TY 2015 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) Mark Nymo MD...................................................................... Board Member	1.0 ................. 5.0	X			0	59,658	7,323
(2) Peter Neal MD...................................................................... Board Member	1.0 ................. 40.0	X			0	392,078	48,731
(3) William Barkley MD...................................................................... Board Member	1.0 ................. 40.0	X			0	349,066	56,688
(4) Scott Polenz...................................................................... Board Member	1.0 ................. 40.0	X			0	226,841	52,127
(5) Sue Tindell...................................................................... Board Chair	1.0 ................. 0.0	X	X		0	0	0
(6) Carol Hakala...................................................................... Board - Vice Chair	1.0 ................. 0.0	X	X		0	0	0
(7) Brittany Nielsen...................................................................... Board Secretary	1.0 ................. 0.0	X	X		0	0	0
(8) Craig Fowler...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(9) Dan Ringwelski...................................................................... Board Member	1.0 ................. 0.0	X			0	0	0
(10) Ned Wolf...................................................................... CEO, LMC	40.0 ................. 0.0		X		292,091	0	56,294
(11) Jackie Klein...................................................................... CFO, LMC	40.0 ................. 0.0		X		180,265	0	50,322
(12) Teri Wilczek...................................................................... CHIEF PHILAN OFFICER, MCHS	1.0 ................. 44.0			X	0	207,692	51,593
(13) Narayana Murali MD...................................................................... CHIEF STRATEGY OFFICER, MCHS	1.0 ................. 45.0			X	0	558,189	59,685
(14) Patti Haney...................................................................... CHIEF HR OFFICER, MCHS	1.0 ................. 44.0			X	0	239,839	54,661
(15) Julie Brussow...................................................................... HEALTH PLAN CEO, MCHS	1.0 ................. 44.0			X	0	404,938	45,520
(16) Jerard Jensen...................................................................... GENERAL COUNSEL, MCHS	1.0 ................. 44.0			X	0	353,735	18,234
(17) Gordon Edwards...................................................................... CFO, MCHS	1.0 ................. 44.0			X	0	128,695	8,174

(A) Name and business address	(B) Description of services	(C) Compensation
MCIS INC, 1701 N FIG AVE MARSHFIELD,WI54449	COMPUTER CONSULTING	2,027,868
CERNER CORPORATION, 2800 ROCKCREEK PARKWAY KANSAS CITY,MO64117	COMPUTER CONSULTING	1,909,611
Medical Staffing Solutions Inc, PO Box 101 RICE LAKE,WI54868	Contract Med. Staff	375,363
Aramark Corporation, 27310 Network Place CHICAGO,IL606731273	Management Services	365,811
Sightpath Medical LLC, PO Box 204253 DALLAS,TX753204253	Medical Services	356,872
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 11

- 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.
right arrow

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

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

OMB No. 1545-0047

2015

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 (Form 990 or 990-EZ))

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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—2014. 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) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2015

Page 6

Part V

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

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

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

2015

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 other 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization LAKEVIEW MEDICAL CENTER INC OF RICE LAKE		Employer identification number 39-0837206

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

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.) $ 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) (2015)

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

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on 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

3,205

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

3,205

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 Line 1i	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) 2015

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," on 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

2015

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" on 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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 on 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 on 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) 2015

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(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 on 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" on 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' on 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	70,793,587	18,078,469	52,715,118
c	Leasehold improvements	0
d	Equipment ...	0	35,093,081	25,510,079	9,583,002
e	Other ...	0	3,371,930	1,392,723	1,979,207
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					69,532,857

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DEFERRED COMPENSATION	548,536
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	548,536
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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' on 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

Part X 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 STANDARDS 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 EVALUATED 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 BY THE CENTER, IT WAS DETERMINED THAT THE APPLICATION OF ASC 740 HAD NO MATERIAL EFFECT ON THE CENTER AT SEPTEMBER 30, 2016 OR 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

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? . . . . . .

Yes

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) . . .	317,188		317,188	0.470 %
b	Medicaid (from Worksheet 3, column a) . . . . .	9,615,345	7,404,000	2,211,345	3.260 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	9,932,533	7,404,000	2,528,533	3.730 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	299,846	10,911	288,935	0.430 %
f	Health professions education (from Worksheet 5) . . .	36,546		36,546	0.050 %
g	Subsidized health services (from Worksheet 6) . . . .	6,974,714	5,754,000	1,220,714	1.800 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	35,721		35,721	0.050 %
j	Total. Other Benefits . .	7,346,827	5,764,911	1,581,916	2.330 %
k	Total. Add lines 7d and 7j .	17,279,360	13,168,911	4,110,449	6.060 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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. ......

815,000

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. ......

268,000

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).....

17,568,000

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

19,602,000

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

-2,034,000

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) 2015

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 with ER-24 HOURS

Schedule H (Form 990) 2015

Page 4

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 15

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

6 a

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 15

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

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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):

HTTP://WWW.LAKEVIEWMEDICAL.COM

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

https://marshfieldclinic.org

A plain language summary of the FAP was widely available on a website (list url):
SEE ABOVE

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) 2015

Page 6

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 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 19. (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) 2015

Page 7

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 Line 5	Lakeview Medical Center Inc. of Rice Lake completed its second 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 Line 6a	The second CHNA was conducted in partnership with two other hospital facilities, Mayo Clinic Health Systems and the Cumberland Clinic and Hospital.
Part V Line 6b	In addition to the two other hospital facilities, the second CHNA was conducted in partnership with the Barron County Health Department and the Wisconsin Department of Health.
Part V Line 11	Upon completion of the CHNA, LMC developed a Hospital Implementation Strategy (HIS) to impact the priorities that were identified. The identified priorities were alcohol and other drug abuse, chronic disease management, and mental health issues. THIS includes goals, objectives, and action plans for the priorities of chronic disease prevention, alcohol and other drug abuse, and mental health issues. As part of LMC's HIS 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 screening numbers meant to their health. The National Diabetes Prevention Program was offered to those community members found to be at risk for diabetes. Included in LMC's HIS related to Mental Health, magnets and fliers with the Mental Health Crisis Line information have been developed and provided to schools, nonprofit organizations, law enforcement and various business and industrial worksites The main focus of the Alcohol and Drug Abuse HIS was working with the sheriffs department on the utilization of the driving simulator. It has been used at events such as the Farmer's Market, 50 Plus and the Barron County Fair. The simulator was used in all drivers education classes across Barron County touching almost every young adult in the County that has gotten their driver's license in the last year by letting them experience what it's like to drive under the influence and receive a DWI. The simulator has also served over 1000 adults in 2015/2016. Companies such as Push, Mosiac,3M and Monarch Paving have had their employees use it.
Part V Line 22d	In determining the maximum amount that may be charged to a fap-eligible person, Lakeview Medical Center 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) 2015

Page 8

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) 2015

Page 9

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. DISCOUNTED CARE IS AVAILABLE TO PATIENTS WITH INCOMES BETWEEN 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES. 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.
Part I Line 7	The Costing METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON LMC'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, HOME CARE AND HOSPICE SERVICES, AND DIALYSIS SERVICES PROVIDED BY LAKEVIEW MEDICAL CENTER. THESE ARE CLINICAL SERVICES MEETING CRITICAL NEEDS IN OUR RURAL AND AGING COMMUNITY.
Part III Line 2	Bad DEBT EXPENSES REPORTED ARE SHOWN AT COST AND CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR 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. Please REFER TO FOOTNOTE 15 ON PAGES 29 AND 30 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, 2016, AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES, AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
Part III Line 9b	Under THE ORGANIZATION'S COLLECTION AND CHARITY CARE POLICIES, LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE, MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE ORGANIZATION'S CHARITY CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR OR SOCIAL WORKERS TO ALLOW THESE PATIENTS THE ABILITY TO GET ASSISTANCE WITH THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL. DEPENDING UPON THE PATIENT'S CONDITION, THE PATIENT OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION. DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. 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 Line 2	Needs Assessment: Lakeview Medical Center, Inc. (LMC) of Rice Lake completed its second community health needs assessment (CHNA) in partnership with the Barron County Health Department, and the following organizations: Wisconsin Department of Health, Marshfield Clinic, Mayo Clinic Health Systems, and Cumberland Clinic and Hospital. The committee has adopted the following 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 related to the health of the community. The CHNA was reviewed by LMC's Board of Directors and subsequently published on LMC's public website in August of 2016. Paper copies are available to anyone requesting a printed version. Print copies were available by request via a tear-off post card located in LMC's Community Benefit Report. This report is mailed to over 40,000 households. Along with analyzing demographic information, our coalition has collected secondary data through both an online and paper surveys concerning disease, death, disability, injury, and community opinions. The survey was translated to somali and spanish to include feedback from underserved populations in the county. Also targeted for feedback in this CHNA was the inmate population in the Barron County jail. Over 900 responses out of the county population of 45,445 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 50 community members, leaders and experts. At a September 30, 2015 meeting attendees came together to review health priority assessment data and accomplishments. From 201 priorities selected, the top 3 health priorities for Barron County were identified as: 1. Alcohol and other drug abuse 2. Mental health issues 3. Chronic disease LMC has representatives actively working on the Thrive BC committees focused on Alcohol and Other Drug Abuse and has representatives serving on the Thrive BC steering committee. Upon completion of the CHNA, LMC completed a hospital implementation strategy (HIS) to impact the priorities identified. The LMC Rice Lake Board of Directors approved the HIS at the August 25, 2016 board meeting and continues to monitor the LMC's community health implementation plan. As part of the HIS related to chronic disease, LMC along with Thrive BC business partners offered a free health screening called Know Your Numbers. This screening enabled community members to help identify risk of diabetes and educated them in regard to what their screening results meant to their health. In 2016 LMC conducted 138 free screenings out of a total of 591 completed collectively. Of the 138 participants screened at LMC, 30% were found to be at risk for developing diabetes. Health education was then offered to participants falling in the risk category. Along with the CHNA, LMC 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 2015 LMC 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 Line 3	Patient EDUCATION OF ELIGIBILITY FOR ASSISTANCE: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO TALK WITH THE HOSPITAL'S PATIENT FINANCIAL COUNSELOR EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAL ASSISTANCE OR BADGERCARE PROGRAMS, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE. POLICIES ARE ALSO AVAILABLE ON THE WEBSITES.
Part VI Line 4	Community Information: The primary service area for Lakeview Medical Center, Inc. (LMC) encompasses all persons living with 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. LMC provides a significant portion of its patient services to beneficiaries of the Medicare and Medical Assistance programs. Medicare and Medical Assistance patients accounted for approximately 66% of the LMC's gross patient service revenue for the year. Other Information: LMC of Rice Lake provides significant charity care and other community benefits as defined by the Internal Revenue Service. (IRS) In addition, as an organization, LMC 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 health care locally. Beyond inpatient hospitalizations, some of the major health services LMC provides are: Birthing Center, Diagnostics, Emergency Care, Hospice, Home Care, Dialysis, Infusion Services, Health and Wellness, Laboratory, Occupational Health, Rehabilitation, Sleep Center, Speech Pathology, Surgical, and Women's Health. LMC is governed by an 11 member board of directors which includes 6 community members.
Part VI Line 5	Community building activities promoting the health in the communities served: Lakeview Medical Center (LMC) 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. The information gathered from this process was used to identify and prioritize community health issues and needs. LMC has focused on education efforts through health programs, and community screenings based on this information. LMC's specific efforts have provided programs to support the Barron County Community Coalition to support the priorities identified in the CHNA: alcohol and other drug abuse, chronic disease, and mental health issues. Excel With Be Well: Lakeview Medical Center is the lead organization in a worksite wellness program. The goal is to engage worksite leaders to adopt best wellness practices at their worksites. LMC coordinates meetings quarterly and provides resources and presenters based on the group's interests and needs. Meetings average an attendance of approximately 40 worksite leaders from a vast array of workforces. LMC coordinated with worksites with our weight loss programs throughout the year with over 20 worksites that participated. Sexual Assault Nurse Examiner (SANE) Program; The SANE program at LMC supports the community effort to address the crime of sexual assault by establishing a process for accurate evidence collection and by providing support for sexual assault survivors. Farmer's Market: LMC has a booth at a local farmer's market that has 200-300 attendees each week. The LMC booth offers health-related information and/or screening related to a different topic each week. LMC administered 175 free blood pressure screenings and 25 flu shots in addition to other activities over the 18 week span that the farmer's market was active. This year the focus was on living a healthy lifestyle which included healthy recipes and food samples, a driving simulator, and balance testing. Not on Tobacco (NOT) Program: Lakeview Medical Center joined the Barron County Community Coalition and led the effort to secure a grant from the Rice Lake Area Health Foundation to reduce tobacco use in the greater Rice Lake area. Through the grant, the Not On Tobacco program was implemented in Barron High School in Barron, Wisconsin and the Restorative Justice Program adopted the NOT program as a sanctioned workshop for rehabilitation. In addition, due to the high statistics of tobacco use during pregnancy, LMC has implemented the First Breath Program. Worksite Wellness Committee: A Worksite Wellness Committee was formed at LMC to share evidence- based best practices for employee health improvements with local employers. 50 Plus: 50 Plus is a free wellness event for those over 50 years old. 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: An LMC representative is a member of the Rice Lake Chamber of Commerce Business and Education Committee. This committee focuses on improving business opportunities and education in Rice Lake. United Way Member: An LMC representative is a member of the Rice Lake United Way Coalition serving the community by issuing community improvement grants. 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. 330 PARTICIPANTS WERE ABLE TO LOSE A TOTAL OF 345 POUNDS DURING THIS 8-WEEK CHALLENGE. LMC HEALTH PROMOTION STAFF PROVIDED PARTICIPANTS WITH WEEKLY NUTRITION AND EXERCISE EDUCATION HAND-OUTS. Coalition serving the community by issuing community improvement grants: The LMC Health Promotions Department's intention is to build sustainable programs for our community that are in alignment with one of the top health concerns identified by the Community Health Improvement Plans and Process (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 program's successes and Lakeview Medical Center's commitment to the health of our communities. 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. LMC financially supports the operating cost as expenses exceed the revenue. Free Blood Pressure Screening: Free blood pressure screenings are provided to community members on a monthly basis at the following locations: Rice Lake Senior Center, LMC Health and Wellness Center, and the LMC Cafe. 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. National Diabetes Prevention Program: Starting in January of 2016 LMC started offering the National Diabetes Prevention Program. This program has been approved by the Center for Disease Control (CDC) and has been proven to be successful in the prevention of diabetes. Our LMC-trained facilitators teach the skills that participants need to lose weight, be more physically active, and to manage stress. The program consists of 16 weekly sessions aimed at helping participants maintain healthy lifestyle changes. Two main goals of the program are weight loss of 7% and achievement of 150 minutes of exercise each week. From January to September of 2016, 5 groups with a total of 87 participants completed the program. Of the 87 participants, 90% stayed with the program through completion. Results indicated 7% weight loss in 85% of those that finished the program with 90% achieving 150 minutes of exercise per week.
Part VI Line 6	Affiliated Health Care System Roles: Marshfield Clinic Health System, INC. is the sole corporate member of Lakeview Medical Center (LMC). The Marshfield Clinic Health System includes Marshfield Clinic, a multi-specialty physician and healthcare organization comprised of over 50 sites, including a site in Rice Lake, Wisconsin. The integration of LMC 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 Line 7	All states with which the organization files a Community Benefit Report: WI

Schedule H (Form 990) 2015

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" on 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

2015

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 on 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 on 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? .........

Yes

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

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

Yes

Any related organization?

Yes

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

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

The organization?

Yes

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

Yes

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

For persons listed on 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 on 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" on 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) 2015

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 on 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 on 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)
1Tyler GeerdesPharmacist	(i) (ii)	115,412 -------------	-------------	96 -------------	15,022 ------------- 0	20,955 ------------- 0	151,485 ------------- 0	0 ------------- 0
2Anna RogallaPharmacist	(i) (ii)	120,750 -------------	600 -------------	414 -------------	17,099 ------------- 0	26,602 ------------- 0	165,465 ------------- 0	0 ------------- 0
3Roberta FreitagPharmacist	(i) (ii)	121,995 -------------	2,183 -------------	1,015 -------------	16,830 ------------- 0	22,390 ------------- 0	164,413 ------------- 0	0 ------------- 0
4Kate HillyerManager - Pharmacy Services	(i) (ii)	130,643 -------------	3,059 -------------	209 -------------	18,225 ------------- 0	22,629 ------------- 0	174,765 ------------- 0	0 ------------- 0
5Teri WilczekCHIEF PHILAN OFFICER, MCHS	(i) (ii)	------------- 201,625	------------- 4,948	------------- 1,119	0 ------------- 30,062	0 ------------- 22,407	0 ------------- 260,161	0 ------------- 0
6Narayana Murali MDCHIEF STRATEGY OFFICER, MCHS	(i) (ii)	------------- 528,688	------------- 9,866	------------- 19,635	0 ------------- 30,062	0 ------------- 30,868	0 ------------- 619,119	0 ------------- 0
7Patti HaneyCHIEF HR OFFICER, MCHS	(i) (ii)	------------- 232,209	------------- 5,007	------------- 2,623	0 ------------- 30,062	0 ------------- 25,594	0 ------------- 295,495	0 ------------- 0
8Julie BrussowHEALTH PLAN CEO, MCHS	(i) (ii)	------------- 395,821	------------- 1,523	------------- 7,594	0 ------------- 30,062	0 ------------- 16,692	0 ------------- 451,692	0 ------------- 0
9Jerard JensenGENERAL COUNSEL, MCHS	(i) (ii)	------------- 349,375	-------------	------------- 4,360	0 ------------- 2,080	0 ------------- 16,997	0 ------------- 372,812	0 ------------- 0
10Daniel RamseyCOO of MCHS & MC	(i) (ii)	------------- 642,776	-------------	------------- 21,496	0 ------------- 2,080	0 ------------- 25,215	0 ------------- 691,567	0 ------------- 0
11Susan Turney MDCEO, MCHS	(i) (ii)	------------- 826,303	------------- 170,000	------------- 94,867	0 ------------- 181,292	0 ------------- 19,783	0 ------------- 1,292,245	0 ------------- 62,794
12Ned WolfCEO, LMC	(i) (ii)	265,304 -------------	6,807 -------------	19,980 -------------	30,062 ------------- 0	27,388 ------------- 0	349,541 ------------- 0	0 ------------- 0
13Jackie KleinCFO, LMC	(i) (ii)	174,676 -------------	4,299 -------------	1,290 -------------	27,007 ------------- 0	24,063 ------------- 0	231,335 ------------- 0	0 ------------- 0
14Cindy Arts-StrenkeCOO, LMC	(i) (ii)	194,083 -------------	4,586 -------------	690 -------------	29,265 ------------- 0	19,213 ------------- 0	247,837 ------------- 0	0 ------------- 0
15Peter Neal MDBoard Member	(i) (ii)	------------- 358,123	------------- 9,616	------------- 24,339	0 ------------- 29,217	0 ------------- 20,759	0 ------------- 442,054	0 ------------- 0
16William Barkley MDBoard Member	(i) (ii)	------------- 338,735	------------- 7,520	------------- 2,811	0 ------------- 30,062	0 ------------- 27,871	0 ------------- 406,999	0 ------------- 0
17Scott PolenzBoard Member	(i) (ii)	------------- 213,832	------------- 5,001	------------- 8,008	0 ------------- 30,062	0 ------------- 22,992	0 ------------- 279,895	0 ------------- 0

Schedule J (Form 990) 2015

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
Part I, Line 3	THE MARSHFIELD CLINIC HEALTH SYSTEMS (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 ORGANIZATIONS CEO/EXECUTIVE DIRECTOR WAS PAID BY RELATED PARTY MARSHFIELD CLINIC HEALTH SYSTEM. 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.
Part I, Line 4B	457(F) Plan SUE TURNEY, MD - $151,230
Part I, Line 5A	SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Part I, Line 5B SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS.
Part I, Line 6A	SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS. Part I, Line 6B SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE, MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEMS INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS.

Schedule J (Form 990) 2015

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

2015

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 IV Line 24a	LAKEVIEW MEDICAL CENTER OF RICE LAKE, INC. (LMC) IS PART OF THE MARSHFIELD CLINIC HEALTH SYSTEM OBLIGATED GROUP. THE OBLIGATED GROUP IS RESPONSIBLE FOR OUTSTANDING FINANCED DEBT OBLIGATIONS, HOWEVER LMC HAS NOT BEEN A DIRECT RECIPIENT OF ANY PROCEEDS FROM THE BORROWINGS. ALL BOND FINANCING RELATED TO THE OBLIGATED GROUP IS DISCLOSED ON THE 990 OF MARSHFIELD CLINIC. Form 990 Part VI Line 6 Marshfield Clinic Health System, Inc. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER.
Form 990 Part VI Line 7a	Marshfield Clinic Health System, Inc. IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEDICAL CENTER AND HAS THE AUTHORITY TO APPOINT MAJORITY OF THE CORPORATE BOARD MEMBERS AND APPROVE THE PUBLIC DIRECTORS.
Form 990 Part VI Line 7b	Marshfield Clinic Health System, Inc. 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 Marshfield Clinic Health System Chief Financial Officer and Marshfield Clinic Health System VP of Finance shall review the completed Form 990. After their review and prior to filing Form 990 with the IRS, the CFO or his/her designee will provide to each member of the Board of Directors a draft copy in electronic or paper form of the completed Form 990 (and all required schedules). The Systems Audit Committee (a subcommittee of the Board of Directors) reviews and approves all corporate tax returns. In addition, the FY16 form 990 was reviewed by outside tax advisor prior to filing.
Form 990 Part VI Line 12c	Excerpts from System Conflict of Interest Policy: All officers, Board directors, and key employees of every Marshfield Clinic Health System (MCHS) entity, as well as any other person designated by the Audit and Compliance Committee (ACC) to be a Required Reporter by virtue of his or her position at a System entity, shall annually complete a conflict of interest disclosure form. Such forms shall be distributed and recorded by the Systems designated Compliance Officer. All Financial Interests disclosed as part of the annual disclosure process shall be reviewed by the ACC. The ACC shall inform the Board of disclosed financial interests which may bear upon or relate to a transaction upon which the Board or another board, committee or other body of a System Entity, may deliberate or act. In addition to the annual disclosures, if at any time between annual disclosures, a Required Reporter becomes aware that the Board, or a board, committee or other body, of any System entity may deliberate or act upon any Transaction that may have any bearing of any kind upon, or may relate in any manner to, an existing, intended or expected Financial Interest of the Required Reporter, he or she shall disclose the Financial Interest to the relevant System Entity board, committee or body chair, as well as to the System's Compliance Officer, in advance of any deliberations or action, written disclosure of the existence, nature and extent of his or her Financial Interest. All written or oral disclosures of Financial Interests shall be recorded in the minutes of the Board and by the office of the Compliance Officer. The Compliance Officer shall disclose the completed forms as necessary to those MCHS employees responsible for completion of the Systems IRS Form 990.
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 Compensation Committee 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 document its determination reasonableness of compensation in a timely manner.
Form 990 Part VI Line 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
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 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 cash distributions to Marshfield Clinic of $37,145,500.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

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

2015

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	MCHS		No
(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		No
(3)SECURITY HEALTH PLAN OF WISCONSIN INC 1515 NORTH SAINT JOSEPHS AVEN MARSHFIELD,WI54449 39-1572880	HMO	WI	501(C)(4)	N/A	MCHS		No
(4)MARSHFIELD CLINIC HERITAGE FNDTN 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 39-1865942	HONOR INDVDLS	WI	501(C)(3)	11-TYPE 1	NA		No
(5)FLAMBEAU HOSPITAL INC 98 SHERRY AVENUE PARK FALLS,WI54552 39-0973724	HOSPITAL	WI	501(C)(3)	3	NA		No
(6)MARSHFIELD CLINIC HEALTH SYSTEM INC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 46-1495343	HOSPITAL	WI	501(C)(3)	11,TYPE III	NA		No
(7)FAMILY HEALTH CENTER OF MARSHFIELD INC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 39-1681547	COM HLTH CTR	WI	501(C)(3)	7	NA		No
(8)MCHS HOSPITALS INC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 81-0977948	HOSPITAL	WI	501(C)(3)	3	MCHS		No
(9)MCHS FOUNDATION INC 1000 NORTH OAK AVENUE MARSHFIELD,WI54449 81-2822823	PHILANTHROPY	WI	501(C)(3)	3	MCHS		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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 3401 CRANBERRY BLVD WESTON,WI54476 20-0691634	MEDICAL SERVICES	WI	NA	RELATED				No			No

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
(1) MCIS INC 1701 NORTH FIG AVE MARSHFIELD,WI54449 47-2138889	IT SERVICES	WI	MCHS	C Corp	0	0		No

Schedule R (Form 990) 2015

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) ............................

Yes

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

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

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

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

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

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) .................

Yes

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) SECURITY HEALTH PLAN OF WISCONSIN INC	M	19,864,514	COST

Schedule R (Form 990) 2015

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) 2015

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 Lakeview Medical Center, Inc. Note 2: The following companies are related to Lakeview Medical Center, Inc. through brother/sister relationships (all with parent company being Marshfield Clinic Health System, Inc.): Marshfield Clinic, Inc. Security Health Plan of Wisconsin, Inc. Flambeau Hospital, Inc. (see note 5 below) MCIS, Inc. MCHS Hospitals, Inc. Marshfield Clinic Health System Foundation, Inc. Note 3: The following companies are subsidiaries of Marshfield Clinic, Inc., a related 501(c)(3) organization: Marshfield Food Safety, LLC (see note 7 below) Marshfield Clinic Heritage Foundation, Inc. Family Health Center of Marshfield, Inc. (See note 8 below) Diagnostic & Treatment Center, LLC (see note 4 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. owns a 50% 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: 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 8: 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. Note 9: Security Administrative Services, LLC is a 100% owned subsidiary of Security Health Plan of Wisconsin, Inc. and is treated as a disregarded entity of Security Health Plan of Wisconsin, Inc. for tax purposes.

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.
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 2015 (Part V, line 2a) ......	5	484
6	Total number of volunteers (estimate if necessary) .............	6	161
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) .........	114,560	55,515
9	Program service revenue (Part VIII, line 2g) .........	86,318,842	87,571,182
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	159,976	206,725
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	361,019	367,073
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	86,954,397	88,200,495
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	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)	523,954	31,494,389
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)....	69,097,415	37,101,474
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	69,621,369	68,595,863
19	Revenue less expenses. Subtract line 18 from line 12.......	17,333,028	19,604,632
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	123,504,147	104,801,737
21	Total liabilities (Part X, line 26).............	52,905,984	51,744,442
22	Net assets or fund balances. Subtract line 21 from line 20.....	70,598,163	53,057,295

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 58,932,973 including grants of $ ) (Revenue $ 87,492,492 )
	LAKEVIEW MEDICAL CENTER PROVIDES MEDICAL, SURGICAL, EMERGENCY, OUTPATIENT, DIALYSIS, AMBULANCE, ONCOLOGY, HOSPICE, AND HOME HEALTH SERVICES.

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 expenses58,932,973

(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) Daniel Ramsey........................................................................ COO of MCHS & MC	1.0 .......................44.0	X		0	664,272	26,151
(19) Susan Turney MD........................................................................ CEO, MCHS	1.0 .......................45.0	X		0	1,091,170	199,830
(20) Cindy Arts-Strenke........................................................................ COO, LMC	40.0 .......................0.0	X		199,359	0	47,682
(21) Tyler Geerdes........................................................................ Pharmacist	40.0 .......................0.0		X	115,508	0	35,480
(22) Anna Rogalla........................................................................ Pharmacist	40.0 .......................0.0		X	121,764	0	43,156
(23) Sherry Johnson........................................................................ Nurse Manager - Hospital	40.0 .......................0.0		X	122,458	0	15,944
(24) Roberta Freitag........................................................................ Pharmacist	40.0 .......................0.0		X	125,193	0	38,739
(25) Kate Hillyer........................................................................ Manager - Pharmacy Services	40.0 .......................0.0		X	133,911	0	40,289

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,290,549	4,676,173	956,623

1a	Federated campaigns..		1a	4,706
b	Membership dues..		1b
c	Fundraising events..		1c	14,556
d	Related organizations		1d	5,500
e	Government grants (contributions)		1e	4,500

f	All other contributions, gifts, grants, and similar amounts not included above		1f	26,253

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		55,515

		Business Code
2a	NET PATIENT SERVICE REVENUE	624100	85,726,854	85,726,854
b	LEASING REVENUE	624100	1,536,990	1,536,990
c	LIFELINE PROGRAM	624100	137,563	137,563
d	OCCUPATIONAL/INDUSTRIAL HEALTH	624100	28,793	28,793
e	ALL OTHER PROGRAM SERVICE REVENUE	624100	140,982	62,292	78,690
f	All other program service revenue.
g Total.Add lines 2a–2f.....			87,571,182

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			230,460			230,460
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		131,679
b	Less: rental expenses		131,679
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	13,201
b	Less: cost or other basis and sales expenses	36,936
c	Gain or (loss)	-23,735
d	Net gain or (loss).....			-23,735			-23,735
8a	Gross income from fundraising events (not including $ 14,556of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b		19,184
c	Net income or (loss) from fundraising events..			-19,184			-19,184
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		10,354
b	Less: direct expenses ...b		671
c	Net income or (loss) from gaming activities..			9,683			9,683
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
Business Code			Miscellaneous Revenue
11a	Cafeteria Revenue		624100	376,574			376,574
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			376,574
12	Total revenue. See Instructions......			88,200,495	87,492,492		652,488

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. 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 ....	861,785		861,785
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	22,754,270	20,373,693	2,380,577
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,165,094	1,912,046	253,048
9	Other employee benefits .......	4,072,515	3,158,768	913,747
10	Payroll taxes ...........	1,640,725	1,466,228	174,497
11	Fees for services (non-employees):
a	Management ......	339,297	339,297
b	Legal .........	186,613		186,613
c	Accounting ...........	81,620		81,620
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)	4,018,033	2,882,576	1,135,457
12	Advertising and promotion ....	357,422		357,422
13	Office expenses .......	1,091,942	784,478	307,464
14	Information technology ......	4,164,172	3,134,974	1,029,198
15	Royalties ..	0
16	Occupancy ...........	2,542,717	2,186,737	355,980
17	Travel ............	167,604	167,604
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	151,556	62,771	88,785
20	Interest ...........	1,316,040	658,020	658,020
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	4,605,439	3,834,045	771,394
23	Insurance ...	142,944	131,858	11,086
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	512,433	512,433
b	DUES AND SUBSCRIPTIONS	187,128	90,931	96,197
c	MEDICAL SUPPLIES	16,321,848	16,321,848
d	EQUIPMENT REPAIRS	914,666	914,666
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	68,595,863	58,932,973	9,662,890	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).

1	Cash–non-interest-bearing ........			2,310	1	2,510
2	Savings and temporary cash investments .........			33,814,788	2	15,606,560
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			13,164,228	4	14,728,774
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 ........			1,054,158	8	1,143,262
9	Prepaid expenses and deferred charges ......			237,048	9	324,600
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	114,514,128
b	Less: accumulated depreciation	10b	44,981,271	71,599,182	10c	69,532,857
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			13,066	13	14,432
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			3,619,367	15	3,448,742
16	Total assets. Add lines 1 through 15 (must equal line 34)...			123,504,147	16	104,801,737

17	Accounts payable and accrued expenses .....	3,352,144	17	3,374,616
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 ..	49,035,837	23	47,821,290
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	518,003	25	548,536
26	Total liabilities. Add lines 17 through 25..	52,905,984	26	51,744,442

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	70,598,163	27	53,057,295
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 ...........	70,598,163	33	53,057,295
34	Total liabilities and net assets/fund balances ........	123,504,147	34	104,801,737