2024-11-13T12:12:10-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2023-01-01 390806828 MEMORIAL HOSPITAL INC MEMO 7157433101 N3708 RIVER AVE NEILLSVILLE WI 54456 JEANETTE WOJTALEWICZ INTERIM CFO 7157433101 2024-11-11 1 1 DAVID LOWENTHAL P00378651 3122071040 2024-11-11 2023 2024-10-15 13:58:12Z MARSHFIELD MEDICAL CENTER-NEILLSVILLE BRIAN HOERNEMAN MD 1000 N OAK AVENUE MARSHFIELD WI 54449 41454010 0 X WWW.MARSHFIELDCLINIC.ORG X 1954 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 75 0 0 661563 94668 40946918 41267508 52907 -2519 91795 90869 41753183 41450526 0 0 0 0 23133835 20930371 0 0 0 20451764 20166389 43585599 41096760 -1832416 353766 53127334 52285487 476853 406943 52650481 51878544 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 32086221 41192354 MEMORIAL HOSPITAL, INC. IS A NOT-FOR-PROFIT 25-BED COMMUNITY HOSPITAL LOCATED IN NEILLSVILLE, WISCONSIN THAT PROVIDES MEDICAL, SURGICAL, EMERGENCY AND URGENT CARE SERVICES. OTHER HOSPITAL SERVICES PROVIDED INCLUDE, BUT ARE NOT LIMITED TO: PRIMARY CARE, ORTHOPEDIC GENERAL SURGERY, ONCOLOGY, ATHLETIC TRAINING, PAIN MANAGEMENT, PHARMACY, PHYSICAL THERAPY, RADIOLOGY, LABORATORY, CARDIAC REHABILITATION, RESPIRATORY THERAPY, OCCUPATIONAL THERAPY AND DIABETIC EDUCATION. 32086221 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 1 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X JANETTE TOWNSEND VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 MARK BUGHER CHAIR - PART YEAR 1.00 9.00 X X 0 24924 0 COLLEEN HOERNEMAN CHAIR 1.00 9.00 X X 0 6500 0 MARK BRADLEY VICE CHAIR 1.00 5.00 X X 0 13000 0 RUWAN DISSANAYAKE MD SECRETARY - PART YEAR 1.00 50.00 X X 0 370856 24157 JOHN BALTUS SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 1.00 54.00 X 0 3125033 382007 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 1.00 54.00 X 0 848741 40127 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO - PART YEAR 1.00 54.00 X 0 1053823 21091 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 515015 29993 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 56.00 X 0 536206 43230 MARGARET MINERICK BOARD MEMBER - PART YEAR 1.00 1.00 X 0 0 0 DAVID HOLMES BOARD MEMBER 1.00 0.00 X 0 0 0 CATHY BUKOWSKI MCHS CFO- PART YEAR 1.00 54.00 X 0 725840 23393 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 116564 0 RYAN NEVILLE FORMER PRESIDENT & CEO 0.00 50.00 X 0 403364 19115 0 7739866 583113 0 1 1 0 VAYA WORKFORCE SOLUTIONS LLC PO BOX 713427 CHICAGO IL 60677 PROFESSIONAL SERVICES 898903 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD AND ENVIRONMENTAL 237385 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 FOOD AND ENVIRONMENTAL 231486 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 PROFESSIONAL SERVICES 178656 CEPHEID INC PO BOX 74007537 CHICAGO IL 60674 LAB SERVICES 126542 12 3687 90981 94668 NET PATIENT SERVICE REVENUE 621110 40461169 40461169 MISC OTHER OPERATING REVENUE 621110 731185 731185 CAFETERIA REVENUE 621110 75154 75154 41267508 802 802 90869 0 90869 90869 90869 163 3484 -3321 -3321 -3321 41450526 41192354 0 163504 16722360 16048856 673504 456337 437368 18969 2737549 2636396 101153 1014125 977224 36901 2000 2000 2365090 2342761 22329 14453 3529 10924 264415 258617 5798 35255 35255 565896 564971 925 66033 61659 4374 2882 2882 2068956 2068956 I/C PURCHASED SERVICES 8723762 638511 8085251 MEDICAL SUPPLIES 3710172 3708419 1753 BAD DEBT EXPENSE 2023123 2023123 WI MEDICAID ACCESS TAX 34000 34000 290352 243694 46658 41096760 32086221 9010539 0 X 1267 1504 8506 21701 8126007 9088703 770308 698949 49999080 8066566 43579876 41932514 578344 496278 63026 45838 53127334 52285487 251758 377125 177794 0 47301 29818 476853 406943 X 52650481 51878544 52650481 51878544 53127334 52285487 X 353766 -1125703 X 0 1 X 1 1 1 X 475076 475076 37586838 2570603 35016235 9873031 5126523 4746508 2064135 369440 1694695 41932514 OPERATING LEASE PAYABLE LT 29818 29818 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), 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, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2023 OR DECEMBER 31, 2022. 1 1 X 1 X 1 X 1 1 0 1 1 5339001 1885242 3453759 0.08840 5339001 1885242 3453759 0.08840 57220 57220 0.00150 57220 57220 0.00150 5396221 1885242 3510979 0.08990 1000 1000 0.00000 700 700 0.00000 1700 1700 0.00000 1 977511 6089334 7411548 -1322214 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - NEILLSVILLE N3708 RIVER AVE NEILLSVILLE WI 54449 1026 X X X X MARSHFIELD MEDICAL CENTER - NEILLSVILLE 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://TINYURL.COM/4ZBXSMVF X 1 23 1 HTTPS://TINYURL.COM/5YX4H2DC 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - NEILLSVILLE PART V, SECTION B, LINE 5: MARSHFIELD MEDICAL CENTER-NEILLSVILLE (MMC-NEILLSVILLE) COMPLETED THE MOST RECENT CHNA IN NOVEMBER 2022, AND ENGAGED A DIVERSE GROUP OF PEOPLE AND ORGANIZATIONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITIES IT SERVED.A TOTAL OF 464 RESPONDENTS COMPLETED THE SURVEY, ALTHOUGH THE RESPONSE RATE VARIED PER QUESTION. DELIBERATE EFFORTS WERE MADE TO REACH MEMBERS OF THE PLAIN COMMUNITY (AMISH, MENNONITE), INDIVIDUALS WHO ARE IN THE JAIL AND ANY/ALL CLARK COUNTY RESIDENTS AT THE COUNTY FAIR. SURVEYS WERE DISTRIBUTED TO VARIOUS INDIVIDUALS AND ORGANIZATIONS, WHICH INCLUDED; MARSHFIELD CLINIC HEALTH SYSTEM, ASPIRUS INC., CLARK COUNTY HEALTH DEPARTMENT, AGING AND DISABILITY RESOURCE CENTER, SCHOOL DISTRICTS, COALITIONS AND MORE. HARD COPY SURVEYS WERE DISTRIBUTED AT THE COUNTY FAIR, AND FOOD PANTRIES. TWO FOCUS GROUPS WERE ALSO HELD TO ENGAGE THOSE THAT REPRESENT MEMBERS OF THE HISPANIC/LATINO COMMUNITY. INDIVIDUALS PRESENT REPRESENTED THE FOLLOWING AGENCIES: HMONG AND HISPANIC COMMUNICATION NETWORK (H2N), FAMILY HEALTH CENTER, MARSHFIELD CLINIC HEALTH SYSTEM, CLARK COUNTY HEALTH DEPARTMENT, LA CLINICA, AND ST. BERNARD CATHOLIC CHURCH. MARSHFIELD MEDICAL CENTER - NEILLSVILLE PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED JOINTLY WITH ASPIRUS, STANLEY HOSPITAL. MARSHFIELD MEDICAL CENTER - NEILLSVILLE PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED JOINTLY WITH THE CLARK COUNTY HEALTH DEPARTMENT. MARSHFIELD MEDICAL CENTER - NEILLSVILLE PART V, SECTION B, LINE 11: THE HEALTH PRIORITIES IDENTIFIED IN THE CHNA WERE:- ALCOHOL AND SUBSTANCE MISUSE- BEHAVIORAL HEALTH- HEALTH EQUITYMMC-NEILLSVILLE IS COMMITTED TO IMPROVING THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE BY STRATEGICALLY FOCUSING ON IMPROVING HEALTH EQUITY IN OUR COMMUNITIES BY IMPLEMENTING STRATEGIES THAT SYSTEMATICALLY FOCUS ON THE SOCIAL DETERMINANTS OF HEALTH AND SUBSEQUENTLY REDUCE HEALTH DISPARITIES. HEALTH PRIORITY: ALCOHOL AND SUBSTANCE MISUSEGOAL 1: REDUCE ALCOHOL AND SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION.- SUPPORT COMMUNITYWIDE ENVIRONMENTAL STRATEGIES, PREVENTION AND/OR POLICY TO ADDRESS ALCOHOL USE AND/OR SUBSTANCE MISUSE.GOAL 2: REDUCE COMMUNITY AND SOCIAL IMPACTS OF ALCOHOL AND SUBSTANCE MISUSE.- SUPPORT COMMUNITY LED RECOVERY EFFORTS.- SUPPORT COMMUNITIES IN EFFORTS TO REDUCE THE NEGATIVE CONSEQUENCES OF SUBSTANCE USE THROUGH HARM REDUCTION STRATEGIES.GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS.HEALTH PRIORITY: BEHAVIORAL HEALTHGOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES.- ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH.- PROVIDE EDUCATIONAL MATERIALS (USING A VARIETY OF PLATFORMS) TO INCREASE CAREGIVER MENTAL HEALTH AND WELLBEING.- PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS.- ENHANCE COMMUNITY MEMBERS' SKILLS TO SUPPORT MENTAL WELLNESS PROMOTION AND SUICIDE PREVENTION.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS.HEALTH PRIORITY: HEALTH EQUITYGOAL 1: ADVANCE HEALTH EQUITY BY REDUCING HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH.- ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES.GOAL 2: INCREASE ACCESS TO COMMUNITY-BASED RESOURCES, SERVICES AND SUPPORTS WITH A FOCUS ON HEALTH EQUITY.- INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCAL GROWN FOOD AND ADDRESS FOOD INSECURITY.- EQUITABLE ACCESS TO COMMUNITY-BASED RESOURCES, SERVICES AND SUPPORTS.GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO IMPROVING EQUITABLE ACCESS TO RESOURCES AND SUPPORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. 4 1 - MARSHFIELD CLINIC COLBY CENTER 111 DEHNE DRIVE COLBY WI 54421 PROVIDER-BASED RURAL HEALTH CLINIC 2 - MARSHFIELD CLINIC GREENWOOD CENTER 102 W CANNERY STREET GREENWOOD WI 54437 PROVIDER-BASED RURAL HEALTH CLINIC 3 - MARSHFIELD CLINIC NEILLSVILLE CENTER N3708 RIVER AVENUE NEILLSVILLE WI 54456 PROVIDER-BASED RURAL HEALTH CLINIC 4 - MARSHFIELD CLINIC STRATFORD CENTER 212800 STAINLESS AVENUE STRATFORD WI 54484 PROVIDER-BASED RURAL HEALTH CLINIC PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE. PART II, COMMUNITY BUILDING ACTIVITIES: MARSHFIELD MEDICAL CENTER-NEILLSVILLE (MMC-NEILLSVILLE), IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT; ENRICHES LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY, ADDRESSING SOCIAL DETERMINANTS OF HEALTH AND HEALTH INEQUITIES. THE HEALTH SYSTEM WAS REQUIRED TO IMPLEMENT A FINANCIAL IMPROVEMENT PLAN BECAUSE OF SIGNIFICANT CHALLENGES IN THE HEALTHCARE INDUSTRY. DESPITE THIS, COMMUNITY-BUILDING ACTIVITIES CONTINUED, AND STRONGER, LOCAL CONNECTIONS WERE MADE. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE: ECONOMIC DEVELOPMENT:MMC-NEILLSVILLE LEADERSHIP PARTICIPATES IN THE CLARK COUNTY ECONOMIC DEVELOPMENT, CORPORATION & TOURISM BUREAU. COMMUNITY SUPPORT:MMC-NEILLSVILLE STAFF PARTNERED WITH INDIANHEAD COMMUNITY ACTION AGENCY PROVIDES FREE NURTURE STYLE PARENTING CLASSES. PROVIDED A FREE, VIRTUAL DIABETES PREVENTION PROGRAM LED BY CDC-CERTIFIED LIFESTYLE COACHES TO EMPOWER PARTICIPANTS TO PREVENT OR DELAY THE ONSET OF TYPE 2 DIABETES. COALITION BUILDING:MMC-NEILLSVILLE LEADERS AND STAFF PARTICIPATE IN MULTIPLE COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY SUCH AS NICOTINE PREVENTION ALLIANCE, HMONG & HISPANIC COMMUNICATION NETWORK, CLARK COUNTY PREVENTION PARTNERSHIP, CLARK COUNTY COLLABORATIVE, CLARK COUNTY IMMUNIZATION COALITION, EAT RIGHT BE FIT COALITION, AND THE LOCAL SAFETY COUNCIL. COMMUNITY HEALTH IMPROVEMENT ADVOCACY:HELD A "WELLNESS DAY AT THE Y" AT THE MMC-NEILLSVILLE YMCA TO PARTICIPATE IN VARIOUS STYLES OF EXERCISE CLASSES AND TOUR THE YMCA. PRESENTED TO THE CLARK COUNTY BOARD OF HEALTH ABOUT NOVEL THC, THE IMPACT ON YOUTH AND COMMUNITY STRATEGIES TO PREVENT SELLING TO INDIVIDUALS UNDER THE AGE 21. PARTNERED WITH CLARK COUNTY HEALTH DEPARTMENT TO PROVIDE VACCINATIONS FOR ABBOTSFORD BACK TO SCHOOL EVENT. DEVELOPED MONTHLY EDUCATIONAL CONTENT TO INCLUDE IN THE AGING AND DISABILITY RESOURCE CENTER (ADRC) MONTHLY NEWSLETTER. TOPICS INCLUDED HEALTHY RECIPE ALTERNATIVES, SALT SUBSTITUTIONS AND HOW THAT HELPS YOUR HEALTH, HOW TO SPOT SIGNS OF A HEART EVENT, ETC. PROVIDED A HEALTH FAIR AT THE CLARK ELECTRIC CUSTOMER APPRECIATION BREAKFAST. DISTRIBUTED INJURY PREVENTION EDUCATIONAL MATERIALS IN COLLABORATION WITH THE HEALTH DEPARTMENT ON FALLS PREVENTION, BICYCLE SAFETY, ATV/UTV SAFETY, AND GUN AND HUNTER'S SAFETY. PROVIDED EDUCATIONAL CONTACT TO LOCAL RADIO STATES AND COORDINATED PHYSICIAN INTERVIEW TO PROMOTE HEALTH. SUPPORTED CLARK COUNTY HEALTH DEPT. IN DEVELOPING A SHARPS DISPOSAL AND MEDICATION DISPOSAL RESOURCE GUIDE. PROVIDED RECOVERY COACH SERVICES FOR PATIENTS AND COMMUNITY MEMBERS SEEKING SUPPORT OR ALREADY IN RECOVERY FROM AN ADDICTION TO ALCOHOL AND/OR OTHER SUBSTANCES. WORKFORCE DEVELOPMENT:MMC-NEILLSVILLE LEADERSHIP IS COLLABORATING WITH THE CHIPPEWA VALLEY TECHNICAL COLLEGE TO PROVIDE A CNA COURSE TO NEILLSVILLE AFTER LOCAL SCHOOLS AFTER HEARING OF A LACK OF ACCESS FOR INTERESTED STUDENTS. MMC-NEILLSVILLE STAFF IS MEETING WITH HEALTHCARE REPRESENTATIVES FROM MULTIPLE MEDICAL FACILITIES IN THE CVTC REGION TO DISCUSS THE EDUCATIONAL NEEDS IN THE COMMUNITY FOR INDIVIDUALS SEEKING HEALTHCARE CAREERS. OTHER COMMUNITY BUILDING:SUPPORTED FEEDING THE HUNGRY PROGRAM TO PROVIDE MEALS TO THOSE LIVING WITH FOOD INSECURITY. PARTICIPATED IN THE EAT RIGHT BE FIT COALITION TO FOCUS ON FOOD SECURITY AND OPPORTUNITIES TO STAY ACTIVE TO MAINTAIN HEALTH IN CLARK COUNTY. COORDINATE ONGOING FOOD DRIVE AND DONATION OF FOOD ITEMS TO THE LOCAL PANTRY. MMC-NEILLSVILLE STAFF COLLABORATED WITH UNITED WAY TO INSTALL A "WE BELONG BOOKS" IN THE ENTRANCE OF MMC-NEILLSVILLE TO PROVIDE ACCESS TO FREE CHILDREN'S BOOKS THAT ARE INCLUSIVE, DIVERSE AND PROMOTE UNDERSTANDING. SUPPORTED THE PLACEMENT OF A HYDROPONIC GARDEN UNIT IN CLARK COUNTY TO PROVIDE EDUCATION ABOUT, AND ACCESS TO, FRESH PRODUCE. PART III, LINE 2: BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 65% AND 61% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2023 AND DECEMBER 30, 2022, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2023 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO-CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE : REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-NEILLSVILLE USES RELIABLE SECONDARY DATA REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, AND DIRECT COMMUNITY INVOLVEMENT TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THE INFORMATION PROVIDED BY THESE SOURCES POINTS TO AREAS OF NEED. MMC-NEILLSVILLE COLLABORATES CLOSELY WITH MARSHFIELD CLINIC HEALTH SYSTEM'S CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA) TO ASSESS, DEVELOP, AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH OF THE LOCAL COMMUNITY. CCHA'S PRIORITY AREAS INCLUDE SUBSTANCE USE PREVENTION, YOUTH BEHAVIORAL HEALTH, HEALTH EQUITY, AND BUILDING COMMUNITY CAPACITY FOR HEALTH IMPROVEMENT. THIS WORK REQUIRES CONTINUAL ASSESSMENT OF THE NEEDS OF THE COMMUNITY WHICH REINFORCES MMC-NEILLSVILLE'S CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. MMC-NEILLSVILLE UTILIZES OUR COMMUNITY CONNECTIONS TEAM AND FINDHELP, AN ELECTRONIC DATABASE OF COMMUNITY RESOURCES AVAILABLE IN AN AREA, TO ASSESS NEEDS AND THEN CONNECT INDIVIDUALS TO THOSE RESOURCES. ADDITIONALLY, THERE ARE PROCESSES IN PLACE AT MMC-NEILLSVILLE TO ESTABLISH ONGOING DIRECT ENGAGEMENT WITH THE LOCAL HEALTH DEPARTMENT, NUMEROUS COMMUNITY-HEALTH-FOCUSED ORGANIZATIONS, COMMUNITY CHAMBERS, BOARDS OF ECONOMIC DEVELOPMENT, YOUTH-FOCUSED ORGANIZATIONS AND OTHER HEALTH IMPROVING ORGANIZATIONS. DIRECT COLLABORATION WITH, AND REQUESTS FROM, THESE GROUPS FURTHER KNOWLEDGE OF THE COMMUNITY AND ITS NEEDS. PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE. INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA.THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: CLARK COUNTY WAS ESTABLISHED IN 1853 AND IS THE 7TH LARGEST GEOGRAPHICALLY RANKED COUNTY IN WISCONSIN WITH A LAND AREA OF 1,209.82 SQUARE MILES (CLARK COUNTY HISTORY, N.D.; U.S. CENSUS, 2010). IT IS CONSIDERED BOTH A MEDICALLY UNDERSERVED AREA AND A RURAL COUNTY (U.S. HEALTH RESOURCES & SERVICES ADMINISTRATION, N.D.). CLARK COUNTY BORDERS FIVE OTHER COUNTIES AND SHARES THREE CITIES WITH OTHER COUNTIES (ABBOTSFORD PARTLY IN MARATHON COUNTY, COLBY PARTLY IN MARATHON COUNTY, AND STANLEY MOSTLY IN CHIPPEWA COUNTY). THE CITY OF NEILLSVILLE IS THE COUNTY SEAT (CLARK COUNTY WISCONSIN, N.D.). IN 2023, CLARK COUNTY POPULATION WAS 34,746. THERE WERE 29.8% OF RESIDENTS UNDER 18 YEARS, 17.1% WHO WERE 65 YEARS AND OVER, AND 48.9% WHO WERE FEMALE. THE RACIAL MAKE-UP OF CLARK COUNTY WAS 91.7% NON-HISPANIC WHITE, 0.5% BLACK OR AFRICAN AMERICAN ALONE, 0.9% AMERICAN INDIAN AND ALASKA NATIVE ALONE, 0.5% ASIAN ALONE, 5.9% HISPANIC OR LATINO, AND 0.5% TWO OR MORE RACES. CLARK COUNTY IS HOME TO A SUBSTANTIAL PLAIN POPULATION AND HISPANIC/LATINO POPULATION. THE PLAIN POPULATION INCLUDES AMISH AND MENNONITE COMMUNITIES, WHO MAKE UP ABOUT ONE-THIRD OF CLARK COUNTY'S POPULATION. APPROXIMATELY 45% OF NEW BIRTHS IN CLARK COUNTY ARE FROM THE PLAIN POPULATION (CLARK COUNTY HEALTH DEPARTMENT, 2023). IN CLARK COUNTY, 83% OF RESIDENTS HAVE COMPLETED HIGH SCHOOL, WHICH IS LOWER THAN THE STATE RATE OF 93%. 46% HAVE COMPLETED A BACHELOR'S DEGREE, WHICH IS LOWER THAN THE STATE RATE OF 70%. THE MEDIAN HOUSEHOLD INCOME WAS $55,800, WHICH WAS LOWER THAN WISCONSIN AT $64,900 AND THE UNITED STATES AT $67,300. THE POVERTY RATE WAS 18%, WHICH IS HIGHER THAN WISCONSIN AT 14% AND THE UNITED STATES AT 17%. 16% OF THE COUNTY POPULATION IS UNINSURED AND 3.2% UNEMPLOYED. PART VI, LINE 5: MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) PROMOTES THE HEALTH OF COMMUNITIES THROUGH ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), A DEPARTMENT WITHIN MCHS SOLELY DEDICATED TO POPULATION HEALTH. CCHA IS GOVERNED BY THE MCHS COMMUNITY HEALTH/COMMUNITY BENEFITS STEERING COMMITTEE WHICH IS TASKED WITH PROVIDING OVERSIGHT AND GUIDANCE ON SYSTEM COMMUNITY HEALTH AND COMMUNITY BENEFIT STRATEGY. THE COMMITTEE IS MADE UP OF INTERNAL EMPLOYEES WHO REPRESENT VARIOUS DIFFERENT DEPARTMENTS AND ROLES WITHIN THE HEALTH SYSTEM. THIS STRONG FOCUS ON COMMUNITY HEALTH IS FURTHER SUPPORTED BY THE MARSHFIELD CLINIC HEALTH SYSTEM BOARD OF DIRECTORS WHICH CONSISTS OF 24 MEMBERS, 11 OF THOSE MEMBERS ARE PHYSICIAN DIRECTORS AND 13 ARE INDEPENDENT DIRECTORS WHO RESIDE WITHIN THE SERVICE AREA AND ARE NOT EMPLOYEES OF THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES THROUGH ACCESSIBLE, AFFORDABLE, AND COMPASSIONATE HEALTH CARE. MCHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY LIVING OUT THIS MISSION INCLUDING PROVIDING SEVERAL SERVICES WHICH WOULD NOT OTHERWISE BE AVAILABLE IN A RURAL SETTING SUCH AS, MCHS PROVIDERS PRACTICING MORE THAN 170 SPECIALTIES AND EMERGENCY ROOMS THAT ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. MCHS TRAINS AND EDUCATES HEALTHCARE PROFESSIONALS THROUGH A VARIETY OF INTERNSHIP PROGRAMS AND PARTNERS REGULARLY WITH LOCAL HIGH SCHOOLS AND COLLEGES TO DISCUSS CAREER, INTERNSHIP, AND VOLUNTEER OPPORTUNITIES FOR STUDENTS. MCHS ACCEPTS FINANCIAL ASSISTANCE AND PAYMENT PLANS ARE AVAILABLE; MCHS ALSO PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (E.G. MEDICARE, MEDICAID). A VARIETY OF HEALTH PROGRAMMING IS PROVIDED TO THE COMMUNITY AT NO COST SUCH AS HEALTH SCREENINGS AT LOCAL EVENTS, TRAINING, AND PREVENTION PROGRAMMING. MCHS STAFF ARE ACTIVELY INVOLVED IN THEIR LOCAL COMMUNITY AND LEND NOT ONLY THEIR EXPERTISE BUT OFTENTIMES LEADERSHIP AS WELL TO MANY ORGANIZATIONS SUCH AS UNITED WAY, YMCA, CHAMBER OF COMMERCE, ETC. STAFF FROM MCHS HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF SUBSTANCE MISUSE, BEHAVIORAL HEALTH, AND HEALTH EQUITY. MCHS SUPPORTS SEVERAL FREE CLINICS BY PROVIDING SERVICES LIKE IMAGING AT NO-COST AND ROUTINELY DONATES SUPPLIES TO COMMUNITY-BASED HEALTH ORGANIZATIONS SUCH AS VACCINES, LAB EQUIPMENT, AND TECHNOLOGY. PART VI, LINE 6: MMC-NEILLSVILLE IS PART OF MARSHFIELD CLINIC HEALTH SYSTEM, INC., AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN AND RESEARCH AND EDUCATION PROGRAMS. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. MARSHFIELD CLINIC HEALTH SYSTEM SERVES RURAL COMMUNITIES AND COLLECTIVELY PROMOTES HEALTH BY REDUCING BARRIERS TO ACCESSING CARE. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE THAT WOULDN'T OTHERWISE BE AVAILABLE THROUGH ITS 60 LOCATIONS AND 11 HOSPITALS IN COMMUNITIES ACROSS NORTHERN, CENTRAL AND WESTERN WISCONSIN AND IN MICHIGAN. MCHS PRIMARY OPERATIONS INCLUDE MARSHFIELD CLINIC; MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, PARK FALLS, AND IRON MOUNTAIN (MICHIGAN); MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, DIVISION OF EDUCATION AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. UNIQUE TO MCHS IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILDS BRIDGES BETWEEN THE HEALTHCARE SYSTEM AND THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THIS COLLABORATION HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO - PART YEAR 0 1225308 0 450000 0 1449725 0 361730 0 20277 0 3507040 0 264534 WILLIAM MELMS MD BOARD MEMBER/MCHS CMO - PART YEAR 0 206266 0 152673 0 694884 0 9900 0 11191 0 1074914 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 0 741668 0 73943 0 33130 0 9900 0 30227 0 888868 0 0 CATHY BUKOWSKI MCHS CFO- PART YEAR 0 571918 0 9200 0 144722 0 9900 0 13493 0 749233 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 349775 0 148993 0 37438 0 9900 0 33330 0 579436 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 466567 0 21085 0 27363 0 9900 0 20093 0 545008 0 0 RYAN NEVILLE FORMER PRESIDENT & CEO 0 133824 0 6570 0 262970 0 5656 0 13459 0 422479 0 0 RUWAN DISSANAYAKE MD SECRETARY - PART YEAR 0 240464 0 114060 0 16332 0 3614 0 20543 0 395013 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B LINE 4A: IN 2023, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $614,466, WILLIAM MELMS, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $610,615, CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $82,431, AND RYAN NEVILLE RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $212,846. LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $275,424 THE FOLLOWING INDIVIDUALS PARTICATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A DISTRIBUTION OR HAVE AN AMOUNT VEST IN THE PLAN. UNDER THE PLAN, AMOUNTS DO NOT VEST UNTIL TWO YEARS AFTER SEPARATION FROM THE ORGANIZATION: RUWAN DISSANAYAKE, MD BRIAN HOERNEMAN, MD SAMANTHA KLEBE, DO WILLIAM MELMS, MD EDWARD FERNANDEZ, MD CATHY BUKOWSKI RYAN NEVILLE FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING MEMORIAL HOSPITAL, INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO MEMORIAL HOSPITAL, INC. SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR MEMORIAL HOSPITAL, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR MEMORIAL HOSPITAL, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS COLLEEN HOERNEMAN AND BRIAN HOERNEMAN, MD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTI0N 501(C)(3)) IS THE SOLE MEMBER OF MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF MEMORIAL HOSPITAL, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION, OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION, OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSON (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL HOSPITAL, INC. DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART X, LINE 20: MEMORIAL HOSPITAL, INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCIAL DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS -1,125,703. 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