Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
A For the 2020 calendar year, or tax year beginning 01-01-2020 , and ending 12-31-2020
BCheck if applicable:
CName of organization
WESTFIELDS HOSPITAL INC
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
8170 33RD AVENUE SOUTH PO BOX 1309
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MINNEAPOLIS, MN554401309
D Employer identification number

39-0808442
E Telephone number

G Gross receipts $ 73,076,927
F Name and address of principal officer:
STEVEN M MASSEY
8170 33RD AVENUE SOUTH PO BOX 1309
MINNEAPOLIS,MN554401309
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HEALTHPARTNERS.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1950
M State of legal domicile: WI
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY HEALTH CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2020 (Part V, line 2a) ...... 5 462
6 Total number of volunteers (estimate if necessary) ............. 6 20
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 39 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 116,434 5,214,241
9 Program service revenue (Part VIII, line 2g) ......... 69,040,953 66,682,131
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 628,006 602,893
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 310,626 219,601
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 70,096,019 72,718,866
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 66,145 53,695
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) 41,004,358 41,635,610
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 26,223,561 25,235,872
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 67,294,064 66,925,177
19 Revenue less expenses. Subtract line 18 from line 12....... 2,801,955 5,793,689
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 57,630,641 71,164,525
21 Total liabilities (Part X, line 26)............. 16,636,727 23,903,141
22 Net assets or fund balances. Subtract line 21 from line 20..... 40,993,914 47,261,384
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2020)
Form 990 (2020)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: WESTFIELDS HOSPITAL, IN PARTNERSHIP WITH OTHERS, WILL IMPROVE THE HEALTH OF OUR PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY HEALTH CARE WHICH MEETS THE NEEDS OF ALL PEOPLE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 60,136,776 including grants of $ 53,695 ) (Revenue $ 66,725,324 )
SEE SCHEDULE O - PRIMARY EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS
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 expensesMediumBullet60,136,776
Form 990 (2020)
Form 990 (2020)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment..
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part IIIClick to see attachment..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
Click to see attachment......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I(see instructions) ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2020)
Form 990 (2020)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
Yes
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2020)
Form 990 (2020)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
462
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
Form 990 (2020)
Form 990 (2020)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024-A if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletDOUGLAS E JOHNSON CHIEF FINANCIAL OFFICER535 HOSPITAL ROAD   NEW RICHMOND,WI54017 (715) 243-2852
Form 990 (2020)
Form 990 (2020)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) GREG CHRISTENSON......................................................................
DIRECTOR & VICE CHAIR
2.41
.................
 
X   X       0 0 0
(2) HEATHER MCABEE......................................................................
DIRECTOR
2.33
.................
 
X           0 0 0
(3) TOM MEWS......................................................................
CHAIR & DIRECTOR
5.66
.................
 
X   X       0 0 0
(4) KATIE WENDT......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(5) PATRICK OLSON......................................................................
DIRECTOR & SECRETARY
2.00
.................
0.00
X   X       0 0 0
(6) REGAN BROWN......................................................................
DIRECTOR
1.50
.................
0.00
X           0 0 0
(7) PAULA KOLBACK......................................................................
DIRECTOR
0.25
.................
0.00
X           0 0 0
(8) JOSEPH A DIETZLER MD......................................................................
DIRECTOR
0.50
.................
39.50
X           0 276,601 54,953
(9) HEIDI G CONRAD......................................................................
TREASURER
0.50
.................
54.50
X   X       0 588,046 189,840
(10) AMY L DEWANE......................................................................
DIRECTOR
0.50
.................
59.50
X           0 384,695 57,598
(11) ANDREW E DORWART MD......................................................................
DIRECTOR
0.50
.................
49.50
X           0 500,108 59,271
(12) ANTHONY C HECHT MD......................................................................
DIRECTOR
0.50
.................
59.50
X           0 533,516 45,050
(13) TYLER R SCHMIDTZ......................................................................
DIRECTOR
0.50
.................
49.50
X           0 355,171 56,653
(14) ERIC W LING MD......................................................................
DIRECTOR AND CMO
0.50
.................
49.50
X   X       0 422,428 56,785
(15) STEVEN M MASSEY......................................................................
DIRECTOR, PRESIDENT
49.50
.................
0.50
X   X       0 339,313 55,643
(16) VINI T MANCHANDA......................................................................
DIRECTOR
0.50
.................
49.50
X           0 299,123 86,344
(17) CRAIG YEHLIK......................................................................
DIRECTOR
0.50
.................
0.00
X           0 0 0
Form 990 (2020)
Form 990 (2020)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) DOUGLAS E JOHNSON........................................................................
CFO (SEPT-DEC)
13.75
.......................41.25
    X       0 415,631 40,274
(19) HELEN A SATHRE........................................................................
VP - PATIENT SERVICES
50.00
.......................0.00
    X       0 35,399 2,817
(20) LEANNE M ROGGEMANN........................................................................
VP PATIENT SERVICES & CNO
45.00
.......................0.00
    X       165,805 0 18,158
(21) MICHELE K RIEDEL........................................................................
PHARMACIST
40.00
.......................0.00
        X   149,911 0 40,994
(22) NICOLE M TROSEN........................................................................
PHARMACY MANAGER
40.00
.......................0.00
        X   166,783 0 8,339
(23) JACQUELINE M NELSON........................................................................
PHARMACIST
45.00
.......................0.00
        X   159,725 0 32,877
(24) SHANNON M O'KEEFE........................................................................
DIRECTOR OF IMAGING SERVICES
40.00
.......................0.00
        X   144,619 0 43,824
(25) JENNIFER L FLETCH........................................................................
PHYSICIAN ASSISTANT/NP
40.00
.......................0.00
        X   144,171 0 10,610
(26) DAVE A DZIUK........................................................................
FORMER DIRECTOR & TREASURE
0.00
.......................0.00
          X 0 487,728 31,867
(27) JASON J LUHRS........................................................................
FORMER CFO
0.00
.......................50.00
          X 0 270,087 51,349
(28) DAVID O DEGEAR MD........................................................................
FORMER VP - MEDICAL AFFAIR
0.00
.......................55.00
          X 0 487,728 58,206




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 931,014 5,395,574 1,001,452
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet38
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
RIVER VALLEY ANESTHESIA INC

PO BOX 118
NEW RICHMOND,WI540170118
ANESTHESIA SERVICES 1,460,854
CANCER CENTER OF WESTERN WISCONSIN

501 HOSPITAL RD
NEW RICHMOND,WI54017
MEDICAL SERVICE 544,436
INFINITE HEALTH COLLABORATIVE

4200 DALBERG DR STE 300
GOLDEN BALLEY,MN55422
MEDICAL SERVICE 540,189
SHARED MEDICAL TECHNOLOGY INC

202 W NEWTON ST
RICE LAKE,WI54868
RADIOLOGY SERVICES 287,844
TWIN CITIES ORTHOPEDICS PA

5803 NEAL AVE N
OAK PARK HEIGHTS,MN55082
MEDICAL SERVICE 208,315
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet9
Form 990 (2020)
Form 990 (2020)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 33,790
e Government grants (contributions)1e 5,180,451
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 5,214,241
 Program Service RevenueAmt Business Code
2a PATIENT SERVICES 623000 66,600,318 66,600,318    
b DIETARY SERVICES 722514 81,813 81,813    
c
d
e
f All other program service revenue.        
g Total. Add lines 2a–2f .....MediumBullet 66,682,131
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 602,893     602,893
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   534,469 6a
b Less: rental expenses   358,061 6b
c Rental income or (loss)   176,408 6c
d Net rental income or (loss).......MediumBullet 176,408     176,408
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory     7a
b Less: cost or other basis and sales expenses     7b
c Gain or (loss)     7c
d Net gain or (loss).........MediumBullet        
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a  
b Less: cost of goods sold .. 10b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a OTHER INCOME 900099 27,739 27,739    
b GIFT SHOP 453220 15,454 15,454    
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 43,193
12 Total revenue. See instructions.....MediumBullet 72,718,866 66,725,324 0 779,301
Form 990 (2020)
Form 990 (2020)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 53,695 53,695
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 183,963   183,963  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 35,199,818 31,090,432 4,109,386  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 872,254 770,423 101,831  
9 Other employee benefits ....... 3,863,636 3,456,266 407,370  
10 Payroll taxes ........... 1,515,939 1,338,961 176,978  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 20,330   20,330  
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 4,507,092 4,462,681 44,411  
12 Advertising and promotion .... 45,014 6,219 38,795  
13 Office expenses ....... 539,056 474,284 64,772  
14 Information technology ...... 248,648 125,885 122,763  
15 Royalties ..        
16 Occupancy ........... 935,487 923,029 12,458  
17 Travel ............ 22,436 18,153 4,283  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 11,032 7,471 3,561  
20 Interest ........... 306,600 306,600    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 3,033,045 2,498,379 534,666  
23 Insurance ... 250,730 250,730    
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 MEDICAL SUPPLIES 12,629,570 12,620,330 9,240  
b EQUIPMENT RENT/LEASE 1,890,177 938,442 951,735  
c OTHER EXPENSE 627,613 627,613    
d TAXES & ASSESSMENTS 119,428 119,428    
e All other expenses 49,614 47,755 1,859  
25 Total functional expenses. Add lines 1 through 24e 66,925,177 60,136,776 6,788,401 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2020)
Form 990 (2020)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 2,011,866 1 21,246,536
2 Savings and temporary cash investments ......... 13,513,647 2 9,365,679
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 7,614,074 4 6,682,859
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6  
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............ 854,608 8 971,282
9 Prepaid expenses and deferred charges ...... 118,386 9 138,388
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 48,683,939
b Less: accumulated depreciation 10b 29,183,179 21,117,157 10c 19,500,760
11 Investments—publicly traded securities . 10,392,039 11 11,364,363
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .. 385,000 13 385,000
14 Intangible assets ............... 1,412,608 14 1,412,608
15 Other assets. See Part IV, line 11 ........... 211,256 15 97,050
16 Total assets. Add lines 1 through 15 (must equal line 33)... 57,630,641 16 71,164,525
Liabilities 17 Accounts payable and accrued expenses ..... 8,480,565 17 16,454,479
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 8,155,238 20 7,448,662
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
  22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
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 924 25 0
26 Total liabilities. Add lines 17 through 25.. 16,636,727 26 23,903,141
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 40,993,914 27 47,261,384
28 Net assets with donor restrictions ...........   28  
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 40,993,914 32 47,261,384
33 Total liabilities and net assets/fund balances ........ 57,630,641 33 71,164,525
Form 990 (2020)
Form 990 (2020)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
72,718,866
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
66,925,177
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
5,793,689
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
40,993,914
5
Net unrealized gains (losses) on investments ...............
5
473,781
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
47,261,384
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2020)
Form 990 (2020)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
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 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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) right arrow (a) 2016 (b) 2017 (c) 2018 (d) 2019 (e) 2020 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
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).
8
 
 
9a
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.
9a
 
 
b
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.
9b
 
 
c
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.
9c
 
 
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
 
 
b
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) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in 11a above?
11b
 
 
c
A 35% controlled entity of a person described in line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described in line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 0.015 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 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2020

Schedule A (Form 990 or 990-EZ) 2020
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 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI
). See instructions
8  
9 Distributable amount for 2020 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2020
(iii)
Distributable
Amount for 2020
1 Distributable amount for 2020 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2020:
a From 2015.......  
b From 2016.......  
c From 2017.......  
d From 2018.......  
e From 2019.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2020 distributable amount  
i Carryover from 2015 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2020 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2020 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2020, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions.
 
6 Remaining underdistributions for 2020. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions.
 
7 Excess distributions carryover to 2021. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2016.....  
b Excess from 2017.....  
c Excess from 2018.....  
d Excess from 2019.....  
e Excess from 2020.....  
Schedule A (Form 990 or 990-EZ) (2020)

Schedule A (Form 990 or 990-EZ) 2020
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) 2020


Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
Name of organization
WESTFIELDS HOSPITAL INC
 
Employer identification number
39-0808442
Part I
Contributors
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


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 3
Name of organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
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) (2020)
Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
Page 4
Name of organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2020)
Additional Data


Software ID:  
Software Version:  
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 BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
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
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

2
Political campaign activity expenditures (see instructions) ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities (see instructions) ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
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) 2020

Schedule C (Form 990 or 990-EZ) 2020
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(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? ...................................................................................................................

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) 2017 (b) 2018 (c) 2019 (d) 2020 (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) 2020


Schedule C (Form 990 or 990-EZ) 2020
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|No
(b)
Amount
1
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:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
No
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
0
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
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."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) .........................................
5
 
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 1: WESTFIELDS HOSPITAL, INC. PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2020


Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 7/25/06, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .............................
9
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.
1a
If the organization elected, as permitted under FASB 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.
b
If the organization elected, as permitted under FASB 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 $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2020

Schedule D (Form 990) 2020
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .......................
3a(i)
 
 
(ii) Related organizations .......................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 .....   195,306 195,306
b Buildings ....   29,470,438 13,684,862 15,785,576
c Leasehold improvements        
d Equipment ....   18,916,944 15,498,317 3,418,627
e Other .....   101,251   101,251
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 19,500,760
Schedule D (Form 990) 2020

Schedule D (Form 990) 2020
Page 3
Part VII
Investments - Other 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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments - Program 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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
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
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
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  
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
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) 2020

Schedule D (Form 990) 2020
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 2: WESTFIELDS HOSPITAL, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2020 OR 2019 FOR UNRECOGNIZED TAX BENEFITS.
Schedule D (Form 990) 2020


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . .
  311 509,096   509,096 0.760 %
b Medicaid (from Worksheet 3, column a) . . . . .   2,928 7,102,082 4,911,615 2,190,467 3.270 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0      
d Total Financial Assistance and Means-Tested Government Programs . . . . .   3,239 7,611,178 4,911,615 2,699,563 4.030 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   304 244,023 53,855 190,168 0.280 %
f Health professions education (from Worksheet 5) . . .   29 94,332   94,332 0.140 %
g Subsidized health services (from Worksheet 6) . . . .   26,537 3,705,322   3,705,322 5.540 %
h Research (from Worksheet 7) .     0      
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     66,244   66,244 0.100 %
j Total. Other Benefits . .   26,870 4,109,921 53,855 4,056,066 6.060 %
k Total. Add lines 7d and 7j .   30,109 11,721,099 4,965,470 6,755,629 10.090 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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     1,740   1,740 0 %
3 Community support            
4 Environmental improvements     691   691 0 %
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     2,431   2,431 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,012,197
3
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. ......
3
179,441
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
19,073,769
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
19,073,769
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
 
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

Yes

 
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 %
11 CANCER CENTER OF WESTERN WISCONSIN
 
ONCOLOGY SERVICES 23.680 % 0 % 0 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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?1Name, 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)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 WESTFIELDS HOSPITAL INC
535 HOSPITAL ROAD
NEW RICHMOND,WI54017
WWW.WESTFIELDSHOSPITAL.COM
WISCONSIN LICENSE # 1050
X X     X   X      
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
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)
WESTFIELDS HOSPITAL INC
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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/WESTFIELDS/ABOUT/COMMUNITY-HE
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2020
Schedule H (Form 990) 2020
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
WESTFIELDS HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE NOTE FOR FULL WEBSITE URL
b
SEE NOTE FOR FULL WEBSITE URL
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 6
Part VFacility Information (continued)

Billing and Collections
WESTFIELDS HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 nonpayment?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
WESTFIELDS HOSPITAL INC
Name of hospital facility or letter of facility reporting group  
Yes No
22 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.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
WESTFIELDS HOSPITAL, INC. PART V, SECTION B, LINE 5: WE BRING THE MISSION TO LIFE BY WORKING WITH COMMUNITY PARTNERS TO BETTER UNDERSTAND WHAT CONTRIBUTES TO AND STANDS IN THE WAY OF GOOD HEALTH AND HOW WE CAN WORK TOGETHER TO IMPROVE HEALTH OUTCOMES. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS AN OPPORTUNITY FOR US TO IDENTIFY THE SIGNIFICANT HEALTH NEEDS OF OUR COMMUNITY AND THE MEASURES AND RESOURCES REQUIRED TO ADDRESS THOSE NEEDS. HEALTHPARTNERS WORKED WITH LOCAL HEALTH DEPARTMENTS, LOCAL COALITIONS, THE CENTER FOR COMMUNITY HEALTH (CCH) AND COMMUNITY PARTNERS TO CONDUCT A COMPREHENSIVE CHNA. IN ADDITION, EACH HOSPITAL ENGAGED WITH LOCAL PUBLIC HEALTH PARTNERS AND OTHER LOCAL HEALTH CARE ORGANIZATIONS ON THE CHNA PROCESS THROUGH PARTICIPATION IN TWO LOCAL COLLABORATIVES: THE CENTER FOR COMMUNITY HEALTH EAST METRO CHA (COMMUNITY HEALTH ASSESSMENT)/CHNA COLLABORATIVE AND THE WEST METRO CHNA COLLABORATION.COMMUNITY INPUT: AS PART OF THE CHNA PROCESS, HEALTHPARTNERS AND WESTFIELDS HOSPITAL PARTNERED TO CONDUCT COMMUNITY INPUT ACTIVITIES TO UNDERSTAND TOP HEALTH PRIORITIES.THE COMMUNITY INPUT IN THIS REPORT INCLUDES:COUNTY PRIORITY DATA: ST. CROIX COUNTY PUBLIC HEALTH, AS A MEMBER OF HEALTHIER TOGETHER, COLLABORATES TO FACILITATE AND SUPPORT THE ASSESSMENT OF COMMUNITY HEALTH PRIORITIES IN ST. CROIX AND PIERCE COUNTIES, WISCONSIN, AND PUBLISHES THIS AS A COMMUNITY HEALTH ASSESSMENT (CHA). HEALTHIER TOGETHER PIERCE & ST. CROIX COUNTIES COMMUNITY HEALTH SURVEY: IN 2015 AND 2018, HEALTHIER TOGETHER SOUGHT COMMUNITY INPUT FROM A RESIDENTIAL SURVEY AND COMMUNITY DIALOGUES. THE SURVEY MEASURED RESIDENTS' PERCEPTIONS OF COMMUNITY STRENGTHS, LEADING HEALTH CONCERNS AND ACCESS TO RESOURCES. IN 2015, 1,363 PARTICIPANTS RESPONDED TO THE SURVEY (548 FROM PIERCE COUNTY AND 815 FROM ST. CROIX COUNTY). IN 2018, 1,072 PARTICIPANTS RESPONDED TO THE SURVEY (368 FROM PIERCE COUNTY AND 704 FROM ST. CROIX COUNTY).COMMUNITY DIALOGUES: IN 2016, HEALTHIER TOGETHER HOSTED COMMUNITY DIALOGUES FOCUSED SPECIFICALLY ON MENTAL HEALTH, OBESITY/OVERWEIGHT, AND ALCOHOL ABUSE. THROUGH GUIDED DISCUSSIONS, PARTICIPANTS SHARED THEIR VISIONS FOR HEALTH IN THE COMMUNITY, CLARIFIED ASPECTS OF THE PRIORITY HEALTH AREAS AND BRAINSTORMED STRATEGIES FOR SUPPORTING COMMUNITY HEALTH. APPROXIMATELY 120 PEOPLE PARTICIPATED IN THESE COMMUNITY DIALOGUES AND FOCUS GROUPS. OTHER HEALTHPARTNERS HOSPITALS ALSO HELD COMMUNITY DIALOGUES. PROVIDER SURVEY: IN 2018, HEALTHPARTNERS SURVEYED HEALTH CARE PROVIDERS TO UNDERSTAND THEIR PERCEPTIONS OF LEADING HEALTH NEEDS AND COMMUNITY RESOURCES AVAILABLE TO HELP THEIR PATIENTS. THE SURVEY ALSO ASKED PROVIDERS TO IDENTIFY BARRIERS THEY FACE IN ADDRESSING HEALTH NEEDS AND RESOURCES TO BETTER SERVE THEIR PATIENTS. TWENTY-THREE HEALTH CARE PROVIDERS COMPLETED THE SURVEY, INCLUDING FIVE WHO PRACTICE AT WESTFIELDS HOSPITAL.
WESTFIELDS HOSPITAL, INC. PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES INCLUDED IN THE 2018 HEALTHPARTNERS CHNA WERE:- LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, STILLWATER, MN.- PARK NICOLLET HEALTH SERVICES INCLUDING PARK NICOLLET METHODIST HOSPITAL (ST. LOUIS PARK, MN)- REGIONS HOSPITAL, MN.- AMERY REGIONAL MEDICAL CENTER, WI.- HUDSON HOSPITAL, HUDSON, WI.
WESTFIELDS HOSPITAL, INC. PART V, SECTION B, LINE 11: THE 2018 HEALTHPARTNERS CHNA RESULTED INTHE 2018 HEALTHPARTNERS CHNA RESULTED IN THE FOLLOWING PRIORITIES:PRIORITY 1: ACCESS TO CAREENSURED THAT EVERY PERSON WHO TOUCHES OUR ORGANIZATION FEELS WELCOMED, INCLUDED, AND VALUED. OUR STRATEGY IS ORGANIZATION-WIDE TRAINING ON DIVERSITY SERVED AS A SPRINGBOARD TO PATIENT & MEMBER BIAS, PATIENT AND DIVERSITY TRAINING AND INTEGRATION INTO ALL-STAFF LEARNING MODULES, WELCOME DAY AND LEADER DEVELOPMENT. WITH GOALS TO IMPROVE ACCESS TO CARE THAT IS APPROPRIATE, AFFORDABLE, AND CONVENIENT. CONTINUED TO INCREASE WEBSITE ACCESS TO PATIENT AND COMMUNITY ACCESS TO HEALTH INFORMATION AND APPOINTMENT SCHEDULING. IMPROVED GEOGRAPHIC ACCESS OF CARE FOR PATIENTS THROUGH COORDINATION OF APPOINTMENT SCHEDULING BETWEEN FIVE SITES IN THE ST. CROIX VALLEY AREA. SIGNIFICANTLY INCREASED TELEMEDICINE FOR PRIMARY, SPECIALTY AND BEHAVIORAL HEALTH SERVICES IN A VERY SHORT TIME FRAME TO INCREASE ACCESS DURING PANDEMIC RESTRICTIONS. WESTFIELDS HOSPITAL SAW A TOTAL OF 14,949 TELEMEDICINE APPOINTMENTS IN 2020. EXPANDED PRIMARY CARE CLINIC HOURS MONDAY-FRIDAY TO BEGIN EARLIER AND END LATER TO INCREASE APPOINTMENT SLOTS AND PROVIDE ADDITIONAL OPTIONS FOR PATIENTS. EXTENDED URGENT CARE HOURS MONDAY-FRIDAY AS WELL AS SATURDAY AND SUNDAY TO IMPROVE ACCESS TO THE APPROPRIATE LEVEL OF CARE RATHER THAN PATIENTS HAVING TO GO TO THE EMERGENCY ROOM. PRIORITY 2: ACCESS TO HEALTHSTRENGTHEN EXISTING AND EXPLORE NEW COMMUNITY PARTNERSHIPS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH. PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT. PROMOTE SUSTAINABLE OPERATIONS TO POSITIVELY IMPACT THE COMMUNITY. DUE TO COVID-19 PANDEMIC, NEW PARTNERSHIPS WERE ESTABLISHED, AND EXISTING PARTNERSHIPS WERE STRENGTHENED TO MEET SHIFTING AND EMERGING COMMUNITY NEEDS. COMMUNITY HEALTH ACTION TEAM (CHAT) CONTINUED TO ENGAGE COMMUNITY LEADERS TO COLLABORATE AND PARTNER DURING THE PANDEMIC, PROVIDING UPDATES AND CROSS-PROMOTING HEALTH MESSAGES TO THE COMMUNITY. HEALTH AND WELL-BEING ADVISORY COMMITTEE CONTINUED TO GUIDE COMMUNITY HEALTH EFFORTS AND RESPONSE THROUGH CROSS-SECTOR COLLABORATION. UPDATED COMMUNITY RESOURCE LIST TO INCLUDE NEW RESOURCES AND SUPPORT DURING COVID PANDEMIC; AVAILABLE TO PATIENTS, STAFF AND COMMUNITY MEMBERS. PRIORITY 3: MENTAL HEALTH AND WELL-BEINGREDUCE THE STIGMA SURROUNDING MENTAL ILLNESS. INCREASE ACCESS TO EDUCATION AND RESOURCES AROUND MENTAL HEALTH AND WELL-BEING. IMPROVE ACCESS TO MENTAL HEALTH SERVICES.WESTFIELDS HOSPITAL IS A PARTNER IN MAKE IT OK, A PROGRAM FOCUSED ON REDUCING THE STIGMA OF MENTAL ILLNESS. IN 2020, THE REACH OF THE MAKE IT OK CAMPAIGN EXPANDED THROUGH TRAINING LOCAL AMBASSADORS, PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. DESPITE THE CHALLENGE OF COVID 19, MAKE IT OK MADE PROGRESS IN REDUCING THE STIGMA OF MENTAL ILLNESS WITH THE FOLLOWING IMPACT FROM MAKE IT OK IN 2020: MAKEITOK.ORG RECEIVED 81,349 WEBSITE VISITS WITH 62,780 UNIQUE VISITORS IN 2020. THE MAKE IT OK TOOLS AND RESOURCES WERE DOWNLOADED MORE THAN 500 TIMES BY PEOPLE IN 250 US CITIES AND 25 MINNESOTA COUNTIES. HELD 11 AMBASSADOR TRAININGS BOTH IN PERSON AND VIRTUALLY, MOBILIZING AN ADDITIONAL 200 AMBASSADORS. REACHED MORE THAN 2,000 PEOPLE THROUGH COMMUNITY PRESENTATIONS, EVENTS AND TABLING. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. MAKE IT OK HAS BEEN A KEY PARTNER IN A COMPREHENSIVE APPROACH TO MENTAL HEALTH FOR STUDENTS IN THE LOCAL SCHOOLS. IN A SURVEY OF MAKE IT OK AMBASSADORS IN OCTOBER 2020, 88% SAID THAT MAKE IT OK WAS MORE IMPORTANT THAN EVER IN A TIME OF SOCIAL ISOLATION AND EMOTIONAL STRESS FOR MANY IN OUR COMMUNITIES. MORE THAN 500 AMBASSADORS ARE NOW TRAINED IN THE ST. CROIX VALLEY AREA. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS MAKE IT OK HAS BEEN A KEY PARTNER IN A COMPREHENSIVE APPROACH TO MENTAL HEALTH FOR STUDENTS I INCREASED VALLEY-WIDE USE OF BEHAVIORAL HEALTH TELEHEALTH (BHTV) PROGRAM FOR PATIENTS ACCESSING EMERGENCY DEPARTMENT CARE DURING A MENTAL HEALTH CRISIS: BEHAVIORAL HEALTH TEAM SERVED OUR COMMUNITY IN NEW AND DIFFERENT WAYS, INCLUDING SOME DIGITAL/VIRTUAL FORMATS, INCLUDING PODCASTS. SIX PODCASTS WERE RECORDED IN 2020, PRIMARILY WITH A MENTAL HEALTH FOCUS ON TOPICS SUCH AS DEPRESSION, ANXIETY AND STRESS RELIEF. IN TOTAL, THESE HAVE BEEN ACCESSED OVER 400 TIMES. CRIMINAL JUSTICE COMMUNITY COLLABORATION TO COORDINATE WITH COUNTY HUMAN SERVICES, THE COURTS AND LAW ENFORCEMENT JURISDICTIONS TO IMPROVE BEHAVIORAL HEALTH CARE AND SERVICES IN ST CROIX COUNTY GRIEF COUNSELOR PARTNERS WITH NEW RICHMOND SCHOOL DISTRICT TO OFFER "GROWING THROUGH GRIEF" PROGRAM FOR IN-SCHOOL SUPPORT FOR STUDENTS COPING WITH THE DEATH OF A LOVED ONE. SERVED 28 STUDENTS AND 23 FAMILIES. CONTINUED: INTEGRATED BEHAVIORAL HEALTH INTO TOTAL HEALTH CARE AT ALL LOCATIONS. CONTINUED: PARTNER WITH SCHOOLS TO PROVIDE MENTAL HEALTH SERVICES TO SCHOOLS AND REDUCE STIGMA.PRIORITY 4: NUTRITION AND PHYSICAL ACTIVITYPROMOTE AND SUPPORT PHYSICAL ACTIVITY AND NUTRITION AND SUPPORT AND ENCOURAGE HEALTHY FOOD AND PHYSICAL ACTIVITY ENVIRONMENT CHANGE. POWERUP: SINCE 2015, WESTFIELDS HOSPITAL HAS SUPPORTED POWERUP, A COMMUNITYWIDE HEALTH INITIATIVE THAT INSPIRES AND ENGAGES THE ENTIRE COMMUNITY TO PROMOTE BETTER EATING AND PHYSICAL ACTIVITIES SO YOUTH CAN REACH THEIR FULL POTENTIAL. OUR WORK WITH HUNDREDS OF PARTNERS ACROSS THE REGION HAS RESULTED IN A HIGH LEVEL OF COMMUNITY AND SCHOOL ENGAGEMENT, STRONGER SCHOOL WELLNESS POLICIES AND PRACTICES; MORE FREE AND LOW-COST OPTIONS FOR PHYSICAL ACTIVITY INCLUDING OPEN GYMS; PARTNERSHIPS WITH STATE AND LOCAL PARKS; TRANSFORMED FOOD PANTRIES, CAFETERIAS AND CONCESSIONS; AND COMMUNITY MOMENTUM TO CREATE CHANGE.POWERUP COMMUNITY ENGAGEMENT HAS GROWN OVER TIME AND ADAPTED DURING COVID 19 COMMUNITY AND SCHOOL VIRTUAL PROGRAMS, RESOURCES AND SOCIAL MEDIA ENGAGEMENT. EVEN WITH THESE LIMITS FOR OUTREACH, MORE THAN 75,000 ENGAGED IN THE ST. CROIX VALLEY AREA IN 2020 THROUGH EVENTS, CLASSES, OUTREACH PROGRAMS AND GROWING ONLINE RESOURCES TO PROMOTE BETTER EATING AND MOVING MORE. NEW POWERUP4KIDS.ORG WEB PLATFORM WITH IMPROVED NAVIGATION, NEW RESOURCES FOR AT-HOME FAMILY ACTIVITIES AND SCHOOL RESOURCES FOR VIRTUAL AND IN-PERSON LEARNING ENVIRONMENTS. ONLINE RECIPE GALLERY, WITH MORE THAN 300 KIDAPPROVED RECIPES, VIDEO GALLERY FOR SCHOOLS AND FAMILIES WITH PHYSICAL ACTIVITY AND FOOD IDEAS FOR KIDS, CLASSROOMS AND FAMILIES. POWERUP SCHOOL CHALLENGE PROGRAM WAS COMPLETED REVISED TO PROVIDE SCHOOLS AND YOUTH SERVING ORGANIZATIONS TO COMPLETE THE CHALLENGE IN A FLEXIBLE WAY, ONLINE OR IN PERSON. THE PROGRAM INSPIRES STUDENTS TO EAT BETTER AND MOVE MORE, AND IN 2020 REACHED ELEMENTARY AGE STUDENTS IN 476 CLASSROOMS IN 23 ST. CROIX VALLEY AREA SCHOOLS. THE TOTAL PROGRAM REACHED STUDENTS IN 54 SCHOOLS AND MORE THAN 900 CLASSROOMS THROUGHOUT MINNESOTA AND WISCONSIN. THE THREEWEEK WINTER WARMUP CHALLENGE INSPIRED KIDS TO STAY ACTIVE DURING THE COLD MONTHS AND WAS IMPLEMENTED IN LOCAL SCHOOLS IN A VIRTUAL FORMAT REACHING 70 ELEMENTARY CLASSROOMS IN FOUR VALLEY SCHOOL DISTRICTS.PRIORITY 5: SUBSTANCE ABUSEREDUCE OPIOID PRESCRIPTIONS, DOSES, AND PATIENTS MEETING CHRONIC OPIOID USE CRITERIA. THROUGH COLLABORATIVE EFFORTS WITH PHARMACY, PRESCRIBERS AND PAIN CLINICS, ACHIEVED SIGNIFICANT REDUCTION IN OPIOID PRESCRIBING IN OUR CARE SYSTEM AND COMMUNITY. VALLEY-WIDE, SINCE 2016, THERE HAS BEEN A 68% AND 52% REDUCTION IN OPIOIDS PRESCRIBED AT DISCHARGE IN HOSPITALS AND EMERGENCY DEPARTMENTS, RESPECTIVELY. INCREASED AWARENESS AND ACCESS OF TREATMENT FOR SUBSTANCE ABUSE (ALCOHOL, TOBACCO, E-CIGARETTES, AND DRUGS). PROVIDED TOBACCO CESSATION CLASSES AND EXPANDED PROGRAMS FOR CHANGE TO INCREASE ACCESS TO ADDICTION COUNSELING AND SERVICES. REDUCED ACCIDENTAL POISONING AND DRUG ABUSE BY OFFERING FREE AND ENVIRONMENTALLY FRIENDLY MEDICATION COLLECTION AT OUR HOSPITALS AND CLINICS FOR THE COMMUNITY. PROMOTED COMMUNITY PRESCRIPTION TAKE-BACK LOCATIONS AND DISPOSAL BAGS, COLLECTING 401 LBS. AT WESTFIELDS HOSPITAL IN 2020.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2020
Schedule H (Form 990) 2020
Page 9
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) 2020
Schedule H (Form 990) 2020
Page 10
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: WESTFIELDS HOPSITAL GIVES ALL PATIENTS AT LEAST THE SAME DISCOUNT AS OUR HIGHEST VOLUME COMMERCIAL PAYER.
PART I, LINE 7: ACTUAL COSTS ESTIMATED USING COST-TO-CHARGE RATIO WORKSHEETS PROVIDED IN SCHEDULE H.
PART I, LINE 7G: WESTFIELDS HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2020, LOSS ON SERVICES FOR HOSPITAL OUTPATIENT SERVICES INCLUDING EMERGENCY, RESPIRATORY THERAPY, PHYSICAL THERAPY, ONCOLOGY, SPECIALTY CLINIC, AND PRIMARY CLINIC TOTALED $3,705,322.
PART II, COMMUNITY BUILDING ACTIVITIES: WESTFIELDS HOSPITAL SUPPORTS INDIVIDUALS, ORGANIZATIONS, EVENTS AND PROGRAMS; IT LIVES OUT ITS COMMITMENT TO IMPROVE THE HEALTH OF THE COMMUNITY. KNOWING MUCH MORE CAN BE ACCOMPLISHED TOGETHER, WESTFIELDS HOSPITALS COMMUNITY BENEFIT PROGRAM STRIVES TO MAKE VALUABLE CONNECTIONS WITH INDIVIDUALS AND ORGANIZATIONS FROM PUBLIC, PRIVATE AND NONPROFIT SECTORS TO SHARE SKILLS AND ASSETS. WESTFIELDS HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT TO IMPROVE THE BUSINESS CLIMATE IN THE REGION. THESE ACTIVITIES INCLUDED EMERGENCY PREPAREDNESS AND YOUTH ASSET DEVELOPMENT, INCLUDING DRUG AND SAFETY PREVENTION, LEADERSHIP DEVELOPMENT/CONFLICT RESOLUTION, HEALTH IMPROVEMENT ADVOCACY, WORKFORCE DEVELOPMENT AND COALITION BUILDING TO PROVIDE LEADERSHIP AND IN-KIND SUPPORT FOR HEALTHIER TOGETHER PIERCE & ST. CROIX COUNTIES AND THE NEW RICHMOND AREA CENTRE WELLNESS FACILITY AND LOCAL COMMUNITY HEALTH. TO PROMOTE POSITIVE BEHAVIOR TO REDUCE OBESITY, WESTFIELDS HAS IMPLEMENTED POWERUP, A COMMUNITY-WIDE YOUTH HEALTH INITIATIVE TO MAKE BETTER EATING AND ACTIVE LIVING EASY, FUN, AND POPULAR, SO THAT OUR YOUTH CAN REACH THEIR FULL POTENTIAL.ADDITIONAL PROGRAMS/ACTIVITIES INCLUDED NEW RICHMOND CHAMBER OF COMMERCE & THE CENTRE PARTNERSHIPS, VISION 2020 COMMUNITY GROUP, AND THE LEADERSHIP TRUST INITIATIVE - A PROGRAM DEDICATED TO PROMOTING AND DEVELOPING DYNAMIC BUSINESS AND COMMUNITY LEADERS.IN SUPPORT OF "HEALTHY FOOD IN HEALTH CARE," LOCAL FARMS AND PROCUREMENT OF LOCAL FOOD, WESTFIELDS PARTICIPATED IN COMMUNITY SUPPORTED AGRICULTURE AND HOSTED WEEKLY FARMER'S MARKET EVENTS.
PART III, LINE 2: WESTFIELDS HOSPITAL USES A HISTORIC BAD DEBT PERCENTAGE THAT IS ROUTINELY MONITORED, REVIEWED, AND UPDATED IN ORDER TO OBTAIN THE BEST ESTIMATE OF THE CURRENT YEAR'S BAD DEBT.
PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS ESTIMATED BASED ON THE GROSS BAD DEBT WRITE OFFS COMING FOR SOLELY UNINSURED PATIENTS. OUR ESTIMATE ASSUMES 1/3 OF THE BAD DEBT FROM UNINSURED PATIENTS WOULD HAVE QUALIFIED FOR EITHER A FULL OR PARTIAL ADJUSTMENT BASED ON OUR FINANCIAL ASSISTANCE POLICY. BECAUSE THE ADJUSTED AMOUNTS ARE TIED TO GROSS CHARGES, THE COST TO CHARGE RATIO IS USED TO ADJUST DOWN TO THE AMOUNT REPORTED AS THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. BAD DEBT WRITE OFFS RESULTING FROM CO-PAYS, DEDUCTIBLES, OR OTHER OUT OF POCKET FROM PATIENTS WITH INSURANCE ARE EXCLUDED. THE AMOUNT REPORTED IS NOT INCLUDED AS COMMUNITY BENEFIT.
SCHEDULE H, PART VI LINE 5 - PROMOTION OF COMMUNITY HEALTH AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL SERVING THE NEW RICHMOND AREA SINCE 1950, WESTFIELDS CONTINUES TO PLAY AN IMPORTANT ROLE AND IS POSITIONED WELL TO MEET THE HEALTH CARE NEEDS OF THE AREA. WESTFIELDS IS A FULL-SERVICE MEDICAL CAMPUS OFFERING EMERGENCY SERVICES, SPECIALTY CLINICS AND PHARMACY, AS WELL AS INPATIENT, OUTPATIENT AND MATERNITY SERVICES. WESTFIELDS IS GOVERNED BY A BOARD OF DIRECTORS WITH REPRESENTATION FROM COMMUNITY MEMBERS.WORKING IN PARTNERSHIP WITH EACH OTHER, WESTFIELDS, THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS, AND THE COMMUNITY ACCOMPLISHED A GREAT DEAL IN 2020. ADVANCEMENTS WERE MADE IN SUPPORT OF THE TRIPLE AIM: TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. DEDICATED STAFF PROMOTE COMMUNITY HEALTH IN THE FOLLOWING WAYS: FREE ON-GOING SUPPORT AND EDUCATION GROUPS IN BEREAVEMENT/ GRIEF, BREASTFEEDING, CANCER, DIABETES, NUTRITION AND WEIGHT MANAGEMENT AND CAREGIVERS; SCHOOL-BASED EDUCATION FOR ELEMENTARY AND SECONDARY SCHOOLS; TRAININGS FOR HEALTH CARE PROFESSIONALS AND NURSING STUDENTS; SELF-HELP PROGRAMMING FOLLOWING CARDIAC REHAB AND PHYSICAL THERAPY TO COMMUNITY MEMBERS.WESTFIELDS ENCOURAGES PATIENTS AND THEIR FAMILIES THEIR PARTNERS IN HEALTH TO BE ACTIVELY INVOLVED IN DECISIONS ABOUT THEIR OWN HEALTH CARE. RESEARCH SHOWS THAT PATIENTS AND THEIR FAMILIES WHO ARE MORE INVOLVED WITH THEIR CARE FEEL THEY GET BETTER RESULTS AND ARE MORE SATISFIED. SAFETY AND SATISFACTION ARE PRIORITIES AT WESTFIELDS. WESTFIELDS IS MORE THAN JUST A HOSPITAL TAKING CARE OF PATIENTS WHEN THEY ARE SICK OR HURT. THE GOAL IS TO BE A LEADING PARTNER IN HEALTH EDUCATION, OUTREACH AND IMPROVEMENT. WESTFIELDS IS CONTINUALLY MAKING IMPROVEMENTS TO REACH THAT GOAL. BENEFITS TO PATIENTS AND THE COMMUNITY IN 2020WESTFIELDS' DEVOTION TO THE HEALTH OF THE COMMUNITY STARTS WITH PROVIDING EXCEPTIONAL MEDICAL CARE TO EACH PATIENT AND EXTENDS TO FAMILIES AND ORGANIZATIONS THROUGHOUT THE REGION. THROUGH ITS COMMUNITY BENEFIT PROGRAM, WESTFIELDS OFFERED SPECIAL HELP AND SUPPORT - FOR INDIVIDUALS OR FAMILIES EXPERIENCING FINANCIAL HARDSHIP OR ORGANIZATIONS STRIVING TO IMPROVE THE QUALITY OF LIFE FOR ALL.TOTAL 2020 COMMUNITY BENEFIT CONTRIBUTION EQUALED $7,308,284, WHICH REPRESENTS 10.9% OF TOTAL EXPENSE. THIS FIGURE IS REPORTED AT COST PER THE CATHOLIC HEALTH ASSOCIATION (CHA) COMMUNITY BENEFIT REPORTING.2020 ACCOMPLISHMENTS INCLUDE: WESTFIELDS HOSPITAL RECEIVED A 5-STAR RATING FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FOR THE QUALITY OF PATIENT CARE IN 2020, PLACING IT IN THE TOP 9% OF ALL HOSPITALS IN THE U.S. NAMED ONE OF THE TOP 20 CRITICAL ACCESS HOSPITALS (CAH) IN THE COUNTRY BY THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA) AND THE CHARTIS CENTER FOR RURAL HEALTH. RECOGNIZED FOR OVERALL EXCELLENCE IN HEALTH OUTCOMES AND PATIENT PERSPECTIVES BY THE NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH AND THE CHARTIS CENTER FOR RURAL HEALTH. EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR ACCREDITATION BY DEMONSTRATING COMPLIANCE WITH ITS NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY IN HOSPITALS. PRACTICE GREENHEALTH AWARDS, INCLUDING: TOP 25 ENVIRONMENTAL EXCELLENCE AWARD, EMERALD AWARD, GREENING THE OR RECOGNITION, AND CIRCLES OF EXCELLENCE FOR LEADERSHIP. GREEN MASTERS PROGRAM (TOP 20% OF COMPANIES) FOR SUSTAINABILITY EXCELLENCE BY THE WISCONSIN SUSTAINABLE BUSINESS COUNCIL. NAMED A TREE CAMPUS HEALTHCARE FACILITY BY THE ARBOR DAY FOUNDATION. FOR OUTPATIENTS, WESTFIELDS: SAW LOWER VOLUMES IN MANY DEPARTMENTS IN 2020 DUE TO COVID-19: 5,029 CT SCANS, 2,091 MAMMOGRAMS, 7,174 EMERGENCY DEPARTMENT VISITS, 8,362 SPECIALTY CLINIC VISITS, AND 50,675 PRIMARY CARE CLINIC VISITS. ROLLED CASE MANAGEMENT PROGRAM ACROSS THE CAMPUS BASED OUT OF THE PRIMARY CARE CLINIC. WE HAVE OVER 50 PATIENTS ENROLLED WITH REFERRALS COMING TO THE TEAM OF RNS.
PART III, LINE 4: SEE THE ORGANIZATION'S FOOTNOTES OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENT.
PART III, LINE 8: MEDICARE SURPLUS (SHORTFALL) IN LINE 7 REPRESENTS THE ADDITIONAL 1% OF ALLOWABLE COST THAT CRITICAL ACCESS HOSPITALS RECEIVE. MEDICARE SHORTFALL IS CURRENTLY EXCLUDED FROM THE COMMUNITY BENEFIT CALCULATION PER THE WHA, BUT CAN BE INCLUDED IN OTHER FINANCIAL REPORTS. WESTFIELDS BASES ITS MEDICARE COSTING METHODOLOGY ON THE CMS MEDICARE COST REPORT METHODOLOGY; COST TO CHARGE RATIO.
PART III, LINE 9B: WESTFIELDS HOSPITAL DEBT COLLECTION POLICY CONTAINS PROVISIONS ON COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. WESTFIELDS WILL NOT REFER ANY ACCOUNT TO A THIRD PARTY DEBT COLLECTION AGENCY UNLESS IT HAS CONFIRMED THAT THERE IS REASONABLE BASIS TO BELIEVE THAT THE PATIENT OWES THE DEBT, ALL KNOWN THIRD-PARTY PAYERS HAVE BEEN PROPERLY BILLED, AND THE PATIENT IS RESPONSIBLE FOR THE REMAINING DEBT.
PART VI, LINE 2: IN 2018, A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) COLLABORATION WAS CONDUCTED FOR HEALTHPARTNERS AND SIX OF ITS HOSPITALS INCLUDING REGIONS HOSPITAL, LAKEVIEW HOSPITAL, HUDSON HOSPITAL & CLINIC, WESTFIELDS HOSPITAL, AMERY HOSPITAL & CLINIC, AND PARK NICOLLET METHODIST HOSPITAL) BY THE IMPROVEGROUP TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES THEY SERVE. THESE HOSPITALS SERVE SIMILAR COMMUNITIES AND HAVE OVERLAPPING STUDY AREAS. THE SYSTEM'S STUDY AREA IS DEFINED AS DAKOTA, HENNEPIN, RAMSEY, SCOTT, AND WASHINGTON COUNTIES IN MINNESOTA AND POLK AND ST. CROIX COUNTIES IN WISCONSIN. WESTFIELDS HOSPITAL SPECIFIC STUDY AREA IS DEFINED AS: ST. CROIX COUNTY PIERCE COUNTYMETHODOLOGYHEALTHPARTNERS AND WESTFIELDS HOSPITAL ENGAGED WITH LOCAL PUBLIC HEALTH PARTNERS IN ST. CROIX COUNTY, AS WELL AS LOCAL COALITIONS, THE CENTER FOR COMMUNITY HEALTH (CCH) AND COMMUNITY PARTNERS TO CONDUCT A COMPREHENSIVE CHNA. WESTFIELDS IS A MEMBER OF HEALTHIER TOGETHER PIERCE & ST. CROIX COUNTIES (HEALTHIER TOGETHER), A COMMUNITY COALITION COMPRISED OF LOCAL HEALTH SYSTEMS, PUBLIC HEALTH AGENCIES, LOCAL BUSINESSES, MEDIA, NONPROFITS, EDUCATION, GOVERNMENT AND COMMUNITY MEMBERS. WESTFIELDS HOSPITAL HAS COLLABORATED AS A LONG-TERM MEMBER OF HEALTHIER TOGETHER TO FACILITATE AND SUPPORT THE ASSESSMENT OF COMMUNITY HEALTH PRIORITIES IN ST. CROIX AND PIERCE COUNTIES, WISCONSIN.IN 2018, HEALTHPARTNERS AND WESTFIELDS HOSPITAL CONTRACTED WITH THE IMPROVE GROUP TO ANALYZE AND REPORT ON THE DATA DESCRIBING THE COMMUNITIES WE SERVE. HEALTHPARTNERS PROVIDED THE IMPROVE GROUP WITH THE DEFINITIONS OF EACH HOSPITAL'S SERVICE AREA, THE INDICATORS TO STUDY FOR THE HEALTH AND DEMOGRAPHIC DATA SUMMARIES AND DATA COLLECTED DURING COMMUNITY CONVERSATIONS. COMMUNITY INPUT WAS COLLECTED IN PARTNERSHIP WITH HEALTHPARTNERS AND HEALTHIER TOGETHER THROUGH COMMUNITY CONVERSATIONS AND MULTIPLE SURVEYS. THE IMPROVE GROUP THEN GATHERED SECONDARY DATA FROM PUBLIC SOURCES, ANALYZED COMMUNITY INPUT DATA AND DEVELOPED SUMMARY REPORTS TO GUIDE A PRIORITIZATION PROCESS. THE HEALTHPARTNERS CHNA TEAM INCLUDED REPRESENTATIVES FROM EACH HEALTHPARTNERS HOSPITAL AND HEALTHPARTNERS LEADERSHIP. ON SEPTEMBER 14, 2018, THE CHNA TEAM MET TO REVIEW THE DATA AND PRIORITIZE THE COMMUNITY HEALTH NEEDS ACROSS THE SYSTEM. HEALTHPARTNERS COLLECTIVELY PRIORITIZED COMMUNITY HEALTH NEEDS USING A PROCESS INFORMED BY THE HANLON METHOD AND OTHER COMMONLY USED PRIORITIZATION METHODS. EACH HOSPITAL SHARED ITS 4 OR 5 PRIORITY TOPIC AREAS AND RATIONALE FOR EACH TOPIC AREA BASED ON: SIZE: NUMBER OF PERSONS AFFECTED, TAKING INTO ACCOUNT VARIANCE FROM BENCHMARK DATA AND TARGETS; SERIOUSNESS: THE DEGREE TO WHICH THE PROBLEM LEADS TO DEATH, DISABILITY AND IMPAIRMENT OF ONE'S QUALITY OF LIFE (MORTALITY AND MORBIDITY); EQUITY: DEGREE TO WHICH SPECIFIC GROUPS ARE AFFECTED BY THE PROBLEM; VALUE: THE IMPORTANCE OF THE PROBLEM TO THE COMMUNITY; AND CHANGE: WHAT IS THE SAME AND WHAT IS DIFFERENT FROM YOUR PREVIOUS CHNA? HEALTHPARTNERS HOSPITALS WORKED IN A THOROUGH, FACILITATED LARGE AND SMALL GROUP PROCESS TO REACH CONSENSUS ON TOP PRIORITIES. THE CHNA TEAM CONSIDERED THE CRITERIA DESCRIBED ABOVE AS WELL AS COMMUNITY INPUT DATA IN THESE DISCUSSIONS. THE FIVE PRIORITIES ARE OF EQUAL IMPORTANCE AND ARE PRESENTED IN ALPHABETICAL ORDER. THE FIVE PRIORITY AREAS ARE:ACCESS TO CAREACCESS TO CARE REFERS TO HAVING EQUITABLE ACCESS TO APPROPRIATE, CONVENIENT AND AFFORDABLE HEALTH CARE. THIS INCLUDES FACTORS SUCH AS PROXIMITY TO CARE, ACCESS TO PROVIDERS, COST, INSURANCE COVERAGE, MEDICAL TRANSPORTATION, CARE COORDINATION WITHIN THE HEALTH CARE SYSTEM AND CULTURAL SENSITIVITY AND RESPONSIVENESS. ACCESS TO HEALTHACCESS TO HEALTH REFERS TO THE SOCIAL AND ENVIRONMENTAL CONDITIONS THAT DIRECTLY AND INDIRECTLY AFFECT PEOPLE'S HEALTH SUCH AS HOUSING, INCOME, EMPLOYMENT, EDUCATION AND MORE. THESE FACTORS, ALSO REFERRED TO AS SOCIAL DETERMINANTS OF HEALTH, DISPROPORTIONATELY IMPACT LOW INCOME COMMUNITIES AND COMMUNITIES OF COLOR. MENTAL HEALTH AND WELL-BEINGMENTAL HEALTH AND WELL-BEING REFERS TO THE INTERCONNECTION BETWEEN MENTAL ILLNESS, MENTAL HEALTH, MENTAL WELL-BEING AND THE ASSOCIATED STIGMA. POOR MENTAL HEALTH IS ASSOCIATED WITH POOR QUALITY OF LIFE, HIGHER RATES OF CHRONIC DISEASE AND A SHORTER LIFESPAN.NUTRITION AND PHYSICAL ACTIVITYNUTRITION AND PHYSICAL ACTIVITY REFERS TO EQUITABLE ACCESS TO NUTRITION, PHYSICAL ACTIVITY AND FOOD AND FEEDING CHOICES. POOR NUTRITION AND PHYSICAL INACTIVITY ARE MAJOR CONTRIBUTORS TO OBESITY AND CHRONIC DISEASES SUCH AS DIABETES, HEART DISEASE AND STROKE, WHICH DISPROPORTIONALLY IMPACT LOW INCOME COMMUNITIES AND COMMUNITIES OF COLOR. SUBSTANCE ABUSESUBSTANCE ABUSE AND ADDICTION ARE THE EXCESSIVE USE OF SUBSTANCES INCLUDING ALCOHOL, TOBACCO, PRESCRIPTION DRUGS, OPIOIDS AND OTHER DRUGS IN A MANNER THAT IS HARMFUL TO HEALTH AND WELL-BEING. PRIORITIES NOT SELECTED: HEALTHPARTNERS DISCUSSED AND CONSIDERED ADDITIONAL OR ALTERNATIVE PRIORITIES DURING THE PRIORITIZATION PROCESS, INCLUDING: OLDER ADULT HEALTH/AGING, MATERNAL AND CHILD HEALTH, ENVIRONMENTAL HEALTH AND INJURY AND VIOLENCE. THESE NEEDS WERE NOT SELECTED AS ONE OF THE TOP FIVE PRIORITIES IN THE CONSENSUS BUILDING PROCESS, HOWEVER, THE THEMES WILL BE CONSIDERED IN THE IMPLEMENTATION FOR THE SELECTED PRIORITY AREAS.
PART VI, LINE 3: WESTFIELDS HOSPITAL IS COMMITTED TO PROVIDING QUALITY MEDICAL CARE TO OUR PATIENTS, INCLUDING THOSE IN NEED OF FINANCIAL ASSISTANCE. AS A RESULT, OUR FINANCIAL ASSISTANCE POLICY (REFERRED TO HEREIN AS "FAP OR "POLICY") IS AVAILABLE TO UNINSURED OR UNDERINSURED PATIENTS BASED ON THE PATIENT'S ABILITY TO PAY FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. OUR POLICY IS AVAILABLE TO PROVIDE EPISODIC HELP; IT IS NOT MEANT TO PROVIDE LONG-TERM, FREE OR DISCOUNTED CARE. OUR POLICY SETS FORTH AND DESCRIBES ELIGIBILITY CRITERIA, HOW WE CALCULATE DISCOUNTS, HOW TO APPLY FOR FINANCIAL ASSISTANCE, THE PROVIDERS DELIVERING CARE IN OUR HOSPITAL AND OUR EMERGENCY MEDICAL CARE POLICY.WESTFIELDS HOSPITAL'S FAP IS WIDELY PUBLICIZED IN MULTIPLE WAYS. PATIENTS CAN OBTAIN FREE COPIES OF THIS POLICY AT ALL PATIENT REGISTRATION LOCATIONS AT WESTFIELDS. FOR ADDITIONAL INFORMATION OR QUESTIONS ABOUT THE APPLICATION PROCESS, OR TO REQUEST COPIES BY MAIL, PATIENTS CAN CONTACT OUR PATIENT FINANCIAL SERVICES DEPARTMENT AT 1-715-243-2600. FREE COPIES OF THIS POLICY AND THE FINANCIAL ASSISTANCE APPLICATION FORM ARE ALSO AVAILABLE AT HTTP://WWW.WESTFIELDSHOSPITAL.COM.
PART VI, LINE 4: WESTFIELDS HOSPITAL SERVES RESIDENTS FROM ST. CROIX COUNTY, WISCONSIN AND SURROUNDING COUNTIES OF POLK, DUNN AND PIERCE. 2019 CENSUS LISTS THE POPULATION OF ST. CROIX COUNTY AT 90,687, A 7.5% POPULATION GROWTH SINCE 2010. RAPID GROWTH CONTINUES WITHIN ST. CROIX COUNTY, IN PART DUE TO ITS CLOSE PROXIMITY TO THE TWIN CITIES (MINNEAPOLIS/ST. PAUL), WHERE MANY RESIDENTS COMMUTE TO WORK. ST. CROIX COUNTY'S POPULATION IS COMPRISED OF 35% UNDER 19, 11% 65 YEARS AND OVER. THE POPULATION IS 95.9% WHITE, 0.9% BLACK, 0.5% AMERICAN INDIAN, 1.1% ASIAN AND 1.6% HISPANIC OR LATINO. ST. CROIX COUNTY HAS A HIGH MEDIAN INCOME COMPARATIVELY WITHIN THE STATE - $81,124 AND A POVERTY RATE APPROXIMATELY HALF THAT OF THE REST OF THE STATE - 4.78%.ACCORDING TO THE 2020 COUNTY HEALTH RANKINGS REPORT, ST. CROIX COUNTY RANKED AS THE SEVENTH HEALTHIEST COUNTY OVERALL IN THE STATE (OUT OF 72 COUNTIES).
PART VI, LINE 5: AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL SERVING THE NEW RICHMOND AREA SINCE 1950, WESTFIELDS HOSPITAL CONTINUES TO PLAY AN IMPORTANT ROLE AND IS POSITIONED WELL TO MEET THE HEALTH CARE NEEDS OF THE AREA. WESTFIELDS HOSPITAL IS A FULL-SERVICE MEDICAL CAMPUS OFFERING EMERGENCY SERVICES, SPECIALTY CLINICS AND PHARMACY, AS WELL AS INPATIENT, OUTPATIENT AND MATERNITY SERVICES. WESTFIELDS HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS WITH REPRESENTATION FROM COMMUNITY MEMBERS.WORKING IN PARTNERSHIP WITH EACH OTHER, WESTFIELDS HOSPITAL, THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS, AND THE COMMUNITY ACCOMPLISHED A GREAT DEAL IN 2020. ADVANCEMENTS WERE MADE IN SUPPORT OF THE TRIPLE AIM: TO ENSURE BETTER HEALTH FOR ALL, IMPROVED PATIENT EXPERIENCE AND AFFORDABLE HEALTH CARE. DEDICATED STAFF PROMOTE COMMUNITY HEALTH IN THE FOLLOWING WAYS: FREE ON-GOING SUPPORT AND EDUCATION GROUPS IN BEREAVEMENT/ GRIEF, BREASTFEEDING, CANCER, DIABETES, NUTRITION AND WEIGHT MANAGEMENT AND CAREGIVERS; SCHOOL-BASED EDUCATION FOR ELEMENTARY AND SECONDARY SCHOOLS; TRAININGS FOR HEALTH CARE PROFESSIONALS AND NURSING STUDENTS; SELF-HELP PROGRAMMING FOLLOWING CARDIAC REHAB AND PHYSICAL THERAPY TO COMMUNITY MEMBERS.WESTFIELDS HOSPITAL ENCOURAGES PATIENTS AND THEIR FAMILIES - THEIR PARTNERS IN HEALTH - TO BE ACTIVELY INVOLVED IN DECISIONS ABOUT THEIR OWN HEALTH CARE. RESEARCH SHOWS THAT PATIENTS AND THEIR FAMILIES WHO ARE MORE INVOLVED WITH THEIR CARE FEEL THEY GET BETTER RESULTS AND ARE MORE SATISFIED. SAFETY AND SATISFACTION ARE PRIORITIES AT WESTFIELDS HOSPITAL. WESTFIELDS HOSPITAL IS MORE THAN JUST A HOSPITAL TAKING CARE OF PATIENTS WHEN THEY ARE SICK OR HURT. THE GOAL IS TO BE A LEADING PARTNER IN HEALTH EDUCATION, OUTREACH AND IMPROVEMENT. WESTFIELDS IS CONTINUALLY MAKING IMPROVEMENTS TO REACH THAT GOAL. BENEFITS TO PATIENTS AND THE COMMUNITY IN 2020WESTFIELDS HOSPITAL'S DEVOTION TO THE HEALTH OF THE COMMUNITY STARTS WITH PROVIDING EXCEPTIONAL MEDICAL CARE TO EACH PATIENT AND EXTENDS TO FAMILIES AND ORGANIZATIONS THROUGHOUT THE REGION. THROUGH ITS COMMUNITY BENEFIT PROGRAM, WESTFIELDS HOSPITAL OFFERED SPECIAL HELP AND SUPPORT - FOR INDIVIDUALS OR FAMILIES EXPERIENCING FINANCIAL HARDSHIP OR ORGANIZATIONS STRIVING TO IMPROVE THE QUALITY OF LIFE FOR ALL.TOTAL 2020 COMMUNITY BENEFIT CONTRIBUTION EQUALED $7,308,284, WHICH REPRESENTS 10.9% OF TOTAL EXPENSE. THIS FIGURE IS REPORTED AT COST PER THE CATHOLIC HEALTH ASSOCIATION (CHA) COMMUNITY BENEFIT REPORTING.2020 ACCOMPLISHMENTS INCLUDE: WESTFIELDS HOSPITAL RECEIVED A 5-STAR RATING FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FOR THE QUALITY OF PATIENT CARE IN 2020, PLACING IT IN THE TOP 9% OF ALL HOSPITALS IN THE U.S. NAMED ONE OF THE TOP 20 CRITICAL ACCESS HOSPITALS (CAH) IN THE COUNTRY BY THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA) AND THE CHARTIS CENTER FOR RURAL HEALTH. RECOGNIZED FOR OVERALL EXCELLENCE IN HEALTH OUTCOMES AND PATIENT PERSPECTIVES BY THE NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH AND THE CHARTIS CENTER FOR RURAL HEALTH. EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR ACCREDITATION BY DEMONSTRATING COMPLIANCE WITH ITS NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY IN HOSPITALS. PRACTICE GREENHEALTH AWARDS, INCLUDING: TOP 25 ENVIRONMENTAL EXCELLENCE AWARD, EMERALD AWARD, GREENING THE OR RECOGNITION, AND CIRCLES OF EXCELLENCE FOR LEADERSHIP. GREEN MASTERS PROGRAM (TOP 20% OF COMPANIES) FOR SUSTAINABILITY EXCELLENCE BY THE WISCONSIN SUSTAINABLE BUSINESS COUNCIL. NAMED A TREE CAMPUS HEALTHCARE FACILITY BY THE ARBOR DAY FOUNDATION. FOR OUTPATIENTS, WESTFIELDS HOSPITAL: SAW LOWER VOLUMES IN MANY DEPARTMENTS IN 2020 DUE TO COVID-19: 5,029 CT SCANS, 2,091 MAMMOGRAMS, 7,174 EMERGENCY DEPARTMENT VISITS, 8,362 SPECIALTY CLINIC VISITS, AND 50,675 PRIMARY CARE CLINIC VISITS. ROLLED CASE MANAGEMENT PROGRAM ACROSS THE CAMPUS BASED OUT OF THE PRIMARY CARE CLINIC. WE HAVE OVER 50 PATIENTS ENROLLED WITH REFERRALS COMING TO THE TEAM OF RNS.
PART VI, LINE 6: PLEASE SEE WESTFIELDS HOSPITAL'S SCHEDULE O: DISCUSSION OF EXEMPT PURPOSE AND ACHIEVEMENTS - "I: CORPORATE STRUCTURE, PURPOSE, GOVERNANCE."
PART VI, LINE 7, REPORTS FILED WITH STATES WI
SCHEDULE H - PART I, LINE 7F -HEALTH PROFESSIONS EDUCATION WESTFIELDS HOSPITAL STAFF PROVIDED CLINICAL TRAINING 29 HEALTH PROFESSIONALS FROM 5 INSTITUTIONS AT A COST OF $94,332.
Schedule H (Form 990) 2020
Additional Data


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number
39-0808442
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) SCHOOL DISTRICT OF NEW RICHMOND
701 E 11TH STREET
NEW RICHMOND,WI54017
39-6003673   45,000       PROGRAM SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
0
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020

Schedule I (Form 990) 2020
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
noncash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
PART I, LINE 2: WESTFIELDS HOSPITAL, INC. (WESTFIELDS) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH WESTFIELDS' MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE WESTFIELDS' FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE.
Schedule I (Form 990) 2020



Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Graphic Arrow Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
If any of the boxes on 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 .....
1b
 
 
2
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 on Line 1a? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
Yes
 
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1HEIDI G CONRAD
TREASURER
(i)

(ii)
0
-------------
427,834
0
-------------
84,240
0
-------------
75,972
0
-------------
149,704
0
-------------
40,136
0
-------------
777,886
0
-------------
74,862
2ANTHONY C HECHT MD
DIRECTOR
(i)

(ii)
0
-------------
290,367
0
-------------
0
0
-------------
243,149
0
-------------
21,375
0
-------------
23,675
0
-------------
578,566
0
-------------
0
3ANDREW E DORWART MD
DIRECTOR
(i)

(ii)
0
-------------
374,724
0
-------------
58,203
0
-------------
67,181
0
-------------
21,375
0
-------------
37,896
0
-------------
559,379
0
-------------
0
4DAVID O DEGEAR MD
FORMER VP - MEDICAL AFFAIR
(i)

(ii)
0
-------------
297,431
0
-------------
0
0
-------------
190,297
0
-------------
21,375
0
-------------
36,831
0
-------------
545,934
0
-------------
0
5DAVE A DZIUK
FORMER DIRECTOR & TREASURE
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
487,728
0
-------------
0
0
-------------
31,867
0
-------------
519,595
0
-------------
0
6ERIC W LING MD
DIRECTOR AND CMO
(i)

(ii)
0
-------------
322,782
0
-------------
7,385
0
-------------
92,261
0
-------------
21,375
0
-------------
35,410
0
-------------
479,213
0
-------------
0
7DOUGLAS E JOHNSON
CFO (SEPT-DEC)
(i)

(ii)
0
-------------
325,510
0
-------------
58,036
0
-------------
32,085
0
-------------
5,700
0
-------------
34,574
0
-------------
455,905
0
-------------
0
8AMY L DEWANE
DIRECTOR
(i)

(ii)
0
-------------
329,370
0
-------------
49,872
0
-------------
5,453
0
-------------
21,375
0
-------------
36,223
0
-------------
442,293
0
-------------
0
9TYLER R SCHMIDTZ
DIRECTOR
(i)

(ii)
0
-------------
308,291
0
-------------
45,294
0
-------------
1,586
0
-------------
22,992
0
-------------
33,661
0
-------------
411,824
0
-------------
0
10STEVEN M MASSEY
DIRECTOR, PRESIDENT
(i)

(ii)
0
-------------
294,678
0
-------------
42,986
0
-------------
1,649
0
-------------
22,992
0
-------------
32,651
0
-------------
394,956
0
-------------
0
11VINI T MANCHANDA
DIRECTOR
(i)

(ii)
0
-------------
256,196
0
-------------
38,784
0
-------------
4,143
0
-------------
50,398
0
-------------
35,946
0
-------------
385,467
0
-------------
0
12JOSEPH A DIETZLER MD
DIRECTOR
(i)

(ii)
0
-------------
193,914
0
-------------
0
0
-------------
82,687
0
-------------
21,183
0
-------------
33,770
0
-------------
331,554
0
-------------
0
13JASON J LUHRS
FORMER CFO
(i)

(ii)
0
-------------
223,370
0
-------------
33,735
0
-------------
12,982
0
-------------
17,706
0
-------------
33,643
0
-------------
321,436
0
-------------
0
14JACQUELINE M NELSON
PHARMACIST
(i)

(ii)
153,442
-------------
0
6,093
-------------
0
190
-------------
0
7,986
-------------
0
24,891
-------------
0
192,602
-------------
0
0
-------------
0
15MICHELE K RIEDEL
PHARMACIST
(i)

(ii)
144,171
-------------
0
477
-------------
0
5,263
-------------
0
7,477
-------------
0
33,517
-------------
0
190,905
-------------
0
0
-------------
0
16SHANNON M O'KEEFE
DIRECTOR OF IMAGING SERVICES
(i)

(ii)
138,018
-------------
0
5,521
-------------
0
1,080
-------------
0
7,231
-------------
0
36,593
-------------
0
188,443
-------------
0
0
-------------
0
17LEANNE M ROGGEMANN
VP PATIENT SERVICES & CNO
(i)

(ii)
159,408
-------------
0
6,330
-------------
0
67
-------------
0
6,847
-------------
0
11,311
-------------
0
183,963
-------------
0
0
-------------
0
18NICOLE M TROSEN
PHARMACY MANAGER
(i)

(ii)
161,959
-------------
0
4,824
-------------
0
0
-------------
0
8,339
-------------
0
0
-------------
0
175,122
-------------
0
0
-------------
0
19JENNIFER L FLETCH
PHYSICIAN ASSISTANT/NP
(i)

(ii)
125,761
-------------
0
473
-------------
0
17,937
-------------
0
0
-------------
0
10,610
-------------
0
154,781
-------------
0
0
-------------
0
Schedule J (Form 990) 2020

Schedule J (Form 990) 2020
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 WESTFIELDS HOSPITAL'S PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS), GROUP HEALTH PLAN, INC., (GHI), OR LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, ALL OF WHICH ARE RELATED ORGANIZATIONS. GHI, REGIONS, AND LAKEVIEW HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF WESTFIELDS PRESIDENT AND OTHER OFFICERS.
PART I, LINES 4A-B OTHER COMPENSATION IN COLUMN BIII OF SCHEDULE J, PART II INCLUDES AMOUNTS RECEIVED AS A SEVERANCE PAYMENT FOR THE FOLLOWING DIRECTORS AND OFFICERS: DAVID A. DZIUK 499,214 DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: HEIDI G. CONRAD 36,201
PART I, LINE 6 WESTFIELDS HOSPITAL, DOES HAVE EMPLOYEES; HOWEVER, WESTFIELDS HOSPITAL'S PRESIDENT AND CHIEF FINANCIAL OFFICER ARE EMPLOYEES OF RELATED ORGANIZATIONS REGIONS HOSPITAL (REGIONS) AND LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (LMHA) RESPECTIVELY. COMPENSATION PAID TO THESE TWO OFFICERS BY REGIONS AND LMHA IS REIMBURSED BY WESTFIELDS HOSPITAL. BOTH REGIONS AND LMHA HAVE MANAGEMENT INCENTIVE PROGRAMS THAT INCENT AND REWARD THE ORGANIZATIONS' BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAM IS AN ELEMENT OF THE PARTICIPANT'S REGIONS OR LMHA TOTAL COMPENSATION PACKAGE. REGIONS AND LMHA MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE BUT ARE NOT LIMITED TO PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, EMPLOYEE AND/OR LEADERSHIP DEVELOPMENT, CARE DELIVERY, PATIENT EDUCATION, SIX AIMS, MARKET SHARE, STRATEGIC CAPABILITIES, FINANCIAL PERFORMANCE (NET MARGIN), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET OPERATING INCOME THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT.
FORM 990, SCH. J, PART II - PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS: HEIDI G. CONRAD $ 74,862 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S.
Schedule J (Form 990) 2020

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part , line 24a. Provide descriptions,
explanations, and any additional information in Part .
SchKMediumBullet Attach to Form 990.

SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number
39-0808442
Part
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A CITY OF NEW RICHMOND WI
 
39-6005554 NONE99999 07-06-2016 3,223,708 REFUNDING OF SERIES 1999A   X   X   X
B VILLAGE OF STAR PRAIRIE WI
 
39-1280538 NONE99999 07-06-2016 6,854,052 REFUNDING OF SERIES 1999B/2016B   X   X   X
Part
Proceeds
A B C D
1 Amount of bonds retired .................. 2,508,763 4,000    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 3,223,708 6,854,052    
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ...............   135,000    
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   3,500,000    
11 Other spent proceeds ............. 3,223,708 3,219,052    
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 1999 2017
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2019, a current refunding issue)? ........
X   X          
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2019, an advance refunding issue)? ........
  X   X        
16 Has the final allocation of proceeds been made? .......... X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X          
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 2
Part
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X        
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X X          
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?       X        
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X        
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X X          
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X        
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........
  X X          
Part
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X        
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X        
b Exception to rebate? ........   X   X        
c No rebate due? ......... X   X          
If "Yes" to line 2c, provide in Part the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X        
Schedule K (Form 990) 2020

Schedule K (Form 990) 2020
Page 3
Part
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X        
b Name of provider ..........  
 
 
 
 
 
 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X        
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X   X        
Part
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X          
Part
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
SCHEDULE K, PART V WESTFIELD'S HOSPITAL FOLLOWS ESTABLISHED WRITTEN PROCEDURES.
SCHEDULE K, PART III, LINES 3B AND 3D WESTFIELD'S HOSPITAL USES INTERNAL LEGAL COUNSEL TO REVIEW ANY MANAGEMENT OR SERVICE CONTRACTS RELATING TO THE FINANCED PROPERTY. IF IT ENCOUNTERS UNUSUAL OR COMPLEX CONTRACT IT WILL ENGAGE BOND COUNSEL OR OTHER OUTSIDE COUNSEL.
Schedule K (Form 990) 2020

Additional Data


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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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
Return Reference Explanation
FORM 990, PART III, LINE 4A- PRIMARY EXEMPT PURPOSE AND ACHIEVEMENTS CORPORATE STRUCTURE, PURPOSE, GOVERNANCE WESTFIELDS HOSPITAL, A STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION, AND IS THE LARGEST CONSUMER-GOVERNED NONPROFIT HEALTH CARE ORGANIZATION IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTH CARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS, INC. (HPI) IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4) AND IS THE PARENT ENTITY OF HEALTHPARTNERS ORGANIZATIONS REFERRED TO COLLECTIVELY AS "HEALTHPARTNERS". HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,800 EMPLOYED PHYSICIANS AND DENTISTS, EIGHT OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 129 PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN SERVING MORE THAN 1.27 MILLION PATIENTS. HEALTHPARTNERS HEALTH PLANS CONTRACT WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS TO SERVE PLAN MEMBERS. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUNDRAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. HEALTHPARTNERS COLLABORATES WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2020 ARE TOTAL COST OF CARE MEASUREMENTS (A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN HEALTHPARTNERS, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL (REGIONS), REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN, INC. IS THE CLASS A CORPORATE MEMBER OF WESTFIELDS HOSPITAL. WESTFIELDS HOSPITAL IS THE SOLE CORPORATE MEMBER OF WESTFIELDS HOSPITAL FOUNDATION. COMMUNITY BENEFIT TO THE COMMUNITY: 1. COMMUNITY HEALTH SERVICES: WESTFIELDS HOSPITAL PANDEMIC COMMUNITY RESPONSE HOSPITALS SERVE AS A CENTER OF STRENGTH FOR A COMMUNITY, EVEN IN THE BEST OF TIMES. DURING DISASTERS AND COMMUNITY HEALTH CRISES LIKE THE COVID-19 PANDEMIC, COMMUNITIES EXPECT HEALTH CARE FACILITIES TO NOT ONLY PROVIDE THE ADDITIONAL CARE THAT'S NEEDED, BUT ALSO CONTINUE THE COMMUNITY SUPPORT THAT INDIVIDUALS AND SOCIAL ENTITIES HAVE COME TO RELY ON. IN 2020, WESTFIELDS HOSPITAL DIRECTLY SUPPORTED COMMUNITY NEEDS THAT AROSE BECAUSE OF THE PANDEMIC IN A NUMBER OF WAYS, INCLUDING: SIGNIFICANTLY INCREASED TELEMEDICINE FOR PRIMARY, SPECIALTY, AND BEHAVIORAL HEALTH SERVICES IN A VERY SHORT TIME FRAME TO INCREASE ACCESS DURING PANDEMIC RESTRICTIONS. OFFERED PERSONAL PROTECTIVE EQUIPMENT (PPE) TO PATIENTS AND VISITORS ENTERING FACILITY TO AID IN PROTECTIVE MEASURES. STAFFED DOOR SCREENERS AT ENTRANCES TO AID IN PROTECTIVE MEASURES (I.E. VISITOR TRACKING, PPE PLACEMENT, AND SECURITY SUPPORT). PARTICIPATED IN COMMUNITY MESSAGING BY HAVING PROVIDERS SHARE INSIGHTS AND RECOMMENDATIONS ON DIFFERENT PLATFORMS. CONTINUED PATIENT EXPERIENCE IN ADVISORY COUNCILS IN A VIRTUAL FORMAT TO BETTER UNDERSTAND AND IMPROVE CARE EXPERIENCE DURING A PANDEMIC. UPDATED COMMUNITY RESOURCE LIST TO INCLUDE NEW RESOURCES AND SUPPORT DURING THE COVID PANDEMIC; AVAILABLE TO PATIENTS, STAFF AND COMMUNITY MEMBERS. PROVIDED INFLUENZA VACCINATION. PARTNERED WITH PUBLIC HEALTH NURSE LIAISON AND COUNTY LEADERS TO SUPPORT INEQUITY NEEDS. CONTINUED TO UTILIZE HUNGER SOLUTIONS REFERRAL WITHIN THE ELECTRONIC MEDICAL RECORD TO SUPPORT FOOD INSECURITY NEEDS. PROVIDED IPADS FOR PATIENT USE TO COMMUNICATE WITH FAMILY AND FRIENDS WHILE HOSPITALIZED DUE TO VISITOR POLICY RESTRICTIONS. OFFERED CONTACTLESS DRIVE-UP OPTION FOR PRESCRIPTION PICK UP FROM OUR RETAIL PHARMACY. CREATED A LABOR POOL FOR THE FOUR ST. CROIX VALLEY HOSPITALS TO ALLOW SHIFTING OF STAFF ACROSS FACILITIES AS NEEDED TO HELP WITH STAFFING ISSUES. CONTINUED TO PROVIDE VAN TRANSPORTATION SERVICE IN A COVID SAFE MANOR AT NO COST TO PATIENTS LIVING WITHIN 25 MILES WHO WOULD HAVE LIMITED ACCESS TO CARE BECAUSE OF NO TRANSPORTATION. ADDITIONALLY, THE HOSPITAL WAS ABLE TO CONTINUE ITS ONGOING COMMUNITYBASED PARTNERSHIPS BY MAKING THE NECESSARY ADAPTATIONS. WITH THE PANDEMIC REQUIRING SOCIAL DISTANCING, OUTREACH AND ACCESS WERE SEVERELY LIMITED, BUT ADJUSTMENTS ALLOWED THE PROGRAMS TO CONTINUE. FOR INSTANCE: COMMUNITY HEALTH ACTION TEACH (CHAT) CONTINUED TO ENGAGE COMMUNITY LEADERS TO COLLABORATE AND PARDNER DURING THE PANDEMIC, PROVIDING UPDATES AND CROSS-PROMOTING HEALTH MESSAGES TO THE COMMUNITY. HEALTH AND WELL-BEING ADVISORY COMMITTEE CONTINUED TO GUIDE COMMUNITY HEALTH EFFORTS AND RESPONSE THROUGH CROSS-SECTOR COLLABORATION. CONTINUED TO SERVE ON CORE LEADERSHIP TEAM FOR SUPERSHELF FOOD SHELF TRANSFORMATION AND MAKE ADAPTATIONS IN DELIVERY METHODS FOR COVID-19. CONTINUED FOOD INSECURITY SCREENER AND REFERRAL FOR ALL WELL-CHILD AND MEDICARE WELL EXAMS. STANDARDIZED FOOD INSECURITY SCREENING AND REFERRAL FOR ALL WELL-CHILD AND MEDICARE WELL EXAMS. PATIENTS WERE PROVIDED WITH A COMMUNITY RESOURCE LIST FOR COUNTY AND COMMUNITY RESOURCES FOR HOUSING, TRANSPORTATION, AND FINANCIAL NEED. CONTINUED PARTNERSHIP WITH THE LOCAL FOOD SHELVES TO EXPAND SUPERSHELF IN ORDER TO INCREASE ACCESS TO HEALTHIER OPTIONS FOR CLIENTS IN MINNESOTA AND WISCONSIN. LITTLE MOMENTS COUNT PROGRAM OFFERED VIRTUAL TRAINING AND RESOURCES TO CONTINUE MOMENTUM OF COLLABORATION TO PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT. SHIFTED CARE AS NEEDED FOR PRIMARY CARE, SPECIALTY CARE, DIABETIC EDUCATION, AND REHAB CARE TO VIDEO OR PHONE VISITS. ADJUSTED OUR STANDING ORDER FOR PRESCRIPTION REFILL MANAGEMENT TO ALLOW FOR EXTENDED REFILLS. ADDED VIDEO VISIT OPTION FOR COVID-19 TEST REQUIREMENTS TO URGENT CARE SETTING. PROVIDED ON-SITE COVID TESTING TO LOCAL EMPLOYER LAKESIDE FOODS WHICH EMPLOYS SEASONAL EMPLOYEES IN A COMMUNAL LIVING ARRANGEMENT. PROVIDED ON-SITE COVID TESTING TO GROUP HOMES TO HELP SUPPORT COUNTY HEALTH DEPARTMENT. NEW POWERUP4KIDS.ORG WEB PLATFORM WITH IMPROVED NAVIGATION, NEW RESOURCES FOR AT-HOME FAMILY ACTIVITIES AND SCHOOL RESOURCES FOR VIRTUAL AND IN-PERSON LEARNING ENVIRONMENTS.
PART III CONT. WITH CARE MODELS BEING FORCED TO CHANGE, THE HOSPITAL CONVENED AND PARTICIPATED IN SEVERAL COMMUNITYBASED COLLABORATIVE EFFORTS TO IMPROVE ACCESS TO COMMUNITY AND MENTAL HEALTH SERVICES, INCLUDING: INCREASED VALLEY-WIDE USE OF BEHAVIORAL HEALTH TELEHEALTH PROGRAM FOR PATIENT ACCESSING EMERGENCY DEPARTMENT CARE DURING A MENTAL HEALTH CRISIS. BEHAVIORAL HEALTH TEAM SERVED OUR COMMUNITY IN NEW AND DIFFERENT WAYS, INCLUDE SOME DIGITAL/VIRTUAL FORMATS INCLUDING PODCASTS. SIX PODCASTS WERE RECORDED IN 2020, PRIMARILY WITH A MENTAL HEALTH FOCUS ON TOPICS SUCH AS DEPRESSION, ANXIETY, AND STRESS RELIEF. CRIMINAL JUSTICE COMMUNITY COLLABORATION TO COORDINATE WITH COUNTY HUMAN SERVICES, THE COURTS, AND LAW ENFORCEMENT JURISDICTIONS TO IMPROVE BEHAVIORAL HEALTH CARE AND SERVICES IN ST. CROIX COUNTY. CONTINUED PARTNERSHIP WITH SCHOOLS TO PROVIDE MENTAL HEALTH SERVICES TO SCHOOLS AND REDUCE STIGMA. IMPROVED GEOGRAPHIC ACCESS OF CARE FOR PATIENTS THROUGH COORDINATION OF APPOINTMENT SCHEDULING BETWEEN FIVE SITES IN THE ST. CROIX VALLEY AREA. VIRTUAL APPOINTMENTS FOR PATIENT CARE IN OUR CLINICS. PROVIDED VACCINATION CLINICS. ADDITIONALLY, THE HOSPITAL WAS ABLE TO MAKE THE MOST OF THE COVID-19 RESPONSE AND RESILIENCE FUNDS IT RECEIVED, USING THOSE DOLLARS TO: PURCHASED ADDITIONAL AIRVO2 UNITS FOR HIGH FLOW NASAL OXYGEN TO HELP IN CARE FOR HOSPITAL ADMITTED COVID PATIENTS. PROCURED ADDITIONAL PAPR HOODS TO HELP ENSURE STAFF CARING FOR COVID POSITIVE PATIENTS HAD ADEQUATE PPE. ADDED PLEXIGLASS SHIELDS AT CHECK IN DESKS TO PROVIDE ADDED PROTECTION FOR STAFF. SUPPORT DOOR SCREENING POSITIONS. SUPPORT PPE NEEDS. SUPPORT CLINIC TEMPORARY STRUCTURE CHANGES TO ALLOW SEPARATED RESPIRATORY VERSUS NON-RESPIRATORY PATIENTS TO REDUCE POTENTIAL EXPOSURE RISKS TO STAFF AND PATIENTS. ASSIST WITH PAYMENT FOR COVID-19 POSITIVE EMPLOYEES WHO CONTRACTED THE ILLNESS AT WORK. ASSIST WITH PAYMENT FOR STAFF WHOSE FTE WAS REDUCED BECAUSE OF LOWER VOLUMES DUE TO COVID-19 RESTRICTIONS RESTRICTING NON-EMERGENT CASES. SUPPORT STAFFING AND RESOURCES FOR COVID TESTING COLLECTION. SUPPORT ADDITIONAL STAFFING COSTS REQUIRED TO CARE FOR COVID-19 PATIENTS. COMMUNITY HEALTH IMPROVEMENT SERVICES NEARLY 650 PEOPLE BENEFITED FROM THE FOLLOWING PROGRAMS OR ACTIVITIES THAT WERE CARRIED OUT AND SUPPORTED BY WESTFIELDS HOSPITAL IN 2020 FOR THE EXPRESS PURPOSE OF IMPROVING COMMUNITY HEALTH, TOTALING A COST OF $148,870. MAKE IT OK: WESTFIELDS HOSPITAL IS A PARTNER IN MAKE IT OK, A PROGRAM FOCUSED ON REDUCING THE STIGMA OF MENTAL ILLNESS. WESTFIELDS HOSPITAL HAS EXPANDED THE REACH OF THIS HEALTHPARTNERS CAMPAIGN INTO OUR COMMUNITY THROUGH TRAINING LOCAL MAKE IT OK AMBASSADORS, LOCAL PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. THERE WERE 81,349 WEBSITE VISITS WITH 62,780 UNIQUE VISITORS TO MAKEITOK.ORG IN 2020. IN 2020 THE REACH OF THE MAKE IT OK CAMPAIGN EXPANDED THROUGH TRAINING LOCAL AMBASSADORS, PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. DESPITE THE CHALLENGE OF COVID 19, MAKE IT OK MADE PROGRESS IN REDUCING THE STIGMA OF MENTAL ILLNESS WITH THE FOLLOWING IMPACT IN 2020: MAKE IT OK HELD 11 AMBASSADOR TRAININGS BOTH IN PERSON AND VIRTUALLY, MOBILIZING AN ADDITIONAL 200 AMBASSADORS. MAKE IT OK REACHED MORE THAN 2,000 PEOPLE THROUGH COMMUNITY PRESENTATIONS, EVENTS AND TABLING. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. MAKE IT OK HAS BEEN A KEY PARTNER IN A COMPREHENSIVE APPROACH TO MENTAL HEALTH FOR STUDENTS IN THE LOCAL SCHOOLS. THERE WERE MORE THAN 70,000 WEBSITE VISITS TO MAKEITOK.ORG IN 2019. THE MAKE IT OK TOOLS AND RESOURCES WERE DOWNLOADED MORE THAN 500 TIMES BY PEOPLE IN 250 US CITIES AND 25 MINNESOTA COUNTIES. IN A SURVEY OF MAKE IT OK AMBASSADORS IN OCTOBER 2020, 88% SAID THAT MAKE IT OK WAS MORE IMPORTANT THAN EVER IN A TIME OF SOCIAL ISOLATION AND EMOTIONAL STRESS FOR MANY IN OUR COMMUNITIES. MORE THAN 500 AMBASSADORS ARE NOW TRAINED IN THE ST. CROIX VALLEY AREA. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS. POWERUP: SINCE 2014, WESTFIELDS HOSPITAL HAS SUPPORTED POWERUP, A COMMUNITYWIDE HEALTH INITIATIVE THAT INSPIRES AND ENGAGES THE ENTIRE COMMUNITY TO PROMOTE BETTER EATING AND PHYSICAL ACTIVITIES SO YOUTH CAN REACH THEIR FULL POTENTIAL. IN 2020, WESTFIELDS HOSPITAL PROVIDED MORE THAN $63,000 IN SUPPORT FOR POWERUP. OUR WORK WITH HUNDREDS OF PARTNERS ACROSS THE REGION HAS RESULTED IN A HIGH LEVEL OF COMMUNITY AND SCHOOL ENGAGEMENT, STRONGER SCHOOL WELLNESS POLICIES AND PRACTICES; MORE FREE AND LOW-COST OPTIONS FOR PHYSICAL ACTIVITY INCLUDING OPEN GYMS; PARTNERSHIPS WITH STATE AND LOCAL PARKS; TRANSFORMED FOOD PANTRIES, CAFETERIAS AND CONCESSIONS; AND COMMUNITY MOMENTUM TO CREATE CHANGE. POWERUP COMMUNITY ENGAGEMENT HAS GROWN OVER TIME, AND ADAPTED DURING COVID 19 COMMUNITY AND SCHOOL VIRTUAL PROGRAMS, RESOURCES AND SOCIAL MEDIA ENGAGEMENT. EVEN WITH THESE LIMITS FOR OUTREACH, MORE THAN 75,000 ENGAGED IN THE ST. CROIX VALLEY AREA IN 2020 THROUGH EVENTS, CLASSES, OUTREACH PROGRAMS AND GROWING ONLINE RESOURCES TO PROMOTE BETTER EATING AND MOVING MORE.
PART III CONT. KEY STRATEGIES AND RESOURCES INCLUDE: NEW POWERUP4KIDS.ORG WEB PLATFORM WITH IMPROVED NAVIGATION, NEW RESOURCES FOR AT-HOME FAMILY ACTIVITIES AND SCHOOL RESOURCES FOR VIRTUAL AND IN-PERSON LEARNING ENVIRONMENTS. POWERUP ONLINE RECIPE GALLERY, WITH MORE THAN 300 KIDAPPROVED RECIPES. POWERUP VIDEO GALLERY FOR SCHOOLS AND FAMILIES WITH PHYSICAL ACTIVITY AND FOOD IDEAS FOR KIDS, CLASSROOMS AND FAMILIES. POWERUP SCHOOL CHALLENGE PROGRAM WAS COMPLETED REVISED TO PROVIDE SCHOOLS AND YOUTH SERVING ORGANIZATIONS TO COMPLETE THE CHALLENGE IN A FLEXIBLE WAY, ONLINE OR IN PERSON. THE PROGRAM INSPIRES STUDENTS TO EAT BETTER AND MOVE MORE, AND IN 2020 REACHED ELEMENTARY AGE STUDENTS IN 476 CLASSROOMS IN 23 ST. CROIX VALLEY AREA SCHOOLS. THE TOTAL PROGRAM REACHED STUDENTS IN 54 SCHOOLS AND MORE THAN 900 CLASSROOMS THROUGHOUT MINNESOTA AND WISCONSIN. THE THREE-WEEK WINTER WARMUP CHALLENGE INSPIRED KIDS TO STAY ACTIVE DURING THE COLD MONTHS AND WAS IMPLEMENTED IN LOCAL SCHOOLS IN A VIRTUAL FORMAT REACHING 70 ELEMENTARY CLASSROOMS IN FOUR VALLEY SCHOOL DISTRICTS. POWERUP WORKED WITH PARTNERS TO HELP INSPIRE AND INFLUENCE THEIR COMMUNITIES, INCLUDING 19 OPEN GYMS IN JANUARY AND FEBRUARY 2020 PRIOR TO RESTRICTIONS. POWERUP COLLABORATES WITH OTHER PARTNERS TO DISSEMINATE BEST PRACTICES FOR CREATING COMMUNITY CHANGE. POWERUP CONCEIVED AND PILOTED METHODS TO TRANSFORM FOOD SHELVES AND IS A FOUNDING PARTNER OF THE SUPERSHELF PROJECT, TRANSFORMING FOOD SHELVES TO MAKE HEALTHY FOOD APPEALING AND ACCESSIBLE FOR ALL. STARTING AS A PILOT IN ONE COMMUNITY, SUPERSHELF IS NOW A ROBUST NIH RESEARCH STUDY WITH 30 FOOD SHELVES TRANSFORMED IN THE REGION AND DEMONSTRATING NATIONAL INFLUENCE TO IMPROVE THE QUALITY OF FOOD FOR THOSE WHO ARE FOOD INSECURE. RESULTS HAVE BEEN PUBLISHED IN PEER REVIEWED JOURNALS (SUPERSHELFMN.ORG). POWERUP HAS A LONG-TERM EVALUATION PLAN TO MONITOR RESULTS. KEY RESULTS INCLUDE: COMMUNITY-WIDE SURVEYS OF RESIDENT FAMILIES WITH CHILDREN HAVE SHOWN STATISTICALLY SIGNIFICANT INCREASES IN PHYSICAL ACTIVITY LEVELS AMONG YOUTH OVER TIME IN TARGETED COMMUNITIES. A REVIEW OF BMI DATA FOR CHILDREN 6-10 YEARS OLD SHOWED A STATISTICALLY SIGNIFICANT POSITIVE DOWNWARD TREND IN THE BMIS OF CHILDREN IN SPECIFIC POWERUP COMMUNITIES COMPARED TO OTHER PATIENTS IN THE BROADER CARE SYSTEM. THESE ARE EXCITING RESULTS, SINCE PAST INITIATIVES NATIONWIDE HAVE SHOWN THAT IT IS DIFFICULT TO DEMONSTRATE COMMUNITY-LEVEL CHANGE IN BEHAVIORS OR HEALTH OUTCOMES. TO DEEPEN THE POWERUP STRATEGY WITH OLDER STUDENTS, IN 2020 POWERUP CONTINUED WITH YEAR TWO OF THE POWERUP TEEN LEADERSHIP COUNCIL, WHICH ENCOURAGES MIDDLE AND HIGH SCHOOL STUDENTS TO BECOME CHAMPIONS FOR HEALTHIER LIFESTYLES AMONG THEIR PEERS AND COMMUNITIES. THESE YOUNG ROLE MODELS DESIGN AND IMPLEMENT PROJECTS THAT MAKE IT EASIER FOR THEIR FELLOW STUDENTS TO ENJOY BETTER EATING AND PHYSICAL ACTIVITY. IN 2020, 24 LOCAL YOUTH FROM DIVERSE BACKGROUNDS WERE RECRUITED AND ARE HIGHLY ENGAGED IN DEVELOPING PROGRAMS FOR THEIR PEERS. THE TEENS ALSO PROVIDE CONSULTATION TO OTHER YOUTH PROGRAMS AND PROJECTS, LOCAL PUBLIC HEALTH AND HEALTHPARTNERS DEPARTMENT OF PEDIATRICS. THEIR INSIGHTS ARE IMPROVING TEEN SERVICES AND PROGRAMS THROUGHOUT THE REGION. COMMUNITY HEALTH EDUCATION ALMOST 200 PEOPLE ATTENDED EDUCATIONAL PROGRAMS, CLASSES, SPECIAL EVENTS, OR SUPPORT GROUPS TAUGHT OR HOSTED BY MEDICAL AND CLINICS STAFF AND CAMPUS PARTNERS. TOTAL COMMUNITY HEALTH EDUCATION EXPENSES TOTALED $75,813. CLASSES INCLUDED FAMILY/PARENTING/SIBLING EDUCATION, SCHOOL-BASED HEALTH EDUCATION, WORKSITE HEALTH EDUCATION, AND SENIOR CARE. IN ADDITION, ALMOST 250 PEOPLE ATTENDED SUPPORT GROUPS HELD FOR THE BROADER COMMUNITY ON DIABETES, NUTRITION AND WEIGHT MANAGEMENT, CONCUSSIONS IN SPORTS, AND HIGH BLOOD PRESSURE. COMMUNITY BASED CLINICAL SERVICES WESTFIELDS HOSPITAL HOSTED A BLOOD DRIVE IN SUPPORT OF THE AMERICAN RED CROSS, OFFERED A FREE DIABETES SCREENING, AND BLOOD PRESSURE SCREENING AT A COST OF $1,336 HEALTH CARE SUPPORT SERVICES IN 2020, ALMOST 200 PEOPLE REALIZED THE BENEFIT OF HEALTH CARE SUPPORT SERVICES AVAILABLE. THESE SERVICES INCLUDED ENROLLMENT ASSISTANCE, INFORMATION AND REFERRAL SERVICES, WHICH WERE PROVIDED TO HELP SECURE A PAYMENT SOURCE OR ACCESS SERVICES BEYOND MEDICAL CARE FOR UNINSURED AND UNDERINSURED PATIENTS. IN ADDITION, VAN TRANSPORTATION IS PROVIDED AT NO COST TO PATIENTS LIVING WITHIN 25 MILES WHO WOULD HAVE LIMITED ACCESS TO CARE AS A RESULT OF NO TRANSPORTATION. THE TOTAL COST OF THESE SERVICES WAS $125,018. 2. HEALTH PROFESSIONAL EDUCATION: WESTFIELDS HOSPITAL'S STAFF PROVIDED CLINICAL TRAINING FOR 29 HEALTH PROFESSIONALS FROM FIVE INSTITUTIONS AT A COST OF $94,332. 3. SUBSIDIZED HEALTH SERVICES: WESTFIELDS HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES EVEN AT A FINANCIAL LOSS. IN 2020, LOSS ON SERVICES FOR OUTPATIENT HEALTH SERVICES INCLUDING EMERGENCY CARE, PRIMARY CLINIC, SPECIALTY CLINIC, ONCOLOGY, AND RESPIRATORY THERAPY TOTALED $4,257,977. FINANCIAL ASSISTANCE AND HEALTH CARE ACCESS FOR LOW-INCOME INDIVIDUALS FINANCIAL ASSISTANCE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. WESTFIELDS HOSPITAL PROVIDED $509,096 IN FINANCIAL ASSISTANCE TO 311 LOW INCOME AND/OR UNINSURED PATIENTS. FINANCIAL ASSISTANCE REPRESENTS ABOUT 0.76% OF WESTFIELDS HOSPITAL'S TOTAL OPERATING EXPENSES. 4. FINANCIAL CONTRIBUTIONS: CASH DONATIONS & GRANTS WESTFIELDS HOSPITAL DONATIONS AND GRANTS TO COMMUNITY ORGANIZATIONS IN SUPPORT OF HEALTH CAREERS EDUCATION AND COMMUNITY BUILDING EFFORTS TO IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY AT LARGE TOTALED $64,697 IN 2020. MAJOR CONTRIBUTIONS WERE MADE TO THE NEW RICHMOND AREA CENTRE (NONPROFIT ORGANIZATION SERVING THE ST. CROIX VALLEY AREA), NEW RICHMOND SCHOOL DISTRICT, CITY OF NEW RICHMOND, LOCAL SCHOOLS, AND MANY OTHERS. SOME EVENTS NORMALLY SPONSORED SUCH AS RELAY FOR LIFE WERE CANCELLED IN 2020, RESULTING IN LOWER OVERALL CONTRIBUTIONS. IN-KIND DONATIONS IN-KIND DONATIONS IN 2020 CONSISTED OF EQUIPMENT AND SUPPLY DONATIONS PROVIDED TO PATIENT FAMILIES AND COMMUNITY MEMBERS TOTALING $1,547. 6. COMMUNITY BUILDING ACTIVITIES: WESTFIELDS HOSPITAL LIVES OUT ITS COMMITMENT TO IMPROVE THE HEALTH OF THE COMMUNITY BY SUPPORTING INDIVIDUALS, ORGANIZATIONS, EVENTS AND PROGRAMS. KNOWING MUCH MORE CAN BE ACCOMPLISHED WHEN PEOPLE COME TOGETHER, WESTFIELDS COMMUNITY BENEFIT PROGRAM STRIVES TO MAKE VALUABLE CONNECTIONS WITH INDIVIDUALS AND ORGANIZATIONS FROM PUBLIC, PRIVATE AND NONPROFIT SECTORS TO SHARE SKILLS AND ASSETS. IN 2020, WESTFIELDS HOSPITAL COMMUNITY-BUILDING ACTIVITIES EQUALED $2,431. WESTFIELDS HOSPITAL PARTICIPATED IN COMMUNITY-BUILDING ACTIVITIES THAT SUPPORTED ECONOMIC DEVELOPMENT TO IMPROVE BUSINESS CLIMATE IN THE REGION; EMERGENCY PREPAREDNESS; HEALTH IMPROVEMENT ADVOCACY; AND COALITION BUILDING TO PROVIDE LEADERSHIP AND IN-KIND SUPPORT FOR HEALTHIER TOGETHER - ST. CROIX COUNTY, THE CENTRE WELLNESS FACILITY, AND LOCAL COMMUNITY HEALTH. 7. COMMUNITY BENEFIT OPERATIONS: 8. ORGANIZATION AWARDS AND ACHIEVEMENTS: WESTFIELDS HOSPITAL RECEIVED A 5-STAR RATING FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) FOR THE QUALITY OF PATIENT CARE IN 2020, PLACING US IN THE TOP 9% OF ALL HOSPITALS IN THE US. NAMED ONE OF THE TOP 20 CRITICAL ACCESS HOSPITALS (CAH) IN THE COUNTRY BY THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA) AND THE CHARTIS CENTER FOR RURAL HEALTH. RECOGNIZED FOR OVERALL EXCELLENCE IN HEALTH OUTCOMES AND PATIENT PERSPECTIVES BY THE NATIONAL ORGANIZATION OF STATE OFFICES OF RURAL HEALTH AND THE CHARTIS CENTER FOR RURAL HEALTH. EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR ACCREDITATION BY DEMONSTRATING COMPLIANCE WITH ITS NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY IN HOSPITALS. PRACTICE GREENHEALTH AWARDS, INCLUDING: TOP 25 ENVIRONMENTAL EXCELLENCE AWARD, EMERALD AWARD, GREENING THE OR RECOGNITION, AND CIRCLES OF EXCELLENCE FOR LEADERSHIP. GREEN MASTERS PROGRAM (TOP 20% OF COMPANIES) FOR SUSTAINABILITY EXCELLENCE BY THE WISCONSIN SUSTAINABLE BUSINESS COUNCIL. NAMED A TREE CAMPUS HEALTHCARE FACILITY BY THE ARBOR DAY FOUNDATION. FOR OUTPATIENTS, WESTFIELDS HOSPITAL: SAW LOWER VOLUMES IN MANY DEPARTMENTS IN 2020 DUE TO COVID-19: 5,029 CT SCANS, 2,091 MAMMOGRAMS, 7,174 EMERGENCY DEPARTMENT VISITS, 8,362 SPECIALTY CLINIC VISITS, AND 50,675 PRIMARY CARE CLINIC VISITS. ROLLED CASE MANAGEMENT PROGRAM ACROSS THE CAMPUS BASED OUT OF THE PRIMARY CARE CLINIC. WE HAVE OVER 50 PATIENTS ENROLLED WITH REFERRALS COMING TO THE TEAM OF RNS.
FORM 990, PART VI, SECTION A, LINE 6 RH WISCONSIN, INC. IS THE CLASS A MEMBER AND GROUP HEALTH PLAN, INC. IS THE CLASS B MEMBER OF WESTFIELDS.
FORM 990, PART VI, SECTION A, LINE 7A THE CLASS A MEMBER (RH WISCONSIN, INC.) APPOINTS THREE DIRECTORS TO REPRESENT THE CLASS A MEMBER. THE CLASS B MEMBER (GROUP HEALTH PLAN, INC.) APPOINTS TWO DIRECTORS TO REPRESENT THE CLASS B MEMBER. TWO HEALTH CARE PROVIDERS ARE NOMINATED AS DIRECTORS BY AN UNRELATED MEDICAL GROUP AND APPOINTED BY MAJORITY VOTE OF THE FULL BOARD. EIGHT COMMUNITY REPRESENTATIVES ARE APPOINTED AS DIRECTORS BY THE CLASS A MEMBER UPON RECOMMENDATION BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B THE CLASS A AND CLASS B MEMBERS (RH WISCONSIN, INC. AND GROUP HEALTH PLAN, INC. RESPECTIVELY) BOTH MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS IMPACTING MEMBERSHIP - RESIGNATION OF A MEMBER - DISSOLUTION - ANY CHANGE IN THE FUNDAMENTAL NATURE OR PURPOSE - MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION - DISPOSITION OF SUBSTANTIALLY ALL ASSETS. ONLY THE CLASS A MEMBER MUST APPROVE THE DECISIONS OF THE BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS NOT IMPACTING MEMBERSHIP - ANNUAL OPERATING AND CAPITAL BUDGETS AND STRATEGIC PLANS - ESTABLISHMENT OF NEW ENTITIES OR SIGNIFICANT RELATIONSHIPS WITH OTHER ENTITIES - UNBUDGETED EXPENDITURES IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - GUARANTEEING THE DEBT OF ANY OTHER PERSON OR ENTITY - A LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER - TRANSFER OF ASSETS TO ANOTHER ENTITY - APPOINTMENT OF AUDITORS - APPOINTMENT OF THE PRESIDENT AND THE BOARD CHAIR.
FORM 990, PART VI, SECTION B, LINE 11B WESTFIELDS HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF WESTFIELDS HOSPITAL. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF WESTFIELDS HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND WESTFIELDS HOSPITAL'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF WESTFIELDS HOSPITAL. WESTFIELDS HOSPITAL MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING.
FORM 990, PART VI, SECTION B, LINE 12C WESTFIELDS HOSPITAL BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND ASKED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE ENDING WITH A REMINDER TO COVERED PERSONS OF THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15 WESTFIELDS' HOSPITAL PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY REGIONS HOSPITAL (REGIONS), GROUP HEALTH PLAN, INC., (GHI), OR LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (LAKEVIEW) ALL OF WHICH ARE RELATED ORGANIZATIONS, OR BY WESTFIELDS HOSPITA;. GHI, AND REGIONS, LAKEVIEW AND WESTFIELDS HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF WESTFIELDS HOSPITAL PRESIDENT AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE EXECUTIVE COMMITTEE OF LAKEVIEW, THE EXECUTIVE COMMITTEE OF REGIONS, THE COMPENSATION COMMITTEE OF GHI OR WESTFIELDS EXECUTIVE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH WESTFIELDS HOSPITAL BOARD OF DIRECTORS INPUT, THE ST CROIX VALLEY EXECUTIVE LEADER CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH WESTFIELDS HOSPITAL BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE WESTFIELDS HOSPITAL PRESIDENT. THE WESTFIELDS HOSPITAL BOARD HAS DELEGATED TO THE PRESIDENT THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL WESTFIELDS HOSPITALS-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY WESTFIELDS HOSPITAL EXECUTIVE COMMITTEE. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2.
FORM 990, PART VI, SECTION C, LINE 19 WESTFIELDS' FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM WESTFIELDS OR HEALTHPARTNERS.
990, PART VII, SEC A, LN 1A, COL (B) - RELATED ORGANIZATION AVERAGE HOURS DIRECTORS AND OFFICERS OF WESTFIELDS HOSPITAL ARE EMPLOYED AND COMPENSATED BY GHI, INC., REGIONS HOSPITAL OR WESTFIELDS HOSPITAL. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2020
Open to Public Inspection
Name of the organization
WESTFIELDS HOSPITAL INC
 
Employer identification number

39-0808442
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?
Yes No
(1)HEALTHPARTNERS INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1693838
HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4)   N/A
 
No
(2)HPI-RAMSEY
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1793333
CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC
 
 
No
(3)GROUP HEALTH PLAN INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0797853
STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC
 
 
No
(4)RH WISCONSIN INC
8171 33RD AVE S PO BOX 1309

MPLS,MN554401309
20-2287016
CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HPI - RAMSEY
 
 
No
(5)HEALTHPARTNERS INSTITUTE
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1670163
HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC
 
 
No
(6)CAPITOL VIEW TRANSITIONAL CARE CENTER
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-2011453
TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
 
No
(7)REGIONS HOSPITAL
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0956618
HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
 
No
(8)REGIONS HOSPITAL FOUNDATION
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1888902
PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY
 
 
No
(9)RHSC INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1891928
HEALTHCARE STAFFING AND INTENSE REHAB SERVICES MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC
 
 
No
(10)PHYSICIANS NECK & BACK CLINICS
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
27-0684883
SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC
 
 
No
(11)HUDSON HOSPITAL INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-0804125
HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC
 
 
No
(12)HUDSON HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1279567
PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC
 
 
No
(13)LAKEVIEW HEALTH FOUNDATION
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1386635
PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) LAKEVIEW HEALTH
 
 
No
(14)LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0811697
HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) LAKEVIEW HEALTH
 
 
No
(15)STILLWATER MEDICAL GROUP
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
83-0379473
CLINIC STAFF AND FACILITIES MN 501(C)(3) 509(A)(3) TYPE I LAKEVIEW HEALTH
 
 
No
(16)LAKEVIEW HEALTH
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
30-0221189
CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY
 
 
No
(17)WESTFIELDS HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1770913
PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) WESTFIELDS HOSPITAL INC
 
Yes
 
(18)RAMSEY INTEGRATED HEALTH SERVICES
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1503090
HOME CARE AND HOSPICE MN 501(C)(3) 509(A)(2) HPI - RAMSEY
 
 
No
(19)PARK NICOLLET HEALTH SERVICES
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
36-3465840
CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) HEALTHPARTNERS INC
 
 
No
(20)PARK NICOLLET FOUNDATION
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
23-7346465
SUPPORT TO RELATED ENTITIES AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES
 
 
No
(21)PARK NICOLLET METHODIST HOSPITAL
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-0132080
HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
 
No
(22)PARK NICOLLET HEALTH CARE PRODUCTS
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
01-0638901
DURABLE MEDICAL EQUIPMENT , PHARMACY AND OTHER HEALTH CARE RETAIL SALES MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES
 
 
No
(23)PARK NICOLLET CLINIC
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-0834920
CLINIC SERVICES MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
 
No
(24)PNMC HOLDINGS
6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
41-1741792
HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES
 
 
No
(25)AMERY REGIONAL MEDICAL CENTER INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-0908320
HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC
 
 
No
(26)AMERY REGIONAL MEDICAL CENTER FOUNDATION INC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1726539
PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC
 
 
No
(27)HUTCHINSON HEALTH
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
84-1715908
HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES
 
 
No
(28)HUTCHINSON HEALTH FOUNDATION
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
36-3317820
PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 509(A)(3) TYPE I HUTCHINSON HEALTH
 
 
No
(29)HEALTHPARTNERS RC
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
84-4261122
HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) PARK NICOLLET HEALTH SERVICES
 
 
No
(30)OLIVIA HOSPITAL & CLINIC FOUNDATION
8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1839619
PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS RC
 
 
No
(31)CANCER CENTER OF WESTERN WISCONSIN
501 HOSPITAL RD

NEW RICHMOND,WI54017
27-3238660
PROVIDE SUPPORT TO HOSPITAL WI 501(C)(3) 509(A)(3) TYPE I  
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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?



(k)
Percentage
ownership


Yes No Yes 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
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTHPARTNERS ADMINISTRATORS INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1629390
THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC
 
C         No
(2) HEALTHPARTNERS ASSOCIATES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
52-2365151
MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
 
C         No
(3) HEALTHPARTNERS SERVICES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683568
MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
 
C         No
(4) HEALTHPARTNERS INSURANCE COMPANY

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683523
MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC
 
C         No
(5) DENTAL SPECIALTIES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
45-1297583
PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC
 
C         No
(6) HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1236798
MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC
 
C         No
(7) PARK NICOLLET ENTERPRISES

6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
41-1656735
REAL ESTATE FOR RELATED ORGANIZATIONS MN PARK NICOLLET HEALTH SERVICES
 
C         No
Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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
No
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 .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
 
No
2
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) HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES

L 655,556 CASH AMOUNT





Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
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)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2020
Schedule R (Form 990) 2020
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2020

Additional Data


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