2017-05-15T11:33:07-05:00 2016-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2015-07-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 JAMES BRAUN CHIEF ADMINISTRATIVE OFFICER/CFO 7157622484 2017-05-11 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2017-05-11 2015 2021-01-29 14:40:06Z JAMES BRAUN 98 SHERRY AVENUE PARK FALLS WI 54552 22974149 0 X HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWS X 1961 WI TO CREATE HEALTHIER COMMUNITIES WHILE IMPROVING THE HEALTH AND WELL BEING OF THE PEOPLE IN THE RURAL SETTINGS SERVED. 14 14 268 166 0 0 154432 132383 21861419 22793415 26359 26705 0 12747 22042210 22965250 0 0 0 0 11657274 12009340 0 0 0 9131097 10080153 20788371 22089493 1253839 875757 15919928 16464599 5248113 4344182 10671815 12120417 X THE FOLLOWING OBJECTIVES PROVIDE THE DIRECTION FOR FLAMBEAU HOSPITAL IN FULFILLING ITS VISION:- TO CONTINUOUSLY IMPROVE QUALITY SERVICES TO CUSTOMERS BY BUILDING EXCELLENCE INTO EVERY ASPECT AND PROCESS OF THE HOSPITAL. CUSTOMERS INCLUDE PATIENTS AND STAFF MEMBERS. THIS EXCELLENCE DEVELOPS FROM TOTAL QUALITY IMPROVEMENT, AN ENVIRONMENT THAT ENCOURAGES EVERYONE TO CONTRIBUTE TO THE HOSPITAL'S MISSION.- TO ENCOURAGE HEALTH PROMOTION AND WELLNESS THROUGH EDUCATIONAL ACTIVITIES. WHEN FEASIBLE, THESE ACTIVITIES WILL BE PURSUED IN CONJUNCTION WITH AREA HEALTH CARE PROVIDERS.- TO COLLABORATE WITH AND PROVIDE REFERRALS TO AGENCIES PROVIDING SERVICES NOT DIRECTLY AVAILABLE AT THE HOSPITAL.- TO MAINTAIN AN OPEN RELATIONSHIP WITH THE MEDICAL AND HOSPITAL STAFF TO ENSURE EFFICIENT AND EFFECTIVE UTILIZATION OF HOSPITAL RESOURCES.- TO PROVIDE IN-SERVICE AND CONTINUING EDUCATIONAL OPPORTUNITIES FOR HEALTH CARE PERSONNEL AS A MEANS OF PROVIDING QUALITY PATIENT CARE. 0 0 16897423 22711157 FLAMBEAU HOSPITAL PROVIDES WELLNESS ACTIVITIES, EDUCATION AND PRIMARY HEALTHCARE SERVICES TO APPROXIMATELY 17,000 RESIDENTS IN OUR SERVICE AREA. HEALTHCARE SERVICE INCLUDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, AND OTHER OUTPATIENT SERVICES. SERVICES FOR THE YEAR ENDED JUNE 30, 2016 INCLUDED 1,737 INPATIENT DAYS, 97 SWING BED DAYS AND 27,314 OUTPATIENT REGISTRATIONS.FLAMBEAU HOME HEALTH PROVIDES HEALTH CARE SERVICES FOR HOMEBOUND PATIENTS INCLUDING PRIMARY CARE, WOUND AND INFECTION SERVICES, PERSONAL CARE SERVICES, PAIN MANAGEMENT AND OTHER MEDICAL SERVICES THAT CAN BE PROVIDED IN THE HOME. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.FLAMBEAU HOSPICE PROVIDES END OF LIFE CARE TO PATIENTS AND THEIR FAMILIES IN THEIR HOMES OR OTHER APPROPRIATE FACILITIES. ALSO PROVIDED ARE CHAPLAIN, VOLUNTEER AND BEREAVEMENT SERVICES. BEREAVEMENT SERVICES CONTINUE AFTER A PATIENT'S DEATH FOR ONE YEAR OR MORE. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS. 16897423 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 52 0 268 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES BRAUN 7157622484 98 SHERRY AVE PARK FALLS WI 54552 BRIAN KIEF PRESIDENT 1.00 X X 0 0 0 TOM OLSON CHAIRPERSON 1.00 X X 0 0 0 RICK SVEHLA VICE CHAIRPERSON/TREASURER 1.00 X X 0 0 0 LOUAY DANIAL MD DIRECTOR 1.00 X 0 0 0 DAVE DEDA DIRECTOR 1.00 X 0 0 0 TIMOTHY LINDGREN MD DIRECTOR 1.00 X 0 0 0 CAROL MADER DIRECTOR 1.00 X 0 0 0 GAYLE STANGLE DIRECTOR 1.00 X 0 0 0 MATTHEW THOMAS MD DIRECTOR 1.00 X 0 0 0 DAVE ANDERSON DIRECTOR 1.00 X 0 0 0 JULIA RUFF DIRECTOR 1.00 X 0 0 0 SUSAN SCHMIDT DIRECTOR 1.00 X 0 0 0 ROGER STRAND DIRECTOR 1.00 X 0 0 0 JAMES BRAUN CHIEF ADMINISTRATIVE OFFICER/CFO 40.00 X 194536 0 38690 DAVE GRUNDSTROM CAO RETIRED 2016 40.00 X 0 234147 6701 SARA B HILGART PHARMACIST 40.00 X 140563 0 16513 ELIZABETH SCHREIBER DIRECTOR OF HEALTH CARE 40.00 X 104392 0 36684 JANE EATON-NYMAN DIR. OF ORGANIZATIONAL INTEGRITY 40.00 X 130321 0 34697 569812 234147 133285 4 0 1 0 MARSHFIELD CLINIC 1000 N OAK AVENUE MARSHFIELD WI 54449 EKG, ADMIN, ER DOCS, LAB SVCS, MRI 2397233 ALEXANDER KORITTNIG 442 S 3RD AVE PARK FALLS WI 54552 ANESTHESIA 486147 SHARED MEDICAL TECHNOLOGY 202 WEST NEWTON ST RIB LAKE WI 54868 MRI AND NUCLEAR MED SERVICES 421886 MCIS INC 1701 N FIG AVENUE MARSHFIELD WI 54449 INFORMATION TECHNOLOGY SERVICES 419568 TRIMEDX LLC 5451 LAKEVIEW PARKWAY S DRIVE INDIANAPOLIS IN 46268 EQUIPMENT MAINTENANCE 194544 5 19979 112404 132383 NET PATIENT SERVICE REVENUE 621110 22239811 22239811 AFFILIATED ORG RENT 900099 246705 246705 OTHER OPERATING REVENUE 621110 224641 224641 CAFETERIA REVENUE 900099 82258 82258 22793415 26705 26705 21646 8899 12747 12747 22965250 22711157 0 121710 233226 233226 8674056 7061941 1612115 246880 202952 43928 2265431 1828376 437055 589747 488681 101066 68804 68804 1594554 283587 1310967 69870 69870 1462998 1440224 22774 447872 378241 69631 234913 160108 74805 1174009 1079418 94591 282505 282505 MEDICAL SERVICES 3123326 3094061 29265 EQUIPMENT RENTAL 580839 541619 39220 BAD DEBT 565834 565834 FOOD 125903 103535 22368 348726 234680 114046 22089493 16897423 5192070 0 6056 53428 4897867 6159341 2779797 2471403 210637 197174 80776 65050 22903724 15911394 7551093 6992330 393702 525873 15919928 16464599 1461987 1406967 3695774 2820611 90352 116604 5248113 4344182 X 9886238 11274724 785577 845693 10671815 12120417 15919928 16464599 X 875757 572845 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3236 3236 0 PART II-B, LINE 1: FLAMBEAU HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED FLAMBEAU HOSPITAL THAT $3,236 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 73128 73128 14157799 9474950 4682849 457922 347865 110057 8099435 6088579 2010856 115440 115440 6992330 ASBESTOS ABATEMENT LIABILITY 201213 DEFERRED BOND ISSUANCE COSTS (OFFSET AGAINST LONG-TERM DEBT) -84609 116604 X 22399416 0 22399416 565834 565834 22965250 21523659 0 21523659 565834 565834 22089493 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 565,834. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 565,834. GOLF OUTING 16116 16116 3369 LIGHTS OF LOVE 5530 5530 5530 21646 21646 8899 8899 12747 1 1 1 X 25.000000000000 1 X 1 1 0 1 1 112601 112601 0.00520 2242824 1521939 720885 0.03350 2355425 1521939 833486 0.03870 4195 90314 90314 0.00420 1 7 28536 28536 0.00130 4226752 2195321 2031431 0.09440 9452 112724 112724 0.00520 1 13654 4458326 2195321 2263005 0.10510 1 13654 6813751 3717260 3096491 0.14380 2471 2471 0.00010 157 18446 18446 0.00090 180 2588 2588 0.00010 1640 16286 16286 0.00080 1089 1089 0.00010 205 24816 24816 0.00120 2182 65696 65696 0.00320 0 565834 7952435 8336644 -384209 X 1 1 1 1 FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS WI 54552 X X X X FLAMBEAU HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X HTTP://MINISTRYHEALTH.ORG/COMMUNITYBENEFITS/2016/FLAMBEAU_CHNA2016.PDF X 1 15 1 HTTP://MINISTRYHEALTH.ORG/COMMUNITYBENEFITS/2016/FLAMBEAU_IMPLEMENTATIONSTR 1 0 1 X 250.000000000000 400.000000000000 X X 1 1 X X X 1 X HTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWS X HTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWS X HTTP://MINISTRYHEALTH.ORG/FH/HOME/COMMUNITYCAREFINANCIALASSISTANCE.NWS X X X X X X 1 X 0 X X X X 1 X X 0 0 FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 5: FORTY COMMUNITY STAKEHOLDERS WERE ASKED TO PARTICIPATE IN THE PLANNING PROCESS. COMMUNITY HEALTH DATA WAS SENT TO ALL OF THEM TWO WEEKS EFORE THE IN-PERSON MEETING. IN REVIEWING THE DATA, THEY WERE ASKED TO COME PREPARED TO DISCUSS: ANY OUTSTANDING GAPS/NEEDS RELATED TO THE THREE CURENT HEALTH PRIORITIES, ANY EMERGING ISSUES DEMONSTRATED BY THE DATA, ANY ADDITIONAL OBSERVATIONS IN REVIEWING THE DATA. A TOTAL OF 27 INDIVIDUALS ATTENDED THE COMMUNITY HEALTH NEEDS ASSESSMENT MEETING. AFTER THE MEETING, STAKEHOLDERS PARTICIPATED IN A FACILITATED DISCUSSION ABOUT THE COMMUNITY HEALTH DATA, PROGRESS ON THE PREVIOUS PRIORITY AREAS AND ANY EMERGING NEEDS. COMMUNITY ASSETS WERE IDENTIFIED AND BASED ON THOSE ASSETS AND ADDDITIONAL CRITERIA, THE GROUPED DISCUSSED AND REACHED CONCENSUS ON THE HEALTH PRIORITIES FOR THE NEXT THREE YEAS. THOSE WHO PARTICIPATED REPRESENTED:- FLAMBEAU HOSPITAL- MARSHFIELD CLINIC- PRICE COUNTY PUBLIC HEALTH- ASPIRUS- PHILLIPS POLICE DEPARTMENT- PARK FALLS SCHOOLS- PHILLIPS SCHOOLS- PRENTICE SCHOOLS- FLAMBEAU HOME HEALTH AND HOSPICE- PRICE COUNTY HUMAN SERVICES- PHILLIPS PUBLIC LIBRARY- UW-EXENSION- TIME OUT SHELTER- COMMUNITY MEMBERS FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 6B: PRICE COUNTY FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 11: BASED ON THE DATA PRESENTED AND THE PRIORITIZATION PROCESS OF THE COMMUNITY STAKEHOLDERS, THE FOLLOWING PRIORITIES WERE SELECTED: AODA AND MENTAL HEALTH, CHRONIC DISEASE PREVENTION, AND NUTRITRION AND HEALTHY FOODS, AND BASED ON THE DATA AND DISCUSSION, THE HOSPITAL HAS CHOSEN TO ADDRESS AGING POPULATION.IN ADDITION TO THE ISSUES SELECTED ABOVE AS TOP PRIORITY, STAKEHOLDERS IDENTIFIED INJURY AND VIOLOENCE AS A SIGNIFICANT HEALTH ISSUES. THIS ISSUE WILL NOT BE ADDRESSED BY FLAMBEAU HOSPITAL AS A TOP PRIORITY BECAUSE IT WILL BE ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY. HOWEVER, THE HOSPITAL WILL PROVIDE STRONG SUPPORT AND WILL COLLABORATE WHENEVER NEEDED WITH THE COMMUNITY EFFORTS AND THE ORGANIZATION EMBRACE (PREVIOUSLY CALLED TIME OUT) WHICH ADDRESSES THIS AREA IN OUR COMMUNITY. THE FLAMBEAU HOSPITAL IMPLEMENTATION STRATEGY IS PART OF A BROAD COMMUNITY EFFORT TO ADDRESS THE PRIORTY NEEDS IN THE COMMUNITY (AODA, MENTAL HEALTH, CHRONIC DISEASE, AND NUTRITION). ADDRESSING THESE PRIORITIES WILL BE COORDINATED BY THE PRICE COUNTY AODA/MENTAL HEALTH COALILITION AND THE HEALTH AND WELLNESS COALITION. FLAMBEAU HOSPITAL ASSOCIATES LEAD AND ACTIVELY PARTICIPATE ON THESE COALITIONS. THIS IMPLEMENTATION STRATEGY ATTACHED TO THE FORM 990 OUTLINES THE ACTIONS FLAMBEAU HOSPITAL WILL TAKE TO ADDRESS THE HEALTH NEEDS. HOWEVER, AS NOTED BELOW, MANY OF THESE STRATEGIES WILL BE IMPLEMENTED COLLABORATIVELY. RECOGNIZING THAT NO ONE ORGANIZATION IS ABLE TO EFFECT SUBSTANTIAL COMMUNITY CHANGE ALONE, THE LONG-TERM OUTCOMES IDENTIFIED IN THIS PLAN WILL BE ACHEIVED WITH MANY COMMUNITY ORGANIZATIONS WORKING TOGETHER FOR COLLECTIVE IMPACT. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 16I: FLAMBEAU HOSPITAL WILL COMMUNICATE THE FAP IN THE FOLLOWING WAYS:A. IF, DURING THE COURSE OF THE PATIENT REGISTRATION PROCESS, CARE ENCOUNTER, TREATMENT, UPON DISCHARGE OR DURING BILLING PROCESS, IT BECOMES EVIDENT THAT A PATIENT MAY NEED FINANCIAL ASSISTANCE, THE PATIENT SHALL BE REFERRED TO THE ORGANIZATION'S FAP. PATIENTS MAY BE IDENTIFIED AS NEEDING FINANCIAL ASSISTANCE AT ANY TIME DURING THE COURSE OF AN ENCOUNTER. A REFERRAL FOR CONSIDERATION OF THE FAP CAN BE INITIATED BY ANY MEMBER OF THE ORGANIZATION'S WORKFORCE, INCLUDING MEDICAL STAFF MEMBERS, WHO BECOME AWARE OF THE PATIENT'S POTENTIAL NEED FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENT'S GUARANTOR OR RESPONSIBLE PARTY MAY MAKE REQUEST FOR FAP CONSIDERATION.B. AT ADMISSIONS AND INTAKE, PATIENTS WILL BE NOTIFIED VERBALLY USING THE FOLLOWING LANGUAGE: IN THE EVENT THAT YOU ARE UNABLE TO PAY FOR THE COST OF THE CARE YOU RECEIVE, FLAMBEAU HOSPITAL OFFERS FINANCIAL ASSISTANCE. A PLAIN LANGUAGE SUMMARY WILL BE PROVIDED TO THE PATIENT.C. PUBLIC AREAS - FINANCIAL ASSISTANCE BROCHURES AND HANDOUTS WILL BE VISUALLY AVAILABLE AT FLAMBEAU HOSPITAL'S REGISTRATION AND WAITING AREAS. IF PATIENTS REQUEST ADDITIONAL INFORMATION ALL AREAS IDENTIFIED WILL HAVE THE FOLLOWING DOCUMENTS AVAILABLE: 1. FAP (COMPLETE POLICY) 2. PLAIN LANGUAGE SUMMARY 3. FAP APPLICATION 4. AMOUNT GENERALLY BILLED (AGB) POLICY 5. BILLING AND COLLECTION POLICYD. ON-LINE - A LINK TO ALL REQUIRED FAP DOCUMENTS WILL BE POSTED ON THE FRONT PAGE OF FLAMBEAU HOSPITAL'S WEBSITE: HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWSE. ON BILLING STATEMENTS - EACH BILLING STATEMENT WILL INCLUDE A PLAIN LANGUAGE SUMMARY THAT DESCRIBES HOW TO ACQUIRE ADDITIONAL INFORMATION REGARDING ELIGIBILITY AND APPLICATION.F. PUBLIC RADIO AND AREA NEWSPAPERS ADS NOTIFIYING COMMUNITY MEMBERS OF THE FINANCIAL ASSISTANCE POLICY. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 22D: FOLLOWING A DETERMINATION OF ELIGIBILITY UNDER THIS FAP, A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN AGB. FLAMBEAU HOSPITAL DETERMINES AGB BASED ON ALL CLAIMS PAID IN FULL TO FLAMBEAU HOSPITAL BY MEDICARE, MEDICARE ADVANTAGE, MEDICAID, MEDICAID HMO AND PRIVATE HEALTH INSURERS (INCLUDING PAYMENTS BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS THEMSELVES), OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS USING THE LOOK-BACK METHOD. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 24: FOLLOWING A DETERMINATION OF ELIGIBILITY UNDER THIS FAP, A PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE CHARGED MORE FOR MEDICALLY NECESSARY CARE THAN AGB. FLAMBEAU HOSPITAL DETERMINES AGB BASED ON ALL CLAIMS PAID IN FULL TO FLAMBEAU HOSPITAL BY MEDICARE, MEDICARE ADVANTAGE, MEDICAID, MEDICAID HMO AND PRIVATE HEALTH INSURERS (INCLUDING PAYMENTS BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS THEMSELVES), OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS USING THE LOOK-BACK METHOD. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT FLAMBEAU HOSPITAL INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT, AND THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPITAL EMERGENCY DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL EMERGENCY DEPARTMENT COME FROM THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF PRICE COUNTY, WISCONSIN. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF FLAMBEAU HOSPITAL AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF FLAMBEAU HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENTS ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITALS MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR THE FORM 990 PURPOSES. PART I, LN 7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $565,834 INCLUDED ON FORM 990, PART IX, LINE 25 WAS NOT INCLUDED IN TOTAL EXPENSES FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGES. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITALS "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. FLAMBEAU HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. FLAMBEAU HOSPITAL, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING SERVICES, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, HOME CARE, HOSPICE, SWING BED SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SURGICAL SERVICES, AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 4: THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED ABOVE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANETHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT FLAMBEAU HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREASS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 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 BENEFICIARES, 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 THE SERVICES TO THE ELDERLY AND DISABLES MEMBERS OF THE COMMUNITY. PART III, LINE 9B: ONCE A PERSON IS KNOWN TO QUALIFY FOR CHARITY CARE, THE HOSPITAL WILL KEEP THAT INFORMATION ON FILE AND AUTOMATICALLY GRANT CHARITY CARE FOR UP TO A YEAR. AT THAT POINT, THE PATIENT WOULD NEED TO REAPPLY OR VERIFY THAT THEIR SITUATION HAS NOT CHANGED SIGNIFICANTLY SINCE THEIR LAST APPLICATION. CHARITY CARE IS APPLIED FIRST BEFORE ANY COLLECTION EFFORTS ARE PURSUED. PART VI, LINE 2: PERIODIC SURVEYS OF THIS COMMUNITY ALONG WITH REVIEW OF SERVICES BEING PROVIDED FOR THE COMMUNITY AT OTHER SITES. ALSO PARTICIPATING WITH PRICE COUNTY ON THE COUNTY HEALTH ASSESSMENT AND HEALTH PLAN. PART VI, LINE 3: INFORMATION IS POSTED IN THE FACILITY AND ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED FOR ANY ASSISTANCE NEEDS THEY MAY HAVE. PART VI, LINE 4: FLAMBEAU HOSPITAL, INC. PROVIDES SERVICES TO RESIDENTS OF PRICE COUNTY, WI AND PORTIONS OF THREE OTHER COUNTIES. THE NEXT CLOSEST HOSPITAL IS 45 MILES AWAY, AND FLAMBEAU HOSPITAL IS DESIGNATED AS UNDERSERVED. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN THE SHORT PERIOD ENDING JUNE 30, 2015, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 73 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR. PART VI, LINE 5: FLAMBEAU HOSPITAL PROVIDES EDUCATION, NEEDED SUBSIDIZED SERVICES AND SUPPORT TO THE COMMUNITY THROUGH SERVICES IT PROVIDES AND COLLABORATION WITH OTHER GROUPS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 0 0 0 0 0 0 0 0 0 JAMES BRAUN CHIEF ADMINISTRATIVE OFFICER/CFO 194536 0 0 0 0 0 7993 0 30697 0 233226 0 0 0 DAVE GRUNDSTROM CAO RETIRED 2016 0 215753 0 4872 0 13522 0 0 0 6701 0 240848 0 0 SARA B HILGART PHARMACIST 140563 0 0 0 0 0 5704 0 10809 0 157076 0 0 0 JANE EATON-NYMAN DIR. OF ORGANIZATIONAL INTEGRITY 130321 0 0 0 0 0 5440 0 29257 0 165018 0 0 0 A CITY OF PARK FALLS WISCONSIN 396005566 2012-02-10 4523750 REFINANCE 1994, 1997, 2007, AND 2009 LOAN AND FINANCE ER DEPARTMENT REMODEL 0 0 0 A 1703139 4523750 90475 3475615 957660 2012 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 MARSHFIELD CLINIC AND MINISTRY HEALTH CARE, INC. ("MINISTRY"), BOTH WISCONSIN TAX-EXEMPT CORPORATIONS, ARE JOINT CORPORATE MEMBERS OF THE HOSPITAL. MINISTRY ALSO, VIA CONTRACT, SHARES CERTAIN GOVERNANCE AUTHORITIES WITH MARSHFIELD CLINIC WITH RESPECT TO THE PARK FALLS AND PHILLIPS ("PRICE COUNTY CLINICS") CLINIC OPERATIONS OF MARSHFIELD CLINIC, WITH MARSHFIELD CLINIC RETAINING THE REMAINING AUTHORITIES. MARSHFIELD CLINIC HAS CONTRACTED TO PROVIDE OPERATING MANAGEMENT TO THE HOSPITAL AND PRICE COUNTY CLINICS. THE GOAL OF THE MEMBERSHIP ARRANGEMENTS IS TO PROVIDE FOR THE EFFECTIVE, ECONOMICAL, AND COORDINATED MANAGEMENT AND OPERATION OF HEALTH CARE SERVICES IN PRICE COUNTY. COLLECTIVELY, THE PARTIES HAVE ESTABLISHED AN INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR PRICE COUNTY. FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBERS HAVE APPROVED RIGHT FOR DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF BUDGET, ADMINISTRATOR, PROPERTY PURCHASED, AND DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B NOT APPLICABLE AS THERE ARE NO SUB-COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. IF THE BOARD MEMBERS WOULD LIKE ANY EXPLANATION OR CHANGES, THEY WOULD HAVE AN OPPORTUNITY TO COMMENT ON THE RETURN BEFORE ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND KEY EMPLOYEES OF THE HOSPITAL ANNUALLY SIGN TO ADHERE TO THE CONFLICT OF INTEREST POLICY AT FLAMBEAU HOSPITAL, INC. IT IS ASSUMED THAT THE BOARD OF DIRECTORS AND KEY EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTEREST DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE BOARD OF DIRECTORS AND KEY EMPLOYEES RESPONSIBILITY TO REVIEW POTENTIAL CONFLICTS OF INTEREST AND IF A CONFLICT EXISTS THE INDIVIDUAL IS PROHIBITED TO VOTE ON TRANSACTIONS WHERE THE POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE MARSHFIELD CLINIC PREPARES A COMPENSATION SCHEDULE THAT IS USED TO DETERMINE TOP MANAGEMENT AND KEY EMPLOYEE COMPENSATION. COMPENSATION STUDIES ARE ALSO USED TO PROVIDE COMPARABILITY DATA. THIS DATA IS REVIEWED AND APPROVED BY INDEPENDENT PERSONS AND ALL DECISIONS ARE SUBSTANTIATED. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: ADMINISTRATION NON-OP OTHER 572,845. FORM 990, PART XI, LINE 2C THE PROCESS IS CONSISTENT WITH PRIOR YEARS. FLAMBEAU HOSPITAL FOUNDATION INC PO BOX 310 PARK FALLS WI 54552 205957150 SUPPORT OF FLAMBEAU HOSPITAL WI 501 (C) 3 11, I FLAMBEAU HOSPITAL INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0