2017-10-27T15:11:08-07:00 2016-12-31 990 2016-01-01 390808509 THE MONROE CLINIC INC MONR 6083242775 515 22ND AVENUE MONROE WI 53566 James Nemeth CFO 6083242775 2017-10-27 69.129.205.76 2016 2021-01-29 14:40:06Z JAMES NEMETH 515 22ND AVENUE MONROE WI 53566 182230207 0 X WWW.MONROECLINIC.ORG X 1963 WI THE MONROE CLINIC, INC. PROVIDES HEALTHCARE SERVICES TO THE COMMUNITIES IN AND SURROUNDING GREEN COUNTY, WI AND STEPHENSON COUNTY, IL. MEDICAL SERVICES ARE PROVIDED REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. 15 9 1372 184 1239693 -2637714 97617 420475 176431839 166450301 1289047 1424479 0 0 177818503 168295255 0 0 0 0 101109335 99807536 0 0 0 67232396 66297764 168341731 166105300 9476772 2189955 271535083 270507743 102143118 99356045 169391965 171151698 X WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS IN HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. VISION: EXCEPTIONAL HEALTH CARE. AN EXCEPTIONAL EXPERIENCE. 0 0 131726012 166105300 MONROE CLINIC IS A NOT-FOR-PROFIT HEALTH SYSTEM FEATURING A MULTI-SPECIALTY CLINIC AND HOSPITAL DEDICATED TO BRINGING THE BEST CARE TO THE COMMUNITIES WE SERVE. WORKING TOGETHER TO ACHIEVE THE HIGHEST STANDARDS OF HEALTHCARE, WE CREATE HEALTHY COMMUNITIES THROUGH GOD'S HEALING SPIRIT. SPONSORED BY THE CONGREGATION OF SISTERS OF ST. AGNES (CSA), MONROE CLINIC OFFERS COMPREHENSIVE HEALTH CARE WITH OVER 120 PROVIDERS, A 24-HOUR EMERGENCY DEPARTMENT, HOME CARE AND HOSPICE SERVICES, AS WELL AS MULTIPLE CLINIC LOCATIONS IN SOUTHERN WISCONSIN AND NORTHERN ILLINOIS. IN ALL THAT WE DO, WE ARE DEDICATED TO HELPING OUR PATIENTS GET BETTER FASTER AND STAY HEALTHIER LONGER. AS A STATE-OF-THE-ART HEALTH SYSTEM, WE OFFER ADVANCED MEDICAL EQUIPMENT AND TECHNOLOGY COMBINED WITH CARE AND SENSITIVITY. PHYSICIANS AND STAFF ARE COMMITTED TO PROVIDING PERSONALIZED HEALTH CARE, EDUCATION AND PEACE OF MIND. OUR PATIENTS BENEFIT FROM EXCEPTIONAL PREVENTIVE AND REHABILITATION SERVICES AND MORE THAN 25 MEDICAL SPECIALTIES. WITH GOD'S BLESSING, MONROE CLINIC IS ABLE TO MEET THE NEEDS OF THOSE WE ARE PRIVILEGED TO SERVE. 0 0 0 131726012 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1701 0 1 1372 1 1 1 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL WI X JAMES NEMETH 6083242775 515 22ND AVENUE MONROE WI 53566 CHRISTINE WELLINGTON CHAIRPERSON 3 0 X X 0 0 0 JAMES BERBERET DIRECTOR 2 X 0 0 0 MICHELLE BRUKWICKI TREASURER & VICE CHAIRPERSON 3 0 X X 0 0 0 DARREN PIPP PHYSICIAN/SECRETARY 50 0 X X 345836 0 28178 SISTER MARY NOEL BROWN DIRECTOR 3 0 X 0 0 0 WENDY BAUMANN DIRECTOR 3 0 X 0 0 0 PATTY JAMES DIRECTOR 3 0 X 0 0 0 PAT LEITZEN FYE DIRECTOR 3 0 X 0 0 0 SISTER SUSAN STUCKI DIRECTOR 3 0 X 0 0 0 LARRY WILLIAMS DIRECTOR 3 0 X 0 0 0 PAUL BEKX CHIEF OF STAFF/DIRECTOR 50 0 X 209555 0 14320 JOSHUA MORRISON PHYSICIAN 50 0 X 324794 0 28573 MARK THOMPSON CHIEF MEDICAL OFFICER 50 0 X X X 478259 0 65888 MICHAEL SANDERS PRESIDENT/CEO 50 0 X X X 875219 0 94425 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 50 0 X 593897 0 49434 JAMES NEMETH CHIEF FINANCIAL OFFICER 50 0 X 315575 0 54474 CARRIE BLUM CHIEF INFORMATION OFFICER 50 0 X 236806 0 41342 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 50 0 X 257908 0 59002 JANE MONAHAN VP MINISTRY/HR 50 0 X 216054 0 39716 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 50 0 X 207718 0 31494 JULIE WILKE VP CLINICAL OPERATIONS 50 0 X X 247448 0 21295 PATRICK LONEY VICE PRESIDENT 50 0 X 152892 0 25326 LANCE SATHOFF PHYSICIAN 50 0 X 930817 0 53956 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 50 0 X 901710 0 48002 WISSAM MATTAR PHYSICIAN 50 0 X 782567 0 28833 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 50 0 X 927880 0 54470 ANTHONY ROGERSON PHYSICIAN 50 0 X 689509 0 47447 8694444 0 786175 108 1 1 0 AMERISOURCE BERGEN DRUG CORP 27550 NETWORK PLACE CHICAGO IL 60671 PHARMACEUTICALS 10343914 STATE OF WISCONSIN DEPT OF HEALTH SERVICES 1 W WILSON ST MADISON WI 53701 HOSPITAL ASSESSMENT 3557943 CARDINAL HEALTH 3740 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 PHARMACEUTICALS/MEDICAL SUPPLIES 2714570 CG SCHMIDT INC 11777 WEST LAKE PARK DRIVE MILWAUKEE WI 53224 CONSTRUCTION MANAGEMENT 2537802 OWENS & MINOR 12199 COLLECTION CENTER DR CHICAGO IL 60693 SURGICAL SUPPLIES 2345483 94 0 0 0 11851 346824 61800 0 420475 NET PATIENT REVENUE 900099 158264968 158264968 0 0 OTHER OPERATING REVENUE 561499 6945640 6945640 0 0 990-T SERVICES TO NON-PATIENTS 621990 1235675 0 1235675 0 ALL OTHER REVENUE - OUTPATIENT 900099 4018 0 4018 0 0 0 0 0 166450301 1447297 1447297 0 0 0 0 0 0 0 0 0 0 0 0 13912134 0 13934952 0 -22818 0 -22818 -22818 0 0 0 0 168295255 166635087 1239693 0 5015427 4363421 652006 71532746 61518161 10014585 3599139 2647818 951321 14786230 12970237 1815993 4873994 3585705 1288289 238475 238475 55500 55500 91579 91579 9122976 6395268 2727708 26659823 23740307 2919516 2508379 363067 2145312 1140593 974009 166584 3074208 3074208 11339239 6791676 4547563 REPAIRS AND MAINTENANCE 5205403 2326329 2879074 DUES AND SUBSCRIPTIONS 1225849 974301 251548 MISCELLANEOUS 5635740 1909926 3725814 166105300 131726012 34379288 0 110690 94463 30212261 16078159 0 0 26841073 26798310 0 0 0 0 0 0 3748655 3746621 2377593 2333758 239516579 141373325 103837203 98143254 96243269 112882053 0 0 0 0 0 0 8164339 10431125 271535083 270507743 17393931 14727384 0 0 0 1699386 73686667 72292213 0 0 0 0 0 0 0 0 11062520 10637062 102143118 99356045 X 164695726 164336838 4696239 6814860 0 0 169391965 171151698 271535083 270507743 X 2189955 3637185 0 0 0 -4067407 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 0 0 1 4015 4015 0 Schedule C, Part II-B, Line 1 WISCONSIN HOSPITAL ASSOCIATION AND CATHOLIC HOSPITAL ASSOCIATION DUES ARE ALLOCATED TO LOBBYING. 3313994 85 271688 0 0 0 3585767 3300227 37367 -23600 0 0 0 3313994 3125858 59712 203657 0 89000 0 3300227 2654654 142898 408306 0 80000 0 3125858 2377224 24079 253351 0 0 0 2654654 0 0.645 0.355 0 1 1 0 1685352 1685352 0 149901333 70084212 79817121 0 0 0 0 0 80982786 67277795 13704991 0 6947108 4011318 2935790 98143254 DEFERRED COMPENSATION 10210150 ASSET RETIREMENT OBLIGATION 426912 10637062 X 167773454 3637186 0 0 -3684129 -46943 167820397 91579 383279 474858 168295255 166013721 0 0 0 0 0 166013721 91579 0 91579 166105300 Schedule D, Part V, Line 4 THE OPERATING ENDOWMENT HAS BEEN ESTABLISHED TO SUPPORT THE OPERATING COSTS OF THE MONROE CLINIC AND HOSPITAL FOUNDATION. THE FUTURE OF HEALTHCARE ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE FUNDING FOR GRANTS AND PROGRAMS THAT SUPPORT THE MONROE CLINIC AND HOSPITAL FOUNDATION MISSION. Schedule D, Part X, Line 2 THE MONROE CLINIC IS A TAX EXEMPT 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 CLINIC IS ALSO EXEMPT FROM STATE INCOME TAX. IN ORDER TO ACCOUNT FOR UNCERTAIN TAX POSITIONS, THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE CLINIC HAS NOT RECORDED ANY ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2016 OR 2015. THE CLINIC'S FEDERAL TAX RETURNS FOR TAX YEARS 2013 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. Schedule D, Part XI, Line 2d INCREASE IN EQUITY IN UNCONSOLIDATED AFFILIATE 466,916 AND CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 2,118,621, AND LOSS ON EXTINGUISHMENT OF DEBT (6,269,666) TOTALING (3,684,129) Schedule D, Part XI, Line 4b OTHER 383,279 IN CONTRIBUTIONS TO THE MONROE CLINIC HOSPITAL FOUNDATION 1 1 1 X 1.20 1 X 1 1 0 1 1 1267663 1267663 0.0075 12846461 12846461 0.0764 103616 103616 0.0006 0 0 14217740 0 14217740 0.0845 508689 508689 508689 0.003 209988 209988 209988 0.0012 2949047 2949047 2949047 0.0175 110030 110030 110030 0.0007 3777754 0 3777754 0 3777754 0.0224 3777754 0 17995494 0 17995494 0.1069 1 5459335 0 12504251 16735515 -4231264 X 1 1 1 1 MONROE CLINIC 515 22ND AVENUE MONROE WI 53566 www.monroeclinic.org X X X X MONROE CLINIC 1 0 0 1 X X X X X X X X X X 16 1 0 1 1 X https://www.monroeclinic.org 1 16 1 https://www.monroeclinic.org 0 0 1 X 120 120 X X X X X X 1 1 X X X 1 X https://www.monroelinic.org X https://www.monroelinic.org X https://www.monroelinic.org X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 3-MONROE CLINIC THE COMMUNITY HEALTH NEEDS ASSESSMENT IS A PRIMARY TOOL USED BY MONROE CLINIC TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINES HOW IT WILL GIVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. THIS ASSESSMENT INCORPORATES COMPONENTS OF SECONDARY DATA ANALYSIS AND INPUT FROM THE COMMUNITY THAT FOCUS ON THE HEALTH NEEDS OF THE SERVICE AREA. Schedule H, Part V, Section B, Line 5-MONROE CLINIC AS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITIES COALITION (GCHCC), MONROE CLINIC COLLABORATED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND PRIORITIZATION OF HEALTH NEEDS. THE MISSION OF THE GCHCC IS: FOSTERING COLLABORATIVE EFFORTS TO ASSESS NEEDS, DEFINE RESOURCES, AND RECOGNIZE OPPORTUNITIES TO BUILD HEALTHIER COMMUNITIES THAT SUPPORT HEALTHY LIFESTYLES. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN-EXTENSION. THE PROCESS FOR THE IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS WAS UNDERTAKEN BY THE GREEN COUNTY HEALTHY COMMUNITY COALITION. AS THE FRAMEWORK FOR IDENTIFYING HEALTH NEEDS, THE COALITION ADOPTED THE STATE PUBLIC HEALTH AGENDA: HEALTHIEST WISCONSIN 2020. THE HEALTH NEEDS WERE DERIVED FROM AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH. THE HEALTH NEEDS WERE PRIORITIZED THROUGH A STRUCTURED PROCESS USING DEFINED CRITERIA. Schedule H, Part V, Section B, Line 6b-MONROE CLINIC MONROE CLINIC IS COMMITTED TO IMPROVE THE HEALTH OF THE COMMUNITIES AND INDIVIDUALS WE SERVE THROUGH EFFECTIVE PARTNERSHIPS. FOR THIS COMMUNITY HEALTH NEEDS ASSESSMENT, MONROE CLINIC WORKED WITH THE GREEN COUNTY HEALTHY COMMUNITIES COALITION. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND UNIVERSITY OF WISCONSIN-EXTENSION. OVER 40 ORGANIZATIONS REPRESENTING GOVERNMENTAL AGENCIES, COMMUNITY-BASED ORGANIZATIONS, THE FAITH COMMUNITY, EDUCATIONAL INSTITUTIONS AND LOCAL BUSINESSES PARTICIPATE IN THE COALITION. Schedule H, Part V, Section B, Line 11-MONROE CLINIC MONROE CLINIC CONDUCTED A 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IN FULFILLMENT OF ITS MANDATED OBLIGATION AS A TAX-EXEMPT HOSPITAL, IN ACCORDANCE WITH THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA). AS AN ACTIVE PARTICIPANT IN THE GREEN COUNTY HEALTHY COMMUNITY COALITION (GCHCC), MONROE CLINIC COLLABORATED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND PRIORITIZATION OF HEALTH NEEDS. THE MISSION OF THE GCHCC IS: FOSTERING COLLABORATIVE EFFORTS TO ASSESS NEEDS, DEFINE RESOURCES, AND RECOGNIZE OPPORTUNITIES TO BUILD HEALTHIER COMMUNITIES THAT SUPPORT HEALTHY LIFESTYLES. THE COALITION IS CO-CHAIRED BY REPRESENTATIVES FROM MONROE CLINIC, GREEN COUNTY HEALTH DEPARTMENT, AND THE UNIVERSITY OF WISCONSIN-EXTENSION. THE ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUSED ON THE HEALTH AND SOCIAL NEEDS OF THE SERVICE AREA. IT INCLUDED COLLECTION AND ANALYSIS OF INPUT FROM PERSONS WHO REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY SERVED BY MONROE CLINIC, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. BASED ON THE RESULTS OF THE PRIMARY AND SECONDARY DATA COLLECTION, HEALTH NEEDS WERE IDENTIFIED. THE GREEN COUNTY HEALTHY COMMUNITY COALITION UNDERTOOK THE PROCESS FOR THE IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS. AS THE FRAMEWORK FOR IDENTIFYING HEALTH NEEDS, THE COALITION ADOPTED THE STATE PUBLIC HEALTH AGENDA, HEALTHIEST WISCONSIN 2020 AND THE NATIONAL AGENDA, HEALTHY PEOPLE 2020. AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH WERE USED TO DETERMINE GREEN COUNTY'S MOST PRESSING HEALTH NEEDS. THE HEALTH NEEDS WERE PRIORITIZED USING A FACILITATED GROUP CONSENSUS METHOD. AS A RESULT OF THE PRIORITIZATION PROCESS, THE HEALTH NEEDS THAT WILL BE ADDRESSED BY MONROE CLINIC IN PARTNERSHIP WITH THE GREEN COUNTY HEALTHY COMMUNITY COALITION ARE: NUTRITION EDUCATION AND FOOD SECURITY, MENTAL HEALTH ACCESS, SUBSTANCE ABUSE, AND PHYSICAL ACTIVITY. 10 MONROE CLINIC - HIGHLAND WOMEN'S CARE 3103 W KUNKLE BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT 1301 S KIWANIS DRIVE FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - FREEPORT EYE CARE 1110 S PARK BLVD FREEPORT IL 61032 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BRODHEAD 1904 FIRST CENTER AVENUE BRODHEAD WI 53520 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - LENA 214 SCHUYLER LENA IL 61048 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - NEW GLARUS 1800 SECOND STREET NEW GLARUS WI 53574 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - ALBANY 700 CAROLAN DRIVE ALBANY WI 53502 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC- DURAND 400 S CENTER STREET DURAND IL 61024 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC FASTCARE 405 W 8TH ST MONROE WI 53566 COMMUNITY-BASED OUTPATIENT CLINIC MONROE CLINIC - BLANCHARDVILLE 309 S MAIN STREET BLANCHARDVILLE WI 53516 COMMUNITY-BASED OUTPATIENT CLINIC Schedule H, Part I, Line 7 A COST TO CHARGE RATIO WAS USED TO COMPUTE THE COST OF COMMUNITY BENEFIT SERVICES. Schedule H, Part I, Line 7g SUBSIDIZED HEALTH SERVICES INCLUDE BEHAVIORAL HEALTH/OUTPATIENT MENTAL HEALTH, PALLIATIVE CARE, SELF-HELP/SPORTS INJURY PREVENTION, AND CONTINUING CARE/HOME CARE SERVICES. Schedule H, Part III, Section A, Line 4 ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE OBLIGATIONS ARE PRIMARILY FROM RESIDENTS OF SOUTHERN WISCONSIN AND NORTHERN ILLINOIS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE CLINIC BILLS THIRD PARTY PAYORS ON EACH PATIENT'S BEHALF OR IF A PATIENT IS UNINSURED THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, SECONDARY INSURANCE IS BILLED AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. THE CLINIC DOES NOT CHARGE INTEREST ON PAST DUE ACCOUNTS. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH REFLECTS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS PRIMARILY FOR UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE CLINIC 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 REVENUES 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 CLINIC ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CLINIC 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. Schedule H, Part III, Section B, Line 8 MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. TO ARRIVE AT COST OF MEDICARE SERVICES THE TOTAL EXPENSES LESS OTHER OPERATING REVENUE IS MULTIPLIED BY THE RATIO OF MEDICARE REVENUE TO TOTAL REVENUE. Schedule H, Part III, Section C, Line 9b MONROE CLINIC RECOGNIZES THE INHERENT VALUE OF ALL INDIVIDUALS. ALL INDIVIDUALS HAVE THE RIGHT TO BE TREATED WITH RESPECT AND DIGNITY. THOSE INDIVIDUALS INDICATING LACK OF FINANCIAL RESOURCES TO PAY FOR SERVICES WILL BE DIRECTED TO MONROE CLINIC'S COMMUNITY CARE PROGRAM TO ENSURE ALL INDIVIDUALS QUALIFYING FOR ASSISTANCE ARE INDEED GIVEN ASSISTANCE. INDIVIDUALS WITH THE FINANCIAL RESOURCES TO PAY FOR SERVICES ARE EXPECTED TO DO SO IN A TIMELY MANNER TO ENSURE MONROE CLINIC'S FINANCIAL HEALTH AND ABILITY TO MAINTAIN OPERATIONS AND CONTINUED COMMUNITY CARE. PATIENTS WITH FINANCIAL RESOURCES ARE ASKED TO PAY CO-PAYMENTS AT THE TIME OF SERVICE AND TO PAY BALANCES REMAINING DUE AFTER INSURANCE HAS PAID WITHIN 30 DAYS OR MAKE MUTUALLY AGREEABLE PAYMENT ARRANGEMENTS WITH PATIENT ACCOUNTING. COLLECTION AGENCIES USED BY MONROE CLINIC GUARANTEE COMPLIANCE WITH THE FAIR DEBT COLLECTION PRACTICES ACT AND THE ACA INTERNATIONAL'S CODE OF ETHICS AND PROFESSIONAL RESPONSIBILITY. Schedule H, Part VI, Line 2 THE GREEN COUNTY HEALTHY COMMUNITY COALITION UNDERTOOK THE PROCESS FOR THE IDENTIFICATION AND PRIORITIZATION OF COMMUNITY HEALTH NEEDS. AS THE FRAMEWORK FOR IDENTIFYING HEALTH NEEDS, THE COALITION ADOPTED THE STATE PUBLIC HEALTH AGENDA, HEALTHIEST WISCONSIN 2020 AND THE NATIONAL AGENDA, HEALTHY PEOPLE 2020. AN EXAMINATION OF DATA ON HEALTH BEHAVIORS AND THE SOCIAL, ECONOMIC AND EDUCATIONAL FACTORS THAT ARE DETERMINANTS OF HEALTH WERE USED TO DETERMINE GREEN COUNTY'S MOST PRESSING HEALTH NEEDS. THE HEALTH NEEDS WERE PRIORITIZED USING A FACILITATED GROUP CONSENSUS METHOD. AS A RESULT OF THE PRIORITIZATION PROCESS, THE HEALTH NEEDS THAT WILL BE ADDRESSED BY MONROE CLINIC IN PARTNERSHIP WITH THE GREEN COUNTY HEALTHY COMMUNITY COALITION ARE: NUTRITION EDUCATION AND FOOD SECURITY, MENTAL HEALTH ACCESS, SUBSTANCE ABUSE, AND PHYSICAL ACTIVITY. Schedule H, Part VI, Line 3 MONROE CLINIC PROVIDES FINANCIAL COUNSELORS WHO ACT AS PATIENT ADVOCATES AND HELP THOSE IN NEED APPLY FOR MONROE CLINIC'S COMMUNITY CARE PROGRAMS OR OTHER STATE, COUNTY OR FEDERAL PROGRAMS (I.E. WISCONSIN BADGERCARE, WISCONSIN AND ILLINOIS WELL WOMAN PROGRAMS, MEDICARE, MEDICAID, ETC.). PATIENTS CAN FIND OUT ABOUT THESE SERVICES THROUGH MONROECLINIC.ORG'S INFORMATION PAGES, MONROE CLINIC'S ANNUAL MISSION REPORT POSTED ON OUR WEBSITE AND MAILED TO HOUSEHOLDS IN OUR SERVICE AREA, AND THROUGH COMMUNITY OUTREACH THAT OFFERS ASSISTANCE EXPLAINING NEW FEDERAL/STATE PROGRAMS OR CHANGES TO THOSE PROGRAMS. ADDITIONALLY, MONROE COUNSELORS HELP PATIENTS UNDERSTAND WHAT PROGRAMS THEY COULD BE ELIGIBLE FOR, HELP THEM THROUGH APPLICATION PROCEDURES AND ALSO PROVIDE APPROVAL/DENIAL NOTIFICATION TO THE PATIENTS IN A TIMELY MANNER. Schedule H, Part VI, Line 4 MONROE CLINIC GIVES SPECIAL CONSIDERATION TO PERSONS IN NEED OF FINANCIAL ASSISTANCE THROUGH OUR COMMUNITY CARE PROGRAM. MONROE CLINIC DOES NOT DISCRIMINATE AGAINST A PATIENT BECAUSE OF RACE, CREED, COLOR, NATIONAL ORIGIN, OR BECAUSE A PATIENT IS COVERED BY A PROGRAM SUCH AS MEDICAID OR MEDICARE. FOR PATIENTS WHO HAVE NO HEALTH INSURANCE LIMITED HEALTH INSURANCE OR WHO EXPECT TO HAVE DIFFICULTY PAYING THEIR BILL THE COMMUNITY CARE PROGRAM PROVIDES HEALTHCARE AT REDUCED COST OR AT NO COST. THE PROGRAM PROVIDES HEALTHCARE WITH A PAYMENT SCHEDULE THAT RECOGNIZES AN INDIVIDUAL'S FINANCIAL CONDITION. COMMUNITY CARE APPLICATIONS ARE ACCEPTED FROM PATIENTS WHO RESIDE IN OUR PRIMARY AND SECONDARY SERVICE AREAS WHICH INCLUDE THE FOLLOWING COUNTIES IN WISCONSIN: GREEN, LAFAYETTE, AND SECTIONS OF DANE, ROCK, AND IOWA COUNTIES. IN ILLINOIS, STEPHENSON AND SECTIONS OF WINNEBAGO AND JODAVIESS COUNTIES. INDIVIDUALS MUST BE A RESIDENT OF ONE OF THESE AREAS FOR A MINIMUM OF THREE MONTHS PRIOR TO BE ELIGIBLE FOR THE COMMUNITY CARE PROGRAM. Schedule H, Part VI, Line 5 A MAJORITY OF THE MONROE CLINIC BOARD OF DIRECTORS IS COMPRISED OF PEOPLE THAT RESIDE IN THE GEOGRAPHIC AREAS WE SERVE. MONROE CLINIC REINVESTS BACK INTO THE COMMUNITY THROUGH ITS COMMUNITY BENEFIT PROGRAMS AND THROUGH MEDICAL EQUIPMENT AND PROGRAMS NEEDED IN THE COMMUNITY. EXAMPLES OF THIS INCLUDE PALLIATIVE CARE, PARISH NURSING PROGRAM, YOUTH APPRENTICESHIP AND JOB SHADOWING PROGRAMS, SCREENING OUTREACH AND MANY OTHER PROGRAMS. FURTHER, MONROE CLINIC HAS INVESTED IN THE ELECTRONIC HEALTH RECORD. OUR PATIENTS ARE GEOGRAPHICALLY DIVERSE AND MONROE CLINIC HAS TEN BRANCH PHYSICIAN CLINICS IN OUTLYING AREAS. THE INVESTMENT IN ELECTRONIC HEALTH RECORDS MEANS THAT OUR PATIENTS CAN BE SEEN ANYWHERE AND HAVE THEIR MEDICAL HISTORY IMMEDIATELY AVAILABLE. THIS PROMOTES BETTER HEALTH FOR OUR PATIENTS AND INCREASED SAFETY AS WE CAN TRACK MEDICAL EVENTS AND ONGOING MEDICATION NEEDS. Schedule H, Part VI, Line 7 LIST OF STATES RECEIVING COMMUNITY BENEFITS REPORTS: WISCONSIN AND ILLINOIS X 1 1 X X X 0 1 0 0 0 1 0 0 0 PAUL BEKX CHIEF OF STAFF/DIRECTOR 209085 0 380 0 90 0 13138 0 1182 0 223875 0 380 0 CARRIE BLUM CHIEF INFORMATION OFFICER 189558 0 47046 0 203 0 35090 0 6252 0 278149 0 47046 0 PAULA RAIBLEY-ELMER VP/CHIEF NURSING OFFICER 204340 0 52426 0 1142 0 38616 0 20386 0 316910 0 52426 0 PATRICK LONEY VICE PRESIDENT 137887 0 14896 0 109 0 21085 0 4241 0 178218 0 14896 0 WISSAM MATTAR PHYSICIAN 781992 0 521 0 54 0 27609 0 1224 0 811400 0 521 0 NICHOLAS MAXWELL PHYSICIAN/GENERAL SURGEON 900931 0 521 0 258 0 28522 0 19480 0 949712 0 521 0 JANE MONAHAN VP MINISTRY/HR 171266 0 44267 0 521 0 33722 0 5994 0 255770 0 44267 0 JOSHUA MORRISON PHYSICIAN 324219 0 521 0 54 0 20194 0 8379 0 353367 0 521 0 JAMES NEMETH CHIEF FINANCIAL OFFICER 257061 0 58362 0 152 0 46346 0 8128 0 370049 0 58362 0 DARREN PIPP PHYSICIAN/SECRETARY 345225 0 521 0 90 0 20305 0 7873 0 374014 0 521 0 ANDREW RIKKERS PHYSICIAN/GENERAL SURGEON 927269 0 521 0 90 0 29804 0 24666 0 982350 0 521 0 ANTHONY ROGERSON PHYSICIAN 688730 0 521 0 258 0 22781 0 24666 0 736956 0 521 0 MICHAEL SANDERS PRESIDENT/CEO 708788 0 159573 0 6858 0 91555 0 2870 0 969644 0 159573 0 LANCE SATHOFF PHYSICIAN 930206 0 521 0 90 0 29290 0 24666 0 984773 0 521 0 JONATHAN SWINDLE PHYSICIAN/ORTHOPEDIC SURGEON 593316 0 521 0 60 0 24768 0 24666 0 643331 0 521 0 MARK THOMPSON CHIEF MEDICAL OFFICER 390387 0 87602 0 270 0 56825 0 9063 0 544147 0 87602 0 LUCINDA WERKHEISER VP/SERVICE EXCELLENCE 166579 0 40868 0 271 0 29951 0 1543 0 239212 0 40868 0 JULIE WILKE VP CLINICAL OPERATIONS 177287 0 69807 0 355 0 17406 0 3889 0 268744 0 69807 0 Schedule J, Part I, Line 1a PROVIDED MEMBERSHIP FOR THE PRESIDENT/CEO TO THE LOCAL KIWANIS ORGANIZATION: TOTAL VALUE: $120 Schedule J, Part I, Line 3 THE ORGANIZATION'S CEO AND SENIOR LEADERSHIP TEAM'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT/NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THE COMMITTEE REVIEW COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER, ADDITIONALLY THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. Schedule J, Part I, Line 4 EMPLOYER DISCRETIONARY CONTRIBUTIONS TO A 457(F) PLAN BASED ON PERFORMANCE AND RETENTION MEASURES. Schedule J, Part I, Line 6 THE ORGANIZATION USES NET EARNINGS AS 20% OF THE CALCULATION FOR THE GAIN SHARE PROGRAM. A WISCONSIN HEALTH AND EDUCATION FACILITIES AUTHORITY 391337855 2016-08-14 40895000 ADVANCED REFUNDING 2009 BONDS 0 0 0 B WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITIES 391337855 2012-04-19 16415700 REFUNDING OF 1999 BOND ISSUE 0 0 0 C WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2012-04-19 21750843 PARTIAL ADVANCED REFUNDING OF 2009 ISSUE 0 0 0 A 0 0 44820949 0 0 44134619 686330 0 0 0 0 0 2016 0 1 1 1 B 0 0 16415700 0 0 0 130700 0 0 0 0 0 2012 1 0 1 1 C 0 0 21750843 0 0 21459843 291207 0 0 0 0 0 2012 0 1 1 1 A 0 0 0 0 0 0 0 1 0 1 B 0 0 0 0 0 0 0 1 0 1 C 0 0 0 0 0 0 0 1 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 A 1 B 1 C 1 SARAH ENDICOTT MICHAEL SANDERS' DAUGHTER 40425 EMPLOYMENT 1 Form 990, Part I, Line 1 SERVICES INCLUDE INPATIENT ROUTINE, INPATIENT ANCILLARY, AND OUTPATIENT HEALTHCARE IN SUPPORT OF THE CORPORATION'S HEALTHCARE MISSION. THE MONROE CLINIC, BECAUSE OF ITS MISSION STATEMENT, OFFERS A CHARITY CARE PROGRAM TO ELIGIBLE BENEFICIARIES. Form 990, Part III, Line 4a IN 2016 OUR PHYSICIANS AND STAFF PROVIDED SERVICES TO PATIENTS ACCESSING OUR SYSTEM WITH OVER 250,000 VISITS. IN 1939, CSA ESTABLISHED ST. CLARE HOSPITAL AT THE REQUEST OF A SMALL GROUP OF PHYSICIANS WHO OPENED MONROE CLINIC IN THE SAME YEAR. IN 1992 ST. CLARE HOSPITAL AND MONROE CLINIC CONSOLIDATED UNDER CONTINUED SPONSORSHIP OF CSA AS A CATHOLIC NOT FOR PROFIT INTEGRATED HEALTHCARE FACILITY. MONROE CLINIC HAS A SPECIAL COMMITMENT TO PROVIDE HEALTHCARE SERVICES TO ALL PATIENTS WITHOUT ANY FORM OF DISCRIMINATION INCLUDING THE ABILITY TO PAY. THE PASSION AND DETERMINATION OF BOTH THE FOUNDING PHYSICIAN AND CSA HAS DEVELOPED AN EXCEPTIONAL HEALTHCARE ORGANIZATION THAT FOCUSES ON QUALITY AND OUTCOME MEASURES THAT EXCEED NATIONAL BENCHMARKS. IN 2010 MONROE CLINIC COMMITTED TO PUBLISHING OUR QUALITY SCORES IN LOCAL NEWSPAPERS AND ON OUR WEBSITE. TO DATE WE HAVE BEEN AMONG THE HIGHEST PERFORMING HOSPITALS IN THE AREA. PATIENT SATISFACTION SCORES ARE SIGNIFICANTLY ABOVE THE AVERAGE OF OTHER HEALTHCARE FACILITIES. OUR HIGHLY TRAINED PHYSICIANS AND STAFF ARE READY TO PROVIDE BOTH EXCEPTIONAL HEALTHCARE AND AN EXCEPTIONAL EXPERIENCE TO THE PATIENTS AND COMMUNITIES WE SERVE. IN CALENDAR YEAR 2016 MONROE CLINIC PROVIDED MORE THAN $14.2 MILLION IN COMMUNITY BENEFIT TO MORE THAN 37,500 INDIVIDUALS. THIS $14.2 MILLION REPRESENTS APPROXIMATELY 8.7 PERCENT OF MONROE CLINIC'S TOTAL NET PATIENT REVENUE. THE COMMUNITY BENEFIT AT COST IS COMPRISED OF $1.3 MILLION OF CHARITY CARE, $12.8 MILLION IN UNREIMBURSED COSTS FOR MEDICAID PATIENTS, $104 THOUSAND IN SUBSIDIZED HEALTHCARE SERVICES (SERVICES PROVIDED TO PATIENTS AT LESS THAN WHAT IT COST US TO PROVIDE THESE SERVICES). EACH YEAR MONROE CLINIC USES SURPLUS FUNDS TO ENHANCE PATIENT AND SCREENING PROGRAMS. THROUGH OUR SPENDING AND THAT OF OUR EMPLOYEES MONROE CLINIC CONTRIBUTES SIGNIFICANTLY TO THE LOCAL COMMUNITY. Form 990, Part VI, Section A, Line 6 THE CORPORATION HAS TWO CLASSES OF MEMBERS. THE CLASS A MEMBERS ARE THE GENERAL SUPERIOR OF CSA AND THOSE PERSONS WHO ARE MEMBERS OF THE GENERAL COUNCIL OF CSA. THE CLASS B MEMBERS ARE INDIVIDUALS APPOINTED BY THE CLASS A MEMBERS AND CONSIST OF NOT LESS THAN NINE MEMBERS AND NOT MORE THAN 13 MEMBERS. Form 990, Part VI, Section A, Line 7a THERE IS A GOVERNING BODY THAT HAS FINAL APPROVAL FOR ANY NEW BOARD MEMBERS. Form 990, Part VI, Section A, Line 7b VARIOUS DECISIONS SUCH AS INDEBTEDNESS OF A CERTAIN SCOPE, MISSION OF THE ORGANIZATION, AND FINAL APPROVAL OF BOARD MEMBERS MUST BE BY CLASS A MEMBERS OF CONGREGATION OF SISTERS OF ST. AGNES SPONSORSHIP MINISTRY BOARD. Form 990, Part VI, Section B, Line 11b ANNUALLY, THE BOARD OF DIRECTORS IS PROVIDED AN OVERVIEW OF THE FORM 990 AND HAS AN OPPORTUNITY TO ASK QUESTIONS AND PROVIDE INPUT. Form 990, Part VI, Section B, Line 12c ANNUALLY, CONFLICT OF INTEREST STATEMENTS AND POLICY ARE DISTRIBUTE TO MEMBERS OF THE BOARD AND ANY EMPLOYEE WHO HAS AUTHORITY TO ENTER INTO CONTRACTS AND OTHER TRANSACTIONS ON BEHALF OF MONROE CLINIC. THE COMPLETED FORMS ARE REVIEWED BY ADMINISTRATION. Form 990, Part VI, Section B, Line 15 THE ORGANIZATION'S CEO AND SENIOR LEADERSHIP TEAM'S COMPENSATION PLAN IS REVIEWED AND APPROVED AT FORMAL MEETINGS OF THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT NON-EMPLOYEE MEMBERS WHO HAVE NO PERSONAL INTEREST IN THE COMPENSATION AGREEMENT TO BE REVIEWED AND RECOMMENDED BY THE COMPENSATION COMMITTEE. THIS COMMITTEE REVIEWS COMPARABLE WISCONSIN AND NATIONAL COMPENSATION DATA AND ESTABLISHES BASE COMPENSATION AT THE COMPARABLE MARKET MEDIAN BY THE POSITION AS OUTLINED IN THE COMPENSATION COMMITTEE CHARTER. ADDITIONALLY THE COMMITTEE HAS AUTHORITY TO RETAIN A COMPENSATION CONSULTANT TO ASSIST THE COMMITTEE IN EVALUATING SENIOR MANAGEMENT COMPENSATION. Form 990, Part VI, Section C, Line 19 A PAPER COPY OF THE DOCUMENTS/STATEMENTS IS PROVIDED UPON REQUEST. Form 990, Part XI, Line 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES EQUITY INCLUDE LOSS ON EXTINGUISHMENT OF DEBT (6,269,666), EARNINGS OF UNCONSOLIDATED AFFILIATES 466,916, CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 2,118,621, AND IN-KIND CONTRIBUTIONS TO FOUNDATION 383,279, TOTAL (4,067,407). MONROE CLINIC AND HOSPITAL FOUNDATION INC 515 22ND AVENUE MONROE WI 53566 205769038 SUPPORT THE MISSION OF THE MONROE CLINIC WI 501(C) (3) LINE 7 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 THE MONROE CLINIC APPLIED FOR AND WAS GRANTED THE AUTOMATIC 6 MONTH EXTENSION.