2013-08-09T13:01:05-05:00 2012-09-30 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH ST MINNEAPOLIS MN 55402 990 2011-10-01 390837206 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE % JACQUELINE KLEIN LAKE 7152341515 1700 WEST STOUT STREET RICE LAKE WI 54868 JACKIE KLEIN 2013-08-09 6123055000 2013-08-09 2011 2016-02-24 21:20:13Z LAKEVIEW MEDICAL CENTER EDWARD H WOLF CAO 1700 WEST STOUT STREET RICE LAKE WI 54868 67545123 false X WWW.LAKEVIEWMEDICAL.COM X 1919 WI LAKEVIEW MEDICAL CENTER SERVES THE COMMUNITY BY PROVIDING SERVICES INTENDED TO ENHANCE THE HEALTH OF THE PEOPLE IN THE SURROUNDING REGION. X 11 6 495 218 0 0 60701 113597 66929460 67152121 -250458 113028 28011 72523 66767714 67451269 0 0 0 0 31035869 31919278 0 0 0 29636505 31102600 60672374 63021878 6095340 4429391 128620549 122828997 35137164 56857848 93483385 65971149 X LAKEVIEW 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. false false 8561128 0 20310227 LAKEVIEW 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. 4773880 0 6015365 LAKEVIEW 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. 3186832 0 10033773 LAKEVIEW 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. 34007027 0 30792756 50528867 true true false false false false false false false false true false false false true false false true false false false false false false true false true true false false true false false false false false false false false false false false true false true false false false false true 33 0 true 495 true false false false false false false false false false false X 11 6 false false false false true true true true true false false true true true true true true true true false WI X JACQUELINE KLEIN 7152366129 1700 W STOUT STREET RICE LAKE WI 54868 X DR BRAD BEKKUM 1.0 X X 0 307717 49318 DR PETER NEAL 1.0 X 0 357268 53013 DR CHARLES T STEWART 1.0 X 0 422444 53013 DR LAURA NELSON 1.0 X 0 363326 51434 JAMES DORRANCE 1.0 X X 0 0 0 MARY BITZ 1.0 X 0 0 0 SANDY BONNEVILLE 1.0 X 0 0 0 PAUL CHASE 1.0 X 0 0 0 DAVE HILDEBRAND 1.0 X 0 0 0 SUE ZAHRBOCK 1.0 X 0 0 0 SCOTT POLENZ 1.0 X 0 0 0 EDWARD WOLF 40.0 X 286277 0 54224 CYNTHIA ARTS-STRENKE 40.0 X 206937 0 43952 JACQUELINE KLEIN 40.0 X 182171 0 43868 ANNA ROGALLA 40.0 X 128717 0 37363 WENDY BROMBEREK 40.0 X 115638 0 36399 DENNIS MOE 40.0 X 137826 0 24626 GERARD LISI 40.0 X 121642 0 30498 SHERRY JOHNSON 40.0 X 129058 0 16841 1308266 1450755 494549 21 false true false CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 COMPUTER CONSULTING 3702848 ARAMARK CORPORATION 24863 NETWORK PLACE CHICAGO IL 606731248 MANAGEMENT SERVICES 372110 QUADRAMED CORPORATION PO BOX 347188 PITTSBURGH PA 152511488 COMPUTER CONSULTING 352058 MEDICAL STAFFING SOLUTIONS PO BOX 101 RICE LAKE WI 54868 CONTRACT LABOR 177615 RX CONSULTANTS 105 WESTERN AVENUE WAUPACA WI 54981 CONTRACT LABOR 140000 7 3800 12301 20606 76890 113597 NET PATIENT SERVICE REVENUE 624100 64981479 64981479 LEASING REVENUE 624100 1606849 1606849 LIFELINE PROGRAM 624100 154289 154289 OCCUPATIONAL/INDUSTRIAL HEALTH 624100 32567 32567 EMPLOYEE MEALS 624100 256378 256378 120559 63987 56572 67152121 137587 0 137587 0 0 88301 21323 66978 66978 66978 34737 59296 -24559 -24559 -24559 5685 12301 11096 -5411 -5411 13095 2139 10956 10956 0 0 67451269 66839171 0 498501 0 0 0 0 788554 788554 0 22799113 19669610 3129503 2238064 1908883 329181 4406311 3733441 672870 1687236 1456634 230602 314871 314871 307456 307456 76224 76224 0 0 0 5807579 2397563 3410016 531594 531594 9321274 8791208 530066 0 0 3337745 1080631 2257114 143407 143407 0 0 629614 629614 0 7339297 7339297 136802 136802 0 PROVISION FOR BAD DEBTS 2607212 2607212 FOOD AND PROVISIONS 367973 367973 DUES AND SUBSCRIPTIONS 181552 88523 93029 63021878 50528867 12493011 0 2230 2310 27395340 21756633 0 0 9500266 11238677 0 0 0 0 0 0 659098 667937 418694 361370 110401881 23201161 89916939 87200720 0 0 0 0 0 15850 0 0 727982 1585500 128620549 122828997 4133030 3055238 500000 500000 0 0 0 0 0 0 0 0 30043170 52800230 0 0 460964 502380 35137164 56857848 X 93483385 65971149 0 0 0 0 93483385 65971149 128620549 122828997 X 4429391 -31941627 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5255530 5255530 70872444 7165805 63706639 31160051 15455624 15704427 3113856 579732 2534124 87200720 0 DEFERRED COMPENSATION 502380 502380 FASB ASC 740 FOOTNOTE: EFFECTIVE 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. VOICES FOR HOSP 17986 12301 5685 7133 900 3063 0 17986 12301 5685 7133 900 3063 11096 -5411 true true true X false false true false true true 652430 0 652430 0.01080 10352362 7797497 2554865 0.04230 0 0 0 11004792 7797497 3207295 0.05310 382448 16666 365782 0.00610 64073 0 64073 0.00110 2109 0 2109 0 0 0 24226 0 24226 0.00040 472856 16666 456190 0.00760 11477648 7814163 3663485 0.06070 536 536 893 893 1429 1429 true 1268136 304491 15776761 20178059 -4401298 X true false 1 1 LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

1700 W Stout Street RICE LAKE WI 54868

X X X LAKEVIEW MEDICAL CENTER INC OF RICE LAKE 1 false true true 200. false true X true true X X X X X true true true X false false PART I, LINE 3C 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 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, #2 NEEDS ASSESSMENT: LAKEVIEW 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. PART VI, #3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UNINSURED 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. PART VI, #4 COMMUNITY INFORMATION: THE 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. 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: RICE LAKE FREE CLINIC: 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. PART VI, #6: AFFILIATED HEALTH CARE SYSTEM ROLES: 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. PART VI, #7: ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: WI 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. X X false false false false false false false false false DR BRAD BEKKUM 0 297697 0 9600 0 420 0 30728 0 18590 0 357035 0 0 DR PETER NEAL 0 353996 0 0 0 3272 0 30728 0 22285 0 410281 0 0 DR CHARLES T STEWART 0 421814 0 0 0 630 0 30728 0 22285 0 475457 0 0 DR LAURA NELSON 0 361913 0 0 0 1413 0 30728 0 20706 0 414760 0 0 EDWARD WOLF 231909 0 100 0 54268 0 36722 0 17502 0 340501 0 0 0 CYNTHIA ARTS-STRENKE 173708 0 100 0 33129 0 24931 0 19021 0 250889 0 0 0 JACQUELINE KLEIN 155758 0 100 0 26313 0 22704 0 21164 0 226039 0 0 0 ANNA ROGALLA 113006 0 90 0 15621 0 16362 0 21001 0 166080 0 0 0 WENDY BROMBEREK 112472 0 30 0 3136 0 13630 0 22769 0 152037 0 0 0 DENNIS MOE 118996 0 60 0 18770 0 16544 0 8082 0 162452 0 0 0 GERARD LISI 98621 0 100 0 22921 0 14662 0 15836 0 152140 0 0 0 LONG TERM DEBT RECLASSIFICATION 2012-06-30 23446959 NET BOOK VALUE 390452970 MARSHFIELD CLINIC 1000 North Oak Ave Marshfield WI 54449 501(c)(3) CASH DISTRIBUTION TO MARSHFIELD CLINIC 2012-01-31 8429000 CASH 390452970 MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 501(c)(3) TRANSFER OF CHETEK CLINIC ASSETS 2011-12-08 65668 NET BOOK VALUE 390452970 MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 501(c)(3) false false false false PART II: LONG TERM DEBT RECLASSIFICATION: THIS 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. PART III, LINE 4D - OTHER PROGRAM SERVICES THE 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 6 MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER. PART VI, SECTION A, LINE 7A MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND HAS THE AUTHORITY TO ELECT BOARD MEMBERS. PART VI, SECTION A, LINE 7B MARSHFIELD 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 11 THE 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 12 ON 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 15B THE 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 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. PART XI, LINE 5 Transfer out of net assets (See Schedule N, Part II for additional details) $31,941,627 MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 390452970 MEDICAL CARE WI 501(C)(3) 3 NA VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL C 1700 WEST STOUT STEET RICE LAKE WI 54868 391329084 SUPPORT ORG. WI 501(C)(3) 11, III-O NA SECURITY HEALTH PLAN OF WISCONSIN INC 1515 N ST JOSEPHS AVE MARSHFIELD WI 54449 391572880 HMO WI 501(C)(4) N/A NA THE HERITAGE FOUNDATION 1000 N OAK AVE MARSHFIELD WI 54449 391865942 HONOR INDIVID WI 501(C)(3) 11-TYPE 1 NA FLAMBEAU HOSPITAL INC 98 SHERRY AVE PARK FALLS WI 54552 390973724 HOSPITAL WI 501(C)(3) 3 NA MARSHFIELD FOOD SAFETY 201056380 FOOD TESTING WI NA RELATED 0 0 false false DIAGNOSTIC TREATMENT CTR 200691634 MEDICAL SVCS WI NA RELATED 0 0 false false true false false false true true true false true true false false false false true true true true