2013-10-28T10:02:30-05:00 2012-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2011-07-01 391101287 RIPON MEDICAL CENTER INC RIPO 9207483101 933 NEWBURY STREET RIPON WI 54971 LESLIE STEPHANY 9209264512 2013-10-24 TERRI REXRODE CPA MST P00096513 9206620016 2013-10-24 X 2011 2016-02-25 16:41:14Z LESLIE STEPHANY 430 E DIVISION ST FOND DU LAC WI 54935 23380878 0 X WWW.AGNESIAN.COM X 1936 WI RIPON MEDICAL CENTER IS A MINISTRY OF AGNESIAN HEALTHCARE, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING ALL PERSONS AT EVERY STAGE OF LIFE. 15 13 233 150 32893 -122809 57061 34994 16202505 23109564 42107 455 -22484 235865 16279189 23380878 0 0 0 0 9677864 11080978 0 0 0 7975370 12383168 17653234 23464146 -1374045 -83268 14055996 14795622 2751095 3402022 11304901 11393600 X THE MISSION OF AGNESIAN HEALTHCARE IS TO PROVIDE COMPASSIONATE CARE THAT BRINGS HOPE, HEALTH AND WHOLENESS TO THOSE WE SERVE BY HONORING THE SACREDNESS AND DIGNITY OF ALL PERSONS AT EVERY STAGE OF LIFE. WE ARE ROOTED IN THE HEALING MINISTRY OF THE CATHOLIC CHURCH AS WE CONTINUE THE MISSION OF OUR SPONSOR, THE CONGREGATION OF SISTERS OF ST. AGNES. 0 0 16168463 23272020 RIPON MEDICAL CENTER OPERATES A 25 BED CRITICAL ACCESS HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES TO RESIDENTS OF RIPON, GREEN LAKE AND THE SURROUNDING COUNTIES. DURING FISCAL YEAR 2012, RIPON MEDICAL CENTER HAD INPATIENT ADMISSIONS OF 673, WITH TOTAL PATIENT DAYS OF 2,755. THERE WAS A TOTAL OF 7,162 EMERGENCY ROOM VISITS AND 1,070 SURGERIES PERFORMED IN FISCAL YEAR 2012. IN ADDITION, RIPON MEDICAL CENTER PROVIDED OUTPATIENT SERVICES IN LAB, IMAGING, PHYSICAL AND OCCUPATIONAL THERAPY, AND CARDIAC REHAB TOTALLING 39,277 VISITS. THE MEDICAL CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY IT PROVIDES TO ITS PATIENTS. THE COST OF SERVICES AND SUPPLIES FURNISHED UNDER THE MEDICAL CENTER'S CHARITY CARE POLICY WAS $245,396 IN FY12. IN ADDITION TO QUALITY HEALTH CARE SERVICES, RIPON MEDICAL CENTER PROVIDES ITS COMMUNITIES WITH EDUCATION, SUPPORT GROUPS AND OTHER COMMUNITY BENEFITS. THE NET COST OF THESE COMMUNITY BENEFITS WAS $117,642 IN FY 2012. 16168463 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 26 0 1 233 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X LESLIE STEPHANY 9209264512 430 E DIVISION ST FOND DU LAC WI 54935 JOAN A KARSTEN 1.00 X X 0 0 0 ALLEN R SCHRAEDER 1.00 X X 0 0 0 JAY B MCDONALD 1.00 X X 0 0 0 KATHRYN A SCHWANDT 1.00 X X 0 0 0 MICHAEL J COMBS MD 1.00 X 0 0 0 J DREW DIEDRICH 1.00 X 0 0 0 MARY A LYKE 1.00 X 0 0 0 DANIEL L PARKS 1.00 X 0 0 0 MICHELE A WITTLER 1.00 X 0 0 0 WILLIAM A BOESCH 1.00 X 0 0 0 SR MARY NOEL BROWN 1.00 X 0 0 0 SR SUSAN STUCKI 1.00 X 0 0 0 STEVEN N LITTLE 50.00 X 0 728403 32425 KATHERINE R VERGOS 50.00 X X 57500 81100 2665 JEAN JOHNSON MD 1.00 X 0 0 0 PAUL BOEDER MD 40.00 X 224994 0 19654 JASON DEVRIES MD 40.00 X 397080 0 19654 HAYDAR SALEH MD 40.00 X 254691 0 4374 STEVEN PALS MD 40.00 X 220896 0 3276 BRADLEY EISENBERG MD 40.00 X 215533 0 4838 1370694 809503 86886 13 0 1 0 BADGER EMERGENCY PHYSICIANS SC PO BOX 11 RIPON WI 54971 EMERGENCY ROOM PHYSICIANS 1168720 CONSULTANTS LABORATORY 430 E DIVISION ST FOND DU LAC WI 54935 LABORATORY SERVICES 651287 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 53202 LEGAL SERVICES 446942 CENTRAL WISCONSIN ANESTHESIA ASSOCIATION PO BOX 249 BERLIN WI 54923 ANESTHESIA SERVICES 260622 AFFINITY MEDICAL GROUP 222 W COLLEGE AVE APPLETON WI 54911 PHYSICIAN SERVICES 259739 6 21920 13074 34994 MEDICARE/MEDICAID 621110 11539873 11539873 PATIENT SERVICE REVENU 621110 10551181 10551181 WORK INJURY/OCC HEALTH 621110 620005 620005 PHARMACY REVENUE 900099 36771 36771 RENTAL INCOME 900099 19872 19872 341862 341862 23109564 455 455 MEDICARE EHR PAYMENT 621110 121639 121639 FOOD SERVICE AND VENDI 900099 40516 40516 MOBILE MEALS 624200 32893 32893 40817 40817 235865 23380878 23272020 32893 40971 138600 138600 8971902 7296365 1675537 247625 58531 189094 1125049 16092 1108957 597802 284005 313797 138496 138496 10327 10327 4688779 4125085 563694 62040 1494 60546 3736439 3059163 677276 487036 6575 480461 486755 155422 331333 24085 15157 8928 46557 37570 8987 19232 19232 1468294 28969 1439325 136693 33364 103329 BAD DEBT 837465 837465 HOSPITAL ASSESSMENT TAX 146054 146054 DUES/SUBSCRIPTIONS/LICE 61227 46068 15159 SPONSORSHIP FEES 4572 4572 29117 21084 8033 23464146 16168463 7295683 0 262297 582176 85281 2617995 3319032 233863 35035 24780 615473 333982 243183 125207 6488868 1211655 4952845 5277213 516569 522651 4503710 4600326 14055996 14795622 2077295 1320974 545000 65000 128800 0 2016048 2751095 3402022 X 8889414 8000884 2415487 3392716 11304901 11393600 14055996 14795622 X -83268 171967 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1587 1587 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING PORTION OF WHA DUES 749150 749150 1839084 641160 1197924 2734176 570495 2163681 1166458 1166458 5277213 OTHER RECEIVABLE 20134 OTHER RECEIVABLE - INTEGNET 138461 BOND RESERVE FUND 121860 WISCONSIN UNEMPLOYMENT RESERVE FUND 107423 NET INVESTMENT IN FOUNDATION FOR RIPON MEDICAL CENTER, INC 3392716 DEFERRED FINANCING COSTS 1759 OTHER INTANGIBLES 817973 4600326 DUE TO AFFILIATES 1134049 DUE TO THIRD PARTIES 881999 2016048 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS 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 FINANCIAL STATEMENTS. RIPON MEDICAL CENTER, INC. RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. FEDERAL RETURNS FOR THE YEARS 2009, 2010, AND 2011 REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. 1 1 X 1 X 165.000000000000 1 X 1 1 1 0 1 1 245396 245396 0.01080 2142753 1573390 569363 0.02520 2388149 1573390 814759 0.03600 3507 3507 0.00020 96282 96282 0.00420 17853 17853 0.00080 117642 117642 0.00520 2505791 1573390 932401 0.04120 1 837465 0 9966483 11332509 -1366026 X 1 1 1 1 RIPON MEDICAL CENTER

933 NEWBURY ST RIPON WI 54971

X X RIPON MEDICAL CENTER INC 1 1 1 165.000000000000 1 300.000000000000 1 X X X 1 1 X X X X X 1 X X 1 X X X X X X 1 X 0 1 PART I, LINE 6A: AN ANNUAL COMMUNITY BENEFIT REPORT IS COMPLETED BY THE FINANCE DEPARTMENT AND DISTRIBUTED TO THE PUBLIC THROUGH THE PUBLIC RELATIONS OFFICE OF AGNESIAN HEALTHCARE, INC. PART I, LINE 7: A COST-TO-CHARGE RATIO WAS USED TO COMPUTE COST OF COMMUNITY BENEFIT SERVICES. OVERALL COSTS LESS TAES WERE DIVISIBLE BY TOTAL CHARGES. PART I, L7 COL(F): BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 WAS $837,465 AND WAS EXCLUDED FROM THE DENOMINATOR PER INSTRUCTIONS. PART III, LINE 4: 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 CONTRACTUAL ADJUSTMENTS AND A CREDIT TO THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY FOR DETERMINING BAD DEBTS IS A COST TO CHARGE RATIO. PART III, LINE 8: MEDICARE SHORTFALL IS NOT TREATED AS A COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES, THE TOTAL EXPENSE LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. PART III, LINE 9B: A ZERO DOLLAR AMOUNT WAS ESTIAMTED FOR THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. IF PATIENTS QUALIFY, THEIR EXPENSES ARE RECLASSIFIED AS CHARITY CARE. PATIENTS WHO RECIEVED A COLLECTION NOTICE COUL APPLY FOR CHARITY CARE. IF THEIR APPLICATION IS APPROVE, THIS WOULD TRIGGER A TRANSFER OF EXPENSES FROM BAD DEBT TO CHARITY CARE. FORM 990, SCHEDULE H, PART III, LINE 9A RIPON MEDICAL CENTER HAS A WRITTEN DEBT COLLECTION POLICY. PAYMENT IS DUE WITHIN 30 DAYS OF RECEIPT OF A STATEMENT. IF PATIENTS DO NOT SET UP ACCEPTABLE PAYMENT ARRANGEMENTS, BILLS WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. FINANCIAL COUNSELORS WORK WITH ALL PATIENTS ON AN INDIVIDUAL BASIS AND MAY OFFER MONTHLY PAYMENTS WITHOUT INTEREST BASED ON DOLLAR AMOUNT, PRIVATE PAY DISCOUNTS (INDIVIDUALS WHO DO NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE BILLED AT REDUCED RATES), OR GUARANTEED BANK LOANS. RIPON MEDICAL CENTER, INC. PART V, SECTION B, LINE 11H: UNINSURED PATIENTS ARE AUTOMATICALLY GIVEN A 15% DISCOUNT. RIPON MEDICAL CENTER, INC. PART V, SECTION B, LINE 15E: COLLECTION AGENCIES ARE ENGAGED TO COLLECT UNPAID BALANCES. THESES AGENCIES ARE AUTHORIZED TO REPORT TO CREDIT AGENCIES. RIPON MEDICAL CENTER, INC. PART V, SECTION B, LINE 16E: COLLECTION AGENCIES ARE AUTHORIZED BY THE HOSPITAL TO ESTABLISH GARNISHMENT AGAINST WAGES ON UNPAID BALANCES THEY ARE ATTEMPTING TO COLLECT. RIPON MEDICAL CENTER, INC. PART V, SECTION B, LINE 19D: UNINSURED PATIENTS AUTOMATICALLY RECEIVE A 15% DISCOUNT OFF GROSS CHARGES. RIPON MEDICAL CENTER, INC. PART V, SECTION B, LINE 21: UNINSURED PATIENTS WOULD AUTOMATICALLY RECEIVE A 15% DISCOUNT. INSURED PATIENTS WHO ARE PART OF AN INSURANCE PLAN WITHOUT A NEGOTIATED RATE WITH THE HOSPITAL MIGHT PAY FULL CHARGES IF THE ENTIRE CHARGE WAS APPLIED TO THEIR DEDUCTIBLE. PART VI, LINE 2: DURING FY12, MANAGEMENT AT RIPON MEDICAL CENTER PARTICIPATED IN A TASK FORCE IDENTIFYING THE COUNTY'S MOST PRESSING HEALTH CONCERNS. THE MEMBERS REVIEWED COUNTY AND STATE DATA AND COMMISSIONED A COMMUNITY SURVEY TO GET RESIENT AN KEY STAKEHOLERS' OPINIONS ON THE MAJOR HEALTH CONCERNS IN THE COUNTY. RESULTS OF THE COMMUNITY HEALTH ASSESSMENT WILL BE MAE AVAILABLE TO THE PUBLIC THROUGH THE HOSPITAL WEBSITE, AS WELL AS THROUGH THE COUNTY HEALTH DEPARTMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - FINANCIAL COUNSELORS AT RIPON MEDICAL CENTER ASSIST PATIENTS WITH APPLICATION TO COMMUNITY CARE. PATIENTS CAN BE REFERRED TO COMMUNITY CARE BY CLERGY, DEPARTMENTS OF RIPON MEDICAL CENTER, SISTERS OR ST. AGNES, PHYSICIANS, AREA SOCIAL AND HEALTH AGENCIES, FAMILY OR SELF. THE APPLICATION IS COMPLETED BY THE PATIENT WITH ASSISTANCE FROM THE FINANCIAL COUNSELOR IF NEEDED. THE FINANCIAL COUNSELOR WILL COMMUNICATE TO THE PATIENT WHAT PROGRAMS THEY WILL BE ELIGIBLE FOR, AS WELL AS PROVIDING NOTIFICATION OF APPROVAL OR DENIAL OF THEIR APPLICATION IN A TIMELY MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - COMMUNITY CARE APPLICATIONS ARE ACCEPTED ONLY FROM PATIENTS OF RIPON MEDICAL CENTER WHO RESIDE IN THE COUNTIES OF CALUMET, COLUMBIA, DODGE, FOND DU LAC, GREEN LAKE, MARQUETTE, WASHINGTON, WAUSHARA OR WINNEBAGO. INDIVIDUALS MUST BE A RESIDENT ON ONE OF THOSE AREAS FOR A MINIMUM OF THREE MONTHS AND PROVIDE SUPPORTING DOCUMENTATION. ON OCCASION INDIVIDUALS ARE NOT COMMUNITY MEMBERS BUT MAY NEED ASSISTANCE; THOSE APPLICATIONS ARE CONSIDERED ON A CASE-BY-CASE BASIS. PART VI, LINE 5: 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 BENEFIT 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 ORER 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: DIALYSIS CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND URGENT CARE, ETENDED CARE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES AND WOMENS SERVICES. PART VI, LINE 6: RIPON MEDICAL CENTER IS PART OF AGNESIAN HEALTHCARE, AN INTEGRATED, COMPREHENSIVE NOT-FOR-PROFIT HEALTHCARE DELIVERY SYSTEM COMPRISED OF SEVEN MINISTRIES: AGNESIAN HEALTHCARE ENTERPRISES, LLC, CONSULTANTS LAB OF WI, LLC, ST. AGNES HOSPITAL, ST. FRANCIS HOME, WAUPUN MEMORIAL HOSPITAL, AND RIPON MEDICAL CENTER. AGNESIAN PROVIDES A CONTINUUM OF HEALTHCARE SERVICES FROM BIRTH TO END OF LIFE, PREVENTATIVE CARE, DIAGNOSIS, TREATMENT AND FOLLOWUP, ASSISTED LIVING, AND INDEPENDENT AND SKILL CARE SERVICES. AGNESIAN HEALTHCARE IS COMMITTED TO ENSURING THAT INDIVIDUALS NEEDING VITAL HEALTHCARE SERVICES GET THE HELP THEY NEED AND DESERVE. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X X 1 0 0 0 0 0 0 0 0 STEVEN N LITTLE 0 372708 0 46395 0 309300 0 0 0 32425 0 760828 0 0 PAUL BOEDER MD 224994 0 0 0 0 0 0 0 19654 0 244648 0 0 0 JASON DEVRIES MD 232686 0 141745 0 22649 0 0 0 19654 0 416734 0 0 0 HAYDAR SALEH MD 232291 0 0 0 22400 0 0 0 4374 0 259065 0 0 0 STEVEN PALS MD 174742 0 0 0 46154 0 0 0 3276 0 224172 0 0 0 BRADLEY EISENBERG MD 186074 0 0 0 29459 0 0 0 4838 0 220371 0 0 0 PART I, LINE 4A STEVEN PALS, MD RECEIVED SEVERENCE PAY IN THE AMOUNT OF $46,154. PAUL BOEDER MD IN ORDER TO BRING OB/GYN SERVICES TO THE COMMUNITY X 175000 14400 0 1 1 JASON DEVRIES MD IN ORDER TO BRING PODIATRY SERVICES TO THE COMMUNITY X 25000 20635 0 1 1 35035 DIEDRICH INSURANCE AGENCY OWNER IS BOARD MEMBER DREW DIEDRICH 36542 OWNER OF INSURANCE AGENCY THAT WRITES COVERAGE FOR RIPON MEDICAL CENTER'S PROPERTY AND AUTO INSURANCE. 0 BADGER EMERGENCY PHYSICIANS MEMBER OF BADGER EMERGENCY PHYSICIANS IS BOARD MEMBER MICHAEL COMBS, MD 1168720 CONTRACT TO PROVIDE PHYSICIAN SERVICES FOR THE EMERGENCY DEPARTMENT AND OCCUPATIONAL HEALTH DEPARTMENT AT RIPON MEDICAL CENTER. 0 SAMANTHA WESTPHAL DAUGHTER OF BOARD MEMBER JAY MCDONALD 51670 COMPENSATION AS AN EMPLOYEE OF RIPON MEDICAL CENTER. DATE OF HIRE WAS 11/17/08. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE DEPARTMENT PREPARES THE FORM 990 AND THE RETURN IS REVIEWED BY THE DIRECTOR OF FINANCE AND CFO. A FINAL COPY OF THE 2011 FORM 990 IS PROVIED TO THE BOARD EECUTIBVE COMMITTEE FOR REVIEW AND APPROVAL BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY, DISCLOSING ANY CONFLICT OF INTEREST THAT MAY EXIST. THE ORGANIZATION'S CEO AND BOARD PRESIDENT REVIEW THE STATEMENTS AND HIGHLIGHT POTENTIAL CONFLICTS. THE BOARD DETERMINES ON A CASE BY CASE BASIS ANY ACTIONS REQUIRED. INDIVIDUALS ARE NOT PERMITTED TO VOTE ON ANY TRANSACTIONS WHERE A CONFLICT OF INTEREST HAS BEEN DETERMINED TO EXIST. ALL CONFLICTS AND PROCEEDINGS ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 DETERMINATION OF COMPENSATION OF THE CEO AND OFFICERS INCLUDES ANALYSIS OF COMPARABLE COMPENSATION SURVEYS BY AN INDEPENDENT COMPENSATION CONSULTANT, WHO RECOMMENDS RANGES OF APPROPRIATE COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS WHO ARE INDEPENDENT, REVIEW AND APPROVE THE COMPENSATION PACKAGE FOR OFFICERS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION IS INCLUDED IN THE BOARD MINUTES. THE FINAL AGREEMENT IS DOCUMENTED WITH A WRITTEN CONTRACT, WHICH IS SIGNED BY BOTH PARTIES. FORM 990, PART VI, SECTION C, LINE 19 RIPON MEDICAL CENTER'S POLICY AND PROCEDURE FIN1069 DEFINES THE PROCEDURE FOR MAKING ANNUAL INFORMATION RETURNS AVAILABLE FOR PUBLIC INSPECTION. INDIVIDUALS REQUESTING INSPECTION ARE REFERRED TO THE AMINISTRATION OFFICE, WHERE THEY ARE PROVIED WITH THE DOCUMENTS AND A CONFERENCE ROOM FOR INSPECTING DOCUMENTS. PHOTCOPIES WILL BE PROVIDED TO THE REQUESTOR. ANYONE MAY INSPECT THE RETURNS UPON DEMAND, WITHOUT AN APPOINTMENT OR ANY FOREWARNING, URING RIPON MEICAL CENTER'S NORMAL BUSINESS HOURS. GOVERNING DOCUMENTS AN CONFLICT OF INTEREST STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION, BUT CAN BE MAE AVAILABLE IF THE REQUESTING PARTY HAS A BONA FIE REASON. ALL FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH POSTING ON A PUBLIC WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN INTEREST IN FOUNDATION 164,084. UNREALIZED LOSS ON INVESTMENTS 7,883. TOTAL TO FORM 990, PART XI, LINE 5: 171,967. FORM 990, PART XII, LINE 2B THE CONSOLIDATED FINANCIAL STATEMENTS OF AGNESIAN HEALTHCARE SYSTEM WERE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM, WIPFLI, LLP. THREE RELATED ENTITIES IN THE AGNESIAN HEALTHCARE SYSTEM, WAUPUN MEMORIAL HOSPITAL, ST. FRANCIS HOME, AND AGNESIAN HEALTHCARE, INC., FILE SEPARATE FORMS 990. FOUNDATION FOR RIPON MEDICAL CENTER 933 NEWBURY STREET RIPON WI 54971 391605953 SUPPORT OF RIPON MEDICAL CENTER WI 501(C)(3) 509(A)(3), TYPE 1 N/A 0 RIPON MEDICAL CENTER ASSOCIATES 933 NEWBURY STREET RIPON WI 54971 396088384 SUPPORT OF RIPON MEDICAL CENTER WI 501(C)(3) 509(A)(3), TYPE 1 N/A 0 AGNESIAN HEALTHCARE INC 430 EAST DIVISION STREET FOND DU LAC WI 54935 390807236 HEALTHCARE WI 501(C)(3) LINE 1 CONGREGATION OF SISTERS OF ST AGNES 0 ST FRANCIS HOME OF FOND DU LAC 33 EVERETT STREET FOND DU LAC WI 54935 391029998 HEALTHCARE WI 501(C)(3) LINE 9 AGNESIAN HEALTHCARE INC 0 AGNESIAN HEALTHCARE FOUNDATION 430 EAST DIVISION STREET FOND DU LAC WI 54935 391684956 FOUNDATION WI 501(C)(3) LINE 11A, I AGNESIAN HEALTHCARE INC 0 WAUPUN MEMORIAL HOSPITAL 620 WEST BROWN STREET WAUPUN WI 53963 390806265 HOSPITAL WI 501(C)(3) LINE 3 AGNESIAN HEALTHCARE INC 0 CONGREGATION OF SISTERS OF ST AGNES 320 COUNTY ROAD K FOND DU LAC WI 54935 390806217 CONVENT WI 501(C)(3) 509(A)(3), TYPE 2 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 RIPON MEDICAN CENTER FOUNDATION C 21920 CASH AGNESIAN HEALTHCARE INC N 335080 CASH AGNESIAN HEALTHCARE INC P 3487 CASH