2017-08-11T15:02:57-05:00 2016-09-30 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2015-10-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE % LISA FENHAUS-JOHNSON LAKE 7152341515 1700 WEST STOUT STREET RICE LAKE WI 54868 BRADLEY D GROSETH CAO 7152341515 2017-08-15 true MONROE J GIERL P01413237 6123055000 2017-08-15 2015 2021-01-29 14:40:06Z LAKEVIEW MEDICAL CENTER BRADLEY D GROSETH CAO 1700 WEST STOUT STREET RICE LAKE WI 54868 88388965 false X WWW.LAKEVIEWMEDICAL.COM X 1919 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 9 5 484 161 0 114560 55515 86318842 87571182 159976 206725 361019 367073 86954397 88200495 0 0 0 0 523954 31494389 0 0 0 69097415 37101474 69621369 68595863 17333028 19604632 123504147 104801737 52905984 51744442 70598163 53057295 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. false false 58932973 87492492 LAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE, AND HOME HEALTH SERVICES. 58932973 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 32 9 true 484 true false false false false false false false false false false false false false X 9 5 false false false false true true true true true false false true true true true true true true true false WI X LISA FENHAUS-JOHNSON 7153875511 1000 N OAK AVE Marshfield WI 54449 X Mark Nymo MD Board Member 1.0 5.0 X 0 59658 7323 Peter Neal MD Board Member 1.0 40.0 X 0 392078 48731 William Barkley MD Board Member 1.0 40.0 X 0 349066 56688 Scott Polenz Board Member 1.0 40.0 X 0 226841 52127 Sue Tindell Board Chair 1.0 0.0 X X 0 0 0 Carol Hakala Board - Vice Chair 1.0 0.0 X X 0 0 0 Brittany Nielsen Board Secretary 1.0 0.0 X X 0 0 0 Craig Fowler Board Member 1.0 0.0 X 0 0 0 Dan Ringwelski Board Member 1.0 0.0 X 0 0 0 Ned Wolf CEO, LMC 40.0 0.0 X 292091 0 56294 Jackie Klein CFO, LMC 40.0 0.0 X 180265 0 50322 Teri Wilczek CHIEF PHILAN OFFICER, MCHS 1.0 44.0 X 0 207692 51593 Narayana Murali MD CHIEF STRATEGY OFFICER, MCHS 1.0 45.0 X 0 558189 59685 Patti Haney CHIEF HR OFFICER, MCHS 1.0 44.0 X 0 239839 54661 Julie Brussow HEALTH PLAN CEO, MCHS 1.0 44.0 X 0 404938 45520 Jerard Jensen GENERAL COUNSEL, MCHS 1.0 44.0 X 0 353735 18234 Gordon Edwards CFO, MCHS 1.0 44.0 X 0 128695 8174 Daniel Ramsey COO of MCHS & MC 1.0 44.0 X 0 664272 26151 Susan Turney MD CEO, MCHS 1.0 45.0 X 0 1091170 199830 Cindy Arts-Strenke COO, LMC 40.0 0.0 X 199359 0 47682 Tyler Geerdes Pharmacist 40.0 0.0 X 115508 0 35480 Anna Rogalla Pharmacist 40.0 0.0 X 121764 0 43156 Sherry Johnson Nurse Manager - Hospital 40.0 0.0 X 122458 0 15944 Roberta Freitag Pharmacist 40.0 0.0 X 125193 0 38739 Kate Hillyer Manager - Pharmacy Services 40.0 0.0 X 133911 0 40289 1290549 4676173 956623 17 false true false MCIS INC 1701 N FIG AVE MARSHFIELD WI 54449 COMPUTER CONSULTING 2027868 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER CONSULTING 1909611 Medical Staffing Solutions Inc PO Box 101 RICE LAKE WI 54868 Contract Med. Staff 375363 Aramark Corporation 27310 Network Place CHICAGO IL 606731273 Management Services 365811 Sightpath Medical LLC PO Box 204253 DALLAS TX 753204253 Medical Services 356872 11 4706 14556 5500 4500 26253 55515 NET PATIENT SERVICE REVENUE 624100 85726854 85726854 LEASING REVENUE 624100 1536990 1536990 LIFELINE PROGRAM 624100 137563 137563 OCCUPATIONAL/INDUSTRIAL HEALTH 624100 28793 28793 ALL OTHER PROGRAM SERVICE REVENUE 624100 140982 62292 78690 87571182 230460 230460 0 0 131679 131679 0 0 0 13201 36936 -23735 -23735 -23735 14556 19184 -19184 -19184 10354 671 9683 9683 0 Cafeteria Revenue 624100 376574 376574 376574 88200495 87492492 652488 X 0 0 0 0 861785 861785 0 22754270 20373693 2380577 2165094 1912046 253048 4072515 3158768 913747 1640725 1466228 174497 339297 339297 186613 186613 81620 81620 0 0 0 4018033 2882576 1135457 357422 357422 1091942 784478 307464 4164172 3134974 1029198 0 2542717 2186737 355980 167604 167604 0 151556 62771 88785 1316040 658020 658020 0 4605439 3834045 771394 142944 131858 11086 FOOD AND PROVISIONS 512433 512433 DUES AND SUBSCRIPTIONS 187128 90931 96197 MEDICAL SUPPLIES 16321848 16321848 EQUIPMENT REPAIRS 914666 914666 68595863 58932973 9662890 0 2310 2510 33814788 15606560 0 0 13164228 14728774 0 0 0 0 0 0 1054158 1143262 237048 324600 114514128 44981271 71599182 69532857 0 0 0 0 13066 14432 0 0 3619367 3448742 123504147 104801737 3352144 3374616 0 0 0 0 0 0 0 0 0 0 49035837 47821290 0 0 518003 548536 52905984 51744442 X 70598163 53057295 0 0 0 0 70598163 53057295 123504147 104801737 X 19604632 -37145500 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3205 3205 false Part II-B Line 1i A percentage of the hospital association dues paid by Lakeview Medical Center are considered payment in support of lobbying efforts. Amounts reported on Schedule C represent the portion attributable to hospital association lobbying efforts. 0 5255530 5255530 0 70793587 18078469 52715118 0 0 35093081 25510079 9583002 0 3371930 1392723 1979207 69532857 0 DEFERRED COMPENSATION 548536 548536 X Part X Line 2d LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THIS ORGANIZATION IS, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. THE SYSTEM APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. BASED ON AN ANALYSIS BY THE CENTER, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE CENTER AT SEPTEMBER 30, 2016 OR 2015. true true true X true X true true true false true true 317188 317188 0.00470 9615345 7404000 2211345 0.03260 9932533 7404000 2528533 0.03730 299846 10911 288935 0.00430 36546 36546 0.00050 6974714 5754000 1220714 0.01800 35721 35721 0.00050 7346827 5764911 1581916 0.02330 17279360 13168911 4110449 0.06060 true 815000 268000 17568000 19602000 -2034000 X true false 1 1 LAKEVIEW MEDICAL CENTER INC OF RICE L 1700 WEST STOUT STREET RICE LAKE WI 54868 X X X GENERAL MED & SURGICAL along with ER-24 HOURS LAKEVIEW MEDICAL CENTER INC OF RICE 1 false false true X X X X X X X X 15 true true true true X HTTP://WWW.LAKEVIEWMEDICAL.COM X true 15 true HTTP://WWW.LAKEVIEWMEDICAL.COM false true X 200. 400. X X X X X true true X X X X true X HTTP://WWW.LAKEVIEWMEDICAL.COM X https://marshfieldclinic.org X SEE ABOVE X X X X X true X false X X X X true X X false false Part V Line 5 Lakeview Medical Center Inc. of Rice Lake completed its second CHNA in partnership with the Barron County Health Department, the Wisconsin Department of Health, and the other healthcare systems in the community. In addition to analyzing demographic information, the group collected secondary data through both an online and paper survey concerning disease, death, disability, injury, and community opinions. The survey was translated to Somalian and Spanish to include feedback from underserved populations in the county. Part V Line 6a The second CHNA was conducted in partnership with two other hospital facilities, Mayo Clinic Health Systems and the Cumberland Clinic and Hospital. Part V Line 6b In addition to the two other hospital facilities, the second CHNA was conducted in partnership with the Barron County Health Department and the Wisconsin Department of Health. Part V Line 11 Upon completion of the CHNA, LMC developed a Hospital Implementation Strategy (HIS) to impact the priorities that were identified. The identified priorities were alcohol and other drug abuse, chronic disease management, and mental health issues. THIS includes goals, objectives, and action plans for the priorities of chronic disease prevention, alcohol and other drug abuse, and mental health issues. As part of LMC's HIS related to chronic disease, LMC offered a free screening for community members to help identify those at risk of diabetes and to educate them on what their screening numbers meant to their health. The National Diabetes Prevention Program was offered to those community members found to be at risk for diabetes. Included in LMC's HIS related to Mental Health, magnets and fliers with the Mental Health Crisis Line information have been developed and provided to schools, nonprofit organizations, law enforcement and various business and industrial worksites The main focus of the Alcohol and Drug Abuse HIS was working with the sheriffs department on the utilization of the driving simulator. It has been used at events such as the Farmer's Market, 50 Plus and the Barron County Fair. The simulator was used in all drivers education classes across Barron County touching almost every young adult in the County that has gotten their driver's license in the last year by letting them experience what it's like to drive under the influence and receive a DWI. The simulator has also served over 1000 adults in 2015/2016. Companies such as Push, Mosiac,3M and Monarch Paving have had their employees use it. Part V Line 22d In determining the maximum amount that may be charged to a fap-eligible person, Lakeview Medical Center used the look-back method, including both Medicare fee for services and all private health insurers in determining the gross charges percentage. Part I Line 3c LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE USES THE FEDERAL POVERTY GUIDELINES AT 200% TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AS STATED IN LINE 3A. DISCOUNTED CARE IS AVAILABLE TO PATIENTS WITH INCOMES BETWEEN 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES. WE ALSO OFFER AN INTEREST FREE PAYMENT PLAN, WITH THE APPROVAL OF THE CREDIT SUPERVISOR, BASED ON THE PATIENT'S CIRCUMSTANCES AND ABILITY TO PAY. THE GUIDELINES FOR THE PAYMENT PLAN INCLUDE: MAXIMUM OF 60 MONTHS, LEVEL PAYMENTS OR A FRONT-END-LOADED ARRANGEMENT (I.E., LOWER INITIAL PAYMENTS WITH A BALLOON PAYMENT IS NOT ACCEPTABLE) AND A MINIMUM OF $25 PER MONTH. Part I Line 7 The Costing METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON LMC'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. Part I, Line 7(g) SUBSIDIZED HEALTH SERVICES CONSIST OF AMBULANCE SERVICES, HOME CARE AND HOSPICE SERVICES, AND DIALYSIS SERVICES PROVIDED BY LAKEVIEW MEDICAL CENTER. THESE ARE CLINICAL SERVICES MEETING CRITICAL NEEDS IN OUR RURAL AND AGING COMMUNITY. Part III Line 2 Bad DEBT EXPENSES REPORTED ARE SHOWN AT COST AND CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. Part III Line 3 The MAJORITY OF BAD DEBT IS INCURRED ON LOW INCOME PATIENTS. ALTHOUGH LMC COMMUNICATES AND ENCOURAGES THESE PATIENTS TO APPLY FOR FINANCIAL ASSISTANCE, MANY DO NOT COMPLETE THE PROCESS. WITHOUT A COMPLETED APPLICATION, THEY ARE TRANSFERRED TO COLLECTION SERVICES AND TREATED AS BAD DEBT EXPENSE. LMC'S TRACKING OF THE FINANCIAL ASSISTANCE SCREENINGS WITH PATIENTS AND THE RELATED NUMBER OF APPLICATIONS NOT COMPLETED WAS USED TO ESTIMATE THE BAD DEBT EXPENSE ATTRIBUTABLE TO THESE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE WITH COMPLETED APPLICATIONS. Part III Line 4 Management PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON AN ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER LAKEVIEW'S CHARITY CARE POLICY EVEN THOUGH LAKEVIEW PROVIDES THIS INFORMATION TO THEM AND ASSISTANCE WITH THE APPLICATION. WITHOUT A COMPLETED APPLICATION THEY ARE TRANSFERRED TO COLLECTION SERVICES AND TREATED AS BAD DEBT EXPENSE. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH THEM SHOULD BE ATTRIBUTABLE TO CHARITY CARE AND A COMMUNITY BENEFIT. Please REFER TO FOOTNOTE 15 ON PAGES 29 AND 30 OF THE CONSOLIDATED FINANCIAL STATEMENTS. Part III Line 8 The TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE LAB AND THERAPY SERVICES REIMBURSED ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. THE COSTING METHOD USED FOR IRS COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2016, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. Part III Line 9b Under THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE, MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO GET ASSISTANCE WITH THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL. DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. THE ORGANIZATION ALSO PUBLISHES INFORMATION REGARDING ITS CHARITY CARE PROGRAM ON ITS WEBSITE. A DESCRIPTION OF THE CHARITY CARE PROGRAM IS INCLUDED IN THE WELCOME BOOKLET THAT PATIENTS RECEIVE UPON ADMISSION. A CHARITY CARE INFORMATIONAL BROCHURE IS GIVEN TO SELF-PAY PATIENTS DURING THE REGISTRATION PROCESS AND MADE AVAILABLE TO ALL PATIENTS. Part VI Line 2 Needs Assessment: Lakeview Medical Center, Inc. (LMC) of Rice Lake completed its second community health needs assessment (CHNA) in partnership with the Barron County Health Department, and the following organizations: Wisconsin Department of Health, Marshfield Clinic, Mayo Clinic Health Systems, and Cumberland Clinic and Hospital. The committee has adopted the following name for the initiative: Thrive Barron County (Thrive BC), Growing Together in Health. Our Mission: Thrive BC will work to engage community members and organizations to focus resources and develop and strengthen partnerships to establish sustainable, safe and healthy communities. Our vision: Community members and organizations working together to improve the quality of life for everyone in Barron county. To meet our vision we will meet regularly and systematically collect, assemble, analyze and make available information related to the health of the community. The CHNA was reviewed by LMC's Board of Directors and subsequently published on LMC's public website in August of 2016. Paper copies are available to anyone requesting a printed version. Print copies were available by request via a tear-off post card located in LMC's Community Benefit Report. This report is mailed to over 40,000 households. Along with analyzing demographic information, our coalition has collected secondary data through both an online and paper surveys concerning disease, death, disability, injury, and community opinions. The survey was translated to somali and spanish to include feedback from underserved populations in the county. Also targeted for feedback in this CHNA was the inmate population in the Barron County jail. Over 900 responses out of the county population of 45,445 were completed. Along with the secondary data, the committee analyzed state and national data based on the 12 Wisconsin health priorities. This data was presented to 50 community members, leaders and experts. At a September 30, 2015 meeting attendees came together to review health priority assessment data and accomplishments. From 201 priorities selected, the top 3 health priorities for Barron County were identified as: 1. Alcohol and other drug abuse 2. Mental health issues 3. Chronic disease LMC has representatives actively working on the Thrive BC committees focused on Alcohol and Other Drug Abuse and has representatives serving on the Thrive BC steering committee. Upon completion of the CHNA, LMC completed a hospital implementation strategy (HIS) to impact the priorities identified. The LMC Rice Lake Board of Directors approved the HIS at the August 25, 2016 board meeting and continues to monitor the LMC's community health implementation plan. As part of the HIS related to chronic disease, LMC along with Thrive BC business partners offered a free health screening called Know Your Numbers. This screening enabled community members to help identify risk of diabetes and educated them in regard to what their screening results meant to their health. In 2016 LMC conducted 138 free screenings out of a total of 591 completed collectively. Of the 138 participants screened at LMC, 30% were found to be at risk for developing diabetes. Health education was then offered to participants falling in the risk category. Along with the CHNA, LMC of Rice Lake assesses the health care needs of the communities and areas it serves by reviewing local demographics and trends in patient service utilization to determine which services could and should be made available to the community in a cost-effective manner. In 2015 LMC joined with Barron County in the Barron County Community Health Needs Assessment (CHNA) to collectively identify local health concerns and address local health priorities linked to state and national priorities. Part VI Line 3 Patient EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO TALK WITH THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. POLICIES ARE ALSO AVAILABLE ON THE WEBSITES. Part VI Line 4 Community Information: The primary service area for Lakeview Medical Center, Inc. (LMC) encompasses all persons living with a 30 to 40 mile radius of the hospital. Some of the communities included in this area are Rice Lake, Cameron, Barron, Birchwood, Ladysmith, Cumberland, Chetek, and Spooner, Wisconsin among many others. LMC provides a significant portion of its patient services to beneficiaries of the Medicare and Medical Assistance programs. Medicare and Medical Assistance patients accounted for approximately 66% of the LMC's gross patient service revenue for the year. Other Information: LMC of Rice Lake provides significant charity care and other community benefits as defined by the Internal Revenue Service. (IRS) In addition, as an organization, LMC believes that it provides a critically important benefit which is not quantified. Lakeview Medical Center, like most community hospitals, was created and is maintained in order to provide health care locally. Beyond inpatient hospitalizations, some of the major health services LMC provides are: Birthing Center, Diagnostics, Emergency Care, Hospice, Home Care, Dialysis, Infusion Services, Health and Wellness, Laboratory, Occupational Health, Rehabilitation, Sleep Center, Speech Pathology, Surgical, and Women's Health. LMC is governed by an 11 member board of directors which includes 6 community members. Part VI Line 5 Community building activities promoting the health in the communities served: Lakeview Medical Center (LMC) partnered with Barron County Public Health, along with the county's two other healthcare systems in the Barron County Community Health Improvement Process to identify local health concerns and address local health priorities. The information gathered from this process was used to identify and prioritize community health issues and needs. LMC has focused on education efforts through health programs, and community screenings based on this information. LMC's specific efforts have provided programs to support the Barron County Community Coalition to support the priorities identified in the CHNA: alcohol and other drug abuse, chronic disease, and mental health issues. Excel With Be Well: Lakeview Medical Center is the lead organization in a worksite wellness program. The goal is to engage worksite leaders to adopt best wellness practices at their worksites. LMC coordinates meetings quarterly and provides resources and presenters based on the group's interests and needs. Meetings average an attendance of approximately 40 worksite leaders from a vast array of workforces. LMC coordinated with worksites with our weight loss programs throughout the year with over 20 worksites that participated. Sexual Assault Nurse Examiner (SANE) Program; The SANE program at LMC supports the community effort to address the crime of sexual assault by establishing a process for accurate evidence collection and by providing support for sexual assault survivors. Farmer's Market: LMC has a booth at a local farmer's market that has 200-300 attendees each week. The LMC booth offers health-related information and/or screening related to a different topic each week. LMC administered 175 free blood pressure screenings and 25 flu shots in addition to other activities over the 18 week span that the farmer's market was active. This year the focus was on living a healthy lifestyle which included healthy recipes and food samples, a driving simulator, and balance testing. Not on Tobacco (NOT) Program: Lakeview Medical Center joined the Barron County Community Coalition and led the effort to secure a grant from the Rice Lake Area Health Foundation to reduce tobacco use in the greater Rice Lake area. Through the grant, the Not On Tobacco program was implemented in Barron High School in Barron, Wisconsin and the Restorative Justice Program adopted the NOT program as a sanctioned workshop for rehabilitation. In addition, due to the high statistics of tobacco use during pregnancy, LMC has implemented the First Breath Program. Worksite Wellness Committee: A Worksite Wellness Committee was formed at LMC to share evidence- based best practices for employee health improvements with local employers. 50 Plus: 50 Plus is a free wellness event for those over 50 years old. The event offers a variety of health screenings, community resources, educational presentations and entertainment. This event is coordinated by a coalition of community agencies led by Lakeview Medical Center. Chamber Member: An LMC representative is a member of the Rice Lake Chamber of Commerce Business and Education Committee. This committee focuses on improving business opportunities and education in Rice Lake. United Way Member: An LMC representative is a member of the Rice Lake United Way Coalition serving the community by issuing community improvement grants. HANG ON CHALLENGE: ANOTHER LAKEVIEW MEDICAL CENTER INITIATIVE TO ADDRESS HEALTH RISKS RELATED TO CHRONIC DISEASE IS OUR HANG ON CHALLENGE. THIS IS A COMMUNITY CHALLENGE TO ASSIST COMMUNITY MEMBERS TO LOSE OR MAINTAIN THEIR WEIGHT DURING THE HOLIDAY SEASON. 330 PARTICIPANTS WERE ABLE TO LOSE A TOTAL OF 345 POUNDS DURING THIS 8-WEEK CHALLENGE. LMC HEALTH PROMOTION STAFF PROVIDED PARTICIPANTS WITH WEEKLY NUTRITION AND EXERCISE EDUCATION HAND-OUTS. Coalition serving the community by issuing community improvement grants: The LMC Health Promotions Department's intention is to build sustainable programs for our community that are in alignment with one of the top health concerns identified by the Community Health Improvement Plans and Process (CHIP) of Barron County: obesity, nutrition, and physical activity. The outcomes obtained will be shared with local civic groups and other community organizations to share the program's successes and Lakeview Medical Center's commitment to the health of our communities. Rice LAKE FREE CLINIC: THE HOSPITAL OFFERS FREE RADIOLOGY AND LAB SERVICES TO THE FREE CLINIC SERVING THE UNDERSERVED POPULATION IN THE AREA. HEALTH AND WELLNESS CENTER: THE HEALTH AND WELLNESS CENTER IS THE ONLY ONE IN THE AREA OFFERING COMMUNITY MEMBERS THE OPPORTUNITY TO EXERCISE WHILE BEING SUPERVISED BY MEDICALLY TRAINED STAFF. LMC financially supports the operating cost as expenses exceed the revenue. Free Blood Pressure Screening: Free blood pressure screenings are provided to community members on a monthly basis at the following locations: Rice Lake Senior Center, LMC Health and Wellness Center, and the LMC Cafe. RADIOLOGY STUDENT EDUCATION, WITC NURSING ORIENTATION and Health Information/ Medical Records education: LAKEVIEW MEDICAL CENTER IS COMMITTED TO SUPPORT THE TRAINING OF FUTURE MEDICAL PROFESSIONALS TO IMPACT PROJECTED MEDICAL STAFF SHORTFALLS. National Diabetes Prevention Program: Starting in January of 2016 LMC started offering the National Diabetes Prevention Program. This program has been approved by the Center for Disease Control (CDC) and has been proven to be successful in the prevention of diabetes. Our LMC-trained facilitators teach the skills that participants need to lose weight, be more physically active, and to manage stress. The program consists of 16 weekly sessions aimed at helping participants maintain healthy lifestyle changes. Two main goals of the program are weight loss of 7% and achievement of 150 minutes of exercise each week. From January to September of 2016, 5 groups with a total of 87 participants completed the program. Of the 87 participants, 90% stayed with the program through completion. Results indicated 7% weight loss in 85% of those that finished the program with 90% achieving 150 minutes of exercise per week. Part VI Line 6 Affiliated Health Care System Roles: Marshfield Clinic Health System, INC. is the sole corporate member of Lakeview Medical Center (LMC). The Marshfield Clinic Health System includes Marshfield Clinic, a multi-specialty physician and healthcare organization comprised of over 50 sites, including a site in Rice Lake, Wisconsin. The integration of LMC and Marshfield Clinic has enhanced the access and quality of health care throughout Rice Lake and the surrounding communities while achieving economic efficiencies. Part VI Line 7 All states with which the organization files a Community Benefit Report: WI X X X X X false true false true true true true false false Tyler Geerdes Pharmacist 115412 96 15022 0 20955 0 151485 0 0 0 Anna Rogalla Pharmacist 120750 600 414 17099 0 26602 0 165465 0 0 0 Roberta Freitag Pharmacist 121995 2183 1015 16830 0 22390 0 164413 0 0 0 Kate Hillyer Manager - Pharmacy Services 130643 3059 209 18225 0 22629 0 174765 0 0 0 Teri Wilczek CHIEF PHILAN OFFICER, MCHS 201625 4948 1119 0 30062 0 22407 0 260161 0 0 Narayana Murali MD CHIEF STRATEGY OFFICER, MCHS 528688 9866 19635 0 30062 0 30868 0 619119 0 0 Patti Haney CHIEF HR OFFICER, MCHS 232209 5007 2623 0 30062 0 25594 0 295495 0 0 Julie Brussow HEALTH PLAN CEO, MCHS 395821 1523 7594 0 30062 0 16692 0 451692 0 0 Jerard Jensen GENERAL COUNSEL, MCHS 349375 4360 0 2080 0 16997 0 372812 0 0 Daniel Ramsey COO of MCHS & MC 642776 21496 0 2080 0 25215 0 691567 0 0 Susan Turney MD CEO, MCHS 826303 170000 94867 0 181292 0 19783 0 1292245 0 62794 Ned Wolf CEO, LMC 265304 6807 19980 30062 0 27388 0 349541 0 0 0 Jackie Klein CFO, LMC 174676 4299 1290 27007 0 24063 0 231335 0 0 0 Cindy Arts-Strenke COO, LMC 194083 4586 690 29265 0 19213 0 247837 0 0 0 Peter Neal MD Board Member 358123 9616 24339 0 29217 0 20759 0 442054 0 0 William Barkley MD Board Member 338735 7520 2811 0 30062 0 27871 0 406999 0 0 Scott Polenz Board Member 213832 5001 8008 0 30062 0 22992 0 279895 0 0 Part I, Line 3 THE MARSHFIELD CLINIC HEALTH SYSTEMS (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE "COMMITTEE") HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL "DISQUALIFIED PERSONS" EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. COMPENSATION TO THE ORGANIZATIONS CEO/EXECUTIVE DIRECTOR WAS PAID BY RELATED PARTY MARSHFIELD CLINIC HEALTH SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, and WRITTEN EMPLOYMENT CONTRACTS. Part I, Line 4B 457(F) Plan SUE TURNEY, MD - $151,230 Part I, Line 5A SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Part I, Line 5B SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Part I, Line 6A SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Part I, Line 6B SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Form 990 Part IV Line 24a LAKEVIEW MEDICAL CENTER OF RICE LAKE, INC. (LMC) IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. THE OBLIGATED GROUP IS RESPONSIBLE FOR OUTSTANDING FINANCED DEBT OBLIGATIONS, HOWEVER LMC HAS NOT BEEN A DIRECT RECIPIENT OF ANY PROCEEDS FROM THE BORROWINGS. ALL BOND FINANCING RELATED TO THE OBLIGATED GROUP IS DISCLOSED ON THE 990 OF MARSHFIELD CLINIC. Form 990 Part VI Line 6 Marshfield Clinic Health System, Inc. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER. Form 990 Part VI Line 7a Marshfield Clinic Health System, Inc. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND HAS THE AUTHORITY TO APPOINT MAJORITY OF THE CORPORATE BOARD MEMBERS AND APPROVE THE PUBLIC DIRECTORS. Form 990 Part VI Line 7b Marshfield Clinic Health System, Inc. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF MARSHFIELD CLINIC. Form 990 Part VI Line 11b The Marshfield Clinic Health System Chief Financial Officer and Marshfield Clinic Health System VP of Finance shall review the completed Form 990. After their review and prior to filing Form 990 with the IRS, the CFO or his/her designee will provide to each member of the Board of Directors a draft copy in electronic or paper form of the completed Form 990 (and all required schedules). The Systems Audit Committee (a subcommittee of the Board of Directors) reviews and approves all corporate tax returns. In addition, the FY16 form 990 was reviewed by outside tax advisor prior to filing. Form 990 Part VI Line 12c Excerpts from System Conflict of Interest Policy: All officers, Board directors, and key employees of every Marshfield Clinic Health System (MCHS) entity, as well as any other person designated by the Audit and Compliance Committee (ACC) to be a Required Reporter by virtue of his or her position at a System entity, shall annually complete a conflict of interest disclosure form. Such forms shall be distributed and recorded by the Systems designated Compliance Officer. All Financial Interests disclosed as part of the annual disclosure process shall be reviewed by the ACC. The ACC shall inform the Board of disclosed financial interests which may bear upon or relate to a transaction upon which the Board or another board, committee or other body of a System Entity, may deliberate or act. In addition to the annual disclosures, if at any time between annual disclosures, a Required Reporter becomes aware that the Board, or a board, committee or other body, of any System entity may deliberate or act upon any Transaction that may have any bearing of any kind upon, or may relate in any manner to, an existing, intended or expected Financial Interest of the Required Reporter, he or she shall disclose the Financial Interest to the relevant System Entity board, committee or body chair, as well as to the System's Compliance Officer, in advance of any deliberations or action, written disclosure of the existence, nature and extent of his or her Financial Interest. All written or oral disclosures of Financial Interests shall be recorded in the minutes of the Board and by the office of the Compliance Officer. The Compliance Officer shall disclose the completed forms as necessary to those MCHS employees responsible for completion of the Systems IRS Form 990. Form 990 Part VI Line 15a & 15B The system's Independent Compensation Committee (Compensation Committee) shall have final authority for approving compensation and benefits of all disqualified persons [as that term is defined in 4958 of the Internal Revenue code (the Code)] employed by the corporation, including but not limited to the corporation's CEO. The term disqualified persons includes, (but is not limited to), any person,( or the person's family member) who was, at any time during the 5-year period ending on the date of the transaction, in a position to exercise substantial influence over the affairs of the organization. It shall be the responsibility of the compensation committee to ensure that the system does not pay an amount that exceeds reasonable compensation for any disqualified person. The compensation committee and its operating procedures shall be designed to establish the rebuttable presumption of reasonableness of compensation outlined in treasury reg. sec. 53.4958-6 with respect to each disqualified person. In determining reasonableness of compensation, the Compensation Committee shall evaluate appropriate information as to comparability of compensation, including but not limited to: compensation levels paid by similarly situated organizations for comparable positions; the availability of similar services in the system's geographic area; current compensation surveys compiled by independent firms; and actual written job offers from similar institutions. The Compensation Committee shall have independent authority to obtain outside expert opinions on the reasonableness and fair market value of compensation and gather other information the committee considers necessary or appropriate to make its decisions on compensation. The Compensation Committee shall document its determination reasonableness of compensation in a timely manner. Form 990 Part VI Line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. Form 990 Part IX Line 11g Marshfield Clinic Health System, Inc., is the parent company for both Marshfield Clinic, Inc. (MC) and Lakeview Medical Center, Inc. (LMC). Most LMC staff are employees of MC and all payroll and benefits are paid and administered by MC. These costs are reported as purchased services for purposes of part IX statement of functional expenses. Form 990 Part XI Line 9 Lakeview Medical Center provided cash distributions to Marshfield Clinic of $37,145,500. MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 390452970 MEDICAL CARE WI 501(C)(3) 3 MCHS false VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 WEST STOUT STREET RICE LAKE WI 54868 391329084 SUPPORT ORG. WI 501(C)(3) 11, III-O NA false SECURITY HEALTH PLAN OF WISCONSIN INC 1515 NORTH SAINT JOSEPHS AVEN MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS false MARSHFIELD CLINIC HERITAGE FNDTN 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 391865942 HONOR INDVDLS WI 501(C)(3) 11-TYPE 1 NA false FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 NA false MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 461495343 HOSPITAL WI 501(C)(3) 11,TYPE III NA false FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) 7 NA false MCHS HOSPITALS INC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) 3 MCHS false MCHS FOUNDATION INC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) 3 MCHS false DIAGNOSTIC TREATMENT CENTER 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI NA RELATED false false MCIS INC 1701 NORTH FIG AVE MARSHFIELD WI 54449 472138889 IT SERVICES WI MCHS C Corp 0 0 false false false true false false false false false false true true false true false false true true true true SECURITY HEALTH PLAN OF WISCONSIN INC M 19864514 COST Part I Note 1: Marshfield Clinic Health System, Inc. (a 501(c)(3) organization), is the parent organization of Lakeview Medical Center, Inc. Note 2: The following companies are related to Lakeview Medical Center, Inc. through brother/sister relationships (all with parent company being Marshfield Clinic Health System, Inc.): Marshfield Clinic, Inc. Security Health Plan of Wisconsin, Inc. Flambeau Hospital, Inc. (see note 5 below) MCIS, Inc. MCHS Hospitals, Inc. Marshfield Clinic Health System Foundation, Inc. Note 3: The following companies are subsidiaries of Marshfield Clinic, Inc., a related 501(c)(3) organization: Marshfield Food Safety, LLC (see note 7 below) Marshfield Clinic Heritage Foundation, Inc. Family Health Center of Marshfield, Inc. (See note 8 below) Diagnostic & Treatment Center, LLC (see note 4 below) Note 4: Marshfield Clinic, Inc. owns a 50% interest in the Diagnostic & Treatment Center, LLC. Those results are reported on the books and records of Marshfield Clinic, Inc. Note 5: Marshfield Clinic Health System, Inc. owns a 50% interest in Flambeau Hospital, inc. Those results are reported on the books and records of Marshfield Clinic Health System, Inc. Note 6: Volunteer Partners of Lakeview Medical Center, Inc., is a supporting organization of Lakeview Medical Center, Inc. Note 7: Marshfield Food Safety, Inc. is a 100% owned subsidiary of Marshfield Clinic, Inc. and is treated as a disregarded entity of Marshfield Clinic, Inc. for tax purposes. Note 8: Marshfield Clinic, Inc. is the sole corporate (non-voting) member of Family Health Center of Marshfield, Inc. Marshfield Clinic, Inc. does not have the authority to appoint board members and therefore is not considered to have control (as defined for 990 reporting purposes) over Family Health Center of Marshfield, Inc. Note 9: Security Administrative Services, LLC is a 100% owned subsidiary of Security Health Plan of Wisconsin, Inc. and is treated as a disregarded entity of Security Health Plan of Wisconsin, Inc. for tax purposes.