2019-08-15T12:37:55-05:00 2018-09-30 390758449 WIPFLI LLP 4890 OWEN AYRES COURT SUITE 200 EAU CLAIRE WI 54701 990 2017-10-01 390806404 VERNON MEMORIAL HEALTHCARE INC VERN 6086372101 507 SOUTH MAIN STREET VIROQUA WI 54665 KYLE BAKKUM CEO 6086372101 2019-08-15 1 HOLLY POKRANDT CPA P00449155 7158323407 2019-08-12 137.26.200.211 2019-08-15 12:36:53 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E4255D669FE7A429B540D12C0E645A16D05D3497 2017 2019-02-21 02:37:17Z KYLE BAKKUM 507 SOUTH MAIN STREET VIROQUA WI 54665 79886719 0 X WWW.VMH.ORG X 1946 WI VERNON MEMORIAL HEALTHCARE, INC. WILL STRIVE TO HAVE THE VISION TO CONTINUALLY PROVIDE THE HIGHEST STANDARD OF CARE TO OUR PATIENTS AND THEIR FAMILIES WHILE BEING 'CLOSE TO HOME.' OUR MISSION IS TO PROVIDE COST-EFFECTIVE, ACCESSIBLE CARE AND SERVICES USING PROFESSIONAL TREATMENT TO THE INJURED, AFFLICTED, AND WELL PEOPLE WHO NEED THE RESOURCES WE HAVE AT OUR COMMAND, WITHOUT REGARD TO RACE, CREED, COLOR, SEX, HANDICAP, NATIONAL ORIGIN, OR ABILITY TO PAY. IT IS OUR INTENTION TO ENSURE THAT IN EACH AND EVERY CASE OUR PATIENTS SHALL BE TREATED WITH COMPASSION, UNDERSTANDING AND DIGNITY. FURTHER, THE RIGHTS AND PRIVILEGES OF THE PEOPLE WE SERVE SHALL ALWAYS BE HELD IN THE HIGHEST REGARD, AND THEIR WELL-BEING MUST ALWAYS HAVE FIRST CONSIDERATION. 11 11 657 101 3851678 -1295397 470436 422794 73915166 76452508 1456232 664483 -27645 -16285 75814189 77523500 327023 175076 0 0 43027422 45349313 0 0 0 32927367 35519447 76281812 81043836 -467623 -3520336 104422124 101829663 30859736 31758110 73562388 70071553 X WE ARE COMMITTED TO BEING THE BEST COMMUNITY HEALTHCARE SYSTEM IN THE REGION. 0 0 51556945 175076 54089194 OUR ORGANIZATION PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE INTERNAL REVENUE SERVICE (IRS). BUT IN ADDITION, WE BELIEVE WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH CANNOT BE QUANTIFIED. OUR ORGANIZATION WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY-CARE THAT WITHOUT THE PRESENCE OF OUR ORGANIZATION, WOULD NOT BE AVAILABLE TO THE PEOPLE IN OUR SERVICE AREA. IN ADDITION TO PROVIDING INPATIENT MEDICAL, OBSTETRICAL, NEWBORN AND SURGICAL INPATIENT SERVICES, WE OFFER A WIDE VARIETY OF OUTPATIENT AND ANCILLARY SERVICES TO THE PEOPLE IN OUR SERVICE AREA. THESE INCLUDE A DIAGNOSTIC SERVICES-LABORATORY, IMAGING AND CARDIAC REHABILITATION PROGRAM, SLEEP STUDY SERVICES, 24-HOUR EMERGENCY SERVICES, URGENT CARE SERVICES, INFUSION AND GASTROINTESTINAL SERVICES, REHABILITATION SERVICES-PHYSICAL, OCCUPATIONAL, RESPIRATORY AND SPEECH THERAPY, SPECIALTY MEDICINE, AND PRIMARY CARE CLINICS. WE ALSO PROVIDE LOCAL ACCESS TO MANY OTHER HEALTH SERVICES INCLUDING HOME HEALTH CARE, HOSPICE INPATIENT AND OUTPATIENT CARE. NEW SERVICES FOR 2018 TO INCLUDE; ONSITE ULTRASOUND, UPGRADED MAMMOGRAPHY TECHNOLOGY ,EXPANSION OF BEHAVIORAL HEALTH SERVICES AND AN EXPANDED CARDIAC REHABILITATION SERVICE.IN FISCAL 2018, HOSPITAL AND HOSPICE INPATIENT SERVICES INCLUDED 3602 ACUTE CARE PATIENT DAYS, AND 273 NEWBORN PATIENT DAYS (ALSO INCLUDED IN ACUTE PATIENT DAYS). THERE WERE 1374 SURGERY CASES, 6493 EMERGENCY ROOM VISITS, 2284 URGENT CARE VISITS, 5574 VISITS TO THE SPECIALTY CLINIC. 14221988 15052304 VERNON MEMORIAL HEALTHCARE, INC. OPERATES FOUR RURAL HEALTH CLINICS LOCATED IN VIROQUA, LAFARGE, SOLDIERS GROVE, AND WESTBY. TOGETHER, THE RURAL HEALTH CLINICS STRIVE TO MEET THE HEALTHCARE NEEDS OF PATIENTS AND FAMILIES WHO LIVE AND WORK IN THE COMMUNITIES THEY SERVE. A TOTAL OF 44,704 CLINIC VISITS OCCURRED IN FISCAL YEAR 2018. 3001897 1699408 VERNON MEMORIAL HEALTHCARE, INC. ALSO PROVIDES HOME HEALTH AND HOSPICE SERVICES. THE HOME CARE AGENCY PROVIDES QUALITY HEALTHCARE TO PATIENTS IN THE COMFORT OF THEIR OWN HOME. THE HOME CARE TEAM WORKS TOGETHER TO PROVIDE INSTRUCTION, CARE AND SUPPORT. DURING FISCAL YEAR 2018, A TOTAL OF 2916 HOME HEALTH VISITS WERE MADE TO 166 INDIVIDUALS. VERNON MEMORIAL HEALTHCARE HOSPICE OFFERS CARE, COMFORT, AND SUPPORT WHEN IT IS NEEDED MOST. HOSPICE IS FOR PATIENTS, FAMILIES, FRIENDS, AND CAREGIVERS DEALING WITH THE END OF LIFE. THIS SUPPORT BRINGS COMFORT, HOPE AND REASSURANCE. VERNON MEMORIAL HEALTHCARE HOSPICE SERVES PATIENTS AT HOME, IN THE BLAND BEKKEDAL HOSPICE HOUSE, IN LONG-TERM CARE FACILITIES, OR AT VERNON MEMORIAL HOSPITAL. HOSPICE CARE WAS PROVIDED TO 165 INDIVIDUALS IN FISCAL YEAR 2018. 2084778 1759924 2084778 1759924 70865608 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 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 76 0 657 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 WI X KAREN TRAYNOR 6086374964 507 SOUTH MAIN STREET VIROQUA WI 54665 BRANDON MUNSON MEMBER 1.00 X 0 0 0 CHARLES NORTON MEMBER 1.00 X 0 0 0 DAVE SARNOWSKI MEMBER (STARTED IN 2018) 1.00 X 0 0 0 KATHY STITTLEBURG MEMBER (STARTED IN 2018) 1.00 X 0 0 0 LUKE LUKASZEWSKI MEMBER (STARTED IN 2018) 1.00 X 0 0 0 MARILYN CLAUSON MEMBER 1.00 X 0 0 0 SHARON NELSON MEMBER 1.00 X 0 0 0 BONNIE RATH SECRETARY 1.00 1.00 X X 0 0 0 NATHAN CAMPBELL TREASURER 1.00 X X 0 0 0 BLANE CHARLES VICE CHAIR 1.00 X X 0 0 0 TRUDY WALLIN CHAIR 1.00 X X 0 0 0 MARY KOENIG CFO 40.00 X 236834 0 47702 KYLE BAKKUM CEO 40.00 X 278990 0 34123 DR ANTHONY MACASAET PHYSICIAN 36.00 X 416997 0 53204 ARNOLD NOMANN CRNA 40.00 X 373506 0 29654 BRIAN MILLER CRNA 40.00 X 405287 0 57273 GREGORY SAUER CRNA 36.00 X 416699 0 53847 DR PATRICK SCOTT PHYSICIAN 39.00 X 365965 0 25102 2494278 0 300905 59 0 1 0 GUNDERSON HEALTH SYSTEM 1900 SOUTH AVE LA CROSSE WI 54601 LAB/RADIOLOGY 2806973 MARKET & JOHNSON 2350 GALLOWAY ST EAU CLAIRE WI 54702 CONSTRUCTION 1490528 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 IMAGING SERVICES 222059 RURAL WI HEALTH COOP 880 INDEPENDENCE LANE SAUK CITY WI 53583 LEGAL SERVICES 202127 GIT-ER-DONE HOME IMPROVEMENT 6773 S STATE HWY 27 VIROQUA WI 54665 GENERAL CONTRACTOR 154378 11 262987 159807 422794 HOSPITAL 621990 50591034 50591034 CLINIC 621110 15052304 15052304 RETAIL PHARMACY 446110 7170003 3414177 3755826 CBRF 623000 1759924 1759924 HOME HEALTH & HOSPICE 621610 1699408 1699408 179835 83983 95852 76452508 500353 500353 283092 299377 -16285 -16285 -16285 2205737 22235 2023300 40542 182437 -18307 164130 164130 77523500 72600830 3851678 648198 175076 175076 617272 617272 33309057 29868866 3440191 1318057 1181927 136130 7901963 7085841 816122 2202964 1936300 266664 306365 306365 132390 132390 5362301 4640539 721762 144153 144153 257795 204941 52854 880447 880447 2453304 2453304 93223 63632 29591 4449699 2850123 1599576 240078 240078 SUPPLIES 15606187 15567923 38264 EQUIPMENT RENTAL & MAIN 2913048 2664095 248953 BAD DEBT EXPENSE 1762718 1762718 DUES AND SUBSCRIPTIONS 615485 364825 250660 302254 45498 256756 81043836 70865608 10178228 0 1914200 1899384 16915552 11057084 797301 951353 9698229 8612122 2592073 2508056 685688 681335 90266963 38220463 51001006 52046500 17737008 18745060 442099 381212 249730 235393 2389238 4712164 104422124 101829663 6182168 5550757 18734528 17970832 4065921 6077221 1877119 2159300 30859736 31758110 X 72664726 69050317 897662 1021236 73562388 70071553 104422124 101829663 -3520336 29501 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4447 4447 0 PART II-B, LINE 1: VERNON MEMORIAL HEALTHCARE, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION AND RURAL WISCONSIN HEALTH COOPERATIVE. THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A SMALL PORTION OF THE ANNUAL DUES WERE USED IN CONJUCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 1757582 1757582 67355262 27781355 39573907 21079773 10439108 10640665 74346 74346 52046500 DEFERRED COMPENSATION PLAN LIABILITY - FUNDED 2159300 2159300 75627419 29501 299377 328878 75298541 2224959 2224959 77523500 79118254 299377 299377 78818877 2224959 2224959 81043836 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE 299,377. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET AGAINST REVENUE 462,241. BAD DEBT EXPENSE NET AGAINST REVENUE 1,762,718. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES NET AGAINST REVENUE 299,377. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET AGAINST REVENUE 462,241. BAD DEBT EXPENSE NET AGAINST REVENUE 1,762,718. IMPAIRMENT LOSS 1 1 X 0 1 X 600.000000000000 1 1 1 0 1 1 1203475 1203475 0.01520 9133388 6265442 2867946 0.03610 10336863 6265442 4071421 0.05130 301634 9390 292244 0.00360 718541 718541 0.00890 196030 196030 0.00240 1216205 9390 1206815 0.01490 11553068 6274832 5278236 0.06620 568 568 0.00000 385 385 0.00000 61545 61545 0.00080 62498 62498 0.00080 0 1762718 771527 16714417 17579947 -865530 X 1 1 1 1 VERNON MEMORIAL HOSPITAL INC 507 SOUTH MAIN ST VIROQUA WI 54665 WWW.VMH.ORG 1053 X X X X VERNON MEMORIAL HEALTHCARE INC 1 0 0 1 X X X X X X X X X X 15 1 1 1 1 X SEE PART V, LINE 7D X SEE PART V, LINE 7D X X 1 16 1 HTTP://WWW.VMH.ORG/CONTENT/COMMUNITY-NEEDS-ASSESSMENT 0 1 X 0.000000000000 600.000000000000 X X X X X 1 1 X X X 1 X WWW.VMH.ORG/CONTENT/FINANCIAL-ASSISTANCE-PROGRAM X WWW.VMH.ORG/CONTENT/FINANCIAL-ASSISTANCE-PROGRAM X WWW.VMH.ORG/CONTENT/FINANCIAL-ASSISTANCE-PROGRAM X X X X X 1 X 0 X X X 1 X 0 0 VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 3J: THE COMMUNITY HEALTH NEEDS ASSESSMENT ("COMPASS NOW 2015") PROCESS INCLUDED A VARIETY OF DATA COLLECTION METHODS USED TO CREATE AN OVERALL DESCRIPTION OF THE ISSUES FACING OUR COMMUNITIES. THESE METHODS INCLUDE A RANDOM HOUSEHOLD SURVEY, FOCUS GROUP DISCUSSIONS HELD WITH COMMUNITY MEMBERS, AN EXTENSIVE REVIEW OF SOCIO-ECONOMIC INDICATORS, AND AN INVENTORY OF COMMUNITY RESOURCES. THE DATA COLLECTED GUIDED THE DEVELOPMENT OF 4 PILLAR PROFILES. WE REFER TO THEM AS PILLARS SINCE THEY CREATE THE BUILDING BLOCKS TO A BETTER LIFE. THE PILLARS OF THE COMPASS ARE: HEALTH, INCOME, EDUCATION, AND COMMUNITY. VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 5: IN ADDITION TO THE RANDOM HOUSEHOLD SURVEY, THE COMPASS NOW 2015 COMMUNITY NEEDS ASSESSMENT ALSO INCLUDED A CONVENIENCE SAMPLE THAT FOCUSED ON SPECIFIC SUBGROUPS IN THE GREAT RIVERS REGION. THE OVERALL OBJECTIVE OF THIS SAMPLING WAS TO COLLECT FEEDBACK FROM POPULATIONS WITHIN THE COMMUNITY THAT WERE POTENTIALLY UNDERREPRESENTED IN THE RANDOM HOUSEHOLD SURVEY DUE TO THE SMALL NUMBER IN WHICH THEY EXIST IN THE COMMUNITY. THESE SMALLER POPULATIONS INCLUDED, BUT WERE NOT LIMITED TO, AFRICAN AMERICANS, HISPANICS, LBGT YOUTH, YOUTH AT-RISK, LOW-INCOME ADULTS, AND SENIOR CITIZENS. RESULTS FROM THIS SURVEY WERE COMPARED TO THE RESPONSES OF THE RANDOM HOUSEHOLD SURVEY RESPONDENTS IN AN ATTEMPT TO DETERMINE ANY SIGNIFICANT DIFFERENCES THAT EXISTED BETWEEN THE GENERAL POPULATION AND THOSE IN SMALL SUBGROUPS WITHIN THE COMMUNITY. IN TOTAL, 753 COMMUNITY MEMBERS SHARED FEEDBACK THROUGH THE CONVENIENCE SAMPLE PROCESS. ANOTHER WAY IN WHICH COMMUNITY FEEDBACK WAS GATHERED WAS THROUGH COMMUNITY CONVERSATIONS. COMPASS COUNCILS WERE ADVISORY GROUPS OF LOCAL EXPERTS IN THE FIELDS OF EDUCATION, INCOME, HEALTH, AND A VARIETY OF COMMUNITY ISSUES. THESE MEMBERS COLLECTED AND REVIEWED DATA, ANALYZED THE SURVEY RESULTS, AND OFFERED PROFESSIONAL INSIGHTS ABOUT TOPIC-SPECIFIC ISSUES IN THE GREAT RIVERS REGION. AFTER SIGNIFICANT REVIEW OF THE DATA AND SURVEY RESULTS, PRIORITY ISSUES WERE IDENTIFIED BY COMPASS COUNCIL MEMBERS. THESE ISSUES WERE THEN RANKED BY COUNCIL MEMBERS USING THE CRITERIA BELOW:1. HOW WIDESPREAD IS THE ISSUE IN OUR COMMUNITY?2. HOW SERIOUS ARE THE EFFECTS OF THE ISSUE IN OUR COMMUNITY?3. HOW IMPORTANT IS THE ISSUE TO THE COMMUNITY? VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 6A: THE COMPASS NOW 2015 PARTNERSHIP WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING OTHER HOSPITALS:1. GUNDERSEN HEALTH SYSTEM2. MAYO CLINIC HEALTH SYSTEM - LACROSSE3. TOMAH MEMORIAL HOSPITAL4. GUNDERSEN TRI-COUNTY MEMORIAL HOSPITAL AND CLINICS5. MAYO CLINIC HEALTH SYSTEM - SPARTA6. GUNDERSEN ST. JOSEPH'S HOSPITAL AND CLINICS VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 6B: THE COMPASS NOW 2015 PARTNERSHIP WAS CONDUCTED IN JOINT EFFORT WITH THE FOLLOWING ORGANIZATIONS:1. GREAT RIVERS UNITED WAY2. LA CROSSE COMMUNITY FOUNDATION3. FIVE LOCAL COUNTY HEALTH DEPARTMENTS4. OTTO BREMER FOUNDATION VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 7D: THE CHNA IS AVAILABLE ON THE HOSPITAL'S WEBSITE: HTTP://WWW.VMH.ORG/CONTENT/COMMUNITY-NEEDS-ASSESSMENTTHE CHNA IS ALSO AVAILABLE ON THE FOLLOWING WEBSITES: HTTP://WWW.GREATRIVERSUNITEDWAY.ORG/OUR-WORK/COMMUNITY-NEEDS-ASSESSMENT/ VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 11: THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY VERNON MEMORIAL HEALTHCARE, INC.; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. THE ITEMS THAT WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA.THREE IDENTIFIED ITEMS WERE ADDRESSED AS FOLLOWS BY VERNON MEMORIAL HEALTHCARE, INC.CHRONIC DISEASE AND CONTRIBUTING FACTORS - CHRONIC DISEASES SUCH AS HEART DISEASE, HYPERTENSION, HIGH CHOLESTEROL, CANCERS AND LUNG DISEASES LIKE ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE ARE ALL TOO COMMON AMONG COMMUNITY MEMBERS. VERNON MEMORIAL HEALTHCARE HAS IMPLEMENTED AN ELECTRONIC HEALTH RECORD SYSTEM THAT HAS A ROBUST POPULATION HEALTH MANAGEMENT MODULE WHICH ASSISTS IN THE MONITORING PROCESS. VERNON MEMORIAL HEALTHCARE HAS DEVELOPED A PROGRAM UTILIZING LIFESTYLE HEALTH COACHES, WHO ARE HIGHLY TRAINED, CERTIFIED, EXPERT FACILITATORS OF MINDSET AND BEHAVIOR CHANGE WHO WILL WORK WITH CLIENTS TO HELP THEM FIND THE WILLPOWER, CONFIDENCE AND SELF-DISCIPLINE NECESSARY TO TAKE BACK CONTROL OF THEIR LIFESTYLE CHOICES. WE ARE ABLE TO HELP CLIENTS STRUGGLING WITH SEDENTARY LIFESTYLES, POOR NUTRITION, TOBACCO USE, CHRONIC STRESS AND OTHER AREAS OF CONCERN. ALSO A CANCER EXERCISE PROGRAM BASED ON A PROGRAM CREATED COLLABORATIVELY BY THE AMERICAN CANCER SOCIETY AND THE AMERICAN COLLEGE OF SPORTS MEDICINE, CERTIFIED CANCER EXERCISE TRAINERS (CETS) DESIGN AND ADMINISTER FITNESS ASSESSMENTS AND EXERCISE PROGRAMS SPECIFIC TO A PERSON'S CANCER DIAGNOSIS, TREATMENT AND CURRENT RECOVERY STATUS HAS BEEN STARTED. AN AQUATIC CARDIAC REHABILITATION PROGRAM IS IN PLACE FOR PEOPLE WHO COULD BENEFIT FROM CARDIAC REHABILITATION DUE TO CHRONIC STABLE ANGINA OR CONGESTIVE HEART FAILURE (CHF), OR FOLLOWING A HEART ATTACK, CORONARY ARTERY BYPASS SURGERY, PTCA/STENT PLACEMENT, VALVE REPLACEMENT OR REPAIR, OR HEART OR HEART/LUNG TRANSPLANTATION. A DIABETIC EDUCATION PROGRAM OFFERS PATIENTS A MULTI-DISCIPLINARY TEAM (RN, RD, EP) TO PROVIDE EDUCATION AND SUPPORT ON MANAGING DIABETES TO IMPROVE OVERALL HEALTH AND PREVENT DIABETES RELATED COMPLICATIONS. VERNON MEMORIAL HEALTHCARE ALSO UTILIZES A RN-SOCIAL WORKER TEAM TO COORDINATE SERVICES/RESOURCES TO ASSIST PATIENTS IN REACHING THEIR OPTIMAL HEALTH.MENTAL HEALTH AND OR SUBSTANCE ABUSE - THE NATIONAL INSTITUTE OF MENTAL HEALTH ESTIMATES 26.2% OF AMERICANS (AGES 18 AND OLDER) SUFFER FROM A DIAGNOSABLE MENTAL ILLNESS IN ANY GIVEN YEAR. ADDITIONALLY, MENTAL DISORDERS ARE THE LEADING CAUSE OF DISABILITY IN THE U.S. FOR PEOPLE AGES 15 TO 44. MENTAL ILLNESS HAS A SIGNIFICANT IMPACT ON THE WORKPLACE THAT OFTEN GOES UNRECOGNIZED. MENTAL ILLNESS CAUSES MORE DAYS OF WORK LOSS AND WORK IMPAIRMENT THAN CHRONIC HEALTH CONDITIONS SUCH AS ASTHMA, DIABETES AND HEART DISEASE. VERNON MEMORIAL HEALTHCARE IN COLLABORATION WITH CENTER POINT COUNSELING, HAS HIRED A PSYCHIATRIST AND A LICENSED CLINICAL SOCIAL WORKER TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES IN OUR REGION. VERNON MEMORIAL HEALTHCARE WILL CONTINUE TO PARTNER WITH THE VERNON COUNTY PARTNERSHIP COUNCIL IN IMPLEMENTING ACTIVITIES AIMED AT EDUCATING YOUTH ABOUT THE CONSEQUENCES OF ILLEGAL DRUG USE AND REDUCING YOUTH ACCESS. THE VERNON COUNTY PARTNERSHIP COUNCIL, EXISTS TO DEVELOP AND SUPPORT PROGRAMMING WHICH ADDRESSES DRUG, ALCOHOL AND TOBACCO CONCERNS RELATED TO YOUTH RISK BEHAVIORS.ORAL HEALTH - ORAL HEALTH IS NOT ONLY IMPORTANT FOR QUALITY OF LIFE, BUT IS RELATED TO THE HEALTH OF THE REST OF THE BODY. ORAL DISEASE CONTINUES TO BE A KEY HEALTH CONCERN FOR THE STATE. ACCORDING TO THE WISCONSIN FAMILY HEALTH SURVEY, IN 2015, 25.8% OF WISCONSIN RESIDENTS IN THE GREAT RIVERS REGION DID NOT RECEIVE A DENTAL VISIT WITHIN THE LAST TWELVE MONTHS. VERNON MEMORIAL HEALTHCARE AND SCENIC BLUFFS COMMUNITY HEALTH CENTER, CASHTON WI HAVE PARTNERED TOGETHER TO PROVIDE NEW/ADDITIONAL ACCESS TO DENTAL SERVICES IN VERNON AND CRAWFORD COUNTIES. VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 13B: PATIENTS' RELIANCE ON MEDICARE OR MEDICAL ASSISTANCE. VERNON MEMORIAL HEALTHCARE, INC. PART V, SECTION B, LINE 16J: NO SIGNIFICANT POPULATION WITHIN SERVICE AREA WITH LIMITED ENGLISH PROFICIENCY. 13 1 - HIRSCH CLINIC 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PROVIDER BASED RURAL HEALTH CLINIC 2 - VERNON MEMORIAL HEALTHCARE PHARMACY 407 S MAIN ST SUITE 400 VIROQUA WI 54665 PHARMACY 3 - SOLAR TOWN PHARMACY 104 SUNSET AVE SOLDIERS GROVE WI 54655 PHARMACY 4 - LAFARGE MEDICAL CLINIC 206 N MILL ST LAFARGE WI 54639 PROVIDER BASED RURAL HEALTH CLINIC 5 - BLAND CLINIC 100 MELBY ST WESTBY WI 54667 PROVIDER BASED RURAL HEALTH CLINIC 6 - VERNON MEMORIAL HEALTHCARE INC 705 ARENA DRIVE VIROQUA WI 54665 HOSPICE 7 - KICKAPOO VALLEY MEDICAL CLINIC 102 SUNSET AVE SOLDIERS GROVE WI 54655 PROVIDER BASED RURAL HEALTH CLINIC 8 - VERNON MEMORIAL PHARMACY - LAFARGE 206 N MILL STREET LAFARGE WI 54639 PHARMACY 9 - VERNON MEMORIAL PHARMACY - WESTBY 115 W STATE STREET WESTBY WI 54667 PHARMACY 10 - FAIR HAVEN 601 ARENA DRIVE VIROQUA WI 54665 ASSISTED LIVING 11 - OLD TIMES 206 POLLY RUDE WAY WESTBY WI 54667 ASSISTED LIVING 12 - BOTHNE HOUSE 100 BOTHNE DRIVE COON VALLEY WI 54623 ASSISTED LIVING 13 - VERNON MEMORIAL HEALTHCARE INC 705 ARENA DRIVE VIROQUA WI 54665 HOME HEALTH AGENCY 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 HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS COSTING METHODS FOR THE FORM 990. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S COMMUNITY BENEFIT, THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND URGENT CARE, HOME CARE, HOSPICE, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH AND AUDIOLOGY, SURGICAL SERVICES, AND WOMENS HEALTH. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF 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 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 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 AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: VERNON MEMORIAL HEALTHCARE, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUES ARE 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 HOSPITAL 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. 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 VERNON MEMORIAL HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS FORM 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THE RECIPIENTS ARE TYPICALLY ELDERLY AND/OR DISABLED MEMBERS OF THE COMMUNITY AND 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: IN ORDER TO PROVIDE THE LEVEL OF AID NECESSARY TO THE GREATEST NUMBER OF PATIENTS IN NEED, AND PROTECT THE RESOURCES NEEDED TO DO SO, THE FOLLOWING GUIDELINES APPLY:1) SERVICES ARE PROVIDED UNDER CHARITY CARE ONLY WHEN DEEMED MEDICALLY NECESSARY AND AFTER PATIENTS ARE FOUND TO HAVE MET ALL FINANCIAL CRITERIA BASED ON THE DISCLOSURE OF PROPER INFORMATION AND DOCUMENTATION. 2) CHARITY CARE IS NOT AVAILABLE FOR ELECTIVE PROCEDURES.3) PATIENTS ARE EXPECTED TO CONTRIBUTE PAYMENT FOR CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATION; THEREFORE, EACH CASE WILL BE REVIEWED SEPARATELY.4) CHARITY CARE IS NOT CONSIDERED AN ALTERNATIVE OPTION FOR PAYMENT AND PATIENTS MAY BE ASSISTED IN FINDING OTHER MEANS OF PAYMENT OR FINANCIAL ASSISTANCE BEFORE APPROVAL FOR CHARITY CARE. 5) UNINSURED PATIENTS WHO ARE BELIEVED TO HAVE THE FINANCIAL ABILITY TO PURCHASE HEALTH INSURANCE MAY BE ENCOURAGED TO DO SO IN ORDER TO ENSURE HEALTHCARE ACCESSIBILITY AND OVERALL WELL-BEING. PART VI, LINE 2: IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) RECENTLY CONDUCTED IN CONJUNCTION WITH AREA HEALTH CARE FACILITIES, THE GREAT RIVERS UNITED WAY AND COUNTY HEALTH DEPARTMENTS, VERNON MEMORIAL HEALTHCARE CONTINUALLY GATHERS AND REVIEWS DATA RELATED TO COMMUNITY NEEDS BY UTILIZING MORE INFORMAL FOCUS AND ADVISORY GROUPS, DISCUSSIONS WITH AREA EMPLOYERS AND WEB SURVEYS, AS WELL AS THROUGH SERVING ON LOCAL AND STATE BOARDS AND COMMITTEES. THE ORGANIZATION COLLABORATES WITH COMMUNITY ORGANIZATIONS, CHURCHES, BUSINESSES, AGENCIES, AND LOCAL COLLEGES AND UNIVERSITIES TO DETERMINE THE NEEDS OF THE COMMUNITIES SERVED. BOARD MEMBERS REPRESENT NOT ONLY THE CITY OF VIROQUA, BUT COME FROM THE DIFFERENT AREAS SERVED BY THE ORGANIZATION. THESE BOARD MEMBERS REGULARLY MEET WITH THE PEOPLE IN THEIR AREAS TO UTILIZE THE SERVICES OFFERED BY THE ORGANIZATION AND BRING BACK THEIR ISSUES AND CONCERNS. ADDITIONAL RESOURCES ADDED TO COLLECTING DATA AND UNDERSTANDING THE COMMUNITIES VERNON MEMORIAL HOSPITAL SERVES ARE INSIGHT DATA COLLECTED ON SOCIAL MEDIA AND FOLLOWING ONLINE AREA TRENDS. INFORMATION HAS ALSO BEEN COLLECTED VIA PATIENT SURVEYS SENT TO PATIENTS POST-VISIT REGARDING THE CARE THEY RECEIVED. PART VI, LINE 3: VERNON MEMORIAL HEALTHCARE MAKES EVERY EFFORT TO EDUCATE PATIENTS ABOUT FINANCIAL ASSISTANCE AVAILABLE AT THE TIME OF REGISTRATION AND FOLLOWING DISCHARGE. REGISTRATION HAS A HARD STOP IN EPIC TO REMIND STAFF TO OFFER FINANCIAL ASSISTANCE TO THE PATIENTS. IF A PATIENT REFUSES FINANCIAL ASSISTANCE AT TIME OF REGISTRATION, IT IS DOCUMENTED. FORMS AND INSTRUCTIONS ARE AVAILABLE AT ALL REGISTRATION AREAS, INCLUDING THE MAIN ENTRANCE TO THE HOSPITAL, OUTPATIENT SERVICES, EMERGENCY ROOM, HOME HEALTH, HOSPICE AND OUTLYING CLINICS. FINANCIAL COUNSELORS ARE AVAILABLE DURING DAYTIME HOURS TO ASSIST PATIENTS WITH THE COMPLETION OF FORMS, EITHER IN PERSON, OVER THE PHONE OR THRU MYCARE. INFORMATION ABOUT CHARITY CARE AND DISCOUNT PROGRAMS IS ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE. SIGNS AND PAMPHLETS REGARDING THE FINANCIAL ASSISTANCE PROGRAM ARE POSTED AT ALL REGISTRATION LOCATIONS. PART VI, LINE 4: VERNON MEMORIAL HEALTHCARE SERVES THE CITY OF VIROQUA AND THE SURROUNDING AREA. OTHER TOWNS IN THE PRIMARY SERVICE AREA INCLUDE WESTBY, READSTOWN, SOLDIERS GROVE, CASHTON, AND LAFARGE. THE SECONDARY SERVICE AREA EXTENDS TO THE CITIES OF DESOTO, FERRYVILLE, HILLSBORO, COON VALLEY, RICHLAND CENTER, GAYS MILLS AND ONTARIO. THE COMMUNITIES AND SURROUNDING RURAL AREAS IN THE PRIMARY SERVICE ARE HAVE AN APPROXIMATE POPULATION OF 28,000. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL 25,000 PERSONS. THE ENTIRE AREA IS RURAL WITH AN AGING POPULATION AND RELATIVELY LOW INCOME LEVELS. PART VI, LINE 5: VERNON MEMORIAL HEALTHCARE PROVIDES A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES TO THE PEOPLE IN THE COMMUNITIES IT SERVICES. SERVICES ARE PROVIDED WITHOUT REGARD TO RACE, COLOR, CREED, RELIGION, GENDER ORIENTATION, DISABILITY, AGE OR NATIONAL ORIGIN. VERNON MEMORIAL HEALTHCARE OPERATES A 24/7 EMERGENCY ROOM THAT IS OPEN TO SERVE ALL IN NEED, REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION OWNS AND OPERATES FOUR RURAL HEALTH CLINICS LOCATED IN THE CITIES OF VIROQUA, WESTBY, SOLDIERS GROVE AND LAFARGE, AS WELL AS FOUR RETAIL PHARMACIES LOCATED IN VIROQUA, WESTBY, LAFARGE, AND SOLDIERS GROVE. HOME HEALTH AND HOSPICE SERVICES (INPATIENT AND OUTPATIENT) ARE ALSO PROVIDED. VERNON MEMORIAL HEALTHCARE COLLABORATES WITH COMMUNITIES, CHURCHES, BUSINESSES AND OTHER HEALTH CARE ORGANIZATIONS IN THE REGION TO FACILITATE AND STRENGTHEN ACCESSIBILITY OF QUALITY COMPREHENSIVE HEALTHCARE SERVICES. THE ORGANIZATION SUPPORTS THE LOCAL COMMUNITIES BY PROVIDING CONVENIENT LOCATIONS FOR PRIMARY CARE AND PHARMACY SERVICES. THE BOARD OF DIRECTORS IS COMPRISED OF INDEPENDENT COMMUNITY MEMBERS WHO REPRESENT THE MAKE-UP OF THE AREAS SERVED BY THE ORGANIZATION. VERNON MEMORIAL HEALTHCARE HAS AN OPEN MEDICAL STAFF MADE UP OF QUALIFIED PHYSICIANS WHO WORK WITH THE HOSPITAL TO PROVIDE CARE TO THE COMMUNITIES SERVED. ALL QUALIFIED PHYSICIANS AND AFFILIATED STAFF WHO ARE GRANTED PRIVILEGES UNDERGO A THOROUGH AND COMPREHENSIVE CREDENTIALING AND ORIENTATION PROCESS. ANY SURPLUS FUNDS GENERATED THROUGH OPERATIONS ARE USED TO CONTINUE TO MEET THE NEEDS OF THE PEOPLE THAT ARE SERVED THROUGH THE ADDITION OF NEW FACILITIES AND EQUIPMENT, OR THE ADDITION OR EXPANSION OF NEEDED SERVICES. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 YOUTH INITIATIVE HIGH SCHOOL 500 EAST JEFFERSON ST VIROQUA WI 54665 391906073 501(C)(3) 10000 MATCHING FUNDS, STUDENT FUNDRAISING VERNON COUNTY TREASURER 400 COURTHOUSE SQUARE VIROQUA WI 54665 396005749 GOV'T ORGANIZATION 7200 COON PRAIRIE TRAIL CONSTRUCTION, TRAIL MAINTENANCE WESTERN TECHNICAL COLLEGE 400 7TH ST N LA CROSSE WI 54602 396002842 GOV'T ORGANIZATION 17500 PARTIAL COMPENSATION NURSING CLINICAL INSTRUCTOR - VIROQUA CAMPUS VERNON COUNTY HISTORICAL SOCIETY 410 S CENTER AVE VIROQUA WI 54665 391429799 501(C)(3) 10000 CAPITAL CAMPAIGN FOR ELEVATOR PROJECT PLEASANT RIDGE WALDORF SCHOOL 431 EAST COURT STREET VIROQUA WI 54665 391357578 GOV'T ORGANIZATION 10000 EARLY CHILDHOOD PROGRAM AND GARDENING EDUCATION FINE ARTS FOUNDATION OF THE WESTBY AREA PO BOX 8 WESTBY WI 54667 392018130 501(C)(3) 75000 PERFORMING ARTS CENTER PLEDGE LA CROSSE SYMPHONY ORCHESTRA 201 MAIN STREET STE 230 LA CROSSE WI 54601 391024330 501(C)(3) 5000 CHAMBER CONCERTS LA FARGE SCHOOL DISTRICT 301 W ADAMS STREET LA FARGE WI 54639 396002844 GOV'T ORGANIZATION 5000 SCOREBOARD WDRT DRIFTLESS COMMUNITY RADIO 311 S MAIN STREET VIROQUA WI 54665 743090618 501(C)(3) 5000 SIGNAL INCREASE CITY OF PRAIRIE DU CHIEN PO BOX 324 214 E BLACKHAWK DRIVE PRAIRIE DU CHIEN WI 53821 396005577 GOV'T ORGANIZATION 5000 SMART BUS CONTRIBUTION 10 PART I, LINE 2: ALL DONEES ARE REQUIRED TO SUBMIT THEIR DONATION REQUESTS TO THE CEO OR MARKETING MANAGER OF VERNON MEMORIAL HEALTHCARE, INC. REQUESTS SUBMITTED TO THE MARKETING MANAGER ARE FORWARDED TO THE CEO FOR FINAL APPROVAL. THE REQUESTS MUST INCLUDE A DETAILED DESCRIPTION OF WHAT THE FUNDS WILL BE USED FOR AND HOW THEY WILL BENEFIT THE COMMUNITY. DONEES ARE ASKED TO PROVIDE CONFIRMATION OF RECEIPT AND AN EXPLANATION OF HOW THE FUNDS WERE USED, EITHER VERBALLY OR IN WRITING, TO THE CEO. IF THE REQUESTS ARE DEEMED BENEFICIAL TO THE NEEDS OF THE COMMUNITY, THE FUNDS ARE AWARDED TO THE APPLYING ORGANIZATION. X X X 0 1 0 0 0 0 0 0 0 MARY KOENIG CFO 236834 0 0 0 0 0 13028 0 34674 0 284536 0 0 0 KYLE BAKKUM CEO 278990 0 0 0 0 0 16131 0 17992 0 313113 0 0 0 DR ANTHONY MACASAET PHYSICIAN 416997 0 0 0 0 0 17833 0 35371 0 470201 0 0 0 ARNOLD NOMANN CRNA 373506 0 0 0 0 0 12980 0 16674 0 403160 0 0 0 BRIAN MILLER CRNA 405287 0 0 0 0 0 15755 0 41518 0 462560 0 0 0 GREGORY SAUER CRNA 416699 0 0 0 0 0 11488 0 42359 0 470546 0 0 0 DR PATRICK SCOTT PHYSICIAN 365965 0 0 0 0 0 17928 0 7174 0 391067 0 0 0 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DGX8 2014-12-09 19445225 REFINANCE 2005 BONDS 0 0 0 A 1320000 19445225 286481 19158744 1 0 1 1 A 0 0 0 0 0.03770 0.03770 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 ANY PERSON WHO IS EIGHTEEN YEARS OF AGE OR OLDER AND A BONA FIDE RESIDENT OF VERNON COUNTY, WISCONSIN, OR THE AREA WITHIN A RADIUS OF TWENTY-FIVE MILES OF THE CITY OF VIROQUA, WISCONSIN, AND WHO HAS HERETOFORE OR MAY HEREAFTER CONTRIBUTE TEN DOLLARS OR MORE TO VERNON MEMORIAL HEALTHCARE, INC. (THE ORGANIZATION") SHALL BE A MEMBER THEREOF. ALL MEMBERS OF THE ORGANIZATION SHALL BE VOTING MEMBERS. EACH MEMBER SHALL HAVE ONE VOTE ON ANY MATTER SUBMITTED TO A VOTE OF THE MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE DUTIES OF THE MEMBERS OF THE ORGANIZATION SHALL BE: THE ELECTION OF MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION, THE REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION, AND THE CHANGING OF THE NUMBER OF DIRECTORS CONSTITUTING THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE DUTIES OF THE MEMBERS OF THE VERNON ORGANIZATION SHALL ALSO INCLUDE: THE AMENDMENT, RESTATEMENT, OR MODIFICATION OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE ORGANIZATION; AND THE APPROVAL OF THE SALE, LEASE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL OF THE ASSETS AND PROPERTY OF THE ORGANIZATION, THE DISSOLUTION OF THE ORGANIZATION, OR ITS MERGER WITH ANOTHER CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS OF VERNON MEMORIAL HEALTHCARE, INC. FOR REVIEW PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS OF VERNON MEMORIAL HEALTHCARE, INC. ARE REQUIRED TO DISCLOSE ALL POSSIBLE CONFLICTS OF INTEREST WHEN FIRST ELECTED TO THE BOARD OF DIRECTORS. DURING THEIR TERMS, IF ANY BUSINESS RELATIONSHIPS ARE ENTERED INTO WHICH MAY AFFECT THEIR INDEPENDENCE AS A MEMBER, THE MEMBER MUST IMMEDIATELY DISCLOSE THESE RELATIONSHIPS. THE COMPLIANCE DEPARTMENT PROVIDES EDUCATION ANNUALLY WHEN BOARD MEMBERS ARE REQUIRED TO UPDATE AND SIGN A CONFLICT OF INTEREST STATEMENT EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE APPROPRIATE SALARY RANGES FOR UPPER MANAGEMENT POSITIONS, VERNON MEMORIAL HEALTHCARE, INC. UTILIZES BENCHMARK DATA FROM SURVEYS CONDUCTED BY RELEVANT TRADE ORGANIZATIONS. THE CEO HAS THE RIGHT TO AMEND THE DETERMINED AMOUNT FOR THE CFO AND COO. THE BOARD HAS THE RIGHT TO AMEND THE AMOUNT FOR THE CEO. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS THE DATA FOR THE CEO ANNUALLY TO DETERMINE THE AMOUNT OF HIS COMPENSATION AND ANY CHANGES IN COMPENSATION ARE MAINTAINED IN THE PERSONNEL FILE. THE CEO REVIEWS THE DATA FOR THE CFO AND COO ANNUALLY TO DETERMINE THE AMOUNT OF COMPENSATION AND ANY CHANGES ARE MAINTAINED IN THE PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 VERNON MEMORIAL HEALTHCARE, INC. MAKES ITS FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC ON A PER REQUEST BASIS. THE FORM 990 IS ALSO AVAILABLE TO THE PUBLIC ON A THIRD PARTY WEBSITE CALLED GUIDESTAR. FORM 990, PART XI, LINE 2C: OVERSIGHT OF AUDIT: VERNON MEMORIAL HEALTHCARE, INC. DOES NOT HAVE A SPECIFIC COMMITTEE WHICH ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THE ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. NO CHANGES HAVE BEEN MADE IN THE PAST YEAR REGARDING THIS OVERSIGHT FUNCTION OF THE GOVERNING BODY. VERNON MEMORIAL HEALTHCARE FOUNDATION INC 507 SOUTH MAIN STREET VIROQUA WI 54665 391515716 FUNDRAISING WI 501(C)3 LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0