2013-11-14T15:57:21-07:00 2012-12-31 990 2012-01-01 390808509 THE MONROE CLINIC INC MONR 6083241357 515 22ND AVENUE MONROE WI 53566 James Nemeth 6083242775 2013-11-08 2012 2016-02-24 21:20:13Z James Nemeth 515 22ND AVENUE MONROE WI 53566 161245522 0 X WWW.MONROECLINIC.ORG X 1963 WI THE MONROE CLINIC, INC. PROVIDES HEALTHCARE SERVICES TO A RURAL AREA NEEDING MEDICAL SERVICES REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY. 15 7 1368 176 1129972 0 110180 535335 152933738 162838333 984947 266741 0 -2475044 154028865 161165365 0 0 0 0 90145758 95767538 0 0 0 57410097 61767107 147555855 157534645 6473010 3630720 238050691 244550154 109077457 107867139 128973234 136683015 X WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS IN HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. VISION: EXCEPTIONAL HEALTHCARE; EXCEPTIONAL EXPERIENCE. 0 0 128241470 0 161708361 MONROE CLINIC IS AN INTEGRATED, COMPREHENSIVE HEALTHCARE ORGANIZATION. THROUGH THE SPONSORSHIP OF THE CONGREGATION OF SISTERS OF ST. AGNES, CSA, MONROE CLINIC IS ANINTEGRAL PART OF THE CATHOLIC CHURCH HEALING MINISTRY. PATIENTS FROM THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS CHOOSE MONROE CLINIC BECAUSE WE HELP PATIENTS GET WELL FASTER AND STAY HEALTHIER LONGER. WE OFFER SERVICES CENTERED ON OUR PATIENTS AND PLACE QUALITY AND CUSTOMER SATISFACTION AS OUR TOP PRIORITIES. MONROE CLINIC UTILIZES STATE OF THE ART EQUIPMENT AND TECHNOLOGY FOR DIAGNOSIS AND TREATMENT, FOCUSING ON HIGH QUALITY MEDICAL CARE. MONROE CLINIC IS COMPRISED OF A FULL SERVICE HOSPITAL THAT IS FULLY INTEGRATED WITH A MULTI-SPECIALTY CLINIC AS WELL AS NUMEROUS OTHER PHYSICIAN CLINIC LOCATIONS. MONROE CLINIC HAS 11 CLINICS IN VARIOUS LOCATIONS. 0 0 0 128241470 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 75 0 1 1368 1 1 1 0 0 0 0 0 X 15 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X JIM NEMETH 6083242775 515 22ND AVENUE MONROE WI 53566 JAMES LEE 3 X 0 0 0 WILLIAM OEMICHEN 3 X X 0 0 0 ANTHONY ROGERSON 50 X X 493184 0 52069 MICHAEL SANDERS 50 2 X X 577895 0 276150 MARK THOMPSON 50 X X 335548 0 136302 SISTER MARY NOEL BROWN 3 2 X 0 0 0 CHARLES DEARTH 3 X 0 0 0 DAVID DEININGER 3 X X 0 0 0 JOHN FREY 50 X 246522 0 47085 MIKE GREENFIELD 3 X X 0 0 0 PATRICIA JAMES 3 X 0 0 0 RACHEL LONG 50 X 146173 0 35118 CHRISTINE WELLINGTON 3 X 0 0 0 SISTER JOMARIE ZIELKE 3 X 0 0 0 AMY SIMANTEL 50 X 165274 0 32442 JULIE WILKE 50 X 305295 0 122063 PAULA RAIBLEY-ELMER 50 X 219225 0 86072 JANE WELDON 50 X 232475 0 50727 LUCINDA WERKHEISER 50 X 163034 0 71538 LANCE SATHOFF 50 X 894730 0 61717 NICHOLAS MAXWELL 50 X 892012 0 60162 ANDREW RIKKERS 50 X 870633 0 67888 JOHN BAZLEY 50 2 X 619614 0 53097 NATHAN MOORE 50 X 518685 0 33773 6680299 0 1186203 15 0 1 0 MAX OLESEVICH MD 3318 AUGUSTA LANE ONALASKA WI 54650 EMERGENCY PHYSICIAN SERVICES 145700 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LAB SERVICES 212590 UW MEDICAL FOUNDATION 600 HIGHLAND AVE MADISON WI 53792 PHYSICIAN ONCOLOGY SERVICES 453736 AMERICAN HEALTHCARE SERVICES ASSOC PO BOX 945 TRAVERSE CITY MI 49681 TEMPORARY STAFF 691653 4 0 0 0 136170 500 398665 120000 535335 NET PATIENT REVENUE 900099 154093266 154093266 0 0 OTHER OPERATING REVENUE 561499 7615095 7615095 0 0 NON-PATIENT SERVICES 621990 1121178 0 1121178 0 LAUNDRY SERVICES 812320 8794 0 8794 0 0 0 0 0 162838333 405907 0 0 405907 0 0 0 0 0 0 0 0 0 0 -59009 0 0 80157 -59009 -80157 -139166 0 0 -139166 0 LOSS ON EXTINGUISHMENT OF DEBT 900099 -2475044 0 0 -2475044 0 0 0 0 -2475044 161165365 161708361 1129972 -2208303 0 0 0 0 0 0 0 0 4466905 3870126 596779 0 0 72619156 62917237 9701919 3298711 2887113 411598 10647031 8557119 2089912 4735735 4057554 678181 0 0 99609 99609 48000 48000 0 0 0 0 0 0 7985084 5236374 2748710 0 0 24327665 23850766 476899 0 0 0 0 2781854 1761287 1020567 0 0 0 0 959753 801630 158123 2881724 2881724 0 0 10904795 5956451 4948344 0 0 REPAIRS AND MAINTENANCE 4108298 1838236 2270062 0 DUES AND SUBSCRIPTIONS 1314864 839092 475772 MISCELLANEOUS 6355461 2786761 3568700 0 0 157534645 128241470 29293175 0 83752 113365 40172466 37262394 0 0 24315844 21885579 0 0 0 0 0 0 2529333 2808434 3926906 3550031 222845719 105238224 110835805 117607495 38175542 43664145 0 0 0 0 479307 334154 17531736 17324557 238050691 244550154 21435412 19364508 0 0 0 0 81979538 81997346 0 0 0 0 785684 79370 0 0 4876823 6425915 109077457 107867139 X 128856007 136565788 117227 117227 0 0 128973234 136683015 238050691 244550154 X 3630720 3620084 0 0 0 458977 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 3629 3629 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 WISCONSIN HOSPITAL ASSOCIATION AND CATHOLIC HOSPITAL ASSOCIATION DUES ALLOCATED TO LOBBYING 0 1294964 1294964 0 138952698 48348470 90604228 0 0 0 0 0 76468043 54065499 22402544 0 6130014 2824255 3305759 117607495 RECEIVABLE FROM FOUNDATION 2008351 INVESTMENT IN UNCONSOLIDATED AFFILIATES 839789 INVESTMENT IN FOUNDATION 1756158 BOND PROCEEDS 5726980 DEFERRED COMPENSATION 6993279 17324557 0 DEFERRED COMPENSATION 6425915 6425915 X 159149298 0 0 0 623617 623617 158525681 2475044 164640 2639684 161165365 157534645 0 0 0 0 0 157534645 0 0 0 157534645 SchD_P10_S00_L01 Schedule D, Part X, Line 1 THE MONROE CLINIC IS A TAX EXEMPT CORPORATION AS DESCRIBED IN SECTION 501C3 OF THE INTERNAL REVENUE CODE(THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501A 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 UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE CLINIC RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 OR 2011. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE FEDERAL AND STATE TAXING AUTHORITIES. SchD_P10_S00_L02 Schedule D, Part X, Line 2 THE 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 UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE CLINIC RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 OR 2011. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE FEDERAL AND STATE TAXING AUTHORITIES. SchD_P11_S00_L02d Schedule D, Part XI, Line 2d INCREASE IN EQUITY IN UNCONSOLIDATED AFFILIATE 126,464 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 497,153 TOTAL 623,617 SchD_P11_S00_L04b Schedule D, Part XI, Line 4b OTHER 164,640 1 1 1 X 1 X 1 1 1 0 1 1 1 3541627 0 3541627 0.0225 1 17030727 0 17030727 0.1081 1 62393 0 62393 0.0004 3 0 20634747 0 20634747 0.1310 8 570868 0 570868 0.0036 1 172423 0 172423 0.0011 7 2800313 0 2800313 0.0178 0 0 0 0 0 4 133326 0 133326 0.0009 20 0 3676930 0 3676930 0.0234 23 0 24311677 0 24311677 0.1544 1 2409793 0 12582291 18039084 -5456793 X 1 1 1 1 MONROE CLINIC

515 22ND AVENUE MONROE WI 53566

X X X MONROE CLINIC 1 1 X X X X X X X X X X 12 1 0 1 X X X X X X 0 0 1 1 150 1 300 1 X X X X X X X X 1 1 X X X X 1 0 1 X 0 0 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 SchH_P01_S00_L07 Schedule H, Part I, Line 7 A COST TO CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES SchH_P01_S00_L07g Schedule H, Part I, Line 7g SUBSIDIZED HEALTH SERVICES INCLUDE BEHAVIORAL HEALTH/OUTPATIENT MENTAL HEALTH, PALLIATIVE CARE, RENAL DIALYSIS, SELF-HELP/SPORTS INJURY PREVENTION, CONTINUING CARE/HOME CARE SERVICES, AND EMERGENCY AND TRAUMA/EMERGENCY DEPARTMENT SchH_P03_S0A_L04 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 PROBABLY UNCOLLECTIBLE AMOUNTS PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED IN 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. SchH_P03_S0B_L08 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. SchH_P03_S0C_L09b 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. SchH_P05_S0B_L01 Schedule H, Part V, Section B, Line 1 MONROE CLINIC'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INCLUDED SOCIAL AND ECONOMIC FACTORS AS A CONTRIBUTOR TO THE HEALTH OF THE COUNTY'S RESIDENTS. BIRTH CHARACTERISTICS MORTALITY/LEADING CAUSES OF DEATH AND HEALTH BEHAVIORS WERE INCLUDED AS OTHER CONTRIBUTING FACTORS IN THE HEALTH NEEDS OF OUR COMMUNITIES. SchH_P05_S0B_L03 Schedule H, Part V, Section B, Line 3 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 DATE 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. SchH_P05_S0B_L07 Schedule H, Part V, Section B, Line 7 THE IMPLEMENTATION STRATEGY ADOPTED BY MONROE CLINIC ACTIVELY ADDRESSES THE HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA AS "PRIORITY HEALTH NEEDS." CERTAIN OTHER HEALTH NEEDS THAT WERE IDENTIFIED BUT NOT SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY INCLUDE: ALCOHOL AND OTHER DRUG USE, CHRONIC DISEASE PREVENTION AND MANAGEMENT, COMMUNICABLE DISEASE PREVENTION AND CONTROL, ENVIRONMENTAL AND OCCUPATIONAL HEALTH, INJURY AND VIOLENCE, ORAL HEALTH, REPRODUCTIVE AND SEXUAL HEALTH, TOBACCO USE AND EXPOSURE. MONROE CLINIC HAS CHOSEN NO TO FOCUS ON THESE AREAS BECAUSE WE BELIEVE WE CAN HAVE A GREATER IMPACT ON THE PRIORITY HEALTH NEEDS. TAKING EXISTING COMMUNITY RESOURCES INTO CONSIDERATION WE HAVE SELECTED TO CONCENTRATE ON THOSE HEALTH NEEDS THAT WE CAN MOST EFFECTIVELY ADDRESS GIVEN OUR AREAS OF FOCUS AND EXPERTISE. THEREFORE THE HOSPITAL'S CHARITABLE RESOURCES WILL BE PLACED ON THE SELECTED PRIORITY HEALTH NEEDS. SchH_P05_S0B_L12 Schedule H, Part V, Section B, Line 12 MONROE CLINIC OFFERS ALL UNINSURED PATIENTS A 10% DISCOUNT ON STANDARD RATES. SchH_P05_S0B_L13 Schedule H, Part V, Section B, Line 13 METHOD FOR APPLYING: PATIENTS MUST FIRST SEEK ASSISTANCE THROUGH OTHER RESOURCES. IF DENIED THEY MUST PROVIDE A LETTER OF DENIAL. IF AN APPLICATION IS MAILED TO A POTENTIAL APPLICANT IT MUST BE COMPLETED USING INCOME INFORMATION FOR THE LAST THREE MONTH PERIOD AND RETURNED TO THE PATIENT ACCOUNTS DEPARTMENT WITHIN 10 DAYS. IF THE POTENTIAL APPLICANT HAS BEEN A RECIPIENT OF COMMUNITY CARE IN THE RECENT PAST THEY DO NOT NEED TO RESUBMIT THE INCOME INFORMATION. SchH_P05_S0B_L14 Schedule H, Part V, Section B, Line 14 OTHER: 1. FINANCIAL COUNSELORS REACH OUT TO SELF-PAY INPATIENTS 2. CLINICAL DEPARTMENTS REFER PATIENTS TO FINANCIAL COUNSELORS 3. THE BILLING OFFICE WILL REFER PATIENTS WHEN ATTEMPTING TO COLLECT ON UNPAID BALANCES. SchH_P05_S0B_L20 Schedule H, Part V, Section B, Line 20 MONROE CLINIC OFFERS ALL UNINSURED PATIENTS A 10% DISCOUNT ON STANDARD RATES. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 MONROE CLINIC IN COLLABORATION WITH 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 HEALTHIEST WISCONSIN 2020 ARE T 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. SchH_P06_S00_L03 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. (IE. WISCONSIN BADGERCARE, WISCONSIN AND ILLINOIS WELL WOMAN PROGRAMS, MEDICARE, MEDICAID, ETC.) PATIENTS CAN FIND OUT ABOUT THESES 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 CLINIC CAREGIVERS IDENTIFY PATIENTS IN NEED AS THEY REGISTER OR AFTER THEY RECEIVE CARE AND CANNOT PAY. 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. SchH_P06_S00_L04 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 FOR MEDICARE. FOR PATIENTS WHO HAVE NO HEALTH INSURANCE LIMITED HEALTH INSURANCE OR WHO EXPECT TO HAVE DIFFICULTY PAYING THEIR BILL THE COMMUNITY CARE PROGRAMS PROVIDES HEALTHCARE AT A 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 AREA WHICH INCLUDES THE FOLLOWING COUNTIES IN WISCONSIN: GREEN, LAFAYETTE, AND SECTIONS OF DANE, ROCK, AND IOWA COUNTIES. IN ILLINOIS: STEPHENSON AND SECTIONS OF WINNEBAGO AND JO DAVIES COUNTIES. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A MINIMUM OF THREE MONTHS PRIOR TO BEING ELIGIBLE FOR THE COMMUNITY CARE PROGRAM. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 A MAJORITY OF THE MONROE CLINIC BOARD OF DIRECTORS IS COMPRISED F PERSONS THAT RESIDE IN THE GEOGRAPHIC AREAS WE SERVE. MONROE CLINIC RE-INVESTS 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 RECORD 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. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 LIST OF STATES RECEIVING COMMUNITY BENEFITS REPORT: WISCONSIN X 1 1 X X X X X 0 0 0 0 0 1 0 0 0 MICHAEL SANDERS 435863 0 138171 0 3861 0 251599 0 24551 0 854045 0 138171 0 ANTHONY ROGERSON 492564 0 470 0 150 0 25102 0 26967 0 545253 0 470 0 JOHN BAZLEY 619517 0 0 0 98 0 26130 0 26967 0 672712 0 0 0 MARK THOMPSON 266870 0 68483 0 195 0 112867 0 23435 0 471850 0 68483 0 JOHN FREY 245752 0 490 0 280 0 20528 0 26557 0 293607 0 490 0 RACHEL LONG 145729 0 294 0 150 0 11626 0 23492 0 181291 0 294 0 AMY SIMANTEL 164784 0 392 0 98 0 12565 0 19877 0 197716 0 392 0 JULIE WILKE 243725 0 61122 0 449 0 101364 0 20699 0 427359 0 61122 0 PAULA RAIBLEY-ELMER 173585 0 44931 0 710 0 65462 0 20610 0 305298 0 44931 0 JANE WELDON 184998 0 47212 0 265 0 38386 0 12341 0 283202 0 47212 0 LANCE SATHOFF 894148 0 485 0 98 0 34750 0 26967 0 956448 0 485 0 NATHAN MOORE 518463 0 170 0 52 0 24975 0 8798 0 552458 0 0 0 NICHOLAS MAXWELL 891372 0 490 0 150 0 40137 0 20025 0 952174 0 490 0 ANDREW RIKKERS 870078 0 490 0 65 0 40921 0 26967 0 938521 0 490 0 LUCINDA WERKHEISER 129164 0 33622 0 248 0 52616 0 18922 0 234572 0 33622 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a PROVIDED MEMBERSHIP FOR THE PRESIDENT/CEO TO THE LOCAL COUNTRY CLUB AND KIWANIS ORGANIZATION: TOTAL VALUE: 1,168. SchJ_P01_S00_L03 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 REVIEWS 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. SchJ_P01_S00_L06 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 2012 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 1 0 1 B 0 0 0 0 0 1 0 1 C 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 A 0 B 0 C 0 SchK_P02_S00_L03 Schedule K, Part II, Line 3 TOTAL PROCEEDS OF ISSUE VARIANCE BETWEEN ISSUE PRICE AND TOTAL PROCEEDS (16,970) IS THE LOSS ON THE INVESTMENT. MARTIN ARNOLD DR. RACHEL LONG'S HUSBAND 230334 EMPLOYMENT 1 F990_P01_S00_L01 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 COMMUNITY CARE PROGRAM TO ELIGIBLE BENEFICIARIES (THIS FALLS UNDER CHARITY CARE). F990_P03_S00_L04a Form 990, Part III, Line 4a THROUGHOUT SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. WITHIN THE CLINICS AND HOSPITAL THERE ARE 81 PHYSICIANS WITH 24 SPECIALTIES SUCH AS ENDOCRINOLOGY AND CARDIOLOGY THAT WORK HARD TO MEET THE NEEDS OF OUR PATIENTS EVERY DAY. DURING 2012 OUR PHYSICIANS AND STAFF PROVIDED SERVICES TO PATIENTS ACCESSING OUR SYSTEM IN TOTAL 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 PHYSICIANS 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 WEB SITE. TO DATE WE HAVE BEEN AMONG THE HIGHEST PERFORMING HOSPITALS IN THE AREA. PATIENT SATISFACTION SCORES ARE ALSO SIGNIFICANTLY ABOVE THE AVERAGE OF OTHER HEALTHCARE FACILITIES. OUR HIGHLY TRAINED PHYSICIANS AND STAFF ARE READY TO PROVIDE BOTH EXCEPTIONAL HEALTH CARE AND AN EXCEPTIONAL EXPERIENCE TO THE PATIENTS AND COMMUNITIES WE SERVE. IN CALENDAR YEAR 2012 MONROE CLINIC PROVIDED MROE THAN $24.3 MILLION IN COMMUNITY BENEFIT TO MORE THAN 71,000 PATIENTS. THIS $24.3 MILLION REPRESENTS APPROXIMATELY 15.8 PERCENT OF MONROE CLINIC'S TOTAL NET PATIENT REVENUE. THE COMMUNITY BENEFIT AT COST IS COMPRISED OF $3.5 MILLION OF CHARITY CARE, $17 MILLION IN UNREIMBURSED COSTS FOR MEDICAID PATIENTS, $2.8 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 SERVICES ACQUIRE NEW TECHNOLOGY ADD NEW SERVICES UPGRADE FACILITIES AND PROVIDE FREE COMMUNITY EDUCATION AND SCREENING PROGRAMS. THROUGH OUR SPENDING AND THAT OF OUR EMPLOYEES MONROE CLINIC CONTRIBUTES SIGNIFICANTLY TO THE LOCAL COMMUNITY. F990_P06_S0A_L06 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. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a THERE IS A GOVERNING BODY THAT HAS FINAL APPROVAL FOR ANY NEW BOARD MEMBERS. F990_P06_S0A_L07b 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. F990_P06_S0B_L11b 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. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c ANNUALLY, CONFLICT OF INTEREST STATEMENTS AND POLICY ARE DISTRIBUTED 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. F990_P06_S0B_L15 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. THE 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. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 A PAPER COPY OF THE DOCUMENTS/STATEMENTS IS PROVIDED UPON REQUEST. F990_P11_S00_L05 Form 990, Part XI, Line 5 OTHER CHANGES IN NET ASSETS OR FUND BALANCES EQUITY IN EARNINGS OF UNCONSOLIDATED AFFILIATES 126,464 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 497,153 OTHER (164,640) TOTAL 458,977 F990_P11_S00_L09 Form 990, Part XI, Line 9 EQUITY IN EARNINGS OF UNCONSOLIDATED AFFILIATES 124,464 CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 497,153 OTHER (164,640) TOTAL 458,977 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SchR_P02_S00_L00 Schedule R, Part II LINE 1, (B) PRIMARY ACTIVITY IS TO SUPPORT THE MISSION OF THE MONROE CLINIC AN EXTENSION OF TIME TO FILE WAS FILED AND APPROVED. NOTICE NUMBER CP211A WAS RECEIVED SEPTEMBER 2, 2013 FROM THE DEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE.