2014-03-17T13:54:45-05:00 2013-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2012-10-01 390799566 Tomah Memorial Hospital TOMA 6083722181 321 Butts Avenue Tomah WI 54660 Joseph Zeps 6083722181 2014-03-18 1 Kim Hunwardsen CPA P00484560 6122536500 2014-03-18 2012 2015-11-30 17:44:51Z Philip J Stuart 321 Butts Avenue Tomah WI 54660 45538805 0 X www.tomahhospital.org X 1948 WI To promote and provide quality health care to patients in a hospital setting 10 10 341 43 0 0 108890 86563 36002750 39496312 1280288 1021136 -5668 -1760 37386260 40602251 0 0 0 0 17452962 18731193 0 0 0 15784147 18663065 33237109 37394258 4149151 3207993 47193219 49454772 12418477 11026021 34774742 38428751 X The mission of Tomah Memorial Hospital, Inc. is to promote and provide quality health care based on customer needs and expectations. In fulfillment of its mission, Tomah Memorial Hospital is committed to view its customers and employees through a holistic approach without consideration to economic status, gender, ethnic origin or personal limitations. 0 0 28513172 37225619 Tomah Memorial Hospital has provided for the health and well being of the residents of Tomah and the surrounding communities for nearly sixty years. The Hospital provides a broad spectrum of health and wellness services to the community, including general medical/surgical and swing bed inpatient care, diagnostic laboratory and radiology services, general and specialty surgical services, 24 hour emergency care services, obstetric services, rehabilitative services, occupational health and wellness programs, and a community outreach program. Key volume indicators for the fiscal year ended September 30, 2013 are as follows:* 1,352 inpatient discharges* 3,552 inpatient days* 14,145 emergency room and urgent care visits* 1,218 surgical and endoscopic procedures* 11,662 radiology procedures (including CT and MRI)* 61,024 laboratory tests* 36,374 rehabilitative services proceduresIn furtherance of its charitable mission, the Hospital provided approximately $793,000 of free and discounted care to area residents (cost of care approximately $462,000), and wrote off $2.69 million of uncollectible accounts (cost equal to $1.57 million). Additionally, based on its most recently completed community benefits survey, the Hospital incurred approximately $1.14 million in net losses related to providing care for individuals with health insurance provided by either the Medicaid program or other governmental insurance programs. The Hospital subsidizes several programs that are deemed vital services for the community, including in-home hospice and palliative care services, a hospice residence, a walk-in clinic located in the rural community of Warrens, WI, and a dedicated community outreach department that provides health and wellness services to area employers and the Tomah community. Subsidies for these programs for fiscal 2013 approximated $2.29 million. Additional details regarding the hospice program and the Warrens Walk-In Clinic can be found below. In addition to providing high quality healthcare services, the Hospital encourages employees to become actively involved in community organizations and projects that provide other benefits to local communities. The Hospital provides many free services to the community, including health and wellness presentations to area school children, CPR and AED training to various organizations, wellness fairs devoted to women and senior citizens, and meeting space to various non-profit and civic organizations. 3964272 1972890 The Hospital provides in-home, inpatient, and residential hospice care to residents of Tomah and the surrounding communities. Residential care is provided via the operation of an eight bed hospice house located off campus. Despite subsidizing the financial losses incurred by the program, the services are deemed vital to the community and represent a necessary component of patient care. For the year ended September 30, 2013, the Hospice program experienced 11,100 program days and 1,782 hospice residence days. 541983 297803 The Hospital began operating an off-site walk-in care clinic during 2008 to better serve the needs of the residents of Warrens, Wisconsin. For the fiscal year ended September 30, 2013, the clinic experienced 3,429 patient visits. The clinic provides residents with a close-to-home, low-cost option for healthcare services (including basic laboratory tests and x-ray capabilities) related to minor injuries and illnesses, and all services provided are supported by the Hospital's Emergency Department. Despite incurring a negative gross contribution margin during 2013, the Hospital's Board of Directors believes the clinic is an important asset to the residents of Warrens and remains committed to supporting it until it achieves a sustainable level of financial performance. 33019427 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 1 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 1 0 0 0 1 13 0 1 341 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Joseph Zeps 6083740307 321 Butts Avenue Tomah WI 54660 Steve Austin 1.00 1.00 X X 0 0 0 Wes Revels 1.00 1.00 X X 0 0 0 James Quartemont 1.00 1.00 X X 0 0 0 Jim Starkweather 1.00 1.00 X X 0 0 0 Phil Yahnke 1.00 1.00 X X 0 0 0 Cynthia Erdman 1.00 0.00 X 0 0 0 Michael Saunders MD 1.00 0.00 X 0 0 0 Alan Conway MD 1.00 0.00 X 0 0 0 Kurt Olson 1.00 0.00 X 0 0 0 Terrie Gaarder 1.00 0.00 X 0 0 0 Paul Potter 1.00 0.00 X 0 0 0 Nodji Van Wychen 1.00 0.00 X 0 0 0 Will Schanhofer MD 1.00 0.00 X 0 0 0 Philip J Stuart 40.00 0.00 X 0 0 0 Joseph Zeps 40.00 0.00 X 126205 0 35741 Rebecca Perz ONPC 40.00 0.00 X 114143 0 37687 Darla Wilson 40.00 0.00 X 162096 0 19184 Todd Chapman 40.00 0.00 X 129294 0 5172 Gerald Fushianes 40.00 0.00 X 155810 0 42459 Laura J Miller 40.00 0.00 X 135960 0 16712 823508 0 156955 7 0 1 0 EmCare Inc 7032 Collections Ctr Dr Chicago IL 60693 Contracted ER physicians 1390207 Tomah Orthopedics 321 Butts Avenue Tomah WI 54660 Contracted Orthopedic surgeons 1244630 Medical X-Ray Consultants 900 W Clairemont Avenue Eau Claire WI 54701 Contracted radiologist services 707653 Rural Wisconsin Health Cooperative Infor 880 Independence Lane Sauk City WI 53583 HIS software licensing/service/support/h 620803 HealthTech Management Services Inc PO Box 636426 Cincinnati OH 452636426 Management services 514239 17 18907 67656 86563 Patient service revenue 622110 38233463 38233463 EHR incentives 900099 1056788 1056788 Supporting revenue 900099 206061 206061 39496312 761559 761559 46303 48063 -1760 -1760 -1760 5144286 3782 4888491 0 255795 3782 259577 259577 40602251 39496312 0 1019376 X 166929 166929 97660 97660 14595663 12609265 1986398 386581 307125 79456 2395553 2065403 330150 1088807 927167 161640 505979 505979 50747 50747 102856 102856 6810870 6643360 167510 210623 1045 209578 1731721 1565256 166465 375667 348677 26990 180178 158174 22004 94823 86900 7923 340422 340422 2219442 2219442 103359 103359 Medical supplies 2737548 2737548 Bad debt expense 2693203 2693203 505627 115421 390206 37394258 33019427 4374831 0 7068500 6384161 6029995 5703086 462896 498574 192165 142303 32908315 18447300 14963845 14461015 16972903 21702986 349574 389702 1153341 172945 47193219 49454772 2123514 2882071 7769359 7363619 1090604 780331 1435000 0 12418477 11026021 X 34115325 37668329 3685 3685 655732 756737 34774742 38428751 47193219 49454772 X 3207993 406515 39501 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 655732 55282 56609 10886 756737 539204 39504 86657 9633 655732 535663 185 13959 10603 539204 483734 36960 22725 7756 535663 410683 88020 -6375 8594 483734 1.00000 0 0 34500 34500 22402656 12557906 9844750 9719371 5618861 4100510 751788 270533 481255 14461015 X Description of Intended Use of Endowment Funds: Part V, Line 4: Permanently restricted net assets are restricted to the Hospice endowment fund and the beneficial interest in a perpetual trust. The interest earned can be used for hospice expenditures. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Tomah Memorial Hospital is organized as a Wisconsin nonprofit corporation and has been recognized by the IRS as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Tomah Memorial Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, Tomah Memorial Hospital is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 1 0 1 1 709 462106 462106 0.01330 6375 9228592 8398588 830004 0.02390 1681 3313045 3002672 310373 0.00890 8765 13003743 11401260 1602483 0.04610 294101 240984 53117 0.00150 3 3804 4506255 2270693 2235562 0.06440 3 3804 4800356 2511677 2288679 0.06590 3 12569 17804099 13912937 3891162 0.11200 0 2693203 36632 7422010 7406813 15197 X 1 1 1 1 Tomah Memorial Hospital

321 Butts Avenue Tomah WI 54660

X X X Warrens Walk-In Clinic - provider based Tomah Memorial Hospital 1 1 X X X X X X X X X 12 1 1 1 X X X X X X 1 0 1 1 100.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X 1 0 X X X 1 X 0 0 1 Hospice Touch Serenity House

330 Butts Avenue Tomah WI 54660

Hospice residence Part I, Line 6a: The Organization participates in the Wisconsin Hospital Association (WHA) Annual Community Benefit reporting process, which is released to the public via a written report distributed to member hospitals as well as the WHA's website. This reporting initiative attempts to quantify the amount of community benefits provided by the Hospital, and includes figures related to community care write-offs, bad debt write-offs, Medicare and Medicaid shortfalls, and programs operated at a loss.The Organization also prepares a quarterly newsletter that is distributed to the public via a mass-mailing. The quarterly newsletter is intended to provide the communities the Hospital serves information regarding Hospital operations, financial results, and programs/initiatives intended to fulfill the Hospital's commitment to community. The newsletter also contains financial highlights from the WHA community benefit report. Current and prior editions of the newsletter are available on the Hospital's website. Part I, Line 7: The methodology for determining charity care and Medicaid/Tricare shortfalls at cost was as follows: a cost to charge ratio was computed using totals from the Hospital's audited financial statements; this ratio was applied to charity care charges, and gross Medicaid/Tricare revenue. Actual reimbursement received from Medicaid/Tricare was then compared to the estimated cost (computed by multiplying the CCR by gross charges) to determine the shortfall. All other items were based on actual program expenses. Also worth noting that the methodology used for charity care/Tricare/Medicaid is the same as the methodology used by the Wisconsin Hospital Association in compiling their annual community benefit report. Part I, L7 Col(f): The amount of bad debt removed from total expenses to determine the percentage was $2,693,203. Part III, Line 4: Accounts are not written off to bad debt until all forms of payment have been applied to the account such as insurance, discounts, and contractual allowances, and the remaining balance is the personal portion due. A payment received on an account previously written off to bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements.The estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care policy is calculated based on an estimate of charges foregone to gross patient charges.The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements. Part III, Line 8: Tomah Memorial Hospital follows the CHA guidelines in reporting community benefits and therefore any Medicare shortfall is excluded from our community benefit report. Providing services to Medicare patients is essential to these patients and the community and increases their access to healthcare services, which is a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by The Centers for Medicaid and Medicare services. Part III, Line 9b: Tomah Memorial Hospital attempts to screen all elective/scheduled patients prior to the receipt of service regarding community care eligibility, and works with patient financial services staff to identify emergent/unscheduled patients who may be eligible for community care (generally after receipt of service). Patients without insurance are offered a 15% discount. Patients that express an interest in community care assistance, are in the process of applying for community care assistance, or waiting on a determination of community care assistance will not have collection efforts imposed on their accounts. After a determination of community care assistance is made, any personal portion due by the patient will follow the same collection procedures as other patients. Tomah Memorial Hospital Part V, Section B, Line 3: The hospital participated in a collaboration of several area non-profit healthcare providers and various community organizations (e.g. local United Way organizations, county health departments, etc.) to conduct a comprehensive community health needs assessment of Tomah, WI, and the surrounding communities. Input for the assessment was solicited via random household surveys and focus group discussions with community members. Leadership for the assessment was provided by representatives from Gundersen Health System and the Great Rivers United Way, with additional representation from healthcare facilities in Hillsboro, Sparta, LaCrosse, Viroqua, and Tomah, WI, as well as county health departments located in Vernon, LaCrosse, Monroe, Trempeleau, and Houston Counties. Tomah Memorial Hospital Part V, Section B, Line 4: Gundersen Health System, Tomah, Sparta, Whitehall, and LaCrosse, WISt Joseph's Community Health Services, Hillsboro, WIMayo Health System, Tomah, Sparta, Arcadia, and LaCrosse, WIVernon Memorial Healthcare, Viroqua, WITri County Memorial, Whitehall, WI Tomah Memorial Hospital Part V, Section B, Line 5c: The community health needs assessment can be accessed at http://www.tomahhospital.org/content/index.cfm?pageID=205. Tomah Memorial Hospital Part V, Section B, Line 6i: Tomah Memorial Hospital has adopted an implementation strategy to address the community health needs identified in its Community Health Needs Assessment. The implementation strategy is posted to the Hospital's website at http://www.tomahhospital.org/content/detail.cfm?pageid=205 Tomah Memorial Hospital Part V, Section B, Line 7: The Community Health Needs Assessment identified alcohol use, health care access and cost, mental health, obesity, dental care access and cost and illegal drug use as needs in the community. All needs were addressed in the fiscal year and will continue to be addressed in the next fiscal year.Current ActionAlcohol Use and Illegal Drug Use: Presentations to area businesses and community education event. The presentations cover the physical, mental and emotional effects of drug and alcohol use with information specific to Monroe county. We partnered with local law enforcement area physicians to provide education on prescription drug abuse. A new Hospital policy was implemented that provides firm guidance on the use of prescription narcotics for patients presenting with pain. Health Care Access and Cost: The Hospital administration is supportive of joint recruiting efforts from Gundersen and Mayo healthcare systems to bring new providers to the community, and when access to a particular service is limited, the Hospital works independently to recruit providers to the community. In August, 2013, the Hospital entered into an agreement to implement a hospitalist program to treat patients admitted to the hospital. The Hospital continues to explore opportunities to expand occupational health services, implement a formal ICU program, and assist the local medical groups with ensuring adequate general surgery, orthopedic surgery, and obstetric coverage are available to the community. Hospital leadership is committed to maintaining a relatively low pricing structure, and annual budgets are assembled with an operating margin of 3% - 5%.Dental Care: The Hospital's Emergency Department provides a dental care handout for patients in need of dental care. During September 2013 the Hospital partnered with a pediatric dentist to begin providing services to area youth in need of extensive dental care.Mental Health: The Hospital has partnered with the Monroe County CHIP Mental Health Workgroup in order to discover how mental health services available to Monroe County can be expanded. The Hospital is part of the Tomah Veteran's Administration Mental Health Executive Committee. Stress relief presentations are given to area business and community education events. Anti-bullying presentations are given to parents and students.Obesity: Annual events are planned and sponsored by the Hospital that provide free health screenings, health information, and healthy refreshments. Presentations are given on preparing food, label reading, positive health effects of exercise and heart health. Tomah Memorial Hospital Part V, Section B, Line 14g: Brochures containing information about financial assistance are available to patients. The Hospital's website contains information regarding community care and financial assistance. Contact information regarding community care and financial assistance is included on billing statements. Summary and contact information is also included in the emergency room, waiting rooms, and business office. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Part VI, Line 2: Tomah Memorial Hospital currently operates on a three-year strategic planning cycle. At the beginning of each cycle, a strategic planning retreat is held during which an analysis is conducted of the services the Hospital currently provides and areas of need that should be addressed by the Hospital. The retreat is open to all Hospital staff, Hospital Board Members, and members of the Hospital's medical staff. The Hospital's medical staff is comprised primarily of physicians employed by other area healthcare providers (e.g. Mayo, Gundersen Lutheran), and as such their input into the strategic planning process allows the Hospital to work collaboratively with other hospitals and health systems in assessing the needs of the community. The strategic planning process is facilitated by a representative of HealthTech Management Services, Inc. (contracted management organization), and the three year plan that is adopted by the Hospital's governance serves as a blueprint for ensuring the Hospital is addressing the needs of the community.In addition to the formal strategic planning process, the Hospital engages in ongoing discussions with various stakeholders (area businesses, physicians, patients, and community members) regarding the services offered at the Hospital, and Hospital leadership evaluates all suggestions offered for improving the many ways in which the Hospital serves its community.Finally, the Hospital participated in a collaborative community health needs assessment project with other area healthcare providers and county health departments. The final report and the Hospital's implementation plan are published on the Hospital's website at www.tomahhospital.org. Part VI, Line 3: Tomah Memorial Hospital makes available brochures containing information about financial assistance to all patients seen in the emergency room/urgent care areas, and any patient that registers for a non-emergent service is questioned by admissions or nursing staff regarding any concerns they might have about the cost of their Hospital services. The Hospital employs a full-time, dedicated patient benefit specialist who works with uninsured and underinsured patients regarding community care applications and financial assistance. Additionally, a review is conducted of all accounts that become delinquent to ensure that an attempt to contact the patient has been made by Hospital staff. Finally, the Hospital is in the process of adding a community care & financial assistance section to its website. Part VI, Line 4: Tomah Memorial Hospital, Inc. is a 25-bed Critical Access Hospital located in Tomah, Wisconsin. The Hospital's primary service area consists of Tomah, WI, and the outlying communities of Camp Douglas, Warrens, Oakdale, and Wilton. Tomah is located in rural western Wisconsin, and as such a significant portion of the Hospital's patient base is comprised of agricultural workers and members of the Amish community. Additionally, Tomah's proximity to two military installations results in a large portion of services provided to members of the military and their families. The Hospital's payer mix is comprised of approximately 15% Medicaid, 37% Medicare, 7% military, 5% self-pay, and 36% commercial insurance. The reimbursement challenges associated with providing a high percentage of services to Medicaid/Medicare recipients and the uninsured has required the Hospital to operate at a high level of efficiency, ensuring that all services provided represent an excellent value to area community members. Although the Hospital has benefited from the additional reimbursement afforded through the Critical Access Hospital program, competition for market share with other area healthcare providers requires Hospital leadership to continually reevaluate service offerings and business lines for appropriateness given the healthcare needs of the community. Part VI, Line 5: Tomah Memorial Hospital's Board of Directors is comprised of community members that represent both a cross section of industry expertise (banking, manufacturing, attorneys, physicians, small business, etc.) as well as an appreciation of the healthcare needs of the community. The Hospital budgets for a targeted operating margin of between 3% and 5% each year. This target was established by the Hospital's Board of Directors, and is believed to represent an appropriate balance between fulfilling the Hospital's charitable purpose and achieving financial results that allow for continued reinvestment in staff and equipment to remain competitive.The Hospital operates a fully staffed Community Health Initiatives Department dedicated to improving the health of the community through wellness education and preventative healthcare strategies. This Department maintains an active presence in the community, sponsoring such events as an annual Women's Health Night, an annual Senior Health and Safety Expo, and various other educational programs in area schools and businesses. Reports Filed With States Part VI, Line 7 WI X X X X 0 0 0 0 0 0 0 1 0 Joseph Zeps 112539 0 1774 0 11892 0 5394 0 31569 0 163168 0 0 0 Rebecca Perz ONPC 111038 0 1581 0 1524 0 5005 0 33802 0 152950 0 0 0 Darla Wilson 148486 0 1955 0 11655 0 6642 0 14174 0 182912 0 0 0 Gerald Fushianes 142379 0 2186 0 11245 0 6791 0 36778 0 199379 0 0 0 Laura J Miller 126534 0 1887 0 7539 0 5542 0 12336 0 153838 0 0 0 Part I, Line 7 Bonuses are provided based on production and performance. The Board of Directors has authority to determine if a bonus should be granted or denied. Supplemental Information Part III Part I, Question 3: Tomah Memorial Hospital does not pay compensation to the Administrator directly. The Administrator is compensated by an unrelated management company, HealthTech Management Services, Inc., and is considered a common law employee of the management company. The Hospital Board of Directors uses the processes described in Part I, Question 3 to help determine appropriate compensation for the Administrator. The Board of Directors also approves the Organization's contract with the Management Company. A Wisconsin Health and Educational Facilities Authority 391337855 2012-08-08 7827337 Refund Revenue Bond Series 2003 issued 7/15/03 0 0 0 A 463718 7827337 155074 7672263 2012 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 Cindy Lambert Family member of Chief Financial Officer 38252 Compensation and benefits as an employee 0 Shana Steele Family member of a current Director of the Board 59408 Compensation and benefits as an employee 0 Form 990, Part VI, Section A, line 1 The Executive Committee includes the Corporation's officers and Chairman of Standing Committees. The Executive Committee has power to transact all regular business of the Corporation during the period between the meetings of the Board of Directors subject to any prior limitation imposed by the Articles of Incorporation, these Bylaws, or the Board, and with the understanding that all matters of major importance will be referred to the Board of Directors. The Chairman of the Board presides as Chairman of Executive Committee and the Treasurer presides in the Chairman's absence. Actions of the Executive Committee are subjected to approval or disapproval at the next regular Board of Directors meeting except for those actions taken pursuant to delegation by the Board of Directors. Form 990, Part VI, Section A, line 2 Steve Austin and Cynthia Erdman have a business relationship. Form 990, Part VI, Section A, line 3 Philip J. Stuart, Administrator of Tomah Memorial Hospital, is employed by HealthTech Management Services, Inc., an unrelated management company. The Administrator has the responsibility of supervising the management, administration and operation of the Organization. Philip was compensated $266,765 for services provided to Tomah Memorial Hospital. Form 990, Part VI, Section B, line 11 A copy of the Form 990 is provided to the Board before it is filed. The Administrator, CFO, and Executive/Finance Committee review the draft in detail. Form 990, Part VI, Section B, line 12c All members of the Board and Administration team are covered by the conflict of interest policy. Potential conflicts are contracts or transactions between the Hospital and a Director or another corporation, firm, association, or entity in which there is a material financial interest. The Hospital administration reviews annual statements for potential conflicts. If the Hospital Administration determines there is a conflict, the person involved must abstain from voting on any matter related to the conflict. Form 990, Part VI, Section B, line 15 The Administrator is employed by HealthTech Management Services, Inc. The Board approves the contract on a three year period with two one-year renewal clauses. Comparability data is used during this process and the decision is documented. The contract was renewed in fiscal year 2010. The Administrator makes recommendations to the Finance/Executive Committee of the Board for other officers. Comparability data is used during this process and the decisions are documented. This is an annual process and was last completed in fiscal year 2013. Form 990, Part VI, Section C, line 19 The Organization's governing documents and conflict of interest policy have not been available to the general public in the past, although Administration is considering posting them on the Organization's website in the future. Financial statements are available through the Organization's bond issuer on the internet, and the Organization presents an annual report to the community, open to the general public, in which a financial report is presented. Additionally, an annual financial report is included in the quarterly mailings the Organization sends to all community members. Other Fees Form 990, Part IX, line 11g Purchased services: Program service expenses 5,884,143. Management and general expenses 22,695. Fundraising expenses 0. Total expenses 5,906,838. Repairs and maintenance: Program service expenses 690,856. Management and general expenses 13,323. Fundraising expenses 0. Total expenses 704,179. Professional fees: Program service expenses 68,361. Management and general expenses 131,492. Fundraising expenses 0. Total expenses 199,853. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Net change in fair value of beneficial interest in perpetual trust 39,501. Tomah Memorial Auxiliary 321 Butts Avenue Tomah WI 54660 390799566 Support Tomah Hospital through gift a shop and thrift store WI 20323 172612 Tomah Memorial Hospital Pederson Trust Fund for the Benefit of Tomah Memorial Hospital 321 Butts Avenue Tomah WI 54660 396173790 Support Tomah Memorial Hospital WI 501(c)(3) Line 11b, II Tomah Memorial Hospital 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0