2019-05-14T15:52:20-05:00 2018-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2017-07-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 JAMES BRAUN CHIEF ADMINISTRATIVE OFFICER/CFO 7157622484 2019-05-14 1 KIMBERLY HELLER CPA P00766668 7158453111 2019-05-14 216.99.223.13 2019-05-14 12:20:54 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FEDE6E2ED2B59B1C13DC36E78E84E5663127854C 2017 2019-02-21 02:37:17Z JAMES BRAUN 98 SHERRY AVENUE PARK FALLS WI 54552 23204414 0 X HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWS X 1961 WI TO PROVIDE HIGH QUALITY, ACCESSIBLE HEALTH CARE SERVICES IN OUR COMMUNITY. 14 14 258 120 0 5563 80071 266441 22517017 22908241 27216 21688 12746 2399 22637050 23198769 0 0 0 0 12378049 13162156 0 0 0 10195387 9989496 22573436 23151652 63614 47117 15372159 13798564 3607219 2207141 11764940 11591423 X THE FOLLOWING OBJECTIVES PROVIDE THE DIRECTION FOR FLAMBEAU HOSPITAL IN FULFILLING ITS VISION:- TO CONTINUOUSLY IMPROVE QUALITY SERVICES TO CUSTOMERS BY BUILDING EXCELLENCE INTO EVERY ASPECT AND PROCESS OF THE HOSPITAL. CUSTOMERS INCLUDE PATIENTS AND STAFF MEMBERS. THIS EXCELLENCE DEVELOPS FROM TOTAL QUALITY IMPROVEMENT, AN ENVIRONMENT THAT ENCOURAGES EVERYONE TO CONTRIBUTE TO THE HOSPITAL'S MISSION.- TO ENCOURAGE HEALTH PROMOTION AND WELLNESS THROUGH EDUCATIONAL ACTIVITIES. WHEN FEASIBLE, THESE ACTIVITIES WILL BE PURSUED IN CONJUNCTION WITH AREA HEALTH CARE PROVIDERS.- TO COLLABORATE WITH AND PROVIDE REFERRALS TO AGENCIES PROVIDING SERVICES NOT DIRECTLY AVAILABLE AT THE HOSPITAL.- TO MAINTAIN AN OPEN RELATIONSHIP WITH THE MEDICAL AND HOSPITAL STAFF TO ENSURE EFFICIENT AND EFFECTIVE UTILIZATION OF HOSPITAL RESOURCES.- TO PROVIDE IN-SERVICE AND CONTINUING EDUCATIONAL OPPORTUNITIES FOR HEALTH CARE PERSONNEL AS A MEANS OF PROVIDING QUALITY PATIENT CARE. 0 0 18703048 0 22824585 FLAMBEAU HOSPITAL PROVIDES WELLNESS ACTIVITIES, EDUCATION AND PRIMARY HEALTHCARE SERVICES TO APPROXIMATELY 17,000 RESIDENTS IN OUR SERVICE AREA. HEALTHCARE SERVICE INCLUDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, AND OTHER OUTPATIENT SERVICES. SERVICES FOR THE YEAR ENDED JUNE 30, 2018 INCLUDED 1,424 INPATIENT DAYS, 33 SWING BED DAYS AND 26,522 OUTPATIENT REGISTRATIONS.FLAMBEAU HOME HEALTH PROVIDES HEALTH CARE SERVICES FOR HOMEBOUND PATIENTS INCLUDING PRIMARY CARE, WOUND AND INFECTION SERVICES, PERSONAL CARE SERVICES, PAIN MANAGEMENT AND OTHER MEDICAL SERVICES THAT CAN BE PROVIDED IN THE HOME. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.FLAMBEAU HOSPICE PROVIDES END OF LIFE CARE TO PATIENTS AND THEIR FAMILIES IN THEIR HOMES OR OTHER APPROPRIATE FACILITIES. ALSO PROVIDED ARE CHAPLAIN, VOLUNTEER AND BEREAVEMENT SERVICES. BEREAVEMENT SERVICES CONTINUE AFTER A PATIENT'S DEATH FOR ONE YEAR OR MORE. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS. 18703048 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 57 0 258 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES BRAUN 7157622484 98 SHERRY AVE PARK FALLS WI 54552 DAVE ANDERSON DIRECTOR 1.00 X 0 0 0 LOUAY DANIAL MD DIRECTOR 1.00 X 0 0 0 DAVE DEDA DIRECTOR 1.00 X 0 0 0 MOQUIN DOUG DIRECTOR 1.00 X 0 0 0 CAROL MADER DIRECTOR 1.00 X 0 0 0 JEREMY NORMINGTON-SLAY DIRECTOR 1.00 X 0 0 0 TOM OLSON DIRECTOR 1.00 X 0 0 0 THOMAS PREBBLE MD DIRECTOR 1.00 X 0 350420 54860 GAYLE STANGLE DIRECTOR 1.00 0.20 X 0 0 0 MATTHEW THOMAS MD DIRECTOR 1.00 X 0 0 0 LAURIE WAGNER DIRECTOR 1.00 X 0 0 0 ROGER STRAND CHAIRPERSON 1.00 X X 0 0 0 BOBBI DAMROW VICE CHAIRPERSON/TREASURER 1.00 X X 0 0 0 JULIA RUFF SECRETARY 1.00 X X 0 0 0 JAMES BRAUN CAO/CFO 40.00 0.20 X 0 216055 28894 JANE EATON-NYMAN CIO 40.00 X 162590 0 43271 LIZ SCHREIBER DON 40.00 X 107991 0 46477 SARA BABLICK PHARMACY DIRECTOR 40.00 X 148378 0 18206 ROBERT PFLANZ SENIOR DIRECTOR SUPPORT SERVICES 40.00 X 104299 0 40170 THOMAS KASTER SENIOR DIRECTOR OF FINANCE 40.00 X 118979 0 40476 642237 566475 272354 5 0 1 0 MARSHFIELD CLINIC 1000 N OAK AVE MARSHFIELD WI 54449 PHYSICAN STAFFING 3531635 ALEXANDER KORITTNIG 442 S 3RD AVENUE PARK FALLS WI 54552 ANESTHESIA 493487 SHARED MEDICAL TECHNOLOGY 202 W NEWTON ST RICE LAKE WI 54868 MEDICAL SERVICES 339165 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 AGENCY STAFFING 163280 TRIMEDX LLC 5451 LAKEVIEW PARKWAY S DR INDIANAPOLIS IN 46268 EQUIPMENT MAINTENANCE 151229 5 14966 251475 266441 NET PATIENT SERVICE REVENUE 621110 22414113 22414113 AFFILIATED ORG RENT 900099 247555 247555 CAFETERIA REVENUE 900099 83656 83656 162917 162917 22908241 21688 21688 8044 14966 5645 2399 2399 23198769 22824585 0 107743 X 566475 350420 216055 8737736 7164144 1573592 313342 253071 60271 2886299 2331125 555174 658304 531680 126624 11403 11403 4937316 4010748 926568 71606 71606 1602889 1569713 33176 333210 262511 70699 187311 152785 34526 48613 48613 1086219 1019974 66245 105203 105203 EQUIPMENT RENTAL 703725 627449 76276 BAD DEBT 299861 299861 FOOD 125815 100865 24950 476325 328563 147762 23151652 18703048 4448604 0 239320 165298 4750773 3204453 2240191 2543271 213180 200229 46318 112181 24443410 18025853 7149962 6417557 732415 1155575 15372159 13798564 1633716 1300990 1827097 726744 146406 179407 3607219 2207141 X 10910648 10517703 854292 1073720 11764940 11591423 15372159 13798564 X 47117 -220634 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4633 4633 0 PART II-B, LINE 1: FLAMBEAU HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED FLAMBEAU HOSPITAL THAT $4,633 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 73128 73128 14996401 10751485 4244916 9315285 7274368 2040917 58596 58596 6417557 INTEREST IN NET ASSETS OF FLAMBEAU HOSPITAL FOUNDATION, INC. 396208 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 759367 1155575 ASBESTOS ABATEMENT LIABILITY 201213 DEFERRED BOND ISSUANCE COSTS (OFFSET AGAINST LONG-TERM DEBT) -21806 179407 X 22898908 0 22898908 299861 299861 23198769 22851791 0 22851791 299861 299861 23151652 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 299,861. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 299,861. GOLF OUTING 16964 8920 8044 5645 LIGHTS OF LOVE 6046 6046 23010 14966 8044 5645 5645 2399 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 0 283128 283128 0.01240 2667662 1599535 1068127 0.04670 2950790 1599535 1351255 0.05910 18627 97401 97401 0.00430 7 28258 28258 0.00120 4628378 1829005 2799373 0.12250 8148 107183 107183 0.00470 26782 4861220 1829005 3032215 0.13270 26782 7812010 3428540 4383470 0.19180 1912 1912 0.00010 120 9962 9962 0.00040 180 2790 2790 0.00010 296 296 0.00000 7052 7052 0.00030 137 23866 23866 0.00100 437 45878 45878 0.00190 0 173067 9072938 9208678 -135740 X 1 1 1 1 FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS WI 54552 X X X X FLAMBEAU HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X X 1 15 1 WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/FLAMBEAU-HOSPITAL/COMMUNITY-HEALTH-NEEDS 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X X X X X X 1 X 0 X X X 1 X 0 0 FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 5: FLAMBEAU HOSPITAL CHAIRED SEVERAL MEETINGS WITH COMMUNITY MEMBERS OVER AN 8-MONTH PERIOD TO DISCUSS, TABULATE AND FORM THE TOP PRIORITY NEEDS IN THE COMMUNITY. THE HOSPITAL WORKED WITH THE PRICE COUNTY PUBLIC HEALTH DEPARTMENT TO CO-CHAIR THESE MEETINGS. ALSO, FLAMBEAU HOSPITAL AND PRICE COUNTY PUBLIC HEALTH DEPARTMENT SENT INVITATIONS TO NUMEROUS GROUPS INCLUDING LOCAL BUSINESSES, GOVERNMENT AGENCIES, CHURCHES, CLINICS, HOSPITALS, SCHOOL DISTRICTS, COUNSELING CENTERS, ADVOCACY GROUPS, PUBLIC CITIZENS, AND CITY AND COUNTY LAW ENFORCEMENT FOR PARTICIPATION IN THE MEETINGS. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 6A: ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 6B: FLAMBEAU HOSPITAL, MARSHFIELD CLINIC, PRICE COUNTY PUBLIC HEALTH, ASPIRUS, PHILLIPS POLICE DEPARTMENT, PARK FALLS SCHOOLS, PHILLIPS SCHOOLS, PRENTICE SCHOOLS, FLAMBEAU HOME HEALTH AND HOSPICE, PRICE COUNTY HUMAN SERVICES, PHILLIPS PUBLIC LIBRARY, UW EXTENSIONS, TIME OUT SHELTER, COMMUNITY MEMBERS. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 7D: HTTPS://WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/FLAMBEAU-HOSPITAL/COMMUNITY-HEALTH-NEEDS FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 11: BASED ON THE DATA REVIEWED, THE COALITION DETERMINED TO FOCUS ON THE FOLLOWING NEEDS: COMMUNITY NEED 1: AOADA/MENTAL HEALTH - STRATEGIES: 1. REDUCE USE AND MISUSE OF PRESCRIPTION DRUGS. 2. PARENTS WHO HOST LOSE THE MOST COMMUNICATION CAMPAIGN. 3. COMMUNITY AWARENESS OF LOCAL PROVIDERS OF AOADA OF MENTAL HEALTH. COMMUNITY NEED 2: CHRONIC DISEASES, NUTRITION AND HEALTHY EATING. - STRATEGIES: 1. STRONG WOMEN PROGRAM (INCLUDES MEN). STRATEGY 2: 5210 EVERY DAY PROGRAM (5 FRUITS AND VEGETABLES, 2 HOURS OR LESS OF SCREEN TIME, 1 HOUR OF PHYSICAL ACTIVITY, 0 SUGARY DRINKS AND MORE WATER). COMMUNITY NEED 3: AGING COMMUNITY - STRATEGIES: 1. DEVELOPING DEMENTIA BUSINESSES. NEEDS IDENTIFIED BUT NOT ADDRESSED: DOMESTIC INJURY AND VIOLENCE: IDENTIFED BY THE GROUP BUT NOT ADDRESSED BY FLAMBEAU HOSPITAL BECAUSE IT IS BEING ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY. HOWEVER, FLAMBEAU HOSPITAL WILL PROVIDE STRONG SUPPORT AND COLLABORATION WHENEVER NEEDED. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 16J: IN ADDITION TO POSTING THE POLICY IN THE ADMISSIONS OFFICE AND WAITING ROOMS, ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED AND GIVEN INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 24: GROSS CHARGES ARE APPLIED TO ALL BILLED SERVICES OF THE HOSPITAL. UPON THE INDIVIDUAL MEETING THE FAP-ELIGIBILITY REQUIREMENTS DISCOUNTS AND ASSISTANCE FOR THOSE NOT ABLE TO PAY ARE THEN APPLIED. FREE CARE IS PROVIDED TO ANY INDIVIDUAL THAT FALLS BELOW 100% OF THE FPG FAMILY INCOME LIMIT. DISCOUNTED CARE IS OFFERED TO ANY INDIVIDUAL THAT FALLS BELOW 200% OF THE FPG FAMILY INCOME LIMIT. FLAMBEAU HOSPITAL, INC. PROVIDES DISCOUNTS ON A SLIDING SCALE METHOD. A 10% DISCOUNT IS GIVEN FOR EVERY 10TH PERCENTILE AN INDIVIUAL IS BELOW THE 200% FPG FAMILY INCOME LIMIT. AN INDIVIDUAL THAT FALLS IN THE 190% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 10% DISCOUNT ON GROSS CHARGES AND AN INDIVIDUAL THAT FALLS IN THE 110% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 90% DISCOUNT ON GROSS CHARGES. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT FLAMBEAU HOSPITAL INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT, AND THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPITAL EMERGENCY DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL EMERGENCY DEPARTMENT COME FROM THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF PRICE COUNTY, WISCONSIN. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF FLAMBEAU HOSPITAL AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF FLAMBEAU HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENTS ABILITY TO PAY. PART I, LN 7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $299,861 INCLUDED ON FORM 990, PART IX, LINE 25 WAS NOT INCLUDED IN TOTAL EXPENSES FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGES. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITALS "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. FLAMBEAU HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. FLAMBEAU HOSPITAL, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING SERVICES, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, HOME CARE, HOSPICE, SWING BED SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SURGICAL SERVICES, AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 4: THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANETHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT FLAMBEAU HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREASS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2018 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE.) PART III, LINE 9B: ONCE A PERSON IS KNOWN TO QUALIFY FOR CHARITY CARE, THE HOSPITAL WILL KEEP THAT INFORMATION ON FILE AND AUTOMATICALLY GRANT CHARITY CARE FOR UP TO A YEAR. AT THAT POINT, THE PATIENT WOULD NEED TO REAPPLY OR VERIFY THAT THEIR SITUATION HAS NOT CHANGED SIGNIFICANTLY SINCE THEIR LAST APPLICATION.CHARITY CARE IS APPLIED FIRST BEFORE ANY COLLECTION EFFORTS ARE PURSUED. PART VI, LINE 2: THE HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IN FISCAL YEAR 2016 AND USED THE DATA AND FINDINGS OF THIS REPORT TO GUIDE THE ORGANIZATION IN THE FUTURE TO BE ABLE TO RESPOND TO THOSE NEEDS.IN ADDITION, THE HOSPITAL IS PARTICIPATING WITH PRICE COUNTY ON THE COUNTY HEALTH ASSESSMENT AND HEALTH PLAN. PART VI, LINE 3: INFORMATION IS POSTED IN THE FACILITY AND ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED FOR ANY ASSISTANCE NEEDS THEY MAY HAVE. PART VI, LINE 4: FLAMBEAU HOSPITAL, INC. PROVIDES SERVICES TO RESIDENTS OF PRICE COUNTY, WI AND PORTIONS OF THREE OTHER COUNTIES. THE NEXT CLOSEST HOSPITAL IS 45 MILES AWAY, AND FLAMBEAU HOSPITAL IS DESIGNATED AS UNDERSERVED. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN THE SHORT PERIOD ENDING JUNE 30, 2018, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 74 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR. PART VI, LINE 5: FLAMBEAU HOSPITAL PROVIDES EDUCATION, NEEDED SUBSIDIZED SERVICES AND SUPPORT TO THE COMMUNITY THROUGH SERVICES IT PROVIDES AND COLLABORATION WITH OTHER GROUPS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI PART VI, LINE 7 WISCONSIN RECEIVES THE COMMUNITY BENEFIT REPORT EVERY OTHER YEAR. X 0 0 0 0 0 0 0 0 0 THOMAS PREBBLE MD DIRECTOR 0 275631 0 72017 0 2772 0 27486 0 27374 0 405280 0 0 JAMES BRAUN CAO/CFO 0 206855 0 6000 0 3200 0 0 0 28894 0 244949 0 0 JANE EATON-NYMAN CIO 160161 0 0 0 2429 0 6730 0 36541 0 205861 0 0 0 LIZ SCHREIBER DON 107009 0 0 0 982 0 4705 0 41772 0 154468 0 0 0 SARA BABLICK PHARMACY DIRECTOR 148226 0 0 0 152 0 5997 0 12209 0 166584 0 0 0 THOMAS KASTER SENIOR DIRECTOR OF FINANCE 118814 0 0 0 165 0 5032 0 35444 0 159455 0 0 0 A CITY OF PARK FALLS WISCONSIN 396005566 2012-02-10 4523750 REFINANCE 1994, 1997, 2007, AND 2009 LOAN AND FINANCE ER DEPARTMENT REMODEL 0 0 0 A 3797007 4523750 90475 3475615 957660 2012 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 MARSHFIELD CLINIC AND MINISTRY HEALTH CARE, INC. ("MINISTRY"), BOTH WISCONSIN TAX-EXEMPT CORPORATIONS, ARE JOINT CORPORATE MEMBERS OF THE HOSPITAL. MINISTRY ALSO, VIA CONTRACT, SHARES CERTAIN GOVERNANCE AUTHORITIES WITH MARSHFIELD CLINIC WITH RESPECT TO THE PARK FALLS AND PHILLIPS ("PRICE COUNTY CLINICS") CLINIC OPERATIONS OF MARSHFIELD CLINIC, WITH MARSHFIELD CLINIC RETAINING THE REMAINING AUTHORITIES. MARSHFIELD CLINIC HAS CONTRACTED TO PROVIDE OPERATING MANAGEMENT TO THE HOSPITAL AND PRICE COUNTY CLINICS. THE GOAL OF THE MEMBERSHIP ARRANGEMENTS IS TO PROVIDE FOR THE EFFECTIVE, ECONOMICAL, AND COORDINATED MANAGEMENT AND OPERATION OF HEALTH CARE SERVICES IN PRICE COUNTY. COLLECTIVELY, THE PARTIES HAVE ESTABLISHED AN INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR PRICE COUNTY. FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBERS HAVE APPROVED RIGHT FOR DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF BUDGET, ADMINISTRATOR, PROPERTY PURCHASED, AND DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B NOT APPLICABLE AS THERE ARE NO SUB-COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. IF THE BOARD MEMBERS WOULD LIKE ANY EXPLANATION OR CHANGES, THEY WOULD HAVE AN OPPORTUNITY TO COMMENT ON THE RETURN BEFORE ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND KEY EMPLOYEES OF THE HOSPITAL ANNUALLY SIGN TO ADHERE TO THE CONFLICT OF INTEREST POLICY AT FLAMBEAU HOSPITAL, INC. IT IS ASSUMED THAT THE BOARD OF DIRECTORS AND KEY EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTEREST DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE BOARD OF DIRECTORS AND KEY EMPLOYEES RESPONSIBILITY TO REVIEW POTENTIAL CONFLICTS OF INTEREST AND IF A CONFLICT EXISTS THE INDIVIDUAL IS PROHIBITED TO VOTE ON TRANSACTIONS WHERE THE POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE MARSHFIELD CLINIC PREPARES A COMPENSATION SCHEDULE THAT IS USED TO DETERMINE TOP MANAGEMENT AND KEY EMPLOYEE COMPENSATION. COMPENSATION STUDIES ARE ALSO USED TO PROVIDE COMPARABILITY DATA. THIS DATA IS REVIEWED AND APPROVED BY INDEPENDENT PERSONS AND ALL DECISIONS ARE SUBSTANTIATED. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G FUNDRAISING FEE: PROGRAM SERVICE EXPENSES 516,771. MANAGEMENT AND GENERAL EXPENSES 883,757. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,400,528. MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 3,493,977. MANAGEMENT AND GENERAL EXPENSES 42,811. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,536,788. FORM 990, PART XI, LINE 9: ADMINISTRATION NON-OP OTHER -242,035. CHANGE IN INTEREST OF FOUNDATION 21,401. FLAMBEAU HOSPITAL FOUNDATION INC PO BOX 310 PARK FALLS WI 54552 205957150 SUPPORT OF FLAMBEAU HOSPITAL WI 501 (C) 3 11, I 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0