2025-11-04T13:02:30-06:00 2024-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2024-01-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 NICHOLAS OLSON EVP, CFO 6053331000 2025-11-04 1 0 JESS WAGENER P01622613 3128792000 2024 2025-03-06 01:10:19Z MARSHFIELD MEDICAL CENTER-PARK FALLS BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 35220185 0 X WWW.MARSHFIELDCLINIC.ORG X 1957 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 125 0 0 108070 1562 41160485 35124052 2077 16651 0 0 41270632 35142265 0 0 0 0 20443952 17327126 0 0 0 16955672 13103127 37399624 30430253 3871008 4712012 33331476 36579229 1575762 2347004 31755714 34232225 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 24197769 0 35124052 FLAMBEAU HOSPITAL, INC. IS A NOT-FOR-PROFIT 25-BED COMMUNITY HOSPITAL LOCATED IN PARK FALLS, WISCONSIN THAT PROVIDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, HOSPICE, HOME HEALTH AND OTHER OUTPATIENT SERVICES. 24197769 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X NICHOLAS OLSON EVP CFO 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 1.00 54.00 X X 0 1584168 39013 COLLEEN HOERNEMAN CHAIR 1.00 10.00 X X 0 5500 0 DAVID HOLMES BOARD MEMBER 1.00 1.00 X 0 0 0 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 51.00 X 0 592054 42454 JOHN BALTUS SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 MARK BRADLEY VICE CHAIR 1.00 6.00 X X 0 5500 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 703503 36357 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 972510 0 CATHY BUKOWSKI FORMER MCHS CFO 0.00 0.00 X 0 631969 0 SUSAN TURNEY MD FORMER MCHS CEO 0.00 0.00 X 0 2241715 0 0 6736919 117824 0 1 1 0 MIRON CONSTRUCTION CO INC PO BOX 1372 GREEN BAY WI 54305 CONSTRUCTION 9757456 LOCUMSMART LLC PO BOX 736389 DALLAS TX 75373 MEDICAL SERVICES 448756 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 PROFESSIONAL SERVICES 369563 BWBR ARCHITECTS INC 380 SAINT PETER ST SUITE 600 SAINT PAUL MN 55102 CONSTRUCTION 284909 BECKMAN COULTER INC DEPT CH 10164 PALATINE IL 60055 LAB SERVICES 219964 14 1562 1562 NET PATIENT SERVICE RE 621110 35049702 35049702 CAFETERIA REVENUE 722310 14915 14915 59435 59435 35124052 318 318 94253 77920 16333 16333 16333 35142265 35109137 0 31566 13756522 13143421 613101 264307 254101 10206 2461081 2385063 76018 845216 815321 29895 6250 6250 1900519 1900447 72 227568 220831 6737 16401 16401 519708 519644 64 30674 27912 2762 15 15 864437 864437 I/C PURCHASED SERVICES 5915231 439911 5475320 MEDICAL SUPPLIES 3367674 3367509 165 EQUIP REPAIRS & MAINT 167849 167555 294 WI MEDICAID ACCESS TAX 45283 45283 41518 29918 11600 30430253 24197769 6232484 0 950 1850 22228 0 16392282 8548913 577479 542298 31065398 3629280 16276494 27436118 62043 50050 33331476 36579229 1283673 2109784 46738 0 245351 237220 1575762 2347004 X 20633555 14270466 11122159 19961759 31755714 34232225 33331476 36579229 X 4712012 -2235501 X 0 1 X 1 1 1 X 673505 673505 22855413 1567905 21287508 7476587 2053545 5423042 59893 7830 52063 27436118 0 ASSET RETIREMENT OBLIGATION 201213 OPERATING LEASE PAYABLE LT 36007 237220 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2024 OR DECEMBER 31, 2023. 1 1 X 1 X 1 X 1 1 1 0 0 216441 0 216441 0.00710 3790715 1540765 2249950 0.07390 0 0 4007156 1540765 2466391 0.08100 52598 0 52598 0.00170 0 0 2063312 1966033 97279 0.00320 0 0 4150 0 4150 0.00010 2120060 1966033 154027 0.00500 6127216 3506798 2620418 0.08600 0 0 0 0 463 0 463 0.00000 0 0 0 0 2200 0 2200 0.00010 0 0 0 0 0 0 2663 2663 0.00010 1 1119354 0 2721749 4411536 -1689787 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - PARK FALLS 98 SHERRY AVENUE PARK FALLS WI 54552 WWW.MARSHFIELDCLINIC.ORG 1028 X X X X MARSHFIELD MEDICAL CENTER - PARK FALLS 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X SEE SUPPLEMENTAL INFO X 1 24 1 SEE SUPPLEMENTAL INFO 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTPS://MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X HTTPS://MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X HTTPS://MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - PARK FALLS PART V, SECTION B, LINE 5: WHEN MARSHFIELD MEDICAL CENTER-PARK FALLS (MMC-PF) CONDUCTED ITS MOST RECENT CHNA IN 2024, THE HOSPITAL ENGAGED A DIVERSE GROUP OF PEOPLE AND ORGANIZATIONS THAT REPRESENTED THE BROAD INTERESTS OF THE COMMUNITIES IT SERVED.PRIMARY DATA COLLECTION PRIMARY DATA WAS COLLECTED USING A COMMUNITY SURVEY AVAILABLE FROM AUGUST 2023 THROUGH DECEMBER 2023. THE PRICE COUNTY COMMUNITY HEALTH SURVEY WAS MODELED AFTER THE RUSK COUNTY, WI COMMUNITY HEALTH SURVEY AND ADAPTED TO FIT THE PRICE COUNTY POPULATION. THE SURVEY FOLLOWED THE COUNTY HEALTH RANKINGS AND ROADMAPS MODEL AND ASKED RESIDENTS TO EVALUATE THE HEALTH OF THEIR COMMUNITY IN FIVE DIFFERENT CATEGORIES: HEALTH OUTCOMES, HEALTH BEHAVIORS, CLINICAL CARE ISSUES, PHYSICAL ENVIRONMENT CONCERNS & SOCIAL AND ECONOMIC FACTORS. THE SURVEY ALSO ASKED FOR BASIC DEMOGRAPHIC INFORMATION TO MORE CLOSELY ALIGN THE DEMOGRAPHICS OF SURVEY RESPONDENTS TO THE POPULATION OF RUSK COUNTY.BOTH RANDOM AND TARGETED SAMPLING WAS UTILIZED. THE SURVEY WAS WIDELY DISTRIBUTED BY UTILIZING SOCIAL MEDIA PLATFORMS, AND PROVIDING PAPER SURVEYS AT VARIOUS COMMUNITY LOCATIONS AND COMMUNITY EVENTS. THE SURVEY WAS AVAILABLE IN SPANISH AND ENGLISH. A TOTAL OF 226 SURVEYS WERE COMPLETED, RESULTING IN A 6% MARGIN OF ERROR TO REPORT VALIDITY AT THE 95% CONFIDENCE LEVEL. SURVEY RESPONDENTS REPRESENTED A WIDE RANGE OF RESIDENTS WITH A VARIETY OF INCOME AND EDUCATION LEVELS, AGE AND HOUSEHOLD SIZE AND CLOSELY MIRRORED THE DEMOGRAPHICS OF THE COUNTY, WITH APPROXIMATELY 96% OF SURVEY RESPONDENTS IDENTIFYING AS WHITE, 3% IDENTIFYING AS OTHER, AND 1% IDENTIFYING AS TWO OR MORE RACES. MOST SURVEY RESPONDENTS WERE BETWEEN THE AGES OF 45-64 (44%), HAD A BACHELOR'S DEGREE LEVEL OF EDUCATION (30%), AND REPORTED A YEARLY HOUSEHOLD INCOME OF $100,000 OR MORE. IN THE FUTURE OTHER EFFORTS WILL BE MADE TO ENSURE THAT THESE DEMOGRAPHICS MORE CLOSELY ALIGN WITH THOSE OF PRICE COUNTY RESIDENTS OVERALL.SECONDARY DATA COLLECTIONLOCAL SECONDARY QUANTITATIVE DATA WAS COMPILED BY THE WISCONSIN INSTITUTE FOR PUBLIC POLICY AND SERVICE (WIPPS) IN JANUARY OF 2024 FROM A VARIETY OF SOURCES BASED ON THE WISCONSIN ASSOCIATION OF LOCAL HEALTH DEPARTMENTS AND BOARDS (WALHDAB) RECOMMENDATIONS. DATA SOURCES INCLUDED US CENSUS, CENTERS FOR DISEASE CONTROL AND PREVENTION, UNITED WAY REPORTS, COUNTY HEALTH RANKINGS, AND MORE. MARSHFIELD MEDICAL CENTER - PARK FALLS PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED JOINTLY WITH THE PRICE COUNTY HEALTH DEPARTMENT. MARSHFIELD MEDICAL CENTER - PARK FALLS PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE COMMUNITY HEALTH SURVEY AND PROCESS, UNITED WAY ALICE DATA, HEALTHIEST WISCONSIN 2020, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MMC-PARK FALLS ARE: - SUBSTANCE USE - BEHAVIORAL HEALTH - HEALTH EQUITY - COMMUNITY CAPACITY, ENGAGEMENT AND INFRASTRUCTURE HEALTH PRIORITY: SUBSTANCE USE GOAL 1: IMPROVE ACCESS TO SUBSTANCE USE DISORDER SERVICES THROUGH CONNECTING COMMUNITY AND CARE DELIVERY EFFORTS - STRATEGY: INCREASE CLINICAL KNOWLEDGE AND CAPACITY ON MEDICATIONS FOR OPIOID USE DISORDER (MOUD) AND OTHER SUBSTANCE USE SERVICES AND SUPPORTS. GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUBSTANCE USE AND PREVENTION - STRATEGY: PARTICIPATE IN AND SUPPORT SUBSTANCE USE AND PREVENTION COALITIONS AND OTHER COMMUNITY EFFORTS. HEALTH PRIORITY: BEHAVIORAL HEALTH GOAL 1: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES THROUGH CONNECTING COMMUNITY AND CARE DELIVERY EFFORTS - STRATEGY: IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, SUPPORT, AND COMMUNITY RESOURCES.GOAL 2: ENGAGE IN COMMUNITY EFFORTS TO ADDRESS SOCIAL EMOTIONAL DEVELOPMENT AND IMPROVE BEHAVIORAL HEALTH - STRATEGY: PARTICIPATE IN AND SUPPORT COMMUNITY BASED BEHAVIORAL HEALTH COALITIONS AND OTHER COMMUNITY EFFORTS. HEALTH PRIORITY: HEALTH EQUITYGOAL 1: REDUCE HEALTH DISPARITIES RELATED TO SOCIAL, ECONOMIC, CULTURAL, GENDER AND/OR COMMUNITY CONDITIONS. - STRATEGY: USE DEMOGRAPHIC DATA TO UNDERSTAND PATIENT AND COMMUNITY REPRESENTATION AND ASSESS HEALTH DISPARITIES AND COMMUNITY ASSETS TO PROVIDE CULTURALLY RESPONSIVE CARE. GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO ADVANCING HEALTH EQUITY AND SOCIAL DETERMINANTS OF HEALTH - STRATEGY: PARTICIPATE IN AND SUPPORT COMMUNITY-BASED HEALTH EQUITY COALITIONS AND OTHER COMMUNITY EFFORTS. HEALTH PRIORITY: COMMUNITY CAPACITY, ENGAGEMENT, AND INFRASTRUCTURE GOAL 1: IMPROVE MMC-PARK FALLS ENGAGEMENT IN THE COMMUNITY THROUGH CIVIC ENGAGEMENT ACTIVITIES THAT ADDRESS HEALTH. - STRATEGY: INCREASE THE NUMBER OF NORTH MARKET EXECUTIVE LEADERS INVOLVED AND ENGAGED IN THE COMMUNITY. GOAL 2: ENGAGE IN COMMUNITY EFFORTS TO ADDRESS HEALTH NEEDS RELATED TO IDENTIFIED PRIORITIES; SUBSTANCE USE, BEHAVIORAL HEALTH OR HEALTH EQUITY. - STRATEGY: HOST OR PARTICIPATE IN COMMUNITY EVENTS OF INITIATIVES. IDENTIFIED HEALTH NEEDS NOT BEING ADDRESSEDTHROUGH THE ASSESSMENT PROCESS, OTHER COMMUNITY HEALTH NEEDS WERE IDENTIFIED THAT HAVE NOT BEEN ADDRESSED IN THIS PLAN. IN PRIORITIZING COMMUNITY HEALTH NEEDS, THE COMMUNITY BENEFITS WORKGROUP (CBW)-PARK FALLS CONSIDERED OTHER ORGANIZATIONS ADDRESSING THE SPECIFIC NEED, THE ABILITY OF MMC-PARK FALLS TO IMPACT CHANGE, AVAILABILITY OF RESOURCES, AS WELL AS READINESS OF THE COMMUNITY FOR INTERVENTIONS. AFTER CONSIDERATION, THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-PARK FALLS CBW AS OTHER COMMUNITY ORGANIZATIONS ARE BETTER EQUIPPED AND HAVE THE RESOURCES IN PLACE TO LEAD EFFORTS TO ADDRESS THEM. CROSS-CUTTING EFFORTS IN MCHS'S STRATEGIC AREAS OF FOCUS MAY INDIRECTLY ADDRESS SOME OF THESE HEALTH NEEDS: - AGING-RELATED CONCERNS - ACCESS TO AFFORDABLE HEALTHCARE AND PROVIDERS - PHYSICAL HEALTH: CHRONIC DISEASE, OBESITY, NUTRITION, PHYSICAL INACTIVITY LINE 7A CHNA REPORT URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2025-27%20MMC-PF%20CHNA%20(FINAL).PDF LINE 10A IMPLEMENTATION STRATEGY URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2025-27%20MMC-PF%20IS%20(FINAL).PDF 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. PART I, LINE 7: COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND LINE 7G (SUBSIDIZED HEALTH SERVICES) IS CALCULATED USING A COST ACCOUNTING SYSTEM. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO THE ORGANIZATION. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO THE ORGANIZATION, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY THE ORGANIZATION THROUGH PHYSICIAN PRACTICES. FOR CY 2024, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $97,279. PART II, COMMUNITY BUILDING ACTIVITIES: MMC-PARK FALLS, IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT; ENRICHES LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY. THE HEALTH SYSTEM CONTINUED TO IMPLEMENT A FINANCIAL IMPROVEMENT PLAN BECAUSE OF SIGNIFICANT CHALLENGES IN THE HEALTHCARE INDUSTRY. DESPITE THIS, COMMUNITY-BUILDING ACTIVITIES CONTINUED, AND STRONGER, LOCAL CONNECTIONS WERE MADE. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE:COMMUNITY SUPPORT: MMC-PARK FALLS STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS INCLUDING: - PROVIDED A FREE, VIRTUAL DIABETES PREVENTION PROGRAM LED BY CDC-CERTIFIED LIFESTYLE COACHES TO EMPOWER PARTICIPANTS TO PREVENT OR DELAY THE ONSET OF TYPE 2 DIABETES - PROVIDED EMS SERVICES AND COVERAGE AT VARIOUS EVENTS INCLUDING TOUR THE FLAMBEAU BIKE RACE, FLAMBEAU RAMA PARADE & 5K, AND PIONEER DAYS PARADE. - HOSTING BLOOD DRIVES TO PROVIDE BLOOD AND BLOOD PRODUCTS TO THE REGIONAL BLOOD BANK. ENVIRONMENTAL IMPROVEMENTS: MMC-PARK FALLS SUPPORTED A SHARPS DISPOSAL EVENT THAT INCREASED KNOWLEDGE OF SAFE DISPOSAL AND INCREASED ACCESS TO SAFE SHARPS DISPOSAL SITES. COALITION BUILDING:MMC-PARK FALLS STAFF PARTICIPATED IN COMMUNITY COALITIONS TO IMPROVE THE HEALTH OF THE COMMUNITY. THESE COALITIONS ARE THE PRICE COUNTY AODA/MENTAL HEALTH COALITION, PRICE COUNTY HEALTH & WELLNESS COALITION. WORKFORCE DEVELOPMENT: MMC-PARK FALLS FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, MEDICAL RESIDENTS, AND INTERNS. OTHER: MMC-PARK FALLS STAFF COORDINATED A MITTEN TREE, WHICH PROVIDES GIFTS TO FAMILIES IN NEED AROUND THE HOLIDAYS. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. 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 DEDUCTIBLES 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. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 62% AND 65% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2024 AND DECEMBER 31, 2023, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2024 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. 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. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-PARK FALLS USES RELIABLE THIRD-PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, AND DIRECT COMMUNITY INVOLVEMENT TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THE INFORMATION PROVIDED BY THESE SOURCES' POINTS TO AREAS OF NEED. MMC-PARK FALLS COLLABORATES CLOSELY WITH MARSHFIELD CLINIC HEALTH SYSTEM'S CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA) TO ASSESS, DEVELOP, AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH OF THE LOCAL COMMUNITY. CCHA'S STRATEGIC AREAS OF FOCUS INCLUDE SUBSTANCE USE, BEHAVIORAL HEALTH, HEALTH EQUITY, AND BUILDING COMMUNITY CAPACITY FOR HEALTH IMPROVEMENT. THIS WORK REQUIRES CONTINUAL ASSESSMENT OF THE NEEDS OF THE COMMUNITY WHICH REINFORCES MMC-PARK FALLS' CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE STRATEGIC AREAS REPRESENT COMPLEX CHALLENGES COMMUNITIES EXPERIENCE EVERY DAY, AND CCHA IS COMMITTED TO IMPROVING. MMC-PARK FALLS UTILIZES THE CENTER FOR COMMUNITY HEALTH ADVANCEMENT'S COMMUNITY CONNECTIONS TEAM AND FINDHELP, A SOCIAL NEEDS PLATFORM THAT INCLUDES AN ELECTRONIC DATABASE OF COMMUNITY RESOURCES AVAILABLE IN AN AREA, TO ASSESS NEEDS AND THEN CONNECT INDIVIDUALS TO THOSE RESOURCES. ADDITIONALLY, THERE ARE PROCESSES IN PLACE AT MMC-PARK FALLS TO ESTABLISH ONGOING DIRECT ENGAGEMENT WITH THE LOCAL HEALTH DEPARTMENT, NUMEROUS COMMUNITY-HEALTH-FOCUSED ORGANIZATIONS, COMMUNITY CHAMBERS, BOARDS OF ECONOMIC DEVELOPMENT, YOUTH-FOCUSED ORGANIZATIONS AND OTHER HEALTH IMPROVING ORGANIZATIONS. DIRECT COLLABORATION WITH, AND REQUESTS FROM, THESE GROUPS FURTHER KNOWLEDGE OF THE COMMUNITY AND ITS NEEDS. 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. PART VI, LINE 4: MMC-PARK FALLS IS A CRITICAL ACCESS HOSPITAL LOCATED IN PARK FALLS, WISCONSIN. PARK FALLS IS ONE OF TWO CITIES LOCATED IN PRICE COUNTY. MMC-PARK FALLS NOT ONLY SERVES PATIENTS AND RESIDENTS OF PRICE COUNTY, BUT ALSO PROVIDES CRITICAL SERVICES TO PATIENTS AND COMMUNITY MEMBERS IN NEIGHBORING COUNTIES. PRICE COUNTY IS LOCATED IN THE NORTH CENTRAL REGION OF WISCONSIN AROUND ASHLAND, SAWYER, ONEIDA, AND TAYLOR COUNTIES. PRICE COUNTY HAS 1,254.06 SQUARE MILES OF LAND AREA AND IS THE 5TH LARGEST COUNTY IN WISCONSIN BY TOTAL AREA. THE COUNTY IS COMPOSED OF 2 CITIES (PARK FALLS AND PHILLIPS), 3 VILLAGES (CATAWBA, KENNAN, AND PRENTICE), AND 17 TOWNSHIPS. THE COUNTY SEAT IS LOCATED IN PHILLIPS. BASED ON THE WISCONSIN OFFICE OF RURAL HEALTH'S DESIGNATIONS, PRICE COUNTY IS DEFINED AS A RURAL COUNTY WITH A POPULATION OF 11.2 PEOPLE PER SQUARE MILE. PRICE COUNTY IS THE 5TH LARGEST COUNTY IN WISCONSIN BY LAND MASS BUT THE 65TH LARGEST (OUT OF 72) FOR POPULATION SIZE. MAJORITY OF THE POPULATION RESIDES IN THE CITY OF PARK FALLS, FOLLOWED BY THE CITY OF PHILLIPS.THE AVERAGE AGE OF PRICE COUNTY RESIDENTS IS 52.1 YEARS. 27.2% OF THE PRICE COUNTY POPULATION IS 65 AND OLDER. THE MEDIAN HOUSEHOLD INCOME FOR PRICE COUNTY IS $55,822, WHICH IS ALMOST $20,000 LOWER THAN THE MEDIAN HOUSEHOLD INCOME FOR THE STATE OF WISCONSIN ($72,458). MEDIAN GROSS RENT IN PRICE COUNTY IS $759, WITH 12.2% OF THE POPULATION LIVING IN POVERTY. ALTHOUGH THE PERCENTAGE OF PRICE COUNTY RESIDENTS WHO GRADUATE FROM HIGH SCHOOL IS SIMILAR TO THE STATE AVERAGE (92.9% VS. 93.1% RESPECTIVELY) THE PERCENTAGE OF RESIDENTS WITH A BACHELOR'S DEGREE OR HIGHER (16%) IS HALF OF THE STATE AVERAGE (32%).93.9% OF RESIDENTS IN PRICE COUNTY ARE WHITE ALONE, NOT HISPANIC OR LATINO. THE NEXT LARGEST RACIAL/ETHNIC GROUP IS HISPANIC OR LATINO AT 1.8% FOLLOWED BY "TWO OR MORE RACES" AT 1.6%. THE FOLLOWING RACES ARE EQUAL TO OR LESS THAN 1% OF THE PRICE COUNTY POPULATION: BLACK OR AFRICAN AMERICAN, AMERICAN INDIAN AND ALASKA NATIVE, ASIAN, NATIVE HAWAIIAN/PACIFIC ISLANDER, AND OTHER. 97.4% OF PRICE COUNTY HOUSEHOLDS SPEAK ENGLISH ONLY. THE FOLLOWING LANGUAGES ARE SPOKEN IN LESS THAN 1% OF PRICE COUNTY HOMES: SPANISH, OTHER INDO-EUROPEAN LANGUAGES, ASIAN OR PACIFIC ISLANDER LANGUAGES, AND OTHER LANGUAGES. 10.9% OF THE PRICE COUNTY POPULATION UNDER THE AGE OF 65 YEARS IS LIVING WITH A DISABILITY. PRICE COUNTY ALSO HAS A UNIQUE CHALLENGE WHEN IT COMES TO BROADBAND ACCESS. ONLY 88.7% OF THE PRICE COUNTY POPULATION HAS A COMPUTER IN THEIR HOUSEHOLD, AND ONLY 80% OF THOSE HOUSEHOLDS WITH COMPUTERS HAVE BROADBAND INTERNET. REFERENCES CAN BE FOUND ON THE MOST RECENT MMC-PF CHNA. PART VI, LINE 5: MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) PROMOTES THE HEALTH OF COMMUNITIES THROUGH ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), A DEPARTMENT WITHIN MCHS SOLELY DEDICATED TO COMMUNITY HEALTH. CCHA IS GOVERNED BY THE ENTERPRISE WIDE MCHS COMMUNITY HEALTH/COMMUNITY BENEFITS STEERING COMMITTEE WHICH IS TASKED WITH PROVIDING OVERSIGHT AND GUIDANCE ON SYSTEM COMMUNITY HEALTH AND COMMUNITY BENEFIT STRATEGY. THE COMMITTEE IS MADE UP OF INTERNAL EMPLOYEES WHO REPRESENT VARIOUS DIFFERENT DEPARTMENTS AND ROLES WITHIN THE HEALTH SYSTEM. THIS STRONG FOCUS ON COMMUNITY HEALTH IS FURTHER SUPPORTED BY THE MARSHFIELD CLINIC HEALTH SYSTEM BOARD OF DIRECTORS WHICH CONSISTS OF 24 MEMBERS, 11 OF THOSE MEMBERS ARE PHYSICIAN DIRECTORS AND 13 ARE INDEPENDENT DIRECTORS WHO RESIDE WITHIN THE SERVICE AREA AND ARE NOT EMPLOYEES OF THE ORGANIZATION.MARSHFIELD CLINIC HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES THROUGH ACCESSIBLE, AFFORDABLE, AND COMPASSIONATE HEALTH CARE. MCHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY LIVING OUT THIS MISSION INCLUDING PROVIDING SEVERAL SERVICES WHICH WOULD NOT OTHERWISE BE AVAILABLE IN A RURAL SETTING SUCH AS, MCHS PROVIDERS PRACTICING MORE THAN 170 SPECIALTIES AND EMERGENCY ROOMS THAT ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. MCHS TRAINS AND EDUCATES HEALTHCARE PROFESSIONALS THROUGH A VARIETY OF INTERNSHIP PROGRAMS AND PARTNERS REGULARLY WITH LOCAL HIGH SCHOOLS AND COLLEGES TO DISCUSS CAREER, INTERNSHIP, AND VOLUNTEER OPPORTUNITIES FOR STUDENTS. MCHS ACCEPTS FINANCIAL ASSISTANCE AND PAYMENT PLANS ARE AVAILABLE; MCHS ALSO PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (E.G. MEDICARE, MEDICAID). A VARIETY OF HEALTH PROGRAMMING IS PROVIDED TO THE COMMUNITY AT NO COST SUCH AS CHILD SAFETY EDUCATION, SUPPORT GROUPS, AND PRESENTATIONS ON A VARIETY OF HEALTH TOPICS. MCHS STAFF ARE ACTIVELY INVOLVED IN THEIR LOCAL COMMUNITY AND LEND NOT ONLY THEIR EXPERTISE BUT OFTENTIMES LEADERSHIP AS WELL TO MANY ORGANIZATIONS SUCH AS UNITED WAY, YMCA, CHAMBER OF COMMERCE, ETC. STAFF FROM MCHS HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF SUBSTANCE MISUSE, BEHAVIORAL HEALTH, AND HEALTH EQUITY. PART VI, LINE 6: MMC-PARK FALLS IS PART OF MARSHFIELD CLINIC HEALTH SYSTEM, INC., AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN AND RESEARCH AND EDUCATION PROGRAMS. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. MARSHFIELD CLINIC HEALTH SYSTEM SERVES RURAL COMMUNITIES AND COLLECTIVELY PROMOTES HEALTH BY REDUCING BARRIERS TO ACCESSING CARE. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE THAT WOULDN'T OTHERWISE BE AVAILABLE THROUGH ITS 60 LOCATIONS AND 11 HOSPITALS IN COMMUNITIES ACROSS NORTHERN, CENTRAL AND WESTERN WISCONSIN AND IN MICHIGAN. MCHS PRIMARY OPERATIONS INCLUDE MARSHFIELD CLINIC LOCATIONS; MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, PARK FALLS, AND IRON MOUNTAIN (MICHIGAN); MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, DIVISION OF EDUCATION AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. UNIQUE TO MCHS IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILDS BRIDGES BETWEEN THE HEALTHCARE SYSTEM AND THE COMMUNITY. CCHA LIVES OUR MISSION THROUGH COLLECTIVE IMPACT, COLLABORATIVE PARTNERSHIPS, AND INNOVATION TO ADDRESS POLICY, SYSTEMS AND ENVIRONMENT TO ADVANCE HEALTH, ESPECIALLY IN RURAL COMMUNITIES. CCHA COLLABORATES 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. THIS COLLABORATION HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD FORMER MCHS CEO 0 0 0 0 0 2241715 0 0 0 0 0 2241715 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 0 1043925 0 516277 0 23966 0 8625 0 30388 0 1623181 0 0 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 0 0 0 0 0 972510 0 0 0 0 0 972510 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 476625 0 201334 0 25544 0 8625 0 27732 0 739860 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 338138 0 225978 0 27938 0 8625 0 33829 0 634508 0 0 CATHY BUKOWSKI FORMER MCHS CFO 0 0 0 0 0 631969 0 0 0 0 0 631969 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B LINE 4A: IN 2024, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $1,879,544 AND CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $631,969. LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $362,171 FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING FLAMBEAU HOSPITAL, 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 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO FLAMBEAU HOSPITAL INC SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR FLAMBEAU HOSPITAL, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR FLAMBEAU HOSPITAL, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS COLLEEN HOERNEMAN AND BRIAN HOERNEMAN, MD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF FLAMBEAU HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBER OF THE BOARD OF DIRECTORS OF FLAMBEAU HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF FLAMBEAU HOSPITAL, INC. MCHS HOSPITALS, 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. 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 THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE EXECUTIVE MANAGEMENT TEAM. AN EXTERNAL ACCOUNTING FIRM REVIEWS AND SIGNS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 FLAMBEAU HOSPITAL, INC. DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTION 8,839,600. NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS -11,075,101. MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 0 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE 1700 W STOUT ST RICE LAKE WI 54868 390837206 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 0 MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) LINE 7 N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 0 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) LINE 7 MCHS 0 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 DICKINSON COUNTY HEALTHCARE SYSTEM 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 382780429 HOSPITAL MI 501(C)(3) LINE 3 MCHS HOSP 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 SECURITY HEALTH PLAN OF WISCONSIN INC L 10955770 COST