2018-11-13T16:53:33-06:00 2017-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2017-01-01 390804125 HUDSON HOSPITAL INC HUDS 7155316000 405 STAGELINE ROAD HUDSON WI 54016 DOUGLAS E JOHNSON CFO 7155316000 2018-11-13 1 MONROE JORDAN GIERL P01413237 6123055000 198.174.110.146 2018-11-13 15:48:41 CS P BC53011EDF70B2E1BD72B439C4A42BAD8A5D7AD2 BC53011EDF70B2E1BD72B439C4A42BAD8A5D7AD2 2017 2019-02-21 02:37:17Z DOUGLAS E JOHNSON 405 STAGELINE ROAD HUDSON WI 54016 57789387 0 X WWW.HUDSONHOSPITAL.ORG X 1950 WI SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS 12 9 469 102 0 0 100659 97155 54040049 55500897 277568 599965 942238 309948 55360514 56507965 9095 19555 0 0 30834103 32353645 0 0 0 21696131 20746465 52539329 53119665 2821185 3388300 79403391 80806157 30297991 26965277 49105400 53840880 X CARING FOR THE HEALTH OF OUR COMMUNITY. 0 0 44848281 19555 55810845 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 44848281 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 0 0 469 1 0 0 0 0 0 0 0 0 0 0 X 12 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X DOUGLAS E JOHNSON - CHIEF FINANCIAL OFFICER 7155316013 405 STAGELINE ROAD HUDSON WI 54016 X RYAN ARMBRUSTER DIRECTOR 1.00 X 0 0 0 ANNETTE COOK DIRECTOR - CHAIR 1.00 X 0 0 0 STEVE KIRBY DIRECTOR 1.00 X 0 0 0 KARI CAMPBELL MD DIRECTOR 1.00 X 0 0 0 MICHAEL MOEN DIRECTOR 1.00 X 0 0 0 MIKE SELLMAN DIRECTOR - VICE CHAIR 1.00 X 0 0 0 KARRIN STOEHR MD DIRECTOR 1.00 X 0 0 0 JONATHAN SUSA MD DIRECTOR 1.00 X 0 0 0 GARY VANDER VORST DIRECTOR 1.00 X 0 0 0 MARVIN KLINGLER MD DIRECTOR 1.00 X 0 0 0 GREG YOUNG MD DIRECTOR 1.00 X 0 0 0 JEROME SIY MD DIRECTOR 0.50 49.50 X 0 401205 68244 MORGAN BARNUMDO DIRECTOR 1.00 X 0 0 0 MEGAN M REMARK DIRECTOR & SECRETARY 0.50 49.50 X 0 659171 173822 MARK HANSBERRY DIRECTOR 0.50 49.50 X 0 422303 73131 SCOTT A SCHNUCKLE DIRECTOR 0.50 49.50 X 0 459235 121497 MARIAN M FURLONG PRESIDENT 42.50 2.50 X 0 402676 75664 DOUGLAS E JOHNSON VP & CFO 21.30 33.70 X 0 366499 118683 STEVE MUELLERLEILE VP - PLANNING & DEVELOPMEN 39.50 0.50 X 161143 0 32111 THOMAS BOROWSKI PRESIDENT 63.00 2.00 X 0 51656 14797 KRISTY YAEGER VP, PATIENT CARE SERVICES & CNO 50.00 X 132712 0 20361 BHAVIN PATEL MD VPMA 40.00 X 0 302298 72923 DANIELLE L FERKINGSTAD NURSE ANESTHETIST 40.00 X 204838 0 34954 DARLA KLEMENTZ DIRECTOR OF PHARMACY 40.00 X 171487 0 27119 HOWARD J GEORGESON NURSE ANESTHETIST 62.00 X 227894 0 42056 KEITH W LARSON NURSE ANESTHETIST 62.00 X 237565 0 41946 CHERYLL A MARTINY-JORGENSEN ANESTHESIA SUPERVISOR 60.00 X 257769 0 4818 JACQUELINE KRECH FORMER VP & CNO 40.00 X 220560 0 22255 ROBBIE HAGELBERG FORMER VP & CNO 0.00 50.00 X 0 221834 19597 1613968 3286877 963978 34 1 1 0 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 RADIOLOGY SERVICES 367945 HUDSON PHYSICIANS 403 STAGELINE RD HUDSON WI 54016 PHYSICIAN SERVICES 304823 CANCER CENTER OF WESTERN WISCONSIN 501 HOSPITAL RD NEW RICHMOND WI 54017 MEDICAL SERVICES 243719 MCGOUGH CONST CO NW 5970 PO BOX 1450 MINNEAPOLIS MN 554855970 CONSTRUCTION SERVICES 218263 COMPUTERIZED MEDICAL IMAGING 719 W HAMILTON AVE SUITE B EAU CLAIRE WI 54701 RADIOLOGY SERVICES 179897 12 46909 45985 4261 97155 PATIENT SERVICE 623990 55143985 55143985 DIETARY 722210 173276 173276 GIFT SHOP 453220 98523 98523 OTHER PATIENT SERVICES 623990 85113 85113 55500897 420284 420284 1591370 1281422 309948 309948 309948 179681 0 179681 179681 179681 56507965 55810845 0 599965 19555 19555 589142 589142 26974658 22381286 4593372 717250 630814 86436 2594116 2347221 246895 1478479 1300308 178171 38647 38647 1000 1000 2032617 1554876 477741 148974 12823 136151 328975 137475 191500 183407 161796 21611 1004983 729694 275289 81517 53162 28355 19005 8725 10280 739531 739531 3266063 3067850 198213 124708 6062 118646 MEDICAL & OTHER SUPPLY 10661946 10599228 62718 EQUIPMENT & MAINTENANCE 1493822 724598 769224 OTHER EXPENSE 342871 95464 247407 TAXES & ASSESSMENTS 219017 219017 59382 58796 586 53119665 44848281 8271384 0 29686747 31433357 208867 242051 5433613 5414487 828200 835602 297598 100921 76563692 40495767 36975826 36067925 3726889 4460157 2245651 2251657 79403391 80806157 6076554 5994295 15450594 12636565 8770843 8334417 30297991 26965277 X 45944314 50284204 3079396 3474986 81690 81690 49105400 53840880 79403391 80806157 X 3388300 960693 386487 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 0 0 PART II-B, LINE 1: HUDSON HOSPITAL, INC. PAYS FOR CERTAIN CORPORATE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 81690 81690 81690 81690 81690 81690 81690 81690 81690 81690 1.00000 0 1 1 11298942 11298942 40050400 24734845 15315555 5464760 1355625 4109135 17115488 13754571 3360917 2634102 650726 1983376 36067925 CANCER CENTER OF WESTERN WISCONSIN 395235 C INVESTMENT IN MYRTLE DIALYSIS 180917 C INTERCOMPANY SHARED ASSETS 125332 C DEBT ISSUANCE COST 201997 C BENEFICIAL INTEREST 3556676 C 4460157 THIRD-PARTY PAYOR SETTLEMENTS 2288000 INTERCOMPANY NOTES PAYABLE 6046417 8334417 X PART V, LINE 4: HUDSON HOSPITAL, INC. HOLDS $81,690 OF PERMANENTLY RESTRICTED ASSETS RELATED TO HUDSON HOSPITAL, INC.'S BENEFICIAL INTEREST IN THE NET ASSETS OF HUDSON HOSPITAL FOUNDATION, INC., A RELATED ORGANIZATION OF HUDSON HOSPITAL, INC. PART X, LINE 2: HUDSON HOSPITAL, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2017 OR 2016 FOR UNRECOGNIZED TAX BENEFITS. 1 1 1 X 1 X 1 1 1 0 1 1 467 379892 379892 0.00720 2039 5625097 4841020 784077 0.01480 2506 6004989 4841020 1163969 0.02200 387075 29495 357580 0.00670 178504 178504 0.00340 949015 949015 0.01790 21431 21431 0.00040 1536025 29495 1506530 0.02840 2506 7541014 4870515 2670499 0.05040 3187 3187 0.00010 94181 94181 0.00180 19810 19810 0.00040 489 489 0.00000 72487 72487 0.00140 11106 11106 0.00020 201260 201260 0.00390 1 1702395 15412070 15412070 X 1 1 1 WESTERN WISCONSIN CANCER CENTER MEDICAL ONCOLOGY AND RADIATION 0.23700 0.00000 0.00000 2 MYRTLE DIALYSIS DIALYSIS 0.10000 0.00000 0.00000 1 1 HUDSON HOSPITAL INC 405 STAGELINE ROAD HUDSON WI 54016 WWW.HUDSONHOSPITAL.ORG STATE OF WI CRITICAL ACCESS # 1039 X X X X HUDSON HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/ X 1 15 1 HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/ 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X X 1 X WWW.HUDSONHOSPITAL.ORG X WWW.HUDSONHOSPITAL.ORG X WWW.HUDSONHOSPITAL.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 5: HUDSON HOSPITAL (THE HOSPITAL) IS AN INTEGRAL PART OF HEALTHIER TOGETHER - PIERCE & ST. CROIX COUNTIES, AND SERVES AS ONE OF THE SIX PARTNERS IN THE COALITION. AS PART OF THE DATA COLLECTION PROCESS FOR THE MOST RECENT CHNA THAT WAS CONDUCTED IN 2015, THE HOSPITAL COLLABORATED EXTENSIVELY WITH THE COALITION TO CONDUCT: - THE COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION (CHANGE) TOOL, DEVELOPED BY CDC'S HEALTHY COMMUNITIES PROGRAM TO HELP ORGANIZE INFORMATION ON INDICATORS RELATED TO ENVIRONMENTS AND POLIES SUPPORTING HEALTH EATING, ACTIVE LIVING, AND CHRONIC DISEASE MANAGEMENT. INTERVIEWS WERE CONDUCTED IN THE COMMUNITY-AT-LARGE, HEALTHCARE, AND SCHOOL SECTORS WITH OVER 25 KEY INFORMANTS. - A PUBLIC OPINION POLL WITH THE HELP OF PUBLIC OPINION STRATEGIES. THE PURPOSE OF THE POLL WAS TO EVALUATE PUBLIC SUPPORT FOR HEALTHIER TOGETHER'S EFFORTS TO PROMOTE HEALTHIER PLACES TO LIVE, WORK AND PLAY. PUBLIC OPINION STRATEGIES COMPLETED THE SURVEY WITH 300 RANDOM ST. CROIX ADULTS. - A COMMUNITY HEALTH NEEDS ASSESSMENT ONLINE AND PAPER SURVEY, HEAVILY PROMOTED WITH PUBLIC HEALTH PROGRAM PARTICIPANTS.FEEDBACK WAS RECEIVED BETWEEN JULY AND DECEMBER 2013 FROM: - STATE, LOCAL, TRIBAL, OR REGIONAL GOVERNMENTAL PUBLIC HEALTH DEPARTMENT (OR EQUIVALENT DEPARTMENT OR AGENCY) WITH KNOWLEDGE, INFORMATION, OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY. - MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN THE COMMUNITY, OR INDIVIDUALS OR ORGANIZATIONS SERVING OR REPRESENTING THE INTERESTS OF SUCH POPULATIONS.FOR A FULL DETAILED LIST OF INSTITUTIONS AND PERSONS, PLEASE SEE OUR WEBSITE: HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/. HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN THE 2015 HEALTHPARTNERS CHNA WERE: - LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, STILLWATER, MN. - PARK NICOLLET METHODIST HOSPITAL, MN. - REGIONS HOSPITAL, MN. - AMERY REGIONAL MEDICAL CENTER, WI. - WESTFIELDS HOSPITAL, INC., NEW RICHMOND, WI. HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE HOSPITAL'S CHNA WAS CONDUCTED IN PARTNERSHIP WITH HEALTHIER TOGETHER - PIERCE & ST. CROIX COUNTIES. FOR A FULL DETAILED LIST OF PARTNERING ORGANIZATIONS, PLEASE SEE OUR WEBSITE: HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/. HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 11: THE 2015 HEALTHPARTNERS CHNA CONDUCTED RESULTED IN THE FOLLOWING PRIORITIES:PRIORITY 1: INCREASE ACCESS TO MENTAL HEALTHPRIORITY 2: PROMOTE POSITIVE BEHAVIORS TO REDUCE OBESITY (NUTRITION / PHYSICAL ACTIVITY)PRIORITY 3: INCREASE ACCESS TO PRIMARY AND PREVENTIVE CARE PRIORITY 4: IMPROVE SERVICE INTEGRATIONPRIORITY 5: PROMOTE CHANGE IN UNHEALTHY LIFESTYLES (TOBACCO / ALCOHOL / SUBSTANCE ABUSE)A FULL REPORT OF THE HOSPITAL'S 2015 CHNA AND ANNUAL IMPLEMENTATION PLAN UPDATE IS POSTED ON THEIR WEBPAGE AT HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/ WHICH PROVIDES A DETAILED DESCRIPTION OF ALL THE ACTIVITIES. HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 13B: THE HOSPITAL OFFERS A STANDARDIZED AND UNIFORM APPROACH TO OFFERING A DISCOUNT FOR THE UNINSURED. THE DISCOUNT IS 50% FOR ALL ELIGIBLE PATIENTS, REGARDLESS OF INCOME. THE HOSPITAL USES FPG FAMILY INCOME LIMIT OF 300% TO DETERMINE ELIGIBILITY FOR ADDITIONAL DISCOUNTED CARE ABOVE AND BEYOND THE 50%. HUDSON HOSPITAL, INC. PART V, SECTION B, LINE 15E: THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. TO INFORM AND EDUCATE PATIENTS ON ITS FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, THE HOSPITAL HAS DEVELOPED AN EXTENSIVE FINANCIAL COUNSELING PROGRAM. WHEN A PATIENT VISITS THE HOSPITAL'S EMERGENCY DEPARTMENT OR IS ADMITTED TO THE HOSPITAL, BASIC INFORMATION ABOUT INSURANCE STATUS IS REQUESTED. IF A PATIENT DOES NOT HAVE HEALTH INSURANCE, PATIENT FINANCIAL SERVICES IS CONTACTED TO MEET OR FOLLOW-UP WITH THE PATIENT. ALL PATIENTS WITHOUT INSURANCE AUTOMATICALLY QUALIFY FOR A DISCOUNT OF 50%, REGARDLESS OF INCOME. IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY ARE ELIGIBLE FOR FURTHER DISCOUNTS, THEY WILL BE REQUESTED TO PROVIDE ADDITIONAL INFORMATION. ENROLLMENT ASSISTANCE, INFORMATION, AND REFERRAL SERVICES ARE AVAILABLE TO HELP SECURE A PAYMENT SOURCE FOR UNINSURED AND UNDER INSURED PATIENTS. PATIENT FINANCIAL SERVICES REPRESENTATIVES TO OVERSEE ITS FINANCIAL ASSISTANCE PROGRAM AND, ALONG WITH SUPPORT FROM DEPARTMENT STAFF, HELPS PATIENTS ENROLL IN GOVERNMENT PROGRAMS, FIND OTHER SOURCES OF PAYMENT, OR ACCESS SERVICES BEYOND MEDICAL CARE. IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS STAFF SOCIAL WORKERS AND CASE MANAGERS TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE. PART I, LINE 7: USED WORKSHEETS PROVIDED IN SCHEDULE H INSTRUCTIONS TO CALCULATE COST TO CHARGE RATIOS. PART I, LINE 7G: HUDSON HOSPITAL (THE HOSPITAL) IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2017, LOSS ON SERVICES FOR HOSPITAL OUTPATIENT SERVICES INCLUDING LACTATION, PROGRAMS FOR CHANGE, INFUSION, OCCUPATIONAL THERAPY, CARDIAC REHABILITATION, RESPIRATORY THERAPY, AND PHYSICAL THERAPY. SCH. H - PART I, LINE 3 - ELIGIBILITY FOR DISCOUNTED CARE THE HOSPITAL CALCULATES FINANCIAL ASSISTANCE BASED ON PATIENTS' HOUSEHOLD INCOME COMPARED TO WHAT'S CALL THE FEDERAL POVERTY GUIDELINES (FPG). PATIENT WHOSE INCOME AND FAMILY SIZE PLACE THEM AT OR BELOW 200% OF THE (FPG) WILL RECEIVE A 100% DISCOUNT. PATIENT'S WHOSE INCOME AND FAMILY SIZE PLACE THEM ABOVE 200%, BUT NOT MORE THAN 300% ABOVE THE (FPG) WILL RECEIVE A SLIDING-SCALE PARTIAL DISCOUNT. IF A PATIENT HAS RECEIVED EMERGENCY OR OTHER MEDICALLY NECESSARY CARE AT THE HOSPITAL AND IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE HOSPITAL WILL NOT CHARGE MORE THAN AMOUNTS GENERALLY BILLED (AGB) TO PATIENTS THAT HAVE HEALTH INSURANCE COVERAGE. THE HOSPITAL CAN DETERMINE PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE BASED THE PATIENTS' ABILITY TO MEET CERTAIN CIRCUMSTANCES, WHICH INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING CONDITIONS: HOMELESSNESS, MEDICALLY NECESSARY SERVICES NOT COVERED OR PAYABLE UNDER A MEDICAID PROGRAM OR FEDERAL GRANT RENDERED TO A QUALIFIED RECIPIENT, QUALIFICATION AND EFFECTIVE DATE FOR MEDICAID SUBSEQUENT TO THE SERVICE DATES, INCARCERATION OR MILITARY SPECIAL CIRCUMSTANCES. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL IS AN ENERGETIC MEMBER OF THE LOCAL, STATE AND REGIONAL COMMUNITIES. AS THE HOSPITAL SUPPORTS INDIVIDUALS, ORGANIZATIONS, EVENTS AND PROGRAMS, IT LIVES OUT ITS COMMITMENT TO IMPROVE THE HEALTH OF THE COMMUNITY. KNOWING MUCH MORE CAN BE ACCOMPLISHED TOGETHER, THE HOSPITAL CONTINUED ITS LEADERSHIP AND CO-FACILITATION OF HEALTHIER TOGETHER - ST. CROIX COUNTY WITH ST. CROIX COUNTY DEPARTMENT OF HEALTH. THROUGH THIS COUNTY-WIDE, COMMUNITY HEALTH IMPROVEMENT INITIATIVE, THE HOSPITAL BEGAN TO ALIGN ITS COMMUNITY BENEFIT PROGRAM WITH COMMUNITY HEALTH IMPROVEMENT EFFORTS AND CONTINUES TO BUILD VALUABLE CONNECTIONS WITH INDIVIDUALS AND ORGANIZATIONS FROM PUBLIC, PRIVATE AND NONPROFIT SECTORS TO SHARE SKILLS AND ASSETS. THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION ADVOCACY GROUPS TO IMPROVE HEALTH, AND WORKFORCE DEVELOPMENT. FOR THESE ACTIVITIES, THE HOSPITAL PARTNERED WITH THE ST. CROIX ECONOMIC DEVELOPMENT, WISCONSIN HOSPITAL ASSOCIATION, ST. CROIX EMS, UNIVERSITY OF WISCONSIN - RIVER FALLS CHANCELLOR'S ADVISORY COUNCIL, THE HEALING ARTS PROGRAM, CANCER CENTER OF WESTERN WISCONSIN, HUDSON HIGH SCHOOL, POWERUP, WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) AND HUDSON CHAMBER OF COMMERCE.THE HOSPITAL CONTINUED ON ITS ECO-FRIENDLY JOURNEY "HEALTH CARE WITHOUT HARM" (2008 COMMITMENT) USING SUSTAINABLE BUSINESS PRACTICES AND ESTABLISHING GREEN PURCHASING POLICIES IN ORDER TO PROVIDE HEALTH CARE THAT IS HEALTHY. GREEN INITIATIVES INCLUDED THE RECYCLING PROGRAM, REDUCTION OF PAPER COPIES, AND REDUCTION OF ENERGY AND WATER CONSUMPTION. IMPLEMENTING SUSTAINABLE BUSINESS PRACTICES HAS MADE THE HOSPITAL A MODEL WITHIN THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS. PART III, LINE 2: "BAD DEBT" REPRESENTS THE UNPAID OBLIGATION FOR CARE PROVIDED TO PATIENTS WHO HAVE BEEN DETERMINED TO BE ABLE TO PAY, BUT HAVE NOT DEMONSTRATED A WILLINGNESS TO DO SO. BAD DEBT INCLUDES ANY UNPAID PATIENT RESPONSIBILITY THAT MAY INCLUDE, BUT IS NOT LIMITED TO, DEDUCTIBLES, CO-INSURANCE, CO-PAYMENTS AND NON-COVERED SERVICES. SCH. H - PART I, LINE 6 - COMMUNITY BENEFIT REPORT AS A NOT-FOR-PROFIT ORGANIZATION, THE HOSPITAL NEEDS TO BE ACCOUNTABLE FOR ITS TAX EXEMPTION STATUS - ACCOUNTABLE TO ITS BOARD, STAFF, PHYSICIANS, DONORS, KEY STAKEHOLDERS, COMMUNITY PARTNERS AND MOST OF ALL TO THE COMMUNITIES IT SERVES. THE 2016 REPORT TO COMMUNITY WAS REVIEWED AT BOTH THE BOARD OF DIRECTORS MEETING AND THE MANAGEMENT COUNCIL MEETING. IT WAS POSTED ON THE HOSPITAL WEBSITE IN DECEMBER 2016 FOR THE GENERAL PUBLIC TO REVIEW (HUDSONHOSPITAL.ORG/COMMUNITYREPORT). PRINT COPIES WERE AVAILABLE AT THE FRONT DESK IF PEOPLE REQUESTED IT. THE REPORT COMMUNICATES THE ACCOMPLISHMENTS AND CHARITABLE WORKS OF THE HOSPITAL IN SUPPORT OF ITS MISSION. THE ONLINE REPORT SUPPORTS THE HOSPITAL'S GREEN INITIATIVE AND SHARES THE HOSPITAL ACCOMPLISHMENTS, SUPPORT EFFORTS OF THE HUDSON HOSPITAL FOUNDATION AND HEALTHIER TOGETHER UPDATES. PART III, LINE 4: IN JULY 2011, THE FASB ISSUED ASU NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR DOUBTFUL ACCOUNTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES, WHICH PROVIDES FINANCIAL STATEMENT USERS WITH GREATER TRANSPARENCY ABOUT A HEALTH CARE ENTITY'S NET PATIENT SERVICE REVENUE AND RELATED ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMENDMENTS REQUIRE HEALTH CARE ENTITIES TO PRESENT THE PROVISION FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) ON THEIR STATEMENT OF OPERATIONS. THIS STANDARD WAS EFFECTIVE BEGINNING WITH THE 2012 FISCAL YEAR.THE FOOTNOTE IN THE HOSPITAL'S FINANCIAL STATEMENTS READS AS FOLLOWS: "HEALTH SERVICE ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS OR CHARITY CARE BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS EITHER DOUBTFUL ACCOUNTS FOR CHARITY CARE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, HP'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE BY TAKING INTO CONSIDERATION, BY PAYOR CATEGORY, THE EXPECTED NET COLLECTIONS, ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE PATIENT RESPONSIBILITY PORTION OF COMMERCIAL ACCOUNTS. THE PRIMARY SOURCE OF THE ALLOWANCE FOR CHARITY CARE IS CHARGES FOR UNINSURED PATIENTS. PATIENTS WHO ARE INSURED ARE ASSESSED SEPARATELY FOR COLLECTABILITY FROM UNINSURED PATIENTS. THE RESULTS OF THESE ASSESSMENTS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CHARITY CARE. FOR PREMIUMS AND OTHER RECEIVABLES, HP'S POLICY IS TO SET UP ALLOWANCES FOR ALL RECEIVABLES OVER 90 DAYS OUTSTANDING." PART III, LINE 8: THE HOSPITAL BASES ITS MEDICARE COSTING METHODOLOGY ON THE CMS MEDICARE COST REPORT METHODOLOGY TO GET THE COST TO CHARGE RATIO. SINCE THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL, REIMBURSEMENT FROM MEDICARE IS EQUAL TO THE COST SO THERE IS NO SURPLUS (SHORTFALL). PART III, LINE 9B: THE HOSPITAL DEBT COLLECTION POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL BELIEVES THAT DEBT COLLECTION POLICIES, WHETHER IMPLEMENTED BY HOSPITAL STAFF OR AGENTS, SHOULD REFLECT THE HOSPITAL'S MISSION AND VALUES. THE HOSPITAL WILL NOT TOLERATE ABUSIVE, HARASSING, OPPRESSIVE, FALSE, DECEPTIVE, OR MISLEADING LANGUAGE OR COLLECTIONS CONDUCT BY ITS DEBT COLLECTION, ATTORNEY AND AGENCY, AND THEIR AGENTS AND EMPLOYEES, AND THE HOSPITAL EMPLOYEES RESPONSIBLE FOR COLLECTING MEDICAL DEBT FROM PATIENTS. THE HOSPITAL WILL NOT REFER ANY ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS IT HAS CONFIRMED THAT:- THERE IS REASONABLE BASIS TO BELIEVE THAT THE PATIENT OWES THE DEBT.- ALL KNOWN THIRD-PARTY PAYERS HAVE BEEN PROPERLY BILLED, AND THE PATIENT IS RESPONSIBLE FOR THE REMAINING DEBT.- IF THE PATIENT HAS INDICATED AN INABILITY TO PAY THE FULL AMOUNT, THE PATIENT HAS BEEN OFFERED A REASONABLE PAYMENT PLAN. THE HOSPITAL WILL NOT REFER PATIENTS TO DEBT COLLECTION AGENCIES WHO ARE PERFORMING AS SPECIFIED IN THEIR PAYMENT PLANS.- THE PATIENT HAS BEEN GIVEN AN OPPORTUNITY TO SUBMIT A FINANCIAL ASSISTANCE APPLICATION. IF THE PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY WILL BE SUSPENDED UNTIL THE APPLICATION HAS BEEN PROCESSED. SCHEDULE H - PART I, LINE 7F - HEALTH PROFESSIONS EDUCATION THE HOSPITAL'S STAFF PROVIDED CLINICAL TRAINING FOR NURSES, NURSING STUDENTS AND HEALTH PROFESSIONALS INCLUDING EMS FROM SEVENTEEN INSTITUTIONS. IN ADDITION, THE HOSPITAL VOLUNTARILY PARTICIPATED IN THE WISCONSIN NURSE RESIDENCY PROGRAM (WNRP). THE PROGRAM IS A STRUCTURED LEARNING EXPERIENCE FOR NEWLY LICENSED REGISTERED NURSES DESIGNED TO PROMOTE EFFECTIVE TRANSITION INTO PROFESSIONAL PRACTICE. NURSES ARE PAIRED WITH EXPERIENCED HOSPITAL NURSES ACTING AS COACH/SUPPORT PERSON, COMPLETED THE 12-MONTH PROGRAM. SCH. H - PART V, SECTION B, LINE 14 - FINANCIAL ASSISTANCE POLICY THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINE PRESCRIBED CALCULATION TO DETERMINE THE MAXIMUM CHARGEABLE AMOUNT FOR PATIENTS DETERMINED TO BE FAP ELIGIBLE. THERE IS ALSO AN UNINSURED DISCOUNT AVAILABLE TO ASSIST THOSE INDIVIDUALS WHO DO NOT HAVE HEALTH INSURANCE. THE HOSPITAL OFFERS A STANDARDIZED AND UNIFORM APPROACH TO OFFERING A DISCOUNT FOR THE UNINSURED AT AMOUNTS NO GREATER THAN AMOUNTS BILLED TO MEDICARE PATIENTS. PART VI, LINE 2: IN 2015, A COMPREHENSIVE, SIX-STEP COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COLLABORATION WAS CONDUCTED FOR HEALTHPARTNERS AND ITS HOSPITALS (REGIONS HOSPITAL, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, HUDSON HOSPITAL, WESTFIELDS HOSPITAL, AMERY REGIONAL MEDICAL CENTER, AND PARK NICOLLET METHODIST HOSPITAL) BY COMMUNITY HOSPITAL CONSULTING TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES THEY SERVE. THESE HOSPITALS SERVE SIMILAR COMMUNITIES AND HAVE OVERLAPPING STUDY AREAS. THE SYSTEM'S STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. THE HOSPITAL'S SPECIFIC STUDY AREA IS DEFINED AS:- ST. CROIX COUNTYDATA ELEMENTS REGARDING ALL SEVEN COUNTIES IN THE SYSTEM'S STUDY AREA ARE INCLUDED IN THIS REPORT FOR COMPARISON, AND ARE ALSO PROVIDED AS AN OPPORTUNITY FOR THE HOSPITALS TO WORK TOGETHER TO MEET THE NEEDS IDENTIFIED IN THE OVERLAPPING COUNTIES.- DEMOGRAPHICS: CHC CONSULTING ANALYZED THE MOST CURRENT DEMOGRAPHICS OF RESIDENTS IN ST. CROIX COUNTY, INCLUDING: OVERALL POPULATION, POPULATION BY RACE AND ETHNICITY, MEDIAN AGE, MEDIAN HOUSEHOLD INCOME, POVERTY LEVELS, FOOD INSECURITY, AND EDUCATIONAL ATTAINMENT.- HEALTH DATA COLLECTION: THE HOSPITAL PARTICIPATED IN A COUNTY-WIDE INITIATIVE TO ANALYZE THE HEALTH OF RESIDENTS IN THE COMMUNITY, THE ST. CROIX COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN 2014-2016.- COMMUNITY INPUT: AS A PART OF THE COUNTY-WIDE ASSESSMENT, COMMUNITY INPUT WAS ANALYZED THROUGH THE FOLLOWING METHODS: COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION (CHANGE) ASSESSMENT, TRANSFORM WISCONSIN PUBLIC OPINION POLL, AND THE CHNA SURVEY.FINAL PRIORITIZED NEEDS- MENTAL AND BEHAVIORAL HEALTH- ACCESS AND AFFORDABILITY- CHRONIC DISEASE AND ILLNESS PREVENTION- EQUITABLE CAREA FULL REPORT OF HUDSON'S CHNA AND IMPLEMENTATION PLAN IS POSTED ON THE HOSPITAL'S WEBPAGE AT HTTP://WWW.HUDSONHOSPITAL.ORG/COMMUNITY/COMMUNITY-HEALTH-IMPROVEMENT/. PART VI, LINE 3: THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE, TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. THE HOSPITAL IS COMPLIANT WITH THE 501R FEDERAL REGULATIONS, AND PROVIDES EASY ACCESS TO THE FINANCIAL ASSISTANCE PROGRAM INCLUDING THE FINANCIAL ASSISTANCE POLICY (FAP), APPLICATION, AND PLAIN LANGUAGE SUMMARY. THE FINANCIAL ASSISTANCE PROGRAM AND LISTS OF PROVIDERS COVERED BY THE PROGRAM IS ALSO WIDELY PUBLICIZED AND AVAILABLE ON THE HOSPITAL'S WEBSITE. TO INFORM AND EDUCATE PATIENTS ABOUT THE FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, EACH PATIENT IS OFFERED AND PROVIDED WITH THE FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY AT INTAKE. THIS INFORMATION IS ALSO IS ALSO PROVIDED IN PUBLIC LOCATIONS SUCH AS ADMITTING AND REGISTRATION AND SENT OUT WITH PATIENT STATEMENTS.IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS STAFF SOCIAL WORKERS AND CASE MANAGERS TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE. PART VI, LINE 4: THE HOSPITAL SERVES RESIDENTS FROM ST. CROIX AND PIERCE COUNTIES IN WESTERN WISCONSIN AND AREAS OF NEIGHBORING MINNESOTA. OUR PRIMARY SERVICE AREA IS HUDSON, WI 54016 (INCLUDES HUDSON, HUDSON TOWNSHIP, TROY, ST. JOSEPH'S AND NORTH HUDSON). OUR SECONDARY SERVICE AREA INCLUDES WI (BALDWIN, HAMMOND, HOULTON, NEW RICHMOND, PRESCOTT, RIVER FALLS, ROBERTS AND SOMERSET) AND MN (BAYPORT, LAKELAND, AND STILLWATER). 2010 CENSUS LISTS THE POPULATION OF ST. CROIX COUNTY AT 84,345, A 33.6% POPULATION GROWTH SINCE 2000. RAPID GROWTH CONTINUES WITHIN ST. CROIX COUNTY, MUCH IN PART DUE TO ITS CLOSE PROXIMITY TO THE TWIN CITIES (MINNEAPOLIS/ST. PAUL) WHERE MANY RESIDENTS COMMUTE TO WORK. ST. CROIX COUNTY'S POPULATION IS COMPRISED OF: 7.4% UNDER 5 YEARS OLD, 26% UNDER 18, 10% 65 YEARS AND OVER, AND 50% FEMALE. THE POPULATION IS 95.9% WHITE, 0.7% BLACK, 0.4% AMERICAN INDIAN, 1.0% ASIAN AND 2.0% HISPANIC OR LATINO. ST. CROIX COUNTY HAS A HIGH MEDIAN INCOME COMPARATIVELY WITHIN THE STATE - $69,682 AND A POVERTY RATE APPROXIMATELY HALF THAT OF THE REST OF THE STATE - 6.3%. PART VI, LINE 5: THE HOSPITAL IS GOVERNED BY A COMMUNITY-BASED BOARD OF DIRECTORS AND THE MEDICAL STAFF IS ORGANIZED IN THE PUBLIC'S INTEREST. WORKING IN PARTNERSHIP WITH EACH OTHER, THE HEALTHPARTNERS FAMILY, HUDSON PHYSICIANS, AND THE COMMUNITY, THE HOSPITAL ACCOMPLISHED A GREAT DEAL IN 2017. ADVANCEMENTS WERE MADE IN SUPPORT OF THE TRIPLE AIM: TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMPLEASE SEE SCHEDULE O: DISCUSSION OF EXEMPT PURPOSE AND ACHIEVEMENTS "I. CORPORATE STRUCTURE, PURPOSE, GOVERNANCE." PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 NAMI ST CROIX INC PO BOX 154 RIVER FALLS WI 54022 391934806 10000 PROGRAM SUPPORT 1 PART I, LINE 2: THE HOSPITAL'S MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE HOSPITAL'S'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE HOSPITAL'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. X X X X 1 1 0 0 0 1 1 0 0 JEROME SIY MD DIRECTOR 0 339295 0 10830 0 51080 0 47950 0 20294 0 469449 0 0 MEGAN M REMARK DIRECTOR & SECRETARY 0 464292 0 138528 0 56351 0 139402 0 34420 0 832993 0 25086 MARK HANSBERRY DIRECTOR 0 351231 0 41440 0 29632 0 41143 0 31988 0 495434 0 0 SCOTT A SCHNUCKLE DIRECTOR 0 310434 0 97432 0 51369 0 89034 0 32463 0 580732 0 12433 MARIAN M FURLONG PRESIDENT 0 287678 0 57524 0 57474 0 45912 0 29752 0 478340 0 0 DOUGLAS E JOHNSON VP & CFO 0 276955 0 60289 0 29255 0 89960 0 28723 0 485182 0 0 STEVE MUELLERLEILE VP - PLANNING & DEVELOPMEN 130005 0 28671 0 2467 0 8098 0 24013 0 193254 0 0 0 KRISTY YAEGER VP, PATIENT CARE SERVICES & CNO 127034 0 5000 0 678 0 0 0 20361 0 153073 0 0 0 BHAVIN PATEL MD VPMA 0 274317 0 9217 0 18764 0 42736 0 30187 0 375221 0 0 DANIELLE L FERKINGSTAD NURSE ANESTHETIST 196853 0 0 0 7985 0 8495 0 26459 0 239792 0 0 0 DARLA KLEMENTZ DIRECTOR OF PHARMACY 157521 0 13374 0 592 0 10327 0 16792 0 198606 0 0 0 HOWARD J GEORGESON NURSE ANESTHETIST 220305 0 0 0 7589 0 9498 0 32558 0 269950 0 0 0 KEITH W LARSON NURSE ANESTHETIST 227468 0 0 0 10097 0 9638 0 32308 0 279511 0 0 0 CHERYLL A MARTINY-JORGENSEN ANESTHESIA SUPERVISOR 234161 0 6023 0 17585 0 4818 0 0 0 262587 0 0 0 JACQUELINE KRECH FORMER VP & CNO 90033 0 26068 0 104459 0 2632 0 19623 0 242815 0 0 0 ROBBIE HAGELBERG FORMER VP & CNO 0 191829 0 27720 0 2285 0 11643 0 7954 0 241431 0 0 PART I, LINES 4A-B A SEVERANCE PAYMENT IN COLUMN B(III) OF SCHEDULE J IS INCLUDED FOR THE FOLLOWING OFFICERS AND DIRECTORS: JACQUELINE KRECH $83,023 DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS: MEGAN M. REMARK $ 25,490 SCOTT A. SCHNUCKLE $ 12,396 MARK HANSBERRY $ 9,304 PART I, LINE 6 HUDSON HOSPITAL, INC. (THE HOSPITAL) OFFICERS, DIRECTORS AND HIGHEST COMPENSATED EMPLOYEES ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS) OR BY GROUP HEALTH PLAN, INC. (GHI), BOTH OF WHICH ARE RELATED ORGANIZATIONS, OR BY THE HOSPITAL. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM REGIONS, GHI OR THE HOSPITAL MANAGEMENT INCENTIVE PROGRAMS, WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. SENIOR VICE PRESIDENT, VICE PRESIDENT, DIRECTOR, MANAGER, OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE BUT ARE NOT LIMITED TO PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, EMPLOYEE AND/OR LEADERSHIP DEVELOPMENT, CARE DELIVERY, PATIENT EDUCATION, SIX AIMS, MARKET SHARE, STRATEGIC CAPABILITIES, FINANCIAL PERFORMANCE (NET MARGIN), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET MARGIN THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT. 990, SCH. J, PART II - PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS AND FORMER DIRECTOR: MEGAN M. REMARK $ 25,086 SCOTT A. SCHNUCKLE $ 12,433 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. A WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY 391337855 97710B6E7 2012-10-03 20513711 REFUNDING OF SERIES 2002 BONDS 1 0 0 A 7469689 20513711 20513711 2001 1 0 1 1 A 0 0 1 0 0 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 SCHEDULE K, PART III, LINES 3B, 3C & 3D HUDSON HOSPITAL USES INTERNAL LEGAL COUNSEL TO REVIEW ANY MANAGEMENT OR SERVICE CONTRACTS RELATING TO THE FINANCED PROPERTY. IF IT ENCOUNTERS UNUSUAL OR COMPLEX CONTRACTS IT WILL ENGAGE BOND COUNSEL OR OTHER OUTSIDE COUNSEL. SCHEDULE K, PART V SINCE 12/31/2012 HUDSON HOSPITAL HAS UNDERTAKEN ESTABLISHING SUCH WRITTEN PROCEDURES. SARAH ARMBRUSTER SARA ARMBURSTER IS THE WIFE OF DIRECTOR RYAN ARMBRUSTER 123972 EMPLOYMENT 0 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS HUDSON HOSPITAL (HOSPITAL) A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA, WESTERN WISCONSIN AND EXPANDING TO SEVERAL OTHER MIDWESTERN STATES. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,800 PHYSICIANS AND DENTISTS, SIX OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 100 OWNED AND LEASED PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND 25 DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO CONTRACTS WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS LOCATED PRIMARILY IN MINNESOTA, WESTERN WISCONSIN AND EXPANDING TO OTHER MIDWESTERN STATES. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN THE HEALTHPARTNERS FAMILY, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATES WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2017 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL (REGIONS), REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN, INC. AND GROUP HEALTH PLAN, INC. (GHI) ARE THE CORPORATE MEMBERS OF THE HOSPITAL. GHI IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE HOSPITAL IS THE SOLE CORPORATE MEMBER OF HUDSON HOSPITAL FOUNDATION (HHF) A FOUNDATION WHOSE PURPOSE IS TO SUPPORT THE HOSPITAL. COMMUNITY BENEFIT TO THE COMMUNITY THE CHARITABLE TRADITION OF THE HOSPITAL CONTINUED IN 2017. OUR COLLEAGUES PARTNERED WITH SCHOOLS, BUSINESSES, AGENCIES AND OTHER HEALTH PROVIDERS THAT SHARE IN OUR VISION OF CREATING A CULTURE - THROUGH EDUCATION AND ECONOMIC DEVELOPMENT - OF COMMUNITY HEALTH AND WELL-BEING. OUR COLLABORATION RESULTED IN IMPROVED HEALTH - AT AN AFFORDABLE COST - AND POSITIVE EXPERIENCES FOR OUR PATIENTS AND THEIR FAMILIES. COMMUNITY HEALTH SERVICES AS A COMMUNITY HEALTH CARE PROVIDER, WE BELIEVE OUR MISSION IS TO DELIVER INFORMATION ON HEALTH AND WELL-BEING BEYOND THE CLINICIAN'S OFFICE OR A HOSPITAL DEPARTMENT. WE ARE COMMITTED TO KEEPING OUR COMMUNITY HEALTHY BY SHARING KNOWLEDGE AT HEALTH FAIRS; AT CLASSES AND SEMINARS; THROUGH WEBINARS, SOCIAL MEDIA AND PRINTED MATERIALS. IN 2017, WE HELD EDUCATIONAL SESSIONS ON, AMONG OTHER TOPICS: ARTHRITIS BREASTFEEDING DIABETES FALLS PREVENTION BACK PAIN KNEE REPLACEMENT BULLYING RESILIENCY DEMENTIA PELVIC HEALTH NUTRITION AND WEIGHT MANAGEMENT SMOKING CESSATION MENTAL HEALTH CAR SEAT AND BIKE SAFETY NEW PARENT ADVANCED DIRECTIVES WE ALSO PROVIDE VARIOUS HEALTH CARE SUPPORT SERVICES THAT INCLUDE TRANSLATION/INTERPRETER SERVICES; CRISIS INTERVENTION; COUNSELING SERVICES; CHAPLAINCY SERVICES; MEDICATION THERAPY MANAGEMENT; AND LIFE ASSIST HOME MONITORING SYSTEM. SUPPORT GROUPS WE ALSO OFFERED AND SUPPORTED SUPPORT GROUPS FOR COMMUNITY MEMBERS AND THEIR FAMILIES EXPERIENCING CARDIOVASCULAR, PARKINSON'S AND CELIAC DISEASES, AS WELL AS GROUPS FOR NEW PARENTS AND THOSE WHO HAVE DIABETES. TOTAL COMMUNITY HEALTH EDUCATION EXPENSES TOTALED $357,580. SUBSIDIZED HEALTH SERVICES THE HOSPITAL PROVIDES FINANCIAL ASSISTANCE AND HEALTH CARE ACCESS FOR LOW-INCOME INDIVIDUALS. THE HOSPITAL IS COMPLIANT WITH THE IRC SECTION 501(R) FEDERAL REGULATIONS, AND PROVIDES EASY ACCESS TO THE FINANCIAL ASSISTANCE PROGRAM INCLUDING THE FINANCIAL ASSISTANCE POLICY (FAP), APPLICATION, AND PLAIN LANGUAGE SUMMARY. THE FINANCIAL ASSISTANCE PROGRAM, WHICH LISTS PROVIDERS COVERED BY THE PROGRAM, IS WIDELY PUBLICIZED AND AVAILABLE ON THE HOSPITAL'S WEBSITE. TO INFORM AND EDUCATE PATIENTS ABOUT THE FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, EACH PATIENT IS OFFERED AND PROVIDED WITH THE FINANCIAL ASSISTANCE PROGRAM AT INTAKE. THIS INFORMATION IS ALSO PROVIDED IN ADMITTING, REGISTRATION AND VARIES PUBLIC AREAS, AND IS SENT OUT WITH PATIENT STATEMENTS. THE HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. IN 2017, THE HOSPITAL PROVIDED $389,892 IN FINANCIAL ASSISTANCE. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES, TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES ARE BELOW THE COST OF CARE PROVIDED. THE EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR PATIENTS TOTALED $784,077. THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2017, LOSS ON SERVICES FOR HOSPITAL INPATIENT AND OUTPATIENT HEALTH SERVICES TOTALED $949,015. THESE SERVICES INCLUDE LACTATION, PROGRAMS FOR CHANGE, INFUSION, OCCUPATIONAL THERAPY, CARDIAC REHABILITATION, RESPIRATORY THERAPY, AND PHYSICAL THERAPY. FORM 990, PART III, LINE 4A TRANSPORTATION PUBLIC TRANSPORTATION IS UNAVAILABLE IN THE CITY OF HUDSON; THEREFORE, UPON REQUEST, VAN TRANSPORTATION WAS MADE AVAILABLE TO COMMUNITY RESIDENTS LIVING WITHIN A 15-MILE RADIUS OF THE HOSPITAL CAMPUS. RESIDENTS CAN USE THE VAN SERVICE FOR MEDICAL-RELATED APPOINTMENTS INCLUDING PHARMACY PICK UP. FINANCIAL CONTRIBUTIONS - CASH DONATIONS AND GRANT THE HOSPITAL'S FINANCIAL CONTRIBUTION IN THE FORM OF CASH DONATIONS AND GRANTS TO OTHER TAX-EXEMPT COMMUNITY ORGANIZATIONS FOR SPONSORSHIPS OR MEMBERSHIP DUES INCLUDING HUDSON RELAY FOR LIFE, NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI), TWIN CITIES HEART WALK, ETC., TOTALED $21,431. IN-KIND DONATIONS IN-KIND SERVICES PROVIDED INCLUDED STAFF HOURS SPENT IN SUPPORT OF FUNDRAISING, FOOD DRIVES, THE REACH OUT AND READ INITIATIVE AND TAXI VOUCHERS FOR LOW-INCOME COMMUNITY MEMBERS. COMMUNITY BUILDING ACTIVITIES WITH THE UNDERSTANDING THAT MORE CAN BE ACCOMPLISHED TOGETHER, THE HOSPITAL'S PARTICIPATION IN HEALTHIER TOGETHER - ST. CROIX, HAS CONNECTED INDIVIDUALS AND ORGANIZATIONS FROM PUBLIC, PRIVATE AND NONPROFIT SECTORS TO SHARE SKILLS AND ASSETS. THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION ADVOCACY GROUPS TO IMPROVE HEALTH, AND WORKFORCE DEVELOPMENT. FOR THESE ACTIVITIES, THE HOSPITAL PARTNERED WITH ST. CROIX ECONOMIC DEVELOPMENT, WISCONSIN HOSPITAL ASSOCIATION, ST. CROIX EMS, UNIVERSITY OF WISCONSIN - RIVER FALLS CHANCELLOR'S ADVISORY COUNCIL, THE HEALING ARTS PROGRAM, CANCER CENTER OF WESTERN WISCONSIN, HUDSON HIGH SCHOOL, POWERUP, WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC) AND HUDSON CHAMBER OF COMMERCE. WE ALSO WORKED WITH SEVERAL COMMUNITY AGENCIES ON THEIR HEALTH AND WELL-BEING EFFORTS. WE HOSTED BLOOD DRIVES FOR THE AMERICAN RED CROSS; SUPPORTED THE AMERICAN CANCER SOCIETY THROUGH OUR PARTICIPATION IN RELAY FOR LIFE; AND SUPPORTED AND PARTICIPATED IN THE NAMI ANNUAL WALK EVENT. SUSTAINABILITY THE HOSPITAL CONTINUED ON ITS ECO-FRIENDLY JOURNEY "HEALTH CARE WITHOUT HARM" (2008 COMMITMENT) USING SUSTAINABLE BUSINESS PRACTICES AND ESTABLISHING GREEN PURCHASING POLICIES IN ORDER TO PROVIDE HEALTH CARE THAT IS HEALTHY. GREEN INITIATIVES INCLUDED THE RECYCLING PROGRAM, REDUCTION OF PAPER COPIES, AND REDUCTION OF ENERGY AND WATER CONSUMPTION. THE HOSPITAL'S GREEN TEAM HAS ACTIVELY PROVIDED COMMUNITY GARDEN PLOTS AND COMPOSTING TO MEMBERS OF THE COMMUNITY; GAVE AWAY "BEE BOMBS" IN ORDER TO INCREASE BEE HIVES IN THE AREA; PROMOTED HUDSON AREA BUSINESSES BY BUYING MEAT AT THE LOCAL ST. CROIX COUNTY FAIR; AND HOSTED AN ELECTRONICS RECYCLING EVENT FOR THE COMMUNITY. IMPLEMENTING SUSTAINABLE BUSINESS PRACTICES HAS MADE THE HOSPITAL A MODEL WITHIN THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS. COMMUNITY BENEFIT OPERATIONS A COMBINATION OF FINANCE, MARKETING, COMMUNITY HEALTH AND EDUCATION STAFF DEDICATE TIME TO THE DATA COLLECTION, ANALYSIS AND REPORTING OF ALL OF THE HOSPITAL'S COMMUNITY BENEFIT ACTIVITIES. IN 2017, THE TIME SPENT ON THESE ACTIVITIES TOTALED $13,348. COMMUNITY HEALTH NEEDS ASSESSMENT: PLEASE REFER TO FORM 990 SCHEDULE H NARRATIVE. HEALTH PROFESSIONAL EDUCATION THE HOSPITAL'S STAFF PROVIDED CLINICAL TRAINING FOR NURSES, NURSING STUDENTS AND OTHER HEALTH PROFESSIONALS AT A COST OF $178,504. IN ADDITION, THE HOSPITAL VOLUNTARILY PARTICIPATED IN THE WISCONSIN NURSE RESIDENCY PROGRAM. THE PROGRAM IS A STRUCTURED LEARNING EXPERIENCE FOR NEWLY LICENSED REGISTERED NURSES DESIGNED TO PROMOTE EFFECTIVE TRANSITION INTO PROFESSIONAL PRACTICE. ORGANIZATIONAL AWARDS AND ACHIEVEMENTS THE HOSPITAL CONTINUES TO BE AN INTEGRAL PART OF THE HUDSON COMMUNITY AND SURROUNDING AREA. THE HOSPITAL HAS BEEN A VITAL AND NECESSARY COMMUNITY RESOURCE SINCE 1953. OUR COMMITMENT TO QUALITY AND COMPASSIONATE CARE CONTINUALLY RECEIVES LOCAL, REGIONAL AND NATIONAL RECOGNITION. IN 2017, WE RECEIVED THE FOLLOWING RECOGNITIONS: NATIONAL RECOGNITION FOR PERFORMANCE LEADERSHIP IN QUALITY AND PATIENT PERSPECTIVE - BY THE CHARTIS CENTER FOR RURAL HEALTH/IVANTAGE HEALTH ANALYTICS AND NATIONAL ORGANIZATION OF STATE OFFICE OF RURAL HEALTH. HUDSON HOSPITAL NAMED IN BECKER'S HOSPITAL REVIEW 62 CRITICAL ACCESS HOSPITALS TO KNOW" BECKER'S HOSPITAL REVIEW NAMES HUDSON HOSPITAL & CLINIC ONE OF ITS 60 GREENEST HOSPITALS IN AMERICA. PRACTICE GREENHEALTH - TOP 25 ENVIRONMENTAL EXCELLENCE AWARD - CIRCLES OF EXCELLENCE - (FOOD TOP 10 RECOGNITION); CIRCLES OF EXCELLENCE (WATER TOP 10 RECOGNITION) AND GREENING THE OPERATING ROOM. AS WELL, THE HOSPITAL RECEIVED FOUR OUT OF FIVE STARS FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES FOR SEVERAL QUALITY MEASURES INCLUDING THE LOW HOSPITAL-ACQUIRED INFECTION RATES AND SHORT EMERGENCY WAIT TIMES. THE HOSPITAL WAS ALSO RECOGNIZED FOR BEING ABOVE THE NATIONAL AVERAGE FOR REDUCING READMISSION RATES, INCREASING PATIENT EXPERIENCE SCORES AND PROVIDING TIMELY AND EFFECTIVE CARE. FORM 990, PART VI, SECTION A, LINE 6 AS OF JANUARY 1, 2009, THE CORPORATE MEMBERS OF THE HOSPITAL ARE GROUP HEALTH PLAN, INC. AND RH-WISCONSIN, INC. THESE SAME ENTITIES ARE ALSO THE CORPORATE MEMBERS OF WESTFIELDS HOSPITAL, INC., A CRITICAL ACCESS HOSPITAL IN NEW RICHMOND, WISCONSIN AND AMERY REGIONAL MEDICAL CENTER,INC., A CRITICAL ACCESS HOSPITAL IN AMERY, WISCONSIN. GROUP HEALTH PLAN, INC. AND RH-WISCONSIN, INC. ARE PART OF THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 7A THE HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF NOT MORE THAN THIRTEEN (13) PERSONS APPOINTED AS FOLLOWS (AMENDED BYLAWS, ART. II, SECT. 2): - SEVEN (7) COMMUNITY DIRECTORS NOMINATED BY THE BOARD'S NOMINATING COMMITTEE AND APPOINTED BY RH-WISCONSIN, INC. - THREE (3) DIRECTORS APPOINTED BY GROUP HEALTH PLAN, INC., ONE OF WHOM MAY BE A PHYSICIAN AND ONE OF WHOM MAY BE THE CHIEF EXECUTIVE OFFICER OF REGIONS HOSPITAL - ONE (1) DIRECTOR WHO IS A MEMBER OF THE ACTIVE MEDICAL STAFF OF THE HOSPITAL AND APPOINTED BY WESTERN WISCONSIN MEDCIAL ASSOCIATES, S.C. OR BY THE LARGEST ACTIVE PRIMARY CARE PHYSICIAN GROUP SERVING THE HOSPITAL. - ONE (1) DIRECTOR SHALL BE THE HOSPITAL'S CHIEF OF STAFF - ONE (1) DIRECTOR SHALL BE A PHYSICIAN NOMINATED BY THE BOARD'S NOMINATING COMMITTEE AND APPOINTED BY RH-WISCONSIN, INC. FORM 990, PART VI, SECTION A, LINE 7B THE HOSPITAL'S CORPORATE MEMBERS - RH-WISCONSIN, INC. AND GROUP HEALTH PLAN, INC. - JOINTLY APPROVE THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS OR INITIATE THESE ACTIONS DIRECTLY (AMENDED BYLAWS, ART. III, SECT. 1): - AMENDMENT OF THE ARTICLES, BYLAWS OR OTHER GOVERNING DOCUMENTS - APPROVAL OF THE ADDITION OR DELETION OF MAJOR SERVICE LINES - SALE, LEASE, MORTGAGE OR PLEDGE OF ANY REAL ESTATE OR INTEREST THEREIN, OR OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS - ADOPTION OF AMENDMENT OF A STRATEGIC PLAN, AND CAPITAL AND OPERATING BUDGETS - APPROVAL OF UNBUDGETED CAPITAL EXPENDITURES - APPROVAL OF BORROWING OR LENDING OF FUNDS IN EXCESS OF ONE MILLION DOLLARS - MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY AND TRANSFER OR CONTRIBUTION OF ASSETS AND FUNDS TO SEPARATE ENTITIES - ESTABLISHMENT OR DIVESTITURE OF ENTITIES OF WHICH THE HOSPITAL HAS AN EQUITY OR MANAGEMENT INTEREST, OR ESTABLISHMENT OF ANY SIGNIFICANT AND CONTINUING RELATIONSHIP WITH ANY ENTITY - APPOINTMENT AND REMOVAL OF THE HOSPITAL'S PRESIDENT AND CHAIR OF THE BOARD OF DIRECTORS - DISSOLUTION AND DISTRIBUTION OF ASSETS FORM 990, PART VI, SECTION B, LINE 11B THE HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND HEALTHPARTNERS, INC.'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE HOSPITAL. ONCE THAT REVIEW PROCESS HAS BEEN COMPLETED, IT IS THE POLICY OF THE HOSPITAL TO MAKE AVAILABLE TO THE FINANCE AND AUDIT COMMITTEE OF IT'S BOARD OF DIRECTORS, AND TO IT'S BOARD OF DIRECTORS, A COPY OF THE 990 PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED TO THE FINANCE AND AUDIT COMMITTEE AND THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE COMMITTEE MEETING. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN COMMITTEE MINUTES OF THE MEETING. THESE MINUTES ARE PRESENTED TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE, AND REINFORCES THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL'S CEO AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS), STILLWATER HEALTH SYSTEM, OR BY GROUP HEALTH PLAN, INC. (GHI), WHICH ARE ALL RELATED ORGANIZATIONS, OR BY THE HOSPITAL. GHI, REGIONS, STILLWATER HEALTH SYSTEM AND THE HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE HOSPITAL'S CEO AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE COMPENSATION COMMITTEE OF THE STILLWATER HEALTH SYSTEM, THE EXECUTIVE COMMITTEE OF REGIONS, THE COMPENSATION COMMITTEE OF GHI OR THE HOSPITAL EXECUTIVE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEE MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH THE HOSPITAL'S BOARD OF DIRECTORS INPUT, THE ST CROIX VALLEY EXECUTIVE LEADER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH THE HOSPITAL'S BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE HOSPITAL CEO. THE HOSPITAL BOARD HAS DELEGATED TO THE CEO THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL THE HOSPITAL-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE HOSPITAL EXECUTIVE COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE HOSPITAL. THE HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE WISCONSIN SECRETARY OF STATE'S OFFICE. THE HOSPITAL'S CONFLICT OF INTEREST POLICY CAN BE VIEWED THROUGH THE HUDSON HOSPITAL.ORG WEBSITE. 990, PART VII, SEC. A, LINE 1A, COL. B: AVERAGE HOURS-RELATED ORGANIZATIONS DIRECTORS AND OFFICERS OF THE HOSPITAL ARE EMPLOYED AND COMPENSATED BY GROUP HEALTH PLAN, INC., REGIONS HOSPITAL, OR THE HOSPITAL. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. FORM 990, PART XI, LINE 9: INCREASE IN INTEREST IN NET ASSETS OF HUDSON HOSPITAL FOUNDATION, INC. 386,487. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 RH-WISCONSIN 8171 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE I HPI - RAMSEY 0 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 0 HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411888902 PROVIDE SUPPORT TO HOSPITAL AND IMPORVE COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY 0 RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411891928 HEALTHCARE STAFFING AND INTENSE REHAB SERVICES MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 0 PHYSICIANS NECK AND BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 270684883 SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC 0 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391279567 PROVIDE SUPPORT TO HOSPITAL AND IMPORVE COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC 1 LAKEVIEW MEMORIAL HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411386635 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM 0 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410811697 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) STILLWATER HEALTH SYSTEM 0 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 CLINIC STAFF AND FACILITIES MN 501(C)(3) 509(A)(3) TYPE I STILLWATER HEALTH SYSTEM 0 STILLWATER HEALTH SYSTEM 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 0 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 0 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) WESTFIELDS HOSPITAL INC 0 RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411503090 HOME CARE AND HOSPICE MN 501(C)(3) 509(A)(2) HPI - RAMSEY 0 PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 363465840 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) HEALTHPARTNERS INC 0 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 SUPPORT TO RELATED ENTITIES AND COMMUNITY TO IMPROVE HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 010638901 DURABLE MEDICAL EQUIPMENT , PHARMACY AND OTHER HEALTH CARE RETAIL SALES MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410834920 CLINIC SERVICES MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411741792 HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 AMERY REGIONAL MEDICAL CENTER INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390908320 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391726539 PROVIDE SUPPORT TO HOSPITAL AND IMPORVE COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC 0 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 0 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 0 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411236798 MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC C 0 PARK NICOLLET ENTERPRISES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411656735 REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES C 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 0 HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES L 957643 CASH AMOUNT HUDSON HOSPITAL FOUNDATION R 386488 CASH AMOUNT