2020-05-15T07:42:46-05:00 2019-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 558021926 990 2018-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 KENT DUMONSEAU CFO 7156855515 2020-05-07 1 JULIE BOYER P01278549 2187275025 2020-05-07 71.13.46.40 2020-05-07 10:19:46 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 930171E15D686EC555C78A932CEAB980F20E2170 2018 2020-11-19 02:30:22Z JASON DOUGLAS 1615 MAPLE LANE ASHLAND WI 54806 125125643 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 15 14 534 110 11393 3257 24874 22325 85837435 104528472 1416360 303918 23288 27714 87301957 104882429 132398 203975 0 0 37138602 44160057 0 0 0 41091817 52058555 78362817 96422587 8939140 8459842 148252124 156143535 25268239 23884940 122983885 132258595 X MEMORIAL MEDICAL CENTER WILL REACH OUT AS A TRUSTED PARTNER TO IMPROVE THE HEALTH AND WELLNESS FOR PEOPLE OF OUR SOUTH SHORE REGION OF LAKE SUPERIOR. 0 0 87040451 203975 104517079 MEMORIAL MEDICAL CENTER (MMC) IS A CRITICAL ACCESS HOSPITAL WITH OVER 60 FULL-TIME PHYSICIANS ON STAFF AND OVER 500 EMPLOYEES. LOCATED IN THE CITY OF ASHLAND, MMC SERVES AS A REGIONAL MEDICAL REFERRAL CENTER FOR PATIENTS FROM SEVEN NORTHWESTERN WISCONSIN COUNTIES AND THE NEIGHBORING GOGEBIC COUNTY OF MICHIGAN. MMC OFFERS INPATIENT AND OUTPATIENT SERVICES INCLUDING: MEDICAL-SURGICAL; INTENSIVE CARE; OBSTETRICS INCLUDING LABOR, DELIVERY, POSTPARTUM AND RECOVERY (LDPR) SUITES; BEHAVIORAL HEALTH; AND 24-HOUR EMERGENCY CARE. INPATIENT AND OUTPATIENT SURGERIES INCLUDE: ORTHOPEDIC, UROLOGY, OPHTHALMOLOGY, ENT AND OB/GYN IN ADDITION TO GENERAL SURGERY. SUPPORT DIAGNOSTIC SERVICES INCLUDE: LABORATORY; RADIOLOGY WITH MRI, CT AND DIAGNOSTIC ULTRASOUND; NUTRITIONAL SERVICES; PHARMACY; ENDOSCOPY SUITES AND A SLEEP DISORDER CENTER. REHABILITATION SERVICES INCLUDE: CARDIAC REHABILITATION AND CARDIOPULMONARY REHABILITATION; PHYSICAL THERAPY AND SPORTS MEDICINE. LIFELINE EMERGENCY RESPONSE SYSTEM, HOSPICE SERVICES AND SOCIAL SERVICES ARE ALSO AVAILABLE WITHIN MMC. AN ADDITIONAL BUILDING ON THE MMC CAMPUS HOUSES THE BEHAVIORAL HEALTH SERVICES PROVIDING INPATIENT AND OUTPATIENT AODA AND MENTAL HEALTH CARE AND THERAPIES. MMC OPENED AS A PRIVATE, NOT-FOR-PROFIT HOSPITAL IN 1972, COMBINING THE SERVICES PREVIOUSLY PROVIDED BY TRINITY HOSPITAL AND ASHLAND COMMUNITY HOSPITAL, BOTH LOCATED IN ASHLAND. MMC IS THE ONLY HOSPITAL LOCATED IN ASHLAND, BAYFIELD AND IRON COUNTIES. 87040451 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 76 0 1 534 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ART MERTIG 7156855500 1615 MAPLE LANE ASHLAND WI 54806 ANNE SULLIVAN BOARD MEMBER 1.00 2.00 X 0 0 0 CHRISTINE IVERSON VICE CHAIR 1.00 1.00 X X 0 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 37.00 3.00 X X 423031 0 47269 JEFFREY LEWIS MEDICAL STAFF PRESIDENT 1.00 X X 0 0 0 JOHN OUJIRI MD BOARD MEMBER 1.00 X 0 0 0 JOHN SMYLIE SECRETARY 1.00 X X 0 0 0 MATTHEW ANICH BOARD MEMBER 1.00 2.00 X 0 0 0 PATRICIA SCHRAUFNAGEL CHAIR 1.00 1.00 X X 0 0 0 PEGGY VAN HOLLEN-KMAN BOARD MEMBER 1.00 X 0 0 0 RICHARD SETZKE BOARD MEMBER 1.00 X 0 0 0 SCOTT WARREN MD BOARD MEMBER 1.00 1.00 X 0 0 0 T JAY JONES BOARD MEMBER 1.00 X 0 0 0 THOMAS CUNNINGHAM MD BOARD MEMBER 1.00 X 300 0 0 THOMAS JOKINEN TREASURER 1.00 X X 0 0 0 TYLER WICKMAN BOARD MEMBER 1.00 X 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER 39.00 1.00 X 241576 0 34756 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 24.00 16.00 X 0 261427 40438 JOHN WHITE PHYSICIAN 40.00 X 423096 0 38491 JUSTIN CUMMINS PHYSICIAN 36.00 X 392382 0 12023 KEVIN MCCLELLAND PHYSICIAN 40.00 X 321091 0 26358 NICHOLAS MILLER PHYSICIAN 40.00 X 510219 0 35964 TERRENCE TUOMINEN PHYSICIAN 40.00 X 393298 0 42711 2704993 261427 278010 38 0 1 0 REGIONAL ENTERPRISES 1615 MAPLE LANE ASHLAND WI 54806 IS/ACCTNG/COMPLIANCE 3736983 ESSENTIA HEALTH 532 EAST 1ST ST DULUTH MN 55805 CALL COVERAGE/ PRO-FEES/ SERVICE AGREEME 3119892 KBK SERVICES PO BOX 546 ASHLAND WI 54806 CONSTRUCTION COMPANY 1610721 TAMARACK 1615 MAPLE LANE ASHLAND WI 54806 ER PRO-FEES 891239 MARKET & JOHNSON 2350 GALLOWAY ST EAU CLAIRE WI 54703 CONSTRUCTION COMPANY 814229 44 17950 4375 22325 PATIENT SERVICE REVENUE 621500 104139443 104128050 11393 CAFETERIA 722210 260487 260487 OTHER OPERATING REVENUE 900099 91397 91397 MISC EMERGENCY ROOM REVENUE 621500 37145 37145 104528472 872973 872973 717156 689442 27714 27714 27714 18978717 6000 19535117 18655 -556400 -12655 -569055 -569055 104882429 104517079 11393 331632 X 177975 177975 26000 26000 780599 808 779791 33213242 31306316 1906926 1139732 1072649 67083 6826246 6360347 465899 2200238 2031670 168568 331404 331404 438319 438319 7992 7992 12260810 11931666 329144 473491 473491 2030286 1621340 408946 1796760 1796760 1131667 984550 147117 390618 280086 110532 191983 167025 24958 6500368 5716595 783773 253078 11449 241629 DRUGS 9425416 9425416 MEDICAL SUPPLIES 6756291 6753492 2799 BAD DEBT EXPENSE 4260053 4260053 REPAIRS & MAINTENANCE 2204590 2159882 44708 3605429 956372 2649057 96422587 87040451 9382136 0 32063884 34374383 13850200 13670756 76083 231922 1278256 644197 2927499 2986896 1478417 1474244 97017228 44956973 49409128 52060255 46179074 49926564 989583 774318 148252124 156143535 8861618 9149553 9691053 7597450 6715568 7137937 25268239 23884940 X 122983885 132258595 122983885 132258595 148252124 156143535 8459842 814868 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7992 7992 0 PART II-B, LINE 1: MEMORIAL MEDICAL CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 426641 426641 36111656 17285423 18826233 53405592 25650498 27755094 7073339 2021052 5052287 52060255 COLLABORATIVE AGREEMENT 7137937 7137937 X 102139341 814868 -4260053 -3445185 105584526 -702097 -702097 104882429 92864631 702097 702097 92162534 4260053 4260053 96422587 PART X, LINE 2: NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE HOSPITAL HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2016. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES -4,260,053. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES -689,442. LOSS ON DISPOSAL OF PROPERTY -12,655. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY 12,655. RECLASSIFICATION OF RENTAL EXPENSES 689,442. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 4,260,053. 1 1 X 1 X 1 X 1 1 1 0 1 1 845940 845940 0.00920 17987727 13628644 4359083 0.04730 18833667 13628644 5205023 0.05650 25195 25195 0.00030 10158304 6802585 3355719 0.03640 276970 276970 0.00300 10460469 6802585 3657884 0.03970 29294136 20431229 8862907 0.09620 1 4260053 31058292 31882434 -824142 X 1 1 1 1 MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 WWW.ASHLANDMMC.COM 1065 X X X X MEMORIAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X 1 18 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 5: THE PLAN WAS DEVELOPED BY A COMMUNITY HEALTH IMPROVEMENT COMMITTEE THAT CONSISTED OF THE HEALTH OFFICER FROM ASHLAND COUNTY HEALTH AND HUMAN SERVICES (CYNDI ZACH), THE HEALTH OFFICER FROM THE IRON COUNTY HEALTH DEPARTMENT (KATIE HAMPSTON), THE HEALTH OFFICER FROM THE BAYFIELD COUNTY HEALTH DEPARTMENT (SARA WARTMAN), A CHIP WRITER FROM THE AREA HEALTH EDUCATION CENTERS WITH ASHLAND COUNTY HEALTH AND HUMAN SERVICES (LAUREN MCKAY), THE DIRECTOR OF BEHAVIORAL HEALTH AT MEMORIAL MEDICAL CENTER (TOM JENSEN), MARKETING SPECIALIST AT MEMORIAL MEDICAL CENTER (BETH PROBST) AND THE DIRECTOR OF STRATEGY AND PATIENT EXPERIENCE AT MEMORIAL MEDICAL CENTER (KEVIN STRANBERG). MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 6B: ORGANIZATIONS INVOLVED INCLUDED MEMORIAL MEDICAL CENTER, ASHLAND COUNTY HEALTH AND HUMAN SERVICES, THE BAYFIELD COUNTY HEALTH DEPARTMENT, AND THE IRON COUNTY HEALTH DEPARTMENT. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 7D: PAPER COPIES ARE AVAILABLE AT THE ASHLAND COUNTY HUMAN SERVICES & HEALTH DEPARTMENT, BAYFIELD COUNTY HEALTH DEPARTMENT AND IRON COUNTY HEALTH DEPARTMENT. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 11: DURING THE PLANNING PROCESS FOR COMMUNITY IMPROVEMENT FOR THE 2015-2017 CHNA, THE TOP THREE PRIORITIES IDENTIFIED WERE: ALCOHOL AND OTHER DRUG USE, MENTAL HEALTH, AND CHRONIC DISEASE, WHILE DETERMINING THAT ALCOHOL AND OTHER DRUG USE WAS TO BE THE TOP PRIORITY OF INTEREST TO ASHLAND AND BAYFIELD COUNTIES. THE FIRST GOAL FOCUSED ON RESEARCHING OPPORTUNITIES TO IMPROVE THE RECOVERY CAPACITY OF ASHLAND AND BAYFIELD COUNTY RESIDENTS ADDICTED TO METHAMPHETAMINE, AND ACHIEVE A SUSTAINABLE, SYSTEMS LEVEL, LOCAL RESPONSE. THE CHIP COALITION WORKED CLOSELY WITH THE CHEQUAMEGON COALITION ON EMERGING DRUGS. THROUGH A FIVE-YEAR, $25,000 PER YEAR GRANT, DRUG RECOGNITION EXPERT (DRE) TRAINING WAS PROVIDED FOR THE ASHLAND POLICE DEPARTMENT AND FINANCIAL SUPPORT FOR CHASE THE K9 DOG. COMMUNITY SHARPS DROP BOX LOCATIONS WERE ADDED THROUGHOUT ASHLAND AND BAYFIELD COUNTIES AND NEW PRESCRIPTION DROP BOX LOCATIONS IN MELLEN AND LA POINTE TO SAFELY ADDRESS DRUG USAGE. MEMORIAL MEDICAL CENTER (MMC) PURCHASED A "HIDDEN IN PLAIN SIGHT" ROOM TO EDUCATE PROVIDERS, PARENTS, COMMUNITY, AND BUSINESS LEADERS ABOUT THE SIGNS OF SOMEONE USING. MMC ALSO INITIATED THE CHILDREN'S DAY TREATMENT PROGRAM WHICH SERVES CHILDREN IN GRADES 1-5 IN AREA SCHOOL DISTRICTS WITH MENTAL HEALTH ISSUES AND ADDRESSES THE WIDESPREAD IMPACT DRUG USAGE CAN HAVE ON THE COMMUNITY.THE SECOND GOAL WAS TO IMPLEMENT STRATEGIES THAT WOULD REDUCE ACCESS TO ALCOHOL FOR INDIVIDUALS UNDER AGE 21 IN ASHLAND AND BAYFIELD COUNTIES. BOTH COUNTIES COLLABORATED THROUGH A 5-YEAR, $500,000, ADOLESCENT HEALTH GRANT. LEAD AND SEED TRAINING WAS IMPLEMENTED IN BAYFIELD COUNTY TO CULTIVATE LEADERSHIP AND IMPROVED DECISION-MAKING SKILLS IN YOUTH. SOURCES OF STRENGTH IS A PROGRAM THAT USES TRAUMA INFORMED, UPSTREAM PREVENTION TO EMPOWER YOUTH. THE PROGRAM IS IN USE AT ASHLAND SCHOOL DISTRICT, CHEQUAMEGON SCHOOL DISTRICT IN GLIDDEN, AND WASHBURN SCHOOLS. YOUTH ADVISORY GROUPS WERE FORMED WITH THE WELLNESS FOR LIFE COALITION TO ADDRESS ADOLESCENT HEALTH CONCERNS IN TWO ASHLAND COUNTY SCHOOLS AND THREE BAYFIELD COUNTY SCHOOLS. BEHAVIORAL HEALTH SERVICES NURSING AT MMC IS WORKING TO SCREEN ALL UNDERAGE PATIENTS FOR ALCOHOL USE AND TO REFER COUNSELING SERVICES AND RESOURCES UPON DISCHARGE.THE THIRD GOAL WAS TO ADVOCATE FOR POLICY CHANGE AND PROVIDE EDUCATION TO DECREASE ALCOHOL AND OTHER DRUG USE IN ASHLAND AND BAYFIELD COUNTIES. THIS IS SUPPORTED BY A 2-YEAR, $50,000 COMMUNITY OPPORTUNITY GRANT. FACT SHEETS ON ALCOHOL USE STATISTICS, COST, AND IMPACTS FOR ASHLAND AND BAYFIELD COUNTIES AND GUIDING MATERIALS WERE SHARED WITH LOCAL GOVERNING BOARDS TO ENCOURAGE BEST PRACTICES OF SERVING ALCOHOL AT COMMUNITY FESTIVALS. THE FACT SHEETS PROVIDE EVIDENCE-BASED RECOMMENDATIONS FOR FESTIVAL LICENSING, SERVER TRAINING, AND PLACE OF LAST DRINK. THE GOAL IS TO BRING THESE MATERIALS TO LOCAL GOVERNMENT, SUCH AS TOWN AND COUNTY BOARD MEETINGS, FOR FUTURE COMMUNITY FESTIVAL PLANNING.OTHER ACCOMPLISHMENTS INCLUDED A REGIONAL AODA MEETING, THE WORK OF VOICES FOR RECOVERY, AND CONTINUED EDUCATION PROVIDED TO THE COMMUNITIES OF ASHLAND AND BAYFIELD BY THE BAY AREA EDUCATION COALITION. ADDITIONALLY, MMC INTRODUCED A PUBLIC AWARENESS CAMPAIGN CENTERED ON AODA AND MENTAL HEALTH IN WINTER 2017.ON THE 2018-2020 CHNA, THE FOLLOWING GOALS WERE SET:OVERALL OBJECTIVE: BUILDING RESILIENCE BY CREATING PROTECTIVE FACTORS THROUGHOUT THE THREE-COUNTY REGION FOR HEALTHIER COMMUNITIES.GOAL 1: INCREASE AWARENESS OF TRAUMA-INFORMED CARE AMONG COMMUNITY MEMBERS. BUILDING ON NEW HORIZONS NORTH'S ZERO SUICIDE GRANT, TRAUMA-INFORMED CARE TRAINING WILL BE PROVIDED TO CENTRAL LOCATIONS IN ALL THREE COUNTIES. TRAINING WILL GROW TO INCLUDE SCHOOL DISTRICTS AND SERVICE PROVIDERS THROUGHOUT 2019.TO PROMOTE TRAUMA-INFORMED CARE AND INCREASE COMMUNITY AWARENESS OF THE IMPACT OF TRAUMA, A MEDIA CAMPAIGN ON TRAUMA-INFORMED CARE WILL BE IMPLEMENTED IN THE THREE COUNTIES. INFORMATION WILL BE DISTRIBUTED THROUGH FACEBOOK PAGES OF LOCAL HEALTH DEPARTMENTS AND MEMORIAL MEDICAL CENTER. PRINTED MEDIA WILL BE DISTRIBUTED IN EARLY 2019 TO INCREASE THE GENERAL PUBLIC'S AWARENESS.DURING THE 2018 TAX YEAR, THE FOLLOWING ACTIVITES WERE CONDUCTED:- THERE WAS A "BRIGHT FUTURES" GRANT RECEIVED BY ASHLAND SCHOOL DISTRICT. - THERE WAS A TRAINING ON COLUMBIA SCREENING TOOL FOR OUR ZERO SUICIDE PROGRAMMING AND WHAT WILL BE DONE IF A PERSON FLAGS AS HIGH RISK FOR SUICIDE.GOAL 2: INCREASE RESILIENCE AMONG ADOLESCENTS.THE ASHLAND - BAYFIELD COUNTY ADOLESCENT HEALTH PROGRAM HAS INITIATED THE SOURCES OF STRENGTH RESILIENCE-BUILDING PROGRAM IN SEVERAL SCHOOL DISTRICTS IN THE COUNTIES AND ESTABLISHED LOCAL TRAINERS FOR THE PROGRAM. THE CHIP STEERING COMMITTEE WILL WORK WITH TRAINERS TO IMPLEMENT ADDITIONAL RESILIENCE PROGRAMMING IN MOST SCHOOL DISTRICTS THROUGHOUT THE THREE-COUNTY REGION IN 2019 AND 2020. IMPLEMENTATION OF RESILIENCE SKILLS AND AODA PREVENTION CAMPAIGN WILL OCCUR VIA PRINT AND SOCIAL MEDIA IN LATE 2019.DURING THE 2018 TAX YEAR, THERE WAS "SOURCE OF STRENGTH AND RESILIENCY" TRAINING IN AREA SCHOOLS. GOAL 3: ADVOCATE AND EDUCATE FOR POLICY CHANGE TO DECREASE AODA ABUSE IN ASHLAND AND BAYFIELD COUNTIES.THE THREE LOCAL HEALTH DEPARTMENTS WILL WORK WITH THE WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION AND LOCAL SCHOOL DISTRICTS TO CREATE A THREE-COUNTY REGIONAL COLLECTION SITE FOR YOUTH RISK BEHAVIOR SURVEY (YRBS) DATA IN 2019. REGIONAL COLLECTION SITES WILL PROVIDE ANONYMITY TO SCHOOLS PARTICIPATING IN THE SURVEY. AS COLLECTION SITES OF REGIONAL-LEVEL STATISTICS, THE LOCAL HEALTH DEPARTMENTS WILL EFFECTIVELY USE THIS DATA TO INCREASE FUNDING FOR PREVENTION PROJECTS AND DEMONSTRATE NEED AND/OR IMPROVEMENTS. THE CHIP STEERING COMMITTEE WILL ASSIST BY WORKING WITH LOCAL NORTHWOODS COALITIONS TO ADVOCATE FOR SCHOOLS TO PARTICIPATE IN THE YRBS. THIS WILL BE THROUGHOUT THE CHIP TIMELINE.FURTHER EFFORTS TO ENHANCE PROTECTIVE FACTORS AMONG YOUTH WILL INCLUDE THE CREATION OF A ONE-PAGE EDUCATIONAL FACT SHEET THAT PROVIDES DATA-SUPPORTED INFORMATION ABOUT JUULING/VAPING AND MARIJUANA RISKS TO COMMUNITY MEMBERS AND LEADERS IN 2019.DURING THE 2018 TAX YEAR, "JUST THE FACTS" PROGRAM WAS BROUGHT TO OUR COMMUNITY BY THE CHIP STEERING COMMITTEE. IT PROVIDED INFORMATION ABOUT VAPING AND MARIJUANA AND TEENAGERS. THERE WAS A HANDOUT WITH INFORMATION ABOUT VAPING AND MARIJUANA IN ADDITION TO A SOCIAL MEDIA CAMPAIGN. THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE IDENTIFIED SEVERAL OTHER HEALTH CONCERNS PREVALENT IN OUR COMMUNITIES WHICH INCLUDED, BUT WERE NOT LIMITED TO: NUTRITION AND HEALTHY FOODS, PHYSICAL ACTIVITY, INJURY AND VIOLENCE PREVENTION, HEALTHY GROWTH AND DEVELOPMENT, TOBACCO USE AND EXPOSURE, COMMUNICABLE DISEASES, ETC. STAKEHOLDERS WERE ASKED TO RANK THESE HEALTH CONCERNS BY PRIORITY, AND WHILE ALL ARE IMPORTANT AND DEMAND TO BE ACKNOWLEDGED, THE COMMITTEE DECIDED TO USE AVAILABLE RESOURCES IN THE MOST EFFICIENT WAY POSSIBLE. THIS MEANT PRIORITIZING THREE ISSUES FOR THE GREATEST IMPACT, RATHER THAN TRYING TO DO A LITTLE IN EACH AREA. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: HTTP://ASHLANDMMC.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 7B, CHNA REPORT - OTHER WEBSITE: HTTPS://CO.ASHLAND.WI.US/INDEX.ASP?SEC=B77F5C3A-9D66-4656-B09F-63B28DF12119&DE=DEBD1C96-ADCF-4ECC-ABF2-234591ABB8E9 PART V, LINE 10A, IMPLEMENTATION PLAN WEBSITE: HTTP://ASHLANDMMC.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 16A, FAP WEBSITE: HTTPS://ASHLANDMMC.COM/WP-LIB/WP-CONTENT/UPLOADS/2020/02/MMC-FINANCIAL-ASSISTANCE-POLICY-UPDATED-2.27.20.PDF PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://ASHLANDMMC.COM/WP-LIB/WP-CONTENT/UPLOADS/2020/02/MMC-FINANCIAL-ASSISTANCE-APPLICATION-2.28.2020.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://ASHLANDMMC.COM/WP-LIB/WP-CONTENT/UPLOADS/2020/02/2020-MMC-FAP-PLAIN-LANGUAGE-SUMMARY-FANCY.PDF PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2019 MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE CARDIAC REHABILITATION, PHYSICAL THERAPY, PSYCHIATRIC/PSYCHOLOGICAL SERVICES AND BEHAVIORAL HEALTH INPATIENT, AND OBSERVATION BEDS. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $4,260,053. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS 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 INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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. 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 UNCOLLECTIBLE ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF SELF-PAY AND OTHER RECEIVABLES HAS INCREASED FROM 53.2% FOR THE YEAR ENDED SEPTEMBER 30, 2018, TO 56.8% FOR THE YEAR ENDED SEPTEMBER 30, 2019. PART III, LINE 3: AT MEMORIAL MEDICAL CENTER, INC. BAD DEBT IS CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY. PART III, LINE 4: SEE FOOTNOTE 1 ON PAGE 7 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6:THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. PART III, LINE 9B: MEMORIAL MEDICAL CENTER'S BILLING AND COLLECTION POLICY STATES:A. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, MMC MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS (ECAS), TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.B. ALL PATIENTS WILL BE OFFERED A PLAIN LANGUAGE SUMMARY (APPENDIX A) AND AN APPLICATION FORM (APPENDIX B) FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) AS PART OF THE DISCHARGE OR INTAKE PROCESS FROM A HOSPITAL.C. AT LEAST THREE SEPARATE STATEMENTS FOR COLLECTION OF SELF-PAY ACCOUNTS SHALL BE MAILED OR EMAILED TO THE LAST KNOWN ADDRESS OF EACH RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT NO ADDITIONAL STATEMENTS NEED BE SENT AFTER A RESPONSIBLE INDIVIDUAL(S) SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP OR HAS PAID IN-FULL. AT LEAST 60 DAYS SHALL HAVE ELAPSED BETWEEN THE FIRST AND LAST OF THE REQUIRED THREE MAILINGS. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS, THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE. ALL SINGLE PATIENT ACCOUNT STATEMENTS OF SELF-PAY ACCOUNTS WILL INCLUDE BUT NOT LIMITED TO:1. AN ACCURATE SUMMARY OF THE HOSPITAL SERVICES COVERED BY THE STATEMENT;2. THE CHARGES FOR SUCH SERVICES;3. THE AMOUNT REQUIRED TO BE PAID BY THE RESPONSIBLE INDIVIDUAL(S) (OR, IF SUCH AMOUNT IS NOT KNOWN, A GOOD FAITH ESTIMATE OF SUCH AMOUNT AS OF THE DATE OF THE INITIAL STATEMENT); AND4. A CONSPICUOUS WRITTEN NOTICE THAT NOTIFIES AND INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE HOSPITAL FAP INCLUDING THE TELEPHONE NUMBER OF THE DEPARTMENT AND DIRECT WEBSITE ADDRESS WHERE COPIES OF DOCUMENTS MAY BE OBTAINED.D. AT LEAST ONE OF THE STATEMENTS MAILED OR EMAILED WILL INCLUDE WRITTEN NOTICE THAT INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE ECAS THAT ARE INTENDED TO BE TAKEN IF THE RESPONSIBLE INDIVIDUAL(S) DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP OR PAY THE AMOUNT DUE BY THE BILLING DEADLINE. SUCH STATEMENT MUST BE PROVIDED TO THE RESPONSIBLE INDIVIDUAL(S) AT LEAST 30 DAYS BEFORE THE DEADLINE SPECIFIED IN THE STATEMENT. A PLAIN LANGUAGE SUMMARY WILL ACCOMPANY THIS STATEMENT. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS, THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE.E. RESPONSIBLE INDIVIDUAL(S) PROPENSITY TO PAY WILL BE SCORED BASED ON THAT ASSESSMENT OF THE RESPONSIBLE INDIVIDUAL(S) LIKELIHOOD TO PAY AND DOLLAR AMOUNT OF THE SELF-PAY ACCOUNT.F. MMC OFFERS PAYMENT PLANS THAT BEAR NO INTEREST. GENERALLY, BALANCE REQUIRE A MINIMUM PAYMENT OF $25.00 PER MONTH AND MUST BE PAID IN FULL WITHIN 24 MONTHS.G. PRIOR TO INITIATION OF ANY ECAS, AN ORAL ATTEMPT WILL BE MADE TO CONTACT RESPONSIBLE INDIVIDUAL(S) BY TELEPHONE AT THE LAST KNOWN TELEPHONE NUMBER, IF ANY, AT LEAST ONCE DURING THE SERIES OF MAILED OR EMAILED STATEMENTS IF THE ACCOUNT REMAINS UNPAID. DURING ALL CONVERSATIONS, THE PATIENT OR RESPONSIBLE INDIVIDUAL(S) WILL BE INFORMED ABOUT THE FINANCIAL ASSISTANCE THAT MAY BE AVAILABLE UNDER THE FAP.H. ECAS MAY BE COMMENCED AS FOLLOWS:1. IF ANY RESPONSIBLE INDIVIDUAL(S) FAIL TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP BY 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT, AND THE RESPONSIBLE PARTIES HAVE RECEIVED A STATEMENT WITH A BILLING DEADLINE DESCRIBED IN SECTION III.E ABOVE, THEN MMC OR COLLECTION AGENCY MAY INITIATE ECAS.2. IF ANY RESPONSIBLE INDIVIDUAL(S) SUBMITS AN INCOMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP PRIOR TO THE APPLICATION DEADLINE, THEN ECAS MAY NOT BE INITIATED UNTIL AFTER EACH OF THE FOLLOWING STEPS HAS BEEN COMPLETED:A. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION OR DOCUMENTATION REQUIRED UNDER THE FAP IN ORDER TO COMPLETE THE APPLICATION FOR FINANCIAL ASSISTANCE, WHICH NOTICE WILL INCLUDE A COPY OF THE PLAIN LANGUAGE SUMMARY.B. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH AT LEAST 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT MMC OR COLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S) IF THE FAP APPLICATION IS NOT COMPLETED OR PAYMENT IS NOT MADE; PROVIDED, HOWEVER, THAT THE COMPLETION DEADLINE FOR PAYMENT MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.C. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION COMPLETES THE APPLICATION FOR FINANCIAL ASSISTANCE, AND PFS DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUAL(S) IS INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE FAP, MMC WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL AND INCLUDE A 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT MMC OR COLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT THE BILLING DEADLINE MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.D. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION FAILS TO COMPLETE THE APPLICATION BY THE COMPLETION DEADLINE SET IN THE NOTICE PROVIDED PURSUANT TO SECTION III.G.3.B ABOVE, THEN ECAS MAY BE INITIATED.E. IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLE INDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, MMC WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING.I. AFTER THE COMMENCEMENT OF ECAS IS PERMITTED UNDER SECTION III.G ABOVE, COLLECTION AGENCIES SHALL BE AUTHORIZED TO REPORT UNPAID ACCOUNTS TO CREDIT AGENCIES, AND TO FILE JUDICIAL OR LEGAL ACTION, GARNISHMENT, OBTAIN JUDGMENT LIENS AND EXECUTE UPON SUCH JUDGMENT LIENS USING LAWFUL MEANS OF COLLECTION; PROVIDED, HOWEVER, THAT PRIOR APPROVAL OF PFS SHALL BE REQUIRED BEFORE INITIAL LAWSUITS MAY BE INITIATED. MMC AND EXTERNAL COLLECTION AGENCIES MAY ALSO TAKE ANY AND ALL LEGAL OTHER ACTIONS INCLUDING BUT NOT LIMITED TO TELEPHONE CALLS, EMAILS, TEXTS, MAILING NOTICES, AND SKIP TRACING TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.IV. POLICY AVAILABILITYCONTACT OUR BUSINESS OFFICE AT 715-685-5500 FOR INFORMATION REGARDING ELIGIBILITY OR THE PROGRAMS THAT MAY BE AVAILABLE TO YOU, TO REQUEST A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TO BE MAILED TO YOU, OR IF YOU NEED A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TRANSLATED TO SPANISH. FULL DISCLOSURE OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY MAY BE FOUND AT WWW.ASHLANDMMC.COM. A PAPER COPY OF OUR FAP, FAP APPLICATION FORM, OR COLLECTION POLICY CAN BE OBTAINED AT OUR FACILITY LOCATED AT 1615 MAPLE LANE, ASHLAND, WI 54806 AT THE REGISTRATION DESK. PART VI, LINE 2: NEEDS ASSESSMENT:MEMORIAL MEDICAL CENTER WORKED WITH A MULTIDISCIPLINARY GROUP OF AREA HEALTH AGENCIES AND ORGANIZATIONS TO SURVEY, IDENTIFY, PRIORITIZE AND IMPACT AREAS OF GREAT HEALTH CONCERNS IN THE COMMUNITIES WE SERVE. WHILE THE CHNA PROCESS INCLUDES DATA COLLECTION THROUGH SURVEYS, FOLLOWED BY ANALYZING THE DATA TO CREATE A CHNA PLAN, THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) COMMITTEE DID AN ADDITIONAL LAYER OF ASSESSMENT TO REALLY ENSURE IMPACTS WERE BEING MADE IN THE COMMUNITIES. STAKEHOLDER QUESTIONNAIRES WERE SENT TO AREA AGENCIES, GROUPS, BUSINESSES, SCHOOLS, ETC. FOR FEEDBACK ON THE PLAN'S IMPACT TO MEASURE HOW AGENCIES VIEW THE EFFICACY OF THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE AND ITS PLANS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:NOTICES ARE PUBLISHED IN THE LOCAL NEWSPAPER, INTERVIEWS ARE CONDUCTED AT ADMISSION AND FOR THOSE PATIENTS PREADMITTED INFORMATION IS DISTRIBUTED AND INTERVIEWS CONDUCTED TO EXPLORE ALL THE AVENUES AVAILABLE FOR PAYMENT OF THEIR HEALTHCARE SERVICES TO INCLUDE THEIR ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 4: COMMUNITY INFORMATION:MEMORIAL MEDICAL CENTER SERVES AN AREA THAT EXTENDS 25 MILES WEST, 75 MILES EAST AND 45 MILES SOUTH. OUR PRIMARY SERVICE AREA HAS A POPULATION OF APPROX. 35,000 PEOPLE. THE AVERAGE INCOME OF OUR SERVICE AREA IS WELL BELOW STATE AVERAGES. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH:MEMORIAL MEDICAL CENTER DOES HAVE AN OPEN MEDICAL STAFF WITH A BROAD RANGE OF SPECIALTIES. THE MEMBERS OF THE MEDICAL STAFF PROVIDE SERVICES OUT OF TWO LARGER CLINICS AS WELL AS MANY SMALL INDEPENDENT PRACTICES. ALL HAVE EQUAL PRIVILEGES ON THE MEDICAL STAFF. IN ADDITION WE HAVE A BOARD OF DIRECTORS THAT REPRESENT THE LARGER SERVICE AREA. BOARD OF DIRECTORS COME FROM COMMUNITIES 30-40 MILES FROM ASHLAND AS WELL AS REPRESENTATIVES FROM ASHLAND AND WASHBURN (10 MILES AWAY). PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:MEMORIAL MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 NEW DAY ADVOCACY CENTER PO BOX 88 ASHLAND WI 54806 391364912 501(C)3 26700 MATCHING FUNDS ASHLAND CARES 211 8TH STREET EAST ASHLAND WI 54806 473650960 501(C)3 10000 GENERAL SUPPORT CAMBA PO BOX 141 CABLE WI 54821 391743206 501(C)3 10000 FUNDING MOUNT ASHWABAY MOUNTAIN BIKE TRAILS DAVE GALLUP FOUNDATION INC 314 MADISON AVE FORK ATKINSON WI 53538 471582030 501(C)3 8000 SOBER LIVING FACILITY EVERGROW LEARNING CENTER 422 W THIRD STREET ASHLAND WI 54806 825220699 501(C)3 100000 FUNDING FOR NEW DAY CARE PROVIDER 5 0 FUTURE CAREGIVER SCHOLARSHIPS AND HOWARD V SANDIN FELLOWSHIP AWARDS 16 26000 PART I, LINE 2: THE HOSPITAL REQUIRES RECIPIENTS TO PROVIDE DOCUMENTATION SUPPORTING EXPENDITURE OF RELATED GRANT FUNDS RECEIVED. EXPENDITURES ARE REQUIRED TO QUALIFY FOR THE PURPOSE THE GRANT/AWARD WAS GIVEN OR THE FUNDS ARE REQUIRED TO BE RETURNED. X X X X 0 0 0 0 0 0 0 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 387215 0 35186 0 630 0 13750 0 33519 0 470300 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER 218859 0 21384 0 1333 0 7856 0 26900 0 276332 0 0 0 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 0 238652 0 22452 0 323 0 11854 0 28584 0 301865 0 0 JOHN WHITE PHYSICIAN 422064 0 0 0 1032 0 12477 0 26014 0 461587 0 0 0 JUSTIN CUMMINS PHYSICIAN 392302 0 0 0 80 0 0 0 12023 0 404405 0 0 0 KEVIN MCCLELLAND PHYSICIAN 304507 0 15000 0 1584 0 13750 0 12608 0 347449 0 0 0 NICHOLAS MILLER PHYSICIAN 495003 0 15000 0 216 0 6000 0 29964 0 546183 0 0 0 TERRENCE TUOMINEN PHYSICIAN 378516 0 13750 0 1032 0 10962 0 31749 0 436009 0 0 0 A ASHLAND COUNTY WISCONSIN 396005666 2011-09-20 10000000 CONSTRUCT AND EQUIP FACILITY 0 0 0 B BAYFIELD COUNTY WISCONSIN 396005670 2011-10-05 3827785 CONSTRUCT AND EQUIP FACILITY 0 0 0 C ASHLAND COUNTY WISCONSIN 396005666 2014-12-29 7120000 CONSTRUCT AND EQUIP FACILITY 0 0 0 A 8532183 10000000 10000000 2012 0 0 0 0 B 3270288 3827785 3827785 2012 0 0 0 0 C 1470127 7120000 123433 6996567 2016 0 0 0 0 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 JASON DOUGLAS PRESIDENT/CEO RETENTION X 70000 28076 0 1 1 NICHOLAS MILLER HIGHLY COMPENSATED EMPLOYEE SIGN-ON BONUS X 30000 7692 0 1 1 JUSTIN CUMMINS HIGHLY COMPENSATED EMPLOYEE SIGN-ON BONUS X 250000 196154 0 1 1 231922 FORM 990, PART VI, SECTION A, LINE 6 REGIONAL ENTERPRISES, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A REGIONAL ENTERPRISES, INC. MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW, REI, AS THE SOLE MEMBER OF MMC, SHALL HAVE THE FOLLOWING RESERVE POWERS: A) THE POWER TO MAKE, AMEND, OR REPEAL MMC'S BYLAWS AND ARTICLES OF INCORPORATION. B) TO APPROVE ANY CHANGE IN MMC'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR MMC. C) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D) TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $1,000,000 IN VALUE. E) TO SELECT AND RETAIN AN INDEPENDENT AUDING FIRM. F) TO APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY MMC. G) TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF MMC. H) BASED ON A RECOMMENDATION FROM THE BOARD OF DIRECTORS OF MMC, TO APPOINT AND MONITOR THE PERFORMANCE OF THE PRESIDENT/CEO OF REI, WHO SHALL ALSO SIMULTANEOUSLY SERVE AS THE PRESIDENT/CEO OF MMC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 MUST GO THROUGH AN ADMINISTRATIVE REVIEW AND THEN BE APPROVED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C A. DEFINITIONS 1. AN "INTERESTED PERSON" MEANS ANY CURRENT DIRECTOR, PRINCIPAL OFFICER OR MEMBER OF A COMMITTEE THAT REPORTS TO THE BOARD OF DIRECTORS. IF A PERSON MEETS THE DEFINITION OF AN INTERESTED PERSON FOR REI OR ANY OF ITS AFFILIATED CORPORATIONS, THAT PERSON SHALL BE CONSIDERED AN INTERESTED PERSON FOR ALL CORPORATIONS WITH THE REI SYSTEM. 2. AN "INSIDER" MEANS ANY PERSON WHO IS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF REI. FOR PURPOSES OF APPLYING THE PROCEDURES OF THIS POLICY, THE FOLLOWING WILL BE CONSIDERED INSIDERS: ANY INTERESTED PERSON AS DEFINED HEREIN; THE MANAGERS AT REI AND ITS AFFILIATED CORPORATIONS; AND MEMBERS OF THE VARIOUS MEDICAL STAFFS AT MEMBERS' HOSPITALS. FOR PURPOSES OF THIS PROTOCOL, A "MANAGER" INCLUDES ANY PERSON WHO MANAGES A DISCRETE SEGMENT OR ACTIVITY OF REI, OR ANY OF ITS AFFILIATES, THAT REPRESENTS A SUBSTANTIAL PORTION (I.E., 10% OR MORE) OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF REI OR SUCH AFFILIATE AS COMPARED TO THE ORGANIZATION AS A WHOLE. FINALLY, ANYONE WHO HAS BEEN AN INTERESTED PERSON AT ANY TIME IN THE PAST FIVE (5) YEARS AND ANYONE WHO WAS A MEMBER OF ANY MEDICAL STAFF OF A MEMBER HOSPITAL AT SOME TIME IN THE PAST FIVE (5) YEARS, SHALL BE CONSIDERED AN INSIDER. 3. FOR PURPOSES OF THIS POLICY, "FAMILY" OF AN INSIDER SHALL MEAN: A. SUCH INDIVIDUAL'S SPOUSE AND THE PARENTS AND SIBLINGS OF THE SPOUSE; B. SUCH INDIVIDUAL'S PARENTS, GRANDPARENTS, SIBLINGS (WHOLE OR HALF BLOOD OR BY ADOPTIONS), CHILDREN, GRANDCHILDREN AND GREAT GRANDCHILDREN; AND C. SPOUSES OF SUCH INDIVIDUAL'S GRANDPARENTS, SIBLINGS, CHILDREN, GRANDCHILDREN, AND GREAT GRANDCHILDREN. B. DISCLOSURE 1. EACH DIRECTOR AND OFFICER SHALL DISCLOSE TO THE BOARD OF DIRECTORS, OR TO THE OTHER MEMBERS OF ANY COMMITTEE CONSIDERING A PROPOSED BUSINESS TRANSACTION OR ARRANGEMENT, THE EXISTENCE AND NATURE OF ANY FINANCIAL INTEREST SUCH PERSON OR A MEMBER OF SUCH PERSON'S FAMILY MAY HAVE WITH RESPECT TO SUCH PROPOSED TRANSACTION OR ARRANGEMENT. EACH DIRECTOR AND PRINCIPAL OFFICER SHALL PROMPTLY MAKE DISCLOSURES AS MAY BE NECESSARY TO KEEP THE BOARD OR COMMITTEE FULLY APPRISED OF SUCH PERSON'S FINANCIAL INTERESTS. DISCLOSURE SHALL ALSO BE ACCOMPLISHED ON AN ANNUAL BASIS BY HAVING EACH DIRECTOR AND PRINCIPAL OFFICER EXECUTE AND DELIVER TO REI A CERTIFICATE REGARDING CONFLICTS OF INTEREST IN SUBSTANTIALLY THE FORM ATTACHED TO THIS POLICY. 2. THE REQUIREMENT THAT INTERESTED PERSONS DISCLOSE THEIR FINANCIAL INTERESTS SUBSTANTIALLY REQUIRES EACH DIRECTOR AND PRINCIPAL OFFICER TO DISCLOSE ANY INSIDER TRANSACTION IN WHICH HE OR SHE, HIS/HER FAMILY MEMBERS OR A CONTROLLED ENTITY ARE INVOLVED. THIS OCCURS BECAUSE THE DEFINITION OF A FINANCIAL INTEREST IS BROADER THAN THE DEFINITION OF AN INSIDER TRANSACTION. HOWEVER, NOT ALL FINANCIAL INTERESTS DISCLOSED WILL RESULT IN A CONFLICT OF INTEREST OR AN INSIDER TRANSACTION. A TRANSACTION INVOLVING A DIRECTOR OR OFFICER WILL FALL INTO ONE OF THE FOLLOWING THREE CATEGORIES: (I) IT NEITHER INVOLVES AN INTERESTED PERSON NOR IS AN INSIDER TRANSACTION, (II) IT INVOLVES AN INTERESTED PERSON, BUT IS NOT AN INSIDER TRANSACTION; OR (III) IT INVOLVES AN INTERESTED PERSON AND IS AN INSIDER TRANSACTION. C. RESPONSE TO DISCLOSURES IF ANY DIRECTOR OR PRINCIPAL OFFICER DISCLOSES A POTENTIAL FINANCIAL INTEREST TO THE BOARD OF DIRECTORS OR ANY COMMITTEE REGARDING A PROPOSED TRANSACTION OR ARRANGEMENT, THE BOARD OR COMMITTEE SHALL FIRST DETERMINE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT COULD BE CONSIDERED AN INSIDER TRANSACTION. IF THE BOARD OR COMMITTEE IS CERTAIN THAT THE TRANSACTION OR ARRANGEMENT WILL NOT INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW ONLY THE PROCEDURES SET FORTH IN SECTION III(C)(1) BELOW. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES IN BOTH SECTION III(C)(1) AND SECTION III(C)(2). 1. PROCEDURES FOR DISCLOSURES OF ANY FINANCIAL INTEREST THAT MAY RESULT IN A CONFLICT OF INTEREST ON THE PART OF AN INTERESTED PERSON THAT DOES NOT MEET THE DEFINITION OF AN INSIDER TRANSACTION A. THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED NO CONFLICT EXISTS, THE INTERESTED PERSON MAY REJOIN THE MEETING AND PARTICIPATE IN THE DISCUSSIONS AND ACTIONS REGARDING THIS AGENDA ITEM. B. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER REI CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. I. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THAT BODY SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN REI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO REI. II. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO REI, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. FURTHER ACTION BY THE BOARD OR COMMITTEE SHALL BE TABLED UNTIL SUCH TIMES AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. C. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF REI AND THAT IS NOT FAIR AND REASONABLE TO REI. D. ONCE DISCUSSION AND/OR ACTION REGARDING THE AGENDA ITEM RELATING TO THE DIRECTOR'S FINANCIAL INTEREST HAS BEEN COMPLETED, THE INTERESTED PERSON MAY REJOIN THE BOARD OR COMMITTEE MEETING. 2. PROCEDURES FOR DISCLOSURE OF ANY FINANCIAL INTEREST THAT MAY RESULT IN A CONFLICT OF INTEREST THAT IS ALSO A POTENTIAL INSIDER TRANSACTION A. THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. IN ADDITION, THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL ALSO DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS A PART OF THIS CONSIDERATION, THE BOARD OR COMMITTEE SHALL ALSO CONSIDER WHETHER THEIR ACTION COULD BE CONSTRUED TO BE AN EXCESS BENEFIT TRANSACTION SUBJECT TO THE INTERMEDIATE SANCTIONS DISCUSSED ABOVE. B. IN DETERMINING WHETHER A TRANSACTION OR ARRANGEMENT IS AN EXCESS BENEFIT TRANSACTION, THE BOARD OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT SHOULD REVIEW APPROPRIATE DATA AS TO COMPARABILITY. THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY REI'S MANAGEMENT. C. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. D. RECORDS OF PROCEEDINGS 1. THE MINUTES OF THE BOARD AND COMMITTEE MEETINGS SHALL CONTAIN: A. THE NAMES OF PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST WITH RESPECT TO ANY PROPOSED TRANSACTION OR ARRANGEMENT WITH REI, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. B. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO BE A PARTY TO AN INSIDER TRANSACTION, THE NATURE OF THE INSIDER'S RELATIONSHIP TO REI, AND A RECORD OF ALL VOTES TAKEN IN CONNECTION WITH THE BOARD'S DECISION AS TO WHETHER THE INSIDER TRANSACTION WAS AN EXCESS BENEFIT TRANSACTION. C. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO ANY TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO PROPOSED TRANSACTION OR A ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN APPROVING OR REJECTING ANY PROPOSED TRANSACTION OR ARRANGEMENT. 2. REI SHALL DOCUMENT THE BASIS FOR ITS DETERMINATION REGARDING WHETHER ANY INSIDER TRANSACTION IS AN EXCESS BENEFIT TRANSACTION. E. VIOLATIONS OF THE PROTOCOL 1. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR OR PRINCIPAL OFFICER HAS FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL INFORM THE DIRECTOR OR PRINCIPAL OFFICER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE DIRECTOR OR PRINCIPAL OFFICER AN OPPORTUNITY TO EXPLAIN WHY DISCLOSURE WAS NOT MADE. 2. IF, AFTER HEARING THE RESPONSE OF THE DIRECTOR OR PRINCIPAL OFFICER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE DIRECTOR HAS IN FACT FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION. THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE ABOVE CONFLICT OF INTEREST POLICY BY PROVIDING A QUESTIONNAIRE TO BOARD MEMBERS ANNUALLY AS WELL AS REVIEWING THE POLICY ANNUALLY WITH THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 MMC PARTICIPATES IN SALARY SURVEYS SPECIFIC TO ADMINISTRATOR POSITIONS. THIS INFORMATION IS USED TO DEVELOP SALARY RANGES FOR THE ADMINISTRATIVE STAFF. THE BOARD OF DIRECTORS PARTICIPATES IN DEVELOPMENT OF RANGES AND ESTABLISHMENT OF SALARIES FOR THE THREE SENIOR LEADERS OF THE ORGANIZATION AS DESCRIBED IN CORPORATE BYLAWS AND BOARD POLICIES. ANY CHANGES TO THE BENEFIT PACKAGE MUST BE APPROVED BY THE MMC BOARD OF DIRECTORS. THE BOARD APPROVES ALL COMPENSATION CHANGES FOR THE PRESIDENT AS OUTLINED IN CORPORATE BYLAWS AND BOARD POLICIES. CHANGES IN COMPENSATION FOR THE VICE-PRESIDENTS ARE DETERMINED BY THE PRESIDENT USING RANGES ESTABLISHED AND APPROVED BY THE BOARD, IN CONJUNCTION WITH SALARY SURVEY INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 11,931,666. MANAGEMENT AND GENERAL EXPENSES 329,144. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,260,810. MEDICAL SERVICES INC 11040 N STATE ROAD 77 HAYWARD WI 54843 391536207 HEALTH CARE WI 501(C)(3) LINE 3 REGIONAL ENTERPRISES INC 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) LINE 10 N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) LINE 12A, I REGIONAL ENTERPRISES INC 0 TAMARACK PROFESSIONAL GROUP INC 1615 MAPLE LANE ASHLAND WI 54806 391198085 HEALTH CARE WI 501(C)(3) LINE 12B, II REGIONAL ENTERPRISES INC 0 REGIONAL WELLNESS FUND OF MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 391360035 SUPPORT WI 501(C)(3) PF N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0