2015-05-13T16:00:55-05:00 2014-09-30 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54701 990 2013-10-01 390806404 VERNON MEMORIAL HEALTHCARE INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 MARY KOENIG CFO 6086372101 2015-05-06 1 HOLLY POKRANDT CPA P00449155 7158323407 2015-05-04 2013 2016-02-25 16:41:14Z MARY KOENIG 507 SOUTH MAIN STREET VIROQUA WI 54665 70103530 0 X WWW.VMH.ORG X 1946 WI VERNON MEMORIAL HEALTHCARE, INC. HAS BEEN COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE AND 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 INSURE 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. VERNON MEMORIAL HEALTHCARE IS COMMITTED TO PROVIDING MODERN FACILITIES AND EQUIPMENT CONSISTENT WITH NEW AND CONTEMPORARY MEDICAL TECHNOLOGY. WE WILL FOSTER, STIMULATE, ENCOURAGE AND PROMOTE CONTINUING HEALTHCARE EDUCATION FOR EMPLOYEES AND THE COMMUNITY WE SERVE. ALL THIS, WE MOST SOLEMNLY AND SINCERELY PLEDGE TO THE PEOPLE WHO NEED US, RECOGNIZING FULLY, THAT SERVICE TO HUMANITY IS THE GREATEST SERVICE OF ALL. 11 11 573 200 4033185 -265770 211948 318115 67757409 66342376 512560 685129 -55574 -50027 68426343 67295593 242467 342976 0 0 33591002 33553631 0 0 0 29003399 29734817 62836868 63631424 5589475 3664169 92268973 94910470 30517300 28680870 61751673 66229600 X 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-EFFECTIVE, ACCESSIBLE CARE AND SERVICE USING PROFESSIONALLY EDUCATED STAFF AND SUPERIOR TECHNOLOGY TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY. OUR CARING AND COMMITMENT TO THE COMMUNITY WILL BE DEMONSTRATED BY OUR EMPHASIS ON HEALTH PROMOTION AND DISEASE PREVENTION THROUGH EDUCATION. 0 0 43260457 342976 50352638 WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HEALTHCARE ORGANIZATION'S COMMUNITY BENEFIT, THIS IS A WORK IN PROGRESS. 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-CARE 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 2014, HOSPITAL INPATIENT SERVICES INCLUDED 2,933 ACUTE CARE PATIENT DAYS, 38 SWING BED PATIENT DAYS, AND 330 NEWBORN PATIENT DAYS. THERE WERE 1,329 SURGERY CASES, 7,412 EMERGENCY ROOM/URGENT CARE VISITS, AND 6,370 VISITS TO THE SPECIALTY CLINIC. 11162797 10839624 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 40,042 CLINIC VISITS OCCURRED IN FISCAL YEAR 2014. 2104031 1116929 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 2014, A TOTAL OF 2,186 HOME HEALTH VISITS WERE MADE TO 100 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 112 INDIVIDUALS IN FISCAL YEAR 2014. 56527285 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 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 47 0 573 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 0 0 1 1 1 1 0 WI X MARY KOENIG 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 PHYLLIS MALIN MEMBER 1.00 X 0 0 0 CHARLES NORTON MEMBER 1.00 X 0 0 0 JERRY MORAN MEMBER 1.00 X 0 0 0 JUDY SCHMIRLER MEMBER 1.00 X 0 0 0 TRUDY WALLIN MEMBER 1.00 X 0 0 0 BONNIE RATH MEMBER 1.00 X 0 0 0 BLANE CHARLES MEMBER 1.00 X 0 0 0 ENID NEUBAUER SECRETARY 1.00 X X 0 0 0 LEE CUNNINGHAM TREASURER 1.00 X X 0 0 0 ROGER JOHNSON VICE CHAIRMAN 1.00 X X 0 0 0 ROBERT KNADLE CHAIRMAN 1.00 X X 0 0 0 KYLE BAKKUM CEO 40.00 X 444184 0 41767 MARY KOENIG CFO 40.00 X 498959 0 31299 DR JEFFREY MENN PHYSICIAN 40.00 X 481952 0 40689 DR ANTHONY MACASAET PHYSICIAN 40.00 X 360856 0 33521 ARNOLD NOMANN CRNA 40.00 X 419034 0 29421 BRIAN MILLER CRNA 40.00 X 339594 0 36336 DR PAUL MARISKANISH PHYSICIAN 40.00 X 466858 0 18693 GARITH STEINER FORMER CEO 40.00 X 838930 0 21645 3850367 0 253371 42 1 1 0 GUNDERSEN HEALTH SYSTEM 1900 SOUTH AVE LA CROSSE WI 54601 LAB/RADIOLOGY 2266254 MARKET & JOHNSON 2350 GALLOWAY STREET EAU CLAIRE WI 54702 CONSTRUCTION 1541688 GPS ANESTHESIA SERVICES N2685 POTATO RIDGE ROAD LA CROSSE WI 54601 ANESTHESIA SERVICES 417920 RURAL WISCONSIN HEALTH COOPERATIVE 880 INDEPENDENCE LANE SAUK CITY WI 53583 MRI SERVICES 268307 CLINICAL ULTRASOUND SERVICES PO BOX 7 POSTVILLE IA 52162 ULTRASOUND SERVICES 222975 13 33781 284334 318115 HOSPITAL 621990 48000283 48000283 CLINIC 621110 10839624 10839624 RETAIL PHARMACY 446110 6176964 2254950 3922014 HOME HEALTH & HOSPICE 621610 1116929 1116929 MEALS AND DIETARY 722210 208576 97405 111171 66342376 625124 625124 254284 304311 -50027 -50027 -50027 2548581 15050 2490085 13541 58496 1509 60005 60005 67295593 62309191 4033185 635102 342976 342976 601618 601618 24513670 22380856 2132814 991162 904926 86236 5776320 5273750 502570 1670861 1457723 213138 56772 56772 88605 88605 5525061 4420680 1104381 110121 110121 248285 199700 48585 630471 630471 2240462 2240462 86408 55928 30480 2604754 1861565 743189 242747 242747 SUPPLIES 12546348 12531351 14997 EQUIPMENT RENTAL & MAIN 2376291 2213841 162450 BAD DEBT EXPENSE 2254208 2254208 DUES AND SUBSCRIPTIONS 587997 346612 241385 136287 42707 93580 63631424 56527285 7104139 0 1836274 1856060 20145362 17551884 640924 784135 6910634 7072138 2253123 2349866 288325 551271 66417034 27451790 36047407 38965244 20041801 21877801 12180 12180 2133896 2141348 550840 459065 1408207 1289478 92268973 94910470 6715814 5845398 22100761 21314125 66045 60449 1634680 1460898 30517300 28680870 X 61024325 65351043 727348 878557 61751673 66229600 92268973 94910470 X 3664169 843158 -29400 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 4222 4222 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. 1686208 1686208 49868542 19392935 30475607 12450834 8058855 4391979 2411450 2411450 38965244 DEFERRED COMPENSATION PLAN LIABILITY - FUNDED 1460898 1460898 X 65876929 843158 304311 1147469 64729460 2566133 2566133 67295593 61369602 304311 304311 61065291 2566133 2566133 63631424 PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, VERNON MEMORIAL HEALTHCARE, INC. ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. VERNON MEMORIAL HEALTHCARE, INC. HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF SEPTEMBER 30, 2014 AND 2013. FEDERAL TAX RETURNS FOR TAX YEARS ENDED SEPTEMBER 30, 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE 304,311. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET AGAINST REVENUE 311,925. BAD DEBT EXPENSE NET AGAINST REVENUE 2,254,208. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE 304,311. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET AGAINST REVENUE 311,925. BAD DEBT EXPENSE NET AGAINST REVENUE 2,254,208. 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 1126980 1126980 0.01840 7196455 4739732 2456723 0.04000 8323435 4739732 3583703 0.05840 239052 15040 224012 0.00360 275325 275325 0.00450 371556 540 371016 0.00600 885933 15580 870353 0.01410 9209368 4755312 4454056 0.07250 390 390 0.00000 630 630 0.00000 57059 1125 55934 0.00090 58079 1125 56954 0.00090 0 1274716 1019770 10940150 11587749 -647599 X 1 0 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 1 X X X X X X X X X X 12 1 1 1 X SEE PART V, LINE 5D X SEE PART V, LINE 5D X X X X X X X X X X 0 0 1 1 300.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 1J: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("COMPASS NOW 2012") 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, FOCUS GROUP DISCUSSIONS HELD WITH COMMUNITY MEMBERS, AN EXTENSIVE REVIEW OF SOCIO-ECONOMIC INDICATORS, AND 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 NOW REPORT ARE: HEALTH, INCOME, EDUCATION, AND COMMUNITY. VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 3: EIGHT KEY STAKEHOLDER MEETINGS WERE HELD. EACH COUNTY FOCUS GROUP TEAM IDENTIFIED KEY COMMUNITY LEADERS REPRESENTING A BROAD RANGE OF COMMUNITY INTERESTS TO PARTICIPATE IN THESE MEETINGS. TWO-HUNDRED FORTY COMMUNITY LEADERS REPRESENTING BUSINESS, CLERGY, HEALTHCARE PROVIDERS AND STAFF, ELECTED OFFICIALS, LAW ENFORCEMENT, EDUCATION, SCHOOL COUNSELORS, UNITED WAY PARTNER AGENCIES, FARMERS, AND COUNTY OFFICIALS FROM THE FIVE COUNTY AREA ATTENDED THE KEY STAKEHOLDER MEETINGS. VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 4: THE COMPASS NOW 2012 PARTNERSHIP WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. GUNDERSEN LUTHERAN2. MAYO CLINIC HEALTH SYSTEM3. TOMAH MEMORIAL HOSPITAL4. TRI-COUNTY MEMORIAL HOSPITAL VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5D: 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/UPLOAD/DOCS/STJOES/COMMUNITYNEEDSASSESSMENTSUMMARY2012.PDFHTTP://MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/LA-CROSSE/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 7: 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. VERNON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 14G: FORMS AND INSTRUCTIONS ARE AVAILABLE AT ALL REGISTRATION AREAS, INCLUDING THE MAIN HOSPITAL, EMERGENCY ROOM, AND OUTLYING CLINICS. 9 HIRSCH CLINIC 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PROVIDER BASED RURAL HEALTH CLINIC VERNON MEMORIAL HEALTHCARE PHARMACY 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PHARMACY LAFARGE MEDICAL CLINIC 111 W SNOW ST LAFARGE WI 54639 PROVIDER BASED RURAL HEALTH CLINIC SOLAR TOWN PHARMACY 104 SUNSET AVE SOLDIERS GROVE WI 54655 PHARMACY BLAND CLINIC 100 MELBY ST WESTBY WI 54667 PROVIDER BASED RURAL HEALTH CLINIC KICKAPOO VALLEY MEDICAL CLINIC 102 SUNSET AVE SOLDIERS GROVE WI 54655 PROVIDER BASED RURAL HEALTH CLINIC VERNON MEMORIAL HEALTHCARE INC 705 ARENA DRIVE VIROQUA WI 54665 HOSPICE VERNON MEMORIAL PHARMACY - WESTBY 115 W STATE STREET WESTBY WI 54667 PHARMACY 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, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,254,208. 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 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 OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CHARITY CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITY CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. 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 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 III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, VERNON MEMORIAL HEALTHCARE, INC. ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS 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), THE ORGANIZATION 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 DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. 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 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 THREE RETAIL PHARMACIES LOCATED IN VIROQUA, WESTBY AND SOLDIERS GROVE. 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 77824 SUPPORT OF BIGLEY POOL, CROSS COUNTRY, POVERTY AWARENESS, BOOK OF THE MONTH PROGRAM YOUTH INITIATIVE HIGH SCHOOL 500 EAST JEFFERSON ST VIROQUA WI 54665 391906073 501(C)(3) 15000 MATCHING FUNDS WESTBY AREA SCHOOL DISTRICT 206 WEST AVE SOUTH WESTBY WI 54667 396005143 GOV'T ORGANIZATION 40000 SOFTBALL FIELD VIROQUA AREA FOUNDATION PO BOX 262 VIROQUA WI 54665 391603279 501(C)(3) 90000 FAIRGROUNDS BUILDING AND VIROQUA PUBLIC LIBRARY RUNNING INC DBA SCENIC MISSISSIPPI REGIONAL TRANSIT (SMRT) 318 W DECKER STREET VIROQUA WI 54665 392014619 GOV'T ORGANIZATION 5000 MATCHING FUNDS FAMILY AND CHILDREN'S CENTER 1707 MAIN STREET LA CROSSE WI 54601 390821863 501(C)(3) 25000 CAMPAIGN FOR BETTER TOMORROWS WDRT - DRIFTLESS COMMUNITY RADIO 311 MAIN STREET VIROQUA WI 54665 743090618 501(C)(3) 5000 PROGRAMMING 7 0 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 255227 0 165630 0 23327 0 15483 0 26284 0 485951 0 62928 0 MARY KOENIG CFO 212642 0 279118 0 7199 0 12939 0 18360 0 530258 0 85921 0 DR JEFFREY MENN PHYSICIAN 473452 0 8500 0 0 0 13062 0 27627 0 522641 0 0 0 DR ANTHONY MACASAET PHYSICIAN 352356 0 8500 0 0 0 17647 0 15874 0 394377 0 0 0 ARNOLD NOMANN CRNA 410857 0 8177 0 0 0 12622 0 16799 0 448455 0 0 0 BRIAN MILLER CRNA 328609 0 6673 0 4312 0 10052 0 26284 0 375930 0 0 0 DR PAUL MARISKANISH PHYSICIAN 458358 0 8500 0 0 0 0 0 18693 0 485551 0 0 0 GARITH STEINER FORMER CEO 0 0 836330 0 2600 0 0 0 21645 0 860575 0 405487 0 PART II, COLUMN F: UNFUNDED DEFERRED COMPENSATION THAT WAS REPORTED IN PRIOR YEARS (2010 THROUGH 2013) ON SCHEDULE J, PART III IS REFLECTED IN PART II, COLUMN F. THE UNFUNDED DEFERRED COMPENSATION WAS PAID OUT IN DECEMBER 2013. THE TOTAL PAID OUT WAS $1,264,887, ALL OF WHICH HAD BEEN RECOGNIZED AS AN EXPENSE IN YEARS PRIOR TO FISCAL YEAR 2014. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VXQ6 2005-05-19 22894672 FINANCE CONSTRUCTION OF FACILITY EXPANSION 0 0 0 A 2005000 22894672 1846325 457893 20590454 2006 0 0 1 1 A 0 0 0 0 0.04530 0.04530 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 SCHEDULE K, PART IV, LINE 2C ARBITRAGE THE REBATE COMPUTATION WAS PERFORMED AS OF MARCH 31, 2010. THE REBATE AMOUNT CALCULATED IN ACCORDANCE WITH TREAS. REG. ACTION 1.148-3(B) FOR THE BONDS WAS $0. 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 THE 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 12 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. 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 9: NET ASSETS RELEASED FROM RESTRICTION FOR OPERATIONS -29,400. 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 11 C - III - FI N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0