2023-09-19T08:43:32-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-01-01 390872080 SAUK PRAIRIE HEALTHCARE INC SAUK 6086433311 260 26TH STREET PRAIRIE DU SAC WI 53578 JAMES DREGNEY CFO 6086433311 2023-09-18 1 JAMES DREGNEY 999009999 0 KOREY BOELTER P00775161 6123764500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SHAWN LERCH 260 26TH STREET PRAIRIE DU SAC WI 53578 118247118 0 X WWW.SAUKPRAIRIEHEALTHCARE.ORG X 1956 WI EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME. 12 12 765 74 0 0 2294619 586708 100639686 110499651 1470180 624974 -40983 -34171 104363502 111677162 52291 53427 0 0 58658621 60007853 0 0 154529 39444279 49232341 98155191 109293621 6208311 2383541 167630839 165561926 78543177 79931378 89087662 85630548 X EXTRAORDINARY HEALTHCARE FROM THE HEART - ONE PERSON AT A TIME.VISION: WE WILL SET THE STANDARD FOR COMMUNITY-BASED HEALTHCARE THAT IMPROVES THE HEALTH AND QUALITY OF LIFE OF THE PEOPLE WE SERVE. 0 0 70454645 53427 91604499 SAUK PRAIRIE HEALTHCARE, INC. (THE "HOSPITAL"), A 36-BED ACUTE CARE GENERAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO SAUK CITY, PRAIRIE DU SAC, AND THE SURROUNDING COMMUNITIES. TOTAL ADMISSIONS FOR 2022 WERE 1,641 (PY: 1,915) WITH PATIENT DAYS OF 4,166 (PY:4,199). KEY PATIENT SERVICES INCLUDING 385 (PY:402) BIRTHS IN THE NURSERY, 5,107 (PY:4,916) SURGICAL PROCEDURES, 62,921 (PY:63,282) REHABILITATION THERAPY SERVICES, 36,218 (PY:33,042) MEDICAL IMAGING SERVICES, AND 18,660 (PY:15,557) EMERGENCY ROOM VISITS ARE AMONG MANY OF THE SERVICES PROVIDED TO PATIENTS DURING 2022. THE HOSPITAL FULFILLS ITS MISSIONS AND VISION BY OFFERING HIGH-QUALITY SERVICES IN RURAL COMMUNITIES, THEREBY ALLOWING OUR PATIENTS TO BE TREATED LOCALLY WITHOUT LENGTHY COMMUTES OR WAITING. THE HOSPITAL HAS GAINED A REGIONAL REPUTATION OF EXCELLENCE IN ORTHOPEDICS, GENERAL SURGERY, AND GYNECOLOGY SURGERY. THE HOSPITAL OPERATES FOUR CLINICS IN RURAL AREAS: LODI, SPRING GREEN, PLAIN, AND MAZOMONIE, BRINGING PRIMARY CARE TO THOSE COMMUNITIES. THE CLINICS HAD CLOSE TO 31,023 (PY:31,542) VISITS IN 2022. AS A CHARITABLE ORGANIZATION, THE HOSPITAL PROVIDED ALMOST 1.8 MILLION (PY:$2.0 MILLION) IN FREE CARE TO PATIENTS IN OUR SERVICE AREA IN 2022, IN ADDITION TO SUBSIDIZING SERVICES THAT DO NOT COVER COSTS, FREE HEALTH SCREENINGS, EDUCATION PROGRAMS, AND YOUTH OUTREACH. 17621195 0 18977018 THE HOSPITAL ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN SPRING GREEN (DBA RIVER VALLEY CLINIC), MAZOMANIE (DBA WISCONSIN HEIGHTS CLINIC), PLAIN, AND LODI, WISCONSIN, AS WELL AS OPERATES ORTHOPEDIC AND SURGICAL PHYSICIAN PRACTICES IN PRAIRIE DE SAC, WISCONSIN. TOTAL CLINIC VISITS TO THESE FIVE SITES FOR 2022 WAS 50,308 (PY:50,385). 88075840 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 44 0 765 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES DREGNEY 6086433311 260 26TH STREET PRAIRIE DU SAC WI 53578 RYAN KRAEMER PRESIDENT 5.00 0.00 X X 7500 0 0 TOM SCHWARZ TRUSTEE 2.50 0.00 X 4000 0 0 KARI APEL TREASURER 3.00 0.00 X X 7218 0 0 TODD SCHAD MD TRUSTEE 2.50 0.00 X 5000 0 0 GEOFF LORENZ VICE PRESIDENT (THROUGH FEB 2022) 3.00 0.00 X X 2813 0 0 ANDREA WYTTENBACH GAVOL TRUSTEE & VICE PRESIDENT 2.00 0.00 X X 5000 0 0 TIM HOMAR TRUSTEE 2.00 0.00 X 5604 0 0 JEFF WRIGHT SECRETARY 3.00 0.00 X X 4468 0 0 RYAN VANRIPER TRUSTEE 2.00 0.00 X 1667 0 0 BRIAN GORMAN TRUSTEE 2.00 0.00 X 4000 0 0 BILL DALRYMPLE TRUSTEE 1.00 0.00 X 2333 0 0 SARA SHACKLETON TRUSTEE 2.00 0.00 X 2669 0 0 CLINTON MACKINNEY TRUSTEE 2.00 0.00 X 2333 0 0 SHAWN LERCH CEO 50.00 0.00 X 388577 0 43156 JAMES DREGNEY CFO 50.00 0.00 X 316591 0 44282 LISA PICKARTS VP PATIENT SERVICES 50.00 0.00 X 158613 0 23052 ANDREW ERTL MD SURGEON 40.00 0.00 X 1253329 0 50137 MICHAEL LAMSON MD SURGEON 40.00 0.00 X 978505 0 46400 DAVID MARCU MD SURGEON 40.00 0.00 X 1061031 0 45808 MATTHEW HEBERT MD SURGEON 40.00 0.00 X 975904 0 50369 THEODORE PARINS MD SURGEON 40.00 0.00 X 621844 0 49048 5808999 0 352252 71 0 1 0 SHARED IMAGING PO BOX 88450 MILWAUKEE WI 532880450 ULTRASOUNDS, CARDIAC ECHO & NUCLEAR MED 1791244 HURON 3005 MOMENTUM PLACE CHICAGO IL 60689 MEDITECH EXPANSE IMPLEMENTATION CONSULTI 1234985 BURLINGTON HEALTHCARE PROVIDERS W329 N4476 LAKELAND DR NASHOTAH WI 53508 CONTRACTED PHYSICIANS 830806 CENTRAL MINNESOTA DIAGNOSTICS 150 10TH STREET NW MILACA MN 563531221 CT & MRI SERVICES 631404 FANSTAFF PO BOX 911452 DENVER CO 802911452 CONTRACTED NURSING 364643 18 81866 504842 5012 586708 HOSPITAL PATIENT REVENUE 621990 90419256 90419256 CLINIC REVENUE 621110 18977018 18977018 OTHER HOSPITAL SERVICES 621990 889834 889834 CAFETERIA AND VENDING 621990 213543 213543 110499651 872148 872148 142076 176247 -34171 -34171 -34171 6146535 6347017 46692 -200482 -46692 -247174 -247174 111677162 110499651 0 590803 53427 53427 996270 996270 48023121 39256596 8659175 107350 2000464 1619419 374924 6121 6014464 4855905 1140204 18355 2973534 2316232 649650 7652 80982 80982 134984 134984 9988486 8355267 1633219 287380 41801 245579 1840364 1311664 528700 1412975 1412975 1336220 169286 1166934 14432 12135 2297 2378454 2332878 45576 9380430 9048894 331536 339395 41481 297914 MEDICAL SUPPLIES 13428133 13428133 REPAIRS & MAINTENANCE 3193048 2115202 1077846 MISCELLANEOUS EXPENSES 2132230 1597171 520008 15051 MEDICAID ASSESSMENT TAX 1243264 1243264 2041564 1520349 521215 109293621 88075840 21063252 154529 611832 601269 35270565 19200799 12653164 18451043 1336321 1446323 1054585 1497518 135303071 74148756 66980110 61154315 43320215 45837048 1162530 965525 5241517 16408086 167630839 165561926 17253281 11038741 42446 56449469 52606780 153693 11831832 4686734 4411579 78543177 79931378 X 83846145 80895032 5241517 4735516 89087662 85630548 167630839 165561926 X 2383541 -5334654 -506001 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 0 0 1 0 1 13535 13535 0 PART II-B, LINE 1: PART II-B, LINE 1: SAUK PRAIRIE HEALTHCARE ("THE HOSPITAL) PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING DEVELOPMENT. THE HOSPITAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE HOSPITAL PAYS MEMBERSHIP FEES TO THE RWHC. THE 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 HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. PART II-B, LINE 1 (D AND G): REPRESENTATIVES FROM THE HOSPITAL ANNUALLY PARTICIPATE IN THE WISCONSIN HOSPITAL ASSOCIATION'S ADVOCACY DAY WHERE THE REPRESENTATIVES ARE GIVEN THE OPPORTUNITY TO GATHER WITH OTHER HEALTHCARE ORGANIZATIONS IN THE STATE OF WISCONSIN AND ALSO MEET WITH STATE GOVERNMENT REPRESENTATIVES WITH THE PURPOSE OF IMPROVING THE DELIVERY OF HEALTHCARE NOT ONLY AT SAUK PRAIRIE HEALTHCARE BUT ALSO COLLECTIVELY IN THE STATE OF WISCONSIN. AS ISSUES OR PROPOSED LEGISLATION ARISE THROUGHOUT THE YEAR, OFFICIALS OF THE HOSPITAL WILL SEND LETTERS OF COMMENT TO LOCAL, STATE, AND FEDERAL GOVERNMENT REPRESENTITIVES TO EITHER SHOW SUPPORT OF PROPOSED CHANGES OR VOICE AN OPINION TO IMPROVE THE OUTCOME OF PROPOSED LEGISLATION OR OTHER CHANGES. THESE ACTIVITIES RESULT IN MINIMAL COST TO THE OPERATION OF THE HOSPITAL. 3130485 -311410 2819075 2778480 352005 3130485 2468306 310174 2778480 2047424 420881 2468306 2075699 -28275 2047424 0.00000 0.69000 0.31000 0 1 1 7338643 7338643 64960724 26282479 38678245 1682538 889144 793394 58347675 46977133 11370542 2973491 2973491 61154315 INVESTMENTS IN AFFILIATES 4735516 FINANCE LEASE ASSETS 105012 OPERATING LEASE ASSETS 11567558 16408086 DEFERRED COMPENSATION LIABILITY 3617457 THIRD PARTY SETTLEMENTS 794122 4411579 X 109925140 176246 176246 109748894 1928268 1928268 111677162 108272671 176246 176246 108096425 1197196 1197196 109293621 PART V, LINE 4: THE SCHNELLER SISTERS FUND SHALL BE HELD AS A SEPARATE PERMANENT ENDOWMENT FUND ON THE BOOKS AND RECORDS OF THE FOUNDATION, THE INCOME FROM WHICH SHALL BE DISTRIBUTED TO SAUK PRAIRIE HEALTHCARE FOR UNRESTRICTED NEEDS. ALL DISTRIBUTIONS FROM THE SCHNELLER SISTERS FUND SHALL BE DESIGNATED AS HAVING BEEN MADE "IN MEMORY OF THE SCHNELLER SISTERS: CECELIA SCHNELLER MUELLER, ADLYNN F. BALFANZ, AND MARY ANN ROSAR." PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL ASSESSES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2022 OR 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 176,246. PART XI, LINE 4B - OTHER ADJUSTMENTS: GOOD NEIGHBOR CLINIC SERVICES PROVIDED 265,865. INVESTMENT INCOME 671,565. OTHER INCOME 59,507. BAD DEBT EXPENSE 931,331. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 176,246. PART XII, LINE 4B - OTHER ADJUSTMENTS: GOOD NEIGHBOR CLINIC SERVICES PROVIDED 265,865. BAD DEBT EXPENSE 931,331. 1 1 X 1 X 1 X 1 1 0 1 1 653948 653948 0.00600 8989796 4382358 4607438 0.04220 9643744 4382358 5261386 0.04820 400753 400753 0.00370 301297 301297 0.00280 4609038 2517485 2091553 0.01910 168850 168850 0.00150 5479938 2517485 2962453 0.02710 15123682 6899843 8223839 0.07530 8569 8569 0.00010 418 418 0.00000 1579 1579 0.00000 10566 10566 0.00010 0 931331 0 18223413 24553475 -6330062 X 1 1 1 1 SAUK PRAIRIE HEALTHCARE INC 260 26TH STREET PRAIRIE DU SAC WI 53578 WWW.SAUKPRAIRIEHEALTHCARE.ORG 122 X X X SAUK PRAIRIE HEALTHCARE INC 1 0 0 1 X X X X X X X X X X 21 1 1 1 1 X SEE LINE 10A X X 1 21 1 WWW.SAUKPRAIRIEHEALTHCARE.ORG/ABOUT/COMMUNITY-HEALTH 0 1 X 100.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANC X WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANC X WWW.SAUKPRAIRIEHEALTHCARE.ORG/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANC X X X X X X 1 X 0 X X X X 1 X 0 0 SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 3J: INPUT FROM LOCAL PHYSICIANS WITH REGARD TO THE HIGHEST COMMUNITY HEALTH NEEDS WAS ALSO INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 5: ALONG WITH COLLECTING AND ANALYZING DATA FROM THE SAUK COUNTY HEALTH AND WELLNESS COALITION SURVEY (INCLUDING 648 RESPONDENTS FROM THE SPH SERVICE AREA) AND ONLINE DATA SOURCES, SIX KEY INFORMANT FOCUS GROUP MEETINGS WERE CONDUCTED WITH STAKEHOLDERS REPRESENTING BROAD INTERESTS OF THE AREA. THE GROUPS INCLUDED, BUT WERE NOT LIMITED TO, SCHOOL REPRESENTATIVES, LAW ENFORCEMENT OFFICERS, HEALTHCARE PROVIDERS, EMERGENCY RESPONSE PROFESSIONALS, CLERGY MEMBERS, MUNICIPAL OFFICIALS, AND COMMUNITY GROUP LEADERS. THE QUESTIONS ASKED WERE RELATED TO GENERAL COMMUNITY ISSUES AND CONCERNS, AT RISK POPULATIONS, ISSUES IN THE COMMUNITY THAT PROMOTE POOR HEALTH, AND ISSUES RELATED TO HEALTHCARE ACCESS. AT THE MEETINGS, HEALTH CONCERNS WERE IDENTIFIED AND PRIORITIZED. IN ADDITION TO THE KEY INFORMANT MEETINGS FACILITATED BY SPH, MANY OTHER COMMUNITY FORUMS WERE HELD BY MEMBERS OF THE SAUK COUNTY HEALTH AND WELLNESS COALITION. ON JANUARY 16, 2021, A "CREATING OUR HEALTH COMMUNITY PLAN" FORUM AND PRIORITY SESSION WAS HELD IN SAUK PRAIRIE. AT THIS STRATEGY SESSION (SEE CHNA APPENDIX FOR A LIST OF PARTICIPANTS AND MEETINGS). SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS: ST. CLARE/SSM HOSPITAL (BARABOO, WI) AND REEDSBURG AREA MEDICAL CENTER (REEDSBURG, WI). SAUK PRAIRIE HEALTHCARE, INC. ALSO WORKED WITH THE RICHLAND HOSPITAL (RICHLAND CENTER) AND UPLAND HILLS HEALTH (DODGEVILLE), BUT TO A LESSER DEGREE THAN ST. CLARE AND REEDSBURG. SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 6B: SAUK PRAIRIE HEALTHCARE WORKED WITH SAUK COUNTY DEPARTMENT OF HEALTH TO IDENTIFY AND PRIORITIZE HEALTH NEEDS. THIS GROUP MEETS ON AT LEAST A QUARTERLY BASIS TO CONTINUALLY ASSESS NEEDS AND COORDINATE AND REPORT ON HEALTH INITIATIVE PROGRESS IN EACH MEMBER'S RESPECTIVE SERVICE AREA. SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 7D: THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS MADE PUBLICLY AVAILABLE IN MAY 2022 VIA THE SAUK PRAIRIE HEALTHCARE WEBSITE. THE CHNA WAS INTERNALLY ANNOUNCED TO EMPLOYEES AND MEDICAL STAFF OF THE HOSPITAL IN JANUARY 2022. IN ADDITION, THE CHNA HAS BEEN PRESENTED AT THE PRAIRIE DU SAC VILLAGE BOARD ON JULY 26, 2022 AND IS SCHEDULED TO BE PRESENTED AT THE SAUK CITY VILLAGE BOARD DURING ITS AUGUST 30, 2022 MEETING. IN ADDITION, THE CHNA WILL BE PRESENTED TO THE SAUK PRAIRIE SCHOOL DISTRICT ON AUGUST 22, 2022, THE SAUK PRAIRIE SOCIAL JUSTICE AND EQUITY INITIATIVE COMMITTEE ON AUGUST 23, 2022, AND THE SAUK PRAIRIE CHAMBER BOARD ON OCTOBER 20, 2022. A PRESS RELEASE WAS CREATED AND SENT TO THE AREA PAPERS THE WEEK OF AUGUST 1, 2022. SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 11: THE FOLLOWING ACTIONS WERE DONE IN 2022 TO ADDRESS SIGNIFICANT HEALTH NEEDS IDENTIFIED IN SPH'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. (1) SPH CONTINUED TRACKING MONTHLY ADVANCE DIRECTIVES WITH PATIENTS TO ASSIST IDENTIFYING TRENDS AND PATTERNS. (2) SAUK PRAIRIE HEALTHCARE FOUNDATION ("SPHF") IN 2023, SAUK PRAIRIE HEALTHCARE HELD MHFA CLASSES: 03/08 IN LODI. IN 2022, SAUK PRAIRIE HEALTHCARE HELD MHFA CLASSES: 02/23 IN SAUK CITY WITH 14 PARTICIPANTS, 08/18 IN LODI WITH 9 PARTICIPANTS, 12/8 IN SAUK CITY, 12/14 IN BLACK EARTH. YOUTH MHFA CLASSES WERE OFFERED AT THE SAUK PRAIRIE SCHOOL DISTRICT ADMINISTRATION BUILDING ON 10/11 & 10/12 (WITH 23 PARTICIPANTS) AS WELL AS 10/15 (WITH 13 PARTICIPANTS.).(3) IN CONTINUING OUR EFFORTS TO REDUCE THE PREVALENCE OF TYPE 2 DIABETES, IN 2022, THE PROGRAM RAN MARCH-JULY WITH 10 PARTICIPANTS. FALL PROGRAM WAS CANCELLED DUE TO LACK OF MINIMUM PARTICIPANTS.(4) THROUGH EFFORTS TO EDUCATE STUDENTS ON THE HEALTH BENEFITS OF FRUITS AND VEGETABLES, SPH'S STIR IT UP PROGRAM 2022: RIVER VALLEY SCHOOL DISTRICT HAS EXPRESSED AN INTEREST AND SPH IS WORKING ON A PROGRAM TO BEGIN FALL OF 22/23 SCHOOL YEAR. LODI SCHOOL DISTRICT HAS EXPRESSED AN INTEREST FOR A PROGRAM THAT WORKS ALONGSIDE THEIR NEW GROW-TOWER.(5) TO HELP PREVENT SUICIDE AND SHARE RESOURCES AND EDUCATION TO LOWER THE LIKELIHOOD THAT OUR COMMUNITY WILL LOSE A MEMBER TO SUICIDE, SPH HAD ONE EMPLOYEE ACTIVELY INVOLVED WITH THE FARMER ANGEL NETWORK, WHICH IS A COLLABORATION OF SAUK CO. PUBLIC HEALTH, EXTENSION SAUK CO., PROJECT RECOVERY, LOCAL CHURCHES AND CONCERNED FARMERS. IN 2022, FARMER ANGEL NETWORK WAS INVOLVED IN OVER 30 EVENTS FOR THE COMMUNITY.(6) SPH FOUNDATION PROVIDED A YOUTH FEMALE EMPOWERMENT PROGRAM AND IN DECEMBER 2022, 33 SAUK PRAIRIE MIDDLE SCHOOL STUDENTS PARTICIPATED IN A SMOOTHIE CLASS, AND NOVEMBER 2022, 20 RIVER VALLEY MIDDLE SCHOOL STUDENTS PARTICIPATED IN A SMOOTHIE CLASS.(7) SPH FOUNDATION DONATED A COMBINED $25,000 TO COMMUNITY PROJECTS THAT CONTRIBUTE TO THE HEALTH OF THE COMMUNITY AS PART OF THE "HEALTHY LIFE GRANTS" PROGRAM.(8) SPH'S FITNESS CENTER CREATED THE STRONGER YOU WELLSPRING PROGRAM THAT INCLUDES SPECIFIC STRENGTH TRAINING EXERCISES WITH MODERATE TO HIGH INTENSITY AND ACTIVITIES TO IMPROVE BALANCE. THE PROGRAM IN INDIVIDUALIZED TO EACH CLIENT, WITH MODIFICATIONS FOR CHRONIC CONDITIONS OR ORTHOPEDIC LIMITS.(9) SPH, IN COORDINATION WITH SAUK COUNTY HEALTH DEPARTMENT, IS SPONSORING A MENTAL HEALTH APPLICATION CALLED CREDIBLEMIND. CREDIBLEMIND IS APP THAT ALLOWS ONLINE ACCESS TO THOUSANDS OF EVIDENCE-BASED RESOURCES, ALL REVIEWED BY BOTH EXPERTS AND USERS FOR A HIGHLY PERSONALIZED EXPERIENCE AND IS EXPECTED TO GO LIVE IN 2023 FOR THE PUBLIC TO USE.(10) SPH'S BEHAVIOR HEALTH PROGRAM HAS IMPLEMENTED ADOLESCENT SERVICES WITH A PARTNERSHIP WITH BEND HEALTH IN 2022 ALLOWING PATIENTS ACCESS TO MENTAL HEALTH SERVICES. IN 2023, SPH IS EXPECTED TO EXPAND CRISIS SUPPORT FOR INPATIENT AND EMERGENCY PATIENTS PARTNERING WITH A HEALTHCARE PROVIDER WHO ASSIST AND FIND MENTAL HEALTH SUPPORT WHEN NEEDED; INCREASING THE SPEED TO ACCESS CARE FOR THE PATIENT.(11) TO HELP REDUCE SUBSTANCE ABUSE, SPH HAD ONE EMPLOYEE ACTIVELY INVOLVED WITH THE SAUK COUNTY PARTNERSHIP FOR PREVENTION (WEBSITE: HTTPS://P4PSAUK.ORG/ ) WHICH IS AN ALLIANCE OF COMMUNITY MEMBERS AND LOCAL ORGANIZATIONS THAT ARE DEDICATED TO PREVENTING THE DANGEROUS USE OF ALCOHOL, TOBACCO, AND OTHER DRUGS. THE MISSION OF P4P IS USE COLLABORATION, EDUCATION, AND ACTION, WE EMPOWER OUR COMMUNITY TO PREVENT THE DANGEROUS USE OF ALCOHOL AND OTHER DRUGS, AND TO FOSTER HEALTHY LIFESTYLES FOR PEOPLE OF ALL AGES. UNLIKE PAST CHNAS, PARTICIPANTS IN OUR COMMUNITY CONVERSATIONS AND KEY INFORMANT INTERVIEWS HIGHLIGHTED THE BOTH THE HIGH COST AND LIMITED AVAILABILITY OF HOUSING AND THE LACK OF SOCIAL CONNECTEDNESS. DURING KEY INFORMANT INTERVIEWS CONDUCTED BY SPH AND COALITION PARTNERS, THE RECURRING ISSUE REGARDING THE LACK OF TRANSPORTATION AVAILABLE TO THOSE POPULATIONS IN NEED WAS BROUGHT TO THE SURFACE. SPECIFIC ISSUES CITED INCLUDE DIFFICULTY GETTING TO AND FROM MEDICAL AND DENTAL VISITS, GROCERY SHOPPING, TRAVELING TO AND FROM WORK, AND THE ABILITY TO ATTEND SOCIAL ACTIVITIES. THIS ISSUE WAS NOT IDENTIFIED BY SPH AND THE COALITION AS A COMMUNITY HEALTH PRIORITY, RATHER IT IS CONSIDERED AN ISSUE THAT AFFECTS EACH OF THE STATED PRIORITY AREAS OF EACH ORGANIZATION. TO THE DEGREE POSSIBLE, TRANSPORTATION WILL BE ADDRESSED AS A KEY COMPONENT OF OUR COMMUNITY HEALTH IMPROVEMENT IMPLEMENTATION PLAN (CHIIP). SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 13B: PATIENTS WHO ARE UNABLE TO COMPLETE AN APPLICATION FORM MAY BE ELIGIBLE FOR COMMUNITY CARE IF OTHER EVIDENCE IS AVAILABLE WHICH MAY INDICATE FINANCIAL HARDSHIP. THIS INFORMATION MAY BE OBTAINED FROM A PATIENT INTERVIEW, CREDIT REPORT, OR OTHER AVAILABLE RECORDS. CONSIDERATION WILL BE GIVEN ON AN INDIVIDUAL BASIS.OTHER PROVISIONS UNDER PRESUMPTIVE ELIGIBILITY:I. DECEASED WITH NO ESTATE - BASED ON THE CONCLUSION THAT THE DESCENDANT HAS NO ASSETS, AND THEREFORE NO ABILITY TO PAY. *II. ACCOUNTS UNCOLLECTIBLE DUE TO DISCHARGE OF DEBTOR BY BANKRUPTCY. *III. IF IT HAS BEEN DETERMINED THAT A PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE, ALL ACCOUNTS CURRENTLY IN THE A/R WITH SPH WILL BE WRITTEN OFF TO COMMUNITY CARE AFTER PAYMENT IS RECEIVED FROM THE INSURANCE. *IV. ANY ACCOUNT RETURNED BY THE COLLECTION AGENCY THAT HAS BEEN DETERMINED TO BE UNCOLLECTIBLE WILL BE CONSIDERED COMMUNITY CARE. *V. QUALIFIED INDIVIDUALS UNDER ANOTHER ORGANIZATION'S SIMILAR COMMUNITY CARE APPLICATION PROCESS.* NO COMMUNITY CARE APPLICATION NEEDS TO BE COMPLETED IN THESE INSTANCES. SAUK PRAIRIE HEALTHCARE, INC. PART V, SECTION B, LINE 16J: INFORMATION ABOUT THE POLICY IS INCLUDED ON BILLING INVOICES, ON ADMISSION INFORMATION, ON THE WEBSITE, AND IS REFERENCED IN COLLECTION EFFORTS. IT IS ALSO MENTIONED IN COMMUNITY TALKS ON HEALTH INSURANCE. 6 1 - ORTHOPEDIC ASSOCIATES OF SAUK PRAIRIE 250 26TH STREET SUITE 150 PRAIRIE DU SAC WI 53578 ORTHOPEDIC CLINIC 2 - LODI MEDICAL CENTER 160 VALLEY DRIVE LODI WI 53555 PHYSICIAN CLINIC 3 - RIVER VALLEY MEDICAL CENTER 436 SUNRISE DRIVE SPRING GREEN WI 53588 RURAL HEALTH CLINIC 4 - WISCONSIN HEIGHTS CLINIC 506 CROCKER STREET SUITE 3 MAZOMANIE WI 53560 PHYSICIAN CLINIC 5 - PLAIN MEDICAL CLINIC 825 MAIN STREET PLAIN WI 53577 RURAL HEALTH CLINIC 6 - SURGICAL ASSOCIATES 250 26TH STREET SUITE 210 PRAIRIE DU SAC WI 53577 SURGICAL CLINIC PART I, LINE 3C: ELIGIBILITY FOR SAUK PRAIRIE HEALTHCARE'S COMMUNITIY CARE (FINANCIAL ASSISTANCE) PROGRAM IS CONSIDERED FOR INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR GOVERNMENTAL HEALTH PLANS, AND WHO ARE UNABLE TO PAY FOR THEIR CARE. ABILITY TO PAY IS DETERMINED BY COMPARING FAMILY INCOME TO FEDERAL POVERTY LEVELS, BUT IT ALSO CONSIDERS THE FAMILY'S ASSETS. DETERMINATIONS ARE BASED UPON AN INDIVIDUAL'S FINANCIAL NEED AND DO NOT TAKE INTO ACCOUNT GENDER, RACE, SOCIAL STATUS, SEXUAL ORIENTATION, OR RELIGIOUS AFFILIATION. INDIVIDUALS MUST RESIDE OR HAVE A PRIMARY CARE PHYSICIAN IN SAUK PRAIRIE HEALTHCARE'S SERVICE AREA TO BE ELIGIBLE. PATIENTS WHO ARE UNABLE TO COMPLETE A COMMUNITY CARE APPLICATION MAY BE ELIGIBLE FOR ASSISTANCE IF OTHER EVIDENCE IS AVAILABLE THAT MAY INDICATE FINANCIAL HARDSHIP. THIS INFORMATION MAY BE OBTAINED FROM A PATIENT INTERVIEW, CREDIT REPORT, OR OTHER AVAILABLE RECORDS. THIS INCLUDES THE FOLLOWING SITUATIONS: (1) DECEASED WITH NO ESTATE (2) DISCHARGE OF DEBTOR BY BANKRUPTCY (3) PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE (4) ACCOUNT IS RETURNED BY THE COLLECTION AGENCY AS UNCOLLECTIBLE (5) QUALIFICATION UNDER ANOTHER ORGANIZATION'S SIMILAR FINANCIAL ASSISTANCE APPLICATION PROCESS. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS PRIMARILY BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER SUGGESTED COSTING METHODS FOR THE FORM 990. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON INTERNAL RECORDS ALLOCATIONS WHICH ARE SIMILAR TO A DIRECT COSTING ACCOUNTING SYSTEM FOR THESE SERVICES NOTED AS SUBSIDIZED HEALTH SERVICES. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT SAUK PRAIRIE HEALTHCARE, INC. INCLUDE THE OPERATION OF SEVERAL HOSPITAL DEPARTMENTS THAT OPERATE AT A LOSS FROM OPERATIONS, BUT ARE CONSIDERED VITAL HOSPITAL AND CLINIC SERVICES SUCH AS AUDIOLOGY & SLEEP, DIABETES MANAGEMENT, SURGICAL ASSOCIATES & UROLOGY, AND SEVERAL OTHER DEPARTMENTS. A LARGE PORTION OF THESE SERVICES ARE ACCESSED BY COMMUNITY MEMBERS THROUGH THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT. IT IS THE GOAL OF SAUK PRAIRIE HEALTHCARE, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING EFFORTS PROMOTE THE PHYSICAL, MENTAL AND ECONOMIC HEALTH OF THE COMMUNITIES IT SERVES. FROM AN ECONOMIC PERSPECTIVE, SAUK PRAIRIE HEALTHCARE, STAFF CONTRIBUTE HUNDREDS OF HOURS TO ECONOMIC DEVELOPMENT (CHAMBERS OF COMMERCE AND ECONOMIC DEVELOPMENT ENTITIES) ACTIVITIES AND SUPPORT WORKFORCE DEVELOPMENT THROUGH COMMUNITY AND EDUCATIONAL PROGRAMS. THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY IS SUPPORTED THROUGH THE DEVELOPMENT OF HEALTH-RELATED COALITIONS, PARTICULARLY THE SAUK PRAIRIE WELLNESS MOVEMENT AND THE SAUK COUNTY HEALTH AND WELLNESS COALITION. 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 DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE FOR INDIVIDUALS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE 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 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 ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVEABLE. PART III, LINE 4: FOR AN EXPLANATION OF THE ORGANIZATION'S BAD DEBT EXPENSE, SEE THE "PATIENT ACCOUNTS RECEIVABLES AND CREDIT POLICY" PARAGRAPHS IN NOTE 1 OF THE AUDITED FINANCIAL STATEMENTS, LOCATED ON PAGES 8-9 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: WHETHER THERE IS SHORTFALL OR A SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE 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. THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS FORM 990 INSTRUCTIONS AND ONLY INCLUDE THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT SAUK PRAIRIE HEALTHCARE, INC., PHYSICIAN SERVICES FOR THE INTERNAL MEDICINE (HOSPITALIST) PROGRAM, PHYSICIAN SERVICES PROVIDED TO TWO OF THE FOUR OUTLYING PHYSICIAN CLINICS, CRNA SERVICES PROVIDED TO PATIENTS UNDERGOING ANESTHESIA AT THE HOSPITAL, AND A SIGNIFICANT PORTION OF LAB AND PHYSICAL THERAPY SERVICES WHICH ARE REIMBURSED BY THE MEDICARE PROGRAM UNDER ANOTHER METHODOLOGY. PHYSICIAN COVERAGE OUTPATIENT LAB SERVICES AND OUTPATIENT PHYSICAL THERAPY SERVICES ARE REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COST OF CARING FOR PATIENTS. EMERGENCY PHYSICIAN 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 SAUK PRAIRIE HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHODOLOGY USED ABOVE FOR IRS FORM 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 OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENT ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED ON A COST REPORTING METHODOLOGY. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LARGER LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR. PART III, LINE 9B: IT IS THE POLICY OF SAUK PRAIRIE HEALTHCARE, INC. THAT EACH PATIENT RECEIVES CARE REGARDLESS OF THE ABILITY TO PAY. IF DURING THE COLLECTION PROCESS A PATIENT DOES NOT COMPLETE THE NECESSARY PAPERWORK OR RESPOND TO ATTEMPTS BY THE HOSPITAL TO PROVIDE CHARITY SERVICES, THE PATIENT MAY STILL REQUEST CHARITY INFORMATION AND COMPLETE THE INFORMATION AT ANY TIME DURING THE COLLECTION PROCESS. THE PATIENT WILL BE REFERRED TO THE HOSPITAL'S CHARITY CARE POLICY AND CAN QUALIFY FOR CHARITY CARE, AND HAVE ANY COLLECTION ISSUES REVERSED BY THE ORGANIZATION, IF THEY SHOW A NEED FOR CARE BASED ON THE HOSPITAL'S POLICY. PART VI, LINE 2: THE HOSPITAL ENGAGES IN THE FOLLOWING ACTIVITIES TO ASSESS THE HEALTHCARE NEEDS OF THE 42,000 RESIDENTS THROUGHOUT ITS 700 SQUARE MILE PRIMARY SERVICE AREA: ANALYZE HEALTH STATUS INFORMATION, EPIDEMIOLOGICAL DATA, AND HOSPITAL DISCHARGE DATA FURNISHED BY THE STATE OF WISCONSIN AND SAUK COUNTY TO IDENTIFY ISSUES AND TRENDS; MEET MONTHLY WITH THE COUNTY HEALTH DEPARTMENT AND TWO OTHER NEARBY HOSPITALS TO ASSESS HIGH PRIORITY HEALTH NEEDS AND COORDINATE ACTION; PARTICIPATE IN AND HELP COORDINATE COUNTY-WIDE INPUT SESSIONS WITH THE COUNTY HEALTH DEPARTMENT; LEAD AND PARTICIPATE IN COMMUNITY WELLNESS GROUPS AND INITIATIVES THROUGHOUT THE SERVICE AREA; CONDUCT "COMMUNITY HEALTH NEED" FOCUS GROUPS CONSISTING OF COMMUNITY LEADERS AND RANDOMLY SELECTED RESIDENTS; ANALYZE THE POPULATION-BASED NEED FOR MEDICAL PROVIDERS BY SPECIALTY. THIS INFORMATION IS ASSESSED AND MODIFIED BY MEMBERS OF THE HOSPITAL MEDICAL STAFF; LEADER PARTICIPATION AND LEADERSHIP IN CIVIC AND COMMUNITY SERVICE ORGANIZATIONS; ACTIVELY ENGAGE HOSPITAL BOARD MEMBERS IN COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND PROVIDE THE BOARD WITH MONTHLY UPDATES REGARDING COMMUNITY HEALTH ACTIVITIES. PART VI, LINE 3: 1. AT THE TIME OF REGISTRATION, A REGISTRATION SPECIALIST WILL INQUIRE IF THERE IS HEALTH INSURANCE. IF NOT, THEY WILL BE ADVISED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM IF THEY RESIDE WITHIN OUR SERVICE AREA. THOSE WHO HAVE A SAUK PRAIRIE BASED PHYSICIAN WILL ALSO BE CONSIDERED FOR ELIGIBILITY. COMMUNITY CARE INFORMATION IS ALSO PROSED ON THE HOSPITAL WEBSITE AND BILLS STATE THAT IF THE PATIENT IS HAVING DIFFICULTY PAYING THEY SHOULD CONTACT A HOSPITAL REPRESENTATIVE, AS THEY MAY BE ELIGIBLE FOR FREE OR REDUCED FEES. 2. ANY PATIENT REQUESTING ADDITIONAL INFORMATION ABOUT THE COMMUNITY CARE PROGRAM WILL BE REFERRED TO THE PATIENT ACCOUNTS SPECIALIST, WHO WILL EXPLAIN THE PROGRAM AND ITS ELIGIBLITY CRITERIA. WHEN APPLICABLE, ALL GOVERNMENT ASSISTANCE PROGRAMS SUCH AS MEDICAID, BADGER CARE, AND CRIME VICTIMS MUST BE EXHAUSTED BEFORE APPLYING FOR COMMUNITY CARE (EXCEPTION: THE GOVERNMENT ASSISTANCE PROGRAM APPLICATION MAY BE WAIBED BASED ON RELIGIOUS BELIEFS). COMMUNITY CARE IS NOT AVAILABLE FOR ELECTIVE PROCEDURES. PERSONS RESIDED IN THE SAUK PRAIRIE MEMORIAL HOSPITAL, INC.'S PRIMARY SERVICE AREA WILL BE CONSIDERED FOR ELIGIBLITY DETERMINATION. IN THE CASE OF EMERGENCY SERVICES, COMMUNITY CARE MAY BE EXTENDED TO THOSE RESIDING OUTSIDE OF THE PRIMARY SERVICE AREA. 3. THE INFORMATION IS ALSO POSTED ON OUR WEBSITE UNDER "PREPARING FOR YOUR STAY." IF AT ANY TIME PRIOR TO, DURING, OR AFTER THE SERVICES ARE PROVIDED THE PATIENT EXPRESSED CONCERNS ABOUT PAYMENT, THE COMMUNITY CARE PROGRAM IS EXPLAINED. INFORMATION IS ALSO PRINTED ON PATIENT STATEMENTS AND DISCUSSED WITH THE PATIENT DURING THE BILLING PROCESS. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA ENCOMPASSES A 700 SQUARE MILE REGION IN RURAL SOUTH CENTRAL WISCONSIN, INCLUDING SAUK, SOUTHERN COLUMBIA, NORTHWEST DANE, NORTHERN IOWA AND EASTERN RICHLAND COUNTIES. THE HOSPITAL IS LOCATED IN SAUK PRAIRIE (COMMON NAME FOR THE NEIGHBORING MUNICIPALITIES OF SAUK CITY AND PRAIRIE DU SAC) AND THE CLINICS ARE LOCATED IN FOUR TOWNS SURROUNDING SAUK PRAIRIE (MAZOMANIE, SPRING GREEN, PLAIN, AND LODI). NO OTHER HOSPITALS ARE LOCATED WITHIN THE PRIMARY SERVICE AREA, HOWEVER EIGHT INPATIENT HOSPITALS (INCLUDING 5 RURAL AND 3 TERTIARY FACILITIES) ARE LOCATED WITHIN A 30 MILES RADIUS OF SAUK PRAIRIE HEALTHCARE, INC. DEMOGRAPHIC ANALYSIS INDICATES A 5-YEAR GROWTH RATE OF 2.5% COMPARED TO THE STATE OF WISCONSIN'S RATE OF 1.9%. AGE GROUPS THAT WILL GROW AT A CONSIDERABLY FASTER RATE THAN THE STATE INCLUDE 0-17 YEAR OLDS (1.9%), 25-34 (15.2%), AND 65+ (16.65%). HEALTH ISSUES AFFECTING THESE AGE SEGMENTS INCLUDE PRENATAL SCREENING, TEEN PREGNANCY, LACK OF ACCESS TO HEALTHCARE, AND MEDICAL ISSUES ASSOCIATED WITH AGING. THE AREA HAS LITTLE RACIAL AND ETHNIC DIVERSITY, ALTHOUGH THE NUMBER OF HISPANIC RESIDENTS HAS INCREASED CONSIDERABLY SINCE 2000. SPECIFIC HEALTH-RELATED ISSUES CONFRONTING THIS POPULATION INCLUDE DIABETES, ACCESS TO CARE, AND LANGUAGE BARRIERS. AVERAGE HOUSEHOLD INCOME OF SERVICE AREA RESIDENTS IS 10% HIGHER THAN THE STATE AVERAGE. THIS DIFFERENCE IS DUE IN LARGE PART BECAUSE OF THE RELATIVELY STRONG JOB MARKET IN MADISON, WHICH ATTRACTS COMMUTERS FROM THE SERVICE AREA. THROUGHOUT THE SERVICE AREA, HOWEVER, AGRICULTURE AND TOURISM REPRESENT A CONSIDERABLE NUMBER OF LOW-PAYING JOBS, TYPICALLY WITHOUT HEALTH BENEFITS. A PORTION OF THE HOSPITAL PRIMARY SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA/POPULATION. THIS AREA IS LOCATED IN THE TOWN OF ARENA (MCD 02575). SAUK COUNTY IS ALSO DESIGNATED AS A HEALTH MANPOWER SHORTAGE AREA FOR PSYCHIATRY. PART VI, LINE 5: SAUK PRAIRIE HEALTHCARE, INC. IS AN INDEPENDENT COMMUNITY HOSPITAL GOVERNED BY AN 11-MEMBER BOARD OF DIRECTORS WHO RESIDE WITHIN THE PRIMARY SERVICE AREA. THE BOARD IS ELECTED BY THE 120 MEMBER COMMUNITY HOSPITAL ASSOCIATION. AN INDEPENDENT HOSPITAL IS A CRUCIAL PART OF THE HOSPITAL'S VISION, BECAUSE IT KEEPS CONTROL AT THE LOCAL LEVEL, NOT IN A CORPORATE HEADQUARTERS LOCATED ELSEWHERE. LOCAL CONTROL ALLOWS THE HOSPITAL TO MAKE DECISIONS THAT ARE BEST FOR THE LOCAL COMMUNITIES. THE SAUK PRAIRIE MEMORIAL HOSPITAL, INC. MEDICAL STAFF PRIVILEGES QUALIFIED PHYSICIANS IN ITS COMMUNITIES. THE VAST MAJORITY OF THE ACTIVE MEDICAL STAFF PRACTICE SOLELY AT THE SAUK PRAIRE MEMORIAL HOSPITAL, INC. OR ASSOCIATED CLINICS. THE HOSPITAL STRATEGIC PLAN SPECIFICALLY ADDRESSES OUR DESIRE TO "IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE AND THE ORGANIZATION'S EFFORTS TO ASSESS THE NEEDS OF THE COMMUNITY AND ADDRESS THOSE NEEDS. SAUK PRAIRIE HEALTHCARE, INC. PROMOTES COMMUNITY HEALTH THROUGH A BROAD ARRAY OF APPROACHES. THE FOLLOWING LIST DESCRIBES SPECIFIC PROGRAMS AND ACTIVITIES THAT CONTRIBUTE TO IMPROVING THE HEALTH OF THE COMMUNITY AND ENHANCING THE PROVISION OF MEDICAL CARE: TRAINING MEDICAL STUDENTS, NURSING STUDENTS, AND OTHER HEALTH PROFESSIONS; COLLABORATION WITH OTHER INDIVIDUALS AND ORGANIZATIONS IN THE COMMUNITY, TO PROVIDE DENTAL SERVICES TO UNINSURED AND UNDERINSURED MEMBERS OF THE COMMUNITIES SERVED WHO WOULD OTHERWISE NOT HAVE ACCESS OR THE ABILITY TO ACCESS THESE SERVICES ON A REGULAR BASIS; ORGANIZE AND/OR PARTICIPATE IN HEALTH FAIRS; OFFER CPR/FIRST AID CLASSES; ISSUE EDUCATIONAL NEWS RELEASES; CONDUCT COMMUNITY-BASED CLINICAL SCREENINGS (HEARING AID CHECKS, BLOOD PRESSURE, AND CHOLESTERAL SCREENING); PROVIDE SERVICES FOR THE GOOD NEIGHBOR CLINIC OF SAUK PRAIRIE, INC. (LOCAL FREE CLINIC); MEDICATION TAKE BACK DAY; DISCOUNTED EQUIPMENT AND SUPPLIES; ADVANCED DIRECTIVES COUNSELING; BLOOD DRIVES; BREASTFEEDING EDUCATION; CANCER EDUCATION; CLINICS FOR UNDERINSURED/LAB & MEDICATION COSTS; COMMUNITY GARDEN; COMMUNITY HEALTH IMPROVEMENT ADVOCACY; DIABETES EDUCATION; FAMILY/PARENTING/SIBLING EDUCATION; IMMUNIZATIONS/PERTUSSIS; MOBILE MEALS; PRESCRIPTION DRUG COLLECTION; SCHOOL-BASED HEALTH EDUCATION PROGRAMS; SCREENING/HEARING; SELF-HELP/CARDIAC REHAB; SELF-HELP/FITNESS AND EXERCISE; SELF-HELP/NUTRITION AND WEIGHT MANAGEMENT; SELF-HELP/SPORTS INJURY PREVENTION; SHARPS COLLECTION; SUPPORT GROUPS-BEREAVEMENT/GRIEF; SUPPORT GROUPS-BREASTFEEDING; SUPPORT GROUP-DIABETES; SUPPORT GROUPS-NEW MOM; SUPPORT GROUPS-SLEEP APNEA; AND TRANSPORTATION TOCKENS (BUS, CAB FARE). PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 TUITION REIMBURSEMENT 19 53427 PART I, LINE 2: TO SUPPORT THE NEEDS OF LOW-INCOME COMMUNITY MEMBERS, SAUK PRAIRIE HEALTHCARE (SPH) PROVIDES SPACE IN OUR OLD HOSPITAL TO GOOD NEIGHBOR CLINIC TO SERVE THOSE INDIVIDUALS. ANY PRODUCTS GIVEN TO GOOD NEIGHBOR CLINIC ARE HAND-DELIVERED. THE SHARED SPACE ENABLES SPH TO SEE HOW THE SUPPLIES ARE BEING USED. SPH ALSO PROVIDES FINANCIAL ASSISTANCE TO EMPLOYEES OF SPH TO ADVANCE THEIR KNOWLEDGE, SKILLS AND ABILITIES THROUGH POST-SECONDARY EDUCATION. APPLICATION FOR TUITION REIMBURSEMENT MUST BE MADE AT LEAST TWO WEEKS PRIOR TO THE COURSE STARTING DATE. THE APPLICATION MATERIALS MUST INCLUDE A COPY OF THE CLASS OR CURRICULUM DESCRIPTION BEING SUBMITTED FOR APPROVAL AND THE COST PER COURSE OR PER CREDIT. THE TUITION REIMBURSEMENT REQUEST FORM MUST BE COMPLETED AND SIGNED BY THE EMPLOYEE, DEPARTMENT DIRECTOR, AND VICE PRESIDENT PRIOR TO THE FIRST DATE OF CLASS. WITHIN 60 DAYS OF COMPLETION OF THE COURSE(S), THE EMPLOYEE MUST SUBMIT RECEIPTS FOR TUITION PAID BY THE EMPLOYEE AND PROOF OF SATISFACTORY COMPLETION TO THE HUMAN RESOURCES DEPARTMENT. UPON VERIFICATION OF ALL INFORMATION, HUMAN RESOURCES WILL ARRANGE FOR A REIMBURSEMENT CHECK TO BE ISSUED TO THE EMPLOYEE. X X X X X 0 0 0 0 0 0 0 0 0 ANDREW ERTL MD SURGEON 473895 0 627672 0 151762 0 15250 0 34887 0 1303466 0 0 0 DAVID MARCU MD SURGEON 446522 0 471054 0 143455 0 15250 0 30558 0 1106839 0 0 0 MATTHEW HEBERT MD SURGEON 438003 0 393375 0 144526 0 15250 0 35119 0 1026273 0 0 0 MICHAEL LAMSON MD SURGEON 440151 0 431375 0 106979 0 15250 0 31150 0 1024905 0 0 0 THEODORE PARINS MD SURGEON 285785 0 214381 0 121678 0 15250 0 33798 0 670892 0 0 0 SHAWN LERCH CEO 299217 0 45000 0 44360 0 12275 0 30881 0 431733 0 0 0 JAMES DREGNEY CFO 253224 0 20000 0 43367 0 13614 0 30668 0 360873 0 0 0 LISA PICKARTS VP PATIENT SERVICES 124294 0 14236 0 20083 0 5739 0 17313 0 181665 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97710B6V9 2013-01-19 38000000 CONSTRUCTION OF NEW HOSPITAL 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2022-02-28 16657945 REFUND SERIES 2013B BONDS 0 0 0 A 38000000 3384222 562253 34053525 2014 0 0 1 1 B 1288229 16657945 2000798 315417 16657945 2022 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/26/2018 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE BOARD'S OFFICERS AND THE IMMEDIATE PAST-PRESIDENT OF THE BOARD SO LONG AS THE IMMEDIATE PAST-PRESIDENT IS A MEMBER OF THE BOARD. WHEN A MEETING OF THE WHOLE IS NOT PRACTICAL OR FEASIBLE DUE TO AN EMERGENCY OR URGENCY OF A MATTER, THE EXECUTIVE COMMITTEE MAY EXERCISE ALL POWERS OF THE BOARD WITH RESPECT TO THE MANAGEMENT OF THE ORGANIZATION'S AFFAIRS WHEN THE BOARD IS NOT MEETING, EXCEPT FOR ELECTING OFFICERS OR FILLING VACANCIES ON THE BOARD OR ANY COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP IN SAUK PRAIRIE HEALTHCARE IS OPEN TO ALL PERSONS RESIDING IN THE ORGANIZATION'S SERVICE AREA AND TO THE ORGANIZATION'S CURRENT EMPLOYEES AND MEDICAL STAFF REGARDLESS OF PLACE OF RESIDENCE. THE ORGANIZATION'S SERVICE AREA IS FROM TIME TO TIME DETERMINED BY THE BOARD. MEMBERSHIP IS OPEN TO NATURAL PERSONS ONLY. CORPORATIONS, PARTNERSHIPS, LIMITED LIABILITIY COMPANIES, TRUSTS AND OTHER ENTITIES THAT ARE NOT NATURAL PERSONS ARE NOT ELIGIBLE FOR MEMBERSHIP. ANY NATURAL PERSON WHO PAYS DUES AS PROVIDED HEREIN SHALL BE A MEMBER OF THE ORGANIZATION AND SHALL BE ENTITLED TO VOTE AT THE ANNUAL OR ANY SPECIAL MEETING OF THE MEMBERSHIP. A NATURAL PERSON WHO CONTRIBUTES BY VOLUNTARY DONATION AN AGGREGATE OF $100.00 TO THE ORGANIZATION, WHICH SHALL CONSTITUTE THE DUES ENTITLING SUCH PERSON TO MEMBERSHIP, AND IS EITHER A RESIDENT OF THE SERVICE AREA, A CURRENT EMPLOYEE, OR MEMBER OF THE MEDICAL STAFF, SHALL BE A MEMBER AND SUCH MEMBERSHIP SHALL NOT TERMINATE AS THE RESULT OF SUBSEQUENT RESIDENCE OUTSIDE OF THE SERVICE AREA. MONETARY CONTRIBUTIONS TO THE SAUK PRAIRIE HEALTHCARE FOUNDATION, LTD. SHALL BE APPLIED TOWARD DUES FOR MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AN ANNUAL MEMBERSHIP SHALL BE ENTITLED TO ONE VOTE AT THE ANNUAL MEETING OR AT ANY SPECIAL MEETINGS OF THE MEMBERSHIP. MEMBERS MAY VOTE ON ELECTIONS OF BOARD MEMBERS, CHANGES TO THE BYLAWS, AND OTHER BUSINESS ALLOWED BY LAW. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED IN DETAIL BY THE DIRECTOR OF FINANCE, THE CFO, AND A DISCUSSION WAS HELD WITH THE CEO FOR ANY NEW OR UNUSUAL ITEMS. UPON APPROVAL, THE BOARD OF DIRECTORS RECEIVED AN ELECTRONIC COPY OF THE FORM 990 PRIOR TO SUBMISSION WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C SINCE SAUK PRAIRIE HEALTHCARE, INC. IS A PART OF A SMALL COMMUNITY, CONFLICTS ARE GENERALLY KNOWN, IF NOT DISCLOSED THROUGH THE ANNUAL PROCESS CONDUCTED BY HUMAN RESOURCES. THE ANNUAL PROCESS INCLUDES ALL DIRECTOR LEVEL EMPLOYEES AND ABOVE OF THE HOSPITAL. THE BOARD OF DIRECTORS HAS A CONFLICT OF INTEREST POLICY AND MUST ANNUALLY SIGN A DISCLOSURE FORM STATING ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD PRESIDENT THEN DISCLOSES ANY CONFLICTS OF INTEREST TO THE FULL BOARD OF DIRECTORS. CONFLICT OF INTEREST STATEMENTS COMPLETED BY BOARD MEMBERS ARE REVIEWED BY THE BOARD PRESIDENT AND EMPLOYEE'S CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY STAFF LEADERSHIP AND/OR ADMINISTRATION. THESE INDIVIDUALS ARE CHARGED WITH THE RESPONSIBILITY OF ENSURING THAT BUSINESS IS CONDUCTED IN A MANNER THAT ADHERES TO THE HOSPITAL'S FORMALLY APPROVED CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS ESTABLISHED POLICY BG-8 TO ESTABLISH ITS COMPENSATION PHILOSOPHY WITH RESPECT TO EXECUTIVE COMPENSATION AND TO DEFINE PRACTICES ASSOCIATED IN ACCORDANCE WITH IRC 4958. HOSPITAL EXECUTIVE SALARY IS SET ANNUALLY USING COMPARABILITY DATA FROM OUTSIDE CONSULTANTS AND THIRD-PARTY SURVEY DATA. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR SETTING SALARY FOR THE CEO BASED ON THE CEO'S JOB PERFORMANCE. THE COMMITTEE RELIES UPON COMPARABILITY DATA DEVELOPED BY OUTSIDE CONSULTANTS TO SUPPORT ITS DECISION MAKING PROCESS AND TO ENSURE COMPETITIVE SALARY LEVELS. THE BOARD REVIEWS BG-8 ANNUALLY AT THE GOVERNANCE COMMITTEE. COMPENSATION FOR OTHER KEY EMPLOYEES IS ESTABLISHED BY APPLICATION OF THE HOSPITAL'S COMPENSATION PHILOSOPHY, WHEREIN RATES OF PAY ARE COMPARED TO MARKET RATES OBTAINED THROUGH PARTICIPATION IN WAGE AND BENEFIT SURVEYS. PAY RANGES ARE OBTAINED FROM SURVEYS OF SIMILARLY SITUATED HOSPITALS LOCATED WITHIN THE STATE OF WISCONSIN IN TERMS OF SIZE AND REVENUE CATEGORY. THE HOSPITAL ADOPTED A "MEET THE MARKET" APPROACH TO COMPENSATION FOR POSITIONS AT THESE LEVELS. THIS MEANS THAT SAUK PRAIRIE HEALTHCARE, INC. TARGETS THE MIDPOINT OF THE PAY RANGE ASSOCIATED WITH EACH POSITION. THE CEO APPROVES COMPENSATION FOR ALL OTHER OFFICERS AND KEY EMPLOYEES BASED ON THE CRITERIA ABOVE. FORM 990, PART VI, SECTION C, LINE 19 THE ABBREVIATED FINANCIAL STATEMENTS ARE A PART OF THE HOSPITAL'S ANNUAL REPORT PRESENTED TO THE PUBLIC AT THE ANNUAL MEETING AND POSTED ON THE HOSPITAL'S WEBSITE. THE ABBREVIATED FINANCIAL STATEMENTS ARE ALSO MADE PUBLICLY AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -506,001. SAUK PRAIRIE HEALTHCARE FOUNDATION LTD 260 26TH STREET PRAIRIE DU SAC WI 53578 930841113 FUNDRAISING WI 501(C)(3) LINE 10 N/A 0 FRIENDS OF SAUK PRAIRIE HEALTHCARE 260 26TH STREET PRAIRIE DU SAC WI 53578 391453754 VOLUNTEERING WI 501(C)(3) LINE 12C, III-FI N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0