2015-08-14T13:01:48-05:00 2014-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY/PO BOX 690 EAU CLAIRE WI 547020690 990 2014-01-01 390773970 LADD MEMORIAL HOSPITAL LADD 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 THOMAS GESKERMANN CEO 7152942111 2015-08-12 1 HOLLY POKRANDT CPA P00449155 7158323407 2015-08-12 2014 2016-03-07 17:11:31Z OSCEOLA MEDICAL CENTER THOMAS GESKERMANN 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 33473646 0 X WWW.MYOMC.ORG X 1947 WI SERVING AS THE CATALYST TO CREATE A HEALTHIER COMMUNITY. 9 9 339 41 1209335 -167417 97006 229643 30370766 33142581 42485 57057 166721 44365 30676978 33473646 0 0 0 0 12472388 12733894 0 0 146129 17451760 17996683 29924148 30730577 752830 2743069 41176366 43189092 23646859 22954808 17529507 20234284 X TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS. 0 0 27217219 31287951 DURING 2014, LADD MEMORIAL HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO THE RESIDENTS OF THE GREATER OSCEOLA AREA, REGARDLESS OF ABILITY TO PAY.INPATIENT SERVICES WERE PROVIDED TO 573 PATIENTS AND TOTALED 1,688 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, OBSTETRIC, NEWBORN AND SWINGBED CARE.OUTPATIENT SERVICES INCLUDED 2,454 EMERGENCY ROOM VISITS; 1,637 RADIOLOGY PROCEDURES; 60,188 LAB PROCEDURES AND 508 SURGERIES, AS WELL AS PHYSICAL THERAPY, CARDIAC REHAB, SLEEP STUDIES AND VARIOUS OTHER HOSPITAL SERVICES.CLINICAL CARE SERVICES INCLUDED CLINIC VISITS, LAB VISITS, NURSE VISITS AND SKILLED VISITS, TOTALING 31,371 VISITS. 27217219 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 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 38 0 339 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WI MN X HEATHER PETERKIN 7152942111 2600 65TH AVENUE OSCEOLA WI 54020 KAREN ELKIN DIRECTOR 1.00 X 0 0 0 HEIDI CONRAD DIRECTOR 1.00 X 0 0 0 WARD MOBERG DIRECTOR 1.00 X 0 0 0 TOM HAUGE DDS DIRECTOR 1.00 X 0 0 0 ARNOLD POTEK MD DIRECTOR 1.00 X 0 0 0 KARI SMITH MD DIRECTOR 1.00 X 0 0 0 TYLER SCHMIDTZ DIRECTOR 1.00 X 0 0 0 PEGGY WEBER CHAIRPERSON 1.00 X X 0 0 0 AL HOGEN VICE CHAIRPERSON 1.00 X X 0 0 0 GREG ISAACSON SECRETARY 1.00 X X 0 0 0 RENE MILNER MD CHIEF MEDICAL OFFICER 1.00 X 0 0 0 HEATHER PETERKIN CFO 40.00 X 113627 0 12073 TOM GESKERMANN CEO 40.00 X 161203 0 24398 LINDA K MOORE CLINIC DIRECTOR 40.00 X 100980 0 16077 NANCY BLAIN PHARMACY MANAGER 40.00 X 120604 0 22477 496414 0 75025 4 0 1 0 HEALTHPARTNERS GROUP HEALTH INC MAIL STOP 21109A ST PAUL MN 551640059 PHYSICIANS 4407511 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 DIAGNOSTIC IMAGING 657663 MARSHFIELD LABS 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 LABORATORY SERVICES 479686 ANESTHETISTS INC OF WISCONSIN 130 S KNOWLES AVE NEW RICHMOND WI 54017 CRNA SERVICES 459055 CPSI PO BOX 850309 MOBILE AL 36685 ELECTRONIC HEALTH RECORDS 343382 7 172894 27083 29666 229643 NET PATIENT SERVICE REV 621990 32094541 30885206 1209335 FITNESS CENTER 713940 402745 402745 CAFETERIA 621990 65288 65288 GIFT SHOP 621990 53452 53452 526555 526555 33142581 56807 56807 44365 0 44365 44365 44365 250 0 250 250 250 33473646 31287951 1209335 746717 X 311301 311301 10168928 8160208 1884139 124581 341870 274339 63343 4188 1770091 1670477 91913 7701 141704 111646 28257 1801 9783 9783 54444 54444 7435106 7016543 418288 275 45129 45129 642864 256457 380537 5870 1573394 1573394 72944 52473 19314 1157 2011824 2011824 35753 35753 MEDICAL SUPPLIES/EQUIPM 5026274 5026274 PROVISION FOR BAD DEBT 753356 753356 FOOD EXPENSE 147818 147818 HOSPITAL ASSESSMENT 108000 108000 79994 54410 25028 556 30730577 27217219 3367229 146129 4788646 6156773 3743212 5766173 8000 0 3128330 3497959 673623 763829 155642 136787 36514112 11212462 27029601 25301650 701308 701308 948004 864613 41176366 43189092 2928922 2923674 325000 195000 18013169 17387240 1832338 1734394 547430 714500 23646859 22954808 X 17521507 20234284 8000 0 17529507 20234284 41176366 43189092 2743069 -38292 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1156 1156 0 PART II-B, LINE 1: LADD MEMORIAL HOSPITAL PAYS AN ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED LADD MEMORIAL HOSPITAL THAT $1,156 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 1547047 1547047 26858228 6077286 20780942 8108837 5135176 2973661 25301650 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 664500 PLEDGE PAYABLE 50000 714500 X PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, LADD MEMORIAL HOSPITAL 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 THE TAX POSITION IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS. LADD MEMORIAL HOSIPTAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2014, OR 2013. FEDERAL TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2011, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 0 1 1 210539 210539 0.00700 2685682 2437177 248505 0.00830 2896221 2437177 459044 0.01530 84846 6896 77950 0.00260 79688 79688 0.00270 7213146 5597839 1615307 0.05390 35133 35133 0.00120 7412813 5604735 1808078 0.06040 10309034 8041912 2267122 0.07570 1000 1000 0.00000 1000 1000 0 406231 81246 8170145 8220272 -50127 X 1 1 1 1 LADD MEMORIAL HOSPITAL DBA OSCEOLA MED 2600 65TH AVENUE OSCEOLA WI 54020 WWW.MYOMC.ORG 1021 X X X X OSCEOLA MEDICAL CENTER 1 0 0 1 X X X X X X X X 13 1 1 1 1 X HTTP://WWW.MYOMC.ORG/ABOUT/COMMUNITY X HTTP://WWW.HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEALTH-NEEDS X 1 13 0 1 0 1 X 200.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X X X X X 1 X 0 X X X 1 X 0 0 OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. THREE SURVEYS WERE USED TO DETERMINE THE LIFESTYLE AND PERCEIVED HEALTH OF THE COMMUNITY. THESE SURVEYS INCLUDED:1. PHONE SURVEY (402 RESPONDENTS)2. A COUNTY WIDE SURVEY OF THE HEALTH OF POLK COUNTY RESIDENTS. THIS SURVEY WAS AVAILABLE AT ALL OF THE LOCAL MEDICAL CENTERS AND THE HEALTH DEPARTMENT, AS WELL AS ADVERTISED IN THE LOCAL NEWSPAPERS AND POSTED ON ALL FOUR OF THE PARTNERS ORGANIZATION'S WEBSITES (1,214 RESPONDENTS)3. A CONSUMER HEALTH SURVEY WHICH WAS MAILED TO POLK COUNTY RESIDENTS (154 RESPONDENTS)IN ADDITION TO THE COMMUNITY SURVEYS, FOUR COMMUNITY FORUMS WERE SPONSORED IN BALSAM LAKE, ST. CROIX FALLS, AMERY, AND OSCEOLA, WISCONSIN. THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. IN ADDITION, A PARTNER MEETING WAS HELD IN DRESSER, WISCONSIN TARGETING KEY ORGANIZATIONS AS WELL AS LOCAL HEALTH-RELATED COALITIONS. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE 10 HEALTH FOCUS AREAS AS WELL AS VOTE FOR THEIR TOP FIVE. FOLLOWING THESE OUTREACH ACTIVITIES, A GROUP OF APPROXIMATELY 20 COMMUNITY PARTNERS PARTICIPATED IN A PROCESS FOCUSING ON REVIEW AND DISCUSSION OF COMPILED DATA ON THE CURRENT HEALTH STATUS OF POLK COUNTY CITIZENS, AS WELL AS VOTING RESULTS FROM THE COMMUNITY FORUMS. DURING THE MEETING, THIS GROUP COMPLETED A PAPER SURVEY TO CAST THEIR VOTES TO DETERMINE THE TOP THREE HEALTH FOCUS AREAS FOR POLK COUNTY. THE TOP HEALTH FOCUS AREAS SELECTED WERE:1. MENTAL HEALTH2. OBESITY3. ALCOHOL USE OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. AMERY REGIONAL MEDICAL CENTER2. ST. CROIX REGIONAL MEDICAL CENTER OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE MOST SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AS FOLLOWS:MENTAL HEALTH - 1. THE HOSPITAL ASSISTED THE COUNTY MENTAL HEALTH TASK FORCE WITH UPDATING ITS BROCHURE OF LOCAL MENTAL HEALTH RESOURCES AND DISTRIBUTING IT WIDELY IN THE COMMUNITY. POLK COUNTY RESIDENTS WILL NOW HAVE KNOWLEDGE OF AND EASY ACCESS TO AN ANNUALLY UPDATED MENTAL HEALTH SERVICES DIRECTORY.2. AN ASSESSMENT, REFERRAL AND FOLLOW UP PROTOCOL WILL BE DEVELOPED FOR THE SCHOOL SYSTEM FOR STUDENTS AT HIGH RISK OF SUICIDE. THE MENTAL HEALTH TASK FORCE COMPLETED THE FINAL YEAR OF A 3-YEAR SUICIDE PREVENTION GRANT TARGETING "QUESTION, PERSUADE, REFER" TRAININGS IN COUNTY SCHOOL DISTRICTS, COMMUNITY AND OTHER SERVICE ORGANIZATIONS. THE HOSPITAL PROVIDED STAFF MEMBERSHIP ON THE TASK FORCE, AND ITS FOUNDATION, THE OSCEOLA COMMUNITY HEALTH FOUNDATION (OCHF), PROVIDED GRANT MONEY. THE HOSPITAL ALSO FUNDED A COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT. THROUGH A GRANT BY OCHF, THE HEALTHY BEGINNINGS PROJECT IN THE COUNTY OFFERED STUDENT THERAPY SERVICES BOTH ONSITE IN THE SCHOOLS AND AT HOME VISITS.3. THE HOSPITAL PARTICIPATED IN THE COUNTY WIDE "BEHIND THE DOOR" CAMPAIGN THAT CALLS FOR MOUNTING AWARENESS POSTERS WITH REFERRAL INFORMATION ON THE BACKSIDES OF PUBLIC DOORS (I.E. BATHROOMS). THIS CAMPAIGN PROMOTES AWARENESS OF SUICIDE AS A PREVENTABLE PUBLIC HEALTH PROBLEM.4. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING FOR DEPRESSION AT ALL PATIENT ENCOUNTERS.5. AN AWARENESS OF THE IMPORTANCE OF PROTECTIVE BEHAVIORS TO COMBAT BULLYING PROVIDED THROUGH A HOSPITAL PROVIDED COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT.IN ADDITION, WITHIN ITS FREE MONTHLY HEALTH SEMINAR SERIES, THE HOSPITAL OFFERED EDUCATION ON ALZHEIMER'S AND RELATED DEMENTIAS, AND SIGNS AND SYMPTOMS OF DEPRESSION. THE MENTAL HEALTH TASK FORCE SECURED AN OTTO BREMER FOUNDATION GRANT TO DEVELOP A DEPRESSION SCREENING PROGRAM (TO BE IMPLEMENTED 2015-2016).OBESITY - THE HOSPITAL AND ITS COMMUNITY HEALTH PARTNERS ADDRESSED THE OBESITY ISSUE AS FOLLOWS:1. CONDUCTED AN ENVIRONMENTAL SCAN OF SCHOOL POLICIES AND OBESITY PREVENTION INITIATIVES IN ORDER TO IMPLEMENT BEST PRACTICE SCHOOL WELLNESS PROGRAMS.2. THROUGH OCHF, FUNDED A FOOD AND VEGETABLE COMPONENT TO AN EXISTING "BACK PACK" PROGRAM IN OSCEOLA THAT PROVIDES SUPPLEMENTAL FOOD FOR FREE AND REDUCED MEALS FAMILIES FOR WEEKEND USE. THROUGH THE HOSPITAL'S FITNESS CENTER, OFFERED "FIT FOR LIFE" FITNESS WEIGHT LOSS CLASSES, AND YOUTH PROGRAMS THAT FEATURED NUTRITION, FITNESS AND WELLNESS.3. THE HOSPITAL IS PROMOTING COUNTY WIDE RECREATIONAL RESOURCES AND CLUBS. THE FREE, JEFF MEYER PUBLIC FITNESS TRAIL WAS OPENED TO ACCOMMODATE FITNESS AND WELLNESS NEEDS IN THE COMMUNITY. THROUGH OCHF, A GRANT WAS PROVIDED TO THE LOCAL "GROW OSCEOLA" GROUP TO PROMOTE FITNESS THROUGH TRAIL USE IN THE OSCEOLA AREA. A RESOURCE BROCHURE DETAILING SCHOOL OBESITY PREVENTION PROGRAMS CREATED AND DISTRIBUTED.4. THROUGH OUR FITNESS CENTER, PARTICIPATED IN A "POWER UP" FITNESS AND NUTRITION EVENT IN THE OSCEOLA SCHOOL DISTRICT TO SUPPORT IMPLEMENTATION OF BEST PRACTICE PROGRAMS TO INCREASE PHYSICAL ACTIVITY AT SCHOOL AND IN THE COMMUNITY.5. THE HOSPITAL IS IDENTIFYING, SUPPORTING, AND PURSUING POLICIES THAT WILL HELP WORKSITES STRENGTHEN THEIR WELLNESS PROGRAMS. THROUGH OUR OCCUPATIONAL HEALTH DEPARTMENT, THE HOSPITAL PROVIDED HEALTH FAIRS AND RELATED OPPORTUNITIES TO ADDRESS WORKSITE WELLNESS PROGRAMS. THE HOSPITAL WORKED WITH OUTSIDE PARTNERS TO PROMOTE WEIGHT LOSS AND HEALTHY LIVING INTO WORKSITES THROUGH INVOGOR-8, A WELLNESS PROGRAM SERIES. A WORKSITE WELLNESS TOOLKIT TRAINING SCHEDULE WAS DEVELOPED FOR BUSINESSES IN POLK COUNTY (TO BE IMPLEMENTED 2015).6. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING TO ADDRESS WEIGHT AND OBESITY ISSUES AT ALL PATIENT ENCOUNTERS.7. THROUGH OUR OCCUPATIONAL HEALTH DEPARTMENT, WORKED WITH ONE AREA INDUSTRY TO PROVIDE BREASTFEEDING AVAILABILITY ON SITE.8. THE HOSPITAL AND OCHF FUND AND HOST SUCCESS BY 6, A UNITED WAY PROGRAM THAT PROVIDES PHYSICAL, EMOTIONAL AND DEVELOPMENT GROWTH TO CHILDREN UNDER SIX AND THEIR PARENTS. IN ADDITION, WITHIN ITS FREE MONTHLY HEALTH SEMINAR SERIES, THE HOSPITAL OFFERED THE FOLLOWING SEMINARS - OUR SELF-HEALING BODIES, BASIC NUTRITION, HOW TO GET STARTED WITH FITNESS AND EXERCISE, AND HOW TO PREPARE QUICK, NUTRITIOUS AND DELICIOUS DINNERS.UNHEALTHY ALCOHOL USETHE HOSPITAL AND ITS COMMUNITY HEALTH PARTNERS ADDRESSED UNHEALTHY ALCOHOL USE THROUGH STAFF TIME, RESOURCES, AND FUNDING AS FOLLOWS:1. COMMUNITY AWARENESS AROUND DRIVING WHILE INTOXICATED WILL BE INCREASED BY A PUBLIC AWARENESS CAMPAIGN. DATA COLLECTED OF OPERATING WHILE INTOXICATED ON UNDERAGE DRINKING CITATIONS GATHERED FROM SHERIFF'S DEPARTMENT AND LOCAL MUNICIPALITIES WILL BE USED IN THIS PUBLIC AWARENESS CAMPAIGN.2. INITIATIVES TO REDUCE UNDERAGE ALCOHOL USE INCLUDE AWARENESS PROVIDED AS PART OF HOSPITAL PROVIDED COUNSELOR IN THE OSCEOLA SCHOOL DISTRICT. 3. THE HEALTH DEPARTMENT SECURED A PARENTS WHO HOST GRANT. THE GOAL OF THIS CAMPAIGN IS TO REDUCE ACCESS TO ALCOHOL BY MINORS AT A MINIMUM OF TWO COMMUNITY EVENTS.4. AS PART OF THE HOSPITAL PROVIDED COUNSELOR SERVICES IN THE OSCEOLA SCHOOL DISTRICT, INCREASE ACCESS TO COUNSELING SERVICES FOR ADOLESCENTS WITH UNDERAGE DRINKING VIOLATIONS AND ADOLESCENTS WHOSE PARENTS ARE CONCERNED ABOUT UNDERAGE DRINKING BEHAVIORS.5. INCREASE COMMUNITY AWARENESS AROUND BINGE DRINKING THROUGH COMPANY HEALTH FAIRS.6. ALL CLINICAL PROVIDERS AT THE HOSPITAL PROVIDE SCREENING TO ADDRESS ALCOHOL USE AT ALL PATIENT ENCOUNTERS.IN ADDITION, AN ENVIRONMENTAL SCAN OF CITY AND TOWN CLERKS CONDUCTED ON EXISTENCE OF LOCAL ALCOHOL POLICIES, A POLK COUNTY GUIDE TO ALCOHOL COMPLIANCE CHECKS COMPLETED, AND A COMMUNITY HEALTH IN ACTION GRANT SECURED FOCUSING ON BEST PRACTICES FOR CHANGING UNHEALTHY ALCOHOL PRACTICES IN COMMUNITIES. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 13B: IN A CASE BY CASE REVIEW, OSCEOLA MEDICAL CENTER HOLDS THE RIGHT TO MAKE EXCEPTIONS TO THE GUIDELINES LISTED IN THE COMMUNITY CARE POLICY (SUCH AS BUT NOT LIMITED TO PRESUMPTIVE GRANTING) WHEN IT IS FOUND TO BE IN THE BEST INTEREST OF THE PATIENT. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 22D: PATIENTS ARE ENCOURAGED TO FILL OUT AN APPLICATION FOR FINANCIAL ASSISTANCE. THE APPLICATION INCLUDES A SUMMARY OF ASSETS AND INCOME. ALONG WITH THE APPLICATION, REQUIRED SUPPORT MAY INCLUDE COPIES OF PAY STUBS, TAX RETURNS, BANK STATEMENTS, ETC. ONCE AN APPLICATION HAS BEEN APPROVED, THE PATIENT'S BILL WILL BE REDUCED BASED ON A COMPARISON OF THEIR ASSETS AND INCOME TO THE MEDICAL CENTER'S POLICY. FOR EXAMPLE IF THE PATIENT'S ASSETS AND INCOME ARE AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES THEN THE ENTIRE BILL IS FORGIVEN. IF THE PATIENT'S ASSETS AND INCOME ARE AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES THEN 90% OF THE BILL WILL BE DISCOUNTED AND THE PATIENT IS RESPONSIBLE FOR 10% OF THE BILL. IF THE PATIENT'S ASSETS AND INCOME ARE AT OR BELOW 300% OF THE FEDERAL POVERTY GUIDELINES THEN 70% OF THE BILL WILL BE DISCOUNTED AND THE PATIENT IS RESPONSIBLE FOR 30% OF THE BILL. THE MEDICAL CENTER'S POLICY CONTINUES ON WITH OTHER DISCOUNT RATES DEPENDING ON THE PATIENT'S ASSETS AND INCOME LEVEL. 4 OSCEOLA CLINIC 2600 65TH AVENUE OSCEOLA WI 54020 PROVIDER BASED CLINIC CLINIC PHARMACY 2600 65TH AVENUE OSCEOLA WI 54020 RETAIL PHARMACY SCANDIA CLINIC 21150 OZARK COURT NORTH SCANDIA MN 55073 FREE STANDING CLINIC WILD RIVER FITNESS CENTER 2630 65TH AVENUE OSCEOLA WI 54020 FITNESS CENTER PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. 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 VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. THE COST OF COMMUNITY HEALTH IMPROVEMENT, HEALTH PROFESSIONALS EDUCATION, AND IN-KIND CONTRIBUTIONS REFLECTS THE DIRECT AND INDIRECT COSTS AS DETERMINED BY THE HOSPITAL. PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. SERVICES INCLUDE NURSERY, MASSAGE THERAPY, OCCUPATIONAL HEALTH, CLINIC SERVICES, EMERGENCY ROOM, AND PHYSICIAN SERVICES. 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 $ 753,356. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS 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 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 IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY-CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. 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 EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE 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 ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. 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 THE HOSPITAL 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 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, OSCEOLA MEDICAL CENTER 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, OSCEOLA MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS 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), OSCEOLA MEDICAL CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO 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: OSCEOLA MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL BUT DID RECOGNIZE A SHORTFALL FROM THE MEDICARE PROGRAM DUE TO SEQUESTRATION ADJUSTMENTS TO AMOUNTS PAID.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.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: THE PATIENT IS ASKED TO FILL OUT A CHARITY CARE APPLICATION PRIOR TO SENDING TO A COLLECTION AGENCY. IF THE PAPERWORK IS NOT RECEIVED THE ACCOUNT IS HANDLED THROUGH THE NORMAL COLLECTION PROCESS. PART VI, LINE 2: THE MEDICAL CENTER ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY BY WORKING WITH COUNTY AND STATE OFFICES, DIRECT COMMUNICATION WITH CIVIC ORGANIZATIONS, AND BASED ON FEEDBACK FROM ONE-ON-ONE CONVERSATIONS WITH PATIENTS. IN ADDITION, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS COMPLETED DURING 2013. THE CHNA SOUGHT INPUT FROM DIVERSE STAKEHOLDERS, INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. THE ULTIMATE GOAL OF THE ASSESSMENT IS TO IDENTIFY HEALTH ISSUES AND DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. THIS EFFORT INCLUDED A COMPREHENSIVE REVIEW OF HEALTH DATA, AN ANALYSIS OF REAL TIME BODY MASS INDEX DATA FROM LOCAL CLIENT PATIENT ELECTRONIC MEDICAL RECORDS AND HEALTH AND LIFESTYLE DATA FROM COMMUNITY SURVEYS. PART VI, LINE 3: OSCEOLA MEDICAL CENTER HAS INFORMATION REGARDING THE CHARITY CARE POLICY AND OTHER FINANCIAL ASSISTANCE OPTIONS AVAILABLE:1. ON THEIR WEBSITE2. PLACED IN MAILINGS3. PAMPHLETS USED BY THE HOSPITAL'S PROVIDERS THAT CAN BE DISTRIBUTED4. A DEDICATED PATIENT ADVOCATE POSITION THAT WORKS ONE ON ONE WITH PATIENTS THESE RESOURCES ARE AVAILABLE TO ENSURE THAT ALL PATIENTS FULLY UNDERSTAND ALL OPTIONS THAT ARE AVAILABLE FOR ASSISTANCE. PART VI, LINE 4: OSCEOLA MEDICAL CENTER SERVES THE CITY OF OSCEOLA WISCONSIN AND NEIGHBORING COMMUNITIES IN WESTERN WISCONSIN AND EASTERN MINNESOTA. THE MEDIAN INCOME IN THE SURROUNDING AREA IS APPROXIMATELY $46,000 PER YEAR. APPROXIMATELY 11% OF THE LOCAL POPULATION LIVES AT OR BELOW THE FEDERAL PROPERTY GUIDELINES AND APPROXIMATELY 18% OF POLK COUNTY'S RESIDENTS RECEIVE SOME TYPE OF ASSISTANCE FROM THE STATE OF WISCONSIN. PART VI, LINE 5: A MAJORITY OF OSCEOLA MEDICAL CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF.OSCEOLA MEDICAL CENTER ALSO PROMOTES COMMUNITY HEALTH BY PROVIDING FREE HEALTH SEMINARS, FREE BABY & ME CLASSES, AND OTHER CLASSES FOR A FEE SUCH AS ATHLETIC SCREENINGS AND PREDIABETES CLASSES. OSCEOLA MEDICAL CENTER IS A NON-PROFIT ORGANIZATION, AND THEREFORE ALL EARNINGS IN EXCESS OF COST ARE USED BY THE HOSPITAL TO IMPROVE THE HEALTHCARE OF THE PEOPLE THEY SERVE THROUGH THE PURCHASE OR UPGRADE OF FACILITIES AND EQUIPMENT, OR THE ADDITION OR EXPANSION OF NEEDED SERVICES. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X X 0 0 0 0 0 0 0 0 0 TOM GESKERMANN CEO 161203 0 0 0 0 0 1635 0 22763 0 185601 0 0 0 A VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006338 2007-06-13 8000000 REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 B TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006044 2007-06-28 7040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 C TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND 390990620 2007-07-13 6040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 A 1287604 8000000 138545 4581314 3280141 2008 1 0 1 1 B 1137187 7040000 80850 6959150 2008 0 0 1 1 C 1267969 6040000 65800 5974200 2008 0 0 1 1 A 0 0 0 0 0.00490 0.00490 0 0 0 B 0 0 0 0 0.00490 0.00490 0 0 0 C 0 0 0 0 0.00490 0.00490 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 SCHEDULE K, PART II, LINE 11, COLUMN A: THE AMOUNT LISTED WAS USED TO REFINANCE EXISTING DEBT. SCHEDULE K, PART IV, LINE 2: THERE IS NO REBATE BECAUSE THERE ARE NO PROCEEDS AVAILABLE FOR INVESTMENT. ALL PROCEEDS HAVE BEEN USED FOR CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM WAS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE THE FORM WAS FILED. THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND THE FULL BOARD OF DIRECTORS RECEIVED A COPY AFTER THE RETURN WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH KEY EMPLOYEE, DIRECTOR, AND OFFICER SIGNS STATEMENT EACH YEAR DURING THEIR ANNUAL REVIEW. PERIODIC EDUCATION IS DONE THROUGH INTERNAL COMMUNICATION. FORM 990, PART VI, SECTION B, LINE 15 IN SETTING THE COMPENSATION OF THE CEO AND CFO, THE EXECUTIVE COMMITTEE SHALL COMPLY WITH LADD MEMORIAL HOSPITAL'S CONFLICT OF INTEREST POLICY AND, WITHOUT LIMITING THAT COMPLIANCE, WILL: (A) ACT ONLY WITH THE PARTICIPATION OF EXECUTIVE COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE MATTER, (B) WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY, AND (C) WILL ADEQUATELY AND TIMELY DOCUMENT THE BASIS FOR ITS DETERMINATION, CONCURRENTLY WITH MAKING THAT DETERMINATION. APPROPRIATE DATA AS TO COMPARABILITY CAN INCLUDE, BUT IS NOT NECESSARILY LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE CORPORATION; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE SAME INDIVIDUAL. ADEQUATE AND TIMELY DOCUMENTATION WILL GENERALLY BE MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE MEETING THAT STATE: THE COMPENSATION AND WHEN IT WAS APPROVED; THE EXECUTIVE COMMITTEE MEMBERS WHO WERE PRESENT AND HOW EACH VOTED; THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMMITTEE AND A SUMMARY OF HOW THE DATA WAS OBTAINED, AND ANY ACTION TAKEN IN SPECIFIC COMPLIANCE WITH THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. IF THE EXECUTIVE COMMITTEE APPROVES A COMPENSATION PACKAGE FOR THE CEO OR CFO THAT IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DETERMINATION OUTSIDE THE RANGE MUST BE RECORDED. MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE THAT DOCUMENT A DECISION ON CEO OR CFO COMPENSATION MUST BE PREPARED BEFORE THE LATER OF THE NEXT MEETING OF THE EXECUTIVE COMMITTEE OR 60 DAYS AFTER THE DECISION, AND MUST BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE WITHIN A REASONABLE PERIOD THEREAFTER. FORM 990, PART VI, SECTION C, LINE 19 LADD MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 4,415,007. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,415,007. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 462,986. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 462,986. LAB SERVICES: PROGRAM SERVICE EXPENSES 505,011. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 505,011. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 837,509. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 837,509. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 796,030. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 275. TOTAL EXPENSES 796,305. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 222,506. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 222,506. DATA PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 195,782. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 195,782. FORM 990, PART XII, LINE 2C: OVERSIGHT OF AUDIT THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT AUDITOR AND MANAGEMENT OVERSEES THE AUDIT PROCESS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OSCEOLA COMMUNITY HEALTH FOUNDATION INC 2600 65TH AVENUE OSCEOLA WI 54020 392029106 FOUNDATION WI 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0