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LAKEVIEW MEDICAL CENTER INC OF RICE LAKE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
LAKEVIEW MEDICAL CENTER INC OF RICE LAKE (EIN 39-0837206)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-09
IRS object ID
201342219349300964
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-09T13:01:05-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14200 WELLS FARGO CTR 90 S 7TH STAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390837206EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKEVIEW MEDICAL CENTER INC OF RICE LAKEBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JACQUELINE KLEINInCareOfName
Name ControlLAKENameControl
Phone7152341515Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11700 WEST STOUT STREETAddressLine1
CityRICE LAKECity
StateWIState
ZIP Code54868ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJACKIE KLEINName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2013-08-09DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123055000Phone
Date Prepared2013-08-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1LAKEVIEW MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonEDWARD H WOLF CAONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11700 WEST STOUT STREETAddressLine1
CityRICE LAKECity
StateWIState
ZIP Code54868ZIPCode
FieldValueIRS element (for citing)
Gross Receipts67545123GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.LAKEVIEWMEDICAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1919YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionLAKEVIEW MEDICAL CENTER SERVES THE COMMUNITY BY PROVIDING SERVICES INTENDED TO ENHANCE THE HEALTH OF THE PEOPLE IN THE SURROUNDING REGION.ActivityOrMissionDescription
Termination Or ContractionXTerminationOrContraction
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees495TotalNbrEmployees
Total Nbr Volunteers218TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year60701ContributionsGrantsPriorYear
Contributions Grants Current Year113597ContributionsGrantsCurrentYear
Program Service Revenue Prior Year66929460ProgramServiceRevenuePriorYear
Program Service Revenue CY67152121ProgramServiceRevenueCY
Investment Income Prior Year-250458InvestmentIncomePriorYear
Investment Income Current Year113028InvestmentIncomeCurrentYear
Other Revenue Prior Year28011OtherRevenuePriorYear
Other Revenue Current Year72523OtherRevenueCurrentYear
Total Revenue Prior Year66767714TotalRevenuePriorYear
Total Revenue Current Year67451269TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year31035869SalariesEtcPriorYear
Salaries Etc Current Year31919278SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year29636505OtherExpensePriorYear
Other Expenses Current Year31102600OtherExpensesCurrentYear
Total Expenses Prior Year60672374TotalExpensesPriorYear
Total Expenses Current Year63021878TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6095340RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4429391RevenuesLessExpensesCY
Total Assets BOY128620549TotalAssetsBOY
Total Assets EOY122828997TotalAssetsEOY
Total Liabilities BOY35137164TotalLiabilitiesBOY
Total Liabilities EOY56857848TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY93483385NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY65971149NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionLAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, HOSPICE, AND HOME HEALTH SERVICES. IT ALSO SERVES THE COMMUNITY BY PROVIDING SERVICES INTENDED TO ENHANCE THE HEALTH OF THE PEOPLE IN THE SURROUNDING REGION.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense8561128Expense
Grants0Grants
Revenue20310227Revenue
DescriptionLAKEVIEW MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT SURGICAL SERVICES IN ORTHOPEDICS, UROLOGY, WOMEN'S HEALTH, ENT AND GENERAL SURGERY. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2012, THERE WERE 3,651 SURGICAL CASES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4773880Expense
Grants0Grants
Revenue6015365Revenue
DescriptionLAKEVIEW MEDICAL CENTER PROVIDES INPATIENT ROOM, BOARD AND CARE TO MEDICAL AND SURGICAL PATIENTS. FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2012 THIS UNIT HAD 2,359 ADMISSIONS AND 6,515 PATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3186832Expense
Grants0Grants
Revenue10033773Revenue
DescriptionLAKEVIEW MEDICAL CENTER LABORATORY PERFORMS INPATIENT AND OUTPATIENT TESTS FOR BOTH LAKEVIEW MEDICAL CENTER AND MARSHFIELD CLINIC. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2012, THERE WERE 297,343 TESTS PERFORMED BY THE LAB.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp34007027TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev30792756TotalOfOtherProgramServiceRev
Total Program Service Expense50528867TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationtruePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109633NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees495NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJACQUELINE KLEINNamePerson
Telephone Number7152366129TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11700 W STOUT STREETAddressLine1
CityRICE LAKECity
StateWIState
ZIP Code54868ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DR BRAD BEKKUM
CHAIRMAN1.0XX030771749318
DR PETER NEAL
DIRECTOR1.0X035726853013
DR CHARLES T STEWART
DIRECTOR1.0X042244453013
DR LAURA NELSON
DIRECTOR1.0X036332651434
JAMES DORRANCE
VICE CHAIRMAN1.0XX000
MARY BITZ
DIRECTOR1.0X000
SANDY BONNEVILLE
DIRECTOR1.0X000
PAUL CHASE
DIRECTOR1.0X000
DAVE HILDEBRAND
DIRECTOR1.0X000
SUE ZAHRBOCK
DIRECTOR1.0X000
SCOTT POLENZ
DIRECTOR1.0X000
EDWARD WOLF
CHIEF ADMINISTRATIVE OFFICER40.0X286277054224
CYNTHIA ARTS-STRENKE
CHIEF OPERATING OFFICER40.0X206937043952
JACQUELINE KLEIN
CHIEF FINANCIAL OFFICER40.0X182171043868
ANNA ROGALLA
STAFF PHARMACIST40.0128717037363X
WENDY BROMBEREK
STAFF PHARMACIST40.0115638036399X
DENNIS MOE
STAFF PHARMACIST40.0137826024626X
GERARD LISI
I.S PROJECT MANAGER40.0121642030498X
SHERRY JOHNSON
INPATIENT SERVICES MANAGER40.0129058016841X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1308266TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1450755TotalReportableCompFrmRltdOrgs
Total Other Compensation494549TotalOtherCompensation
Number Individuals GT100 K21NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CERNER CORPORATION
PO BOX 412702KANSAS CITYMO64141COMPUTER CONSULTING3702848
ARAMARK CORPORATION
24863 NETWORK PLACECHICAGOIL606731248MANAGEMENT SERVICES372110
QUADRAMED CORPORATION
PO BOX 347188PITTSBURGHPA152511488COMPUTER CONSULTING352058
MEDICAL STAFFING SOLUTIONS
PO BOX 101RICE LAKEWI54868CONTRACT LABOR177615
RX CONSULTANTS
105 WESTERN AVENUEWAUPACAWI54981CONTRACT LABOR140000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Federated Campaigns3800FederatedCampaigns
Fundraising Events12301FundraisingEvents
Government Grants20606GovernmentGrants
All Other Contributions76890AllOtherContributions
Total Contributions113597TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
NET PATIENT SERVICE REVENUE6241006498147964981479
LEASING REVENUE62410016068491606849
LIFELINE PROGRAM624100154289154289
OCCUPATIONAL/INDUSTRIAL HEALTH6241003256732567
EMPLOYEE MEALS624100256378$256,378

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column120559TotalRevenueColumn
Related Or Exempt Function Income63987RelatedOrExemptFunctionIncome
Exclusion$56,572ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue67152121TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column137587TotalRevenueColumn
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$137,587ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real88301Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real21323Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real66978Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column66978TotalRevenueColumn
Exclusion$66,978ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other34737Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other59296Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-24559Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-24559TotalRevenueColumn
Exclusion-$24,559ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events5685GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events12301CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses11096FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-5411TotalRevenueColumn
Exclusion-$5,411ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming13095GrossIncomeGaming
Gaming Direct Expenses2139GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column10956TotalRevenueColumn
Exclusion$10,956ExclusionAmount

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column67451269TotalRevenueColumn
Related Or Exempt Function Income66839171RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$498,501ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total788554Total
Management And General788554ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total22799113Total
Program Services19669610ProgramServices
Management And General3129503ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2238064Total
Program Services1908883ProgramServices
Management And General329181ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4406311Total
Program Services3733441ProgramServices
Management And General672870ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1687236Total
Program Services1456634ProgramServices
Management And General230602ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total314871Total
Program Services314871ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total307456Total
Management And General307456ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total76224Total
Management And General76224ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5807579Total
Program Services2397563ProgramServices
Management And General3410016ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total531594Total
Management And General531594ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9321274Total
Program Services8791208ProgramServices
Management And General530066ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total3337745Total
Program Services1080631ProgramServices
Management And General2257114ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total143407Total
Program Services143407ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total629614Total
Program Services629614ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7339297Total
Program Services7339297ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total136802Total
Management And General136802ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISION FOR BAD DEBTS26072122607212
FOOD AND PROVISIONS367973367973
DUES AND SUBSCRIPTIONS1815528852393029

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total63021878Total
Program Services50528867ProgramServices
Management And General12493011ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2230BOY
EOY2310EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY27395340BOY
EOY21756633EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9500266BOY
EOY11238677EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY659098BOY
EOY667937EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY418694BOY
EOY361370EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis110401881LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec23201161LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY89916939BOY
EOY87200720EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY15850EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY727982BOY
EOY1585500EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY128620549BOY
EOY122828997EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4133030BOY
EOY3055238EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY500000BOY
EOY500000EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY30043170BOY
EOY52800230EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY460964BOY
EOY502380EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY35137164BOY
EOY56857848EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY93483385BOY
EOY65971149EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY93483385BOY
EOY65971149EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY128620549BOY
EOY122828997EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4429391ReconcilationRevenueExpenses
Reconcilation Other Changes-31941627ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5255530OtherCostOrOtherBasis
Book Value5255530BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis70872444OtherCostOrOtherBasis
Depreciation7165805Depreciation
Book Value63706639BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis31160051OtherCostOrOtherBasis
Depreciation15455624Depreciation
Book Value15704427BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3113856OtherCostOrOtherBasis
Depreciation579732Depreciation
Book Value2534124BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings87200720TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMPENSATIONDescription
Amount$502,380Amount
FieldValueIRS element (for citing)
Total Of Amounts502380TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFASB ASC 740 FOOTNOTE:Identifier
ExplanationEFFECTIVE OCTOBER 1, 2007, THE ORGANIZATION ADOPTED FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, 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. BASED ON AN ANALYSIS PREPARED BY THE ORGANIZATION, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE ORGANIZATION AT SEPTEMBER 30, 2012.Explanation

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1VOICES FOR HOSPNameOfEvent1
Gross Receipts Event117986GrossReceiptsEvent1
Charitable Contributions Event112301CharitableContributionsEvent1
Gross Revenue Event15685GrossRevenueEvent1
Food And Beverage Event17133FoodAndBeverageEvent1
Entertainment Event1900EntertainmentEvent1
Other Direct Expenses Event13063OtherDirectExpensesEvent1
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total17986GrossReceiptsTotal
Charitable Contributions Total12301CharitableContributionsTotal
Gross Revenue Total Events5685GrossRevenueTotalEvents
Food And Beverage Total Events7133FoodAndBeverageTotalEvents
Entertainment Total Events900EntertainmentTotalEvents
Other Direct Expenses Total Events3063OtherDirectExpensesTotalEvents
Direct Expense Summary Events11096DirectExpenseSummaryEvents
Net Income Summary-5411NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigentfalseFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense652430TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense652430NetCommunityBenefitExpense
Percent Of Total Expense0.01080PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10352362TotalCommunityBenefitExpense
Direct Offsetting Revenue7797497DirectOffsettingRevenue
Net Community Benefit Expense2554865NetCommunityBenefitExpense
Percent Of Total Expense0.04230PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense11004792TotalCommunityBenefitExpense
Direct Offsetting Revenue7797497DirectOffsettingRevenue
Net Community Benefit Expense3207295NetCommunityBenefitExpense
Percent Of Total Expense0.05310PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense382448TotalCommunityBenefitExpense
Direct Offsetting Revenue16666DirectOffsettingRevenue
Net Community Benefit Expense365782NetCommunityBenefitExpense
Percent Of Total Expense0.00610PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense64073TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense64073NetCommunityBenefitExpense
Percent Of Total Expense0.00110PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2109TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense2109NetCommunityBenefitExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense24226TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense24226NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense472856TotalCommunityBenefitExpense
Direct Offsetting Revenue16666DirectOffsettingRevenue
Net Community Benefit Expense456190NetCommunityBenefitExpense
Percent Of Total Expense0.00760PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11477648TotalCommunityBenefitExpense
Direct Offsetting Revenue7814163DirectOffsettingRevenue
Net Community Benefit Expense3663485NetCommunityBenefitExpense
Percent Of Total Expense0.06070PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense536TotalCommunityBuildingExpense
Net Community Building Expense536NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense893TotalCommunityBuildingExpense
Net Community Building Expense893NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense1429TotalCommunityBuildingExpense
Net Community Building Expense1429NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,268,136BadDebtExpenseAmount
Amount Attributable To304491AmountAttributableTo
Amount Reimbursed By Medicare15776761AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare20178059CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4401298MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CarefalseProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1LAKEVIEW MEDICAL CENTER INC OF RICE LAKEBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11700 W Stout StreetAddressLine1
CityRICE LAKECity
StateWIState
ZIP Code54868ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1LAKEVIEW MEDICAL CENTER INC OF RICE LAKEBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
Uninsured DiscountXUninsuredDiscount
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiestrueCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 3CLAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE USES THE FEDERAL POVERTY GUIDELINES AT 200% TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AS STATED IN LINE 3A. FOR SELF-PAY INDIVIDUALS WHO DON'T QUALIFY FOR FREE CARE PER OUR POLICY, WE OFFER A 6% DISCOUNT (OUR HIGHEST COMMERCIAL DISCOUNT). WE ALSO OFFER AN INTEREST FREE PAYMENT PLAN, WITH THE APPROVAL OF THE CREDIT SUPERVISOR BASED ON THE PATIENT'S CIRCUMSTANCES AND ABILITY TO PAY. THE GUIDELINES FOR THE PAYMENT PLAN INCLUDE: MAXIMUM OF 60 MONTHS, LEVEL PAYMENTS OR A FRONT-END-LOADED ARRANGEMENT (I.E., LOWER INITIAL PAYMENTS WITH A BALLOON PAYMENT IS NOT ACCEPTABLE) AND A MINIMUM OF $25 PER MONTH (I.E., $5 PER MONTH ON A $25 BALANCE IS NOT APPROPRIATE). Part I, Line 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL OPERATING EXPENSES LESS 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. REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
PART II:COMMUNITY BUILDING ACTIVITIES PROMOTING THE HEALTH IN THE COMMUNITIES SERVED: LAKEVIEW MEDICAL CENTER PARTNERED WITH BARRON COUNTY PUBLIC HEALTH, ALONG WITH THE COUNTYS 2 OTHER HEALTHCARE SYSTEMS IN THE BARRON COUNTY COMMUNITY HEALTH IMPROVEMENT PROCESS TO IDENTIFY LOCAL HEALTH CONCERNS AND ADDRESS LOCAL HEALTH PRIORITIES LINKED TO STATE AND NATIONAL PRIORITIES. THE INFORMATION GATHERED FROM THIS PROCESS WAS USED TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH ISSUES AND NEEDS. LAKEVIEW MEDICAL CENTER HAS FOCUSED ON EDUCATION EFFORTS THROUGH HEALTH FAIRS, HEALTH EVENTS, AND COMMUNITY SCREENINGS IN THE COMMUNITY BASED ON THIS INFORMATION. LAKEVIEW MEDICAL CENTERS SPECIFIC EFFORTS HAVE PROVIDED PROGRAMS TO STRENGTHEN "BE WELL BARRON COUNTY" WHICH IS AN INITIATIVE TO INCREASE PHYSICAL ACTIVITY AND DECREASE OBESITY RATES OF BARRON COUNTY RESIDENTS. THE "NOT ON TOBACCO" (NOT) PROGRAM LAKEVIEW SPONSORS, IS TO SUPPLY INFORMATION TO HELP KIDS ALREADY USING TOBACCO TO QUIT.
PART III, LINE 4:MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON AN ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER LAKEVIEWS CHARITY CARE POLICY EVEN THOUGH LAKEVIEW PROVIDES THIS INFORMATION TO THEM AND ASSISTANCE WITH THE APPLICATION. WITHOUT A COMPLETED APPLICATION THEY ARE TRANSFERRED TO COLLECTION SERVICES AND TREATED AS BAD DEBT EXPENSE. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH THEM SHOULD BE ATTRIBUTABLE TO CHARITY CARE AND A COMMUNITY BENEFIT.
PART III, LINE 8:THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H 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 ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE LAB AND THERAPY SERVICES REIMBURSED ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. THE COSTING METHOD USED FOR IRS COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2012, 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 BENEFICIARIES, 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 SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B:UNDER THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE, MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO GET ASSISTANCE WITH THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL. DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. THE ORGANIZATION ALSO PUBLISHES INFORMATION REGARDING ITS CHARITY CARE PROGRAM ON ITS WEBSITE. A DESCRIPTION OF THE CHARITY CARE PROGRAM IS INCLUDED IN THE "WELCOME" BOOKLET THAT PATIENTS RECEIVE UPON ADMISSION. A CHARITY CARE INFORMATIONAL BROCHURE IS GIVEN TO SELF-PAY PATIENTS DURING THE REGISTRATION PROCESS. PART V, LINE 10: LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE USES THE FEDERAL POVERTY GUIDELINES AT 200% TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AS STATED IN LINE 3A. FOR SELF-PAY INDIVIDUALS WHO DON'T QUALIFY FOR FREE CARE PER OUR POLICY, WE OFFER A 6% DISCOUNT (OUR HIGHEST COMMERCIAL DISCOUNT). WE ALSO OFFER AN INTEREST FREE PAYMENT PLAN, WITH THE APPROVAL OF THE CREDIT SUPERVISOR BASED ON THE PATIENT'S CIRCUMSTANCES AND ABILITY TO PAY. THE GUIDELINES FOR THE PAYMENT PLAN INCLUDE: MAXIMUM OF 60 MONTHS, LEVEL PAYMENTS OR A FRONT-END-LOADED ARRANGEMENT (I.E., LOWER INITIAL PAYMENTS WITH A BALLOON PAYMENT IS NOT ACCEPTABLE) AND A MINIMUM OF $25 PER MONTH (I.E., $5 PER MONTH ON A $25 BALANCE IS NOT APPROPRIATE).
PART VI, #2LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER. IN 2011, LAKEVIEW MEDICAL CENTER JOINED WITH BARRON COUNTY IN THE BARRON COUNTY COMMUNITY HEALTH IMPROVEMENT PROCESS (CHIP) TO COLLECTIVELY IDENTIFY LOCAL HEALTH CONCERNS AND ADDRESS LOCAL HEALTH PRIORITIES LINKED TO STATE AND NATIONAL PRIORITIES. PARTNERS TO JOIN LAKEVIEW MEDICAL CENTER AND BARRON COUNTY PUBLIC HEALTH IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND CHIPP PROCESS ARE THE FOLLOWING ORGANIZATIONS: WISCONSIN DEPARTMENT OF HEALTH, MARSHFIELD CLINIC, MARSHFIELD CLINIC DENTAL CENTER, MAYO CLINIC HEALTH SYSTEMS, AND THE CUMBERLAND CLINIC AND HOSPITAL. OUR STEERING COMMITTEE MEMBERS HAVE SHOWN COMMITMENT DEDICATING FOUR HOURS PER MONTH TO MEET AND STRENGTHEN OUR PARTNERSHIPS AND DEVELOP A PLAN TO IMPROVE THE HEALTH OF BARRON COUNTY RESIDENTS. THE COMMITTEE HAS IDENTIFIED A NAME FOR THE INITIATIVE, THRIVE BARRON COUNTY (THRIVE BC), GROWING TOGETHER IN HEALTH. OUR MISSION: THRIVE BC WILL WORK TO ENGAGE COMMUNITY MEMBERS AND ORGANIZATIONS TO FOCUS RESOURCES AND DEVELOP AND STRENGTHEN PARTNERSHIPS TO ESTABLISH SUSTAINABLE, SAFE AND HEALTHY COMMUNITIES. OUR VISION: COMMUNITY MEMBERS AND ORGANIZATIONS WORKING TOGETHER TO IMPROVE THE QUALITY OF LIFE FOR EVERYONE IN BARRON COUNTY. TO MEET OUR VISION WE WILL MEET REGULARLY AND SYSTEMATICALLY COLLECT, ASSEMBLE, ANALYZE, AND MAKE AVAILABLE INFORMATION ON THE HEALTH OF THE COMMUNITY. OUR COALITION HAS COLLECTED SECONDARY DATA THROUGH BOTH AN ONLINE AND PAPER SURVEY CONCERNING DISEASE, DEATH, DISABILITY, INJURY AND COMMUNITY OPINIONS. THE SURVEY WAS TRANSLATED TO SOMALIAN AND SPANISH TO INCLUDE FEEDBACK FROM UNDERSERVED POPULATIONS IN THE COUNTY. ONE THOUSAND ONE HUNDRED AND THIRTEEN RESPONSES OUT OF THE COUNTY POPULATION OF 45,850 WERE COMPLETED. ALONG WITH THE SECONDARY DATA, THE COMMITTEE IS ANALYZING STATE AND NATIONAL DATA BASED ON THE 12 WISCONSIN HEALTH PRIORITIES. THIS DATA WAS PRESENTED TO COMMUNITY MEMBERS, LEADERS AND EXPERTS AT A SEPTEMBER 26, 2012 MEETING WHERE ATTENDEES SELECTED THE TOP THREE HEALTH PRIORITIES FOR BARRON COUNTY WHICH ARE: 1) ALCOHOL AND OTHER DRUGS; 2) MENTAL HEALTH; AND 3) CHRONIC DISEASE. LAKEVIEW MEDICAL CENTER HAS ESTABLISHED A COMMUNITY BENEFIT OVERSIGHT COMMITTEE THAT WILL DEVELOP ITS COMMUNITY HEALTH IMPLEMENTATION PLAN. LAKEVIEW MEDICAL CENTER ALSO HAS REPRESENTATIVES SERVING ON THE 3 THRIVE COMMITTEES FOCUSED ON ALCOHOL AND OTHER DRUGS, MENTAL HEALTH, AND CHRONIC DISEASE.NEEDS ASSESSMENT:
PART VI, #3UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO TALK WITH THE HOSPITALS PATIENT FINANCIAL COUNSELOR EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENTS BILL IS GENERATED. THE FINANCIAL COUSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITALS CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:
PART VI, #4THE PRIMARY SERVICE AREA FOR LAKEVIEW MEDICAL CENTER ENCOMPASSES ALL PERSONS LIVING WITHIN A 30 TO 40 MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE RICE LAKE, CAMERON, BARRON, BIRCHWOOD, LADYSMITH, CUMBERLAND, CHETEK, AND SPOONER, WISCONSIN, AMONG MANY OTHERS. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS, THESE MEDICARE AND MEDICAL ASSISTANCE PATIENTS ACCOUNTED FOR APPROXIMATELY 66% OF THE HOSPITALS GROSS PATIENT SERVICE REVENUE FOR THE YEAR.COMMUNITY INFORMATION:
OTHER INFORMATION:LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. LAKEVIEW MEDICAL CENTER, LIKE MOST COMMUNITY 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 SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, HOSPICE, HOME CARE, DIALYSIS, INFUSION SERVICES, HEALTH AND WELLNESS SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. LAKEVIEW MEDICAL CENTER IS GOVERNED BY AN ELEVEN MEMBER BOARD OF DIRECTORS, INCLUDING SIX COMMUNITY MEMBERS.
PART VI, #5:THE HOSPITAL OFFERS FREE RADIOLOGY AND LAB SERVICES TO THE FREE CLINIC SERVING THE UNDERSERVED POPULATION IN THE AREA. HEALTH AND WELLNESS CENTER THE HEALTH AND WELLNESS CENTER IS THE ONLY ONE IN THE AREA OFFERING COMMUNITY MEMBERS THE OPPORTUNITY TO EXERCISE WHILE BEING SUPERVISED BY MEDICALLY TRAINED STAFF. RADIOLOGY STUDENT EDUCATION AND WITC NURSING ORIENTATION LAKEVIEW MEDICAL CENTER IS COMMITTED TO SUPPORT THE TRAINING OF FUTURE MEDICAL PROFESSIONALS TO IMPACT PROJECTED MEDICAL STAFF SHORTFALLS. WORK WEIGHT LOSS CHALLENGE IN LIGHT OF RISING OBESITY ISSUES IN THE COUNTY THIS PROGRAM WAS DEVELOPED. THERE WERE 425 PARTICIPANTS FROM 20 AREA BUSINESSES WHO LOST A TOTAL OF 4,147 POUNDS DURING THIS 12-WEEK CHALLENGE. THROUGHOUT THE 12 WEEKS, FITNESS CLASSES AND NUTRITIONAL EDUCATION WAS OFFERED FREE OF CHARGE OR AT A NOMINAL FEE.RICE LAKE FREE CLINIC:
PART VI, #6:MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER. MARSHFIELD CLINIC IS A MULTI-SPECIALTY PHYSICIAN AND HEALTHCARE ORGANIZATION COMPRISED OF OVER 40 SITES, INCLUDING A SITE IN RICE LAKE, WISCONSIN, THE INTEGRATION OF LAKEVIEW MEDICAL CENTER AND MARSHFIELD CLINIC HAS ENHANCED THE ACCESS AND QUALITY OF HEALTH CARE THROUGHOUT RICE LAKE AND THE SURROUNDING COMMUNITIES WHILE ACHIEVING ECONOMIC EFFICIENCIES.AFFILIATED HEALTH CARE SYSTEM ROLES:
PART VI, #7:WIALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT:
COMMUNITY BUILDING ACTIVITIES:THE SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM: THE SANE PROGRAM AT LAKEVIEW MEDICAL CENTER SUPPORTS COMMUNITY EFFORTS TO ADDRESS THE CRIME OF SEXUAL ASSAULT BY ESTABLISHING A PROCESS FOR ACCURATE EVIDENCE COLLECTION AND SUPPORT FOR SEXUAL ASSAULT SURVIVORS. NOT ON TOBACCO (NOT) PROGRAM: LAKEVIEW MEDICAL CENTER JOINED THE SAFE AND STABLE FAMILY COALITION AND LED THE EFFORT TO SECURE A GRANT FROM THE RICE LAKE AREA HEALTH FOUNDATION TO REDUCE THE TOBACCO USE IN THE GREATER RICE LAKE AREA. THROUGH THE GRANT, THE NOT ON TOBACCO (NOT) PROGRAM WAS IMPLEMENTED IN BARRON HIGH SCHOOL AND THE RESTORATIVE JUSTICE PROGRAM ADOPTED THE NOT PROGRAM AS A SANCTIONED WORKSHOP FOR REHABILITATION. ALSO, DUE TO THE HIGH STATISTICS OF SMOKING DURING PREGNANCY, LAKEVIEW MEDICAL CENTER HAS IMPLEMENTED THE FIRST BREATH PROGRAM. LAKEVIEW MEDICAL CENTER HAS BEEN REWARDED MINI-GRANTS THROUGH THE SAFE AND STABLE FAMILY COALITION TO HELP INCENTIVE PARTICIPANTS IN THE PROGRAM. THE PREGNANCY HELP CENTER HAS PARTNERED WITH LAKEVIEW MEDICAL CENTER TO UTILIZE THIS FREE PROGRAM FOR THEIR CLIENTS. ANOTHER ALARMING STATISTIC SHOWS HIGH NUMBERS OF MOTHERS WHO QUIT SMOKING DURING PREGNANCY, BUT START SMOKING AFTER DELIVERY. WITH THIS HEALTH ISSUE, LAKEVIEW MEDICAL CENTER RECEIVED A GRANT TO IMPLEMENT A SMOKING CESSATION PROGRAM TARGETED TO THIS POPULATION. WORKSITE WELLNESS COMMITTEE: A WORKSITE WELLNESS COMMITTEE WAS FORMED AT LAKEVIEW MEDICAL CENTER TO SHARE BEST EVIDENCED BASED PRACTICES FOR EMPLOYEE HEALTH IMPROVEMENTS WITH LOCAL EMPLOYERS. A COMMUNITY OUTREACH SERIES IS OFFERED WHICH BRINGS PHYSICIANS AND PATIENTS TOGETHER IN A CASUAL ENVIRONMENT TO ANSWER QUESTIONS ABOUT SPECIFIC HEALTH NEEDS. 50 PLUS: 50 PLUS IS A FREE WELLNESS EVENT FOR THOSE OVER 50. THE EVENT OFFERS A VARIETY OF HEALTH SCREENINGS, COMMUNITY RESOURCES, EDUCATIONAL PRESENTATION AND ENTERTAINMENT. THIS EVENT IS COORDINATED BY A COALITION OF COMMUNITY AGENCIES LED BY LAKEVIEW MEDICAL CENTER. CHAMBER MEMBER: A HOSPITAL REPRESENTATIVE IS A MEMBER OF THE RICE LAKE CHAMBER OF COMMERCES BUSINESS AND EDUCATION COMMITTEE FOCUSING ON IMPROVING BUSINESS OPPORTUNITIES AND EDUCATION IN RICE LAKE. UNITED WAY MEMBER: A HOSPITAL REPRESENTATIVE IS A MEMBER OF THE RICE LAKE UNITED WAY COALITION SERVING THE COMMUNITY BY ISSUING COMMUNITY IMPROVEMENT GRANTS. FARMERS MARKET: LAKEVIEW MEDICAL CENTER HAS A BOOTH AT A LOCAL FARMERS MARKET THAT HAS 200 300 ATTENDEES EACH WEEK. THE HOSPITAL OFFERS A DIFFERENT HEALTH RELATED TOPIC/SCREENING EACH WEEK. LAKEVIEW MEDICAL CENTER HAS ADMINISTERED 245 BLOOD PRESSURES, 30 FLU SHOTS, 18 FALL AND BALANCE TESTS, AND 2 LUNG CAPACITY TESTS AT THE BOOTH. THE LAKEVIEW MEDICAL CENTER PROMOTIONS DEPARTMENTS INTENTION IS TO BUILD SUSTAINABLE PROGRAMS FOR OUR COMMUNITY THAT IS IN ALIGNMENT WITH ONE OF THE TOP HEALTH CONCERNS IDENTIFIED BY THE COMMUNITY HEALTH IMPROVEMENT PLANS AND PROCESSES (CHIP) OF BARRON COUNTY: OBESITY, NUTRITION AND PHYSICAL ACTIVITY. THE OUTCOMES OBTAINED WILL BE SHARED WITH LOCAL CIVIC GROUPS AND OTHER COMMUNITY ORGANIZATIONS TO SHARE THE PROGRAMS SUCCESSES AND LAKEVIEW MEDICAL CENTERS COMMITMENT TO THE HEALTH OF OUR COMMUNITIES.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR BRAD BEKKUM
0297697096000420030728018590035703500
DR PETER NEAL
03539960003272030728022285041028100
DR CHARLES T STEWART
0421814000630030728022285047545700
DR LAURA NELSON
03619130001413030728020706041476000
EDWARD WOLF
23190901000542680367220175020340501000
CYNTHIA ARTS-STRENKE
17370801000331290249310190210250889000
JACQUELINE KLEIN
15575801000263130227040211640226039000
ANNA ROGALLA
1130060900156210163620210010166080000
WENDY BROMBEREK
112472030031360136300227690152037000
DENNIS MOE
118996060018770016544080820162452000
GERARD LISI
9862101000229210146620158360152140000

Schedule N IRS990ScheduleN

FieldValueIRS element (for citing)
Liquidation TableLiquidationTable

Disposition Table DispositionTable (3 entries)

Description Of AssetDescriptionOfAssetDate Of DistributionDateOfDistributionFMV Of AssetFMVOfAssetMethod Of FMV DeterminationMethodOfFMVDeterminationEINEINAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeIRC SectionIRCSection
MARSHFIELD CLINIC
LONG TERM DEBT RECLASSIFICATION2012-06-3023446959NET BOOK VALUE3904529701000 North Oak AveMarshfieldWI54449501(c)(3)
MARSHFIELD CLINIC
CASH DISTRIBUTION TO MARSHFIELD CLINIC2012-01-318429000CASH3904529701000 NORTH OAK AVENUEMARSHFIELDWI54449501(c)(3)
MARSHFIELD CLINIC
TRANSFER OF CHETEK CLINIC ASSETS2011-12-0865668NET BOOK VALUE3904529701000 NORTH OAK AVENUEMARSHFIELDWI54449501(c)(3)
FieldValueIRS element (for citing)
Director Of Successor2falseDirectorOfSuccessor2
Employee Of Successor2falseEmployeeOfSuccessor2
Owner Of Successor2falseOwnerOfSuccessor2
Receive Compensation2falseReceiveCompensation2

Form990 Schedule N Part III Form990ScheduleNPartIII

FieldValueIRS element (for citing)
IdentifierPART II: LONG TERM DEBT RECLASSIFICATION:Identifier
ExplanationTHIS TRANSFER WAS A RECLASSIFICATION WITHIN LAKEVIEW MEDICAL CENTER. MARSHFIELD CLINIC TRANSFERRED ASSETS RELATED TO THE PORTION OF THE NEW LAKEVIEW MEDICAL CENTER BUILDING THAT WERE PAID FOR BY MARSHFIELD CLINIC IN FISCAL YEAR 2011. BECAUSE THE BOND ISSUE RELATED TO THESE ASSETS WAS NOT COMPLETED AT THE TIME OF TRANSFER, THIS AMOUNT WAS HELD IN NET ASSETS. ONCE THE BOND ISSUE WAS COMPLETED, THIS AMOUNT WAS TRANSFERRED FROM NET ASSETS TO LONG TERM DEBT. CASH DISTRIBUTION TO MARSHFIELD CLINIC: TRANSFER OF CASH FROM LAKEVIEW MEDICAL CENTER TO MARSHFIELD CLINIC BASED ON PRIOR AGREEMENTS. CHETEK CLINIC ASSETS: AT TERMINATION OF JOINT VENTURE WITH MARSHFIELD CLINIC ON FAMILY PRACTICE CLINIC IN CHETEK, WI, LAKEVIEW MEDICAL CENTER TRANSFERRED THE ASSETS ASSOCIATED WITH THAT CLINIC TO MARSHFIELD CLINIC AT NET BOOK VALUE.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanation
PART III, LINE 4D - OTHER PROGRAM SERVICESTHE OTHER PROGRAM SERVICES OF LAKEVIEW MEDICAL CENTER INCLUDE IMAGING, WOMEN'S HEALTH INPATIENT AND OUTPATIENT CARE AND ALL INDIRECT EXPENSES ASSOCIATED WITH FURTHERING THE EXEMPT PURPOSE.
PART VI, SECTION A, LINE 6MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER.
PART VI, SECTION A, LINE 7AMARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND HAS THE AUTHORITY TO ELECT BOARD MEMBERS.
PART VI, SECTION A, LINE 7BMARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF MARSHFIELD CLINIC.
PART VI, SECTION B, LINE 11THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT, THEN REVIEWED BY KPMG LLP. THE COMPLETED 990, INCLUDING REQUIRED SCHEDULES IS EMAILED TO AND REVIEWED BY THE BOARD MEMBERS BEFORE FILING.
PART VI, SECTION B, LINE 12ON AN ANNUAL BASIS, BOARD MEMBERS, TOP MANAGEMENT, AND EMPLOYEES WHO HAVE CONTACT WITH SUPPLIERS SIGN A STATEMENT ACKNOWLEDGING THEIR UNDERSTANDING AND ADHERENCE TO THE CONFLICT OF INTEREST POLICY. IN ADDITION TO THE REQUIREMENT OF AN ANNUAL COMPLETED DISCLOSURE FORM, IT IS THE CONTINUING RESPONSIBILITY OF THE DISCLOSING INDIVIDUALS TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS OF INTEREST AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. THE INDIVIDUALS REQUIRED TO COMPLETE THE DISCLOSURE FORM INCLUDE: BOARD MEMBERS, ADMINISTRATION (CAO, COO AND CFO), AND MANAGERS OF MATERIALS MANAGEMENT, INFORMATION TECHNOLOGY, LAB, IMAGING, COMMUNITY RELATIONS/MARKETING AND PLANT OPERATIONS.
PART VI, SECTION B, LINES 15A AND 15BTHE BOARD OF DIRECTORS DETERMINES AND APPROVES THE CAO'S SALARY BASED ON SURVEY'S COMPARABILITY DATA AND AN OUTSIDE CONSULTING FIRM HAS BEEN USED AT TIMES. SALARIES OF OTHER MANAGEMENT EMPLOYEES ARE BASED ON MARKET SURVEYS ANALYZED BY THE HUMAN RESOURCES DEPARTMENT AND APPROVED BY THE ADMINISTRATIVE TEAM AND/OR THE CAO.
PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
PART XI, LINE 5Transfer out of net assets (See Schedule N, Part II for additional details) $31,941,627

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
MARSHFIELD CLINIC
1000 NORTH OAK AVENUEMARSHFIELDWI54449390452970MEDICAL CAREWI501(C)(3)3NA
VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL C
1700 WEST STOUT STEETRICE LAKEWI54868391329084SUPPORT ORG.WI501(C)(3)11, III-ONA
SECURITY HEALTH PLAN OF WISCONSIN INC
1515 N ST JOSEPHS AVEMARSHFIELDWI54449391572880HMOWI501(C)(4)N/ANA
THE HERITAGE FOUNDATION
1000 N OAK AVEMARSHFIELDWI54449391865942HONOR INDIVIDWI501(C)(3)11-TYPE 1NA
FLAMBEAU HOSPITAL INC
98 SHERRY AVEPARK FALLSWI54552390973724HOSPITALWI501(C)(3)3NA

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

EINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
MARSHFIELD FOOD SAFETY
201056380FOOD TESTINGWINARELATED00falsefalse
DIAGNOSTIC TREATMENT CTR
200691634MEDICAL SVCSWINARELATED00falsefalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgtrueSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgtruePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg