2022-11-09T09:07:09-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 10 S RIVERSIDE PLAZA 9TH FLOOR CHICAGO IL 60606 990 2021-01-01 461495343 MARSHFIELD CLINIC HEALTH SYSTEM INC MARS 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 CATHY BUKOWSKI INTERIM CFO 7153875511 2022-11-08 1 CATHY BUKOWSKI 999009999 DAVID LOWENTHAL P00378651 3122071040 2022-11-08 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z SUSAN TURNEY MD CEO 1000 N OAK AVENUE MARSHFIELD WI 54449 294208313 0 X WWW.MARSHFIELDCLINIC.ORG/HEALTH-SYSTEM X 2012 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 24 12 13107 0 0 0 740363 981080 63557762 257235541 1155996 13031952 0 0 65454121 271248573 59733 715929 0 0 38546337 136731781 0 0 0 28805229 122082246 67411299 259529956 -1957178 11718617 563033323 776311660 219894629 138476241 343138694 637835419 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 259529956 715929 257235541 MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) WAS INCORPORATED IN OCTOBER 2012 AS PART OF A PROSPECTIVE REORGANIZATION OF MARSHFIELD CLINIC AND ITS AFFILIATED ENTITIES INTO AN INTEGRATED HEALTHCARE SYSTEM. THE REORGANIZATION WAS IMPLEMENTED UPON RECEIPT OF AN INTERNAL REVENUE SERVICE (IRS) DETERMINATION LETTER RECOGNIZING MCHS AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3) IN 2014. MCHS AS A STANDALONE ENTITY HOUSES CERTAIN ADMINISTRATIVE FUNCTIONS THAT SUPPORT THE SYSTEM AS A WHOLE. 259529956 1 1 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1286 0 1 13107 1 0 0 0 0 0 0 0 0 0 0 1 0 X 24 12 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X CATHY BUKOWSKI VP OF FINANCE 7153875511 1000 N OAK AVENUE MARSHFIELD WI 54449 ELVIS PETER MD BOARD MEMBER 3.00 52.00 X 0 809998 58956 JAYANTH VEDRE MD BOARD MEMBER 2.00 52.00 X 0 737357 58187 NICHOLAS BODMER MD BOARD MEMBER 2.00 52.00 X 0 756944 52331 DAVID JUNKER MD BOARD MEMBER 2.00 52.00 X 0 715032 60533 EDWARD FERNANDEZ MD BOARD MEMBER 3.00 54.00 X 0 649951 53931 MATTHEW THOMAS MD BOARD MEMBER - PART YEAR 3.00 55.00 X 0 675232 48836 SUSHMA THAPPETA MD BOARD MEMBER 2.00 52.00 X 0 556152 52737 MARK BAUMGARTNER BOARD MEMBER 2.00 0.00 X 3000 0 0 KENT RAY DO BOARD MEMBER 3.00 53.00 X 0 346150 50987 TIMOTHY WENGERT MD BOARD MEMBER 2.00 52.00 X 0 333758 47774 ALPA SHAH MD SECRETARY 4.00 39.00 X X 0 264619 19759 MARK BUGHER CHAIR 9.00 1.00 X X 23500 0 0 MICHAEL LUEBKE BOARD MEMBER 4.00 1.00 X 21500 0 0 TERRY FRANKLAND BOARD MEMBER 4.00 1.00 X 10500 0 0 DAVID SHORE BOARD MEMBER - PART YEAR 4.00 0.00 X 1000 0 0 FRITZ WENZEL BOARD MEMBER 4.00 0.00 X 5500 0 0 MARK BRADLEY VICE CHAIR 4.00 2.00 X X 8500 0 0 RICHARD LEINENKUGEL TREASURER 4.00 0.00 X X 5500 0 0 COLLEEN HOERNEMAN BOARD MEMBER 2.00 0.00 X 3000 0 0 JOHN NEAL MD BOARD MEMBER 3.00 52.00 X 0 821556 58360 PATRICK WOLF DO BOARD MEMBER 3.00 52.00 X 0 405954 46404 BILL FONTI BOARD MEMBER 2.00 0.00 X 4500 0 0 GEORGE BROWN MD BOARD MEMBER 2.00 0.00 X 6500 0 0 LEAH BRASH BOARD MEMBER 4.00 0.00 X 6000 0 0 BERNIE PATTERSON BOARD MEMBER 2.00 0.00 X 4500 0 0 JANET LINDEMANN MD BOARD MEMBER 4.00 0.00 X 6500 0 0 SUSAN TURNEY MD MCHS CEO 50.00 5.00 X 2088402 0 310931 GORDON EDWARDS MCHS CFO/COO 50.00 5.00 X 849211 0 54294 NARAYANA MURALI MD MCHS CHIEF STRATEGY OFFICER 50.00 5.00 X 783446 0 55354 JERARD JENSEN MCHS GENERAL COUNSEL 50.00 5.00 X 844246 0 59187 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 50.00 5.00 X 668017 0 50987 JULIE BRUSSOW - PART YEAR SECURITY HEALTH PLAN CEO 50.00 5.00 X 453122 0 38601 JEANNE SCINTO - PART YEAR CHIEF TRANSFORMATION OFFICER 50.00 5.00 X 498661 0 40710 PAULA PRITZL MCHS CHIEF HR OFFICER 50.00 0.00 X 397195 0 51991 KRISTA HOGLUND SECURITY HEALTH PLAN CEO 50.00 5.00 X 348666 0 50397 7040966 7072703 1321247 1158 0 1 0 LOCUMTENENS COM LLC PO BOX 405547 ATLANTA GA 30384 MEDICAL SVCS 3590589 HURON CONSULTING GROUP INC 3005 MOMENTUM PLACE CHICAGO IL 60689 PROFESSIONAL SVCS 3493546 ATWATER SOLUTIONS LLC PO BOX 611 DEVON PA 19333 PROFESSIONAL SVCS 3087806 XTEND HEALTHCARE LLC 90 VOLUNTEER DRIVE SUITE 150 HENDERSONVILLE TN 37075 PROFESSIONAL SVCS 2282592 CHARTIS GROUP LLC DEPARTMENT 5925 CAROL STREAM IL 60122 PROFESSIONAL SVCS 2148031 105 459936 521144 981080 INTERCOMPANY REVENUE 561000 252389762 252389762 CONTRACT REVENUE 561000 4845779 4845779 257235541 3696489 3696489 32292771 2432 22762896 196844 9529875 -194412 9335463 9335463 271248573 257235541 0 13031952 X 551306 551306 164623 164623 6617328 6617328 102918845 102918845 6355395 6355395 13204039 13204039 7636174 7636174 3000119 3000119 948154 948154 31764305 31764305 4984725 4984725 5099231 5099231 45671274 45671274 4102470 4102470 848269 848269 7347 7347 421 421 18500955 18500955 4769450 4769450 RECRUITMENT EXPENSES 1308619 1308619 DUES, SUB., LICENSES 631530 631530 EXCISE TAXES AND OTHER 353275 353275 EQUIPMENT EXPENSES 92102 92102 259529956 259529956 0 0 15968170 148394558 264229 260374 6044082 18752308 10161300 29574225 11935946 16983023 204319346 125897070 68012875 78422276 126452159 130973805 128687419 187311016 195318498 165534540 188645 105535 563033323 776311660 219559993 138323186 204333 93666 130303 59389 219894629 138476241 X 343138694 637835419 343138694 637835419 563033323 776311660 X 11718617 8739619 274238489 X 0 1 X 1 1 1 X X 3 MARSHFIELD CLINIC INC 390452970 3 1 0 0 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE 390837206 3 1 0 0 FLAMBEAU HOSPITAL 390973724 3 1 0 0 3 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 FORM 990, PART IV, SECTION A, LINE 6: THE COMMUNITY ENGAGEMENT DEPARTMENT PROVIDES SUPPORT TO VARIOUS LOCAL NONPROFIT ORGANIZATIONS. FORM 990, PART IV, SECTION D, LINE 3: SUPPORTING ORGANIZATIONS HAVE A SIGNIFICANT VOICE IN THE ORGANIZATION'S INVESTMENT POLICIES AND USE OF ITS INCOME OR ASSETS BY VIRTUE OF THE OVERLAP OF BOARD AND EXECUTIVE OVERSIGHT. FORM 990, PART IV, SECTION E, LINE 3A: MCHS HAS THE RIGHT TO APPOINT, ELECT OR APPROVE/DISAPPROVE MEMBERS OF MOST OF THE SUPPORTED ORGANIZATIONS' BOARDS. IN THE CASE OF MARSHFIELD CLINIC, INC., MCHS DOES NOT ELECT OR APPOINT, BUT THE 11 MEMBERS OF THE MARSHFIELD CLINIC BOARD ARE ALSO MEMBERS OF THE MCHS BOARD. FORM 990, PART IV, SECTION E, LINE 3B: THERE IS EITHER BOARD OVERLAP OR EXECUTIVE OVERLAP IN EACH OF THE AFFILIATED ORGANIZATIONS. EXECUTIVE LEADERS FROM EACH SUPPORTED ORGANIZATION REPORT TO MCHS EXECUTIVES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 895973 0 1 100255 996228 0 FORM 990, PART II-B: WHERE ITS EXPERIENCE MAY BE HELPFUL, MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) MAY OFFER RECOMMENDATIONS CONCERNING LEGISLATION OR REGULATIONS BEING CONSIDERED. IN ADDITION, IT MAY ANALYZE AND TAKE POSITIONS ON ISSUES THAT HAVE A RELATIONSHIP TO THE ORGANIZATION'S OPERATIONS. OCCASIONALLY STAFF MEMBERS WILL SEND MAIL TO MEMBERS OF CONGRESS AND THEIR STAFF. MCHS IS ALSO A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. TOTAL DUES PAID BY MCHS ARE REPORTED ON LINE 1-I. 77550 77550 8776103 1865053 6911050 269050 194095 74955 195188062 123833457 71354605 8581 4465 4116 78422276 LTD PTNSHP COMM INV 187311016 F 187311016 INVESTMENT IN HHJV -224836 F INVESTMENT IN SHP 165759376 F 165534540 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 OR DECEMBER 31, 2020. 1 MARSHFIELD AREA UNITED WAY 156 S CENTRAL AVE PO BOX 771 MARSHFIELD WI 54449 391035073 501(C)(3) 120500 0 GENERAL SUPPORT MARSHFIELD AREA YMCA 410 W MCMILLAN ST MARSHFIELD WI 54449 391557086 501(C)(3) 42500 0 GENERAL SUPPORT UNITED WAY OF MARATHON 137 RIVER DR WAUSAU WI 54403 390935496 501(C)(3) 30000 0 GENERAL SUPPORT MOSAIC TELECOM PO BOX 664 CAMERON WI 54822 391868406 501(C)(3) 30000 0 GENERAL SUPPORT UNITED WAY-NORTHWOODS PO BOX 177 RHINELANDER WI 54501 391247457 501(C)(3) 30000 0 GENERAL SUPPORT UNITED WAY OF PORTAGE COUNTY 1100 CENTERPOINT DR STE 302 STEVENS POINT WI 54481 390831152 501(C)(3) 22500 0 GENERAL SUPPORT UNITED WAY OF GREATER CHIPPEWA VALLEY 3603 N HASTINGS WAY STE 200 EAU CLAIRE WI 54703 391077901 501(C)(3) 20000 0 GENERAL SUPPORT WITTENBERG TELEPHONE 104 W WALKER ST PO BOX 160 WITTENBERG WI 54499 390718390 501(C)(3) 15000 0 GENERAL SUPPORT TOWN OF DRAMMEN S 12185 OAK RD ELEVA WI 54738 396005861 501(C)(3) 15000 0 GENERAL SUPPORT MARSHFIELD ROTARY CLUB PO BOX 463 MARSHFIELD WI 54449 396076889 501(C)(3) 15000 0 GENERAL SUPPORT COUNTY OF EAU CLAIRE 721 OXFORD AVE EAU CLAIRE WI 54703 396005694 501(C)(3) 10325 0 GENERAL SUPPORT UNITED WAY OF DODGE COUNTY 215 CORPORATE DR STE H5 BEAVER DAM WI 53916 396030786 501(C)(3) 10000 0 GENERAL SUPPORT AMERICAN RED CROSS PO BOX 73013 CHICAGO IL 60673 530196605 501(C)(3) 10000 0 GENERAL SUPPORT CITY OF EAU CLAIRE PO BOX 1087 EAU CLAIRE WI 54702 396005436 501(C)(3) 8000 0 GENERAL SUPPORT CLARK CO 4H AND FFA PO BOX 30 NEILLSVILLE WI 54456 391657136 501(C)(3) 6373 0 GENERAL SUPPORT 15 0 PATIENT COST CHARITABLE BENEFIT 250 164623 N/A N/A PART I, LINE 2: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) PROVIDES ASSISTANCE (PRIMARILY CONTRIBUTIONS) TO A VARIETY OF ORGANIZATIONS, ALL OF WHICH ARE 501(C)(3). MCHS MAKES DETERMINATIONS ON GRANTS AND OTHER ASSISTANCE BASED ON THE RECIPIENT ORGANIZATION'S MISSION, REPUTATION AND THE ORGANIZATION'S INTENDED USE OF FUNDS. X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 SUSAN TURNEY MD MCHS CEO 1754423 0 5000 0 328979 0 280404 0 30527 0 2399333 0 248642 0 GORDON EDWARDS MCHS CFO/COO 757620 0 10000 0 81591 0 21816 0 32478 0 903505 0 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 782228 0 0 0 62018 0 21816 0 37371 0 903433 0 0 0 JOHN NEAL MD BOARD MEMBER 0 765156 0 11900 0 44500 0 21816 0 36544 0 879916 0 0 ELVIS PETER MD BOARD MEMBER 0 767567 0 0 0 42431 0 21816 0 37140 0 868954 0 0 NARAYANA MURALI MD MCHS CHIEF STRATEGY OFFICER 740814 0 0 0 42632 0 21816 0 33538 0 838800 0 0 0 NICHOLAS BODMER MD BOARD MEMBER 0 569834 0 146648 0 40462 0 21816 0 30515 0 809275 0 0 JAYANTH VEDRE MD BOARD MEMBER 0 456045 0 239091 0 42221 0 21816 0 36371 0 795544 0 0 DAVID JUNKER MD BOARD MEMBER 0 659400 0 13000 0 42632 0 21816 0 38717 0 775565 0 0 MATTHEW THOMAS MD BOARD MEMBER - PART YEAR 0 622100 0 10500 0 42632 0 21816 0 27020 0 724068 0 0 WILLIAM MELMS MD CHIEF MEDICAL OFFICER 609735 0 10000 0 48282 0 21816 0 29171 0 719004 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 384645 0 220868 0 44438 0 21816 0 32115 0 703882 0 0 SUSHMA THAPPETA MD BOARD MEMBER 0 342140 0 192870 0 21142 0 21816 0 30921 0 608889 0 0 JEANNE SCINTO - PART YEAR CHIEF TRANSFORMATION OFFICER 412055 0 0 0 86606 0 8700 0 32010 0 539371 0 0 0 JULIE BRUSSOW - PART YEAR SECURITY HEALTH PLAN CEO 372395 0 10000 0 70727 0 21816 0 16785 0 491723 0 0 0 PATRICK WOLF DO BOARD MEMBER 0 376016 0 5000 0 24938 0 21816 0 24588 0 452358 0 0 PAULA PRITZL MCHS CHIEF HR OFFICER 359239 0 5000 0 32956 0 21816 0 30175 0 449186 0 0 0 KRISTA HOGLUND SECURITY HEALTH PLAN CEO 283254 0 30000 0 35412 0 21816 0 28581 0 399063 0 0 0 KENT RAY DO BOARD MEMBER 0 318354 0 5000 0 22796 0 21816 0 29171 0 397137 0 0 TIMOTHY WENGERT MD BOARD MEMBER 0 303820 0 5000 0 24938 0 21816 0 25958 0 381532 0 0 ALPA SHAH MD SECRETARY 0 247028 0 0 0 17591 0 17949 0 1810 0 284378 0 0 PART I, LINE 1A THE ORGANIZATION MAY OCCASIONALLY REIMBURSE OR PROVIDE A HOUSING ALLOWANCE FOR KEY EXECUTIVES IN ORDER TO ASSIST WITH RELOCATING TO THE AREA. THE ORGANIZATION MAY ALSO CONTRIBUTE TO OR REIMBURSE FOR HEALTH AND SOCIAL CLUB DUES AS DEEMED NECESSARY IN ORDER TO SUPPORT A BUSINESS NEED. PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B LINE 4A: IN 2021, JEANNE SCINTO RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $58,734. LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $284,113 THE FOLLOWING INDIVIDUALS PARTICATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A DISTRIBUTION OR HAVE AN AMOUNT VEST IN THE PLAN. UNDER THE PLAN, AMOUNTS DO NOT VEST UNTIL TWO YEARS AFTER SEPARATION FROM THE ORGANIZATION: NARAYANA MURALI, MD JERARD JENSEN GORDON EDWARDS WILLIAM MELMS, MD EDWARD FERNANDEZ, MD ALPA SHAH, MD JEANNE SCINTO PAULA PRITZL SUSHMA THAPPETA, MD NICHOLAS BODMER, MD KENT RAY, DO JAYANTH VEDRE, MD DAVID JUNKER, MD JOHN NEAL, MD TIMOTHY WENGERT, MD PATRICK WOLF, DO MATTHEW THOMAS, MD ELVIS PETER, MD KRISTA HOGLUND PART I, LINE 7 SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. A WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97710BZ54 2012-06-13 107540304 ACQUISITION, CONSTRUCTION, & RENOVATION 0 0 0 B WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97712DUG9 2016-10-05 316977541 SEE PART VI 0 0 0 C WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 97712DA71 2017-09-13 328044486 REFUNDING OF SERIES 2017A BONDS 0 0 0 D WISCONSIN HEALTH AND ED FACILITIES AUTHORITY 391337855 977121DQ5 2018-09-26 100000000 SEE PART VI 0 0 0 A 3050000 107928259 1440312 106487947 0 0 1 1 B 10560000 316990839 6038 2672884 102907260 211404657 2017 1 0 1 1 C 7475000 328044486 3044486 325000000 1 0 1 1 D 50000000 100000000 737000 99263000 0 0 0 1 A 0 1 1 1 1 1 0.00020 0.00020 0 0 1 B 0 1 1 1 1 1 0.00020 0.00020 0 1 0.00080 1 1 C 0 1 1 1 1 1 0.01060 0.01060 0 1 0.00490 1 1 D 0 1 1 1 1 1 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 1 1 0 0 0 1 C 0 1 1 0 0 0 0 0 1 D 0 1 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 COLUMN A: PART II, LINE 3: THE DIFFERENCE BETWEEN PART II, LINE 3 AND PART I (E) IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART IV, LINE 2C: THE REBATE COMPUTATION PERFORMED AS OF 02/15/2017 CONFIRMED THAT NO REBATE WAS DUE ON THE BONDS. ENTITY 2: PART I(F): THE BORROWER ACQUIRED BEAVER DAM COMMUNITY HOSPITALS, INCLUDING ALL OF ITS OUTSTANDING DEBT. PROCEEDS OF THE BONDS WERE USED TO REFINANCE ALL OR PORTIONS OF BEAVER DAM'S OUTSTANDING 2012A, 2012B, AND 2013A BONDS. FOR TAX PURPOSES, THE BONDS WERE TREATED AS AN ACQUISITION/NEW MONEY ISSUANCE. COLUMN B: PART I(F): THE BONDS WERE ISSUED TO REIMBURSE THE BORROWER FOR COSTS ASSOCIATED WITH ITS NEW MONEY PROJECT AS WELL AS TO REISSUE THE SERIES 2012 BONDS (ISSUED ON 4/13/12), REFUND THE SERIES 2006B BONDS (ISSUED ON 1/31/06) REFINANCE A LINE OF CREDIT BY JP MORGAN CHASE BANK, N.A. (DRAWN ON 2/16/16) LINE OF CREDIT ISSUED ON (4/1/12), REFUND VARIOUS USDA LOANS AND PAY THE CHIPPEWA LEASE (ISSUED JULY 14, 2006). PART II, LINE 3: THE DIFFERENCE BETWEEN PART II, LINE 3 AND PART I (E) IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART IV, LINE 2B: THE CURRENT REFUNDING PORTION OF THE BOND MET THE 6 MONTH EXCEPTION TO REBATE. PART IV, LINE 2C: THE ARBITRAGE GROUP REBATE REPORT DATED OCTOBER 1, 2021 STATED THAT THERE IS NO REBATE LIABILITY. ENTITY 2: PART I(F): THE BONDS WERE ISSUED TO PAY ALL OF A PORTION OF THE COSTS OF THE PROJECT, TO PAY THE COSTS OF THE CURRENT REFUNDING OF THE AUTHORITY'S (I) VARIABLE RATE REVENUE BONDS, SERIES 2017D (MARSHFIELD CLINIC HEALTH SYSTEM, INC) ISSUED ON DECEMBER 28, 2017, (II) ADJUSTABLE RATE REVENUE BONS, SERIES 2018B (MARSHFIELD CLINIC HEALTH SYSTEM, INC) ISSUED ON SEPTEMBER 26, 2018, (III) ADJUSTABLE RATE REVENUE BONDS, SERIES 2018C (MARSHFIELD CLINIC HEALTH SYSTEM, INC. ISSUED ON NOVEMBER 8, 2018, AND TO PAY CERTAIN COSTS ASSOCIATED WITH THE ISSUANCE OF THE BONDS INCLUDING THE PREMIUMS ON THE BOND INSURANCE POLICY. PART II, LINE 3: THE DIFFERENCE BETWEEN PART II, LINE 3 AND PART I (E) IS DUE TO INTEREST EARNINGS ON BOND PROCEEDS. PART IV, LINE 2B: THE CURRENT REFUNDING PORTION OF THE BOND MET THE 6 MONTH EXCEPTION TO REBATE. COLUMN C: PART I(F): THE SERIES 2017A TAXABLE BONDS WERE ISSUED ON 06/30/2017. PART IV, LINE 2B: THE 2017BC BONDS MET THE 6 MONTH EXCEPTION TO REBATE. COLUMN D: PART I(F): THE BONDS WERE ISSUED TO FINANCE OR REIMBURSE THE BORROWER FOR COSTS ASSOCIATED WITH THE ACQUISITION, CONSTRUCTION, RENOVATION, AND EQUIPPING OF THE PROJECT AS WELL AS TO PAY ISSUANCE COSTS. PART IV, LINE 2B: ALL PROCEEDS OF THE BONDS WERE EXPENDED WITHIN SIX MONTHS OF THE ISSUE DATE, AND HAVE THUS MET THE REQUIREMENTS OF THE SIX-MONTH EXCEPTION TO REBATE. A WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 NONEAVAIL 2019-09-30 52700000 SEE PART VI 0 0 0 B WI HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712D6Y7 2020-06-30 318530787 SEE PART VI 0 0 0 A 3145000 53683201 334352 21569440 31779408 0 0 0 1 B 318531498 1186942 1726605 100011535 215606416 1 0 0 1 A 0 1 1 1 1 1 0 0 1 B 0 1 1 1 1 1 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 1 0 1 0 0 0 1 A 1 B 1 JULIE KOPLITZ FAMILY RELATIONSHIP WITH BOARD MEMBER TERRY FRANKLAND 95484 COMPENSATION 0 JUSTIN KOPLITZ FAMILY RELATIONSHIP WITH BOARD MEMBER TERRY FRANKLAND 134739 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS RICHARD LEINENKUGEL AND MARK BRADLEY HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO/COO AND TAX DEPARTMENT. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MARSHFIELD CLINIC HEALTH SYSTEM, INC. (MCHS) DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 31,764,305. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,764,305. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTION 129,434. EQUITY INCOME FROM SECURITY HEALTH PLAN 5,348,320. NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 268,967,981. EQUITY INCOME FROM MC HHJV LLC -207,246. SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 1 FLAMBEAU HOSPITAL INC 98 SHERRRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 LAKEVIEW MEDICAL CENTER INC 1700 W STOUT ST RICE LAKE WI 54868 390837206 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 1 VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) 12-TYPE III N/A 0 FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD WI 54449 391681547 COM HLTH CTR WI 501(C)(3) LINE 7 N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 1 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(2) LINE 7 MCHS 1 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 THE DIAGNOSTIC & TREATMENT CENTER LLC 3401 CRANBERRY BLVD WESTON WI 54476 200691634 MEDICAL SERVICES WI N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 MARSHFIELD CLINIC INC S 129434 COST FLAMBEAU HOSPITAL INC S 17575472 COST LAKEVIEW MEDICAL CENTER INC OF RICE LAKE S 37709046 COST MCHS HOSPITALS INC S 239661298 COST MCHS FOUNDATION INC R 278850 COST MEMORIAL HOSPITAL INC R 25696453 COST MARSHFIELD CLINIC INC P 111792 COST LAKEVIEW MEDICAL CENTER INC OF RICE LAKE P 1747620 COST SECURITY HEALTH PLAN OF WISCONSIN INC P 4047612 COST MCHS HOSPITALS INC P 15986610 COST MCHS FOUNDATION INC C 459936 COST FORM 990, PART V, LINE 1: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A 501(C)3 ORGANIZATION), IS THE PARENT ORGANIZATION OF THE FOLLOWING ORGANIZATIONS: MARSHFIELD CLINIC, INC. SECURITY HEALTH PLAN OF WISCONSIN, INC. MCHS HOSPITALS, INC. MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION, INC.