2026-09-24T12:06:11-05:00 2025-12-31 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 220 DULUTH MN 55812 990 2025-01-01 391027536 BLACK RIVER HEALTH INC BLAC 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 TAMMY HERNANDEZ INTERIM VP OF FINANCE/CFO 7152845361 2026-09-23 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-09-23 2025 BLACK RIVER MEMORIAL HOSPITAL CARL SELVICK 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 100929257 0 X WWW.BLACKRIVERHEALTH.COM X 1966 WI BLACK RIVER HEALTH, INC.'S MISSION IS TO PROVIDE OUTSTANDING AND COMPREHENSIVE HEALTHCARE FOR YOU AND YOUR FAMILY, DELIVERED LOCALLY WITH COMPASSION. 9 6 479 39 8546 2488 58263 114672 66780361 93342396 3147371 2441096 26926 70711 70012921 95968875 5000 5000 0 0 36471584 52577675 0 0 0 29093448 38958118 65570032 91540793 4442889 4428082 107569105 113040646 31121490 30794071 76447615 82246575 X BLACK RIVER HEALTH, INC.'S MISSION IS TO PROVIDE OUTSTANDING AND COMPREHENSIVE HEALTHCARE FOR YOU AND YOUR FAMILY, DELIVERED LOCALLY WITH COMPASSION. 0 0 66554422 5000 86483613 BLACK RIVER MEMORIAL HOSPITAL, INC. PROVIDES HIGH-QUALITY, COST-EFFECTIVE, PRIMARY, AND MENTAL HEALTH CARE TO ALL PEOPLE IN NEED OF CARE. AMONG THE INPATIENT AND OUTPATIENT SERVICES PROVIDED ARE DIAGNOSTIC IMAGING, REHABILITATION SERVICES, RESPIRATORY CARE, SURGICAL SERVICES, INFUSION THERAPY, LAB SERVICES, PHARMACY SERVICES, 24-HOUR EMERGENCY ROOM AND MANY OTHERS. IN 2025, THE HOSPITAL PROVIDED 3,065 INPATIENT DAYS OF CARE TO ADULTS, PEDIATRICS, SWING BED, AND NURSERY INPATIENTS AS WELL AS 9,662EMERGENCY ROOM AND 36,839 OUTPATIENT SERVICES TO THOSE IN NEED OF CARE. THE HOSPITAL ALSO SERVES AS A VITAL LINK TO THE COMMUNITY BY PROVIDING OUTREACH PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS IN AN EFFORT TO ENHANCE THE HEALTH AND WELFARE OF THE PEOPLE IN ITS AREA. IN ITS EFFORT TO ATTAIN THIS GOAL THE HOSPITAL PROVIDES:-FREE AND REDUCED-COST CARE TO THOSE WITH A DEMONSTRATED NEED-CARE TO THOSE COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH MAY NOT COVER THE CHARGES OR COST OF SERVICES PROVIDED-HEALTH EDUCATION AND OUTREACH PROGRAMS TO ALL MEMBERS OF THE COMMUNITY AT LITTLE OR NO COST TO THE PARTICIPANTSCHARITY CARE GIVEN TO PERSONS UTILIZING OUR HOSPITAL AMOUNTED TO A TOTAL OF $964,914 IN TOTAL CHARGES. IN ADDITION, WE FURNISH CARE TO PERSONS COVERED UNDER GOVERNMENT ENTITLEMENT PROGRAMS WHICH PAY AT RATES LESS THAN CHARGES. DISCOUNTS TO THESE PROGRAMS FOR HOSPITAL SERVICES AMOUNTED TO $20,785,788.BLACK RIVER MEMORIAL HOSPITAL, INC. ALSO CONDUCTED NUMEROUS EDUCATIONAL AND SUPPORTIVE ACTIVITIES TO ENCOURAGE THE GOOD HEALTH AND WELFARE OF THE MEMBERS OF THE COMMUNITIES IT SERVES. THESE ACTIVITIES INCLUDE:-PROVIDING ASSISTANCE TO HEALTH EDUCATORS BY SPONSORING INTERNSHIPS FOR STUDENT NURSES, RADIOLOGICAL, REHABILITATION, AND LABORATORY TECHNICIAN STUDENTS.-PROVIDING CHILDBIRTH EDUCATIONAL CLASSES-PROVIDING LEADERSHIP TO STATE AND REGION-WIDE HEALTH ORGANIZATIONS INCLUDING THE WISCONSIN HOSPITAL ASSOCIATION, HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION, NURSE EXECUTIVES, HEALTH EDUCATORS, PERINATAL CARE ASSOCIATION AND THE WISCONSIN HEALTHCARE PUBLIC RELATIONS AND MARKETING SOCIETY TO FURTHER HEALTHCARE GOALS OUTSIDE OF OUR DIRECT SERVICE AREA.OTHER SERVICES WE PROVIDE INCLUDE GRIEF SUPPORT GROUP. COALITIONS WE SUPPORT ARE: BREASTFEEDING COALITION, BLACK RIVER AREA SAFETY COUNCIL, TOGETHER FOR JACKSON COUNTY KIDS, AND JACKSON IN ACTION. BLACK RIVER MEMORIAL HOSPITAL'S WOUND CARE CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY MAY 2021 AND PERFORMED 6,283 OUTPATIENT PROCEDURES IN 2025. 707992 0 2291462 BLACK RIVER HEALTHCARE CLINIC OPENED TO BRMH EMPLOYEES IN JUNE AND THE GENERAL PUBLIC IN JULY 2020. BLACK RIVER HEALTHCARE CLINIC IS AN INTEGRATED CLINIC OFFERING BEHAVIORAL HEALTH AND PRIMARY CARE SERVICES. IN 2025, BEHAVIORAL HEALTH VISITS WERE 4,996 AND PRIMARY CARE VISITS WERE 34,125. 262758 0 1201227 BLACK RIVER MEMORIAL HOSPITAL'S INFUSION CENTER BEGAN PROVIDING SERVICES TO THE COMMUNITY IN AUGUST 2021 WHICH INCLUDE INTRODUCING CHEMOTHERAPY TO OUR SERVICE MIX FOR THE FIRST TIME. INFUSION VISITS IN 2025 WERE 1,425. 0 0 3262417 BLACK RIVER HEALTH, INC OPENED A RETAIL PHARMACY IN OUR KC CLINIC CAMPUS LOCATION. THIS WAS COMPLETED IN OCTOBER 2025. 0 0 3262417 67525172 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 36 0 479 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X TAMMY HERNANDEZ 7152845361 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 DR NICHOLAS KITOWSKI DIRECTOR/PHYSICIAN 27.00 X 564190 0 94819 DR CAROL MARTIN CHIEF OF STAFF/DIR. 34.00 X X 516812 0 97808 TIMOTHY TRANBERG CHAIR 4.00 X X 0 0 0 KATHERINE POTTER VICE CHAIR 4.00 X X 0 0 0 DR THOMAS WALKER TREASURER 4.00 X X 0 0 0 WALLACE APLAND III DIRECTOR 4.00 X 0 0 0 DR MICHELLE CLARK-FORSTING DIR./CHIEF PHYS. EXEC. 40.00 X 363166 0 88571 KRISTIN FRANKS DIRECTOR 4.00 X 0 0 0 TIMOTHY KUNES DIRECTOR (THRU 6/2025) 4.00 X 0 0 0 DR KIRK LANE DIRECTOR 4.00 X 0 0 0 CARL SELVICK CEO 40.00 X 511958 0 51659 HOLLY WINN CFO 40.00 X 437226 0 89305 CATHY BUKOWSKI VP OF FINANCE/CFO 40.00 X 207254 0 34713 DR JESSE SUSA PHYSICIAN 27.00 X 341179 0 86027 DR DARIN ANTONELLI PHYSICIAN 27.00 X 479344 0 91915 DR ESTEBAN MILLER PHYSICIAN 27.00 X 368581 0 58931 DR EDWARD ZHOVTIS PHYSICIAN 27.00 X 364240 0 81549 DR JOHN MURPHY PHYSICIAN 27.00 X 364228 0 79167 MARY BETH WHITE-JACOBS FORMER CEO 40.00 X 133366 0 0 4651544 0 854464 83 1 1 0 WIPFLI 4890 OWENS AYRES COURT SUITE 200 EAU CLAIRE WI 54701 REVENUE CYCLE CODING/BILLING 1975690 BURLINGTON HEALTHCARE PROVIDERS PO BOX 180512 DELAFIELD WI 53018 EMERGENCY ROOM STAFFING 545675 PINNACLE ORTHOPEDICS 1204 LAKEVIEW DRIVE 6 TOMAH WI 54860 ORTHOPEDIC PROFESSIONAL SERVICES 415650 FOCUSONE PO BOX 850861 MINNEAPOLIS MN 55485 PROFESSIONAL STAFFING SERVICES 303228 MEDICUS EMERGENCY ROOM SERVICES LLC 22 ROULSTON ROAD WINDHAM NH 03087 EMERGENCY ROOM STAFFING 218636 10 114672 114672 HOSPITAL PATIENT SERVICE REVENUE 621400 86578744 86578744 CLINIC REVENUE 621400 2291462 2291462 INFUSION REVENUE 621400 1201227 1201227 3270963 3167286 8546 95131 93342396 2254606 2254606 70711 0 70711 70711 70711 5146872 4957532 2850 189340 -2850 186490 186490 95968875 93238719 8546 2606938 X 5000 5000 3057481 3057481 34033633 27562726 6470907 1411546 1219464 192082 11605511 8714694 2890817 2469504 1820734 648770 191611 191611 4851 4851 79160 79160 10636401 6309501 4326900 571146 571146 905015 7218 897797 1980265 865 1979400 626448 476349 150099 111656 89917 21739 816397 608894 207503 3709368 2766560 942808 386078 386078 MEDICAL SUPPLIES AND PH 10254746 10241350 13396 BAD DEBT EXPENSE 6327863 6327863 EQUIPMENT RENTAL AND MA 793527 355126 438401 DUES AND SUBSCRIPTIONS 383531 99870 283661 1180055 919041 261014 91540793 67525172 24015621 0 125166 50183 2875672 4135357 12089808 15678543 1642500 1944251 709922 701815 81618380 50736884 28088143 30881496 52564217 48850220 9473677 10798781 107569105 113040646 5466374 6271842 18461145 17429286 7193971 7092943 31121490 30794071 X 76447615 82246575 76447615 82246575 107569105 113040646 4428082 1370878 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4851 4851 0 PART II-B, LINE 1: BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR ,BLACK RIVER MEMORIAL, INC. PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, CLINICAL EDUCATION, PROVIDER PRIVILEGING AND CREDENTIALING SERVICES, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT 11.4% OR 2,160, OF THE FEES PAID BY BLACK RIVER MEMORIAL, INC WENT TO LOBBYING EFFORTS. BLACK RIVER MEMORIAL, INC. IS ALSO A MEMBER OF THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE WHA PROVIDES SUPPORT SERVICES FOR A NUMBER OF MEMBERS WHICH INCLUDE BUT ARE NOT LIMITED TO QUALITY AND SAFETY DATA REPORTING AND RESOURCES, DATA REPOSITORY, AND EDUCATION. THEY ALSO HOST MULTIPLE COUNCILS FOR THEIR MEMBERS. THE WHA DETERMINED THAT 16.4% OR $2,691 OF THE MEMBERSHIP DUES PAID WENT TO LOBBYING. 511499 511499 43663023 25343525 18319498 33666394 25393359 8273035 3777464 3777464 30881496 DEFERRED COMPENSATION PLAN ASSETS 3987169 RIGHT OF USE ASSETS 4120596 AMOUNTS RECEIVABLE FROM THIRD PARTY REIMBURSEMENT PROGRAMS 2691016 10798781 DEFERRED COMPENSATION PLAN LIABILITY 2868175 OPERATING LEASE LIABILITY 4224768 7092943 90932730 1370878 1370878 89561852 79160 6327863 6407023 95968875 85133770 0 85133770 79160 6327863 6407023 91540793 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 6,327,863. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET AGAINST REVENUE 6,327,863. 1 1 X 1 X 1 X 1 1 1 0 1 1 495267 495267 0.00580 12236525 10074070 2162455 0.02540 12731792 10074070 2657722 0.03120 20188 20188 0.00020 78910 78910 0.00090 20689206 10539902 10149304 0.11910 20788304 10539902 10248402 0.12020 33520096 20613972 12906124 0.15140 133238 133238 0.00160 91088 91088 0.00110 14973 14973 0.00020 239299 239299 0.00290 0 3247941 1623970 15038780 14956173 82607 X 1 1 1 1 BLACK RIVER HEALTH INC 711 WEST ADAMS STREET BLACK RIVER FALLS WI 54615 WWW.BRMH.NET 1037 X X X X BLACK RIVER HEALTH INC 1 0 0 1 X X X X X X X X X 25 1 0 0 1 X HTTPS://BLACKRIVERHEALTH.COM/ABOUT-US/ X 1 25 1 HTTPS://BLACKRIVERHEALTH.COM/ABOUT-US/ 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X WWW.BRMH.NET/PATIENTS-VISITORS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 5: IN 2025, WE CONTINUED OUR EFFORTS TO IMPLEMENT ACTION ITEMS OUTLINED IN OUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) & COMPLETED OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA).MEETINGS WITH THE PUBLIC HEALTH DEPARTMENT & OTHER AGENCIES HELPED TO ALIGN MUTUAL AGENCY-SPECIFIC CHIP PRIORITIES. THESE DISCUSSIONS FOCUSED ON COORDINATING STRATEGIES AND RESOURCES TO ADDRESS SHARED HEALTH CONCERNS, PROMOTE CROSS-AGENCY EFFORTS, AND AVOID DUPLICATION. MULTI-AGENCY CAMPAIGNS WERE LAUNCHED TO INCREASE AWARENESS OF JACKSON COUNTY'S HEALTH PRIORITIES, USING DIVERSE COMMUNICATION CHANNELS TO REACH A WIDE RANGE OF COMMUNITY MEMBERS.BLACK RIVER HEALTH (FORMERLY KNOWN AS BLACK RIVER MEMORIAL) REPRESENTATIVE PARTICIPATION OCCURRED IN ONGOING COMMUNITY TASK FORCES, COALITIONS, AND MULTI-AGENCY MEETINGS, GATHERING INPUT FROM A BROAD CROSS-SECTION OF COMMUNITY REPRESENTATIVES. THESE COLLABORATIVE EFFORTS FOCUSED ON ADDRESSING BROAD COMMUNITY HEALTH PRIORITIES AS WELL AS THE SPECIFIC FOCUS AREAS IDENTIFIED PREVIOUSLY BY BLACK RIVER MEMORIAL HOSPITAL (BRMH), NOW BLACK RIVER HEALTH (BRH).KEY GROUPS INVOLVED INCLUDED THE JACKSON COUNTY CHILDCARE NETWORK, JACKSON COUNTY RESILIENCY ALLIANCE, JACKSON COUNTY CRISIS COLLABORATION, JACKSON COUNTY WORKFORCE CONNECTIONS, JACKSON COUNTY CHRONIC DISEASE COALITION, JACKSON COUNTY HOMELESS COALITION, INTERFAITH CAREGIVERS VOLUNTEER AGENCY, AND THE COMMUNITY SUPPORT WORKER PROGRAM.MANY OF THESE CROSS-AGENCY INITIATIVES WERE ALIGNED WITH BRMH'S IDENTIFIED PRIORITIES:1. MENTAL HEALTH SUICIDE, AND SELF-HARM PREVENTION2. MENTAL HEALTH ACCESS3. HEALTHCARE ACCESS, AVAILABILITY, AND AFFORDABILITY BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 11: PRIORITY 1- MENTAL HEALTH: SUICIDE AND SELF-HARM- GOAL 1: DELIVER COMPASSIONATE, HIGH-QUALITY EMERGENCY CARE DURING MENTAL HEALTH CRISES.- TACTICS: DESIGN EMERGENCY DEPARTMENT BEHAVIORAL HEALTH CARE AND BUILD PARTNERSHIPS- ON-DEMAND BEHAVIORAL HEALTH SERVICES VIA TELEHEALTH: WE CONTINUED TO PROVIDE ON-DEMAND EMERGENT BEHAVIORAL HEALTH SERVICES THROUGH TELEHEALTH IN THE EMERGENCY DEPARTMENT (ED), INCLUDING NECESSARY REFERRALS TO INPATIENT PSYCHIATRIC CARE WHEN REQUIRED.- ENHANCED REFERRAL PROCESS FOR MENTAL HEALTH CRISES: REFERRAL PROCESS FOR PATIENTS PRESENTING WITH MENTAL HEALTH CRISES IN THE ED HAS BEEN ENHANCED TO ENSURE APPROPRIATE FOLLOW-UP WITH BEHAVIORAL HEALTH PROVIDERS AND EFFECTIVE COLLABORATION WITH PRIMARY CARE PROVIDERS FOR COMPREHENSIVE PATIENT CARE.- UPDATED MENTAL HEALTH RESOURCE INFORMATION: LOCAL MENTAL HEALTH RESOURCE OFFERINGS ARE MAINTAINED AND PROVIDED TO PATIENTS, WITH A KEY FOCUS ON PROMOTING 211 AS THE MOST CURRENT AND ACCESSIBLE REGIONAL RESOURCE FOR MENTAL HEALTH SUPPORT.- CONTINUED COLLABORATION IN JACKSON COUNTY CRISIS TEAM: ONGOING PARTICIPATION IN THE JACKSON COUNTY CRISIS COLLABORATION TEAM CONTINUES TO STRENGTHEN COMMUNITY EFFORTS IN IMPROVING CRISIS RESPONSE AND MENTAL HEALTH SUPPORT.- BLACK RIVER HEALTH MENTAL HEALTH SERVICES: IN 2025, TWO CLINIC LOCATIONS (KROHN AND BLACK RIVER HEALTH CARE CENTER WERE SUCCESSFULLY INTEGRATED, ALLOWING FOR SHARED RESOURCES AND MORE COLLABORATIVE CARE FOR BOTH ACUTE AND CHRONIC MENTAL HEALTH CONDITIONS. GOAL 2: INCREASE PARTICIPATION IN LOCAL EDUCATIONAL OPPORTUNITIES AND CAMPAIGNS FOCUSED ON SUICIDE AND SELF-HARM AWARENESS.- TACTICS: COMMUNITY ENGAGEMENT AND MENTAL HEALTH AWARENESS INITIATIVES- SUPPORT FOR COMMUNITY EVENTS: AS BLACK RIVER HEALTH, WE CONTINUED TO SUPPORT LOCAL COMMUNITY EVENTS THROUGH GUEST SPEAKERS, FINANCIAL CONTRIBUTIONS, IN-KIND DONATIONS, AND EDUCATIONAL MATERIALS, ALL CONTRIBUTING TO INCREASED ATTENDANCE AND IMPACT, AS REFLECTED IN CBISA DATA.- BRMH WEBSITE MENTAL HEALTH RESOURCES: WE ACTIVELY MAINTAINED AND REFINED BRMH NOW BLACK RIVER HEALTH WEBSITE'S MENTAL HEALTH RESOURCES, OUTLINING COMPREHENSIVE SERVICE INFORMATION, TO PROVIDE ONGOING SUPPORT AND EDUCATION.- MENTAL HEALTH AWARENESS THROUGH MOMENTUM MAGAZINE: MENTAL HEALTH-RELATED CONTENT CONTINUED TO BE DISTRIBUTED THROUGH MOMENTUM MAGAZINE AND OTHER DIGITAL AND PRINT CHANNELS, FOCUSING ON RAISING AWARENESS ABOUT SUICIDE PREVENTION AND THE CRITICAL IMPORTANCE OF SEEKING HELP.PRIORITY 2-MENTAL HEALTH: ACCESSGOAL 1: IMPROVE EFFICIENCY AND COORDINATION OF BEHAVIORAL HEALTH SERVICES BY EXPANDING AND ALIGNING OFFERINGS WITH PATIENT NEEDS.TACTICS: ENHANCE IN BEHAVIORAL HEALTH SERVICES & AWARENESS:- TELEHEALTH BEHAVIORAL HEALTH SERVICES: CONTINUED OFFERINGS TO INCLUDE BOTH IN-OFFICE TELEHEALTH ROOMS AND OFF-SITE TELEHEALTH OPTIONS, ENSURING GREATER ACCESSIBILITY FOR PATIENTS.- OPERATIONAL IMPROVEMENTS: OPTIMIZED PROVIDER SCHEDULING, INCREASING OVERALL EFFICIENCY AND ACCESS TO BEHAVIORAL HEALTH SERVICES FOR OUR PATIENTS.- MARKETING CAMPAIGNS: STRATEGIC MARKETING CAMPAIGNS WERE LAUNCHED TARGETING BOTH REFERRAL SOURCES AND THE GENERAL PUBLIC, AIMED AT RAISING AWARENESS OF OUR LOCAL SERVICES.- BLACK RIVER HEALTH MENTAL HEALTH SERVICES: IN 2025, TWO CLINIC LOCATIONS (KROHN AND BLACK RIVER HEALTH CARE CENTER WERE SUCCESSFULLY INTEGRATED, ALLOWING FOR SHARED RESOURCES AND MORE COLLABORATIVE CARE FOR BOTH ACUTE AND CHRONIC MENTAL HEALTH CONDITIONSGOAL 2: DEVELOP STRATEGIC PARTNERSHIPS TO EXPAND BEHAVIORAL HEALTH SERVICES FOR UNDERSERVED POPULATIONS.TACTICS: BEHAVIORAL HEALTH AND ACCESS TO CARE INITIATIVES- SCHOOL-BASED MENTAL HEALTH PLANNING: ONSITE SERVICES TO LOCAL SCHOOL DISTRICT WAS EVALUATED AND CONTINUES AS PART OF BLACK RIVER HEALTH-MENTAL HEALTH SERVICE OFFERINGS, PLACING A LCSW ON SITE AT BLACK RIVER SCHOOL DISTRICT.- BEHAVIORAL HEALTH SERVICES IN THE EMERGENCY DEPARTMENT: CONTINUED OFFERING ON-DEMAND TELEHEALTH BEHAVIORAL HEALTH SUPPORT WITHIN THE ED, INCLUDING TIMELY ASSESSMENTS AND REFERRALS FOR INPATIENT PSYCHIATRIC CARE WHEN NEEDED.- EXPANDED FINANCIAL ASSISTANCE PROGRAM: ENHANCED PROMOTION OF THE FINANCIAL ASSISTANCE PROGRAM THROUGH TARGETED PATIENT OUTREACH AND COMMUNITY COMMUNICATION EFFORTS. POLICY UPDATES BROADENED ELIGIBILITY CRITERIA BASED ON INCOME, IMPROVING ACCESS TO CARE. EXTERNAL AGENCIES, INCLUDING PUBLIC HEALTH, RECEIVED TRAINING ON THE REVISED POLICY TO IMPROVE COMMUNITY ALIGNMENT AND AWARENESS.PRIORITY 3-HEALTHCARE ACCESS, AFFORDABILITY, AND AVAILABILITYGOAL 1: INCREASE THE EFFICIENCY OF CARE DELIVERY ACROSS ALL BRMH SERVICE LINES.TACTICS: REFINE CLINICAL OPERATIONS & CARE COORDINATION - EVALUATION OF CLINICAL STAFFING AND OPERATIONS: CLINICAL DEPARTMENTS CONDUCTED COMPREHENSIVE REVIEWS OF STAFFING MODELS AND OPERATIONAL WORKFLOWS. CMS-REPORTED DATA AND NATIONAL STANDARDS OF PRACTICE WERE ADOPTED TO ALIGN WITH EVIDENCE-BASED BEST PRACTICES. THE QAPI COMMITTEE OVERSEES OUTCOME TRACKING AND PROCESS IMPROVEMENTS TO ADVANCE QUALITY, EFFICIENCY, AND PATIENT-CENTERED CARE.- SUSTAINED TELEHEALTH SERVICES: MAINTAINED TELEHEALTH OFFERINGS TO ENSURE ACCESS TO SPECIALTY SERVICES, INCLUDING ACUTE MENTAL HEALTH CARE, TELE-ICU SERVICES, AND TELE-STROKE CARE, ENABLING ACCESS TO CRITICAL AND TIME-SENSITIVE CARE.- STRATEGIC REGIONAL COLLABORATION: BLACK RIVER HEALTH JOINED THE CIBOLA HIGH VALUE NETWORK, THIS NETWORK ALLOWS INDEPENDENT RURAL HOSPITALS TO COLLABORATE, ENHANCING CARE QUALITY AND REDUCING ADMINISTRATIVE BURDENS. GOAL 2: IMPROVE AFFORDABILITY OF LOCAL, HIGH-QUALITY CARE THROUGH RESPONSIBLE RESOURCE MANAGEMENT AND EXTERNAL FUNDINGTACTICS: ORGANIZATION OF INTERNAL AND EXTERNAL COLLABORATIVE PARTNERS AND FUNDING SOURCES - OPTIMIZED 340B PROGRAM PARTICIPATION: REFINED BRMH'S ENGAGEMENT WITH THE 340B DRUG PRICING PROGRAM TO MAXIMIZE COST SAVINGS, EXTENDING PRACTICES TO BLACK RIVER HEALTH CLINIC LOCATIONS. SAVINGS ARE REINVESTED TO OFFSET OPERATIONAL COSTS AND SUPPORT THE EXPANSION OF ESSENTIAL HEALTHCARE SERVICES, IMPROVING OVERALL ACCESS AND AFFORDABILITY FOR OUR PATIENTS.- BLACK RIVER HEALTH PHARMACY: ESTABLISHED IN OCTOBER 2025, IT WAS FOUNDED TO KEEP CARE LOCAL WHILE IMPROVING COORDINATION BETWEEN FAMILY MEDICINE AND PHARMACY THERAPEUTICS.- ONCOLOGY SERVICE LINE REFINEMENT: ESTABLISHED A LOCAL ONCOLOGY SERVICE LINE IN PARTNERSHIP WITH KROHN CLINIC AND GUNDERSEN LUTHERAN. THIS INITIATIVE PROVIDES PATIENTS WITH ACCESS TO ONCOLOGISTS, INFUSION THERAPY, AND DIAGNOSTIC SERVICES WITHIN THE COMMUNITY, REDUCING TRAVEL BURDENS AND IMPROVING CONTINUITY OF CARE.- ORTHOPEDIC SERVICE LINE EXPANSION: LAUNCHED BLACK RIVER HEALTH'S ORTHOPEDIC SERVICE LINE IN 2025 TO MEET GROWING COMMUNITY DEMAND FOR SPECIALIZED SERVICES, ENHANCING LOCAL ACCESS AND REDUCING THE NEED FOR OUT-OF-AREA REFERRALS.- BLACK RIVER HEALTH INTEGRATION OF SERVICES: IN THE FIRST YEAR OF INCORPORATING HOSPITAL AND CLINIC SERVICES, COMPLETED INTEGRATION OF KEY SERVICE AREAS FOR ALL LOCATIONS ON BLACK RIVER HEALTH CAMPUS, FOCUSING ON DELIVERING COORDINATED, COMPREHENSIVE CARE ACROSS THE CONTINUUM. THE FOCUS CONTINUES TO IMPROVE ACCESS AND BUILD RESPONSIVE SERVICE LINES TAILORED TO LOCAL NEEDS- SUSTAINABLE ENERGY INITIATIVES: CONTINUING TO MANAGE AND EXPLORE SUSTAINABLE ENERGY SOLUTIONS TO REDUCE LONG-TERM OPERATIONAL COSTS AND ADVANCE ENVIRONMENTAL STEWARDSHIP. THESE INITIATIVES SUPPORT FISCAL RESPONSIBILITY AND ALIGN WITH OUR COMMITMENT TO COMMUNITY WELL-BEING. ONGOING FACILITIES MANAGEMENT PLANNING WILL OCCUR WITH THE EXPANSION OF CARE LOCATIONS. BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 13B: PROPENSITY TO PAY BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 13H: THE HOSPITAL WILL CONSIDER THE OTHER DEBTS OF THE PATIENT. A PATIENT'S HOSPITAL BILL THAT IS LARGE IN COMPARISON TO THE PATIENT'S INCOME IS ALSO CONSIDERED FOR CATASTROPHIC CARE. BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 16J: THE HOSPITAL POSTS A NOTICE IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION ARE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. BLACK RIVER HEALTH, INC. PART V, SECTION B, LINE 20E: THE HOSPITAL POSTS A NOTICE IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICE STATING THAT THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE UPON REQUEST. THE FINANCIAL ASSISTANCE GUIDELINES AND CONTACT INFORMATION ARE ALSO MADE AVAILABLE ON THE HOSPITAL'S WEBSITE. PART I, LINE 6A: BLACK RIVER 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 DATABASE AND WEBSITE. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT 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. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT BLACK RIVER HEALTH, INC. INCLUDE THE OPERATION OF THE HOSPITAL'S INPATIENT NURSING UNIT AND EMERGENCY ROOM. THE SUBSIDIZED INPATIENT UNIT INCLUDES THE MEDICAL/SURGICAL, OBSERVATION, OB AND HOSPITALIST NURSING UNITS. THE HOSPITAL INPATIENT UNIT DEPARTMENT AND EMERGENCY ROOM OPERATES 24-HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A GROUP OF HIGHLY TRAINED STAFF INCLUDING HOSPITALIST PHYSICIANS, REGISTERED NURSES, AND OTHER SUPPORT STAFF. MANY OF THE ADMISSIONS TO THE HOSPITAL INPATIENT NURSING UNIT COME FROM THE HOSPITAL'S EMERGENCY DEPARTMENT WHICH IS OPERATED TO PROVIDE EMERGENCY CARE TO PATIENTS OF THE COMMUNITY AND SURROUNDING AREAS. ALL OF THESE SUBSIDIZED HEALTH SERVICES WORK IN SUPPORT AND COOPERATION WITH THE COMBINED EFFORTS OF BLACK RIVER HEALTH, INC. AND SHARE MANY SUPPORT FUNCTIONS OF THE HOSPITAL IN AN EFFORT TO PROVIDE EXCELLENT, LOW COST CARE TO PATIENTS IN THEIR LOCAL COMMUNITY AND AREA. A SIGNIFICANT PAYOR FOR THESE PROGRAMS IS THE MEDICARE PROGRAM WHICH DOES NOT REIMBURSE THE HOSPITAL FOR THESE SERVICES IN ALL CASES BASED ON COST SO A SIGNIFICANT LOSS IS ABSORBED BY THE HOSPITAL TO PROVIDE THESE SERVICES TO MEMBERS OF THE COMMUNITY. IT IS THE GOAL OF BLACK RIVER HEALTH, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.THE COSTING METHODOLOGY FOR SUBSIDIZED HEALTH SERVICES IS BASED ON THE COSTING METHODS USED ON THE HOSPITAL'S MEDICARE COST REPORT. THIS METHODOLOGY PROVIDES FOR A DIRECT ALLOCATION OF EXPENSES AS WELL AS PROVIDING THE SAME DATA TO THE MEDICARE PROGRAM AS WELL AS TO THE IRS FOR FORM 990 PURPOSES. 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 $ 6,327,863. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PROVIDES FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT THAT IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES AND SAME DAY APPOINTMENTS THROUGH THE BLACK RIVER HEALTHCARE CLINIC, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SPEECH, SURGICAL SERVICES, AND WOMEN'S HEALTH. WE DISCONTINUED OUR HOMECARE AND HOSPICE PROGRAMS IN MAY 2023 AND BEGAN CCM AND TCM SERVICES. IN PARTNERSHIP WITH KROHN CLINIC AND GUNDERSEN LUTHERAN, WE CONTINUED PROVIDING OUR ONCOLOGY SERVICE LINE IN 2025. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: 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 ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: BLACK RIVER HEALTH, INC. IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS MEDICARE REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY 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 BLACK RIVER HEALTH, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF JACKSON COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO 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) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES. PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND COMMUNITY CARE POLICIES, BLACK RIVER HEALTH, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S COMMUNITY 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 FINANCIAL COUNSELOR 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 COMMUNITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE HOSPITAL RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES. PART VI, LINE 2: EVERY THREE YEARS, BRH CONSIDERS OUR COMMUNITY'S MOST PRESSING HEALTH NEEDS BY CONDUCTING A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE 2025 ASSESSMENT WAS COMPLETED BY A GROUP OF HOSPITAL EMPLOYEES AND INCLUDES QUANTITATIVE AND QUALITATIVE DATA THAT SERVE TO GUIDE BOTH OUR COMMUNITY BENEFIT AND STRATEGIC PLANNING. THROUGH OUR CHNA, BRH HAS IDENTIFIED THE GREATEST HEALTH NEEDS IN OUR HOSPITAL'S COMMUNITIES ENABLING BRH TO ENSURE OUR RESOURCES ARE APPROPRIATELY DIRECTED TOWARD OUTREACH, PREVENTION, EDUCATION, AND WELLNESS OPPORTUNITIES WHERE THE GREATEST IMPACT CAN BE ACHIEVED. DURING THE 2025 ASSESSMENT WE IDENTIFIED THE TOP THREE NEEDS TO MENTAL HEALTH SUICIDE AND SELF-HARM PREVENTION, ACCESS TO MENTAL HEALTH SERVICES, AND ACCESS, AVAILABILITY, AND AFFORDABILITY OF HEALTHCARE. THE ORGANIZATION IS IN THE PROCESS OF PLANNING FOR OUR NEXT CHNA IN 2028. PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S PATIENT FINANCIAL ADVOCATES EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE PATIENT FINANCIAL ADVOCATE EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM AND OFFERS THE FINANCIAL ASSISTANCE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGER CARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR BLACK RIVER HEALTH, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 30-MILE RADIUS OF THE HOSPITAL. THIS AREA INCLUDES JACKSON COUNTY AND PARTS OF EAU CLAIRE, MONROE, LA CROSSE, TREMPEALEAU, WOOD, ADAMS, AND CLARK COUNTIES. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE ALMA CENTER, BLAIR, HIXTON, HUMBIRD, MELROSE, MERRILLAN, SPARTA, OSSEO, TOMAH, NEILLSVILLE, AND WHITEHALL. BLACK RIVER HEALTH, INC. IS THE ONLY HOSPITAL LOCATED IN JACKSON COUNTY, WISCONSIN. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS AS WELL AS THE HO-CHUNK NATION (A LOCAL TRIBAL NATION WITH A LARGE PORTION OF ITS POPULATION RESIDING IN JACKSON COUNTY, WISCONSIN). THE HO-CHUNK NATION ALSO IS ABLE TO ACCESS CARE AT THE HOSPITAL AT REDUCED RATES THROUGH A REGULATION KNOWN AS THE "MEDICARE-LIKE PAYMENTS RULE." THE HOSPITAL ALSO IS A SUPPLIER OF HEALTH CARE SERVICES TO FIVE STATE OPERATED INSTITUTIONS WHICH ARE OPERATED BY THE WISCONSIN DEPARTMENT OF CORRECTIONS. THE STATE OF WISCONSIN ALSO REIMBURSES THE HOSPITAL AT RATES BELOW THE GENERAL PUBLIC TO REDUCE COSTS PASSED ON TO TAXPAYER IN THE STATE. PART VI, LINE 5: AS A COMMUNITY-OWNED HOSPITAL, BLACK RIVER HEALTH, INC. CONTINUES TO BE PROACTIVELY INVOLVED WITH AREA COMMUNITY MEMBERS THROUGH A VARIETY OF EDUCATIONAL FORUMS, SUPPORT GROUPS, WELLNESS AND SAFETY FAIRS, DIABETES FAIR, HO-CHUNK HEALTH FAIR, KIDS' SAFETY CAMP, PRE-NATAL AND BREASTFEEDING CLASSES. OTHER SUPPORT GROUPS NOT ONLY INCLUDE DIABETES AND BEREAVEMENT, BUT WE OFFER A BETTER BREATHERS SUPPORT GROUP AND A BETTER SLEEPERS SUPPORT GROUP. THERE ARE A NUMBER OF LOCAL ORGANIZATIONS THAT ARE REPRESENTED OR FACILITATED BY HOSPITAL STAFF INCLUDING: JACKSON IN ACTION, GREATER BLACK RIVER AREA SAFETY COUNCIL, JACKSON COUNTY HEALTHCARE ALLIANCE, JACKSON COUNTY TOBACCO COALITION, TOGETHER FOR JACKSON COUNTY KIDS, JACKSON COUNTY EMERGENCY MANAGEMENT PLANNING WORKFORCE, AND MANY OTHERS. THE HOSPITAL WELCOMES MEDICAL STUDENTS FOR INTERNSHIPS AND CLINICALS. THE HOSPITAL ALSO PARTICIPATES IN THE MEALS ON WHEELS PROGRAM BY DELIVERING MEALS TO LOCAL SENIORS WHO ARE HOME BOUND. THE HOSPITAL ALSO PROVIDES SUPPORT AND SPONSORSHIP TO THE RED CROSS BLOODMOBILE SEVERAL TIMES A YEAR. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES WI X X X X 1 1 0 0 0 0 0 0 0 DR NICHOLAS KITOWSKI DIRECTOR/PHYSICIAN 513671 0 50000 0 519 0 46934 0 47885 0 659009 0 0 0 DR CAROL MARTIN CHIEF OF STAFF/DIR. 377752 0 137512 0 1548 0 47139 0 50669 0 614620 0 0 0 DR DARIN ANTONELLI PHYSICIAN 447855 0 30000 0 1489 0 43661 0 48254 0 571259 0 0 0 CARL SELVICK CEO 386450 0 96196 0 29312 0 45310 0 6349 0 563617 0 0 0 HOLLY WINN CFO 339251 0 96427 0 1548 0 47060 0 42245 0 526531 0 0 0 DR MICHELLE CLARK-FORSTING DIR./CHIEF PHYS. EXEC. 314543 0 36000 0 12623 0 37154 0 51417 0 451737 0 0 0 DR EDWARD ZHOVTIS PHYSICIAN 270163 0 92529 0 1548 0 38089 0 43460 0 445789 0 0 0 DR JOHN MURPHY PHYSICIAN 341202 0 21478 0 1548 0 39322 0 39845 0 443395 0 0 0 DR ESTEBAN MILLER PHYSICIAN 277079 0 10865 0 80637 0 21167 0 37764 0 427512 0 0 0 DR JESSE SUSA PHYSICIAN 310867 0 30000 0 312 0 36704 0 49323 0 427206 0 0 0 CATHY BUKOWSKI VP OF FINANCE/CFO 189011 0 15000 0 3243 0 18845 0 15868 0 241967 0 0 0 MARY BETH WHITE-JACOBS FORMER CEO 0 0 0 0 133366 0 0 0 0 0 133366 0 0 0 PART I, LINES 4A-B SCHEDULE J, PART I, LINE 4A: THE FOLLOWING EMPLOYEES RECEIVED SEVERANCE PAYMENTS, INCLUDED IN TAXABLE COMPENSATION, DURING 2025: DR. ESTEBAN MILLER - $80,000 MARY BETH WHITE-JACOBS - $133,366 SCHEDULE J, PART I, LINE 4B: BLACK RIVER HEALTH HAS CERTAIN EMPLOYEES THAT PARTICIPATE IN A 457(F) PLAN. THERE WERE NO DISTRIBUTIONS IN 2025. HOWEVER, THERE WERE EMPLOYER CONTRIBUTIONS FOR THE FOLLOWING INDIVIDUALS: DR. CAROL MARTIN - $26,139 HOLLY WINN - $26,060 CARL SELVICK - $24,310 DR. MICHELLE CLARK-FORSTING - $16,154 CATHY BUKOWSKI - $7,608 DR. NICHOLAS KITOWSKI - $25,934 DR. DARRIN ANTONELLI - $22,661 DR. ESTEBAN MILLER - $13,167 EDWARD ZHOVTIS - $18,589 DR. JOHN MURPHY - $18,322 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-02-01 24000000 HOSPITAL ADDITIONS AND RENOVATIONS; REFUNDING OF 2005 BOND SERIES 0 0 0 A 6457424 24000000 10163311 146704 13689985 2019 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/01/2024 MICHAEL JACOBS SON OF MARY BETH WHITE-JACOBS, FORMER CEO 96803 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS OF BLACK RIVER HEALTH, INC. RECEIVED A COPY OF THE 990 FOR REVIEW PRIOR TO THE FILING OF THEIR RETURN. MEMBERS OF THE BOARD WILL DO A FORMAL REVIEW OF THE FORM AFTER FILING. THE HOSPITAL'S CHIEF OFFICERS REVIEWED THE RETURN IN DETAIL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C CONFLICTS OF INTEREST ARE REVIEWED ANNUALLY BY THE BOARD OF DIRECTORS. ANY ISSUES WHICH MAY ARISE ARE DISCUSSED AND HANDLED APPROPRIATELY. ANY MEMBER OF THE BOARD OF DIRECTORS WITH NOTED CONFLICTS ARE ASKED TO ABSTAIN FROM VOTING ON ANY POTENTIAL CONFLICTED ISSUES. A SIMILAR PROCESS IS USED BY THE BOARD OF DIRECTORS FOR THE REVIEW OF CONFLICTS OF INTEREST WITH THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY CONSIDERING COMPENSATION LEVELS AT SIMILAR SITUATED ORGANIZATIONS (TYPICALLY NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS IN THE SAME REVENUE CATEGORY OR GEOGRAPHICAL AREA). THE COMPENSATION OF ADMINISTRATIVE LEVEL EMPLOYEES IS REVIEWED BY THE CEO AND APPROVED IN THE BUDGET BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 BLACK RIVER HEALTH, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SUMMARIZED FINANCIAL STATEMENT DATA IS ALSO AVAILABLE THROUGH THE WISCONSIN HOSPITAL ASSOCIATION'S WEBSITE AND THE HOSPITAL'S ANNUAL REPORT, WHICH IS PUBLISHED ON THE HOSPITAL'S WEBSITE. FORM 990, PART IX, LINE 11G RADIOLOGY FEES: PROGRAM SERVICE EXPENSES 1,717,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,717,486. ANESTHESIOLOGY FEES: PROGRAM SERVICE EXPENSES 16,318. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,318. MRI/CT/NUCLEAR MED SERVICES: PROGRAM SERVICE EXPENSES 542,011. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 542,011. PHYSICIANS FEES: PROGRAM SERVICE EXPENSES 1,080,379. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,080,379. LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 294,682. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 294,682. OTHER: PROGRAM SERVICE EXPENSES 2,658,625. MANAGEMENT AND GENERAL EXPENSES 4,326,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,985,525.