2017-11-14T15:50:51-06:00 2016-12-31 135665207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH STREET MINNEAPOLIS MN 55402 990 2016-01-01 390804125 HUDSON HOSPITAL INC HUDS 7155316000 405 STAGELINE ROAD HUDSON WI 54016 DOUGLAS E JOHNSON CFO 7155316000 2017-11-14 1 MONROE JORDAN GIERL P01413237 6123055000 198.174.110.146 2017-11-14 15:50:29 CS P 1A39D2BAC3E977A191A219CBBAAA8778AA2E0A5D 282CC43464B9830A349574F670F0BA37F913502D 2016 2017-02-10 21:41:12Z DOUGLAS E JOHNSON 405 STAGELINE ROAD HUDSON WI 54016 55923305 0 X WWW.HUDSONHOSPITAL.ORG X 1950 WI SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS 13 10 446 120 0 0 56865 100659 55406949 54040049 127238 277568 152622 942238 55743674 55360514 11432 9095 0 0 33376530 30834103 0 0 0 20288039 21696131 53676001 52539329 2067673 2821185 81294796 79403391 35831837 30297991 45462959 49105400 X CARING FOR THE HEALTH OF OUR COMMUNITY. 0 0 44989537 9095 54982287 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 44989537 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 446 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 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 0.50 X 0 0 0 ANNETTE COOK DIRECTOR - VICE CHAIR 1.00 X 0 0 0 STEVE KIRBY DIRECTOR 0.50 X 0 0 0 LINCOLN LIKNESS DO DIRECTOR 0.50 X 0 0 0 MICHAEL MOEN DIRECTOR & CHAIR 1.00 X 0 0 0 MIKE SELLMAN DIRECTOR 0.50 X 0 0 0 KARRIN STOEHR MD DIRECTOR 0.50 X 0 0 0 JONATHAN SUSA MD DIRECTOR 0.50 X 0 0 0 GARY VANDER VORST DIRECTOR 0.50 X 0 0 0 GREG YOUNG MD DIRECTOR 0.50 X 0 0 0 JERONE SIY MD DIRECTOR 0.50 44.50 X 0 392898 66167 BURKE KEALEY MD DIRECTOR 0.50 44.50 X 0 585957 91812 MEGAN M REMARK DIRECTOR & SECRETARY 0.50 49.50 X 0 642838 169856 SCOTT A SCHNUCKLE DIRECTOR 0.50 49.50 X 0 443021 115584 MARIAN M FURLONG PRESIDENT 42.50 2.50 X 0 338465 73902 DOUGLAS E JOHNSON VP & CFO 21.30 33.70 X 0 372676 76277 JACQUELINE M KRECH VP & CNO 50.00 X 176996 0 29348 STEVE MUELLERLEILE VP - PLANNING & DEVELOPMENT 39.50 0.50 X 225403 0 33893 ANN F RIPLEY VP - OPERATIONS, COMPLIANCE 0.50 54.50 X 105626 0 26339 DANIELLE L FERKINGSTAD NURSE ANESTHETIST 40.00 X 202932 0 33004 GALEEN K FEYEREISEN NURSE ANESTHETIST 60.00 X 226524 0 23319 HOWARD J GEORGESON NURSE ANESTHETIST 64.00 X 220716 0 38582 KEITH W LARSON NURSE ANESTHETIST 45.00 X 239004 0 41308 CHERYLL A MARTINY-JORGENSEN ANESTHESIA SUPERVISOR 60.00 X 235027 0 39376 ROBBIE HAGELBERG FORMER VP & CNO 40.00 X 0 207220 24205 1632228 2983075 882972 37 1 1 0 COMPUTERIZED MEDICAL IMAGING 719 W HAMILTON AVE SUITE B EAU CLAIRE WI 54701 RADIOLOGY SERVICES 363526 SHARED MEDICAL TECHNOLOGY INC 202 W NEWTON ST RICE LAKE WI 54868 MEDICAL DIAGNOSTIC SERVICES 298111 CANCER CENTER OF WESTERN WISCONSIN 501 HOSPITAL RDN CO NEW RICHMOND WI 54017 MEDICAL SERVICES 271888 HUDSON PHYSICIANS 403 STAGELINE RD HUDSON WI 54016 PHYSICIAN SERVICES 225084 MEDICAL SOLUTIONS INC 1010 102ND ST SE 300 OMAHA NE 68114 STAFFING 181731 13 100159 500 100659 PATIENT SERVICE 623990 53680740 53680740 DIETARY 722210 166759 166759 GIFT SHOP 453220 104770 104770 OTHER HEALTH CARE 623990 87780 87780 54040049 277568 277568 1505029 562791 942238 942238 942238 55360514 54982287 0 277568 9095 9095 597605 597605 25945934 22130895 3815039 283488 245492 37996 3324736 2956695 368041 682340 590886 91454 39270 39270 1099 99 1000 1525558 1018859 506699 259887 27054 232833 433632 127429 306203 151104 120115 30989 1532847 1223312 309535 91770 39218 52552 19504 4025 15479 1281449 1281449 4511859 4487563 24296 153859 5762 148097 MEDICAL & OFFICE SUPPLY 9557793 9547803 9990 EQUIPMENT & MAINTENANCE 1384475 626818 757657 OTHER EXPENSE 467670 269291 198379 TAXES & ASSESSMENTS 250119 250119 34236 27558 6678 52539329 44989537 7549792 0 29079242 29686747 142331 208867 4478379 5433613 1130085 828200 370819 297598 74337127 37361301 40567404 36975826 3282869 3726889 2243667 2245651 81294796 79403391 9674414 6076554 18236627 15450594 7920796 8770843 35831837 30297991 X 42689815 45944314 2691454 3079396 81690 81690 45462959 49105400 81294796 79403391 X 2821185 547392 273864 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 43912759 24163309 19749450 16491325 12557153 3934172 2634101 640839 1993262 36975826 THIRD-PARTY PAYOR SETTLEMENTS 2571917 CAPITAL LEASE LIABILITY 6198926 8770843 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, 2016 OR 2015 FOR UNRECOGNIZED TAX BENEFITS. 1 1 1 X 1 X 1 1 1 0 1 1 424 276668 276668 0.00530 2217 6086873 4902484 1184389 0.02250 2641 6363541 4902484 1461057 0.02780 410386 410386 0.00780 337279 337279 0.00640 1005828 1005828 0.01910 11070 11070 0.00020 1764563 1764563 0.03350 2641 8128104 4902484 3225620 0.06130 7317 7317 0.00010 38424 38424 0.00070 51847 51847 0.00100 49332 49332 0.00090 89 89 0.00000 4039 4039 0.00010 151048 151048 0.00280 1 1566748 12373200 12373200 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: 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 HUDSON HOSPITAL & CLINIC'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 2016, LOSS ON SERVICES FOR HOSPITAL OUTPATIENT SERVICES INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, LACTATION SERVICES, INFUSION, CARDIAC REHABILITATION AND PROGRAMS FOR CHANGE. 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 HUDSON HOSPITAL AND IS ELIGIBLE FOR FINANCIAL ASSISTANCE, HUDSON WILL NOT CHARGE MORE THAN AMOUNTS GENERALLY BILLED (AGB) TO PATIENTS THAT HAVE HEALTH INSURANCE COVERAGE. PART II, COMMUNITY BUILDING ACTIVITIES: HUDSON HOSPITAL (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. IN 2016, THE HOSPITAL PARTNERED WITH LAKEVIEW MEMORIAL HOSPITAL FOUNDATION, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, STILLWATER MEDICAL GROUP, HEALTHPARTNERS, AND WESTFIELDS HOSPITAL TO CONTINUE TO PROVIDE POWERUP, A COMMUNITY-WIDE YOUTH HEALTH INITIATIVE TO MAKE BETTER EATING AND ACTIVE LIVING EASY, FUN, AND POPULAR, SO THAT OUR YOUTH CAN REACH THEIR FULL POTENTIAL. POWERUP IS A LONG-TERM COMMITMENT TO CREATE CHANGE OVER 10 YEARS IN PARTNERSHIP WITH SCHOOLS, BUSINESSES, HEALTH CARE, CIVIC GROUPS, FAMILIES, KIDS, AND THE ENTIRE COMMUNITY.THE HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORT ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT INCLUDING THE TOBACCO COALITION, HEALTHWATCH OF ST. CROIX COUNTY, WEST CENTRAL REGIONAL TRAUMA ADVISORY COUNCIL (RTAC), THE HEALING ARTS PROGRAM, HUDSON CHAMBER, ST. CROIX COUNTY ECONOMIC DEVELOPMENT CORPORATION (EDC), AND THE HUDSON SCHOOL DISTRICT.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'S HEALTHY. GREEN INITIATIVES INCLUDED THE RECYCLING PROGRAM, COMMUNITY SHARPS DISPOSAL SITE, REDUCTION OF ENERGY AND WATER CONSUMPTION, CREATION AND EXPANSION OF THE COMMUNITY GARDEN - THE HOSPITAL IN SUPPORT OF HEALTHIER TOGETHER INITIATIVES, AND THE FOSTERING OF HEALING ENVIRONMENTS INCLUDING THE COMMUNITY LABYRINTH. IMPLEMENTING SUSTAINABLE BUSINESS PRACTICES HAS MADE THE HOSPITAL A MODEL WITHIN THE HEALTHPARTNERS FAMILY OF CARE. 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."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.THE FOOTNOTE IN THE HOSPITAL'S FINANCIAL STATEMENTS READS AS FOLLOWS: "ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, BASED ON ESTABLISHED GUIDELINES FOR IDENTIFYING UNCOLLECTIBLE PATIENT ACCOUNTS AND CLASSIFYING THESE ACCOUNTS AS DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL'S MANAGEMENT PERIODICALLY ASSESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS 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. 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."BAD DEBT IS CURRENTLY EXCLUDED FROM THE COMMUNITY BENEFIT CALCULATION PER WISCONSIN HOSPITAL ASSOCIATION (WHA). 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). MEDICARE SHORTFALL IS CURRENTLY EXCLUDED FROM THE COMMUNITY BENEFIT CALCULATION PER WHA, BUT CAN BE INCLUDED IN OTHER FINANCIAL REPORTS. 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 - 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 2016. 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 X X X X 0 1 0 0 0 1 1 0 0 JERONE SIY MD DIRECTOR 0 282555 0 14250 0 96093 0 46035 0 20132 0 459065 0 0 BURKE KEALEY MD DIRECTOR 0 499792 0 80800 0 5365 0 55331 0 36481 0 677769 0 0 MEGAN M REMARK DIRECTOR & SECRETARY 0 463296 0 143559 0 35983 0 135409 0 34447 0 812694 0 17102 SCOTT A SCHNUCKLE DIRECTOR 0 315452 0 98429 0 29140 0 84625 0 30959 0 558605 0 10161 MARIAN M FURLONG PRESIDENT 0 257841 0 68848 0 11776 0 45308 0 28594 0 412367 0 0 DOUGLAS E JOHNSON VP & CFO 0 272057 0 74284 0 26335 0 42843 0 33434 0 448953 0 0 JACQUELINE M KRECH VP & CNO 175777 0 0 0 1219 0 3600 0 25748 0 206344 0 0 0 STEVE MUELLERLEILE VP - PLANNING & DEVELOPMENT 188857 0 34652 0 1894 0 10222 0 23671 0 259296 0 0 0 DANIELLE L FERKINGSTAD NURSE ANESTHETIST 198518 0 500 0 3914 0 8002 0 25002 0 235936 0 0 0 GALEEN K FEYEREISEN NURSE ANESTHETIST 222282 0 0 0 4242 0 9174 0 14145 0 249843 0 0 0 HOWARD J GEORGESON NURSE ANESTHETIST 219921 0 500 0 295 0 7302 0 31280 0 259298 0 0 0 KEITH W LARSON NURSE ANESTHETIST 233399 0 500 0 5105 0 9763 0 31545 0 280312 0 0 0 CHERYLL A MARTINY-JORGENSEN ANESTHESIA SUPERVISOR 223620 0 6408 0 4999 0 9925 0 29451 0 274403 0 0 0 ROBBIE HAGELBERG FORMER VP & CNO 0 192974 0 14227 0 19 0 6299 0 17906 0 231425 0 0 PART I, LINE 4B 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 $ 24,754 SCOTT A. SCHNUCKLE $ 11,437 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 $ 17,102 SCOTT A. SCHNUCKLE $ 10,161 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 6435041 20513711 20513711 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. 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE 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 AND WESTERN WISCONSIN. 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 PLAN'S SERVE MORE THAN 1.6 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 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 24 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 AND WESTERN WISCONSIN. 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 COLLABORATE 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 2015 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. IS THE SOLE CORPORATE MEMBER OF THE HOSPITAL. 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: CHARITABLE TRADITION CONTINUED AS THE HOSPITAL REACHED OUT TO THOSE IN NEED OF ITS SERVICES. STAFF ENGAGED IN COMMUNITY PARTNERSHIPS WITH SCHOOLS, BUSINESSES, AGENCIES, AND OTHER HEALTH PROVIDERS INVESTED IN COMMUNITY HEALTH, EDUCATION, ECONOMIC DEVELOPMENT, AND CULTURE THE HOSPITAL AIMS TO BE THE PREMIER PARTNER IN THE COMMUNITY'S QUEST FOR HEALTH AND HAPPINESS. WORKING IN PARTNERSHIP WITH EACH OTHER, THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS, HUDSON PHYSICIANS AND THE COMMUNITY, THE HOSPITAL ACCOMPLISHED A GREAT DEAL IN 2016. ADVANCEMENTS WERE MADE IN SUPPORT OF THE TRIPLE AIM: TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. 1. COMMUNITY HEALTH EDUCATION: - COMMUNITY MEMBERS ATTENDED EDUCATIONAL PROGRAMS, CLASSES, SPECIAL EVENTS, HEALTH FAIRS OR SUPPORT GROUPS TAUGHT OR HOSTED BY MEDICAL AND CLINIC STAFF AND CAMPUS PARTNERS OR WERE HOSPITAL FITNESS CENTER MEMBERS (1:1 EDUCATION AND FITNESS TRAINING). THE HOSPITAL ALSO PROVIDED COMMUNITY HEALTH INFORMATION THROUGH A QUARTERLY NEWSLETTER TO RESIDENTS IN WESTERN WISCONSIN. TOTAL COMMUNITY HEALTH EDUCATION EXPENSES TOTALED $398,174. - CLASSES INCLUDED ADVANCED DIRECTIVES, BREASTFEEDING, BABY SIGN LANGUAGE, BABYSITTING CLASSES, FAMILY/PARENTING/SIBLING EDUCATION, HEART DISEASE, MEDICATION SAFETY, MENTAL HEALTH AND DEPRESSION, NUTRITION/WEIGHT MANAGEMENT, SCHOOL-BASED HEALTH EDUCATION, WORKFORCE DEVELOPMENT, HAND HYGIENE, EFFECTS OF SMOKING, HEALTHY EATING AND PORTION CONTROL AND HEALTH CARE CAREER DAY. - SPECIAL HEALTH EDUCATION PROGRAMS AND EVENTS WERE PRESENTED TO AREA YOUTH (ANNUAL BIKE SAFETY CLINIC, NUTRITION EDUCATION & THE HIGH SCHOOL STEM PROGRAM). - SUPPORT GROUPS FACILITATED BY STAFF INCLUDED NEW PARENT, SMOKING CESSATION, CELIAC, WEIGHT LOSS AND WELLNESS. OTHER SUPPORT GROUPS OFFERED ON CAMPUS BY COMMUNITY PARTNERS INCLUDED CARDIOVASCULAR DISEASE, DIABETES, AND PARKINSON'S DISEASE. - THE HEALTH RESOURCE CENTER IS A LENDING LIBRARY AND ONLINE MEDICAL LIBRARY WHERE PATIENTS, THEIR FAMILY AND FRIENDS, STAFF AND COMMUNITY MEMBERS CAN ACCESS HEALTH AND WELLNESS INFORMATION FROM PRINT RESOURCES, INTERNET SITES AND TAPES. - THE FITNESS CENTER, AN ON-SITE EXERCISE FACILITY, WAS AVAILABLE TO COMMUNITY MEMBERS AND EMPLOYEES AT A DISCOUNTED RATE. REHABILITATION CENTER STAFF CREATE FITNESS PROGRAMS AND PROVIDE EXERCISE AND EDUCATION PROGRAMS FOR MEMBERS, EMPLOYEES, AND PHASE 3 CARDIAC REHABILITATION PARTICIPANTS. - THE HOSPITAL HOSTED NUMEROUS BLOOD DRIVES IN SUPPORT OF THE AMERICAN RED CROSS THROUGHOUT THE YEAR BY PLANNING, ADVERTISING AND STAFFING BLOOD DRIVE EVENTS. - THE HOSPITAL'S GREEN TEAM ACTIVELY SOUGHT NUMEROUS WAYS TO REDUCE WASTE AND INCREASE RECYCLING EFFORTS. THEY HOSTED AN ELECTRONICS RECYCLING EVENT FOR THE COMMUNITY ON EARTH DAY WHERE 40+ TONS WAS COLLECTED. 2. HEALTH PROFESSIONAL EDUCATION. THE HOSPITAL'S STAFF PROVIDED CLINICAL TRAINING FOR NURSES AND NURSING STUDENTS AND OTHER HEALTH PROFESSIONALS INCLUDING EMS FROM REGIONAL INSTITUTIONS AT A COST OF $337,279. 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. THREE NURSES, PAIRED WITH EXPERIENCED HOSPITAL NURSES ACTING AS COACH/SUPPORT PERSON, COMPLETED THE 12-MONTH PROGRAM. 3. SUBSIDIZED HEALTH SERVICES: FINANCIAL ASSISTANCE AND HEALTHCARE ACCESS FOR LOW-INCOME INDIVIDUALS. IN 2016, THE HOSPITAL PROVIDED $276,668 IN FINANCIAL ASSISTANCE. 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. CARE FOR MEDICAID PATIENTS. 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 $1,184,389. FORM 990, PART III, LINE 4A SUBSIDIZED HEALTH SERVICES. THE HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2016, LOSS ON SERVICES FOR HOSPITAL INPATIENT AND OUTPATIENT HEALTH SERVICES TOTALED $1,005,828. THESE SERVICES INCLUDE LACTATION, OCCUPATIONAL THERAPY, RESPIRATORY THERAPY, PHYSICAL THERAPY, INFUSION, PROGRAMS FOR CHANGE, AND CARDIAC REHABILITATION. UPON REQUEST, VAN TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUS WAS AVAILABLE TO COMMUNITY RESIDENTS WHOM LIVED WITHIN A 15-MILE RADIUS. TRANSPORTATION WAS PROVIDED TO PATIENTS, VISITORS, AND COMMUNITY MEMBERS AT A MINIMAL RATE FOR VISITS TO THE HOSPITAL CAMPUS AND CAMPUS TENANTS. HEALTH CARE SUPPORT SERVICES. IN 2016, COMMUNITY MEMBERS REALIZED THE BENEFIT OF HEALTH CARE SUPPORT SERVICES AVAILABLE INCLUDING TRANSLATION/INTERPRETER SERVICES, VAN TRANSPORTATION, CRISIS INTERVENTION AND COUNSELING SERVICES, AND LIFELINE HOME MONITORING SYSTEM, TO NAME A FEW. IN 2016, THE HOSPITAL BEGAN OFFERING CHAPLAINCY SERVICES FOR PATIENTS, VISITORS, FAMILY, AND COMMUNITY MEMBERS. PROGRAMS FOR CHANGE, THE HOSPITAL'S OUTPATIENT CHEMICAL ADDICTION TREATMENT AND RECOVERY CARE PROGRAM, OFFERED PARENTS AND FAMILY MEMBERS THE OPPORTUNITY TO PARTICIPATE IN EDUCATIONAL LECTURES, GROUP DISCUSSION, AND FAMILY TREATMENT GROUPS FREE OF CHARGE IN SUPPORT OF THEIR LOVED ONE. FINANCIAL SERVICES, 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 PROGRAM 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 EMPLOYS STAFF SOCIAL WORKERS AND CASE MANAGERS TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE. 4. FINANCIAL CONTRIBUTIONS: CASH DONATIONS & GRANTS. 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, NAMI, TWIN CITIES HEART WALK, ETC. TOTALED $11,070. IN-KIND DONATIONS. IN-KIND SERVICES PROVIDED INCLUDED STAFF HOURS SPENT IN SUPPORT OF BOARD OR COMMITTEE WORK INCLUDING: HUDSON ROTARY CLUB, HUDSON CHAMBER OF COMMERCE, ST. CROIX ECONOMIC DEVELOPMENT CORPORATION, ST. CROIX COUNTY SUBSTANCE ABUSE ADVISORY COMMITTEE, UW-RIVER FALLS CHANCELLOR ADVISORY COUNCIL, ST. CROIX VALLEY VISUAL ARTS COUNCIL, CANCER CENTER OF WESTERN WISCONSIN, ST, CROIX VALLEY YMCA, AND WISCONSIN HOSPITAL ASSOCIATION IN ADDITION, MD MISSION TRIP SUPPLIES; SPECIAL EVENTS PLANNING (HEART WALK, NAMI WALK, HUDSON RELAY FOR LIFE); AND OVERHEAD EXPENSES OF SPACE PROVIDED TO NOT-FOR-PROFIT COMMUNITY GROUPS FOR MEETINGS. 5. COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL SUPPORTS INDIVIDUALS, ORGANIZATIONS, EVENTS AND PROGRAMS; IT LIVES OUT ITS COMMITMENT TO IMPROVE THE HEALTH OF THE COMMUNITY. 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 ALSO PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT INCLUDING THE TOBACCO COALITION, HEALTHWATCH OF ST. CROIX COUNTY, WEST CENTRAL REGIONAL TRAUMA ADVISORY COUNCIL (RTAC), THE HEALING ARTS PROGRAM 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'S HEALTHY. GREEN INITIATIVES INCLUDED THE RECYCLING PROGRAM, COMMUNITY SHARPS DISPOSAL SITE, REDUCTION OF ENERGY AND WATER CONSUMPTION, CREATION AND EXPANSION OF THE COMMUNITY GARDEN - THE HOSPITAL IN SUPPORT OF HEALTHIER TOGETHER INITIATIVES, AND THE FOSTERING OF HEALING ENVIRONMENTS INCLUDING THE COMMUNITY LABYRINTH. IMPLEMENTING SUSTAINABLE BUSINESS PRACTICES HAS MADE THE HOSPITAL A MODEL WITHIN THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS. 6. 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 2016, THE TIME SPENT ON THESE ACTIVITIES TOTALED $6,522 AND $5,690 FOR COMMUNITY HEALTH NEEDS ASSESSMENT EXPENSES. COMMUNITY HEALTH NEEDS ASSESSMENT: PLEASE REFER TO FORM 990 SCHEDULE H NARRATIVE. 7. ORGANIZATION 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. - BECKER'S HOSPITAL REVIEW RANKED HUDSON HOSPITAL & CLINIC AS ONE OF THE "50 CRITICAL ACCESS HOSPITALS TO KNOW, AND RECOGNIZED AS A CRITICAL ACCESS HOSPITAL THAT HAS DEMONSTRATED EXCELLENCE IN CARING FOR THEIR COMMUNITIES. - 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. - THE HOSPITAL WAS AWARDED THREE OF THE MOST PRESTIGIOUS ENVIRONMENTAL ACHIEVEMENT AWARDS OFFERED BY PRACTICE GREENHEALTH-THE NATION'S LEADING HEALTH CARE COMMUNITY THAT EMPOWERS ITS MEMBERS TO INCREASE THEIR EFFICIENCIES AND ENVIRONMENTAL STEWARDSHIP WHILE IMPROVING PATIENT SAFETY THROUGH BEST PRACTICES. THE HOSPITAL RECEIVED THE CIRCLES OF EXCELLENCE AWARD IN THE FOOD CATEGORY, GREENING THE OR AND GREENHEALTH EMERALD AWARD FOR ACHIEVING IMPROVEMENTS IN MERCURY ELIMINATION, WASTE REDUCTION AND RECYCLING. - FOR THE SEVENTH YEAR IN A ROW, HEALTHPARTNERS-ALONG WITH THE HOSPITAL WAS NAMED ONE OF THE "MOST WIRED" HEALTH CARE ORGANIZATIONS IN THE COUNTRY. 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. 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 AS REQUIRED BY THE BYLAWS OF THE HOSPITAL, THE BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ALL BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS AND KEY EMPLOYEES ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND REQUESTED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTEREST. THE GENERAL COUNSEL WILL SUMMARIZE THE FINDINGS FOLLOWING REVIEW OF THE QUESTIONNAIRE AND SUBMIT A REPORT TO THE CHAIR AND HOSPITAL PRESIDENT. 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. 387,942. TRANSFER OF NET ASSETS TO HUDSON HOSPITAL FOUNDATION, INC. -114,078. 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CLAIMSHEALTHCARE SERVICES L 100147 CASH AMOUNT HUDSON HOSPITAL FOUNDATION R 114078 CASH AMOUNT