2022-11-15T13:41:47-06:00 2021-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-01-01 390773970 LADD MEMORIAL HOSPITAL INC LADD 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 KELLY MACKEN-MARBLE CEO 7152942111 2022-11-14 1 KELLY MACKEN-MARBLE 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z OSCEOLA MEDICAL CENTER KELLY MACKEN-MARBLE 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 57263610 0 X WWW.MYOMC.ORG X 1947 WI SERVING AS THE CATALYST TO CREATE A HEALTHIER COMMUNITY. 12 12 316 19 2580862 0 599075 7679002 40651408 49003877 48956 100410 399903 480321 41699342 57263610 0 0 0 0 16727677 17154016 0 0 208991 24220887 26776287 40948564 43930303 750778 13333307 46005640 50238162 24701894 15647079 21303746 34591083 TO INSPIRE AND IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH HOME-TOWN CUSTOMER SERVICE, QUALITY AND STRATEGIC PARTNERSHIPS. 0 0 36369425 0 46423015 DURING 2021, 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 596 PATIENTS AND TOTALED 2,326 DAYS OF SERVICE. INPATIENT SERVICES INCLUDED GENERAL MEDICINE, SURGERY, PEDIATRIC, AND OBSTETRIC.OUTPATIENT SERVICES INCLUDED 3,266 EMERGENCY ROOM VISITS, AND 1,602 OP SURGERIES. CLINICAL CARE SERVICES INCLUDED 23,066 CLINIC VISITS, 8,765 WALK IN VISITS, TOTALING 31,831. 36369425 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 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 24 0 316 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI MN X KIM ERICSON 7152942111 2600 65TH AVENUE PO BOX 218 OSCEOLA WI 54020 MATT FORGE CEO 40.00 1.00 X 254459 0 15525 KIM ERICSON CFO 40.00 1.00 X 196389 0 14510 JEANETTE BOISSY REGISTERED NURSE 36.00 X 177274 0 26494 MISTY CHARLIER CAO 40.00 1.00 X 159892 0 37221 MARYBETH GUSTAFSON PHARMACIST 40.00 X 156507 0 30253 NATALIA CROPPER NURSE PRACTITONER 36.00 X 117185 0 34754 WILLIAM RYAN PHYSICIAN ASSISTANT 36.00 X 134493 0 12820 COBY SOMSEN NURSE PRACTITONER 36.00 X 137636 0 5073 RACHEL ZIMMER CNO 40.00 X 135529 0 5098 ANNE MARIE PUESHNER CHAIRPERSON 1.00 X X 0 0 0 PETER MANSHIP VICE-CHAIRPERSON 1.00 X X 0 0 0 DEBORAH PETERS SECRETARY 1.00 X 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 BECKY STYLES BOARD MEMBER 1.00 X 0 0 0 AMANDA TREMBREULL MD BOARD MEMBER (THRU JULY) 1.00 X 0 0 0 1469364 0 181748 9 0 1 0 HEALTHPARTNERS MAIL STOP 21109A ST PAUL MN 55164 PHYSICIANS 6202203 TWIN CITIES ORTHOPEDICS 4200 DAHLBERG DR GOLDEN VALLEY MN 55422 ORTHOPEDIC SERVICES 1261590 MARSHFIELD LABS 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 LABORATORY SERVICES 918586 RIVER VALLEY ANESTHESIA PO BOX 118 NEW RICHMOND WI 54017 CRNA SERVICES 861044 CMDI PO BOX 158 MILACA MN 56353 DIAGNOSTIC IMAGING 808348 11 135520 7511906 31576 7679002 NET PATIENT SERVICE REV 621990 48823791 46242929 2580862 FITNESS CENTER 713940 180086 180086 49003877 85874 85874 7924 0 7924 7924 7924 14536 0 14536 14536 14536 GIFT SHOP 900099 44406 44406 427991 427991 472397 57263610 46423015 2580862 580731 X 818623 818623 13014087 9713353 3144821 155913 289238 218424 67308 3506 2144841 1550852 569096 24893 887227 626288 250886 10053 15787 15787 11861234 11590299 270935 21006 17800 3206 327134 244401 82733 1352673 71685 1280988 608679 436214 172465 7946 6516 1430 302401 241877 58150 2374 1560432 1248120 300060 12252 61568 61568 MEDICAL SUPPLIES 3829356 3779084 50272 DRUGS 3827857 3826835 1022 BAD DEBT EXPENSE 1493076 1493076 EQUIPMENT RENTAL AND MA 858603 816993 41610 648535 487608 160927 43930303 36369425 7351887 208991 10757933 14375832 1879189 9696213 5548871 6308693 1090998 942205 257621 408366 37296411 20231478 17912349 17064933 5661944 49780 810688 901224 561047 490916 1525000 0 46005640 50238162 4183345 3794211 2192 2192 11910863 10843996 1147898 910691 7457596 95989 24701894 15647079 X 21303746 34591083 21303746 34591083 46005640 50238162 13333307 -45970 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 1483 1483 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 $1,483 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 1545900 1545900 27156642 13147795 14008847 8593869 7083683 1510186 17064933 AMOUNTS PAYABLE FROM 3RD PARTY REIMBURSEMENT PROGRAMS 50000 GRANT RESERVE 45989 95989 1 1 X 1 X 1 X 1 1 1 0 1 1 257468 257468 0.00590 4108270 3337530 770740 0.01750 4365738 3337530 1028208 0.02340 637207 637207 0.01450 30800 30800 0.00070 3095445 1362168 1733277 0.03950 143132 143132 0.00330 3906584 1362168 2544416 0.05800 8272322 4699698 3572624 0.08140 0 620701 310351 11845702 11627240 218462 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 19 1 1 1 1 X HTTPS://MYOMC.ORG/ABOUT/COMMUNITY X HTTP://WWW.POLKCOUNTYHEALTHDEPT.ORG/REPORTS/COMMUNITY-HEALTH-ASSESSMENT/ X 1 19 1 HTTPS://MYOMC.ORG/ABOUT/COMMUNITY 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/163-FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/163-FINANCIAL-ASSISTANCE-POLICY X HTTPS://WWW.MYOMC.ORG/INFO/PATIENTS/BILLING/163-FINANCIAL-ASSISTANCE-POLICY X X X X X X 1 X 0 X X X X 1 X 0 0 OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SOUGHT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS, AND THE PUBLIC. A COUNTY WIDE SURVEY OF THE HEALTH OF POLK COUNTY RESIDENTS WAS MADE AVAILABLE AT ALL OF THE LOCAL MEDICAL CENTERS AND THE HEALTH DEPARTMENT, AS WELL AS ADVERTISED IN THE LOCAL NEWSPAPERS AND POSTED ON ALL FOUR OF THE PARTNERS ORGANIZATION'S WEBSITES (650 RESPONDENTS).IN ADDITION TO THE AFOREMENTIONED SURVEY, FOUR COMMUNITY FORUMS WERE SPONSORED IN BALSAM LAKE, ST. CROIX FALLS, AMERY AND OSCEOLA. THE COMMUNITY MEMBERS IN ATTENDANCE OFFERED INPUT AND SUGGESTIONS ON THE HEALTH FOCUS AREAS. IN ADDITION, A PARTNER MEETING WAS HELD TARGETING KEY ORGANIZATIONS AND STAKEHOLDERS AS WELL AS LOCAL HEALTH-RELATED COALITION REPRESENTATIVES. AT EACH OF THESE VENUES, ATTENDEES HAD THE OPPORTUNITY TO PROVIDE INPUT ON THE TOP HEALTH FOCUS AREAS.THE FINAL TOP HEALTH FOCUS AREAS SELECTED BY PARTICIPANTS IN THE CHNA PROCESS WERE:1. MENTAL HEALTH2. SUBSTANCE USE AND ABUSE3. NUTRITION AND PHYSICAL ACTIVITY4. ACCESS TO CARE OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED AND A COMMUNITY HEALTH IMPROVEMENT PROCESS ("CHIP") WAS DEVELOPED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. AMERY REGIONAL MEDICAL CENTER2. ST. CROIX REGIONAL MEDICAL CENTER OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED AND CHIP DEVELOPED IN JOINT EFFORT WITH THE POLK COUNTY HEALTH DEPARTMENT. OSCEOLA MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE MOST SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AS FOLLOWS:MENTAL HEALTH - 1. ONGOING SCREENINGS DURING CLINIC VISITS.2. INCREASED THE AMOUNT OF MENTAL HEALTH TOPICS THROUGH SOCIAL MEDIA.3. CONTINUE DEVOTING STAFF TIME TO COUNTY AND AREA MENTAL HEALTH COMMITTEES.4. SUPPORTED THE ANNUAL UPDATE AND DISTRIBUTION OF THE MENTAL HEALTH TASK FORCE DIRECTORY.5. PROVIDED FUNDS THROUGH OUR FOUNDATION TO PROVIDE EMOTIONAL TESTING TRAINING FOR OSCEOLA SCHOOL DISTRICT STAFF, MEDICATIONS FOR SHELTER RESIDENTS THROUGH COMMUNITY REFERRAL AGENCY, SUCCESS BY 6 PROGRAMMING FOR CHILDREN AND FAMILIES OF NEWBORNS TO 6.6. PROVIDED INFORMATION AND FREE MASSAGES AT NORTHWIRE EMPLOYEE HEALTH FAIR.OBESITY1. PROVIDED A GET FIT FOR LIFE PROGRAM TO ADDRESS FITNESS WEIGHT MANAGEMENT AND HEALTHY NUTRITION. FUNDS TO REDUCE COST OF PROGRAM PROVIDED BY OUR FOUNDATION.2. OFFERED RIGHT STEP, A WEIGHT MANAGEMENT AND HEALTHY NUTRITION PROGRAM FOR YOUTH. FUNDS TO REDUCE COST OF PROGRAM PROVIDED BY OUR FOUNDATION.3. PROVIDED INFORMATION AT OUR BOOTH AT POLK COUNTY HEALTH FAIR4. PROVIDED STAFF HOURS TO PLAN COMMUNITY WIDE "DOC WALK" FOR FITNESS AND HEALTH RELATED TOPICS.5. SPONSORED QUARTERLY NUTRITION TALKS THROUGH OUR TABLETALK PROGRAM.6. CONTINUE OFFERING FREE FITNESS JAM SESSIONS AT OUR FITNESS CENTER.SUBSTANCE ABUSE1. PROVIDED FUNDS THROUGH OUR FOUNDATION FOR DRUG PROGRAMS AT ST. CROIX FALLS SCHOOL DISTRICT.2. PARTNERED WITH OSCEOLA SCHOOL DISTRICT, COUNTY PUBLIC HEALTH AND OTHERS TO SPONSOR A DRUG AWARENESS NIGHT.3. INCREASED THE AMOUNT OF THE SUBSTANCE ABUSE TOPICS THROUGH SOCIAL MEDIA.ACCESS TO CARE1. CONTINUING A WALK-IN CLINIC THAT PROVIDES LONGER HOURS IN THE DAY TO SEE PATIENTS.2. PROVIDED FUNDS THROUGH OUR FOUNDATION TO INTERFAITH CAREGIVERS TO PROVIDE TRANSPORTATION TO APPOINTMENTS.3. CONTINUE OFFERING INFLUENZA VACCINE CLINICS AT LOCAL BUSINESSES THROUGH THE OCCUPATIONAL HEALTH PROGRAM. 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 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: THE MEDICAL CENTER ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY BY WORKING WITH COUNTY AND STATE OFFICES, COMMUNICATING WITH CIVIC ORGANIZATIONS, INTERPRETING PATIENT TRENDS AND INTERPRETING FEEDBACK FROM ONE-ON-ONE PATIENT CONVERSATIONS.IN ADDITION, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS COMPLETED EVERY THREE YEARS. THE CHNA SOUGHT INPUT FROM DIVERSE STAKEHOLDERS, INCLUDING HEALTHCARE PROVIDERS, COMMUNITY LEADERS AND THE PUBLIC. THE ULTIMATE GOAL OF THE ASSESSMENT IS TO IDENTIFY HEALTH ISSUES AND DEVELOP STRATEGIES TO ADDRESS THE COMMUNITY'S HEALTH NEEDS. THE EFFORT INCLUDED A COMPREHENSIVE REVIEW OF HEALTH DATA, AN ANALYSIS OF REAL TIME BODY MASS INDEX DATA FROM LOCAL CLIENT PATIENT ELECTRONIC MEDICAL RECORDS AND HEALTH AND LIFESTYLE DATA FROM COMMUNITY SURVEYS. PART VI, LINE 3: OSCEOLA MEDICAL CENTER HAS INFORMATION REGARDING THE CHARITY CARE POLICY AND OTHER FINANCIAL ASSISTANCE OPTIONS AVAILABLE: 1. A DEDICATED PATIENT ADVOCACY POSITION THAT WORKS ONE ON ONE WITH PATIENTS 2. PLACED IN MAILINGS 3. PAMPHLETS USED BY THE HOSPITAL'S PROVIDERS THAT CAN BE DISTRIBUTED 4. IN PLAIN SIGHT AT EACH POINT OF REGISTRATION 6. THE FAP AND BILLING AND COLLECTION POLICIES ARE AVAILABLE AT THE OSCEOLA PUBLIC LIBRARY 5. ON THEIR WEBSITE THESE RESOURCES ARE AVAILABLE TO ENSURE THAT ALL PATIENTS FULLY UNDERSTAND ALL OPTIONS THAT ARE AVAILABLE FOR ASSISTANCE. PART VI, LINE 4: OSCEOLA MEDICAL CENTER SERVES THE CITY OF OSCEOLA, WISCONSIN, AND NEIGHBORING COMMUNITIES IN WESTERN WISCONSIN AND EASTERN MINNESOTA. THE MEDIAN INCOME IN THE SURROUNDING AREA IS APPROXIMATELY $59,994 PER YEAR. APPROXIMATELY 8.6% OF THE LOCAL POPULATION LIVES AT OR BELOW THE FEDERAL POVERTY GUIDELINES AND APPROXIMATELY 7% OF THE POPULATION DOES NOT HAVE HEALTH INSURANCE. PART VI, LINE 5: OSCEOLA MEDICAL CENTER PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH COMMUNITY-BASED PARTNERSHIPS, THE FOUNDATION GRANT PROGRAM, EDUCATIONAL ACTIVITIES, THE OPERATION OF A 24-HOUR EMERGENCY DEPARTMENT AVAILABLE TO THE ENTIRE COMMUNITY, THE OPERATION OF A FITNESS CENTER THAT IS AVAILABLE TO THE ENTIRE COMMUNITY, THE MAINTENANCE OF A PUBLIC FITNESS TRAIL, SPORT COURT AND AN ALL-INCLUSIVE PLAYGROUND ON ITS CAMPUS THAT IS FREE AND OPEN TO THE PUBLIC. DURING THE COVID-19 PANDEMIC, OSCEOLA MEDICAL CENTER COORDINATED COVID-19 VACCINATION AND BOOSTER CLINICS THAT WERE FREE AND OPEN TO THE COMMUNITY AS WELL AS COVID-19 TESTING. A MAJORITY OF OSCEOLA MEDICAL CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL, NOR FAMILY MEMBERS THEREOF.OSCEOLA MEDICAL CENTER IS A NON-PROFIT ORGANIZATION, AND THEREFORE ALL EARNINGS IN EXCESS OF COST ARE USED BY THE HOSPITAL TO IMPROVE THE HEALTH OF THE PEOPLE THEY SERVE THROUGH FACILITIES AND EQUIPMENT IMPROVEMENTS, MEDICAL TRAINING, EDUCATION AND EXPANSION OF NEEDED SERVICES. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X X 0 0 0 0 0 0 0 0 0 MATT FORGE CEO 254459 0 0 0 0 0 5950 0 9575 0 269984 0 0 0 KIM ERICSON CFO 196389 0 0 0 0 0 5328 0 9182 0 210899 0 0 0 JEANETTE BOISSY REGISTERED NURSE 177274 0 0 0 0 0 5278 0 21216 0 203768 0 0 0 MISTY CHARLIER CAO 159892 0 0 0 0 0 4851 0 32370 0 197113 0 0 0 MARYBETH GUSTAFSON PHARMACIST 156507 0 0 0 0 0 5015 0 25238 0 186760 0 0 0 NATALIA CROPPER NURSE PRACTITONER 113387 0 3798 0 0 0 3690 0 31064 0 151939 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 414593 8000000 138545 4581314 3280141 2008 1 0 1 1 B 372252 7040000 80850 6959150 2008 0 0 1 1 C 295866 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 8,464,456. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,464,456. ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 861,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 861,044. LAB SERVICES: PROGRAM SERVICE EXPENSES 946,566. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 946,566. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,119,351. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,119,351. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 198,882. MANAGEMENT AND GENERAL EXPENSES 270,935. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 469,817. 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 135520 ACTUAL