2023-04-11T16:04:44-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 390831153 CUMBERLAND MEMORIAL HOSPITAL INC CUMB 7158227500 1110 7TH AVENUE CUMBERLAND WI 54829 MICHAEL GUTSCH CEO 7158227500 2023-04-02 1 MICHAEL GUTSCH 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-04-02 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z CUMBERLAND HEALTHCARE MICHAEL GUTSCH 1110 7TH AVENUE CUMBERLAND WI 54829 35413659 0 X WWW.CUMBERLANDHEALTHCARE.COM X 1955 WI PROVIDE EXCEPTIONAL QUALITY CARE, EVERY STEP OF THE WAY. 7 7 256 50 30299 0 3738477 3380917 26933654 30986603 819198 1018842 3956 4089 31495285 35390451 0 4636 0 0 15262474 16395374 0 0 0 11393055 15078173 26655529 31478183 4839756 3912268 34131044 48084790 12499628 24834203 21631416 23250587 TO BE AN INDEPENDENT, COMMUNITY-BASED HEALTH SYSTEM DEDICATED TO PROVIDING EXCEPTIONAL QUALITY CARE, EVERY STEP OF THE WAY. 0 0 26078649 4636 30956304 CUMBERLAND MEMORIAL HOSPITAL, INC. D/B/A CUMBERLAND HEALTHCARE (THE ORGANIZATION") IS AN INDEPENDENT, NONPROFIT, FACILITY THAT SERVES NORTHWEST WISCONSIN. THE ORGANIZATION OPERATES A HOSPITAL (CUMBERLAND MEMORIAL HOSPITAL) AND TWO RURAL HEALTH CLINICS (LOCATED IN CUMBERLAND AND TURTLE LAKE). CUMBERLAND MEMORIAL HOSPITAL BECAME A CRITICAL ACCESS HOSPITAL ON AUGUST 19, 2005, LICENSED FOR 25 ACUTE CARE BEDS. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, THERAPY, WOUND CARE, CHEMOTHERAPY, RADIOLOGY, LAB, AMBULANCE SERVICE AND GENERAL SURGERY. DURING FISCAL YEAR 2022, ACUTE CARE DAYS TOTALED 1220, SWING BED DAYS TOTALED 578.THE ORGANIZATION PROVIDED 18 INPATIENT AND 226 OUTPATIENT SURGERIES ALONG WITH 289 SCOPE PROCEDURES. THERE WERE ALSO 3061 EMERGENCY ROOM VISITS. CUMBERLAND CLINIC TOTAL VISITS WERE 19,226 AND TURTLE LAKE WERE 2,126. 26078649 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 17 0 256 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ANGIE MARTENS 7158227500 1110 7TH AVENUE CUMBERLAND WI 54829 MATT GORES CHAIRPERSON 1.00 X X 3125 0 0 CANDACE COTONE VICE CHAIR 1.00 X X 2000 0 0 MARTIN PETERS TREASURER 1.00 X X 2000 0 0 ANN HENDRICKS SECRETARY 1.00 X X 600 0 0 JOSEPH LESCHISIN TRUSTEE 1.00 X 2000 0 0 THOMAS LINGEN MD TRUSTEE 1.00 X 2200 0 0 JENNIFER TURCOTT TRUSTEE 1.00 X 0 0 0 MICHAEL GUTSCH CEO 40.00 X 273739 0 33191 ANGIE MARTENS CFO 40.00 X 173653 0 8969 ROBERT LINDBERG COO 40.00 X 169712 0 29749 DR AMY BAIR GENERAL SURGEON 40.00 X 402793 0 24131 DR CRAIG JENNINGS PHYSICIAN 40.00 X 320343 0 40189 DR KIMBERLY AUCOIN PHYSICIAN 40.00 X 273901 0 6661 DONALD FULLERTON CRNA 20.00 X 225364 0 37191 STEFANIE RINEHARDT CRNA 20.00 X 207464 0 42184 2058894 0 222265 26 0 1 0 CUMBERLAND CLINIC 1110 7TH AVENUE CUMBERLAND WI 54829 PHYSICIAN SERVICES 1847912 ATHENA HEALTH 311 ARSENAL STREET WATERTOWN MA 02472 ELECTRONIC HEALTH RECORD SERVICES 653755 MEDICAL INFORMATION TECHNOLOGY MEDITECH CIRCLE WESTWOOD MA 02090 ELECTRONIC HEALTH RECORD SERVICES 643047 SHARED MEDICAL TECHNOLOGY 2020 W NEWTON ST RICE LAKE WI 54868 ULTRASOUND SERVICES 445597 HEALTHEAST MEDICAL LAB 69 W EXCHANGE ST ST PAUL MN 55102 LAB SERVICES 354048 9 17000 3271559 92358 3380917 PATIENT SERVICE REVENUE 621990 30719633 30719633 NURSING HOME REVENUE 623000 210000 210000 56970 26671 30299 30986603 141971 141971 893773 1000 0 17902 893773 -16902 876871 876871 9395 17000 5306 4089 4089 35390451 30956304 30299 1022931 X 4636 4636 501725 501725 12456008 11036906 1419102 302533 263722 38811 2242206 1886972 355234 892902 742294 150608 37477 37477 89100 89100 4678935 4348495 330440 109746 109746 1565557 1411653 153904 1382460 1382460 310920 310920 64985 60612 4373 3921 2977 944 2257027 1713663 543364 139610 139610 MEDICAL SUPPLIES 2155615 2155615 PHARMACEUTICALS 1340932 1340932 REPAIRS & MAINTENACE 331097 329796 1301 EQUIPMENT RENTAL 235929 235929 374862 233527 141335 31478183 26078649 5399534 0 2152825 912777 1024358 1131317 3290435 5924708 408647 325000 732136 785376 73058 47088 49309615 19518931 10517427 29790684 10299574 9037357 5632584 130483 34131044 48084790 2971987 5442796 824082 471380 5002477 18834669 3701082 85358 12499628 24834203 X 21631416 23250587 21631416 23250587 34131044 48084790 3912268 -2293097 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4729 4729 0 PART II-B, LINE 1: CUMBERLAND MEMORIAL HOSPITAL (THE ORGANIZATION") PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. THE ORGANIZATION IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. A PORTION OF THE FEES PAID BY THE ORGANIZATION IN FY 2022 WERE RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 939678 939678 13693005 12150217 1542788 1743895 108445 1635450 9007750 7260269 1747481 23925287 23925287 29790684 DEFERRED COMPENSATION PLAN LIABILITIES 85358 85358 32979774 -2293097 -122886 -2415983 35395757 -5306 -5306 35390451 31360603 5306 5306 31355297 122886 122886 31478183 PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS NET AGAINST REVENUE -122,886. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -5,306. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 5,306. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS NET AGAINST REVENUE 122,886. GOLF OUTING 26395 17000 9395 300 2300 1580 848 278 26395 17000 9395 300 2300 1580 848 278 5306 4089 1 1 X 1 X 1 X 1 1 0 1 1 59058 59058 0.00190 3568616 2448631 1119985 0.03560 3627674 2448631 1179043 0.03750 26853 1160 25693 0.00080 58975 58975 0.00190 6430594 4195567 2235027 0.07100 4636 4636 0.00010 6521058 4196727 2324331 0.07380 10148732 6645358 3503374 0.11130 280 280 0.00000 280 280 0.00000 0 64301 12860 9865601 9767921 97680 X 1 1 1 1 CUMBERLAND MEMORIAL HOSPITAL 1110 7TH AVENUE CUMBERLAND WI 54829 SEE SCHEDULE H PART V SUPPLEMENTAL 1058 X X X X AMBULANCE SERVICE; RURAL HEALTH CLINICS CUMBERLAND MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 18 1 SEE PART V, SECTION C, LINE 7D 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE 2022 CHNA WAS COMPLETED THROUGH THRIVE BARRON COUNTY, WHICH BRINGS ALL LOCAL COMPETING HEALTHCARE SYSTEMS TOGETHER AND THE BARRON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES. OVER 800 SURVEYS WERE SENT OUT ELECTRONICALLY AND IN-PERSON TO BARRON COUNTY RESIDENTS ASKING THEM ABOUT WHAT THEY THOUGHT OUR TOP HEALTH CONCERNS WERE. ONCE THE VOTES WERE TALLIED, THE THRIVE BARRON COUNTY STEERING COMMITTEE MET TO DETERMINE THE HEALTH CONCERNS MOVING FORWARD. CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: 2022 CHNA WAS DONE WITH THE FOLLOWING FACILITIES: AMERY REGIONAL MEDICAL CENTER, BARRON COUNTY AGING & DISABILITY RESOURCE CENTER, CUMBERLAND MEMORIAL HOSPITAL, MAYO CLINIC HEALTH SYSTEM AND MARSHFIELD CLINIC HEALTH SYSTEM, BARRON COUNTY PUBLIC HEALTH. CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: CUMBERLAND MEMORIAL HOSPITAL WORKED WITH BARRON COUNTY PUBLIC HEALTH (BARRON, WI) TO IDENTIFY AND PRIORITIZE HEALTH NEEDS. CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: PART V, SECTION B, LINE 7A & 10A:HOSPITAL FACILITIES WEBSITE: CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/PART V, SECTION B, LINE 7D:SENT TO THRIVE AT BARRON COUNTY AND THEY ALSO DISTRIBUTE AND HAVE THEM AVAILABLE CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BARRON COUNTY HAS CREATED A GROUP CALLED THRIVE BARRON COUNTY, WHICH IS MADE UP OF HEALTHCARE FACILITIES IN THE COUNTY, INCLUDING CUMBERLAND MEMORIAL HOSPITAL. TOGETHER THRIVE BARRON COUNTY CONDUCTED A CHNA AND SINCE THEN EACH YEAR A NEW ASSESSMENT WAS DONE. IN 2022, THE TOP THREE HEALTH CONCERNS WERE ALCOHOL, TOBACCO, AND OTHER DRUG ABUSE (ATODA), MENTAL HEALTH AND CHRONIC DISEASE. GROUPS CALLED CHATS (COMMUNITY HEALTH ACTION TEAMS) WERE FORMED TO ADDRESS THE NEEDS IDENTIFIED AND SINCE 2012 HAVE BEEN WORKING TO BETTER SERVE THE NEEDS OF THE COUNTY RESIDENTS. ADDITIONALLY, CUMBERLAND MEMORIAL HOSPITAL ANNUALLY HOLDS THE "KNOW YOUR NUMBERS" HEALTH FAIR WHICH PROVIDES FREE SCREENINGS TO AREA RESIDENTS THAT COULD POTENTIALLY ADDRESS MAJOR MEDICAL CONCERNS.AS WITH ALL HEALTHCARE ORGANIZATIONS, ADEQUATE RESOURCES ARE NOT AVAILABLE TO ADDRESS EVERY UNMET HEALTH NEED IN THE COMMUNITIES CUMBERLAND MEMORIAL HOSPITAL SERVES. THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE STEERING COMMITTEE DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE. OVER THE NEXT THREE YEARS, CUMBERLAND MEMORIAL HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN THE COMMUNITY, CONGRUENT WITH THE HOSPITAL'S MISSION. CUMBERLAND MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE THROUGH THE BUSINESS OFFICE STAFF. PATIENTS ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL'S WEBSITE ALSO ENCOURAGES PATIENTS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE POLICY. PART V, LINE 16A, B, C: THE FAP WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/THE FAP APPLICATION FORM WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/A PLAIN LANGUAGE SUMMARY OF THE FAP WAS WIDELY AVAILABLE ON A WEBSITE: HTTPS://CUMBERLANDHEALTHCARE.COM/PATIENTS-VISITORS/PATIENT-FINANCIAL-SERVICES/ 2 1 - CUMBERLAND HEALTHCARE MEDICAL CLINIC 1110 7TH AVENUE CUMBERLAND WI 54829 RURAL HEALTH CLINIC 2 - CUMBERLAND HEALTHCARE TURTLE LAKE CENTER 632 US HWY 8 TURTLE LAKE WI 54889 RURAL HEALTH CLINIC PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST HOSPITAL REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHODOLOGY USED IS BASED ON MEDICARE COST REPORTING METHODS. PART I, LINE 7G: THE COST OF SUBSIDIZED SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDED THE CLINICS AND THE EMERGENCY ROOM DEPARTMENT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH CUMBERLAND MEMORIAL HOSPITAL. IT HAS BEEN THE GOAL OF CUMBERLAND MEMORIAL HOSPITAL TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. PART II, COMMUNITY BUILDING ACTIVITIES: CUMBERLAND MEMORIAL HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. SEE PART 1, LINE 7 FOR THE CALCULATED COST OF PROVIDING COMMUNITY SERVICES. CUMBERLAND MEMORIAL HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES: AMBULANCE SERVICES, BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY 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 THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS, A SMALL AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET BEEN PAID, OR FOR PAYORS AND PATIENTS 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 COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS 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 FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: CUMBERLAND MEMORIAL HOSPITAL IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE HOSPITAL FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT CUMBERLAND MEMORIAL HOSPITAL OR AMBULANCE SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND AMBULANCE SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT CUMBERLAND MEMORIAL HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF CUMBERLAND, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND CHARITABLE CARE POLICIES, CUMBERLAND MEMORIAL HOSPITAL MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITABLE CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICES AS WELL AS THE CHARITY AND COMMUNITY CARE PROGRAM TO ALLOW PATENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE ON A CASE-BY-CASE BASIS. PART VI, LINE 2: IN 2020 CUMBERLAND HEALTHCARE ACHIEVED CDC RECOGNITION AS A DIABETES PREVENTION PROGRAM ORGANIZED BY DISTANCE LEARNING CLASS TYPE. OUR DIABETIC PROGRAM CONTINUES WITH CLASSES AND PARTICIPANTS THAT INCLUDES A DIABETES PREVENTION PROGRAM. THIS IS LED BY NUMEROUS RNS AND RD'S. WE NOW OFFER THIS PROGRAM VIRTUALLY OR IN PERSON TO MEET THE NEEDS OF OUR COMMUNITY. THE PANDEMIC HAS CERTAINLY MADE THINGS MORE CHALLENGING THESE LAST FEW YEARS. WE ARE IN OUR FINAL YEAR OF THE DIABETIC GRANT WE RECEIVED. THIS GRANT HAS ALLOWED US TO PROVIDE STAFF TIME, SUPPLIES, AND EQUIPMENT (IPADS) FOR DIABETIC EDUCATION. WE CONTINUE TO BRING IPADS TO AREA HEALTH AND WELLNESS FAIRS FOR DIABETIC PREVENTION TESTING. WE ARE ALSO STILL USING FUNDS FROM THE MENTAL HEALTH GRANT - TRYING TO DO OUTREACH AND BRING MORE AWARENESS TO MENTAL HEALTH BY VISITING AREA SCHOOL. WE OFFERED OUR ANNUAL KNOW YOUR NUMBERS HEALTH FAIR IN A MODIFIED WAY SPRING 2021 AND BACK TO NORMAL IN 2022. THIS CONTINUES WITH FREE HEALTH SCREENINGS FOR THE COMMUNITY OFFERING FREE BLOOD WORK. WE CONTINUE TO GET SPECIALISTS TO COME TO OUR FACILITY TO PROVIDE AS MANY SERVICES LOCALLY AS WE CAN. IN LATE 2021-2022 WE RECEIVED A GRANT TO BE USED FOR MENTAL HEALTH AND ALLOW US TO REACH OUT TO OUR SURROUNDING COMMUNITY EASIER. WE DEVELOPED A PLAN TO BE VISIBLE IN OUR AREA SCHOOLS TO INCREASE THE AWARENESS OF OUR MENTAL HEALTH PROVIDERS AS A RESOURCE AS WELL AS EDUCATE THE AREA YOUTH ABOUT MENTAL HEALTH, DEPRESSION AND SUICIDE. WE HAVE STARTED TRANSITIONAL CARE MANAGEMENT A PATIENT-CENTERED PROGRAM AS PATIENT'S TRANSITION FROM THE HOSPITAL TO HOME WITH A GOAL FOR THEM TO BE SUCCESSFUL AND SAFE AND DECREASE THE CHANCES OF READMISSION. THIS ALLOWS PATIENTS DIRECT ACCESS TO THEIR PRIMARY CARE PROVIDER REDUCING ER VISITS AND COORDINATES THEIR CARE AND FOLLOW-UP. IN 2022 WE LAUNCHED CHRONIC CARE MANAGEMENT WITH AN RN COORDINATOR THAT FOLLOWS THOSE PATIENTS WITH CHRONIC DISEASE AND HEALTH CONDITIONS SUCH AS DIABETES, HIGH BLOOD PRESSURE MULTIPLE SCLEROSIS, ETC., TO HELP MOTIVATE PATIENTS TO PERSIST IN THERAPY AND INTERVENTIONS FOR A BETTER QUALITY OF LIFE. PART VI, LINE 3: IF A PATIENT IS IDENTIFIED AS UNINSURED, CUMBERLAND HEALTHCARE STAFF WORKS WITH THE PATIENT AND/OR THEIR FAMILY TO DETERMINE IF THEY ARE ELIGIBLE FOR ANY TYPE OF GOVERNMENT PROGRAMS OR QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ASSISTANCE INFORMATION IS ALSO PUBLICIZED ON OUR WEBSITE. PART VI, LINE 4: THE HOSPITAL SERVES THE COMMUNITIES OF CUMBERLAND, TURTLE LAKE, AND ALMENA, WI AND SURROUNDING COMMUNITIES WITHIN A 20-MILE RADIUS. THERE ARE THREE OTHER HOSPITALS LOCATED IN THE RURAL AREA THAT THE ORGANIZATION SERVES. WE ALSO HAVE A SATELLITE CLINIC IN TURTLE LAKE WHICH OFFERS FAMILY PRACTICE AND REHAB SERVICES. PART VI, LINE 5: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. OUR ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. WE ALSO PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PROVIDE SERVICE AT SPORTING EVENTS. SURPLUS FUNDS ARE INVESTED BACK INTO THE FACILITY AND ITS EQUIPMENT TO ENSURE THE NEEDED SERVICES ARE CONTINUED TO BE PROVIDED IN THIS COMMUNITY. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X 0 0 0 0 0 0 0 0 0 DR AMY BAIR GENERAL SURGEON 402662 0 0 0 131 0 11711 0 12420 0 426924 0 426794 0 DR CRAIG JENNINGS PHYSICIAN 241800 0 78332 0 211 0 4773 0 35416 0 360532 0 360321 0 MICHAEL GUTSCH CEO 237759 0 31492 0 4488 0 7815 0 25376 0 306930 0 306783 0 DR KIMBERLY AUCOIN PHYSICIAN 250000 0 23650 0 251 0 4469 0 2192 0 280562 0 280311 0 DONALD FULLERTON CRNA 223856 0 1500 0 8 0 8007 0 29184 0 262555 0 262530 0 STEFANIE RINEHARDT CRNA 205876 0 1500 0 88 0 6476 0 35708 0 249648 0 249542 0 ROBERT LINDBERG COO 155574 0 14030 0 108 0 29749 0 0 0 199461 0 0 0 ANGIE MARTENS CFO 158047 0 15248 0 358 0 6777 0 2192 0 182622 0 182246 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND A FINAL DRAFT IS GIVEN TO THE BOARD MEMBERS OF CUMBERLAND MEMORIAL HOSPITAL. UPON APPROVAL FROM THE BOARD MEMBERS, THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE (IRS). FORM 990, PART VI, SECTION B, LINE 12C CUMBERLAND MEMORIAL HOSPITAL REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. OFFICERS AND KEY EMPLOYEES OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SIGN A CODE OF CONDUCT STATEMENT. IN THE CODE OF CONDUCT STATEMENT, IT MENTIONS THE CONFLICT OF INTEREST. ANY PERSON THAT BELIEVES TO HAVE A CONFLICT SHOULD DISCLOSE AS A MATTER OF RECORD TO THE BOARD ON AN ANNUAL BASIS OR AS THE INTEREST DEVELOPS AND BEFORE IT IS CONSUMMATED. ANY DIRECTOR HAVING A CONFLICT MAY NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER. THE DIRECTOR CAN STATE THEIR POSITION ON THE MATTER BEFORE ABSTAINING FROM VOTE. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE SET ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILARLY SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN SIMILAR REVENUE CATEGORIES). THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SETTING THE SALARY OF THE CEO BASED ON JOB PERFORMANCE. THE BOARD RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION-MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. ALL OTHER NON-UNION WAGES ARE REVIEWED SEMI-ANNUALLY IN COMPARISON TO THE RURAL WISCONSIN HEALTH COOPERATIVE WAGE SURVEY. THIS WAGE SURVEY INCLUDES WAGE DATA OF 27 RURAL HEALTH CARE ORGANIZATIONS. THE GOAL OF THE ORGANIZATION IS TO REMAIN WITHIN THE WAGE SURVEY AVERAGES, BASED ON YEARS OF SERVICE TO BE COMPETITIVE WITH SIMILAR ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 CUMBERLAND MEMORIAL HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,656,947. MANAGEMENT AND GENERAL EXPENSES 330,440. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,987,387. CONTRACTED ER PHYSICIANS: PROGRAM SERVICE EXPENSES 740,321. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 740,321. CONTRACTED - PHARMACY: PROGRAM SERVICE EXPENSES 445,675. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 445,675. CONTRACTED RADIOLOGY/NUCLEAR MEDICINE SERVICES: PROGRAM SERVICE EXPENSES 451,305. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 451,305. CONTRACTED PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,054,247. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,054,247. FORM 990, PART XII, LINE 2C, AUDIT OVERSIGHT: CUMBERLAND MEMORIAL HOSPITAL'S ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND ANY QUESTIONS OR CONCERNS REGARDING THE STATEMENTS ARE ADDRESSED BY THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.