2024-08-13T08:56:29-05:00 2023-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-10-01 391140373 PRAIRIE RIDGE HEALTH INC PRAI 9206232200 1515 PARK AVENUE COLUMBUS WI 539251618 MELISSA MANGAN VP OF FINANCE & CFO 9206232200 2024-08-06 1 0 MICHAEL J PETERSON CPA P01833529 2187224705 2024-08-06 2022 2024-08-08 14:25:15Z JOHN RUSSELL 1515 PARK AVENUE COLUMBUS WI 539251618 81615468 0 X WWW.PRAIRIERIDGE.HEALTH X 1970 WI ACCREDITED ACUTE CARE HOSPITAL PROVIDING A FULL ARRAY OF HEALTH CARE SERVICES TO PATIENTS. 11 9 464 110 0 0 394393 259549 73137252 73817865 1069467 1461736 0 0 74601112 75539150 0 0 0 0 33510977 37104901 0 0 165117 29437013 31376806 62947990 68481707 11653122 7057443 116511306 123602795 30228854 28644749 86282452 94958046 X BY BUILDING CARING RELATIONSHIPS WITH THOSE WE SERVE, WE GUIDE THE JOURNEY TO HEALTH AND WELLNESS. 0 0 56443363 0 73438209 PRAIRIE RIDGE HEALTH, INC. (PRH) IS A WISCONSIN NONPROFIT, NONSTOCK CORPORATION THAT IS LICENSED AS A 25-BED CRITICAL ACCESS HOSPITAL (CAH). PRAIRIE RIDGE HEALTH, INC. PROVIDES INPATIENT, OUTPATIENT, AND CLINIC MEDICAL SERVICES TO PATIENTS. FOR THE FISCAL YEAR ENDED 9/30/23, 822 ACUTE ADMISSIONS RESULTED IN 2,827 INPATIENT DAYS. IN ADDITION, THERE WERE 138 DELIVERIES, 259 NEWBORN DAYS, AND 169 INPATIENT SURGERIES. ON THE OUTPATIENT SIDE, PRH PROVIDES A MULTITUDE OF SERVICES INCLUDING EMERGENCY ROOM, LAB, RADIOLOGY, REHABILITATION, SURGERY, INFUSION THERAPY, AND NUTRITION SERVICES. FOR THE FISCAL YEAR ENDED 9/30/23, PRH SAW 16,196 PATIENTS IN THE EMERGENCY ROOM AND URGENT CARE. 704 PATIENTS HAD OUTPATIENT SURGERY AND 1,054 GASTROINTESTINAL PROCEDURES WERE PERFORMED. PRH ALSO OPERATES THREE PHYSICIAN CLINICS LOCATED IN COLUMBUS, BEAVER DAM, AND MARSHALL. OUR EXPERIENCED AND CARING PROVIDERS SPECIALIZE IN ORTHOPEDICS, GENERAL SURGERY, OB/GYN, FAMILY MEDICINE, INTERNAL MEDICINE AND PHYSICAL AND OCCUPATIONAL THERAPY AND IMAGING SERVICES. FOR THE FISCAL YEAR ENDED 9/30/23, THERE WERE 26,348 CLINIC VISITS, 5,906 THERAPY VISITS AND 832 IMAGING SCANS.THE HOSPITAL PROVIDES HEALTH CARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. SINCE THE HOSPITAL DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS $355,000 FOR THE YEAR ENDED SEPTEMBER 30, 2023, CALCULATED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES FOR THE HOSPITAL BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO ITS PATIENTS. 56443363 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 43 0 464 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MELISSA MANGAN 9206231368 VP OF FINANCE CFO PARK AVENUE WI 53925 MATTHEW NIESEN MD CHF OF STF/SURGEON (THRU DEC 2022) 40.00 X 1080099 0 47657 GARY GALVIN MD CHIEF OF STAFF/GENERAL SURGEON 40.00 X 443374 0 47657 LESLIE ALZUHN-HANSEN MD DIRECTOR/OB/GYN PHYSICIAN 40.00 X 397603 0 50507 JENNIFER HOMMAN CHAIR 0.40 X X 0 0 0 JO ANN EVANS VICE CHAIR 0.40 X X 0 0 0 RANDALL BOBHOLZ TREASURER 0.40 X X 0 0 0 PETE SIMON SECRETARY 0.40 X X 0 0 0 MARGO FRANCISCO DIRECTOR (THRU MAY 2023) 0.40 X 0 0 0 ERIN JONES DIRECTOR 0.40 X 0 0 0 MATT KINSELLA DIRECTOR 0.40 X 0 0 0 KYLE NONDORF DIRECTOR 0.40 X 0 0 0 JULIE SANITER DIRECTOR 0.40 X 0 0 0 DAWIT TESFASILASSIE DIRECTOR 0.40 X 0 0 0 JOHN D RUSSELL PRESIDENT & CEO 40.00 X 587272 0 50707 MELISSA MANGAN VP OF FINANCE & CFO 40.00 X 197254 0 46407 ANN ROUNDY SR VP CULTURE, STRATEGY & GROWTH 40.00 X 318281 0 50710 JAMIE HENDRIX VP PATIENT CARE SERVICES 40.00 X 303045 0 50933 ROBB WHINNEY DO GENERAL SURGEON 40.00 X 454973 0 47657 KATHRYN KALDOR MD OB/GYN PHYSICIAN 40.00 X 405493 0 47657 VERONICA MINIER MD FAMILY PRACTICE PHYSICIAN 30.00 X 361204 0 41987 ASGHAR MARWAT MD INTERNAL MEDICINE PHYSICIAN 40.00 X 322674 0 43842 MICHELLE BRYAN MD FAMILY PRACTICE PHYSICIAN 32.00 X 257746 0 29367 5129018 0 555088 46 0 1 0 MADISON EMERGENCY PHYSICIANS SC 700 S PARK STREET MADISON WI 53715 ER PHYSICIAN SERVICES 2269960 SHARED IMAGING SERVICES LLC 915 17TH STREET PRAIRIE DU SAC WI 53578 NUCLEAR MEDICINE & ULTRASOUND SERVICES 1498077 COLUMBIA ANESTHESIA LLC W3767 MONSON RD RIO WI 53960 ANESTHESIA SERVICES 1339049 TOTALMED STAFFING 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 MEDICAL STAFFING 955566 SSM HEALTH CARE OF WI 2901 LANDMARK PLACE STE 300 MADISON WI 53713 HEALTHCARE SERVICES 762793 16 127652 5105 126792 259549 NET PATIENT REVENUE 621110 71234303 71234303 PHARMACY REVENUE 456110 1531206 1531206 CAFETERIA REVENUE 722514 379656 379656 CLINIC RENTAL REVENUE 531120 375604 375604 297096 297096 73817865 1407864 1407864 6109995 20195 6075578 740 34417 19455 53872 53872 75539150 73438209 0 1841392 X 3326553 2704487 622066 25006817 20926023 3965189 115605 726325 586942 135823 3560 6234399 5039743 1165833 28823 1810807 1464174 338621 8012 142197 115606 26591 60485 60485 7764 7764 10063179 8147275 1913404 2500 519333 422218 97115 1474252 1198567 275685 1201552 976862 224690 35785 29093 6692 66503 54067 12436 715816 581958 133858 4325186 3516376 808810 349589 284216 65373 MEDICAL SUPPLIES 6052125 4920378 1131747 REPAIRS & MINOR EQUIPME 2755527 2240243 515284 BAD DEBT 1651567 1651567 EQUIPMENT RENTAL EXPENS 564844 459218 105626 1391102 1124350 260135 6617 68481707 56443363 11873227 165117 25860629 573557 5911750 28657655 2262 8207 11571215 12117660 40000 720000 1180000 1167938 1138305 312611 532144 95691700 47489377 42399912 48202323 27182612 29220055 1382377 1932889 116511306 123602795 8256543 8590156 21106311 19795193 866000 259400 30228854 28644749 X 84900075 93284557 1382377 1673489 86282452 94958046 116511306 123602795 X 7057443 1327039 291112 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7764 7764 0 PART II-B, LINE 1: A PERCENTAGE OF DUES PAID TO AMERICAN HOSPITAL ASSOCIATION, RURAL WISCONSIN HEALTH COOPERATIVE, WISCONSIN HOSPITAL ASSOCIATION, AND WISCONSIN INSTITUTE OF CPAS ARE CONSIDERED LOBBYING. 604511 12663 89321 706495 744571 9654 -149624 604511 583281 6704 154586 744571 496979 34815 51487 583281 392741 96704 7534 496979 0.00000 0.54210 0.45790 0 1 1 5651479 5651479 66271221 33452281 32818940 18357762 12092193 6265569 5411238 1944903 3466335 48202323 OPERATING LEASE OBLIGATION 259400 259400 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY PRAIRIE RIDGE HEALTH FOUNDATION, A RELATED ORGANIZATION. THE ENDOWMENT CONSISTS OF FOUR SEPARATE FUNDS ESTABLISHED TO BENEFIT THE HOSPITAL: FOR WOMEN'S HEALTH, INFRASTRUCTURE IMPROVEMENTS, COMMUNITY HEALTH, AND GENERAL OPERATIONS OF THE HOSPITAL. EACH FUND IS MAINTAINED BY THE FOUNDATION IN VARIOUS INVESTMENTS, AND THE FOUNDATION IS RESPONSIBLE FOR ALL INVESTMENT DECISIONS. PART X, LINE 2: THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 1 X 1 X 1 X 1 1 1 0 1 1 355000 355000 0.00530 7251479 3854156 3397323 0.05080 7606479 3854156 3752323 0.05610 31180 6297 24883 0.00040 8989 8989 0.00010 12060877 3339487 8721390 0.13050 68455 68455 0.00100 12169501 3345784 8823717 0.13200 19775980 7199940 12576040 0.18810 10101 10101 0.00020 80 778 778 0.00000 80 10879 10879 0.00020 1 633090 16497587 16549605 -52018 X 1 1 1 1 PRAIRIE RIDGE HEALTH 1515 PARK AVENUE COLUMBUS WI 53925 WWW.PRAIRIERIDGE.HEALTH 1042 X X X PRAIRIE RIDGE HEALTH INC 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE SUPPLEMENTAL INFO X 1 21 1 SEE SUPPLEMENTAL INFO 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X 1 X WWW.PRAIRIERIDGE.HEALTH/EN/PATIENT-BILLING/COMMUNITY-CARE X WWW.PRAIRIERIDGE.HEALTH/EN/PATIENT-BILLING/COMMUNITY-CARE X WWW.PRAIRIERIDGE.HEALTH/EN/PATIENT-BILLING/COMMUNITY-CARE X X X X X X X 1 X 0 X X X X 1 X 0 0 PRAIRIE RIDGE HEALTH, INC. PART V, SECTION B, LINE 5: PRAIRIE RIDGE HEALTH COLLABORATED WITH COMMUNITY PARTNERS TO CONDUCT SURVEYS, REVIEW DATA AND TO FORMULATE GOALS AND STRATEGIES FOR OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). INTERVIEWS WITH COLUMBIA COUNTY RESIDENTS, KEY COMMUNITY MEMBERS AND LEADERS IN BUSINESS, HEALTHCARE, PUBLIC SERVICE, SCHOOLS, AND MANY OTHER INDUSTRIES WERE CONDUCTED TO IDENTIFY CONCERNS AND HEALTHCARE NEEDS IN THE COMMUNITIES WE SERVE, AS WELL AS TO ASSESS THE NUMBER OF AREA - BASED PROGRAMS AND ORGANIZATIONS THAT ALREADY EXIST TO ADDRESS COMMUNITY NEEDS. PRAIRIE RIDGE HEALTH, INC. PART V, SECTION B, LINE 7D: PART V, SECTION B, LINES 7 AND 10:WWW.PRAIRIERIDGE.HEALTH/EN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PRAIRIE RIDGE HEALTH, INC. PART V, SECTION B, LINE 11: 2022 CHNA STRATEGIC IMPLEMENTATION PLAN ACTIVITIES DONE TOWARDS EACH INITIATIVE INCLUDE BUT IS NOT LIMITED TO:PRIORITY #1: INCREASING PRIMARY CARE ACCESSGOAL: INCREASE PRIMARY CARE ACCESS BY 4 NEW PROVIDERS IN COLUMBIA COUNTY OR 14.35%, REDUCING THE RATIO OF PHYSICIANS TO RESIDENTS FROM 2300:1 TO 1970:1. STRATEGY #1: INVESTING IN NEW PROVIDERS PRAIRIE RIDGE HEALTH HAS IDENTIFIED PRIMARY CARE ACCESS AS A KEY AREA OF NEED FOR THE COMMUNITIES WE SERVE. OUR EMPLOYEE SERVICES TEAM IS ACTIVELY WORKING ON RECRUITING AND ONBOARDING NEW FAMILY MEDICINE PROVIDERS, INCLUDING PHYSICIANS AND NURSE PRACTITIONERS. ACTION: SINCE THE IMPLEMENTATION OF THIS CHNA IN 2022, FIVE NEW PRIMARY CARE PROVIDERS HAVE BEEN HIRED AND ONBOARDED AND RECRUITMENT CONTINUES FOR ADDITIONAL PROVIDERS. SINCE THAT TIME, WE HAVE LOST TWO PROVIDERS DUE TO RELOCATION.STRATEGY #2: COLLABORATION WITH THE EMERGENCY DEPARTMENT WORK WITH LEADERS IN THE EMERGENCY DEPARTMENT TO ENSURE THAT:-EDUCATION AND BROCHURES ARE READILY AVAILABLE IN THE WAITING ROOM AND EXAM ROOMS SHOWCASING OUR PRIMARY CARE PROVIDERS AND THEIR LOCATIONS.ACTION: THIS HAS BEEN COMPLETED AND CONTINUES TO BE UPDATED MONTHLY.-ENSURE THAT EMERGENCY DEPARTMENT STAFF DISCUSS PRIMARY CARE OPTIONS WITH UNATTACHED PATIENTS. ACTION: MET WITH ER MANAGER MULTIPLE TIMES WHO CONFIRMS THAT THIS IS A STANDARD PRACTICE FOR ER TEAM. STRATEGY #3: COLLABORATION WITH THE PRAIRIE RIDGE HEALTH OCCUPATIONAL HEALTH TEAMPROVIDE THE OCCUPATIONAL HEALTH TEAM THAT PROVIDES ON-SITE SERVICES FOR LOCAL BUSINESSES, WITH BASIC INFORMATION ON THE SCOPE OF PRIMARY CARE MEDICINE AS WELL AS A LIST OF PROVIDERS AND WAYS TO ACCESS PRIMARY CARE IN THE COUNTY. ACTION: PROVIDED PRIMARY CARE SHEETS FOR OCCUPATIONAL HEALTH FOLDERS THAT GO TO NEW PARTICIPANTS IN THEIR PROGRAM.STRATEGY #4: PUBLIC EDUCATION-THE MARKETING TEAM WILL UTILIZE SOCIAL MEDIA, RADIO, PRINT ADS AND BILLBOARDS TO INCREASE AWARENESS ABOUT PRIMARY CARE OPTIONS AT PRAIRIE RIDGE HEALTH AND THE IMPORTANCE OF PREVENTATIVE CARE. ACTION: UPDATED PRIMARY CARE ONE-PAGER, PROMOTING PRIMARY CARE PROVIDERS AT PRAIRIE RIDGE HEALTH AND IN THE LARGER COMMUNITY. THESE ARE IN MULTIPLE PLACES THROUGHOUT THE HOSPITAL AND CLINICS, INCLUDING REGISTRATION DESKS, ER, LAB AND REHAB WAITING AREAS.ACTION: AN OPEN HOUSE/HEALTH FAIR WAS HELD IN MAY 2023 THAT HAD ABOUT 300 GUESTS. PRIMARY CARE HAD A TABLE TO PROMOTE OUR SERVICES AND PROVIDERS.PRIORITY #2: INCREASING DIABETES DIAGNOSESGOAL: INCREASE NEW DIABETES DIAGNOSES BY .2% OR 100 OR ABOUT 33 PEOPLE PER YEAR.STRATEGY #1: STANDARDIZE SCREENING MEASURES -THE AMERICAN DIABETES ASSOCIATION RECOMMENDS SCREENING BEGIN AT 35, REGARDLESS OF BMI. OUR CURRENT BASIC SCREENING AUTO-ENROLLMENT IS: PATIENTS WITHOUT A DIABETES DIAGNOSIS AGE 40 AND UP WITH A BMI OVER 25 HAVE A TRIGGER THAT PROMPTS THE PROVIDER TO ORDER A A1C OR FASTING GLUCOSE TEST. ADDITIONAL TRIGGERS ARE AVAILABLE BASED ON A PATIENT'S RISK PROFILE.ACTION: BECAUSE WE ARE PART OF A LARGER NETWORK THAT USES THE SAME HEALTH MEDICAL RECORDS SYSTEM, WE ARE NOT ABLE TO EASILY CHANGE ENROLLMENT TRIGGERS. WE CONTINUE TO WORK WITH THE INFORMATICS DEPARTMENT AND CLINICAL TEAM TO ADVOCATE TO BOTH INSURANCE PLANS AND TO OUR MEDICAL RECORDS OWNER TO REIMBURSE AND UPDATE THE APPROPRIATE ENROLLMENT TRIGGERS BASED ON THE AMERICAN DIABETES ASSOCIATION UPDATED SCREENING GUIDELINES.-CREATE A QUICK REFERENCE GUIDE WITH RECOMMENDED SCREENINGS TO BE POSTED NEAR ALL CLINIC WORKSTATIONS. ACTION: THIS HAS BEEN CHANGED TO A LARGER SCREENING-FOCUSED BROCHURE TO REDUCE CLUTTER AT CLINIC WORKSTATIONS. THIS SCREENING BROCHURE IS CURRENTLY BEING DEVELOPED AND WILL HIGHLIGHT RECOMMENDED SCREENINGS FOR: DIABETES COLON CANCER BREAST CANCER SKIN CANCER LUNG CANCER BONE DENSITYSTRATEGY #2: COLLABORATION WITH LOCAL BUSINESSES AND OCCUPATIONAL HEALTH -WORK WITH LOCAL BUSINESSES, INCLUDING PHARMACIES TO PROVIDE DIABETES SCREENING EDUCATION AND INFORMATION ABOUT PRAIRIE RIDGE HEALTH SERVICES.-PROVIDE THE OCCUPATIONAL HEALTH TEAM WITH GENERAL DIABETES EDUCATION, INCLUDING SCREENING GUIDELINES AND WAYS TO GET SCREENED.ACTION: THIS HAS BEEN COMPLETED AND WE CONTINUE TO MEET WITH THE OCCUPATIONAL HEALTH TEAM.STRATEGY #3: PUBLIC EDUCATION- THE MARKETING TEAM WILL WORK WITH THE DIABETES EDUCATORS TO UTILIZE SOCIAL MEDIA, RADIO, PRINT ADS AND BILLBOARDS TO INCREASE AWARENESS ABOUT THE IMPORTANCE OF DIABETES SCREENING AND OPTIONS FOR SERVICES AT PRAIRIE RIDGE HEALTH. ACTION: CONTINUE TO OFFER DIABETES EDUCATION THROUGH PRINT ADVERTISING, DIGITAL MARKETING, SIGNAGE WITHIN THE HOSPITAL. WE CONTINUE TO WORK WITH THE DIABETES EDUCATION TEAM TO SUPPORT MARKETING THEIR SERVICES, EVENTS, AND EDUCATION OPPORTUNITIES, INCLUDING DIABETES AWARENESS MONTH IN NOVEMBER.-SUPPORT THE NUTRITION AND DIABETES EDUCATION TEAM WITH THEIR ANNUAL DIABETES FAIR THAT OCCURS EVERY NOVEMBER. THIS FAIR IS OPEN TO THE COMMUNITY AND WILL BE HEAVILY PROMOTED. THE FAIR INCLUDES EXPERT PRESENTATIONS, ON THE SPOT SCREENING TOOLS, COOKING DEMONSTRATIONS, INTERACTIVE EDUCATIONAL TABLES AND LOCAL VENDORS AND RESOURCES. ACTION: THIS EVENT WAS PLANNED IN FY2023 FOR NOVEMBER 2023. -BECAUSE OF COVID-19, MANY OF OUR EXTERNAL EDUCATION EVENTS WERE LIMITED OR COMPLETELY STOPPED. OUR TEAM WILL RE-ENGAGE WITH THE COMMUNITY THROUGH IN-PERSON SUPPORT GROUPS, PRESENTATIONS IN THE COMMUNITY AT LOCAL GROUPS, BUSINESSES, AND HEALTH FAIRS. ACTION: AN OPEN HOUSE/HEALTH FAIR WAS HELD IN MAY 2023 THAT HAD ABOUT 300 GUESTS. DIABETES AND NUTRITION HAD A TABLE AT THE EVENT TO OFFER SCREENING INFORMATION, AS WELL AS THE OPPORTUNITY TO MAKE HEALTHY SNACKS, LEARN ABOUT INTUITIVE EATING, AND MORE. STRATEGY #4: PROVIDER EDUCATION-ENGAGE AND SUPPORT THE DIABETES EDUCATION TEAM TO PROVIDE TRAINING FOR THE PRIMARY CARE TEAM AND CLINIC STAFF ON DIABETES SCREENING AND RESOURCES FOR NEWLY DIAGNOSED PATIENTS. ACTION: MET WITH THE PRIMARY CARE AND DIABETES TEAM TO DISCUSS SCREENING PROTOCOLS IN FALL 2022. THE DIABETES TEAM SENDS QUARTERLY UPDATES TO THE PRIMARY CARE PROVIDERS WITH UPDATES THAT INCLUDES BEST PRACTICES FOR DIABETES SCREENINGS. [CONTINUED LATER IN SCHEDULE H, PART V DISCLOSURES...] PRAIRIE RIDGE HEALTH, INC. PART V, SECTION B, LINE 13B: PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES BASED ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF PRH; HOWEVER, THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO (RECEIVED BY PRH FOR) PATIENTS COVERED BY MEDICARE, MEDICAID AND ALL PRIVATE HEALTH INSURERS.PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED BASED ON INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. HOMELESS OR RECEIVED CARE FROM A HOMELESS OR FREE CLINIC;2. PATIENT IS DECEASED WITH NO KNOWN ESTATE;3. ACCOUNTS UNCOLLECTIBLE DUE TO DISCHARGE OF DEBTOR BY BANKRUPTCY;4. ALL DATES OF SERVICE WITHIN 30-DAYS PRIOR TO WHEN A PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE;5. OUT-OF-STATE MEDICAL ASSISTANCE COVERAGE NOT CONTRACTED WITH PRH OR ARE LISTED AS NO FUNDS AVAILABLE;6. QUALIFICATION FOR TREATMENT UNDER THE MEMORANDUM OF UNDERSTANDING BETWEEN COLUMBIA COUNTY HEALTH AND HUMAN SERVICES AND PRH. PRAIRIE RIDGE HEALTH, INC. PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS PROVIDED TO PATIENTS UPON ADMISSION. SCHEDULE H, PART V, SECTION B, LINE 11 - CONTINUED DISCLOSURE PRIORITY #3: INCREASING COLORECTAL SCREENINGGOAL: INCREASE COLORECTAL SCREENING BY .5% OR AN ADDITIONAL 135 (45 PER YEAR) COLONOSCOPIES.STRATEGY #1: STANDARDIZE SCREENING MEASURES -THE AMERICAN CANCER SOCIETY RECOMMENDS THAT PEOPLE AT AVERAGE RISK OF COLORECTAL CANCER (MEANING, NO SIGNIFICANT RISK OR FAMILY HISTORY) SHOULD START REGULAR SCREENINGS AT AGE 45. OUR CURRENT BASIC SCREENING AUTO-ENROLLMENT IS: AUTO-ENROLLMENT FOR ALL PATIENTS AGED 50-75. ADDITIONAL TRIGGERS ARE AVAILABLE BASED ON A PATIENT'S RISK PROFILE.ACTION: BECAUSE WE ARE PART OF A LARGER NETWORK THAT USES THE SAME HEALTH MEDICAL RECORDS SYSTEM, WE ARE NOT ABLE TO EASILY CHANGE ENROLLMENT TRIGGERS. WE CONTINUE TO WORK WITH THE INFORMATICS DEPARTMENT AND CLINICAL TEAM TO ADVOCATE TO BOTH INSURANCE PLANS AND TO OUR MEDICAL RECORDS OWNER TO REIMBURSE AND UPDATE THE APPROPRIATE ENROLLMENT TRIGGERS BASED ON THE AMERICAN CANCER SOCIETY'S UPDATED SCREENING GUIDELINES.CREATE A QUICK REFERENCE GUIDE WITH RECOMMENDED SCREENINGS TO BE POSTED NEAR ALL CLINIC WORKSTATIONS. THIS HAS BEEN CHANGED TO A LARGER SCREENING-FOCUSED BROCHURE TO REDUCE CLUTTER AT CLINIC WORKSTATIONS. ACTION: THIS SCREENING BROCHURE IS CURRENTLY BEING DEVELOPED AND WILL HIGHLIGHT RECOMMENDED SCREENINGS FOR:DIABETESCOLON CANCERBREAST CANCERSKIN CANCERLUNG CANCERBONE DENSITYSTRATEGY #2: COLLABORATION WITH LOCAL BUSINESSES AND OCCUPATIONAL HEALTH -WORK WITH LOCAL BUSINESSES, INCLUDING PHARMACIES TO PROVIDE INFORMATION ON COLORECTAL SCREENINGS AND OPTIONS.-PROVIDE THE OCCUPATIONAL HEALTH TEAM WITH GENERAL COLORECTAL CANCER EDUCATION, INCLUDING SCREENING GUIDELINES AND WAYS TO GET SCREENED.ACTION: OCCUPATIONAL HEALTH OFFERS AMERICAN CANCER SOCIETY SCREENING BROCHURES IN THEIR NEW PATIENT FOLDERS. A SCREENING BROCHURE IS IN THE PROCESS OF BEING DEVELOPED.STRATEGY #3: PUBLIC EDUCATION- THE MARKETING TEAM WILL UTILIZE SOCIAL MEDIA, RADIO, PRINT ADS AND BILLBOARDS TO INCREASE AWARENESS ABOUT THE IMPORTANCE OF COLORECTAL SCREENING AND OPTIONS FOR SERVICES AT PRAIRIE RIDGE HEALTH AND IN THE COMMUNITY. ACTION: AN OPEN HOUSE/HEALTH FAIR WAS HELD IN MAY 2023 THAT HAD ABOUT 300 GUESTS. CANCER SCREENING AND NAVIGATION HAD A TABLE TO PROMOTE OUR SERVICES. WE ALSO OFFERED BROCHURES AND HANDOUTS ON COLORECTAL CANCER SCREENING OPTIONS. ACTION: SOCIAL MEDIA, PRINT ADVERTISEMENTS, RADIO ADS, AND INTERNAL SIGNAGE HAS BEEN UTILIZED TO PROMOTE COLORECTAL SCREENING OPTIONS.STRATEGY #4: COLLABORATION WITH PRAIRIE RIDGE HEALTH CLINICS- WORK WITH LEADERS IN THE PRAIRIE RIDGE HEALTH CLINICS TO ENSURE THAT:- EDUCATION AND BROCHURES ARE READILY AVAILABLE IN THE WAITING ROOM AND EXAM ROOMS EXPLAINING THE IMPORTANCE OF COLORECTAL SCREENING AND OPTIONS FOR SERVICES AT PRAIRIE RIDGE HEALTH AND IN THE COMMUNITY. ACTION: CLINIC TEAM CONTINUES TO OFFER HANDOUTS ON COLORECTAL CANCER SCREENING OPTIONS, INCLUDING AT-HOME OPTIONS, IN EXAM ROOMS AND WAITING ROOMS.- CONTINUE TO ENGAGE PATIENTS THROUGH THEIR PRIMARY CARE PROVIDERS THROUGH PHONE CALLS AND LETTERS ENCOURAGING PATIENTS DUE FOR A SCREENING.ACTION: CLINIC AND SURGERY TEAMS CONTINUE TO UTILIZE THESE PROTOCOLS.NO HOSPITAL FACILITY CAN ADDRESS ALL THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. PRAIRIE RIDGE HEALTH'S IMPLEMENTATION STRATEGY FOCUSES ON THE COMMUNITY HEALTH NEEDS PREVIOUSLY SPECIFIED AND WILL NOT FOCUS ON THE FOLLOWING NEEDS IDENTIFIED:1. ALCOHOL ABUSE AND EXCESSIVE DRINKING CONTINUES TO FLUCTUATE AND HAS BEEN SINCE 2003. THIS IS A STATEWIDE ISSUE AND PRAIRIE RIDGE HEALTH IS AWARE OF THIS NEED IN THE COUNTY. HOWEVER, AT THIS TIME, PRAIRIE RIDGE HEALTH DOES NOT HAVE THE STAFF OR RESOURCES TO PROPERLY ADDRESS THIS NEED.2. SMOKING/TOBACCO USE IS BEING ADDRESSED BY HEALTH EXPERTS AT A STATE LEVEL THROUGH THE IMPLEMENTATION OF A STATEWIDE SMOKING BAN, EFFECTIVE JULY 2010, AND REMEDIATION PROGRAMS. IN ADDITION, PRAIRIE RIDGE HEALTH OFFERS SMOKING CESSATION CLASSES.3. DRUG ABUSE, SPECIFICALLY OPIOID ABUSE, IS CURRENTLY BEING ADDRESSED BY PARCC - PREVENTION AND RECOVERY COLUMBIA COUNTY COALITION. THESE PROGRAMS AIM AT ELIMINATING THE ABUSE OF OPIOIDS FROM A PREVENTION FOCUS. AT THE TIME OF THIS PRINTING, PRAIRIE RIDGE HEALTH WILL HAVE FIVE PROVIDERS PROVIDING MEDICATION-ASSISTED TREATMENT (MAT) FOR OPIOID USE DISORDER.WHILE IT IS NOT A 2022 CHNA INITIATIVE, PRAIRIE RIDGE HEALTH IS ALREADY WORKING ON THE FOLLOWING:MAMMOGRAPHY SCREENINGS CONTINUE TO BE BELOW NATIONAL AVERAGES IN COLUMBIA COUNTY. THE PRAIRIE RIDGE HEALTH TEAM HAS BEEN DEDICATED TO INCREASING SCREENING RATES SINCE THE 2016 CHNA.REDUCING OBESITY AND INCREASING PHYSICAL ACTIVITY HAVE BEEN PRIORITIES ON EVERY CHNA SINCE THE FIRST ONE COMPLETED IN 2013. ALTHOUGH THOSE GOALS ARE NOT ON THE 2022 CHNA, OUR PRIMARY CARE AND SPECIALTY TEAMS WILL CONTINUE TO WORK ON THEM THROUGH EDUCATION, SCREENING, NUTRITION SERVICES, PHYSICAL AND OCCUPATIONAL THERAPIES.ACCESS TO MENTAL AND BEHAVIORAL HEALTH IS A RECOGNIZED NEED IN COLUMBIA COUNTY. PRAIRIE RIDGE HEALTH IS AWARE OF THIS NEED IN THE COUNTY. PRAIRIE RIDGE HEALTH HIRED TWO PSYCHIATRISTS AND TWO OUTPATIENT PSYCHOTHERAPISTS DURING FY2023. WE HOPE TO EXPAND THAT TEAM TO INCLUDE MORE COUNSELORS IN THE COMING YEARS. VISIT WWW.PRAIRIERIDGE.HEALTH FOR UPDATED INFORMATION ON THIS SERVICE OR VISIT COLUMBIA COUNTY'S BEHAVIORAL HEALTH AND LONG-TERM SUPPORT PROGRAM.THE LACK OF DENTAL CARE IN THE COUNTY PROVES TO BE A LARGE ISSUE, BUT THE HOSPITAL CANNOT DIRECTLY IMPACT THIS METRIC. MANY OF THE FOCUS GROUP PARTICIPANTS MENTIONED A LACK OF DENTISTS. MANY PEOPLE DO NOT RECEIVE THE DENTAL CARE THEY NEED BECAUSE THEY EITHER CANNOT MAKE AN APPOINTMENT, DO NOT HAVE THE TRANSPORTATION TO GET TO AN APPOINTMENT, DO NOT HAVE INSURANCE AND CANNOT AFFORD DENTAL CARE, OR THEIR INSURANCE IS NOT ACCEPTED. THIS FURTHER EXACERBATES THE METRIC OF POOR DENTAL HEALTH. THE HOSPITAL WILL CONTINUE TO WORK WITH LOCAL DENTISTS WHEN A PATIENT PRESENTS TO THE EMERGENCY DEPARTMENT OR EXPRESSES A NEED. 2 1 - PRAIRIE RIDGE HEALTH CLINIC 134 CORPORATE DRIVE BEAVER DAM WI 53916 PHYSICIAN CLINIC 2 - PRAIRIE RIDGE HEALTH CLINIC 301 W MAIN STREET SUITE A MARSHALL WI 53559 PHYSICIAN CLINIC PART I, LINE 3C: PATIENTS WHOSE FAMILY INCOME ARE AT OR BELOW 200% OF THE FPL ARE ELIGIBLETO RECEIVE FREE CARE.PATIENTS WHOSE FAMILY INCOME ARE ABOVE 200% BUT NOT MORE THAN 400% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT AMOUNTS NO GREATER THAN THE AMOUNTS GENERALLY BILLED.PATIENTS WHOSE FAMILY INCOME EXCEEDS 400% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES BASED ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE, AT THE DISCRETION OF PRH; HOWEVER, THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED TO (RECEIVED BY PRH FOR) PATIENTS COVERED BY MEDICARE, MEDICAID AND ALL PRIVATE HEALTH INSURERS.PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED BASED ON INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. HOMELESS OR RECEIVED CARE FROM A HOMELESS OR FREE CLINIC;2. PATIENT IS DECEASED WITH NO KNOWN ESTATE;3. ACCOUNTS UNCOLLECTIBLE DUE TO DISCHARGE OF DEBTOR BY BANKRUPTCY;4. ALL DATES OF SERVICE WITHIN 30-DAYS PRIOR TO WHEN A PATIENT HAS BEEN APPROVED FOR MEDICAL ASSISTANCE;5. OUT-OF-STATE MEDICAL ASSISTANCE COVERAGE NOT CONTRACTED WITH PRH OR ARE LISTED AS NO FUNDS AVAILABLE;6. QUALIFICATION FOR TREATMENT UNDER THE MEMORANDUM OF UNDERSTANDING BETWEEN COLUMBIA COUNTY HEALTH AND HUMAN SERVICES AND PRH. PART I, LINE 6A: PRAIRIE RIDGE HEALTH, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S WEBSITE. 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 HOSPITAL'S TOTAL OPERATING EXPENSES DIVIDED BY GROSS PATIENT SERVICE REVENUE. 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. THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES FOR LINE 7G ON THE FIRST PAGE OF SCHEDULE H OF THE FORM 990 IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. THIS ALLOCATION METHOD AND PRINCIPLES OF ALLOCATION WERE USED TO DERIVE A SPECIFIC AMOUNT OF COST ALLOCATION TO THE VARIOUS PROGRAMS AND COST CENTERS OPERATED BY THE ORGANIZATION. MEDICAID FOR LINE 7B WAS CALCULATED USING THE RATIO OF COST TO CHARGE METHODOLOGY.THE COMMUNITY BENEFIT REPORTED ON LINES 7E, 7F, AND 7I ARE BASED ON ACTUAL COST. PART I, LINE 7G: THE ORGANIZATION INCLUDES THE FOLLOWING SERVICES AS THEIR CALCULATED SUBSIDIZED SERVICES FOR PURPOSES OF SCHEDULE H. IN DETERMINING THE NET AMOUNTS REPORTED ON SCHEDULE H, THE ORGANIZATION UTILIZES THE FORMAT OF WORKSHEET 6 PROVIDED BY THE IRS. SERVICES INCLUDE: ICU, INPATIENT UNIT, MARSHALL CLINIC. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,651,567. PART II, COMMUNITY BUILDING ACTIVITIES: PRAIRIE RIDGE HEALTH PARTICIPATES IN THE COMMUNITY CHAMBER OF COMMERCE, OFFERS A COMMUNITY SHARPS DISPOSAL PROGRAM AND PROVIDES MEDICATION TAKE BACK DAYS THROUGHOUT THE YEAR. PART III, LINE 2: THE AMOUNT REPORTED ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE HOSPITAL DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ORGANIZATION HAS A THOROUGH FINANCIAL ASSISTANCE POLICY AND ESTIMATES THAT NO AMOUNT OF BAD DEBT IS ATTRIBUTABLE TO THOSE THAT MAY QUALIFY FOR THE ASSISTANCE UNDER SUCH POLICY. PART III, LINE 4: THE FINANCIAL STATEMENT FOOTNOTE REGARDING IMPLICIT PRICE CONCESSIONS MAY BE FOUND ON PAGES 15-17 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION, AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS ANESTHESIA PROFESSIONAL SERVICES, RESPIRATORY THERAPY PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN PROFESSIONAL SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENTS AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY AND CLINICAL PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT PRAIRIE RIDGE HEALTH PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30, 2023, 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, PRAIRIE RIDGE HEALTH 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 COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, 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. PART VI, LINE 2: PRAIRIE RIDGE HEALTH 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 TO BE CONSISTENT WITH PRAIRIE RIDGE HEALTH'S MISSION IN THE COMMUNITY. PRAIRIE RIDGE HEALTH ALSO REVIEWS STATISTICS IN THE HOSPITAL, CLINIC, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE ORGANIZATION ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND ITS PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY. A FORMAL COMMUNITY NEEDS ASSESSMENT WAS COMPLETED DURING FY22 AND APPROVED BY THE BOARD ON AUGUST 25, 2022. PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE ORGANIZATION'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S 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, LINE 4: PRAIRIE RIDGE HEALTH'S SERVICE AREA INCLUDES COLUMBUS, FALL RIVER, CAMBRIA, DOYLESTOWN, FRIESLAND, MARSHALL, RANDOLPH, RIO, WATERLOO, BEAVER DAM, SUN PRAIRIE AND OTHER SURROUNDING COMMUNITIES. PRAIRIE RIDGE HEALTH BORDERS THREE COUNTIES, COLUMBIA, DANE, AND DODGE, BUT PRIMARILY DEFINES ITS COMMUNITY AS THE SOUTHERN RIGHT SECTOR OF COLUMBIA COUNTY AND ADJACENT COMMUNITIES. ACCORDING TO THE MOST RECENT CENSUS, THIS SERVICE AREA HAD AN ESTIMATED POPULATION OF 57,133 PEOPLE. THE ORGANIZATION PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS, ESPECIALLY THOSE BENEFICIARIES WHO ARE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY AND RURAL SURROUNDING AREAS WHO OTHERWISE WOULD HAVE A DIFFICULT TIME TRAVELING TO LARGER FACILITIES AND IN SOME CASES COULD BE MORE THAN 20+ MILES AWAY FROM PRAIRIE RIDGE HEALTH. IN FISCAL YEAR 2023, THESE MEDICARE AND MEDICAL ASSISTANCE PATIENTS ACCOUNTED FOR NEARLY 55 PERCENT OF THE GROSS PATIENT SERVICE REVENUE PROVIDED BY THE ORGANIZATION DURING THE YEAR. PART VI, LINE 5: PRAIRIE RIDGE HEALTH HAS AN 11-MEMBER BOARD OF DIRECTORS, 4 OF WHICH ARE COMMUNITY MEMBERS THAT RESIDE IN COLUMBIA COUNTY. PRH ALSO MAINTAINS AN OPEN MEDICAL STAFF. SURPLUS FUNDS ARE USED TO REINVEST IN EQUIPMENT, TECHNOLOGY, AND INFRASTRUCTURE IN ORDER TO ENSURE THAT PRH IS ABLE TO SUPPORT THE PROMOTION OF COMMUNITY HEALTH WELL INTO THE FUTURE. WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S COMMUNITY BENEFIT, THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. PRAIRIE RIDGE HEALTH, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND, IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. PRAIRIE RIDGE HEALTH, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH, WITHOUT THE HOSPITAL AND CLINICS, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, SWING BED SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH PATHOLOGY, SURGICAL SERVICES, LIFELINE, OCCUPATIONAL HEALTH, WOMENS' SERVICES, PRIMARY CARE AND OUTPATIENT PSYCHIATRY TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART VI, LINE 6: THE HOSPITAL SIGNED A MASTER AGREEMENT AND AFFILIATION AGREEMENT WITH SSM HEALTHCARE OF WISCONSIN (SSM WISCONSIN). AS PART OF THIS AFFILIATION, SSM WISCONSIN HAS THE RIGHT TO APPOINT THREE DIRECTORS TO THE HOSPITAL'S BOARD OF DIRECTORS. THE AGREEMENT ALSO SPECIFIES CERTAIN BOARD RESOLUTIONS THAT MUST BE APPROVED BY THE SSM WISCONSIN BOARD MEMBERS. IN THE EVENT OF LIQUIDATION, DISSOLUTION OR SALE OF THE HOSPITAL, SSM WISCONSIN WOULD RECEIVE 40 PERCENT OF THE NET PROCEEDS. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X 1 0 0 0 0 0 0 0 0 MATTHEW NIESEN MD CHF OF STF/SURGEON (THRU DEC 2022) 943336 0 136470 0 293 0 12200 0 35457 0 1127756 0 0 0 JOHN D RUSSELL PRESIDENT & CEO 491518 0 95064 0 690 0 15250 0 35457 0 637979 0 0 0 ROBB WHINNEY DO GENERAL SURGEON 384804 0 69479 0 690 0 12200 0 35457 0 502630 0 0 0 GARY GALVIN MD CHIEF OF STAFF/GENERAL SURGEON 399554 0 41840 0 1980 0 12200 0 35457 0 491031 0 0 0 KATHRYN KALDOR MD OB/GYN PHYSICIAN 318303 0 86500 0 690 0 12200 0 35457 0 453150 0 0 0 LESLIE ALZUHN-HANSEN MD DIRECTOR/OB/GYN PHYSICIAN 315453 0 81700 0 450 0 12200 0 38307 0 448110 0 0 0 VERONICA MINIER MD FAMILY PRACTICE PHYSICIAN 193920 0 166951 0 333 0 8306 0 33681 0 403191 0 0 0 ANN ROUNDY SR VP CULTURE, STRATEGY & GROWTH 252788 0 64924 0 569 0 14340 0 36370 0 368991 0 0 0 ASGHAR MARWAT MD INTERNAL MEDICINE PHYSICIAN 192075 0 130437 0 162 0 11547 0 32295 0 366516 0 0 0 JAMIE HENDRIX VP PATIENT CARE SERVICES 238257 0 64259 0 529 0 14377 0 36556 0 353978 0 0 0 MICHELLE BRYAN MD FAMILY PRACTICE PHYSICIAN 183614 0 73986 0 146 0 7567 0 21800 0 287113 0 0 0 MELISSA MANGAN VP OF FINANCE & CFO 170362 0 26672 0 220 0 9405 0 37002 0 243661 0 0 0 PART I, LINE 4A MATTHEW NIESEN RECEIVED A SEVERANCE PAYMENT OF $73,857. A CITY OF COLUMBUS WISCONSIN 396005417 2004-12-14 10000000 FINANCE THE IMPROVEMENT AND PURCHASE EQUIPMENT FOR THE HOSPITAL FACILITY 0 0 0 B CITY OF COLUMBUS WISCONSIN 396005417 2005-06-06 2000000 FINANCE THE IMPROVEMENT OF THE EXISTING HOSPITAL FACILITY 0 0 0 C CITY OF COLUMBUS WISCONSIN 396005417 2013-12-12 8000000 FINANCE THE RENOVATION AND PURCHASE EQUIPMENT FOR THE HOSPITAL FACILITIES 0 0 0 D CITY OF COLUMBUS WISCONSIN 396005417 2014-06-25 2000000 FINANCE THE RENOVATION AND PURCHASE EQUIPMENT FOR THE HOSPITAL FACILITIES 0 0 0 A 7643360 10000000 200000 9800000 2006 0 0 1 1 B 1544250 2000000 40000 1960000 2006 0 0 1 1 C 1529771 8000000 8000000 2015 0 0 1 1 D 387533 2000000 2000000 2016 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 1 0 0 0 1 D 0 0 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A CITY OF COLUMBUS WISCONSIN 396005417 2019-05-14 10000000 FINANCE THE RENOVATION AND PURCHASE EQUIPMENT FOR THE HOSPITAL FACILITIES 0 0 0 A 978261 10000000 10000000 2020 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 LESLIE ALZUHN-HANSEN MD BOARD DIRECTOR RELOCATING AND ESTABLISHING NEW MEDICAL PRACTICE X 200000 40000 0 0 1 40000 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE/LONG RANGE PLANNING COMMITTEE SHALL CONSIST OF THE CHAIR, THE VICE CHAIR, THE SECRETARY, AND THE TREASURER OF THE CORPORATION, THE CHIEF OF THE MEDICAL STAFF, AND ONE CLASS S DIRECTOR. NO EMPLOYED PHYSICIAN, OTHER THAN THE CHIEF OF THE MEDICAL STAFF, SHALL SERVE ON THE EXECUTIVE/LONG RANGE PLANNING COMMITTEE. THE CLASS S DIRECTOR SHALL BE SELECTED BY SSMWI FROM TIME TO TIME, AND SSMWI SHALL HAVE THE RIGHT TO SUBSTITUTE ANOTHER CLASS S DIRECTOR FOR ANY MEETING OF THE COMMITTEE THAT THE DESIGNATED CLASS S DIRECTOR IS UNABLE TO ATTEND. THE PRESIDENT WILL PARTICIPATE AS A NON-VOTING MEMBER OF THE COMMITTEE. THE CHAIR OF THE BOARD SHALL BE CHAIR OF THE COMMITTEE. THE EXECUTIVE/LONG RANGE PLANNING COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, EXCEPT THE POWER TO: (I) ELECT OFFICERS OF THE CORPORATION, OR (II) FILL VACANCIES IN THE BOARD OF DIRECTORS OR IN THE EXECUTIVE/LONG RANGE PLANNING COMMITTEE, OR (III) AMEND OR REPEAL ANY PROVISIONS OF THESE BYLAWS OR THE ARTICLES OF INCORPORATION OF THE CORPORATION, EXCEPT AS OTHERWISE PROVIDED FOR IN THESE BYLAWS, OR(IV) APPROPRIATE FUNDS OF THE CORPORATION NOT INCLUDED IN THE BUDGET EXCEEDING AN AMOUNT FOR ANY ONE PURPOSE IN ANY ONE FISCAL YEAR FIXED OR AUTHORIZED BY THE BOARD FROM TIME TO TIME, OR (V) ADOPT PROGRAMS WHICH WOULD INVOLVE CONTINUING ACTIVITY OR SUPPORT BY THE CORPORATION FOR MORE THAN ONE FISCAL YEAR, OR (VI) TAKE ANY ACTION REQUIRING THE APPROVALS SET FORTH IN SECTION 4.10 OF THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A SSM HEALTH CARE OF WISCONSIN, INC. APPOINTS THREE DIRECTORS TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS BY THE BOARD OF DIRECTORS REQUIRE PRIOR WRITTEN APPROVAL OF SSM HEALTH CARE OF WISCONSIN, INC.: APPROVAL OF ANY AMENDMENT OR RESTATEMENT OF THE CORPORATION'S RESTATED ARTICLES OF INCORPORATION OR OF THE RESTATED BYLAWS; APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; APPROVAL OF ANY MERGER OR CONSOLIDATION INVOLVING THE CORPORATION AND APPROVAL OF THE DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS ARE GIVEN THE OPPORTUNITY TO REVIEW THE RETURN BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS REVIEWED BY EITHER THE SENIOR ACCOUNTANT OR FINANCE MANAGER FOR COMPLETION AND ACCURACY AND BY THE CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS CHECKS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY WHENEVER THERE IS A CHANGE IN PEOPLE GOVERNING ANY PART OF THE HOSPITAL OPERATIONS. SHOULD A CONFLICT ARISE, THE INTERESTED DIRECTOR OR OFFICER MUST PROMPTLY DISCLOSE THE CONFLICT IN WRITING TO THE BOARD OF DIRECTORS AND THE INTERESTED PERSON DOES NOT VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS THE BOARD OF DIRECTORS REVIEWS MARKET DATA FOR THE PRESIDENT & CEO, VP OF FINANCE & CFO AND ALL OTHER KEY EMPLOYEES. A REVIEW OF THE CRITERIA NECESSARY FOR INCENTIVE COMPENSATION IS ALSO DONE ANNUALLY. THE PROCESS AND DETERMINATION ARE DOCUMENTED IN THE PERSONNEL FILES AND BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 5,411,223. MANAGEMENT AND GENERAL EXPENSES 1,244,648. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,655,871. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 889,759. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 889,759. OTHER FEES: PROGRAM SERVICE EXPENSES 1,846,293. MANAGEMENT AND GENERAL EXPENSES 668,756. FUNDRAISING EXPENSES 2,500. TOTAL EXPENSES 2,517,549. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN THE FOUNDATION 291,112. PRAIRIE RIDGE HEALTH FOUNDATION INC 1515 PARK AVENUE COLUMBUS WI 53925 391656161 SUPPORT PRAIRIE RIDGE HEALTH, INC. WI 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0