2025-11-04T13:04:43-06:00 2024-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2024-01-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE LAKE 7152341515 1700 W STOUT STREET RICE LAKE WI 54868 NICHOLAS OLSON EVP, CFO 6053331000 2025-11-04 1 0 JESS WAGENER P01622613 3128792000 2024 2025-03-06 01:10:19Z MARSHFIELD MEDICAL CENTER-RICE LAKE BILL GASSEN 2301 EAST 60TH ST SIOUX FALLS SD 57104 140039395 0 X WWW.MARSHFIELDCLINIC.ORG X 1975 WI WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 4 0 250 0 0 17616 11684 152615794 140078776 -2959 -56834 0 0 152630451 140033626 0 0 0 0 63918603 61934547 0 0 0 83692640 77854092 147611243 139788639 5019208 244987 100153915 84890656 40057118 37889123 60096797 47001533 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 112947742 0 140078776 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT 40-BED COMMUNITY HOSPITAL LOCATED IN RICE LAKE, WISCONSIN THAT PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE AND HOME HEALTH SERVICES. 112947742 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 0 1 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X NICHOLAS OLSON EVP CFO 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 DOUG MATHISON BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID HOLMES BOARD MEMBER 1.00 1.00 X 0 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 1.00 51.00 X 0 592054 42454 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 1.00 54.00 X X 0 1584168 39013 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 1.00 54.00 X 0 703503 36357 COLLEEN HOERNEMAN CHAIR 1.00 10.00 X X 0 5500 0 JOHN BALTUS SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 MARK BRADLEY VICE CHAIR 1.00 6.00 X X 0 5500 0 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 1.00 54.00 X 0 972510 0 SUSAN TURNEY MD FORMER MCHS CEO 0.00 0.00 X 0 2241715 0 CATHY BUKOWSKI FORMER MCHS CFO 0.00 0.00 X 0 631969 0 0 6736919 117824 0 1 1 0 LOCUMSMART LLC PO BOX 736389 DALLAS TX 75373 MEDICAL SERVICES 3895993 VAYA WORKFORCE SOLUTIONS LLC PO BOX 713427 CHICAGO IL 60677 PROFESSIONAL SERVICES 2592610 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 FOOD AND ENVIRONMENTAL 1599099 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD AND ENVIRONMENTAL 1463262 SHARED MEDICAL SERVICES INC 209 LIMESTONE PASS COTTAGE GROVE WI 53527 PROFESSIONAL SERVICES 713613 32 8350 3334 11684 NET PATIENT SERVICE RE 621110 139529916 139529916 CAFETERIA REVENUE 722310 265352 265352 INTERCOMPANY REVENUE 621110 165201 165201 118307 118307 140078776 3576 3576 -55732 -55732 1091 5769 -4678 -4678 -4678 140033626 139813424 0 208518 51480628 50395999 1084629 880653 859530 21123 6841842 6684518 157324 2731424 2665297 66127 6037261 6030341 6920 13590 1405 12185 1352254 1217398 134856 82898 82898 2049780 2006243 43537 352045 346591 5454 1121600 1121600 4638401 4638401 MEDICAL SUPPLIES 32819459 32817548 1911 I/C PURCHASED SERVICES 27303339 2036355 25266984 WI MEDICAID ACCESS TAX 1567524 1567524 EQUIP REPAIRS & MAINT 351971 350001 1970 163970 126093 37877 139788639 112947742 26840897 0 X 6011 3900 3344 0 33936520 23216804 2491451 2256231 123601942 64206269 63671667 59395673 44922 18048 100153915 84890656 13498726 3442868 -7716 172216 26548194 34274039 17914 0 40057118 37889123 X 60096797 47001533 60096797 47001533 100153915 84890656 X 244987 -13340251 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3788469 3788469 81346390 34480172 46866218 57020 44221 12799 33990402 26594933 7395469 4419661 3086943 1332718 59395673 0 X PART X, LINE 2: THE ORGANIZATION APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. THE SYSTEM HAS DETERMINED THAT IT DOESN'T HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2024 OR DECEMBER 31, 2023. 1 1 X 1 X 1 X 1 1 1 0 0 698284 0 698284 0.00500 16462975 6475173 9987802 0.07140 0 0 17161259 6475173 10686086 0.07640 1610188 0 1610188 0.01150 2162 0 2162 0.00000 31416999 29315305 2101694 0.01500 0 0 7676 0 7676 0.00010 33037025 29315305 3721720 0.02660 50198284 35790478 14407806 0.10300 0 0 0 0 0 0 0 0 0 0 1366 0 1366 0.00000 0 0 0 0 0 0 1366 1366 0.00000 1 7126255 0 7503637 9179110 -1675473 X 1 1 1 1 MARSHFIELD MEDICAL CENTER - RICE LAKE 1700 W STOUT STREET RICE LAKE WI 54868 WWW.MARSHFIELDCLINIC.ORG 82 X X X MARSHFIELD MEDICAL CENTER - RICE LAKE 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL INFO X 1 23 1 SEE SUPPLEMENTAL INFO 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X WWW.MARSHFIELDCLINIC.ORG/PATIENT-RESOURCES/BILLING/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 5: DIRECT COLLABORATION WITH LOCAL COMMUNITY PARTNERS INCLUDED TWO THRIVE STEERING COMMITTEE CHA/CHIP PLANNING MEETINGS IN AUGUST 2022 AND DECEMBER 2022. TO ACHIEVE COMPLIANCE, MMC-RICE LAKE COMPLETED A ONE-YEAR CHNA/IS IN 2021 WITH A COMMUNITY HEALTH ASSESSMENT SURVEY AND KEY INFORMANT INTERVIEWS. TO ALIGN WITH BARRON COUNTY HEALTH DEPARTMENT AND THE THRIVE STEERING COMMITTEE, MMC-RICE LAKE UTILIZED THE COMMUNITY HEALTH SURVEY DATA, KEY INFORMANT INTERVIEW DATA, TWO PLANNING MEETINGS, AND THE ADDITION OF THE COMMUNITY AFFIRMATION SURVEY TO COMPLETE THE 2022 MMC-RICE LAKE CHNA.THE SURVEY COLLECTED 250 RESPONSES BETWEEN MARCH AND APRIL 2021 FROM BARRON COUNTY RESIDENTS. OVERALL, RESPONDENTS TENDED TO BE WHITE, FEMALE AND BETWEEN THE AGES OF 35-44 AND 55-64. OF SURVEY RESPONDENTS, 6.76% WERE RETIRED AND 7.43% WORK PART TIME. THIS SURVEY DATA WAS UTILIZED IN THE 2021 MMC-RICE LAKE CHNA AND 2022 MMC-RICE LAKE CHNA.PRIMARY DATA COLLECTION FOR AN AFFIRMATION SURVEY WAS COMPLETED IN JANUARY 2022. THE PURPOSE OF THE SURVEY WAS TO MEET THE NEED OF THE BARRON COUNTY CHA AND OTHER HEALTH SYSTEMS CHNA/IS. AN ELECTRONIC SURVEY WAS WIDELY DISTRIBUTED BY BARRON COUNTY PUBLIC HEALTH AND THE THRIVE STEERING COMMITTEE, WHICH INCLUDED MMC-RICE LAKE.THE SURVEY COLLECTED 361 RESPONSES BETWEEN DECEMBER 2021 AND JANUARY 2022 FROM BARRON COUNTY RESIDENTS.FOR THIS ASSESSMENT KEY INFORMANT INTERVIEWS WERE CONDUCTED VIA WEBEX (VIDEO CONFERENCING PLATFORM) AND TELEPHONE TO OBSERVE COVID-19 PANDEMIC SAFETY PROTOCOLS. THREE INDIVIDUALS COMPLETED AN INTERVIEW AND RESULTING INSIGHTS WERE COMPILED INTO A SUMMARY REPORT. MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITY(S):- MAYO CLINIC HEALTH SYSTEM NORTHLAND- AMERY HOSPITAL AND CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING NON-HOSPITAL FACILITY(S):- BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)- AGING AND DISABILITY RESOURCE CENTER OF BARRON, RUSK, AND WASHBURN COUNTIES- UNIVERSITY OF WISCONSIN-EAU CLAIRE- WISCONSIN INDIANHEAD TECHNICAL COLLEGE (WITC)- CUMBERLAND HEALTHCARE- RICE LAKE AREA FREE CLINIC- NORTHLAKES COMMUNITY CLINIC MARSHFIELD MEDICAL CENTER - RICE LAKE PART V, SECTION B, LINE 11: AFTER COMPLETING EXTENSIVE REVIEW OF THE BARRON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY, KEY INFORMANT INTERVIEW SUMMARY, HEALTHIEST WISCONSIN 2020, COUNTY HEALTH RANKINGS, AND OTHER QUANTITATIVE AND QUALITATIVE DATA, THE TOP COMMUNITY HEALTH PRIORITIES IDENTIFIED BY MARSHFIELD MEDICAL CENTER IN RICE LAKE ARE: - ALCOHOL AND SUBSTANCE ABUSE - BEHAVIORAL HEALTH - HEALTH EQUITYHEALTH PRIORITY: ALCOHOL AND SUBSTANCE USEGOAL 1: REDUCE ALCOHOL & SUBSTANCE USE AMONG YOUTH AND ADOLESCENTS BY REDUCING RISK AND ENHANCING PROTECTION.- PREVENT ALCOHOL AND SUBSTANCE USE BY IDENTIFYING AND IMPLEMENTING INDIVIDUAL AND/OR ENVIRONMENTAL PREVENTION STRATEGIES.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO ALCOHOL AND SUBSTANCE USE PREVENTION EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: BEHAVIORAL HEALTH GOAL 1: INCREASE ACCESS TO COMMUNITY-BASED MENTAL AND EMOTIONAL WELLNESS SERVICES.- ENHANCE COMMUNITY CAPACITY TO PROVIDE RESOURCES THAT INCREASE SOCIAL EMOTIONAL SKILL DEVELOPMENT AND IMPROVE MENTAL WELLNESS OF YOUTH.- PROVIDE EDUCATIONAL MATERIALS (USING A VARIETY OF PLATFORMS) TO INCREASE CAREGIVER MENTAL HEALTH AND WELLBEING. - PROVIDE DIRECT TECHNICAL ASSISTANCE AND TRAINING TO ADULTS WHO WORK WITH AND SUPPORT YOUTH AROUND BEHAVIOR GUIDANCE AND YOUTH MENTAL WELLNESS.- ENHANCE COMMUNITY MEMBERS' SKILLS TO SUPPORT MENTAL WELLNESS PROMOTION AND SUICIDE PREVENTION.GOAL 2: ENGAGE IN COMMUNITY EFFORTS RELATED TO SUPPORTING BEHAVIORAL HEALTH EFFORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. HEALTH PRIORITY: HEALTH EQUITYGOAL 1: ADVANCE HEALTH EQUITY BY FOCUSING ON COMMUNITY-BASED HEALTH DISPARITIES AND ADDRESSING SOCIAL DETERMINANTS OF HEALTH.- ADDRESS SOCIAL NEEDS OF PATIENTS AND COMMUNITIES BY SCREENING AND CONNECTING TO RESOURCES.GOAL 2: REDUCE HEALTH DISPARITIES RELATED TO PHYSICAL, SOCIAL, ECONOMIC AND/OR COMMUNITY CONDITIONS.- INCREASE COMMUNITY CAPACITY TO PROVIDE NUTRITIOUS, LOCAL GROWN FOOD AND ADDRESS FOOD INSECURITY.GOAL 3: ENGAGE IN COMMUNITY EFFORTS RELATED TO IMPROVING EQUITABLE ACCESS TO RESOURCES AND SUPPORTS.- PARTICIPATE IN COMMUNITY-BASED WORKGROUPS. THE FOLLOWING HEALTH NEEDS WILL NOT BE ADDRESSED BY MMC-RICE LAKE FOR REASONS INDICATED:- INJURY & VIOLENCE PREVENTION: INJURY AND VIOLENCE ARE IMPORTANT AREAS OF FOCUS. INSTEAD OF LEADING THIS CHARGE, MMC-RICE LAKE STAFF PARTICIPATE IN A VARIETY OF COMMUNITY GROUPS SUPPORTING THIS AREA INCLUDING, BARRON-WASHBURN COUNTY CAREGIVER COALITION AND COMMUNITY CONNECTIONS TO PROSPERITY (CCP). EMBRACE INC. (A DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCY THAT PROVIDES SAFE SHELTER AND SUPPORTIVE SERVICES FOR SURVIVORS), AGING AND DISABILITY RESOURCE CENTER (ADRC) OF BARRON, RUSK, AND WASHBURN COUNTIES, AND BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEAD AND HAVE EXPERTISE IN THIS AREA. - COMMUNICABLE DISEASE PREVENTION & CONTROL: THIS IS AN IMPORTANT AREA OF FOCUS, AND MMC-RICE LAKE HAS SYSTEMS AND PROCESSES IN PLACE TO PREVENT AND REDUCE THE SPREAD OF COMMUNICABLE DISEASES. THE HOSPITAL WILL NOT TAKE THE LEAD ON THIS AREA IN COMMUNITY OUTREACH AS THIS IS AN AREA THE BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) LEADS AND HAS EXPERTISE IN.- ORAL HEALTH: MARSHFIELD CLINIC RICE LAKE DENTAL CENTER ADDRESSES THE COMMUNITY NEED FOR ORAL HEALTH BY SERVING PATIENTS REGARDLESS OF ABILITY TO PAY OR INSURANCE STATUS. WHILE MMC-RICE LAKE ADDRESSES ORAL HEALTH IT IS NOT LISTED AS ONE OF THE TOP HEALTH PRIORITIES. LINE 7A CHNA REPORT URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2023-2025%20MMC-RL%20CHNA.PDF LINE 10A IMPLEMENTATION STRATEGY URL HTTPS://WWW.MARSHFIELDCLINIC.ORG/CLINICLOCATIONS/DOCUMENTS/2023-2025%20MMC-RL%20IS.PDF PART I, LINE 3C: AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON INCOME AS COMPARED WITH FEDERAL POVERTY GUIDELINES. OTHER ELIGIBILITY FACTORS INCLUDE: ASSET LIMITATIONS, INSURANCE STATUS AND RESIDENCY. ACCOUNT BALANCE IS CONSIDERED FOR MEDICAL INDIGENCE ELIGIBILITY. PART I, LINE 7: COST TO CHARGE RATIOS ARE USED TO CALCULATE THE AMOUNTS ON LINE 7A - 7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS) AND LINE 7G (SUBSIDIZED HEALTH SERVICES) IS CALCULATED USING A COST ACCOUNTING SYSTEM. ALL OTHER AMOUNTS FOR LINES 7E, 7F, 7H AND 7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST TO CHARGE RATIO, OR SIMILAR COST ACCOUNTING METHODOLOGY. THESE COSTS STILL REPRESENT THE COSTS TO PROVIDE BENEFITS. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES ARE CLINICAL SERVICES PROVIDED TO BOTH INPATIENTS AND OUTPATIENTS DESPITE A FINANCIAL LOSS TO THE ORGANIZATION. EACH LOSS HAS BEEN CALCULATED AFTER REMOVING LOSSES ASSOCIATED WITH BAD DEBTS, FINANCIAL ASSISTANCE AND MEDICAID. ALTHOUGH THESE SERVICES GENERATE OVERALL LOSSES TO THE ORGANIZATION, THEY CONTINUE TO MEET THE NEEDS OF THE COMMUNITIES SERVED. VARIOUS SERVICES THAT GENERATE LOSSES ARE PROVIDED BY THE ORGANIZATION THROUGH PHYSICIAN PRACTICES. FOR CY 2024, SUBSIDIZED HEALTH SERVICES PROVIDED THROUGH CLINIC PHYSICIAN PRACTICES GENERATED LOSSES OF $2,101,694. PART II, COMMUNITY BUILDING ACTIVITIES: MMC-RICE LAKE, IN ALIGNMENT WITH THE MARSHFIELD CLINIC HEALTH SYSTEM MISSION STATEMENT; ENRICHES LIVES, BY PARTICIPATING IN VARIOUS COMMUNITY BUILDING ACTIVITIES TO IMPROVE THE HEALTH OF THE COMMUNITY. THE HEALTH SYSTEM CONTINUED TO IMPLEMENT A FINANCIAL IMPROVEMENT PLAN BECAUSE OF SIGNIFICANT CHALLENGES IN THE HEALTHCARE INDUSTRY. DESPITE THIS, COMMUNITY-BUILDING ACTIVITIES CONTINUED, AND STRONGER, LOCAL CONNECTIONS WERE MADE. SOME EXAMPLES OF COMMUNITY BUILDING ACTIVITIES INCLUDE: COMMUNITY SUPPORT: MMC-RICE LAKE STAFF PARTICIPATED IN COMMUNITY PROGRAMS AND EVENTS INCLUDING: - PROVIDED COMMUNITY HEALTH EDUCATION PRESENTATIONS ON TOPICS SUCH AS: FALLS PREVENTION, OSTEOPOROSIS, CAREGIVER HEALTH AND WELLBEING, AND HEALTHY AGING. - PROVIDED EMS SERVICES AND COVERAGE AT THE BARRON COUNTY FAIR AND BARRON COUNTY RODEO. ENVIRONMENTAL IMPROVEMENTS: MMC-RICE LAKE PROVIDED A MEDICATION DISPOSAL KIOSK IN THE HOSPITAL OPEN TO THE PUBLIC AND ENCOURAGES SAFE DISPOSAL OF MEDICATION IN THE COMMUNITY. MMC-RICE LAKE SUPPORTS HARM REDUCTION METHODS RELATED TO USED SHARPS, BY ACCEPTING USED SHARPS FROM ANYONE IN THE COMMUNITY REGARDLESS OF PATIENT STATUS. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS: MMC-RICE LAKE - IMPLEMENTS A HOSPITAL VOLUNTEER PROGRAM, HOSPITAL VOLUNTEERS HOST EVENTS TO FINANCE THE MMC-RICE LAKE SCHOLARSHIP PROGRAM OPEN TO HIGH SCHOOL SENIORS IN THE COMMUNITY. - OFFERS A MEDICAL ASSISTANT TRAINING PROGRAM. - IMPLEMENTS A HIGH SCHOOL INTERNSHIP WHERE STUDENTS ROTATE THROUGH MULTIPLE HOSPITAL DEPARTMENTS COMPLETING FULL-DAY OBSERVATIONS AND CONTRIBUTE VOLUNTEER SERVICE. COALITION BUILDING: MMC-RICE LAKE STAFF PARTICIPATED IN COMMUNITY COALITIONS AND COLLABORATIONS WITH THE PURPOSE OF IMPROVING THE HEALTH OF THE COMMUNITY INCLUDING THE BARRON COUNTY COMMUNITY COALITION AND BARRON COUNTY THRIVE STEERING COMMITTEE. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: MMC-RICE LAKE PROVIDED RECOVERY COACH SERVICES FOR PATIENTS AND COMMUNITY MEMBERS SEEKING SUPPORT OR ALREADY IN RECOVERY FROM AN ADDICTION TO ALCOHOL AND/OR OTHER SUBSTANCES. WORKFORCE DEVELOPMENT: MMC-RICE LAKE FUNCTIONED AS A CLINICAL SITE FOR STUDENT NURSES, STUDENT-NURSING ASSISTANTS, PRECEPTORS FOR HEALTHCARE JOBS, AND MEDICAL RESIDENTS AND INTERNS. PART III, LINE 3: NO BAD DEBT IS ESTIMATED TO RELATE TO CHARITY CARE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS ANDIDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS 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 CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT 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 OFFAGAINST THE ALLOWANCE. THE SYSTEM'S IMPLICIT ALLOWANCE FOR SELF-PAY PATIENTS WAS APPROXIMATELY 62% AND 65% OF SELF-PAY ACCOUNTS RECEIVABLE AS OF DECEMBER 31, 2024 AND DECEMBER 31, 2023, RESPECTIVELY. PART III, LINE 8: THE ALLOWABLE MEDICARE COST ON PART III, LINE 6 IS DETERMINED USING THE CY 2024 MEDICARE COST REPORT. THE REIMBURSEMENT FROM MEDICARE IS DEDUCTED FROM THE ESTIMATED COST USING A COST-TO-CHARGE RATIO IN ORDER TO DETERMINE THE SHORTFALL FROM THE MEDICARE PROGRAM. THE SYSTEM TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT. THE REASONS FOR THIS TREATMENT INCLUDE (1) NON-NEGOTIABLE MEDICARE RATES ARE SOMETIMES NOT ALIGNED WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS; (2) THE SYSTEM IS ALLEVIATING THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES; AND (3) IRS REV. RUL. 69-545 NOTES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THIS ACTION INDICATES THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PURSUING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: IN ADDITION TO THE CHNA REPORTED IN PART FIVE SECTION B, MMC-RICE LAKE USES RELIABLE THIRD-PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, AND DIRECT COMMUNITY INVOLVEMENT TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THE INFORMATION PROVIDED BY THESE SOURCES' POINTS TO AREAS OF NEED. MMC-RICE LAKE COLLABORATES CLOSELY WITH MARSHFIELD CLINIC HEALTH SYSTEM'S CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA) TO ASSESS, DEVELOP, AND IMPLEMENT PROGRAMS TO IMPROVE THE HEALTH OF THE LOCAL COMMUNITY. CCHA'S STRATEGIC AREAS OF FOCUS INCLUDE SUBSTANCE USE, BEHAVIORAL HEALTH, HEALTH EQUITY, AND BUILDING COMMUNITY CAPACITY FOR HEALTH IMPROVEMENT. THIS WORK REQUIRES CONTINUAL ASSESSMENT OF THE NEEDS OF THE COMMUNITY WHICH REINFORCES MMC-RICE LAKE'S CHNA AND FURTHER SUPPORTS THE STRATEGIES IDENTIFIED IN THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE STRATEGIC AREAS REPRESENT COMPLEX CHALLENGES COMMUNITIES EXPERIENCE EVERY DAY, AND CCHA IS COMMITTED TO IMPROVING. MMC-RICE LAKE UTILIZES THE CENTER FOR COMMUNITY HEALTH ADVANCEMENT'S COMMUNITY CONNECTIONS TEAM AND FINDHELP, A SOCIAL NEEDS PLATFORM THAT INCLUDES AN ELECTRONIC DATABASE OF COMMUNITY RESOURCES AVAILABLE IN AN AREA, TO ASSESS NEEDS AND THEN CONNECT INDIVIDUALS TO THOSE RESOURCES. ADDITIONALLY, THERE ARE PROCESSES IN PLACE AT MMC-RICE LAKE TO ESTABLISH ONGOING DIRECT ENGAGEMENT WITH THE LOCAL HEALTH DEPARTMENT, NUMEROUS COMMUNITY-HEALTH-FOCUSED ORGANIZATIONS, COMMUNITY CHAMBERS, BOARDS OF ECONOMIC DEVELOPMENT, YOUTH-FOCUSED ORGANIZATIONS AND OTHER HEALTH IMPROVING ORGANIZATIONS. DIRECT COLLABORATION WITH, AND REQUESTS FROM, THESE GROUPS FURTHER KNOWLEDGE OF THE COMMUNITY AND ITS NEEDS. PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARITABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE.INFORMATION ON THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA. THE MCHS FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: MMC-RICE LAKE IS A 40-BED COMMUNITY HOSPITAL IN RICE LAKE WISCONSIN. MMC-RICE LAKE OFFERS A 24/7 EMERGENCY DEPARTMENT, AMBULANCE SERVICES, FULL SCOPE OF GENERAL AND ORTHOPEDIC SURGERY SERVICES, COMPREHENSIVE OUTPATIENTS CANCER CARE SERVICES, AND INPATIENT AND OUTPATIENT PHYSICAL THERAPY, REHABILITATION AND OCCUPATIONAL THERAPY. BARRON COUNTY IS LOCATED IN NORTHWESTERN WISCONSIN. THE COUNTY IS COMPRISED OF FOUR CITIES (BARRON, CHETEK, CUMBERLAND, AND RICE LAKE), SIX VILLAGES (ALMENA, CAMERON, DALLAS, HAUGEN, NEW AUBURN, PRAIRIE FARM, AND TURTLE LAKE), AND 25 TOWNSHIPS WITH A TOTAL POPULATION OF 46,719 IN 2021; APPROXIMATELY 65.9% OF WHICH IS RURAL. THE CITY OF RICE LAKE IS WHERE MARSHFIELD MEDICAL CENTER-RICE LAKE IS LOCATED AND HAD A TOTAL POPULATION OF 8,939 IN 2021. RICE LAKE IS LOCATED ABOUT 100 MILES EAST OF MINNEAPOLIS, MN AND ABOUT 60 MILES NORTH OF EAU CLAIRE, WI. THE RACIAL MAKE-UP OF BARRON COUNTY IS 94.9% WHITE, 0.7% ASIAN, 3.0% HISPANIC OR LATINO, 1.4% TWO OR MORE RACES, 1.8% BLACK OR AFRICAN AMERICAN, AND 1.3% AMERICAN INDIAN AND ALASKA NATIVE. THE MEDIAN HOUSEHOLD INCOME IN BARRON COUNTY IS $52,346 COMPARED TO THE STATE AVERAGE OF $63,293 WITH THE POVERTY RATE OF 10%. THE EDUCATION LEVEL OF BARRON COUNTY RESIDENTS IS LOWER THAN THE STATEWIDE AVERAGE. ACCORDING TO THE LATEST CENSUS ESTIMATES, 90.6% OF BARRON RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, COMPARED TO 92.6% STATEWIDE. LIKEWISE, 20.6% OF BARRON RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 30.8% STATEWIDE. PART VI, LINE 5: MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) PROMOTES THE HEALTH OF COMMUNITIES THROUGH ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), A DEPARTMENT WITHIN MCHS SOLELY DEDICATED TO COMMUNITY HEALTH. CCHA IS GOVERNED BY THE ENTERPRISE WIDE MCHS COMMUNITY HEALTH/COMMUNITY BENEFITS STEERING COMMITTEE WHICH IS TASKED WITH PROVIDING OVERSIGHT AND GUIDANCE ON SYSTEM COMMUNITY HEALTH AND COMMUNITY BENEFIT STRATEGY. THE COMMITTEE IS MADE UP OF INTERNAL EMPLOYEES WHO REPRESENT VARIOUS DIFFERENT DEPARTMENTS AND ROLES WITHIN THE HEALTH SYSTEM. THIS STRONG FOCUS ON COMMUNITY HEALTH IS FURTHER SUPPORTED BY THE MARSHFIELD CLINIC HEALTH SYSTEM BOARD OF DIRECTORS WHICH CONSISTS OF 24 MEMBERS, 11 OF THOSE MEMBERS ARE PHYSICIAN DIRECTORS AND 13 ARE INDEPENDENT DIRECTORS WHO RESIDE WITHIN THE SERVICE AREA AND ARE NOT EMPLOYEES OF THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES THROUGH ACCESSIBLE, AFFORDABLE, AND COMPASSIONATE HEALTH CARE. MCHS PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY LIVING OUT THIS MISSION INCLUDING PROVIDING SEVERAL SERVICES WHICH WOULD NOT OTHERWISE BE AVAILABLE IN A RURAL SETTING SUCH AS, MCHS PROVIDERS PRACTICING MORE THAN 170 SPECIALTIES AND EMERGENCY ROOMS THAT ARE AVAILABLE TO ALL PATIENTS REGARDLESS OF THE ABILITY TO PAY. MCHS TRAINS AND EDUCATES HEALTHCARE PROFESSIONALS THROUGH A VARIETY OF INTERNSHIP PROGRAMS AND PARTNERS REGULARLY WITH LOCAL HIGH SCHOOLS AND COLLEGES TO DISCUSS CAREER, INTERNSHIP, AND VOLUNTEER OPPORTUNITIES FOR STUDENTS. MCHS ACCEPTS FINANCIAL ASSISTANCE AND PAYMENT PLANS ARE AVAILABLE; MCHS ALSO PARTICIPATES IN GOVERNMENT-SPONSORED HEALTH PROGRAMS (E.G. MEDICARE, MEDICAID). A VARIETY OF HEALTH PROGRAMMING IS PROVIDED TO THE COMMUNITY AT NO COST SUCH AS CHILD SAFETY EDUCATION, SUPPORT GROUPS, AND PRESENTATIONS ON A VARIETY OF HEALTH TOPICS. MCHS STAFF ARE ACTIVELY INVOLVED IN THEIR LOCAL COMMUNITY AND LEND NOT ONLY THEIR EXPERTISE BUT OFTENTIMES LEADERSHIP AS WELL TO MANY ORGANIZATIONS SUCH AS UNITED WAY, YMCA, CHAMBER OF COMMERCE, ETC. STAFF FROM MCHS HAVE BEEN INSTRUMENTAL IN ACCOMPLISHING COMMUNITY NEEDS ASSESSMENTS AND IMPLEMENTATION OF COMMUNITY INITIATIVES IN AREAS OF SUBSTANCE MISUSE, BEHAVIORAL HEALTH, AND HEALTH EQUITY. PART VI, LINE 6: MMC-RICE LAKE IS PART OF MARSHFIELD CLINIC HEALTH SYSTEM, INC., AN INTEGRATED HEALTH SYSTEM SERVING WISCONSIN AND MICHIGAN'S UPPER PENINSULA WITH MORE THAN 12,000 EMPLOYEES INCLUDING MORE THAN 1,600 PROVIDERS COMPRISING OVER 170 SPECIALTIES, A HEALTH PLAN AND RESEARCH AND EDUCATION PROGRAMS. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. MARSHFIELD CLINIC HEALTH SYSTEM SERVES RURAL COMMUNITIES AND COLLECTIVELY PROMOTES HEALTH BY REDUCING BARRIERS TO ACCESSING CARE. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE THAT WOULDN'T OTHERWISE BE AVAILABLE THROUGH ITS 60 LOCATIONS AND 11 HOSPITALS IN COMMUNITIES ACROSS NORTHERN, CENTRAL AND WESTERN WISCONSIN AND IN MICHIGAN. MCHS PRIMARY OPERATIONS INCLUDE MARSHFIELD CLINIC LOCATIONS; MARSHFIELD CHILDREN'S HOSPITAL; MARSHFIELD MEDICAL CENTER HOSPITALS IN MARSHFIELD, EAU CLAIRE, BEAVER DAM, LADYSMITH, MINOCQUA, NEILLSVILLE, RICE LAKE, STEVENS POINT, WESTON, PARK FALLS, AND IRON MOUNTAIN (MICHIGAN); MARSHFIELD CLINIC RESEARCH INSTITUTE, SECURITY HEALTH PLAN, DIVISION OF EDUCATION AND MARSHFIELD CLINIC HEALTH SYSTEM FOUNDATION. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 1 0 0 0 0 0 0 0 SUSAN TURNEY MD FORMER MCHS CEO 0 0 0 0 0 2241715 0 0 0 0 0 2241715 0 0 BRIAN HOERNEMAN MD BOARD MEMBER/INTERIM MCHS CEO 0 1043925 0 516277 0 23966 0 8625 0 30388 0 1623181 0 0 JEANETTE WOJTALEWICZ INTERIM MCHS CFO 0 0 0 0 0 972510 0 0 0 0 0 972510 0 0 SAMANTHA KLEBE DO BOARD MEMBER/MCHS CMO 0 476625 0 201334 0 25544 0 8625 0 27732 0 739860 0 0 EDWARD FERNANDEZ MD BOARD MEMBER 0 338138 0 225978 0 27938 0 8625 0 33829 0 634508 0 0 CATHY BUKOWSKI FORMER MCHS CFO 0 0 0 0 0 631969 0 0 0 0 0 631969 0 0 PART I, LINE 3 THE MARSHFIELD CLINIC HEALTH SYSTEM'S (MCHS) INDEPENDENT COMPENSATION COMMITTEE (THE COMMITTEE) HAS FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS EMPLOYED BY ANY OF THE ORGANIZATIONS IN THE SYSTEM. THE COMMITTEE USES COMBINATIONS OF THE FOLLOWING TO EVALUATE COMPENSATION: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, AND WRITTEN EMPLOYMENT CONTRACTS. PART I, LINES 4A-B LINE 4A: IN 2024, SUSAN TURNEY, MD RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $1,879,544 AND CATHY BUKOWSKI RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $631,969. LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED A DISTRIBUTION FROM OR HAD AMOUNTS VEST IN THE PLAN: SUSAN TURNEY, MD - $362,171 FORM 990, PART IV, LINE 4: MARSHFIELD CLINIC HEALTH SYSTEM (INCLUDING LAKEVIEW MEDICAL CENTER INC.) IS A MEMBER OF VARIOUS HEALTHCARE ASSOCIATIONS (I.E. WISCONSIN HOSPITAL ASSOCIATION) THAT MAY PERFORM SOME LOBBYING ACTIVITY. ALL ASSOCIATED DUES ARE DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. FORM 990, PART V, LINE 1C: COMPENSATION REPORTED FOR THE INDEPENDENT CONTRACTORS HAS BEEN PAID BY A RELATED ORGANIZATION AND CENTRAL PURCHASING ORGANIZATION, MARSHFIELD CLINIC HEALTH SYSTEM, EIN 46-1495343. COMPENSATION REPORTED REPRESENTS SERVICES SOLELY PROVIDED TO LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE SO IS INCLUDED AS IF PAID BY THE ORGANIZATION. MARSHFIELD CLINIC HEALTH SYSTEM HAS COMPLIED WITH A/P FILING REQUIREMENTS. FORM 990, PART V, LINE 2A: ALL PERSONNEL SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. ALL PHYSICIAN SERVICES FOR LAKEVIEW MEDICAL CENTER, INC. ARE PERFORMED BY EMPLOYEES OF MARSHFIELD CLINIC, INC. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS COLLEEN HOERNEMAN AND BRIAN HOERNEMAN, MD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE EXECUTIVE MANAGEMENT TEAM. AN EXTERNAL ACCOUNTING FIRM REVIEWS AND SIGNS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THOSE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSONS (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO THE COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FROM 990, PART X, LINE 20: LAKEVIEW MEDICAL CENTER INC. IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. SINCE THE OBLIGATED GROUP IS RESPONSIBLE FOR ALL OUTSTANDING FINANCED DEBT OBLIGATIONS, ALL BOND RELATED REPORTING IS DISCLOSED ON THE FORM 990 OF MARSHFIELD CLINIC HEALTH SYSTEM INC. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS WITH RELATED ORGANIZATIONS -13,340,251. MARSHFIELD CLINIC INC 1000 N OAK AVE MARSHFIELD WI 54449 390452970 MEDICAL SVCS WI 501(C)(3) LINE 3 MCHS 0 VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 W STOUT ST RICE LAKE WI 54868 391329084 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPH AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A MCHS 0 FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 N OAK AVE MARSHFIELD WI 54449 461495343 SUPPORT ORG WI 501(C)(3) LINE 12D, III-O N/A 0 MCHS HOSPITALS INC 1000 N OAK AVE MARSHFIELD WI 54449 810977948 HOSPITAL WI 501(C)(3) LINE 3 MCHS 0 MCHS FOUNDATION INC 1000 N OAK AVE MARSHFIELD WI 54449 812822823 PHILANTHROPY WI 501(C)(3) LINE 7 MCHS 0 BEAVER DAM COMMUNITY HOSPITALS INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 391157876 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 MEMORIAL HOSPITAL INC N3708 RIVER AVE NEILLSVILLE WI 54456 390806828 HOSPITAL WI 501(C)(3) LINE 3 MCHS HOSP 0 DICKINSON COUNTY HEALTHCARE SYSTEM 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 382780429 HOSPITAL MI 501(C)(3) LINE 3 MCHS HOSP 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 1 SECURITY HEALTH PLAN OF WISCONSIN INC L 32055434 COST