2020-07-15T17:06:53-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-07-01 391157876 BEAVER DAM COMMUNITY HOSPITALS INC DBA MARSHFIELD MEDICAL CENTER - BEAVER DAM BEAV 9208877181 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 GORDON T EDWARDS MCHS - COO & CFO 9208877181 2020-07-15 1 KOREY BOELTER P00775161 6123764500 67.137.57.251 2020-07-15 12:32:22 CD P 556679616493003E6E17937C0791D09847FC9451 39F506601BE52B1AEC27478C749FC3D7BEC65D0C 2018 2020-09-23 17:36:50Z JOSEPH GILENE 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 120745033 0 X WWW.BDCH.COM X 1972 WI ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 5 1031 295 3981125 176785 292661 1565615 104712694 107873368 4739991 2067362 3780470 3663209 113525816 115169554 128525 127188 0 0 53204053 54148666 0 0 0 56489500 57602552 109822078 111878406 3703738 3291148 180456848 188667538 83047420 88296365 97409428 100371173 X BE THE REGIONAL DESTINATION FOR HEALTH CARE BY CULTIVATING AN ENGAGING WORK ENVIRONMENT IN WHICH OUR CARE TEAM DELIVERS UNPRECEDENTED QUALITY, SAFETY AND SERVICE AT A COMPETITIVE PRICE. 0 0 74860540 127188 74140305 THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT SERVICES TO ITS PATIENTS. IN THE FISCAL YEAR ENDED 6/30/2019, THERE WERE 4,285 INPATIENT DAYS, 1,525 ADMISSIONS, 272 BIRTHS, 590 NURSERY DAYS, AND 89,165 OUTPATIENT VISITS. THERE ARE MEDICAL/SURGICAL, TELEMETRY, INTENSIVE CARE, OBSTETRICS, AND NURSERY UNITS ON THE INPATIENT FLOORS. THERE IS AN EMERGENCY ROOM, URGENT CARE, SURGERY CENTER, REHABILITATION CENTER, PAIN CLINIC, OUTPATIENT MEDICAL ONCOLOGY CLINIC, MEDICAL IMAGING, PHARMACY DEPARTMENT AND A WOUND CENTER. THESE SERVICES ALL GENERATE NET PATIENT REVENUE. 5438930 0 8529714 HILLSIDE MANOR IS A 115 BED NURSING HOME CERTIFIED BY MEDICARE/MEDICAID THAT OFFERS SKILLED NURSING, COMPREHENSIVE REHABILITATION, AND AN EXTENSIVE ACTIVITIES PROGRAM. TOTAL PATIENT DAYS FOR THE FISCAL YEAR ENDED 6/30/2019 WERE 35,207. 4066995 0 5902509 THE HOMECARE PROGRAM INCLUDES HOME HEALTH AND HOSPICE SERVICES. HOME HEALTH OFFERS SKILLED NURSING, PERSONAL CARE, AND REHABILITATION TO PATIENTS IN THEIR OWN HOME. THERE WERE 15,482 HOMECARE VISITS FOR THE FISCAL YEAR ENDED 6/30/2019. THE HOSPICE PROGRAM PROVIDES SUPPORT TO PATIENTS WHO ARE TERMINALLY ILL. THE HOSPICE PROGRAM HAD 19,348 TOTAL DAYS FOR THE FISCAL YEAR ENDED 6/30/2019. 8053403 0 20826062 OTHER PROGRAMS INCLUDE PHYSICIAN CLINICS, OCCUPATIONAL HEALTH, DAYCARE PROGRAM, ASSISTED LIVING PROGRAM, REFERENCE LABORATORY, HOMEMAKER PROGRAM, AND SPORTS FITNESS FACILITY. 8053403 0 20826062 92419868 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 91 0 1031 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 5 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 WI X DEBBIE CHILDRESS CONTROLLER 9208876384 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 SUSAN TURNEY MD DIRECTOR/MCHS CEO 1.00 46.00 X 0 2454892 293295 NARAYANA MURALI MD DIRECTOR/MCHS CSO 1.00 46.00 X 0 854715 58091 KIMBERLY JM MILLER PRESIDENT & CEO (THROUGH MARCH 2019) 40.00 3.00 X 712229 0 51960 RUWAN DISSANAYAKE MD MEMBER 1.00 42.00 X 0 532235 55060 MARK BUGHER CHAIR 1.00 3.00 X X 0 38500 0 CHUCK NASON SECRETARY 1.00 3.00 X X 0 6500 0 MARK BRADLEY VICE CHAIR 1.00 3.00 X X 0 1000 0 JIM KIRSH CHAIR (THROUGH MAY 2019) 1.00 0.00 X X 0 0 0 SUE SUTTER VICE CHAIR DIRECTOR 1.00 0.00 X X 0 0 0 MARSHA BORLING SECRETARY DIRECTOR (THROUGH MAY 2019) 1.00 0.00 X X 0 0 0 DOUG MATHISON TREASURER DIRECTOR (THROUGH MAY 2019) 1.00 0.00 X X 0 0 0 JOHN BALTUS TREASURER 1.00 2.00 X X 0 0 0 KARLA CHASE PAST CHAIR (THROUGH MAY 2019) 1.00 1.00 X X 0 0 0 FRANK PODOJIL BOARD MEMBER (THROUGH MAY 2019) & CHIEF OF STAFF 40.00 0.00 X 0 0 0 TERRY O'CONNOR MEMBER (TROUGH MAY 2019) 1.00 0.00 X 0 0 0 JASON SMITH CHIEF MEDICAL OFFICER 40.00 0.00 X 377943 0 39645 CAROLYN CATTON INTERIM CHIEF PATIENT CARE (THROUGH NOV 2018) 40.00 0.00 X 252515 0 7744 MELANIE BRUINS CHIEF TALENT OFFICER 40.00 0.00 X 182592 0 50145 DAVID CORSO CHIEF OPERATING OFFICER (THROUGH SEPT 2018) 40.00 0.00 X 203153 0 6854 JOSEPH GILENE CEO 40.00 3.00 X 0 0 0 PAUL PALMER SURGEON 40.00 0.00 X 910408 0 46828 JERARD JENSEN MCHS GENERAL COUNSEL 1.00 44.00 X 0 874226 56133 JOSEPH PUCCINELLI ORTHOPEDIC SURGEON 40.00 0.00 X 664473 0 45634 GORDON EDWARDS MCHS CFO/COO 0.00 44.00 X 0 702259 59345 JAINIE ORRINGTON-MYERS SURGEON (THROUGH MARCH 2019) 40.00 0.00 X 413868 0 34844 ROBERT SEIPEL ORTHOPEDIC SURGEON 40.00 0.00 X 643589 0 70356 MOLLY MEIER PODIATRIST 40.00 0.00 X 279864 0 35660 DONNA HUTCHINSON FORMER CFO 0.00 0.00 X 136333 0 0 4776967 5464327 911594 38 1 1 0 HALL RENDER KILLIAN 39778 TREASURY CENTER CHICAGO IL 60691 LEGAL SERVICES 1110950 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 50331 CONTRACT LABOR 976308 GREENFIELD REHABILITATION AGENCY 7517 W COLDSPRING ROAD GREENFIELD WI 53220 REHABILITATION SERVICES 678880 DAILY CARE HOSPITALISTS LLC PO BOX 11934 GREEN BAY WI 543071934 CONTRACT LABOR 583521 A1 EXCEL HOSPITALIST GROUP 18111 W WISCONSINS AVE 102 BROOKFIELD WI 53045 CONTRACT LABOR 534535 15 104143 1461472 1565615 NET PATIENT REVENUES 621300 101027978 100620399 407579 ASSISTED CARE PROGRAM 623990 2235127 2235127 PHARMACY REVENUES 621990 2065709 2065709 HOMEMAKER SERVICES 812900 1762223 1667784 94439 OCC HEALTH PROGRAM 621990 529348 529348 252983 252983 107873368 1808169 1808169 2244032 1854545 389487 389487 306485 83002 3974463 750 3687654 28366 286809 -27616 259193 259193 68 4914 -4846 -4846 DAYCARE REVENUE 624410 1290634 200938 1089696 MISCELLANEOUS INCOME 900099 837388 837388 FOOD SERVICE 722320 629217 629217 521329 486896 17217 17216 3278568 115169554 106830863 3981125 2791951 66000 66000 61188 61188 2172529 2172529 203218 203218 39528765 38275462 1253303 1924734 1812934 111800 7562636 7101998 460638 2756784 2532648 224136 939601 81280 858321 83561 83561 173866 173866 10565228 7413305 3151923 280265 280265 2768778 1785889 982889 4837918 3554061 1283857 1718149 1214341 503808 246686 210096 36590 151277 99799 51478 2291699 1892012 399687 8422608 6118507 2304101 302889 260863 42026 UBI TAXES 59293 59293 MED. SUPPLIES & DRUGS 13864243 13813486 50757 BAD DEBT EXPENSE 4865432 4865432 ASSESSMENT/USER FEES 2223831 262940 1960891 3807228 997627 2809601 111878406 92419868 19458538 0 40389 41907 8365148 11607574 13226771 12601826 2457598 2554884 1756078 1630566 195281315 111166887 82534260 84114428 69418695 73374118 378965 322028 2278944 2420207 180456848 188667538 10289903 10570445 72408 73919 55218644 58545075 261040 213901 9517000 8757000 7688425 10136025 83047420 88296365 X 95130482 97950966 2278946 2420207 97409428 100371173 180456848 188667538 X 3291148 2189890 -2519293 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2962 2962 0 PART II-B, LINE 1: BDCH PAYS ANNUAL MEMBERSHIP FEES TO WISCONSIN HOSPITAL ASSOCIATION (WHA), A PORTION OF WHICH WAS USED BY WHA FOR LOBBYING ON BEHALF OF ITS MEMBERS. 0 1 X 4030364 4030364 117358318 56430921 60927397 3088469 711606 2376863 70661640 54024360 16637280 142524 142524 84114428 OBLIGATION UNDER CAPITAL LEASE 361067 ACCRUED PENSION LIABILITY 9424949 ESTIMATED SETTLEMENTS DUE TO THIRD-PARTY PAYORS 350009 10136025 X PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE FUNDS THAT ARE THE RESIDENTS' THAT ARE DEPOSITED IN A SEPARATE BANK ACCOUNT. THESE FUNDS ARE TRACKED SEPARATELY FROM BDCH'S FUNDS AND BELONG TO THE RESIDENTS. SECURITY DEPOSITS ARE DEPOSITS PAID TO BDCH UPON ENTERING INTO A RENTAL AGREEMENT FOR CBRF RESIDENTS AND ARE DUE BACK TO THE TENANTS UPON TERMINATION OF THEIR RENTAL AGREEMENT. PART X, LINE 2: ALL OF THE ENTITIES WITHIN THE CORPORATION ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC, EXCEPT BDMCB2 AND DHE. BDMCB2 AND DHE ARE LIMITED LIABILITY COMPANIES AND ARE NOT DIRECTLY SUBJECT TO TAXATION. THEY HAVE ELECTED TO BE TREATED AS DISREGARDED ENTITIES FOR FEDERAL INCOME TAX PURPOSES. INCOME AND LOSSES OF THE COMPANIES ARE PASSED THROUGH TO AND REPORTED FOR INCOME TAX PURPOSES BY THE CORPORATION. THE CORPORATION FOLLOWS THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) GUIDANCE ON INCOME TAXES, ACCOUNTING FOR UNCERTAINTIES IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE CORPORATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. UNRELATED BUSINESS TAXABLE INCOME IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ALSO ADDRESSES DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS. AT JUNE 30, 2019 AND 2018, THERE WERE NO UNRECOGNIZED TAX BENEFITS IDENTIFIED OR RECORDED AS LIABILITIES. 1 1 X 1 X 0 1 1 1 0 1 1 1836996 1836996 0.01640 13866871 7286676 6580195 0.05880 15703867 7286676 8417191 0.07520 1821920 1821920 0.01630 1750 1750 0.00000 1823670 1823670 0.01630 17527537 7286676 10240861 0.09150 1 4865432 535198 15291499 18435010 -3143511 X 1 1 1 1 BEAVER DAM COMMUNITY HOSPITAL 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 WWW.BDCH.COM 199 X X X BEAVER DAM COMMUNITY HOSPITAL 1 0 1 1 X X X X X X X X X 18 1 0 1 1 X WWW.BDCH.COM/COMMUNITY-HEALTH-NEEDS X X 1 18 1 WWW.BDCH.COM/COMMUNITY-HEALTH-NEEDS 0 1 X 150.000000000000 0.000000000000 X X 1 1 X X X X 1 X WWW.BDCH.COM/FINANCIAL-ASSISTANCE X WWW.BDCH.COM/FINANCIAL-ASSISTANCE X WWW.BDCH.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 BEAVER DAM COMMUNITY HOSPITAL PART V, SECTION B, LINE 2: EFFECTIVE MAY 1, 2019 MCHS HOSPITALS, INC. BECAME THE SOLE MEMBER OF BEAVER DAM COMMUNITY HOSPITALS, INC. (BDCH) D/B/A MARSHFIELD MEDICAL CENTER-BEAVER DAM THROUGH A MEMBER SUBSTITUTION AGREEMENT. MCHS HOSPITALS, INC. IS A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION. THE ARTICLES OF INCORPORATION AND THE BYLAWS WERE AMENDED AND RESTATED. THE PURPOSE OF THE CORPORATION IS TO OPERATE EXCLUSIVELY FOR THE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, INCLUDING SPECIFICALLY TO PROMOTE THE HEALTH OF THE PUBLIC BY OWNING AND OPERATING ONE OR MORE LICENSED HOSPITALS AND/OR OTHER FACILITIES PROVIDING HEALTHCARE SERVICES TO RESIDENTS OF THE GEOGRAPHIC AREAS SERVED BY THE CORPORATION. BEAVER DAM COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: BDCH GATHERED QUALITATIVE INFORMATION AND PERSPECTIVES ON COMMUNITY HEALTH NEEDS THROUGH ONE-ON-ONE AND SMALL GROUP INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS. REFER TO PAGES 30 AND 31 OF THE CHNA FOR LIST OF COMMUNITY MEMBERS AND ORGANIZATIONS AND THE CHNA FOR SPECIFIC PARTICIPANTS BEAVER DAM COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: DODGE COUNTY AND JEFFERSON COUNTY. BEAVER DAM COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA IS OFTEN DISCUSSED IN PRESENTATIONS THE HOSPITAL PARTICIPATES IN, SUCH AS CHAMBER OF COMMERCE AND OTHER LOCAL CIVIC AND COMMUNITY ORGANIZATION EVENTS. BEAVER DAM COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: BECAUSE OF LIMITED RESOURCES, BDCH CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALTH NEED. AS SUCH, BDCH HAS ELECTED TO TAKE A HOLISTIC APPROACH BY ENGAGING WITH HEALTHWAYS, INC. TO CREATE A BLUE ZONES DESIGNATED AREA ENCOMPASSING DODGE COUNTY. IT IS THROUGH THIS PARTNERSHIP THAT WE HAVE ADDRESSED NUTRITIONAL AND PHYSICAL ACTIVITY BARRIERS AND SUBSTANCE ABUSE CONCERNS IN FY19. THERE ARE NOW SEVERAL RESTAURANTS AND WORKPLACES WITHIN DODGE COUNTY THAT ARE "BLUE ZONES CERTIFIED", MEANING THESE BUSINESSES HAVE PROVEN TO PROVIDE HEALTHY OPTIONS TO THEIR CUSTOMERS (THROUGH HEALTHY MENU OPTIONS) AND EMPLOYEES (THROUGH CREATION OF WALKING MOAIS OR OTHER HEALTH-RELATED ACTIVITIES). IN ADDITION, THE BLUE ZONES PROJECT HELD SEVERAL COMMUNITY-SPECIFIC ENGAGEMENT EVENTS THROUGHOUT THE YEAR, FOCUSING ON THE ENVIRONMENT, FOOD, ALCOHOL AND TOBACCO.ANOTHER EXAMPLE OF HOW BDCH IS PROMOTING THE HEALTH OF THE COMMUNITY IS THROUGH ITS ENGAGEMENT WITH HEALTHWAYS, INC. TO CREATE A BLUE ZONES DESIGNATED AREA THAT ENCOMPASSES DODGE COUNTY. THROUGH THIS PARTNERSHIP WITH HEALTHWAYS, INC. WE ADDRESS AND PROMOTE HEALTHY LIFESTYLES THROUGH NUTRITIONAL AND PHYSICAL ACTIVITY AS WELL AS FOCUS ON SUBSTANCE ABUSE CONCERNS. BUSINESSES AND COMMUNITIES PARTNER TOGETHER WITH BDCH TO PROVIDE HEALTHY OPTIONS AND LIFESTYLES FOR THEIR CUSTOMERS, EMPLOYEES AND CITIZENS. ALL OF THE BLUE ZONES PROGRAMS ARE OFFERED TO THE COMMUNITY FREE OF CHARGE. WE WORK WITH THE COUNTY AND CITY MUNICIPALITIES, FAITH-BASED ORGANIZATIONS, GROCERY STORES, AND SCHOOLS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COUNTY RESIDENTS. 16 1 - HILLSIDE MANOR 803 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 SKILLED NURSING FACILITY 2 - REMEMBRANCE HOME 1810 NORTH SPRING STREET BEAVER DAM WI 53916 DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY 3 - EAGLES WINGS 408 STONE STREET BEAVER DAM WI 53916 COMMUNITY-BASED RESIDENTIAL FACILITY 4 - BEAVER DAM REFERENCE LAB 707 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 REFERENCE LAB 5 - BEAVER DAM ORTHOPEDIC CLINIC 705 SOUTH UNIVERSITY AVENUE STE 150 BEAVER DAM WI 53916 PHYSICIAN CLINIC 6 - COLUMBUS MEDICAL CLINIC 1580 WEST JAMES STREET COLUMBUS WI 53925 PHYSICIAN CLINIC 7 - WAUPUN MEDICAL CLINIC 180 GATEWAY DRIVE WAUPUN WI 53963 PHYSICIAN CLINIC 8 - HORICON MEDICAL CLINIC 610 WASHINGTON STREET HORICON WI 53032 PHYSICIAN CLINIC 9 - SURGICAL SPECIALISTS 705 SOUTH UNIVERSITY AVENUE STE 350 BEAVER DAM WI 53916 GENERAL SURGERY CLINIC 10 - JUNEAU MEDICAL CLINIC 420 WEST NORTH STREET JUNEAU WI 53039 PHYSICIAN CLINIC 11 - SLEEP LAB 919 UNIVERSITY AVENUE BEAVER DAM WI 53916 SLEEP LAB 12 - HILLSIDE HOMECARE AND HOSPICE 709 SOUTH UNIVERSITY AVENUE BEAVER DAM WI 53916 HOME HEALTH AGENCY 14 - BEAVER DAM MEDICAL CLINIC 130 WARREN STREET BEAVER DAM WI 53916 PHYSICIAN CLINIC 15 - BDCH CHIROPRACTIC 211 CORPORATE DRIVE H BEAVER DAM WI 53916 CHIROPRACTIC CLINIC 16 - PODIATRY CLINIC 705 SOUTH UNIVERSITY AVENUE STE 150 BEAVER DAM WI 53916 PHYSICIAN CLINIC PART I, LINE 3C: BEAVER DAM COMMUNITY HOSPITAL ("BDCH") GRANTS FINANCIAL ASSISTANCE IF THEY (A) RECEIVE EMERGENCY MEDICAL CARE OR MEDICALLY NECESSARY CARE, (B) SUBMIT A COMPLETE COMMUNITY CARE APPLICATION INCLUDING REQUIRED SUPPORTING DOCUMENTS AND (C) HAVE HOUSEHOLD INCOME LESS THAN 150% OF FEDERAL POVERTY GUIDELINES. BDCH MAY ALSO GIVE FINANCIAL ASSISTANCE BASED ON A PROPENSITY-TO-PAY FORMULA THAT IS PROVIDED AND RUN BY A THIRD-PARTY VENDOR. PART I, LINE 6A: IN ADDITION TO ITS COMMUNITY BENEFITS REPORT WHICH IT PREPARES, BDCH PREPARES AN ANNUAL REPORT EACH YEAR THAT IS DISTRIBUTED TO MEMBERS OF THE COMMUNITIES THAT WE SERVE. WITHIN THE ANNUAL REPORT IS A SECTION REGARDING COMMUNITY BENEFITS. PART I, LINE 7: CHARITY CARE IS DETERMINED BY UTILIZING THE TOTAL AMOUNT FROM THE PATIENT BILLING SYSTEM THAT IS WRITTEN OFF USING THE CHARITY CARE ALLOWANCE CHARGE CODES FROM THE CHARGEMASTER. THIS AMOUNT TIES TO THE NUMBER THAT IS REPORTED IN THE AUDITED FINANCIAL STATEMENTS FOR THE FISCAL YEAR ENDED 6/30/19. THE TOTAL CHARITY CARE AMOUNT REPORTED ON LINE 7A COLUMN (C) IS REDUCED TO COST BY APPLYING BDCH'S COST TO CHARGE RATES AS CALCULATED ON IRS SCHEDULE H, WORKSHEET 2. PART I, LINE 7G: BDCH DOES NOT HAVE SUFFICIENT INFORMATION AT THIS TIME TO DETERMINE IF SUBSIDIZED SERVICES EXIST BASED ON THE DEFINITION AND CALCULATIONS REQUIRED BY THE IRS AND IS WORKING TO PROVIDE SUCH INFORMATION. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSES THAT WAS EXCLUDED FROM THE CALCULATION TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSES AS A PERCENT OF TOTAL EXPENSES WAS $4,865,432. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON LINE 2 IS THE AMOUNT OF PATIENT RECEIVABLE THAT WAS DEEMED UNCOLLECTIBLE DURING FY2019. BDCH BELIEVES THAT ITS CHARITY CARE AND RELATED COMMUNITY BENEFIT IS UNDERESTIMATED DUE TO PATIENTS THAT MAY POTENTIALLY QUALIFY FOR CHARITY CARE BUT CHOOSE NOT TO APPLY FOR IT. IN ADDITION, THERE IS ADDITIONAL BAD DEBT EXPENSE DUE TO CHARITY CARE APPLICATIONS THAT ARE MISSING INFORMATION AND ARE THEREFORE INCOMPLETE. BAD DEBT IN FY2019 IS $4,865,432 PART III, LINE 3: TO CALCULATE THE CHARITY-ELIGIBLE COST OF ACCOUNTS WRITTEN OFF AS BAD DEBT EXPENSE ON LINE 3, THE PERCENT OF POPULATION BELOW POVERTY LEVEL WAS DETERMINED FROM U.S. CENSUS BUREAU INFORMATION. THIS PERCENTAGE WAS MULTIPLIED BY THE COST OF THE AMOUNT WRITTEN OFF TO BAD DEBT WHICH PRODUCED THE AMOUNT OF CHARGES WRITTEN OFF TO BAD DEBT THAT COULD BE ASSUMED TO BE CHARITY-ELIGIBLE. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" DISCLOSURE IN NOTE 2 (PAGE 8) OF THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE FY 2019 FILED MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST TO DETERMINE THE ESTIMATED SHORTFALL FROM THE MEDICARE PROGRAM. BDCH RECOGNIZES THAT THE ESTIMATED SHORTFALL IS ACTUALLY GREATER THAN WHAT IS INCLUDED IN PART III, LINE 7 DUE TO THE NON-ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THIS SHORTFALL OF $3,143,511 IS NOT CLASSIFIED AS COMMUNITY BENEFIT. HOWEVER, BDCH BELIEVES IT IS AN IMPORTANT CONTRIBUTION MADE BY THE HOSPITAL TO SUPPORT ITS MISSION OF DELIVERING EXCELLENCE ACROSS A CONTINUUM OF SERVICES, EVEN IF WE ARE NOT COMPENSATED FULLY FOR DOING SO. IN ADDITION, MANY OF THESE PATIENTS WOULD QUALIFY FOR MEDICAID AS SEVERAL PATIENTS CARRY IT AS A SECONDARY PLAN, SO THEREFORE, IF THE MEDICARE PROGRAM DID NOT EXIST, MEDICAID WOULD BE THE PRIMARY INSURANCE FOR MANY PATIENTS, WHICH IS CONSIDERED TO BE COMMUNITY BENEFIT. PART III, LINE 9B: BDCH MAKES EVERY EFFORT TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY CARE OR OTHER FINANCIAL ASSISTANCE. AS DESCRIBED IN PART VI, QUESTION 3, BDCH HAS PROCESSES IN PLACE TO INFORM PATIENTS OF OUR CHARITY CARE POLICY AND TO PROVIDE THEM WITH INFORMATION IN APPLYING FOR OTHER THIRD-PARTY OR GOVERNMENT REIMBURSEMENT. IF THE PATIENT'S INCOME LEVEL QUALIFIES THEM FOR CHARITY CARE, THE FULL AMOUNT OF THEIR ACCOUNT BALANCE IS WRITTEN OFF AS CHARITY CARE. IF THE PATIENT DOES NOT AUTOMATICALLY QUALIFY FOR CHARITY CARE, THEY CAN PROVIDE ADDITIONAL INCOME INFORMATION TO DETERMINE IF THEY QUALIFY FOR FULL CHARITY CARE WRITE-OFFS. IF THE PATIENT DOES NOT QUALIFY FOR CHARITY CARE, THEN THE PATIENT IS RESPONSIBLE FOR THE REMAINING BALANCE. THE PATIENT HAS THE OPTION TO MAKE INSTALLMENT PAYMENTS WITH NO INTEREST. IN THE EVENT THAT THE PATIENT DEFAULTS ON THEIR INSTALLMENT PAYMENTS OR DOES NOT COOPERATE WITH BDCH'S COLLECTION EFFORTS, THE ACCOUNT WILL BE SENT TO A COLLECTION AGENCY. PART VI, LINE 2: EVERY 5 YEARS, THE HEALTH DEPARTMENTS OF DODGE AND JEFFERSON COUNTY AND THE CITY OF WATERTOWN CONDUCT A JOINT COMPREHENSIVE CHNA AND COMPILE A REPORT CONTAINING AN ANALYSIS OF THE QUALITATIVE AND QUANTITATIVE INFORMATION GATHERED FROM SEVERAL SOURCES INCLUDING FOCUS GROUPS, THE US CENSUS BUREAU, AND THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM, AMONG OTHERS. THE REPORT INCORPORATES DATA TO ADDRESS ALL 11 HEALTH PRIORITIES IN THE WISCONSIN STATE HEALTH PLAN. BDCH HAS OBTAINED A COPY OF THE FULL REPORT AND UTILIZES THE INFORMATION TO ASSESS THE HEALTH NEEDS OF OUR COMMUNITY. IN ADDITION, BDCH SUPPORTS CHURCH HEALTH SERVICES, A LOCAL ORGANIZATION COMMITTED TO SERVING LOW-INCOME PATIENTS WITH NO INSURANCE, AND MEET WITH THEM TO ASSESS THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: AT BDCH, WE COMMUNICATE OUR COMMUNITY CARE POLICY UPON REGISTRATION TO SELF-PAY PATIENTS FOR INPATIENT CARE, AT WHICH TIME PATIENTS MAY BE QUALIFIED FOR COMMUNITY CARE IMMEDIATELY. FOR OUR OUTPATIENT SELF-PAY PATIENTS, WE INCLUDE CONTACT INFORMATION IN OUR LETTERS AND STATEMENTS, ENCOURAGING THE PATIENTS TO CONTACT US IF THEY DO NOT HAVE THE MEANS TO PAY THEIR MEDICAL EXPENSES. WHEN CONTACTED, WE ASK QUESTIONS TO DETERMINE IF THE PATIENT MAY QUALIFY. IF SO, WE MAIL OUT A PACKET FOR COMPLETION. PART VI, LINE 4: BEAVER DAM COMMUNITY HOSPITALS, INC. SERVES THE GREATER DODGE AND COLUMBIA COUNTY REGION. THE HOME SERVICES PROGRAM ALSO TRAVELS TO OUR PATIENTS IN THEIR HOMES UP TO 30 MILES AWAY. THE POPULATION OF THE AREA WE SERVE IS APPROXIMATELY 145,000 PEOPLE. DEMOGRAPHICALLY, ABOUT 20% OF THE POPULATION IS UNDER THE AGE 18, ABOUT 62% IS AGED 18-64 AND ABOUT 18% IS AGE 65 AND OLDER. OUR HOSPITAL SERVES PATIENTS OF ALL AGES. ALTHOUGH THE POPULATION IS PRIMARILY CAUCASIAN, THERE IS A GROWING HISPANIC POPULATION. MULTIPLE LANGUAGES ARE SPOKEN IN THE AREA, AND THEREFORE INTERPRETATION SERVICES ARE PROVIDED FOR ALL PATIENTS. PART VI, LINE 5: BDCH HAS A LONG HISTORY OF SERVING THE COMMUNITY OF BEAVER DAM AND THE SURROUNDING REGION. BDCH HAS CONTINUALLY GROWN SERVICES TO RESPOND TO THE NEEDS OF PATIENTS WE SERVE ACROSS THE REGION IN CARRYING OUT ITS MISSION OF PROVIDING EXCELLENCE ACROSS THE CONTINUUM. BDCH OFFERS SEVERAL HEALTH AND COMMUNITY PROGRAMS AT NO OR LOW COST SUCH AS HEALTH AND SAFETY FAIRS, LACTATION CONSULTATION SERVICES, SUPPORT GROUPS, HEALTH SCREENINGS, MEMORY CARE CLINIC, WELLNESS CLASSES, MEALS ON WHEELS, AND JOINT REPLACEMENT SEMINARS, FOOT CLINIC & PACEMAKER CLINIC AND SELF-REQUESTED, WALK-IN LAB TESTING AMONG OTHERS. THE AFFILIATION WITH MCHS WILL INCREASE SPECIALTY SERVICES PROVIDED TO THE COMMUNITY THAT PREVIOUSLY REQUIRED PATIENTS TO TRAVEL A MINIMUM OF 45 MINUTES TO LARGER FACILITIES. BDCH HAS AN OPEN MEDICAL STAFF, A LOCAL COMMUNITY ADVISORY BOARD COMPRISED OF COMMUNITY MEMBERS, AND USES ITS SURPLUS FUNDS TO REINVEST IN TECHNOLOGYAND PROGRAM SERVICES TO BETTER SERVE ITS PATIENTS. BDCH SUPPORTS CHURCH HEALTH SERVICES, A LOCAL ORGANIZATION COMMITTED TO PROVIDING HEALTH SERVICES TO LOW-INCOME PATIENT WITHOUT INSURANCE. BDCH PARTICIPATES AS A DROP-OFF SITE FOR SHARPS AND IN THE WISCONSIN HOSPITAL EMERGENCY PREPAREDNESS PLAN WHOSE PURPOSE IS TO MEET A COMMUNITY NEED BY BRINGING ORGANIZATIONS TOGETHER IN THE EVENT OF AN EMERGENCY IN A COLLABORATIVE AND ORGANIZED MANNER. BDCH'S LEADERSHIP STAFF PARTICIPATES IN MANY LOCAL ORGANIZATIONS THROUGHOUT THE REGION.ANOTHER EXAMPLE OF HOW BDCH IS PROMOTING THE HEALTH OF THE COMMUNITY IS THROUGH ITS ENGAGEMENT WITH HEALTHWAYS, INC. TO CREATE A BLUE ZONES DESIGNATED AREA THAT ENCOMPASSES DODGE COUNTY. THROUGH THIS PARTNERSHIP WITH HEALTHWAYS, INC. WE ADDRESS AND PROMOTE HEALTHY LIFESTYLES THROUGH NUTRITIONAL AND PHYSICAL ACTIVITY AS WELL AS FOCUS ON SUBSTANCE ABUSE CONCERNS. BUSINESSES AND COMMUNITIES PARTNER TOGETHER WITH BDCH TO PROVIDE HEALTHY OPTIONS AND LIFESTYLES FOR THEIR CUSTOMERS, EMPLOYEES AND CITIZENS. ALL OF THE BLUE ZONES PROGRAMS ARE OFFERED TO THE COMMUNITY FREE OF CHARGE. WE WORK WITH THE COUNTY AND CITY MUNICIPALITIES, FAITH-BASED ORGANIZATIONS, GROCERY STORES, AND SCHOOLS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COUNTY RESIDENTS. PART VI, LINE 6: BDCH BECAME PART OF AN AFFILIATED HEALTHCARE SYSTEM, MARSHFIELD CLINIC HEALTH SYSTEM (MCHS), ON MAY 1, 2019. BDCH SPONSORS THE BLUE ZONES PROJECT IN DODGE COUNTY, WHICH ADVOCATES FOR THE ADVANCEMENT OF COMMUNITY HEALTH INITIATIVES THROUGHOUT THE COUNTY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 BEAVER DAM COMMUNITY HOSPITALS FOUNDATION INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391499140 501(C)(3) 62000 SUPPORT FOR HILLSIDE MANOR BEAUTY SHOP, HOSPICE HOME, HILLSIDE HOSPICE AND LIFELINE. 1 0 EMPLOYEE TUITION REIMBURSEMENT 24 61188 PART I, LINE 2: THE GRANTS GIVEN TO OUTSIDE ORGANIZATIONS WERE GIVEN TO A RELATED ENTITY. FUNDS TRANSFERRED ARE MONITORED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS AS BOTH ENTITIES ARE UNDER COMMON MANAGEMENT. THE GRANTS GIVEN TO INDIVIDUALS WERE RELATED TO BDCH'S EMPLOYEE TUITION REIMBURSEMENT PROGRAM. THIS PROGRAM PROVIDES ELIGIBLE EMPLOYEES WITH THE OPPORTUNITY TO OBTAIN, MAINTAIN, OR IMPROVE JOB-RELATED OR CAREER-RELATED OBJECTIVES THROUGH PARTICIPATION IN ACADEMIC COURSES AT ACCREDITED COLLEGES AND UNIVERSITIES. THIS PROGRAM IS MONITORED BY HUMAN RESOURCES AND IN ORDER TO RECEIVE THIS BENEFIT, EMPLOYEES MUST GET COURSE APPROVAL PRIOR TO ENROLLMENT, SUCCESSFULLY COMPLETE EACH COURSE WITH A MINIMUM OF A "C" FOR UNDERGRADUATE COURSES OR "B" FOR GRADUATE COURSES, AND SUBMIT A COPY OF AN ITEMIZED RECEIPT WITHIN ONE MONTH FOLLOWING THE END OF CLASS. X X 1 1 X X X X X 1 1 0 1 1 1 1 0 0 SUSAN TURNEY MD DIRECTOR/MCHS CEO 0 1686332 0 510000 0 258560 0 270897 0 22398 0 2748187 0 154255 NARAYANA MURALI MD DIRECTOR/MCHS CSO 0 720583 0 112500 0 21632 0 29497 0 28594 0 912806 0 0 KIMBERLY JM MILLER PRESIDENT & CEO (THROUGH MARCH 2019) 510128 0 86675 0 115426 0 11000 0 40960 0 764189 0 0 0 RUWAN DISSANAYAKE MD MEMBER 0 357107 0 153832 0 21296 0 29497 0 25563 0 587295 0 0 JASON SMITH CHIEF MEDICAL OFFICER 303183 0 33000 0 41760 0 11000 0 28645 0 417588 0 0 0 CAROLYN CATTON INTERIM CHIEF PATIENT CARE (THROUGH NOV 2018) 189344 0 0 0 63171 0 7744 0 0 0 260259 0 0 0 MELANIE BRUINS CHIEF TALENT OFFICER 130176 0 27450 0 24966 0 6649 0 43496 0 232737 0 0 0 DAVID CORSO CHIEF OPERATING OFFICER (THROUGH SEPT 2018) 127208 0 32500 0 43445 0 6854 0 0 0 210007 0 0 0 PAUL PALMER SURGEON 821627 0 69650 0 19131 0 11000 0 35828 0 957236 0 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 0 741937 0 112500 0 19789 0 29497 0 26636 0 930359 0 0 JOSEPH PUCCINELLI ORTHOPEDIC SURGEON 643241 0 0 0 21232 0 11000 0 34634 0 710107 0 0 0 GORDON EDWARDS MCHS CFO/COO 0 570052 0 90000 0 42207 0 29497 0 29848 0 761604 0 0 JAINIE ORRINGTON-MYERS SURGEON (THROUGH MARCH 2019) 393519 0 19719 0 630 0 11000 0 23844 0 448712 0 0 0 ROBERT SEIPEL ORTHOPEDIC SURGEON 641818 0 0 0 1771 0 29500 0 40856 0 713945 0 0 0 MOLLY MEIER PODIATRIST 279486 0 0 0 378 0 8250 0 27410 0 315524 0 0 0 DONNA HUTCHINSON FORMER CFO 0 0 0 0 136333 0 0 0 0 0 136333 0 0 0 PART I, LINE 1A PRIOR TO MAY 1, 2019 BDCH PROVIDED BDCH-OWNED HOUSING TO THE INTERIM CHIEF PATIENT CARE OFFICER, WHO WAS A TEMPORARY EMPLOYEE. THIS WAS INCLUDED IN HER TAXABLE W-2 COMPENSATION. BDCH PROVIDED BDCH-OWNED HOUSING TO THE CEO. THIS WAS REPORTED TO HIM ON A FORM 1099. CURRENTLY, MCHS, MAY OCCASIONALLY REIMBURSE OR PROVIDE A HOUSING ALLOWANCE FOR KEY EXECUTIVES IN ORDER TO ASSIST WITH RELOCATING TO THE AREA. THE ORGANIZATION MAY ALSO CONTRIBUTE TO OR REIMBURSE FOR HEALTH AND SOCIAL CLUB DUES AS DEEMED NECESSARY IN ORDER TO SUPPORT A BUSINESS NEED. PART I, LINE 1B BDCH OCCASIONALLY PROVIDES HOUSING OR A HOUSING ALLOWANCE TO TEMPORARY EMPLOYEES. DETERMINATIONS ARE MADE BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. WHEN THIS BENEFIT IS PROVIDED TO A TEMPORARY EMPLOYEE, BDCH FOLLOWS IRS GUIDELINES IN RECORDING AND REPORTING THE BENEFIT. PART I, LINES 4A-B SEVERANCE (RELATED ORGANIZATION) DANIEL RAMSEY - $557,469 457(F) PLAN SUSAN TURNEY, MD - $167,215 PART I, LINE 5 BEGINNING MAY 1, 2019, SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING, NOT ONLY FINANCIAL MESAURES, SUCH AS REVENUE GROTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. PART I, LINE 6 PRIOR TO MAY 1, 2019 THE BDCH BOARD OF DIRECTORS APPROVED AN INCENTIVE PLAN FOR THE CHIEF EXECUTIVE OFFICER THAT IS RELATED TO THE FINANCIAL PERFORMANCE, QUALITY, PATIENT SATISFACTION, EMPLOYEE TURNOVER, ORGANIZATIONAL GROWTH AND INDIVIDUAL PERSONAL GOALS. THE INCENTIVE MATRIX WAS APPROVED BY THE BOARD EXECUTIVE COMPENSATION COMMITTEE. EACH YEAR THE INCENTIVE COMPENSATION MEASURES ARE CALCULATED AFTER COMPLETION OF THE EXTERNAL AUDIT AND PRESENTED TO THE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE WHICH IS COMPRISED OF FIVE INDEPENDENT BOARD MEMBERS FOR APPROVAL. THE EXECUTIVE TEAM INCENTIVE PLAN IS THEN DEVELOPED BASED ON THE CEO'S PLAN AND DIRECTION OF BOARD APPROVED GOALS. BEGGINING MAY 1, 2019, SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING, NOT ONLY FINANCIAL MESAURES, SUCH AS REVENUE GROTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. A WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 2012-05-09 25745000 REFINANCE 2004A CALLABLE, 2004B, & 1998 BONDS 0 0 0 B WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 97712DBW5 2013-06-25 42864560 REFINANCE 2004A BONDS 0 0 0 A 8475000 25745000 312355 25645000 2006 1 0 1 1 B 6535000 42864560 4352086 646395 29374307 8491772 2006 0 1 1 1 A 0 1 1 1 0 0.00030 0.00100 0.00130 0 0 1 B 0 1 1 1 0 0.00010 0.00190 0.00200 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/15/2017 FORM 990, PART VI, SECTION A, LINE 1 THROUGH MAY 2019, THE MEMBERSHIP OF THE EXECUTIVE COMMITTEE CONSISTED OF THE CHAIRPERSON OF THE BOARD, THE SECRETARY, THE TREASURER, AND THE VICE CHAIRPERSON OF THE BOARD AND SUCH MEMBERS OF THE BOARD OF DIRECTORS AS MAY BE APPOINTED BY THE BOARD OF DIRECTORS. THE COMMITTEE HAD THE POWER TO TRANSACT ALL REGULAR BUSINESS OF BDCH DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS COULD OVERRULE ANY ACTION PREVIOUSLY TAKEN BY THE EXECUTIVE COMMITTEE. AFTER MAY 2019, THE EXECUTIVE COMMITTEE WAS ELIMINATED. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS CHUCK NASON AND MARK BRADLEY HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE ARTICLES WERE AMENDED IN APRIL 2019 AND THE BYLAWS WERE AMENDED IN MAY 2019 TO MAKE THE FOLLOWING SIGNIFICANT CHANGES: - MCHS HOSPITALS, INC. (MCHSH) BECAME THE SOLE CORPORATE MEMBER OF BEAVER DAM COMMUNITY HOSPITALS, INC. (BDCH) EFFECTIVE MAY 1, 2019. MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) IS THE PARENT COMPANY OF MCHSH. - EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WAS ELIMINATED FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS A SINGLE MEMBER: MCHS HOSPITALS, INC., A WISCONSIN NON-STOCK CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF BEAVER DAM COMMUNITY HOSPITALS, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF BEAVER DAM COMMUNITY HOSPITALS, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B BDCH ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE LOCAL FINANCE TEAM, CONTROLLER, CAO, VP OF FINANCE AND SYSTEM CFO. 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, SECTION B, LINE 12C PRIOR TO MAY 1, 2019, EACH DIRECTOR, OFFICER AND COMMITTEE MEMBER, AS A CONDITION TO SERVING THE CORPORATION IN HIS OR HER RESPECTIVE ROLE AND ANNUALLY THEREAFTER, SIGNS A STATEMENT AGREEING TO BE BOUND BY THE TERMS OF THE CONFLICT OF INTEREST POLICY. ANY DIRECTOR, OFFICER OR COMMITTEE MEMBER HAVING A FINANCIAL INTEREST OR OTHER INTEREST IN A CONTRACT, MATTER OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF SUCH PERSON'S INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT, MATTER OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE CORPORATION'S INTEREST. AFTER THE POTENTIALLY CONFLICTED INDIVIDUAL HAS LEFT THE ROOM, THE BOARD OR COMMITTEE TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL BE INVITED BACK TO PRESENT ANY FACTUAL INFORMATION HE OR SHE DEEMS APPROPRIATE OR TO RESPOND TO QUESTIONS IF SUCH IS REQUESTED OF OTHERS PRESENT. THE INDIVIDUAL SHALL THEN AGAIN LEAVE THE ROOM AND NOT VOTE ON, NOR USE PERSONAL INFLUENCE ON, OR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION TO OR RESPOND TO QUESTIONS AS DESCRIBED ABOVE) IN THE DISCUSSIONS AND DELIBERATIONS WITH RESPECT TO SUCH CONTRACT, MATTER OR TRANSACTION. SUCH PERSON MAY BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT, MATTER OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. EFFECTIVE MAY 2019 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, OR ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15A PRIOR TO MAY 1, 2019, THE DETERMINATION OF THE CEO'S COMPENSATION WAS IMPLEMENTED, REVIEWED, AND MONITORED BY THE BOARD OF DIRECTORS' EXECUTIVE COMPENSATION COMMITTEE. THIS COMMITTEE IS COMPRISED OF FIVE INDEPENDENT BOARD MEMBERS AND IS ASSISTED BY AN OUTSIDE NATIONALLY RECOGNIZED CONSULTING FIRM DEALING WITH HOSPITAL EXECUTIVE COMPENSATION AND BENEFITS. SALARIES AND BENEFITS FOR THE CEO WERE EVALUATED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND COMPARED TO THE NATIONAL EXECUTIVE COMPENSATION BENCHMARKS FOR HOSPITAL EXECUTIVES. THE DETERMINATION OF THE OTHER OFFICERS', AND KEY EMPLOYEES' COMPENSATION WAS IMPLEMENTED, REVIEWED, AND MONITORED BY THE CEO BASED ON NATIONAL EXECUTIVE COMPENSATION BENCHMARKS. THIS WAS DONE ANNUALLY. EFFECTIVE MAY 1, 2019 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 MARSHFIELD CLINIC HEALTH SYSTEM (MCHS), INCLUDING BUT NOT LIMITED TO MCHS'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY (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 REASONABLE OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 BDCH DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. BDCH DOES HOWEVER MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC USING SEVERAL METHODS. FIRST, AN ANNUAL REPORT IS DISTRIBUTED TO THE COMMUNITY USING THE CURRENT MAILING ADDRESSES IN OUR SERVICE AREA. IN ADDITION, SINCE WE HAVE TAX-EXEMPT BONDS, WE REPORT OUR FINANCIAL STATEMENTS THROUGH THE MUNICIPAL SECURITIES RULEMAKING BOARD'S ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA). FORM 990, PART XI, LINE 9: PENSION-RELATED CHANGES -2,519,293. 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