2020-11-13T11:21:39-06:00 2019-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-01-01 390806828 MEMORIAL HOSPITAL INC NEILLSVILLE WISCONSIN MEMO 7157433101 216 SUNSET PLACE NEILLSVILLE WI 54456 RYAN NEVILLE CAO 7157433101 2020-11-13 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-11-13 71.13.38.61 2020-11-13 08:24:39 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2019 2021-01-29 14:40:06Z MARSHFIELD MEDICAL CENTER-NEILLSVILLE RYAN NEVILLE 216 SUNSET PLACE NEILLSVILLE WI 54456 29376774 0 X WWW.MEMORIALMEDCENTER.ORG X 1954 WI CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 8 5 208 75 224751 0 187906 609738 27219175 28087683 12298 13751 356545 648893 27775924 29360065 0 0 0 0 15817544 15450584 0 0 3174 12520329 10995953 28337873 26446537 -561949 2913528 14740637 17644761 6785433 6776029 7955204 10868732 WE ENRICH LIVES TO CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE. 0 0 16975436 0 23289518 MEMORIAL HOSPITAL, INC. (THE "HOSPITAL"), A 25-BED RURAL HOSPITAL, IS A NONPROFIT, NONSTOCK WISCONSIN CORPORATION PROVIDING SERVICES TO NEILLSVILLE, WISCONSIN, AND THE SURROUNDING COMMUNITIES. HOSPITAL INPATIENT SERVICES IN 2019 INCLUDED 816 ACUTE PATIENT DAYS, 294 OBSERVATION PATIENT DAYS, AND 420 SWING BED PATIENT DAYS. EMERGENCY ROOM VISITS TOTALED 2,370, URGENT CARE VISITS TOTALED 2,624, AND SURGERIES AND PROCEDURES TOTALED 681 IN 2019. OTHER HOSPITAL SERVICES PROVIDED IN 2019 INCLUDED BUT WERE NOT LIMITED TO: PRIMARY CARE, ORTHOPEDIC GENERAL SURGERY, AND ONCOLOGY CLINIC AND PROCEDURES, ATHLETIC TRAINING, PAIN MANAGEMENT, PHARMACY, PHYSICAL THERAPY, RADIOLOGY, LABORATORY, CARDIAC REHABILITATION, RESPIRATORY THERAPY, OCCUPATIONAL THERAPY, AND DIABETIC EDUCATION. 4408644 0 4308717 MEMORIAL HOSPITAL, INC. ALSO OWNS AND OPERATES TWO CLINICS LOCATED IN NEILLSVILLE AND GREENWOOD, WISCONSIN. TOTAL CLINIC VISITS FOR 2019 WERE 15,780. 763937 0 345540 THE ASSISTED LIVING FACILITY IS AN ALTERNATIVE FOR SENIORS WHO CAN NO LONGER LIVE SAFELY IN THEIR OWN HOME, YET DO NOT NEED 24-HOUR MEDICAL SUPERVISION. SUNSET GARDENS (SG) IS A HOUSING AND HEALTH CARE ALTERNATIVE, COMBINING INDEPENDENCE WITH PERSONAL CARE, IN A WARM, DIGNIFIED, HOME-LIKE ATMOSPHERE. SG HAS 11 PRIVATE ROOMS AND 2 DOUBLE ROOMS, FOR A COUPLE OR SIBLINGS. MEALS, SNACKS, HOUSEKEEPING, LAUNDRY, CABLE TELEVISION, AND MAINTENANCE SERVICES ARE PROVIDED. SOCIAL AND RECREATIONAL PROGRAMS AND A CHAPEL ARE ALSO PROVIDED. HEALTH CARE SERVICES INCLUDE A REGISTERED NURSE ON-SITE OR ON-CALL 24-HOURS PER DAY, MEDICATION MANAGEMENT, AND PERSONAL CARE SERVICES PROVIDED BY CERTIFIED NURSING ASSISTANTS. THE ASSISTED LIVING FACILITY PROVIDED APPROXIMATELY 3,650 RESIDENT DAYS DURING 2019. 22148017 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 32 0 208 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KELLY SILBERNAGEL 7157433101 216 SUNSET PLACE NEILLSVILLE WI 54456 X MARIA CRUZ-APOLINARIO MD PHYSICIAN 1.00 45.00 X 0 661773 25404 DAVID CARLSON MD PHYSICIAN 1.00 45.00 X 0 537273 25209 OSAMA ALSAIED MD PHYSICIAN 1.00 45.00 X 0 367961 21252 GARY ANDERSON MD PHYSICIAN 1.00 45.00 X 0 326380 20420 AMY SCHNEIDER DE CORTEZ PHYSICIAN 1.00 45.00 X 0 263211 25239 JERARD JENSEN MCHS GENERAL COUNSEL 1.00 45.00 X 0 871750 65456 GORDON EDWARDS MCHS CFO/COO 1.00 45.00 X 0 759168 51553 STEVEN KULICK CHIEF EXPERIENCE OFFICER 1.00 45.00 X 0 584726 46900 JEANNE SCINTO CHIEF TRANSFORMATION OFFICER 1.00 45.00 X 0 402329 32319 RYAN NEVILLE CAO MMC-NEILLSVILLE 45.00 0.50 X 125720 167639 19340 KELLY SILBERNAGEL CFO MMC-NEILLSVILLE 45.00 X 66563 97248 26059 MARK BUGHER CHAIR 1.00 X X 0 33000 0 MARK BRADLEY VICE CHAIR 1.00 X X 0 1000 0 JOHN BALTUS TREASURER 1.00 X X 0 0 0 CHUCK NASON SECRETARY 1.00 X X 0 7500 0 RUWAN DISSANAYAKE MD BOARD MEMBER 1.00 40.00 X 0 472736 68019 NARAYANA MURALI MD BOARD MEMBER/MCHS CSO 1.00 45.00 X 0 923371 69477 SUSAN SUTTER BOARD MEMBER 1.00 X 0 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 1.00 45.00 X 0 2421029 300156 192283 8898094 796803 1 0 1 0 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 AGENCY NURSING 645585 WI ANESTHESIA SVC LLC W5844 ROLLING HILLS DR NEILLSVILLE WI 54456 ANESTHESIA SERVICES 501431 STAFF CARE INC PO BOX 281923 ATLANTA GA 30384 EMERGENCY ROOM PHYSICIANS 254386 WOLD ARCHITECTS INC 332 MINNESOTA ST STE W2000 ST PAUL MN 55101 ARCHITECT FOR NEW BUILDING 177744 EMILE SALVO MC SC 17312 INTERLUDE ROAD TOMAH WI 54460 EMERGENCY ROOM PHYSICIANS 144363 5 578266 19812 11660 609738 HOSPITAL REVENUE 621110 23433426 23289518 143908 CLINIC REVENUE 621110 4308717 4308717 ASSISTED LIVING REVENUE 623000 345540 345540 28087683 30460 30460 16709 -16709 -16709 -16709 DIETARY 722514 248019 248019 INVESTMENT IN UNCONSOLIDATED AFFI 900099 136130 136130 HOUSEKEEPING 812900 80843 80843 183901 183901 648893 29360065 27943775 224751 581801 X 201760 143114 58646 11839142 9904934 1934208 381685 318464 63221 2209163 1841672 367491 818834 683204 135630 4765081 3968488 796593 17244 1376 15868 176316 80689 95627 250445 51469 196761 2215 438335 434081 4254 93708 79772 13936 2306 2132 174 64286 39549 24673 64 946981 610662 335449 870 114742 1884 112858 BAD DEBT 1287359 1287359 MEDICAL SUPPLIES 1094191 1091563 2628 DRUG EXPENSE 697948 697948 MEDICAL EQUIPMENT 152701 145497 7204 894310 764160 130125 25 26446537 22148017 4295346 3174 662621 191682 952371 2376469 2866151 3416962 619931 503743 298533 0 21865322 14288948 5678922 7576374 0 54151 3662108 3525380 14740637 17644761 2915207 57626 1785613 1486710 2084613 5231693 6785433 6776029 X 7955204 10290466 578266 7955204 10868732 14740637 17644761 2913528 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6035 6035 0 PART II-B, LINE 1: MEMORIAL HOSPITAL, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE WHA HAS NOTIFIED MEMORIAL HOSPITAL, INC. THAT $1,960 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. MEMORIAL HOSPITAL, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, MEMORIAL HOSPITAL, INC. PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PHYSICIAN COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTH CARE ISSUES IN AN EFFORT TO PROMOTE BETTER HEALTH CARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. THE RWHC DETERMINED THAT $4,075 OF THE FEES PAID IN 2019 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTH CARE ENVIRONMENT IN THE STATE OF WISCONSIN. 10205 1361 11566 9735 526 -56 10205 7926 1006 803 9735 6407 1268 251 7926 6386 21 6407 0.00000 1.00000 0.00000 0 1 1 515789 515789 10993857 8801221 2192636 6148185 5487727 660458 4207491 4207491 7576374 INVESTMENT IN CENTRAL MN DIAGNOSTIC, INC. 603779 DEFERRED COMPENSATION PLAN ASSETS 677564 AMOUNTS RECEIVABLE FROM THIRD-PARTY REIMBURSEMENT PROGRAMS 1369843 INTEREST IN MARSHFIELD HEALTH SYSTEM FOUNDATION, INC 578266 OTHER RECEIVABLES 295928 3525380 DEFERRED COMPENSATION LIABILITIES 677564 ASSET RETIREMENT OBLIGATION 601505 DUE TO RELATED PARTIES 3952624 5231693 1 1 X 1 X 1 X 1 1 0 1 1 105038 105038 0.00400 2808661 1503721 1304940 0.04930 2913699 1503721 1409978 0.05330 32250 815 31435 0.00120 50807 50807 0.00190 10741602 5736084 5005518 0.18930 5115 5115 0.00020 10829774 5736899 5092875 0.19260 13743473 7240620 6502853 0.24590 1136 1136 0.00000 525 525 0.00000 1835 1835 0.00010 3496 3496 0.00010 0 869223 347689 7411498 7450917 -39419 X 1 1 1 1 MEMORIAL HOSPITAL INC 216 SUNSET PLACE NEILLSVILLE WI 54456 WWW.MEMORIALMEDCENTER.ORG 1026 X X X X MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, SECTION C, LINE 7D X X 1 19 1 SEE SUPPLEMENTAL INFO 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X SEE SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: MARSHFIELD MEDICAL CENTER - NEILLSVILLE COLLABORATED WITH COMMUNITY PARTNERS TO ASSESS THE HEALTH AND NEEDS OF THE COMMUNITY THROUGH MEETINGS, SURVEYS, COMMUNITY CONVERSATIONS, KEY INFORMANT INTERVIEWS AND A VARIETY OF DATA SOURCES. MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH MINISTRY OUR LADY OF VICTORY HOSPITAL IN STANLEY, WISCONSIN. MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED IN JOINT EFFORT WITH THE CLARK COUNTY HEALTH DEPARTMENT, ASCENSION HEALTH SYSTEM, AND THE DEPARTMENT OF HUMAN DEVELOPMENT AND RELATIONS, UNIVERSITY OF WISCONSIN-EXTENSION. MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 7D: HTTP://MEMORIALMEDCENTER.ORG/WP-CONTENT/UPLOADS/2016/06/MMC-N-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-FINAL-SEPTEMBER-2019.PDF MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: TO HELP ADDRESS THE THREE KEY AREAS OF NEED IDENTIFIED WORK IS BEING DONE TO SUPPORT IMPLEMENTATION OF AN ALCOHOL AND OTHER DRUG ABUSE PREVENTION CURRICULUM, CREATE AWARENESS OF ELECTRONIC NICOTINE DELIVERY SYSTEMS, WORK WITH AODA PREVENTION COMMUNITY GROUP, PROVIDE MENTAL HEALTH AND SUICIDE PREVENTION TRAININGS, DEVELOP AODA AND MENTAL HEALTH RESOURCES, ENGAGE IN COMMUNITY MENTAL HEALTH GROUPS, IMPROVE ACCESS TO HEALTHY NUTRITION, PROMOTE BREASTFEEDING, PROMOTE PHYSICAL ACTIVITY, AND ENGAGEMENT IN CHRONIC DISEASE MANAGEMENT. PART V, LINE 10A HTTP://MEMORIALMEDCENTER.ORSEG/WP-CONTENT/UPLOADS/2016/07/MMC-N-IMPLEMENTATION-STRATEGY-FINAL-SEPTEMBER-2019.PDF PART V, LINE 16A HTTP://MEMORIALMEDCENTER.ORG/WP-CONTENT/UPLOADS/2016/07/MCHSFINANCIAL-ASSISTANCE-POLICY062119.PDF PART V, LINE 16B HTTP://MEMORIALMEDCENTER.ORG/WP-CONTENT/UPLOADS/2016/07/MCHSFINANCIAL-ASSISTANCE-APPLICATION_ENGLISH.PDF PART V, LINE 16C HTTP://MEMORIALMEDCENTER.ORG/WP-CONTENT/UPLOADS/2016/07/PLAIN-LANGUAGE-SUMMAR_ENGLISH.PDF 3 1 - MEMORIAL MEDICAL CENTER 216 SUNSET PLACE NEILLSVILLE WI 54456 PROVIDER-BASED RURAL HEALTH CLINIC 2 - GREENWOOD FAMILY MEDICAL CENTER 201 SOUTH MAIN GREENWOOD WI 54437 PROVIDER-BASED RURAL HEALTH CLINIC 3 - SUNSET GARDENS 216 SUNSET PLACE NEILLSVILLE WI 54456 ASSISTED LIVING FACILITY PART I, LINE 6A: MEMORIAL HOSPITAL, 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 THE WHA'S WEBSITE. PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBT, 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 7G: THE COST OF SUBSIDIZED HEALTH SERVICES IS BASED ON COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDE THE OPERATION OF TWO FAMILY PRACTICE CLINICS, HOSPITAL INPATIENT UNIT, AND EMERGENCY ROOM. IT IS THE GOAL OF MEMORIAL HOSPITAL, INC. TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.SUBSIDIZED HEALTH SERVICES INCLUDES INPATIENT & OBSERVATION SERVICES, RURAL HEALTH CLINIC SERVICES, AND EMERGENCY SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY THAT THE HOSPITAL SERVES. THROUGH COLLABORATION WITH LOCAL ORGANIZATIONS, THE HOSPITAL PROVIDES INFORMATION TO THE COMMUNITY REGARDING VARIOUS ISSUES THAT AFFECT HEALTH SUCH AS BABYSITTING CLASSES, SERVING ON PUBLIC HEALTH BOARDS, WORKING WITH DISASTER PREPAREDNESS, CPR CLASSES, DIABETIC SUPPORT GROUPS, PRESCRIPTION ASSISTANCE, STRESS MANAGEMENT, PREVENTATIVE SERVICES, AND OTHERS. 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 DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE CONSOLIDATED 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 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 RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS DO NOT COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE HOSPITAL 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 ARE REDUCED FOR EXPLICIT PRICE CONCESSIONS AND BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS AN IMPLICIT PRICE CONCESSION. IN EVALUATING THE COLLECTABILITY OF PATIENTS' ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND CONTRACTUAL TERMS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE. FOR RECEIVABLES ASSOCIATED WITH PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ADDITIONAL IMPLICIT DISCOUNT, IF NECESSARY (I.E., FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND CO-PAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS 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 CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS AN IMPLICIT DISCOUNT 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 FINANCIAL RESPONSIBLE. 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. PART III, LINE 8: MEMORIAL HOSPITAL, INC. IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. BASED ON THE INSTRUCTIONS, THE TOTAL MEDICARE REVENUE SHOWN ON THIS FORM 990 INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE THAT IS ACTUALLY RECEIVED BY THE HOSPITAL FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE DO NOT INCLUDE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT OR ANESTHESIA SERVICES AT THE HOSPITAL. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT METHODOLOGY AT RATES THAT ARE OFTEN BELOW THE COST OF PROVIDING CARE TO PATIENTS. EMERGENCY AND ANESTHESIA SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND THEREFORE THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF NEILLSVILLE, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN AND MID-LEVEL PRACTITIONER SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS FROM SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THE RECIPIENTS ARE TYPICALLY ELDERLY AND/OR DISABLED MEMBERS OF THE COMMUNITY AND 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: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WHICH SETS FORTH COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO BE ELIGIBLE OR PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. MULTIPLE MEASURES ARE TAKEN TO COMMUNICATE THE AVAILABILITY OF FINANCIAL ASSISTANCE AND DETERMINE WHETHER A PATIENT IS FINANCIAL ASSISTANCE ELIGIBLE BEFORE PERUSING EXTRAORDINARY COLLECTION ACTIONS (ECAS). ECAS MAY INCLUDE: REPORTING TO CONSUMER CREDIT REPORTING AGENCIES, PURSUING LEGAL JUDGEMENTS, FILING LIENS, GARNISHING WAGES, REQUIRING PREPAYMENT FOR NON-EMERGENCY SERVICES. ECAS WILL NOT BE INITIATED AND FURTHER ACTION WILL NOT BE TAKEN ON EXISTING ECAS ONCE A FINANCIAL ASSISTANCE APPLICATION IS IN PROCESS. IF THE PATIENT IS DETERMINED FINANCIAL ASSISTANCE ELIGIBLE, REASONABLE MEASURES WILL BE TAKEN TO REVERSE ANY ECA ALREADY IN PLACE. PART VI, LINE 2: OUTSIDE OF THE CHNA, THE HOSPITAL CONTINUES TO LOOK AT WAYS IT CAN EXPAND ACCESS TO AFFORDABLE, LOCAL HEALTH CARE AS WELL AS SUPPORT OTHER COMMUNITY ACTIVITIES RELATED TO THE WELLNESS OF CLARK COUNTY. IN 2019 AFTER JOINING MARSHFIELD CLINIC HEALTH SYSTEM THERE WAS A SIGNIFICANT REDUCTION IN CHARGES FOR LAB SERVICES AS WELL AS AN EXPANSION OF OUTREACH OF SPECIALTY PHYSICIANS COMING ONSITE TO PROVIDE SERVICES. A NEW ELECTRONIC HEALTH RECORD AND BILLING SOFTWARE WERE ALSO IMPLEMENTED IMPROVING RECORD ACCESS AND SHARED BILLING FOR PATIENTS NEEDING SPECIALTY CARE OUTSIDE OF NEILLSVILLE. PART VI, LINE 3: PATIENT ASSISTANCE CENTER COUNSELORS ASSIST INDIVIDUALS WITH IDENTIFYING, REFERRING AND/OR APPLYING FOR PUBLIC, PRIVATE OR CHARTABLE RESOURCES FOR WHICH THE PATIENT MAY QUALIFY. COUNSELORS ARE AVAILABLE VIA PHONE AND IN PERSON TO ASSIST INDIVIDUALS WITH FINANCIAL ASSISTANCE. INFORMATION TO THE MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) FINANCIAL ASSISTANCE POLICY IS POSTED IN HOSPITAL REGISTRATION AND ADMITTING LOCATIONS AND IN THE HOSPITAL EMERGENCY DEPARTMENT. FINANCIAL ASSISTANCE INFORMATION IS PRINTED ON MONTHLY BILLING STATEMENTS AND INCORPORATED INTO OTHER COMMUNICATIONS IN ORDER TO WIDELY PUBLICIZE THE AVAILABILITY OF FINANCIAL ASSISTANCE, AS DESCRIBED IN THE MCHS BILLING AND COLLECTION POLICY. THE MCHS FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY ARE AVAILABLE IN ENGLISH, SPANISH, HMONG AND ANY OTHER LANGUAGE THAT IS THE PRIMARY LANGUAGE SPOKEN BY THE LESSER OF 1,000 INDIVIDUALS OR 5% OF THE POPULATION OF THE SERVICE AREA. THE FINANCIAL ASSISTANCE POLICY (INCLUDING THE PLAIN LANGUAGE SUMMARY), THE FINANCIAL ASSISTANCE APPLICATION AND THE BILLING AND COLLECTION POLICY MAY BE OBTAINED FREE OF CHARGE: ON THE HOSPITAL WEBSITE, IN PERSON, FROM FINANCIAL COUNSELORS, BY PHONE AND BY MAIL. PART VI, LINE 4: THE HOSPITALS MAIN SERVICE AREA IS CLARK COUNTY WHICH HAS A POPULATION OF APPROXIMATELY 35,000. IT IS CONSIDERED BOTH A MEDICALLY UNDERSERVED AREA AND A RURAL COUNTY. CLARK COUNTY IS ALSO HOME TO A SUBSTANTIAL PLAIN POPULATION, WHICH INCLUDES THE AMISH AND MENNONITE COMMUNITIES, WHO MAKE UP ABOUT ONE-THIRD OF CLARK COUNTY'S POPULATION. APPROXIMATELY 45% OF NEW BIRTHS IN CLARK COUNTY ARE FROM THE PLAIN POPULATION. PART VI, LINE 5: OUR HOSPITAL PROVIDED FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. WE ALSO OFFER CRITICALLY IMPORTANT COMMUNITY BENEFITS WHICH ARE NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES; LAB, RADIOLOGY, EMERGENCY AND URGENT CARE, INFUSION SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SURGICAL AND WOMEN'S HEALTH SERVICES IN A COMMUNITY THAT LACKS ADEQUATE TRANSPORTATION TO TRAVEL TO ANOTHER COMMUNITY. PART VI, LINE 6: MARSHFIELD CLINIC WAS FOUNDED IN 1916 BY SIX PHYSICIANS PRACTICING IN MARSHFIELD, A RURAL CENTRAL WISCONSIN CITY. AT ITS INCEPTION, CLINIC FOUNDERS SAW RESEARCH AND EDUCATION AS CRITICAL TO THEIR PRACTICE OF HEALTH CARE AND THAT REMAINS SO TODAY.THE CLINIC BECAME A 501(C)(3) NONPROFIT ORGANIZATION IN 1992 AND IN 2014, MARSHFIELD CLINIC HEALTH SYSTEM, INC., WAS FORMED. THE HEALTH SYSTEM'S MISSION IS TO ENRICH LIVES AND CREATE HEALTHY COMMUNITIES THROUGH ACCESSIBLE, AFFORDABLE, COMPASSIONATE HEALTH CARE.THE HEALTH SYSTEM TODAY IS AN INTEGRATED SYSTEM SERVING WISCONSIN AND BEYOND, WITH MORE THAN 10,000 EMPLOYEES INCLUDING OVER 1,200 PROVIDERS IN 86 SPECIALTIES. ITS ENTITIES PROVIDE SERVICE AND HEALTH CARE TO MORE THAN TWO MILLION RESIDENTS THROUGH OVER 50 CLINICAL CARE CENTERS IN 34 WISCONSIN COMMUNITIES.UNIQUE TO MCHS IS ITS CENTER FOR COMMUNITY HEALTH ADVANCEMENT (CCHA), WHICH BUILD BRIDGES BETWEEN THE HEALTHCARE SYSTEM AND THE PLACES IN THE COMMUNITY WHERE PEOPLE LIVE, WORK AND PLAY. THE CCHA WORKS WITH COALITIONS, BUSINESSES, EDUCATIONAL SYSTEMS, LAW ENFORCEMENT AGENCIES, TRIBAL NATIONS, LOCAL GOVERNMENTS, AND OTHER HEALTHCARE PROVIDERS, NONPROFIT ORGANIZATIONS AND OTHER ENTITIES TO IMPROVE COMMUNITY HEALTH. MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) DEEPLY BELIEVES IN PROMOTING COMMUNITY HEALTH THROUGH BUILDING AND SUSTAINING STRONG INTERNAL AND EXTERNAL PARTNERSHIPS AND COLLABORATIONS. FOR THIS REASON, MCHS AND ITS AFFILIATED ENTITIES WORK TOGETHER INTERNALLY AND EXTERNALLY WITH COMMUNITY PARTNERS, STAKEHOLDERS AND RESIDENTS TO IMPROVE COMMUNITY HEALTH. PART VI, LINE 7, REPORTS FILED WITH STATES WI X 1 1 X X X X X 0 1 0 1 1 1 1 0 0 MARIA CRUZ-APOLINARIO MD PHYSICIAN 0 281873 0 376279 0 3621 0 2080 0 23324 0 687177 0 0 DAVID CARLSON MD PHYSICIAN 0 537273 0 0 0 0 0 2080 0 23129 0 562482 0 0 OSAMA ALSAIED MD PHYSICIAN 0 284893 0 72416 0 10652 0 2080 0 19172 0 389213 0 0 GARY ANDERSON MD PHYSICIAN 0 291129 0 29861 0 5390 0 2080 0 18340 0 346800 0 0 AMY SCHNEIDER DE CORTEZ PHYSICIAN 0 241610 0 19573 0 2028 0 2080 0 23159 0 288450 0 0 JERARD JENSEN MCHS GENERAL COUNSEL 0 763410 0 102974 0 5366 0 29241 0 36215 0 937206 0 0 GORDON EDWARDS MCHS CFO/COO 0 653789 0 82379 0 23000 0 29241 0 22312 0 810721 0 0 STEVEN KULICK CHIEF EXPERIENCE OFFICER 0 561606 0 19148 0 3972 0 2080 0 44820 0 631626 0 0 JEANNE SCINTO CHIEF TRANSFORMATION OFFICER 0 400002 0 0 0 2327 0 2080 0 30239 0 434648 0 0 RYAN NEVILLE CAO MMC-NEILLSVILLE 125720 127385 0 0 0 40254 0 800 4381 14159 130101 182598 0 0 KELLY SILBERNAGEL CFO MMC-NEILLSVILLE 66563 78973 0 0 0 18275 0 3053 5096 17910 71659 118211 0 0 RUWAN DISSANAYAKE MD BOARD MEMBER 0 359861 0 110079 0 2796 0 29241 0 38778 0 540755 0 0 NARAYANA MURALI MD BOARD MEMBER/MCHS CSO 0 759819 0 131250 0 32302 0 29241 0 40236 0 992848 0 0 SUSAN TURNEY MD BOARD MEMBER/MCHS CEO 0 1743990 0 350200 0 326839 0 270641 0 29515 0 2721185 0 0 PART I, LINE 1A THE ORGANIZATION MAY OCCASIONALLY REIMBURSE OR PROVIDE HOUSING ALLOWANCE FOR KEY EXECUTIVES IN ORDER TO ASSIST WITH RELOCATING TO THE AREA. THE ORGANIZATION MAY ALSO CONTRIBUTE TO OR REIMBURSE FOR WELLNESS AS DEEMED NECESSARY IN ORDER TO SUPPORT A BUSINESS NEED. PART I, LINE 4B MEMORIAL HOSPITAL, INC. OFFERS AN EXECUTIVE 457(F) RETIREMENT PLAN, ESTABLISHED IN 2006, IN WHICH THE EMPLOYER MAY MAKE DISCRETIONARY CREDITS TO THE DEFERRED COMPENSATION ACCOUNT OF THE PARTICIPANTS. THE AMOUNT CONTRIBUTED TO THE PARTICIPANTS IS DETERMINED ON AN ANNUAL BASIS BY THE EMPLOYER. THERE WERE NO PARTICIPANTS IN THE PLAN WHO RECEIVED DISTRIBUTIONS FROM THE 457(F) PLAN IN 2019. MEMORIAL HOSPITAL ALSO OFFERS A 457(B) RETIREMENT PLAN. DURING 2019, SUSAN TURNEY, MD CONTRIBUTED 241,400 TO THE PLAN. PART I, LINE 5 SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS PART I, LINE 6 SEVERAL INDIVIDUALS MAY RECEIVE INCENTIVE COMPENSATION BASED ON A VARIETY OF FACTORS, INCLUDING NOT ONLY FINANCIAL MEASURES SUCH AS REVENUE GROWTH OR EARNINGS, BUT ALSO QUALITY, SERVICE MARKET EXPANSION, COMMUNITY & EMPLOYEE ENGAGEMENT, AND OTHER OUTCOMES OR EXPECTATIONS SET BY THE BOARD AND/OR CEO. ANY PERFORMANCE BONUS IS SUBJECT TO REVIEW BY THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE FOR REASONABLENESS THOMAS SILBERNAGEL FAMILY MEMBER OF OFFICER, KELLY SILBERNAGEL 501431 OWNER OF COMPANY PROVIDING 24/7 CRNA COVERAGE 0 FORM 990, PART VI, SECTION A, LINE 6 MCHS HOSPITALS, INC. (A WISCONSIN NONSTOCK, NONPROFIT ORGANIZATION DESCRIBED IN CODE SECTION 501(C)(3)) IS THE SOLE MEMBER OF MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A MCHS HOSPITALS, INC. (AS THE SOLE MEMBER) HAS THE RESERVE POWER TO APPOINT OR REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO APPROVE ANY CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS OF MEMORIAL HOSPITAL, INC. MCHS HOSPITALS, INC. (THE SOLE MEMBER) HAS THE RIGHT TO INITIATE AND APPROVE LONG-TERM BORROWING AND OTHER FORMS OF LONG-TERM INDEBTEDNESS, INITIATE AND APPROVE THE PURCHASE, SALE OR ENCUMBRANCE OF REAL AND PERSONAL PROPERTY AND APPROVE OR DISAPPROVE ANNUAL OPERATING AND CAPITAL BUDGETS. MCHS HOSPITALS, INC. (THE SOLE MEMBER) ALSO HAS THE RIGHT TO INITIATE AND APPROVE ANY OF THE FOLLOWING ACTIONS: MERGER, CONSOLIDATION, AFFILIATION, OR JOINT VENTURE WITH ANY OTHER ENTITY OR ENTITIES; LIQUIDATION, REORGANIZATION, OR DISSOLUTION OF THE ORGANIZATION; FILING OF A VOLUNTARY PETITION IN BANKRUPTCY; ANY CHANGE IN CONTROL OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B MARSHFIELD CLINIC HEALTH SYSTEM, INC. ENGAGES A PUBLIC ACCOUNTING FIRM TO PREPARE AND REVIEW THE FORM 990 IN ADDITION TO REVIEW BY THE SYSTEM CFO, VP OF FINANCE AND CONTROLLER. PRIOR TO FILING THE FORM WITH THE IRS, THE CFO AND HIS/HER DESIGNEE WILL PROVIDE TO EACH MEMBER OF THE SYSTEM'S AUDIT AND COMPLIANCE COMMITTEE (A SUBCOMMITTEE OF THE BOARD OF DIRECTORS) A COPY IN ELECTRONIC OR PAPER FORM OF THE COMPLETED FORM 990 (AND ALL REQUIRED SCHEDULES) FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, BOARD DIRECTORS, AND KEY EMPLOYEES OF EVERY MARSHFIELD CLINIC HEALTH SYSTEM (MCHS) ENTITY, AS WELL AS ANY OTHER PERSON DESIGNATED BY THE AUDIT AND COMPLIANCE COMMITTEE (ACC) TO BE A REQUIRED REPORTER BY VIRTUE OF HIS OR HER POSITION AT A SYSTEM ENTITY, SHALL ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM. SUCH FORMS SHALL BE DISTRIBUTED AND RECORDED BY THE SYSTEM'S DESIGNATED COMPLIANCE OFFICER. ALL FINANCIAL INTERESTS DISCLOSED AS PART OF THE ANNUAL DISCLOSURE PROCESS SHALL BE REVIEWED BY THE ACC. THE ACC SHALL INFORM THE BOARD OF DISCLOSED FINANCIAL INTERESTS WHICH MAY BEAR UPON OR RELATE TO A TRANSACTION UPON WHICH THE BOARD OR ANOTHER BOARD, COMMITTEE OR OTHER BODY OF A SYSTEM ENTITY, MAY DELIBERATE OR ACT. IN ADDITION TO THE ANNUAL DISCLOSURES, IF AT ANY TIME BETWEEN ANNUAL DISCLOSURES, A REQUIRED REPORTER BECOMES AWARE THAT THE BOARD, OR A BOARD, COMMITTEE OR OTHER BODY, OF ANY SYSTEM ENTITY MAY DELIBERATE OR ACT UPON ANY TRANSACTION THAT MAY HAVE ANY BEARING OF ANY KIND UPON, OR MAY RELATE IN ANY MANNER TO, AN EXISTING, INTENDED OR EXPECTED FINANCIAL INTEREST OF THE REQUIRED REPORTER, HE OR SHE SHALL DISCLOSE THE FINANCIAL INTEREST TO THE RELEVANT SYSTEM ENTITY BOARD, COMMITTEE OR BODY CHAIR, AS WELL AS TO THE SYSTEM'S COMPLIANCE OFFICER, IN ADVANCE OF ANY DELIBERATIONS OR ACTION, WRITTEN DISCLOSURE OF THE EXISTENCE, NATURE AND EXTENT OF HIS OR HER FINANCIAL INTEREST. ALL WRITTEN OR ORAL DISCLOSURES OF FINANCIAL INTERESTS SHALL BE RECORDED IN THE MINUTES OF THE BOARD AND BY THE OFFICE OF THE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER SHALL DISCLOSE THE COMPLETED FORMS AS NECESSARY TO THE MCHS EMPLOYEES RESPONSIBLE FOR COMPLETION OF THE IRS FORM 990. FORM 990, PART VI, SECTION B, LINE 15 THE SYSTEM'S INDEPENDENT COMPENSATION COMMITTEE (COMPENSATION COMMITTEE) SHALL HAVE FINAL AUTHORITY FOR APPROVING COMPENSATION AND BENEFITS OF ALL DISQUALIFIED PERSON (AS THAT TERM IS DEFINED IN 4958 OF THE INTERNAL REVENUE CODE (THE CODE)) EMPLOYED BY THE CORPORATION, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S CEO. THE TERM DISQUALIFIED PERSONS INCLUDES (BUT IS NOT LIMITED TO) ANY PERSON (OR THE PERSON'S FAMILY MEMBER) WHO WAS, AT ANY TIME DURING THE 5-YEAR PERIOD ENDING ON THE DATE OF THE TRANSACTION, IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE ORGANIZATION. IT SHALL BE THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE TO ENSURE THAT THE SYSTEM DOES NOT PAY AN AMOUNT THAT EXCEEDS REASONABLE COMPENSATION FOR ANY DISQUALIFIED PERSON. THE COMPENSATION COMMITTEE AND ITS OPERATING PROCEDURES SHALL BE DESIGNED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS OF COMPENSATION OUTLINED IN TREASURY REG. SEC. 53.4958-6 WITH RESPECT TO EACH DISQUALIFIED PERSON. IN DETERMINING REASONABLENESS OF COMPENSATION, THE COMPENSATION COMMITTEE SHALL EVALUATE APPROPRIATE INFORMATION AS TO COMPARABILITY OF COMPENSATION, INCLUDING BUT NOT LIMITED TO: COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE SYSTEM'S GEOGRAPHIC AREA; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN JOB OFFERS FROM SIMILAR INSTITUTIONS. THE COMPENSATION COMMITTEE SHALL HAVE INDEPENDENT AUTHORITY TO OBTAIN OUTSIDE EXPERT OPINIONS ON THE REASONABLENESS AND FAIR MARKET VALUE OF COMPENSATION AND GATHER OTHER INFORMATION IT CONSIDERS NECESSARY OR APPROPRIATE TO MAKE ITS DECISIONS ON COMPENSATION. THE COMPENSATION COMMITTEE SHALL TIMELY DOCUMENT ITS DETERMINATION OF REASONABLENESS OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 MEMORIAL HOSPITAL, INC. DOES NOT MAKE ITS CURRENT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UNLESS INCLUDED AS PART OF A FORM THAT IS REQUIRED TO BE PUBLICLY AVAILABLE. FORM 990, PART VII, LINE 1A, EXPLANATION FOR HOURS WORKED: SOME OFFICERS AND BOARD MEMBERS ALSO PROVIDED SERVICE TO COUNTRY VIEW, INC., A RELATED ORGANIZATION. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. FORM 990, PART IX, LINE 11G CONTRACTED LABORATORY SERVICES: PROGRAM SERVICE EXPENSES 236,987. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 236,987. CONTRACTED ANESTHESIA SERVICES: PROGRAM SERVICE EXPENSES 541,033. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541,033. CONTRACTED RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 1,005,264. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,005,264. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,533,823. MANAGEMENT AND GENERAL EXPENSES 796,593. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,330,416. CONTRACTED PHYSICIANS: PROGRAM SERVICE EXPENSES 214,703. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 214,703. CONTRACTED NURSING SERVICES: PROGRAM SERVICE EXPENSES 436,678. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 436,678. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT AUDITOR AND MANAGEMENT OVERSEES THE AUDIT PROCESS. THIS PROCESS DID NOT CHANGE IN 2018. 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