TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DR PETER NEAL........................................................................ CHAIRMAN	1.0 .......................40.0	X	X		373,260	50,700
(2) DR WILLIAM BARKLEY........................................................................ DIRECTOR	1.0 .......................40.0	X			284,066	56,884
(3) DR MARK NYMO........................................................................ DIRECTOR	1.0 .......................40.0	X			157,678	36,378
(4) SCOTT POLENZ........................................................................ DIRECTOR	1.0 .......................40.0	X			196,786	48,489
(5) DR DANIEL ERICKSON........................................................................ DIRECTOR	1.0 .......................40.0	X			229,252	47,286
(6) DR BRADLEY BEKKUM........................................................................ DIRECTOR	1.0 .......................40.0	X			369,732	54,449
(7) CAROL HAKALA........................................................................ VICE CHAIRMAN	1.0 .......................0.0	X	X		0	0
(8) SUE TINDELL........................................................................ SECRETARY	1.0 .......................0.0	X			0	0
(9) CRAIG FOWLER........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(10) DANIEL RINGWELSKI........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(11) ROBERT BERG........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(12) JAMES DORRANCE........................................................................ VICE CHAIRMAN	1.0 .......................0.0	X	X		0	0
(13) DAVID HILLEBRAND........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0
(14) Sue Turney MD........................................................................ MCHS CEO	0.0 .......................40.0	X			368,821	34,248
(15) Ken Letkeman........................................................................ CIO MCHS, CEO MCIS	0.0 .......................40.0	X			315,102	54,436
(16) EDWARD WOLF........................................................................ CHIEF ADMINISTRATIVE OFFICER	40.0 .......................0.0		X		264,557	55,734
(17) CYNTHIA ARTS-STRENKE........................................................................ CHIEF OPERATING OFFICER	40.0 .......................0.0			X	177,654	44,773

(A) Name and business address	(B) Description of services	(C) Compensation
CERNER CORPORATION, PO BOX 412702 KANSAS CITY,MO64141	COMPUTER CONSULTING	1,943,703
ARAMARK CORPORATION, 24863 NETWORK PLACE CHICAGO,IL606731248	MANAGEMENT SERVICES	408,190
SIGHTPATH MEDICAL LLC, PO BOX 204253 DALLAS,TX753204253	MEDICAL SERVICES	275,335
AUREUS HEALTHCARE ONE LLC, PO BOX 3037 OMAHA,NE68103	TEMP MEDICAL SERVICE	186,683
WIPFLI LLP, PO BOX 3160 MILWAUKEE,WI53201	FINANCIAL CONSULTANT	161,075
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 6

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............	0
4	Benefits paid to or for members ....	0
5	Compensation of current officers, directors, trustees, and key employees ....	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages ....	380,993	380,993
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	34,443	34,443
9	Other employee benefits .......	81,565	81,565
10	Payroll taxes ...........	26,953	26,953
11	Fees for services (non-employees):
a	Management ......	344,775	344,775
b	Legal .........	185,759		185,759
c	Accounting ...........	147,862		147,862
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	33,252,860	27,897,554	5,355,306
12	Advertising and promotion ....	283,402		283,402
13	Office expenses .......	1,175,704	857,120	318,584
14	Information technology ......	4,649,229	3,374,181	1,275,048
15	Royalties ..	0
16	Occupancy ...........	2,591,178	2,228,413	362,765
17	Travel ............	166,637	166,637
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	140,217	42,350	97,867
20	Interest ...........	1,297,710	648,855	648,855
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	6,452,538	5,208,778	1,243,760
23	Insurance ..............	152,252	140,897	11,355
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	FOOD AND PROVISIONS	504,762	504,762
b	DUES AND SUBSCRIPTIONS	174,710	83,828	90,882
c	MEDICAL SUPPLIES	16,698,584	16,698,584
d	EQUIPMENT REPAIRS	879,236	879,236
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	69,621,369	59,599,924	10,021,445	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	2,310	1	2,310
2	Savings and temporary cash investments .........	22,940,991	2	33,814,788
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	12,433,492	4	13,164,228
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
		0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,105,069	8	1,054,158
9	Prepaid expenses and deferred charges ..........	279,475	9	237,048
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	113,668,682
b	Less: accumulated depreciation .....	10b	42,069,500	76,968,502	10c	71,599,182
11	Investments—publicly traded securities ..........	0	11	2,609,106
12	Investments—other securities. See Part IV, line 11 .....	0	12	0
13	Investments—program-related. See Part IV, line 11 .....	12,334	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	3,360,668	15	1,023,327
16	Total assets. Add lines 1 through 15 (must equal line 34)......	117,102,841	16	123,504,147
	17	Accounts payable and accrued expenses .........	3,649,031	17	3,352,144
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	50,285,764	23	49,035,837
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	562,911	25	518,003
26	Total liabilities. Add lines 17 through 25.........	54,497,706	26	52,905,984
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	62,605,135	27	70,598,163
28	Temporarily restricted net assets ...........	0	28	0
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	62,605,135	33	70,598,163
34	Total liabilities and net assets/fund balances ........	117,102,841	34	123,504,147

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

2,182

Total. Add lines 1c through 1i ...............................

2,182

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B	A percentage of the Hospital Association dues paid by Lakeview Medical Center are considered payment in support of lobbying efforts. Amounts reported on Schedule C represent the portion attributable to Hospital Association lobbying efforts.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	5,255,530		5,255,530
b	Buildings ................	0	70,578,760	16,551,156	54,027,604
c	Leasehold improvements ............	0		0	0
d	Equipment ................	0	34,650,609	24,239,119	10,411,490
e	Other .................	0	3,183,783	1,279,225	1,904,558
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					71,599,182

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
DEFERED COMPENSATION		518,003








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		518,003
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Form Sch D Part XII Line 2d

LAKEVIEW MEDICAL CENTER INC. OF RICE LAKE IS A NOT-FOR-PROFIT CORPORATION, AS DESCRIBED IN SECTION 501(C)(3) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. THIS ORGANIZATION IS, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. THE SYSTEM APPLIES FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARD CODIFICATION (ASC) TOPIC 740, INCOME TAXES (ASC 740), WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS WILL BE EVALATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. BASED ON AN ANALYSIS PREPARED BY THE SYSTEM, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE SYSTEM AT SEPTEMBER 30, 2015 OR 2014.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization
LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ

filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total .................

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2014

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Hospice (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	25,597	25,597
2	Less: Contributions . .
3	Gross income (line 1 minus line 2) . . .	25,597	25,597
4	Cash prizes . . .	25	25
5	Noncash prizes . .	1,482	1,482
6	Rent/facility costs . .
7	Food and beverages .
8	Entertainment . . .	200	200
9	Other direct expenses .	218	218
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........		1,925
11	Net income summary. Subtract line 10 from line 3, column (d)...........		23,672

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2014

Page 3

Does the organization conduct gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activities conducted in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	336,488		336,488	0.480 %
b	Medicaid (from Worksheet 3, column a) ....	9,871,032	7,960,167	1,910,865	2.740 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	10,207,520	7,960,167	2,247,353	3.220 %
Other Benefits		320,426	26,157	294,269	0.420 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	320,426	26,157	294,269	0.420 %
f	Health professions education (from Worksheet 5) ..	78,799		78,799	0.110 %
g	Subsidized health services (from Worksheet 6) ..	4,105,255	3,361,728	743,527	1.070 %
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	30,787		30,787	0.040 %
j	Total. Other Benefits ..	4,535,267	3,387,885	1,147,382	1.640 %
k	Total. Add lines 7d and 7j .	14,742,787	11,348,052	3,394,735	4.860 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

847,000

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

273,000

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

18,376,000

Enter Medicare allowable costs of care relating to payments on line 5.....

21,477,000

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-3,101,000

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	LAKEVIEW MEDICAL CENTER INC OF RICE L 1700 WEST STOUT STREET RICE LAKE,WI54868	X	X	X	GENERAL MED & SURGICAL, ALONG

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	LAKEVIEW MEDICAL CENTER INC OF RICE
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): HTTP://WWW.LAKEVIEWMEDICAL.COM

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): HTTP://WWW.LAKEVIEWMEDICAL.COM

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	LAKEVIEW MEDICAL CENTER INC OF RICE
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url): HTTP://WWW.LAKEVIEWMEDICA

A plain language summary of the FAP was widely available on a website (list url):
HTTP://WWW.LAKEVIEWMEDICA

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	LAKEVIEW MEDICAL CENTER INC OF RICE
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, Section B, Line 5	Lakeview Medical Center Inc. of Rice Lake completed its CHNA in partnership with the Barron County Health Department, the Wisconsin Department of Health and the other healthcare systems in the community. In addition to analyzing demographic information, the group collected secondary data through both an online and paper survey concerning disease, death, disability, injury and community opinions. The survey was translated to Somalian and Spanish to include feedback from underserved populations in the county.
Part V, Section B, Line 6a	The CHNA was conducted in partnership with two other hospital facilities, Mayo Clinic Health Systems and the Cumberland Clinic and Hospital.
Part V, Section B, Line 6b	In addition to the two other hospital facilities, the CHNA was conducted in partnership with the Barron County Health Department and the Wisconsin Department of Health.
Part V, Section B, Line 11	Upon completion of the CHNA, LMC completed a community health implementation plan (CHIP) to impact the priorities identified in the CHNA, which are alcohol and other drugs, chronic disease management and mental health. The CHIP includes goals, objectives and action plans for the priorities of chronic disease prevention and alcohol and other drug use. Mental health was also identified as a priority in the CHNA, but unlike the other two priority areas, LMC does not have any resources in place to support this issue independently. As a strategy of LMC's CHIP plan related to chronic disease, LMC offered a free screening for community members to help identify those at risk of diabetes and to educate them on what their numbers mean to their health. Education was offered to those who were found to be at risk.
Part V, Section B, Line 22d	In determining the maximum amount that may be charged to a FAP-eligible person, Lakeview used the look-back method, including both Medicare fee for services and all private health insurers in determining the gross charges percentage.

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I Line 3c	LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE USES THE FEDERAL POVERTY GUIDELINES AT 200% TO DETERMINE ELIGIBILITY FOR PROVIDING FREE CARE AS STATED IN LINE 3A. FOR SELF-PAY INDIVIDUALS WHO DON'T QUALIFY FOR FREE CARE PER OUR POLICY, WE OFFER A 12% DISCOUNT (OUR HIGHEST COMMERCIAL DISCOUNT). WE ALSO OFFER AN INTEREST FREE PAYMENT PLAN, WITH THE APPROVAL OF THE CREDIT SUPERVISOR BASED ON THE PATIENT'S CIRCUMSTANCES AND ABILITY TO PAY. THE GUIDELINES FOR THE PAYMENT PLAN INCLUDE: MAXIMUM OF 60 MONTHS, LEVEL PAYMENTS OR A FRONT-END-LOADED ARRANGEMENT (I.E., LOWER INITIAL PAYMENTS WITH A BALLOON PAYMENT IS NOT ACCEPTABLE) AND A MINIMUM OF $25 PER MONTH (I.E., $5 PER MONTH ON A $25 BALANCE IS NOT APPROPRIATE).
Part I Line 7	THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
Part I Line 7(g)	SUBSIDIZED HEALTH SERVICES CONSIST OF AMBULANCE SERVICES AND DIALYSIS SERVICES PROVIDED BY LAKEVIEW MEDICAL CENTER. THESE ARE CLINICAL SERVICES MEETING CRITICAL NEEDS IN OUR RURAL AND AGING COMMUNITY.
Part II	COMMUNITY BUILDING ACTIVITIES PROMOTING THE HEALTH IN THE COMMUNITIES SERVED: LAKEVIEW MEDICAL CENTER PARTNERED WITH BARRON COUNTY PUBLIC HEALTH, ALONG WITH THE COUNTY'S TWO OTHER HEALTHCARE SYSTEMS IN THE BARRON COUNTY COMMUNITY HEALTH IMPROVEMENT PROCESS TO IDENTIFY LOCAL HEALTH CONCERNS AND ADDRESS LOCAL HEALTH PRIORITIES LINKED TO STATE AND NATIONAL PRIORITIES. THE INFORMATION GATHERED FROM THIS PROCESS WAS USED TO IDENTIFY AND PRIORITIZE COMMUNITY HEALTH ISSUES AND NEEDS. LAKEVIEW MEDICAL CENTER HAS FOCUSED ON EDUCATION EFFORTS THROUGH HEALTH FAIRS, HEALTH EVENTS, AND COMMUNITY SCREENINGS IN THE COMMUNITY BASED ON THIS INFORMATION. LAKEVIEW MEDICAL CENTER'S SPECIFIC EFFORTS HAVE PROVIDED PROGRAMS TO STRENGTHEN BE WELL BARRON COUNTY WHICH IS AN INITIATIVE TO INCREASE PHYSICAL ACTIVITY AND DECREASE OBESITY RATES OF BARRON COUNTY RESIDENTS. LAKEVIEW MEDICAL CENTER IS THE LEAD ORGANIZATION AND PARTNERS CLOSELY WITH BE WELL BARRON COUNTY IN A WORKSITE WELLNESS PROGRAM ENTITLED EXCEL WITH BE WELL. OUR GOAL IS TO ENGAGE WORKSITE LEADERS TO ADOPT BEST WELLNESS PRACTICES AT THEIR WORKSITES. LAKEVIEW MEDICAL CENTER COORDINATES MEETINGS SIX TIMES A YEAR AND PROVIDES RESOURCES AND PRESENTERS BASED ON THE GROUP'S INTERESTS AND NEEDS. MEETINGSAVERAGE ABOUT 40 WORKSITE LEADERS FROM A VAST ARRAY OF WORKFORCES AND SIZES. LAKEVIEW MEDICAL CENTER COORDINATED WITH WORKSITES WITH OUR WEIGHT LOSS PROGRAMS THROUGHOUT THE YEAR WITH OVER 20 WORKSITES WHOM HAVE PARTICIPATED. THE NOT ON TOBACCO (NOT) PROGRAM LAKEVIEW SPONSORS, IS TO SUPPLY INFORMATION TO HELP KIDS ALREADY USING TOBACCO TO QUIT.
Part III Line 2	BAD DEBT EXPENSE REPORTED IS SHOWN AT COST AND CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICUALR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE.
Part III Line 3	THE MAJORITY OF BAD DEBT IS INCURRED ON LOW INCOME PATIENTS. ALTHOUGH LMC COMMUNICATES AND ENCOURAGES THESE PATIENTS TO APPLY FOR FINANCIAL ASSISTANCE, MANY DO NOT COMPLETE THE PROCESS. WITHOUT A COMPLETED APPLICATION THEY ARE TRANSFERRED TO COLLECTION SERVICES AND TREATED AS BAD DEBT EXPENSE. LMC'S TRACKING OF THE FINANCIAL ASSISTANCE SCREENINGS WITH PATIENTS AND THE RELATED NUMBER OF APPLICATIONS NOT COMPLETED WAS USED TO ESTIMATE THE BAD DEBT EXPENSE ATTRIBUTABLE TO THESE PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE WITH COMPLETED APPLICATIONS.
Part III Line 4	MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON AN ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT-OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER LAKEVIEW'S CHARITY CARE POLICY EVEN THOUGH LAKEVIEW PROVIDES THIS INFORMATION TO THEM AND ASSISTANCE WITH THE APPLICATION. WITHOUT A COMPLETED APPLICATION THEY ARE TRANSFERRED TO COLLECTION SERVICES AND TREATED AS BAD DEBT EXPENSE. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE CHARITY APPLICATION, SO THE BAD DEBT EXPENSE ASSOCIATED WITH THEM SHOULD BE ATTRIBUTABLE TO CHARITY CARE AND A COMMUNITY BENEFIT.
Part III Line 4	PLEASE REFER TO FOOTNOTE 15 ON PAGES 32 AND 33 OF THE CONSOLIDATED FINANCIAL STATEMENTS.
Part III Line 8	THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER ALL CONTRACTUAL ADJUSTMENTS FOR SERVICES REIMBURSED BY THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE LAB AND THERAPY SERVICES REIMBURSED ON FEE SCHEDULES AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. THE COSTING METHOD USED FOR IRS COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED SEPTEMBER 30,2014, 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 ORGANIZATIONS COLLECTION AND CHARITY CARE POLICIES, LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE, MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATIONS 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 HOSPITALS PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO GET ASSISTANCE WITH THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL. DEPENDING UPON THE PATIENTS CONDITION, THE PATIENT OR THE PATIENTS 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 HOSPITALS COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. THE ORGANIZATION ALSO PUBLISHES INFORMATION REGARDING ITS CHARITY CARE PROGRAM ON ITS WEBSITE. A DESCRIPTION OF THE CHARITY CARE PROGRAM IS INCLUDED IN THE WELCOME BOOKLET THAT PATIENTS RECEIVE UPON ADMISSION. A CHARITY CARE INFORMATIONAL BROCHURE IS GIVEN TO SELF-PAY PATIENTS DURING THE REGISTRATION PROCESS AND MADE AVAILABLE TO ALL PATIENTS.
PART VI, #2:	NEEDS ASSESSMENT: LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN PARTNERSHIP WITH THE BARRON COUNTY HEALTH DEPARTMENT, AND THE FOLLOWING ORGANIZATIONS: WISCONSIN DEPARTMENT OF HEALTH, MARSHFIELD CLINIC, MARSHFIELD CLINIC DENTAL CENTER, MAYO CLINIC HEALTH SYSTEMS, AND THE CUMBERLAND CLINIC AND HOSPITAL. THE COMMITTEE HAS ADOPTED A NAME FOR THE INITIATIVE, THRIVE BARRON COUNTY (THRIVE BC), GROWING TOGETHER IN HEALTH. OUR MISSION: THRIVE BC WILL WORK TO ENGAGE COMMUNITY MEMBERS AND ORGANIZATIONS TO FOCUS RESOURCES AND DEVELOP AND STRENGTHEN PARTNERSHIPS TO ESTABLISH SUSTAINABLE, SAFE AND HEALTHY COMMUNITIES. OUR VISION: COMMUNITY MEMBERS AND ORGANIZATIONS WORKING TOGETHER TO IMPROVE THE QUALITY OF LIFE FOR EVERYONE IN BARRON COUNTY. TO MEET OUR VISION WE WILL MEET REGULARLY AND SYSTEMATICALLY COLLECT, ASSEMBLE, ANALYZE, AND MAKE AVAILABLE INFORMATION ON THE HEALTH OF THE COMMUNITY. THE CHNA WAS REVIEWED BY LAKEVIEW MEDICAL CENTERS BOARD OF DIRECTORS AND SUBSEQUENTLY PUBLISHED ON LAKEVIEW MEDICAL CENTERS WEBSITE IN EARLY 2013 MAKING IT WIDELY AVAILABLE TO THE COMMUNITY. HARD COPIES ARE AVAILABLE TO ANYONE REQUESTING A PRINTED VERSION. ALONG WITH ANALYZING DEMOGRAPHIC INFORMATION OUR COALITION HAS COLLECTED SECONDARY DATA THROUGH BOTH AN ONLINE AND PAPER SURVEY CONCERNING DISEASE, DEATH, DISABILITY, INJURY AND COMMUNITY OPINIONS. THE SURVEY WAS TRANSLATED TO SOMALIAN AND SPANISH TO INCLUDE FEEDBACK FROM UNDERSERVED POPULATIONS IN THE COUNTY. ONE THOUSAND ONE HUNDRED AND THIRTEEN RESPONSES OUT OF THE COUNTY POPULATION OF 45,850 WERE COMPLETED. ALONG WITH THE SECONDARY DATA, THE COMMITTEE ANALYZED STATE AND NATIONAL DATA BASED ON THE 12 WISCONSIN HEALTH PRIORITIES. THIS DATA WAS PRESENTED TO COMMUNITY MEMBERS, LEADERS AND EXPERTS AT A SEPTEMBER 26, 2012 MEETING WHERE ATTENDEES SELECTED THE TOP THREE HEALTH PRIORITIES FOR BARRON COUNTY WHICH ARE: 1) ALCOHOL AND OTHER DRUGS; 2) MENTAL HEALTH; AND 3) CHRONIC DISEASE. LAKEVIEW MEDICAL CENTER HAS REPRESENTATIVES ACTIVELY WORKING ON THE THRIVE COMMITTEES FOCUSED ON ALCOHOL AND OTHER DRUGS. THE HOSPITAL ALSO HAS REPRESENTATIVES SERVING ON THE THRIVE STEERING COMMITTEE. UPON COMPLETION OF THE CHNA, LMC COMPLETED A COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) TO IMPACT THE PRIORITIES IDENTIFIED IN THE CHNA, WHICH ARE ALCOHOL AND OTHER DRUGS, CHRONIC DISEASE MANAGEMENT AND MENTAL HEALTH. THE CHIP INCLUDES GOALS, OBJECTIVES, AND ACTION PLANS FOR THE PRIORITIES OF CHRONIC DISEASE PREVENTION AND ALCOHOL AND OTHER DRUGS. MENTAL HEALTH WAS ALSO IDENTIFIED AS A PRIORITY IN THE CHNA, BUT UNLIKE THE OTHER TWO PRIORITY AREAS, LMC DOES NOT HAVE ANY RESOURCES IN PLACE TO SUPPORT THIS ISSUE INDEPENDENTLY. THE RICE LAKE BOARD OF DIRECTORS WILL MONITOR THE HOSPITALS COMMUNITY HEALTH IMPLEMENTATION PLAN. THE LMC RICE LAKE BOARD OF DIRECTORS APPROVED THE CHIP AT THEIR SEPTEMBER 29, 2013 BOARD MEETING. AS A STRATEGY OF LAKEVIEW MEDICAL CENTERS CHIP PLAN RELATED TO CHRONIC DISEASE, LMC ALONG WITH THRIVE BC PARTNERS OFFERED A FREE SCREENING FOR COMMUNITY MEMBERS TO HELP IDENTIFY THOSE AT RISK OF DIABETES AND TO EDUCATE THEM ON WHAT THEIR NUMBERS MEAN TO THEIR HEALTH. LAKEVIEW MEDICAL CENTER CONDUCTED 120 FREE SCREENINGS AND COLLECTIVELY 553 WERE COMPLETED IN BARRON COUNTY. OF THE 553 PEOPLE SCREENED 33% WERE FOUND TO BE AT RISK FOR DEVELOPING DIABETES. EDUCATION WAS OFFERED TO THOSE WHO WERE FOUND TO BE AT RISK. ALONG WITH THE CHNA, LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER. IN 2012 LAKEVIEW MEDICAL CENTER JOINED WITH BARRON COUNTY IN THE BARRON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO COLLECTIVELY IDENTIFY LOCAL HEALTH CONCERNS AND ADDRESS LOCAL HEALTH PRIORITIES LINKED TO STATE AND NATIONAL PRIORITIES.
PART VI, #3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO TALK WITH THE HOSPITALS PATIENT FINANCIAL COUNSELOR EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENTS BILL IS GENERATED. THE FINANCIAL COUSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITALS CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. POLICIES ARE ALSO AVAILABLE ON THE WEBSITES.
PART VI, #4:	COMMUNITY INFORMATION: THE PRIMARY SERVICE AREA FOR LAKEVIEW MEDICAL CENTER ENCOMPASSES ALL PERSONS LIVING WITHIN A 30 TO 40 MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE RICE LAKE, CAMERON, BARRON, BIRCHWOOD, LADYSMITH, CUMBERLAND, CHETEK, AND SPOONER, WISCONSIN, AMONG MANY OTHERS. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS, THESE MEDICARE AND MEDICAL ASSISTANCE PATIENTS ACCOUNTED FOR APPROXIMATELY 65% OF THE HOSPITALS GROSS PATIENT SERVICE REVENUE FOR THE YEAR. OTHER INFORMATION: LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT BENEFIT WHICH IS NOT QUANTIFIED. LAKEVIEW MEDICAL CENTER, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH, WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, HOSPICE, HOME CARE, DIALYSIS, INFUSION SERVICES, HEALTH AND WELLNESS SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES AND WOMENS SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. LAKEVIEW MEDICAL CENTER IS GOVERNED BY AN ELEVEN MEMBER BOARD OF DIRECTORS, INCLUDING SIX COMMUNITY MEMBERS.
PART VI, #5:	RICE LAKE FREE CLINIC: THE HOSPITAL OFFERS FREE RADIOLOGY AND LAB SERVICES TO THE FREE CLINIC SERVING THE UNDERSERVED POPULATION IN THE AREA. HEALTH AND WELLNESS CENTER THE HEALTH AND WELLNESS CENTER IS THE ONLY ONE IN THE AREA OFFERING COMMUNITY MEMBERS THE OPPORTUNITY TO EXERCISE WHILE BEING SUPERVISED BY MEDICALLY TRAINED STAFF. LAKEVIEW MEDICAL CENTER FINANCIALLY SUPPORTS THE OPERATING COST AS EXPENSES EXCEED THE REVENUE. FREE BLOOD PRESSURE SCREENINGS ARE PROVIDED TO THE COMMUNITY MONTHLY AT THE FOLLOWING LOCATIONS: RICE LAKE SENIOR CENTER, LMC HEALTH AND WELLNESS CENTER, AND LMC CAF. RADIOLOGY STUDENT EDUCATION, WITC NURSING ORIENTATION AND HEALTH INFORMATION MEDICAL RECORDS EDUCATION LAKEVIEW MEDICAL CENTER IS COMMITTED TO SUPPORT THE TRAINING OF FUTURE MEDICAL PROFESSIONALS TO IMPACT PROJECTED MEDICAL STAFF SHORTFALLS. HANG ON CHALLENGE ANOTHER LAKEVIEW MEDICAL CENTER INITIATIVE TO ADDRESS HEALTH RISKS RELATED TO CHRONIC DISEASE IS OUR HANG ON CHALLENGE. THIS IS A COMMUNITY CHALLENGE TO ASSIST COMMUNITY MEMBERS TO LOSE OR MAINTAIN THEIR WEIGHT DURING THE HOLIDAY SEASON. 350 PARTICIPANTS WERE ABLE TO LOSE A TOTAL OF 500 POUNDS DURING THIS 8-WEEK CHALLENGE. LMC HEALTH PROMOTION STAFF PROVIDED PARTICIPANTS WITH WEEKLY NUTRITION AND EXERCISE EDUCATION HAND-OUTS. FAMILY FUN POKER WALK THIS PROGRAM WAS ATTENDED BY 200 COMMUNITY PARTICIPANTS. LOCAL PHYSICIANS AND THEIR FAMILIES WALKED THE COMMUNITY WALKING TRAIL AND PROVIDED EDUCATION IN A COMMUNITY SETTING. LAKEVIEW MEDICAL CENTER PARTNERED WITH LOCAL BUSINESSES AND PROVIDED ATTENDEES WITH A HEALTHY LUNCH AND PRIZES. THIS INITIATIVE WAS DESIGNED TO ADDRESS OUR COMMUNITYS NEED FOR PHYSICAL ACTIVITY AND THE BENEFIT TO TALK TO HEALTH CARE PROVIDER IN CASUAL SETTING. WEIGHT LOSS CHALLENGE IN LIGHT OF RISING OBESITY ISSUES IN THE COUNTY THIS PROGRAM WAS DEVELOPED. THERE WERE 700 PARTICIPANTS FROM 15 AREA BUSINESSES AND THE COMMUNITY WHO LOST A TOTAL OF 6125 POUNDS DURING THIS 12-WEEK CHALLENGE. THROUGHOUT THE 12 WEEKS, FITNESS CLASSES AND NUTRITIONAL EDUCATION WAS OFFERED FREE OF CHARGE OR AT A NOMINAL FEE. FARMERS MARKET LMC HAS A BOOTH AT A LOCAL FARMERS MARKET THAT HAS 200-300 ATTENDEES EACH WEEK. THE HOSPITAL OFFERS A DIFFERENT HEALTH RELATED TOPIC/SCREENING EACH WEEK. LMC HAS ADMINISTERED 200 FREE BLOOD PRESSURES AND 35 FLU SHOTS AMONG OTHER ACTIVITIES OVER THE 18 WEEKS. A FOCUS THIS YEAR WAS ON LIVING A HEALTHY LIFESTYLE INCLUDING HEALTHY RECIPES/FOOD SAMPLES, DRIVING SIMULATOR, AND TAI CHI.
PART VI, #6:	AFFILIATED HEALTH CARE SYSTEM ROLES: MARSHFIELD CLINIC HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER. THE HEALTH SYSTEM INCLUDES MARSHFIELD CLINIC, A MULTI-SPECIALTY PHYSICIAN AND HEALTHCARE ORGANIZATION COMPRISED OF OVER 40 SITES, INCLUDING A SITE IN RICE LAKE, WISCONSIN. THE INTEGRATION OF LAKEVIEW MEDICAL CENTER AND MARSHFIELD CLINIC HAS ENHANCED THE ACCESS AND QUALITY OF HEALTH CARE THROUGHOUT RICE LAKE AND THE SURROUNDING COMMUNITIES WHILE ACHIEVING ECONOMIC EFFICIENCIES.
PART VI, #7:	ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: WI COMMUNITY BUILDING ACTIVITIES: THE SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM: THE SANE PROGRAM AT LAKEVIEW MEDICAL CENTER SUPPORTS COMMUNITY EFFORTS TO ADDRESS THE CRIME OF SEXUAL ASSAULT BY ESTABLISHING A PROCESS FOR ACCURATE EVIDENCE COLLECTION AND SUPPORT FOR SEXUAL ASSAULT SURVIVORS. NOT ON TOBACCO (NOT) PROGRAM: LAKEVIEW MEDICAL CENTER JOINED THE SAFE AND STABLE FAMILY COALITION AND LED THE EFFORT TO SECURE A GRANT FROM THE RICE LAKE AREA HEALTH FOUNDATION TO REDUCE THE TOBACCO USE IN THE GREATER RICE LAKE AREA. THROUGH THE GRANT, THE NOT ON TOBACCO (NOT)PROGRAM WAS IMPLEMENTED IN BARRON HIGH SCHOOL AND THE RESTORATIVE JUSTICE PROGRAM ADOPTED THE NOT PROGRAM AS A SANCTIONED WORKSHOP FOR REHABILITATION. ALSO, DUE TO THE HIGH STATISTICS OF SMOKING DURING PREGNANCY, LAKEVIEW MEDICAL CENTER HAS IMPLEMENTED THE FIRST BREATH PROGRAM. LAKEVIEW MEDICAL CENTER HAS BEEN REWARDED MINI-GRANTS THROUGH THE SAFE AND STABLE FAMILY COALITION TO HELP INCENTIVE PARTICIPANTS IN THE PROGRAM. THE PREGNANCY HELP CENTER HAS PARTNERED WITH LAKEVIEW MEDICAL CENTER TO UTILIZE THIS FREE PROGRAM FOR THEIR CLIENTS. ANOTHER ALARMING STATISTIC SHOWS HIGH NUMBERS OF MOTHERS WHO QUIT SMOKING DURING PREGNANCY, BUT START SMOKING AFTER DELIVERY. WITH THIS HEALTH ISSUE, LAKEVIEW MEDICAL CENTER RECEIVED A GRANT TO IMPLEMENT A SMOKING CESSATION PROGRAM TARGETED TO THIS POPULATION. BOTH OF THESE INITIATIVES WERE PART OF THE HOSPITALS CHIP. WORKSITE WELLNESS COMMITTEE: A WORKSITE WELLNESS COMMITTEE WAS FORMED AT LAKEVIEW MEDICAL CENTER TO SHARE BEST EVIDENCED BASED PRACTICES FOR EMPLOYEE HEALTH IMPROVEMENTS WITH LOCAL EMPLOYERS. 50 PLUS: 50 PLUS IS A FREE WELLNESS EVENT FOR THOSE OVER 50. THE EVENT OFFERS A VARIETY OF HEALTH SCREENINGS, COMMUNITY RESOURCES, EDUCATIONAL PRESENTATIONS AND ENTERTAINMENT. THIS EVENT IS COORDINATED BY A COALITION OF COMMUNITY AGENCIES LED BY LAKEVIEW MEDICAL CENTER. CHAMBER MEMBER: A HOSPITAL REPRESENTATIVE IS A MEMBER OF THE RICE LAKE CHAMBER OF COMMERCES BUSINESS AND EDUCATION COMMITTEE FOCUSING ON IMPROVING BUSINESS OPPORTUNITIES AND EDUCATION IN RICE LAKE. UNITED WAY MEMBER: A HOSPITAL REPRESENTATIVE IS A MEMBER OF THE RICE LAKE UNITED WAY COALITION SERVING THE COMMUNITY BY ISSUING COMMUNITY IMPROVEMENT GRANTS. THE LAKEVIEW MEDICAL CENTER HEALTH PROMOTIONS DEPARTMENTS INTENTION IS TO BUILD SUSTAINABLE PROGRAMS FOR OUR COMMUNITY THAT IS IN ALIGNMENT WITH ONE OF THE TOP HEALTH CONCERNS IDENTIFIED BY THE COMMUNITY HEALTH IMPROVEMENT PLANS AND PROCESSES (CHIP) OF BARRON COUNTY: OBESITY, NUTRITION AND PHYSICAL ACTIVITY. THE OUTCOMES OBTAINED WILL BE SHARED WITH LOCAL CIVIC GROUPS AND OTHER COMMUNITY ORGANIZATIONS TO SHARE THE PROGRAMS SUCCESSES AND LAKEVIEW MEDICAL CENTERS COMMITMENT TO THE HEALTH OF OUR COMMUNITIES.
PART VI, #7:

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DR PETER NEALCHAIRMAN	(i) (ii)	0 ............................... 370,337	0 ............................... 0	0 ............................... 2,923	0 ............................... 28,839	0 ............................... 21,861	0 ............................... 423,960	0 ............................... 0
2DR WILLIAM BARKLEYDIRECTOR	(i) (ii)	0 ............................... 282,949	0 ............................... 0	0 ............................... 1,117	0 ............................... 29,571	0 ............................... 27,313	0 ............................... 340,950	0 ............................... 0
3DR MARK NYMODIRECTOR	(i) (ii)	0 ............................... 153,443	0 ............................... 0	0 ............................... 4,235	0 ............................... 20,737	0 ............................... 15,641	0 ............................... 194,056	0 ............................... 0
4SCOTT POLENZDIRECTOR	(i) (ii)	0 ............................... 196,069	0 ............................... 0	0 ............................... 717	0 ............................... 27,822	0 ............................... 20,667	0 ............................... 245,275	0 ............................... 0
5DR DANIEL ERICKSONDIRECTOR	(i) (ii)	0 ............................... 227,327	0 ............................... 0	0 ............................... 1,925	0 ............................... 29,250	0 ............................... 18,036	0 ............................... 276,538	0 ............................... 0
6DR BRADLEY BEKKUMDIRECTOR	(i) (ii)	0 ............................... 323,456	0 ............................... 45,495	0 ............................... 781	0 ............................... 29,853	0 ............................... 24,596	0 ............................... 424,181	0 ............................... 0
7EDWARD WOLFCHIEF ADMINISTRATIVE OFFICER	(i) (ii)	0 ............................... 262,577	0 ............................... 0	0 ............................... 1,980	0 ............................... 29,423	0 ............................... 26,311	0 ............................... 320,291	0 ............................... 0
8CYNTHIA ARTS-STRENKECHIEF OPERATING OFFICER	(i) (ii)	0 ............................... 176,964	0 ............................... 0	0 ............................... 690	0 ............................... 24,466	0 ............................... 20,307	0 ............................... 222,427	0 ............................... 0
9JACQUELINE KLEINCHIEF FINANCIAL OFFICER	(i) (ii)	0 ............................... 159,564	0 ............................... 0	0 ............................... 1,264	0 ............................... 22,515	0 ............................... 24,401	0 ............................... 207,744	0 ............................... 0
10KATE HILLYERPHARMACY MANAGER	(i) (ii)	0 ............................... 124,510	0 ............................... 0	0 ............................... 192	0 ............................... 15,491	0 ............................... 20,371	0 ............................... 160,564	0 ............................... 0
11ANNA ROGALLAPHARMACIST	(i) (ii)	0 ............................... 118,912	0 ............................... 0	0 ............................... 393	0 ............................... 15,567	0 ............................... 26,525	0 ............................... 161,397	............................... 0
12Sue Turney MDMCHS CEO	(i) (ii)	0 ............................... 276,791	0 ............................... 85,000	0 ............................... 7,030	0 ............................... 29,590	0 ............................... 4,658	0 ............................... 403,069	0 ...............................
13Ken LetkemanCIO MCHS, CEO MCIS	(i) (ii)	0 ............................... 314,337	0 ............................... 0	0 ............................... 765	0 ............................... 29,767	0 ............................... 24,669	0 ............................... 369,538	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part 1, Ln 3

The Marshfield Clinic Health System's (MCHS) Independent Compensation Committee (the "Committee") has final authority for approving compensation and benefits of all "disqualified persons" employed by any of the organizations in the System. Compensation to the organization's CEO/Executive Director were paid by related party Marshfield Clinic. The Committee uses combinations of the following to evaluate compensation: Compensation Committee,Independent Compensation Consultant, Compensation survey or study, Approval by the board or compensation committee, and Written employment contracts. Please see Schedule O disclosure relating to Part VI Governance, Management, and Disclosures, Lines 15a and 15b for further information.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Return Reference	Explanation
Form 990 Part III Line 1	LAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE, AND HOME HEALTH SERVICES. LMC ENRICHES LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.
Form 990 Part III Line 4a	LAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE, AND HOME HEALTH SERVICES. LMC ENRICHES LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.
Form 990 Part VI Line 6	MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER.
Form 990 Part VI Line 7a	MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND HAS THE AUTHORITY TO ELECT BOARD MEMBERS.
Form 990 Part VI Line 7b	MARSHFIELD CLINIC IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND THE DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF MARSHFIELD CLINIC.
Form 990 Part VI Line 11b	THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT, THEN REVIEWED BY KPMG LLP. THE COMPLETED 990, INCLUDING REQUIRED SCHEDULES IS EMAILED TO AND REVIEWED BY THE BOARD MEMBERS BEFORE FILING.
Form 990 Part VI Line 12c	ON AN ANNUAL BASIS, BOARD MEMBERS, TOP MANAGEMENT, AND EMPLOYEES WHO HAVE CONTACT WITH SUPPLIERS SIGN A STATEMENT ACKNOWLEDGING THEIR UNDERSTANDING AND ADHERENCE TO THE CONFLICT OF INTEREST POLICY. IN ADDITION TO THE REQUIREMENT OF AN ANNUAL COMPLETED DISCLOSURE FORM, IT IS THE CONTINUING RESPONSIBILITY OF THE DOSCLOSING INDIVIDUALS TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS OF INTEREST AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. THE INDIVIDUALS REQUIRED TO COMPLETE THE DISCLOSURE FORM INCLUDE: BOARD MEMBERS, ADMINISTRATION (CAO, COO, AND CFO), AND MANAGERS OF MATERIALS MANAGEMENT, INFORMATION TECHNOLOGY, LAB, IMAGING, COMMUNITY RELATIONS/MARKETING, AND PLANT OPERATIONS.
Form 990 Part VI Line 15a & 15b	The System's Independent Compensation Committee (Compensation Committee) shall have final authority for approving compensation and benefits of all "disqualified persons" (as that term is defined in 4958 of the Internal Revenue Code (the "Code")) employed by the Corporation, including but not limited to the Corporation's CEO. The term "disqualified persons" includes (but is not limited to) any person (or the person's family member) who was, at any time during the 5-year period ending on the date of the transaction, in a position to exercise substantial influence over the affairs of the organization. It shall be the responsibility of the Compensation Committee to ensure that the System does not pay an amount that exceeds reasonable compensation for any disqualified person. The Compensation Committee and its operating procedures shall be designed to establish the rebuttable presumption of reasonableness of compensation outlined in Treasury Reg. Sec. 53.4958-6 with respect to each disqualified person. In determining reasonableness of compensation, the compensation committee shall evaluate appropriate information as to comparability of compensation, including but not limited to: compensation levels paid by similarly situated organizations for comparable positions; the availability of similar services in the System's geographic area; current compensation surveys compiled by independent firms; and actual written job offers from similar institutions. The ICC shall have independent authority to obtain outside expert opinions on the reasonableness and fair market value of compensation and gather other information the Committee considers necessary or appropriate to make its decisions on compensation. The Compensation Committee shall timely document its determination of reasonableness of compensation.
Form 990 Part VI Line 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
Part VII	Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees and Independent Contractors Marshfield Clinic Health System, Inc. (MCHS) is the parent company of Lakeview Medical Center Inc. of Rice Lake. As such, the Executives of MCHS are listed on the Lakeview Medical Center Inc. of Rice Lake form 990 as key employees. Much of the Marshfield Clinic Health System Executive team joined the organization in calendar year 2015. Lakeview Medical Center Inc. of Rice Lake has a corporate tax year of October 1 through September 30. For purposes of this section and Schedule J, IRS requires that we report W-2 wages from 2014 calendar year end. There is no reportable compensation for much of the executive team for this reporting period, but will be in future years.
Form 990 Part IX Line 11g	Marshfield Clinic Health System, Inc., is the parent company for both Marshfield Clinic, Inc. (MC) and Lakeview Medical Center, Inc. (LMC). Most LMC staff are employees of MC and all payroll and benefits are paid and administered by the MC. These costs are reported as purchased services for purposes of Part IX Statement of Functional Expenses.
Form 990 Part XI Line 9	LAKEVIEW MEDICAL CENTER PROVIDED A CASH DISTRIBUTION TO MARSHFIELD CLINIC OF $9,340,000.
FORM 990 PART IX LINE 11G	DESCRIPTION:Other TOTAL FEES:33252860

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

LAKEVIEW MEDICAL CENTER INC OF RICE LAKE

Employer identification number

39-0837206

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 39-0452970	MEDICAL CARE	WI	501(C)(3)	3	NA
(2) VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL 1700 WEST STOUT STREET RICE LAKE,WI54868 39-1329084	SUPPORT ORG.	WI	501(C)(3)	11, III-O	NA
(3) SECURITY HEALTH PLAN OF WISCONSIN INC 1515 NORTH SAINT JOSEPHS AVEN MARSHFIELD,WI54449 39-1572880	HMO	WI	501(C)(4)	N/A	NA
(4) THE HERITAGE FOUNDATION 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 39-1865942	HONOR INDIVID	WI	501(C)(3)	11-TYPE 1	NA
(5) FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS,WI54552 39-0973724	HOSPITAL	WI	501(C)(3)	3	NA
(6) MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 46-1495343	HOSPITAL	WI	501(C)(3)		N/A
(7) FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 N OAK AVE MARSHFIELD,WI54449 46-1495343	COMM. HTHCNTR	WI	501(C)(3)	7	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) DIAGNOSTIC TREATMENT CENTER	MEDICAL SERVICES			RELATED

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Marshfield Clinic Inc		9,340,000

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

Part I

NOTE 1: MARSHFIELD CLINIC HEALTH SYSTEM, INC. (A 501(C)3 ORGANIZATION), IS THE PARENT ORGANIZATION OF MARSHFIELD CLINIC, INC. NOTE 2: THE FOLLOWING COMPANIES ARE RELATED TO MARSHFIELD CLINIC, INC. THROUGH BROTHER/SISTER RELATIONSHIPS (ALL WITH PARENT COMPANY BEING MARSHFIELD CLINIC HEALTH SYSTEM, INC.): LAKEVIEW MEDICAL CENTER, INC. SECURITY HEALTH PLAN OF WISCONSIN, INC. FLAMBEAU HOSPITAL, INC. (SEE NOTE 5 BELOW), MCIS, INC. (SEE NOTE 9 BELOW) NOTE 3: THE FOLLOWING COMPANIES ARE SUBSIDIARIES OF MARSHFIELD CLINIC, INC.: MARSHFIELD FOOD SAFETY, LLC (SEE NOTE 8 BELOW), MARSHFIELD CLINIC HERITAGE FOUNDATION, INC., FAMILY HEALTH CENTER OF MARSHFIELD, INC. (SEE NOTE 10 BELOW), DIAGNOSTIC & TREATMENT CENTER, LLC (SEE NOTE 4 BELOW), and MARSHFIELD CLINIC INFORMATION SERVICES, INC. (SEE NOTE 7 BELOW) NOTE 4: MARSHFIELD CLINIC, INC. OWNS A 50% INTEREST IN THE DIAGNOSTIC & TREATMENT CENTER, LLC. THOSE RESULTS ARE REPORTED ON THE BOOKS AND RECORDS OF MARSHFIELD CLINIC, INC. NOTE 5: MARSHFIELD CLINIC HEALTH SYSTEM, INC. has A 50% member INTEREST IN FLAMBEAU HOSPITAL, INC. THOSE RESULTS ARE REPORTED ON THE BOOKS AND RECORDS OF MARSHFIELD CLINIC HEALTH SYSTEM, INC. NOTE 6: VOLUNTEER PARTNERS OF LAKEVIEW MEDICAL CENTER, INC., IS A SUPPORTING ORGANIZATION OF LAKEVIEW MEDICAL CENTER, INC. NOTE 7: AS OF 1/1/15, AND AS DIRECTED BY AN OFFICIAL PLAN OF MERGER, MARSHFIELD CLINIC INFORMATION SERVICES, INC., EFFECTIVELY MERGED WITH AND INTO MCIS, INC., THE SURVIVING CORPORATION. MARSHFIELD CLINIC INFORMATION SERVICES, INC. WAS EFFECTIVELY DISSOLVED AS OF 1/1/15. NOTE 8: MARSHFIELD FOOD SAFETY, INC. IS A 100% OWNED SUBSIDIARY OF MARSHFIELD CLINIC, INC. AND IS TREATED AS A DISREGARDED ENTITY OF MARSHFIELD CLINIC, INC. FOR TAX PURPOSES. NOTE 9: STOCK OWNERSHIP OF MCIS, INC. TRANSFERRED FROM MARSHFIELD CLINIC, INC. TO MARSHFIELD CLINIC HEALTH SYSTEM, INC. ON 1/1/15 NOTE: 10 MARSHFIELD CLINIC, INC. IS THE SOLE CORPORATE (NON-VOTING) MEMBER OF FAMILY HEALTH CENTER OF MARSHFIELD, INC. MARSHFIELD CLINIC, INC. DOES NOT HAVE THE AUTHORITY TO APPOINT BOARD MEMBERS AND THEREFORE IS NOT CONSIDERED TO HAVE CONTROL (AS DEFINED FOR 990 REPORTING PURPOSES) OVER FAMILY HEALTH CENTER OF MARSHFIELD, INC.

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: LAKEVIEW MEDICAL CENTER SERVES THE COMMUNITY BY PROVIDING SERVICES INTENDED TO ENHANCE THE HEALTH OF THE PEOPLE IN THE SURROUNDING REGION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	9
6	Total number of volunteers (estimate if necessary) .............	6	165
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	90,402	114,560
9	Program service revenue (Part VIII, line 2g) .........	68,820,077	86,318,842
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	180,088	159,976
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	129,015	361,019
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	69,219,582	86,954,397
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,000	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	28,792,034	523,954
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	30,502,801	69,097,415
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	59,296,835	69,621,369
19	Revenue less expenses. Subtract line 18 from line 12.......	9,922,747	17,333,028
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	117,102,841	123,504,147
21	Total liabilities (Part X, line 26).............	54,497,706	52,905,984
22	Net assets or fund balances. Subtract line 21 from line 20.....	62,605,135	70,598,163

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 59,599,925 including grants of $ ) (Revenue $ 86,191,980 )
	LAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE AND HOME HEALTH SERVICES. LMC ENRICHES LIVES TO CREATE HEALTHY COMMUNITEIS THROUGH ACCESSIBLE, AFFORADABLE, COMPASSIONATE HEALTH CARE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses59,599,925

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) JACQUELINE KLEIN........................................................................ CHIEF FINANCIAL OFFICER	40.0 .......................0.0	X		0	160,828	46,915
(19) KATE HILLYER........................................................................ PHARMACY MANAGER	40.0 .......................0.0		X	0	124,702	35,861
(20) ANNA ROGALLA........................................................................ PHARMACIST	40.0 .......................0.0		X	0	119,305	42,093
(21) SHERRY JOHNSON........................................................................ NURSE MANAGER	0.0 .......................40.0		X	0	117,693	14,675
(22) TYLER GEERDES........................................................................ PHARMACIST	0.0 .......................40.0		X	0	112,806	16,742
(23) ROBERTA FREITAG........................................................................ PHARMACIST	0.0 .......................40.0		X	0	107,518	38,784

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	3,479,760	678,447

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a		3,585
b	Membership dues....1b
c	Fundraising events....1c		25,597
d	Related organizations...1d
e	Government grants (contributions)1e		15,392

f	All other contributions, gifts, grants, and similar amounts not included above1f		69,986

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			114,560
			Business Code
2a	NET PATIENT SERVICE REVENUE		624100	84,445,217	84,445,217
b	LEASING REVENUE		624100	1,504,666	1,504,666
c	LIFELINE PROGRAM		624100	130,636	130,636
d	OCCUPATIONAL/INDUSTRIAL HEALTH		624100	37,220	37,220
e	ALL OTHER PROGRAM SERVICE REVENUE		624100	201,103	74,241		126,862
f	All other program service revenue .
g	Total. Add lines 2a–2f........			86,318,842
3	Investment income (including dividends, interest, and other similar amounts).......			160,941			160,941
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents	128,191
b	Less: rental expenses	128,191
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		5,300
b	Less: cost or other basis and sales expenses		6,265
c	Gain or (loss)		-965
d	Net gain or (loss)..........			-965			-965
8a	Gross income from fundraising events (not including $ 25,597 of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b		1,925
c	Net income or (loss) from fundraising events..			-1,925			-1,925
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		3,065
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			3,065			3,065
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	CAFETERIA REVENUE		624100	359,879			359,879
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			359,879
12	Total revenue. See Instructions......			86,954,397	86,191,980		647,857


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			2,310	1	2,310
2	Savings and temporary cash investments .........			22,940,991	2	33,814,788
3	Pledges and grants receivable, net ...........			0	3	0
4	Accounts receivable, net .............			12,433,492	4	13,164,228
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,105,069	8	1,054,158
9	Prepaid expenses and deferred charges ..........			279,475	9	237,048
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	113,668,682
b	Less: accumulated depreciation .....	10b	42,069,500	76,968,502	10c	71,599,182
11	Investments—publicly traded securities ..........			0	11	2,609,106
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 .....			12,334	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			3,360,668	15	1,023,327
16	Total assets. Add lines 1 through 15 (must equal line 34)......			117,102,841	16	123,504,147
17	Accounts payable and accrued expenses .........			3,649,031	17	3,352,144
18	Grants payable .................			0	18	0
19	Deferred revenue ................			0	19	0
20	Tax-exempt bond liabilities .............			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			50,285,764	23	49,035,837
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			562,911	25	518,003
26	Total liabilities. Add lines 17 through 25.........			54,497,706	26	52,905,984
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			62,605,135	27	70,598,163
28	Temporarily restricted net assets ...........			0	28	0
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			62,605,135	33	70,598,163
34	Total liabilities and net assets/fund balances ........			117,102,841	34	123,504,147