2011-08-15T12:32:49-05:00 2010-09-30 KPMG LLP 303 EAST WACKER DRIVE CHICAGO IL 60601 990 2009-10-01 390452970 MARSHFIELD CLINIC MARS 7153875511 1000 North Oak Avenue Marshfield WI 54449 Gary Jankowski 2011-08-12 3126651000 2009 2016-02-24 21:20:13Z Karl Ulrich MD President 1000 North Oak Avenue Marshfield WI 54449 1272425175 false X www.marshfieldclinic.org X 1916 WI The mission of Marshfield Clinic is to serve patients through accessible high quality health care, research and education. 18 0 7928 200 23761597 -65244 12849354 16383765 976985981 1034494382 7705368 4765727 4086723 3200395 1001627426 1058844269 11692057 16095160 0 0 666058644 680175629 0 0 1130235 306276123 329993628 984026824 1026264417 17600602 32579852 840984920 910521045 513938503 529684302 327046417 380836743 THE MISSION OF MARSHFIELD CLINIC IS TO SERVE PATIENTS THROUGH ACCESSIBLE, HIGH QUALITY HEALTH CARE, RESEARCH AND EDUCATION. THROUGH RESEARCH, EDUCATION AND STANDARDIZATION OF QUALITY, OUR VISION IS TO REDUCE THE BURDEN OF DISEASE, DISABILITY AND COST FOR OUR PATIENTS AND COMMUNITIES. false false 778056905 16095160 934931546 Patient Medical Care SEE SCHEDULE O 46719374 9692196 MEDICAL RESEARCH AND EDUCATION SEE SCHEDULE O 62836723 89870640 LABORATORY MEDICINE SEE SCHEDULE O 887613002 true true false true false false true false true true false true false false false false false false true true false true false true true false true false false false false false false true false true true false false false true true true false true 584 0 true 7928 true true true false false false false true true false false false 18 0 false false true false true true true true true false false true true true true true true false false true true OH WI X BRIAN EWERT 7153875511 CORPORATE SECRETARY - 1000 N OAK A Marshfield WI 54449 Aron Adkins MD 62.0 X 378192 0 51587 Timothy Boyle MD 55.0 X 416077 0 69184 Eric Penniman DO 55.0 X 224868 0 59339 Ivan Schaller MD 50.0 X 206921 0 59564 John Crump MD 60.0 X 314807 0 48377 Humberto Vidaillet MD 55.0 X 351834 0 82692 Rebecca Campbell MD 47.0 X 244955 0 35836 David Cook MD 55.0 X 244310 0 70679 Erik Dickson MD 55.0 X 236406 0 64070 Daniel Erickson MD 55.0 X 166401 0 43905 Humayun Khan MD 55.0 X 228211 0 53770 Ronald Martin MD 70.0 X 360293 0 73134 William Melms MD 45.0 X 178157 0 62196 Elvis Peter MD 55.0 X 270339 0 54994 Ellen Schumann MD 55.0 X 188381 0 71940 Karen Shulman MD 30.0 X 146262 0 44968 C Todd Stewart MD 55.0 X 534904 0 58613 Tim Wengert MD 60.0 X 461624 0 74667 Mike Wenman MD 55.0 X 264428 0 88435 Qasim Raza MD 55.0 X 310018 0 67486 Wallace Brucker MD 55.0 X 568509 0 69488 Matthew Thomas MD 60.0 X 407858 0 83221 Matthias Weiss MD 55.0 X 539904 0 93767 Sharlene Kreitlow MD 55.0 X 266550 0 61783 Mark LePage MD 55.0 X 488540 0 83499 John Melski MD 60.0 X 394520 0 89276 Stephen Blonsky MD 55.0 X 248104 0 79460 Karl Ulrich MD 65.0 X 573606 0 73462 Douglas Reding MD 56.0 X 565295 0 72902 Brian Ewert MD 55.0 X 235895 0 68130 David Simenstad MD 60.0 X 1222122 0 89402 Timothy Swan MD 60.0 X 545128 0 85459 Gary Jankowski 55.0 X 371389 0 88985 Paul Liss MD 55.0 X 401603 0 73399 Greg Burnett MD 55.0 X 299355 0 72074 William Yanke MD 65.0 X 318104 0 75488 Gary Zimbric MD 55.0 X 295576 0 63977 Laura Nelson MD 57.0 X 332937 0 84074 Edna DeVries MD 55.0 X 337193 0 67399 Jim Coleman 55.0 X 363866 0 70334 Daniel DeGroot 55.0 X 209308 0 36600 David Keefe 55.0 X 263130 0 71739 Gene Shaw MD 55.0 X 391299 0 89099 Frederic Bollow MD 50.0 X 465840 0 89974 Rodney Sorensen MD 55.0 X 390144 0 74099 Roderick Koehler MD 55.0 X 265956 0 66495 Robert A Carlson MD 55.0 X 366164 0 50587 Theodore Praxel MD 55.0 X 314016 0 73898 Gary Pesicka MD 55.0 X 350421 0 88839 Juan Mesa MD 55.0 X 877631 0 85459 Richard Mercier MD 55.0 X 581796 0 73324 Scott Paulman MD 60.0 X 1206133 0 66827 John Neal MD 60.0 X 1211001 0 90183 Sanjay Rao MD 60.0 X 1385866 0 65959 Thomas Fasciszewski MD 60.0 X 1394134 0 67299 Kamal Thapar MD 80.0 X 2100807 0 69488 Reed Hall 55.0 X 214571 0 60531 Gary P Mayeux MD 55.0 X 380970 0 74692 26872629 0 4076107 1119 true true false SIEMENS MEDICAL SOLUTIONS Dept Ch 14195 PALATINE IL 600554195 EQUIPMENT/LEASE 4227843 MARKET MATERIALS LLC 2350 galloway st - po box 630 EAU CLAIRE WI 547020630 REMOD 4860015 MCGOUGH CONSTRUCTION CO INC 2737 fairview ave north ST PAUL MN 551131372 REMOD 5092916 AE BUSINESS SOLUTIONS 2310 crossroads dr ste 2800 MADISON WI 53718 SERVICE/CAP EQUIP. 5622941 MARKET JOHNSON INC 2350 galloway st - po box 630 EAU CLAIRE WI 547020630 REMOD 14748117 85 10000 0 435557 66327 10768701 5103180 3202639 16383765 PATIENT MEDICAL CARE 621500 934931546 934921610 9936 LABORATORY MEDICINE 621500 89870640 66170727 23699913 MEDICAL RESEARCH & EDUCATION 621500 9692196 9640448 51748 1034494382 5173675 5173675 1321734 1321734 85890 85890 235778 250871 -15093 -15093 -15093 151618034 5464930 153392479 5420167 -1774445 44763 -1729682 -1729682 252217 407365 71396 180821 180821 31661 8670 22991 22991 56802537 54437323 2365214 2365214 CAFETERIA SALES 900099 560572 560572 560572 1058844269 1010732785 23761597 7966122 16095160 16095160 0 0 0 18789115 9424190 9364925 0 510537551 455912931 54020300 604320 48345747 42493708 5783583 68456 72846124 60098152 12635205 112767 29657092 25721767 3893375 41950 0 516818 56824 459994 181192 181192 154275 154275 0 0 32571759 21794330 10699708 77721 7948078 11828 7912959 23291 7557961 3425564 4123259 9138 33834669 19196488 14547149 91032 26582 26582 21693190 18669428 2990998 32764 8279448 7369628 880929 28891 0 390487 390487 15006882 7684470 7322412 0 27552333 25894881 1651682 5770 2381165 2190819 190346 OPERATING SUPPLIES 126089800 126054610 8954 26236 MAINTENANCE AND REPAIRS 6794843 6565662 226632 2549 UNRELATED BUSINESS INCOME TAX 603923 603923 OPERATING EXPENSES 1978715 1813338 160027 5350 BAD DEBTS 35085282 35085282 1346226 1032950 313276 1026264417 887613002 137521180 1130235 7163735 7800788 57520659 61993094 3233174 2785376 150861134 146002536 0 0 0 0 32814304 37236895 12677862 13284313 4968904 6545016 595518595 257115187 304046567 338403408 127792149 148105733 0 0 10962106 10799743 40000 2433667 128904326 135130476 840984920 910521045 96114551 105549309 0 0 1263063 715700 297415000 288240000 0 0 0 0 24384461 36476621 0 0 94761428 98702672 513938503 529684302 X 307056755 359926725 19773579 20693935 216083 216083 327046417 380836743 840984920 910521045 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 714206 false false 714206 false Description of the organization's lobbying activity: Where its experience may be helpful, Marshfield Clinic may offer recommendations concerning legislation or regulations being considered. In addition, it may analyze and take positions on issues that have a relationship to the organization's operations. 6584 728662 X true 29443159 2333428 2927520 655044 34049063 27221448 2413872 614273 806434 29443159 0.67000 0.33000 0.00000 false false 14208812 14208812 321745321 102692199 219053122 4239715 2542361 1697354 211051936 147694653 63357283 1639040 42633771 4185975 40086836 338403407 COLLATERAL HELD FOR SEC. LOAN 41937140 DEF FIN COSTS AND OTHER 4231045 RESTR BY DONORS FOR SPEC PURP 18121195 RESTRICTED FOR RETIREMENT PLAN 20843197 RESTRICTED FOR LIAB. INSURANCE 18199978 RESTR FOR UNEMPLOYMENT COMP 3655439 TRUST - REVENUE BOND 26331405 RESTRICTED FUNDS - OTHER 1811077 135130476 124500 PAYABLE UNDER SECURITIES LENDI 42676235 HEALTH PLAN PREPAYMENT 17000000 ESTIMATED RESERVE - SELF INSUR 10529504 457 PLAN PAYABLE 20843197 MISCELLANEOUS 7529236 98702672 Part III, Line 4 The Mission of Marshfield Clinic is to serve patients through accessible, high quality health care, research and education. As part of serving patients, the Clinic strives to provide an inviting atmosphere to treat patients and assist in the healing process. Pleasant facilities and grounds, plus appropriate works of art all assist in this healing process, as well as serve to enhance the work environment for physicians and staff. Quality works of art also enhance the Clinic's educational mission by displaying art work for school children as well as patients and visitors. Part V, Line 4 Marshfield Clinic maintains endowment funds in the following categories: general endowment to fund operations: endowed programs to fund various patient care, research and education programs such as oncology research, summer student intern programs, and the angel fund; and endowed chairs and endowed distinguished physician/scientist awards to fund the research, education or administrative activities of the named chair or award recipient. Part VIII Student loans may be awarded based on the needs of the Marshfield Clinic. A loan is given for a specific type of degree (CRNA for example) for which the clinic forsees a potential or real shortage in the near future. The agreement provides for the Clinic to sponsor the person through the loan with the intent on hiring if there is a need when the person graduates. The loan is forgiven over a period of time if they are hired by the clinic. Part X, Line 2 Effective October 1, 2007, the Clinic adopted Financial Accounting Standards Board (F'ASB) 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, de-recognition, 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 Clinic, it was determined that the application of ASC 740 had no material effect on the Clinic at September 30, 2010 or 2009. Auction Champs 198670 132778 65892 0 15061 0 0 500 7988 Trap Shoot 163258 62845 100413 0 4085 3285 2338 450 25646 6 297654 211742 85912 0 0 0 0 3750 8293 659582 407365 252217 0 19146 3285 2338 4700 41927 71396 180821 31661 625 8045 false 31661 625 8045 8670 22991 WI true false true false 0.20000 0.80000 Jill Kurszewski 1000 N Oak Ave Marshfield WI 54449 false Jill Kurszewski 2594 Coord. & management of Clinic gaming activities X false true Family Health Center 1515 St Josephs Ave Marshfield WI 54449 391681547 501(C)(3) 15656589 General Support Marshfield Area United Way PO Box 771 Marshfield WI 54449 391035073 501(C)(3) 75758 General Support New Visions Gallery 1000 N Oak Ave Marshfield WI 54449 510190879 501(C)(3) 24000 FMV RENT General Support United Way - Wausau 127 River Drive Wausau WI 54403 390935496 501(C)(3) 25500 General Support Friends of St Joseph's Hospital 2661 County HWY I Chippewa Falls WI 54729 390810545 501(C)(3) 15000 General Support WI Womens Health Foundation 2503 Todd Dr Madison WI 54713 391900678 501(C)(3) 10000 General Support Northcentral Technical College 1000 W Campus Drive Wausau WI 54401 391077093 501(c)(3) 6000 General Support WMC Foundation Inc Po Box 352 Madison WI 537010352 391394068 501(c)(3) 12000 General Support United Way Of Greater Eau Claire Po Box 232 Eau Claire WI 547010232 391077901 501(c)(3) 11200 General Support WI Sport Show 2736 Irene Dr Eau Claire WI 54701 010855245 6700 General Support AM Birkebeiner Ski Fdn Po Box 911 Hayward WI 54843 391503175 501(c)(3) 6500 General Support Deerskin Depot Com -Debra G Moteing 404 Gilbert Ave Eau Claire WI 54701 397604142 6372 General Support Angel On My Shoulder 1000 W Campus Dr Wausau WI 54401 391858288 501(C)(3) 5066 General Support Eau Claire Area Development Co 101 N Farwell St Ste 101 Eau Claire WI 54702 391488940 501(c)(6) 5050 General Support Heritage Foundation 1000 N Oak Ave Marshfield WI 54449 391865942 501(c)(3) 11309 41137 FMV Rent/Service General Support 12 3 Monitoring Grants Schedule I, Part I, Line 2 Marshfield Clinic (the Clinic) provides assistance (primarily contributions) to a variety of organizations, most of which are 501 (C)(3) and some of which are affiliates for financial reporting purposes (i.e. Family Health Center and Heritage Foundation). The Clinic makes determinations on grant assistance and other assistance (i.e. contributions) based on the recipient organization's mission, reputation, and the organization's intended use of funds. The largest contribution is to Family Health Center (FHC), which is a member of the Clinic's obligated group and included in the Clinic's consolidated financial statements. FHC's mission and use of funds are aligned with the Clinic's mission as a 501(C)(3) organization, and monitored closely. X X X X false false false false false false false false false Karl Ulrich MD 570588 0 0 0 3018 0 54092 0 19371 0 647069 0 0 0 Douglas Reding MD 552077 0 11166 0 2052 0 52728 0 20174 0 638197 0 0 0 Brian Ewert MD 234886 0 0 0 1009 0 47228 0 20902 0 304025 0 0 0 Timothy Swan MD 543916 0 0 0 1212 0 69228 0 16231 0 630587 0 0 0 David Simenstad MD 1220910 0 0 0 1212 0 69228 0 20174 0 1311524 0 0 0 Aron Adkins MD 377314 0 0 0 878 0 28648 0 22939 0 429779 0 0 0 Timothy Boyle MD 415447 0 0 0 630 0 47220 0 21964 0 485261 0 0 0 Eric Penniman DO 224448 0 0 0 420 0 42056 0 17283 0 284207 0 0 0 Ivan Schaller MD 205115 0 0 0 1806 0 39194 0 20370 0 266485 0 0 0 John Crump MD 313001 0 0 0 1806 0 30728 0 17648 0 363183 0 0 0 Humberto Vidaillet MD 343329 0 0 0 8505 0 58228 0 24464 0 434526 0 0 0 Rebecca Campbell MD 243149 0 0 0 1806 0 32928 0 2907 0 280790 0 0 0 David Cook MD 236124 0 6380 0 1806 0 52728 0 17951 0 314989 0 0 0 Erik Dickson MD 235782 0 0 0 624 0 44931 0 19138 0 300475 0 0 0 Daniel 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PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS LINE 4a - PATIENT MEDICAL CARE MARSHFIELD CLINIC (THE CLINIC) HAS 777 PHYSICIANS IN 86 MEDICAL SPECIALTIES AND SUBSPECIALTIES LOCATED IN 54 LOCATIONS THROUGHOUT NORTHERN, CENTRAL AND WESTERN WISCONSIN. FOR 94 YEARS, THE CLINIC HAS PROVIDED MEDICAL CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. CHARITY CARE DETERMINATIONS ARE BASED ON FINANCIAL INFORMATION PROVIDED BY THE PATIENT AND ANALYSIS OF OTHER RELEVANT INFORMATION. BECAUSE THE CLINIC ANTICIPATES EITHER NO OR NOMINAL PAYMENT FOR THESE SERVICES, THE AMOUNTS ARE EXCLUDED FROM REVENUES. THERE WERE APPROXIMATELY 3,800,000 PATIENT ENCOUNTERS FOR FISCAL YEAR 2010. THE CLINIC PROVIDED CHARITY CARE OF $3,222,000 IN FISCAL YEAR 2010 BASED ON THE COST OF PROVIDING CARE TO PATIENTS WHO CANNOT AFFORD TO PAY IN ACCORDANCE WITH ITS CHARITY CARE POLICY. THE STATE OF WISCONSIN EXPANDED ITS MEDICAID PROGRAM IN JULY 2009 TO INCLUDE LOW-INCOME CHILDLESS ADULTS THROUGH THE BADGERCARE PLUS (BC+) CORE PLAN. MANY PATIENTS WERE NOT ACTIVE ON THE PLAN UNTIL THE FALL OF 2009, THE BEGINNING OF THE CLINIC'S FISCAL YEAR 2010. APPROXIMATELY 6,500 CLINIC PATIENTS BECAME ENROLLED IN THE BC+ CORE PLAN. MANY OF THESE PATIENTS PREVIOUSLY QUALIFIED FOR THE CLINIC'S CHARITY CARE PROGRAM. THE ONLY ADDITIONAL ASSISTANCE NEEDED BY THIS POPULATION IS FOR NON-COVERED BC+ CORE PLAN SERVICES. WITH THE SHIFT OF PATIENTS TO BC+ CORE PLAN, CHARITY CARE FOR THIS POPULATION HAS DECREASED SIGNIFICANTLY WITH THE CLINIC RECEIVING MEDICAID REIMBURSEMENT THROUGH THE BADGERCARE PROGRAM FOR PROVISION OF THESE MEDICAL SERVICES. THE CLINIC'S BOARD ALSO APPROVED AN INCREASE OF THE COMMUNITY CARE POVERTY LEVEL THRESHOLD TO 200% OF THE FEDERAL POVERTY LEVEL, UP FROM 185%, MAKING THE CLINIC'S CHARITY CARE PROGRAM AVAILABLE TO MORE PATIENTS. THE CLINIC ALSO PROVIDES SUBSTANTIAL COMMUNITY SUPPORT THROUGH THE PROVISION OF SERVICES TO INDIVIDUALS SUPPORTED BY PUBLIC PROGRAMS SUCH AS GENERAL RELIEF, MEDICARE AND MEDICAID. THE CLINIC'S COST OF PROVIDING SERVICES UNDER THESE PROGRAMS IN EXCESS OF REIMBURSEMENT RECEIVED BY THE CLINIC, AND THE ESTIMATED UNREIMBURSED COST OF PROVIDING CARE TO LOW INCOME UNDERINSURED AND UNINSURED PATIENTS THROUGH THE CLINIC'S PARTNERSHIP WITH FAMILY HEALTH CENTER, A FEDERALLY FUNDED COMMUNITY HEALTH CENTER, WAS $187,526,000 IN FISCAL YEAR 2010. PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS LINE 4B - MEDICAL RESEARCH AND EDUCATION THROUGH ITS RESEARCH DIVISION, MARSHFIELD CLINIC RESEARCH FOUNDATION (MCRF), THE CLINIC IS ENGAGED IN MEDICAL AND SCIENTIFIC RESEARCH ON NATIONAL AND INTERNATIONAL LEVELS. THE MCRF MISSION IS TO DISCOVER AND COMMUNICATE SCIENTIFIC KNOWLEDGE THAT SUBSTANTIALLY IMPROVES HUMAN HEALTH AND WELL BEING. SINCE MCRF'S ESTABLISHMENT IN 1959, RESEARCH DISCOVERIES BY MCRF SCIENTISTS AND CLINIC PHYSICIANS HAVE EXPANDED KNOWLEDGE IN MULTIPLE FIELDS OF HUMAN HEALTH AND REDUCED THE BURDEN OF DISEASE AND DISABILITY. AREAS OF FOCUS INCLUDE CLINICAL RESEARCH, RURAL AND AGRICULTURAL HEALTH AND SAFETY, HUMAN GENETICS, EPIDEMIOLOGY, AND BIOMEDICAL INFORMATICS. THE MARSHFIELD CLINIC EDUCATION DIVISION ALSO HAS A HISTORY OF STRONG COMMITMENT TO EDUCATION AND PUBLIC SERVICE. FULL RESIDENCY PROGRAMS FOR RECENT MEDICAL SCHOOL GRADUATES INCLUDE INTERNAL MEDICINE, PEDIATRICS, MEDICINE AND PEDIATRICS, DERMATOLOGY, GENERAL SURGERY AND TRANSITIONAL YEAR. ALL PROGRAMS ARE FULLY ACCREDITED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME) OF THE AMERICAN MEDICAL ASSOCIATION. THE CLINIC HAS EXEMPLARY ACCREDITATION STATUS WITH THE ACCREDITATION COUNCIL ON CONTINUING MEDICAL EDUCATION [ACCME] AS A LONGSTANDING PROVIDER OF CONTINUING MEDICAL EDUCATION TO AREA PHYSICIANS AND ALLIED HEALTH PROVIDERS. ADDITIONALLY, WE SERVE AS AN ACADEMIC CLINICAL CAMPUS OF THE UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH. WE HAVE OVER 80 NATIONAL POST-SECONDARY ACADEMIC AFFILIATIONS AND OVER 30 STATE POST-SECONDARY ACADEMIC AFFILIATIONS FOR STUDENT, RESIDENT, AND FELLOWSHIP TRAINING. LASTLY, EACH YEAR THE CLINIC SPONSORS PUBLIC EDUCATIONAL EVENTS INCLUDING THE LAWTON LECTURE, FACES OF AGING, AND PROVIDES THE PUBLIC WITH ONE OF THE MOST COMPREHENSIVE AND RELIABLE PATIENT EDUCATION WEBSITES. PART III STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS LINE 4C - LABORATORY MEDICINE MARSHFIELD LABS PROVIDES COMPREHENSIVE ANATOMICAL AND HIGH-COMPLEXITY DIAGNOSTIC TESTING SERVICES TO PATIENTS OF MARSHFIELD CLINIC AND OTHER AREA MEDICAL FACILITIES. IN ADDITION TO THE PRIMARY LABORATORY LOCATED IN MARSHFIELD, MARSHFIELD LABS IS SERVING THE NEEDS OF SURROUNDING COMMUNITIES WITH SMALLER LABS AT MANY MARSHFIELD CLINIC CENTERS THROUGHOUT CENTRAL AND NORTHERN WISCONSIN. PROXIMITY TO OUR LABORATORIES PROVIDES CONVENIENCE AND EXPEDITIOUS SERVICE TO MARSHFIELD CLINIC PATIENTS. MARSHFIELD LABS HAS BECOME A CENTER FOR THE LATEST TECHNOLOGIES AND MOST ADVANCED TESTING METHODS UTILIZED TODAY. SOME OF THE ADVANCED TESTS AND EMERGING TECHNOLOGIES OFFERED BY MARSHFIELD LABS WOULD NOT OTHERWISE BE AVAILABLE TO PATIENTS IN RURAL AREAS. SUPPLEMENTAL INFORMATION Part VI, Section A, Line 4 Marshfield Clinic's Bylaws were amended effective January 11, 2010 as follows: *The number of Directors on the Board of Directors was changed from twenty-three members to eighteen members. *The Board of Directors is comprised of four Officers and fourteen "Division Directors". *The Clinic's Shareholders elect the four Officers (who concurrently serve as Directors). *The Shareholders in each of the Clinic's seven clinical divisions elect two Directors, for a total of fourteen Directors. *There is no longer an Executive Committee of the Board of Directors. Part VI Governance, Management, and Disclosure, Line 6 Marshfield Clinic has 656 physicians who are referred to as "shareholders." As disclosed in the organization's original Form 1023, all shareholders sign an agreement that provides that the assets of the organization are held in trust for charitable, educational and scientific purposes. "Shareholders" do not build up equity in the organization and, in the event of dissolution of Marshfield Clinic, all of the assets of the organization would be distributed to another charitable organization. Part VI Governance, Management, and Disclosure, Line 7a The shareholders have the right to elect the organization's officers and directors. Part VI Governance, Management, and Disclosure, Line 7b The shareholders have the right to approve any changes to the organization's Articles of Incorporation and Bylaws by a vote of two-thirds of the shareholders present at each of two consecutive shareholder meetings at which a quorum is present. The shareholders have the right to terminate the employment of a physician-shareholder by a vote of four-fifths of the outstanding shareholders entitled to vote The shareholders have the right to approve any dissolution or liquidation of the organization by a vote of four-fifths of the shareholders. In the event of liquidation or dissolution of the organization, after payment of liabilities, the shareholders by majority vote of the shareholders shall select the educational, scientific or charitable organizations to which the organization's assets shall be transferred. Part VI Governance, Management, and Disclosure, Line 11a The Chief Financial Officer and Controller shall review the completed Form 990 and Form 990-T in-depth. After their review and prior to filing Form 990 and Form 990-T with the IRS, the CFO or his/her designee will provide to each member of the Board of Directors a copy in electronic or paper form of the completed Form 990 (and all required schedules) and the completed Form 990-T (and all required schedules). Thereafter, at the next Board meeting (or at a special meeting called for this purpose), the CFO and/or his/her designee shall review the forms and schedules with the board members and answer any questions. Part VI Governance, Management, and Disclosure, Line 12c Each disclosing individual shall complete and submit the disclosure form to the Secretary of the Board of Directors on or before January 1st of each year, or, if earlier, within one month after the individual qualifies as a disclosing individual. Each disclosing individual shall update his/her disclosure form during the year as necessary. The secretary shall maintain the completed disclosure forms in a confidential manner. The Secretary shall make the completed disclosure forms available to the executive committee and/or Board of Directors as necessary to make conflict of interest determinations and decisions concerning the fairness and reasonableness of transactions to Marshfield Clinic. In addition, the Secretary shall disclose the completed forms as necessary to those Clinic employees responsible for completion of the Clinic's IRS Form 990. Part VI Governance, Management, and Disclosure, Lines 15a, and 15b In late 2008, the Clinic established an Independent Compensation Committee (the "Committee") to have final authority in approving compensation of directors, officers and other disqualified persons, as defined in IRC Section 4958. The Committee and its operating procedures were designed to establish the rebuttable presumption of reasonableness described in Treas. Reg. 53.4958-6. However, as a result of an internal compliance review conducted in mid-2010, the Clinic discovered that certain of the Committee's procedures and documentation may not have fully satisfied the rebuttable presumption requirements. The Clinic's leadership worked with the Committee to improve the procedures and documentation for the upcoming compensation review and approval cycle. As a result, in late 2010, the Committee established compensation for the 2011 calendar year in a manner that complied with the rebuttable presumption requirements. Specifically, the Committee consisted solely of persons having no conflicts of interest. The Committee reviewed appropriate comparability data to confirm that total compensation amounts to be paid were reasonable and comparable to amounts paid by similarly-situated organizations. Finally, the compensation review and approval process were thoroughly and timely documented. Part VI Governance, Management, and Disclosure, Lines 19 Marshfield Clinic does not make its current governing documents, Conflict of Interest Policy or financial statements available to the public. Federal tax law does not require that such documents be made publicly available unless they were included on a form that is publicly available. Marshfield Clinic does make available its Form 1023, as required. SUPPLEMENTAL INFORMATION Schedule A, Part I Schedule H Requirement Per IRS instructions for the Form 990, "the definition of hospitals for Schedule A (Form 990 or 990-EZ), Part I, is different from the definition for Schedule H (Form 990), hospitals. Accordingly, any Organization that checks this box may or may not be required to complete Schedule H (Form 990)". Marshfield Clinic is not recognized by any State as a hospital. Therefore, Marshfield Clinic is not required to complete Schedule H. Form 990, Part VII, Section A, Column B Estimated hours per week devoted to related organizations: ALL OF THE FOLLOWING ARE .5 HOURS: Karl J. Ulrich, M.D.(Psychiatrist) Douglas J. Reding, M.D. (Oncologist/Hematologist) David J. Simenstad, M.D. (Orthopedic Surgeon) Brian Ewert, MD (Nephrologist) Stephen Blonsky, MD (Nephrology) Humberto Vidaillet, MD (Electrophysiologist) Ivan B. Schaller, M.D. (Internal Medicine) Qasim Raza, MD (Hospitalist) - Central 2 C. Todd Stewart, MD (Pediatric Intensivist) Mark LePage, MD (Radiology) Dan Erickson, MD (Family Practitioner) Matthew Thomas, MD (Urology) Ron Martin, MD (General Surgeon) Matthias Weiss, MD (Oncology/Hematology) John Melski, MD (Dermatologist) Sharlene Kreitlow, MD (OB/GYN) Wallace "Brad" Brucker, MD (Orthopedics) Humayun Khan, MD (Emergency Medicine/Urgent Care) Aron S. Adkins, M.D. (Endocrinologist) Timothy R. Boyle, M.D. (Otolaryngologist) Eric Penniman, DO (Family Practitioner) John Crump, MD (Pulmonologist) Becky Campbell, MD (Pediatric Neurologist) David Cook, MD (Emergency Medicine/Urgent Care) Erik Dickson, MD (Family Practitioner) William Melms, MD (Family Practitioner) Elvis Peter, MD (Hospitalist) Ellen Schumann, MD (Pediatritian) Karen Shulman, MD (Family Practitioner) Tim Wengert, MD (General Surgeon) Mike Wenman, MD (Emergency Medicine/Urgent Care) Robert A. Carlson, MD - 2 hours Business Transactions with Interested Persons Schedule L, Part IV, Column D Salaries for these individuals have been set based on the Marshfield Clinic's normal salary setting process, which includes documentation and comparison of applicable market rates and other comparability data based on the individual's respective position. Benefits are established consistent with the Clinic's benefit plan structure for comparable positions. Transactions with Related Organizations Schedule R, Part V, Line 2 1a. Health Insurance benefits purchased by Marshfield Clinic (for employees) from Security Health Plan 1b. l 1c. $63,505,939 2a. Security Health Plan loan guaranteed by Marshfield Clinic 2b. d 2c. $5,926,786 3a. Food Safety loan from Marshfield Clinic 3b. d 3c. $4,500,000 4a. Security Health Plan loan to Marshfield Clinic 4b. e 4c. $25,000,000 5a. Lease of office space by Marshfield Clinic from Security Health Plan 5b. j 5c. $238,789 6a. Medical Services provided by Marshfield Clinic to Security Health Plan participants 6b. k 6c. $214,600,580 7a. Reimbursements by Security Health to Marshfield Clinic for proactive health and anticoagulation services 7b. k 7c. $1,582,695 8a. Reimbursements by Security Health to Marshfield Clinic for administrative services 8b. k 8c. $27,560,693 9a. Reimbursements by Security Health to Marshfield Clinic for grounds maintenance 9b. k 9c. $148,753 10a. Payment to Security Health Plan for interest on loan 10b. q 10c. $88,377 11a. Payment from Security Health Plan for patient care initiatives 11b. r 11c. $880,810 12a. Marshfield Clinic transfer of land to Marshfield Food Safety 12b. q 12c. $90,583 13a. Reimbursements by Marshfield Food Safety to Marshfield Clinic for operational expenses 13b. p 13c. $275,938 14a. Marshfield Food Safety partnership distribution to Marshfield Clinic 14b. r 14c. $100,000 15a. Cash and Non-cash Contributions from Security Health Plan 15b. c 15c. $66,327 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 Indivi WI 501(c)(3) 11 - Type 1 NA Volunteer Partners of Lakeview Medical C 1100 N Main Street Rice Lake WI 54868 391329084 Support Org WI 501(c)(3) 11,III-O NA Flambeau Hospital Inc 98 Sherry Ave Park Falls WI 54552 390973724 hospital WI 501(c)(3) 3 NA Lakeview Medical Center of Rice Lake 1700 West Stout St Rice Lake WI 54868 390837206 Hospital WI 501(c)(3) 3 na Marshfield Food Safety Food testing WI NA Related 136169 1581412 false false Diagnostic Treatment Ctr medical svcs WI NA Related 5494290 20459939 false false true true false true true true false false true true true true false false true true true true SEE SCHEDULE O