2011-11-10T14:04:56-06:00 2011-03-31 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-04-01 390892183 SPOONER HEALTH SYSTEM INC SPOO 7156351225 819 ASH STREET SPOONER WI 54801 MICHAEL D SCHAFER 7156351225 2011-11-07 1 6123764500 2010 2016-03-07 17:11:31Z MICHAEL D SCHAFER 819 ASH STREET SPOONER WI 54801 22988895 0 X WWW.SPOONERHEALTHSYSTEM.COM X 1955 WI TO PROVIDE HIGH QUALITY HEALTHCARE. 7 6 333 75 0 0 13610 42126 21656949 22634301 92505 190608 95202 94818 21858266 22961853 0 0 0 0 11936935 12277747 0 0 0 9074845 9726733 21011780 22004480 846486 957373 18852131 19565709 5971805 5432351 12880326 14133358 X TO PROVIDE HIGH QUALITY HEALTHCARE. 0 0 12350238 17879696 SPOONER HEALTH SYSTEM PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES TO PATIENTS SUCH AS 24-HOUR EMERGENCY CARE, ACUTE CARE, SURGICAL, OBSTETRICS, REHABILITATION, DIAGNOSTIC, AND HOSPICE CARE. FOR THE FISCAL YEAR ENDING 3/31/11, THERE WERE 3,299 INPATIENT DAYS, 739 INPATIENT DISCHARGES, 173 NEWBORN DAYS, 10,312 OUTPATIENT VISITS, 6,044 EMERGENCY ROOM VISITS, AND 566 SURGERIES. SPOONER HEALTH SYSTEM PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. A FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THIS PROGRAM INCLUDES FEE DISCOUNTS, AS WELL AS 100% FREE CARE. SPOONER HEALTH SYSTEM ALSO PROVIDES NUMEROUS HEALTHCARE AND WELLNESS CLASSES, SUPPORT GROUPS, AND VARIOUS EDUCATIONAL/HEALTH SCREENING OPPORTUNITIES AS A COMMUNITY BENEFIT. THESE PROGRAMS ARE OFFERED TO ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. SPOONER HEALTH SYSTEM ALSO RECEIVES DONATED SERVICES FROM COMMUNITY VOLUNTEERS. 3356500 4289175 THE NURSING HOME PROVIDES ITS RESIDENTS WITH 24-HOUR NURSING CARE, SOCIAL SERVICES, ACTIVITY THERAPY, DIETARY SERVICES, AND REHABILITATION THERAPY. FOR THE FISCAL YEAR ENDING 3/31/11, THERE WERE 30,150 RESIDENT DAYS, 55 RESIDENT ADMISSIONS, AND 65 RESIDENT DISCHARGES. 502692 465430 THE HOME HEALTH AGENCY PROVIDES NURSING AND REHABILITATION SERVICES TO PATIENTS IN THEIR HOME. FOR THE FISCAL YEAR ENDING 3/31/11, THERE WERE 3,280 HOME HEALTH VISITS, 143 ADMITTED CASES, AND 138 DISCHARGED CASES. 16209430 1 1 0 0 0 0 0 1 0 1 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 1 19 0 333 1 0 0 0 0 1 1 1 1 0 0 0 0 X 7 6 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 0 0 WI X X REBECCA BUSCH CFO 7156351225 819 ASH STREET SPOONER WI 54801 SHELDON JOHNSON 1.00 X X 0 0 0 DON HAACK 1.00 X X 0 0 0 BARB JADERBORG 1.00 X X 0 0 0 MARK VAN ETTEN MD 5.00 X 17998 0 0 MIKE KNOEPKE 1.00 X X 0 0 0 NANCY MARKGREN 1.00 X 0 0 0 ADAM LIEGL 1.00 X 0 0 0 MICHAEL SCHAFER 40.00 X 190364 0 24648 REBECCA BUSCH 40.00 X 85343 0 18230 BRUCE LAIRD 40.00 X 119066 0 4261 PATRICK MCCANN MD 36.00 X 218646 0 32867 ANNE MENTELE CRNA 20.00 X 145212 0 30531 TIMOTHY SCHMIDT CRNA 20.00 X 142305 0 28578 TIMOTHY BASSETT 40.00 X 113246 0 1136 1032180 0 140251 7 0 1 1 WAPITI MEDICAL GROUP - WOOD RIVER 603 S DAKOTA MILBANK SD 57252 ER PHYSICIAN COVERAGE 715686 A'VIANDS LLC 11751 W COUNTY RD B SUITE 300 ROSEVILLE MN 55113 NUTRITION SERVICES DEPT 537795 SHARED MEDICAL TECHNOLOGY 202 W NEWTON RICE LAKE WI 54868 DIAGNOSTIC RADIOLOGY 530553 SUNDANCE REHABILITATION CORP 200 NORTHPOINT CIRCLE STE 302 SEVEN FIELDS PA 16046 REHABILITATION SERVICES 458641 HEALTHTECH MANAGEMENT SERVICES 405 DUKE DRIVE SUITE 210 FRANKLIN TN 37067 MANAGEMENT FEES 226241 6 6864 35262 42126 PATIENT SERVICE REV. 621400 22634301 22634301 22634301 190608 190608 54630 19112 35518 35518 35518 7930 6864 7930 0 MISCELLANEOUS 900099 59300 59300 59300 22961853 22634301 0 285426 336361 13499 322862 9416632 7444656 1971976 155591 134209 21382 1812820 1404429 408391 556343 427037 129306 226241 226241 48987 48987 53162 53162 2898069 2197325 700744 98663 94840 3823 2673245 1793642 879603 327184 327184 111664 72864 38800 56005 18793 37212 128880 128880 776081 776081 231830 231830 BAD DEBT EXPENSE 1585326 1585326 REPAIRS & MAINTENANCE 317916 70966 246950 EMPLOYEE RECOGNITION 49318 49318 DIRECTORS EXPENSE 27212 27212 COMMUNITY BENEFITS 22123 22123 94827 46883 47944 22004480 16209430 5795050 0 800 800 3638316 2410375 3183941 3061352 228443 252434 112222 139369 18307207 12617446 5745611 5689761 5901693 7970484 25516 32041 15589 9093 18852131 19565709 2891490 2972989 830708 506530 32041 2132091 1828791 117516 92000 5971805 5432351 X 12866701 14119733 13625 13625 12880326 14133358 18852131 19565709 X 957373 295659 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 193349 193349 7325149 4141990 3183159 306985 278412 28573 10248951 8197044 2051907 232773 232773 5689761 ASSET RETIREMENT OBLIGATION 92000 92000 22961853 22004480 957373 295659 295659 1253032 22961853 0 22961853 0 22961853 22004480 0 22004480 0 22004480 FIN 48 - THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. SCHEDULE D, PART IV, LINE 2B: RESIDENT FUNDS ARE HELD BY SPOONER HEALTH SYSTEM ON BEHALF OF RESIDENTS. RESIDENTS MAY WITHDRAW FUNDS AT ANYTIME. 1 1 1 X 1 X 1 1 1 0 1 1 208 153321 153321 0.00750 3740150 2904346 835804 0.04090 208 3893471 2904346 989125 0.04840 29291 29291 0.00140 34 27855 27855 0.00140 1 144 176904 176904 0.00870 116 43746 43746 0.00210 1 294 277796 277796 0.01360 1 502 4171267 2904346 1266921 0.06200 2 932 932 0.00000 10 48 8361 8361 0.00040 1 27 178 178 0.00000 2 57 2634 2634 0.00010 1 109 109 0.00000 6 412 10340 10340 0.00050 22 544 22554 22554 0.00100 1 849309 7053987 7283824 -229837 X 1 1 1 1 SPOONER HEALTH SYSTEM INC

819 ASH STREET SPOONER WI 54801

X X X X NURSING HOME, HOME HLTH AGENCY SPOONER HEALTH SYSTEM 1 PART I, L7 COL(F): THE HOSPITAL IS REPORTING $1,585,326 OF BAD DEBT EXPENSE IN FORM 990, PART IX, LINE 24A. TOTAL EXPENSE, LESS THIS AMOUNT, ARE $20,419,153. THIS AMOUNT IS USED TO CALCULATE THE PERCENTAGE OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART II: SPOONER HEALTH SYSTEM (SHS) IS VERY INVOLVED IN WASHBURN COUNTY EMERGENCY PREPAREDNESS EFFORTS. SHS IS ALSO VERY ACTIVE IN THE FOLLOWING ORGANIZATIONS THAT DIRECTLY PROMOTE THE HEALTH OF PERSONS LIVING IN WASHBURN COUNTY: REGIONAL BIOTERRORISM, WASHBURN COUNTY CHILD SAFETY COALITION, REGIONAL TRAUMA ADVISORY COUNCIL, DRUG ENDANGERED CHILDREN, COMMUNITY COORDINATED RESPONSE TEAM, ELDER ABUSE INTERDISCIPLINARY TEAM, AND FAITH IN ACTION. PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"PAYMENT FOR SERVICES IS REQUIRED UPON RECEIPT OF A BILL, AFTER PAYMENT BY INSURANCE, IF ANY. SELF-PAY ACCOUNTS ARE ANALYZED FOR COLLECTIBILITY BASED ON THE MONTHS PAST DUE AND PAYMENT HISTORY. AN ALLOWANCE IS ESTIMATED FOR THESE ACCOUNTS BASED ON THE HISTORICAL EXPERIENCE OF THE HOSPITAL. ACCOUNTS THAT ARE DETERMINED TO BE UNCOLLECTIBLE ARE SENT TO A COLLECTION AGENCY AND WRITTEN OFF AT THAT TIME."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 8: FROM PART III, LINE 7 NO AMOUNT FROM THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. FROM PART III, LINE 6, THE TOTAL ALLOWABLE COST REPORTED TO MEDICARE WAS BASED ON THE 2011 FILED MEDICARE COST REPORT. PART III, LINE 9B: TO FURTHER THE SPOONER HEALTH SYSTEM MISSION OF BEING A COMMUNITY ORIENTED HEALTH SYSTEM THROUGH THE PROVISION OF FINANCIAL ASSISTANCE FOR MEDICALLY NECESSARY HEALTHCARE TO BE APPLIED IN A FAIR, CONSISTENT, RESPECTFUL AND OBJECTIVE MANNER TO LOW-INCOME PATIENTS. IN SUPPORT OF OUR VALUES OF THE PERSON, INTEGRITY, CONFIDENCE, EXCELLENCE, ENTHUSIASM, AND FELLOWSHIP, SPOONER HEALTH SYSTEM PROVIDES A SLIDING SCALE DISCOUNT ON BILLED CHARGES TO PATIENTS FOR MEDICALLY NECESSARY CARE DELIVERED TO THOSE WHO QUALIFY. THE FINANCIAL ASSISTANCE PROGRAM IS NOT CONSIDERED TO BE A SUBSTITUTE FOR PERSONAL RESPONSIBILITY, AND PATIENTS ARE EXPECTED TO COOPERATE WITH THE PROCEDURES TO OBTAIN THE DISCOUNT AND TO CONTRIBUTE TO THE COST OF THEIR CARE BASED ON THEIR INDIVIDUAL ABILITY TO PAY. SPOONER HEALTH SYSTEM WILL CONTINUE TO WORK WITH PATIENTS TO RESOLVE THE REMAINDER OF THEIR BALANCE AFTER FINANCIAL ASSISTANCE. AFTER PAYMENT PLAN ARRANGEMENTS HAVE BEEN MADE AND BEFORE TRANSFER TO A COLLECTION AGENCY, SPOONER HEALTH SYSTEM WILL SEND A NOTICE TO PATIENTS WHO HAVE FAILED TO MAKE PAYMENT ARRANGEMENTS OR WHO DO NOT COMPLY WITH MUTUALLY AGREED UPON PAYMENT PLANS. THE NOTICE WILL ALERT THE PATIENT OF THEIR BALANCE AND THAT IF THEIR FINANCIAL SITUATION HAS CHANGED, THEY MAY HAVE THE OPPORTUNITY FOR A NEW PAYMENT PLAN. PART VI, LINE 2: SPOONER HEALTH SYSTEM IS WORKING WITH WASHBURN COUNTY PUBLIC HEALTH AND OTHER AREA AGENCIES TO DO A COMPLETE COUNTY-WIDE COMMUNITY NEEDS ASSESSMENT. PART VI, LINE 3: SPOONER HEALTH SYSTEM COMMUNICATES THE AVAILABILITY OF FINANCIAL ASSISTANCE IN APPROPRIATE PATIENT CARE SETTINGS, INCLUDING THE EMERGENCY DEPARTMENT AND IN ALL REGISTRATION AREAS. PATIENTS ARE PROVIDED INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE UPON REGISTRATION OR ADMISSION TO THE FACILITY. SPOONER HEALTH SYSTEM PERSONNEL ARE AVAILABLE TO HELP PATIENTS UNDERSTAND AND APPLY FOR GOVERNMENTAL PROGRAMS AND THE FINANCIAL ASSISTANCE PROGRAM. APPLICATIONS FOR ASSISTANCE WILL BE MADE USING THE REQUEST FOR FINANCIAL ASSISTANCE (RFA) FORMS, WHICH ARE AVAILABLE IN ALL REGISTRATION AREAS OR VIA MAIL FROM THE BUSINESS OFFICE. INDIVIDUALS OTHER THAN THE PATIENT SUCH AS THE PATIENT'S PHYSICIAN, FAMILY MEMBERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, OR HOSPITAL PERSONNEL MAY MAKE REQUESTS FOR FINANCIAL ASSISTANCE ON THE PATIENT'S BEHALF. PART VI, LINE 4: SPOONER HEALTH SYSTEM PRIMARILY SERVES THE COMMUNITIES WITHIN WASHBURN COUNTY IN NORTHWESTERN WISCONSIN. WASHBURN COUNTY IS THE 28TH LARGEST COUNTY IN WISCONSIN WITH AN ESTIMATED POPULATION OF 16,666 (2009). THE MEDIAN HOUSEHOLD INCOME IS JUST UNDER $40,000 WITH 12.2% OF PERSONS BELOW POVERTY LEVEL (PER 2008 DATA). WASHBURN COUNTY HAD A 6.6% UNEMPLOYMENT RATE IN 2006 PER DWD, BUREAU OF WORKFORCE INFORMATION. PART VI, LINE 7: SPOONER HEALTH SYSTEM IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X 0 0 0 0 0 0 0 0 0 MICHAEL SCHAFER 189854 0 0 0 510 0 16500 0 8148 0 215012 0 0 0 PATRICK MCCANN MD 218646 0 0 0 0 0 6728 0 26139 0 251513 0 0 0 ANNE MENTELE CRNA 145212 0 0 0 0 0 4555 0 25976 0 175743 0 0 0 TIMOTHY SCHMIDT CRNA 142305 0 0 0 0 0 4438 0 24140 0 170883 0 0 0 SUPPLEMENTAL INFORMATION PART III MICHAEL SCHAFER IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS ON AN ANNUAL BASIS. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. SUPPLEMENTAL INFORMATION PART III DR. VAN ETTEN IS EMPLOYED BY ESSENTIA HEALTH, WHICH IS UNRELATED TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS ESSENTIA HEALTH FOR DR. VAN ETTEN'S SERVICES AS MEDICAL STAFF DIRECTOR. CITY OF SPOONER WASHBURN COUNTY WI 396005613 2007-10-14 720000 PHONE SYSTEM AND RADIOLOGY EQUIPMENT (CT SCANNER AND MAMMOGRAPHY EQUIPMENT) 0 0 0 CITY OF SPOONER WASHBURN COUNTY WI 396005613 2009-08-12 540000 PHARMACY, SURGERY, LAB AND X-RAY EQUIPMENT 0 0 0 146096 720000 720000 2007 0 0 1 1 178083 540000 10171 529829 2009 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 SPOONER HEALTH SYSTEM HAS AN EXECUTIVE COMMITTEE CONISTING OF THE BOARD PRESIDENT, VICE-PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 SPOONER HEALTH SYSTEM CONTRACTS WITH HEALTHTECH MANAGEMENT SERVICES TO PROVIDE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED BY MANAGEMENT BEFORE BEING FORWARDED TO THE BOARD OF DIRECTORS. AT THE BOARD OF DIRECTORS MEETING, THE 990 IS REVIEWED WITH BOARD MEMBERS WHO APPROVE IT. THE 990 IS THEN FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF SPOONER HEALTH SYSTEM THAT ALL POTENTIAL CONFLICTS OF INTEREST SHOULD BE IDENTIFIED BY ALL MEMBERS OF THE GOVERNING BOARD, PHYSICIANS, OFFICERS, MANAGERS AND EMPLOYEES OF THE ORGANIZATION. IF A CONFLICT SHOULD ARISE, IT WOULD BE DISCLOSED TO THE APPROPRIATE SUPERVISOR, COMPLIANCE OFFICER, OR HOTLINE. IT WOULD THEN BE REVIEWED BY THE COMPLIANCE OFFICER, COMPLIANCE COMMITTEE AND POSSIBLY THE BOARD OF DIRECTORS. RESTRICTIONS WOULD BE DETERMINED AND IMPOSED AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15A MICHAEL SCHAFER, CEO, IS AN EMPLOYEE OF THE UNRELATED MANAGEMENT COMPANY THAT PROVIDES SERVICES TO SPOONER HEALTH SYSTEM. SPOONER HEALTH SYSTEM PAYS THE MANAGEMENT COMPANY A MANAGEMENT FEE FOR MICHAEL SCHAFER'S SERVICES AS CEO. THE MANAGEMENT COMPANY PERFORMS A SALARY REVIEW OF THE CEO OF SPOONER HEALTH SYSTEM EACH YEAR AND PROVIDES THE APPROPRIATE INFORMATION TO SPOONER HEALTH SYSTEM'S BOARD OF DIRECTORS EACH YEAR. THROUGH THIS REVIEW, THE BOARD OF DIRECTORS IS ABLE TO REVIEW THE COMPARABILITY DATA RELIED UPON IN DETERMINING THE CEO'S COMPENSATION. THE INFORMATION IS PRESENTED BY THE MANAGEMENT COMPANY TO THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM, ALONG WITH A PERFORMANCE EVALUATION AND A RECOMMENDATION OF A SALARY LEVEL WHICH IS THEN APPROVED BY THE BOARD OF DIRECTORS OF SPOONER HEALTH SYSTEM. ALL OFFICERS AND KEY EMPLOYEES' COMPENSATION ARE REVIEWED ON AN ANNUAL BASIS AND COMPARED TO MARKET DATA GATHERED BY THE HUMAN RESOURCES DEPARTMENT. THIS PROCESS WAS LAST COMPLETED FOR THE CEO IN 2011. FOR ALL OTHER OFFICERS AND KEY EMPLOYEES THE PROCESS WAS LAST COMPLETED IN 2011. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 295,659.