2016-05-13T09:44:31-05:00 2015-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2014-07-01 390973724 FLAMBEAU HOSPITAL INC FLAM 7157622484 98 SHERRY AVENUE PARK FALLS WI 54552 JAMES BRAUN CHIEF FINANCIAL OFFICER 7157622484 2016-05-05 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2016-05-05 2014 2016-08-17 19:52:53Z JAMES BRAUN 98 SHERRY AVENUE PARK FALLS WI 54552 22045454 0 X HTTP://MINISTRYHEALTH.ORG/FH/HOME.NWS X 1961 WI TO CREATE HEALTHIER COMMUNITIES WHILE IMPROVING THE HEALTH AND WELL BEING OF THE PEOPLE IN THE RURAL SETTINGS SERVED. 14 14 264 14 0 0 242534 154432 20741763 21861419 28012 26359 0 0 21012309 22042210 0 0 0 0 11202414 11657274 0 0 0 9068675 9131097 20271089 20788371 741220 1253839 14974437 16030789 5922806 5358974 9051631 10671815 X THE FOLLOWING OBJECTIVES PROVIDE THE DIRECTION FOR FLAMBEAU HOSPITAL IN FULFILLING ITS VISION:- TO CONTINUOUSLY IMPROVE QUALITY SERVICES TO CUSTOMERS BY BUILDING EXCELLENCE INTO EVERY ASPECT AND PROCESS OF THE HOSPITAL. CUSTOMERS INCLUDE PATIENTS AND STAFF MEMBERS. THIS EXCELLENCE DEVELOPS FROM TOTAL QUALITY IMPROVEMENT, AN ENVIRONMENT THAT ENCOURAGES EVERYONE TO CONTRIBUTE TO THE HOSPITAL'S MISSION.- TO ENCOURAGE HEALTH PROMOTION AND WELLNESS THROUGH EDUCATIONAL ACTIVITIES. WHEN FEASIBLE, THESE ACTIVITIES WILL BE PURSUED IN CONJUNCTION WITH AREA HEALTH CARE PROVIDERS.- TO COLLABORATE WITH AND PROVIDE REFERRALS TO AGENCIES PROVIDING SERVICES NOT DIRECTLY AVAILABLE AT THE HOSPITAL.- TO MAINTAIN AN OPEN RELATIONSHIP WITH THE MEDICAL AND HOSPITAL STAFF TO ENSURE EFFICIENT AND EFFECTIVE UTILIZATION OF HOSPITAL RESOURCES.- TO PROVIDE IN-SERVICE AND CONTINUING EDUCATIONAL OPPORTUNITIES FOR HEALTH CARE PERSONNEL AS A MEANS OF PROVIDING QUALITY PATIENT CARE. 0 0 16190681 21766779 FLAMBEAU HOSPITAL PROVIDES WELLNESS ACTIVITIES, EDUCATION AND PRIMARY HEALTHCARE SERVICES TO APPROXIMATELY 17,000 RESIDENTS IN OUR SERVICE AREA. HEALTHCARE SERVICE INCLUDES INPATIENT CARE AND SWING BED SERVICES ALONG WITH LABORATORY, RADIOLOGY, PHARMACY, REHABILITATION, SURGERY, AND OTHER OUTPATIENT SERVICES. SERVICES FOR THE YEAR ENDED JUNE 30, 2015 INCLUDED 1,620 INPATIENT DAYS, 128 SWING BED DAYS AND 27,963 OUTPATIENT REGISTRATIONS.FLAMBEAU HOME HEALTH PROVIDES HEALTH CARE SERVICES FOR HOMEBOUND PATIENTS INCLUDING PRIMARY CARE, WOUND AND INFECTION SERVICES, PERSONAL CARE SERVICES, PAIN MANAGEMENT AND OTHER MEDICAL SERVICES THAT CAN BE PROVIDED IN THE HOME. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS.FLAMBEAU HOSPICE PROVIDES END OF LIFE CARE TO PATIENTS AND THEIR FAMILIES IN THEIR HOMES OR OTHER APPROPRIATE FACILITIES. ALSO PROVIDED ARE CHAPLAIN, VOLUNTEER AND BEREAVEMENT SERVICES. BEREAVEMENT SERVICES CONTINUE AFTER A PATIENT'S DEATH FOR ONE YEAR OR MORE. THESE SERVICES ARE PROVIDED TO THE SAME SERVICE AREA AND INCLUDED UNDUPLICATED PATIENT DAYS AND SERVICES TO PATIENTS. 16190681 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 57 0 1 264 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 WI X JAMES BRAUN 7157622484 98 SHERRY AVE PARK FALLS WI 54552 TOM OLSON CHAIRPERSON 1.00 X X 0 0 0 DOUG MOQUIN VICE CHAIRPERSON 1.00 X X 0 0 0 RICK SVEHLA SECRETARY 1.00 X X 0 0 0 BOBBI DAMROW DIRECTOR 1.00 X 0 0 0 LOUAY DANIAL MD DIRECTOR 1.00 X 0 0 0 DAVE DEDA DIRECTOR 1.00 X 0 0 0 JOANN IDES DIRECTOR 1.00 X 0 0 0 BRIAN KIEF DIRECTOR 1.00 X 0 0 0 TIMOTHY LINDGREN MD DIRECTOR 1.00 X 0 0 0 CAROL MADER DIRECTOR 1.00 X 0 0 0 NARAYANA MURALI MD DIRECTOR (TERM 1/31/15) 1.00 X 0 0 0 BOB SCHIENEBECK DIRECTOR 1.00 X 0 0 0 GAYLE STANGLE DIRECTOR 1.00 X 0 0 0 MATTHEW THOMAS MD DIRECTOR 1.00 X 0 0 0 JOE WOLF DIRECTOR 1.00 X X 0 0 0 DAVID GRUNDSTROM CAO 40.00 X 0 190375 45881 JAMES BRAUN CFO 40.00 X 157783 0 35388 JANE EATON-NYMN DIRECTOR OF ORGANIZATIONAL 40.00 X 119685 0 34148 SARA HILGART PHARMACIST 40.00 X 128656 0 15317 406124 190375 130734 3 0 1 0 MARSHFIELD CLINIC 1000 N OAK AVENUE MARSHFIELD WI 54449 EKG, ADMIN, ER DOCS, LAB SVCS, MRI 1899220 SIEMENS MEDICAL SOLUTIONS USA 40 LIBERTY BOULEVARD MALVERN PA 19355 EQUIPMENT & SUPPLIES 566126 ALEXANDER KORITTNIG 442 S 3RD AVE PARK FALLS WI 54552 ANESTHESIA 475232 SHARED MEDICAL TECHNOLOGY 202 WEST NEWTON ST RIB LAKE WI 54868 MRI AND NUCLEAR MED SERVICES 382439 TRIMEDX LLC 5451 LAKEVIEW PARKWAY S DRIVE INDIANAPOLIS IN 46268 EQUIPMENT MAINTENANCE 295847 8 24014 38948 24640 66830 154432 NET PATIENT SERVICE REVENUE 621110 21309783 21309783 AFFILIATED ORG RENT 900099 247577 247577 OTHER OPERATING REVENUE 621110 209419 209419 CAFETERIA REVENUE 900099 94640 94640 21861419 26359 26359 3244 15109 3244 0 22042210 21766779 0 120999 193170 193170 8369826 6674228 1695598 238944 192152 46792 2278750 1806045 472705 576584 476416 100168 69017 69017 1109190 225620 883570 69262 69262 1573513 1525880 47633 523855 420562 103293 241955 188447 53508 1129208 1061639 67569 147586 147586 MEDICAL SERVICES 2736479 2700522 35957 EQUIPMENT RENTAL 654329 605862 48467 BAD DEBT 437961 437961 COMMUNICATION 121514 121514 317228 191794 125434 20788371 16190681 4597690 0 149440 6056 4373763 4897867 2145217 2779797 221641 210637 43119 80776 23663288 16112195 7431466 7551093 609791 504563 14974437 16030789 1468050 1461987 4185592 3695774 67951 0 201213 201213 5922806 5358974 X 8386646 9886238 664985 785577 9051631 10671815 14974437 16030789 X 1253839 366345 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3468 3468 0 PART II-B, LINE 1: FLAMBEAU HOSPITAL PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE AHA AND WHA HAVE NOTIFIED FLAMBEAU HOSPITAL THAT $3,468 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 73128 73128 14060002 8985002 5075000 446144 323483 122661 9076014 6803710 2272304 8000 8000 7551093 ASBESTOS ABATEMENT LIABILITY 201213 201213 X 21604249 0 21604249 437961 437961 22042210 20350410 0 20350410 437961 437961 20788371 PART X, LINE 2: THE HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAX ON RELATED INCOME. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 437,961. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET AGAINST REVENUE 437,961. GOLF OUTING 18353 15109 3244 3244 18353 15109 3244 3244 3244 0 1 1 1 X 1 X 1 1 1 0 1 1 95940 95940 0.00470 2351759 1851997 499762 0.02460 2447699 1851997 595702 0.02930 83314 83314 0.00410 28536 28536 0.00140 3858519 2130539 1727980 0.08490 112724 112724 0.00550 4083093 2130539 1952554 0.09590 6530792 3982536 2548256 0.12520 2431 2431 0.00010 18446 18446 0.00090 2588 2588 0.00010 16286 16286 0.00080 1089 1089 0.00010 21816 21816 0.00110 62656 62656 0.00310 0 235630 6523873 6459281 64592 X 1 1 1 1 FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS WI 54552 X X X X FLAMBEAU HOSPITAL INC 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://MINISTRYHEALTH.ORG/FLAMBEAUHOSPITAL/FLAMBEAU_COMMUNITY_ASSESSMENT_5. X 1 12 1 HTTP://MINISTRYHEALTH.ORG/FLAMBEAUHOSPITAL/FLAMBEAU_BENEFIT_IMPLEMENTATION_ 1 0 1 X 100.000000000000 200.000000000000 X X 1 1 1 X X X 1 0 X X 1 X 0 0 FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 5: FLAMBEAU HOSPITAL CHAIRED SEVERAL MEETINGS WITH COMMUNITY MEMBERS OVER AN 8-MONTH PERIOD TO DISCUSS, TABULATE AND FORM THE TOP PRIORITY NEEDS IN THE COMMUNITY. THE HOSPITAL WORKED WITH THE PRICE COUNTY PUBLIC HEALTH DEPARTMENT TO CO-CHAIR THESE MEETINGS. ALSO, FLAMBEAU HOSPITAL AND PRICE COUNTY PUBLIC HEALTH DEPARTMENT SENT INVITATIONS TO NUMEROUS GROUPS INCLUDING LOCAL BUSINESSES, GOVERNMENT AGENCIES, CHURCHES, CLINICS, HOSPITALS, SCHOOL DISTRICTS, COUNSELING CENTERS, ADVOCACY GROUPS, PUBLIC CITIZENS, AND CITY AND COUNTY LAW ENFORCEMENT FOR PARTICIPATION IN THE MEETINGS. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 11: THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY FLAMBEAU HOSPITAL; 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. SEVERAL OF THE ITEMS NOT ADDRESSED PRIMARILY WERE DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING THE SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA. FLAMBEAU HOSPITAL ALSO CONSIDERED STAFFING RESOURCES IN ADDITION TO FINANCIAL CONSIDERATIONS TO ENSURE THAT THERE ARE ENOUGH PERSONNEL RESOURCES AVAILABLE FOR ANY PROGRAMS THAT MAY NOT CURRENTLY BE OFFERED BY THE HOSPITAL. DUE TO THE FINANCIAL AND STAFFING CONSTRAINTS, THE HOSPITAL HAS DETERMINED THE TOP FIVE PRIORITIES THAT THEY WILL FOCUS THEIR ATTENTION ON, AS THESE ISSUES WERE THE MOST CRITICAL AND SIGNIFICANT WORK NEEDS TO BE DONE IN THESE AREAS. OVER THE NEXT THREE YEARS AS THE IMPLEMENTATION STRATEGY IS IMPLEMENTED, THE HOSPITAL PLANS TO CONTINUALLY EVALUATE THE BENEFITS PROVIDED TO THE COMMUNITY MEMBERS TO ENSURE THAT HEATH NEEDS ARE MET WHENEVER POSSIBLE. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 16I: IN ADDITION TO POSTING THE POLICY IN THE ADMISSIONS OFFICE AND WAITING ROOMS, ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED AND GIVEN INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE POLICY. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 22D: GROSS CHARGES ARE APPLIED TO ALL BILLED SERVICES OF THE HOSPITAL. UPON THE INDIVIDUAL MEETING THE FAP-ELIGIBILITY REQUIREMENTS DISCOUNTS AND ASSISTANCE FOR THOSE NOT ABLE TO PAY ARE THEN APPLIED. FREE CARE IS PROVIDED TO ANY INDIVIDUAL THAT FALLS BELOW 100% OF THE FPG FAMILY INCOME LIMIT. DISCOUNTED CARE IS OFFERED TO ANY INDIVIDUAL THAT FALLS BELOW 200% OF THE FPG FAMILY INCOME LIMIT. FLAMBEAU HOSPITAL, INC. PROVIDES DISCOUNTS ON A SLIDING SCALE METHOD. A 10% DISCOUNT IS GIVEN FOR EVERY 10TH PERCENTILE AN INDIVIUAL IS BELOW THE 200% FPG FAMILY INCOME LIMIT. AN INDIVIDUAL THAT FALLS IN THE 190% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 10% DISCOUNT ON GROSS CHARGES AND AN INDIVIDUAL THAT FALLS IN THE 110% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 90% DISCOUNT ON GROSS CHARGES. FLAMBEAU HOSPITAL, INC. PART V, SECTION B, LINE 24: GROSS CHARGES ARE APPLIED TO ALL BILLED SERVICES OF THE HOSPITAL. UPON THE INDIVIDUAL MEETING THE FAP-ELIGIBILITY REQUIREMENTS DISCOUNTS AND ASSISTANCE FOR THOSE NOT ABLE TO PAY ARE THEN APPLIED. FREE CARE IS PROVIDED TO ANY INDIVIDUAL THAT FALLS BELOW 100% OF THE FPG FAMILY INCOME LIMIT. DISCOUNTED CARE IS OFFERED TO ANY INDIVIDUAL THAT FALLS BELOW 200% OF THE FPG FAMILY INCOME LIMIT. FLAMBEAU HOSPITAL, INC. PROVIDES DISCOUNTS ON A SLIDING SCALE METHOD. A 10% DISCOUNT IS GIVEN FOR EVERY 10TH PERCENTILE AN INDIVIUAL IS BELOW THE 200% FPG FAMILY INCOME LIMIT. AN INDIVIDUAL THAT FALLS IN THE 190% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 10% DISCOUNT ON GROSS CHARGES AND AN INDIVIDUAL THAT FALLS IN THE 110% OF THE FPG FAMILY INCOME LIMIT WOULD BE GIVEN A 90% DISCOUNT ON GROSS CHARGES. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT FLAMBEAU HOSPITAL INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT, AND THE COMMUNITY BASED HOSPICE AND HOMECARE PROGRAMS. THE HOSPITAL EMERGENCY DEPARTMENT OPERATES 24 HOURS PER DAY, SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED NURSING STAFF INCLUDING REGISTERED NURSES, LICENSED PRACTICED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL EMERGENCY DEPARTMENT COME FROM THE COMMUNITY AND SURROUNDING AREAS. THE HOSPICE AND HOMECARE PROGRAMS ARE PROVIDED AS COMMUNITY SUPPORT SERVICES TO THE AREA OF PRICE COUNTY, WISCONSIN. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF FLAMBEAU HOSPITAL AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF FLAMBEAU HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENTS ABILITY TO PAY. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITALS MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR THE FORM 990 PURPOSES. PART I, LN 7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $437,961 INCLUDED ON FORM 990, PART IX, LINE 25 WAS NOT INCLUDED IN TOTAL EXPENSES FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGES. PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITALS "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. FLAMBEAU HOSPITAL, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE HOSPITAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. FLAMBEAU HOSPITAL, INC., LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING SERVICES, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, HOME CARE, HOSPICE, SWING BED SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SURGICAL SERVICES, AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 4: THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT 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 PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNTS REPORTED ABOVE. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANETHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT FLAMBEAU HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREASS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2014 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.)WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING THE SERVICES TO THE ELDERLY AND DISABLES MEMBERS OF THE COMMUNITY. PART III, LINE 9B: ONCE A PERSON IS KNOWN TO QUALIFY FOR CHARITY CARE, THE HOSPITAL WILL KEEP THAT INFORMATION ON FILE AND AUTOMATICALLY GRANT CHARITY CARE FOR UP TO A YEAR. AT THAT POINT, THE PATIENT WOULD NEED TO REAPPLY OR VERIFY THAT THEIR SITUATION HAS NOT CHANGED SIGNIFICANTLY SINCE THEIR LAST APPLICATION. CHARITY CARE IS APPLIED FIRST BEFORE ANY COLLECTION EFFORTS ARE PURSUED. PART VI, LINE 2: THE HOSPITAL COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT IN FISCAL YEAR 2013 AND USED THE DATA AND FINDINGS OF THIS REPORT TO GUIDE THE ORGANIZATION IN THE FUTURE TO BE ABLE TO RESPOND TO THOSE NEEDS.IN ADDITION, THE HOSPITAL IS PARTICIPATING WITH PRICE COUNTY ON THE COUNTY HEALTH ASSESSMENT AND HEALTH PLAN. PART VI, LINE 3: INFORMATION IS POSTED IN THE FACILITY AND ALL PATIENTS WHO REGISTER AS SELF-PAY ARE CONTACTED FOR ANY ASSISTANCE NEEDS THEY MAY HAVE. PART VI, LINE 4: FLAMBEAU HOSPITAL, INC. PROVIDES SERVICES TO RESIDENTS OF PRICE COUNTY, WI AND PORTIONS OF THREE OTHER COUNTIES. THE NEXT CLOSEST HOSPITAL IS 45 MILES AWAY, AND FLAMBEAU HOSPITAL IS DESIGNATED AS UNDERSERVED. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN THE SHORT PERIOD ENDING JUNE 30, 2015, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 73 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR. PART VI, LINE 5: FLAMBEAU HOSPITAL PROVIDES EDUCATION, NEEDED SUBSIDIZED SERVICES AND SUPPORT TO THE COMMUNITY THROUGH SERVICES IT PROVIDES AND COLLABORATION WITH OTHER GROUPS TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 0 0 0 0 0 0 0 0 0 DAVID GRUNDSTROM CAO 0 187217 0 0 0 3158 0 26406 0 19475 0 236256 0 0 JAMES BRAUN CFO 157783 0 0 0 0 0 6567 0 28820 0 193170 0 0 0 JANE EATON-NYMN DIRECTOR OF ORGANIZATIONAL 119685 0 0 0 0 0 4768 0 29380 0 153833 0 0 0 A CITY OF PARK FALLS WISCONSIN 396005566 2012-02-10 4523750 REFINANCE 1994, 1997, 2007, AND 2009 LOAN AND FINANCE ER DEPARTMENT REMODEL 0 0 0 A 827976 4523750 90475 3475615 957660 2012 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 MARSHFIELD CLINIC AND MINISTRY HEALTH CARE, INC. ("MINISTRY"), BOTH WISCONSIN TAX-EXEMPT CORPORATIONS, ARE JOINT CORPORATE MEMBERS OF THE HOSPITAL. MINISTRY ALSO, VIA CONTRACT, SHARES CERTAIN GOVERNANCE AUTHORITIES WITH MARSHFIELD CLINIC WITH RESPECT TO THE PARK FALLS AND PHILLIPS ("PRICE COUNTY CLINICS") CLINIC OPERATIONS OF MARSHFIELD CLINIC, WITH MARSHFIELD CLINIC RETAINING THE REMAINING AUTHORITIES. MARSHFIELD CLINIC HAS CONTRACTED TO PROVIDE OPERATING MANAGEMENT TO THE HOSPITAL AND PRICE COUNTY CLINICS. THE GOAL OF THE MEMBERSHIP ARRANGEMENTS IS TO PROVIDE FOR THE EFFECTIVE, ECONOMICAL, AND COORDINATED MANAGEMENT AND OPERATION OF HEALTH CARE SERVICES IN PRICE COUNTY. COLLECTIVELY, THE PARTIES HAVE ESTABLISHED AN INTEGRATED HEALTH CARE DELIVERY SYSTEM FOR PRICE COUNTY. FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBERS HAVE APPROVED RIGHT FOR DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL OF BUDGET, ADMINISTRATOR, PROPERTY PURCHASED, AND DIRECTORS. FORM 990, PART VI, SECTION A, LINE 8B NOT APPLICABLE AS THERE ARE NO SUB-COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. IF THE BOARD MEMBERS WOULD LIKE ANY EXPLANATION OR CHANGES, THEY WOULD HAVE AN OPPORTUNITY TO COMMENT ON THE RETURN BEFORE ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND KEY EMPLOYEES OF THE HOSPITAL ANNUALLY SIGN TO ADHERE TO THE CONFLICT OF INTEREST POLICY AT FLAMBEAU HOSPITAL, INC. IT IS ASSUMED THAT THE BOARD OF DIRECTORS AND KEY EMPLOYEES WILL RECOGNIZE CONFLICTS OF INTEREST WITH ANY PERSONS OR FIRMS MENTIONED IN THE POLICY. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY INTEREST DESCRIBED IN THE POLICY SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE BOARD OF DIRECTORS AND KEY EMPLOYEES RESPONSIBILITY TO REVIEW POTENTIAL CONFLICTS OF INTEREST AND IF A CONFLICT EXISTS THE INDIVIDUAL IS PROHIBITED TO VOTE ON TRANSACTIONS WHERE THE POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE MARSHFIELD CLINIC PREPARES A COMPENSATION SCHEDULE THAT IS USED TO DETERMINE TOP MANAGEMENT AND KEY EMPLOYEE COMPENSATION. COMPENSATION STUDIES ARE ALSO USED TO PROVIDE COMPARABILITY DATA. THIS DATA IS REVIEWED AND APPROVED BY INDEPENDENT PERSONS AND ALL DECISIONS ARE SUBSTANTIATED. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: ADMINISTRATION NON-OP OTHER 366,345. FORM 990, PART XI, LINE 2C THE PROCESS IS CONSISTENT WITH PRIOR YEARS. FLAMBEAU HOSPITAL FOUNDATION INC PO BOX 310 PARK FALLS WI 54552 205957150 SUPPORT OF FLAMBEAU HOSPITAL WI 501 (C) 3 11, I FLAMBEAU HOSPITAL INC 1 FLAMBEAU HOSPITAL AUXILIARY INC PO BOX 310 PARK FALLS WI 54552 510211754 SUPPORT OF FLAMBEAU HOSPITAL WI 501 (C) 3 LINE 11D, III-O N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0