2015-08-07T16:52:07-07:00 2014-12-31 990 2014-01-01 390808509 THE MONROE CLINIC INC MONR 6083242775 515 22ND AVENUE MONROE WI 53566 James Nemeth CFO 6083242775 2015-06-30 2014 2016-02-25 16:41:14Z James Nemeth 515 22nd Avenue Monroe WI 53566 208258246 0 X WWW.MONROECLINIC.ORG X 1963 WI THE MONROE CLINIC, INC. PROVIDES HEALTHCARE SERVICES TO THE COMMUNITIES IN AND SURROUNDING GREEN COUNTY, WI AND STEPHENSON COUNTY, IL. MEDICAL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. 15 9 1342 127 821494 0 173446 152146 168009534 172789829 2656092 3657774 0 0 170839072 176599749 0 0 0 0 101080610 100789497 0 0 0 64111766 64736227 165192376 165525724 5646696 11074025 254726229 264790166 105814903 104589203 148911326 160200963 X WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS IN HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. VISION: EXCEPTIONAL HEALTH CARE. AN EXCEPTIONAL EXPERIENCE. 0 0 130392001 0 172789829 MONROE CLINIC IS A NOT-FOR-PROFIT HEALTH SYSTEM FEATURING A MULTI-SPECIALTY CLINIC AND HOSPITAL DEDICATED TO BRINGING THE BEST CARE TO THE COMMUNITIES WE SERVE. WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS OF HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. SPONSORED BY THE CONGREGATION OF SISTERS OF ST. AGNES (CSA), MONROE CLINIC OFFERS COMPREHENSIVE HEALTH CARE WITH OVER 120 PROVIDERS, A 24-HOUR EMERGENCY ROOM, HOME CARE AND HOSPICE SERVICES, AS WELL AS MULTIPLE CLINIC LOCATIONS IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. IN ALL THAT WE DO, WE ARE DEDICATED TO HELPING OUR PATIENTS GET BETTER FASTER AND STAY HEALTHIER LONGER. AS A STATE-OF-THE-ART HEALTH SYSTEM, WE OFFER ADVANCED MEDICAL EQUIPMENT AND TECHNOLOGY COMBINED WITH CARE AND SENSITIVITY. PHYSICIANS AND STAFF ARE COMMITTED TO PROVIDING PERSONALIZED HEALTH CARE, EDUCATION AND PEACE OF MIND. OUR PATIENTS BENEFIT FROM EXCEPTIONAL PREVENTIVE AND REHABILITATION SERVICES AND MORE THAN 25 MEDICAL SPECIALTIES. WITH GOD'S BLESSING, MONROE CLINIC IS ABLE TO MEET THE NEEDS OF THOSE WE ARE PRIVILEGED TO SERVE. 0 0 0 130392001 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1609 0 1 1342 1 1 1 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL WI X JAMES NEMETH 6083242775 515 22ND AVENUE MONROE WI 53566 WILLIAM OEMICHEN CHAIRPERSON 3 0 X X 0 0 0 MICHAEL SANDERS PRESIDENT/CEO 50 0 X X X 616888 0 203264 MARK THOMPSON CHIEF MEDICAL OFFICER 50 0 X X 420917 0 148135 SISTER MARY NOEL BROWN DIRECTOR 3 2 X 0 0 0 CHARLES DEARTH DIRECTOR 3 0 X 0 0 0 DAVID DEININGER DIRECTOR 3 0 X 0 0 0 JOHN FREY PHYSICIAN/SECRETARY 50 0 X X 259205 0 44981 MIKE GREENFIELD TREASURER 3 0 X X 0 0 0 PATRICIA JAMES DIRECTOR 3 X 0 0 0 RACHEL LONG PHYSICIAN/DIRECTOR 50 0 X 202810 0 41225 CHRISTINE WELLINGTON VICE CHAIRPERSON 3 X X 0 0 0 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 50 0 X 642795 0 57422 JAMES BERBERET DIRECTOR 3 0 X 0 0 0 DARREN PIPP PHYSICIAN/DIRECTOR 50 0 X 318572 0 42223 CHRISTOPHER SMITH PHYSICIAN/CHIEF OF STAFF 50 0 X 243361 0 40285 SISTER SUSAN STUCKI DIRECTOR 3 0 X 0 0 0 Michelle Brukwicki Director 3 0 X 0 0 0 JULIE WILKE VP CLINICAL OPERATIONS 50 0 X 323865 0 104567 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 50 0 X 228191 0 78142 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 50 0 X 170291 0 61629 JAMES NEMETH CHIEF FINANCIAL OFFICER 50 0 X 204305 0 59358 CARRIE BLUM CHIEF INFORMATION OFFICER 50 0 X 175378 0 62776 JANE MONAHAN VP MINISTRY/HR 50 0 X 167463 0 61704 LANCE SATHOFF PHYSICIAN/ORTHOPEDIC SURGEON 50 0 X 944251 0 63563 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 50 0 X 930687 0 57049 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 50 0 X 912130 0 67082 DAVID BUCHANAN PHYSICIAN/INTERVENTIONAL CARDIOLOGIST 50 0 X 616746 0 48943 WISSAM MATTAR PHYSICIAN 50 0 X 723374 0 47790 8101229 0 1290138 115 0 1 0 AMERISOURCE BERGEN DRUG CORP 27550 NETWORK PLACE CHICAGO IL 60671 PHARMACEUTICALS 10416772 STATE OF WISCONSIN DEPT OF HEALTH SERVICES 1 W WILSON ST MADISON WI 53701 HOSPITAL ASSESSMENT 3723754 OWENS & MINOR 12199 COLLECTION CENTER DR CHICAGOE IL 60693 SURGICAL SUPPLIES 2436642 EPIC SYSTEMS CORP 5301 TOKAY BLVD MADISON WI 53711 EHR MANAGEMENT 1754016 CG SCHMIDT INC 11777 WEST LAKE PARK DRIVE MILWAUKEE WI 53224 CONSTRUCTION 1378424 97 0 0 0 0 143279 8867 0 152146 NET PATIENT REVENUE 900099 165170234 165170234 0 0 OTHER OPERATING REVENUE 561499 6798101 6798101 0 0 NON-PATIENT SERVICES 621990 814245 0 814245 0 LAUNDRY SERVICES 812320 7249 0 7249 0 0 0 0 0 172789829 1157671 1157671 0 0 0 0 0 0 0 0 0 0 0 0 34158600 0 31658497 0 2500103 0 2500103 2500103 0 0 0 0 176599749 175626109 821494 0 5105775 4442024 663751 70598284 60714524 9883760 3925789 2951766 974023 0 16338602 13961295 2377307 4821047 4020898 800149 128351 128351 52173 52173 188178 188178 8304504 5111035 3193469 25351211 22196766 3154445 2593929 404257 2189672 1168695 1007842 160853 3604987 3604987 11393785 6542859 4850926 REPAIRS AND MAINTENANCE 4714818 2254651 2460167 0 DUES AND SUBSCRIPTIONS 1249215 860418 388797 0 MISCELLANEOUS 5986381 2130501 3855880 0 165525724 130392001 35133723 0 136902 121461 24240330 23009831 0 0 24360809 23868900 0 0 0 0 0 0 3104967 3626318 3338154 3137041 230387448 121019241 112043674 109368207 66500525 94231253 0 0 0 0 189003 32786 20811865 7394369 254726229 264790166 17194315 17556537 0 0 0 0 80181268 77350268 0 0 0 0 40482 0 0 0 8398838 9682398 105814903 104589203 X 148794099 160103736 117227 97227 0 0 148911326 160200963 254726229 264790166 X 11074025 -1182427 0 0 0 1398039 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 0 0 1 3827 3827 0 Schedule C, Part II-B, Line 1 Wisconsin Hospital Association and Catholic Hospital Association dues are allocated to lobbying. 3125858 59712 203657 0 89000 0 3300227 2654654 142898 408306 0 80000 0 3125858 2377224 24079 253351 0 0 0 2654654 2348831 0 28393 0 0 0 2377224 2061146 42722 244963 0 0 0 2348831 0.583 0.106 0.311 0 1 1 0 1570352 1570352 0 141130503 58163780 82966723 0 0 0 0 0 81427474 59438921 21988553 0 6259119 3416540 2842579 109368207 RECEIVABLE FROM FOUNDATION 2008351 INVESTMENT IN UNCONSOLIDATED AFFILIATES 1266815 INVESTMENT IN FOUNDATION 4119203 7394369 0 DEFERRED COMPENSATION 9682398 9682398 X 177963902 0 0 0 1596341 1596341 176367561 0 232188 232188 176599749 165525724 0 0 0 0 0 165525724 0 0 0 165525724 Schedule D, Part V, Line 4 THE OPERATING ENDOWMENT HAS BEEN ESTABLISHED TO SUPPORT THE OPERATING COSTS OF THE MONROE CLINIC AND HOSPITAL FOUNDATION. THE FUTURE OF HEALTHCARE ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE FUNDING FOR GRANTS AND PROGRAMS THAT SUPPORT THE MONROE CLINIC AND HOSPITAL FOUNDATION MISSION. Schedule D, Part X, Line 2 THE MONROE CLINIC IS A TAX EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE CLINIC IS ALSO EXEMPT FROM STATE INCOME TAX. IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON 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 FINANCIAL STATEMENTS. THE CLINIC HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2014 OR 2013. THE CLINIC'S FEDERAL TAX RETURNS FOR TAX YEARS 2011 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. Schedule D, Part XI, Line 2d Increase in equity in unconsolidated affiliate 410,111 change in interest in net assets of Foundation 1,186,230 Total 1,596,341 Schedule D, Part XI, Line 4b OTHER 232,188 IN CONTRIBUTIONS TO THE MONROE CLINIC HOSPITAL FOUNDATION 1 1 1 X 1.20 1 X 1 1 0 1 1 0 0 1831657 0 1831657 0.011 0 0 11959253 0 11959253 0.0723 0 0 157014 0 157014 0.0009 0 0 13947924 0 13947924 0.0842 0 0 2375765 0 2375765 0.0144 0 0 577381 0 577381 0.0034 0 0 269668 0 269668 0.0016 0 0 0 0 0 0 0 0 95035 0 95035 0.0006 0 0 3317849 0 3317849 0.0200 0 0 17265773 0 17265773 0.1042 1 6261446 0 11857831 19718600 -7860769 X 1 1 1 1 MONROE CLINIC 515 22ND AVENUE MONROE WI 53566 X X X MONROE CLINIC 1 0 0 1 X X X X X X X X X X 12 1 0 1 1 X www.monroeclinic.org 1 13 1 www.monroeclinic.org 0 0 1 X 120 120 X X X X X X 1 1 X X X 1 X X X X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-MONROE CLINIC MONROE CLINIC IS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITIES COALITION. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN EXTENSION. THE GREEN COUNTY HEALTHY COMMUNITIES COALITION INCLUDES INDIVIDUALS WHO ARE EXPERTS IN PUBLIC HEALTH, LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY AND CHRONIC DISEASE POPULATION OR REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES THAT HAVE "CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY." A LIST OF THE COALITION MEMBERS WHO PARTICIPATED IN THE IDENTIFICATION OF PRIORITIZED HEALTH NEEDS, THEIR TITLES, ORGANIZATIONS AND LEADERSHIP ROLES CAN BE FOUND IN ATTACHMENT 2 OF THE CHNA. THE COALITION MET SIX TIMES BETWEEN MARCH 2011 AND SEPTEMBER 1, 2012, AVERAGING ATTENDANCE BY 40 COMMUNITY MEMBERS. Schedule H, Part V, Section B, Line 5-MONROE CLINIC AS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITIES COALITION (GCHCC), MONROE CLINIC COLLABORATED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND PRIORITIZATION OF HEALTH NEEDS. THE MISSION OF THE GCHCC IS: FOSTERING COLLABORATIVE EFFORTS TO ASSESS NEEDS, DEFINE RESOURCES, AND RECOGNIZE OPPORTUNITIES TO BUILD HEALTHIER COMMUNITIES THAT SUPPORT HEALTHY LIFESTYLES. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN-EXTENSION. THE PROCESS FOR THE IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS WAS UNDERTAKEN BY THE GREEN COUNTY HEALTHY COMMUNITY COALITION. AS THE FRAMEWORK FOR IDENTIFYING HEALTH NEEDS, THE COALITION ADOPTED THE STATE PUBLIC HEALTH AGENDA: HEALTHIEST WISCONSIN 2020. THE HEALTH NEEDS WERE DERIVED FROM AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH. THE HEALTH NEEDS WERE PRIORITIZED THROUGH A STRUCTURED PROCESS USING DEFINED CRITERIA. Schedule H, Part V, Section B, Line 6b-MONROE CLINIC AS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITIES COALITION (GCHCC), MONROE CLINIC COLLABORATED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND PRIORITIZATION OF HEALTH NEEDS. COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN-EXTENSION. Schedule H, Part V, Section B, Line 11-MONROE CLINIC MONROE CLINIC PLANS TO MEET THE IDENTIFIED PRIORITY HEALTH NEEDS THROUGH A COMMITMENT OF RESOURCES FOR 1) ACCESS TO HIGH-QUALITY HEALTH SERVICES/HEALTHY GROWTH AND DEVELOPMENT, 2) ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION AND 3) MENTAL HEALTH CARE. SUPPORT AND REFER CLIENTS TO CHRONIC DISEASE MANAGEMENT PROGRAMS AVAILABLE IN THE COMMUNITY. PROVIDE EDUCATIONAL OPPORTUNITIES ON HEALTH LITERACY AND APPROPRIATE USE OF HEALTH CARE SERVICES. PROVIDE COORDINATED CARE WITH REFERRALS FOR MENTAL AND DENTAL HEALTH CARE SERVICES. PROVIDE COMMUNITY OUTREACH AND EDUCATION FOR THE HEALTH INSURANCE "MARKET PLACE"/ EXCHANGE. PROMOTE THE USE OF PREVENTIVE CARE SERVICES. THROUGH A MONROE CLINIC PARTNERSHIP WITH COLONY BRANDS, CREATE AND ENCOURAGE PARTICIPATION IN AN EMPLOYEE CLINIC TO IMPROVE HEALTH ACCESS AND USE OF PREVENTIVE SERVICES. PROVIDE AUTOMATED CALLS AND DIRECT MAIL TRIGGERS TO REMIND PATIENTS TO OBTAIN PREVENTIVE SCREENINGS. EXPAND RURAL TRAINING TRACKS AND PROGRAMS IN MEDICAL EDUCATION. PARTNER WITH WISCONSIN RURAL RESIDENCY ASSISTANCE PROGRAM. PROVIDE WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION/PHYSICAL ACTIVITY FOR CHILDREN. MONROE CLINIC WILL BE A PICK UP SIGHT FOR LOCAL CSA (COMMUNITY SUPPORTED AGRICULTURE). PROVIDE SUPPORT TO UW-EXTENSION NUTRITION EDUCATOR POSITION WHO PROVIDES HOME VISITS AND COMMUNITY EDUCATION TO LOW-INCOME FAMILIES TO INCREASE KNOWLEDGE OF SEASONAL LOCAL PRODUCE AND ITS USE IN PREPARING HEALTHIER SNACKS AND MEALS. CONTINUE PUBLIC SERVICE BY PROVIDING FRUIT AND VEGETABLE OF THE MONTH INFORMATION TO LOCAL SCHOOLS, DAY CARE AGENCIES, AND OTHER PUBLIC LOCATIONS. PARTNER WITH ALBANY SUSTAINABLE AGRICULTURAL EDUCATION CENTER TO DEVELOP A COMMUNITY GARDEN IN ALBANY. PRODUCE FROM THE GARDEN WILL BE USED IN THE SCHOOL LUNCH PROGRAM. IDENTIFY THE AMOUNT OF TIME K-5 CHILDREN IN GREEN COUNTY ARE SPENDING IN PHYSICAL EDUCATION CLASSES. SURVEY WORKSITES TO DETERMINE WHETHER THEY HAVE AN EMPLOYEE WELLNESS PLAN AND HOW PHYSICAL ACTIVITY IS INTEGRATED IN THE PLAN. DEVELOP AN EMPLOYEE WELLNESS PROGRAM AT MONROE CLINIC AS A MODEL FOR OTHER ORGANIZATIONS. WORK TO BUILD A NETWORK BETWEEN MONROE CLINIC, GREEN COUNTY HUMAN SERVICES, GREEN COUNTY HEALTH DEPARTMENT, GREEN HAVEN, SARP (SEXUAL ASSAULT RECOVERY PROGRAM), NAMI (NATIONAL ALLIANCE ON MENTAL ILLNESS), GUPPY (GREEN COUNTY UNITED PREVENTION PROFESSIONALS FOR YOUTH) AND BLACKHAWK TECHNICAL COLLEGE TO DISSEMINATE PUBLIC AWARENESS INFORMATION. HOST AN ANNUAL MENTAL HEALTH FORUM COVERING CURRENT ISSUES AND TOPICS PERTINENT TO COMMUNITY AND PROFESSIONALS. MONROE CLINIC BEHAVIORAL HEALTH, GREEN COUNTY HUMAN SERVICES, GREEN COUNTY HEALTH DEPARTMENT, AND OTHERS ARE WORKING TO BUILD MORE CAPACITY FOR EXTERNAL CONNECTIONS AND REFERRALS, AS WELL AS INTERNAL SCREENINGS, AND OTHER OPTIONS TO IMPROVE ACCESS TO COMMUNITY MEMBERS FOR NEEDED MENTAL HEALTH SERVICES. PROVIDE TRAINING TO LOCAL PARENT EDUCATORS, ENABLING THEM TO OFFER 'RAISING A THINKING CHILD' CURRICULUM TO PARENTS AROUND THE COUNTY. Schedule H, Part V, Section B, Line 16a-MONROE CLINIC www.monroelinic.org Schedule H, Part V, Section B, Line 16b-MONROE CLINIC www.monroeclinic.org Schedule H, Part V, Section B, Line 16c-MONROE CLINIC www.monroeclinic.org 10 MONROE CLINIC - HIGHLAND WOMEN'S CARE 3103 W KUNKLE BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT 1301 S KIWANIS DRIVE FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT EYE CARE 1110 S PARK BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BRODHEAD 1904 FIRST CENTER AVENUE BRODHEAD WI 53520 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - LENA 214 SCHUYLER LENA IL 61048 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - NEW GLARUS 1800 SECOND STREET NEW GLARUS WI 53574 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - ALBANY 700 CAROLAN DRIVE ALBANY WI 53502 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC- DURAND 400 S CENTER STREET DURAND IL 61024 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC FASTCARE 405 W 8TH ST MONROE WI 53566 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BLANCHARDVILLE 309 S MAIN STREET BLANCHARDVILLE WI 53516 COMMUNITY-BASED OUTPATIENT CLINIC Schedule H, Part I, Line 3c IN ADDITION TO INCOME, THE MONROE CLINIC CONSIDERS ASSETS IN EXCESS OF $75,000 EXCLUDING THE APPLICANT'S PRIMARY RESIDENCE AND ESSENTIAL TRANSPORTATION. Schedule H, Part I, Line 7 A COST TO CHARGE RATIO WAS USED TO COMPUTE THE COST OF COMMUNITY BENEFIT SERVICES. Schedule H, Part I, Line 7g SUBSIDIZED HEALTH SERVICES INCLUDE BEHAVIORAL HEALTH/OUTPATIENT MENTAL HEALTH, PALLIATIVE CARE, SELF-HELP/SPORTS INJURY PREVENTION, AND CONTINUING CARE/HOME CARE SERVICES. Schedule H, Part III, Section A, Line 4 ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE BALANCES ARE PRIMARILY FROM RESIDENTS OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. THE CLINIC BILLS THIRD PARTY PAYORS ON EACH PATIENT'S BEHALF OR IF A PATIENT IS UNINSURED THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, SECONDARY INSURANCE IS BILLED AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS FOR WHICH THE PATIENTS ARE PERSONALLY RESPONSIBLE. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT. THE CLINIC DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE CARRYING AMOUNTS OF ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE 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. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEET'S NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Section B, Line 8 MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES THE TOTAL EXPENSES LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. Schedule H, Part III, Section C, Line 9b MONROE CLINIC RECOGNIZES THE INHERENT VALUE OF ALL INDIVIDUALS. ALL INDIVIDUALS HAVE THE RIGHT TO BE TREATED WITH RESPECT AND DIGNITY. THOSE INDIVIDUALS INDICATING LACK OF FINANCIAL RESOURCES TO PAY FOR SERVICES WILL BE DIRECTED TO MONROE CLINIC'S COMMUNITY CARE PROGRAM TO ENSURE ALL INDIVIDUALS QUALIFYING FOR ASSISTANCE ARE INDEED GIVEN ASSISTANCE. INDIVIDUALS WITH THE FINANCIAL RESOURCES TO PAY FOR SERVICES ARE EXPECTED TO DO SO IN A TIMELY MANNER TO ENSURE MONROE CLINIC'S FINANCIAL HEALTH AND ABILITY TO MAINTAIN OPERATIONS AND CONTINUED COMMUNITY CARE. PATIENTS WITH FINANCIAL RESOURCES ARE ASKED TO PAY CO-PAYMENTS AT THE TIME OF SERVICE AND TO PAY BALANCES REMAINING DUE AFTER INSURANCE HAS PAID WITHIN 30 DAYS OR MAKE MUTUALLY AGREEABLE PAYMENT ARRANGEMENTS WITH PATIENT ACCOUNTING. COLLECTION AGENCIES USED BY MONROE CLINIC GUARANTEE COMPLIANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT AND THE ACA INTERNATIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY. Schedule H, Part VI, Line 2 MONROE CLINIC, IN COLLABORATION WITH THE GREEN COUNTY HEALTH DEPARTMENT, THE GREEN COUNTY HEALTHY COMMUNITIES COALITION ASSESSED THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES USING THE STATE PUBLIC HEALTH AGENDA, HEALTHIEST WISCONSIN 2020, AS THE FRAMEWORK. THE GOALS OF THE HEALTHIEST WISCONSIN 2020 ARE TO IMPROVE HEALTH ACROSS THE LIFE SPAN AND ELIMINATE HEALTH DISPARITIES AND ACHIEVE HEALTH EQUALITY. THE HEALTH NEEDS WERE DERIVED FROM AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH. Schedule H, Part VI, Line 3 MONROE CLINIC PROVIDES FINANCIAL COUNSELORS WHO ACT AS PATIENT ADVOCATES AND HELP THOSE IN NEED APPLY FOR MONROE CLINIC'S COMMUNITY CARE PROGRAMS OR OTHER STATE, COUNTY OR FEDERAL PROGRAMS (I.E. WISCONSIN BADGERCARE, WISCONSIN AND ILLINOIS WELL WOMAN PROGRAMS, MEDICARE, MEDICAID, ETC.). PATIENTS CAN FIND OUT ABOUT THESE SERVICES THROUGH MONROECLINIC.ORG'S INFORMATION PAGES, MONROE CLINIC'S ANNUAL MISSION REPORT POSTED ON OUR WEBSITE AND MAILED TO HOUSEHOLDS IN OUR SERVICE AREA, AND THROUGH COMMUNITY OUTREACH THAT OFFERS ASSISTANCE EXPLAINING NEW FEDERAL/STATE PROGRAMS OR CHANGES TO THOSE PROGRAMS. ADDITIONALLY, MONROE COUNSELORS HELP PATIENTS UNDERSTAND WHAT PROGRAMS THEY COULD BE ELIGIBLE FOR, HELP THEM THROUGH APPLICATION PROCEDURES AND ALSO PROVIDE APPROVAL/DENIAL NOTIFICATION TO THE PATIENTS IN A TIMELY MANNER. Schedule H, Part VI, Line 4 MONROE CLINIC GIVES SPECIAL CONSIDERATION TO PERSONS IN NEED OF FINANCIAL ASSISTANCE THROUGH OUR COMMUNITY CARE PROGRAM. MONROE CLINIC DOES NOT DISCRIMINATE AGAINST A PATIENT BECAUSE OF RACE, CREED, COLOR, NATIONAL ORIGIN, OR BECAUSE A PATIENT IS COVERED BY A PROGRAM SUCH AS MEDICAID OR MEDICARE. FOR PATIENTS WHO HAVE NO HEALTH INSURANCE LIMITED HEALTH INSURANCE OR WHO EXPECT TO HAVE DIFFICULTY PAYING THEIR BILL THE COMMUNITY CARE PROGRAM PROVIDES HEALTHCARE AT REDUCED COST OR AT NO COST. THE PROGRAM PROVIDES HEALTHCARE WITH A PAYMENT SCHEDULE THAT RECOGNIZES AN INDIVIDUAL'S FINANCIAL CONDITION. COMMUNITY CARE APPLICATIONS ARE ACCEPTED FROM PATIENTS WHO RESIDE IN OUR PRIMARY AND SECONDARY SERVICE AREAS WHICH INCLUDE THE FOLLOWING COUNTIES IN WISCONSIN: GREEN, LAFAYETTE, AND SECTIONS OF DANE, ROCK, AND IOWA COUNTIES. IN ILLINOIS, STEPHENSON AND SECTIONS OF WINNEBAGO AND JODAVIESS COUNTIES. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A MINIMUM OF THREE MONTHS PRIOR TO BE ELIGIBLE FOR THE COMMUNITY CARE PROGRAM. Schedule H, Part VI, Line 5 A MAJORITY OF THE MONROE CLINIC BOARD OF DIRECTORS IS COMPRISED OF PEOPLE THAT RESIDE IN THE GEOGRAPHIC AREAS WE SERVE. MONROE CLINIC REINVESTS BACK INTO THE COMMUNITY THROUGH ITS COMMUNITY BENEFIT PROGRAMS AND THROUGH MEDICAL EQUIPMENT AND PROGRAMS NEEDED IN THE COMMUNITY. EXAMPLES OF THIS INCLUDE PALLIATIVE CARE, PARISH NURSING PROGRAM, YOUTH APPRENTICESHIP AND JOB SHADOWING PROGRAMS, SCREENING OUTREACH AND MANY OTHER PROGRAMS. FURTHER, MONROE CLINIC HAS INVESTED IN THE ELECTRONIC HEALTH RECORD. OUR PATIENTS ARE GEOGRAPHICALLY DIVERSE AND MONROE CLINIC HAS TEN BRANCH PHYSICIAN CLINICS IN OUTLYING AREAS. THE INVESTMENT IN ELECTRONIC HEALTH RECORDS MEANS THAT OUR PATIENTS CAN BE SEEN ANYWHERE AND HAVE THEIR MEDICAL HISTORY IMMEDIATELY AVAILABLE. THIS PROMOTES BETTER HEALTH FOR OUR PATIENTS AND INCREASED SAFETY AS WE CAN TRACK MEDICAL EVENTS AND ONGOING MEDICATION NEEDS. Schedule H, Part VI, Line 7 LIST OF STATES RECEIVING COMMUNITY BENEFITS REPORTS: WISCONSIN AND ILLINOIS X 1 1 0 0 0 0 0 1 0 0 0 MICHAEL SANDERS PRESIDENT/CEO 499242 0 113686 0 3960 0 193623 0 9641 0 820152 0 113686 0 MARK THOMPSON CHIEF MEDICAL OFFICER 358829 0 61908 0 180 0 138621 0 9514 0 569052 0 61908 0 JOHN FREY PHYSICIAN/SECRETARY 258545 0 402 0 258 0 16810 0 28171 0 304186 0 402 0 RACHEL LONG PHYSICIAN/DIRECTOR 202311 0 241 0 258 0 14290 0 26935 0 244035 0 241 0 JULIE WILKE VP CLINICAL OPERATIONS 273061 0 50015 0 789 0 95784 0 8783 0 428432 0 50015 0 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 189103 0 37880 0 1208 0 56556 0 21586 0 306333 0 37880 0 WISSAM MATTAR PHYSICIAN 722918 0 402 0 54 0 32294 0 15496 0 771164 0 402 0 LANCE SATHOFF PHYSICIAN/ORTHOPEDIC SURGEON 943759 0 402 0 90 0 35046 0 28517 0 1007814 0 402 0 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 930285 0 402 0 0 0 34975 0 22074 0 987736 0 402 0 JANE MONAHAN VP MINISTRY/HR 139668 0 27093 0 702 0 41709 0 19995 0 229167 0 27093 0 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 911672 0 398 0 60 0 38565 0 28517 0 979212 0 398 0 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 141678 0 28224 0 389 0 41606 0 20023 0 231920 0 28224 0 DAVID BUCHANAN PHYSICIAN/INTERVENTIONAL CARDIOLOGIST 610435 0 5915 0 396 0 21866 0 27077 0 665689 0 5915 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 642339 0 402 0 54 0 30138 0 27284 0 700217 0 402 0 JAMES NEMETH CHIEF FINANCIAL OFFICER 178780 0 25253 0 272 0 52732 0 6626 0 263663 0 25253 0 DARREN PIPP PHYSICIAN/DIRECTOR 318080 0 402 0 90 0 19849 0 22374 0 360795 0 402 0 CHRISTOPHER SMITH PHYSICIAN/CHIEF OF STAFF 242899 0 402 0 60 0 14191 0 26094 0 283646 0 402 0 CARRIE BLUM CHIEF INFORMATION OFFICER 161246 0 14017 0 115 0 42292 0 20484 0 238154 0 14017 0 Schedule J, Part I, Line 1a Provided membership for the President/CEO to the local Kiwanis organization: total value: $105 Schedule J, Part I, Line 3 The organization's CEO and senior leadership team's compensation plan is reviewed and approved at formal meetings of the Compensation Committee of the Board of Directors. The Compensation Committee is comprised of independent/non-employee members who have no personal interest in the compensation arrangement to be reviewed and recommended by the Compensation Committee. The Committee review comparable Wisconsin and National Compensation data and establishes base compensation at the comparable market median by position as outlined in the Compensation Committee Charter, additionally the Committee has authority to retain a compensation consultant to assist the committee in evaluating senior management compensation. Schedule J, Part I, Line 6 The organization uses net earnings as 25% of the calculation for the Gain Share Program. A REDEVELOPMENT AUTHORITY OF THE CITY 271322385 611420AP5 2009-11-24 64459717 CONSTRUCTION OF HOSPITAL 1 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITIES 391337855 2012-04-19 16415700 REFUNDING OF 1999 BOND ISSUE 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2012-04-19 21750843 PARTIAL ADVANCED REFUNDING OF 2009 ISSUE 0 0 0 A 0 20855000 64442747 4653664 6327046 0 1036820 0 0 57522008 0 0 2012 0 0 1 1 B 0 0 16415700 0 0 0 130700 0 0 0 16285000 0 2000 1 0 1 1 C 0 0 21750843 0 0 21459636 291207 0 0 0 0 0 2012 0 1 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 C 0 0 0 0 0 0 0 1 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 Schedule K, Part I, Column a-11/24/2009 64,459,717 REDEVELOPMENT AUTHORITY OF THE CITY Total proceeds of issue variance between issue price and total proceeds (16,970) is the loss on the investment. Schedule K, Part I, Column c-04/19/2012 16,415,700 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHO WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITIES Sarah Endicott Michael Sander's daughter 70483 Employment 1 Lara Salyer Smith DO Christopher Smith's wife 220454 Employment 1 Schedule L, Part IV Schedule L, Part IV, Line 1 - (A) Name of person: Sarah Endicott, (B) Relationship between interested person and organization: Daughter of Mike Sanders, President/CEO, (D) Description of transaction: Employment Schedule L, Part IV, Line 2 - (A) Name of person: Lara Salyer Smith, DO (B) Relationship between interested person and organization: Spouse of Christopher Smith, DO, (D) Description of transaction: Employment Form 990, Part I, Line 1 Services include inpatient routine, inpatient ancillary, and outpatient healthcare in support of the corporation's health care mission. The Monroe Clinic, because of its mission statement, offers a Charity Care program to eligible beneficiaries. Form 990, Part III, Line 4a IN 2014 OUR PHYSICIANS AND STAFF PROVIDED SERVICES TO PATIENTS ACCESSING OUR SYSTEM WITH OVER 250,000 VISITS. IN 1939, CSA ESTABLISHED ST. CLARE HOSPITAL AT THE REQUEST OF A SMALL GROUP OF PHYSICIANS WHO OPENED MONROE CLINIC IN THE SAME YEAR. IN 1992 ST. CLARE HOSPITAL AND MONROE CLINIC CONSOLIDATED UNDER CONTINUED SPONSORSHIP OF CSA AS A CATHOLIC NOT FOR PROFIT INTEGRATED HEALTHCARE FACILITY. MONROE CLINIC HAS A SPECIAL COMMITMENT TO PROVIDE HEALTHCARE SERVICES TO ALL PATIENTS WITHOUT ANY FORM OF DISCRIMINATION INCLUDING THE ABILITY TO PAY. THE PASSION AND DETERMINATION OF BOTH THE FOUNDING PHYSICIAN AND CSA HAS DEVELOPED AN EXCEPTIONAL HEALTHCARE ORGANIZATION THAT FOCUSES ON QUALITY AND OUTCOME MEASURES THAT EXCEED NATIONAL BENCHMARKS. IN 2010 MONROE CLINIC COMMITTED TO PUBLISHING OUR QUALITY SCORES IN LOCAL NEWSPAPERS AND ON OUR WEBSITE. TO DATE WE HAVE BEEN AMONG THE HIGHEST PERFORMING HOSPITALS IN THE AREA. PATIENT SATISFACTION SCORES ARE SIGNIFICANTLY ABOVE THE AVERAGE OF OTHER HEALTHCARE FACILITIES. OUR HIGHLY TRAINED PHYSICIANS AND STAFF ARE READY TO PROVIDE BOTH EXCEPTIONAL HEALTHCARE AND AN EXCEPTIONAL EXPERIENCE TO THE PATIENTS AND COMMUNITIES WE SERVE. IN CALENDAR YEAR 2014 MONROE CLINIC PROVIDED MORE THAN $17.2 MILLION IN COMMUNITY BENEFIT TO MORE THAN 37,500 INDIVIDUALS. THIS $17.2 MILLION REPRESENTS APPROXIMATELY 10.4 PERCENT OF MONROE CLINIC'S TOTAL NET PATIENT REVENUE. THE COMMUNITY BENEFIT AT COST IS COMPRISED OF $1.8 MILLION OF CHARITY CARE, $11.9 MILLION IN UNREIMBURSED COSTS FOR MEDICAID PATIENTS, $2.4 MILLION IN SUBSIDIZED HEALTHCARE SERVICES (SERVICES PROVIDED TO PATIENTS AT LESS THAN WHAT IT COST US TO PROVIDE THESE SERVICES). EACH YEAR MONROE CLINIC USES SURPLUS FUNDS TO ENHANCE PATIENT AND SCREENING PROGRAMS. THROUGH OUR SPENDING AND THAT OF OUR EMPLOYEES MONROE CLINIC CONTRIBUTES SIGNIFICANTLY TO THE LOCAL COMMUNITY. Form 990, Part VI, Section A, Line 6 The Corporation has two Classes of members. The Class A members are the General Superior of CSA and those persons who are members of the General Council of CSA. The Class B members are individuals appointed by the Class A members and consist of not less than nine members and not more than 13 members. Form 990, Part VI, Section A, Line 7a There is a governing body that has final approval for any new board members. Form 990, Part VI, Section A, Line 7b Various decisions such as indebtedness of a certain scope, mission of the organization, and final approval of board members must be by Class A members of Congregation of Sisters of St. Agnes Sponsorship Ministry Board. Form 990, Part VI, Section B, Line 11b Annually, the Board of Directors is provided an overview of the Form 990 and has an opportunity to ask questions and provide input. Form 990, Part VI, Section B, Line 12c Annually, Conflict of Interest Statements and Policy are distribute to members of the Board and any employee who has authority to enter into contracts and other transactions on behalf of Monroe Clinic. The completed forms are reviewed by administration. Form 990, Part VI, Section B, Line 15 The organization's CEO and Senior Leadership Team's compensation plan is reviewed and approved at formal meetings of the Compensation Committee of the Board of Directors. The Compensation Committee is comprised of independent non-employee members who have no personal interest in the Compensation agreement to be reviewed and recommended by the Compensation Committee. This Committee reviews comparable Wisconsin and National Compensation data and establishes base compensation at the comparable market median by the position as outlined in the Compensation Committee Charter. Additionally the Committee has authority to retain a Compensation Consultant to assist the committee in evaluating Senior Management Compensation. Form 990, Part VI, Section C, Line 19 A paper copy of the documents/statements is provided upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances equity in earnings of unconsolidated affiliates 443,997 and change in interest in net assets of foundation 954,042, Total 1,398,039 MONROE CLINIC AND HOSPITAL FOUNDATION INC 515 22ND AVENUE MONROE WI 53566 205769038 SUPPORT THE MISSION OF THE MONROE CLINIC WI 501(C) (3) LINE 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 THE MONROE CLINIC APPLIED FOR AND WAS GRANTED THE AUTOMATIC 3 MONTH EXTENSION.