2023-11-15T15:02:09-06:00 2022-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-01-01 390773970 LADD MEMORIAL HOSPITAL INC LADD 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 KELLY MACKEN-MARBLE CEO 7152942111 2023-11-15 1 KELLY MACKEN-MARBLE 999009999 0 MICHAEL J PETERSON CPA P01833529 2187224705 2023-11-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z OSCEOLA MEDICAL CENTER KELLY MACKEN-MARBLE 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 53425365 0 X WWW.MYOMC.ORG X 1947 WI ASPIRE TO DELIVER THE BEST COMPREHENSIVE AND RELIABLE COMMUNITY HEALTHCARE. 13 13 318 17 2648741 0 7679002 653161 49003877 52475633 100410 163385 480321 128586 57263610 53420765 0 0 0 0 17154016 18609025 0 0 127135 26776287 28974225 43930303 47583250 13333307 5837515 50238162 55634810 15647079 15948495 34591083 39686315 TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY HEALTHCARE AND STRATEGIC PARTNERSHIPS. 0 0 39155268 0 49826892 DURING 2022, LADD MEMORIAL HOSPITAL PROVIDED INPATIENT, OUTPATIENT, AND CLINICAL CARE SERVICES TO THE RESIDENTS OF THE GREATER OSCEOLA AREA, REGARDLESS OF ABILITY TO PAY.INPATIENT SERVICES WERE PROVIDED TO 394 PATIENTS AND TOTALED 1,686 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, AND OBSTETRIC.OUTPATIENT SERVICES INCLUDED 3,993 EMERGENCY ROOM VISITS, AND 1,687 OP SURGERIES. CLINICAL CARE SERVICES INCLUDED 25,070 CLINIC VISITS, 8,877 WALK IN VISITS, TOTALING 33,947. 39155268 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 31 0 318 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 WI MN X TAMMY WALSH 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 KIMBERLY ERICSON CFO 40.00 1.00 X 209077 0 17329 MISTY CHARLIER CAO 40.00 1.00 X 172850 0 40080 JEANETTE BOISSY REGISTERED NURSE 36.00 X 163976 0 27179 MATT FORGE CEO (THRU JULY 2022) 40.00 1.00 X 162303 0 10719 WILLIAM RYAN PHYSICIAN ASSISTANT 36.00 X 149415 0 20888 NATALIA CROPPER NURSE PRACTITONER 36.00 X 124447 0 37275 MEGAN SANDREN CRO 40.00 X 139465 0 4533 ERYCCA OSTERBAUER REGISTERED NURSE 36.00 X 138266 0 5228 KIMBERLY WELLUMSON SURGICAL NURSE NAVIGATOR 36.00 X 129254 0 4001 KELSEY DERRICK COO 40.00 X 117472 0 4416 KELLY MACKEN-MARBLE CEO (FROM SEP 2022) 40.00 1.00 X 73963 0 2822 ANNE MARIE PUESHNER CHAIRPERSON 1.00 X X 0 0 0 PETER MANSHIP VICE-CHAIRPERSON (THRU DEC 2022) 1.00 X X 0 0 0 DEBORAH PETERS VICE-CHAIRPERSON 1.00 X X 0 0 0 BECKY STYLES SECRETARY 1.00 X X 0 0 0 PENNY AUSTAD BOARD MEMBER 1.00 X 0 0 0 FELIX BLANCO MD BOARD MEMBER 1.00 X 0 0 0 JOHN CLARK BOARD MEMBER 1.00 X 0 0 0 MARK ERICKSON BOARD MEMBER 1.00 X 0 0 0 JOHN GEARIN BOARD MEMBER 1.00 X 0 0 0 KIERSTEN JUSTINGER BOARD MEMBER 1.00 0.50 X 0 0 0 GREG KUMLIEN DC BOARD MEMBER 1.00 X 0 0 0 TYLER SCHMIDTZ BOARD MEMBER 1.00 X 0 0 0 ERIK SEVERSON MD BOARD MEMBER 1.00 X 0 0 0 AMIN UDDEN DDS BOARD MEMBER 1.00 X 0 0 0 1580488 0 174470 23 0 1 0 HEALTHPARTNERS MAIL STOP 21109A ST PAUL MN 55164 PHYSICIANS 5919637 TWIN CITIES ORTHOPEDICS 4200 DAHLBERG DR GOLDEN VALLEY MN 55422 ORTHOPEDIC SERVICES 1332618 RIVER VALLEY ANESTHESIA PO BOX 118 NEW RICHMOND WI 54017 CRNA SERVICES 1017510 CMDI PO BOX 64756 ST PAUL MN 55164 DIAGNOSTIC IMAGING 908202 MARSHFIELD LABS 1000 NORTH OAK AVE MARSHFIELD WI 54449 LABORATORY SERVICES 789354 15 133137 258199 261825 653161 NET PATIENT SERVICE REV 621990 52221927 49573186 2648741 FITNESS CENTER 713940 253706 253706 52475633 167985 167985 4076 0 4076 4076 4076 4600 -4600 -4600 -4600 GIFT SHOP 900099 33300 33300 91210 91210 124510 53420765 49826892 2648741 291971 X 955029 955029 14006828 10619149 3297362 90317 345135 264683 78201 2251 2284638 1668827 601618 14193 1017395 725971 285250 6174 19608 19608 12453382 12159894 293488 128017 123337 4680 427708 312378 114779 551 1637790 74633 1563157 648486 459447 189039 24171 21574 2597 276079 220823 53088 2168 1462320 1169645 281194 11481 76981 76981 DRUGS 4468693 4468137 556 MEDICAL SUPPLIES 4093656 4091216 2440 BAD DEBT EXPENSE 1808156 1808156 EQUIPMENT RENTAL AND MA 438443 419043 19400 1010735 548355 462380 47583250 39155268 8300847 127135 14375832 17772368 9696213 9226035 6308693 5892598 942205 1094594 408366 520801 37752007 21204813 17064933 16547194 49780 44765 901224 915670 490916 420785 0 3200000 50238162 55634810 3794211 5076098 2192 325810 10843996 9752619 910691 793968 95989 0 15647079 15948495 X 34591083 39686315 34591083 39686315 50238162 55634810 5837515 -742283 0 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 1141 1141 0 PART II-B, LINE 1: LADD MEMORIAL HOSPITAL 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. THE WHA HAS NOTIFIED LADD MEMORIAL HOSPITAL THAT $1,141 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 1545900 1545900 27156643 14103116 13053527 9049464 7101697 1947767 16547194 AMOUNTS RECEIVABLE FROM 3RD PARTY REIMBURSEMENT PROGRAMS 3200000 3200000 1 1 X 1 X 1 X 1 1 0 1 1 244654 244654 0.00510 4943882 3925045 1018837 0.02140 5188536 3925045 1263491 0.02650 3158535 1725587 1432948 0.03010 3158535 1725587 1432948 0.03010 8347071 5650632 2696439 0.05660 0 774323 387162 11953709 11850661 103048 X 1 1 1 1 LADD MEMORIAL HOSPITAL INC DBA OSCEOLA MED 2600 65TH AVENUE OSCEOLA WI 54020 WWW.MYOMC.ORG 1021 X X X X OSCEOLA MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://MYOMC.ORG/IMAGES/PDF/CHA%20FINAL.PDF X HTTP://WWW.POLKCOUNTYHEALTHDEPT.ORG/REPORTS/COMMUNITY-HEALTH-ASSESSMENT/ X X 1 22 1 HTTP://WWW.POLKCOUNTYHEALTHDEPT.ORG/REPORTS/COMMUNITY-HEALTH-ASSESSMENT/ 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES X HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES X HTTPS://WWW.MYOMC.ORG/FINANCIAL-POLICIES X X X X X X 1 X 0 X X X 1 X 0 0 OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 5: THE 2022 COMMUNITY HEALTH NEEDS ASSESSEMENT PROCESS ENGAGED BROAD COMMUNITY OF INTERESTS AND A COUNTY WIDE SURVEY OF POLK COUNTY RESIDENTS WITH MORE THAN 600 RESPONDENTS.COMMUNITY FOCUS AREAS INCLUDED:1. MENTAL HEALTH 2. ADDICTION AND SUBSTANCE ABUSE3. ACCESS TO CARETHE ORGANIZATION PARTNERED WITH AMERY AND ST CROIX FALLS TO COMPLETE THE ASSESSMENT. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 6A: A COMMUNITY HEALTH IMPROVEMENT PROCESS WAS INITIATED IN PARTNERSHIP WITH AMERY REGIONAL MEDICAL CENTER AND ST CROIX REGIONAL MEDICAL CENTER. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 6B: POLK COUNTY HEALTH DEPARTMENT OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 7D: POLK COUNTY HEALTH DEPARTMENT OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 11: AS PART OF OUR CHNA ACTION PLAN, OMC PRIORITIZED INITIATIVES TO SUPPORT THE MOST IMPORTANT NEEDS OF THE COMMUNITY. INTEGRATED BEHAVIORAL HEALTH PROGRAM:1. PROGRAM DEVELOPMENT OF AN IBH PROGRAM WITH A 2023 GO LIVE DATE.2. INTERNAL MENTAL HEALTH RESOURCES TO SUPPORT PHYSICIANS IN SUPPORTING PATIENTS AND FAMILY MEMBERS IN NEED OF INTERVENTION, ONGOING SUPPORT OR OTHER NEEDS. 3. FUNDRAISING TO SUPPORT EXPANSION INTO THE INPATIENT AND ED SETTINGS. ACCESS TO CARE:1. EXPANSION OF PRIMARY CARE SERVICES TO BETTER MEET DEMAND. SIX ADDITIONAL CLINICIANS HIRED TO SUPPORT EXPANSION. 2. LAUNCH OF LOW COST VIRTUAL CARE PROGRAM CALLED CLICKCLINIC AT $45.00 PER VISIT. LIFESTYLE MEDICINE PROGRAM:1. PROVIDES INFRASTRUCTURE AND SUPPORT TO ADDRESS OBESITY AND WEIGHT MANAGEMENT SERVICES. ADDRESSING DAY CARE NEEDS IS A SIGNIFICANT FOCUS FOR OMC IN 2023 AND 2024. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 13B: IN A CASE BY CASE REVIEW, OSCEOLA MEDICAL CENTER HOLDS THE RIGHT TO MAKE EXCEPTIONS TO THE GUIDELINES LISTED IN THE COMMUNITY CARE POLICY (SUCH AS BUT NOT LIMITED TO PRESUMPTIVE GRANTING) WHEN IT IS FOUND TO BE IN THE BEST INTEREST OF THE PATIENT. 3 1 - CLINIC PHARMACY 2600 65TH AVENUE OSCEOLA WI 54020 RETAIL PHARMACY 2 - OSCEOLA CLINIC 2600 65TH AVENUE OSCEOLA WI 54020 PROVIDER BASED CLINIC 3 - WILD RIVER FITNESS CENTER 2630 65TH AVENUE OSCEOLA WI 54020 FITNESS CENTER PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS AVAILABLE UPON REQUEST. PART I, LINE 7: THE COSTING METHOD 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 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 IRS COSTING METHODS FOR THE FORM 990. THE COST OF COMMUNITY HEALTH IMPROVEMENT, HEALTH PROFESSIONALS EDUCATION, AND IN-KIND CONTRIBUTIONS REFLECTS THE DIRECT AND INDIRECT COSTS AS DETERMINED BY THE HOSPITAL. PART I, LINE 7G: THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. SERVICES INCLUDE NURSERY, OCCUPATIONAL HEALTH, CLINIC SERVICES, EMERGENCY ROOM, AND PHYSICIAN SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE 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 CARE LOCALLY THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE TODAY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, WALK-IN CLINIC, INFUSION SERVICES, 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 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 ACCOUNTS RECEIVABLE, OSCEOLA MEDICAL CENTER 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, OSCEOLA MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), OSCEOLA MEDICAL CENTER RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF THEIR PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE TO 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: OSCEOLA MEDICAL CENTER HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT.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 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. PART III, LINE 9B: ONCE APPROVED FOR FINANCIAL ASSISTANCE, THAT FINANCIAL ASSISTANCE IS VALID FOR ONE YEAR FROM THE APPROVAL DATE WITH FOLLOW UP VERIFICATION COMPLETED AFTER 6 MONTHS. IT IS THE PATIENT'S RESPONSIBILITY TO NOTIFY OMC IMMEDIATELY SHOULD THERE BE ANY CHANGE IN THE DETERMINING FACTORS WITHIN THE APPROVED YEAR PERIOD. PART VI, LINE 2: OSCEOLA MEDICAL CENTER IS ACTIVE IN SUPPORTING OUR COMMUNITY THROUGH PARTICIPATION IN LOCAL AND REGIONAL BOARDS, COMMUNITY ORGANIZATIONS, THE AREA SCHOOL DISTRICT AND AREA BUSINESSES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ALSO PROVIDES GUIDANCE AS TO THE ISSUES MOST IMPACTING OUR COMMUNITY AND HOW WE CAN BEST PROVIDE SERVICES AND SUPPORT AND IMPROVE HEALTH AND WELLNESS. PART VI, LINE 3: OSCEOLA MEDICAL CENTER PROVIDES RESOURCES TO ENSURE PATIENTS ARE AWARE OF RESOURCES THEY MAY BE ELIGIBLE FOR, INCLUDING THE FOLLOWING:1. CHARITY CARE POLICY THAT OUTLINES SUPPORT AVAILABLE FOR THOSE THAT ARE UNDER OR UNINSURED. 2. ELIBIGILITY AND INSURANCE VERIFICATION PRIOR OR AT THE TIME OF SERVICE TO ENSURE UNDERSTANDING OF WHAT IS BEING BILLED AND WHAT REFERRAL FOR RESOURCES AVAILBLE TO THEM EITHER INTERNALLY OR EXTERNALLY.3. FINANCIAL ASSISTANCE POLICY IS PUBLICLY AVAILABLE AT THE TIME OF REGISTRATION AND IN THE COMMUNITY. 4. OMC WEBSITE ALSO PROVIDES GUIDANCE AND RESOURCES TO PATIENTS AND FAMILIES. PART VI, LINE 4: OSCEOLA MEDICAL CENTER SERVICES A WIDE GEOGRAPHIC AREA THAT CONSTITUTES OUR PRIMARY SERVICE AREA IN NORTHWEST WISCONSIN AND INTO EASTERN MINNESOTA, WHICH INCLUDES A POPULATION OF OVER 200,000 PEOPLE. THE AVERAGE AGE OF RESIDENTS IS 45.9 YEARS. MEDIAN HOUSEHOLD INCOME IS $67,878.00. THOSE MEETING POVERTY GUIDELINES ARE AT 8.5% AND INCREASING. HOUSING, TRANSPORTATION, ACCESS TO MENTAL HEALTH SERVICES AND DAY CARE SUPPORT CONTINUE TO BE SIGNIFICANT NEEDS IN THE COMMUNITY. PART VI, LINE 5: OSCEOLA MEDICAL CENTER IS A NON PROFIT ORGANIZATION IN NORTHWEST WISCONSIN. ANY REVENUES IN EXCESS OF EXPENSES ARE REINVESTED IN THE FACILITIES, MEDICAL EQUIPMENT TO EXPAND SERVICES PROVIDED TO PATIENTS, SERVICE EXPANSION AND RECRUITMENT TO EXPAND ACCESS TO CARE. IN THE PRIOR FISCAL YEAR WE PROVIDED IN EXCESS OF $600,000 IN CHARTIY CARE TO THOSE IN NEED. THE OSCEOLA COMMUNTIY HEALTH FOUNDATION, FOUNDATION THAT IS A PART OF OSCEOLA MEDICAL CENTER, PROVIDES COMMUNTIY GRANTS TO LOCAL ORGANIZATIONS AS WELL AS RAISES FUNDS TO SUPPORT PURCHASE OF NEEDED SURIGICAL EQUIPMENT AND THIS YEAR-FUNDS TO START A COMMUNITY WORKFORCE DEVELOPMENT AND CLINICAL EDUCATION PROGRAM. OSCEOLA MEDICAL CENTER HAS A BOARD MADE UP OF A MAJORITY OF COMMUNITY DIRECTORS ENSURNG THE VOICE THE COMMUNITY IS A PART OF THE GOVERNANCE STRUCTURE. OUR CAMPUS INCLUDES THE WILD RIVER FITNESS CENTER AND EMERGENCY SERVICES 24/7. WE ALSO PROVIDE MANY COMMUNITY BASED SERVICES LIKE FLU SHOT CLINIC AND SPORTS PHYSICALS. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X X 0 0 0 0 0 0 0 0 0 KIMBERLY ERICSON CFO 208377 0 700 0 0 0 6494 0 10835 0 226406 0 0 0 MISTY CHARLIER CAO 172150 0 700 0 0 0 5436 0 34644 0 212930 0 0 0 JEANETTE BOISSY REGISTERED NURSE 163976 0 0 0 0 0 4615 0 22564 0 191155 0 0 0 MATT FORGE CEO (THRU JULY 2022) 162303 0 0 0 0 0 4673 0 6046 0 173022 0 0 0 WILLIAM RYAN PHYSICIAN ASSISTANT 120283 0 29132 0 0 0 4167 0 16721 0 170303 0 0 0 NATALIA CROPPER NURSE PRACTITONER 123745 0 702 0 0 0 3969 0 33306 0 161722 0 0 0 A VILLAGE OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006338 2007-06-13 8000000 REFINANCE EXISTING BONDS & CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 B TOWN OF OSCEOLA HOSPITAL FACILITIES REVENUE BOND 396006044 2007-06-28 7040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 C TOWN OF FARMINGTON HOSPITAL FACILITIES REVENUE BOND 390990620 2007-07-13 6040000 CONSTRUCT NEW HOSPITAL BUILDING 0 0 0 A 423979 8000000 138545 4581314 3280141 2008 1 0 1 1 B 380679 7040000 80850 6959150 2008 0 0 1 1 C 302564 6040000 65800 5974200 2008 0 0 1 1 A 0 0 0 0 0.01270 0.01270 0 0 0 B 0 0 0 0 0.01270 0.01270 0 0 0 C 0 0 0 0 0.01270 0.01270 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 A 0 B 0 C 0 SCHEDULE K, PART II, LINE 11, COLUMN A: THE AMOUNT LISTED WAS USED TO REFINANCE EXISTING DEBT. SCHEDULE K, PART IV, LINE 2: THERE IS NO REBATE BECAUSE THERE ARE NO PROCEEDS AVAILABLE FOR INVESTMENT. ALL PROCEEDS HAVE BEEN USED FOR CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM WAS REVIEWED AND APPROVED BY THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER BEFORE THE FORM WAS FILED. THE BOARD OF DIRECTORS FINANCE COMMITTEE MEETING AND THE FULL BOARD OF DIRECTORS RECEIVED A COPY AFTER THE RETURN WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT IS MONITORED THROUGHOUT THE YEAR. ANNUALLY THE BOARD OF DIRECTORS MUST ATTEST TO ANY KNOWN CONFLICTS AS DEFINED BY THE POLICY. IF AT THAT TIME, OR DURING THE YEAR, A MEMBER BELIEVES THERE TO BE A CONFLICT THEY MUST DISCLOSE SUCH EXISTENCE TO THE BOARD OR COMMITTEE THAT THE OPPORTUNITY PERTAINS TO. THE REMAINING BOARD OR COMMITTEE THEN MUST DETERMINE IF A CONFLICT ACTUALLY EXISTS. IF SO, THE CONFLICTED BOARD MEMBER HAS THE ABILITY TO PRESENT TO THE BOARD ON THE MATTER BUT THEN MUST ABSTAIN FROM FURTHER DISCUSSION OR VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 IN SETTING THE COMPENSATION OF THE CEO AND CFO, THE EXECUTIVE COMMITTEE SHALL COMPLY WITH LADD MEMORIAL HOSPITAL, INC.'S CONFLICT OF INTEREST POLICY AND, WITHOUT LIMITING THAT COMPLIANCE, WILL: (A) ACT ONLY WITH THE PARTICIPATION OF EXECUTIVE COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICT OF INTEREST CONCERNING THE MATTER, (B) WILL OBTAIN AND RELY UPON APPROPRIATE DATA AS TO COMPARABILITY, AND (C) WILL ADEQUATELY AND TIMELY DOCUMENT THE BASIS FOR ITS DETERMINATION, CONCURRENTLY WITH MAKING THAT DETERMINATION. APPROPRIATE DATA AS TO COMPARABILITY CAN INCLUDE, BUT IS NOT NECESSARILY LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF THE CORPORATION; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE SAME INDIVIDUAL. ADEQUATE AND TIMELY DOCUMENTATION WILL GENERALLY BE MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE MEETING THAT STATE: THE COMPENSATION AND WHEN IT WAS APPROVED; THE EXECUTIVE COMMITTEE MEMBERS WHO WERE PRESENT AND HOW EACH VOTED; THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE EXECUTIVE COMMITTEE AND A SUMMARY OF HOW THE DATA WAS OBTAINED, AND ANY ACTION TAKEN IN SPECIFIC COMPLIANCE WITH THE MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. IF THE EXECUTIVE COMMITTEE APPROVES A COMPENSATION PACKAGE FOR THE CEO OR CFO THAT IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DETERMINATION OUTSIDE THE RANGE MUST BE RECORDED. MINUTES OR OTHER RECORDS OF THE EXECUTIVE COMMITTEE THAT DOCUMENT A DECISION ON CEO OR CFO COMPENSATION MUST BE PREPARED BEFORE THE LATER OF THE NEXT MEETING OF THE EXECUTIVE COMMITTEE OR 60 DAYS AFTER THE DECISION, AND MUST BE REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE WITHIN A REASONABLE PERIOD THEREAFTER. FORM 990, PART VI, SECTION C, LINE 19 LADD MEMORIAL HOSPITAL, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 8,663,575. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,663,575. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 1,017,510. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,017,510. LAB SERVICES: PROGRAM SERVICE EXPENSES 900,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 900,333. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,240,483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,240,483. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 337,993. MANAGEMENT AND GENERAL EXPENSES 293,488. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 631,481. OSCEOLA COMMUNITY HEALTH FOUNDATION INC 2600 65TH AVENUE OSCEOLA WI 54020 392029106 FOUNDATION WI 501(C)(3) LINE 12B, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 OSCEOLA COMMUNITY HEALTH FOUNDATION C 133137 ACTUAL