2014-07-15T11:23:17-05:00 2013-12-31 390758449 WIPFLI LLP 3703 OAKWOOD HILLS PKWY/PO BOX 690 EAU CLAIRE WI 547020690 990 2013-01-01 390773970 LADD MEMORIAL HOSPITAL LADD 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 THOMAS GESKERMANN CEO 7152942111 2014-07-11 1 HOLLY POKRANDT CPA P00449155 7158323407 2014-07-11 2013 2015-11-30 17:44:51Z OSCEOLA MEDICAL CENTER THOMAS GESKERMANN 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 30684255 0 X WWW.MYOMC.ORG X 1947 WI TO ENHANCE THE VITALITY OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL CARE THROUGH A CULTURE OF COMPASSION AND HOME-TOWN SERVICE. 10 10 327 46 1351128 -210105 418636 97006 30990265 30370766 77067 42485 451428 166721 31937396 30676978 0 0 0 0 12208100 12472388 0 0 141354 17240977 17451760 29449077 29924148 2488319 752830 41433071 41176366 24675529 23646859 16757542 17529507 X TO ENHANCE THE VITALITY OF OUR COMMUNITY BY PROVIDING EXCEPTIONAL CARE THROUGH A CULTURE OF COMPASSION AND HOME-TOWN SERVICE. 0 0 26514162 28905240 DURING 2013, 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 456 PATIENTS AND TOTALED 1,191 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, OBSTETRIC, NEWBORN AND SWINGBED CARE.OUTPATIENT SERVICES INCLUDED 2,327 EMERGENCY ROOM VISITS; 2,887 RADIOLOGY PROCEDURES; 55,676 LAB PROCEDURES AND 434 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 31,314 VISITS. 26514162 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 42 0 327 1 1 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 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 ARNOLD POTEK MD DIRECTOR 1.00 X 0 0 0 KARI SMITH MD 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 TYLER SCHMIDTZ DIRECTOR 1.00 X 0 0 0 PEGGY WEBBER CHAIRPERSON 1.00 X X 0 0 0 AL HOGAN 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 JEFFREY K MEYER CEO (THROUGH 09/2013) 40.00 X 144679 0 19512 HEATHER PETERKIN CFO 40.00 X 102363 0 6275 THOMAS GESKERMANN CEO (EFFECTIVE 10/2013) 40.00 X 37862 0 4749 NANCY BLAIN PHARMACY MANAGER 40.00 X 120437 0 22105 ANDREW LINDLOFF CLINIC PHARMACY DIRECTOR 40.00 X 113045 0 30281 518386 0 82922 4 0 1 0 HEALTHPARTNERS GROUP HEALTH INC MAIL STOP 21109A ST PAUL MN 551640059 PHYSICIANS 4080138 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 DIAGNOSTIC IMAGING 660300 MARSHFIELD LABS 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 LABORATORY SERVICES 492529 ANESTHETISTS INC OF WISCONSIN 130 S KNOWLES AVE NEW RICHMOND WI 54017 CRNA SERVICES 463764 CPSI PO BOX 850309 MOBILE AL 36685 ELECTRONIC HEALTH RECORDS 222123 8 57609 18139 21258 97006 NET PATIENT SERVICE REV 621990 29727896 28376768 1351128 FITNESS CENTER 713940 405936 405936 CAFETERIA 621990 144901 144901 GIFT SHOP 621990 51669 51669 MISCELLANEOUS 621990 22535 22535 17829 17829 30370766 49362 49362 44185 0 44185 44185 44185 400 7277 -6877 -6877 -6877 ELECTRONIC MEDICAL RECORDS INCENT 621990 122536 122536 122536 30676978 28905240 1351128 323604 X 315440 315440 10100809 8199770 1778797 122242 313661 255147 54710 3804 1601439 1494438 99484 7517 141039 111687 27594 1758 16557 16557 61175 61175 7100311 6703085 396736 490 53985 53985 668515 297998 366129 4388 1592500 1592500 64096 46948 16198 950 2077228 2077228 39573 39573 MEDICAL SUPPLIES/EQUIPM 4730374 4730374 PROVISION FOR BAD DEBT 700505 700505 FOOD EXPENSE 133355 133355 HOSPITAL ASSESSMENT 108000 108000 105586 63127 42254 205 29924148 26514162 3268632 141354 3467284 4788646 3641470 3743212 30601 8000 3329771 3128330 1534 692469 673623 145784 155642 36615070 9585469 28578469 27029601 701308 701308 844381 948004 41433071 41176366 2791535 2928922 455000 325000 18607973 18013169 1922075 1832338 898946 547430 24675529 23646859 X 16726941 17521507 30601 8000 16757542 17529507 41433071 41176366 752830 19135 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 1209 1209 0 PART II-B, LINE 1: LADD MEMORIAL HOSPITAL PAYS AN ANNUAL ASSOCIATION MEMBERSHIP TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. WHA HAS NOTIFIED LADD MEMORIAL HOSPITAL THAT APPROXIMATELY $1,209 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 1547047 1547047 26858228 4950824 21907404 8209795 4634645 3575150 27029601 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 449811 PLEDGE PAYABLE 97619 547430 X PART X, LINE 2: THE MEDICAL CENTER AND FOUNDATION ARE NONPROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE MEDICAL CENTER AND THE FOUNDATION ARE ALSO EXEMPT FROM STATE TAXES ON RELATED INCOME. THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN CERTAIN ACTIVITIES SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME (UBI). UBI IS NOT SIGNIFICANT. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION 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. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 AND 2012. FEDERAL TAX RETURNS FOR THE YEARS ENDED 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 1 X 1 X 1 1 0 1 1 376488 376488 0.01290 2846104 2156934 689170 0.02360 3222592 2156934 1065658 0.03650 58772 10999 47773 0.00160 69408 69408 0.00240 6790291 5326331 1463960 0.05010 4398 4398 0.00020 6922869 5337330 1585539 0.05430 10145461 7494264 2651197 0.09080 6880 6880 0.00020 6880 6880 0.00020 0 399938 79988 7277670 7205613 72057 X 1 1 1 1 LADD MEMORIAL HOSPITAL DBA OSCEOLA MED 2600 65TH AVENUE OSCEOLA WI 54020 X X X X OSCEOLA MEDICAL CENTER 1 1 X X X X X X X X 13 1 1 1 X HTTP://WWW.MYOMC.ORG/ABOUT/COMMUNITY X HTTP://WWW.HEALTHYPOLKCOUNTY.COM/COMMUNITY-HEA X X X X X X 1 0 1 1 200.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X X X X 1 0 X X X 1 X 0 0 OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 3: 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 4: 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 20D: 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 REVENUES. 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 $ 700,505. 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 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: THE COSTING METHOD USED IS BASED ON A COST-TO-CHARGE RATIO WHICH WAS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THE COST OF BAD DEBT AMOUNTS IS CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REFLECTS THE COST OF SERVICES PROVIDED TO UNINSURED COMMUNITY MEMBERS AND DEDUCTIBLES OR COINSURANCE AMOUNTS FOR UNDERINSURED PATIENTS WHO ARE UNABLE TO PAY FOR A PORTION OF SERVICES. ACCOUNTS RECEIVABLE PRIMARILY CONSISTS OF UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE MEDICAL CENTER BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT. THE MEDICAL CENTER DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. ACCOUNTS RECEIVABLE ARE RECORDED NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH 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 REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE 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, THE MEDICAL CENTER 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 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. THE COST OF INCURRED BAD DEBT EXPENSE SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE COST PRIMARILY RELATES TO THE COINSURANCE AND DEDUCTIBLES FOR SERVICES PROVIDED TO COMMUNITY MEMBERS. IF MANY OF THESE INDIVIDUALS HAD TAKEN THE TIME TO FILL OUT THE CHARITY CARE APPLICATION THEY WOULD HAVE QUALIFIED. IT IS PROHIBITIVE FOR THE MEDICAL CENTER TO FOLLOW UP WITH EACH OF THESE INDIVIDUALS. PART III, LINE 8: THE MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND THEREFORE DID NOT RECOGNIZE A SHORTFALL FROM THE MEDICARE PROGRAM.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: THE 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 MEDICAL CENTER'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: THE 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 THE MEDICAL CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE MEDICAL CENTER'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE MEDICAL CENTER, NOR FAMILY MEMBERS THEREOF.THE 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 MEDICAL CENTER 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 JEFFREY K MEYER CEO (THROUGH 09/2013) 125064 0 0 0 19615 0 6402 0 13110 0 164191 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 1056658 8000000 138545 4581314 3280141 2008 1 0 1 1 B 932428 7040000 80850 6959150 2008 0 0 1 1 C 1077745 6040000 65800 5974200 2008 0 0 1 1 A 0 0 0 0 0.00560 0.00560 0 0 0 B 0 0 0 0 0.00560 0.00560 0 0 0 C 0 0 0 0 0.00560 0.00560 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 AT BOTH THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND AT THE FULL BOARD OF DIRECTORS MEETING. BOTH THE BOARD OF DIRECTORS AND THE FINANCE COMMITTEE APPROVED THE FORM BEFORE FILING. 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 THE MEDICAL CENTER'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 4,215,194. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,215,194. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 427,281. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,281. LAB SERVICES: PROGRAM SERVICE EXPENSES 504,429. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 504,429. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 829,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 829,449. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 726,732. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 490. TOTAL EXPENSES 727,222. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 204,531. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,531. DATA PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 192,205. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,205. FORM 990, PART XI, 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, TYPE II N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0