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BEAVER DAM COMMUNITY HOSPITALS INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
BEAVER DAM COMMUNITY HOSPITALS INC (EIN 39-1157876)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-09
IRS object ID
202213139349301016
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-09T07:47:03-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN381357951PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line110 S RIVERSIDE PLAZA 9TH FLOORAddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60606ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391157876EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BEAVER DAM COMMUNITY HOSPITALS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBEAVBusinessNameControlTxt
Phone9208877181PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1707 SOUTH UNIVERSITY AVENUEAddressLine1Txt
CityBEAVER DAMCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53916ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCATHY BUKOWSKIPersonNm
Person TitleINTERIM CFOPersonTitleTxt
Phone9208877181PhoneNum
Signature2022-11-04SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstCATHYPersonFirstNm
Person LastBUKOWSKIPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDAVID LOWENTHALPreparerPersonNm
PTINP00378651PTIN
Phone3122071040PhoneNum
Preparation2022-11-04PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer0TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MARSHFIELD MEDICAL CENTER-BEAVER DAMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerSUSAN TURNEY MD CEOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 N OAK AVENUEAddressLine1Txt
CityMARHSFIELDCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54449ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$113,402,777GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BDCH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1972FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionWE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers300TotalVolunteersCnt
Total Gross UBI$2,909,287TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,480,051PYContributionsGrantsAmt
CY Contributions Grants$2,600,168CYContributionsGrantsAmt
PY Program Service Revenue$53,974,667PYProgramServiceRevenueAmt
CY Program Service Revenue$97,034,288CYProgramServiceRevenueAmt
PY Investment Income$7,354,701PYInvestmentIncomeAmt
CY Investment Income$4,214,542CYInvestmentIncomeAmt
PY Other Revenue$1,604,499PYOtherRevenueAmt
CY Other Revenue$3,048,637CYOtherRevenueAmt
PY Total Revenue$65,413,918PYTotalRevenueAmt
CY Total Revenue$106,897,635CYTotalRevenueAmt
PY Grants And Similar Paid$1,301,419PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$200CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$29,233,446PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$60,586,155CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$24,402,229PYOtherExpensesAmt
CY Other Expenses$46,150,681CYOtherExpensesAmt
PY Total Expenses$54,937,094PYTotalExpensesAmt
CY Total Expenses$106,737,036CYTotalExpensesAmt
PY Revenues Less Expenses$10,476,824PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$160,599CYRevenuesLessExpensesAmt
Total Assets BOY$194,576,205TotalAssetsBOYAmt
Total Assets EOY$189,592,696TotalAssetsEOYAmt
Total Liabilities BOY$77,614,649TotalLiabilitiesBOYAmt
Total Liabilities EOY$67,246,840TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$116,961,556NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$122,345,856NetAssetsOrFundBalancesEOYAmt
MissionWE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$98,736,787ExpenseAmt
Grant$200GrantAmt
Revenue$93,528,385RevenueAmt
DescBEAVER DAM COMMUNITY HOSPITALS, INC. (BDCH) IS A NOT-FOR-PROFIT 60-BED COMMUNITY HOSPITAL LOCATED IN BEAVER DAM, WISCONSIN THAT PROVIDES BOTH INPATIENT AND OUTPATIENT SERVICES. THERE ARE MEDICAL/SURGICAL, TELEMETRY, INTENSIVE CARE, OBSTETRICS, AND NURSERY UNITS ON THE INPATIENT FLOORS. THERE IS AN EMERGENCY ROOM, URGENT CARE, SURGERY CENTER, REHABILITATION CENTER, PAIN CLINIC, OUTPATIENT MEDICAL ONCOLOGY CLINIC, MEDICAL IMAGING, PHARMACY DEPARTMENT AND A WOUND CENTER. BDCH ALSO OPERATES A 115-BED NURSING HOME AND PROVIDES HOME HEALTH AND HOSPICE SERVICES.Desc
Total Program Service Expenses$98,736,787TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document188IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CATHY BUKOWSKI VP OF FINANCEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7153875511PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 N OAK AVENUEAddressLine1Txt
CityMARSHFIELDCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54449ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MARK BUGHER
CHAIR1.009.00Yes (X)Yes (X)$0$23,500$0
MARK BRADLEY
VICE CHAIR1.005.00Yes (X)Yes (X)$0$8,500$0
RUWAN DISSANAYAKE MD
SECRETARY1.0050.00Yes (X)Yes (X)$0$486,599$52,360
JOHN BALTUS
TREASURER1.000.00Yes (X)Yes (X)$0$0$0
DOUG MATHISON
BOARD MEMBER1.001.00Yes (X)$0$0$0
SUSAN TURNEY MD
BOARD MEMBER/MCHS CEO1.0054.00Yes (X)$0$2,088,402$310,931
COLLEEN HOERNEMAN
BOARD MEMBER1.001.00Yes (X)$0$3,000$0
NARAYANA MURALI MD
BOARD MEMBER/MCHS CSO1.0054.00Yes (X)$0$783,446$55,354
GORDON EDWARDS
MCHS CFO/COO1.0054.00Yes (X)$0$849,211$54,294
JERARD JENSEN
MCHS GENERAL COUNSEL1.0054.00$0$844,246$59,187Yes (X)
WILLIAM MELMS MD
CHIEF MEDICAL OFFICER1.0054.00$0$668,017$50,987Yes (X)
ANGELIA FOSTER
CHIEF ADMIN OFFICER MMC-BEAVER DAM50.000.00$304,953$0$51,493Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$304,953TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,754,921TotReportableCompRltdOrgAmt
Total Other Compensation$634,606TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
A1 EXCEL HOSPITALIST GROUP LLC
W200N5300 BEECHCRAFT RDMENOMONEE FALLSWI53051MEDICAL SERVICES$1,998,514
DIRECT MANAGEMENT COMPANY LLC
1600 N HIGH POINTMIDDLETONWI53562PROFESSIONAL SERVICES$948,613
QUEST DIAGNOSTICS
PO BOX 775460CHICAGOIL60677MEDICAL SERVICES$638,164
ALLSCRIPTS HEALTHCARE SOLUTIONS INC
24630 NETWORK PLACECHICAGOIL60673PROFESSIONAL SERVICES$606,436
GREENFIELD REHABILITATION AGENCY INC
3360 GATEWAY RD SUITE 100BROOKFIELDWI53045MEDICAL SERVICES$603,396
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
Government Grants$2,600,168GovernmentGrantsAmt
Total Contributions$2,600,168TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
NET PATIENT SERVICE REVENUE621110$90,860,431$90,860,431
ALL OTHER OPERATING REVENUE621110$2,495,449$2,495,449
RETAIL TRADE621110$2,137,939$2,137,939
DAYCARE REVENUE621110$1,060,500$172,505$887,995
CAFETERIA REVENUE621110$479,969$479,969
FieldValueIRS element (for citing)
Total Program Service Revenue$97,034,288TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,184,502TotalRevenueColumnAmt
Exclusion$1,184,502ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$3,599,848RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$562,500RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$3,037,348RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,037,348TotalRevenueColumnAmt
Unrelated Business Revenue-$116,647UnrelatedBusinessRevenueAmt
Exclusion$3,153,995ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$8,972,532SecuritiesAmt
Other$150OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$5,942,642SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$3,029,890SecuritiesAmt
Other$150OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,030,040TotalRevenueColumnAmt
Exclusion$3,030,040ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescVENDING REVENUEDesc
Business722515BusinessCd
Total Revenue Column$11,289TotalRevenueColumnAmt
Exclusion$11,289ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$11,289OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$106,897,635TotalRevenueColumnAmt
Related Or Exempt Func Income$93,528,385RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$2,909,287UnrelatedBusinessRevenueAmt
Exclusion$7,859,795ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$200TotalAmt
Program Services$200ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$49,501,787TotalAmt
Program Services$46,591,653ProgramServicesAmt
Management And General$2,910,134ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,957,730TotalAmt
Program Services$2,876,881ProgramServicesAmt
Management And General$80,849ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,221,160TotalAmt
Program Services$4,785,912ProgramServicesAmt
Management And General$435,248ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,905,478TotalAmt
Program Services$2,687,479ProgramServicesAmt
Management And General$217,999ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$102TotalAmt
Management And General$102ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$840TotalAmt
Management And General$840ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$79,578TotalAmt
Management And General$79,578ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$5,531,985TotalAmt
Program Services$3,060,264ProgramServicesAmt
Management And General$2,471,721ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$19,037TotalAmt
Program Services$19,037ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,904,906TotalAmt
Program Services$1,774,969ProgramServicesAmt
Management And General$129,937ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,493,338TotalAmt
Program Services$1,487,479ProgramServicesAmt
Management And General$5,859ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,446,866TotalAmt
Program Services$2,280,236ProgramServicesAmt
Management And General$1,166,630ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$307,714TotalAmt
Program Services$272,371ProgramServicesAmt
Management And General$35,343ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,154,178TotalAmt
Program Services$1,154,178ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$8,153,130TotalAmt
Program Services$8,153,130ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$90,120TotalAmt
Program Services$90,120ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$14,516,729$14,468,474$48,255
BAD DEBT EXPENSE$4,630,080$4,630,080
EQIP. REPAIRS & MAINT.$2,603,291$2,224,533$378,758
WI MEDICAID ACCESS TAX$1,994,255$1,994,255

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$224,532TotalAmt
Program Services$185,536ProgramServicesAmt
Management And General$38,996ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$106,737,036TotalAmt
Program Services$98,736,787ProgramServicesAmt
Management And General$8,000,249ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$16,984,028BOYAmt
EOY$9,539,767EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,692,171BOYAmt
EOY$2,520,994EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,160,199BOYAmt
EOY$4,160,199EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$13,964,253BOYAmt
EOY$13,580,901EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,449,714BOYAmt
EOY$2,757,969EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,082,305BOYAmt
EOY$899,323EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$203,124,132LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$132,470,725LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$73,824,953BOYAmt
EOY$70,653,407EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$41,856,400BOYAmt
EOY$37,230,648EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$36,128,235BOYAmt
EOY$46,251,161EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY-$88,200BOYAmt
EOY$487EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$700,000EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,522,147BOYAmt
EOY$1,297,840EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$194,576,205BOYAmt
EOY$189,592,696EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$12,109,941BOYAmt
EOY$9,124,970EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$27,121BOYAmt
EOY$244,147EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$49,136,449BOYAmt
EOY$47,625,799EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$130,116BOYAmt
EOY$171,317EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$8,353,696BOYAmt
EOY$7,243,841EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,857,326BOYAmt
EOY$2,836,766EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$77,614,649BOYAmt
EOY$67,246,840EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$112,801,357BOYAmt
EOY$118,185,657EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,160,199BOYAmt
EOY$4,160,199EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$116,961,556BOYAmt
EOY$122,345,856EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$194,576,205BOYAmt
EOY$189,592,696EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$160,599ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,328,625NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$3,895,076OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,030,364OtherCostOrOtherBasisAmt
Book Value$4,030,364BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$80,735,094OtherCostOrOtherBasisAmt
Depreciation$38,912,652DepreciationAmt
Book Value$41,822,442BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,828,679OtherCostOrOtherBasisAmt
Depreciation$1,189,098DepreciationAmt
Book Value$1,639,581BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$112,478,088OtherCostOrOtherBasisAmt
Depreciation$89,054,612DepreciationAmt
Book Value$23,423,476BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,051,907OtherCostOrOtherBasisAmt
Depreciation$3,314,363DepreciationAmt
Book Value-$262,456BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$70,653,407TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescLTD PTNSHP COMM INVDesc
Book Value$46,251,161BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$46,251,161TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ACCRUED PENSION LIABILITY$2,640,466
OTHER PAYROLL LIABILITY$196,300
FieldValueIRS element (for citing)
Total Liability$2,836,766TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:SECURITY DEPOSITS ARE PAID TO BDCH BY RESIDENTS OF THE NURSING HOME UPON ENTERING INTO A RENTAL AGREEMENT AND ARE DUE BACK TO TENANTS UPON TERMINATION OF THEIR RENTAL AGREEMENT. THESE FUNDS ARE TRACKED SEPARATELY FROM BDCH'S FUNDS AND BELONG TO THE RESIDENTS.
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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$445,402TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$445,402NetCommunityBenefitExpnsAmt
Total Expense0.00440TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,958,708TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,664,497DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,404,110TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,664,497DirectOffsettingRevenueAmt
Net Community Benefit Expns$445,402NetCommunityBenefitExpnsAmt
Total Expense0.00440TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$563,270TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$563,270NetCommunityBenefitExpnsAmt
Total Expense0.00550TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,050TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,050NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$564,320TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$564,320NetCommunityBenefitExpnsAmt
Total Expense0.00550TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,968,430TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,664,497DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,009,722NetCommunityBenefitExpnsAmt
Total Expense0.00990TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$1,493,664BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$12,962,817ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$21,888,490CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$8,925,673MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARSHFIELD MEDICAL CENTER - BEAVER DAMBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1707 S UNIVERSITY AVENUEAddressLine1Txt
CityBEAVER DAMCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53916ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.BDCH.COMWebsiteAddressTxt
State License199StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MARSHFIELD MEDICAL CENTER-BEAVER DAMBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted21CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTPS://TINYURL.COM/4UKH6DU4OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt21ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://TINYURL.COM/MVAME6BAStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCEFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCEFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCEFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MARSHFIELD MEDICAL CENTER-BEAVER DAMPART V, SECTION B, LINE 5: WHEN MARSHFIELD MEDICAL CENTER-BEAVER DAM (MMC-BD) CONDUCTED ITS MOST RECENT CHNA, THE HOSPITAL ENGAGED A DIVERSE GROUP OF PEOPLE AND ORGANIZATIONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITIES IT SERVED. THE MMC-BD COMMUNITY HEALTH NEEDS PRIORITIZATION PROCESS WAS LED BY THE MMC-BD CHNA WORKGROUP (CHNA WORKGROUP). MEMBERS OF THE CHNA WORKGROUP INCLUDED SENIOR LEADERSHIP FROM MMC-BD, MMC-BD COMMUNITY HEALTH STAFF, AND REPRESENTATIVES FROM CHURCH HEALTH SERVICES (LOCAL FREE CLINIC) AND UNITED WAY OF DODGE COUNTY. THE MMC-BD STAFF COORDINATING THE CHNA PROCESS HAS 11+ YEARS OF EXPERIENCE WORKING AT A LOCAL PUBLIC HEALTH DEPARTMENT AND HAS PREVIOUSLY COORDINATED CHNA PROCESSES.BECAUSE MMC-BD CHANGED FISCAL YEARS TO ALIGN WITH THE MARSHFIELD CLINIC HEALTH SYSTEM FISCAL YEAR, AND BECAUSE OF THE COVID-19 PANDEMIC, REPRESENTATIVES OF DODGE COUNTY PUBLIC HEALTH DEPARTMENT WERE EXEMPT FROM PARTICIPATING IN THE 2021 MMC-BD ASSESSMENT PROCESS.DIRECT COMMUNITY INPUT WAS GATHERED THROUGH A COMMUNITY HEALTH SURVEY AND WAS THE MAJORITY OF THE PRIMARY DATA REVIEWED FOR THE MOST RECENT CHNA. AN ELECTRONIC (ONLINE) SURVEY WAS WIDELY DISTRIBUTED BY MMC-BD AND COMMUNITY PARTNERS TO DODGE COUNTY COMMUNITY MEMBERS (THOSE WHO LIVE AND/OR WORK IN DODGE COUNTY). AN ABBREVIATED HARDCOPY VERSION OF THE ELECTRONIC COMMUNITY HEALTH SURVEY WAS CREATED FOR RESIDENTS WITH LIMITED ACCESS TO THE INTERNET AND LIMITED HEALTH LITERACY. PAPER SURVEYS WERE DISTRIBUTED BY UNITED WAY OF DODGE COUNTY AND CHURCH HEALTH SERVICES AND THROUGH THE DODGE COUNTY INTERAGENCY GROUP. A TOTAL OF 430 DODGE COUNTY COMMUNITY MEMBERS PARTICIPATED IN THE SURVEY, OF WHICH APPROXIMATELY 275 PARTICIPANTS RESPONDED TO THE MAJORITY OF THE HEALTH NEEDS QUESTIONS. SURVEY RESPONDENTS REPRESENTED A RANGE OF RESIDENTS WITH A VARIETY OF INCOME AND EDUCATION LEVELS, AGES, AND HOUSEHOLD SIZE.
MARSHFIELD MEDICAL CENTER-BEAVER DAMPART V, SECTION B, LINE 6A: MARSHFIELD MEDICAL CENTER-BEAVER DAM WAS THE ONLY HOSPITAL PARTICIPATING IN THE MOST RECENT MMC-BD CHNA.
MARSHFIELD MEDICAL CENTER-BEAVER DAMPART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S): - CHURCH HEALTH SERVICES- UNITED WAY OF DODGE COUNTY
MARSHFIELD MEDICAL CENTER-BEAVER DAMPART V, SECTION B, LINE 11: A NUMBER OF HEALTH AREAS WERE IDENTIFIED THROUGH THE MOST RECENT CHNA: - ALCOHOL MISUSE- SUBSTANCE USE- MENTAL HEALTH - OBESITY- CHRONIC DISEASE PREVENTION AND MANAGEMENT- TRANSPORTATION ACCESS- ACCESS TO TECHNOLOGY/WI-FI/BROADBAND- QUALITY, AFFORDABLE CHILDCARE/AFTER-SCHOOL CARE - NUTRITION INSECURITYDUE TO THE INTERCONNECTED NATURE OF SEVERAL HEALTH AREAS, THE MMC-BEAVER DAM CHNA WORKGROUP CHOSE TO COMBINE MANY COMMUNITY HEALTH AREAS AND LIVING CONDITIONS INTO THE IDENTIFIED HEALTH PRIORITIES OF:- ALCOHOL AND SUBSTANCE USE- BEHAVIORAL HEALTH- CHRONIC DISEASE- SOCIAL DETERMINANTS OF HEALTHHEALTH PRIORITY 1: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE YOUTH SUBSTANCE USE- STRATEGY 1: SUPPORT COMMUNITY WIDE ENVIRONMENTAL STRATEGIES, PREVENTION, AND/OR POLICY TO ADDRESS UNDERAGE ALCOHOL USE.GOAL 2: REDUCE COMMUNITY IMPACT RELATED TO SUBSTANCE USE AND MISUSE- STRATEGY 1: SUPPORT COMMUNITY WIDE ENVIRONMENTAL STRATEGIES, PREVENTION AND/OR POLICY TO ADDRESS SUBSTANCE USE.- STRATEGY 2: SUPPORT COMMUNITY LED RECOVERY EFFORTS TO REDUCE SUBSTANCE USE- STRATEGY 3: SUPPORT WORKPLACE DRUG PREVENTION AND RECOVERY EFFORTS.GOAL 3: ENGAGE IN COMMUNITY EFFORTS- STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY 2: BEHAVIORAL HEALTHGOAL 1: DECREASE SUICIDE RATES FOR HIGH RISK POPULATIONS- STRATEGY 1: ENHANCE COMMUNITY MEMBER'S SKILLS TO SUPPORT MENTAL HEALTH PROMOTION AND SUICIDE PREVENTION.- STRATEGY 2: PROMOTE PROTECTIVE FACTORS THAT BUILD SENSE OF BELONGING.- STRATEGY 3: SUPPORT SUICIDE PREVENTION COMMUNITY AWARENESS EVENTS.GOAL 2: IMPROVE SOCIAL AND EMOTIONAL DEVELOPMENT OF CHILDREN AND ADOLESCENTS- STRATEGY 1: INCREASE AVAILABILITY OF MENTAL HEALTH SERVICES.- STRATEGY 2: ENHANCE COMMUNITY CAPACITY TO ADDRESS HIGH RISK YOUTH NEEDS THROUGH AFTERSCHOOL CARE OPTIONS.- STRATEGY 3: ENHANCE SCHOOL CAPACITY TO PROVIDE HIGH QUALITY SOCIAL, EMOTIONAL ASSESSMENT, SUPPORT, AND LEARNING.GOAL 3: ENGAGE IN COMMUNITY EFFORTS- STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY 3: CHRONIC DISEASEGOAL 1: IMPROVE ACCESS TO HEALTHY FOODS- STRATEGY 1: INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCALLY GROWN FOOD AND ADDRESS FOOD INSECURITY.GOAL 2: REDUCE RATES OF PREVENTABLE CHRONIC CONDITIONS WITH FOCUS ON OBESITY/DIABETES- STRATEGY 1: ENHANCE PROGRAMMING TO IMPACT CHRONIC DISEASE SELF-MANAGEMENT AND PREVENTION WITH A FOCUS ON OBESITY AND DIABETES.- STRATEGY 2: PROVIDE EDUCATION AND SKILL BUILDING OPPORTUNITIES.GOAL 3: ENGAGE IN COMMUNITY EFFORTS- STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH PRIORITY 4: SOCIAL DETERMINANTS OF HEALTH (SDOH)GOAL 1: INCREASE KNOWLEDGE AND AWARENESS OF HEALTH EQUITY- STRATEGY 1: CONDUCT AN ORGANIZATIONAL (INTERNAL) AND COMMUNITY ASSESSMENT (EXTERNAL) ASSESSMENT OF HEALTH DISPARITIES AND HEALTH EQUITY AND DEVELOP A WORK PLAN TO ADDRESS THOSE GAPS.GOAL 2: IMPROVE HEALTH OUTCOMES BY CONNECTING CLINICAL PRACTICE TO COMMUNITY EFFORTS TO ADDRESS SDOH BARRIERS- STRATEGY 1: SUPPORT AND CONNECT PATIENTS AND COMMUNITY MEMBERS TO RESOURCES TO ADDRESS SOCIALLY DETERMINED NEEDS. GOAL 3: IMPROVE HEALTH OUTCOMES BY IMPROVING LIVING CONDITIONS TO ADDRESS SDOH BARRIERS- STRATEGY 1: ENGAGE IN COMMUNITY CAPACITY BUILDING IN THE PHYSICAL, SOCIAL, AND/OR ECONOMIC ENVIRONMENT.GOAL 4: ENGAGE IN COMMUNITY EFFORTS- STRATEGY 1: PARTICIPATE IN COMMUNITY-BASED GROUPSHEALTH NEEDS NOT ADDRESSEDTHROUGH THE ASSESSMENT PROCESS, THE CHNA WORKGROUP IDENTIFIED OTHER COMMUNITY HEALTH NEEDS THAT WERE NOT PRIORITIZED. THE CHNA WORKGROUP CONSIDERED OTHER ORGANIZATIONS ADDRESSING THE SPECIFIC NEED, THE ABILITY OF MMC-BD TO IMPACT CHANGE, AVAILABILITY OF RESOURCES, AS WELL AS READINESS OF THE COMMUNITY FOR INTERVENTIONS. AFTER CONSIDERATION, THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-BD FOR REASONS INDICATED: - ORAL HEALTH: MMC-BD IS WORKING TO GROW PARTNERSHIPS WITH LOCAL SERVICES THAT PROVIDE LOW-COST ORAL HEALTHCARE. FOR THE 2021 CHNA, THIS HEALTH NEED WAS NOT PRIORITIZED BY THE CHNA WORKGROUP. THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, AND THE FACT THAT MMC-BD IS NOT CURRENTLY EQUIPPED TO MEET THIS NEED. - ACCESS TO AND AFFORDABILITY OF CARE: MMC-BD CONTINUES TO MAKE PROGRESS TOWARDS INCREASING ACCESS AND REDUCING COST OF HIGH-QUALITY CARE. FOR THE 2021 CHNA, THIS HEALTH NEED WAS NOT PRIORITIZED BY THE CHNA WORKGROUP. THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, THE VERY BROAD NATURE OF THIS NEED, IN THAT IT IS NOT EASILY DEFINED AND NOT EASILY MEASURED.- POVERTY/LOW WAGE JOBS: MMC-BD'S CAPACITY TO ADDRESS SOCIOECONOMIC LEVELS OF DODGE COUNTY RESIDENTS IS VERY LIMITED. HOWEVER, OTHER ORGANIZATIONS IN THE COUNTY, INCLUDING THE UNITED WAY, ARE ADDRESSING THIS ISSUE. BY SHARING RESOURCES TO THOSE WHO NEED IT, MMC-BD IS COLLABORATING WITH THE AGENCIES WHO ARE WELL EQUIPPED TO ADDRESS SOCIOECONOMIC STRESSORS. THIS DECISION IS DUE IN PART TO RESOURCE LIMITATIONS, THE VERY BROAD NATURE OF THIS NEED, IN THAT IT IS NOT EASILY DEFINED AND NOT EASILY MEASURED.- STRESS THAT ACCOMPANIES POVERTY: SIMILAR TO ADDRESSING POVERTY AND LOW-WAGE JOBS, MMC-BD'S CAPACITY TO ADDRESS STRESS DUE TO SOCIOECONOMIC STATUS IS LIMITED. HOWEVER, TO ATTEMPT TO ALLEVIATE STRESS, MMC-BD IS COMMITTED TO STRENGTHENING THE COMMUNITY TIES WITH OTHER AGENCIES BY PROVIDING REFERRALS TO SUCH AGENCIES AND IS CONTINUALLY WORKING TO INCREASE ACCESS TO LOW-COST SERVICES.
PART V, LINE 13A:THE FINANCIAL ASSISTANCE POLICY LINK PROVIDED HAS BEEN UPDATED AFTER THE YEAR ENDED DECEMBER 31, 2021 AND NOW REFLECTS A FAMILY INCOME LIMIT FOR FREE CARE OF 100%. AS OF DECEMBER 31, 2021, THE FAMILY INCOME LIMIT FOR FREE CARE WAS 200%.
FieldValueIRS element (for citing)
Facility6FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - HILLSIDE MANOR
803 S UNIVERSITY AVENUEBEAVER DAMWI53916SKILLED NURSING FACILITY
2 - REMEMBRANCE HOME
1810 NORTH SPRING STREETBEAVER DAMWI53916DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY
3 - EAGLES WINGS
408 STONE STREETBEAVER DAMWI53916DEMENTIA-SPECIFIC COMMUNITY-BASED RESIDENTIAL FACILITY
4 - BEAVER DAM REFERENCE LAB
707 SOUTH UNIVERSITY AVENUEBEAVER DAMWI53916REFERENCE LAB
5 - HILLSIDE HOMECARE AND HOSPICE
709 SOUTH UNIVERSITY AVENUEBEAVER DAMWI53916HOME HEALTH AGENCY
6 - STONE TERRACE RETIREMENT LIVING CENTER
819 SOUTH UNIVERSITY AVENUEBEAVER DAMWI53916RESIDENTIAL CARE APARTMENT COMPLEX

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY.THE FINANCIAL ASSISTANCE POLICY LINK PROVIDED HAS BEEN UPDATED AFTER THE YEAR ENDED DECEMBER 31, 2021 AND NOW REFLECTS A FAMILY INCOME LIMIT FOR FREE CARE OF 100%. AS OF DECEMBER 31, 2021, THE FAMILY INCOME LIMIT FOR FREE CARE WAS 200%.
PART I, LINE 7:EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE:AMOUNTS CALCULATED IN PART I, LINE 7 ARE DETERMINED BASED ON A COST-TO-CHARGE RATIO. OTHER BENEFITS ARE DETERMINED BASED ON THE DIRECT AND INDIRECT COSTS (WHERE ALLOCATED) ASSOCIATED WITH A PROGRAM NET OF EARNED REVENUE.
PART II, COMMUNITY BUILDING ACTIVITIES:MARSHFIELD MEDICAL CENTER-BEAVER DAM (MMC-BD) LOCATED IN BEAVER DAM, WISCONSIN, PARTICIPATED IN VARIOUS COMMUNITY BUILDING ACTIVITIES WITH THE PURPOSE TO IMPROVE THE HEALTH OF THE COMMUNITY, INCLUDING ADDRESSING SOCIAL DETERMINATES OF HEALTH AND HEALTH INEQUITIES. DUE TO COVID-19, MANY COMMUNITY BUILDING ACTIVITIES WERE LIMITED OR CANCELED DURING THIS REPORTING PERIOD. HOWEVER, STAFF DID PARTICIPATE IN REGIONAL COMMUNITY GROUPS COORDINATING EFFORTS TO ADDRESS COVID-19. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDED:COALITION BUILDING:MMC-BD STAFF PARTICIPATED IN MULTIPLE COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY SUCH AS BLUE ZONES PROJECT DODGE COUNTY, DODGE COUNTY INTERAGENCY, ALLIANCE FOR SUBSTANCE ABUSE PREVENTION (ASAP) DODGE COUNTY, PLAYGROUND MOVEMENT BEAVER DAM, ACTIVE WISCONSIN, AND WISCONSIN PUBLIC HEALTH ASSOCIATION.ECONOMIC DEVELOPMENT:THE CHIEF ADMINISTRATIVE OFFICER OF MMC-BD SITS ON THE BOARD OF DIRECTORS FOR THE BEAVER DAM AREA CHAMBER OF COMMERCE. COMMUNITY OUTREACH STAFF PARTICIPATE IN THE BEAVER DAM, FOX LAKE, HORICON, JUNEAU AND WAUPUN CHAMBERS OF COMMERCE REPRESENTING MMC-BD ACTIVELY ENGAGING IN CHAMBER ACTIVITIES THAT SUPPORT ECONOMIC DEVELOPMENT OF THE COMMUNITIES MMC-BD SERVES.COMMUNITY SUPPORT:MMC-BD PARTNERED WITH TWO AREA FOOD BANKS TO COORDINATE TWO USDA FARMERS TO FAMILIES FOOD BOX PROGRAM "TRUCK TO TRUNK" EVENTS IN 2021 WHICH WERE FREE FOR ALL AREA RESIDENTS BEING IMPACTED BY FOOD INSECURITY. MMC-BD PARTNERED WITH LOCAL ORGANIZATIONS TO HAVE BOXES BROUGHT TO WHERE THE PEOPLE WERE TO HELP THOSE IN NEED THAT DIDN'T HAVE TRANSPORTATION AND WITH THE LOCAL PUBLIC TRANSIT COMPANY TO DO INDIVIDUAL DELIVERIES TO HOMES. EACH EVENT INCLUDED SEVERAL MMC-BD EMPLOYEES. MMC-BD SUPPORTED THE BLUE ZONES PROJECT OF DODGE COUNTY UNTIL THE END OF AUGUST 2021. BLUE ZONES PROJECT IS A COMMUNITY-WIDE WELL-BEING IMPROVEMENT INITIATIVE DESIGNED TO MAKE HEALTHY CHOICES EASIER FOR EVERYONE. THIS IS DONE USING EVIDENCE-BASED BEST PRACTICES IN PUBLIC POLICY, PRESENTING TOOLS TO OPTIMIZE WORKSITES', SCHOOLS AND ORGANIZATIONS' ENVIRONMENTS FOR WELL-BEING, AND CREATING OPPORTUNITIES FOR INDIVIDUALS TO ARTICULATE PURPOSE AND CONNECT WITH FRIENDS AND COMMUNITY. DODGE COUNTY WAS AWARDED BLUE ZONES PROJECT CERTIFIED COMMUNITY STATUS IN 2020 WHICH IS VALID THROUGH AUGUST 2023.ENVIRONMENTAL IMPROVEMENTS:MMC-BD PROVIDED SHARPS DISPOSAL IN THE HOSPITAL THAT WAS OPENED TO THE PUBLIC TO ENCOURAGE SAFE DISPOSAL OF SHARPS IN THE COMMUNITY. A MEDICATION DISPOSAL RECEPTACLE IS BEING PLANNED TO BE AVAILABLE IN THE MMC-BD PHARMACY IN EARLY 2022.LEADERSHIP DEVELOPMENT AND LEADERSHIP TRAINING FOR COMMUNITY MEMBERS:MMC-BD PARTNERS WITH LEADERSHIP BEAVER DAM, A TRAINING PROGRAM TO DEVELOP COMMUNITY LEADERS COORDINATED BY THE BEAVER DAM CHAMBER OF COMMERCE. MMC-BD HOSTS THE COHORT ONCE A YEAR TO TEACH PARTICIPANTS ABOUT THE HEALTH CARE INDUSTRY AND WHAT IMPACT MMC-BD HAS LOCALLY.MMC-BD STAFF ALSO CONDUCTED "PURPOSE WORKSHOPS" FOR COMMUNITY MEMBERS. WORKSHOPS PROVIDE AN OPPORTUNITY TO BEGIN TO EXPLORE WHAT ONE'S PURPOSE IS. PARTICIPANTS ACTIVELY PARTICIPATE IN ENGAGING ACTIVITIES TO HELP THEM DISCOVER THEIR GIFTS AND THEN BEGIN TO UNDERSTAND HOW THEY CAN USE THESE GIFTS AND LIVE LIFE WITH GREATER PURPOSE. ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENTS AND SAFETY:MMC-BD STAFF PARTICIPATED AS BOARD SECRETARY AND AN ANNUAL CONFERENCE PLANNING COMMITTEE MEMBER FOR THE WISCONSIN PUBLIC HEALTH ASSOCIATION (WPHA). WPHA'S ADVOCACY PRIORITIES INCLUDED EARLY CHILDHOOD EDUCATION, CRIMINAL JUSTICE REFORM, INCOME STABILITY AND EMPLOYMENT, AND HOUSING. MMC-BD STAFF ALSO PARTICIPATE IN THE COUNCIL OF ADVOCATES WITH THE WI BIKE FED WORKING TO ADVANCE BIKING INITIATIVES THROUGHOUT THE STATE.WORKFORCE DEVELOPMENT:MMC-BD MENTORED AN MPH STUDENT INTERN AND AREA HEALTH EDUCATION CENTER COMMUNITY HEALTH INTERNSHIP PROGRAM STUDENT INTERN IN 2021.
PART III, LINE 2:BAD DEBT EXPENSE IS REPORTED AT COST USING A COST-TO-CHARGE RATIO.
PART III, LINE 3:NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE.
PART III, LINE 4:PATIENT ACCOUNTS RECIEVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS 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 DEDUCTIBLES AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT IN THE PERIOD OF SERVICE ON BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 60% AND 55% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2021 AND DECEMBER 31, 2020, RESPECTIVELY.
PART III, LINE 8:THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2021 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDES (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
PART III, LINE 9B:THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE.
PART VI, LINE 2:IN 2021, MMC-BD IDENTIFIED AND PRIORITIZED COMMUNITY HEALTH PRIORITIES THROUGH A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS THAT INCLUDED INPUT FROM ORGANIZATION LEADERSHIP, COMMUNITY HEALTH DEPARTMENT STAFF, AND COMMUNITY PARTNERS. DIRECT COMMUNITY INPUT WAS GATHERED THROUGH A COMMUNITY HEALTH SURVEY. ASSESSMENT ACTIVITIES FOCUSED ON UNDERSTANDING THE PRIORITIES OF THE UNDERSERVED IN THE COMMUNITY. THE CHNA INCLUDED PRIMARY AND SECONDARY DATA. PRIMARY DATA INCLUDED A COUNTY-WIDE SURVEY AND FOCUS GROUP. SECONDARY DATA WAS COMPILED INTO DATA PACKETS WHICH INCLUDED SELECTED DATA FROM VARIOUS SOURCES:- 2020 COUNTY HEALTH RANKINGS & ROADMAPS - YOUTH RISK BEHAVIOR SURVEY - BEHAVIOR RISK FACTOR SURVEILLANCE SURVEY - 2020 DODGE COUNTY ALICE REPORT - WI DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH PROFILE - ENVIRONMENTAL PUBLIC HEALTH DATA TRACKER - DODGE COUNTY COMMUNITY WELL-BEING INDEXMMC-BD CHNA USED THE FOLLOWING PROCESS TO CONDUCT THE ASSESSMENT AND ESTABLISH THE COMMUNITY HEALTH PRIORITIES:- STEP 1: DATA PRESENTED FOR CONSIDERATION- STEP 2: SELECTING PRIORITIZATION PROCESSES- STEP 3A: HEALTH NEEDS PRIORITIZED- STEP 3B: SPECIFIC ASPECTS OF HEALTH PRIORITIES- STEP 3C: SOCIAL DETERMINANTS OF HEALTH (SDOH) PRIORITIZATION- STEP 4: CONFIRM PRIORITIES WITH FINAL REVIEW
PART VI, LINE 3:PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE. INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA.THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL.
PART VI, LINE 4:MMC-BD STRIVES TOWARD AFFORDABLE AND ACCESSIBLE HEALTH CARE FOR ALL. MANY PATIENTS AND COMMUNITY MEMBERS RESIDE IN RURAL AREAS OF DODGE COUNTY AND NEIGHBORING COUNTIES. MMC-BD RECOGNIZES THAT OUR SERVICE AREA COMMUNITY EXTENDS BEYOND DODGE COUNTY'S BORDERS. THE MMC-BD PRIMARY SERVICE AREA LIES ENTIRELY WITHIN DODGE COUNTY, WISCONSIN.DODGE COUNTY IS LOCATED IN SOUTH-EASTERN REGION OF WISCONSIN, POPULATION NEARLY 88,000. KNOWN FOR ITS LAKES, STREAMS AND SMALL TOWNS, DODGE COUNTY OFFERS A PEACEFUL RURAL ENVIRONMENT LOCATED WITHIN AN HOUR DRIVE OF MILWAUKEE, MADISON AND FOX VALLEY METROPOLITAN AREAS. THE COUNTY IS COMPRISED OF FOUR CITIES, BEAVER DAM, MAYVILLE, JUNEAU (COUNTY SEAT) AND HORICON. OTHER MAJOR CITIES, A PORTION OF WHICH IS IN DODGE COUNTY, INCLUDE WATERTOWN, HARTFORD, WAUPUN AND COLUMBUS. DODGE COUNTY IS ALSO HOME TO OVER 30 VILLAGES AND TOWNSHIPS.DODGE COUNTY HAS A HIGHER MEDIAN AGE OF 42.4 YEARS THAN THE STATE AT 39.7. THE COUNTY IS 89.6% WHITE COMPARED TO 87% WHITE AT THE STATE LEVEL. ABOUT 5% OF RESIDENTS IDENTIFY AS HISPANIC AND 4.6% OF RESIDENTS SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME.IN DODGE COUNTY, 90.8% OF ADULT RESIDENTS HAVE A HIGH SCHOOL DEGREE OR HIGHER. THE MEDIAN INCOME OF A DODGE COUNTY RESIDENT IS $60,652, WHICH IS LESS THAN THE STATE AVERAGE ($61,747) AND THE RATE OF POVERTY IS 8.0%, WHICH IS LOWER THAN THE STATE AT 10.4% AND 43.9% OF RESIDENTS WORKED OUTSIDE OF DODGE COUNTY, COMMUTING TO SURROUNDING AREAS.THERE IS A GROWING SPANISH-SPEAKING POPULATION IN DODGE COUNTY. MANY ARE EMPLOYED IN THE AGRICULTURE SECTOR, WORKING ON FARMS OR FACTORIES, OR IN SEASONAL JOBS, WHICH PRESENT UNIQUE HEALTH CHALLENGES AND BARRIERS. THERE IS AN AMISH COMMUNITY IN COLUMBIA COUNTY ON THE BORDER OF DODGE COUNTY. THIS COMMUNITY IS WIDESPREAD OVER SEVERAL TOWNSHIPS AND CONSISTS OF SMALL TO MEDIUM-SIZED AMISH FARMSTEADS AND INDIVIDUAL HOMES. WHEN IN NEED OF MEDICAL CARE, MMC-BD IS OFTEN THE CLOSEST LOCATION FOR THESE FAMILIES.
PART VI, LINE 5:MARSHFIELD MEDICAL CENTER- BEAVER DAM FURTHERED ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY WITH THE FOLLOWING REPRESENTATION:- BEAVER DAM AREA CHAMBER OF COMMERCE BOARD- BEAVER DAM ROTARY- LION'S CLUB INTERNATIONAL- BEAVER DAM AREA COMMUNITY THEATRE BOARD- SOUTHEASTERN WISCONSIN WORKFORCE DEVELOPMENT BOARDADDITIONAL INITIATIVES SUPPORTED BY MMC-BD INCLUDE:- RECOVERY MEALS PROGRAM TO ASSIST FOOD/NUTRITION-INSECURE PATIENTS IN GETTING ACCESS TO HEALTHY FOODS UPON DISCHARGE- SUPPORTED CHURCH HEALTH SERVICES, A LOCAL ORGANIZATION COMMITTED TO PROVIDING HEALTH SERVICES TO LOW-INCOME PATIENTS WITHOUT INSURANCE- HARVESTED AND DISTRIBUTED FRESH HYDROPONIC LETTUCE TO AREA FOOD PANTRIES- PROVIDED FREE VIRTUAL HEALTHY COOKING DEMONSTRATIONS- PROVIDED MEALS ON WHEELS AND FOOT CLINICS- OFFERED LACTATION CONSULTANT SERVICESMMC-BD CREATED A COMMUNITY HEALTH GRANT PROGRAM IN 2021. THE INTENT OF THE PROGRAM IS TO SUPPORT LOCAL NOT-FOR-PROFIT ORGANIZATIONS ACTIVELY WORKING TO DEVELOP NEW IDEAS OR ENHANCE EXISTING PROJECTS THAT IMPROVE THE HEALTH OF RESIDENTS OF DODGE COUNTY AND BEYOND. PRIORITIES IDENTIFIED BY THE CHNA AND IS INCLUDE ALCOHOL AND SUBSTANCE ABUSE, BEHAVIORAL HEALTH, CHRONIC DISEASE PREVENTION AND SOCIAL DETERMINANTS OF HEALTH. GRANTS, FROM $1,000-$10,000, WERE AVAILABLE. SIX GRANTS TOTALING $25,000 WERE DISTRIBUTED IN 2021.
PART VI, LINE 6:MARSHFIELD CLINIC WAS FOUNDED IN 1916 BY SIX PHYSICIANS PRACTICING IN MARSHFIELD, A RURAL CENTRAL WISCONSIN CITY. AT ITS INCEPTION, CLINIC FOUNDERS SAW RESEARCH AND EDUCATION AS CRITICAL TO THEIR PRACTICE OF HEALTH CARE AND THAT REMAINS SO TODAY. THE CLINIC BECAME A 501(C)(3) NONPROFIT ORGANIZATION IN 1992 AND IN 2014, MARSHFIELD CLINIC HEALTH SYSTEM, INC. WAS FORMED. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. THE HEALTH SYSTEM TODAY IS AN INTEGRATED SYSTEM SERVING WISCONSIN AND BEYOND, WITH MORE THAN 12,000 EMPLOYEES INCLUDING OVER 1,400 PROVIDERS COMPRISING MORE THAN 170 SPECIALTIES AND SUBSPECIALTIES. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE TO MORE THAN TWO MILLION RESIDENTS THROUGH OVER 60 LOCATIONS IN 40 WISCONSIN COMMUNITIES IN NORTHERN, CENTRAL AND WESTERN WISCONSIN. PRIMARY OPERATIONS INCLUDE: MARSHFIELD CLINIC, MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, WESTON, PARK FALLS AND MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. THE HEALTH SYSTEM DEEPLY BELIEVES IN PROMOTING COMMUNITY HEALTH THROUGH BUILDING AND SUSTAINING STRONG INTERNAL AND EXTERNAL PARTNERSHIPS AND COLLABORATIONS. FOR THIS REASON, THE HEALTH SYSTEM AND ITS AFFILIATED ENTITIES WORK TOGETHER INTERNALLY AND EXTERNALLY WITH COMMUNITY PARTNERS, STAKEHOLDERS AND RESIDENTS TO IMPROVE COMMUNITY HEALTH. UNIQUE TO THE HEALTH SYSTEM IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILD BRIDGES BETWEEN THE HEALTH SYSTEM AND THE PLACES IN THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. THE CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. THE CCHA INCLUDES HOSPITAL STAFF WHO ARE CLOSELY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY (IS) IN THEIR RESPECTIVE COUNTIES. THIS HELPS TO ALIGN COMMUNITY HEALTH PRIORITIES IDENTIFIED IN THE CHNA WITH HEALTH SYSTEM PRIORITIES.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
SUSAN TURNEY MD
BOARD MEMBER/MCHS CEO$0$1,754,423$0$5,000$0$328,979$0$280,404$0$30,527$0$2,399,333$0$248,642
GORDON EDWARDS
MCHS CFO/COO$0$757,620$0$10,000$0$81,591$0$21,816$0$32,478$0$903,505$0$0
JERARD JENSEN
MCHS GENERAL COUNSEL$0$782,228$0$0$0$62,018$0$21,816$0$37,371$0$903,433$0$0
NARAYANA MURALI MD
BOARD MEMBER/MCHS CSO$0$740,814$0$0$0$42,632$0$21,816$0$33,538$0$838,800$0$0
WILLIAM MELMS MD
CHIEF MEDICAL OFFICER$0$609,735$0$10,000$0$48,282$0$21,816$0$29,171$0$719,004$0$0
RUWAN DISSANAYAKE MD
SECRETARY$0$348,045$0$96,819$0$41,735$0$20,245$0$32,115$0$538,959$0$0
ANGELIA FOSTER
CHIEF ADMIN OFFICER MMC-BEAVER DAM$303,215$0$0$0$1,738$0$21,816$0$29,677$0$356,446$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3THE 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, LINE 4BTHE 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 RUWAN DISSANAYAKE, MD JERARD JENSEN GORDON EDWARDS WILLIAM MELMS, MD

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART IV, LINE 4:MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING BEAVER DAM COMMUNITY HOSPITALS, INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC.
FORM 990, PART V, LINE 2A:ALL PERSONNEL SERVICES FOR BEAVER DAM COMMUNITY HOSPITALS, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR BEAVER DAM COMMUNITY HOSPITALS, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC.
FORM 990, PART VI, SECTION A, LINE 6MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF BEAVER DAM COMMUNITY HOSPITALS, INC.
FORM 990, PART VI, SECTION A, LINE 7AMCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF BEAVER DAM COMMUNITY HOSPITALS, INC.
FORM 990, PART VI, SECTION A, LINE 7BMCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF BEAVER DAM COMMUNITY HOSPITALS, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11BMARSHFIELD 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 12CALL 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 BEAVER DAM 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 15THE 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 INSURE 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 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 19BEAVER DAM COMMUNITY HOSPITALS, INC. 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 VII, SECTION A:COMPENSATION REPORTED FOR ANGELIA FOSTER HAS BEEN PAID BY A RELATED ORGANIZATION AND COMMON PAYMASTER, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. SINCE ALL SERVICES PERFORMED BY THIS INDIVIDUAL WERE FOR BEAVER DAM COMMUNITY HOSPITALS INC, THE COMPENSATION HAS BEEN REPORTED IN COLUMN D AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH PAYROLL FILING REQUIREMENTS.
FORM 990, PART X, LINE 20:BEAVER DAM COMMUNITY HOSPITALS, INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC.
FORM 990, PART XI, LINE 9:NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS 3,813,430. EQUITY INCOME IN AFFILIATES 81,646.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
DODGE HEALTH ENTERPRISES LLC
715 S UNIVERSITY AVEBEAVER DAMWI53916391538653REFERENCE LABWI$348,930$5,287,438BDCH
DELMAN DEVELOPMENT LLC
707 S UNIVERSITY AVEBEAVER DAMWI53916272375085REAL ESTATEWI-$65,188$1,218,807BDCH
BEAVER DAM MEDICAL BUILDING 2 LLC
705 S UNIVERSITY AVEBEAVER DAMWI53916391157876BUILDING MANAGEMENTWI$524,156$16,002,435BDCH
WELL LIFE HOME MEDICAL EQUIPMENT AND SUPPLIES LLC
707 S UNIVERSITY AVEBEAVER DAMWI53916812463679DURABLE MEDICAL EQUIPMENTWI$0$0BDCH

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
BEAVER DAM COMMUNITY HOSPITALS FOUNDATION INC
707 S UNIVERSITY AVEBEAVER DAMWI53916391499140PHILANTHROPYWI501(C)(3)LINE 10BDCHYes (1)
MCHS HOSPITALS INC
1000 N OAK AVEMARSHFIELDWI54449810977948HOSPITALWI501(C)(3)LINE 3MCHS0
FLAMBEAU HOSPITAL INC
98 SHERRY AVEPARK FALLSWI54552390973724HOSPITALWI501(C)(3)LINE 3MCHS HOSP0
LAKEVIEW MEDICAL CENTER INC
1700 W STOUT STRICE LAKEWI54868390837206HOSPITALWI501(C)(3)LINE 3MCHS HOSP0
VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL
1700 W STOUT STRICE LAKEWI54868391329084SUPPORT ORGWI501(C)(3)LINE 12D, III-O0N/A
FAMILY HEALTH CENTER OF MARSHFIELD INC
1000 N OAK AVEMARSHFIELDWI54449391681547COM HLTH CTRWI501(C)(3)LINE 70N/A
MARSHFIELD CLINIC INC
1000 N OAK AVEMARSHFIELDWI54449390452970MEDICAL SVCSWI501(C)(3)LINE 3MCHS0
SECURITY HEALTH PLAN OF WISCONSIN INC
1515 N ST JOSEPH AVEMARSHFIELDWI54449391572880HMOWI501(C)(4)N/AMCHS0
MARSHFIELD CLINIC HEALTH SYSTEM INC
1000 N OAK AVEMARSHFIELDWI54449461495343SUPPORT ORGWI501(C)(3)LINE 12D, III-O0N/A
MCHS FOUNDATION INC
1000 N OAK AVEMARSHFIELDWI54449812822823PHILANTHROPYWI501(C)(3)LINE 7MCHS0
MEMORIAL HOSPITAL INC
N3708 RIVER AVENEILLSVILLEWI54456390806828HOSPITALWI501(C)(3)LINE 3MCHS HOSP0

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1THE DIAGNOSTIC & TREATMENT CENTER LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13401 CRANBERRY BLVDAddressLine1Txt
CityWESTONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54476ZIPCd
FieldValueIRS element (for citing)
EIN200691634EIN
Primary ActivitiesMEDICAL SVCSPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd