2025-08-14T08:42:55-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 390938661 BURNETT MEDICAL CENTER INC BURN 7154635353 257 WEST SAINT GEORGE AVENUE GRANTSBURG WI 54840 MARK THAYER CEO 7154635353 2025-08-13 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-12 2023 2025-03-06 01:10:19Z MARK THAYER 257 WEST SAINT GEORGE AVENUE GRANTSBURG WI 54840 29220504 0 X WWW.BURNETTMEDICALCENTER.COM X 1956 WI THE MISSION OF BURNETT MEDICAL CENTER IS TO PROVIDE COMPASSIONATE, COMPREHENSIVE, COMMUNITY HEALTHCARE THAT EXCEEDS OUR CUSTOMER'S EXPECTATIONS. OUR MISSION, AS WELL AS OUR VISION AND VALUES, SERVES AS A GUIDELINE FOR DAILY DECISION MAKING AND REPRESENTS THE PRINCIPLES AND PRACTICES THAT WE CONSTANTLY APPLY. THE COMFORT AND CARE OF OUR PATIENTS IS A MAJOR FOCUS OF OURS. WE WANT TO BE THE HEALTHCARE PROVIDER OF "CHOICE" - PROVIDING EXPERT AND COST-EFFECTIVE CARE IN A "HOMETOWN" ATMOSPHERE. ANOTHER OBJECTIVE OF OURS IS TO PROVIDE EDUCATION THAT WILL INCREASE HEALTH AWARENESS. PART OF OUR MISSION IS TO CONTINUALLY PUT THE "CARE" IN HEALTHCARE. MORE HEALTHCARE INFORMATION IS NOW AVAILABLE FROM OUR WEBSITE, WHICH ALSO PROVIDES PATIENT EDUCATION RESOURCES FOR THOSE WE SERVE. 7 7 259 12 0 0 712157 596800 25999729 28516483 62859 72891 34263 34330 26809008 29220504 0 0 0 0 13659173 14784873 0 0 0 13126149 14683861 26785322 29468734 23686 -248230 23043072 23132366 11846796 11871306 11196276 11261060 X THE MISSION OF BURNETT MEDICAL CENTER IS TO PROVIDE COMPASSIONATE, COMPREHENSIVE, COMMUNITY HEALTHCARE THAT EXCEEDS OUR CUSTOMER'S EXPECTATIONS. OUR MISSION, AS WELL AS OUR VISION AND VALUES, SERVES AS A GUIDELINE FOR DAILY DECISION MAKING AND REPRESENTS THE PRINCIPLES AND PRACTICES THAT WE CONSTANTLY APPLY. THE COMFORT AND CARE OF OUR PATIENTS IS A MAJOR FOCUS OF OURS. WE WANT TO BE THE HEALTHCARE PROVIDER OF "CHOICE" - PROVIDING EXPERT AND COST-EFFECTIVE CARE IN A "HOMETOWN" ATMOSPHERE.ANOTHER OBJECTIVE OF OURS IS TO PROVIDE EDUCATION THAT WILL INCREASE HEALTH AWARENESS. PART OF OUR MISSION IS TO CONTINUALLY PUT THE "CARE" IN HEALTHCARE. MORE HEALTHCARE INFORMATION IS NOW AVAILABLE FROM OUR WEBSITE, WHICH ALSO PROVIDES PATIENT EDUCATION RESOURCES FOR THOSE WE SERVE. 0 0 13102793 0 22229610 HOSPITAL:BURNETT MEDICAL CENTER, LOCATED IN RURAL NORTHWEST WISCONSIN IS A 17-BED CRITICAL ACCESS HOSPITAL THAT PROVIDES THE FOLLOWING SERVICES THROUGHOUT A THREE-COUNTY REGION:ACUTE CARE HAS 50+ EMPLOYEES WHO ALSO WORK IN OR, ER, AND PAR. WE PROVIDE GENERAL INPATIENT MEDICAL AND SURGICAL CARE, AS WELL AS A LARGE VOLUME OF OUTPATIENT SERVICES WHICH INCLUDE: OP SURGERY, CHEMOTHERAPY, BLOOD TRANSFUSION, IV THERAPY AS EXAMPLES. ALL OF THE RN STAFF IS ACLS ACCREDITED AND THE ENTIRE STAFF IS CERTIFIED IN CPR. THE GOAL OF THE NURSING STAFF IS TO PROVIDE EXCELLENT PATIENT CARE, CLOSE TO HOME, NEAR FAMILY AND FRIENDS.WE ALSO PROVIDE A FULL RANGE OF SERVICES FROM A 24/7 ER TO CARDIAC REHAB, AND WE PROVIDE OTHER THERAPEUTIC AND DIAGNOSTIC SERVICES VIA RADIOLOGY, LAB, PHYSICAL THERAPY, AND OCCUPATIONAL THERAPY.DURING FY2024, IN A TOTAL OF 720 PATIENT DAYS WE SERVED 359 PATIENTS IN OUR INPATIENT AND SWING BED PROGRAMS. WE PERFORMED 177 SURGICAL PROCEDURES, SAW 3434 PATIENTS IN EMERGENCY, AND PROVIDED SERVICES FOR 14342 OTHER OUTPATIENT VISITS. GROSS HOSPITAL REVENUE OF $180,416 WAS PROVIDED AS CHARITY CARE TO 75 DIFFERENT PATIENTS FOR 155 EPISODES OF CARE.SINCE JUNE OF 2004, BURNETT MEDICAL CENTER HAS BEEN PARTICIPATING IN A PROGRAM DEVELOPED BY ABBOTT NORTHWESTERN HOSPITAL AND THE MINNEAPOLIS HEART INSTITUTE. THE LEVEL 1 HEART ATTACK PROGRAM IS AN INNOVATIVE APPROACH TO TREATING PATIENTS SUFFERING FROM A HEART ATTACK. THE KEY INGREDIENT FOR SUCCESS IS SPEED IN TREATMENT. THE GOAL IS TO TREAT AND TRANSPORT PATIENTS WITHIN 120 MINUTES, MEANING 120 MINUTES FROM THE TIME A PATIENT ENTERS THE EMERGENCY ROOM AT BURNETT MEDICAL CENTER UNTIL THE FIRST BALLOON IS INFLATED OR STENT PLACED AT ABBOTT NORTHWESTERN HOSPITAL (ABNW).BECAUSE RURAL HOSPITALS DO NOT HAVE THE CAPABILITY TO DO ANGIOPLASTY, IT IS IMPORTANT TO MOVE A HEART ATTACK PATIENT TO THE NEAREST HOSPITAL THAT HAS A HEART CATHETERIZATION LAB. THE LEVEL 1 PROGRAM HAS A DEFINITE PROTOCOL TO MOVE THESE PATIENTS QUICKLY DURING THAT "GOLDEN HOUR" WHEN ANGIOPLASTY IS THE MOST SUCCESSFUL.BURNETT MEDICAL CENTER IS ONE OF 30 HOSPITALS IN MINNESOTA AND WISCONSIN PARTICIPATING IN THE LEVEL 1 PROGRAM. CLEARLY, THE LEVEL 1 PROGRAM IS ADVANTAGEOUS TO RESIDENTS OF BURNETT COUNTY, KNOWING THAT CARDIOVASCULAR DISEASE IS THE LEADING CAUSE OF DEATH FOR MEN AND WOMEN IN THE US. THIS TEAM APPROACH GIVES PATIENTS THE ADVANTAGE OF TIME WHICH TRANSLATES TO BETTER OUTCOMES AND DECREASED MORTALITY. BURNETT MEDICAL CENTER'S MEDICAL AND NURSING STAFF HAVE BEEN TRAINED FOR THIS PROGRAM AND ARE PREPARED AND PLEASED TO PROVIDE QUICK ACCESS TO EFFICIENT CARDIAC CARE THROUGH THE LEVEL 1 HEART ATTACK PROGRAM. 5210981 0 3319383 CLINIC:BURNETT MEDICAL CENTER CLINIC IS LOCATED JUST OFF HIGHWAY 70 IN GRANTSBURG AND IS PART OF OUR EXPANDED FACILITY. THE CLINIC IS STAFFED BY 19 EMPLOYEES INCLUDING (2) PHYSICIANS, (5) CERTIFIED NURSE PRACTITIONERS, AND (1) CERTIFIED NURSE MIDWIFE. SERVED SPECIALISTS INCLUDING A GENERAL SURGEON, A PULMONOLOGIST, AN INTERNAL MEDICINE PHYSICIAN AND OTHERS ALL SEE PATIENTS IN THE CLINIC.WE ARE PLEASED TO OFFER OUR PATIENTS A RANGE OF SERVICES INCLUDING: PHYSICALS (INCLUDING WELL CHILD CHECKS, PRE-OPERATIVE, DOT, ETC.), OBSTETRICAL EXAMS, HEALTH STATUS ASSESSMENTS, DIAGNOSIS AND TREATMENT OF COMMON, ACUTE AND CHRONIC HEALTH CONDITIONS, IMMUNIZATIONS, FAMILY PLANNING, DIABETIC EDUCATION, WOMEN'S HEALTH, COLONOSCOPY PROCEDURES, FRACTURE CARE, VASECTOMIES, ROUTINE LABORATORY TESTING, EKG'S, AND HOLTER MONITORING. ADDITIONALLY, THE CLINIC LABORATORY IS A CERTIFIED COLLECTION SITE FOR URINE DRUG SCREENING.HOURS OF OPERATION HAVE BEEN EXPANDED TO ALLOW PEOPLE INCREASED ACCESS, INCLUDING WORKING FAMILIES WITH SCHOOL-AGE CHILDREN, PEOPLE THAT WORK VARYING SHIFTS, ETC. OUR PROVIDERS HAVE COLLABORATIVE RELATIONSHIPS WITH AREA INDUSTRIES, INCLUDING THE LOCAL SCHOOL SYSTEMS. THIS ALLOWS BURNETT MEDICAL CENTER TO PROVIDE EDUCATIONAL OPPORTUNITIES TO EMPLOYEES OF THESE INDUSTRIES, INCLUDING BLOODBORNE PATHOGENS TRAINING, HEALTH EDUCATION TO SCHOOL CHILDREN, AND PARTICIPATION IN EMPLOYEE HEALTH FAIRS. BMC PROVIDERS PARTICIPATE IN THE LOCAL ROTARY GROUP AND IN COUNTY COALITIONS TO REDUCE PRESCRIPTION DRUG ABUSE AND IMPROVE AWARENESS OF WELLNESS ACTIVITIES IN THE AREA. WE ALSO SPONSOR AN ANNUAL 5K/10K EVENT THAT RAISES FUNDS FOR A LOCAL CHARITY WHILE PROMOTING HEALTHY LIFESTYLES. THIS YEAR IS OUR 17TH ANNUAL! OVER 11,505 PRIMARY CARE CLINIC VISITS AND SPECIALTY CLINIC VISITS 941 WERE PROVIDED DURING FY 2024. CLINIC GROSS REVENUE OF $28,268 WAS PROVIDED AS CHARITY CARE TO 44 DIFFERENT PATIENTS IN 108 VISITS. 4234234 0 2967490 CONTINUING CARE:THE CONTINUING CARE CENTER OF BURNETT MEDICAL CENTER OFFERS 46 SEMI-PRIVATE AND 4 PRIVATE ROOM ACCOMMODATIONS AND A FULL RANGE OF HEALTH AND PERSONAL CARE SERVICES. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY ARE AVAILABLE, AS WELL AS NUTRITIONAL SERVICES, RECREATIONAL ACTIVITIES, AND SOCIAL SERVICES. ADDITIONALLY, ADULT DAY CARE AND RESPITE CARE IS AVAILABLE. THE GOAL OF THE CONTINUING CARE CENTER'S STAFF IS TO PROVIDE NECESSARY HEALTH SERVICES WHILE MAINTAINING AN ATMOSPHERE OF HOPE, HARMONY, HUMOR, AND A "HOME" AWAY FROM HOME.WE STRIVE TO ENHANCE THE QUALITY OF RESIDENTS' LIFE VIA A VENUE FOR COMMUNITY-BASED VOLUNTEERS SHARING THEIR TIME AND TALENT WITH OUR RESIDENTS, SUCH AS MUSICAL BANDS, ROTARY CLUB SPONSORED FUNCTIONS, ETC.DURING FY 2024 WE HAD 10,601 RESIDENT DAYS SERVING ABOUT 84 DIFFERENT RESIDENTS. 22548008 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 17 0 259 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MARK THAYER 7154635353 257 WEST SAINT GEORGE AVE GRANTSBURG WI 54840 PATRICK TAYLOR PRESIDENT 0.50 X X 0 0 0 CHRIS SYBERS VICE PRESIDENT 0.50 X X 0 0 0 JULIE FIEDLER SECRETARY/TREASURER 0.50 X X 0 0 0 RANDY CAREY DIRECTOR 0.50 X 0 0 0 LOIS CARLSON DIRECTOR 0.50 X 0 0 0 JOHN HILL DIRECTOR 0.50 X 0 0 0 TAYLOR PAAP DIRECTOR 0.50 X 0 0 0 GORDON LEWIS CEO 40.00 X 251360 0 10235 GORDON FORBORT CFO 40.00 X 110000 0 0 TIMOTHY NOVICK MD 40.00 X 357842 0 48949 JORDAN FRASER MD 40.00 X 237530 0 51140 MARK THAYER MD 40.00 X 202239 0 41544 LINAE HICKS NURSE PRACTITIONER 40.00 X 180993 0 49229 ANDERS ULLAND MD/SURGEON 40.00 X 198877 0 16846 1538841 0 217943 20 0 1 0 SF HOLDING LLC 2195 160TH ST CROIX FALLS WI 54024 ANESTHESIA 423048 WIPFLI LLP PO BOX 3160 MILWAUKEE WI 53201 AUDIT/IT SERVICES 249139 SPORTING INNOVATION LLC 1434 182ND AVE NEW RICHMOND WI 54017 MD ER 140460 MEADOWS ANESTHESIA INC 10513 STONEBRIDGE TRAIL N STILLWATER MN 55082 ANESTHESIA 126324 4 595250 1550 596800 HOSPITAL PATIENT SERVICE REVENUE 621990 20300719 20300719 CLINIC PATIENT SERVICE REVNUE 621110 3319383 3319383 NURSING HOME RESIDENT SERVICE REV 623000 2967490 2967490 PHARMACY REVENUE 456110 1928891 1928891 28516483 72891 72891 11080 0 11080 11080 11080 CAFETERIA REVENUE 900099 13826 13826 9424 9424 23250 29220504 28516483 0 107221 X 343563 343563 11213882 9185082 2028800 240633 198680 41953 2203945 1770839 433106 782850 628228 154622 144154 144154 82744 82744 11346 11346 5432364 5031528 400836 105264 105264 1882525 223932 1658593 242475 242475 397845 397845 92747 70993 21754 201702 162494 39208 1177809 962425 215384 146384 146384 MEDICAL SUPPLIES 2315833 2315833 REPAIRS & MAINTENANCE 1133738 525134 608604 BAD DEBT EXPENSE 881899 881899 MINOR EQUIPMENT 155696 154665 1031 279336 38431 240905 29468734 22548008 6920726 0 250 250 4775637 4295504 4120497 4552633 343185 367051 108247 108592 29417520 19831277 9599881 9586243 2888594 3270845 1206781 951248 23043072 23132366 2366966 2940163 8042363 7595708 1437467 1335435 11846796 11871306 X 11150275 11221459 46001 39601 11196276 11261060 23043072 23132366 X -248230 98264 214750 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4993 4993 0 PART II-B, LINE 1: BURNETT MEDICAL CENTER, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED BURNETT MEDICAL CENTER, INC. THAT $4,993($2,223 TO AHA, $1,202 TO WHA AND $1,568 TO LEADING AGE) OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 50000 50000 20653930 13902328 6751602 8713590 5928949 2784641 9586243 457(B) PLAN PAYABLE 972105 HEALTH AND HUMAN SERVICES ACCELERATED AND ADVANCED PAYMENT PROGRAM 175 OPERATING LEASE OBLIGATIONS 363155 1335435 28055995 98264 200950 299214 27756781 1463723 1463723 29220504 28586835 0 28586835 881899 881899 29468734 PART XI, LINE 2D - OTHER ADJUSTMENTS: CMDI EQUITY GAINS 200,950. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 881,899. GRANTS RECEIVED FOR PROPERTY AND EQUIPMENT ACQUISITIONS 581,824. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 881,899. 1 1 X 1 X 1 X 1 1 1 0 1 1 39011 39011 0.00130 5170630 3515562 1655068 0.05620 5209641 3515562 1694079 0.05750 4340489 1745515 2594974 0.08810 1266 1266 0.00000 4341755 1745515 2596240 0.08810 9551396 5261077 4290319 0.14560 0 536179 268090 6327592 6254946 72646 X 1 1 1 1 BURNETT MEDICAL CENTER INC 257 WEST SAINT GEORGE AVENUE GRANTSBURG WI 54840 1034 X X X X BURNETT MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X SEE SUPPLEMENTAL INFORMATION X HEALTHYBURNETT.ORG X X 1 24 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X X 1 X 0 X X X X 1 X 0 0 BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS, EFFORTS WERE MADE TO ENGAGE AND GATHER INPUT FROM INDIVIDUALS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY SERVED. THIS WAS ACCOMPLISHED IN THE FOLLOWING CAPACITIES:1. CHNA CORE PARTNERS: AS THE PRIMARY DRIVERS OF THE PROCESS, FACILITATORS OF THE CHNA FROM BURNETT MEDICAL CENTER AND BURNETT COUNTY DHHS-PUBLIC HEALTH, EACH BROUGHT KNOWLEDGE OF THEIR POPULATION SERVED, THEIR NEEDS, AND RESOURCES CURRENTLY AVAILABLE TO ADDRESS THOSE NEEDS. CORE PARTNERS ARE ALSO ACTIVELY INVOLVED IN OTHER COMMUNITY HEALTH-RELATED GROUPS AND CONVEYED INPUT REGARDING THE HEALTH NEEDS OF THE GROUPS' RESPECTIVE TARGET POPULATIONS THROUGHOUT THE PROCESS.2. SURVEY: THE SURVEY WAS AVAILABLE TO THE PUBLIC FOR ABOUT 1 MONTH AND WAS DISTRIBUTED ONLINE THROUGH VARIOUS CHANNELS SUCH AS FACEBOOK, BURNETT MEDICAL CENTER'S WEBSITE, AND MULTIPLE MASS EMAILS TO ORGANIZATIONS AND INDIVIDUALS. THE SURVEY ASKED RESPONDENTS TO IDENTIFY WHAT THEY PERCEIVED TO BE THE THREE BIGGEST HEALTH PROBLEMS AND RISKY BEHAVIORS AMONG BURNETT COUNTY RESIDENTS. DEMOGRAPHIC QUESTIONSABOUT INCOME, INSURANCE TYPE, AND RACE/ETHNICITY, AMONG OTHERSWERE ALSO ASKED TO IDENTIFY MEMBERS OF DIFFERENT POPULATIONS AND THUS ENSURE THEIR REPRESENTATION. BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: BURNETT COUNTY DHHS-PUBLIC HEALTH BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 7D: LINE 7A:BURNETTMEDICALCENTER.COMLINE 10A:BURNETTMEDICALCENTER.COM BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: IN RESPONSE TO THE REQUIREMENTS UNDER THE AFFORDABLE CARE ACT, BURNETT MEDICAL CENTER (BMC), IN PARTNERSHIP WITH THE BURNETT COUNTY DHHS-PUBLIC HEALTH, JOINTLY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WHICH HAS BEEN HIGHLIGHTED IN OUR PREVIOUS 990, SCHEDULE H SUBMISSIONS. AS A RESULT OF THIS PARTNERSHIP, WE, ALONG WITH MANY PUBLIC AND PRIVATE HEALTHCARE INTERESTS, WORK COLLABORATIVELY VIA THE FORMATION OF HEALTHY BURNETT, AN ENTERPRISE THAT SEEKS AND WELCOMES OTHER COMMUNITY MEMBERS AND ORGANIZATIONS TO WORK TOGETHER IN ADDRESSING THE MOST COMPELLING NEEDS IDENTIFIED VIA THE CHNA. THE UNPRECEDENTED GLOBAL PANDEMIC REQUIRED ALL HANDS-ON DECK TO ADDRESS THE CATACLYSMIC IMPACT OF COVID 19, AT THE EXPENSE OF OTHER IDENTIFIED AND COMPELLING COMMUNITY CHALLENGES. THE HEALTHY BURNETT COALITION HAS NOT MET IN PERSON SINCE THE START OF THE PANDEMIC AND THE PLAN IS TO RESUME IN-PERSON MEETINGS ONCE THE PUBLIC HEALTH EMERGENCY IS LIFTED.ACCORDINGLY, BURNETT MEDICAL CENTER'S INVOLVEMENT AND COMMITMENT TO THE IDENTIFIED ISSUES REMAIN: ALCOHOL AND OTHER DRUG ABUSE (AODA): BMC SEEKS TO IMPROVE ACCESS TO COUNSELING BY KEEPING AN UPDATED LIST OF AODA COUNSELING SERVICES AND COLLABORATING WITH AODA STAKEHOLDERS TO ASSIST THE COMMUNITY IN EARLY REFERRAL AND POTENTIAL TREATMENT. BMC CONTINUES TO PROVIDE EDUCATION AND PROMOTION OF CURRENT RESOURCES THROUGH EVENTS AND USE OF SOCIAL MEDIA. AS OF RECENT, BMC HAS ALSO STARTED, AND IS CO-LEADING, A NEW COALITION CALLED YOUTH OF BURNETT COUNTY (YOBC), WHICH AIMS TO IMPACT YOUTH IN BURNETT COUNTY, SPECIFICALLY PREVENTION EFFORTS FOCUSED ON NICOTINE, TOBACCO/VAPING USE.BEHAVIORAL HEALTH: BURNETT MEDICAL CENTER (BMC) WILL IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES BY WORKING TOWARDS OFFERING ADULT PSYCHIATRIC SERVICES VIA TELEMEDICINE WITH THE POTENTIAL OF ADDING PEDIATRIC/ADOLESCENT TELEPSYCHIATRY SERVICES IN THE FUTURE. ALREADY THROUGH YOBC, BMC HAS BEEN APART OF THE EFFORTS TO FUND A MOTIVATIONAL SPEAKER TO SPEAK AT ALL THREE SCHOOL DISTRICTS IN BURNETT COUNTY, SPREADING THE MESSAGE THAT EACH CHILD MATTERS. THE COUNTY ALSO HAS A NEW CRISIS LINE AND BMC HAS BEEN HELPING SPREAD THE WORD WITH NEW INTERNAL POSTERS, BUSINESS CARDS, AND SHARING THIS NEW NUMBER ON SOCIAL MEDIA.INFECTIOUS DISEASE: BURNETT MEDICAL CENTER (BMC) INCREASED ACCESS, EDUCATED, AND PREVENTED FURTHER SPREAD OF COVID-19 BY REVAMPING THE CLINIC LOBBY TO IMPLEMENT A MASS VACCINATION CLINIC FOR TWO TO THREE MONTHS. ONCE THE SURGE SLOWED DOWN, BMC THEN DESIGNATED STAFF TO ADMINISTER COVID-19 VACCINES IN THE CLINIC ONCE A WEEK. BMC NEWSLETTERS HAVE BEEN USED TO CONTINUE TO EDUCATE THE COMMUNITY ABOUT COVID-19 AND HOW IMPORTANT IT IS TO GET VACCINATED, WEAR A MASK, AND SOCIAL DISTANCE, WHEN APPROPRIATE. BURNETT COUNTY PUBLIC HEALTH AND BMC UPDATED THE COMMUNITY WITH VARIOUS COVID UPDATES VIA SOCIAL MEDIA AS WELL.AS REQUIRED, BMC AND OUR PARTNERS ARE FOCUSED ON RE-CONVENING TO PLAN, STUDY, IDENTIFY AND ADJUST THE CONTINUING AND NEW OPPORTUNITIES ASSUMING WE WILL NOT BE PRECLUDED BY A CONTINUATION OF ANY FUTURE COVID RESTRICTIONS THAT MAY ARISE, THUS PRECLUDING THE REQUISITE INFORMATION GATHERING AND CONSENSUS BUILDING, WHICH HAS BEEN OUR HALLMARK.BURNETT MEDICAL CENTER IS THE SOLE HOSPITAL IN BURNETT COUNTY (880 SQUARE MILES). WE ARE A 17-BED, RURAL CRITICAL ACCESS HOSPITAL, COMBINED WITH AN EMPLOYED PROVIDER RURAL HEALTH CLINIC, 24/7 EMERGENCY DEPARTMENT, AND A 50-BED LONG-TERM CARE CENTER. AS SUCH, WE TAKE OUR MISSION SERIOUSLY, AND REMAIN-EVER FOCUSED ON OUR DAILY CALLING OF PROVIDING QUALITY, COMPASSIONATE CARE. MINDFUL OF OUR MISSION--WE, LIKE FEDERAL, STATE, AND LOCAL GOVERNMENT--MUST BALANCE THE MANY COMPELLING AND COMPETING NEEDS, WITHIN A SEVERELY CONSTRAINED RESOURCE ENVIRONMENT. THERE IS GREAT NEED AMONG THOSE WE SERVE. WE ACKNOWLEDGE THE MANY COMPETING HEALTH ISSUES INHERENT IN SERVING A POPULATION THAT HAS FEWER FINANCIAL RESOURCES, THAT IS OLDER, AND IS MORE GEOGRAPHICALLY DISPERSED THAN THAT OF EITHER THE STATE OR THE NATION.WE ARE ACUTELY AWARE AND RECOGNIZE THAT THERE ARE MANY OTHER COMPELLING HEALTHCARE ISSUES. WHILE WE CAN AND DO IDENTIFY THESE NEEDS, WE ARE FORCED TO PRIORITIZE THE MOST NEEDED AND COMPELLING AS DETERMINED BY OUR CHNA PROCESS, AND WITHIN THE LIMITED RESOURCES AVAILABLE IN A POOR, RURAL COUNTY. BE ASSURED THAT AS RESOURCES AND GRANT-FUNDING MAY BECOME AVAILABLE, BURNETT MEDICAL CENTER, WILL CONTINUE TO ALLOCATE TIME, TALENT, AND RESOURCES TO THE SIGNIFICANT HEALTH NEEDS THAT HAVE BEEN CAPTURED IN OUR CONSENSUS-BUILDING CHNA PROCESS. BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 13H: HOMELESSNESS IS ALSO A DETERMINATION FACTOR. BURNETT MEDICAL CENTER, INC. PART V, SECTION B, LINE 16J: REGISTRATION AND CLINIC PERSONNEL OFTEN REFER UNINSURED AND LOW-INCOME INDIVIDUALS TO A FINANCIAL COUNSELOR TO DISCUSS THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 16A HTTPS://WWW.BURNETTMEDICALCENTER.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE/ 2 1 - BURNETT MEDICAL CENTER CLINIC 257 W ST GEORGE AVE GRANTSBURG WI 54840 PROVIDER BASED RURAL HEALTH CLINIC 2 - THE CONTINUING CARE CENTER OF BURNETT MEDICAL CENTER 257 W ST GEORGE AVE GRANSTBURG WI 54840 SKILLED NURSING FACILITY PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE MEDICAL CENTER'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: THE COST OF SUBSIDIZED SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDE THE OPERATION OF THE CLINIC. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH BURNETT MEDICAL CENTER, INC. IT HAS BEEN THE GOAL OF BURNETT MEDICAL CENTER, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY. PART II, COMMUNITY BUILDING ACTIVITIES: WE ARE CLOSE TO THE COMMUNITIES WE SERVE AND TAKE AN ACTIVE ROLE IN ADDRESSING THE ROOT FACTORS CONTRIBUTING TO OUR COMMUNITY'S HEALTH STATUS. WE DO SO THROUGH OUR INVOLVEMENT IN COMMUNITY-BUILDING PARTNERSHIPS THAT ADDRESS ECONOMIC DEVELOPMENT AND COMMUNITY HEALTH IMPROVEMENT ISSUES.THE ORGANIZATION'S CEO SERVES AS A BOARD MEMBER OF THE GRANTSBURG INDUSTRIAL DEVELOPMENT CORPORATION (GIDC) AS WELL AS THE BURNETT COUNTY DEVELOPMENT ASSOCIATION (BDCA). THESE ORGANIZATIONAL ENTERPRISES SEEK TO ENCOURAGE ECONOMIC GROWTH IN BURNETT MEDICAL CENTER'S PRIMARY SERVICE AREA. GIDC AND BDCA HAVE A STRONG HISTORY OF BRINGING NEW INDUSTRY INTO THE AREA WHICH RESULTS IN INCREASED EMPLOYMENT OPPORTUNITIES AND STRENGTHENS THE LOCAL ECONOMY. KNOWING THAT UNEMPLOYMENT LEADS TO AN INCREASE IN UNHEALTHY BEHAVIORS-WHICH IN TURN CAN LEAD TO INCREASED RISK FOR DISEASE OR MORTALITY-GIDC'S AND BDCA'S MISSION OF ENCOURAGING ECONOMIC GROWTH FAVORABLE AND DIRECTLY IMPACTS THE HEALTH OF BURNETT MEDICAL CENTER'S SERVICE AREA. 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 MEDICAL CENTER'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CHARITY CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE MEDICAL CENTER ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITY CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS 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 OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE 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. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES. EVEN THOUGH THE HOSPITAL PROVIDES THIS INFORMATION TO ALL PATIENTS, A SMALL AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL 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 AMOUNTSDUE 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 MEDICAL CENTER 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 AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: BURNETT MEDICAL CENTER, INC. IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUE IS PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE MEDICAL CENTER FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT BURNETT MEDICAL CENTER, INC. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY 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 BURNETT MEDICAL CENTER, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF GRANTSBURG, 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 MEDICAL CENTER PATIENT SERVICE REVENUE (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 AND MID-LEVEL PRACTITIONER SERVICES WHICH THE MEDICAL CENTER WOULD SHOW A LARGE LOSS ON THESE SERVICES. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: PATIENTS RECEIVE OUR COMMUNITY CARE APPLICATION WHEN THEY PRESENT FOR SERVICES. THEY ARE ENCOURAGED TO REVIEW THE APPLICATION AND SUBMIT THE REQUIRED INFORMATION TO APPLY FOR POTENTIAL COVERAGE. IF THEY HAVE QUESTIONS OR NEED HELP WITH THE APPLICATION THEY MAY MEET WITH OUR FINANCIAL COUNSELOR AND/OR OUR BUSINESS OFFICE MANAGER. PART VI, LINE 2: WE CONTINUE TO RELY ON MARKETING AND DEMOGRAPHIC DATA FOR BOTH OUR PRIMARY AND SECONDARY SERVICE AREAS AS SUPPLIED BY THE WISCONSIN HOSPITAL ASSOCIATION THROUGH KAAVIO. SUCH MARKET-BASED ANALYSIS PROVIDES EVIDENCE-BASED ESTIMATES AND PROJECTIONS FOR THE MEDICAL NEEDS OF THOSE THAT LIVE WITHIN OUR SERVICE AREA. WE THEN ASSESS THE AVAILABILITY OF EXISTING HEALTHCARE PROVIDERS AND SERVICES TO DETERMINE WHAT GAPS MAY EXIST, AND HOW WE CAN BEST ALIGN OUR SERVICES IN ORDER TO BE ENGAGED IN THE ABILITY TO ADDRESS UNMET NEED IN PARTNERSHIP WITH BOTH PUBLIC AND PRIVATE PROVIDERS OF HEALTHCARE SERVICES. THE RESULT OF OUR REVIEW AND ANALYSIS SERVES AS A FUNDAMENTAL BASIS FOR THE DEVELOPMENT OF GOALS AND OBJECTIVES IN OUR STRATEGIC PLAN.FURTHERMORE, AS REQUIRED BY LAW, WE CONDUCT AND COMPLETE, ONCE EVERY THREE YEARS, A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AS REQUIRED UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, AND RELY ON OUR FINDINGS TO DETERMINE ANY NEEDED CHANGES OR CHALLENGES IN OUR FOCUS. IN CONDUCTING THE CHNA, BOTH QUANTITATIVE AND QUALITATIVE DATA, IS COLLECTED IN COLLABORATION WITH THE BURNETT COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES-PUBLIC HEALTH.QUANTITATIVE DATA SOURCES INCLUDING THE COUNTY HEALTH RANKINGS, THE UNITED STATES CENSUS BUREAU, THE WISCONSIN DEPARTMENT OF HEALTH SERVICES, WISCONSIN INTERACTIVE STATISTICS ON HEALTH, AND THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM WERE RELIED UPON AND USED TO ASSESS THE HEALTH NEEDS OF THE SERVICE AREA BY COMPARING COUNTY-LEVEL DATA FOR GIVEN INDICATORS OF HEALTH TO STATE AND NATIONAL BENCHMARKS. WE INTEGRATED THIS QUANTITATIVE DATA WITH THE QUALITATIVE DATA THAT WAS GATHERED FROM COMMUNITY MEMBERS AND ORGANIZATIONS TO DEVELOP A BETTER UNDERSTANDING OF COMMUNITY PERCEPTIONS OF THE SERVICE AREA'S HEALTH NEEDS. THIS DATA IS GATHERED THROUGH (1) AN INTERNET-BASED SURVEY AND PAPER SURVEY OF APPROXIMATELY 400 INDIVIDUALS, (2) FOCUS GROUPS, AND (3) A KEY INFORMANT INTERVIEW. HOWEVER, DUE TO THE PANDEMIC, ONLY THE SURVEY WAS CONDUCTED.THE RESULTS OF THE ASSESSMENT ARE USED ALONG WITH KNOWLEDGE OF EXISTING ASSETS AVAILABLE TO MEET IDENTIFIED HEALTH NEEDS IN DEVELOPING AN IMPLEMENTATION STRATEGY THAT DELINEATES HOW BURNETT MEDICAL CENTER WILL TARGET EXISTING PROGRAMS AND RESOURCES, TARGET AND DEPLOY ANY AVAILABLE ADDITIONAL RESOURCES, AND COLLABORATE WITH OTHER COMMUNITY ENTITIES TO ADDRESS THE IDENTIFIED HEALTH NEEDS. FURTHERMORE, BURNETT MEDICAL CENTER HAS TAKEN A LEAD ROLE IN FORMULATING A COMMUNITY-WIDE PLAN TO ADDRESS THE TOP HEALTH NEEDS IDENTIFIED THROUGH THE CHNA. THE PLAN IS BEING EXECUTED BY THE COMMUNITY COLLABORATIVE "HEALTHY BURNETT" THAT WAS CREATED AS A RESULT OF THE CHNA TO ADDRESS THE IDENTIFIED HEALTH NEEDS. PART VI, LINE 3: PATIENTS ARE TOLD ABOUT OUR COMMUNITY CARE PROGRAM BY OUR FINANCIAL COUNSELOR, REGISTRATION STAFF, PATIENT ACCOUNT REPRESENTATIVES AND BUSINESS OFFICE MANAGER. IN ADDITION, WE HAVE SIGNS POSTED BY BOTH OUR CLINIC AND ER REGISTRATION AREAS INFORMING OUR PATIENTS OF THE COMMUNITY CARE PROGRAM AVAILABLE AT OUR FACILITY. IF THE PATIENT FEELS THEY WILL NEED ASSISTANCE WITH THEIR MEDICAL BILLS, THEY ARE ENCOURAGED TO APPLY FOR THE COMMUNITY CARE PROGRAM WITH ALL THE REQUIRED INFORMATION. FINALLY, PATIENTS ALSO HAVE ACCESS TO THE COMMUNITY CARE APPLICATION INFORMATION ON OUR WEBSITE, FOR EASIER ACCESS FOR OUR PATIENTS. WHILE WE DO NOT HAVE ANY CERTIFIED APPLICATION COUNSELORS, WE ARE CHARTER MEMBERS THAT JOINED THE FEDERAL GOVERNMENT'S CHAMPIONS FOR COVERAGE CAMPAIGN TO HELP EDUCATE PEOPLE ABOUT AND TO PROMOTE THE HEALTH INSURANCE MARKETPLACE. AS A CHAMPION FOR COVERAGE, WE HAVE UNDERTAKEN INITIATIVES TO DIRECT PEOPLE TO THE MARKETPLACE, INCLUDING SENDING OUR PATIENTS TO THE OFFICIAL CONSUMER SOURCES (HEALTHCARE.GOV WEBSITE AND CONSUMER CALL CENTER) TO LEARN ABOUT THE MARKETPLACE AND GET COVERAGE, HANGING POSTERS AND FACT SHEETS IN OUR FACILITY, INCLUDING AN ARTICLE ABOUT THE MARKETPLACE IN OUR QUARTERLY COMMUNITY NEWSLETTER, AND HAVING STAFF LEARN ABOUT THE MARKETPLACE IN EDUCATION SESSIONS. WE HAVE ALSO PARTICIPATED IN A COUNTY-WIDE EDUCATION SESSION ON THE NEW HEALTHCARE EXCHANGE AND HAVE WILLINGLY PROVIDED POSITIVE, RESPONSIVE ANSWERS TO MEDIA INQUIRIES. PART VI, LINE 4: LOCATED IN RURAL NORTHWESTERN WISCONSIN, BURNETT COUNTY IS THE PRIMARY SERVICE AREA FOR BURNETT MEDICAL CENTER (BMC) AND BMC IS THE SOLE HOSPITAL IN BURNETT COUNTY. WHILE BURNETT MEDICAL CENTER IS A 17 BED FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL, IT ALSO HAS A 50-BED LONG TERM CARE CENTER, AS WELL AS A PRIMARY CARE CLINIC. FURTHERMORE, BURNETT COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA/POPULATION (ID NUMBER 03764), HAVING BEEN SO DESIGNATED ON JUNE 28, 1984. NOT LIMITED TO SERVING JUST BURNETT COUNTY, BURNETT MEDICAL CENTER ALSO PROVIDES CARE FOR RESIDENTS IN VARYING DEGREES TO RESIDENTS LIVING IN ONE OF THE FOUR ADJOINING WISCONSIN COUNTIES (DOUGLAS, WASHBURN, POLK, AND BARRON) AS WELL AS TWO ADJOINING COUNTIES IN MINNESOTA (PINE AND CHISAGO). BOTH BURNETT COUNTY IN WISCONSIN AND PINE COUNTY IN MINNESOTA ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS, AND THE REMAINING COUNTIES AFOREMENTIONED, HAVE AREAS WITHIN THEIR COUNTIES DESIGNATED AS MEDICALLY UNDERSERVED AS WELL. DEMOGRAPHICALLY, BASED ON THE MOST CURRENTLY AVAILABLE US CENSUS DATA, THE 2020 ESTIMATES FOR BURNETT COUNTY REFLECT A POPULATION OF 15,363. BURNETT COUNTY'S MEDIAN AGE OF 53.1 YEARS ABOUT 1.3 TIMES OLDER THAN THE REST OF WISCONSIN (39.6 YEARS) AND THE UNITED STATES (38.2 YEARS). THE POPULATION OF BURNETT COUNTY IS PREDOMINATELY WHITE (90%) BUT HAS A NOTABLE NATIVE AMERICAN POPULATION (3%). ROUGHLY $10,000 LOWER THAN WISCONSIN, THE AVERAGE HOUSEHOLD INCOME OF BURNETT COUNTY WAS $53,555. FURTHERMORE, THE UNEMPLOYMENT RATE OF BURNETT COUNTY WAS 3%, COMPARED WITH 2.3% FOR WISCONSIN. DESPITE OUR RURAL LOCATION IN NORTHWEST WISCONSIN, WE ARE IN A RELATIVELY COMPETITIVE MARKET AS RESIDENTS FROM BOTH OUR PRIMARY AND SECONDARY SERVICE AREAS HAVE ACCESS TO TEN HOSPITALS (IN EITHER WISCONSIN OR MINNESOTA) WITHIN 50 MILES OF BURNETT MEDICAL CENTER'S GEOGRAPHIC LOCATION IN GRANTSBURG, WISCONSIN. AS STATED PREVIOUSLY, BURNETT MEDICAL CENTER OPERATES AN EMPLOYED-PROVIDER MEDICAL CLINIC WHICH IS ONE OF MANY COMPETITOR CLINICS WITHIN OUR PRIMARY AND SECONDARY MARKETS. FINALLY, WE TAKE OUR ROLE AS A VITAL PART OF A NECESSARY HEALTH CARE SAFETY NET FOR ALL SERIOUSLY, INCLUDING THE UNINSURED, AS EVIDENCED BY OUR 24/7 EMERGENCY DEPARTMENT WHICH PROVIDES EMERGENT, URGENT, AND PRIMARY CARE TO ALL THAT PRESENT TO THE EMERGENCY DEPARTMENT. WE STAND READY AS, WITH PRIDE, WE ARE ACUTELY AWARE OF OUR MISSION OF SERVICE TO EVERY PATIENT, EVERY MINUTE, OF EVERY DAY. PART VI, LINE 5: AS A SOLE COMMUNITY RURAL HOSPITAL, WE TAKE PRIDE IN BEING CLOSE TO THOSE WE SERVE. WE SHARE WITH THE COMMUNITY VIA PRINT, SOCIAL, AND ONLINE MEDIA OUTLETS RELEVANT AND HELPFUL KNOWLEDGE OF OUR SERVICES, AS WELL AS EDUCATIONAL INFORMATION ON VARIOUS HEALTH TOPICS. WE ALSO SHARE AND PROMOTE OUR MISSION THROUGHOUT THE COMMUNITIES SERVED. WE LEARN DIRECTLY FROM THOSE WE SERVE BY OUR BOARD OF DIRECTORS GOVERNING STRUCTURE WHICH IS COMPOSED OF SEVEN UNCOMPENSATED COMMUNITY VOLUNTEERS FROM THROUGHOUT BURNETT COUNTY, THAT RESIDE IN EITHER OUR PRIMARY OR SECONDARY SERVICE AREA, NONE OF WHICH ARE NEITHER EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS. WE ENJOY THE CONTINUED SUPPORT OF OUR COMMUNITY VIA A HEALTHCARE FOUNDATION, WHICH PROVIDES PHILANTHROPIC SUPPORT TO FULFILLING THE HOSPITAL'S MISSION. IN ORDER TO ENSURE CONTINUED AND READY ACCESS TO QUALIFIED HEALTHCARE PROVIDERS, WE TAKE PRIDE IN HAVING AN OPEN MEDICAL STAFF MODEL THAT EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN OUR COMMUNITY. WHEN WE HAVE SURPLUS FUNDS, THOSE FUNDS, COMBINED WITH OUR LOCAL FOUNDATION AND OTHER GRANTS OBTAINED THROUGH COMPETITIVE PROCESSES, ARE USED FOR IMPROVEMENTS IN PATIENT CARE AND QUALITY, AS EVIDENCED BY THE PURCHASE OF NEW AND NEEDED CAPITAL EQUIPMENT. WE ALSO HAVE CONTINUED INVESTMENTS TOWARDS A NEW ELECTRONIC MEDICAL RECORD, AND WE REMAIN FOCUSED ON ACHIEVING THE GOALS OF FEDERALLY ESTABLISHED MEANINGFUL USE GUIDELINES AND EXPECTATIONS. ADVOCACY OF THE COMMUNITY'S HEALTHCARE NEEDS ARE DONE LOCALLY BY MEMBERS OF THE BOARD SPEAKING WITH LOCAL OFFICIALS ON RELEVANT ISSUES THAT MAY AFFECT THE HOSPITAL. ADDITIONALLY, THE ORGANIZATION'S CEO CONTINUES TO SERVE AS A MEMBER OF THE WISCONSIN HOSPITAL ASSOCIATION'S PUBLIC POLICY COUNCIL, AS WELL AS A MEMBER OF THE HOSPITAL ASSOCIATION'S NETWORK ADEQUACY TASK FORCE, AND TELEMEDICINE TASK FORCE IN SUPPORT OF THE ASSOCIATION'S MISSION AND STRATEGIC PLAN THAT EMPHASIZES ADVOCACY FOR INITIATIVES FOR COMMUNITY, STATE AND NATIONAL EFFORTS FOR IMPROVING THE OVERALL HEALTH OF THE POPULATION AND CONTINUED READY ACCESS TO QUALITY HEALTHCARE FOR ALL. FINALLY, MINDFUL OF THE NEED FOR SUPPORT OF VARIOUS METHODS OF INSURANCE, WE ARE PROUD OF OUR PARTICIPATION IN SUCH GOVERNMENTALLY-SPONSORED HEALTHCARE PROGRAMS SUCH AS MEDICARE, MEDICAID, AND TRICARE, ALL OF WHICH HAVE AN INCREASED FOCUS ON THE PROVISION OF VALUED BASED SERVICES, TO INCLUDE AN INCREASED EMPHASIS ON PREVENTATIVE CARE SERVICES. SUCH SERVICES FOCUS ON THE EARLY DETECTION AND INTERVENTION(S) WHICH ARE DESIGNED TO PREVENT OR DELAY THE HARMFUL ASPECTS MORE CHRONIC HEALTH CONDITIONS, SUCH AS DIABETES AND CONGESTIVE HEART FAILURE. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X 0 0 0 0 0 0 0 0 0 TIMOTHY NOVICK MD 356282 0 0 0 1560 0 8805 0 40144 0 406791 0 0 0 JORDAN FRASER MD 237368 0 0 0 162 0 7441 0 43699 0 288670 0 0 0 GORDON LEWIS CEO 224789 0 25000 0 1571 0 7494 0 2741 0 261595 0 0 0 MARK THAYER MD 200262 0 0 0 1977 0 6094 0 35450 0 243783 0 0 0 LINAE HICKS NURSE PRACTITIONER 180170 0 0 0 823 0 0 0 49229 0 230222 0 0 0 ANDERS ULLAND MD/SURGEON 198184 0 0 0 693 0 4076 0 12770 0 215723 0 0 0 A BURNETT COUNTY 396005675 2007-03-23 7000000 TO REFINANCE AND PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION 0 0 0 B VILLAGE OF GRANTSBURG 396006277 2007-04-10 5000000 TO PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION 0 0 0 C VILLAGE OF SIREN 396008452 2007-04-25 4850000 TO PROVIDE FUNDS FOR BUILDING RENOVATION AND EXPANSION 0 0 0 A 4011599 7000000 140000 5464764 1395236 2008 1 0 1 1 B 2859427 5000000 100000 4900000 2008 0 0 1 1 C 2773645 4850000 97000 4753000 2008 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 FORM 990, PART VI, SECTION A, LINE 6 EACH PERSON, BUSINESS, CORPORATION, OR ORGANIZATION WHO HAS CONTRIBUTED AND PAID ONE HUNDRED DOLLARS OR MORE TO BURNETT MEDICAL CENTER, INC. "THE MEDICAL CENTER" SHALL BE A LIFETIME MEMBER OF THE MEDICAL CENTER. EACH PERSON, BUSINESS, CORPORATION, OR ORGANIZATION IS ENTITLED TO HOLD A MAXIMUM OF ONE MEMBERSHIP CERTIFICATE. A HUSBAND AND WIFE, OR TWO OR MORE RELATED PERSONS, MAY HOLD A MEMBERSHIP AS JOINT TENANTS, HOWEVER, ONLY ONE VOTE PER MEMBERSHIP SHALL BE PERMITTED. FORM 990, PART VI, SECTION A, LINE 7A THE DUTIES OF THE MEMBERS OF THE MEDICAL CENTER SHALL BE: THE FORMULATION AND DEVELOPMENT OF THE OVERALL PURPOSES, OBJECTIVES, AND PHILOSOPHY OF THE MEDICAL CENTER; THE ELECTION OF MEMBERS OF THE BOARD OF DIRECTORS OF THE MEDICAL CENTER; THE REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS OF THE MEDICAL CENTER; THE CHANGING OF THE NUMBER OF DIRECTORS CONSTITUTING THE BOARD OF DIRECTORS; THE AMENDMENT, RESTATEMENT, OR MODIFICATION OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE MEDICAL CENTER; AND THE APPROVAL OF THE SALE, LEASE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL OF THE ASSETS AND PROPERTY OF THE MEDICAL CENTER OR ITS MERGER WITH ANOTHER CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS FOR BURNETT MEDICAL CENTER, INC. REVIEWS AND APPROVES FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BURNETT MEDICAL CENTER, INC. HAS A CONFLICT OF INTEREST POLICY. THE PURPOSE OF THIS POLICY IS TO PROTECT THE INTEREST OF THE MEDICAL CENTER WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE CORPORATION. IT IS EXPECTED THAT SUCH PERSONS SHALL EXERCISE THE UTMOST GOOD FAITH IN ALL TRANSACTIONS TOUCHING UPON THEIR DUTIES AT BURNETT MEDICAL CENTER, INC. AND ITS PROPERTY. ALL MEMBERS OF THE BOARD COMPLETE A DISCLOSURE FORM UPON APPOINTMENT, AND REVIEW AND SIGN IT ANNUALLY THEREAFTER. THIS STATEMENT ESTABLISHES THE DUTY OF AN INTERESTED PARTY TO DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST DISCLOSE ALL MATERIAL FACTS. AFTER ANY SUCH DISCLOSURE, HE/SHE SHALL LEAVE THE GOVERNING BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING BOARD MEMBERS. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS OF SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF MEMBERS FAIL TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 BURNETT MEDICAL CENTER INC.'S EXECUTIVE COMPENSATION POLICY IS DESIGNED WITH THE GOAL OF PROVIDING REMUNERATION THAT IS FAIR, REASONABLE, AND COMPETITIVE. THE MEDICAL CENTER'S BOARD MAY ESTABLISH A COMPENSATION COMMITTEE OR MAY ACT AS A COMMITTEE OF THE WHOLE IN EXECUTIVE SESSION. THE COMMITTEE OVERSEES THE TOTAL COMPENSATION PACKAGES TO ENSURE THAT THEY ARE COMPETITIVE WITH OTHER HEALTHCARE ORGANIZATIONS, REFLECT JOB RESPONSIBILITIES AND REQUIREMENTS, AND ARE FAIR, EQUITABLE, AND CONSISTENTLY MANAGED. THE COMMITTEE MEETS AS OFTEN AS IT DEEMS APPROPRIATE TO CARRY OUT ITS RESPONSIBILITIES. IN GENERAL, THE MEDICAL CENTER POSITIONS TOTAL EXECUTIVE COMPENSATION AT THE MEDIAN OF THE MARKET. THE BOARD OF DIRECTORS USES CONTEMPORANEOUS DATA INCLUDING EXECUTIVE COMPENSATION DATA FROM THE WISCONSIN HOSPITAL ASSOCIATION AS A GUIDE WHEN APPROVING THE COMPENSATION OF THE ADMINISTRATOR AND CHIEF FINANCIAL OFFICER. THE POLICY IS MEANT TO BE FLEXIBLE SO THAT COMPENSATION CAN BE ABOVE OR BELOW THE MEDIAN BASED ON EXPERIENCE, PERFORMANCE, SIZE AND COMPLEXITY OF ORGANIZATION, AND BUSINESS NEED TO ATTRACT AND RETAIN EXECUTIVE TALENT. FORM 990, PART VI, SECTION C, LINE 19 BURNETT MEDICAL CENTER, INC. MAKES ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. FORM 990, PART IX, LINE 11G RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 548,357. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 548,357. ANESTHESIOLOGY CONTRACT LABOR: PROGRAM SERVICE EXPENSES 546,585. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 546,585. CLINIC PURCHASED SERVICES AND CONTRACT LABOR: PROGRAM SERVICE EXPENSES 631,936. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 631,936. LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 271,483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 271,483. DIETARY PURCHASED SERVICES AND CONTRACT LABOR: PROGRAM SERVICE EXPENSES 362,056. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 362,056. EMERGENCY CONTRACT LABOR: PROGRAM SERVICE EXPENSES 953,626. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 953,626. MEDICAL AND ADMIN PURCHASED SERVICES AND CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,717,485. MANAGEMENT AND GENERAL EXPENSES 400,836. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,118,321. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 13,800. CHANGE IN INVESTMENT IN UNCONSOLIDATED AFFILIATE 200,950. FORM 990, PART XII, LINE 2C: OVERSIGHT OF THE AUDIT: BURNETT MEDICAL CENTER, INC. DOES NOT HAVE A SPECIFIC COMMITTEE WHICH ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.