT THIS URL: HTTPS://WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSIS TANCE Form 990 Sch H 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. Form 990 Sch H 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. Form 990 Sch H Part II 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. Some examples of community building activities included: Coalition Building Marshfield Medical Center-Rice Lake 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 Marshfield Medical Center-Rice Lake staff participated in community programs and events. Examples included: - Know Your Numbers and 50 Plus Events - Diabetes Prevention Program (DPP) - MMC-RL Health and Wellness Center - Free radiology and lab services to the Rice Lake Area Free Clinic Workforce Development Marshfield Medical Center-Rice Lake collaborated with area high schools to offer programs for high school students interested in medical careers as well as observational job experiences for high school graduates. MMC-RL functioned as a clinical site for student nurses, student nursing assistants, preceptors for healthcare jobs, and medical residents and interns. Form 990 Sch H Part III Line 2 BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. Form 990 Sch H 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. Form 990 Sch H Part III Line 8 THE MEDICARE SHORTFALL ATTRIBUTED TO IDENTIFIED SUBSIDIZED HEALTH SERVICES ARE INCLUDED AS COMMUNITY BENEFIT IN THE CURRENT YEAR. THESE SERVICES INCLUDE AMBULANCE, HOME CARE AND HOSPICE AND DIALYSIS. THE MEDICARE ALLOWABLE COSTS AS REPORTED ON THE MEDICARE COST REPORT DO NOT FULLY CAPTURE THE ACTUAL COSTS OF PROVIDING THESE SERVICES THAT ARE ESSENTIAL TO VARIOUS UNDERSERVED POPULATIONS IN THE COMMUNITY. Form 990 Sch H 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. Form 990 Sch H Part VI Line 2 Marshfield Medical Center-Rice Lake 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 communitys 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) Form 990 Sch H 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. Form 990 Sch H 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 Bachelors degree or higher, compared to 29% statewide. Form 990 Sch H 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: - Coordinated and hosted 50 Plus events, which are free wellness events for those over 50 years old and includes a variety of health screenings, community resources, and educational presentations. - 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). - Offered free radiology and lab services to the Rice Lake Area Free Clinic, serving the underserved population in the area. - Offered community members the opportunity to exercise at the MMC-RL Health and Wellness Center while being supervised by medically trained staff. MMC-RL financially supported the operating cost as expenses exceed revenue. - Provided free monthly blood pressure screenings to community members. - Offered the National Diabetes Prevention Program (DPP). Form 990 Sch H 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. (MCHS) was formed. The health systems 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 10,000 employees including over 1,200 providers in 86 specialties. MCHS and its affiliated entities provide service and health care to more than two million residents through over 50 clinical care centers in 34 Wisconsin communities. Unique to MCHS is its Center for Community Health Advancement (CCHA), which builds bridges between the healthcare system and the places in the community where people live, work and play. 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. CCHA includes Marshfield Medical Center-Rice Lake staff who are closely involved in the Community Health Needs Assessment (CHNA) and Implementation Strategy in Barron County. This helps to align community health priorities identified in the CHNA with health system priorities. Marshfield Clinic Health System (MCHS) deeply believes in promoting community health through building and sustaining strong internal and external partnerships and collaborations. For this reason, MCHS and its affiliated entities work together internally and externally with community partners, stakeholders and residents to improve community health. true Charity Care 105 1310967 Form 990 Sch I Part I Line 2 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. X X true true X X X X X true true false true true true true false false Tom Lundquist MD Board Member 0 209061 0 9761 0 4362 0 29497 0 25534 0 278215 0 0 Scott Polenz Board Member 0 257715 0 0 0 5982 0 29497 0 24143 0 317337 0 0 Neelakantan Namboodiri MD Board Member 0 344222 0 0 0 17328 0 29497 0 20809 0 411856 0 0 Bradley Groseth Chief Admin Officer 0 289116 0 7500 0 630 0 2080 0 31339 0 330665 0 0 Narayana Murali MD MCHS Chief Strategy Officer 0 720583 0 112500 0 21632 0 29497 0 28594 0 912806 0 0 Jerard Jensen MCHS General Counsel 0 741937 0 112500 0 19789 0 29497 0 26636 0 930359 0 0 Gordon Edwards MCHS CFO/COO 0 570052 0 90000 0 42207 0 29497 0 29848 0 761604 0 0 Susan Turney MD MCHS CEO 0 1686332 0 510000 0 258560 0 270897 0 22398 0 2748187 0 154255 Ned Wolf Former LMC CEO 0 333897 0 0 0 32949 0 29497 0 30543 0 426886 0 0 Cindy Arts-Strenke Former LMC COO 0 201186 0 0 0 1290 0 29007 0 19614 0 251097 0 0 Daniel Ramsey Former MCHS COO 0 -456 0 0 0 557469 0 0 0 456 0 557469 0 0 Steven Kulick Chief Experience Officer 0 216878 0 0 0 8702 0 1769 0 9678 0 237027 0 0 Form 990 Sch J 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. Form 990 Sch J 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. Form 990 Sch J Part I Line 4a SEVERANCE DANIEL RAMSEY - $557,469 Form 990 Sch J Part I Line 4b 457(F) PLAN SUSAN TURNEY, MD - $165,215 Form 990 Sch J Part I Line 5a & 5b 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. Form 990 Sch J Part I Line 6a & 6b 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. 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 Line 6 MARSHFIELD CLINIC HEALTH SYSTEM, 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 Line 7a MARSHFIELD CLINIC HEALTH SYSTEM, INC. (AS THE SOLE MEMBER) HAS THE AUTHORITY TO APPOINT MAJORITY OF THE CORPORATE BOARD MEMBERS AND APPROVE THE PUBLIC DIRECTORS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. Form 990 Part VI Line 7b MARSHFIELD CLINIC HEALTH SYSTEM, 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. Marshfield Clinic Health System, 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. MARSHFIELD CLINIC HEALTH SYSTEM, 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 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, VP OF FINANCE AND CONTROLLER. 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 COMPLETE FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. Form 990 Part VI 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 Line 15a & 15b 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 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 OTHER CHANGES IN NET ASSETS NET ASSET TRANSFERS WTIH RELATED ORGS: ($1,657,000) --------------------------------------------------- TOTAL OTHER CHANGES IN NET ASSETS: ($1,657,000) MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 Medical Svcs WI 501(C)(3) 3 MCHS false VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) 12-TYPE III NA false SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS false FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 NA false MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 HOSPITAL WI 501(C)(3) 12 TYPE III NA false FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) 7 NA false MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) 3 MCHS false MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) 7 NA false BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) 3 MCHS HOSP false MEMORIAL HOSPITAL INC 216 SUNSET PL NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) 3 MCHS HOSP false THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SVCS WI NA RELATED 0 0 false false false false true false false false false false false true true false false false false true true true true Form 990 Sch R MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A 501(C)(3) ORGANIZATION), IS THE PARENT ORGANIZATION OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. THE FOLLOWING COMPANIES ARE RELATED TO LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE THROUGH BROTHER/SISTER RELATIONSHIPS DUE TO A COMMON PARENT ORGANIZATION: MARSHFIELD CLINIC, INC. SECURITY HEALTH PLAN OF WISCONSIN, INC. FLAMBEAU HOSPITAL, INC. MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION, INC. MCHS HOSPITALS, INC.