2023-11-07T08:18:18-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 391027536 BLACK RIVER MEMORIAL HOSPITAL INC BLAC 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 HOLLY WIN CFO 7152845361 2023-11-05 1 HOLLY WIN 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2023-11-03 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CARL SELVICK 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 64058496 0 X WWW.BRMH.NET X 1966 WI IN THE SPIRIT OF "EXCELLENCE ALWAYS," BLACK RIVER MEMORIAL HOSPITAL, INC.'S MISSION IS TO: PROVIDE HIGH QUALITY, ACCESSIBLE, PROGRESSIVE HEALTH CARE; CONNECT PATIENTS WITH VALUED HEALTH CARE PROVIDERS AND SERVICES; ENHANCE THE HEALTH AND WELLBEING OF ALL PEOPLE WE SERVE; REMAIN FISCALLY VIABLE TO REINVEST IN THE COMMUNITY'S FUTURE HEALTH CARE NEEDS.THE VISION OF BLACK RIVER MEMORIAL HOSPITAL IS TO BE THE HEALTH CARE PROVIDER AND EMPLOYER OF CHOICE IN JACKSON COUNTY AND THE SURROUNDING COUNTIES. 9 8 408 48 4868 4161 5503760 16291 60702248 62950055 1091456 726789 41647 35699 67339111 63728834 5000 4000 0 0 36976089 36947920 0 0 0 26394668 28426692 63375757 65378612 3963354 -1649778 96205640 89753789 30708641 29743779 65496999 60010010 X IN THE SPIRIT OF "EXCELLENCE ALWAYS," BLACK RIVER MEMORIAL HOSPITAL, INC.'S MISSION IS TO HELP PATIENT'S IMPROVE THEIR LIVES THROUGH COMPASSIONATE, COMMUNITY-BASED CARE. 0 0 45399598 4000 53511483 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PRIMARY AND MENTAL HEALTH CARE TO ALL PEOPLE IN NEED OF CARE. AMONG THE INPATIENT AND OUTPATIENT SERVICES PROVIDED ARE DIAGNOSTIC IMAGING, REHABILITATION SERVICES, RESPIRATORY CARE, SURGICAL SERVICES, CARDIAC MONITORED CARE, LAB SERVICES, PHARMACY SERVICES, 24-HOUR EMERGENCY ROOM, POISON CONTROL, AND MANY OTHERS. IN 2022, THE HOSPITAL PROVIDED 3,717 INPATIENT DAYS OF CARE TO ADULTS, PEDIATRICS, SWING BED, AND NURSERY INPATIENTS AS WELL AS 9,849 EMERGENCY ROOM/URGENT CARE AND 32,175 OUTPATIENT SERVICES TO THOSE IN NEED OF CARE. THE HOSPITAL ALSO SERVES AS A VITAL LINK TO THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS IN AN EFFORT TO ENHANCE THE HEALTH AND WELFARE OF THE PEOPLE IN ITS AREA. IN ITS EFFORT TO ATTAIN THIS GOAL THE HOSPITAL PROVIDES:-FREE AND REDUCED-COST CARE TO THOSE WITH A DEMONSTRATED NEED-CARE TO THOSE COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH MAY NOT COVER THE CHARGES OR COST OF SERVICES PROVIDED-HEALTH EDUCATION AND OUTREACH PROGRAMS TO ALL MEMBERS OF THE COMMUNITY AT LITTLE OR NO COST TO THE PARTICIPANTSCHARITY CARE GIVEN TO PERSONS UTILIZING OUR HOSPITAL AMOUNTED TO A TOTAL OF $974,798 IN TOTAL CHARGES. IN ADDITION, WE FURNISH CARE TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH PAY AT RATES LESS THAN CHARGES. DISCOUNTS TO THESE PROGRAMS FOR HOSPITAL SERVICES AMOUNTED TO $9,934,674BLACK RIVER MEMORIAL HOSPITAL, INC. ALSO CONDUCTED NUMEROUS EDUCATIONAL AND SUPPORTIVE ACTIVITIES TO ENCOURAGE THE GOOD HEALTH AND WELFARE OF THE MEMBERS OF THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE:-FACILITIES FOR MEETINGS AND SUPPORT PERSONNEL, INCLUDING LEADERSHIP FOR A GRIEF SUPPORT GROUP AND THE, PERS (A PERSONAL EMERGENCY RESPONSE SYSTEM AVAILABLE AT NOMINAL COSTS TO AREA RESIDENTS), DIABETES EDUCATION GROUP AND A NEWLY FORMED CANCER SUPPORT GROUP.-PROVIDING ASSISTANCE TO HEALTH EDUCATORS BY SPONSORING INTERNSHIPS FOR STUDENT NURSES, RADIOLOGICAL, REHABILITATION, AND LABORATORY TECHNICIAN STUDENTS.-PROVIDING CHILD BIRTH EDUCATIONAL CLASSES, THE SUMMER ATHLETIC ENHANCEMENT PROGRAM DESIGNED TO EDUCATE ATHLETICS ON PROPER TRAINING AND PREPARATION FOR SPORTS.-PROVIDING LEADERSHIP TO STATE AND REGION WIDE HEALTH ORGANIZATIONS INCLUDING THE WISCONSIN HOSPITAL ASSOCIATION, HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION, NURSE EXECUTIVES, HEALTH EDUCATORS, PERINATAL CARE ASSOCIATION AND THE WISCONSIN HEALTHCARE PUBLIC RELATIONS AND MARKETING SOCIETY TO FURTHER HEALTHCARE GOALS OUTSIDE OF OUR DIRECT SERVICE AREA.OTHER SERVICES WE PROVIDE INCLUDE GRIEF SUPPORT GROUP. COALITIONS WE SUPPORT ARE: BREASTFEEDING COALITION, BLACK RIVER AREA SAFETY COUNCIL, TOGETHER FOR JACKSON COUNTY KIDS, JACKSON IN ACTION, AND WELLNESS PROGRAMMING FOR AREA BUSINESSES. BLACK RIVER MEMORIAL HOSPITAL'S WOUND CARE CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY MAY 2021 AND PERFORMED 4,731 OUTPATIENT PROCEDURES IN 2022. 1894725 0 2956529 BLACK RIVER HEALTHCARE CLINIC OPENED TO BRMH EMPLOYEES IN JUNE AND THE GENERAL PUBLIC IN JULY 2020. BLACK RIVER HEALTHCARE CLINIC IS AN INTEGRATED CLINIC OFFERING BEHAVIORAL HEALTH AND PRIMARY CARE SERVICES. IN 2022, BEHAVIORAL HEALTH VISITS WERE 2,354 AND PRIMARY CARE VISITS WERE 5,841. 1536561 0 1161790 OTHER HOME-BASED SERVICES OFFERED INCLUDE BLACK RIVER MEMORIAL HOSPITAL'S HOMECARE AND HOSPICE PROGRAMS THAT PROVIDE COMPREHENSIVE HEALTHCARE SERVICES IN THE MOST COMFORTABLE SETTING-THE PATIENT'S HOME. IN 2022, THERE WERE 2,505 TOTAL HOMECARE VISITS PROVIDED TO PATIENTS CONSISTING OF SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, HOME HEALTH AIDE, AND MEDICAL SOCIAL SERVICE HEALTHCARE SERVICES PROVIDED TO PATIENTS IN THEIR HOMES. 494293 0 1104111 HOME-BASED SERVICES:BLACK RIVER MEMORIAL HOSPITAL'S HOME-BASED SERVICES GIVE PATIENTS WITH LIFE-LIMITING OR TERMINAL ILLNESSES THE OPPORTUNITY TO LIVE WITH DIGNITY DURING THE LAST STAGE OF THEIR LIFE. TOTAL HOSPICE DAYS OF SERVICE PROVIDED TO PATIENTS IN 2022 WERE 5,465. 263947 0 1123274 BLACK RIVER MEMORIAL HOSPITAL'S INFUSION CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY IN AUGUST 2021 WHICH INCLUDE INTRODUCING CHEMOTHERAPY TO OUR SERVICE MIX FOR THE FIRST TIME. 8 0 1946285 OTHER PROGRAMS 758248 0 4173670 49589132 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 38 0 408 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CARL SELVICK 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 DR CAROL MARTIN CHIEF OF STAFF/DIRECTOR 38.00 X X 402941 0 64386 ESTEBAN MILLER MD CMO 42.00 X 382758 0 63268 SMITA RAJASEKARAN MD PHYSICIAN 34.00 X 364655 0 62303 JOSEPH AHN DR PHYSICIAN 40.00 X 335276 0 57532 DR BRAXTON FRITZ PHYSICIAN 40.00 X 303366 0 61331 RICHARD MINNIHAN MD PHYSICIAN 34.00 X 299260 0 62503 HOLLY WINN CFO 40.00 X 283985 0 56808 MARY BETH WHITE-JACOBS CEO (SECRETARY) (THRU JULY) 40.00 X 228339 0 35954 KYLE KOVACEVICH CFO 40.00 X 213975 0 47111 CARL SELVICK CEO 40.00 X 173737 0 12594 ALEX BRADLEY CHOWN CHAIRPERSON 5.00 X X 0 0 0 JOHN DRACE VICE CHAIRPERSON (THRU JUNE) 4.00 X X 0 0 0 MICHELE SEVERSON VICE CHAIRPERSON 4.00 X X 0 0 0 MICHELLE GREENDEER-RAVE TREASURER 4.00 X X 0 0 0 CHRISTINE HOVELL DIRECTOR 4.00 X 0 0 0 TIMOTHY KUNES DIRECTOR 4.00 X 0 0 0 KATHERINE POTTER DIRECTOR 4.00 X 0 0 0 TIMOTHY TRANBERG DIRECTOR 4.00 X 0 0 0 DR THOMAS WALKER DIRECTOR 4.00 X 0 0 0 2988292 0 523790 54 0 1 0 R1 RCM INC 29586 NETWORK PLACE 29586 CHICAGO IL 60673 REVENUE CYCLE CODING/BILLING 1240703 BLACK RIVER ANESTHESIA ASSOCIATES 812 WESTWIND DRIVE BLACK RIVER FALLS WI 54615 CRNA/ANESTHESIA PROFESSIONAL SERVICE 890998 DUDLEY ANESTHESIA SC 607 L HAUSER RD ONALASKA WI 54650 CRNA/ANESTHESIA PROFESSIONAL SERVICE 311863 EZ ANESTHESIA 47336 QUEENS GROVE CIRCLE DRESBACH MN 55947 CRNA/ANESTHESIA PROFESSIONAL SERVICE 310011 CHIPPEWA VALLEY ORTHOPEDICS 1200 OAKLEAF WAY STE A ALTOONA WI 547202245 ORTHOPEDIC SURGICAL SERVICES 298009 5 16291 16291 HOSPITAL PATIENT SERVICE REVENUE 621400 54645431 54645431 CLINIC REVENUE 621400 2956529 2956529 HOSPICE PATIENT REVENUE 621400 1161790 1161790 HOMECARE PATIENT REVENUE 621400 1104111 1104111 3082194 1935611 12635 1133948 62950055 645872 645872 30972 0 30972 30972 30972 154766 246486 102788 217547 51978 28939 80917 80917 21821 9327 12494 12494 -7767 -7767 -7767 63728834 61803472 4868 1904203 X 4000 4000 1519830 1519830 24469245 20502876 3966369 1287247 1070222 217025 7914076 6373549 1540527 1757522 1389079 368443 148189 148189 116533 116533 10406819 6691163 3715656 457427 457427 766526 210084 556442 1627394 4734 1622660 667314 652323 14991 148995 127500 21495 718970 534176 184794 3420428 2541287 879141 227131 227131 MEDICAL SUPPLIES AND PH 5256577 5216686 39891 BAD DEBT EXPENSE 2789300 2789300 EQUIPMENT RENTAL & MAIN 515142 514002 1140 FOOD EXPENSE 378266 378266 781681 589885 191796 65378612 49589132 15789480 0 31826 0 20433914 20508911 11613975 10785924 734223 856802 514905 461382 71323429 42461564 31349193 28861865 28191990 24880040 3335614 3398865 96205640 89753789 4951141 5596089 1046261 223909 21354401 20422740 140239 0 3216599 3501041 30708641 29743779 X 65466335 59989247 30664 20763 65496999 60010010 96205640 89753789 -1649778 -3837211 0 X 0 1 X 1 1 1 X 0 0 0 0 0 0 0 0 1 6823 6823 0 PART II-B, LINE 1: BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR BLACK RIVER MEMORIAL, INC. 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, CLINICAL EDUCATION, PROVIDER PRIVILEGING AND CREDENTIALING SERVICES, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES 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. THE RWHC DETERMINED THAT 19.1% OR 4,388 OF THE FEES PAID BY BLACK RIVER MEMORIAL, INC WENT TO LOBBYING EFFORTS. BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE WHA PROVIDES SUPPORT SERVICES FOR A NUMBER OF MEMBER WHICH INCLUDE BUT ARE NOT LIMITED TO QUALITY AND SAFETY DATA REPORTING AND RESOURCES, DATA REPOSITORY, AND EDUCATION. THEY ALSO HOST MULTIPLE COUNCILS FOR THEIR MEMBERS. THE WHA DETERMINED THAT 16.7% OR $2,435 OF THE MEMBERSHIP DUES PAID WENT TO LOBBYING. 582699 582699 42874105 21041991 21832114 26565623 21419573 5146050 1301002 1301002 28861865 DEFERRED COMPENSATION PLAN LIABILITY 2360727 THIRD-PARTY REIMBURSMENT PROGRAMS 160000 OPERATING LEASE LIABILITY 892788 NEGATIVE CASH 87526 3501041 56995117 -3837211 9327 -3827884 60823001 116533 2789300 2905833 63728834 62482106 9327 9327 62472779 116533 2789300 2905833 65378612 PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 9,327. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 2,789,300. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 9,327. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 2,789,300. 1 1 X 1 X 275.000000000000 1 X 1 1 0 1 1 620485 620485 0.00990 11191608 6104319 5087289 0.08130 11812093 6104319 5707774 0.09120 80285 80285 0.00130 18460177 13861820 4598357 0.07350 49571 49571 0.00080 18590033 13861820 4728213 0.07560 30402126 19966139 10435987 0.16680 39665 39665 0.00060 39665 39665 0.00060 0 2789465 1394732 10978748 10870048 108700 X 1 1 1 1 BLACK RIVER MEMORIAL HOSPITAL INC 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 WWW.BRMH.NET 1037 X X X X BLACK RIVER MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X WWW.BRMH.NET/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 22 1 WWW.BRMH.NET/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 275.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X BRMH.NET/FINANCIAL-ASSISTANCE X BRMH.NET/FINANCIAL-ASSISTANCE X BRMH.NET/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X X 1 X 0 0 BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: BEGINNING THE WORK IN 2021, BRMH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR THE COMMUNITIES IT SERVES IN JACKSON COUNTY. THIS ASSESSMENT IS CONTINUALLY UPDATED AS APPROPRIATE AND THE NEXT REPORT OF A FULL ASSESSMENT WILL BE COMPLETED BY DECEMBER 31, 2025. TO COMPLETE THE ASSESSMENT AND WORK PLAN, BRMH WORKED WITH THE FOLLOWING COMMUNITY PARTNERS: JACKSON COUNTY PUBLIC HEALTH, HO-CHUNK NATION, JACKSON COUNTY SERVANT LED COMMUNITY, MEDICAL COLLEGE OF WISCONSIN, AND CHILDREN'S WISCONSIN. AN ELECTRONIC COMMUNITY HEALTH NEEDS AND MARKET SURVEY WAS DEPLOYED IN LATE APRIL 2022 AND WAS PROMOTED THROUGH A VARIETY OF CHANNELS. TO ENTICE CITIZENS TO TAKE THE SURVEY, THE FIRST 500 UNIQUE RESPONDENTS RECEIVED A $10.00 GAS CARD. FLYERS PROMOTING THE SURVEY WERE DISTRIBUTED THROUGHOUT THE COMMUNITY TO RETAIL OUTLETS AND COMMUNITY GATHERING SPOTS SUCH AS THE LUNDA COMMUNITY CENTER AND THE BLACK RIVER FALLS PUBLIC LIBRARY. 500 FLYERS WERE DISTRIBUTED AT THE LOCAL HANSEN'S IGA GROCERY STORE TO BE STUFFED INTO SHOPPERS' BAGS. EMAIL LIST-SERVE GROUPS, SUCH AS AREA CHURCHES, AND LOCAL SERVICE GROUPS SUCH AS THE ROTARY CLUB RECEIVED THE FLYER ENCOURAGING PARTICIPATION. BRMH PROMOTED THE SURVEY ON THEIR SOCIAL MEDIA CHANNELS, AND WEBSITE, AND PROMOTED IT INTERNALLY ENCOURAGING STAFF TO PARTICIPATE. TO CAPTURE FEEDBACK FROM THE MOST VULNERABLE POPULATIONS IN JACKSON COUNTY, STAFF VISITED ASSISTED LIVING FACILITIES, SENIOR CENTERS, AND LARGE EMPLOYERS OF THE SPANISH-SPEAKING POPULATION. ULTIMATELY, THE SURVEY WAS TAKEN BY ABOUT 1,500 PARTICIPANTS. A TWO-PART COMMUNITY FORUM WAS HELD ON SEPTEMBER 29TH AND OCTOBER 13TH, 2022, AT THE JACKSON COUNTY HEALTH AND HUMAN SERVICES BUILDING WITH A VARIETY OF COMMUNITY MEMBERS IN ATTENDANCE. A FOCUS GROUP MADE UP OF HEALTHCARE PROVIDERS, PUBLIC HEALTH OFFICIALS, BUSINESS LEADERS, AND REPRESENTATIVES FROM OTHER COMMUNITY RESOURCE PROVIDERS, WAS PRESENTED WITH THE DATA FROM THE 2022 SURVEY AND THE TOP COMMUNITY HEALTH NEEDS WERE IDENTIFIED. TOP FOUR HEALTH NEEDS: FAMILY AND COMMUNITY RESOURCE AWARENESS AND ACCESS, MENTAL HEALTH SUICIDE AND SELF-HARM, AND MENTAL HEALTH ACCESS, AND HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY. AS THE ONLY HOSPITAL IN JACKSON COUNTY, BRMH LEADERSHIP AND MEMBERS OF THE BRMH COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WORK TEAM DECIDED TO FOCUS ON THE FOLLOWING HEALTH NEEDS: MENTAL HEALTH SUICIDE AND SELF-HARM, MENTAL HEALTH ACCESS, AND HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE CHNA WAS COMPLETED WITH THE HO-CHUNK NATION AND JACKSON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: A FOCUS GROUP MADE UP OF HEALTHCARE PROVIDERS, PUBLIC HEALTH OFFICIALS, BUSINESS LEADERS, AND REPRESENTATIVES FROM OTHER COMMUNITY RESOURCE PROVIDERS, WAS PRESENTED WITH THE DATA FROM THE 2022 SURVEY AND THE TOP COMMUNITY HEALTH NEEDS WERE IDENTIFIED. TOP FOUR HEALTH NEEDS: FAMILY AND COMMUNITY RESOURCE AWARENESS AND ACCESS, MENTAL HEALTH SUICIDE AND SELF-HARM, AND MENTAL HEALTH ACCESS, AND HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY. AS THE ONLY HOSPITAL IN JACKSON COUNTY, BRMH LEADERSHIP AND MEMBERS OF THE BRMH COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WORK TEAM DECIDED TO FOCUS ON THE FOLLOWING HEALTH NEEDS: MENTAL HEALTH SUICIDE AND SELF-HARM, MENTAL HEALTH ACCESS, AND HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY. IT WAS DECIDED THAT THE TOP HEALTH NEED, FAMILY AND COMMUNITY RESOURCE AWARENESS AND ACCESS, COULD BE ADEQUATELY ADDRESSED BY OTHER COMMUNITY ORGANIZATIONS. THE HEALTH-RELATED NEEDS FELT MORE APPROPRIATE FOR THE HOSPITAL'S ATTENTION. MENTAL HEALTH: SUICIDE AND SELF-HARMGOAL ONE: DELIVER COMPASSIONATE, HIGH-QUALITY EMERGENCY CARE DURING TIMES OF A MENTAL HEALTH CRISIS- TACTICS: - CONTINUE TO OFFER EMERGENT BEHAVIORAL HEALTH SERVICES ON DEMAND VIA TELEHEALTH WITHIN OUR EMERGENCY DEPARTMENT (ED) DURING TIMES OF CRISIS, INCLUDING CONNECTING PATIENTS WITH INPATIENT PSYCHIATRY CARE IF NECESSARY. - ENHANCE OUR REFERRAL PROCESS THAT ENSURES A PATIENT PRESENTING IN THE EMERGENCY DEPARTMENT DURING A MENTAL HEALTH CRISIS HAS PROPER FOLLOW-UP WITH AN APPROPRIATE PROVIDER INCREASING THE CHANCES FOR EARLIER INTERVENTION IN THE FUTURE. - DISCUSS LOCAL OFFERINGS AND PROVIDE PATIENTS WITH RESOURCES AS PART OF THEIR EMERGENCY VISIT TO HELP REDUCE THE RISK OF PATIENTS NEEDING EMERGENCY CARE.GOAL TWO: HELP TO DEVELOP AND INCREASE PARTICIPATION IN LOCAL EDUCATIONAL OPPORTUNITIES AND CAMPAIGNS AIMED AT BRINGING AWARENESS TO SUICIDE AND SELF-HARM.- TACTICS: - SUPPORT LOCAL EVENTS THROUGH GUEST SPEAKERS, MONETARY CONTRIBUTIONS, IN-KIND DONATIONS, AND BROCHURES ABOUT SERVICE OFFERINGS TO HELP INCREASE ATTENDANCE AND THE OVERALL IMPACT OF THE EVENT. - PROMOTE THE DOWNLOAD AND UTILIZATION OF OUR GUIDED MENTAL HEALTH JOURNAL AVAILABLE ON OUR WEBSITE BRMH.NET - CREATE AND DISTRIBUTE CONTENT THROUGH OUR MOMENTUM MAGAZINE, ONLINE BLOG, AND SOCIAL MEDICAL CHANNELS AIMED TO INCREASE AWARENESS OF SUICIDE AND ASKING FOR HELP. - HOST A MENTAL WELLNESS WALK-A-THON (SEPTEMBER 9, 2023) IN COLLABORATION WITH COMMUNITY PARTNERS TO INCREASE LOCAL AWARENESS OF MENTAL WELLNESS AND PROMOTE ASKING FOR HELP. MENTAL HEALTH: ACCESSGOAL ONE: INCREASE THE EFFICIENCY OF CARE ACROSS ALL BEHAVIORAL HEALTH SERVICE OFFERINGS BY OPTIMIZING OPERATIONS, EXPANDING SERVICES, AND ALIGNING SERVICES TO IDENTIFIED PATIENT NEEDS.- TACTICS: - ALIGN AND EXPAND TELEHEALTH OFFERINGS FOR BEHAVIORAL HEALTH PATIENTS. - RECRUIT A HIGH-QUALITY BEHAVIORAL HEALTH PROVIDER WITH SPECIALIZATIONS BEYOND WHAT IS CURRENTLY OFFERED TO PATIENTS. - CONTINUALLY OPTIMIZE PROVIDER SCHEDULES TO ENSURE PATIENTS CAN BE SEEN IN A TIMELY MANNER.GOAL TWO: DEVELOP STRATEGIC PARTNERSHIPS WITH LOCAL ENTITIES CENTERED AROUND THE GOAL OF DELIVERING HIGH-QUALITY BEHAVIORAL HEALTH SERVICES TO UNDERSERVED POPULATIONS.- TACTICS: - IN COLLABORATION WITH AREA SCHOOL DISTRICTS, EXPLORE THE FEASIBILITY OF LAUNCHING A SCHOOL-BASED MENTAL HEALTH PROGRAM. - CONTINUE TO OFFER EMERGENT BEHAVIORAL HEALTH SERVICES ON DEMAND VIA TELEHEALTH WITHIN OUR EMERGENCY DEPARTMENT (ED) DURING TIMES OF CRISIS, INCLUDING CONNECTING PATIENTS WITH INPATIENT PSYCHIATRY CARE IF NECESSARY. - CONTINUE TO ENHANCE AND PROMOTE OUR FINANCIAL ASSISTANCE PROGRAM THROUGH ONE-ON-ONE CONVERSATIONS WITH PATIENTS AND OTHER EXTERNAL COMMUNICATION TOOLS TO HELP ENSURE FINANCES ARE NOT A BARRIER TO RECEIVING NECESSARY MENTAL HEALTH SERVICES. MENTAL HEALTH: HEALTHCARE ACCESS, AFFORDABILITY, AND AVAILABILITYGOAL ONE: INCREASE THE EFFICIENCY OF THE DELIVERY OF CARE ACROSS EVERY SERVICE LINE OFFERED AT BRMH. - TACTICS: - IDENTIFY AND ADDRESS OPPORTUNITIES TO INCREASE EFFICIENCY AND PATIENT-CENTEREDNESS IN ALL SERVICE LINES. - REDESIGN THE HOMECARE AND HOSPICE SERVICE LINES INTO A SUSTAINABLE, PATIENT-CENTERED SERVICE UNDER THE BLACK RIVER HEALTHCARE CLINIC - ALIGN AND EXPAND TELEHEALTH OFFERINGS TO MEET COMMUNITY NEEDS IN ORDER TO INCREASE ACCESS TO SPECIALTY SERVICES. - DEVELOP STRATEGIC PARTNERSHIPS WITH REGIONAL FACILITIES TO HELP KEEP HIGH-QUALITY HEALTHCARE LOCAL. - ENHANCE OUR REFERRAL PROCESS THAT ENSURES A PATIENT PRESENTING IN THE EMERGENCY DEPARTMENT (ED) HAS PROPER FOLLOW-UP WITH AN APPROPRIATE PROVIDER - IN COLLABORATION WITH AREA SCHOOL DISTRICTS, EXPLORE THE FEASIBILITY OF LAUNCHING A SCHOOL-BASED MENTAL HEALTH PROGRAM.GOAL TWO: INCREASE THE AFFORDABILITY OF HIGH-QUALITY, LOCAL CARE BY BEING A GOOD STEWARD OF LOCAL RESOURCES AND CAPTURING MORE EXTERNAL FUNDING OPPORTUNITIES.- TACTICS: - LAUNCH A DONOR-CENTERED FOUNDATION WITH A FOCUS ON SECURING STATE AND FEDERAL GRANTS TO HELP FUND THE DELIVERY OF CRITICAL SERVICE LINES AND VALUE-ADDED EXPERIENCES FOR PATIENTS AND THEIR LOVED ONES. - ENHANCE THE ORGANIZATION'S PARTICIPATION IN THE FEDERAL 340B DRUG PRICING PROGRAM TO CONTINUALLY INCREASE THE ACCESS AND AFFORDABILITY OF COMPREHENSIVE HEALTHCARE SERVICES TO THE COMMUNITY. - INCREASE THE AFFORDABILITY AND LONG-TERM ACCESS TO LOCAL HEALTHCARE BY IMPLEMENTING VARIOUS SUSTAINABLE ENERGY INITIATIVES ACROSS OUR FACILITIES TO HELP REDUCE OPERATIONAL EXPENSES AND CONTRIBUTE TO THE RESPONSIBLE STEWARDSHIP OF LOCAL RESOURCES. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL WILL CONSIDER THE OTHER DEBTS OF THE PATIENT. A PATIENT'S HOSPITAL BILL THAT IS LARGE IN COMPARISON TO THE PATIENT'S ASSETS OR INCOME IS ALSO CONSIDERED FOR CATASTROPHIC CARE. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16J: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. BLACK RIVER MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. 1 1 - BLACK RIVER MEMORIAL HOSPITAL HOME-BASED 311 COUNTY RD A BLACK RIVER FALLS WI 54615 HOME HEALTH AGENCY OFFICE, HOSPICE PROGRAM OFFICE, DME SERVICES PART I, LINE 6A: BLACK RIVER MEMORIAL HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S DATABASE AND WEBSITE. 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 LESS THE PROVISION FOR BAD DEBT 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 IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT BLACK RIVER MEMORIAL HOSPITAL, INC. INCLUDE THE OPERATION OF THE HOSPITAL'S CLINIC, INPATIENT NURSING UNIT AND EMERGENCY ROOM, AS WELL AS THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE SUBSIDIZED INPATIENT UNIT INCLUDES THE MEDICAL/SURGICAL, OBSERVATION, AND HOSPITALIST NURSING UNITS. THE HOSPITAL INPATIENT UNIT DEPARTMENT AND EMERGENCY ROOM OPERATES 24-HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED STAFF INCLUDING HOSPITALIST PHYSICIANS, REGISTERED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT NURSING UNIT COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF JACKSON COUNTY, WISCONSIN. JACKSON COUNTY IS A LARGE COUNTY IN WISCONSIN AND OFTEN SIGNIFICANT TRAVEL AND EFFORTS ARE NEEDED TO PROVIDE THESE SERVICES TO PATIENTS IN THE MOST COMFORTABLE SETTING WHICH IS THEIR HOMES. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF BLACK RIVER MEMORIAL HOSPITAL, INC. AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF BLACK RIVER MEMORIAL HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PROVIDES FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND SAME DAY APPOINTMENTS THROUGH THE BLACK RIVER HEALTHCARE CLINIC, HOME CARE, HOSPICE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH, SURGICAL SERVICES, AND WOMEN'S HEALTH. 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 OF PATIENTS 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 HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE 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 UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET 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 HOSPITAL 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 UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: BLACK RIVER MEMORIAL HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY 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 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF JACKSON COUNTY, 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 REVENUES (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 SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND COMMUNITY CARE POLICIES, BLACK RIVER MEMORIAL HOSPITAL, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S COMMUNITY 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, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. PART VI, LINE 2: EVERY THREE YEARS, BRMH CONSIDERS OUR COMMUNITY'S MOST PRESSING HEALTH NEEDS BY CONDUCTING A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE 2022 ASSESSMENT WAS COMPLETED BY A GROUP OF HOSPITAL EMPLOYEES AND INCLUDES QUANTITATIVE AND QUALITATIVE DATA THAT SERVE TO GUIDE BOTH OUR COMMUNITY BENEFIT AND STRATEGIC PLANNING. THROUGH OUR CHNA, BRMH HAS IDENTIFIED THE GREATEST HEALTH NEEDS IN OUR HOSPITAL'S COMMUNITIES ENABLING BRMH TO ENSURE OUR RESOURCES ARE APPROPRIATELY DIRECTED TOWARD OUTREACH, PREVENTION, EDUCATION, AND WELLNESS OPPORTUNITIES WHERE THE GREATEST IMPACT CAN BE ACHIEVED. OUR TOP THREE NEEDS ARE BEHAVIORAL HEALTH CARE (INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDER), OBESITY, AND DEMENTIA/ALZHEIMER'S CARE. PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S PATIENT FINANCIAL ADVOCATES EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE PATIENT FINANCIAL ADVOCATE EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERS THE FINANCIAL ASSISTANCE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGER CARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR BLACK RIVER MEMORIAL HOSPITAL, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 30-MILE RADIUS OF THE HOSPITAL. THIS AREA INCLUDES JACKSON COUNTY AND PARTS OF EAU CLAIRE, MONROE, LA CROSSE, TREMPEALEAU, WOOD, ADAMS, AND CLARK COUNTIES. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE ALMA CENTER, BLAIR, HIXTON, HUMBIRD, MELROSE, MERRILLAN, SPARTA, OSSEO, TOMAH, NEILLSVILLE, AND WHITEHALL. BLACK RIVER MEMORIAL HOSPITAL, INC. IS THE ONLY HOSPITAL LOCATED IN JACKSON COUNTY, WISCONSIN. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS AS WELL AS THE HO-CHUNK NATION (A LOCAL TRIBAL NATION WITH A LARGE PORTION OF ITS POPULATION RESIDING IN JACKSON COUNTY, WISCONSIN). THE HO-CHUNK NATION ALSO IS ABLE TO ACCESS CARE AT THE HOSPITAL AT REDUCED RATES THROUGH A REGULATION KNOWN AS THE "MEDICARE-LIKE PAYMENTS RULE." THE HOSPITAL ALSO IS THE MAIN SUPPLIER OF HEALTH CARE SERVICES TO FIVE STATE OPERATED INSTITUTIONS WHICH ARE OPERATED BY THE WISCONSIN DEPARTMENT OF CORRECTIONS. THE STATE OF WISCONSIN ALSO REIMBURSES THE HOSPITAL AT RATES BELOW THE GENERAL PUBLIC TO REDUCE COSTS PASSED ON TO TAXPAYER IN THE STATE. PART VI, LINE 5: AS A COMMUNITY-OWNED HOSPITAL, BLACK RIVER MEMORIAL HOSPITAL, INC. CONTINUES TO BE PROACTIVELY INVOLVED WITH AREA COMMUNITY MEMBERS THROUGH A VARIETY OF EDUCATIONAL FORUMS, SUPPORT GROUPS, WELLNESS AND SAFETY FAIRS, PRE-NATAL AND BREASTFEEDING CLASSES. OTHER SUPPORT GROUPS NOT ONLY INCLUDE DIABETES AND BEREAVEMENT. THERE ARE A NUMBER OF LOCAL ORGANIZATIONS THAT ARE REPRESENTED OR FACILITATED BY HOSPITAL STAFF INCLUDING: JACKSON IN ACTION, JACKSON COUNTY HEALTHCARE ALLIANCE, TOGETHER FOR JACKSON COUNTY KIDS, BREAST FEEDING COALITION, JACKSON COUNTY BROADBAND COMMISSION, JACKSON COUNTY CRISIS INTERVENTION COLLABORATION, JACKSON COUNTY HOMELESS COALITION, LOCAL EMERGENCY PLANNING COMMISSION (LEPC), JACKSON COUNTY CHILDCARE NETWORK, JACKSON COUNTY EMERGENCY READINESS COALITION, AND JACKSON COUNTY CRIMINAL JUSTICE COORDINATING COUNCIL. THE HOSPITAL WELCOMES MEDICAL STUDENTS FOR INTERNSHIPS AND CLINICALS. THE HOSPITAL ALSO PARTICIPATES IN THE MEALS ON WHEELS PROGRAM BY DELIVERING MEALS TO LOCAL SENIORS WHO ARE HOME BOUND. THE HOSPITAL ALSO PROVIDES SUPPORT AND SPONSORSHIP TO THE RED CROSS BLOODMOBILE SEVERAL TIMES A YEAR. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X 0 0 0 0 0 0 0 0 0 DR CAROL MARTIN CHIEF OF STAFF/DIRECTOR 401393 0 0 0 1548 0 18300 0 46086 0 467327 0 0 0 ESTEBAN MILLER MD CMO 382218 0 0 0 540 0 16000 0 47268 0 446026 0 0 0 SMITA RAJASEKARAN MD PHYSICIAN 363827 0 0 0 828 0 17500 0 44803 0 426958 0 0 0 JOSEPH AHN DR PHYSICIAN 334916 0 0 0 360 0 18300 0 39232 0 392808 0 0 0 DR BRAXTON FRITZ PHYSICIAN 303042 0 0 0 324 0 18300 0 43031 0 364697 0 0 0 RICHARD MINNIHAN MD PHYSICIAN 298719 0 0 0 541 0 18300 0 44203 0 361763 0 0 0 HOLLY WINN CFO 277272 0 0 0 6713 0 17326 0 39482 0 340793 0 0 0 MARY BETH WHITE-JACOBS CEO (SECRETARY) (THRU JULY) 177302 0 0 0 51037 0 12923 0 23031 0 264293 0 0 0 KYLE KOVACEVICH CFO 179732 0 0 0 34243 0 8027 0 39084 0 261086 0 0 0 CARL SELVICK CEO 163799 0 0 0 9938 0 10267 0 2327 0 186331 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-02-01 24000000 HOSPITAL ADDITIONS AND RENOVATIONS; REFUNDING OF 2005 BOND SERIES 0 0 0 A 940296 24000000 10163311 146704 13689985 2019 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 MICHAEL JACOBS SON OF MARY BETH WHITE-JACOBS, CEO 78716 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 MEMBERSHIP OF BLACK RIVER MEMORIAL HOSPITAL, INC. CONSISTS OF TWO CLASSES, INDIVIDUAL AND GROUP AS FOLLOWS: INDIVIDUAL MEMBERSHIP-ANY ADULT RESIDING WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS HE OR SHE RESIDES WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES. A FAMILY CONTRIBUTION, OR ONE BY EITHER SPOUSE INDIVIDUALLY, ENTITLES BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIP IN THE CORPORATION. GROUP MEMBERSHIP-ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHICH HAS CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR THE CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS THE ORGANIZATION IS IN EXISTENCE. SUCH ORGANIZATIONS SHALL DESIGNATE ANNUALLY, IN WRITING, ONE PERSON TO ACT ON ITS BEHALF AT MEETINGS OF MEMBERS. MEMBERSHIP SHALL TERMINATE IF THE MEMBER RELINQUISHES MEMBERSHIP OR IF THE MEMBER CEASES TO EXIST. NEW MEMBERS MAY BE ANY ADULT RESIDING WITHIN, OR ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION HAVING AN ESTABLISHED BUSINESS ADDRESS WITHIN, THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO DID NOT CONTRIBUTE TO THE 1965 CAMPAIGN FOR THE HOSPITAL BUILDING MAY THEREAFTER BECOME A LIFE MEMBER AS PROVIDED IN 1 OR 2 ABOVE BY CONTRIBUTING TWENTY DOLLARS ($20.00) OR MORE TO THE CORPORATION, EXCEPT AS OF JUNE 1, 2001, A FAMILY CONTRIBUTION SHALL NO LONGER ENTITLE BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIPS IN THE CORPORATION. WHENEVER A NEW INDIVIDUAL MEMBERSHIP IS CREATED, ONE INDIVIDUAL SHALL BE IDENTIFIED AS THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS SHALL ELECT MEMBERS OF THE BOARD OF DIRECTORS. EACH MEMBER IS ENTITLED TO ONE VOTE, AND EACH GROUP MEMBER SHALL, BEFORE THE START OF THE MEETING, DESIGNATE IN WRITING TO THE SECRETARY OF THE CORPORATION THE PERSON ENTITLED TO VOTE FOR THE GROUP MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF BLACK RIVER MEMORIAL HOSPITAL, INC. HAVE THE AUTHORITY TO VOTE ON ALL MATTERS PRESENTED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS OF BLACK RIVER MEMORIAL HOSPITAL, INC. RECEIVED A COPY OF THE 990 FOR REVIEW PRIOR TO THE FILING OF THEIR RETURN. MEMBERS OF THE BOARD WILL DO A FORMAL REVIEW OF THE FORM AFTER FILING. THE HOSPITAL'S CHIEF OFFICERS REVIEWED THE RETURN IN DETAIL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. ANY ISSUES WHICH MAY ARISE ARE DISCUSSED AND HANDLED APPROPRIATELY. ANY MEMBER OF THE BOARD OF DIRECTORS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON ANY POTENTIAL CONFLICTED ISSUES. A SIMILAR PROCESS IS USED BY THE BOARD OF DIRECTORS FOR THE REVIEW OF CONFLICTS OF INTEREST WITH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILAR SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN THE SAME REVENUE CATEGORY OR GEOGRAPHICAL AREA). THE COMPENSATION OF ADMINISTRATIVE LEVEL EMPLOYEES IS REVIEWED BY THE CEO AND APPROVED IN THE BUDGET BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 BLACK RIVER MEMORIAL HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SUMMARIZED FINANCIAL STATEMENT DATA IS ALSO AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION'S WEBSITE AND THE HOSPITAL'S ANNUAL REPORT, WHICH IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FORM 990, PART IX, LINE 11G ANESTHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 1,590,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,590,120. RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 899,405. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 899,405. EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 291,412. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 291,412. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 222,768. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 222,768. MRI/CT/NUCLEAR MED SERVICES: PROGRAM SERVICE EXPENSES 758,232. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 758,232. OTHER: PROGRAM SERVICE EXPENSES 2,929,226. MANAGEMENT AND GENERAL EXPENSES 3,715,656. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,644,882.