2025-10-16T12:02:28-05:00 2024-09-30 393647910 WIPFLI ADVISORY LLC 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2023-10-01 391030310 GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION INC GREA 9203904000 672 JOHNSON ST 300 WATERTOWN WI 530943827 BEN WEHMEIER PRESIDENT 9203902269 2025-10-15 1 1 SOLOMON MARDAKHAEV P01806552 6105653930 2025-10-15 2023 2025-03-06 01:10:19Z X BEN WEHMEIER 672 JOHNSON ST 300 WATERTOWN WI 530943827 56201287 0 X WWW.WATERTOWNHEALTHFOUNDATION.COM X 1965 WI TO INSPIRE COLLABORATION, MOBILIZE RESOURCES AND ENCOURAGE INNOVATION THAT MEASURABLY CONTRIBUTES TO THE WELLBEING OF OUR COMMUNITIES. 15 13 9 20 0 0 288398 545727 22502946 23283979 3389729 6436099 137959 826633 26319032 31092438 1769211 5033523 0 0 1209668 1286129 0 0 0 23400926 24411570 26379805 30731222 -60773 361216 115519180 131180063 18771112 22603436 96748068 108576627 TO INSPIRE COLLABORATION, MOBILIZE RESOURCES AND ENCOURAGE INNOVATION THAT MEASURABLY CONTRIBUTES TO THE WELLBEING OF OUR COMMUNITIES. 0 0 29426853 5033523 23423207 GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION OPERATES AS A HEALTH FOUNDATION, SERVING AS A CATALYST FOR COMMUNITY HEALTH. WE LEAD OUR OWN FOUNDATION-DIRECTED HEALTH PROGRAMMING AND OFFER RESPONSIVE GRANT CYCLES. THE FOUNDATION HOLDS A 20% INTEREST IN WATERTOWN HOLDING COMPANY, LLC. THE FOUNDATION ALSO HOLDS MAJORITY OWNERSHIP INTEREST IN TWO SENIOR APARTMENT COMPLEXES, WATERTOWN SENIOR HOUSING, LLC AND WATERTOWN SENIOR HOUSING II, LLC. THE FOUNDATION HOLDS 100% INTEREST IN GWCHF HOLDINGS LLC, WHICH OPERATES A NONPROFIT CENTER AS WELL AS LAND FOR HOUSING REDEVELOPMENT PURPOSES. 29426853 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 11 0 9 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X X BEN WEHMEIER 9203902269 672 JOHNSON STREET SUITE 300 WATERTOWN WI 53094 TINA CRAVE PRESIDENT 40.00 X X 214596 0 30571 DEB PORTMAN SECRETARY 40.00 X X 50506 0 24577 MIKE SULLIVAN MD CHAIR 4.00 X X 0 0 0 MARGARET HANRAHAN VICE CHAIR 2.00 X X 0 0 0 RANDY PHELPS TREASURER 2.00 X X 0 0 0 ANDREA MERFELD SECRETARY (THRU JAN 2024) 30.00 X X 0 0 0 STEVEN BATTENBERG DIRECTOR 2.00 X 0 0 0 ELLIOT CLARK DIRECTOR 2.00 X 0 0 0 CHARLES EGGERT DIRECTOR (THRU DEC 2023) 2.00 X 0 0 0 ORLANDO DOMINGUEZ DIRECTOR 2.00 X 0 0 0 MEGAN HARTWICK DIRECTOR (THRU DEC 2023) 2.00 X 0 0 0 KARLA MULLEN DIRECTOR 2.00 X 0 0 0 WILLIAM OSWALD DIRECTOR 2.00 X 0 0 0 CAROL QUEST DIRECTOR 2.00 X 0 0 0 NATE SALAS DIRECTOR 2.00 X 0 0 0 TIM SCHULER DIRECTOR 2.00 X 0 0 0 MICK SELCK DIRECTOR 2.00 X 0 0 0 MARCY TESSMANN DIRECTOR 2.00 X 0 0 0 NATHAN PETERS CHIEF FINANCIAL OFFICER 40.00 X 137658 0 28540 KIMBERLY MELCHER CHIEF IMPACT OFFICER 40.00 X 125813 0 27804 528573 0 111492 3 0 1 0 0 200000 345727 545727 JOINT VENTURE - HOSPITAL 621110 22225833 22225833 JOINT VENTURE - SENIOR HOUSING 900002 1058146 1058146 23283979 2113900 2113900 687405 0 687405 687405 687405 29154318 276730 24904791 204058 4249527 72672 4322199 4322199 REIMBURSEMENT FOR TENANT IMPROVEM 900099 138804 138804 424 424 139228 31092438 23423207 0 7123504 5033523 5033523 616794 529268 87526 547416 485055 62361 60046 56095 3951 61873 48478 13395 57568 5436 52132 5340 5340 362752 362752 361701 361701 30074 1096 28978 76421 20640 55781 65201 65201 403324 403324 25198 819 24379 210373 192410 17963 809839 809839 694682 694682 75018 1166 73852 JOINT VENTURE - HOSPITA 20593544 20593544 REPAIRS AND MAINTENANCE 596614 537119 59495 DUES AND SUBSCRIPTIONS 17940 850 17090 STATE HOUSING COMPLIANC 4410 4410 21571 9099 12472 30731222 29426853 1304369 0 940870 2675654 236431 179658 1754 744 25813 824 26635645 5134017 20243599 21501628 76548272 87436850 16070535 17702824 1451906 1681881 115519180 131180063 734664 4411355 16728544 16652848 1307904 1539233 18771112 22603436 X 96748068 108527631 48996 96748068 108576627 115519180 131180063 X 361216 11090194 377149 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25000 25000 0 PART II-B, LINE 1: GRANT TO WISCONSIN EARLY CHILDHOOD ASSOCIATION: PURPOSE -SUPPORTING "RAISING WISCONSIN POLICY AGENDA" 3370820 3370820 21451184 4643788 16807396 1813641 490229 1323412 21501628 INVESTMENT IN WATERTOWN HOLDING COMPANY, LLC 17702824 F 17702824 SECURITY DEPOSITS PAYABLE 71646 LANDMARK LOANS PAYABLE 13583 DEFERRED COMPENSATION LIABILITY 1454004 1539233 19594047 11090194 11090194 8503853 362752 22225833 22588585 31092438 9774926 0 9774926 362752 20593544 20956296 30731222 PART XI, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL/JOINT VENTURE REVENUE 22,225,833. PART XII, LINE 4B - OTHER ADJUSTMENTS: HOSPITAL/JOINT VENTURE EXPENSES 20,593,544. 1 1 X 1 X 1 X 1 1 0 1 1 404028 404028 0.01360 2600110 695226 1904884 0.06420 3004138 695226 2308912 0.07780 16200 16200 0.00050 197881 167469 30412 0.00100 16009 16009 0.00050 230090 167469 62621 0.00200 3234228 862695 2371533 0.07980 1 286496 3267936 3718317 -450381 X 1 1 1 1 WATERTOWN REGIONAL MEDICAL CENTER LLC 125 HOSPITAL DR WATERTOWN WI 53098 HTTP://WWW.WATERTOWNREGIONAL.COM/ 105 X X X WATERTOWN REGIONAL MEDICAL CENTER LLC 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.WATERTOWNREGIONAL.COM/COMMUNITY-HEALTH-ASSESSMENT X WWW.WATERTOWNHEALTHFOUNDATION.COM/OURPRIORITIES.HTML#POPUP2 X 1 22 1 SEE SCHEDULE H, PART V, SECTION C FOR FULL WEBSITE 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, LINE 16J FOR FULL WEBSITE X SEE PART V, LINE 16J FOR FULL WEBSITE X SEE PART V, LINE 16J FOR FULL WEBSITE X X X X X 1 X 0 X X X 1 X 0 0 WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 5: WE HELD THREE FOCUS GROUPS IN THREE COMMUNITIES BETWEEN TWO COUNTIES AND A COMMUNITY NEEDS ASSESSMENT SUMMIT WHERE INPUT WAS OBTAINED FROM A DIVERSE GROUP OF STAKEHOLDERS. WATERTOWN REGIONAL MEDICAL CENTER AND FORT HEALTHCARE SURVEYED THEIR EMPLOYEES INCLUDING PROVIDERS. COMMUNITY WIDE SURVEYS WERE AVAILABLE IN DODGE AND JEFFERSON COUNTY AT VARIOUS LOCATIONS INCLUDING IN AN ELECTRONIC AND PAPER FORM AS WELL AS ENGLISH AND SPANISH. WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 6A: FORT HEALTHCARE AND BEAVER DAM COMMUNITY HOSPITAL (NOW MARSHFIELD MEDICAL CENTER BEAVER DAM) WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 6B: DODGE COUNTY HUMAN SERVICES & HEALTH DEPARTMENT; GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION; JEFFERSON COUNTY HEALTH DEPARTMENT; ROCK RIVER COMMUNITY CLINIC; WATERTOWN DEPARTMENT OF PUBLIC HEALTH WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 11: BASED ON THE RESULTS OF THE CHNA, WATERTOWN REGIONAL MEDICAL CENTER HAS SELECTED THREE OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS. 1. ACCESS TO AFFORDABLE, QUALITY MENTAL HEALTH CARE2. EQUITABLE ACCESS TO COMMUNITY-BASED RESOURCES AND SUPPORT3. ACCESS TO AFFORDABLE, QUALITY HOUSING AND AFFORDABLE, RELIABLE TRANSPORTATION4. ACCESS TO AFFORDABLE, QUALITY CHILDCAREWATERTOWN REGIONAL MEDICAL CENTER PLANS TO MEET THE SIGNIFICANT HEALTH NEED BY: 1. ACCESS TO AFFORDABLE, QUALITY MENTAL HEALTH CARE WATERTOWN REGIONAL MEDICAL CENTER UNDERSTANDS THE IMPORTANCE OF MENTAL HEALTH CARE. AS SUCH, WRMC WILL CONTINUE TO PROVIDE THE FOLLOWING SERVICES:OUTPATIENT BEHAVIORAL HEALTH SERVICES: DIRECTIONS COUNSELING CENTER, LOCATED AT 123 HOSPITAL DRIVE SUITE 110, OFFERS OUTPATIENT MENTAL HEALTH SERVICES. DIRECTIONS COUNSELING CENTER OFFERS INDIVIDUAL COUNSELING, CHILDREN AND ADOLESCENTS COUNSELING, MARRIAGE AND FAMILY COUNSELING, ALCOHOL AND OTHER DRUG COUNSELING AS WELL AS MEDICATION MANAGEMENT. THIS CLINIC CONSISTS OF FOUR LICENSED THERAPISTS, A PSYCHOLOGIST, AND A PSYCHIATRIC NURSE PRACTITIONER. DIRECTIONS COUNSELING CENTER UNDERSTANDS THE IMPORTANCE OF MAKING BEHAVIORAL HEALTH SERVICES ACCESSIBLE AND CONVENIENT FOR PATIENTS AND, AS SUCH, WRMC WILL CONTINUE TO OFFER BEHAVIORAL HEALTH APPOINTMENTS. THE APPOINTMENTS WILL BE PROVIDED IN WATERTOWN AT THE DIRECTIONS COUNSELING CENTER, VIRTUALLY USING SECURE TECHNOLOGY, AND AT OTHER WRMC CLINIC LOCATIONS INCLUDING LAKE MILLS AND JOHNSON CREEK. COLUMBIA SUICIDE SCREENING: WATERTOWN REGIONAL MEDICAL CENTER UTILIZES THE COLUMBIA SUICIDE SEVERITY RATING SCALE THROUGHOUT THE HOSPITAL AND CLINICS TO SCREEN ALL PATIENTS 12 YEARS AND OLDER FOR RISK OF SUICIDE. THOSE INDIVIDUALS WHO RATE MODERATE TO HIGH RISK ARE REFERRED TO COMMUNITY BEHAVIORAL HEALTH RESOURCES TO ENSURE THEIR SAFETY. WRMC WILL CONTINUE TO SCREEN PATIENTS.INPATIENT GERIATRIC PSYCHIATRY: WATERTOWN REGIONAL MEDICAL CENTER CURRENTLY HAS A 15-BED INPATIENT BEHAVIORAL HEALTH UNIT SPECIFIC TO SERVING ADULTS 55 YEARS AND OLDER WHO ARE EXPERIENCING ACUTE PSYCHIATRIC SYMPTOMS THAT ARE PUTTING THE INDIVIDUAL OR OTHERS AT IMMEDIATE RISK OR DANGER DUE TO THEIR MENTAL ILLNESS. THIS UNIT HAS SERVED HUNDREDS OF OLDER ADULTS WHO NEED ACUTE CRISIS STABILIZATION AND WILL CONTINUE TO DO SO. WRMC ACKNOWLEDGES THAT THE NEED FOR THIS SERVICE MAY QUICKLY OUTGROW THE CURRENT UNIT. THEREFORE, CURRENTLY, WRMC IS EXPLORING THE IDEA OF ADDING 11-BEDS TO THEIR INPATIENT GERIATRIC PSYCHIATRY PROGRAM. 2. EQUITABLE ACCESS TO COMMUNITY-BASED RESOURCES AND SUPPORT WATERTOWN REGIONAL MEDICAL CENTER STRIVES TO ENSURE ALL PATIENTS HAVE EQUAL ACCESS TO COMMUNITYBASED RESOURCES AND SUPPORT. ROCK RIVER COMMUNITY CLINIC: THE ROCK RIVER COMMUNITY CLINIC PROVIDES MEDICAL AND DENTAL CARE TO THOSE THAT ARE UNDERINSURED AND UNINSURED IN DODGE, JEFFERSON, AND WALWORTH COUNTY. THE ROCK RIVER COMMUNITY CLINIC HAS A CLINIC LOCATION IN WATERTOWN, WI. WRMC PROVIDES LAB AND IMAGING SERVICES FOR PATIENTS OF THE ROCK RIVER COMMUNITY CLINICWATERTOWN. THE COSTS OF THESE SERVICES ARE DONATED BY WRMC. WRMC UNDERSTANDS HOW VALUABLE THIS CLINIC IS TO THE RESIDENTS OF OUR COMMUNITY THEREFORE WRMC WILL CONTINUE ITS SUPPORT.MEDICAID ELIGIBILITY: WATERTOWN REGIONAL MEDICAL CENTER IS COMMITTED TO ASSESSING WHETHER CURRENT PATIENTS WHO ENTER OUR ORGANIZATION ARE ELIGIBLE FOR MEDICAID. OFTEN THE PROCESS OF APPLYING FOR MEDICAID CAN BE OVERWHELMING TO PATIENTS DUE TO THE NUMBER OF FORMS AND DOCUMENTATION THAT IS REQUIRED OF THEM. MEDICAID OFFERS A VARIETY OF SERVICES THAT PATIENTS MAY BENEFIT SUCH AS MEDICAL CARE AND TRANSPORTATION. WRMC WILL CONTINUE TO ASSIST PATIENTS THROUGH THE MEDICAID APPLICATION PROCESS TO DETERMINE ELIGIBILITY. CASE MANAGEMENT: WATERTOWN REGIONAL MEDICAL CENTER CURRENTLY HAS A CASE MANAGEMENT TEAM THAT PROVIDES PATIENTS DISCHARGING FROM THE HOSPITAL RESOURCES TO MAINTAIN HEALTH AND WELLNESS. OUR CASE MANAGEMENT TEAM ASSISTS WITH ARRANGING SERVICES SUCH AS LONG-TERM CARE PLACEMENT, HOME HEALTH SERVICES, WOUND-CARE, PALLIATIVE AND HOSPICE SERVICES, AFTER-CARE FOLLOW UP WITH PRIMARY CARE, BEHAVIORAL HEALTH FOLLOW UP, AND IN-HOME HEALTH AGENCIES. OUR CASE MANAGEMENT TEAM WORKS CLOSELY WITH DODGE AND JEFFERSON COUNTY ADULT PROTECTIVE SERVICES (APS) AND THE AGING AND DISABILITY RESOURCE CENTERS (ADRC) AS WELL AS COUNTY CRISIS TEAMS. OUR CASE MANAGEMENT TEAM MAKES REFERRALS TO COUNTY ADRCS FOR LONG-TERM CARE FUNDING, MEALS ON WHEELS, SUPPORT GROUPS, AND ADDITIONAL RESOURCES. WRMC WILL CONTINUE TO SCREEN PATIENTS FOR POTENTIAL NEEDS POST-MEDICAL CARE. CENTER FOR WOMEN'S HEALTH-SOCIAL DETERMINANTS OF HEALTH SCREENING: IN PARTNERSHIP WITH THE LOCAL WELCOME BABY COALITION, WATERTOWN REGIONAL MEDICAL CENTER IS COMMITTED TO FULFILLING WELCOME BABY'S FOCUS OF ENSURING ALL FAMILIES HAVE SUPPORT AND THE NECESSARY TO BE CONFIDENT IN PROVIDING A SAFE, STABLE, AND SUPPORTIVE ENVIRONMENT FOR NEWBORNS. WRMC'S CENTER FOR WOMEN'S HEALTH WILL ASSESS EACH EXPECTING MOTHER'S SOCIAL DETERMINANTS OF HEALTH ON WEEK EIGHT AND WEEK TWENTY OF THEIR PRENATAL CARE. IF AN EXPECTING MOTHER SCORES HIGH IN A CERTAIN AREA SUCH AS HOUSING, TRANSPORTATION, ACCESS TO FOOD, ETC., THEY WILL MAKE THE NECESSARY REFERRAL TO LOCAL AGENCIES WHO CAN ASSIST THESE MOTHERS SUCH AS PUBLIC HEALTH, WATERTOWN FAMILY CONNECTIONS, WIC, ETC. WRMC WILL CONTINUE TO BE AN ACTIVE AND PARTICIPATE IN THE WELCOME BABY COALITION ENSURING WE ARE MEETING THE NEEDS OF OUR EXPECTING MOTHERS WITHIN OUR COMMUNITY. SPANISH TRANSLATED DOCUMENTATION: WATERTOWN REGIONAL MEDICAL CENTER WILL CONTINUE TO MAKE MORE HOSPITAL AND CLINIC SIGNAGE, FORMS, AND DOCUMENTS AVAILABLE IN SPANISH. 3. ACCESS TO AFFORDABLE, QUALITY HOUSING AND AFFORDABLE, RELIABLE TRANSPORTATION WRMC UNDERSTANDS THAT ACCESS TO QUALITY AFFORDABLE HOUSING IMPACTS THE HEALTH OUTCOMES OF THE COMMUNITY. AS SUCH, WRMC LEADERS HAVE COMMITTED TO ASSISTING GROUPS THAT WORK ON THESE ISSUES. FOR EXAMPLE, EVERY CHILD THRIVES PARTNERS WILL HOST A COMMUNITY HOUSING SUMMIT IN 2023 TO HELP COMMUNITY LEADERS BETTER UNDERSTAND THE CHALLENGES AND OPPORTUNITIES. WRMC LEADERS WILL PARTICIPATE IN THIS SUMMIT AND ADD PERSPECTIVE AND LEADERSHIP AS NEEDED.4. ACCESS TO AFFORDABLE, QUALITY CHILDCARE WRMC UNDERSTANDS THAT ACCESS TO QUALITY, AFFORDABLE CHILDCARE IMPACTS THE HEALTH OUTCOMES OF THE COMMUNITY. WRMC IS A MEMBER OF EVERY CHILD THRIVES, A PARTNERSHIP OF 50+ AGENCIES ACROSS DODGE AND JEFFERSON COUNTIES WORKING TO EXPAND CHILDCARE. WRMC LEADERS SERVE ON THE LEADERSHIP COUNCIL FOR THIS COLLABORATIVE EFFORT. WRMC'S ROLE IN THIS EFFORT IS TO SUPPORT COMMUNITY THINKING, PROVIDE ACCESS TO POPULATION-LEVEL HEALTH DATA, AND ADVOCATE AT THE LOCAL AND STATE LEVELS FOR POLICIES THAT PROMOTE ACCESS TO QUALITY EARLY CARE AND EDUCATION. WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 16J: FULL WEBSITE FOR FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.WATERTOWNREGIONAL.COM/FINANCIAL-ASSISTANCE-PROGRAMTHE HOSPITAL WAS NOT REQUIRED TO TRANSLATE THE FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY INTO ANY LEP LANGUAGES. THERFORE, SCHEDULE H, PART V, LINE 16I WAS ANSWERED NO. 13 1 - EYE PHYSICIAN PRACTICE 123 HOSPITAL DRIVE SUITE 1002 WATERTOWN WI 53098 EYE PHYSICIAN PRACTICE 2 - ORTHOPEDICS AND SPORTS MEDICINE CLINIC 123 HOSPITAL DRIVE SUITE 1008 WATERTOWN WI 53098 ORTHOPEDICS AND SPORTS MEDICINE CLINIC 3 - AODAMENTAL COUNSELING 125 HOSPITAL DRIVE SUITE 110 WATERTOWN WI 53098 AODA/MENTAL COUNSELING 4 - OBGYN PHYSICIAN PRACTICE 128 HOSPITAL DRIVE WATERTOWN WI 53098 OB/GYN PHYSICIAN PRACTICE 5 - PHYSICIAN PRACTICE 1507 DOCTORS COURT WATERTOWN WI 53094 PHYSICIAN PRACTICE 6 - PHYSICIAN PRACTICE 134 HOSPITAL DRIVE WATERTOWN WI 53098 PHYSICIAN PRACTICE 7 - PULMONOLOGY CENTER 123 HOSPITAL DRIVE SUITE 2009 WATERTOWN WI 53098 PULMONOLOGY CENTER 8 - UROLOGY CLINIC 123 HOSPITAL DRIVE SUITE 2006 WATERTOWN WI 53098 UROLOGY CLINIC 9 - PHYSICIAN PRACTICE 102 VILLAGE WALK LANE JOHNSON CREEK WI 53038 PHYSICIAN PRACTICE 10 - PHYSICIAN PRACTICE 1025 MULBERRY STREET LAKE MILLS WI 53551 PHYSICIAN PRACTICE 11 - PHYSICIAN PRACTICE 111 ANNA STREET WATERLOO WI 53594 PHYSICIAN PRACTICE 12 - OCCUPATIONAL HEALTH 123 HOSPITAL DRIVE SUITE 2004 WATERTOWN WI 53098 OCCUPATIONAL HEALTH 13 - PHYSICIAN PRACTICE 334 S WESTERN AVE JUNEAU WI 53039 PHYSICIAN PRACTICE PART I, LINE 7: MEDICARE COST REPORT COST TO CHARGE RATIO PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBTS EXCLUDED FROM THE CALCULATIONS IS 20% OF THE TOTAL HOSPITAL BAD DEBTS ($1,052,340). THE ORGANIZATION OWNS 20% OF THE HOSPITAL. SCHEDULE H, PART I, LINE 7 THE INFORMATION PRESENTED IN THE TABLE REPRESENTS 20% OF THE INFORMATION PRESENTED ON THE 12/31/23 K-1 OF WATERTOWN REGIONAL MEDICAL CENTER. GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION OWNS A 20% INTEREST IN THE HOSPITAL. SCHEDULE H, PART I, LINE 6 THE COMMUNITY BENEFIT REPORT WAS PREPARED BY THE HOSPITAL, WATERTOWN HOLDING COMPANY, LLC. PART II, COMMUNITY BUILDING ACTIVITIES: WRMC PROVIDES BOARD AND COMMITTEE LEADERSHIP FOR NUMEROUS HEALTH-ENHANCING PARTNER ORGANIZATIONS THROUGHOUT OUR TWO COUNTY SERVICE AREA. WE PROVIDE MEDICAL DIRECTOR SERVICES FOR MULITIPLE EMS UNITS AND LEAD SEVERAL LOCAL HEALTH AND SAFETY COALITIONS TO ENSURE THAT LOCAL PARTNERS ARE WORKING WELL TOGETHER TO ADVANCE THE HEALTH AND SAFETY OF OUR REGION. PART III, LINE 2: BAD DEBT EXPENSE TIMES COST TO CHARGE RATIO. SCHEDULE H, PART II THE INFORMATION PRESENTED IN THE TABLE REPRESENTS 20% OF THE INFORMATION PRESENTED ON THE 12/31/22 K-1 OF WATERTOWN REGIONAL MEDICAL CENTER. GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION OWNS A 20% INTEREST IN THE HOSPITAL. PART III, LINE 4: THE HOSPITAL HAS AND FOLLOWS A BAD DEBT POLICY. PART III, LINE 8: MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. THE FIGURES ON LINE 6 OF PART III REPRESENT 20% (FOUNDATION'S INTEREST IN THE HOSPITAL) OF 12 MONTHS THE 8/31/24 MEDICARE COST REPORT. PART III, LINE 9B: THE ACCOUNT BALANCES OF PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER WRMC'S FINANCIAL ASSISTANCE POLICY, BUT WHO FAIL TO PAY THE REMAINING (DISCOUNTED) BALANCE WHEN DUE, ARE CONSIDERED UNCOLLECTIBLE BAD DEBTS FOR THE AMOUNT OF SUCH BALANCES; SUCH ACCOUNTS WILL BE REFERRED TO OUTSIDE AGENCIES FOR COLLECTION. PART VI, LINE 2: WRMC UTILIZES STATE INPATIENT AND OUTPATIENT HEALTHCARE ENCOUNTER DATA TO IDENTIFY THE TYPES OF CONDITIONS FOR WHICH THE COMMUNITY IS SEEKING CARE. THIS DATA PROVIDES INFORMATION ON CHRONIC DISEASE NEEDS. THE DATA ALSO IDENTIFIES WHERE COMMUNITY MEMBERS ARE ACCESSING CARE SO WRMC CAN IDENTIFY NEEDS FOR ADDITIONAL OR ENHANCED LOCAL SERVICES. THE ORGANIZATION UTILIZES QUALITY AND PATIENT EXPERIENCE DATA (BOTH INTERNAL DATA AND BENCHMARK BEST PRACTICE DATA) TO IDENTIFY NEEDS, PRIORITIES AND RESULTS. WRMC LEADERSHIP PARTICIPATES ON MULTIPLE COMMUNITY HEALTH COALITIONS AND NON-PROFIT BOARDS TO GAIN SUBJECTIVE AND OBJECTIVE INPUT ON COMMUNITY NEEDS. LEADERSHIP PARTICIPATION IN THESE EFFORTS ENSURES WRMC'S EAR IS ALWAYS OPEN TO THE NEEDS OF MULTI-SECTOR COMMUNITY PARTNERS. PART VI, LINE 3: WRMC USES MULTIPLE METHODS TO EDUCATE PATIENTS ABOUT ELIGIBILITY FOR FINANCIAL ASSISTANCE. LOCAL REFERRING PROVIDERS ARE FAMILIAR WITH WRMC'S CHARITY CARE POLICIES AND OFTEN GET PATIENTS IN CONTACT WITH WRMC FINANCIAL COUNSELORS AS THE CARE PROCESS IS INITIATED. OUR FRONT OFFICE/RECEPTION STAFF AT EACH POINT OF ENTRY IS EDUCATED ON BILLING AND ASSISTANCE PROCEDURES AND CAN SERVE AS AN IMMEDIATE RESOURCE FOR PATIENTS, REFERRING PATIENTS TO FINANCIAL COUNSELORS TO PROVIDE PERSONALIZED COUNSELING WHEN NECESSARY. MESSAGING ABOUT AVAILABILITY OF FINANCIAL PAYMENT ASSISTANCE IS DISPLAYED AT EACH REGISTRATION AREA, AND PATIENTS ARE PROVIDED WITH A COPY OF WRMC'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: WRMC SERVES THE RESIDENTS OF DODGE AND JEFFERSON COUNTIES IN A SERVICE AREA OF ROUGHLY 120,000 LIVES. BASIC COUNTY DEMOGRAPHIC INFORMATION IS AS FOLLOWS: DODGE COUNTY JEFFERSON COUNTY% RESIDENTS BELOW POVERTY 7.6% 7.6%% WITH HS DIPLOMA 91.3% 92.8%% SPEAK LANGUAGE OTHER THAN ENGLISH 5.3% 5.3%% RESIDENTS UNINSURED 4.1% 4.5%MEDIAN HOUSEHOLD INCOME $71,747 $77,018 PART VI, LINE 5: WRMC HAS AN OPEN MEDICAL STAFF AND A GENEROUS CHARITY CARE PROGRAM. WRMC IS ACTIVE IN COMMUNITY HEALTH IMPROVEMENT IN THE REGION. AN ACTIVE MEMBER OF THE DODGE-JEFFERSON HEALTHIER COMMUNITY PARTNERSHIP, WE WORK IN PARTNERSHIP WITH LOCAL HEALTH DEPARTMENTS, HOSPITALS, AND THE GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION TO DEVELOP COMMUNITY HEALTH IMPROVEMENT PLANS. WRMC ALSO HAS AN ACTIVE CO-CHAIR POSITION IN OUR LOCAL HEALTH AND WELLNESS COALITION, GET HEALTHY WATERTOWN. GET HEALTHY WATERTOWN CONSISTS OF REPRESENTATIVES FROM VARIOUS ORGANIZATIONS WITHIN WATERTOWN ALONG WITH COMMUNITY MEMBERS WHO FOCUS ON GOALS THAT ALIGN WITH OUR COMMUNITY HEALTH ASSESSMENT AND FOCUS PRIMARILY ON PHYSICAL ACTIVITY, NUTRITION, AND MENTAL HEALTH. HEALTH EQUITY IS CONSIDERED WHEN PROVIDING SUPPORT FOR VARIOUS INITIATIVES IN THE COMMUNITY INCLUDING COMMUNITY GARDENS AND WALKING PROGRAMS. WE PROVIDE ONGOING SUPPORT (IN THE FORM OF FINANCIAL FUNDING AND DONATED DIAGNOSTIC AND LAB TESTING SERVICES) TO OUR LOCAL FREE CLINIC, THE ROCK RIVER COMMUNITY CLINIC. WRMC DEVELOPS ACTIVE PARTNERSHIPS WITH COMMUNITY PROVIDERS TO ENSURE QUALITY CARE ACROSS THE CONTINUUM. SUPPORT OF OUR LOCAL HOSPICE PROVIDER, RAINBOW HOSPICE, HAS BEEN A SIGNIFICANT PRIORITY. TWO WRMC LEADERS SERVE ON THE RAINBOW HOSPICE BOARD AND WRMC HAS MADE SIZABLE FINANCIAL DONATIONS TO ENHANCE THE HOSPICE SERVICES AVAILABLE LOCALLY. IN ADDITION TO RAINBOW HOSPICE, WE HAVE LEADERSHIP TEAM MEMBERS SERVING ON THE BOARDS OF OUR YMCA, UW CANCER CENTER JOHNSON CREEK BOARD, AND ECONOMIC DEVELOPMENT ORGANIZATION.OBESITY IS A KEY HEALTH CONCERN FOR OUR REGION, AND WRMC IS ACTIVE IN PROMOTING LIFESTYLE CHANGE. HARVEST MARKET CONTINUES TO PROVIDE HEALTHY FOOD TO THE COMMUNITY INCLUDING EMPLOYEES, PATIENTS, AND GUESTS. A "GO, SLOW, WHOA" SYSTEM IS IN PLACE WHICH HIGHLIGHTS FOOD THAT ARE CONSIDERED HEALTHY AND MEET CERTAIN DIETARY GUIDELINES, FOODS THAT SHOULD BE EATEN ON OCCASION BUT MIGHT CONTAIN ONE OR TWO ITEMS OVER THE RECOMMENDATION, AND OPTIONS THAT ARE DEEMED 'ON OCCASION' ITEMS WHICH SHOULD BE VIEWED AS A SPECIAL MEAL OR TREAT. WE OFFER AN ON-GOING FREE CLASS THAT TEACHES THE BASICS OF HEART HEALTHY EATING, AND WE HAVE DEVELOPED A COMMUNITY KITCHEN THAT OFFERS HEALTHY COOKING CLASSES AT A SIGNIFICANTLY DISCOUNTED RATE. OVER THE PAST YEAR WE HAVE HOSTED MULTIPLE SCHOOL GROUPS TO TEACH CHILDREN HEALTHY EATING HABITS. WE ALSO PROVIDE A FREE HEART HEALTHY CLASS TO MEMBERS OF OUR CARDIAC REHAB PROGRAM AT NO COST. WRMC ALSO HOSTED A COMMUNITY GARDEN LAST YEAR DONE ON VOLUNTEER TIME AND PRODUCE WAS PROVIDED TO A SENIOR MEAL SITE IN CONJUNCTION WITH THE WATERTOWN DEPARTMENT OF PUBLIC HEALTH AND RIVERSIDE MIDDLE SCHOOL GARDEN.WRMC HAS AN OPEN MEDICAL STAFF AND A GENEROUS CHARITY CARE PROGRAM. PART VI, LINE 6: WRMC IS A JOINT VENTURE BETWEEN THE GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION, INC. AND SCION HEALTH. FIFTY PERCENT OF WRMC'S BOARD OF DIRECTORS ARE LOCAL AND APPOINTED BY THE GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION. THESE MEMBERS REPRESENT THE DIVERSE NEEDS OF THE WATERTOWN REGION. WRMC ALSO IS GOVERNED BY A BOARD OF TRUSTEES WHO OVERSEE CLINICAL QUALITY, CREDENTIALING AND ACCREDITATION. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 COMMUNITY CARE PRESCHOOL & CHILD CARE INC 130 EAST MAPLE BEAVER DAM WI 53916 391200332 501(C)(3) 25000 0 CHILDCARE SITE EXPANSION CORNERSTONE OF GRACE PO BOX 746 WATERTOWN WI 530989998 843775046 501(C)(3) 25500 0 BOARD GIFT 2023, EICKSTAEDT LANE HOUSING GINGERBREAD PRESCHOOL AND CHILD CARE CENTER INC 120 KUCKKAN LANE WATERTOWN WI 53094 391775177 501(C)(3) 11066 0 CHILDCARE SITE EXPANSION, ASQ HUB GRANT GLACIAL COMMUNITY YMCA 1750 E VALLEY ROAD OCONOMOWOC WI 53066 390806378 501(C)(3) 3687189 0 BOARD GIFT 2023, EMPLOYER SPONSORED CARE, 2024 ECT FOCUS GROUP, ASQ HUB GRANT, DHS SOCIAL ISOLATION AND LONELINESS GLACIAL HERITAGE DEVELOPMENT PARTNERSHIP 864 COLLINS ROAD SUITE 111 JEFFERSON WI 53549 813362283 501(C)(3) 39692 0 THRIVEED STAFF STRATEGIC PLANNING, 2024 ECT FOCUS GROUP TED, TECHNICAL ASSISTANCE SUPPORT HABITAT FOR HUMANITY OF WAUKESHA COUNTY 2020 SPRINGDALE ROAD WAUKESHA WI 53186 391642114 501(C)(3) 105113 0 COMMUNITY PARTNERSHIP CULTIVATION, HABITAT FOR HUMANITY; BUILDING A BETTER JEFFERSON COUNTY JOHNSON CREEK SCHOOL DISTRICT 455 AZTALAN STREET JOHNSON CREEK WI 53038 396002757 GOVERNMENTAL 15370 0 COMMUNITY CONVERSATION - JOHNSON CREEK, ASQ HUB GRANT, SOURCES OF STRENGTH LAKE MILLS AREA SCHOOL DISTRICT 120 E LAKE PARK PLACE LAKE MILLS WI 53551 396023287 GOVERNMENTAL 16737 0 PLAYWORKS ACTIVE RECESS - ES & MS, LEADER IN ME, ASQ HUB GRANT LAKE MILLS MORAVIAN CHURCH 301 COLLEGE ST LAKE MILLS WI 53551 390901062 501(C)(3) 32000 0 CHILDCARE SITE EXPANSION MADISON COLLEGE 1300 W MAIN ST WATERTOWN WI 53098 391086718 501(C)(3) 107371 0 BUILDING THE DODGE/JEFFERSON EARLY CARE AND EDUCATION PIPELINE, HEALTHWORKS NETWORK MENTAL HEALTH FIRST AID (MHFA) TRAINING MARANATHA BAPTIST UNIVERSITY INC 745 W MAIN ST WATERTOWN WI 53094 391097032 501(C)(3) 50399 0 ASQ HUB GRANT - KIDDIE KAMPUS, WATERTOWN EMPLOYER SPONSORED CARE PATH OF HUSTISFORD N4540 HICKORY ROAD HUSTISFORD WI 53034 872193394 501(C)(3) 13463 0 RIVERSIDE PARK & TWEEDY STREET BRIDGE LIGHTS PROJECT RAINBOW HOSPICE 147 W ROCKWELL ST JEFFERSON WI 53549 391628298 501(C)(3) 39552 0 DHS SOCIAL ISOLATION AND LONELINESS, VISIONARY COMMUNITY LEADERS INITIATIVE: STEERING RAINBOWS FUTURE IN COMMUNITY WELLNESS READING & MATH INC (WISCONSIN READING CORPS) 1200 WASHINGTON SOUTH STE 310 MINNEAPOLIS MN 55415 472306902 501(C)(3) 60000 0 WI READING CORP (SY21-25 ONGOING) ROCK RIVER COMMUNITY CLINIC 1461 WEST MAIN STREET WHITEWATER WI 53190 205297560 501(C)(3) 254850 0 MANAGEMENT TRANSITION, BOARD GIFT 2023, MENTAL HEALTH ACCESS GRANT WRITER SCHOOL DISTRICT OF JEFFERSON 206 S TAFT AVE JEFFERSON WI 53549 391207754 GOVERNMENTAL 10400 0 PLAYWORKS ACTIVE RECESS - EAST ELEM, PLAYWORKS JEFFERSON MS SCHOOL DISTRICT OF JEFFERSON - SULLIVAN ELEMENTARY SCHOOL 618 BAKERTOWN ROAD SULLIVAN WI 53178 391207754 GOVERNMENTAL 18300 0 PLAYWORKS ACTIVE RECESS - SULLIVAN ELEM SCHOOL DISTRICT OF JEFFERSON - WEST ELEMENTARY 900 WEST MILWAUKEE STREET JEFFERSON WI 53549 391207754 GOVERNMENTAL 24000 0 PLAYWORKS ACTIVE RECESS - WEST ELEM ST PAUL'S LUTHERAN CHURCH & SCHOOL 1530 S MAIN ST LAKE MILLS WI 53551 391020546 501(C)(3) 35000 0 CHILDCARE SITE EXPANSION THE GATHERING SOURCE W7115 STATE ROAD 60 - 16 JUNEAU WI 53039 462956183 501(C)(3) 20000 0 PROGRAM FACILITY IMPROVEMENTS TRINITY ST LUKE'S 801 S 5TH ST WATERTOWN WI 530944614 391660940 501(C)(3) 30000 0 CHILDCARE SITE EXPANSION WATERLOO SCHOOL DISTRICT 715 N MONROE ST WATERLOO WI 53594 396008524 GOVERNMENTAL 36300 0 PLAYWORKS ACTIVE RECESS - MIDDLE & ELEM WATERTOWN DEPARTMENT OF PUBLIC HEALTH 515 S FIRST ST WATERTOWN WI 53094 396005640 GOVERNMENTAL 6060 0 RESULTS BASED ACCOUNTABILITY, ASQ HUB GRANT, NEW PARENT FOCUS GROUP WATERTOWN UNIFIED SCHOOL DISTRICT 111 DODGE ST WATERTOWN WI 53094 396005031 GOVERNMENTAL 121000 0 BOARD GIFTS 2023 RMS PANTHER DEN, 2024 ECT FOCUS GROUP, EARLY LEARNING SYSTEMS COORDINATOR, WUSD MENTAL HEALTH / SEL COORDINATOR WATERTOWN UNIFIED SCHOOL DISTRICT - DOUGLAS 1101 PROSPECT ST WATERTOWN WI 53098 396005031 GOVERNMENTAL 5200 0 PLAYWORKS ACTIVE RECESS WATERTOWN UNIFIED SCHOOL DISTRICT- WEBSTER 634 S 12TH STREET WATERTOWN WI 53094 396005031 GOVERNMENTAL 5200 0 PLAYWORKS ACTIVE RECESS - WEBSTER WI ALLIANCE FOR INFANT MENTAL HEALTH 6213 MIDDLETON SPRINGS DR STE 204 MIDDLETON WI 53562 271258002 501(C)(3) 113140 0 PYRAMID MODEL IMPLEMENTATION WISCONSIN EARLY CHILDHOOD ASSOCIATION (WECA) 2908 MARKETPLACE DRIVE FITCHBURG WI 53719 391345572 501(C)(3) 27207 0 RAISING WISCONSIN POLICY AGENDA, WECA CHILDCARE CONSULTING WISCONSIN LATINO CHAMBER OF COMMERCE 5262 VERONA RD FITCHBURG WI 53711 261771853 501(C)(3) 25000 0 FUTURO ECE ENTREPRENEURS WISCONSIN PHILANTHROPY NETWORK 790 N MILWAUKEE ST MILWAUKEE WI 53202 396236498 501(C)(3) 10000 0 WPN FUNDERS COLLABORATIVE FOR CHILDREN AND FAMILIES ZACHARIAH'S ACRES ADMINISTRATIVE OFFICE BROOKFIELD WI 53005 452213437 501(C)(3) 25000 0 EDUCATIONAL KITCHEN EXPANSION 31 0 PART I, LINE 2: THE FOUNDATION HAS CLEAR ELIGIBILITY CRITERIA FOR GRANTS. FOUNDATION STAFF REVIEW ELIGIBILITY CRITERIA PRIOR TO PRESENTING GRANT APPLICANTS TO THE FOUNDATION'S GRANT COMMITTEE. COMMITTEE MEMBERS REVIEW, RATE AND APPROVE REQUESTS BASED ON PRE-IDENTIFIED CRITERIA. X X X X 0 0 0 0 0 0 0 1 0 TINA CRAVE PRESIDENT 194596 0 20000 0 0 0 8000 0 22571 0 245167 0 0 0 NATHAN PETERS CHIEF FINANCIAL OFFICER 137658 0 0 0 0 0 6032 0 22508 0 166198 0 0 0 KIMBERLY MELCHER CHIEF IMPACT OFFICER 115813 0 10000 0 0 0 5296 0 22508 0 153617 0 0 0 PART I, LINE 7 SCHEDULE J, PART II, COLUMN (B)(II) REPORTS DISCRETIONARY INCENTIVE AMOUNTS THAT WERE APPROVED BY THE BOARD BASED UPON PERFORMANCE. AMENDED RETURN: 2023 FORM 990 WAS AMENDED TO CORRECT: SCHEDULE R, PART I, COLUMN E FOR HOFFMAN MATZ, LLC FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE AT ITS MONTHLY MEETING. ONCE APPROVED THERE, IT IS DISTRIBUTED TO THE FULL BOARD ELECTRONICALLY FOR COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY COVERS OFFICERS, DIRECTORS AND EMPLOYEES. EACH COMPLETES A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. DETERMINATIONS ABOUT A CONFLICT ARE MADE AT THE BOARD LEVEL FOR OFFICERS AND DIRECTORS AND AT THE LEVEL OF THE PRESIDENT FOR STAFF MEMBERS. CONFLICTS ARE REVIEWED BY THE BOARD. WHEN A CONFLICT EXISTS, MEMBERS ARE ABLE TO PARTICIPATE IN DISCUSSION ON THE GIVEN TOPIC BUT MAY BE ASKED TO LEAVE THE ROOM PRIOR TO DELIBERATION AND VOTING. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE THE COMPENSATION OF THE OFFICER OF THE CORPORATION, AN EXTERNAL BENCHMARKING COMPENSATION SURVEY DATA IS USED TO DETERMINE A FAIR AND REASONABLE SALARY AND BENEFITS. THIS FUNCTION IS PERFORMED BY EXECUTIVE COMMITTEE MEMBERS. CONTEMPORANEOUS NOTES OF THE COMPENSATION COMMITTEE ARE KEPT BY THE BOARD CHAIRMAN. FORM 990, PART VI, SECTION C, LINE 18 AVAILABLE IN PERSON AT THE FOUNDATION'S OFFICE. 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 XI, LINE 9: DISTRIBUTIONS TO NON-CONTROLLING PARTNERS -91,423. RESTATEMENT OF PRIOR YEAR FIXED ASSETS AND NET ASSETS 468,572. WATERTOWN COLLECTIVE LLC 672 JOHNSON ST SUITE 300 WATERTOWN WI 53094 391030310 CORPORATE CENTER WI 708320 13167925 GWCHF HOLDINGS LLC HOFFMAN MATZ LLC 672 JOHNSON ST SUITE 300 WATERTOWN WI 53094 391030310 LAND FOR FUTURE DEVELOPMENT WI 203603 4178658 GWCHF HOLDINGS LLC EICKSTAEDT LANE LLC 672 JOHNSON ST SUITE 300 WATERTOWN WI 53094 391030310 RESIDENTIAL RENTAL PROPERTY WI 29173 459997 GWCHF HOLDINGS LLC GWCHF HOLDINGS LLC 672 JOHNSON ST SUITE 300 WATERTOWN WI 53094 391030310 HOLDING COMPANY WI WATERTOWN SENIOR HOUSING LLC 5201 EAST TERRACE DRIVE SUITE 300 MADISON WI 53718 391994439 LOW INCOME SENIOR HOUSING WI FOUNDATION RELATED 302092 1308595 0 0 0.60000 WATERTOWN SENIOR HOUSING II LLC 5201 EAST TERRACE DRIVE SUITE 300 MADISON WI 53718 470863700 LOW INCOME SENIOR HOUSING WI FOUNDATION RELATED 332246 1474881 0 0 0.60000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WATERTOWN HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 611757641 HOSPITAL TN PATIENT SERVICE REVENUE 0 1163330 8501582 0 0 0.20000