2019-05-14T15:04:00-05:00 2018-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 558021926 990 2017-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 KENT DUMONSEAU CFO 7156855515 2019-05-09 1 MARY BETH SANTORI P00023783 2187275025 66.98.98.9 2019-05-09 17:47:34 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A3EA2213F362026AE26E78146383F0EC02CC4472 2017 2019-02-21 02:37:17Z JASON DOUGLAS 1615 MAPLE LANE ASHLAND WI 54806 91968275 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 14 11 467 151 9583 754 70800 24874 79155666 85837435 904967 1416360 27367 23288 80158800 87301957 78136 132398 0 0 33881427 37138602 0 0 0 37151951 41091817 71111514 78362817 9047286 8939140 141527126 148252124 27586420 25268239 113940706 122983885 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 68009198 132398 85827852 MEMORIAL MEDICAL CENTER (MMC) IS A CRITICAL ACCESS HOSPITAL WITH OVER 60 FULL-TIME PHYSICIANS ON STAFF AND OVER 400 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. 68009198 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 71 0 1 467 1 1 1 0 0 0 0 0 0 0 0 0 X 14 11 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 MATTHEW ANICH BOARD MEMBER/FORMER TREASURER 1.00 2.00 X X 0 0 0 SCOTT WARREN MD BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN OUJIRI MD BOARD MEMBER 1.00 X 0 0 0 ANNE SULLIVAN BOARD MEMBER 1.00 2.00 X 0 0 0 PATRICIA SCHRAUFNAGEL CHAIR 1.00 1.00 X X 0 0 0 THOMAS JOKINEN TREASURER 1.00 X X 0 0 0 CHRISTINE IVERSON VICE CHAIR 1.00 1.00 X X 0 0 0 T JAY JONES BOARD MEMBER 1.00 X 0 0 0 WILLIAM SLOAN FORMER SECRETARY 1.00 1.00 X X 0 0 0 THOMAS CUNNINGHAM MD BOARD MEMBER 1.00 X 12600 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 37.00 3.00 X X 386553 0 48292 PEGGY VAN HOLLEN-KMAN BOARD MEMBER 1.00 X 0 0 0 MARK SNEED MD MEDICAL STAFF PRESIDENT 1.00 X X 39630 0 0 JOHN SMYLIE SECRETARY 1.00 X X 0 0 0 RICHARD SETZKE BOARD MEMBER 1.00 X 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER 39.00 1.00 X 226188 0 36173 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 24.00 16.00 X 0 246638 42520 DIANE LULICH VICE PRESIDENT 40.00 X 155273 0 40840 JOHN WHITE PHYSICIAN 40.00 X 426540 0 32682 MAX OLESEVICH PHYSICIAN 40.00 X 293188 0 57 KEVIN MCCLELLAND PHYSICIAN 36.00 X 321542 0 23455 HERBERT WHITE PHYSICIAN 36.00 X 318441 0 34698 TERRENCE TUOMINEN PHYSICIAN 40.00 X 456048 0 43885 2636003 246638 302602 31 0 1 0 REGIONAL ENTERPRISES 1615 MAPLE LANE ASHLAND WI 54806 IS/ACCTNG/COMPLIANCE 3856300 ESSENTIA HEALTH 532 EAST 1ST ST DULUTH MN 55805 CALL COVERAGE/ PRO-FEES/ SERVICE AGREEME 3408604 SUPERIOR ANESTHESIA 301 ELLIS AVENUE ASHLAND WI 54806 ANESTHESIA SERVICES 869419 TAMARACK 1615 MAPLE LANE ASHLAND WI 54806 ER PRO-FEES 789074 KBK SERVICES PO BOX 546 ASHLAND WI 54806 CONSTRUCTION COMPANY 642548 29 3849 21025 24874 PATIENT SERV REV 621500 85533413 85523830 9583 CAFETERIA 722210 224067 224067 OTHER OPERATING REVENUE 900099 68080 68080 MEDICARE EHR INCENTIVE PAYMENTS 524114 11875 11875 85837435 664630 664630 682005 658717 23288 23288 23288 4746274 13057 4006268 1333 740006 11724 751730 751730 87301957 85827852 9583 1439648 X 122398 122398 10000 10000 982472 41880 940592 27658029 25724883 1933146 1067251 997653 69598 5453232 4865747 587485 1977618 1797373 180245 218385 33093 185292 397665 397665 8071 8071 11120265 10920526 199739 386224 62495 323729 1397918 876088 521830 1512310 1512310 1194265 1151179 43086 290099 187172 102927 204676 176777 27899 5539184 4698698 840486 200415 8047 192368 UBI TAX 4000 4000 DRUGS 8395357 8395357 MEDICAL SUPPLIES 3433691 3436065 -2374 REPAIRS & MAINTENANCE 1858884 1841879 17005 4930408 2661888 2268520 78362817 68009198 10353619 0 64842905 32063884 12906832 13850200 79600 76083 790239 1278256 2852247 2927499 881292 1478417 95361851 45952723 42345825 49409128 15213603 46179074 1614583 989583 141527126 148252124 8676656 8861618 11722509 9691053 7187255 6715568 27586420 25268239 X 113940706 122983885 113940706 122983885 141527126 148252124 8939140 104039 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8071 8071 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. 234271 234271 33492392 16348617 17143775 54220059 27600002 26620057 7415129 2004104 5411025 49409128 COLLABORATIVE AGREEMENT 6405568 THIRD-PARTY PAYOR SETTLEMENTS 310000 6715568 X 86231626 104039 104039 86127587 1174370 1174370 87301957 77188447 646993 646993 76541454 1821363 1821363 78362817 PART X, LINE 2: NOT-FOR-PROFIT 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. NOT-FOR-PROFIT 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 2015. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,821,363. LOSS ON DISPOSAL OF PROPERTY 11,724. RECLASSIFICATION OF RENTAL EXPENSES -658,717. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY -11,724. RECLASSIFICATION OF RENTAL EXPENSES 658,717. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,821,363. 1 1 1 X 1 X 1 1 1 0 1 1 1062611 1062611 0.01390 15927019 12246481 3680538 0.04810 16989630 12246481 4743149 0.06200 17056 17056 0.00020 9275401 6532798 2742603 0.03580 207390 207390 0.00270 9499847 6532798 2967049 0.03870 26489477 18779279 7710198 0.10070 1 1821363 26889966 26387888 502078 X 1 1 1 1 MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 ASHLANDMMC.COM/ 1065 X X X X MEMORIAL MEDICAL CENTER 1 0 0 1 X X X X X X X X 15 1 0 1 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X 1 15 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X HTTP://ASHLANDMMC.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/ 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: AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, COMMUNITY INPUT WAS SOUGHT THROUGH SURVEYING 597 RESIDENTS WITHIN THE CHEQUAMEGON BAY REGION IN FALL OF 2015. SURVEY RESPONSES WERE SOUGHT VIA SOCIAL MEDIA, PRESS RELEASES PUBLISHED IN 8 AREA NEWSPAPERS, EMAIL OUTREACH AMONG PUBLIC HEALTH AND HOSPITAL OFFICIALS, COMMUNITY DROP BOXES AROUND THE REGION AND A SURVEYOR GATHERING DATA FROM UNDERSERVED POPULATIONS SUCH AS WORKING WITH SENIORS AT SENIOR MEALS AND THE AREA'S SENIOR CENTER, ATTENDING TRIBAL HEALTH FAIRS, AND CANVASING IN SOME OF OUR OUTLYING COMMUNITIES. AN ADDITIONAL STAKEHOLDER PRIORITIZING SESSION TOOK PLACE IN SEPTEMBER, 2015 WHICH HAD OVER 50 ATTENDEES INCLUDING LOCAL LAW ENFORCEMENT, SOCIAL SERVICES, PUBLIC HEALTH, ELECTED OFFICIALS, SCHOOL PERSONNEL, SOCIAL SERVICES AND CONCERNED CITIZENS. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 6B: BAYFIELD COUNTY HEALTH DEPARTMENT AND ASHLAND COUNTY HEALTH & HUMAN SERVICES DEPARTMENT. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 7D: FINALIZED REPORTS ARE DISTRIBUTED AT AREA LIBRARIES AND TO THE COUNTY BOARD MEMBERS OF ASHLAND AND BAYFIELD. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COORDINATED TEAM OF MEMORIAL MEDICAL CENTER, ASHLAND COUNTY HEALTH & HUMAN SERVICES DEPARTMENT, AND BAYFIELD COUNTY HEALTH DEPARTMENT DETERMINED THAT DUE TO THE MAGNITUDE OF THE NUMBER ONE HEALTH ISSUE IDENTIFIED, IT WAS ESSENTIAL TO FOCUS EFFORTS ON THAT AREA TO MAKE AN IMPACT ON THE OVERALL REGION. THIS DECISION WAS MADE IN PART DUE TO REGIONAL RESOURCE ALLOCATION AND THE SEVERE MAGNITUDE OF THE PROBLEM. IN ADDITION, A NUMBER OF ACTIVITIES WERE CURRENTLY GOING ON IN THE COMMUNITY AROUND MENTAL HEALTH AND NUTRITION/HEALTHY FOODS (ISSUES IDENTIFIED AS NUMBER 2 AND NUMBER 3) - BOTH OF WHICH MMC AND OTHER PARTNERS ARE ACTIVELY INVOLVED IN.THE FOLLOWING THREE GOALS AND ACTIVITIES AROUND ALCOHOL AND OTHER DRUG USE TOOK PLACE IN 2017 INCLUDING:GOAL 1: RESEARCH OPPORTUNITIES TO IMPROVE RECOVERY CAPACITY OF BAYFIELD AND ASHLAND COUNTY RESIDENTS ADDICTED TO METHAMPHETAMINE AND BUILD INTERNAL CAPACITY TO ACHEIVE AND SUSTAIN A SYSTEMS LEVEL LOCAL RESPONSE.THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) STEERING COMMITTEE CONNECTED WITH THE COORDINATOR OF THE CHEQUAMEGON COALITION ON EMERGING DRUGS IN REGARDS TO HOW WE CAN WORK TOGETHER TO ADDRESS METH USE WITHIN OUR COMMUNITY. THIS GROUP IS PRIMARILY MOVING FORWARD ON THIS GOAL WITH INPUT AND PARTICIPATION FROM CHIP MEMBERS.THE COALITION RECEIVED A FEDERAL FIVE-YEAR PARTNERSHIP FOR SUCCESS GRANT FOR $25,000 PER YEAR. THE FOCUS IS TO REDUCE AVAILABILITY AND ACCESS, INCREASE AWARENESS, FORM COLLABORATIONS, AND INCREASE THE AMOUNT OF DATA FOR STATEWIDE USE OF ALL DRUGS, INCLUDING METHAMPHETAMINE. 2017-2018 ACTIVITIES INCLUDED:- DRUG RECOGNITION EXPERT (DRE) TRAINING WAS PROVIDED FOR THE ASHLAND POLICE DEPARTMENT AND FINANCIAL SUPPORT FOR CHASE THE K9 DOG.- MEMORIAL MEDICAL CENTER PURCHASED "HIDDEN IN PLAIN SIGHT" ROOM TO EDUCATE PROVIDERS, PARENTS, COMMUNITY MEMBERS, AND BUSINESS LEADERS ABOUT THE SIGNS OF SOMEONE USING.- CONTINUED COLLABORATION TO IMPLEMENT PRESCRIPTION DROP BOXES THROUGHOUT THE AREA.- PROVIDE FUNDING FOR LAW ENFORCEMENT OFFICERS TO BECOME DRUG RECOGNITION EXPERTS. THIS PROGRAM TRAINS OFFICERS TO RECOGNIZE THE SIGNS AND SYMPTOMS OF IMPAIRMENT FROM THE SEVEN CATEGORIES OF DRUGS BY UTILIZING A TWELVE-STEP EVALUATION PROGRAM.- HOSTED OR PARTICIPATED IN REGIONAL COMMUNITY FORUMS AROUND DRUG USE AND ABUSE.GOAL 2: IMPLEMENT STRATEGIES DESIGNED TO REDUCE ACCESS TO ALCOHOL BY INDIVIDUALS UNDER THE AGE OF 21 IN BAYFIELD AND ASHLAND COUNTIES.ACTIVITIES TO DATE INCLUDE:- ASHLAND AND BAYFIELD COUNTIES WERE AWARDED A 5-YEAR GRANT OF $100,000 PER YEAR TO ADDRESS ADOLESCENT HEALTH. AS PART OF THIS GRANT, EFFORTS AROUND ALCOHOL ABUSE ARE BEING ADDRESSED.- MMC STARTED THE REGIONS ONLY ADOLESCENT INTENSIVE OUTPATIENT GROUP THAT PROVIDES HELP TO ANYONE AGES 12-18 WHOSE LIFE HAS BEEN NEGATIVELY IMPACTED BY THEIR SUBSTANCE USE DISORDER AND MAY BE DIAGNOSED WITH A MENTAL HEALTH DISORDER AS WELL.- ASHLAND COUNTY PARTICIPATED IN THE LEAD AND SEED TRAINING, CULTIVATING LEADERSHIP AND IMPROVED DECISION-MAKING SKILLS IN 2017.- SOURCES OF STRENGTH WAS INSTITUTED IN ASHLAND SCHOOL DISTRICT, CHEQUAMEGON SCHOOL DISTRICT IN GLIDDEN, AND WASHBURN SCHOOL DISTRICT. THIS IS THE CDC-RECOMMENDED CURRICULUM TO IMPROVE ADOLESCENT HEALTH OUTCOMES (WHICH INCLUDES ALCOHOL EDUCATION) HAS BEEN IMPLEMENTED IN FOUR SCHOOLS IN BAYFIELD COUNTY AND THREE SCHOOLS IN ASHLAND COUNTY.- CONTINUE TO SUPPORT YOUTH ADVISORY GROUPS IN THREE BAYFIELD COUNTY SCHOOLS AND TWO ASHLAND COUNTY SCHOOLS.- MMC 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 WIDE-SPREAD IMPACT ON DRUG USAGE CAN HAVE ON THE COMMUNITY.RECOVERY SERVICES STAFF IS ATTENDING THE CRIMINAL JUSTICE COUNCIL, WHICH FOCUSES AROUND HOW LAW ENFORCEMENT IS ADDRESSING RECOVERY IN OUR COMMUNITY. MMC ALSO HAS MEMBERSHIP ON THE ASHLAND COUNTY CRIMINAL JUSTICE ADVISORY BOARD.MMC RECOVERY SERVICES STAFF PARTICIPATES IN WEEKLY DRUG COURT.GOAL 3: ADVOCATE AND EDUCATE FOR POLICY CHANGE TO DECREASE AODA ABUSE IN ASHLAND AND BAYFIELD COUNTIES.BAYFIELD COUNTY, IN COLLABORATION WITH MMC WAS AWARDED A TWO-YEAR COMMUNITY OPPORTUNITY GRANT FOR $25,000 PER YEAR. FUNDS FROM THE COMMUNITY OPPORTUNITY GRANT WILL BE USED TO ADDRESS THE HARMFUL EFFECTS OF ALCOHOL ABUSE AND MISUSE IN NORTHWEST WISCONSIN. MORE SPECIFICALLY, THE PROJECT, WHICH IS IN COORDINATION WITH THE AREA'S LOCAL CHIP COALITION, WILL FOCUS ON INCREASING AWARENESS OF ALCOHOL ABUSE IN OUR REGION TO REGIONAL DECISION MAKERS, AS WELL AS FACILITATE POLICY AND ENVIRONMENTAL CHANGES TO UTILIZE BEST PRACTICES ON ALCOHOL AVAILABILITY VIA OUTLET DENSITY, LICENSING AND SALES. THE FOLLOWING ACTIVITIES HAVE TAKEN PLACE WITHIN MMC SURROUNDING OUR AODA GOALS:- FACT SHEET ON SPECIFIC ALCOHOL STATISTICS/COSTS/IMPACT FOR ASHLAND, BAYFIELD, DOUGLAS, AND SAWYER COUNTIES HAS BEEN ESTABLISHED AND WAS DISTRIBUTED.- VOICE FOR RECOVERY. PARTICIPATION AND LEADERSHIP BY MMC RECOVERY SERVICES STAFF. HOSTED MONTHLY SAFE AND SOBER EVENTS INCLUDING HOLIDAY THEMED PARTIES AND OTHER SAFE GATHERINGS. YEARLY PARTICIPATION IN A COLOR RUN. MOST RECENTLY, MMC AIDED IN THE START-UP OF ASHLAND'S DROP-IN CENTER: PARTNERS IN RECOVERY CENTER.- ED2RECOVERY INITIATIVE. IN 2017-2018, NEW HORIZONS NORTH PARTNERED WITH MMC TO OFFER AN EVIDENCE-BASED APPROACH TO REDUCE THE IMPACT OF SUBSTANCE USE IN THE REGION. THE ED2RECOVERY INITIATIVE WAS LAUNCHED AND WILL INTEGRATE TRAINED PEER 'RECOVERY COACHES' TO RESPOND TO OPIOID RELATED CRISES IN THE EMERGENCY DEPARTMENT. THE GOAL IS TO PROVIDE A TRAINED PEER RESPONSE 24/7 AT THIS CRISIS POINT TO MEET PEOPLE (AND THEIR FAMILIES), ENGAGE THEM IN RECOVERY, AND EMPOWER THEM TO ACCESS THE SUPPORTS AND RESOURCES AVAILABLE IN OUR COMMUNITY FROM EVERY HELPING AGENCY WE HAVE. THE OVER-ARCHING GOAL OF THIS PROJECT IS TO SAVE LIVES, REDUCE EMERGENCY DEPARTMENT RECIDIVISM AND SUPPORT LONG-TERM RECOVERY IN OUR COMMUNITY. RECOVERY COACHES ARE ABLE TO DO THIS BECAUSE THEY HAVE "BEEN THERE AND ARE EXCELLENT NAVIGATORS TO RECOVERY.COMMUNITY EVENTS INCLUDED: - HOSTED A COMMUNITY SHOWING OF WRITTEN OFF (A DOCUMENTARY) - HOSTED A SEMINAR ON TEEN SUBSTANCE USE AND RISKS- HOSTED AND SPONSORED SHOWCASE FOR RECOVERY- HOSTED COMMUNITY DISCUSSIONS FACILITATED BY MMC'S BEHAVIORAL HEALTH STAFF ON ISSUES OF SELF-CARE- PARTICIPATED IN THE BAY AREA HEALTH EDUCATION COALITION THAT MMC SPONSORED AND PARTICIPATED IN WITH A FOCUS ON RECOVERY- CONTINUED INVOLVEMENT ON THE CHEQUAMEGON AREA COALITION ON EMERGING DRUGS MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER. PART V, SECTION B, LINE 7B, CHNA REPORT - OTHER WEBSITE: HTTPS://CO.ASHLAND.WI.US/VERTICAL/SITES/%7B215E4EAC-21AA-4D0B-8377-85A847C0D0ED%7D/UPLOADS/HHSCHIP_2015-17.PDF PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: HTTP://ASHLANDMMC.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 10A, IMPLEMENTATION PLAN WEBSITE: HTTP://ASHLANDMMC.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://ASHLANDMMC.COM/WP-CONTENT/UPLOADS/2019/02/FINANCIAL-ASSISTANCE-APPLICATION-2.27.19.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://ASHLANDMMC.COM/WP-CONTENT/UPLOADS/2019/02/2019-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 2018 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 $1,821,363. PART III, LINE 2: MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. THE HOSPITAL DOES NOT CHARGE INTEREST ON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF AS PROVISION FOR BAD DEBT WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF THE PROVISION FOR BAD DEBT WHEN RECEIVED.THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF SELF-PAY AND OTHER RECEIVABLES HAS DECREASED FROM 59.8 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2017 TO 53.2 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2018. 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: RECONCILIATION OF TOTAL MEDICARE PROGRAM AND WHAT IS ALLOWED ON THE COST REPORT:MEMORIAL MEDICAL CENTER, INC. IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST (LESS 2% MEDICARE SEQUESTRATION). THE HOPSITAL FACILITY'S TOTAL MEDICARE SHORTFALL IS $1,547,353, OF WHICH A SURPLUS OF $502,078 (CONSISTING OF $26,889,966 NET REVENUE AND $26,387,888 COST) IS INCLUDED ON PART III, SECTION B, LINES 5-7, AND A SHORTFALL OF $2,049,431 (CONSISTING OF $5,644,475 NET REVENUE AND $7,693,906 COST) REPRESENT ALL OTHER MEDICARE SERVICES NOT INCLUDED IN THE ANNUAL COST REPORT.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 715-934-4267 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 IS WORKING WITH LOCAL ORGANIZATIONS INCLUDING ASHLAND AND BAYFIELD COUNTY AND LOCAL SENIOR CITIZEN GROUPS TO PUT TOGETHER A 3 YEAR COMMUNITY NEEDS ASSESSMENT. THE PROCESS WILL INCLUDE SURVEYS OF AREA GROUPS AND INDIVIDUALS TO GAIN A PERSPECTIVE OF NEEDS THAT LOCAL CITIZENS BELIEVE ARE NECESSARY TO MEET THE HEALTHCARE NEEDS OF THE AREA. 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 35000 GENERAL SUPPORT BUILDING FUND BRICK MINISTRIES INCTHE 420 ELLIS AVE ASHLAND WI 54806 611536545 25000 GENERAL SUPPORT BUILDING SUPPORT ASHLAND CARES 211 8TH STREET EAST ASHLAND WI 54806 473650960 501(C)3 10000 GENERAL SUPPORT PARTNERS OF MMC 1615 MAPLE LANE ASHLAND WI 54806 237317450 501(C)3 10000 OPERATING SUPPORT ASHLAND AREA DEVELOPMENT CORP 422 THIRD STREET WEST ASHLAND WI 54806 391483663 10000 GENERAL SUPPORT 2 3 3 FUTURE CAREGIVER SCHOLARSHIPS AND 8 HOWARD V SANDIN FELLOWSHIP AWARDS 11 10000 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 355265 0 30658 0 630 0 13500 0 34792 0 434845 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER 206148 0 18813 0 1227 0 7691 0 28482 0 262361 0 0 0 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 0 226502 0 19936 0 200 0 10048 0 32472 0 289158 0 0 DIANE LULICH VICE PRESIDENT 154515 0 0 0 758 0 7765 0 33075 0 196113 0 0 0 JOHN WHITE PHYSICIAN 425508 0 0 0 1032 0 0 0 32682 0 459222 0 0 0 MAX OLESEVICH PHYSICIAN 292978 0 0 0 210 0 0 0 57 0 293245 0 0 0 KEVIN MCCLELLAND PHYSICIAN 305510 0 15000 0 1032 0 11723 0 11732 0 344997 0 0 0 HERBERT WHITE PHYSICIAN 298497 0 15000 0 4944 0 6142 0 28556 0 353139 0 0 0 TERRENCE TUOMINEN PHYSICIAN 380016 0 75000 0 1032 0 11693 0 32192 0 499933 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 7339296 10000000 10000000 2012 0 0 0 0 B 2813562 3827785 3827785 2012 0 0 0 0 C 1003177 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 TERRENCE TUOMINEN HIGHLY COMPENSATED EMPLOYEE SIGN-ON BONUS X 59000 11472 0 1 1 JASON DOUGLAS PRESIDENT/CEO RETENTION X 70000 38077 0 1 1 JOHN WHITE HIGHLY COMPENSATED EMPLOYEE RECRUITMENT INCENTIVE X 60000 26534 0 1 1 76083 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 10,920,526. MANAGEMENT AND GENERAL EXPENSES 199,739. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,120,265. 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