BLACK RIVER HEALTH INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: BLACK RIVER HEALTH INC (EIN 39-1027536)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-11-15
IRS object ID: 202223199349304952
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
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-11-15T09:09:06-06:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1502 LONDON ROAD SUITE 200	AddressLine1Txt
City	DULUTH	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55812	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	391027536	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BLACK RIVER MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	BLAC	BusinessNameControlTxt
Phone	7152845361	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	711 WEST ADAMS STREET	AddressLine1Txt
City	BLACK RIVER FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54615	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CARL SELVICK	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	7152845361	PhoneNum
Signature	2022-11-12	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	CARL	PersonFirstNm
Person Last	SELVICK	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MICHAEL J PETERSON CPA	PreparerPersonNm
PTIN	P01833529	PTIN
Phone	2187224705	PhoneNum
Preparation	2022-11-12	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CARL SELVICK	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	711 WEST ADAMS STREET	AddressLine1Txt
City	BLACK RIVER FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54615	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$67,981,573	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.BRMH.NET	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1966	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	IN THE SPIRIT OF "EXCELLENCE ALWAYS," BLACK RIVER MEMORIAL HOSPITAL, INC.'S MISSION IS TO: PROVIDE HIGH QUALITY, ACCESSIBLE, PROGRESSIVE HEALTH CARE; CONNECT PATIENTS WITH VALUED HEALTH CARE PROVIDERS AND SERVICES; ENHANCE THE HEALTH AND WELLBEING OF ALL PEOPLE WE SERVE; REMAIN FISCALLY VIABLE TO REINVEST IN THE COMMUNITY'S FUTURE HEALTH CARE NEEDS.THE VISION OF BLACK RIVER MEMORIAL HOSPITAL IS TO BE THE HEALTH CARE PROVIDER AND EMPLOYER OF CHOICE IN JACKSON COUNTY AND THE SURROUNDING COUNTIES.	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	412	TotalEmployeeCnt
Total Volunteers	154	TotalVolunteersCnt
Total Gross UBI	$3,178	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$62	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$5,747,746	PYContributionsGrantsAmt
CY Contributions Grants	$5,503,760	CYContributionsGrantsAmt
PY Program Service Revenue	$59,799,461	PYProgramServiceRevenueAmt
CY Program Service Revenue	$60,702,248	CYProgramServiceRevenueAmt
PY Investment Income	$897,574	PYInvestmentIncomeAmt
CY Investment Income	$1,091,456	CYInvestmentIncomeAmt
PY Other Revenue	$33,000	PYOtherRevenueAmt
CY Other Revenue	$41,647	CYOtherRevenueAmt
PY Total Revenue	$66,477,781	PYTotalRevenueAmt
CY Total Revenue	$67,339,111	CYTotalRevenueAmt
PY Grants And Similar Paid	$4,000	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$5,000	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$36,746,864	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$36,976,089	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$24,850,867	PYOtherExpensesAmt
CY Other Expenses	$26,394,668	CYOtherExpensesAmt
PY Total Expenses	$61,601,731	PYTotalExpensesAmt
CY Total Expenses	$63,375,757	CYTotalExpensesAmt
PY Revenues Less Expenses	$4,876,050	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,963,354	CYRevenuesLessExpensesAmt
Total Assets BOY	$96,587,959	TotalAssetsBOYAmt
Total Assets EOY	$96,205,640	TotalAssetsEOYAmt
Total Liabilities BOY	$35,540,523	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$30,708,641	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$61,047,436	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$65,496,999	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	IN THE SPIRIT OF "EXCELLENCE ALWAYS," BLACK RIVER MEMORIAL HOSPITAL, INC.'S MISSION IS TO SERVE PATIENTS WITH EXCELLENCE, AND THE HOSPITAL'S VISION IS TO STRIVE TO BE THE BEST COMMUNITY HOSPITAL IN THE NATION.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$43,734,724	ExpenseAmt
Grant	$5,000	GrantAmt
Revenue	$53,834,995	RevenueAmt
Desc	HOSPITAL:BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PRIMARY AND MENTAL HEALTH CARE TO ALL PEOPLE IN NEED OF CARE. AMONG THE INPATIENT AND OUTPATIENT SERVICES PROVIDED ARE DIAGNOSTIC IMAGING, REHABILITATION SERVICES, RESPIRATORY CARE, SURGICAL SERVICES, CARDIAC MONITORED CARE, LAB SERVICES, PHARMACY SERVICES, 24-HOUR EMERGENCY ROOM, POISON CONTROL, AND MANY OTHERS. IN 2021, THE HOSPITAL PROVIDED 3,697 INPATIENT DAYS OF CARE TO ADULTS, PEDIATRICS, SWING BED, AND NURSERY INPATIENTS AS WELL AS 9,471 EMERGENCY ROOM/URGENT CARE AND 22,468 OUTPATIENT SERVICES TO THOSE IN NEED OF CARE. THE HOSPITAL ALSO SERVES AS A VITAL LINK TO THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS IN AN EFFORT TO ENHANCE THE HEALTH AND WELFARE OF THE PEOPLE IN ITS AREA. IN ITS EFFORT TO ATTAIN THIS GOAL THE HOSPITAL PROVIDES:-FREE AND REDUCED-COST CARE TO THOSE WITH A DEMONSTRATED NEED-CARE TO THOSE COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH MAY NOT COVER THE CHARGES OR COST OF SERVICES PROVIDED-HEALTH EDUCATION AND OUTREACH PROGRAMS TO ALL MEMBERS OF THE COMMUNITY AT LITTLE OR NO COST TO THE PARTICIPANTSCHARITY CARE GIVEN TO PERSONS UTILIZING OUR HOSPITAL AMOUNTED TO A TOTAL OF $1,392,776 IN TOTAL CHARGES. IN ADDITION, WE FURNISH CARE TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH PAY AT RATES LESS THAN CHARGES. DISCOUNTS TO THESE PROGRAMS FOR HOSPITAL SERVICES AMOUNTED TO $9,963,062.00.BLACK RIVER MEMORIAL HOSPITAL, INC. ALSO CONDUCTED NUMEROUS EDUCATIONAL AND SUPPORTIVE ACTIVITIES TO ENCOURAGE THE GOOD HEALTH AND WELFARE OF THE MEMBERS OF THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE:-FACILITIES FOR MEETINGS AND SUPPORT PERSONNEL, INCLUDING LEADERSHIP FOR A GRIEF SUPPORT GROUP AND THE, PERS (A PERSONAL EMERGENCY RESPONSE SYSTEM AVAILABLE AT NOMINAL COSTS TO AREA RESIDENTS), DIABETES EDUCATION GROUP AND A NEWLY FORMED CANCER SUPPORT GROUP.-PROVIDING ASSISTANCE TO HEALTH EDUCATORS BY SPONSORING INTERNSHIPS FOR STUDENT NURSES, RADIOLOGICAL, REHABILITATION, AND LABORATORY TECHNICIAN STUDENTS.-PROVIDING CHILD BIRTH EDUCATIONAL CLASSES, THE SUMMER ATHLETIC ENHANCEMENT PROGRAM DESIGNED TO EDUCATE ATHLETICS ON PROPER TRAINING AND PREPARATION FOR SPORTS.-PROVIDING LEADERSHIP TO STATE AND REGION WIDE HEALTH ORGANIZATIONS INCLUDING THE WISCONSIN HOSPITAL ASSOCIATION, HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION, NURSE EXECUTIVES, HEALTH EDUCATORS, PERINATAL CARE ASSOCIATION AND THE WISCONSIN HEALTHCARE PUBLIC RELATIONS AND MARKETING SOCIETY TO FURTHER HEALTHCARE GOALS OUTSIDE OF OUR DIRECT SERVICE AREA.OTHER SERVICES WE PROVIDE INCLUDE GRIEF SUPPORT GROUP. COALITIONS WE SUPPORT ARE: BREASTFEEDING COALITION, BLACK RIVER AREA SAFETY COUNCIL, TOGETHER FOR JACKSON COUNTY KIDS, JACKSON IN ACTION, AND WELLNESS PROGRAMMING FOR AREA BUSINESSES. BLACK RIVER MEMORIAL HOSPITAL'S WOUND CARE CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY MAY 2021.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$2,420,368	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$2,616,253	RevenueAmt
Desc	BLACK RIVER HEALTHCARE CLINIC OPENED TO BRMH EMPLOYEES IN JUNE AND THE GENERAL PUBLIC IN JULY 2020. BLACK RIVER HEALTHCARE CLINIC IS AN INTEGRATED CLINIC OFFERING BEHAVIORAL HEALTH AND PRIMARY CARE SERVICES.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$1,424,662	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$1,172,695	RevenueAmt
Desc	OTHER HOME-BASED SERVICES OFFERED INCLUDE BLACK RIVER MEMORIAL HOSPITAL'S HOMECARE AND PALLIATIVE PROGRAMS THAT PROVIDE COMPREHENSIVE HEALTHCARE SERVICES IN THE MOST COMFORTABLE SETTING-THE PATIENT'S HOME. IN 2021, THERE WERE 4,505 TOTAL HOMECARE VISITS PROVIDED TO PATIENTS CONSISTING OF SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, HOME HEALTH AIDE, AND MEDICAL SOCIAL SERVICE HEALTHCARE SERVICES PROVIDED TO PATIENTS IN THEIR HOMES.	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)

ExpenseExpenseAmt	GrantGrantAmt	RevenueRevenueAmt	DescDesc
$602,502	$0	$1,470,754	HOME-BASED SERVICES:BLACK RIVER MEMORIAL HOSPITAL'S HOME-BASED SERVICES GIVE PATIENTS WITH LIFE-LIMITING OR TERMINAL ILLNESSES THE OPPORTUNITY TO LIVE WITH DIGNITY DURING THE LAST STAGE OF THEIR LIFE. TOTAL HOSPICE DAYS OF SERVICE PROVIDED TO PATIENTS IN 2021 WERE 5,394.
$183,287	$0	$676,973	BLACK RIVER MEMORIAL HOSPITAL'S INFUSION CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY IN AUGUST 2020 WHICH INCLUDE INTRODUCING CHEMOTHERAPY TO OUR SERVICE MIX FOR THE FIRST TIME.
$338,601	$0	$839,836	OTHER PROGRAMS

Field	Value	IRS element (for citing)
Total Other Prog Srvc Expense	$1,124,390	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant	$0	TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue	$2,987,563	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$48,704,144	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	34	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	412	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (1)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (1)	Form990TFiledInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	9	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	CARL SELVICK	PersonNm
Phone	7152845361	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	711 WEST ADAMS STREET	AddressLine1Txt
City	BLACK RIVER FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54615	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd
BEN BOARDMAN MD
PHYSICIAN	40.00	Yes (X)	$460,661	$0	$42,306
DR THOMAS WALKER
DIRECTOR	4.00		$0	$0	$0	Yes (X)
DR CAROL MARTIN
CHIEF OF STAFF/DIRECTOR	38.00		$412,173	$0	$80,398	Yes (X)
ESTEBAN MILLER MD
CMO	42.00	Yes (X)	$401,751	$0	$42,199
MARY BETH WHITE-JACOBS
CEO (SECRETARY)	40.00		$330,275	$0	$90,336		Yes (X)
JOSEPH AHN MD
PHYSICIAN	40.00	Yes (X)	$352,508	$0	$40,625
SMITA RAJASEKARAN MD
PHYSICIAN	34.00	Yes (X)	$345,563	$0	$39,834
RICHARD MINNIHAN MD
PHYSICIAN	34.00	Yes (X)	$305,932	$0	$39,881
MATTHEW STREETER
CFO (THRU JULY)	40.00		$216,655	$0	$31,902		Yes (X)
KYLE KOVACEVICH
CFO	40.00		$140,363	$0	$58,461		Yes (X)
ALEX BRADLEY CHOWN
CHAIRPERSON	5.00		$0	$0	$0	Yes (X)	Yes (X)
JOHN DRACE
VICE CHAIRPERSON	4.00		$0	$0	$0	Yes (X)	Yes (X)
ELLEN MOLDENHAUER RN
TREASURER (THRU JUNE)	4.00		$0	$0	$0	Yes (X)	Yes (X)
MICHELLE GREENDEER-RAVE
TREASURER	4.00		$0	$0	$0	Yes (X)	Yes (X)
DANIEL DIEHN
DIRECTOR (THRU SEPT)	4.00		$0	$0	$0	Yes (X)
CHRISTINE HOVELL
DIRECTOR	4.00		$0	$0	$0	Yes (X)
TIMOTHY KUNES
DIRECTOR	4.00		$0	$0	$0	Yes (X)
KATHERINE POTTER
DIRECTOR	4.00		$0	$0	$0	Yes (X)
MICHELE SEVERSON
DIRECTOR	4.00		$0	$0	$0	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$2,965,881	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$465,942	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	9	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
BLACK RIVER ANESTHESIA ASSOCIATES
812 WESTWIND DRIVE	BLACK RIVER FALLS	WI	54615	CRNA/ANESTHESIA PROFESSIONAL SERVICE	$831,605
CHIPPEWA VALLEY ORTHOPEDICS
1200 OAKLEAF WAY STE A	ALTOONA	WI	547202245	ORTHOPEDIC SURGICAL SERVICES	$619,312
R1 RCM INC
29586 NETWORK PLACE 29586	CHICAGO	IL	60673	REVENUE CYCLE CODING/BILLING	$517,771
DIANA WILLIAMS DBA CHAMONIX LLC
712 S ELM STREET	HINSDALE	IL	60521	ED PHYSICIAN	$343,737
DUDLEY ANESTHESIA SC
607 L HAUSER RD	ONALASKA	WI	54650	CRNA/ANESTHESIA PROFESSIONAL SERVICE	$297,550

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	9	CntrctRcvdGreaterThan100KCnt
Government Grants	$5,486,000	GovernmentGrantsAmt
All Other Contributions	$17,760	AllOtherContributionsAmt
Total Contributions	$5,503,760	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
HOSPITAL PATIENT SERVICE REVENUE	621400	$53,834,995	$53,834,995
CLINIC REVENUE	621400	$2,616,253	$2,616,253
HOMECARE PATIENT REVENUE	621400	$1,470,754	$1,470,754
HOSPICE PATIENT REVENUE	621400	$1,172,695	$1,172,695

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,607,551	TotalRevenueColumnAmt
Related Or Exempt Func Income	$1,516,809	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,178	UnrelatedBusinessRevenueAmt
Exclusion	$87,564	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$60,702,248	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$529,698	TotalRevenueColumnAmt
Exclusion	$529,698	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$31,713	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$31,713	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$31,713	TotalRevenueColumnAmt
Exclusion	$31,713	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$1,187,612	SecuritiesAmt
Other	$2,500	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$628,354	SecuritiesAmt
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$559,258	SecuritiesAmt
Other	$2,500	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$561,758	TotalRevenueColumnAmt
Exclusion	$561,758	ExclusionAmt

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	$24,042	GrossSalesOfInventoryAmt
Cost Of Goods Sold	$14,108	CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$9,934	TotalRevenueColumnAmt
Exclusion	$9,934	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$67,339,111	TotalRevenueColumnAmt
Related Or Exempt Func Income	$60,611,506	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$3,178	UnrelatedBusinessRevenueAmt
Exclusion	$1,220,667	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$5,000	TotalAmt
Program Services	$5,000	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$867,992	TotalAmt
Management And General	$867,992	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$24,396,768	TotalAmt
Program Services	$20,313,689	ProgramServicesAmt
Management And General	$4,083,079	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,155,984	TotalAmt
Program Services	$990,095	ProgramServicesAmt
Management And General	$165,889	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$8,874,478	TotalAmt
Program Services	$7,231,060	ProgramServicesAmt
Management And General	$1,643,418	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,680,867	TotalAmt
Program Services	$1,353,291	ProgramServicesAmt
Management And General	$327,576	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$130,043	TotalAmt
Management And General	$130,043	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$125,985	TotalAmt
Management And General	$125,985	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$8,678,823	TotalAmt
Program Services	$5,882,698	ProgramServicesAmt
Management And General	$2,796,125	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$538,768	TotalAmt
Management And General	$538,768	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$688,396	TotalAmt
Program Services	$184,543	ProgramServicesAmt
Management And General	$503,853	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$1,481,943	TotalAmt
Program Services	$28,787	ProgramServicesAmt
Management And General	$1,453,156	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$566,389	TotalAmt
Program Services	$544,193	ProgramServicesAmt
Management And General	$22,196	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$137,940	TotalAmt
Program Services	$130,846	ProgramServicesAmt
Management And General	$7,094	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$752,106	TotalAmt
Program Services	$558,795	ProgramServicesAmt
Management And General	$193,311	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$3,686,219	TotalAmt
Program Services	$2,627,131	ProgramServicesAmt
Management And General	$1,059,088	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$170,915	TotalAmt
Management And General	$170,915	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES AND PH	$4,811,832	$4,601,709	$210,123
BAD DEBT EXPENSE	$2,917,699	$2,917,699
EQUIPMENT RENTAL & MAIN	$584,583	$584,583
FOOD EXPENSE	$352,626	$352,626

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$770,401	TotalAmt
Program Services	$397,399	ProgramServicesAmt
Management And General	$373,002	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$63,375,757	TotalAmt
Program Services	$48,704,144	ProgramServicesAmt
Management And General	$14,671,613	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$22,425	BOYAmt
EOY	$31,826	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$23,106,944	BOYAmt
EOY	$20,433,914	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$8,622,382	BOYAmt
EOY	$11,613,975	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$879,808	BOYAmt
EOY	$734,223	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$860,876	BOYAmt
EOY	$514,905	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$70,407,207	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$39,058,014	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$33,783,032	BOYAmt
EOY	$31,349,193	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$26,813,918	BOYAmt
EOY	$28,191,990	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,498,574	BOYAmt
EOY	$3,335,614	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$96,587,959	BOYAmt
EOY	$96,205,640	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$4,937,229	BOYAmt
EOY	$4,951,141	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
EOY	$1,046,261	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$22,254,852	BOYAmt
EOY	$21,354,401	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$399,396	BOYAmt
EOY	$140,239	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,949,046	BOYAmt
EOY	$3,216,599	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$35,540,523	BOYAmt
EOY	$30,708,641	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$61,047,436	BOYAmt
EOY	$65,466,335	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
EOY	$30,664	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$61,047,436	BOYAmt
EOY	$65,496,999	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$96,587,959	BOYAmt
EOY	$96,205,640	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$3,963,354	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$455,545	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$30,664	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$6,623	OtherActivitiesAmt
Total Lobbying Expenditures	$6,623	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR BLACK RIVER MEMORIAL, INC. 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 ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT 19.1% OR 4,259 OF THE FEES PAID BY BLACK RIVER MEMORIAL, INC WENT TO LOBBYING EFFORTS. THE WHA DETERMINED THAT 16.7% OR $2,364 OF THE MEMBERSHIP DUES PAID WENT TO LOBBYING.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$562,619	OtherCostOrOtherBasisAmt
Book Value	$562,619	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$42,882,900	OtherCostOrOtherBasisAmt
Depreciation	$19,246,359	DepreciationAmt
Book Value	$23,636,541	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$26,312,659	OtherCostOrOtherBasisAmt
Depreciation	$19,811,655	DepreciationAmt
Book Value	$6,501,004	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$649,029	OtherCostOrOtherBasisAmt
Book Value	$649,029	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$31,349,193	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
DEFERRED COMPENSATION PLAN LIABILITY	$2,605,277
THIRD-PARTY REIMBURSMENT PROGRAMS	$60,000
OPERATING LEASE LIABILITY	$551,322

Field	Value	IRS element (for citing)
Total Liability	$3,216,599	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$64,765,080	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$455,545	NetUnrealizedGainsInvstAmt
Other Revenue	$14,108	OtherRevenueAmt
Revenue Not Reported	$469,653	RevenueNotReportedAmt
Revenue Subtotal	$64,295,427	RevenueSubtotalAmt
Investment Expenses Not Incld	$125,985	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$2,917,699	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$3,043,684	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$67,339,111	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$60,346,181	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$14,108	OtherExpensesIncludedAmt
Expenses Not Reported	$14,108	ExpensesNotReportedAmt
Expenses Subtotal	$60,332,073	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$125,985	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$2,917,699	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$3,043,684	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$63,375,757	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART XI, LINE 2D - OTHER ADJUSTMENTS:	COST OF GOODS SOLD 14,108.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE NET AGAINST REVENUE 2,917,699.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	COST OF GOODS SOLD 14,108.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE NET AGAINST REVENUE 2,917,699.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Free Care Other	275.000000000000	FreeCareOtherPct

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$903,398	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$903,398	NetCommunityBenefitExpnsAmt
Total Expense	0.01430	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$10,729,564	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,164,088	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,565,476	NetCommunityBenefitExpnsAmt
Total Expense	0.07200	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$11,632,962	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$6,164,088	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,468,874	NetCommunityBenefitExpnsAmt
Total Expense	0.08630	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,295	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,295	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$79,968	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$79,968	NetCommunityBenefitExpnsAmt
Total Expense	0.00130	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$20,961,153	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,154,607	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,806,546	NetCommunityBenefitExpnsAmt
Total Expense	0.12320	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$57,653	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$57,653	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$21,103,069	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$13,154,607	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,948,462	NetCommunityBenefitExpnsAmt
Total Expense	0.12550	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$32,736,031	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$19,318,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$13,417,336	NetCommunityBenefitExpnsAmt
Total Expense	0.21180	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,739	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$19,739	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,739	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$19,739	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReportedInd
Bad Debt Expense	$1,892,510	BadDebtExpenseAmt
Reimbursed By Medicare	$10,674,741	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$10,569,050	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$105,691	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BLACK RIVER MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	711 WEST ADAMS STREET	AddressLine1Txt
City	BLACK RIVER FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54615	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.BRMH.NET	WebsiteAddressTxt
State License	1037	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	BLACK RIVER MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	19	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.BRMH.NET/HEALTH-NEEDS-ASSESSMENT/	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	19	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	WWW.BRMH.NET/HEALTH-NEEDS-ASSESSMENT/	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	275.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare	Yes (X)	LookBackMedicareInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 5: DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE FINANCIAL ASSISTANCE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL FINANCIAL ASSISTANCE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES.A COMMUNITY SURVEY PLANNING SESSION WAS HELD ON MARCH 1, 2019, AND INCLUDED BLACK RIVER MEMORIAL HOSPITAL, JACKSON COUNTY PUBLIC HEALTH, HO-CHUNK NATION, AND A CDC STUDENT INTERN. HO-CHUNK NATION RECENTLY SURVEYED ITS MEMBERS AND MANY OF THE QUESTIONS USED IN THEIR SURVEY WERE ADDED TO COLLECT COMPARATIVE DATA. SINCE THE LAST CHNA, SURVEYS WERE CONDUCTED DURING SEVERAL COMMUNITY EVENTS. SURVEY PARTICIPANTS WERE ASKED TO RANK THE TOP TEN HEALTH CONCERNS IN ORDER OF MOST IMPORTANCE TO THE LEAST IMPORTANT. DRUG ABUSE REMAINS THE HIGHEST CONCERN WITH MENTAL/BEHAVIORAL HEALTH A CLOSE SECOND. OBESITY AND ALCOHOL ABUSE FOLLOWED.THE JACKSON COUNTY PUBLIC HEALTH DEPARTMENT COMPLETED TWO ON-SITE COMMUNITY CONVERSATIONS ON DECEMBER 4 AND DECEMBER 7, 2018, WITH TARGETED POPULATIONS. BOTH TARGET GROUPS CONSISTED OF RETIRED MALES THAT CONGREGATE MOST WEEKDAYS FOR SOCIALIZATION INCLUDING SHARING BREAKFAST OR PLAYING CARDS. THE PURPOSE OF THESE CONVERSATIONS WAS FOR A STATE HEALTH MINI-GRANT OUTREACH ASSESSMENT. THERE WERE 4 QUESTIONS IN FOCUS. THE OVERALL MESSAGE WAS, IN THEIR OPINION, PEOPLE NEED TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH AND WELL-BEING. HAVING GOOD VALUES, SHOWING KINDNESS, AND BEING IN TUNE WITH RESOURCES AVAILABLE POSITIVELY AFFECT THE QUALITY OF LIFE IN JACKSON COUNTY.BLACK RIVER MEMORIAL HOSPITAL HAS THE VISION TO BE THE BEST COMMUNITY HOSPITAL IN THE NATION. TO FULFILL THEIR MISSION TO SERVE RESIDENTS OF JACKSON COUNTY WITH EXCELLENCE, BRMH SOUGHT INPUT FROM CONSUMERS TO LEARN WAYS TO STRENGTHEN RELATIONSHIPS AND BETTER SERVE THE NEEDS OF THE COMMUNITY. AN ELECTRONIC COMMUNITY HEALTH NEEDS AND MARKET SURVEY WAS DEPLOYED IN LATE APRIL AND WAS PROMOTED THROUGH A VARIETY OF CHANNELS. TO ENTICE CITIZENS TO TAKE THE SURVEY, THE FIRST 500 UNIQUE RESPONDENTS RECEIVED A $10 GAS CARD. FLYERS PROMOTING THE SURVEY WERE DISTRIBUTED THROUGHOUT THE COMMUNITY TO RETAIL OUTLETS AND COMMUNITY GATHERING SPOTS SUCH AS THE LUNDA COMMUNITY CENTER. FIVE-HUNDRED FLYERS WERE DISTRIBUTED AT THE LOCAL HANSEN'S GROCERY STORE TO BE STUFFED INTO SHOPPERS' BAGS. EMAIL LIST-SERVE GROUPS, SUCH AS AREA CHURCHES AND LOCAL SERVICE GROUPS SUCH AS THE ROTARY CLUB RECEIVED THE FLYER ENCOURAGING PARTICIPATION. JACKSON COUNTY PUBLIC HEALTH PROMOTED THE SURVEY THROUGH ALL CHANNELS WITHIN THE COUNTY AND REQUESTED THE LOCAL SCHOOL DISTRICTS TO FORWARD ONTO STAFF AND PARENTS. TO CAPTURE FEEDBACK FROM THE MOST VULNERABLE POPULATIONS IN JACKSON COUNTY, STAFF VISITED THE LOCAL FOOD PANTRIES, ASSISTED LIVING FACILITIES, AND SENIOR CENTERS. THE SURVEY WAS TAKEN BY 680 PEOPLE AND REFLECTED RESPONSES FROM 19 INDIVIDUAL ZIP CODES.
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 6B: THE CHNA WAS COMPLETED WITH THE HO-CHUNK NATION AND JACKSON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES.
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 11: DURING THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT, THERE WERE MANY NEEDS IDENTIFIED DURING THE PROCESS. ALTHOUGH WE CANNOT ADDRESS EVERY NEED IN OUR COMMUNITY WE COLLABORATE WITH AREA PARTNERS TO HELP IMPROVE THE LIVES IN OUR REGION. DUE TO LIMITED RESOURCES, BRMH'S EFFORTS ARE FOCUSED ON THE PRIORITIES WHICH IMPACT THE GREATEST NUMBER OF PEOPLE. THERE ARE THREE IDENTIFIED NEEDS THAT WE FOCUS ON; BEHAVIORAL HEALTH CARE (INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDER), OBESITY, AND DEMENTIA/ALZHEIMER'S CARE. OUR EFFORTS WERE THWARTED DURING 2020 AS MOST OF OUR ATTENTION WAS FOCUSED ON THE COVID-19 PANDEMIC, BUT NOT ENTIRELY. ONE PRIORITY, BEHAVIORAL HEALTH CARE, CONTINUES TO BE A NEED IN OUR AREA. FOCUSING ON THIS NEED AND ACKNOWLEDGING THE LACK OF BEHAVIORAL HEALTH PROVIDERS IN OUR AREA, WE CONTINUED WITH OUR GROWTH PLAN AND OPENED THE BLACK RIVER HEALTHCARE CLINIC TO PROVIDE A HOLISTIC APPROACH TO PATIENT CARE BY INTEGRATING PRIMARY CARE WITH BEHAVIORAL HEALTH CARE. THIS APPROACH TREATS THE ENTIRE PERSON, MIND, BODY, AND SPIRIT. AND, NO ONE IS TURNED AWAY REGARDLESS OF THEIR ABILITY TO PAY.A SECOND PRIORITY; OBESITY. DURING THE PANDEMIC, WE WERE UNABLE TO PARTICIPATE IN SEVERAL COMMUNITY EVENTS WE WOULD TYPICALLY BE INVOLVED IN. EVEN THOUGH SOCIAL GATHERING WAS NOT ALLOWED, WE SPEARHEADED SELF-GUIDED, VIRTUAL EVENTS FOR WALKING AND RUNNING PARTNERING WITH JACKSON IN ACTION A LOCAL COALITION. THE THIRD PRIORITY THAT ROSE TO THE TOP DURING OUR MOST RECENT CHNA WAS THE NEED FOR ADDITIONAL RESOURCES FOR INDIVIDUALS WITH ALZHEIMER'S OR DEMENTIA. WE PARTNER WITH AREA AGENCIES AND PLAY AN INTEGRAL PART IN CAREGIVER SUPPORT GROUPS TO OFFER RESPITE. WE ARE CONTINUING TO EXPLORE OPPORTUNITIES TO HELP CARE FOR INDIVIDUALS DIAGNOSED WITH THESE DISEASES AND FOR THOSE WHO CARE FOR THEM. AS PREVIOUSLY MENTIONED, PLANS WERE PUT ON HOLD IN 2020 FOR EXPLORING FURTHER JOINT VENTURES WITH AREA AGENCIES TO IDENTIFY GAPS IN THIS ARENA, HOWEVER; STAFF IN DEPARTMENTS WHO CARED FOR PATIENTS WHO PRESENTED WITH ALZHEIMER'S OR DEMENTIA PATIENTS RECEIVED SKILLS TRAINING TO BETTER CARE FOR THAT POPULATION.
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 13H: THE HOSPITAL WILL CONSIDER THE OTHER DEBTS OF THE PATIENT. A PATIENT'S HOSPITAL BILL THAT IS LARGE IN COMPARISON TO THE PATIENT'S ASSETS OR INCOME IS ALSO CONSIDERED FOR CATASTROPHIC CARE.
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 16J: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE.
BLACK RIVER MEMORIAL HOSPITAL, INC.	PART V, SECTION B, LINE 20E: THE HOSPITAL POSTED A NOTICE IN THE EMERGENCY ROOMS, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION WERE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION WERE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE.

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	1 - BLACK RIVER MEMORIAL HOSPITAL HOME-BASED	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	311 COUNTY RD A	AddressLine1Txt
City	BLACK RIVER FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54615	ZIPCd

Field	Value	IRS element (for citing)
Facility	HOME HEALTH AGENCY OFFICE, HOSPICE PROGRAM OFFICE, DME SERVICES	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 6A:	BLACK RIVER MEMORIAL HOSPITAL, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S DATABASE AND WEBSITE.
PART I, LINE 7:	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 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 BLACK RIVER MEMORIAL HOSPITAL, INC. INCLUDE THE OPERATION OF THE HOSPITAL'S CLINIC, INPATIENT NURSING UNIT AND EMERGENCY ROOM, AS WELL AS THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE SUBSIDIZED INPATIENT UNIT INCLUDES THE MEDICAL/SURGICAL, OBSERVATION, AND HOSPITALIST NURSING UNITS. THE HOSPITAL INPATIENT UNIT DEPARTMENT AND EMERGENCY ROOM OPERATES 24-HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED STAFF INCLUDING HOSPITALIST PHYSICIANS, REGISTERED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT NURSING UNIT COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF JACKSON COUNTY, WISCONSIN. JACKSON COUNTY IS A LARGE COUNTY IN WISCONSIN AND OFTEN SIGNIFICANT TRAVEL AND EFFORTS ARE NEEDED TO PROVIDE THESE SERVICES TO PATIENTS IN THE MOST COMFORTABLE SETTING WHICH IS THEIR HOMES. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF BLACK RIVER MEMORIAL HOSPITAL, INC. AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF BLACK RIVER MEMORIAL HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY 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 FORM 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 $ 2,917,699.
PART II, COMMUNITY BUILDING ACTIVITIES:	OUR HOSPITAL PROVIDES FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND SAME DAY APPOINTMENTS THROUGH THE BLACK RIVER HEALTHCARE CLINIC, HOME CARE, HOSPICE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES, AND WOMEN'S HEALTH.
PART III, LINE 2:	THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
PART III, LINE 3:	MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE.
PART III, LINE 4:	ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE 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 FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:	BLACK RIVER MEMORIAL HOSPITAL, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY 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 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF JACKSON COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.
PART III, LINE 9B:	UNDER THE HOSPITAL'S COLLECTION AND COMMUNITY CARE POLICIES, BLACK RIVER MEMORIAL HOSPITAL, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S COMMUNITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE COMMUNITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES.
PART VI, LINE 2:	EVERY THREE YEARS, BRMH CONSIDERS OUR COMMUNITY'S MOST PRESSING HEALTH NEEDS BY CONDUCTING A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE 2019 ASSESSMENT WAS COMPLETED BY A GROUP OF HOSPITAL EMPLOYEES AND INCLUDES QUANTITATIVE AND QUALITATIVE DATA THAT SERVE TO GUIDE BOTH OUR COMMUNITY BENEFIT AND STRATEGIC PLANNING. THROUGH OUR CHNA, BRMH HAS IDENTIFIED THE GREATEST HEALTH NEEDS IN OUR HOSPITAL'S COMMUNITIES ENABLING BRMH TO ENSURE OUR RESOURCES ARE APPROPRIATELY DIRECTED TOWARD OUTREACH, PREVENTION, EDUCATION, AND WELLNESS OPPORTUNITIES WHERE THE GREATEST IMPACT CAN BE ACHIEVED. OUR TOP THREE NEEDS ARE BEHAVIORAL HEALTH CARE (INCLUDING MENTAL HEALTH AND SUBSTANCE USE DISORDER), OBESITY, AND DEMENTIA/ALZHEIMER'S CARE.
PART VI, LINE 3:	UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S PATIENT FINANCIAL ADVOCATES EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE PATIENT FINANCIAL ADVOCATE EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERS THE FINANCIAL ASSISTANCE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGER CARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4:	THE PRIMARY SERVICE AREA FOR BLACK RIVER MEMORIAL HOSPITAL, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 30-MILE RADIUS OF THE HOSPITAL. THIS AREA INCLUDES JACKSON COUNTY AND PARTS OF EAU CLAIRE, MONROE, LA CROSSE, TREMPEALEAU, WOOD, ADAMS, AND CLARK COUNTIES. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE ALMA CENTER, BLAIR, HIXTON, HUMBIRD, MELROSE, MERRILLAN, SPARTA, OSSEO, TOMAH, NEILLSVILLE, AND WHITEHALL. BLACK RIVER MEMORIAL HOSPITAL, INC. IS THE ONLY HOSPITAL LOCATED IN JACKSON COUNTY, WISCONSIN. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS AS WELL AS THE HO-CHUNK NATION (A LOCAL TRIBAL NATION WITH A LARGE PORTION OF ITS POPULATION RESIDING IN JACKSON COUNTY, WISCONSIN). THE HO-CHUNK NATION ALSO IS ABLE TO ACCESS CARE AT THE HOSPITAL AT REDUCED RATES THROUGH A REGULATION KNOWN AS THE "MEDICARE-LIKE PAYMENTS RULE." THE HOSPITAL ALSO IS THE MAIN SUPPLIER OF HEALTH CARE SERVICES TO FIVE STATE OPERATED INSTITUTIONS WHICH ARE OPERATED BY THE WISCONSIN DEPARTMENT OF CORRECTIONS. THE STATE OF WISCONSIN ALSO REIMBURSES THE HOSPITAL AT RATES BELOW THE GENERAL PUBLIC TO REDUCE COSTS PASSED ON TO TAXPAYER IN THE STATE.
PART VI, LINE 5:	AS A COMMUNITY-OWNED HOSPITAL, BLACK RIVER MEMORIAL HOSPITAL, INC. CONTINUES TO BE PROACTIVELY INVOLVED WITH AREA COMMUNITY MEMBERS THROUGH A VARIETY OF EDUCATIONAL FORUMS, SUPPORT GROUPS, WELLNESS AND SAFETY FAIRS, DIABETES FAIR, HO-CHUNK HEALTH FAIR, KIDS' SAFETY CAMP, COMMUNITY CPR AND FIRST AID TRAINING, PRE-NATAL AND BREASTFEEDING CLASSES, AND BABYSITTING CLINICS. OTHER SUPPORT GROUPS NOT ONLY INCLUDE DIABETES AND BEREAVEMENT, BUT WE OFFER A BETTER BREATHERS SUPPORT GROUP AND A BETTER SLEEPERS SUPPORT GROUP. THERE ARE A NUMBER OF LOCAL ORGANIZATIONS THAT ARE REPRESENTED OR FACILITATED BY HOSPITAL STAFF INCLUDING: JACKSON IN ACTION, GREATER BLACK RIVER AREA SAFETY COUNCIL, JACKSON COUNTY HEALTHCARE ALLIANCE, JACKSON COUNTY TOBACCO COALITION, TOGETHER FOR JACKSON COUNTY KIDS, JACKSON COUNTY EMERGENCY MANAGEMENT PLANNING WORKFORCE, AND MANY OTHERS. THE HOSPITAL WELCOMES MEDICAL STUDENTS FOR INTERNSHIPS AND CLINICALS. THE HOSPITAL ALSO PARTICIPATES IN THE MEALS ON WHEELS PROGRAM BY DELIVERING MEALS TO LOCAL SENIORS WHO ARE HOME BOUND. THE HOSPITAL ALSO PROVIDES SUPPORT AND SPONSORSHIP TO THE RED CROSS BLOODMOBILE SEVERAL TIMES A YEAR.
PART VI, LINE 6:	N/A
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BEN BOARDMAN MD
PHYSICIAN	$435,522	$0	$10,000	$0	$15,139	$0	$28,772	$0	$13,534	$0	$502,967	$0	$0	$0
DR CAROL MARTIN
CHIEF OF STAFF/DIRECTOR	$401,345	$0	$10,000	$0	$828	$0	$31,900	$0	$48,498	$0	$492,571	$0	$0	$0
ESTEBAN MILLER MD
CMO	$369,544	$0	$31,667	$0	$540	$0	$31,900	$0	$10,299	$0	$443,950	$0	$0	$0
MARY BETH WHITE-JACOBS
CEO (SECRETARY)	$276,016	$0	$51,883	$0	$2,376	$0	$49,300	$0	$41,036	$0	$420,611	$0	$0	$0
JOSEPH AHN MD
PHYSICIAN	$342,148	$0	$10,000	$0	$360	$0	$31,900	$0	$8,725	$0	$393,133	$0	$0	$0
SMITA RAJASEKARAN MD
PHYSICIAN	$334,735	$0	$10,000	$0	$828	$0	$31,900	$0	$7,934	$0	$385,397	$0	$0	$0
RICHARD MINNIHAN MD
PHYSICIAN	$305,572	$0	$0	$0	$360	$0	$31,900	$0	$7,981	$0	$345,813	$0	$0	$0
MATTHEW STREETER
CFO (THRU JULY)	$100,396	$0	$40,536	$0	$75,723	$0	$12,408	$0	$19,494	$0	$248,557	$0	$0	$0
KYLE KOVACEVICH
CFO	$119,507	$0	$13,560	$0	$7,296	$0	$12,065	$0	$46,396	$0	$198,824	$0	$0	$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	391337855	BondIssuerEIN
Bond Issued	2019-02-01	BondIssuedDt
Issue Price	$24,000,000	IssuePriceAmt
Purpose	HOSPITAL ADDITIONS AND RENOVATIONS; REFUNDING OF 2005 BOND SERIES	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$909,086	RetiredAmt
Total Proceeds	$24,000,000	TotalProceedsAmt
Refunding Escrow	$10,163,311	RefundingEscrowAmt
Issuance Costs From Proceeds	$146,704	IssuanceCostsFromProceedsAmt
Capital Expenditures	$13,689,985	CapitalExpendituresAmt
Substantial Completion	2019	SubstantialCompletionYr
Refunding Tax Exempt Bonds	Yes (1)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	Yes (1)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (1)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Concerning UBI	0.01170	PrivateBusConcerningUBIPct
Total Private Business Use	0.01170	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	0	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	Yes (1)	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	0	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	0	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	0	ProceduresCorrectiveActionInd

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	MICHAEL JACOBS	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	SON OF MARY BETH WHITE-JACOBS, CEO	RelationshipDescriptionTxt
Transaction	$76,919	TransactionAmt
Transaction	EMPLOYMENT COMPENSATION	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	MEMBERSHIP OF BLACK RIVER MEMORIAL HOSPITAL, INC. CONSISTS OF TWO CLASSES, INDIVIDUAL AND GROUP AS FOLLOWS: INDIVIDUAL MEMBERSHIP-ANY ADULT RESIDING WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS HE OR SHE RESIDES WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES. A FAMILY CONTRIBUTION, OR ONE BY EITHER SPOUSE INDIVIDUALLY, ENTITLES BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIP IN THE CORPORATION. GROUP MEMBERSHIP-ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION WITHIN THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHICH HAS CONTRIBUTED THE SUM OF TWENTY DOLLARS OR MORE TO THE 1965 CAMPAIGN FOR THE CONSTRUCTION OF THE HOSPITAL BUILDING SHALL BE ENTITLED TO LIFE MEMBERSHIP AS LONG AS THE ORGANIZATION IS IN EXISTENCE. SUCH ORGANIZATIONS SHALL DESIGNATE ANNUALLY, IN WRITING, ONE PERSON TO ACT ON ITS BEHALF AT MEETINGS OF MEMBERS. MEMBERSHIP SHALL TERMINATE IF THE MEMBER RELINQUISHES MEMBERSHIP OR IF THE MEMBER CEASES TO EXIST. NEW MEMBERS MAY BE ANY ADULT RESIDING WITHIN, OR ANY COMMUNITY GROUP SUCH AS A CHURCH, RELIGIOUS ASSOCIATION, FRATERNAL ORGANIZATION, CHARITABLE ORGANIZATION, VETERANS ORGANIZATION, CIVIC CLUB, BUSINESS ORGANIZATION, OR CORPORATION HAVING AN ESTABLISHED BUSINESS ADDRESS WITHIN, THE GEOGRAPHICAL AREA OF JACKSON COUNTY AND ADJOINING COUNTIES WHO DID NOT CONTRIBUTE TO THE 1965 CAMPAIGN FOR THE HOSPITAL BUILDING MAY THEREAFTER BECOME A LIFE MEMBER AS PROVIDED IN 1 OR 2 ABOVE BY CONTRIBUTING TWENTY DOLLARS ($20.00) OR MORE TO THE CORPORATION, EXCEPT AS OF JUNE 1, 2001, A FAMILY CONTRIBUTION SHALL NO LONGER ENTITLE BOTH HUSBAND AND WIFE TO INDIVIDUAL MEMBERSHIPS IN THE CORPORATION. WHENEVER A NEW INDIVIDUAL MEMBERSHIP IS CREATED, ONE INDIVIDUAL SHALL BE IDENTIFIED AS THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS SHALL ELECT MEMBERS OF THE BOARD OF DIRECTORS. EACH MEMBER IS ENTITLED TO ONE VOTE, AND EACH GROUP MEMBER SHALL, BEFORE THE START OF THE MEETING, DESIGNATE IN WRITING TO THE SECRETARY OF THE CORPORATION THE PERSON ENTITLED TO VOTE FOR THE GROUP MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBERS OF BLACK RIVER MEMORIAL HOSPITAL, INC. HAVE THE AUTHORITY TO VOTE ON ALL MATTERS PRESENTED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B	THE BOARD OF DIRECTORS OF BLACK RIVER MEMORIAL HOSPITAL, INC. RECEIVED A COPY OF THE 990 FOR REVIEW PRIOR TO THE FILING OF THEIR RETURN. MEMBERS OF THE BOARD WILL DO A FORMAL REVIEW OF THE FORM AFTER FILING. THE HOSPITAL'S CHIEF OFFICERS REVIEWED THE RETURN IN DETAIL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICTS OF INTEREST ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. ANY ISSUES WHICH MAY ARISE ARE DISCUSSED AND HANDLED APPROPRIATELY. ANY MEMBER OF THE BOARD OF DIRECTORS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON ANY POTENTIAL CONFLICTED ISSUES. A SIMILAR PROCESS IS USED BY THE BOARD OF DIRECTORS FOR THE REVIEW OF CONFLICTS OF INTEREST WITH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILAR SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN THE SAME REVENUE CATEGORY). THE COMPENSATION OF ADMINISTRATIVE LEVEL EMPLOYEES IS REVIEWED BY THE CEO AND APPROVED IN THE BUDGET BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19	BLACK RIVER MEMORIAL HOSPITAL, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SUMMARIZED FINANCIAL STATEMENT DATA IS ALSO AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION'S WEBSITE AND THE HOSPITAL'S ANNUAL REPORT, WHICH IS PUBLISHED ON THE HOSPITAL'S WEBSITE.
FORM 990, PART IX, LINE 11G	ANESTHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 1,553,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,553,044. RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 697,139. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 697,139. EMERGENCY ROOM FEES: PROGRAM SERVICE EXPENSES 429,666. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 429,666. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 400,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 400,385. MRI/CT/NUCLEAR MED SERVICES: PROGRAM SERVICE EXPENSES 625,209. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 625,209. OTHER: PROGRAM SERVICE EXPENSES 2,177,255. MANAGEMENT AND GENERAL EXPENSES 2,796,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,973,380.
FORM 990, PART XI, LINE 9:	CHANGE IN INTEREST IN NET ASSETS OF FOUNDATON 30,664.