SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
GREATER WATERTOWN COMMUNITY HEALTH
FOUNDATION INC
Employer identification number

39-1030310
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
 
No
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
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
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) . . . 		           
b Medicaid (from Worksheet 3, column a) . . . . .     14,273,361 5,846,767 8,426,594 8.620 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     14,273,361 5,846,767 8,426,594 8.620 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     111,869 8,504 103,365 0.110 %
f Health professions education (from Worksheet 5) . . .     55,653   55,653 0.060 %
g Subsidized health services (from Worksheet 6) . . . .     1,373,361 874,772 498,589 0.510 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     208,958   208,958 0.210 %
j Total. Other Benefits . .     1,749,841 883,276 866,565 0.890 %
k Total. Add lines 7d and 7j .     16,023,202 6,730,043 9,293,159 9.510 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development     6,540   6,540 0.010 %
3 Community support     15,858   15,858 0.020 %
4 Environmental improvements     1,207   1,207 0 %
5 Leadership development and training for community members     21,985   21,985 0.020 %
6 Coalition building     15,093   15,093 0.020 %
7 Community health improvement advocacy     68,320   68,320 0.070 %
8 Workforce development            
9 Other            
10 Total     129,003   129,003 0.140 %
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 Heathcare 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
1,238,531
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
 
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
6,846,091
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
7,428,822
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-582,731
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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 WATERTOWN REGIONAL MEDICAL CENTER LLC
125 HOSPITAL DR
WATERTOWN,WI53098
HTTP://WWW.WATERTOWNREGIONAL.COM/
1766-800 		X X         X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
WATERTOWN REGIONAL MEDICAL CENTER LLC
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 13
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  
6a 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 Yes  
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 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTP://WWW.WATERTOWNREGIONAL.COM/MAIN/COMMUNITYBENEFIT.ASPX
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
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" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

WATERTOWN REGIONAL MEDICAL CENTER LLC
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) 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 Included measures to publicize the policy 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
b
c
d
e
f
g
h
i
Billing and Collections
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 non-payment?.................................. 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
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

WATERTOWN REGIONAL MEDICAL CENTER LLC
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
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 18. (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
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
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) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 5: THE HOSPITAL WAS PART OF A JEFFERSON AND DODGE COUNTY COMMUNITY GROUP. THE ASSESSMENT INCLUDED PERSPECTIVES ON HEALTH FROM PROFESSIONAL AND LAY PEOPLE IN OUR COMMUNITY. THE LEADERSHIP PARTICIPANTS WERE:1. ALEX LICHTENSTEIN BS, COMMUNITY HEALTH ASSESSMENT AND IMPROVEMENT PLANNER, EMERGENCY PREPAREDNESS COORDINATOR2. YVONNE S. EIDE, MS, RN, PUBLIC HEALTH NURSE CONSULTANT, WISCONSIN DEPARTMENT HEALTH SERVICES3. KATHI CAULEY, DIRECTOR OF JEFFERSON COUNTY HUMAN SERVICES4. ED ORMONT, MENTAL HEALTH/AODA SERVICES SUPERVISOR, DODGE COUNTY HUMAN SERVICES AND HEALTH5. CAROL QUEST, RN, BSN, DIRECTOR/HEALTH OFFICER, WATERTOWN DEPARTMENT OF PUBLIC HEALTH6. JODY LANGFELDT, RN, BSN, PUBLIC HEALTH OFFICER, DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT7. GAIL SCOTT, RN, BSN, DIRECTOR/HEALTH OFFICER, JEFFERSON COUNTY HEALTH DEPARTMENT8. MEGAN MATUSZESKI, MS, CPWC, CORPORATE AND COMMUNITY WELLNESSCOORDINATOR, UW HEALTH PARTNERS WATERTOWN REGIONAL MEDICAL CENTER9. LEE CLAY, RN, BSN, FCN, ST. MARY CATHOLIC CHURCH10. TINA CRAVE, CHIEF EXPERIENCE OFFICER, UW HEALTH PARTNERSWATERTOWN REGIONAL MEDICAL CENTER11. MIKE MURPHY, RN, BSN, MBA, CHIEF PATIENT CARE OFFICER, BEAVER DAMCOMMUNITY HOSPITAL12. BRIDGET MONAHAN, RN, MPH, MANAGER, COMMUNITY HEALTH AND WELLNESS,FORT HEALTHCARE13. AUGIE TIETZ, WATERTOWN CITY COUNCIL, JEFFERSON COUNTY SUPERVISOR- 4TH DISTRICT14. MICHAEL GRAJEWSKI, MD, UW HEALTH PARTNERS WATERTOWN REGIONALMEDICAL CENTER
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 6A: HOSPITALS THAT PARTICIPATED ARE WATERTOWN REGIONAL MEDICAL CENTER, BEAVERDAM COMMUNITY HOSPITAL, FORT HEALTHCARE.
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 6B: CITY OF WATERTOWN PUBLIC HEALTH, DODGE COUNTY PUBLIC HEALTH, JEFFERSON COUNTY PUBLIC HEALTH
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 7D: WEBSITE FOR CHNA:HTTP://WWW.WATERTOWNREGIONAL.COM/MAIN/COMMUNITYBENEFIT.ASPX
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 11: AFTER ANALYZING THE DATA, WE DETERMINED THE TOP FOCUS AREAS FOR OUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). OUR HIGHLIGHTED FOCUS AREAS CONSIST OF: 1. OBESITY/EXCESSIVE WEIGHT 2. LACK OF PHYSICAL ACTIVITY 3. POOR NUTRITION HABITS 4. MENTAL HEALTH (INCLUDING SMOKING AND EXCESSIVE DRINKING) THROUGH A VARIETY OF COMMUNITY POLICIES AND PROGRAMS, WRMC FOCUSES ON PHYSICAL ACTIVITY AND HEALTHY NUTRITION HABITS IN A MANNER THAT PROMOTES BENEFICIAL LIFESTYLE HABITS AND SUSTAINABILITY. NUTRITION IMPLEMENTATION PLAN: A. NOURISHMENT TRANSFORMATION - MAKE "CHOOSING HEALTH" THE EASY CHOICE. GOAL 1: OPEN HARVEST MARKET IN THE BEGINNING OF NOVEMBER OF 2013 TO SERVE AS A MODEL OF HEALTHY EATING FOR ASSOCIATES, PATIENTS, AND THE COMMUNITY. OUTCOMES: A. DECREASE THE ACCESSIBILITY OF SUGAR-SWEETENED BEVERAGES BY REMOVING THEM FROM WRMC MENUS B. ELIMINATE TRANS-FATS FROM ALL MENU ITEMS C. SHOWCASE EASILY ACCESSIBLE PRODUCE AND HEALTHY SNACKS GOAL 2: DEVELOP HARVEST DEMONSTRATION KITCHEN TO PROVIDE NUTRITION AND COOKING EDUCATION TO 500+ ADULTS AND CHILDREN ANNUALLY. OUTCOMES: A. INCREASE ACCESSIBILITY OF NUTRITION EDUCATION B. CREATE INTERACTIVE PLATFORM FOR LEARNING C. COMMUNITY-WIDE ACCESSIBILITY TO CHEF AND REGISTERED DIETICIANS GOAL 3: PROVIDE AFFORDABLE ACCESS TO FRESH, LOCAL PRODUCE. OUTCOMES: A. HOST CSA DROP-OFF SITE B. DEVELOP ON-SITE GARDEN AS A COMMUNITY EDUCATION TOOL B. ONE WELLNESS REDEFINED GOAL 4: ENGAGE FIVE EMPLOYER GROUPS TO HELP THEIR "HIGH RISK" EMPLOYEES MAKE LASTING LIFESTYLE CHANGES THROUGH THE ONE WELLNESS REDEFINED PROGRAM. OUTCOMES: A. PROVIDE PHYSICIAN, FITNESS SPECIALIST, REGISTERED DIETICIAN, MINDFULNESS EXPERT, AND WELLNESS COACH GUIDANCE ON AN INDIVIDUAL AND GROUP LEVEL B. PERSONALIZED PLAN TO MEET WELLNESS GOALS C. IMPROVE THE HEALTH AND WELL-BEING OF EMPLOYER GROUPS PHYSICAL ACTIVITY IMPLEMENTATION PLAN: A. COMMUNITY WELLNESS COALITION GOAL 1: INCREASE ACTIVE MEMBERSHIP IN OUR WELLNESS COALITION, "GET HEALTHY WATERTOWN", BY 50% TO INCLUDE REPRESENTATION FROM THE FOLLOWING AREAS: HOSPITAL, SCHOOL DISTRICT, LOCAL BUSINESS, PUBLIC HEALTH, AND CIVIC ORGANIZATIONS. DEVELOP A PHYSICAL ACTIVITY PLAN IN COLLABORATION WITH THIS COALITION. OUTCOMES: A. IMPROVE OPPORTUNITIES TO POSITIVELY IMPACT THE WATERTOWN REGION BY REPRESENTING A LARGER GROUP OF COMMUNITY MEMBERS B. PROMOTE FITNESS VIA A COMMUNITY PHYSICAL ACTIVITY PLAN B. BIKE PATH DEVELOPMENT GOAL 2: ENGAGE COMMUNITY SUPPORT FOR THE DEVELOPMENT OF BIKE PATHS (SPECIFICALLY FROM WATERTOWN TO IXONIA). OUTCOMES: A. INCREASE AVAILABILITY OF SAFE BIKE ROUTES BETWEEN COMMUNITIES B. ENCOURAGE INCREASED PHYSICAL ACTIVITY C. EMPLOYEE HEALTH GOAL 3: ENGAGE FIVE EMPLOYER GROUPS TO HELP THEIR "HIGH RISK" EMPLOYEES MAKE LASTING LIFESTYLE CHANGES THROUGH THE ONE WELLNESS PROGRAM. OUTCOMES: A. PROVIDE ACCESS TO PHYSICIAN, FITNESS SPECIALIST, REGISTERED DIETICIAN, MINDFULNESS EXPERT, AND WELLNESS COACH ON AN INDIVIDUAL AND GROUP LEVEL B. PERSONALIZED PLAN TO MEET WELLNESS GOALS C. IMPROVE THE HEALTH AND WELL-BEING OF EMPLOYER GROUPS D. PROVIDE MEDICAL FITNESS FOR OUR REGION'S HIGHEST RISK PATIENTS GOAL 4: SERVE 250+ HIGH RISK PATIENTS ANNUALLY (WHOSE NEEDS ARE NOT BEING MET BY TRADITIONAL COMMUNITY FITNESS CENTERS) IN OUR MEDICAL FITNESS CENTER. OUTCOMES: A. ENCOURAGE INCREASED PHYSICAL ACTIVITY VIA MEDICAL SUPPORT STAFF AND TECHNOLOGY-ENHANCED FITNESS EQUIPMENT B. PROVIDE SAFE ENVIRONMENT THROUGH ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) CERTIFIED FITNESS SPECIALISTS E. COMMUNITY FITNESS PROGRAMMING GOAL 5: HELP A MINIMUM OF 50 PARTICIPANTS PER YEAR TO BECOME COMMITTED TO A REGULAR EXERCISE PROGRAM BY COMPLETING THE NO-COST WRMC ANNUAL 5K TRAINING PROGRAM. MENTAL HEALTH WRMC AIMS TO PROVIDE, PROMOTE, AND SUPPORT THE MENTAL AND EMOTIONAL HEALTH OF THE COMMUNITY THROUGH COUNSELING, EDUCATION, CLINICAL INTERVENTION, AND PREVENTION. MENTAL HEALTH IMPLEMENTATION PLAN: A. MENTAL & BEHAVIORAL HEALTH CLINIC GOAL 1: PROVIDE MUCH NEEDED PROFESSIONAL MENTAL HEALTH, SUBSTANCE ABUSE, AND COUNSELING SERVICES TO THE GREATER WATERTOWN COMMUNITY THROUGH DIRECTIONS COUNSELING BY SERVING 6,500+ PATIENT VISITS PER YEAR. OUTCOMES: A. IMPACT THOSE NEEDING ASSISTANCE WITH MENTAL AND BEHAVIORAL HEALTH CONCERNS IN A POSITIVE MANNER B. SUPPORT COMMUNITY MEMBERS WHO MAY HAVE LIMITED OR NO ACCESS TO OTHER RESOURCES C. PROMOTE HEALTHY CHOICES AND REDUCE RISKY BEHAVIOR B. INTEGRATE BEHAVIORAL HEALTH SERVICES INTO AT LEAST TWO PRIMARY CARE CLINICS GOAL 1: IMPLEMENT STANDARDIZED BEHAVIORAL HEALTH SCREENINGS AND PROCESSES TO PROVIDE EARLY INTERVENTION BEHAVIORAL HEALTHCARE IN A CLINIC SETTING. OUTCOMES: A. IDENTIFY PATIENTS AT RISK B. PREVENT INCREASED RISK BEHAVIOR C. PROVIDE ADVANCED MENTAL HEALTH SERVICES WHEN NEEDED GOAL 2: PROVIDE ACCESS TO PREVENTATIVE BEHAVIORAL HEALTHCARE BY INCORPORATING MENTAL HEALTH AND/OR HEALTH COACHING PROFESSIONALS INTO THE PRIMARY CARE CLINIC TEAM. A. UTILIZE HEALTH COACHING METHODS TO ASSIST IN SUPPORTING PATIENT BEHAVIOR CHANGE B. PREVENT INCREASED RISK BEHAVIOR C. FACILITATE TRANSITIONS TO ADVANCED MENTAL HEALTH SERVICES WHEN NEEDED THE COMMUNITY HEALTH NEEDS AND INDICATORS THAT WERE ASSESSED BUT ARE NOT BEING IMMEDIATELY ADDRESSED INCLUDE THE FOLLOWING AREAS: REDUCE SCREEN TIME INCREASE BREASTFEEDING INITIATION, DURATION, AND EXCLUSIVITY DUE TO INSUFFICIENT RESOURCES THAT WOULD BE NECESSARY TO EFFECTIVELY ADDRESS THESE HEALTH INDICATORS, THEY ARE NOT INCLUDED IN THE CURRENT CHIP.A. INCREASE KNOWLEDGE OF TRAINING VIA A CERTIFIED FITNESS TRAINER, REGISTERED DIETICIAN, AND SPORTS MEDICINE PHYSICIAN B. ENCOURAGE ASSOCIATE AND COMMUNITY PARTICIPATION IN WALKING/RUNNING C. PREPARE PARTICIPANTS FOR COMMUNITY 5K
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 22D: CALCULATED IN THIS CASE USING THE LOOK-BACK METHOD SET FORTH IN APPLICABLE TREASURY REGULATIONS, CONSIDERING AMOUNTS ALLOWED BY MEDICARE AND COMMERCIAL PAYORS DURING A PRIOR 12-MONTH MEASUREMENT PERIOD.
PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 16A WEBSITE: HTTPS://WATERTOWNMEMORIALHOSPITAL.PATIENTCOMPASS.COM/RA/GENERAL/BILLINGPOLI
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 16B WEBSITE: HTTPS://WATERTOWNMEMORIALHOSPITAL.PATIENTCOMPASS.COM/RA/GENERAL/BILLINGPOLI
WATERTOWN REGIONAL MEDICAL CENTER, LLC PART V, SECTION B, LINE 16C WEBSITE: HTTPS://WATERTOWNMEMORIALHOSPITAL.PATIENTCOMPASS.COM/RA/GENERAL/BILLINGPOLI
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?19
Name and address Type of Facility (describe)
1 ORTHOPEDICS AND SPORTS MEDICINE CLINIC
123 HOSPITAL DRIVE SUITE 1008
WATERTOWN,WI53098 		ORTHOPEDICS AND SPORTS MEDICINE CLINIC
2 OBGYN PHYSICIAN PRACTICE
128 HOSPITAL DRIVE
WATERTOWN,WI53098 		OB/GYN PHYSICIAN PRACTICE
3 EYE PHYSICIAN PRACTICE
123 HOSPITAL DRIVE SUITE 1002
WATERTOWN,WI53098 		EYE PHYSICIAN PRACTICE
4 REHAB SERVICES
1684 S CHURCH ST
WATERTOWN,WI53094 		REHAB SERVICES
5 PHYSICIAN PRACTICE
1025 MULBERRY STREET
LAKE MILLS,WI53551 		PHYSICIAN PRACTICE
6 PHYSICIAN PRACTICE
1507 DOCTORS COURT
WATERTOWN,WI53094 		PHYSICIAN PRACTICE
7 PHYSICIAN PRACTICE
102 VILLAGE WALK LANE
JOHNSON CREEK,WI53038 		PHYSICIAN PRACTICE
8 AODAMENTAL COUNSELING
129 HOSPITAL DRIVE
WATERTOWN,WI53098 		AODA/MENTAL COUNSELING
9 INTERNAL MEDICINE CLINIC
123 HOSPITAL DRIVE SUITE 2009
WATERTOWN,WI53098 		INTERNAL MEDICINE CLINIC
10 UROLOGY CLINIC
123 HOSPITAL DRIVE SUITE 2006
WATERTOWN,WI53098 		UROLOGY CLINIC
11 PHYSICIAN PRACTICE
111 ANNA STREET
WATERLOO,WI53594 		PHYSICIAN PRACTICE
12 ASSISTED LIVING
125A HOSPITAL DRIVE
WATERTOWN,WI53098 		ASSISTED LIVING
13 ASSISTED LIVING
161 GOEHL ROAD
WATERLOO,WI53594 		ASSISTED LIVING
14 PHYSICIAN PRACTICE
334 S WESTERN AVE
JUNEAU,WI53039 		PHYSICIAN PRACTICE
15 PLASTIC SURGERY AND MEDISPA
123 HOSPITAL DRIVE SUITE 2003
WATERTOWN,WI53098 		PLASTIC SURGERY AND MEDISPA
16 PHYSICIAN PRACTICE
W1046 MARIETTA SUITE 230
IXONIA,WI53036 		PHYSICIAN PRACTICE
17 REHAB SERVICES
621 W RACINE ST
JEFFERSON,WI53549 		REHAB SERVICES
18 OCCUPATIONAL HEALTH
123 HOSPITAL DRIVE SUITE 2004
WATERTOWN,WI53098 		OCCUPATIONAL HEALTH
19 PHYSICIAN PRACTICE
W359 N5002 BROWN ST SUITE 208
OCONOMOWOC,WI53066 		PHYSICIAN PRACTICE
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 7: MEDICARE COST REPORT COST TO CHARGE RATIO
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,111,500.
PART II, COMMUNITY BUILDING ACTIVITIES: WRMC PROVIDES BOARD AND COMMITTEE LEADERSHIP FOR NUMEROUS HEALTH-ENHANCING PARTNER ORGANIZATIONS THROUGHOUT OUR TWO COUNTY SERVICE AREA. WE PROVIDE MEDICAL DIRECTOR SERVICES FOR MULITIPLE EMS UNITS AND LEAD SEVERAL LOCAL HEALTH AND SAFETY COALITIONS TO ENSURE THAT LOCAL PARTNERS ARE WORKING WELL TOGETHER TO ADVANCE THE HEALTH AND SAFETY OF OUR REGION.
PART III, LINE 8: 100% OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. WATERTOWN REGIONAL MEDICAL CENTER IS COMMITTED TO SERVING ALL PATIENTS, REGARDLESS OF ABILITY TO PAY OR IF THE PAYMENTS TO BE RECEIVED WILL BE LESS THAN THE COST TO PROVIDE THE SERVICE, WHICH IS THE CASE FOR MEDICARE AND MEDICAID PATIENTS. THE FIGURES ON LINE 6 OF PART III COME FROM THE 8/31/15 MEDICARE COST REPORT.
PART III, LINE 9B: THE ACCOUNT BALANCES OF PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER WRMC'S FINANCIAL ASSISTANCE POLICY, BUT WHO FAIL TO PAY THE REMAINING (DISCOUNTED) BALANCE WHEN DUE, ARE CONSIDERED UNCOLLECTIBLE BAD DEBTS FOR THE AMOUNT OF SUCH BALANCES; SUCH ACCOUNTS WILL BE REFERRED TO OUTSIDE AGENCIES FOR COLLECTION.
PART VI, LINE 2: EVERY THREE YEARS, WATERTOWN REGIONAL MEDICAL CENTER (WRMC) PERFORMS A COMMUNITY HEALTH ASSESSMENT IN PARTNERSHIP WITH THE CITY OF WATERTOWN, DODGE COUNTY AND JEFFERSON COUNTY HEALTH DEPARTMENTS AS WELL AS FORT HEALTH CARE AND BEAVER DAM HOSPITAL. OUR LAST NEEDS ASSESSMENT IN 2013. PUBLIC HEALTH DATA WAS USED TO IDENTIFY THE REGION'S TOP HEALTH AND SAFETY NEEDS. INPUT FROM A WIDE VARIETY OF COMMUNITY STAKEHOLDERS WAS INCORPORATED. A COMMUNITY FORUM WAS HELD. PRIORITIES WERE IDENTIFIED IN COLLABORATION WITH OUR PUBLIC HEALTH PARTNERS, COMMUNITY LEADERS, OTHER HEALTH PROVIDERS AND COMMUNITY MEMBERS REPRESENTING DIVERSE NEEDS OF THE COMMUNITY. RESULTS OF THE NEEDS ASSESSMENT WERE MADE PUBLICALLY AVAILABLE THROUGH A COMMUNITY FORUM, PRESENTATIONS TO OUR HEALTHCARE COMMUNITY AND OUR WEBSITE.THE FOLLOWING HAVE BEEN IDENTIFIED AS OUR REGIONS' GREATEST HEALTH NEEDS: A. HEALTHY DIET B. PHYSICAL ACTIVITY C. MENTAL HEALTH D. ALCOHOL/SUBSTANCE ABUSEWRMC'S COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS DEVELOPED IN RESPONSE TO THE NEEDS ASSESSMENT AND APPROVED BY THE WRMC BOARD OF DIRECTORS IN SEPTEMBER, 2013. THE CHIP IS ALSO POSTED ON THE WRMC WEBSITE.EVERY THREE YEARS, WATERTOWN REGIONAL MEDICAL CENTER (WRMC) PERFORMS A COMMUNITY HEALTH ASSESSMENT IN PARTNERSHIP WITH THE CITY OF WATERTOWN, DODGE COUNTY AND JEFFERSON COUNTY HEALTH DEPARTMENTS AS WELL AS FORT HEALTH CARE AND BEAVER DAM HOSPITAL. OUR LAST NEEDS ASSESSMENT IN 2013. PUBLIC HEALTH DATA WAS USED TO IDENTIFY THE REGION'S TOP HEALTH AND SAFETY NEEDS. INPUT FROM A WIDE VARIETY OF COMMUNITY STAKEHOLDERS WAS INCORPORATED. A COMMUNITY FORUM WAS HELD. PRIORITIES WERE IDENTIFIED IN COLLABORATION WITH OUR PUBLIC HEALTH PARTNERS, COMMUNITY LEADERS, OTHER HEALTH PROVIDERS AND COMMUNITY MEMBERS REPRESENTING DIVERSE NEEDS OF THE COMMUNITY. RESULTS OF THE NEEDS ASSESSMENT WERE MADE PUBLICALLY AVAILABLE THROUGH A COMMUNITY FORUM, PRESENTATIONS TO OUR HEALTHCARE COMMUNITY AND OUR WEBSITE.THE FOLLOWING HAVE BEEN IDENTIFIED AS OUR REGIONS' GREATEST HEALTH NEEDS: A. HEALTHY DIET B. PHYSICAL ACTIVITY C. MENTAL HEALTH D. ALCOHOL/SUBSTANCE ABUSEWRMC'S COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS DEVELOPED IN RESPONSE TO THE NEEDS ASSESSMENT AND APPROVED BY THE WRMC BOARD OF DIRECTORS IN SEPTEMBER, 2013. THE CHIP IS ALSO POSTED ON THE WRMC WEBSITE.
PART VI, LINE 3: WRMC USES MULTIPLE METHODS TO EDUCATE PATIENTS ABOUT ELIGIBILITY FOR FINANCIAL ASSISTANCE. LOCAL REFERRING PROVIDERS ARE FAMILIAR WITH WRMC'S CHARITY CARE POLICIES AND OFTEN GET PATIENTS IN CONTACT WITH WRMC FINANCIAL COUNSELORS AS THE CARE PROCESS IS INITIATED. OUR FRONT OFFICE/RECEPTION STAFF AT EACH POINT OF ENTRY IS EDUCATED ON BILLING AND ASSISTANCE PROCEDURES AND CAN SERVE AS AN IMMEDIATE RESOURCE FOR PATIENTS, REFERRING PATIENTS TO FINANCIAL COUNSELORS TO PROVIDE PERSONALIZED COUNSELING WHEN NECESSARY. MESSAGING ABOUT AVAILABILITY OF FINANCIAL PAYMENT ASSISTANCE IS DISPLAYED AT EACH REGISTRATION AREA, AND PATIENTS ARE PROVIDED WITH A COPY OF WRMC'S FINANCIAL ASSISTANCE POLICY.IN ADDITION TO BEING PROVIDED TO EACH PATIENT AT REGISTRATION, OUR FINANCIAL ASSISTANCE POLICIES ARE AVAILABLE ON OUR WEBSITE, AND THE NUMBERS FOR OUR FINANCIAL COUNSELORS ARE READILY PUBLICIZED. IN ADDITION, OUR PATIENT FINANCIAL COUNSELORS CONTACT UNINSURED AND SELF-PAY PATIENTS TO FACILITATE OBTAINMENT OF INSURANCE COVERAGE. ONCE ADMITTED TO THE MEDICAL CENTER, EACH PATIENT RECEIVES A WELCOME FOLDER, WHICH OUTLINES BILLING PROCEDURES AND FINANCIAL ASSISTANCE RESOURCES. THESE POLICIES AND RESOURCES ARE ALSO AVAILABLE 24/7 ON OUR WEBSITE AT WATERTOWNREGIONAL.COM.
PART VI, LINE 4: WRMC SERVES THE RESIDENTS OF DODGE AND JEFFERSON COUNTIES IN A SERVICE AREA OF ROUGHLY 120,000 LIVES. BASIC COUNTY DEMOGRAPHIC INFORMATION IS AS FOLLOWS: DODGE COUNTY JEFFERSON COUNTY% RESIDENTS BELOW POVERTY 9.2% 11.2%% WITH HS DIPLOMA 87.5% 91.7%% SPEAK LANGUAGE OTHER THAN ENGLISH 4.6% 6.1%% RESIDENTS UNINSURED 6.8% 7.2%MEDIAN HOUSEHOLD INCOME $53,189 $54,522
PART VI, LINE 5: WRMC HAS AN OPEN MEDICAL STAFF AND A GENEROUS CHARITY CARE PROGRAM. WRMC IS ACTIVE IN COMMUNITY HEALTH IMPROVEMENT IN THE REGION. AN ACTIVE MEMBER OF THE DODGE JEFFERSON HEALTHY COMMUNITY PARTNERSHIP, WE WORK IN PARTNERSHIP WITH LOCAL HEALTH DEPARTMENTS TO DEVELOP COMMUNITY HEALTH IMPROVEMENT PLANS. WE PROVIDE ONGOING SUPPORT (IN THE FORM OF FINANCIAL FUNDING AND DONATED DIAGNOSTIC AND LAB TESTING SERVICES) TO OUR LOCAL FREE CLINIC, THE WATERTOWN AREA CARES CLINIC (WACC) AND PROVIDE FINANCIAL SUPPORT TO OUR LOCAL FREE DENTAL CLINIC, THE COMMUNITY DENTAL CLINIC. WRMC DEVELOPS ACTIVE PARTNERSHIPS WITH COMMUNITY PROVIDERS TO ENSURE QUALITY CARE ACROSS THE CONTINUUM. SUPPORT OF OUR LOCAL HOSPICE PROVIDER, RAINBOW HOSPICE, HAS BEEN A SIGNIFICANT PRIORITY. TWO WRMC LEADERS SERVE ON THE RAINBOW HOSPICE BOARD. TWO WRMC PHYSICIANS PROVIDE MEDICAL DIRECTION FOR HOSPICE, AND WRMC HAS MADE SIZABLE FINANCIAL DONATIONS TO ENHANCE THE HOSPICE SERVICES AVAILABLE LOCALLY. IN ADDITION TO RAINBOW HOSPICE, WE HAVE LEADERSHIP TEAM MEMBERS SERVING ON THE BOARDS OF OUR YMCA, COMMUNITY DENTAL CLINIC, CHAMBER OF COMMERCE AND ECONOMIC DEVELOPMENT ORGANIZATION.OBESITY IS A KEY HEALTH CONCERN FOR OUR REGION, AND WRMC IS ACTIVE IN PROMOTING LIFESTYLE CHANGE. LEADERSHIP COORDINATION OF OUR LOCAL RUN/WALK SERIES IS AN EXAMPLE OF OUR OBESITY PREVENTION EFFORTS. OVER THE PAST TWO YEARS WE TRANSFORMED OUR HOSPITAL FOOD SERVICE TO FORM HARVEST MARKET. HARVEST WAS DESIGNED TO SERVE AS AN EXAMPLE OF HEALTHY EATING, MAKING IT EASY FOR EMPLOYEES, PATIENTS AND GUESTS TO "CHOOSE HEALTH" WITH AFFORDABLE, FRESH AND SCRATCH MEALS MADE WITH NUTRITIOUS LOCAL INGREDIENTS. OUR OPERATIONAL THEME IS "FOOD IS MEDICINE AND WE INVEST IN COMMUNITY EDUCATION. WE OFFER AN ON-GOING FREE CLASS THAT TEACHES THE BASICS OF HEART HEALTHY EATING, AND WE HAVE DEVELOPED A COMMUNITY KITCHEN THAT OFFERS HEALTHY COOKING CLASSES AT A SIGNIFICANTLY DISCOUNTED RATE. OVER THE PAST YEAR WE HAVE HOSTED MULTIPLE SCHOOL GROUPS TO TEACH CHILDREN HEALTHY EATING HABITS.
PART VI, LINE 6: WRMC IS A JOINT VENTURE BETWEEN THE GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION, INC. AND LIFEPOINT HEALTH. FIFTY PERCENT OF WRMC'S BOARD OF DIRECTORS ARE LOCAL AND APPOINTED BY THE GREATER WATERTOWN COMMUNITY HEALTH FOUNDATION. THESE MEMBERS REPRESENT THE DIVERSE NEEDS OF THE WATERTOWN REGION. WRMC ALSO IS GOVERNED BY A BOARD OF TRUSTEES WHO OVERSEE CLINICAL QUALITY, CREDENTIALING AND ACCREDITATION.
PART VI, LINE 7, REPORTS FILED WITH STATES WI
Schedule H (Form 990) 2014
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