2025-08-13T10:57:04-05:00 2024-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-10-01 390944012 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS MOUN 6083393331 402 WEST LAKE STREET FRIENDSHIP WI 53934 FRANK PEREZ-GUERRA CEO 6083393331 2025-08-12 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-08-06 2023 2025-03-06 01:10:19Z GUNDERSEN MOUNDVIEW HOSPITAL & CLINICS FRANK PEREZ-GUERRA 402 WEST LAKE STREET FRIENDSHIP WI 53934 36914548 0 X WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW X 1959 WI TOGETHER, WE INSPIRE YOUR BEST LIFE BY RELENTLESSLY CARING, LEARNING AND INNOVATING. 9 5 175 70 0 0 92084 122479 24924368 35884432 359449 699809 159664 194687 25535565 36901407 0 600 0 0 8400294 18352667 0 0 0 15846048 16115872 24246342 34469139 1289223 2432268 21024749 24370099 2702190 3618761 18322559 20751338 X LEADING WITH LOVE, WE COURAGEOUSLY COMMIT TO A FUTURE OF HEALTHY PEOPLE AND THRIVING COMMUNITIES. THIS IS OUR VISION. 1 0 21114658 600 22357772 THE HOSPITAL IS A GENERAL MEDICAL CRITICAL ACCESS HOSPITAL LICENSED FOR 25 BEDS. DURING FISCAL YEAR 2024, THE HOSPITAL HAD 402 ACUTE INPATIENT DAYS AND 1,110 SWING-BED DAYS. THE HOSPITAL ALSO HAD 7,781 EMERGENCY ROOM/URGENT CARE AND 10,715 CLINIC VISITS. 9207053 0 13592747 THE HOSPITAL ALSO HAS AN OUTPATIENT PHARMACY THAT IS THE ONLY IN ITS COUNTY (ADAMS, WI), AND IN 2024 FILLED 94,453 PRESCRIPTIONS. 30321711 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 209 0 175 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X FRANK PEREZ-GUERRA 6083393331 402 WEST LAKE STREET FRIENDSHIP WI 53934 SARAH ROSSMAN TREASURER/SECRETARY 2.00 48.00 X X 158797 0 27560 STEPHANIE CARROLL BOARD TRUSTEE/MD HOSPITALIST 2.00 48.00 X 312603 0 65146 BRYAN ERDMANN BOARD TRUSTEE/COO 2.00 48.00 X 409876 0 74345 ROXANNE POTTS BOARD TRUSTEE/CLINICAL OPS. DIRECTOR 2.00 48.00 X 168885 0 46658 TADD WORMET CHAIR 2.00 X X 0 0 0 PAUL FISCH VICE CHAIR 2.00 X X 0 0 0 LAURIE INDA BOARD TRUSTEE 2.00 X 0 0 0 KAREN MILLER BOARD TRUSTEE 2.00 X 0 0 0 JOE THEISEN BOARD TRUSTEE 2.00 X 0 0 0 FRANK PEREZ-GUERRA CEO 48.00 2.00 X 198119 0 54078 SCOTT RATHGABER CEO-BGHS 2.00 48.00 X 0 1644221 68728 STEVE LITTLE CFO-BGHS (THRU 02/2024) 2.00 48.00 X 0 333317 0 JOHN CEELEN CFO-BGHS (BEG. 02/2024) 2.00 48.00 X 0 0 0 DEENA KEDROWSKI OUTPATIENT PHARMACY MANAGER 40.00 X 197266 0 38061 DAVID BROWN PHARMACIST 40.00 X 188852 0 6576 NEIL DONNER PHARMACIST 40.00 X 181812 0 13202 PRESTON PIETRZAK PHARMACIST 40.00 X 155181 0 18585 BRAD SHAW INPATIENT PHARMACY MANAGER 40.00 X 202982 0 5226 GERALD OETZEL FORMER CFO-BGHS 0.00 0.00 X 0 555068 18108 2174373 2532606 436273 19 1 1 0 COMPHEALTH PO 972651 DALLAS TX 753972651 CONTRACT STAFFING SERVICES 690702 STAFFENCY 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT RN/LAB SERVICES 621524 NUWEST GROUP HOLDINGS PO BOX 9410 SEATTLE WA 981246404 CONTRACT NURSING SERVICES 510674 MEDICAL SOLUTIONS LLC PO BOX 850737 MINNEAPOLIS MN 554850737 CONTRACT NURSING SERVICES 469717 SOUND CHOICE IMAGING LLC 36976 BRIDLEWOOD LANE OCONOMOWOC WI 53066 CONTRACT RN/LAB/IMAGING SERVICES 364753 8 109783 12696 122479 NET PATIENT SERVICE REVENUE 621300 22228625 22228625 PHARMACY 456110 13592747 13592747 MEDICAL BUILDING RENT 531120 53859 53859 9201 9201 35884432 699809 699809 18610 13141 5469 5469 5469 E.H.R INCENTIVE 900099 66087 66087 CAFETERIA 722514 31125 31125 92006 92006 189218 36901407 35950519 0 828409 600 600 1516069 1516069 14081952 13536647 545305 824267 824267 1216913 1136657 80256 713466 621520 91946 990696 990696 14467 14467 42230 42230 4703 4703 1929818 1845603 84215 42633 569 42064 432822 322802 110020 9564 9564 661583 617569 44014 108170 106682 1488 21816 16234 5582 5432 5432 616392 328461 287931 65278 65278 MEDICAL SUPPLIES 10109407 10109407 PHARMACY DRUGS AND VACC 617322 617322 BAD DEBT EXPENSE 149876 16143 133733 DUES AND SUBSCRIPTIONS 79798 24634 55164 213865 187030 26835 34469139 30321711 4147428 0 1175 1065 10781880 13432114 3049390 3687711 702338 854301 80154 84246 9704381 4176598 5593555 5527783 731667 715000 84590 67879 21024749 24370099 1559189 1890174 3658 4058 201991 168775 937352 1555754 2702190 3618761 X 17783559 20137338 539000 614000 18322559 20751338 21024749 24370099 2432268 -3489 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4703 4703 0 PART II-B, LINE 1: MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA) & AMERICAN HOSPITAL ASSOCIATION VIA WHA, AND THE RURAL WISCONSIN HEALTH COOPERATIVE. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT BUT DISCUSSIONS WITH EACH ENTITY REVEAL A PERCENTAGE OF THEIR WORK, AND THUS A PERCENTAGE OF THE DUES EXPENSE IS DEDICATED TO LOBBYING SERVICES. 76500 76500 6199280 1812444 4386836 3041201 1987208 1053993 387400 376946 10454 5527783 DUE TO RELATED PARTY 466961 403 (B) PLAN 663145 PAYABLES TO THIRD-PARTY REIMBURSEMENT PROGRAMS 425648 1555754 X PART X, LINE 2: GUNDERSEN HEALTH SYSTEM HAS REVIEWED TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO LIABILITIES EXIST FOR UNCERTAIN TAX POSITIONS. THE SYSTEM'S INCOME TAX RETURNS ARE NO LONGER SUBJECT TO EXAMINATION FOR 2018 AND PRIOR YEARS. 1 1 X 1 X 1 X 1 1 1 0 1 1 703693 703693 0.02050 4853620 2606876 2246744 0.06550 5557313 2606876 2950437 0.08600 234269 16150 218119 0.00640 31583 31583 0.00090 8232648 6963093 1269555 0.03700 8498500 6979243 1519257 0.04430 14055813 9586119 4469694 0.13030 1 78361 3291 6420958 6456304 -35346 X 1 1 1 1 MOUNDVIEW MEMORIAL HOSPITAL & CLINICS 402 WEST LAKE STREET PO BOX 40 FRIENDSHIP WI 53934 WWW.GUNDERSENHEALTH.ORG/MOUNDVIEW 1014 X X X X MOUNDVIEW MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 23 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.GUNDERSENHEALTH.ORG/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MOUNDVIEW MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: MOUNDVIEW MEMORIAL HOSPITAL & CLINICS DID NOT CONDUCT A NEW SURVEY IN 2024. WE USED THE 52 QUESTION SURVEY THAT WAS PART OF THE CHNA THAT WE PARTICIPATED IN WITH ADAMS COUNTY HEALTH AND HUMAN SERVICES. THE SURVEY PRIMARILY INCLUDED A MIX OF RANKING QUESTIONS AND "CHECK ALL THAT APPLY" QUESTIONS. SOME EXAMPLES OF THE QUESTIONS INCLUDED: DEMOGRAPHICS, RATING OF THE COMMUNITY AND OPPORTUNITIES AVAILABLE IN THE COMMUNITY (JOBS, SOCIAL/RECREATIONS, SCHOOLS, CHILDCARE PROVIDERS, AFFORDABLE HOUSING, SAFETY, POLICE/SHERIFF, AVAILABLE RESOURCES) THE NEED FOR TRANSPORTATION, HEALTH SERVICES, FOOD; THEIR CONCERN FOR VARIOUS HEALTH ISSUES IN THE COMMUNITY SUCH AS MENTAL HEALTH, JOB LOSS, POVERTY, ALCOHOL AND DRUG USE), THEIR CONCERN FOR SAFETY RELATED ISSUES, WHAT THEY FELT WERE THE MOST IMPORTANT HEALTH PROBLEMS IN THE COMMUNITY. THE SURVEY TOOK PLACE THROUGHOUT THE SUMMER OF 2021 NOT 2024. WE USED THE 2021 SURVEY AS PART OF THE DATA FOR OUR 2024 NEEDS ASSESSMENT. WE THEN COLLECTED ADDITIONAL DATA IN 2024 THROUGH KEY INFORMANT INTERVIEWS, A COMMUNITY FOCUS GROUP AND KEY STAKEHOLDER MEETING WITH HEALTH NEEDS RANKINGS. MOUNDVIEW MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: GUNDERSEN HEALTH SYSTEM MOUNDVIEW MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: ADAMS COUNTY HEALTH AND HUMAN SERVICES - DIVISION OF PUBLIC HEALTH MOUNDVIEW MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: MENTAL HEALTHOVERALL GOAL: DEVELOP INITIATIVES TO IMPROVE THE MENTAL HEALTH OF AREA RESIDENTS. REDUCE THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS IN THE LAST 30 DAYS TO LESS THAN THE 5.1 DAYS REPORTED IN THE 2024 COUNTY HEALTH RANKINGS.ACTION: MENTAL HEALTH SUPPORT FOR THOSE EXPERIENCING LOSSPROGRAMS/INITIATIVES:- ESTABLISH A STRUCTURED, RESEARCH BASED LOCAL GRIEF SUPPORT PROGRAM FOR THE DEATH OF LOVED ONE.ACTION: RESILIENCY FOR DISADVANTAGED YOUTHPROGRAMS/INITIATIVES:- GROW THE SCHOOL MENTOR PROGRAM TO INCLUDE STAFF FROM TWO COMMUNITY BUSINESSES OR AGENCIES THAT ARE NOT AFFILIATED WITH GUNDERSEN.ACTION: WORK WITH COMMUNITY PARTNERS ON MENTAL HEALTH INITIATIVES.- CONTINUE TO SERVE ON AND PARTICIPATE IN THE COUNTY MENTAL HEALTH COMMUNITY ACTION TEAM AND RELATED INITIATIVES.- ESTABLISH A ONESTOP LOCATION FOR AREA RESOURCES AND EVENTS FOR THE BENEFIT OF AREA RESIDENTS' OVERALL MENTAL AND PHYSICAL HEALTH.ACCESS TO CAREOVERALL GOAL: IMPROVE ACCESS TO HEALTHCARE PROVIDERS THROUGH RECRUITMENT AND RETENTION EFFORTS AND ENCOURAGING AREA YOUTH TO ENTER HEALTHCARE CAREERS. IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO RESULT IN DECREASED CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE.ACTION: IMPROVE ACCESS TO AREA RESOURCES AND SERVICESPROGRAMS/INITIATIVES:- IMPROVE LOCAL TRANSPORTATION OPTIONS THROUGH A MULTIAGENCY APPROACH. CONTINUE SERVING ON THE TRANSPORTATION COMMUNITY ACTION TEAM.ACTION: IMPROVE NUTRITION AND PHYSICAL ACTIVITY TO DECREASE CHRONIC ILLNESS, THEREBY REDUCING THE NEED FOR CARE.PROGRAMS/INITIATIVES:PROGRAMS/INITIATIVES:- INCREASE AWARENESS AND ENCOURAGE USE OF LOCAL PHYSICAL ACTIVITY AND NUTRITION RESOURCES TO DECREASE OBESITY.- DEVELOP TARGETED PROGRAMS/INITIATIVES THROUGH THE COMMUNITY ACTION TEAMACTION: IMPROVE ACCESS TO HEALTHCARE SERVICESPROGRAMS/INITIATIVES:- IMPLEMENT PEDIATRIC MOBILE CARE VAN PILOT PROGRAM IN FRIENDSHIP.- CONTINUE RECRUITMENT OF SPECIALISTS AND PRIMARY CARE PHYSICIANS.- IMPROVE ACCESS TO SURGICAL SERVICES.ACTION: ADDRESS CAREER SHORTAGE AREAS BY OFFERING JOB EXPLORATION, CLINICALS AND INTERNSHIP OPPORTUNITIES.PROGRAMS/INITIATIVES:- GROW THE HEALTH CAREER ACADEMY AT AF HIGH SCHOOL- OFFER 8TH GRADE CAREER TOURS AND ESTABLISH NEW CAREER EXPLORATION OPPORTUNITIES FOR YOUNGER STUDENTS.- CONTINUE TO OFFER JOB SHADOWS, INTERNSHIPS AND SUBSTANCE ABUSEOVERALL GOAL: DECREASE THE DRUG OVERDOSE DEATHS TO LESS THAN THE 26 OVERDOSE DEATHS REPORTED FROM 20192023 BY THE ADAMS COUNTY SHERRIFF'S DEPARTMENT.ACTION: PARTNER WITH LOCAL AGENCIES ON TREATMENT PLANS FOR DRUG OFFENDERSPROGRAMS/INITIATIVES:- LAB SUPPORT FOR DRUG COURT SCREENINGS- PROVIDE SPACE AND SUPPORT TO NOBLE COMMUNITY CLINIC (BEHAVIORAL HEALTH)ACTION: PARTICIPATE IN LOCAL EDUCATION AND DECREASE AVAILABILITY OF PRESCRIPTION DRUGSPROGRAMS/INITIATIVES:- PARTICIPATE IN DRUG FREE ADAMS COUNTY PROGRAMS AND OTHER INITIATIVES.- PROMOTE DRUG TAKE BACK PROGRAMS.- MAINTAIN THE MEDICATION DROP BOX SPONSORED BY HOSPITAL PHARMACY.SOCIAL DETERMINANTS OF HEALTH (THAT SIMULTANEOUSLY IMPACT ECONOMIC HEALTH, PARTICULARLY HOUSING, WORKFORCE & ECONOMIC DEVELOPMENT, TRANSPORTATION, EDUCATION & CHILDCARE)OVERALL GOAL: IMPROVE THE HEALTH AND WELLBEING OF RESIDENTS AND THE COUNTY'S ECONOMY. THE ROOT CAUSE OF MANY HEALTH BEHAVIORS AND OUTCOMES CAN BE TIED TO POVERTY/LOW INCOME. IN ADAMS COUNTY THIS IS COMPOUNDED BY OVER HALF OF THE WORKFORCE NOT LIVING IN THE AREA, IMPACTING THE ECONOMY AND OVERALL HEALTH OUTCOMES. WE SEEK TO INCREASE THE COUNTY'S MEDIAN HOUSEHOLD INCOME ($55,223) AND DECREASE THE MEDIAN WORKFORCE AGE (55.1 YEARS) BY WORKING WITH OTHERS ON INITIATIVES TO ATTRACT/KEEP YOUNGER RESIDENTS AND FAMILIES AND ENCOURAGE BUSINESS DEVELOPMENT.ACTION: PARTNER WITH OTHERS IN THE COMMUNITY ON THE CREATION OF LOCAL ECONOMIC DEVELOPMENTPROGRAMS/INITIATIVES:- SERVE ON THE RURAL PARTNERS NETWORK HOUSING COMMITTEE (GOAL OF INCREASING AVAILABLE, ATTRACTIVE WORKFORCE HOUSING AS OVER HALF OF THE COUNTY WORKFORCE DOES NOT LIVE IN THE AREA AND THEREFORE DOES NOT SUBSTANTIALLY CONTRIBUTE TO THE LOCAL ECONOMY)- SERVE ON THE RURAL PARTNERS NETWORK DOWNTOWN IMPROVEMENT COMMITTEE (GOAL OF IMPROVING THE LOOK, FEEL, OFFERINGS AND ACTIVITIES OF DOWNTOWN ADAMS AND FRIENDSHIP TO MAKE THE CENTER OF THE COUNTY A MORE APPEALING PLACE TO HELP RETAIN AND RECRUIT WORKERS AND IMPROVE THE AREA ECONOMY)- SERVE ON THE RURAL PARTNERS WORKFORCE DEVELOPMENT COMMITTEE (GOAL OF ATTRACTING NEW BUSINESSES TO THE AREA AND HELPING EXISTING BUSINESSES RECRUIT AND RETAIN QUALIFIED STAFF TO IMPROVE THE AREA ECONOMY)- SERVE ON THE COUNTY ECONOMIC DEVELOPMENT BOARD AND/OR OTHER RELATED INITIATIVES.ACTION: ADDRESS THE CHILDCARE SHORTAGEPROGRAMS/INITIATIVES:- SERVE ON THE ADAMS COUNTY CHILDCARE ALLIANCE COMMITTEE TO HELP IMPROVE THE AVAILABILITY OF LOCAL CHILDCARE OPTIONSACTION: ADDRESS TRANSPORTATION NEEDSPROGRAMS/INITIATIVES:- LISTED UNDER HEALTHCARE ACCESS ACTION: PROVIDE SUPPORT FOR LOCAL SCHOOLSPROGRAMS/INITIATIVES:- ASSIST WITH SCHOOL IMPROVEMENT AND/OR REFERENDUM COMMITTEES AS NEEDED. (SCHOOLS ARE ONE OF THE CORNERSTONES OF A SUCCESSFUL COMMUNITY)ACTION: OFFER INCENTIVES AND SCHOLARSHIPS WITH A FOCUS ON LOCAL, NON-TRADITIONAL STUDENTS PURSUING HIGH-NEED HEALTHCARE CAREERSPROGRAMS/INITIATIVES:- PROVIDE HEALTHCARE SCHOLARSHIPS WITH THE CONTINGENCY THAT THE STUDENT WORKS LOCALLY.- PROVIDE MENTORING FOR YOUTH RECEIVING SCHOLARSHIPS MOUNDVIEW MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. PART V, SECTION B LINE 7A HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48911 PART V, SECTION B LINE 10A HTTPS://WWW.GUNDERSENHEALTH.ORG/DOCUMENT/48906 2 1 - GUNDERSEN FRIENDSHIP CLINIC 402 WEST LAKE STREET PO BOX 40 FRIENDSHIP WI 53934 RURAL HEALTH CLINIC 2 - GUNDERSEN WESTFIELD CLINIC 207 NORTH PIONEER PARK ROAD WESTFIELD WI 53964 RURAL HEALTH CLINIC PART I, LINE 3C: HOSPITAL PATIENTS NOT MEETING FINANCIAL ASSISTANCE ELIGIBILITY THRESHOLDS MAY BE ELIGIBLE FOR ASSISTANCE UNDER CIRCUMSTANCES WHEN HOSPITAL MEDICAL BILLS WOULD RESULT IN SEVERE FINANCIAL HARDSHIP. PATIENTS, OR THEIR GUARANTORS, MAY BE ELIGIBLE FOR CATASTROPHIC CARE ASSISTANCE IF THEY HAVE INCURRED OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY GMV THAT EXCEED 25% OF FAMILY INCOME AND HAVE ASSETS BELOW THE EQUIVALENT OF 600% OF THE FPL THRESHOLD. PART I, LINE 7: THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. PART I, LINE 7G: THE ORGANIZATION OPERATES 2 RURAL HEALTH CLINICS, AN OBSERVATION ROOM AND EMERGENCY ROOM WHERE THE COSTS EXCEED THE NET PATIENT SERVICE REVENUE. THESE SERVICES WOULD NOT BE PROVIDED TO THE COMMUNITY IF NOT FOR THE LEADERSHIP OF THE HOSPITAL. THE ORGANIZATION UTILIZED THEIR COST REPORT AND OTHER INTERNAL INFORMATION TO DETERMINE THE AMOUNTS TO BE RECORDED PER WORKSHEET 6 OF THE IRS FORM SCHEDULE H INSTRUCTIONS. AMOUNTS RECORDED HERE HAVE NOT BEEN DUPLICATED IN OTHER AREAS OF THE FORM, MEDICAID, BAD DEBT, FINANCIAL ASSISTANCE HAS BEEN REMOVED FROM THE AMOUNTS REPORTED AND THESE SERVICES WERE EXCLUDED FROM THE MEDICARE SURPLUS/SHORTFALL CALCULATION. 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 $ 149,876. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTES HEALTH OF THE COMMUNITIES IT SERVES THROUGH LOCAL ADVERTISEMENTS, INVOLVEMENT WITH CHAMBER OF COMMERCE, DEPARTMENT OF AGING AND OTHER COMMUNITY ORGANIZATIONS. THE AMOUNT OF SUPPORT IS DIFFICULT TO QUANTIFY. PART III, LINE 2: THE RATIO OF PATIENT COST TO CHARGES WAS CALCULATED BY DIVIDING HOSPITAL EXPENSES NET OF NON-PATIENT REVENUE AND IDENTIFIED COMMUNITY BENEFIT EXPENSE BY GROSS PATIENT REVENUE. THE PERCENTAGE WAS THEN MULTIPLIED BY THE GROSS REVENUES ON BAD DEBT ACCOUNTS. PART III, LINE 3: IT IS CONSIDERED COMMUNITY BENEFIT AS THE HOSPITAL IS REIMBURSED ON MEDICARE ALLOWABLE COSTS. MEDICARE ALLOWABLE COSTS ARE DEFINED BY MEDICARE. THEY DO NOT NECESSARILY CAPTURE ALL COSTS OF THE HOSPITAL PROVIDING SERVICES TO THE COMMUNITY. CONSEQUENTLY, THERE ARE COSTS NOT REIMBURSED BY EITHER PATIENT OR THE PROGRAM. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND CURRENT STATUS OF INDIVIDUAL ACCOUNTS.IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 ORGANIZATION 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 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 ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE BASED ON ITS 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 COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUE DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE ORGANIZATION AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUE FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MOUNDVIEW MEMORIAL HOSPITAL & CLINICS PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: PATIENTS UPON REGISTRATION ARE GIVEN THE POLICY AND REQUIREMENTS TO BE ELIGIBLE FOR CHARITY CARE. THEY ARE ENCOURAGED BY A FINANCIAL ADVISOR TO REVIEW THEIR SITUATION FOR ELIGIBILITY. PART VI, LINE 2: THE HOSPITAL COMMUNICATES REGULARLY WITH PUBLIC HEALTH TO ADDRESS COMMUNITY HEALTH NEEDS. WE ANNUALLY REVIEW LOCAL, REGIONAL AND STATE DATA SOURCES. THE HOSPITAL COMPLETES REPORTS ON INFECTIOUS AND COMMUNICABLE DISEASE AND MONITORS FOR OUTBREAKS. ANNUAL RISK ASSESSMENTS ARE COMPLETED ON TB AND INFECTION CONTROL ISSUES. THE HOSPITAL MEASURES CHRONIC DISEASE SCREENING RATES. THE HOSPITAL REVIEWS DATA RELEVANT TO WORK BEING COMPLETED THROUGH THE LOCAL COMMUNITY ACTION TEAMS WHO ARE ADDRESSING THE PRIORITIZED HEALTH NEEDS. PART VI, LINE 3: THE HOSPITAL ANNUALLY UPDATES THE AVAILABILITY OF ITS CHARITY PLAN AND QUALIFYING INCOME NEEDS TO QUALIFY ON THE HOSPITAL WEBSITE. THE EXISTENCE OF A CHARITY PLAN IS POSTED IN THE ADMITTING AREA. UPON REGISTRATION, THE PATIENT IS INFORMED OF THE HOSPITAL'S CHARITY PLAN, ELIGIBILITY, AND METHODS FOR APPLYING. ANYONE INTERESTED IN FURTHER INFORMATION IS REFERRED TO THE PATIENT ACCOUNT COORDINATOR FOR QUESTIONS AND ELIGIBILITY. THIS PERSON WORKS WITH THE PATIENT IN APPLICATION AS WELL AS EXPLORING THE POSSIBLE ELIGIBILITY OF ANY OTHER GOVERNMENT PROGRAM THAT MAY BE APPLICABLE, I.E. MEDICAID, BADGER CARE. PART VI, LINE 4: GUNDERSEN MOUNDVIEW SERVES ALL RESIDENTS OF ADAMS COUNTY (POPULATION 21,226 PER CENSUS 2022 QUICK FACTS). WE ALSO SERVE WESTFIELD AREA RESIDENTS, LOCATED IN MARQUETTE COUNTY. HOWEVER, OUR PRIMARY SERVICE AREA IS THE CENTRAL PORTION OF ADAMS COUNTY INCLUDING THE ZIP CODES OF ADAMS, FRIENDSHIP, ARKDALE AND GRAND MARSH WHICH MAKE UP OVER 74% OF OUR REVENUE. THE MAJORITY OF ADAMS COUNTY RESIDENTS ARE WHITE (93.1%) AND A HIGH PERCENTAGE (31%) ARE AGE 65 AND OVER. THE MEDIAN HOUSEHOLD INCOME ($51,878) IS CONSIDERABLY LOWER THAN THE STATE. TOURISM AND AGRICULTURE ARE AMONG THE COUNTY'S LARGEST INDUSTRIES. THE COUNTY IS MEDICALLY UNDERSERVED AND HAS RANKED IN THE BOTTOM OF THE WI COUNTY HEALTH RANKINGS IN TERMS OF HEALTH OUTCOMES AND FACTORS. PART VI, LINE 5: THE HOSPITAL IS A STRONG COMMUNITY PARTNER IN MANY LOCAL HEALTH EFFORTS. WE PROVIDE MONETARY AND IN-KIND SUPPORT TO SEVERAL INITIATIVES SUCH AS DONATIONS TO RECREATIONAL/WELLNESS PROGRAMS (EXAMPLE-PROVIDING FREE BIKE HELMETS TO YOUTH AND FUNDING TENNIS RACKETS TO BE USED BY SCHOOL STUDENTS AND AT YMCA TENNIS CLASSES). WE ALSO HAVE A PHYSICIAN SERVING ON THE LOCAL HEALTH BOARD, STAFF SERVING ON NUMEROUS COMMUNITY COALITIONS, COLLECT DONATIONS FOR AREA FOOD PANTRIES AND MUCH MORE. THESE ARE JUST A FEW AREAS WE HAVE ASSISTED. THE HOSPITAL BOARD ALSO INCLUDES COMMUNITY MEMBERS WHO ARE UNPAID. PART VI, LINE 6: THE ORGANIZATION IS A PART OF EMPLIFY HEALTH WHICH IS THE COMBINATION OF GUNDERSEN HEALTH AND BELLIN HEALTH SYSTEMS. IT IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ENHANCING THE PHYSICAL AND EMOTIONAL WELL-BEING OF INDIVIDUALS IN. IN COLLABORATION WITH COMMUNITIES, EMPLOYERS, SCHOOLS, AND GOVERNMENT OFFICIALS, WE SUPPORT INDIVIDUALS AND FAMILIES ON THEIR LIFELONG JOURNEY TOWARD OPTIMAL HEALTH. OUR COMMITMENT LIES IN DELIVERING SAFE, RELIABLE, AND COST-EFFECTIVE COMPREHENSIVE HEALTH SOLUTIONS, ALL WHILE UPHOLDING THE VALUES OF RESPECT AND COMPASSION. THROUGH OUR INNOVATIVE INITIATIVES, WE AIM TO TRANSFORM HEALTHCARE DELIVERY NOT ONLY IN OUR REGION BUT ALSO ON A GLOBAL SCALE. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 SCOTT RATHGABER CEO-BGHS 0 1274504 0 200000 0 169717 0 45225 0 23503 0 1712949 0 0 GERALD OETZEL FORMER CFO-BGHS 0 480094 0 70000 0 4974 0 12220 0 5888 0 573176 0 0 BRYAN ERDMANN BOARD TRUSTEE/COO 408646 0 0 0 1230 0 45225 0 29120 0 484221 0 0 0 STEPHANIE CARROLL BOARD TRUSTEE/MD HOSPITALIST 312018 0 0 0 585 0 38790 0 26356 0 377749 0 0 0 STEVE LITTLE CFO-BGHS (THRU 02/2024) 0 258317 0 75000 0 0 0 0 0 0 0 333317 0 0 FRANK PEREZ-GUERRA CEO 193521 0 0 0 4598 0 29075 0 25003 0 252197 0 0 0 DEENA KEDROWSKI OUTPATIENT PHARMACY MANAGER 196234 0 0 0 1032 0 5967 0 32094 0 235327 0 0 0 ROXANNE POTTS BOARD TRUSTEE/CLINICAL OPS. DIRECTOR 160292 0 0 0 8593 0 24659 0 21999 0 215543 0 0 0 BRAD SHAW INPATIENT PHARMACY MANAGER 202742 0 0 0 240 0 3948 0 1278 0 208208 0 0 0 DAVID BROWN PHARMACIST 187820 0 0 0 1032 0 5298 0 1278 0 195428 0 0 0 NEIL DONNER PHARMACIST 180859 0 0 0 953 0 208 0 12994 0 195014 0 0 0 SARAH ROSSMAN TREASURER/SECRETARY 156674 0 0 0 2123 0 23193 0 4367 0 186357 0 0 0 PRESTON PIETRZAK PHARMACIST 154965 0 0 0 216 0 4421 0 14164 0 173766 0 0 0 PART I, LINE 3 A RELATED ORGANIZATION OF THE FILING ORGANIZATION USES ONE OR MORE OF THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY, AND -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PLEASE REFER TO THE FORM 990, PART VI, LINE 15A DISCLOSURE IN SCHEDULE O FOR ADDITIONAL DETAILS ON HOW COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED. FORM 990, PART III, LINE 2 REINTRODUCTION OF AN ORTHOPEDIC SERVICES PROGRAM, INCLUDING IN-HOUSE PROCEDURES. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL HAS A NINE MEMBER BOARD OF DIRECTORS COMPRISED OF FIVE MEMBERS FROM THE HEALTH SYSTEM AND FOUR COMMUNITY DIRECTORS CHOSEN FROM OUR LOCAL SERVICE AREA. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SOLICITS NOMINATIONS FROM CANDIDATES TO FILL OPEN BOARD SEATS. THE FULL BOARD THEN VOTES TO APPROVE OR DISAPPROVE THE NEW POSITION. FORM 990, PART VI, SECTION A, LINE 7B MEMBERS OF THE BOARD OF DIRECTORS MUST APPROVE ANY BYLAW CHANGES. FORM 990, PART VI, SECTION B, LINE 11B THE IRS FORM 990 IS REVIEWED BY MANAGEMENT AND PROVIDED TO THE FINANCE COMMITTEE AND THEN ENTIRE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED EVERY YEAR BY THE POLICY AND PROCEDURE COMMITTEE AND BY THE CEO. OFFICERS AND DIRECTORS ARE REQUIRED TO REVIEW THE POLICY AND DISCLOSE CONFLICTS. THE CEO REVIEWS THE SIGNED STATEMENTS. IF THERE IS A CONFLICT, THE CONFLICT WOULD BE DECLARED, AND THE MEMBER WOULD ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A THE HEALTH SYSTEM RELAYS ON MARKET COMPARABLE SALARY DATA TO SET THE RANGE OF COMPENSATION FOR THE CEO POSITION. THE RANGES ARE ADJUSTED AND REVIEWED ANNUALLY BY THE BOARD'S COMPENSATION COMMITTEE, WITH FINAL APPROVAL BY THE SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION BELIEVES THE GOVERNING DOCUMENTS AND POLICIES ARE THE PROPERTY OF THE ORGANIZATION AND ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE AUDITED FINANCIAL STATEMENTS ARE NOW REQUIRED TO BE ATTACHED TO FORM 990. AUDITED FINANCIAL INFORMATION IS POSTED ANNUALLY ON THE HOSPITAL'S WEBSITE. 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