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/form990 for instructions and the latest informtion.
OMB No. 1545-0047
2017
Open to Public Inspection
Name of the organization
DIVINE SAVIOR HEALTHCARE INC
 
Employer identification number

39-0806250
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) . . .
    166,016   166,016 0.170 %
b Medicaid (from Worksheet 3, column a) . . . . .     15,618,229 11,979,406 3,638,823 3.790 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     15,784,245 11,979,406 3,804,839 3.960 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     249,450 18,757 230,693 0.240 %
f Health professions education (from Worksheet 5) . . .     50,019   50,019 0.050 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     299,469 18,757 280,712 0.290 %
k Total. Add lines 7d and 7j .     16,083,714 11,998,163 4,085,551 4.250 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2017
Schedule H (Form 990) 2017
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     4,500   4,500 0 %
9 Other            
10 Total     4,500   4,500 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 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
5,591,218
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
2,795,609
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
16,629,412
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
19,477,935
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-2,848,523
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) 2017
Schedule H (Form 990) 2017
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 DIVINE SAVIOR HEALTHCARE INC
2817 NEW PINERY ROAD
PORTAGE,WI53901
80
X X         X   AMBULANCE SERVICE  
Schedule H (Form 990) 2017
Page 4
Schedule H (Form 990) 2017
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)
DIVINE SAVIOR HEALTHCARE 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 15
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   No
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 15
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTP://WWW.DSHEALTHCARE.COM/MAIN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX
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) 2017
Page 5
Schedule H (Form 990) 2017
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
DIVINE SAVIOR HEALTHCARE 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
WWW.DSHEALTHCARE.COM
b
DSHEALTHCARE.COM/SITES/DSHEALTHCARE.COM/ASSETS/FILES/COMMUNITYCARE/COMMUNIT
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
Page 6
Part VFacility Information (continued)

Billing and Collections
DIVINE SAVIOR HEALTHCARE 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) 2017
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Schedule H (Form 990) 2017
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
DIVINE SAVIOR HEALTHCARE 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) 2017
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Schedule H (Form 990) 2017
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, 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
DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 5: DIVINE SAVIOR HEALTHCARE IS DEEPLY INVOLVED IN THE COMMUNITIES IT SERVES. EMPLOYEES SERVE ON COMMUNITY SERVICE, ECONOMIC DEVELOPMENT, EDUCATION, AND HEALTHRELATED COMMITTEES WHERE THEY ARE ABLE TO CONTINUALLY SOLICIT INFORMATION AND USE IT TO CONTINUALLY MAKE DECISIONS THAT BEST SUIT THE NEEDS OF THOSE SERVED. DIVINE SAVIOR'S BOARD OF DIRECTORS IS COMPRISED OF DELEGATES FROM ITS SPONSORSHIP AND LOCAL COMMUNITY/BUSINESS LEADERS WHO GUIDE, DIRECT, AND APPROVE THE STRATEGIES AND OPERATING POLICIES OF THE ORGANIZATION. DIVINE SAVIOR HAS ASSEMBLED AN INTERDISCIPLINARY TASK FORCE THAT INCLUDES BOARD MEMBERS, EMPLOYEES, COMMUNITY MEMBERS, AND LEADERS TO DETERMINE THE COMMUNITY HEALTH NEEDS AND A FIVE YEAR STRATEGIC PLAN. DIVINE SAVIOR IS CURRENTLY OPERATING WITHIN A FIVE YEAR PLAN THAT IS REVIEWED AND UPDATED ACCORDINGLY. DIVINE SAVIOR IS ALSO USING THE DATA COMPILED FOR THE CHNA THIS YEAR AND WILL REEVALUATE AND CREATE A NEW STRATEGIC PLAN THAT WILL BE REFLECTED IN THE 2018 CHNA. QUANTITATIVE DATA IN THE CHNA INCLUDES STATISTICS AND DEMOGRAPHIC INFORMATION FROM COUNTY HEALTH STUDIES OF COMMUNITY HEALTH NEEDS IN COLUMBIA AND MARQUETTE COUNTIES (PRIMARY SERVICE AREA) AS WELL AS PATIENT STATISTICS AND TRENDS FROM DIVINE SAVIOR HEALTHCARE'S INTERNAL RECORDS. QUALITATIVE DATA INCLUDES INTERVIEWS WITH COMMUNITY MEMBERS AND LOCAL EXPERTS IN PUBLIC HEALTH, GOVERNMENT AND COMMUNITY EMPLOYERS DURING WHICH INPUT ON HEALTH NEEDS AND SOLUTIONS WAS REQUESTED. FOR THE 2015 ASSESSMENT, DIVINE SAVIOR HEALTHCARE LEADERS REVIEWED THE UPDATED DATA AND THEN REEVALUATED THE PRIORITIES. THE PRIORITIES WERE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR COMMENTS. THE CHNA, INCLUDING THE FINAL PRIORITIES ALONG WITH UPDATED DATA, WAS PRESENTED TO THE BOARD OF DIRECTORS FOR INPUT AND FINAL APPROVAL.
DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 11: BASED ON THE RESEARCH AND DATA COLLECTION FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION IDENTIFIED FOUR CATEGORIES OF HEALTH NEEDS: ACCESS, DISEASED-BASED, WELLNESS AND PREVENTION, AND MISCELLANEOUS. EXISTING RESOURCES AND STRATEGIES FOR ADDRESSING THESE IDENTIFIED NEEDS WERE REVIEWED AS WELL.BELOW ARE THE WAYS THAT THE ORGANIZATION IS ADDRESSING THESE ITEMS. THESE ARE ALSO OUTLINED IN THE IMPLEMENTATION STRATEGY TO THE COMMUNITY HEALTH NEEDS ASSESSMENT:ACCESS NEEDS:PRIMARY CARE ACCESS-WE CONTINUE TO RECRUIT FOR NEW PROVIDERS IN FAMILY MEDICINE, INTERNAL MEDICINE, AND SURGERY.-WE WORK WITH THE UNIVERSITY OF WISCONSIN ASSISTING IN GRADUATE MEDICAL EDUCATION IN PRIMARY CARE AND SPECIALTY CARE.-WE WILL CONTINUE TO DEVELOP RESOURCES TO BETTER SERVE MARQUETTE COUNTY COMMUNITIES WITHIN OUR SERVICE AREA.-THE WELLNESS CENTER WAS COMPLETED IN 2016 AND INCLUDES NEW SPACE FOR CURRENT PROVIDERS IN THE AREA OF PODIATRY, PHYSICAL MEDICINE, ORTHOPEDICS, REHAB THERAPIES, AND AUDIOLOGY.SPECIALTY PHYSICIAN SERVICES-WE RECENTLY RECRUITED AN INTERNAL MEDICINE PHYSICIAN AND PLANS TO CONTINUE RECRUITING ADDITIONAL PROVIDERS IN THIS AREA AS THIS CONTINUES TO BE A NEED IN THE REGION.-WE ARE DEVELOPING RELATIONSHIPS WITH EXISTING SPECIALTY PRACTICES IN MADISON TO BRING MORE SPECIALTIES TO ENHANCE OUR ALREADY EXISTING OUTREACH PROVIDER CLINIC THAT CURRENTLY INCLUDES: CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ENT, ONCOLOGY, PODIATRY, OPHTHALMOLOGY, SPECIALTY OB/GYN AND UROLOGY.MENTAL HEALTH AND SUBSTANCE ABUSE-WE HAVE TAKEN A CLOSER LOOK AT OUR PRESCRIPTION MEDICATION AND PAIN MANAGEMENT PROTOCOLS AND IMPLEMENTED POLICIES IN ORDER TO REDUCE THE POTENTIAL FOR ABUSE.SENIOR SERVICES-WE HAVE INVESTED SIGNIFICANT RESOURCES IN THE OPENING OF TIVOLI. TIVOLI OFFERS SKILLED NURSING CARE, ASSISTED LIVING, AND A RANGE OF OTHER COMMUNITY BASED SERVICES FOR SENIORS.ACCESS FOR THE UNINSURED-WE CURRENTLY PROVIDES APPROXIMATELY $455,000 IN CHARITY CARE FOR THOSE WITHOUT HEALTH CARE COVERAGE IN OUR COMMUNITY.-WE WILL CONTINUE TO OFFER SERVICES TO ASSIST PEOPLE IN LOCATING HEALTH CARE COVERAGE OR ASSISTANCE PROGRAMS.DISEASE-BASED NEEDS:CANCER-WE CONTINUE TO OFFER CANCER RELATED PREVENTION, EDUCATION, DIAGNOSTIC, AND THERAPEUTIC SERVICES. -WE CURRENTLY ARE EXPLORING THE POSSIBILITY OF AN INTERVENTIONAL RADIOLOGY PROGRAM.CARDIOVASCULAR AND CEREBROVASCULAR- WE CONTINUE TO OFFER PREVENTION, EDUCATION, DIAGNOSTIC AND TREATMENT SERVICES FOR THESE ILLNESSES.-DIVINE SAVIOR EMERGENCY MEDICAL PROFESSIONALS WILL CONTINUE TO LEAD IN CARE OF THOSE WITH A CARDIOVASCULAR/CEREBROVASCULAR EMERGENCY.DIABETES, PULMONARY, AND KIDNEY DISEASE-PRIMARY CARE PROVIDERS WILL CONTINUE TO CARE EXTENSIVELY FOR THEIR PATIENTS WITH THESE DISEASES AND MORE PROVIDERS ARE BEING RECRUITED SO THAT WE CAN MEET THE NEED TO CARE FOR THOSE WITH THESE MEDICAL CONDITIONS.-WE WILL CONTINUE TO OFFER AND INCREASE OFFERINGS IN EXERCISE PROGRAMS, COMMUNITY EDUCATION EFFORTS AND WORKPLACE HEALTH INITIATIVES TO ADDRESS ISSUES RELATED TO PHYSICAL ACTIVITY, DIET, OBESITY AND CHRONIC CONDITIONS. THIS IS PART OF THE RATIONALE FOR THE CREATION OF LA VITA AT THE WELLNESS CENTER.ALZHEIMER'S, DEMENTIA AND GERO-PSYCHIATRY-WE PROVIDE MEMORY CARE FOR THOSE WHO HAVE A NEED FOR RESIDENTIAL CARE AT TIVOLI.-WE FOCUS ON RECRUITMENT OF PRIMARY CARE PROVIDERS WHO HAVE A SPECIAL INTEREST AND EXPERTISE IN GERIATRICS.-WE WILL BE WORKING WITH THE PAQUETTE CENTER TO ENHANCE ACCESS TO GERO-PSYCHIATRY SERVICESCHRONIC LOW BACK PAIN-OUR FOCUS WILL BE ON EXPLORING PROGRAMS THAT INVOLVE NONSURGICAL TREATMENT AND PREVENTION OF CHRONIC BACK AND NECK PAIN.-IN 2015, WE BEGAN OFFERING THE SPINE CLINIC PROGRAM TO STRENGTHEN SPINAL MUSCLES THROUGH EXERCISE.WELLNESS/PREVENTION/PUBLIC HEALTH NEEDS:DIVINE SAVIOR OFFERS, AND WILL CONTINUE TO OFFER, A BROAD RANGE OF PROGRAMS DIRECTED TOWARD COMMUNITY WELLNESS AND PREVENTION. THOSE INCLUDE: -HEALTH SCREENINGS -EXERCISE CLASSES -SUPPORT GROUPS -COMMUNITY EDUCATION -CPR AND FIRST AID TRAINING -CORPORATE HEALTH AND WELLNESSIN 2016, WE EMBARKED ON A "NEW KIND OF CARE" CAMPAIGN, WORKING WITH LOCAL BUSINESSES AND COMMUNITY FACILITES IN ORDER TO PROMOTE HEALTHY AND SAFE CHOICES IN THE PLACES PEOPLE ARE BEING FACED WITH MAKING A DECISION.MISCELLANEOUS NEEDS:TRANSPORTATION-LOCAL TAXI SERVICES AND THE COUNTIES ARE PROVIDING SERVICE SUPPORT FOR MEDICAL TRANSPORTATION FOR THOSE WHO NEED IT.TRANSLATION SERVICES-WE CURRENTLY USE A SERVICE THAT PROVIDES PHONE AND VIDEO TRANSLATION TO PATIENTS AND WE ALSO HAVE TWO LOCAL BI-LINGUAL SPANISH SPEAKING TRANSLATORS WHO SUPPLEMENT THIS SERVICE FOR THE SPANISH-SPEAKING COMMUNITY.EMERGENCY DETOX-WE WILL CONVENE A MULTI-AGENCY FORUM TO GENERATE APPROACHES TO THIS PROBLEM.DOWNTOWN PORTAGE PRESENCE-WE WILL CONTINUE TO PARTICIPATE IN ACTIVITIES THAT PROMOTE ECONOMIC GROWTH IN ALL AREAS OF THE COMMUNITY.SEVERAL OTHER NEEDS WERE NOT ADDRESSED BY DIVINE SAVIOR HEALTHCARE, INC. AS ANOTHER ORGANIZATION WITHIN THE COMMUNITY ALREADY PROVIDES THESE SERVICES WHICH ARE NOT IN THE HOSPITAL'S PRIMARY AREA OF HEALTHCARE EXPERTISE. ONE EXAMPLE OF THESE TYPES OF SERVICES IS A FREE DENTAL CLINIC TO PROVIDE ACCESS TO PATIENTS WHO ARE OTHERWISE UNABLE TO AFFORD PROPER DENTAL CARE. IN RECENT YEARS, A COMMUNITY GROUP HAS ORGANIZED A FREE DENTAL CLINIC TO PROCESS ACCESS TO DENTAL CARE FOR INDIVIDUALS WITH FINANCIAL NEEDS THAT LIMIT THEIR ACCESS TO DENTAL SERVICES.
DIVINE SAVIOR HEALTHCARE, INC. PART V, SECTION B, LINE 20E: THE FINANCIAL ASSISTANCE POLICY IS POSTED IN EACH OF THE HOSPITAL'S PHYSICIAN CLINICS. FINANCIAL ASSISTANCE INFORMATIONAL CARDS ARE ALSO GIVEN TO ANYONE INDICATING FINANCIAL HARDSHIP, AND THEY ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL WILL ONLY INITIATE COLLECTION ACTIVITIES NOTED IN SCHEDULE H, PART V, LINE 17 IF A PATIENT DOES NOT RESPOND OR PROVIDE INFORMATION TO REQUESTS TO APPLY FOR CHARITY CARE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2017
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Schedule H (Form 990) 2017
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?5
Name and address Type of Facility (describe)
1 1 - TIVOLI EXTENDED CARE FACILITY
2817 NEW PINERY ROAD
PORTAGE,WI53901
SKILLED NURSING FACILITY, ASSISTED LIVING FACILITY, AND HOME HEALTH PROGRAM
2 2 - DIVINE SAVIOR HEALTHCARE CLINIC
2817 NEW PINERY ROAD
PORTAGE,WI53901
PHYSICIAN CLINIC
3 3 - PARDEEVILLE DIVINE SAVIOR CLINIC
102 GILLETTE STREET
PARDEEVILLE,WI53954
PHYSICIAN CLINIC
4 4 - CROSSROADS DIVINE SAVIOR CLINIC
N4390 CROSSROADS CLINIC ROAD
OXFORD,WI53952
PHYSICIAN CLINIC
5 5 - DIVINE SAVIOR WELLNESS CENTER
2815 NEW PINERY ROAD
PORTAGE,WI53901
WELLNESS CENTER
6
7
8
9
10
Schedule H (Form 990) 2017
Page 10
Schedule H (Form 990) 2017
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 6A: DIVINE SAVIOR HEALTHCARE, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S WEBSITE.
PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
PART I, LINE 7, 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 $ 5,882,186.
PART II, COMMUNITY BUILDING ACTIVITIES: WHILE THERE IS GROWING ARGUMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. DIVINE SAVIOR HEALTHCARE, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. DIVINE SAVIOR HEALTHCARE, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, URGENT CARE, HOME CARE, RENAL DIALYSIS, INFUSION SERVICES, SWING BED SERVICES, NURSING HOME SERVICES, ASSISTED LIVING SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, WOMEN'S SERVICES, AND AMBULANCE SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.
PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL PATIENT ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.
PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE FOR. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE, AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, HOSPITALIST PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT DIVINE SAVIOR HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2017 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B: UNDER THE HOSPITAL'S COLLECTION AND CHARITABLE CARE POLICIES, DIVINE SAVIOR HEALTHCARE, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITABLE CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION.DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY AND COMMUNITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE ORGANIZATION RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES.
PART VI, LINE 2: DIVINE SAVIOR HEALTHCARE, INC. ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH THE ORGANIZATION'S MISSION IN THE COMMUNITY. THE ORGANIZATION ALSO REVIEWS STATISTICS IN HOSPITAL, NURSING HOME, CLINIC, HOME HEALTH, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE ORGANIZATION ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND IT'S PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY.AS PART OF THE STRATEGIC PLANNING PROCESS, DIVINE SAVIOR HEALTHCARE, INC. PREVIOUSLY CONDUCTED A COMMUNITY NEEDS ASSESSMENT UTILIZING A CONSULTING SERVICE TO SPEAK DIRECTLY TO COMMUNITY LEADERS AND RESIDENTS TO IDENTIFY COMMUNITY NEEDS. DIVINE SAVIOR HEALTHCARE, INC. CONTINUOUSLY STUDIES PATIENT NEEDS AND IMPLEMENTS FACILITY, PATIENT SERVICE, AND COMMUNITY PLANNING INITIATIVES THAT REQUIRE EXTENSIVE INVESTMENTS OF TIME AND RESOURCES. IN RESPONSE TO THE IDENTIFIED NEED FOR ADDITIONAL SERVICES AND IMPROVED FACILITIES, DIVINE SAVIOR HEALTHCARE, INC. COMPLETED A NEW EXTENDED CARE AND ASSISTED LIVING CAMPUS ADJACENT TO THE CURRENT HOSPITAL FACILITY WITH A TUNNEL BETWEEN THE FACILITIES FOR IMPROVED ACCESS, WHICH SINCE OPENING HAS PROVIDED GREAT BENEFITS TO PATIENTS OVER THE PAST FOUR YEARS. IN ADDITION, DIVINE SAVIOR HEALTHCARE, INC. CONTINUES ONGOING RECRUITMENT EFFORTS FOR EMPLOYED PHYSICIANS TO MEET THE PRIMARY AND SPECIALTY CARE NEEDS OF THE COMMUNITY. ONE OF THE AREAS IDENTIFIED AS A NEED WAS ACCESS TO PRIMARY CARE IN THE SURROUNDING COMMUNITIES AND IN RESPONSE TO THIS NEED, DIVINE SAVIOR HEALTHCARE, INC. STUDIED THE FINANCIAL VIABILITY AND COMMUNITY HEALTH NEEDS OF OPENING AN ADDITIONAL SATELLITE CLINIC. PLANNING WAS DONE FOR A NEW CLINIC THROUGHOUT FISCAL YEAR 2013 AND THE ORGANIZATION OPENED AN ADDITIONAL PRIMARY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF OXFORD, WISCONSIN IN FISCAL YEAR 2014. THE ORGANIZATION ALSO ADDED ADDITIONAL CLINICAL, PHYSICAL MEDICINE, AND WELLNESS FACILITY SPACE ON THE HOSPITAL CAMPUS IN FISCAL YEAR 2016 TO PROVIDE ADDITIONAL PATIENT ACCESS AND SPACE. DUE TO CHANGES IN THE OVERALL NATIONAL HEALTHCARE ENVIRONMENT, THE ORGANIZATION RESPONDED TO THESE CHANGES BY IMPLEMENTING ELECTRONIC MEDICAL RECORDS IN THE CLINICS AND THE EMERGENCY ROOM OVER THE PAST FOUR YEARS AND CONTINUES TO WORK TOWARD FULL ELECTRONIC MEDICAL RECORDS IN THE ENTIRE ORGANIZATION.MEMBERS OF THE BOARD OF DIRECTORS OF DIVINE SAVIOR HEALTHCARE, INC. ARE ALSO MADE UP OF COMMUNITY LEADERS WHICH ARE IN TOUCH WITH NEEDS IN THE COMMUNITY. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.
PART VI, LINE 3: UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY AND COMMUNITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID PROGRAM, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR DIVINE SAVIOR HEALTHCARE, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE PORTAGE, PARDEEVILLE, WISCONSIN DELLS, LAKE DELTON, BRIGGSVILLE, WYOCENA, POYNETTE, OXFORD, AND ARLINGTON, WISCONSIN, AMONG MANY OTHERS. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RESIDE IN THE ORGANIZATION'S EXTENDED AND LONG-TERM CARE FACILITIES OR PATIENTS WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN 2017, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 50.8 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR.
PART VI, LINE 5: AS A RELIGIOUS BASED ORGANIZATION, DIVINE SAVIOR HEALTHCARE, INC. PROVIDES FAITH BASED SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH SCREENINGS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS.
PART VI, LINE 7, REPORTS FILED WITH STATES WI
Schedule H (Form 990) 2017
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