2012-08-10T08:34:58-05:00 2011-09-30 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH ST MINNEAPOLIS MN 55402 990 2010-10-01 390452970 MARSHFIELD CLINIC MARS 7153875511 1000 North Oak Avenue Marshfield WI 54449 Gary Jankowski 2011-08-06 6123055000 2010 2016-02-24 21:20:13Z Brian Ewert MD President 1000 North Oak Avenue Marshfield WI 54449 1432738167 false X www.marshfieldclinic.org X 1916 WI The mission of Marshfield Clinic is to serve patients through accessible high quality health care, research and education. 18 0 8129 380 22834324 -123283 16383765 13925149 1034494382 1105037055 4765727 13704633 3200395 3173823 1058844269 1135840660 16095160 16062852 0 0 680175628 708667692 0 0 1464738 329993630 338611986 1026264418 1063342530 32579851 72498130 910521045 923892451 529684302 486354897 380836743 437537554 X THE MISSION OF MARSHFIELD CLINIC IS TO SERVE PATIENTS THROUGH ACCESSIBLE, HIGH QUALITY HEALTH CARE, RESEARCH AND EDUCATION. THROUGH RESEARCH, EDUCATION AND STANDARDIZATION OF QUALITY, OUR VISION IS TO REDUCE THE BURDEN OF DISEASE, DISABILITY AND COST FOR OUR PATIENTS AND COMMUNITIES. false false 798848466 1002049837 Patient Medical Care SEE SCHEDULE O 50131304 11969576 10173890 MEDICAL RESEARCH AND EDUCATION SEE SCHEDULE O 63372756 92813327 LABORATORY MEDICINE SEE SCHEDULE O 912352526 true true false true false false true false true true false false true true true false true false true true false false false true true false true false true true false true false false false false false false true false true true false false false true true true true false true 744 0 true 8129 true true true false false false false true true false false false false X 18 0 false false false false true true true true true false false true true true true true true true true true true OH WI X NARAYANA MURALI MD CORP SEC 7153875511 1000 N OAK AVE Marshfield WI 54449 X Stephen Blonsky MD 55.0 X 240847 0 57307 Humbert Vidaillet MD 55.0 X 401359 0 54388 Ivan B Schaller MD 50.0 X 181330 0 45875 Qasim Raza MD 55.0 X 353816 0 52256 C Todd Stewart MD 55.0 X 543756 0 51566 Mark LePage MD 55.0 X 473245 0 52066 Dan Erickson MD 55.0 X 175277 0 47168 Matthew Thomas MD 60.0 X 379673 0 46326 Ron Martin MD 70.0 X 354467 0 40761 Matthias Weiss MD 55.0 X 433858 0 57427 John Melski MD 60.0 X 401511 0 52057 Sharlene Kreitlow MD 55.0 X 220678 0 52804 Wallace B Brucker MD 55.0 X 480487 0 55410 Humayan Khan MD 55.0 X 208083 0 35894 Karl Ulrich MD 65.0 X 601830 0 51566 Doug Reding MD 56.0 X 581156 0 51676 Brian Ewert MD 55.0 X 248911 0 51725 David Simenstad MD 60.0 X 1211604 0 52176 Gary Jankowski CFO 55.0 X 363268 0 52053 Jim Coleman 55.0 X 369912 0 52805 David Keefe 55.0 X 257102 0 38469 Steve Christianson 55.0 X 201024 0 50570 Tom Satkus 55.0 X 230671 0 22075 Paul Liss MD 55.0 X 402822 0 50456 Theodore Praxel MD 55.0 X 311391 0 52513 Marv Kuehner MD 55.0 X 287785 0 48015 William Yanke MD 65.0 X 318381 0 55235 Gary Zimbric MD 55.0 X 289200 0 52885 Greg Burnett MD 55.0 X 299855 0 51410 Richard Mercier MD 55.0 X 546786 0 52855 Timothy Swan MD 60.0 X 531245 0 48150 John Kelly 55.0 X 184939 0 46026 Daniel DeGroot 55.0 X 204422 0 36254 Fred Bollow MD 60.0 X 327369 0 50052 Rod Sorensen MD 50.0 X 393833 0 54266 David Cook MD 55.0 X 241200 0 50295 Rick Koehler MD 55.0 X 262034 0 51228 Gene Shaw MD 55.0 X 372973 0 51566 Chong Lee MD 60.0 X 1124545 0 53215 Scott Paulman MD 60.0 X 1495896 0 33861 Sanjay Rao MD 60.0 X 1316580 0 50150 Thomas Faciszewski MD 60.0 X 1504420 0 52165 Kamal Thapar MD 80.0 X 2064678 0 54775 Reed Hall 55.0 X 121808 0 26040 21516027 0 2145832 1170 true true false SIEMENS MEDICAL SOLUTIONS Dept Ch 14195 PALATINE IL 600554195 EQUIPMENT/LEASE 6490736 MARKET MATERIALS LLC 2350 galloway st - po box 630 EAU CLAIRE WI 547020630 SUPPLIES/REMODELING 4682511 LINDSAY STONE BRIGGS 1 SOUTH PINCKNEY ST STE 500 MADISON MN 53703 ADVERTISING 3136517 AE BUSINESS SOLUTIONS 2310 crossroads dr ste 2800 MADISON WI 53718 SERVICE/CAP EQUIP. 3301130 PHILIPS HEALTHCARE PO BOX 100355 ATLANTA GA 303840355 SERVICE/PROD/EQUIP 2524876 170 560820 58672 11616264 1689393 297896 13925149 PATIENT MEDICAL CARE 621500 1002049838 1002048029 1809 LABORATORY MEDICINE 621500 92813327 70073306 22740021 MEDICAL RESEARCH & EDUCATION 621500 10173890 10081396 92494 1105037055 4357378 4357378 1087780 1087780 350987 350987 262000 228624 33376 33376 33376 248478347 35045 240220819 33098 8257528 1947 8259475 8259475 243162 209632 33530 33530 49640 49640 49640 58351500 56205334 2146166 2146166 CAFETERIA SALES 900099 560124 560124 560124 1135840660 1082202731 22834324 16878456 16062852 16062852 0 0 0 14529675 7391309 7138366 0 533921506 471541642 61577962 801902 55241023 48280226 6879278 81519 78120249 63374461 14606717 139071 26855239 23094737 3712318 48184 0 759334 53484 705850 284784 284784 227163 227163 0 0 33796512 22576952 11114412 105148 8462283 33845 8414941 13497 4060705 2528285 1514405 18015 41062027 21755797 19196638 109592 89086 89086 20306058 17097701 3179929 28428 8647732 7685695 920022 42015 0 470962 470908 54 13450351 6887925 6562426 0 28712923 26979015 1725267 8641 1992429 1951619 40810 OPERATING SUPPLIES 137094330 136018832 1011079 64419 MAINTENANCE AND REPAIRS 8540926 8326268 212995 1663 UNRELATED BUSINESS INCOME TAX -201443 -201443 OPERATING EXPENSES 1021141 939289 79208 2644 BAD DEBTS 28296386 28296386 1538297 1117655 420642 1063342530 912352526 149525266 1464738 7800788 23581434 61993094 68949433 2785376 2300400 146002536 171291730 0 0 0 0 37236895 36518491 13284313 15236070 6545016 6525881 610760883 283866022 338403408 326894861 148105733 149635235 0 0 10799743 13272812 2433667 3017211 135130476 106668893 910521045 923892451 105549309 109057158 715700 791099 288240000 282955000 0 0 36476621 36731548 0 0 98702672 56820092 529684302 486354897 X 359926725 416405020 20693935 20916451 216083 216083 380836743 437537554 910521045 923892451 X 72498130 -15797319 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 783411 false false 783411 false Description of the organization's lobbying activity: Where its experience may be helpful, Marshfield Clinic may offer recommendations concerning legislation or regulations being considered. In addition, it may analyze and take positions on issues that have a relationship to the organization's operations. 3965 1027022 X true 34049063 3310280 -266824 1244515 35848004 29443159 2333428 2927520 655044 34049063 27221448 2413872 614273 806434 29443159 0.68000 0.32000 0.00000 false false 14621700 14621700 330401801 115223627 215178174 6394944 2642536 3752408 238724835 161171870 77552965 1836524 18781079 4827989 15789614 326894861 RESTRICTED FUNDS - OTHER 11568961 RESTRICTED FOR RETIREMENT PLAN 22925116 RESTRICTED FOR LIAB. INSURANCE 18320732 RESTR FOR UNEMPLOYMENT COMP 3681869 TRUST - REVENUE BOND 27362722 RESTR BY DONORS FOR SPEC PURP 18829214 DEFERRED FINANCING COSTS 3980279 106668893 124500 HEALTH PLAN PREPAYMENT 17500000 ESTIMATED RESERVE - SELF INSUR 9597596 457 PLAN PAYABLE 22925116 MISCELLANEOUS 6672880 56820092 PART III, LINE 4 THE MISSION OF MARSHFIELD CLINIC IS TO SERVE PATIENTS THROUGH ACCESSIBLE, HIGH QUALITY HEALTH CARE, RESEARCH AND EDUCATION. AS PART OF SERVING PATIENTS, THE CLINIC STRIVES TO PROVIDE AN INVITING ATMOSPHERE TO TREAT PATIENTS AND ASSIST IN THE HEALING PROCESS. PLEASANT FACILITIES AND GROUNDS, PLUS APPROPRIATE WORKS OF ART ALL ASSIST IN THIS HEALING PROCESS, AS WELL AS SERVE TO ENHANCE THE WORK ENVIRONMENT FOR PHYSICIANS AND STAFF. QUALITY WORKS OF ART ALSO ENHANCE THE CLINIC'S EDUCATIONAL MISSION BY DISPLAYING ART WORK FOR SCHOOL CHILDREN AS WELL AS PATIENTS AND VISITORS. PART V, LINE 4 MARSHFIELD CLINIC MAINTAINS ENDOWMENT FUNDS IN THE FOLLOWING CATEGORIES: GENERAL ENDOWMENT TO FUND OPERATIONS, ENDOWED PROGRAMS TO FUND VARIOUS PATIENT CARE, RESEARCH AND EDUCATION PROGRAMS SUCH AS ONCOLOGY RESEARCH, SUMMER STUDENT INTERN PROGRAMS, AND THE ANGEL FUND; AND ENDOWED CHAIRS AND ENDOWED DISTINGUISHED PHYSICIAN/SCIENTIST AWARDS TO FUND THE RESEARCH, EDUCATION OR ADMINISTRATIVE ACTIVITES OF THE NAMED CHAIR OR AWARD RECIPIENT. PART X, LINE 2 EFFECTIVE OCTOBER 1, 2007, THE CLINIC ADOPTED FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC 740), INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN UNDER ASC 740. TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DE-RECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. BASED ON AN ANALYSIS PREPARED BY THE CLINIC, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE CLINIC AT SEPTEMBER 30, 2011 OR 2010. North America 1 22 Program Services FOOD SAFETY TESTS 1831000 1 22 1 22 1831000 1831000 false false false false false false Part I, Line 3(1) Marshfield Food Safety, LLC (MFS), a joint venture between Marshfield Clinic (MC) and CSA Holdings, LLC, provides food safety testing services on-site at or nearby various food producers for the benefit of the public. MC increased its voting control of MFS from 80% to 90% effective May 31, 2011. MFS Canada Food Safety is a 100% owned subsidiary of MFS and maintains its operations in Canada. It commenced its operations in 2011 and include the same types of activities as MFS. For tax reporting purposes, MFS is a disregarded entity. The Canadian operational information is being disclosed on the Schedule F to assure compliance with 990 requirements. The listed employees are employees of MFS and not of Marshfield Clinic. The expenditures listed represent 90% (MC's share of MFS as of September 30, 2011) of operational expenses incurred by MFS Canada. Auct. of Champ. 237079 190784 46295 0 7792 8000 3195 500 2332 TRAP SHOOT 190873 74623 116250 0 41705 22796 1560 0 16910 10 381370 300753 80617 0 26432 22090 13770 350 42198 809322 566160 243162 0 75929 52886 18525 850 61440 209630 33532 49640 false 49640 49640 WI true false true false 0.22000 0.78000 Jill Kurszewski 1000 N Oak Ave Marshfield WI 54449 false Jill Kurszewski 2769 Coord. & management of Clinic gaming activies X false true Family Health Center 1515 St Josephs Ave Marshfield WI 54449 391681547 501(C)(3) 15656590 General Support Marshfield Area United Way PO Box 771 Marshfield WI 54449 391035073 501(C)(3) 93000 General Support New Visions Gallery rent 1000 N Oak Ave Marshfield WI 54449 510190879 501(C)(3) 25000 FMV RENT General Support United Way - Wausau 127 River Drive Wausau WI 54403 390935496 501(C)(3) 23000 General Support Community Foundation 300 3rd st Suite 310 Wausau WI 54403 391577472 501(C)(3) 14000 General Support Friends of St Joseph's Hospital 2661 County HWY I Chippewa Falls WI 54729 390810545 501(C)(3) 15000 General Support WI Womens Health Foundation 2503 Todd Dr Madison WI 54713 391900678 501(C)(3) 11250 General Support University of Wisconsin 105 Garfield Ave PO Box 4004 Eau Claire WI 54702 391805963 501(c)(3) 33584 General Support Marshfield Area YMCA 410 McMillan St Marshfield WI 54449 391557086 501(C)(3) 7500 General Support UWMC Foundation Inc Po Box 352 Madison WI 537010352 391138823 501(c)(3) 11500 General Support Angel On My Shoulder 1000 W Campus Dr Wausau WI 54401 391858288 501(c)(3) 20689 General Support Heritage Foundation 1000 N Oak Ave Marshfield WI 54449 391865942 501(c)(3) 15002 41439 FMV Rent General Support UNITED WAY OF MERRIL 813 E-1ST ST PO BOX 813 MERRIL WI 54452 391286800 501(C)(3) 5652 General Support HOPE PREGNANCY RESOURCES 605 24TH AVE SOUTH STE 20 WAUSAU WI 54401 450474297 501(C)(3) 6350 General Support MFLD AREA COMMUNITY FDN PO- BOX 456 MARSHFIELD WI 54449 396578767 501(C)(3) 11000 General Support 15 Schedule I, Part I, Line 2 Marshfield Clinic (the Clinic) provides assistance (primarily contributions) to a variety of organizations, most of which are 501 (C)(3) and some of which are affiliates for financial reporting purposes (i.e., Family Health Center and Heritage Foundation). The Clinic makes determinations on grant assistance and other assistance (i.e., contributions) based on the recipient organization's mission, reputation, and the organization's intended use of funds. The largest contribution is to Family Health Center (FHC), which is a member of the Clinic's obligated group and included in the Clinic's consolidated financial statements. FHC's mission and use of funds are aligned with the Clinic's mission as a 501(C)(3) organization, and monitored closely. X X X X false false false false false false false false false Karl Ulrich MD 578506 0 0 0 23324 0 30728 0 20837 0 653395 0 0 0 Doug Reding MD 579104 0 0 0 2052 0 30728 0 20947 0 632831 0 0 0 Brian Ewert MD 231199 0 0 0 17712 0 30728 0 20997 0 300636 0 0 0 David Simenstad MD 1193892 0 0 0 17712 0 30728 0 21447 0 1263779 0 0 0 Stephen Blonsky MD 223305 0 0 0 17542 0 30728 0 26579 0 298154 0 0 0 Humbert Vidaillet MD 399307 0 0 0 2052 0 30728 0 23659 0 455746 0 0 0 Ivan B Schaller MD 179679 0 0 0 1651 0 26646 0 19229 0 227205 0 0 0 Qasim Raza MD 352251 0 0 0 1565 0 30728 0 21528 0 406072 0 0 0 C Todd Stewart MD 543126 0 0 0 630 0 30728 0 20837 0 595321 0 0 0 Mark LePage MD 456325 0 0 0 16920 0 30728 0 21337 0 525310 0 0 0 Dan Erickson MD 173652 0 0 0 1625 0 24128 0 23040 0 222445 0 0 0 Matthew Thomas MD 362673 0 0 0 17000 0 30728 0 15597 0 425998 0 0 0 Ron Martin MD 337337 0 0 0 17130 0 30728 0 10032 0 395227 0 0 0 Matthias Weiss MD 419491 0 0 0 14367 0 30728 0 26699 0 491285 0 0 0 John Melski MD 382239 0 0 0 19272 0 30728 0 21328 0 453567 0 0 0 Sharlene Kreitlow MD 220048 0 0 0 630 0 30728 0 22076 0 273482 0 0 0 Wallace B Brucker MD 479865 0 0 0 622 0 30728 0 24682 0 535897 0 0 0 Humayan Khan MD 206809 0 0 0 1274 0 30518 0 5376 0 243977 0 0 0 Gary Jankowski CFO 336835 0 100 0 26333 0 30728 0 21325 0 415321 0 0 0 Jim Coleman 358805 0 400 0 10707 0 30728 0 22077 0 422717 0 0 0 David Keefe 239536 0 100 0 17466 0 30728 0 7740 0 295570 0 0 0 Steve Christianson 195314 0 100 0 5610 0 29133 0 21437 0 251594 0 0 0 Tom Satkus 211299 0 100 0 19272 0 2080 0 19995 0 252746 0 0 0 Paul Liss MD 399830 0 0 0 2992 0 30728 0 19728 0 453278 0 0 0 Theodore Praxel MD 310179 0 0 0 1212 0 30728 0 21785 0 363904 0 0 0 Marv Kuehner MD 285966 0 0 0 1819 0 30728 0 17286 0 335799 0 0 0 William Yanke MD 316521 0 0 0 1860 0 30728 0 24507 0 373616 0 0 0 Gary Zimbric MD 287148 0 0 0 2052 0 30728 0 22156 0 342084 0 0 0 Greg Burnett MD 298154 0 0 0 1701 0 30728 0 20682 0 351265 0 0 0 Richard Mercier MD 544734 0 0 0 2052 0 30728 0 22127 0 599641 0 0 0 Timothy Swan MD 513533 0 0 0 17712 0 30728 0 17422 0 579395 0 0 0 John Kelly 183985 0 100 0 854 0 27954 0 18072 0 230965 0 0 0 Daniel DeGroot 203110 0 100 0 1212 0 27977 0 8277 0 240676 0 0 0 Fred Bollow MD 307679 0 0 0 19690 0 30728 0 19323 0 377420 0 0 0 Rod Sorensen MD 391942 0 0 0 1891 0 30728 0 23537 0 448098 0 0 0 David Cook MD 238428 0 0 0 2772 0 30728 0 19567 0 291495 0 0 0 Rick Koehler MD 261068 0 0 0 966 0 30728 0 20499 0 313261 0 0 0 Gene Shaw MD 355507 0 0 0 17466 0 30728 0 20837 0 424538 0 0 0 Chong Lee MD 1106953 0 0 0 17592 0 30728 0 22487 0 1177760 0 0 0 Scott Paulman MD 1478976 0 0 0 16920 0 30728 0 3133 0 1529757 0 0 0 Sanjay Rao MD 1316160 0 0 0 420 0 30728 0 19422 0 1366730 0 0 0 Thomas Faciszewski MD 1503544 0 0 0 876 0 30728 0 21437 0 1556585 0 0 0 Kamal Thapar MD 2063627 0 0 0 1051 0 30728 0 24047 0 2119453 0 0 0 Reed Hall 120158 0 0 0 1650 0 15656 0 10384 0 147848 0 0 0 WI HEALTH & EDUCATIONAL FACILITY AUTHORITY 391337855 97710VZY7 2006-01-31 71634384 Building & Equipment false false false WI HEALTH & EDUCATIONAL FACILITY AUTHORITY 391337855 97710VZZ4 2006-01-31 65000000 Building & Equipment false false false 1585000 0 74627549 5405593 0 0 699591 0 0 68522365 0 0 2008 false false true true 1665000 0 69008189 0 0 0 829612 0 0 68178577 0 0 2008 false false true true false true false false true 0.00560 0.00560 true false false false false true true false false false false false false true true false false false false Janice Liss spouse of key EMPLOYEE employee 44162 SALARY AND BENEFITS false STEPHANTE VIDAILLET employee 47674 SALARY AND BENEFITS false BUSINESS TRANSACTIONS WITH INTERESTED PERSONS PART IV, COLUMN D SALARIES FOR THESE INDIVIDUALS HAVE BEEN SET BASED ON THE MARSHFIELD CLINIC'S NORMAL SALARY SETTING PROCESS, WHICH INCLUDES DOCUMENTATION AND COMPARISON OF APPLICABLE MARKET RATES AND OTHER COMPARABILITY DATA BASED ON THE INDIVIDUAL'S RESPECTIVE POSITION . BENEFITS ARE ESTABLISHED CONSISTENT WITH THE CLINIC'S BENEFIT PLAN STRUCTURES FOR COMPARABLE POSITIONS. Reason for Disclosure: Janice Liss - Spouse of Key Employee Stephanie Vidaillet - Daughter-in-law of Director X 19 6059 fmv/sales price X 12930 fmv/sales price X 3 6258 fmv/sales price X 19 3995 fmv/sales price X Travel/experiences 60 81144 fmv/sales price X Livestock 40 36695 fmv/sales price X Food & beverage 77 12583 fmv/sales price X Miscellaneous 332 119428 fmv/sales price false true false SUPPLEMENTAL INFORMATION Part III Statement of Program Service Accomplishments Line 4a - Patient Medical Care Marshfield Clinic (the Clinic) has 765 physicians in 86 medical specialties and subspecialties located in 54 locations throughout northern, central and western Wisconsin. For 95 years, the Clinic has provided medical care to all patients regardless of their ability to pay. Charity care determinations are based on financial information provided by the patient and analysis of other relevant information. Because the Clinic anticipates either no or nominal payment for these services, the amounts are excluded from revenues. There were approximately 3,800,000 patient encounters for fiscal year 2011. The Clinic provided Charity Care of $6,799,000 in fiscal year 2011 based on the cost of providing care to patients who cannot afford to pay in accordance with its Charity Care Policy. The Clinic also provides substantial community support through the provision of services to individuals supported by public programs such as general relief, Medicare and Medicaid. The Clinic's cost of providing services under these programs in excess of reimbursement received by the Clinic, and the estimated unreimbursed cost of providing care to low income underinsured and uninsured patients through the Clinic's partnership with Family Health Center, a federally funded community health center was $170,303,000 in fiscal year 2011. Line 4b - Medical Research and Education Through its research division, Marshfield Clinic Research Foundation (MCRF), the Clinic is engaged in medical and scientific research on national and international levels. The MCRF mission is to discover and communicate scientific knowledge that substantially improves human health and well-being. Since MCRF's establishment in 1959, research discoveries by MCRF scientists and Clinic physicians have expanded knowledge in multiple fields of human health and reduced the burden of disease and disability. Areas of focus include clinical research, rural and agricultural health and safety, human genetics, epidemiology, and biomedical informatics. The Marshfield Clinic Education Division also has a history of strong commitment to education and public service. Full residency programs for recent medical school graduates include internal medicine, pediatrics, medicine and pediatrics, dermatology, general surgery and transitional year. All programs are fully accredited by the Accreditation Council for Graduate Medical Education (ACGME) of the American Medical Association. The Clinic has exemplary accreditation status with the Accreditation Council on Continuing Medical Education [ACCME] as a longstanding provider of Continuing Medical Education to area physicians and allied health providers. Additionally, we serve as an academic clinical campus of the University of Wisconsin School of Medicine and Public Health. We have over 80 national post-secondary academic affiliations and over 30 State post-secondary academic affiliations for student, resident, and fellowship training. Lastly, each year the Clinic sponsors public educational events including the Lawton Lecture, Faces of Aging, and provides the public with one of the most comprehensive and reliable patient education websites. Line 4c - Laboratory Medicine Marshfield Labs provides comprehensive anatomical and high-complexity diagnostic testing services to patients of Marshfield Clinic and other area medical facilities. In addition to the primary laboratory located in Marshfield, Marshfield Labs is serving the needs of surrounding communities with smaller labs at many Marshfield Clinic centers throughout central and northern Wisconsin. Proximity to our laboratories provides convenience and expeditious service to Marshfield Clinic patients. Marshfield Labs has become a center for the latest technologies and most advanced testing methods utilized today. Some of the advanced tests and emerging technologies offered by Marshfield Labs would not otherwise be available to patients in rural areas. Part VI Governance, Management, and Disclosure, Line 6 As of September 30, 2011 the Marshfield Clinic has 647 physicians who are referred to as "shareholders." As disclosed in the organization's original Form 1023, all shareholders sign an agreement that provides that the assets of the organization are held in trust for charitable, educational and scientific purposes. "Shareholders" do not build up equity in the organization and, in the event of dissolution of Marshfield Clinic, all of the assets of the organization would be distributed to another charitable organization. Part VI Governance, Management, and Disclosure, Line 7a The shareholders have the right to elect the organization's officers and directors. Part VI Governance, Management, and Disclosure, Line 7b The shareholders have the right to approve any changes to the organization's Articles of Incorporation and Bylaws by a vote of two-thirds of the shareholders present at each of two consecutive shareholder meetings at which a quorum is present. The shareholders have the right to terminate the employment of a physician-shareholder by a vote of four-fifths of the outstanding shares entitled to vote. The shareholders have the right to approve any dissolution or liquidation of the organization by a vote of four-fifths of the shareholders. In the event of liquidation or dissolution of the organization, after payment of liabilities, the shareholders by majority vote of the shareholders shall select the educational, scientific or charitable organizations to which the organization's assets shall be transferred. Part VI Governance, Management, and Disclosure, Line 11a The Chief Financial Officer and Controller shall review the completed Form 990 and Form 990-T in depth. After their review and prior to filing Form 990 and Form 990-T with the IRS, the CFO or his/her designee will provide to each member of the Board of Directors a copy in electronic or paper form of the completed Form 990 (and all required schedules) and the completed Form 990-T (and all required schedules). Thereafter, at the next Board meeting (or at a special meeting called for this purpose), the CFO and/or his/her designee shall review the forms and schedules with the board members and answer any questions. In addition, the FY11 Form 990 was reviewed by KPMG prior to filing. Part VI Governance, Management, and Disclosure, Line 12c Each disclosing individual shall complete and submit the disclosure form to the Secretary of the Board of Directors on or before January 1st of each year, or, if earlier, within one month after the individual qualifies as a disclosing individual. Each disclosing individual shall update his/her disclosure form during the year as necessary. The secretary shall maintain the completed disclosure forms in a confidential manner. The Secretary shall make the completed disclosure forms available to the executive committee and/or Board of Directors as necessary to make conflict of interest determinations and decisions concerning the fairness and reasonableness of transactions to Marshfield Clinic. In addition, the Secretary shall disclose the completed forms as necessary to those Clinic employees responsible for completion of the Clinic's IRS Form 990. Part VI Governance, Management, and Disclosure, Lines 15a, and 15b In late 2008, the Clinic established an Independent Compensation Committee (the "Committee") to have final authority in approving compensation of directors, officers and other disqualified persons, as defined in IRC Section 4958. The Committee and its operating procedures were designed to establish the rebuttable presumption of reasonableness described in Treas. Reg. 53.4958-6. However, as a result of an internal compliance review conducted in mid-2010, the Clinic discovered that certain parts of the Committee's procedures and documentation may not have fully satisfied the rebuttable presumption requirements. The Clinic's leadership worked with the Committee to improve the procedures and documentation for the upcoming compensation review and approval cycle. As a result, in late 2010, the Committee established compensation for the 2011 calendar year in a manner that complied with the rebuttable presumption requirements. Specifically, the Committee consisted solely of persons having no conflicts of interest. The Committee reviewed appropriate comparability data to confirm that total compensation amounts to be paid were reasonable and comparable to amounts paid by similarly-situated organizations. Finally, the compensation review and approval process was thoroughly and timely documented. Part VI Governance, Management, and Disclosure, Line 19 Marshfield Clinic does not make its current governing documents, Conflict of Interest Policy or financial statements available to the public. Federal tax law does not require that such documents be made publicly available unless they were included on a form that is publicly available. Marshfield Clinic does make available its Form 1023, as required. Schedule A, Part I Per IRS instructions for the Form 990, "the definition of hospitals for Schedule A (Form 990 or 990-EZ), Part I, is different from the definition for Schedule H (Form 990), hospitals. Accordingly, any organization that checks this box may or may not be required to complete Schedule H (Form 990)." Marshfield Clinic is not recognized by any State as a hospital. Therefore, Marshfield Clinic is not required to complete Schedule H. Part XI, Line 5 - Reconciliation of Net Assets Net Asset Transfers: Reimbursement from Security Health Plan for remodeling 604,555 Reimbursement from Security Health Plan for support of Clinic initiatives 10,238,197 Transfer building to Lakeview Medical Center (23,945,201) Transfer of earnings from Lakeview Medical Center 3,577,000 Reimbursement to Family Health Center for expenses (14,664) ------------- TOTAL NET ASSET TRANSFERS (9,540,113) Unrealized Gains (Losses) (6,736,979) Current year change in unfunded benefit liability 566,384 Reduction in shareholder equity (9,000) Miscellaneous adjustments (77,609) ------------- TOTAL OTHER CHANGES IN NET ASSETS (15,797,317) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Stephen Blonsky, MD TITLE:Nephrology- East HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Humbert Vidaillet, MD TITLE:Electrophysiologist - Central HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ivan B. Schaller, MD TITLE:Internal Medicine - East HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Qasim Raza, MD TITLE:Hospitalist - Central 2 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:C. Todd Stewart, MD TITLE:Pediatric Intensivist - Centra HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark LePage, MD TITLE:Radiology - Central 3 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dan Erickson, MD TITLE:Family Practitioner - Northwes HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Matthew Thomas, MD TITLE:Urology - North HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ron Martin, MD TITLE:General Surgeon - Central 1 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Matthias Weiss, MD TITLE:Oncology/Hematology - North HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:John Melski, MD TITLE:Dermatologist - Central 3 HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Sharlene Kreitlow, MD TITLE:OB/GYN - Northwest HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Wallace B. Brucker, MD TITLE:Orthopaedics - West HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Humayan Khan, MD TITLE:Emergency Medicine/Urgent Care HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Karl Ulrich, MD TITLE:President HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Doug Reding, MD TITLE:Oncologist/Hematologist - V P HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Brian Ewert, MD TITLE:Nephrologist - Secretary HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:David Simenstad, MD TITLE:Orthopaedic Surgeon- Treasurer HOURS:1 Security Health Plan Of Wisconsin Inc 1515 N St Josephs Ave Marshfield WI 54449 391572880 HMO WI 501(C)(4) N/A NA The Heritage Foundation 1000 N Oak Ave Marshfield WI 54449 391865942 Honor Indivi WI 501(C)(3) 11 - Type 1 NA Lakeview Medical Center Auxilary Inc 1100 N Main Street Rice Lake WI 54868 391329084 Support Org WI 501(C)(3) 11,III-O NA Flambeau Hospital Inc 98 Sherry Ave Park Falls WI 54552 390973724 hospital WI 501(C)(3) 3 NA Lakeview Medical Center of Rice Lake 1700 West Stout St Rice Lake WI 54868 390837206 Hospital WI 501(C)(3) 3 na Marshfield Food Safety Food testing WI NA Related -1218511 3157106 false 0 true 0.90000 Diagnostic Treatment Ctr medical svcs WI NA Related 6951979 19363882 false 0 true 0.50000 true true true true true false false false true true true true false false true true true true SECURITY HEALTH PLAN OF WISCONSIN INC 1P 33078880 SECURITY HEALTH PLAN OF WISCONSIN INC 1Q 297363 SECURITY HEALTH PLAN OF WISCONSIN INC IR 10852751 MARSHFIELD FOOD SAFETY LLC 1A 348123 MARSHFIELD FOOD SAFETY LLC 1D 4808651 MARSHFIELD FOOD SAFETY LLC IP 1396032 SECURITY HEALTH PLAN OF WISCONSIN INC 1E 25000000 SECURITY HEALTH PLAN OF WISCONSIN INC 1A 27027 SECURITY HEALTH PLAN OF WISCONSIN INC 1c 58672 SECURITY HEALTH PLAN OF WISCONSIN INC 1d 5422718 SECURITY HEALTH PLAN OF WISCONSIN INC 1j 94253 SECURITY HEALTH PLAN OF WISCONSIN INC 1k 229243228 SECURITY HEALTH PLAN OF WISCONSIN INC 1l 72425651