2020-10-06T12:14:17-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 BRANDON BAY CFO 7157622484 2020-10-01 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-10-01 4.4.25.242 2020-10-01 14:30:42 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2021-01-29 14:40:06Z X JEFF EUCLIDE 98 SHERRY AVENUE PARK FALLS WI 54552 24420118 0 X HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWS X 1961 WI TO PROVIDE HIGH QUALITY, ACCESSIBLE HEALTH CARE SERVICES IN OUR COMMUNITY. 14 14 267 127 0 0 266441 94569 22908241 24301148 21688 10668 2399 9130 23198769 24415515 0 24000 0 0 13162156 13245570 0 0 0 9989496 11684572 23151652 24954142 47117 -538627 13798564 14919663 2207141 3858847 11591423 11060816 X THE FOLLOWING OBJECTIVES PROVIDE THE DIRECTION FOR FLAMBEAU HOSPITAL IN FULFILLING ITS VISION:- TO CONTINUOUSLY IMPROVE QUALITY SERVICES TO CUSTOMERS BY BUILDING EXCELLENCE INTO EVERY ASPECT AND PROCESS OF THE HOSPITAL. CUSTOMERS INCLUDE PATIENTS AND STAFF MEMBERS. THIS EXCELLENCE DEVELOPS FROM TOTAL QUALITY IMPROVEMENT, AN ENVIRONMENT THAT ENCOURAGES EVERYONE TO CONTRIBUTE TO THE HOSPITAL'S MISSION.- TO ENCOURAGE HEALTH PROMOTION AND WELLNESS THROUGH EDUCATIONAL ACTIVITIES. WHEN FEASIBLE, THESE ACTIVITIES WILL BE PURSUED IN CONJUNCTION WITH AREA HEALTH CARE PROVIDERS.- TO COLLABORATE WITH AND PROVIDE REFERRALS TO AGENCIES PROVIDING SERVICES NOT DIRECTLY AVAILABLE AT THE HOSPITAL.- TO MAINTAIN AN OPEN RELATIONSHIP WITH THE MEDICAL AND HOSPITAL STAFF TO ENSURE EFFICIENT AND EFFECTIVE UTILIZATION OF HOSPITAL RESOURCES.- TO PROVIDE IN-SERVICE AND CONTINUING EDUCATIONAL OPPORTUNITIES FOR HEALTH CARE PERSONNEL AS A MEANS OF PROVIDING QUALITY PATIENT CARE. 0 0 19583786 24000 24224297 FLAMBEAU HOSPITAL PROVIDES WELLNESS ACTIVITIES, EDUCATION AND PRIMARY HEALTHCARE SERVICES TO APPROXIMATELY 17,000 RESIDENTS IN OUR SERVICE AREA. HEALTHCARE SERVICE INCLUDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, AND OTHER OUTPATIENT SERVICES. SERVICES FOR THE YEAR ENDED JUNE 30, 2019 INCLUDED 1,350 INPATIENT DAYS, 6 SWING BED DAYS AND 26,455 OUTPATIENT REGISTRATIONS.FLAMBEAU HOME HEALTH PROVIDES HEALTH CARE SERVICES FOR HOMEBOUND PATIENTS INCLUDING PRIMARY CARE, WOUND AND INFECTION SERVICES, PERSONAL CARE SERVICES, PAIN MANAGEMENT AND OTHER MEDICAL SERVICES THAT CAN BE PROVIDED IN THE HOME. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.FLAMBEAU HOSPICE PROVIDES END OF LIFE CARE TO PATIENTS AND THEIR FAMILIES IN THEIR HOMES OR OTHER APPROPRIATE FACILITIES. ALSO PROVIDED ARE CHAPLAIN, VOLUNTEER AND BEREAVEMENT SERVICES. BEREAVEMENT SERVICES CONTINUE AFTER A PATIENT'S DEATH FOR ONE YEAR OR MORE. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS. 19583786 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 267 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X BRANDON BAY 7157622484 98 SHERRY AVE PARK FALLS WI 54552 SCOTT CARPENTER MD DIRECTOR 1.00 X 0 0 0 LOUAY DANIAL MD DIRECTOR 1.00 X 0 0 0 DAVE DEDA DIRECTOR 1.00 X 0 0 0 MOQUIN DOUG DIRECTOR 1.00 X 0 0 0 BECKY MICHELS DIRECTOR 1.00 X 0 0 0 JEREMY NORMINGTON-SLAY DIRECTOR (TERM 10/2018) 1.00 X 0 0 0 THOMAS PREBBLE MD DIRECTOR 1.00 X 0 352173 52254 KRISTEN REUKAUF DIRECTOR 1.00 X 0 0 0 DEB STANDRIDGE DIRECTOR 1.00 X 0 0 0 GAYLE STANGLE DIRECTOR 1.00 0.20 X 0 0 0 MATTHEW THOMAS MD DIRECTOR 1.00 X 0 0 0 LAURIE WAGNER DIRECTOR 1.00 X 0 0 0 ROGER STRAND CHAIRPERSON 1.00 X X 0 0 0 CAROL MADER SECRETARY 1.00 X X 0 0 0 JULIA RUFF VICE CHAIRPERSON/TREASURER 1.00 X X 0 0 0 JAMES BRAUN CAO/CFO 40.00 0.20 X 0 219236 49448 JANE EATON-NYMAN CIO 40.00 X 182651 0 38647 ELIZABETH SCHREIBER DON 40.00 X 121737 0 36226 SARA BABLICK PHARMACY DIRECTOR 40.00 X 151520 0 20732 ROBERT PFLANZ SNR. DIRECTOR SUPP SVCS 40.00 X 107946 0 38147 THOMAS KASTER SNR. DIRECTOR FIN (TERM 11/2018) 40.00 X 120979 0 38439 684833 571409 273893 9 0 1 0 ALEXANDER KORITTNIG 442 S 3RD AVENUE PARK FALLS WI 54552 ANESTHESIA 506398 SHARED MEDICAL TECHNOLOGY 202 W NEWTON ST RICE LAKE WI 54868 MEDICAL SERVICES 347283 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 AGENCY STAFFING 272688 READYLINK HEALTHCARE PO BOX 1047 THOUSAND PALMS CA 92276 CONTRACTED NURSING SERVICES 114858 4 9070 85499 94569 NET PATIENT SERVICE REVENUE 621110 23811823 23811823 AFFILIATED ORG RENT 900099 245325 245325 CAFETERIA REVENUE 900099 76851 76851 167149 167149 24301148 10668 10668 13733 9070 4603 9130 9130 24415515 24224297 0 96649 X 24000 24000 673112 404428 268684 8761829 7058497 1703332 268422 228996 39426 2881137 2300279 580858 661070 524895 136175 46195 46195 5172351 4457411 714940 81943 81943 1426083 1404408 21675 800076 2725 797351 311910 246417 65493 168727 123927 44800 32843 32843 784267 784267 1157886 1099590 58296 112481 112481 EQUIPMENT RENTAL 744340 574209 170131 BAD DEBT 370847 370847 FOOD 130992 104498 26494 ASSOCIATION DUES 84273 41947 42326 259358 203292 56066 24954142 19583786 5370356 0 165298 172230 3204453 1465224 2543271 4750154 200229 214749 112181 60137 27014875 19161934 6417557 7852941 1155575 404228 13798564 14919663 1300990 2963141 726744 0 0 653690 179407 242016 2207141 3858847 X 10517703 10100976 1073720 959840 11591423 11060816 13798564 14919663 X -538627 8020 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5263 5263 0 PART II-B, LINE 1: FLAMBEAU HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED FLAMBEAU HOSPITAL THAT $5,263 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 73128 73128 15133838 11193571 3940267 10892059 7968363 2923696 915850 915850 7852941 ASBESTOS ABATEMENT LIABILITY 201213 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 40803 242016 X 24044668 0 24044668 370847 370847 24415515 23799028 0 23799028 1155114 1155114 24954142 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 370,847. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 370,847. PAYMENTS TO AFFILIATES 784,267. GOLF OUTING 17633 7900 9733 150 150 2350 LIGHTS OF LOVE 5170 1170 4000 300 200 1453 22803 9070 13733 150 150 300 200 3803 4603 9130 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 0 210574 210574 0.00890 2440290 1416203 1024087 0.04350 2650864 1416203 1234661 0.05240 79433 79433 0.00340 1943 24614 24614 0.00100 50 4901495 1736035 3165460 0.13450 6625 131564 131564 0.00560 8618 5137106 1736035 3401071 0.14450 8618 7787970 3152238 4635732 0.19690 1949 1949 0.00010 320 7410 7410 0.00030 246 3616 3616 0.00020 4444 4444 0.00020 456 456 0.00000 16 2735 2735 0.00010 582 20610 20610 0.00090 0 824759 9385280 9937043 -551763 X 1 1 1 1 FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS WI 54552 X X X X FLAMBEAU HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE SUPPLEMENTAL INFORMATION X X 1 18 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 250.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/CENTERS/FLAMBEAU%20HOSPITAL/ X X X X X X 1 X 0 X X X X 1 X 0 0 FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 5: FLAMBEAU HOSPITAL WORKED CLOSELY WITH THE PRICE COUNTY HEALTH DEPARTMENT IN ORDER TO HAVE INPUT FROM A BROAD SPECTRUM OF COMMUNITY PROFESSIONALS. INDIVIDUALS INCLUDED IN THE FOLLOWING ALL PROVIDED VALUABLE INPUT THROUGH THEIR ATTENDANCE AT THE COMMUNITY NEEDS FORUM: PRICE COUNTY BOARD OF SUPERVISORS, PRICE COUNTY AGING AND DISABILITY RESOURCE CENTER UNIT, PRICE COUNTY CHILDREN AND YOUTH UNIT, PRICE COUNTY BEHAVIORAL HEALTH UNIT, PRICE COUNTY PUBLIC HEALTH UNIT, PRICE COUNTY SHERIFF'S DEPARTMENT, PARK FALLS POLICE DEPARTMENT, CHEQUAMEGON SCHOOL DISTRICT, PHILLIPS SCHOOL DISTRICT, EXTENSION PRICE COUNTY, PHILLIPS PUBLIC LIBRARY, NEW HORIZONS NORTH, EMBRACE, FLAMBEAU HOME HEALTH & HOSPICE, FALMBEAU HOSPITAL, LIMBERG & ASSOCIATES COUNSELING, LLC, MARSHFIELD CLINIC HEALTH SYSTEM AND ASCENSION WISCONSIN. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 6B: PRICE COUNTY, PRICE COUNTY PUBLIC HEALTH AND FLAMBEAU HOSPITAL FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 7D: HTTPS://WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/FLAMBEAU-HOSPITAL/COMMUNITY-HEALTH-NEEDSLINE 10A:WWW.MARSHFIELDCLINIC.ORG/LOCATIONS/FLAMBEAU-HOSPITAL/COMMUNITY-HEALTH-NEEDS FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 11: FLAMBEAU HOSPITAL AND PRICE COUNTY PUBLIC HEALTH CONDUCTED THE ASSESSMENT AND PRIORITIZATION PROCESS FROM JULY 2018 TO DECEMBER 2018. BASED ON THE DATA REVIEWED, COMMUNITY INPUT AND THE PRIORITIZATION PROCESS, THE FOLLOWING PRIORITIES WERE SELECTED: 1) MENTAL HEALTH 2) ALCOHOL AND OTHER DRUG ABUSE 3) CHRONIC DISEASES THIS IMPROVEMENT PLAN IS PART OF A BROAD COMMUNITY EFFORT TO ADDRESS THE PRIORITY HEALTH NEEDS IN THE COMMUNITY. THIS IMPROVEMENT PLAN OUTLINES THE ACTIONS FLAMBEAU HOSPITAL AND PRICE COUNTY PUBLIC HEALTH WILL TAKE TO ADDRESS THE LOCAL HEALTH NEEDS. AS NOTED BELOW, MANY OF THESE STRATEGIES WILL BE IMPLEMENTED COLLABORATIVELY. RECOGNIZING THAT NO ONE ORGANIZATION CAN AFFECT SUBSTANTIAL COMMUNITY CHANGE ALONE, THE LONG-TERM OUTCOMES IDENTIFIED IN THIS PLAN WILL BE ACHIEVED AS MANY COMMUNITY ORGANIZATIONS WORK TOGETHER FOR COLLECTIVE IMPACT. COALITIONS HAVE BEEN FORMED TO NOT ONLY MEET ON A REGULAR BASIS, BUT ALSO TO EXECUTE OUR SMART METRICS - METRICS THAT ARE SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, AND TIME-RELATED. REPORTS ARE FILED QUARTERLY TO RECORD THE STATUS OF EACH STRATEGY/PRIORITY. MINOR NEEDS THAT ARE NOT OUTLINED IN THE MOST RECENT CHNA HAVE BEEN IDENTIFIED AND FLAMBEAU HOSPITAL HAS MADE COLLECTIVE EFFORTS TO ESTABLISH SUPPORT FOR SUCH NEEDS. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 16J: IN ADDITION TO POSTING THE POLICY IN THE ADMISSIONS OFFICE AND WAITING ROOMS, ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED AND GIVEN INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY. 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 HOSPITALS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. 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 FLAMBEAU HOSPITAL INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT, AND THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPITAL EMERGENCY DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL EMERGENCY DEPARTMENT COME FROM THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF PRICE COUNTY, WISCONSIN. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF FLAMBEAU HOSPITAL 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 FLAMBEAU HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENTS ABILITY TO PAY. PART I, LN 7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $1,420,847 INCLUDED ON FORM 990, PART IX, LINE 25 WAS NOT INCLUDED IN TOTAL EXPENSES FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGES. PART II, COMMUNITY BUILDING ACTIVITIES: FLAMBEAU HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. FLAMBEAU HOSPITAL, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING SERVICES, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, HOME CARE, HOSPICE, SWING BED SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SURGICAL SERVICES, AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 4: ATTACHED ARE UNAUDITED FINANCIAL STATEMENTS FOR FLAMBEAU HOSPITAL FOR THE YEAR ENDED JUNE 30, 2019. COMPLETION OF THE AUDIT HAS BEEN DELAYED AS A RESULT OF A PENDING TRANSACTION INVOLVING THE HOSPITAL'S CORPORATE MEMBERS AND, AS A RESULT, AUDITED STATEMENTS ARE NOT AVAILABLE AT THIS TIME. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANETHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT FLAMBEAU HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREASS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2019 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.) PART III, LINE 9B: ONCE A PERSON IS KNOWN TO QUALIFY FOR CHARITY CARE, THE HOSPITAL WILL KEEP THAT INFORMATION ON FILE AND AUTOMATICALLY GRANT CHARITY CARE FOR UP TO A YEAR. AT THAT POINT, THE PATIENT WOULD NEED TO REAPPLY OR VERIFY THAT THEIR SITUATION HAS NOT CHANGED SIGNIFICANTLY SINCE THEIR LAST APPLICATION.CHARITY CARE IS APPLIED FIRST BEFORE ANY COLLECTION EFFORTS ARE PURSUED. PART VI, LINE 2: THE HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IN FISCAL YEAR 2019 AND USED THE DATA AND FINDINGS OF THIS REPORT TO GUIDE THE ORGANIZATION IN THE FUTURE TO BE ABLE TO RESPOND TO THOSE NEEDS. IN ADDITION, THE HOSPITAL IS PARTICIPATING WITH PRICE COUNTY ON THE COUNTY HEALTH ASSESSMENT AND HEALTH PLAN. PART VI, LINE 3: INFORMATION IS POSTED IN THE FACILITY AND ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED FOR ANY ASSISTANCE NEEDS THEY MAY HAVE. THE INFORMATION IS ALSO PROVIDED IN ALL BILLING STATEMENTS AND WITH ANY LETTERS FOR COLLECTIONS. PART VI, LINE 4: FLAMBEAU HOSPITAL, INC. PROVIDES SERVICES TO RESIDENTS OF PRICE COUNTY, WI AND PORTIONS OF THREE OTHER COUNTIES. THE NEXT CLOSEST HOSPITAL IS 45 MILES AWAY, AND FLAMBEAU HOSPITAL IS DESIGNATED AS UNDERSERVED. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN THE SHORT PERIOD ENDING JUNE 30, 2019, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 74 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR. PART VI, LINE 5: FLAMBEAU HOSPITAL PROVIDES EDUCATION, NEEDED SUBSIDIZED SERVICES AND SUPPORT TO THE COMMUNITY THROUGH SERVICES IT PROVIDES AND COLLABORATION WITH OTHER GROUPS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SCHOLARSHIPS 5 24000 PART I, LINE 2: THE ORGANIZATION HAS A PROCESS OF SELECTING, AWARDING AND MONITORING SCHOLARSHIP RECIPIENTS. X 1 0 0 0 0 0 0 0 0 THOMAS PREBBLE MD DIRECTOR 0 285247 0 59496 0 7430 0 29497 0 22757 0 404427 0 0 JAMES BRAUN CAO/CFO 0 208481 0 6000 0 4755 0 27635 0 21813 0 268684 0 0 JANE EATON-NYMAN CIO 179603 0 0 0 3048 0 0 0 38647 0 221298 0 0 0 ELIZABETH SCHREIBER DON 120696 0 0 0 1041 0 0 0 36226 0 157963 0 0 0 SARA BABLICK PHARMACY DIRECTOR 151346 0 0 0 174 0 0 0 20732 0 172252 0 0 0 THOMAS KASTER SNR. DIRECTOR FIN (TERM 11/2018) 120813 0 0 0 166 0 0 0 38439 0 159418 0 0 0 PART I, LINE 4A THOMAS KASTER - $59,520 FORM 990, PART VI, SECTION A, LINE 6 MARSHFIELD CLINIC AND MINISTRY HEALTH CARE, INC. ("MINISTRY"), BOTH WISCONSIN TAX-EXEMPT CORPORATIONS, ARE JOINT CORPORATE MEMBERS OF THE HOSPITAL. MINISTRY ALSO, VIA CONTRACT, SHARES CERTAIN GOVERNANCE AUTHORITIES WITH MARSHFIELD CLINIC WITH RESPECT TO THE PARK FALLS AND PHILLIPS ("PRICE COUNTY CLINICS") CLINIC OPERATIONS OF MARSHFIELD CLINIC, WITH MARSHFIELD CLINIC RETAINING THE REMAINING AUTHORITIES. MARSHFIELD CLINIC HAS CONTRACTED TO PROVIDE OPERATING MANAGEMENT TO THE HOSPITAL AND PRICE COUNTY CLINICS. THE GOAL OF THE MEMBERSHIP ARRANGEMENTS IS TO PROVIDE FOR THE EFFECTIVE, ECONOMICAL, AND COORDINATED MANAGEMENT AND OPERATION OF HEALTH CARE SERVICES IN PRICE COUNTY. COLLECTIVELY, THE PARTIES HAVE ESTABLISHED AN INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR PRICE COUNTY. FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBERS HAVE APPROVED RIGHT FOR DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF BUDGET, ADMINISTRATOR, PROPERTY PURCHASED, AND DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B NOT APPLICABLE AS THERE ARE NO SUB-COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. IF THE BOARD MEMBERS WOULD LIKE ANY EXPLANATION OR CHANGES, THEY WOULD HAVE AN OPPORTUNITY TO COMMENT ON THE RETURN BEFORE ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND KEY EMPLOYEES OF THE HOSPITAL ANNUALLY SIGN TO ADHERE TO THE CONFLICT OF INTEREST POLICY AT FLAMBEAU HOSPITAL, INC. IT IS ASSUMED THAT THE BOARD OF DIRECTORS AND KEY EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTEREST DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE BOARD OF DIRECTORS AND KEY EMPLOYEES RESPONSIBILITY TO REVIEW POTENTIAL CONFLICTS OF INTEREST AND IF A CONFLICT EXISTS THE INDIVIDUAL IS PROHIBITED TO VOTE ON TRANSACTIONS WHERE THE POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE MARSHFIELD CLINIC PREPARES A COMPENSATION SCHEDULE THAT IS USED TO DETERMINE TOP MANAGEMENT AND KEY EMPLOYEE COMPENSATION. COMPENSATION STUDIES ARE ALSO USED TO PROVIDE COMPARABILITY DATA. THIS DATA IS REVIEWED AND APPROVED BY INDEPENDENT PERSONS AND ALL DECISIONS ARE SUBSTANTIATED. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G ER SERVICES: PROGRAM SERVICE EXPENSES 1,888,349. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,888,349. ANESTHESIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 532,675. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 532,675. MED SURG SERVICES: PROGRAM SERVICE EXPENSES 404,493. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 404,493. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,631,894. MANAGEMENT AND GENERAL EXPENSES 714,940. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,346,834. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST OF FOUNDATION 8,020. FORM 990 - AMENDED RETURN DISCLOSURE THE ORGANIZATION HAS AMENDED THE FORM 990 TO REFLECT THE COMPLETION OF THEIR FINANCIAL STATEMENT AUDIT FOR THE YEAR ENDED 12/31/2019. AS SUCH THE FORM 990 HAS BEEN UPDATED TO INDICATE AN INDEPENDENT AUDIT ON PART IV, LINE 12A. ADDITIONALLY, PART XII, LINES 2B AND 2C HAVE BOTH BEEN "YES AND LINE 2B ALSO HAS BEEN CHANGED TO INDICATING THE FINANCIAL STATEMENTS WERE AUDITED ON A "SEPARATE BASIS." THE FINAL FINANCIAL STATEMENTS HAVE BEEN ATTACHED PURSUANT TO PART IV, LINE 20B TO SUPPLEMENT INFORMATION REQUIRED FOR EXEMPT HOSPITALS. FLAMBEAU HOSPITAL FOUNDATION INC PO BOX 310 PARK FALLS WI 54552 205957150 SUPPORT OF FLAMBEAU HOSPITAL WI 501 (C) 3 LINE 12A, I FLAMBEAU HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0