2017-07-25T14:55:52-05:00 2016-09-30 390758449 Wipfli LLP 3703 Oakwood Hills Pkwy Eau Claire WI 54701 990 2015-10-01 390806404 Vernon Memorial Healthcare inc VERN 6086372101 507 South Main Street VIROQUA WI WI 54665 Mary Koenig CFO 6086372101 2017-07-19 1 HOLLY POKRANDT CPA P00449155 7158323407 2017-07-19 2015 2021-01-29 14:40:06Z Mary Koenig 507 South Main Street VIROQUA WI WI 54665 80101776 0 X www.vmh.org X 1946 WI VERNON MEMORIAL HEALTHCARE, INC. WILL STRIVE TO HAVE THE VISION TO CONTINUALLY PROVIDE THE HIGHEST STANDARD OF CARE TO OUR PATIENTS AND THEIR FAMILIES WHILE BEING 'CLOSE TO HOME.' OUR MISSION IS TO PROVIDE COST-EFFFECTIVE, ACCESSIBLE CARE AND SERVICES USING PROFESSIONAL TREATMENT TO THE INJURED, AFFLICTED, AND WELL PEOPLE WHO NEED THE RESOURCES WE HAVE AT OUR COMMAND, WITHOUT REGARD TO RACE, CREED, COLOR, SEX, HANDICAP, NATIONAL ORIGIN, OR ABILITY TO PAY. IT IS OUR INTENTION TO ENSURE THAT IN EACH AND EVERY CASE OUR PATIENTS SHALL BE TREATED WITH COMPASSION, UNDERSTANDING AND DIGNITY. FURTHER, THE RIGHTS AND PRIVILEGES OF THE PEOPLE WE SERVE SHALL ALWAYS BE HELD IN THE HIGHEST REGARD, AND THEIR WELL-BEING MUST ALWAYS HAVE FIRST CONSIDERATION. 10 10 590 125 3757959 -1217385 367841 477424 71679620 74586404 782138 813598 -49079 -30663 72780520 75846763 376628 343884 0 0 37498804 40020870 0 0 0 30076729 32916700 67952161 73281454 4828359 2565309 97191474 100851925 27326196 27026118 69865278 73825807 X WE ARE COMMITTED TO BEING THE BEST COMMUNITY HEALTHCARE SYSTEM IN THE REGION. 1 0 47890539 343884 56564093 Our organization provides significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit which cannot be quantified. Our organization was created and is maintained in order to provide care locally that, without the presence of our organization, would not be available to the people in our service area.Beyond medical, obstetrical, newborn, and surgical inpatient hospitalizations, we provide local access to many other health services including a birthing center, a dialysis center, diagnostic services-laboratory, imaging and cardiac testing, 24-hour emergency services, urgent care services, infusion services, gastrointestinal services, home health care, hospice inpatient and outpatient care, rehabilitation services-physical, occupational, respiratory and speech therapy, specialty medicine, and primary care clinics. In fiscal year 2016, hospital inpatient services included 3,008 acute care patient days, 129 swing bed patient days, and 299 newborn patient days. There were 1,321 surgery cases, 7,991 emergency room/urgent care visits, and 7,187 visits to the specialty clinic. 13131066 11524837 Vernon Memorial Healthcare, Inc. operates four rural health clinics located in Viroqua, LaFarge, Soldiers Grove, and Westby. Together, the rural health clinics strive to meet the healthcare needs of patients and families who live and work in the communities they serve. A total of 40,603 clinic visits occurred in fiscal year 2016. 2528426 1429990 Vernon Memorial Healthcare, Inc. also provides home health and hospice services. The Home care agency provides quality healthcare to patients in the comfort of their own home. The Home care team works together to provide instruction, care and support. During fiscal year 2016, a total of 2,314 home health visits were made to 147 individuals. Vernon Memorial Healthcare Hospice offers care, comfort, and support when it is needed most. Hospice is for patients, families, friends, and caregivers dealing with the end of life. This support brings comfort, hope and reassurance. Vernon Memorial Healthcare Hospice serves patients at home, in the Bland Bekkedal hospice house, in long-term care facilities, or at Vernon Memorial hospital. Hospice care was provided to 139 individuals in fiscal year 2016. 1586975 1309525 Vernon Memorial Healthcare, Inc. began providing assisted living care services in January 2016 at locations in Viroqua, Westby, and Coon Valley. the average monthly census of residents in the assisted living facilities was 51 in 2016. 1586975 1309525 65137006 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 67 0 590 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Mary Koenig 6086372101 507 South Main Street VIROQUA WI WI 54665 Charles Norton Member 1.00 X 0 0 0 Therese Flock Member 1.00 X 0 0 0 Brandon Munson Member 1.00 X 0 0 0 Trudy Wallin SECRETARY 1.00 X X 0 0 0 Bonnie Rath MEMBER 1.00 X 0 0 0 Blane Charles MEMBER 1.00 X 0 0 0 GINGER VONRUDEN MEMBER 1.00 X 0 0 0 Lee Cunningham TREASURER 1.00 X X 0 0 0 ROGER JOHNSON CHAIRMAN 1.00 X X 0 0 0 SHARON NELSON MEMBER 1.00 X 0 0 0 Kyle Bakkum CEO 40.00 X 268650 0 40585 Mary Koenig CFO 40.00 X 238135 0 32688 DR JAMES GILL ER Physician 40.00 X 367137 0 10327 Dr Anthony Macasaet Physician 32.00 X 421243 0 33453 Arnold Nomann CRNA 40.00 X 400776 0 29894 Brian Miller CRNA 40.00 X 380006 0 37715 Dr Patrick Scott Physician 40.00 X 386862 0 25954 2462809 0 210616 45 0 1 0 Market & Johnson 2350 Galloway Street Eau Claire WI 54702 BUILDING CONTRACTOR 4579869 MARKET MATERIALS 2350 GALLoway Street EAu Claire WI 54702 BUILDING CONTRACTOR 1352649 Gundersen Health System 1900 South Ave La Crosse WI 54601 Lab/Radiology 1350380 RWHC ITN 880 Independence Ln Sauk City WI 53583 IT services 616292 GPS Anesthesia Services N2685 Potato Ridge Road La Crosse WI 54601 Anesthesia Services 439650 13 305174 172250 477424 Hospital 621990 53134089 53134089 Clinic 621110 11524837 11524837 Retail Pharmacy 446110 6998742 3341638 3657104 Home Health & hospice 621610 1429990 1429990 CBRF 623000 1309525 1309525 189221 88366 100855 74586404 588462 588462 274337 305000 -30663 -30663 -30663 4175149 3950013 225136 225136 225136 75846763 70828445 3757959 782935 343884 343884 576248 576248 28262045 25684904 2577141 1150074 1045202 104872 8170564 7425512 745052 1861939 1665269 196670 198045 198045 76616 76616 6134767 5222815 911952 141067 141067 256805 208736 48069 770337 770337 1945683 1945683 85795 64992 20803 3298326 2370402 927924 223543 223543 Supplies 14798901 14761813 37088 Equipment Rental & Main 2907837 2630914 276923 Bad debt expense 1342587 1342587 Dues and Subscriptions 636125 380598 255527 100266 43695 56571 73281454 65137006 8144448 0 1878775 1919790 17564785 11034520 1074627 595301 7174996 8121045 2389008 2508415 461451 495625 83055935 33678065 43964518 49377870 21024646 23556890 12180 235114 282154 581794 1364334 2425561 97191474 100851925 6033063 5123588 19629003 19194586 302242 1164400 1361888 1543544 27326196 27026118 X 68693577 73138950 1171701 686857 69865278 73825807 97191474 100851925 2565309 1395220 0 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 4412 4412 0 Part II-B, Line 1: Vernon Memorial Healthcare, Inc. pays annual association membership dues to the wisconsin hospital association and rural wisconsin health cooperative. These dues are primarily for access to educational materials and staff training and development. A small portion of the annual dues were used in conjuction with lobbying activities with the goal of improving the overall healthcare environment. 1572408 1572408 64458785 23633927 40824858 16370623 10044138 6326485 654119 654119 49377870 deferred compensation plan liability - funded 1543544 1543544 75884440 1395220 305000 1700220 74184220 1662543 1662543 75846763 71923911 305000 305000 71618911 1662543 1662543 73281454 Part XI, Line 2d - Other Adjustments: Rental Expenses net against revenue 305,000. Part XI, Line 4b - Other Adjustments: Expenses net against revenue 319,956. Bad debt expense net against revenue 1,342,587. Impairment Loss Part XII, Line 2d - Other Adjustments: Rental Expenses net against revenue 305,000. Part XII, Line 4b - Other Adjustments: Expenses net against revenue 319,956. Bad debt expense net against revenue 1,342,587. Loss on extinguishment of debt Impairment Loss 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 930897 930897 0.01290 8068565 5516357 2552208 0.03550 8999462 5516357 3483105 0.04840 253618 11730 241888 0.00340 314621 314621 0.00440 275852 275852 0.00380 844091 11730 832361 0.01160 9843553 5528087 4315466 0.06000 400 400 0.00000 2500 2500 0.00000 2500 2500 0.00000 95 95 0.00000 57589 684 56905 0.00080 63084 684 62400 0.00080 0 1342587 770048 13578267 14263429 -685162 X 1 1 1 1 Vernon Memorial Hospital Inc 507 South Main St Viroqua WI 54665 WWW.VMH.ORG 1053 X X X X Vernon Memorial Hospital Inc 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X See part V, line 7d X See part V, line 7D X X 1 15 1 http://www.vmh.org/content/community-needs-assessment 0 0 1 X 250.000000000000 250.000000000000 X X X X X X 1 1 X X X X 1 X http://www.vmh.org/content/financial-assistance-program X http://www.vmh.org/content/financial-assistance-program X http://www.vmh.org/content/financial-assistance-program X X X X X 1 X 0 X X X X 1 X 0 0 Vernon Memorial Hospital, Inc. Part V, Section B, Line 3j: The Community Health Needs Assessment ("Compass Now 2015") process included a variety of data collection methods used to create an overall description of the issues facing our communities. These methods include a random household survey, convenience survey, community conversations, and an extensive review of socio-economic indicators which provides an inventory of community resources. The data collected guided the development of 4 pillar profiles. We refer to them as pillars since they create the building blocks to a better life. The pillars of the Compass are: Health, Income/Economic, Education, and Community. Vernon Memorial Hospital, Inc. Part V, Section B, Line 5: In addition to the Random Household Survey, the COMPASS NOW 2015 community needs assessment also included a convenience sample that focused on specific subgroups in the Great Rivers Region. The overall objective of this sampling was to collect feedback from populations within the community that were potentially underrepresented in the Random Household Survey due to the small number in which they exist in the community. These smaller populations included, but were not limited to, African Americans, Hispanics, LGBT youth, youth at-risk, low-income adults, and senior citizens. Results from this survey were compared to the responses of the Random Household Survey respondents in an attempt to determine any significant differences that existed between the general population and those in smaller subgroups within the community. In total, 753 community members shared feedback through the convenience sample process. Another way in which community feedback was gathered was through community conversations.COMPASS councils were advisory groups of local experts in the fields of education, income, health, and a variety of community issues. These members collected and reviewed data, analyzed the survey results, and offered professional insights about topic-specific issues in the Great Rivers Region. After significant review of the data and survey results, priority issues were identified by COMPASS council members. These issues were then ranked by Council members using the criteria below:1. How widespread is the issue in our community?2. How serious are the effects of the issue in our community?3. How important is the issue to the community? Vernon Memorial Hospital, Inc. Part V, Section B, Line 6a: The Compass Now 2015 partnership was conducted in joint effort with the following other hospitals:1. Gundersen Health System2. Mayo Clinic Health System - La Crosse3. Gundersen St. Joseph's Hospital and Clinics4. Mayo Clinic Health System - Sparta5) Tomah Memorial Hospital6) Gundersen Tri-County Hospital and Clinics Vernon Memorial Hospital, Inc. Part V, Section B, Line 6b: The Compass Now 2015 partnership was conducted in joint effort with the following organizations:1. Great Rivers United Way2. La Crosse Community Foundation3. Otto Bremer Foundation4. LaCrosse Community Foundation5. Five Local County health departments Vernon Memorial Hospital, Inc. Part V, Section B, Line 7d: The CHNA is available on the hospital's website: http://www.vmh.org/content/community-needs-assessmentThe CHNA is also available on the following websites: http://www.greatriversunitedway.org/our-work/community-needs-assessment/http://www.gundersenhealth.org/app/files/public/1316/community-st-joe-assess-2015.pdfhttp://mayoclinichealthsystem.org/locations/la-crosse/about-us/community-health-needs-assessment Vernon Memorial Hospital, Inc. Part V, Section B, Line 11: There were items identified in the CHNA which were not addressed by Vernon Memorial Healthcare, Inc.; however, all items were considered if a need was brought to the attention of the group during the information gathering phase of the CHNA process. The items that were not addressed primarily were not addressed due to the financial constraint of providing a new service for a limited population of people within the primary service area.Three identified items were addressed as follows by Vernon Memorial Healthcare, Inc.Chronic Disease and Contributing Factors Chronic diseases such as heart disease, hypertension, high cholesterol, cancers and lung diseases like asthma and chronic obstructive pulmonary disease are all too common among community members. Vernon Memorial Healthcare is implementing an electronic health record system that has a robust population health management module which will assist in the monitoring process. Vernon Memorial Healthcare has developed a program utilizing Lifestyle Health Coaches, who are highly trained, certified, expert facilitators of mindset and behavior change who will work with clients to help them find the willpower, confidence and self-discipline necessary to take back control of their lifestyle choices. We are able to help clients struggling with sedentary lifestyles, poor nutrition, tobacco use, chronic stress and other areas of concern. Also a cancer exercise program based on a program created collaboratively by the American Cancer Society and the American College of Sports Medicine, Certified Cancer Exercise Trainers (CETs) design and administer fitness assessments and exercise programs specific to a person's cancer diagnosis, treatment and current recovery status has been started. An aquatic cardiac rehabilitation program is in place for people who could benefit from Cardiac Rehabilitation due to chronic stable angina or congestive heart failure (CHF), or following a heart attack, coronary artery bypass surgery, PTCA/Stent placement, valve replacement or repair, or heart or heart/lung transplantation. A diabetic education program offers patients a multi-disciplinary team (RN, RD, EP) to provide education and support on managing diabetes to improve overall health and prevent diabetes related complications. Vernon Memorial Healthcare also utilizes a RN-Social worker team to coordinate services/resources to assist patients in reaching their optimal health.Mental Health and or Substance Abuse - The National Institute of Mental health estimates 26.2% of Americans (ages 18 and older) suffer from a diagnosable mental illness in any given year. Additionally, mental disorders are the leading cause of disability in the U.S. for people ages 15 to 44. Mental illness has a significant impact on the workplace that often goes unrecognized. Mental illness causes more days of work loss and work impairment than chronic health conditions such as asthma, diabetes and heart disease. Vernon Memorial Healthcare in collaboration with Center Point Counseling, has hired a psychiatrist and a Licensed Clinical Social worker to improve access to mental health services in our region. Vernon Memorial Healthcare will continue to partner with the Vernon County Partnership Council in implementing activities aimed at educating youth about the consequences of illegal drug use and reducing youth access. The Vernon County Partnership Council, exists to develop and support programming which addresses drug, alcohol and tobacco concerns related to youth risk behaviors.Oral Health - Oral Health is not only important for quality of life, but is related to the health of the rest of the body. Oral disease continues to be a key health concern for the state. According to the Wisconsin Family Health Survey, in 2015, 25.8% of Wisconsin residents in the Great Rivers Region did not receive a dental visit within the last twelve months. Vernon Memorial Healthcare and Scenic Bluffs Community Health Center, Cashton WI have partnered together to provide new/additional access to dental services in Vernon and Crawford counties. Vernon Memorial Hospital, Inc. Part V, Section B, Line 13b: Patient's reliance on Medicare or Medicaid. Vernon Memorial Hospital, Inc. Part V, Section B, Line 22d: Lookback method. 13 1 - HIRSCH CLINIC 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PROVIDER BASED RURAL HEALTH CLINIC 2 - VERNON MEMORIAL HEALTHCARE PHARMACY 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PHARMACY 3 - LAFARGE MEDICAL CLINIC 206 N Snow St LAFARGE WI 54639 PROVIDER BASED RURAL HEALTH CLINIC 4 - solar town pharmacy 104 SUNSET AVE SOLDIERS GROVE WI 54655 PHARMACY 5 - BLAND CLINIC 100 MELBY ST WESTBY WI 54667 PROVIDER BASED RURAL HEALTH CLINIC 6 - KICKAPOO VALLEY MEDICAL CLINIC 102 SUNSET AVE SOLDIERS GROVE WI 54655 PROVIDER BASED RURAL HEALTH CLINIC 7 - VERNON MEMORIAL HEALTHCARE INC 705 Arena Drive VIROQUA WI 54665 HOSPICE 8 - Vernon memorial pharmacy - lafarge 206 N mill street lAFARGE WI 54639 pharmacy 9 - Vernon Memorial Pharmacy - Westby 115 W State Street Westby WI 54667 PharmACY 10 - OLD TIMES 206 POLLY RUDE WAY WESTBY WI 54667 ASSISTED LIVING 11 - FAIRHAVEN 601 ARENA DRIVE VIROQUA WI 54665 ASSISTED LIVING 12 - BOTHNE HOUSE 100 BOTHNE DRIVE COON VALLEY WI 54623 ASSISTED LIVING 13 - VERNON MEMORIAL HEALTHCARE INC 705 Arena Drive VIROQUA WI 54665 HOME HEALTH AGENCY Part I, Line 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE hospital'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. PART I, LINE 7, COLUMN (F) THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $1,342,587. Part II, Community Building Activities: While there is a growing agreement in the United States about what constitutes a non-profit hospital's community benefit, this is a work in progress. Our hospital provides charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit which is not quantified. Our hospital, like most rural hospitals, was created and is maintained in order to provide local access to many health services: birthing center, diagnostics, emergency services and urgent care, home care, hospice, infusion services, inpatient care, laboratory services, occupational health, rehabilitation services, specialty medicine, speech and audiology, surgical services, and womens health. Part III, Line 8: Vernon Memorial Healthcare, Inc. is designated as a critical access hospital and as such a portion of its revenues are paid under a cost reimbursement system. Based on the instructions, the total medicare revenue shown on this form 990 includes only a portion of the gross medicare revenue that is actually received by the hospital from the medicare program. The amounts listed for Medicare do not include physician and mid-level practitioner services for the coverage of the emergency department. Physician coverage is reimbursed primarily on a fee schedule reimbursement methodology at rates that are often below the costs of caring for patients. Emergency services provided to Medicare patients are vital to the well-being of the community and as such these costs and shortfalls should also be considered as an additional benefit that Vernon Memorial Healthcare, Inc. provides to the community and surrounding area. The costing method used above for IRS Form 990 compliance reporting is also based on an overall average cost-to-charge ratio 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) divided by total operating expenses less the provision for bad debt expense. This ratio is then multiplied by the total medicare services which are reimbursed on a cost methodology excluding the fee schedule items like physician and mid-level practitioner services which the hospital would show a large loss on these services.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THE RECIPIENTS ARE TYPICALLY ELDERLY AND/OR DISABLED MEMBERS OF THE COMMMUNITY AND 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: IN ORDER TO PROVIDE THE LEVEL OF AID NECESSARY TO THE GREATEST NUMBER OF PATIENTS IN NEED, AND PROTECT THE RESOURCES NEEDED TO DO SO, THE FOLLOWING GUIDELINES APPLY:1) SERVICES ARE PROVIDED UNDER CHARITY CARE ONLY WHEN DEEMED MEDICALLY NECESSARY AND AFTER PATIENTS ARE FOUND TO HAVE MET ALL FINANCIAL CRITERIA BASED ON THE DISCLOSURE OF PROPER INFORMATION AND DOCUMENTATION. 2) THE MAXIMUM CHARITY CARE WRITE OFF FOR AN ELECTIVE SURGERY PROCEDURE WILL BE 50% OF BILLED CHARGES. 3) PATIENTS ARE EXPECTED TO CONTRIBUTE PAYMENT FOR CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION; THEREFORE, EACH CASE WILL BE REVIEWED SEPARATELY.4) CHARITY CARE IS NOT CONSIDERED AN ALTERNATIVE OPTION FOR PAYMENT AND PATIENTS MAY BE ASSISTED IN FINDING OTHER MEANS OF PAYMENT OR FINANCIAL ASSISTANCE BEFORE APPROVAL FOR CHARITY CARE. 5) UNINSURED PATIENTS WHO ARE BELIEVED TO HAVE THE FINANCIAL ABILITY TO PURCHASE HEALTH INSURANCE MAY BE ENCOURAGED TO DO SO IN ORDER TO ENSURE HEALTHCARE ACCESSIBILITY AND OVERALL WELL-BEING. PART III, LINE 2 THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL PATIENT SERVICES REVENUE DIVIDED BY OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS.THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT WERE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. PART III, LINE 3 MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE 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 ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. Part VI, Line 2: In addition to the Community Health Needs Assessment recently conducted in conjunction with area healthcare facilities, the Great Rivers United Way and county health departments, Vernon Memorial Healthcare continually gathers and reviews data related to community needs by utilizing more informal focus and advisory groups, discussions with area employers, and web surveys, as well as through serving on local and state boards and committees. The Organization collaborates with community organizations, churches, businesses, agencies, and local colleges and universities to determine the needs of the communities served. Board members represent not only the city of Viroqua, but come from the different areas served by the Organization. These Board members regularly meet with the people in their areas to utilize the services offered by the Organization and bring back their issues and concerns. Part VI, Line 3: Vernon Memorial Healthcare, Inc. makes every effort to educate patients about charity care and other discount programs available at the time of registration and following discharge. Forms and instructions are available at all registration areas, including the main hospital, emergency room and outlying clinics. Financial counselors are available during daytime hours to assist patients with completion of forms, either in person or over the phone. Information about charity and discount programs is also available on the organization's website and e-newsletter. Signs regarding the community care program are posted at all registration locations. Part VI, Line 4: Vernon Memorial Healthcare, Inc. serves the city of Viroqua and the surrounding area. Other towns in the primary service area include Westby, Readstown, Soldiers Grove, Cashton, and LaFarge. The secondary service area extends to the cities of DeSoto, Ferryville, Hillsboro, Coon Valley, Richland Center, Gays Mills, and Ontario. The communities and surrounding rural areas in the primary service area have an approximate population of 23,000. The secondary service area includes an additional 25,000 persons. The entire area is rural with an aging population and relatively low income levels. Part VI, Line 5: Vernon Memorial Healthcare, Inc. provides a full range of inpatient and outpatient services to the people in the communities it serves. Services are provided without regard to race, color, creed, religion, gender orientation, disability, age, or national origin. Vernon Memorial Healthcare, Inc. operates a 24/7 emergency room that is open to serve all in need, regardless of ability to pay. The organization owns and operates four rural health clinics located in the cities of Viroqua, Westby, Soldiers Grove, and LaFarge, as well as four retail pharmacies located in Viroqua, Westby, Soldiers Grove and LaFarge. Home health and Hospice services (inpatient and outpatient) are also provided. Vernon Memorial Healthcare, Inc. collaborates with communities, churches, businesses, and other healthcare organizations in the region to facilitate and strengthen accessibility of quality comprehensive healthcare services. The organization supports the local communities by providing convenient locations for primary care and pharmacy services. The Board of Directors is comprised of independent community members who represent the make-up of the areas served by the organization. Vernon Memorial Healthcare, Inc. has an open medical staff made up of qualified physicians who work with the hospital to provide care to the communities served. All qualified physicians and affiliated staff who are granted privileges undergo a thorough and comprehensive credentialing and orientation process. Any surplus funds generated through operations are used to continue to meet the needs of the people that are served through the addition of new facilities and equipment, or the addition or expansion of needed services. Part VI, Line 7, Reports Filed With States WI 1 Viroqua Area Schools 115 N Education Ave Viroqua WI 54665 396004944 GOV'T ORGANIZATION 37700 Support of Bigley Pool, Cross Country, book of the month program, harvest challenge Youth Initiative High School 500 East Jefferson St Viroqua WI 54665 391906073 501(c)(3) 15000 Matching funds, student fundraising WESTBY AREA SCHOOL DISTRICT 206 WEST AVE SOUTH WESTBY WI 54667 396005143 GOV'T ORGANIZATION 19015 softball field project Viroqua Area Foundation PO Box 262 Viroqua WI 54665 391603279 501(c)(3) 123750 Fairgrounds building and Viroqua Public Library Family and Children's Center 1707 Main street La Crosse WI 54601 390821863 501(c)(3) 5000 Matching funds for event City of Prairie du Chien 214 E Blackhawk Drive Prairie du Chien WI 53821 396005636 GOV'T ORGANIZATION 5000 Support for Regional Bus Service Vernon Trails 311 N Washington Street Viroqua WI 54665 710885732 501(c)(3) 8350 Matching funds - trail building, maintenance and equipment Western Technical College 400 7th St N La Crosse WI 54602 396002842 GOV'T ORGANIZATION 35000 Partial compensation nursing clinical instructor - Viroqua campus Vernon County Historical Society 4105 center ave Viroqua WI 54665 391429799 501(c)(3) 10000 capital campaign for elevator project FINE ARTS FOUNDATION OF WESTBY AREA PO BOX 8 WESTBY WI 54667 392018130 501(c)(3) 25000 Performing Arts Center Pledge FRIENDS OF LAWTON MEMORIAL LIBRARY 118 BIRD STREET LA FARGE WI 54639 205596172 501(c)(3) 20000 Library addition LA FARGE AREA SCHOOLS 301 W ADAMS STREET LA FARGE WI 54639 396002844 GOV'T ORGANIZATION 5250 Bleachers PLEASANT RIDGE WALDORF SCHOOL 431 EAST COURT STREET VIROqua WI 54665 391357578 501(c)(3) 9437 Early Childhood Program/Guest Speaker 13 Part I, Line 2: All donees are required to submit their donation requests to the CEO or marketing manager of Vernon Memorial Healthcare, Inc. Requests submitted to the marketing manager are forwarded to the CEO for final approval. The requests must include a detailed description of what the funds will be used for and how they will benefit the community. Donees are asked to provide confirmation of receipt and an explanation of how the funds were used, either verbally or in writing, to the CEO. If the requests are deemed beneficial to the needs of the community, the funds are awarded to the applying organization. X X X 0 1 0 0 0 0 0 0 0 Kyle Bakkum CEO 263650 0 5000 0 0 0 15981 0 24604 0 309235 0 0 0 Mary Koenig CFO 233135 0 5000 0 0 0 12950 0 19738 0 270823 0 0 0 DR JAMES GILL ER Physician 362137 0 5000 0 0 0 10327 0 0 0 377464 0 0 0 Dr Anthony Macasaet Physician 416243 0 5000 0 0 0 18000 0 15453 0 454696 0 0 0 Arnold Nomann CRNA 395776 0 5000 0 0 0 12706 0 17188 0 430670 0 0 0 Brian Miller CRNA 375548 0 4458 0 0 0 10815 0 26900 0 417721 0 0 0 Dr Patrick Scott Physician 381862 0 5000 0 0 0 18000 0 7954 0 412816 0 0 0 A Wisconsin Health and Educational Facilities Authority 391337855 97712DGX8 2014-12-09 19445225 REFINANCE 2005 BONDS 0 0 0 A 200000 19445225 286481 19158744 1 0 1 1 A 0 0 0 0 0.03540 0.03540 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Form 990, Part III, line 2 During 2016, Vernon Memorial Healthcare, Inc. purchased three community-based residential care facilities (CBRFs). The CBRFs are located in Viroqua, Westby, and Coon Valley, Wisconsin. Form 990, Part VI, Section A, line 6 Any person who is eighteen years of age or older and a bona fide resident of Vernon County, Wisconsin, or the area within a radius of twenty-five miles of the City of Viroqua, Wisconsin, and who has heretofore or may hereafter contribute ten dollars or more to Vernon Memorial Healthcare, Inc. (the organization") shall be a member thereof. All members of the Organization shall be voting members. Each member shall have one vote on any matter submitted to a vote of the members of the Organization. Form 990, Part VI, Section A, line 7a The duties of the members of the Organization shall be: the election of members of the Board of Directors of the Organization, the removal of members of the Board of Directors of the Organization, and the changing of the number of directors constituting the Board of Directors of the Organization. Form 990, Part VI, Section A, line 7b The duties of the members of the Vernon Organization shall also include: the amendment, restatement, or modification of the Articles of Incorporation or Bylaws of the Organization; and the approval of the sale, lease, or other disposition of all, or substantially all of the assets and property of the Organization, the dissolution of the Organization, or its merger with another corporation. Form 990, Part VI, Section B, line 11 The form 990 is reviewed by the board of directors of Vernon Memorial Healthcare, Inc. at their regularly scheduled board meeting prior to filing the return. Form 990, Part VI, Section B, line 12c All board members of vernon memorial healthcare, inc. are required to disclose all possible conflicts of interest when first elected to the board of directors. during their terms, if any business relationships are entered into which may affect their independence as a member, the member must immediately disclose these relationships. The compliance department provides education annually when board members are required to update and sign a conflict of interest statement each year. Form 990, Part VI, Section B, line 15 To determine appropriate salary ranges for upper management positions, Vernon Memorial Healthcare, Inc. utilizes benchmark data from surveys conducted by relevant trade organizations. The CEO has the right to amend the determined amount for the CFO and COO. The board has the right to amend the amount for the CEO. The executive committee of the board reviews the data for the CEO annually to determine the amount of his compensation and any changes in compensation are maintained in the personnel file. The CEO reviews the data for the CFO and COO annually to determine the amount of compensation and any changes are maintained in the personnel file. Form 990, Part VI, Section C, line 19 Vernon Memorial Healthcare, Inc. makes its financial statements and governing documents available to the public on a per request basis. The form 990 is also available to the public on a third party website called GuideStar. Form 990, Part XI, Line 2c: Oversight of audit: Vernon Memorial Healthcare, Inc. does not have a specific committee which assumes the responsibility for oversight of the audit. The entire board of directors is responsible for selection of the independent accountant. No changes have been made in the past year regarding this oversight function of the governing body. Vernon Memorial Healthcare Foundation Inc 507 South Main Street Viroqua WI 54665 391515716 Fundraising WI 501(C)3 Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0