2016-08-09T12:55:34-05:00 2015-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY EAU CLAIRE WI 54701 990 2014-10-01 390808526 BALDWIN AREA MEDICAL CENTER INC BALD 7156843311 730 10TH AVENUE BALDWIN WI 540020300 BRIAN LOVDAHL CHIEF FINANCIAL OFFICER 7156843311 2016-08-05 1 PAUL M TRACZEK CPA P00449155 7158323407 2016-08-05 2014 2016-12-15 16:53:06Z ALISON PAGE 730 10TH AVENUE BALDWIN WI 540020300 38152047 0 X WWW.HEALTHYBALDWIN.ORG X 1936 WI BALDWIN AREA MEDICAL CENTER, INC., IS A NONSTOCK, NONPROFIT CORPORATION OPERATING A CRITICAL ACCESS HOSPITAL AS A MEANS TO PROVIDE PATIENT ACCESS TO COMPREHENSIVE MEDICAL, SURGICAL, CLINICAL, AND EMERGENCY CARE FOR INPATIENT AND AMBULATORY PATIENT POPULATIONS. THE CORNERSTONE OF THE MEDICAL CENTER'S MISSION IS TO PROVIDE PATIENTS FROM THE COMMUNITIES WE SERVE WITH ACCESS TO COORDINATED, INTEGRATED, HIGH QUALITY HEALTHCARE VIA A SEAMLESS CONTINUUM OF CARE THROUGH THE SERVICES OF THE HOSPITAL AND CLINICS. 9 7 340 52 2704 0 131898 608690 33606312 36494587 139723 172505 98649 89058 33976582 37364840 1500 500 0 0 18890192 20173350 0 91450 91450 14541624 15434987 33433316 35700287 543266 1664553 32314516 39967016 8528403 14465621 23786113 25501395 X BALDWIN AREA MEDICAL CENTER, INC. IS DEDICATED TO DELIVERING HIGH QUALITY HEALTH AND WELLNESS SERVICES AND BEING A HEALTHCARE RESOURCE FOR EVERYONE WE SERVE. 1 0 24531201 500 28454803 BALDWIN AREA MEDICAL CENTER, INC. (THE "MEDICAL CENTER") OPERATES A CRITICAL ACCESS HOSPITAL WITH A CLEAR AND CONSISTENT CHARITABLE PURPOSE WHICH IS TO PROVIDE HEALTHCARE SERVICES TO ALL RESIDENTS OF THE COMMUNITIES SERVED WITHOUT REGARD TO AGE, RACE, GENDER, CREED, NATIONAL ORIGIN, ABILITY TO PAY, AND PHYSICAL OR MENTAL HANDICAP. THE DEDICATION OF THE MEDICAL CENTER'S WORKFORCE PROVIDES A STRONG FOUNDATION FOR PROGRAM DEVELOPMENT THAT IS BASED UPON COMMUNITY NEED AND IN ALIGNMENT WITH ORGANIZATIONAL VALUES OF EXCELLENCE, INTEGRITY, SERVICE, TEAMWORK, AND STEWARDSHIP. THE MEDICAL CENTER OFFERS COMPREHENSIVE PRIMARY CARE SERVICES AND MANY OTHER SERVICES DEVELOPED IN RESPONSE TO THE NEEDS OF THE PATIENT POPULATION WE SERVE. THE MEDICAL CENTER IS DEVELOPING A FOCUS ON INTEGRATIVE HEALTH SERVICES THAT INCLUDE HOLISTIC SERVICES PROVIDED BY TRADITIONAL MEDICAL PRACTITIONERS, BEHAVIORAL HEALTH SPECIALISTS, DIETICIANS, AND FITNESS EXPERTS. THE MEDICAL CENTER IS DEVELOPING SPECIFIC SERVICES IN THE AREA OF RESILIENCY TRAINING (I.E., A COLLECTION OF SERVICES AIMED AT TEACHING PEOPLE TO MANAGE THEIR OWN PHYSICAL AND EMOTIONAL WELL-BEING) AND IS PILOTING RESILIENCY SERVICES WITH EMPLOYEES. DURING FISCAL YEAR 2015, THERE WERE 374 MEDICAL/SURGICAL ADMISSIONS, 208 SWING BED DAYS, AND 52 NEWBORN DELIVERIES. THE MEDICAL CENTER ALSO HAD 4,154 EMERGENCY ROOM VISITS IN FISCAL YEAR 2015 ALONG WITH ALMOST 30,000 AMBULATORY VISITS. MEDICAL CENTER REPRESENTATIVES PROVIDE A VARIETY OF VOLUNTEER SERVICES TO ENHANCE THE COMMUNITY BY PARTICIPATING IN THE RELAY FOR LIFE, LOCAL HIGH SCHOOL EDUCATION PROGRAMS FOR STUDENTS IN REGARD TO CAREER CHOICES, AND MANY OTHER INITIATIVES. THE MEDICAL CENTER OFFERS SCHOLARSHIP FUNDS TO SELECT AREA HIGH SCHOOL SENIORS LOOKING TO PURSUE A CAREER IN HEALTHCARE AND GRANT PROGRAM DOLLARS TO EMPLOYEES LOOKING TO ENHANCE THEIR PROFESSIONAL SKILLS IN A HEALTH RELATED EDUCATION FIELD. THE MEDICAL CENTER FURTHER SERVES THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT ARE INTENDED TO ENHANCE THE HEALTH AND WELL-BEING OF THE PEOPLE IN THE COMMUNITY. SOME OF THESE SERVICES AND/OR SUPPORT GROUPS INCLUDE: COMMUNITY WIDE HEALTH AND WELLNESS PROGRAMS; "BE WELL" ? A PROGRAM TO PREVENT OBESITY IN ELEMENTARY AGE STUDENTS; CARDIAC, DIABETES, MENTAL HEALTH, AND DEPRESSION SUPPORT GROUPS; DIABETES SELF-MANAGEMENT CLASSES; NUTRITION AND WEIGHT MANAGEMENT CONSULTATION AND PROGRAMS; EXPECTANT PARENT CLASSES AND BREASTFEEDING EDUCATION. THE MEDICAL CENTER IS ALSO OFFERING VIRTUAL EDUCATION CLASSES WHERE MEDICAL CENTER REPRESENTATIVES PROVIDE EDUCATIONAL EVENTS VIA WEBINAR SESSIONS.UNCOMPENSATED CARE:THE MOST SIGNIFICANT EXPRESSION OF CHARITABLE SERVICE IS THE PROVISION OF UNCOMPENSATED HEALTHCARE SERVICES.A. CHARITY CARE THE MEDICAL CENTER PROVIDES HEALTHCARE SERVICES TO ALL PEOPLE, REGARDLESS OF THEIR ABILITY TO PAY. FOR THOSE INDIVIDUALS WITH VERIFIED INCOME THAT IS AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES, SERVICES ARE PROVIDED WITHOUT ANY EXPECTATION OF PAYMENT. FOR INDIVIDUALS THAT HAVE VERIFIED INCOME AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINE, CARE IS AVAILABLE ON A DISCOUNTED SLIDING SCALE. THE MEDICAL CENTER SCREENS POTENTIAL CHARITY CARE PROGRAM PARTICIPANTS AND MAKES PATIENT INFORMATION READILY AVAILABLE ON THE CHARITY CARE PROGRAM. PROCEDURES ARE IN PLACE THAT ACTIVELY SEEK TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR CHARITY CARE. SEE ADDITIONAL INFORMATION ON THE COST OF THIS COMMUNITY BENEFIT IN SCHEDULE H OF THE FORM 990.B. PROVISION FOR BAD DEBT - UNCOLLECTABLE ACCOUNTS THE MEDICAL CENTER ESTABLISHED A PROVISION FOR BAD DEBT EXPENSE (VALUED AT THE USUAL AND CUSTOMARY CHARGE) THAT REPRESENTS THOSE HEALTHCARE SERVICES WHICH WERE PROVIDED TO PATIENTS THAT WERE UNABLE OR UNWILLING TO PAY. SEE ADDITIONAL INFORMATION ON THE COST OF THIS COMMUNITY BENEFIT IN SCHEDULE H OF THE FORM 990. C. GOVERNMENT ENTITLEMENT PROGRAMS THE MEDICAL CENTER FURNISHES HEALTHCARE SERVICES TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS SUCH AS MEDICARE AND MEDICAID. SUCH PROGRAMS PROVIDE PAYMENT FOR SERVICES OFTEN AT RATES THAT ARE SUBSTANTIALLY BELOW THE USUAL AND CUSTOMARY CHARGE. SEE ADDITIONAL INFORMATION ON THE COST OF THESE COMMUNITY BENEFITS PROVIDED IN SCHEDULE H OF THE FORM 990. 5734822 7100979 BALDWIN AREA MEDICAL CENTER, INC. ALSO PROVIDES OUTPATIENT HEALTHCARE SERVICES AT THREE LOCAL CLINICS THAT IT OPERATES. DURING FISCAL YEAR 2015, TOTAL OUTPATIENT ENCOUNTERS AT THESE CLINICS WERE 28,493. ONE OF THE THREE CLINICS IS DESIGNATED AS A PROVIDER-BASED RURAL HEALTH CLINIC.IN ADDITION, THE THREE CLINICS PROVIDED CHARITY CARE AND BAD DEBT EXPENSE FOR FISCAL YEAR 2015 IN THE AMOUNT OF $3,105 AND $52,605, RESPECTIVELY. 396303 148366 BALDWIN AREA MEDICAL CENTER, INC. HAS A FITNESS CENTER THAT IS OPEN TO ALL EMPLOYEES, PATIENTS, AND THE GENERAL PUBLIC. SINCE THEN, VOLUMES HAVE INCREASED DRAMATICALLY. THE CENTER HAS OVER 700 MEMBERS WITH MORE THAN 33,900 ANNUAL VISITS. 30662326 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 1 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 96 0 340 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X BRIAN LOVDAHL 7156843311 730 10TH AVENUE BALDWIN WI 540020300 MARY AABY DIRECTOR / CFO ADORAY HOME HEALTH 1.00 24.00 X 0 63550 4216 CLINT SEMRAU DO DIRECTOR/SURGEON 40.00 X 379345 0 37156 BARRY GRANT DIRECTOR 1.00 X 0 0 0 DANIELLE JOHNSON DIRECTOR 1.00 X 0 0 0 JULIE HERMAN DIRECTOR 1.50 X 0 0 0 PATRICK HAYES CHAIRPERSON/PRESIDENT 1.00 X X 0 0 0 EILEEN LAFAVOR SECRETARY/TREASURER 1.00 X X 0 0 0 DANE RASMUSSEN DIRECTOR 1.00 X 0 0 0 RON SILER VICE PRESIDENT 1.00 X X 0 0 0 ALISON PAGE CEO 50.00 1.00 X 258978 0 32916 BRIAN LOVDAHL CFO 45.00 1.00 X 141545 0 15247 JOEL STOECKELER MD PHYSICIAN 45.00 X 436907 0 33653 SHAIMA SULEMANKHIL MD PHYSICIAN 45.00 X 417067 0 42638 SAMUEL INKUMSAH MD PHYSICIAN 56.00 X 341050 0 38298 MARK ROMZEK MD SURGEON 40.00 X 485777 0 37560 REID BERGER PA-C PHYSICIAN ASSISTANT 45.00 X 253343 0 22204 2714012 63550 263888 17 0 1 0 ALLINA HEALTH SYSTEM NW 7710 PO BOX 9383 MINNEAPOLIS MN 55440 ER PHYSICIAN SERVICES / EKG / IT SERVICE 2252468 ANESTHETISTS INC OF WI PO BOX 159 2302 HWY 46 DEER PARK WI 54007 ANESTHESIA 624966 CENTRAL MN DIAGNOSTIC IMAGING 150 10TH NW PO BOX 158 MILACA MN 56353 RADIOLOGY 557331 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE MN 53527 NUCLEAR MEDICINE 309602 QUEST DIAGNOSTICS PO BOX 12989 CHICAGO IL 60693 LAB SERVICES 241402 9 83744 524946 608690 PATIENT SERVICES REVENUE 621400 35489307 35486603 2704 OTHER HOSPITAL SERVICES/CAFETERIA 621400 787735 787735 WELLNESS CENTER REVENUE 621400 148366 148366 SCHOOL NURSING 621400 69179 69179 36494587 140505 140505 71927 3660 68267 68267 68267 773219 25508 609537 157190 163682 -131682 32000 32000 37611 16820 20791 20791 37364840 35704148 2704 1049298 X 500 500 457703 457703 16323416 13930463 2392953 349831 298547 51284 1948624 1662963 285661 1093776 909843 183933 39160 39160 37705 37705 91450 91450 5218499 4910528 307971 175076 175076 490659 283843 206816 262981 262981 475513 475513 42327 24094 18233 2016 2016 3010780 3010780 185331 185331 MEDICAL SUPPLIES AND PH 2822575 2822575 BAD DEBT EXPENSE 1380673 1380673 MINOR EQUIPMENT AND REP 626548 596723 29825 DUES AND SUBSCRIPTIONS 115270 47570 67700 549874 307711 242163 35700287 30662326 4946511 91450 328578 698894 7251481 5131596 170756 508005 3957823 5383111 683126 765182 284266 490942 39286979 18092321 11997908 21194658 4214466 4455551 3426112 1339077 32314516 39967016 2903963 3187083 244707 360134 473958 937889 4511344 6000000 61113 3564283 333318 416232 8528403 14465621 X 23615357 24993390 170756 508005 23786113 25501395 32314516 39967016 X 1664553 -438070 488799 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6473 6473 0 PART II-B, LINE 1: BALDWIN AREA MEDICAL CENTER, INC. (THE "MEDICAL CENTER") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. WHA AND AHA HAVE NOTIFIED THE MEDICAL CENTER THAT A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. THE MEDICAL CENTER IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, BAMC PAYS MEMBERSHIP FEES TO RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE BETTER HEALTHCARE OPERATIONS FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT A PORTION OF THE FEES PAID BY THE MEDICAL CENTER RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. 2545088 2545088 25929586 12849425 13080161 8271538 5242896 3028642 2540767 2540767 21194658 BOARD-DESIGNATED INVESTMENTS 4455551 F 4455551 DEFERRED COMPENSATION LIABILITY 100295 457(B) PLAN LIABILITY 315937 416232 X X X X X 0 NEWDAY NONPROFIT SOLUTIONS LLC 1710 FENWICK AVE EAU CLAIRE WI 54701 CAPITAL CAMPAIGN ASSISTANCE 0 597596 83000 514596 THE SWEENEY GROUP 88 OAK CREEK TRAIL MADISON WI 53717 CAPITAL CAMPAIGN ASSISTANCE 0 72000 8575 63425 669596 91575 578021 WI GOLF OUTING 20330 20330 8041 AFTERNOON TEA 9496 9496 4146 2 7785 7785 4633 37611 37611 16820 16820 20791 1 1 1 X 1 X 1 1 0 1 1 31535 31535 0.00090 31535 31535 0.00090 195531 195531 0.00570 13876565 9782842 4093723 0.11930 7909 7909 0.00020 14080005 9782842 4297163 0.12520 14111540 9782842 4328698 0.12610 0 844685 422343 11580274 11708750 -128476 X 1 1 1 1 BALDWIN AREA MEDICAL CENTER INC 730 10TH AVENUE BALDWIN WI 54002 WWW.HEALTHYBALDWIN.ORG 1052 X X X X BALDWIN AREA MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 12 1 1 1 1 X SEE PART V, SECTION B, LINE 5D X SEE PART V, SECTION B, LINE 5D X X 1 12 1 HTTP://WWW.HEALTHYBALDWIN.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X WWW.HEALTHYBALDWIN.ORG/VISIT/COMMUNITY-CARE X WWW.HEALTHYBALDWIN.ORG/VISIT/COMMUNITY-CARE X X X X X X 1 X 1 X X X X 1 X 0 0 BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SOUGHT INPUT FROM DIVERSE STAKEHOLDERS, INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. A SURVEY WAS CREATED AND COMPLETED BY 421 RESIDENTS OF ST. CROIX COUNTY, WHERE PARTICIPANTS IDENTIFIED THE HEALTH PRIORITIES THAT THEY FEEL ARE THE MOST IMPERATIVE TO ADDRESS IN THE ST. CROIX COUNTY REGION. BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: CONDUCTED WITH: HUDSON HOSPITAL; HUDSON, WISCONSIN RIVER FALLS AREA HOSPITAL; RIVER FALLS, WISCONSIN WESTFIELDS HOSPITAL; NEW RICHMOND, WISCONSIN BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: CONDUCTED WITH ST. CROIX COUNTY PUBLIC HEALTH DEPARTMENT BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 7D: THE CHNA CAN BE FOUND ON THE HOSPITAL WEBSITE AT: HTTP://WWW.HEALTHYBALDWIN.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/THE CHNA IS ALSO AVAILABLE ON THE VILLAGE OF BALDWIN AND THE BALDWIN CHAMBER OF COMMERCE WEBSITES.FINALLY, THE CHNA IS ALSO ATTACHED TO THE FORM 990 RETURN. BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: BALDWIN AREA MEDICAL CENTER, INC. IDENTIFIED SEVERAL NEEDS WHICH WERE PRIORITIZED AND INCLUDE THE FOLLOWING WHICH ARE CURRENTLY BEING ADDRESSED THROUGH EXISTING PROGRAMS AT THE HOSPITAL OR BY FUTURE INITIATIVES OR COLLABORATION WITH OTHER ORGANIZATIONS. THESE KEY HEALTH NEEDS IN THE COMMUNITY ARE OUTLINES ALONG WITH THEIR IMPLEMENTATION AND ACTION PLANS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT POSTED ON THE MEDICAL CENTER'S WEBSITE:- PROMOTE INCREASING PHYSICAL ACTIVITY AND ACCESS TO NUTRITION RESOURCES TO PREVENT AND TREAT OBESITY- INCREASE ACCESS TO MENTAL HEALTH CARE- IMPROVE ACCESS TO PRIMARY AND PREVENTATIVE CARETHERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY BALDWIN AREA MEDICAL CENTER, 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. ONE NEED THAT WAS IDENTIFIED BUT IS NOT BEING ADDRESSED INCLUDES IMPROVING ACCESS TO DENTISTRY. THIS NEED IS NOT CURRENTLY BEING ADDRESSED AS IT LIES BEYOND THE TRADITIONAL SCOPE OF CARE PROVIDED BY OUR MEDICAL CENTER AND MEDICAL STAFF. BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 16I: AVAILABILITY OF THE FAP IS ALSO PRINTED PATIENT BILLING STATEMENTS WHICH ARE MAILED MONTHLY TO ANY PATIENT HAVING A SELF PATIENT ACCOUNT BALANCE. BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 22D: ALL FAP-ELIGIBLE PATIENTS ARE CHARGED ACCORDING TO THE MEDICAL CENTER'S NORMAL CHARGEMASTER AND THEN DISCOUNTS ARE PROVIDED FROM THE STANDARD CHARGE BASED ON THE PATIENT'S DETERMINATION ACCORDING TO THE FINANCIAL AID DISCOUNT POLICY. ALL PRIVATE PAY PATIENTS ARE OFFERED A 10% DISCOUNT VIA LETTER IF THEY PAY THE ACCOUNT WITHIN THIRTY DAYS FROM THE DATE THEY RECEIVE THE LETTER EVEN IF A PATIENT DOES NOT QUALIFY FOR ASSISTANCE UNDER THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. IN ADDITION TO THE PRIVATE PAY DISCOUNT NOTED ABOVE, PATIENTS THAT QUALIFY UNDER THE CHARITY CARE PROGRAM CAN BE ELIGIBLE FOR THE FOLLOWING DISCOUNTS:UN-INSURED PATIENTS:INCOME OR RESOURCE AVAILABILITY LEVEL: 0-100% OF FEDERAL POVERTY GUIDELINES (FPG)DISCOUNT PERCENTAGE: 100% INCOME OR RESOURCE AVAILABILITY LEVEL: 100-125% OF FPGDISCOUNT PERCENTAGE: 50%INCOME OR RESOURCE AVAILABILITY LEVEL: 126-150% OF FPGDISCOUNT PERCENTAGE: 20%INCOME OR RESOURCE AVAILABILITY LEVEL: 151-300% OF FPGDISCOUNT PERCENTAGE: 10%UNDER-INSURED PATIENTS:INCOME OR RESOURCE AVAILABILITY LEVEL: 0-100% OF FPGDISCOUNT PERCENTAGE: 100%INCOME OR RESOURCE AVAILABILITY LEVEL: 101-150% OF FPGDISCOUNT PERCENTAGE: 20%INCOME OR RESOURCE AVAILABILITY LEVEL: 151-300% OF FPGDISCOUNT PERCENTAGE: 10% PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE: WWW.HEALTHYBALDWIN.ORG/VISIT/COMMUNITY-CARE BALDWIN AREA MEDICAL CENTER, INC. PART V, SECTION B, LINE 16C WEBSITE: WWW.HEALTHYBALDWIN.ORG/VISIT/COMMUNITY-CARE 3 BALDWIN CLINIC 730 10TH AVENUE BALDWIN WI 54002 PROVIDER-BASED RURAL HEALTH CLINIC ROBERTS MEDICAL CLINIC 503 CHERRY LANE ROBERTS WI 54023 PHYSICIAN CLINIC HUDSON CLINIC 502 2ND ST HUDSON WI 54016 MENTAL HEALTH SERVICES OUTPATIENT CLINIC 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 MEDICAL CENTER'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. 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. (THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES FOR LINE 7G ON THE FIRST PAGE OF SCHEDULE H OF THE FORM 990 IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY BALDWIN AREA MEDICAL CENTER, INC.) PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDE THE OPERATION OF THE ADULTS AND PEDIATRICS HOSPITAL INPATIENT UNIT, THE EMERGENCY DEPARTMENT, AND THE RURAL HEALTH CLINIC. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH BALDWIN AREA MEDICAL CENTER, INC. IT IS THE GOAL OF BALDWIN AREA MEDICAL CENTER, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF THE PATIENT'S ABILITY TO PAY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,380,673. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT", THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. BALDWIN AREA MEDICAL CENTER, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE MEDICAL CENTER BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. BALDWIN AREA MEDICAL CENTER, INC., LIKE MOST COMMUNITY 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 MEDICAL CENTER PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, SWING-BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, WOUND CARE, BEHAVIORAL HEALTH, AND WOMEN'S SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 2: THE COSTING METHOD AND CALCULATIONS USED ON FORM 990 ARE BASED ON TOTAL OPERATING EXPENSES EXCLUDING BAD DEBT EXPENSE. THE COMMUNITY BENEFIT EXPENSE PERCENTAGES ARE CALCULATED BY DIVIDING THE COMMUNITY BENEFIT EXPENSE FOR EACH CATEGORY OF COMMUNITY SERVICES PROVIDED BY BALDWIN AREA MEDICAL CENTER, INC. REPORTED IN THE TABLE ON LINE 7 PART I OF THE SCHEDULE H BY THE TOTAL OPERATING EXPENSES OF THE MEDICAL CENTER LESS THE PROVISION FOR BAD DEBTS. PART III, LINE 3: 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 ITS ASSESSMENT OF HISTORICAL COLLECTION LIKLIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUSTANDING AFTER THE MEDICAL CENTER HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS DO NOT COMPLETE REQURIED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE MEDICAL CENTER PROVIDES THIS INFORMATION TO ALL PATIENTS AND PROVIDES ASSISSTANCE WITH THE APPLICATION. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE AND THE MEDICAL CENTER HAS REFLECTED AN AMOUNT OF THESE ADDITIONAL BAD DEBTS IN PART III OF SCHEDULE H OF THE 990. PART III, LINE 4: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, BALDWIN AREA MEDICAL CENTER, INC. ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF PATIENT REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, BALDWIN AREA MEDICAL CENTER, INC. ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), BALDWIN AREA MEDICAL CENTER, INC. RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE MEDICAL CENTER, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE MEDICAL CENTER AS WELL AS HOSPITAL INPATIENT PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND PHYSICIAN 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 BALDWIN AREA MEDICAL CENTER, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2015, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (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 MEDICAL CENTER'S COLLECTION AND CHARITY CARE POLICIES, BALDWIN AREA MEDICAL CENTER, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE MEDICAL CENTER'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 MEDICAL CENTER'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE MEDICAL CENTER, DEPENDING UPON THE PATIENT'S CONDITION, 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 MEDICAL CENTER'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. PART VI, LINE 2: BALDWIN AREA MEDICAL CENTER, INC. ASSESSES THE HEALTHCARE 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. BALDWIN AREA MEDICAL CENTER, INC. IS ALSO A PARTICIPATING MEMBER IN HEALTHIER TOGETHER-ST. CROIX COUNTY, A GROUP IN WHICH LOCAL HOSPITALS, PUBLIC HEALTH, OTHER HEALTH RELATED AND GOVERNMENT ENTITIES, AND COMMUNITY MEMBERS IN ST. CROIX COUNTY WORK TOGETHER TO BETTER UNDERSTAND THE CURRENT AND FUTURE HEALTH NEEDS OF ST. CROIX COUNTY. THE HEALTHIER-TOGETHER-ST. CROIX COUNTY TEAM FOLLOWS THE CENTERS FOR DISEASE CONTROL AND PREVENTION'S (CDC) COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION (CHANGE) TOOL, WHICH WAS DESIGNED TO HELP COMMUNITIES DEVELOP AN ACTION PLAN THROUGH ASSESSMENT AND PRIORTIZATION. PART VI, LINE 3: UNINSURED AND UNDERINSURED PATIENTS ARE ASKED TO MEET WITH THE MEDICAL CENTER'S 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 MEDICAL CENTER'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. PART VI, LINE 4: BALDWIN AREA MEDICAL CENTER, INC. IS LOCATED IN ST. CROIX COUNTY. BALDWIN AREA MEDICAL CENTER, INC.'S PRIMARY SERVICE AREA INCLUDES COMMUNITIES WITHIN A 25 MILE RADIUS. PART VI, LINE 5: BALDWIN AREA MEDICAL CENTER, INC. IS ENGAGED IN MANY ASPECTS OF PROMOTING COMMUNITY HEALTH. NURSING STAFF FROM THE MEDICAL CENTER STAFF THE LOCAL SCHOOL DISTRICT NURSING OFFICE. OUR PHYSICIANS SERVE AS MEDICAL DIRECTORS FOR SCHOOL DISTRICTS IN OUR SERVICE AREA. THROUGHOUT THE YEAR, BALDWIN AREA MEDICAL CENTER, INC. OFFERS EDUCATIONAL SESSIONS OPEN TO ALL COMMUNITY MEMBERS ON A BROAD RANGE OF HEALTH AND MEDICAL TOPICS SUCH AS HEART HEALTH, PAIN MANAGEMENT, EMOTIONAL WELL-BEING, END OF LIFE PLANNING, CAR SEAT SAFETY, AND MUCH MORE. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X X 0 1 0 0 0 0 0 0 0 CLINT SEMRAU DO DIRECTOR/SURGEON 379345 0 0 0 0 0 7800 0 29356 0 416501 0 0 0 ALISON PAGE CEO 258978 0 0 0 0 0 7800 0 25116 0 291894 0 0 0 BRIAN LOVDAHL CFO 141545 0 0 0 0 0 4278 0 10969 0 156792 0 0 0 JOEL STOECKELER MD PHYSICIAN 436907 0 0 0 0 0 7800 0 25853 0 470560 0 0 0 SHAIMA SULEMANKHIL MD PHYSICIAN 417067 0 0 0 0 0 7800 0 34838 0 459705 0 0 0 SAMUEL INKUMSAH MD PHYSICIAN 341050 0 0 0 0 0 7800 0 30498 0 379348 0 0 0 MARK ROMZEK MD SURGEON 485777 0 0 0 0 0 6935 0 30625 0 523337 0 0 0 REID BERGER PA-C PHYSICIAN ASSISTANT 253343 0 0 0 0 0 7600 0 14604 0 275547 0 0 0 PART I, LINE 4B THE MEDICAL CENTER HAS ESTABLISHED A DEFERRED COMPENSATION ARRANGEMENT MADE TO THE PLAN BY EXECUTIVE LEVEL EMPLOYEES AND MEDICAL PROVIDERS. EMPLOYEES INCLUDED IN SCHEDULE J TO THE FORM 990 WHO CONTIBUTED TO THE DEFERRED COMPENSATION PLAN INCLUDED: ALISON PAGE; JOEL STOECKLER, MD; SHAIMA SULEMANKHIL, MD; SAMUEL INKUMSAH, MD; AND MARK ROMZEK, MD. A BALDWIN VILLAGE OF 396006200 2014-11-14 6000000 HOSPITAL CONSTRUCTION 0 0 0 A 6000000 161527 5838473 0 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART III, LINE 2 BALDWIN AREA MEDICAL CENTER IS EXPANDING SERVICES TO BUSINESSES IN TEH COMMUNITIES SERVED. THESE SERVICES INCLUDED HEALTH SCREENING, EDUCATION, PRE-EMPLOYMENT SCREENING AND WORKPLACE EVALUATION. ALSO, A COMPREHENSIVE SET OF SERVICES TO MANAGE CHRONIC PAIN HAS BEEN DEVELOPED AND LAUNCHED BY BALDWIN AREA MEDICAL CENTER. THE PROGRAM IS MANAGED BY THE PHYSICAL THERAPY DEPARTMENT. THE PROGREM IS INTENDED TO REDUCE THE RELIANCE ON ADDICTIVE PAIN KILLERS FOR PEOPLE SUFFERING FROM CHRONIC PAIN. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY BALDWIN AREA MEDICAL CENTER, INC.'S MANAGEMENT. THE FORM 990 IS ALSO PROVIDED TO THE BOARD MEMBERS FOR REVIEW AND FINAL APPROVAL PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS DISCUSSED AT THE ANNUAL MEETING, AND BOARD MEMBERS ARE REQUIRED TO REVIEW, UPDATE, AND SIGN ANNUAL DISCLOSURE STATEMENTS. THE BOARD CHAIR MONITORS FOR CONFLICTS AND ANY BOARD MEMBERS WITH KNOWN CONFLICTS ARE ASKED TO REFRAIN FROM VOTING ON THOSE CONFLICTED ITEMS. FORM 990, PART VI, SECTION B, LINE 15 FOR ALL POSITIONS, SALARY SURVEYS ARE COMPLETED BY BALDWIN AREA MEDICAL CENTER, INC. AND THE DATA IS COLLECTED BY A THIRD-PARTY. THE REVIEW OF THE DATA IS CONDUCTED BY BALDWIN AREA MEDICAL CENTER, INC. IN THE CASE OF THE CEO, THE DATA IS REVIEWED BY THE BOARD CHAIR AND EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WHO DETERMINE WHAT THE CEO RECEIVES FOR A SALARY INCREASE. SENIOR MANAGER POSITIONS ARE REVIEWED BY THE CEO WHO MAKES THE FINAL DECISION AS TO THE INCREASE AMOUNT OR WAGE ADJUSTMENT. HOWEVER, IN THE MAJORITY OF INSTANCES IT HAS BEEN BASED UPON WHAT THE MEDICAL CENTER CAN AFFORD, WHICH HAS BEEN HELD LOWER THAN SUGGESTED MARKET OR MERIT INCREASES. FOR ALL OTHER POSITIONS, THE HUMAN RESOURCES DIRECTOR MAKES THE RECOMMENDATION AND THE SENIOR MANAGER REVIEWS THE RECOMMENDATION AND FINALLY THE ENTIRE PLAN IS REVIEWED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G EMERGENCY ROOM PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,282,212. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,282,212. LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 347,391. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 347,391. RADIOLOGY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,173,790. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,173,790. ANESTHESIA PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 667,653. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 667,653. CLINIC CONTRACTED PHYSICIANS: PROGRAM SERVICE EXPENSES 218,208. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,208. PHARMACY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 497,941. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 497,941. HOUSEKEEPING/LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 76,064. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,064. EKG PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 254,240. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 254,240. OB PHYSICIAN CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 182,530. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 182,530. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 210,499. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 210,499. ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 307,971. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 307,971. FORM 990, PART XI, LINE 9: INCREASE IN EQUITY OF UNCONSOLIDATED AFFILIATES 151,550. REMOVAL OF INVESTMENT IN ADORAY 0. INCREASE IN PLEDGES RECEIVABLE 337,249. FORM 990, PART XII, LINE 2C, SELECTION OF INDEPENDENT ACCOUNTANT: THE MEDICAL CENTER ANSWERED "YES" TO QUESTION 2C UNDER PART XII OF THE 990, INDICATING THAT THE MEDICAL CENTER DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE FULL BOARD OF DIRECTORS REVIEWS THE FINANCIAL STATEMENTS AND LISTENS TO THE AUDIT FIRM PRESENTATION. MEMBERS OF THE BOARD ALSO ARE GIVEN ACCESS TO THE AUDIT FIRM THROUGHOUT THE YEAR AND ARE ALLOWED THE OPPORTUNITY TO MEET WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT DURING THE ANNUAL FINANCIAL STATEMENT PRESENTATION. THERE WERE NO CHANGES TO THESE PROCEDURES IN FISCAL YEAR 2015. ST CROIX VALLEY SHARED SERVICES INC 2231 HWY 12 BALDWIN WI 540029248 391791601 HOME HEALTH AND HOSPICE WI 501(C)(3) LINE 9 N/A 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 ST CROIX VALLEY SHARED SERVICES INC D 122070 81.38% OF LOC BALANCE AT 09/30/15