2022-11-07T08:58:54-06:00 2021-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-01-01 390929538 ST JOSEPH'S HEALTH SERVICES INC STJO 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 ROBIN NELSON FINANCE ADMINISTRATOR 6084898000 2022-11-03 1 ROBIN NELSON 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-10-30 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z GUNDERSEN ST JOSEPH'S HOSPITAL AND CLINICS ROBIN NELSON PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 34773181 0 X WWW.GUNDERSENHEALTH.ORG/ST-JOSEPHS X 1949 WI WE WILL ENHANCE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES WHILE ENRICHING EVERY LIFE WE TOUCH, INCLUDING PATIENTS, FAMILIES, AND STAFF. 8 6 228 4 0 0 3697741 1763788 22000065 32548429 17954 11211 108795 449753 25824555 34773181 0 0 0 0 12462461 16205219 0 0 0 11828411 13384510 24290872 29589729 1533683 5183452 52106996 60670818 27539498 31287406 24567498 29383412 X WE WILL DISTINGUISH OURSELVES THROUGH PATIENT CARE, EDUCATION, RESEARCH AND IMPROVED HEALTH IN THE COMMUNITIES WE SERVE. 0 0 20853813 0 27577094 ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY HEALTH CARE SERVICES AND OTHER FINANCIAL SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY INCLUDING THE HEALTH OF LOW INCOME PATIENTS. THE ORGANIZATION OPERATES A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING ACUTE CARE SERVICES TO THE HILLSBORO, WISCONSIN AREA. INPATIENT SERVICES INCLUDE ACUTE CARE FOR MEDICAL, SURGICAL, SWING BED, AND HOSPICE PATIENTS. ST. JOSEPH'S HEALTH SERVICES, INC. ALSO PROVIDES DIAGNOSTIC SERVICES TO PATIENTS, SUCH AS X-RAY, LAB, AND THERAPY SERVICES. THE HOSPITAL HAD 1,259 TOTAL INPATIENT DAYS DURING THE FISCAL YEAR. OF THOSE PATIENT DAYS 725 WERE RELATED TO ACUTE INPATIENT SERVICES AND 534 DAYS OF CARE PROVIDED TO HOSPICE AND SWING BED PATIENTS. THE HOSPITAL'S SWING BED PROGRAM PROVIDES CARE TO PATIENTS NEEDING EITHER SKILLED NURSING OR REHABILITATIVE PROGRAMS IN THE HOSPITAL SETTING. THE SWING BED PROGRAM IS A VITAL SERVICE TO THE COMMUNITY AS THERE CURRENTLY IS NO SKILLED NURSING FACILITY IN HILLSBORO, WISCONSIN, AND THIS PROGRAM ALLOWS MANY PATIENTS THE OPPORTUNITY TO BE CARED FOR IN THEIR COMMUNITY.ST. JOSEPH'S HEALTH SERVICES ALSO PROVIDES VARIOUS OUTPATIENT SERVICES INCLUDING EMERGENCY AND URGENT CARE SERVICES; DIAGNOSTIC PROCEDURES, SUCH AS X-RAYS, CT SCANS, MRI'S, AND LABORATORY TESTING; SURGICAL PROCEDURES; AND THERAPY PROGRAMS INCLUDING PHYSICAL, OCCUPATIONAL, SPEECH, AND RESPIRATORY THERAPY SERVICES ARE AMONG THE MANY SERVICES PROVIDED BY THE HOSPITAL.ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITH MINIMAL CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. IN ADDITION, ST. JOSEPH'S IS A PROVIDER UNDER THE WISCONSIN MEDICAID PROGRAM. UNDER THIS PROGRAM, THE ORGANIZATION IS LEGALLY BOUND TO ACCEPT THE AMOUNT DETERMINED BY THE STATE AS PAYMENT IN FULL FOR EACH PATIENT'S CHARGES. (SEE ADDITIONAL INFORMATION ON THE COST OF PROVIDING THESE SERVICES INCLUDED IN SCHEDULE H OF THE FROM 990.)ST. JOSEPH'S PROVIDES THE MEALS FOR THE SENIOR MEAL SITE COMMUNITY MEMBERS. DUE TO COVID RESTRICTIONS THESE MEALS ARE DELIVERED TO THE MEMBERS HOME. WE OFFERS ADULT FITNESS IN OUR REHABILITATION GYM, HOME MONITORING EQUIPMENT SO PATIENT'S CAN SAFELY GO HOME TO RECOVER. WE OFFER LIFELINES FOR SENIORS TO GIVE THEN SOME SECURITY IN THEIR OWN HOMES IN CASE OF EMERGENCY. ST. JOSEPH'S IS VERY INVOLVED IN THE CARE OF THE SCHOOL AGE CHILDREN IN OUR SERVICE AREA. THROUGH CONTRACTS WITH THE AREA SCHOOLS WE PROVIDE THEM WITH NURSES, ATHLETIC TRAINERS, AND BEHAVIORAL HEALTH THERAPISTS. WE PROVIDE ALL THE TRAINING, CME, AND EDUCATION TO SUPPORT THESE PROVIDERS IN THE SCHOOL SYSTEM. 3745582 0 4953161 ST. JOSEPH'S HEALTH SERVICES, INC. ALSO OPERATES THREE CLINICS LOCATED IN HILLSBORO, ELROY, AND WONEWOC, WISCONSIN. DURING THE FISCAL YEAR THESE THREE CLINICS PROVIDED A TOTAL OF 14,604 VISITS TO PATIENTS. ALL THREE OF THE CLINICS ARE DESIGNATED RURAL HEALTH CLINICS BY THE MEDICARE AND MEDICAID PROGRAMS AND AS SUCH BY DEFINITION ARE LOCATED IN DESIGNATED RURAL AND UNDERSERVED AREAS OF THE COUNTRY BY HEALTH CARE PRACTITIONERS. THESE CLINICS PROVIDE CARE TO A LARGE PORTION OF MEDICARE AND MEDICAID BENEFICIARIES WHO WITHOUT ACCESS TO CARE LOCALLY WOULD BE REQUIRED TO TRAVEL FURTHER DISTANCES FOR QUALITY HEALTHCARE. PATIENTS OF THE CLINICS ARE ALSO ELIGIBLE TO QUALIFY UNDER ST. JOSEPH'S HEALTH SERVICES FINANCIAL ASSISTANCE POLICY AS IT IS THE GOAL OF THE ORGANIZATION TO PROVIDE QUALITY HEALTHCARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 24599395 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 53 0 228 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ROBIN NELSON 6084898000 PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 MIKE MCKEE VICE CHAIR 0.80 40.00 X X 0 258496 38361 SCOTT LARSON PHARMACIST 50.00 0.00 X 202802 0 22355 KRISTIE MCCOIC ADMINISTRATOR 0.00 50.00 X 0 174011 28884 ROBIN NELSON FINANCE ADMINISTRATOR 50.00 0.00 X 56077 89597 29112 TRAVIS WOJTOWICZ PROVIDER 50.00 0.00 X 139698 0 34582 DENISE KROES NURSE 50.00 0.00 X 144700 0 27647 ANDREA ANDERSON PROVIDER 50.00 0.00 X 137603 0 33672 MICHELLE GARDNER PROVIDER 50.00 0.00 X 129817 0 40200 RACHEL ALBRECHT MBA TREASURER/ADMIN DIRECTOR 0.80 40.00 X X 0 135467 25905 KEVIN FEYEN BOARD DIRECTOR (THRU SEPT)/MGR CONSTRUCTION 0.80 40.00 X 0 119077 24166 TONI TENGBLAD DIRECTOR OF IP SERVICES 50.00 0.00 X 108260 0 31915 ASHLEY THAYER DIRECTOR OF OP SERVICES 50.00 0.00 X 111519 0 14711 THEA FRONK DIRECTOR OF IP SERVICES 50.00 0.00 X 14792 0 0 JIM MLSNA CHAIR 0.80 0.00 X X 0 0 0 ANN BRADNAU HYNEK SECRETARY 0.80 0.00 X X 0 0 0 NATALIE ADAMS BOARD DIRECTOR 0.80 0.00 X 0 0 0 KATHY KLOCK BOARD DIRECTOR 0.80 0.00 X 0 0 0 DANA MEYERS BOARD DIRECTOR 0.80 0.00 X 0 0 0 MIKE RORAFF BOARD DIRECTOR 0.80 0.00 X 0 0 0 1045268 776648 351510 7 0 1 0 GUNDERSEN HEALTH SYSTEM 1900 SOUTH AVE LA CROSSE WI 54601 HEALTH & ADMIN SERVICES 7294750 CD SMITH CONSTRUCTION INC PO BOX 1006 FOND DU LAC WI 54936 CONSTRUCTION 491980 KRISTINE LADIKA 27349 COUNTY HWY V WONEWOC WI 53968 CRNA SERVICES 473856 SHARED IMAGING SERVICES 944 WATER ST SAUK CITY WI 53583 ULTRASOUND & NUCLEAR MEDICINE SERVICES 199944 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MR SERVICES 122910 5 518303 1245485 1763788 NET PATIENT SERVICE REVENUE 621400 26490816 26490816 PHARMACY REVENUE 446110 6039439 6039439 18174 18174 32548429 11211 11211 INSURANCE PROCEEDS 900099 124881 124881 DIETARY/CAFETERIA 722514 122912 122912 201960 201960 449753 34773181 32530255 0 479138 553153 553153 12348382 10936758 1411624 311781 267281 44500 2204488 1856488 348000 787415 642012 145403 1194876 1194876 53540 53540 2694429 2592496 101933 54607 85 54522 682976 439963 243013 900 900 289053 282652 6401 25665 21019 4646 45778 35835 9943 764456 611565 152891 2460267 1968214 492053 60228 60228 PHARMACY EXPENSE 1880855 1880855 PROVISION FOR BAD DEBTS 1358885 1358885 MEDICAL SUPPLIES 1085361 1084773 588 REPAIRS AND MAINTENANCE 447982 447187 795 284652 172427 112225 29589729 24599395 4990334 0 1000 1150 11236609 20612012 2894588 4147826 431029 492820 301816 338499 40381761 6581495 34781094 33800266 107421 107623 2353439 1170622 52106996 60670818 3507977 2343987 309253 0 22917706 24370481 804562 4572938 27539498 31287406 X 23743527 29025778 823971 357634 24567498 29383412 52106996 60670818 X 5183452 -367538 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 4552 4552 0 PART II-B, LINE 1: ST. JOSEPH'S HEALTH SERVICES, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING, HOWEVER, A PORTION OF THE ANNUAL DUES PAID TO THE WHA WAS USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. ST. JOSEPH'S HEALTH SERVICES, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, THE ORGANIZATION 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, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. THESE EFFORTS ALSO INCLUDE LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. 735914 735914 31608954 3132072 28476882 7472182 3402559 4069623 564711 46864 517847 33800266 3RD PARTY SETTLEMENTS PAYABLE 3084112 DUE FROM GLAS 33771 ASSET RETIREMENT OBLIGATION 156582 ADVANCED COVID PAYMENTS 1298473 4572938 X PART X, LINE 2: GUNDERSEN HEALTH SYSTEM HAS REVIEWED TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2016 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 0 1 0 199786 199786 0.00710 3654201 3302360 351841 0.01250 3853987 3302360 551627 0.01960 51690 44530 7160 0.00030 11960 11960 0.00040 14001331 8972818 5028513 0.17810 1350 900 450 0.00000 14066331 9018248 5048083 0.17880 17920318 12320608 5599710 0.19840 400 400 0.00000 400 400 0.00000 1 632889 316445 10159172 10067817 91355 X 1 1 1 1 ST JOSEPH'S HEALTH SERVICES INC PO BOX 527 400 WATER AVENUE HILLSBORO WI 54634 HTTP://WWW.GUNDERSENHEALTH.ORG/ST-JOSE 1005 X X X X PROVIDER BASED PHYSICIAN CLINICS ST JOSEPH'S HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X SEE SUPPLEMENTAL INFORMATION X 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X HTTP://WWW.GUNDERSENHEALTH.ORG/PAY-MY-BILL/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 5: IN PREPARING THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), ST. JOSEPH'S HEALTH SERVICES, INC. GATHERED INFORMATION IN THREE WAYS:- A RANDOM HOUSEHOLD SURVEY- CONVENIENCE SAMPLING OF IDENTIFIED GROUPS- AN ANALYSIS OF COUNTY HEALTH RANKINGS DATA- INPUT FROM COUNTY STAKEHOLDERS. ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:- TRI-COUNTY MEMORIAL HOSPITAL- GUNDERSEN LUTHERAN HEALTH CENTER- MAYO CLINIC HEALTH SYSTEM- TOMAH MEMORIAL HOSPITAL- VERNON MEMORIAL HEALTHCARE ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER ORGANIZATIONS:- GREAT RIVERS UNITED WAY- LA CROSSE COMMUNITY FOUNDATION- LA CROSSE COUNTY HEALTH DEPARTMENT- MONROE COUNTY HEALTH DEPARTMENT- VERNON COUNTY HEALTH DEPARTMENT- TREMPEALEAU COUNTY HEALTH DEPARTMENT- HOUSTON COUNTY PUBLIC HEALTH DEPARTMENT ST. JOSEPH'S HEALTH SERVICES, INC. PART V, SECTION B, LINE 11: THE CHNA WAS COMPLETED IN 2018 AND THE IMPLEMENTATION STRATEGY WAS OFFICIALLY ADOPTED IN EARLY 2019. THE FOLLOWING ISSUES ARE ADDRESSED IN THE IMPLEMENTATION STRATEGY: ADDICTION AND SUBSTANCE ABUSE - REDUCE THE NUMBER OF OPIOID PRESCRIPTIONS WHILE INCREASING THE USE OF OTHER PAIN RELIEF MODALITIES. ACCESS TO MEDICAL ACUPUNCTURE WAS EXPANDED. NEW PAIN CLINIC SERVICES WERE INTRODUCED IN LATE 2021. ADDICTION AND SUBSTANCE ABUSE - REDUCE THE USE OF TOBACCO PRODUCTS IN THE COMMUNITIES SERVED BY GUNDERSEN ST. JOSEPH'S. PATIENTS ARE SCREENED FOR TOBACCO USE AT PRIMARY CARE APPOINTMENTS. INTERACTIVE PRESENTATIONS ARE DONE FOR THE SCHOOL DISTRICTS TO EDUCATE ON THE DANGERS OF VAPING AND TOBACCO USE. BEHAVIORAL HEALTH - GET AHEAD OF THE ISSUE BY PROMOTING AWARENESS OF ADVERSE CHILDHOOD EXPERIENCES. BEHAVIORAL HEALTH DEVELOPED A SCHOOL-BASED BEHAVIORAL HEALTH PROGRAM TO PROVIDE BEHAVIORAL HEALTH SERVICES TO 3 LOCAL SCHOOLS. ACCESS AND COST OF HEALTHCARE AS A RESPONSE TO THE PANDEMIC GUNDERSEN ST. JOSEPH'S DEVELOPED THE GSTJ PODCAST TO EDUCATION AND INFORM THE COMMUNITY ON VARIOUS HEALTH TOPICS. ACCESS AND COST OF HEALTHCARE - PROVIDE CONVENIENT ACCESS TO CARE CLOSE TO HOME BY PROVIDING NURSE MIDWIFE PROGRAM, ACCESS TO ENT, GYNECOLOGY, AND PAIN CLINIC SERVICES. ACCESS AND COST OF HEALTHCARE EXPANDED URGENT CARE HOURS TO IMPROVE ACCESS TO AFFORDABLE CARE. ISSUES NOT ADDRESSED BY GUNDERSEN ST. JOSEPH'S INCLUDE CONCERNS REGARDING EMPLOYMENT AND LIVABLE WAGES ALTHOUGH THE ORGANIZATION WILL LEND SUPPORT TO AREA ORGANIZATIONS AND PARTNERS ON THIS TOPIC WHEN REQUIRED. PART V, SECTION B LINE 7A HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ PART V, SECTION B LINE 7B HTTPS://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ PART V, SECTION B LINE 10 HTTPS://WWW.GUNDERSENHEALTH.ORG/COMMUNITY-ASSESSMENT/ 3 1 - ST JOSEPH'S HEALTH SERVICES-HILLSBORO 400 WATER AVENUE HILLSBORO WI 54634 PHYSICIAN CLINIC 2 - ST JOSEPH'S HEALTH SERVICES-ELROY 1705 OMAHA STREET ELROY WI 53929 PHYSICIAN CLINIC 3 - ST JOSEPH'S HEALTH SERVICES-WONEWOC 301 RAILROAD STREET WONEWOC WI 53968 PHYSICIAN CLINIC PART I, LINE 3C: CATASTROPHIC CARE ASSISTANCE:FINANCIAL ASSISTANCE PROVIDED TO ELIGIBLE PATIENTS WITH ANNUALIZED FAMILY INCOMES IN EXCESS OF 400% OF THE FEDERAL POVERTY LEVEL, AND ASSETS OF LESS THAN THE EQUIVALENT OF 600% OF THE FEDERAL POVERTY LEVEL, AND FINANCIAL OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GHS IN EXCESS OF 25% OF THE FAMILY INCOME.DISCOUNTED CARE:FINANCIAL ASSISTANCE THAT PROVIDES A DISCOUNT, FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS, BASED ON A SLIDING SCALE, FOR ELIGIBLE PATIENTS, OR PATIENT GUARANTORS, WITH ANNUALIZED FAMILY INCOMES BETWEEN 200-400% OF THE FEDERAL POVERTY LEVEL AND ASSETS AT OR BELOW SIX TIMES THE FEDERAL. POVERTY LEVEL.1. FAMILY INCOME ABOVE 200% FPL BUT EQUAL TO OR LESS THAN 225% FPL ARE ELIGIBLE TO RECEIVE A 80% DISCOUNT ON THE PATIENT BALANCE DUE.2. FAMILY INCOME ABOVE 225% FPL BUT EQUAL TO OR LESS THAN 250% FPL ARE ELIGIBLE TO RECEIVE A 60% POLICY DISCOUNT ON THE PATIENT BALANCE DUE.3. FAMILY INCOME ABOVE 250% FPL BUT EQUAL TO OR LESS THAN 275% FPL ARE ELIGIBLE TO RECEIVE A 40% DISCOUNT ON THE PATIENT BALANCE DUE.4. FAMILY INCOME ABOVE 275% FPL BUT EQUAL TO OR LESS THAN 400% FPL ARE ELIGIBLE TO RECEIVE A 20% DISCOUNT ON THE PATIENT BALANCE DUE.FREE CARE:A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION FOR ELIGIBLE MEDICAL SERVICES PROVIDED BY GHS FOR ELIGIBLE PATIENTS, OR THEIR GUARANTORS, WITH ANNUALIZED FAMILY INCOMES AT OR BELOW 200% OF THE FPL WITH ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL. UNINSURED DISCOUNT:PATIENTS WITH NO THIRD-PARTY COVERAGE WILL BE PROVIDED AN UNINSURED DISCOUNT, FOR ELIGIBLE SERVICES PROVIDED BY GHS UNDER THIS POLICY, AT THE TIME THAT THE UNDISCOUNTED CHARGES ARE RENDERED. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE THE FOLLOWING:1. ELECTIVE PROCEDURES NOT MEDICALLY NECESSARY, AS WELL AS SERVICES TYPICALLY, NOT COVERED BY MEDICARE OR DEFINED BY MEDICARE OR OTHER HEALTH INSURANCE COVERAGE AS NOT MEDICALLY NECESSARY.2. LASIK SURGERY, CHIROPRACTIC CARE, FERTILITY SERVICES, CONTACTS/GLASSES, COSMETIC SURGERY/PLASTIC SERVICES, HEARING AIDS, ORTHODONTICS, DENTAL SERVICES.3. SERVICES RECEIVED FROM CARE PROVIDERS NOT EMPLOYED BY GHS (E.G. PRIVATE AND/OR NON-GHS MEDICAL OR PHYSICIAN PROFESSIONALS, AMBULANCE TRANSPORT, ETC.). PATIENTS ARE ENCOURAGED TO CONTACT THESE PROVIDERS DIRECTLY TO INQUIRE INTO ANY AVAILABLE ASSISTANCE AND TO MAKE PAYMENT ARRANGEMENTS. SEE APPENDIX 3 FOR FULL LISTING OF PROVIDERS NOT COVERED UNDER THIS POLICY.4. DEDUCTIBLES AND COINSURANCE ASSOCIATED WITH MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS OUT-OF-NETWORK AS DEFINED BY THEIR INSURERS 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 ORGANIZATION'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 ST. JOSEPH'S HEALTH SERVICES, INC. INCLUDE THE OPERATION OF THE INPATIENT MEDICAL SURGICAL UNIT, EMERGENCY ROOM, AND RURAL HEALTH CLINICS. THE HOSPITAL AND CLINICS ARE OPERATED TO PROVIDE SUPPORT TO THE COMMUNITY BY PROVIDING HOSPITALIZATION, EMERGENCY, AND CLINICAL SERVICES TO THE SURROUNDING RURAL AREAS, WHICH WOULD OTHERWISE BE UNDERSERVED. IT IS THE GOAL OF ST. JOSEPH'S HEALTH SERVICES, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. THE COSTING METHOD FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED IN THE HOSPITAL'S MEDICARE COST REPORT WHICH 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 990 PURPOSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,358,885. PART II, COMMUNITY BUILDING ACTIVITIES: ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. ST. JOSEPH'S HEALTH SERVICES, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING, BUT NOT LIMITED TO: DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, SWING BED SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, AND WOMEN'S 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:ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED, IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS WHICH REFLECTS MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.THE ORGANIZATION DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).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: PATIENTS WITH APPROVED FINANCIAL ASSISTANCE QUALIFY FOR SIX MONTHS. NEW PATIENT BALANCES DURING THAT SIX MONTHS ARE AUTOMATICALLY REDUCED BY THE APPROVED DISCOUNT AND ARE NOT SENT TO COLLECTIONS. ONCE FINANCIAL ASSISTANCE EXPIRES OR IS NOT RENEWED, COLLECTIONS RESUME AS PER COLLECTION POLICY. PART VI, LINE 2: THE HOSPITAL REVIEWS THE UTILIZATION OF SERVICES THAT ARE CURRENTLY AVAILABLE AT THE HOSPITAL. AN EVALUATION OF THE AREA DEMOGRAPHIC IS USED TO DETERMINE WHAT NEW SERVICES MAYBE APPROPRIATE TO PROVIDE. PART VI, LINE 3: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE AT ALL CHECK IN AREAS OF OUR HOSPITAL AND CLINICS. INFORMATION IS INCLUDED WITH THE BILLING STATEMENT. AVAILABLE ON THE HOSPITAL'S WEBSITE, OR BY CALLING THE PATIENT ACCOUNTS DEPARTMENT. PART VI, LINE 4: WE HAVE A 30 MILE SERVICE THAT INCLUDES THE SEVERAL COUNTIES, VERNON, SAUK, MONROE, JUNEAU AND RICHLAND. OUR PATIENT POPULATION IS MADE UP LARGELY OF MEDICARE & MEDICAID PATIENTS. PART VI, LINE 5: A LARGE FOCUS IN 2021 WAS TO PROVIDE VACCINATION CLINICS FOR FLU AND COVID VACCINES, THAT WERE EASILY ACCESSIBLE TO PATIENT'S. WE PROVIDED THE MEALS THE COMMUNITY MEMBERS SIGNED UP FOR THE MEAL SITE PROGRAM. DUE TO COVID RESTRICTIONS THESE MEALS WERE DELIVERED TO THE HOMES IN 2021 PART VI, LINE 6: THROUGH THE HOSPITAL'S AFFILIATION WITH GUNDERSEN HEALTH SYSTEM SPECIALTY CARE SERVICES ARE PROVIDED AT OUR HILLSBORO LOCATION BRINGING CARE TO OUR LOCAL PATIENTS CLOSE TO HOME. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 MIKE MCKEE VICE CHAIR 0 248797 0 9699 0 0 0 10500 0 27861 0 296857 0 0 SCOTT LARSON PHARMACIST 198288 0 4100 0 414 0 8160 0 14195 0 225157 0 0 0 KRISTIE MCCOIC ADMINISTRATOR 0 164390 0 7206 0 2415 0 5146 0 23738 0 202895 0 0 ROBIN NELSON FINANCE ADMINISTRATOR 53781 85587 2000 4010 296 0 2327 2921 10657 13207 69061 105725 0 0 TRAVIS WOJTOWICZ PROVIDER 111492 0 2100 0 26106 0 4912 0 29670 0 174280 0 0 0 DENISE KROES NURSE 141000 0 3700 0 0 0 5928 0 21719 0 172347 0 0 0 ANDREA ANDERSON PROVIDER 134683 0 2735 0 185 0 5657 0 28015 0 171275 0 0 0 MICHELLE GARDNER PROVIDER 122984 0 2288 0 4545 0 5491 0 34709 0 170017 0 0 0 RACHEL ALBRECHT MBA TREASURER/ADMIN DIRECTOR 0 126350 0 6460 0 2657 0 1417 0 24488 0 161372 0 0 SCHEDULE J, PART 1, LINE 3 FOR THE PURPOSE OF DETERMINING EXECUTIVE COMPENSATION, ST. JOSEPH'S HEALTH SERVICES, INC. RELIED ON ITS AFFILIATED ORGANIZATION, GUNDERSON LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ANGIE NOVY SISTER OF OFFICER 39196 SALARY 0 DORIS SKEMP MOTHER OF OFFICER 11833 SALARY 0 FORM 990, PART VI, SECTION A, LINE 6 THE ARTICLES OF INCORPORATION OF ST. JOSEPH'S HEALTH SERVICES, INC. PROVIDES FOR ONE MEMBER OF THE CORPORATION. THE SOLE MEMBER OF ST. JOSEPH'S HEALTH SERVICES, INC. IS GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER AND UNDER THE TERMS OF THE AFFILIATION AGREEMENT, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT, REMOVE, OR ELECT CERTAIN OFFICERS AND/OR MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. MAY APPOINT FIVE MEMBERS OF THE BOARD OF DIRECTORS OF ST. JOSEPH'S HEALTH SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., HAS THE FOLLOWING RESERVE RIGHTS OF APPROVAL: THE INCURRENCE OF DEBT (OTHER THAN DEBT INCURRED FOR THE ACQUISITION OF GOODS THAT ARE ACQUIRED IN THE ORDINARY COURSE OF BUSINESS OR DEBT INCLUDED IN APPROVED BUDGETS) AND THE GRANT OF ANY SECURITY INTERESTS, PLACE ANY ENCUMBRANCES, ENTER INTO ANY COVENANTS, AND DIRECT EXECUTION OF ANY DOCUMENTS AND THE TAKING OF ANY ACTIONS NECESSARY OR APPROPRIATE IN CONNECTION WITH THE INCURRENCE OF SUCH DEBT; AND THE ANNUAL OPERATING BUDGET AND CAPITAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND THEN REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF ST. JOSEPH'S HEALTH SERVICES, INC. REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST-COMPENSATED EMPLOYEES TO COMPLETE ITS ANNUAL DISCLOSURE QUESTIONNAIRE. THESE QUESTIONNAIRES ARE THEN REVIEWED BY THE BOARD OF DIRECTORS, NOTING ANY RELATIONSHIPS THAT COULD POTENTIALLY CREATE A CONFLICT OF INTEREST. ALL NOTED CONFLICTS ARE DISCLOSED ANNUALLY TO THE BOARD AND ANY MEMBERS OF THE BOARD WITH CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON THOSE ISSUES. THE ORGANIZATION ALSO NOTES AND DOCUMENTS IF ANY BUSINESS OWNED BY BOARD MEMBERS OR EMPLOYEES DO BUSINESS WITH THE ORGANIZATION TO ENSURE THAT COMPETITIVE BIDS ARE SOUGHT FOR SERVICES. FORM 990, PART VI, SECTION B, LINE 15 FOR THE PURPOSES OF DETERMINING COMPENSATION, ST. JOSEPH'S HEALTH SERVICES, INC. RELIED ON IT'S AFFILIATED ORGANIZATION, GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., TO ESTABLISH COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. GUNDERSON LUTHERAN HEALTH SYSTEM, INC. USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION SURVEY OR STUDY, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990 IS MADE AVAILABLE TO THE PUBLIC AT ITS MAIN BUSINESS OFFICE DURING NORMAL BUSINESS HOURS. FORM 990 INCLUDES MUCH OF THE INFORMATION CONTAINED WITHIN THE ORGANIZATION'S GOVERNING DOCUMENTS. CONFLICTS OF INTEREST ARE ALSO NOTED ON FORM 990. THE AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS THEY ARE REQUIRED TO BE ATTACHED TO THE FORM 990. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN UNRESTRICTED NET ASSETS OF FOUNDATION -367,538. 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