2017-10-31T09:02:50-05:00 2017-03-31 420714325 RSM US LLP 227 W FIRST ST STE 700 DULUTH MN 558021926 990 2016-04-01 391536207 MEDICAL SERVICES INC D/B/A HAYWARD AREA MEMORIAL HOSPITAL MEDI 7156348911 11040 N STATE ROAD 77 HAYWARD WI 548436391 TIM GULLINGSRUD CHIEF EXECUTIVE OFFICER 7156348911 2017-10-26 1 MARY BETH SANTORI P00023783 2187275025 108.171.131.188 2017-10-26 15:38:38 CD P C2FA9223C533CC77C020C9433D94AFB5279B52D8 FD692F96E85B5AF2B5DB6D792DFA676E0E759D7B 2016 2018-03-14 21:41:22Z HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE TIM GULLINGSRUD 11040 N STATE ROAD 77 HAYWARD WI 548436391 46883520 0 X HTTP://HAYWARDMEMORIALHOSPITAL.COM X 1986 WI TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA 11 9 342 120 0 0 55511 73736 42950813 45536032 468521 281588 232430 183443 43707275 46074799 0 0 0 0 18291755 18911426 0 0 0 19856894 20208317 38148649 39119743 5558626 6955056 63113666 69441535 14173204 12942501 48940462 56499034 X CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA 0 0 32231314 45563142 HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE IS A 25 BED CRITICAL ACCESS HOSPITAL, 50 BED NURSING HOME, AND 20 APARTMENT RCAC FACILITY. THE HOSPITAL CAMPUS ALSO CONTAINS TWO ATTACHED CLINICS THAT ARE OWNED AND OPERATED BY ESSENTIA HEALTH AND NORTHLAKES COMMUNITY HEALTH CENTER. THESE CLINICS EMPLOY APPROXIMATELY 18 FULL-TIME PHYSICIANS, AND ADDITIONAL PART-TIME SPECIALTY CARE PHYSICIANS WHO DO ROUNDS AND SEE PATIENTS AT THE HOSPITAL THROUGHOUT THE MONTH. THE HOSPITAL, NURSING HOME AND ASSISTED LIVING EMPLOY CLOSE TO 320 EMPLOYEES. IN FY '16-'17 THE HOSPITAL HAD 719 INPATIENT ADMISSIONS AND 2288 IP DAYS, 527 OBSERVATION ADMISSIONS WITH 13,066 HOURS OF CARE, AND 82 TCU ADMISSIONS WITH 760 CENSUS DAYS OF CARE. THE NURSING HOME HAD 79 ADMISSIONS WITH 17,293 CENSUS DAYS, AND THE ASSISTED LIVING HAD 7,280 RESIDENT DAYS WITH AN AVERAGE MONTHLY CENSUS OF 19.95 FOR THE FISCAL YEAR WITH 20 TOTAL APARTMENTS. THE EMERGENCY ROOM IS STAFFED BY A PHYSICIAN 24/7/365 SEEING 10,081 PATIENTS. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. AS A RESULT OF OUR 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, AN URGENT CARE WAS OPENED IN 2017. IT SERVED 881 PATIENTS DURING THE LAST THREE MONTHS OF THE FISCAL YEAR. THE OPERATING ROOM PERFORMED 835 CASES AND ENDOSCOPY PERFORMED 996 PROCEDURES. RADIOLOGY EXAMS TOTAL 20,550, AND LAB EXAMS TOTAL 54,600 PER YEAR. HAYWARD HOSPITAL PERFORMED 137 DELIVERIES LAST YEAR WITH 281 NEWBORN DAYS.HAYWARD IS A POPULAR VACATION HOME DESTINATION AND ATTRACTS TOURISTS THROUGHOUT THE YEAR. HAYWARD IS ALSO A POPULAR RECREATIONAL AREA ATTRACTING MOUNTAIN BIKERS, SKIERS, BOATING, FISHING, AND GENERAL OUTDOOR ACTIVITIES. MEDICAL PROFESSIONALS ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. 32231314 1 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 342 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X BRAD ZELLER 7159344245 11040 N STATE ROAD 77 HAYWARD WI 54843 KAREN GUSTAFSON TREASURER 1.00 1.00 X X 0 0 0 HEIDI HABEL FORMER DIRECTOR - RESIGNED 7/27/16 1.00 X 0 0 0 BRENT KELLEY DO DIRECTOR 1.00 X 0 0 0 BARBARA KOERPEL-DUFFY CHAIR 1.00 2.00 X X 0 0 0 HARRY MALCOLM MD SECRETARY 1.00 1.00 X X 0 0 0 TIM GULLINGSRUD DIRECTOR/CEO - MSI 38.00 2.00 X X 233234 0 44548 GARY NATHAN DIRECTOR 1.00 X 0 0 0 JASON DOUGLAS DIRECTOR/PRESIDENT - REI 1.00 39.00 X 0 377451 45625 JAMES MILLER VICE CHAIR 1.00 1.00 X X 0 0 0 AMY BEILKE DIRECTOR 1.00 X 0 0 0 DEVON DANNEN MD DIRECTOR 1.00 X 0 0 0 JOHN GARRETT DIRECTOR 1.00 X 0 0 0 BRAD ZELLER VICE PRESIDENT - MSI 38.00 2.00 X 146448 0 40229 KENT DUMONSEAU CFO - REI 14.00 26.00 X 0 227203 41519 HEATHER SHEEHAN VICE PRESIDENT - MSI 39.00 1.00 X 148085 0 40054 SUSAN BAUER CRNA 40.00 X 187172 0 40173 MATTHEW VINCENT CRNA 40.00 X 179657 0 44318 MICHAEL LAIRD PHARMACIST 40.00 X 136442 0 36213 ALLISON FARLEY PHARMACY DIRECTOR 40.00 X 146348 0 40963 JULIE BOE CRNA 40.00 X 182980 0 37183 1360366 604654 410825 18 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 PROFESSIONAL FEES/RENT 3021446 WAPITI MEDICAL GROUP 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 ER SERVICES 1869305 ESSENTIA HEALTH-HAYWARD 11134 N STATE RD 77 HAYWARD WI 54843 ER ON-CALL SERVICES 364379 UNIVERSAL HOSPITAL SERVICES PO BOX 851313 MINNEAPOLIS MN 554851313 REPAIRS AND MAINTENCE OF MEDICAL EQUIPME 218955 ESSENTIA HEALTH 407 E 3RD STREET DULUTH MN 55805 PATHOLOGY, SLEEP STUDY, LAB & DIRECTORSH 157090 12 73736 73736 HOSPITAL 621500 41486578 41486578 NURSING HOME 623000 3050631 3050631 ASSISTED LIVING 623000 880596 880596 ELECTRONIC HEALTH RECORD INCENTIV 621500 106130 106130 DIABETES 621500 12097 12097 45536032 218146 218146 169622 76368 93254 93254 93254 789295 6500 732353 0 56942 6500 63442 63442 CAFETERIA 900099 63079 63079 MISCELLANEOUS 900099 27110 27110 90189 46074799 45563142 0 437921 676906 676906 13714041 12481522 1232519 521599 475459 46140 2992447 2690665 301782 1006433 876614 129819 64976 64976 133143 133143 141609 141609 903321 903321 2495586 2495586 387444 313063 74381 3003215 2426668 576547 83463 83463 HOSPITAL SUPPLIES & OTH 7196259 7196259 NURSING SUPPLIES & OTHE 2351549 2351549 PROVISION FOR DOUBTFUL 1927740 1927740 OTHER GENERAL SERVICE S 1491775 1491775 28237 28237 39119743 32231314 6888429 0 20714271 29020336 10713111 6913634 1114955 1219225 137981 129738 44979360 23227448 22714034 21751912 5903321 6652239 1815993 3754451 63113666 69441535 3070237 3338660 11102967 9603841 14173204 12942501 X 48940462 56499034 48940462 56499034 63113666 69441535 6955056 603516 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2517 2517 0 PART II-B, LINE 1: HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE PAY 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. 45799 45799 32760948 16155865 16605083 9832277 6203133 3629144 2340336 868450 1471886 21751912 MUTUAL FUNDS 6652239 F 6652239 ASSETS LIMITED AS TO USE 3754451 3754451 X 44820443 603516 -1927740 -1324224 46144667 -69868 -69868 46074799 37261871 69868 69868 37192003 1927740 1927740 39119743 PART X, LINE 2: THE COMPANY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. 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 COMPANY HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES -1,927,740. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -76,368. GAIN ON SALE OF EQUIPMENT 6,500. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 76,368. GAIN ON SALE OF EQUIPMENT -6,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,927,740. 1 1 1 X 1 X 1 1 0 1 1 200725 200725 0.00540 6667095 5084507 1582588 0.04260 6867820 5084507 1783313 0.04800 153358 7946 145412 0.00390 12125313 8590282 3535031 0.09500 31347 31347 0.00080 12310018 8598228 3711790 0.09970 19177838 13682735 5495103 0.14770 1 1927740 0 13897870 14306661 -408791 X 1 1 1 1 HAYWARD AREA MEMORIAL HOSPITAL 11040 N STATE ROAD 77 HAYWARD WI 54843 1040 X X X X HAYWARD AREA MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X 15 1 0 1 1 X HTTP://HAYWARDMEMORIALHOSPITAL.COM/ABOUT-US/COMMUNITY-COMMITMENT/ X X 1 15 1 HTTP://HAYWARDMEMORIALHOSPITAL.COM/ABOUT-US/COMMUNITY-COMMITMENT/ 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 1 X 0 X X X X 1 X 0 0 HAYWARD AREA MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: HAYWARD AREA MEMORIAL HOSPITAL (HAMH) WORKED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER (THE CENTER) OF DULUTH, MINNESOTA TO ADMINISTER THEIR COMMUNITY HEALTH ASSESSMENT PROCESS.IN THE SUMMER OF 2015, THE CENTER CONFERRED WITH LEADERS FROM THE HOSPITAL TO DISCUSS THE OBJECTIVES OF A REGIONAL HEALTH NEEDS ASSESSMENT MAILED SURVEY. A SURVEY INSTRUMENT WAS DEVELOPED TO ASSESS THE HEALTH CARE NEEDS AND PREFERENCES IN THE SERVICE AREA. THE SURVEY INSTRUMENT WAS DESIGNED TO BE EASILY COMPLETED BY RESPONDENTS. RESPONSES WERE ELECTRONICALLY SCANNED TO MAXIMIZE ACCURACY. THE SURVEY WAS DESIGNED TO ASSEMBLE INFORMATION FROM LOCAL RESIDENTS REGARDING DEMOGRAPHICS OF RESPONDENTS, UTILIZATION AND PERCEPTION OF LOCAL HEALTH SERVICES, PERCEPTION OF COMMUNITY HEALTH. HAMH PROVIDED THE CENTER WITH A LIST OF INPATIENT HOSPITAL ADMISSIONS. ZIP CODES WITH THE GREATEST NUMBER OF ADMISSIONS WERE STRATIFIED IN THE INITIAL SAMPLE SELECTION. EACH AREA WOULD BE REPRESENTED IN THE SAMPLING PROPORTIONATE TO BOTH THE OVERALL SERVED POPULATION AND THE NUMBER OF PAST ADMISSIONS. EIGHT HUNDRED RESIDENTS WERE SELECTED RANDOMLY FROM PRIME NET DATA SOURCE, A MARKETING ORGANIZATION. ALTHOUGH THE SURVEY SAMPLES WERE, PROPORTIONATELY SELECTED, ACTUAL SURVEYS RETURNED FROM EACH POPULATION AREA VARIED. MEMBERS OF THE HOSPITAL AND HOSPITAL PARTNERS WERE ASSEMBLED TO IDENTIFY THE TOP COMMUNITY HEALTH NEEDS BASED ON THE COMMUNITY HEALTH ASSESSMENT FINDINGS. TEAM MEMBERS FROM HAMH INCLUDE: CEO - TIM GULLINGSRUD, VICE PRESIDENT OF ADMINISTRATION - BRAD ZELLER, VICE PRESIDENT OF SENIOR SERVICES - HEATHER SHEEHAN, BOARD OF DIRECTOR PRESIDENT - BARB KOERPEL DUFFY, HOSPITAL DIRECTOR OF NURSING, RN - SANDY HARM, QUALITY DIRECTOR, RN - PATTI PATEFIELD, PATIENT FINANCIAL SERVICES DIRECTOR - ANN GLEICHERT, MARKETING/COMMUNICATIONS DIRECTOR - CHERIE MORGAN, INFECTION PREVENTION/EDUCATION DIRECTOR, RN - MELODY RUEHL, EMERGENCY DEPARTMENT NURSE MANAGER, RN - LISA ANDERSON. TEAM MEMBERS FROM THE COMMUNITY INCLUDE: NORTHLAKES COMMUNITY CLINIC MANAGER - STACY KOLKIND, ESSENTIA HEALTH-HAYWARD CLINIC MANAGER - LINDA PARKER, SAWYER COUNTY DIRECTOR OF PUBLIC HEALTH, RN - EILEEN SIMAK, HAYWARD COMMUNITY SCHOOLS SUPERINTENDENT - CRAIG OLSON, LAC COURTE OREILLES HEALTH CENTER DIRECTOR - GREGG DUFFEK, NORTHWEST FAMILY CONNECTION RESOURCES, EXECUTIVE DIRECTOR - JACQUELINE STRAND. HAYWARD AREA MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: TEAM MEMBERS FROM THE COMMUNITY INCLUDE: NORTHLAKES COMMUNITY CLINIC MANAGER - STACY KOLKIND, ESSENTIA HEALTH-HAYWARD CLINIC MANAGER - LINDA PARKER, SAWYER COUNTY DIRECTOR OF PUBLIC HEALTH, RN - EILEEN SIMAK, HAYWARD COMMUNITY SCHOOLS SUPERINTENDENT - CRAIG OLSON, LAC COURTE OREILLES HEALTH CENTER DIRECTOR - GREGG DUFFEK, NORTHWEST FAMILY CONNECTION RESOURCES, EXECUTIVE DIRECTOR - JACQUELINE STRAND. HAYWARD AREA MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: HAMH DISTRIBUTED A PRESS RELEASE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT FINDINGS AND IMPLEMENTATION STRATEGY IN THE LOCAL NEWSPAPER. HAYWARD AREA MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: IN SUPPORT OF THE FY 2017 - FY 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, AND ONGOING COMMUNITY BENEFITS INITIATIVES, HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE PLANS TO IMPLEMENT THE FOLLOWING STRATEGIES TO IMPACT AND MEASURE COMMUNITY HEALTH IMPROVEMENT.ADDRESS ACCESS TO URGENT CARE SERVICESHAYWARD AREA MEMORIAL HOSPITAL RECOGNIZES THE NEED FOR ACCESS TO HEALTH CARE SERVICES DURING TIMES THAT THE PRIMARY CLINICS ARE NOT PRESENTLY OPEN. CURRENTLY, THE ONLY OPTIONS AVAILABLE TO PATIENTS NEEDING CARE DURING THE TIME THAT THE PRIMARY CARE CLINICS ARE NOT OPEN ARE TO: 1) SEEK CARE IN THE EMERGENCY ROOM WHICH HAS A MUCH HIGHER ASSOCIATED COST AND CAN RESULT IN SIGNIFICANT DELAYS IN RECEIVING CARE DUE TO THE UNPREDICTABLE DEMAND OF EMERGENCY SERVICES; 2) TRAVEL TO AN URGENT CARE SERVICE LOCATED IN ANOTHER COMMUNITY THE CLOSEST OF WHICH IS OVER 50 MILES AWAY; 3) WAIT TO SEEK CARE UNTIL THE PRIMARY PHYSICIAN CLINIC IS OPEN WHICH COULD DELAY TREATMENT FOR SEVERAL DAYS.GOAL: TO PROMOTE TIMELY AND CARE/COST LEVEL APPROPRIATE OPTIONS FOR RECEIVING CARE DURING TIMES WHEN THE PRIMARY CARE CLINICS ARE NOT OPEN.OBJECTIVES: PROVIDE AN OPTION FOR THE APPROPRIATE LEVEL OF CARE DURING TIMES THE PRIMARY CARE CLINIC IS NOT TRADITIONALLY OPEN, OFFER A LOWER COST ALTERNATIVE TO CARE THAN THE MUCH HIGHER COST OF CARE THAT IS FOUND IN AN EMERGENCY ROOM SETTING, DECREASE THE NEED TO TRAVEL TO FIND URGENT CARE SERVICES.PROGRESS: - HAMH OPENED URGENT CARE ON JANUARY 9, 2017. HOURS WERE 5 P.M. TO 10 P.M. MONDAY THROUGH FRIDAY AND 10 A.M. TO 10 P.M. SATURDAYS AND SUNDAYS. THE COMMUNITY HAS WELCOMED URGENT CARE AND AN AVERAGE OF 300-400 PATIENTS ARE BEING SEEN PER MONTH, WITH A LINE OFTEN FORMING BEFORE THE DOORS OPEN EACH DAY. EVALUATION OF THE URGENT CARE WILL CONTINUE IN ORDER TO MEET THE DEMANDS AND NEEDS OF THE COMMUNITY. CREATE AWARENESS OF SPECIALTY CARE SERVICES AVAILABLE LOCALLYMANY RESIDENTS LIVING IN AND AROUND HAYWARD FIND IT DIFFICULT TO TRAVEL A MINIMUM OF 50 MILES TO OTHER COMMUNITIES TO RECEIVE SPECIALTY CARE. MANY SPECIALISTS PROVIDE SERVICES IN HAYWARD, HOWEVER; COMMUNITY MEMBERS NEEDING THESE SERVICES ARE UNAWARE THAT THEY ARE AVAILABLE LOCALLY.GOAL: TO RAISE COMMUNITY AWARENESS OF SPECIALTY CARE SERVICES AVAILABLE IN HAYWARDOBJECTIVES: INCREASE AWARENESS OF SPECIALTY SERVICES AVAILABLE LOCALLY, REDUCE THE NEED TO TRAVEL TO RECEIVE SPECIALTY SERVICES, INCREASE IN SCOPE AND FREQUENCY THE NUMBER OF SPECIALTY SERVICES TRAVELING TO THE HAYWARD AREA.PROGRESS: - A COMPREHENSIVE MARKETING CAMPAIGN WAS COMPLETED IN THE FALL OF 2016 IN ORDER TO INCREASE COMMUNITY AWARENESS OF HEALTHCARE SERVICES THAT COULD BE RECEIVED IN HAYWARD. MANY PHYSICIANS USE THE NEWLY RENOVATED SPECIALTY CLINIC RANGING FROM 2 DAYS A WEEK TO 1 DAY A MONTH. ADVERTISING INCLUDED NEWSPAPER, RADIO, WEBSITE AND BROCHURES HIGHLIGHTING THE SPECIALTY CLINIC, PHYSICIANS AND THEIR SPECIALTIES. EVERY PHYSICIAN PROVIDING SERVICES IS ALSO FEATURED ON THE HAMH WEBSITE AND SIGNAGE WAS IMPROVED FOR THE SPECIALTY CLINIC NOTING PHYSICIANS AND THEIR SPECIALTIES. SEVERAL ADDITIONAL SPECIALTY CARE PHYSICIANS SEE PATIENTS IN THE ATTACHED ESSENTIA HEALTH CLINIC AND NORTHLAKES CLINIC. ENGAGE THE COMMUNITY IN PREVENTION/WELLNESS ACTIVITIES AND ROLE MODEL WELLNESSHAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE RECOGNIZES THE CONNECTION BETWEEN LIFESTYLE BEHAVIORS AND CHRONIC DISEASES. BY FOCUSING ON EDUCATION AND PREVENTION, WE BELIEVE WE CAN IMPROVE THE QUALITY OF LIFE FOR THE MEMBERS OF OUR COMMUNITY WHILE ALSO REDUCING THE OVERALL LIFETIME COST OF HEALTHCARE. WE ALSO ACKNOWLEDGE OUR ROLE IN THE HEALTH OF OUR COMMUNITY AND THE NEED FOR US TO BE ROLE MODELS OF HEALTHY BEHAVIORS.GOAL: TO PROMOTE AND ROLE MODEL HEALTHY BEHAVIORS TO OUR COMMUNITY WHICH WILL RESULT IN AN IMPROVED QUALITY OF LIFE.OBJECTIVES: IMPROVE AWARENESS OF HEALTHY BEHAVIORS, INCREASE AWARENESS OF HEALTH ACTIVITIES AVAILABLE IN OUR AREA, OFFER HEALTHY ACTIVITIES ON OUR CAMPUS THAT ALLOW RESIDENTS OF ALL AGES AN OPPORTUNITY TO INCREASE THEIR LEVEL OF EXERCISEPROGRESS: - HAMH PARTNERED WITH THE CHEQUAMEGON AREA MOUNTAIN BIKE ASSOCIATION (CAMBA) TO DEVELOP MOUNTAIN BIKE TRAILS ON THE HOSPITAL CAMPUS. BOTH 2K AND 8K LOOPS WERE CREATED. THE TRAILS ARE AVAILABLE FOR FAT TIRE BIKING IN THE WINTER MONTHS. THE HOSPITAL TRAILS WERE ALSO EXPANDED TO CONNECT TO THE CITY TRAILS SO PEOPLE WALKING TO THE FACILITY COULD DO SO SAFELY AND TRAIL USERS NO LONGER HAVE TO WALK OR BIKE ON THE HIGHWAY IN ORDER TO CONNECT FROM ONE TRAIL TO ANOTHER. - HAMH PARTICIPATES IN COMMUNITY HEALTH EXPOS INCLUDING A WOMEN'S HEALTH AND A SENIOR CENTER HEALTH FAIR TO PROVIDE INFORMATION ON HEALTH SCREENINGS, SAFETY AND PREVENTION, WELLNESS INFORMATION AND FREE CLASSES AND SUPPORT GROUPS.- THE ORGANIZATION'S TRAUMA COMMITTEE LAUNCHED A SAFETY CAMPAIGN WORKING WITH AREA SCHOOLS, DAYCARES, SUMMER YOUTH PROGRAMS, OUTDOOR EVENTS AND SAWYER COUNTY HEALTH & HUMAN SERVICES TO PROVIDE BIKE HELMETS FOR CHILDREN. REGISTERED NURSES HELPED FIT THE CHILDREN WITH THE HELMETS AND TALKED TO CHILDREN ABOUT THE IMPORTANCE OF WEARING HELMETS AND SAFETY EQUIPMENT. - WELLNESS WAS ADDED TO HAMH'S STRATEGIC PLAN AS A BREAK-THROUGH INITIATIVE. A WELLNESS SUBCOMMITTEE WAS BEEN FORMED TO DEVELOP AND IMPLEMENT AN EMPLOYEE WELLNESS PROGRAM WITH A GOAL OF ENHANCING STAFF MENTAL, PHYSICAL, FINANCIAL AND SPIRITUAL WELLBEING. WELLNESS OFFERINGS THAT SHOW POSITIVE RESULTS AND ARE DESIRABLE TO STAFF WILL BE SHARED WITH THE COMMUNITY. - HAMH'S BOARD OF DIRECTORS APPROVED PLANS FOR AN ADDITIONAL 20-APARTMENT EXPANSION OF OUR ASSISTED LIVING. THE PLANS INCLUDE A LARGE SPACE FOR HOLDING EMPLOYEE AND COMMUNITY WELLNESS ACTIVITIES AND EDUCATIONAL SEMINARS. EXPAND COMMUNITY COLLABORATIONSPARTNERSHIPS AND COLLABORATIONS ARE IMPORTANT IN ALLOWING HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE TO ACHIEVE ITS MISSION OF IMPROVING THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA. BY WORKING WITH OTHER ENTITIES, WE WILL BE ABLE TO POOL OUR COLLECTIVE RESOURCES AND ACHIEVE MORE ON BEHALF OF OUR COMMUNITY THEN ANY ENTITY COULD ACCOMPLISH ON ITS OWN.GOAL: TO PARTNER AND COLLABORATE WITH OTHER ENTITIES TO CREATE OR ENHANCE HEALTH RELATED SERVICES TO OUR COMMUNITY.OBJECTIVES: SEEK OPPORTUNITIES TO COLLABORATE WITH OTHER HEALTH CARE AND GOVERNMENTAL ORGANIZATIONS, LEVERAGE THESE RELATIONSHIPS TO ENHANCE THE SERVICES PROVIDED TO OUR COMMUNITYPROGRESS: - IN JANUARY 2017, HAMH PARTNERED WITH REGIONAL CLINICS, ESSENTIA HEALTH-HAYWARD AND NORTHLAKES COMMUNITY CLINIC TO PROVIDE A MENTAL WELLNESS SEMINAR. BEHAVIORAL HEALTH PROFESSIONALS PROVIDED EDUCATION ON MINDFULNESS AND SHARED TIPS AND TECHNIQUES TO MAINTAIN AND IMPROVE TO REDUCE STRESS AND ANXIETY AND IMPROVE OVERALL MENTAL WELLBEING. - HAMH DONATED $3,000 TO THE NORTHWEST CONNECTION FAMILY RESOURCES FOR THE PURCHASE OF CAR SEATS TO BE GIVEN TO FAMILIES IN NEED. - HAMH FURTHER DEVELOPED ITS CAREER EXPLORER PROGRAM WHICH IS A PROGRAM OFFERED TO AREA HIGH SCHOOL STUDENTS WHICH ALLOWS AN IN-DEPTH LOOK AT A VARIETY OF HEALTHCARE CAREERS AND PROVIDES AN OPPORTUNITY FOR HANDS-ON LEARNING THROUGHOUT THE HOSPITAL AND SENIOR LIVING CENTER. - HAMH IS ONE OF FOURTEEN HOSPITALS WORKING WITH THE RURAL WISCONSIN HEALTH COOPERATIVE TO BRING ADDITIONAL MENTAL HEALTH SERVICES TO RURAL WISCONSIN.- HAMH IS A MEMBER OF THE NORTHWEST WISCONSIN HEALTHCARE COALITION WHICH IS A COLLABORATION OF PRIVATE AND PUBLIC PARTNERS WORKING TOGETHER TO PREPARE FOR, RESPOND TO, AND RECOVER FROM EMERGENCIES. COMMUNITY HEALTH NEEDS NOT ADDRESSEDHAYWARD AREA MEMORIAL HOSPITAL HAS CHOSEN NOT TO FOCUS ON THE FOLLOWING NEEDS THAT WERE IDENTIFIED THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT AND PRIORITIZATION PROCESS:INTEGRATE BEHAVIORAL HEALTH SERVICES INTO PRIMARY CARE - HAYWARD AREA MEMORIAL HOSPITAL DOES NOT EMPLOY BEHAVIORAL HEALTH PROVIDERS AND OUR SOCIAL SERVICES DEPARTMENT WILL WORK WITH THESE PATIENTS TO REFER THEM TO THE SPECIFIC SERVICES NEEDED.MAINTAIN CUSTOMER LOYALTY - CUSTOMER LOYALTY IS MORE A BUSINESS AND OPERATIONAL FUNCTION AND DOES NOT SEEM TO FIT INTO THE SPIRIT OF A COMMUNITY HEALTH NEED. HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE IS DEDICATED TO MAINTAINING AND IMPROVING CUSTOMER LOYALTY AND WILL DO SO OUTSIDE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. PART V, LINE 16A, FAP WEBSITE: HTTP://HAYWARDMEMORIALHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/ PART V, LINE 16B, FAP APPLICATION FORM WEBSITE: HTTP://HAYWARDMEMORIALHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/ PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTP://HAYWARDMEMORIALHOSPITAL.COM/PATIENT-INFORMATION/FINANCIAL-ASSISTANCE-POLICY/ 2 1 - WATER'S EDGE 11040 N STATE ROAD 77 HAYWARD WI 54843 NURSING HOME 2 - WATER'S EDGE 11040 N STATE ROAD 77 HAYWARD WI 54843 ASSISTED LIVING FACILITY PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH PATHOLOGY, DIABETES EDUCATION, EMERGENCY, OBSERVATION BEDS, NURSING HOME, AND ASSISTED LIVING. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $1,927,740. PART II, COMMUNITY BUILDING ACTIVITIES: MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY SUCH AS BREASTFEEDING EDUCATION, BLOOD DRIVES, CHILD BIRTH CLASSES, DISASTER READINESS, DIABETES EDUCATION, HEALTH FAIRS, HABITAT FOR HUMANITY, IN KIND DONATIONS AND CASH DONATIONS AS EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. THE ACTIVITIES HAVE BEEN REPORTED ON SCHEDULE H, PART I, LINE 7E. PART III, LINE 2: ACCOUNTS RECEIVABLE FOR THE COMPANY ARE STATED AT NET REALIZABLE VALUE. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE COMPANY ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE COMPANY ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND A PROVISION FOR BAD DEBTS, 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 INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE COMPANY RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF SELF-PAY RECEIVABLES HAS DECREASED FROM 67.0 PERCENT FOR THE YEAR ENDED MARCH 31, 2016, TO 66.6 PERCENT FOR THE YEAR ENDED MARCH 31, 2017.THE COMPANY HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2017 OR 2016. THE COMPANY DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD PARTY PAYORS. PART III, LINE 3: AT HAYWARD AREA MEMORIAL HOSPITAL 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 AUDITED FINANCIAL STATEMENTS PART III, LINE 8: HAYWARD AREA MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST, LESS 2% SEQUESTRATION. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $293,613 AND ALLOWABLE COSTS OF $782,329 RESULTING IN A SHORTFALL OF $488,717. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE. THE MEDICARE ADVANTAGE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $416,102 AND ALLOWABLE COSTS OF $411,982 RESULTING IN A SURPLUS OF $4,120. 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: HAYWARD AREA MEMORIAL HOSPITAL'S BILLING AND COLLECTION POLICY STATES:A. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, HAMH 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. HAMH 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 HAMH 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 HAMH 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, HAMH WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL AND INCLUDE A 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT HAMH 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, HAMH 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. HAMH 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 PATIENT FINANCIAL SERVICES AT 715-934-4842 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.HAYWARDMEMORIALHOSPITAL.COM/PATIENT-INFORMATION. A PAPER COPY OF OUR FAP, FAP APPLICATION FORM, OR COLLECTION POLICY CAN BE OBTAINED AT OUR FACILITY LOCATED AT 11040 N STATE RD. 77, HAYWARD, WI 54843 AT THE REGISTRATION DESK.PATIENTS REQUEST ASSISTANCE AND AT THAT POINT RECEIVE THE DOCUMENTS TO APPLY FOR CHARITY CARE. MEDICAL SERVICES, INC DOES POST A LARGE SIGN IN THE LOBBY THAT STATES "THIS HEALTH CARE FACILITY IS REQUIRED TO GIVE A REASONABLE AMOUNT OF ITS SERVICES FREE OR AT A REDUCED CHARGE TO PERSONS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE. IF YOU ARE NOT ABLE TO PAY FOR ALL OR PART OF THE CARE YOU NEED, PLEASE CONTACT THE ADMISSIONS OR PATIENT FINANCIAL SERVICES OF THIS FACILITY AND ASK ABOUT THE AVAILABILITY OF SUCH CARE". THIS SIGN IS PLACED IN A LOCATION THAT ALL PATIENTS CAN SEE AND ASK FOR DOCUMENTS TO COMPLETE TO START THE CHARITY CARE APPLICATION PROCESS. COMMUNITY CARE INFORMATION IS ALSO INCLUDED IN ALL ADMISSION FOLDERS AND ALL ROOMS HAVE INFORMATIONAL BINDERS WITH CHARITY CARE INFORMATION. PART VI, LINE 2: FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH CLINICS, ASSISTED LIVING FACILITY, AND PHYSICIANS FROM THE COMMUNITY. FOLLOWING THE COMPLETION OF THE ASSESSMENT, VARIOUS WORK GROUPS ARE CONVENED. APPROPRIATE STAFF MEMBERS FROM THE FACILITY THEN WORK WITH COMMUNITY MEMBERS TO DEVELOP PROGRAMS AND APPROACHES TO ADDRESS THE IDENTIFIED HEALTH ISSUES. SOME EXAMPLES INCLUDE ABUSE OF PRESCRIPTION DRUGS, SEXUAL ABUSE PREVENTION PROGRAMS, UNDERAGE ALCOHOL USE, TRANSPORT ISSUES, TELEHEALTH, PATIENT ADVOCACY PROGRAM, AND REDUCED COST CLINIC. PART VI, LINE 3: ALL PATIENTS ARE BILLED THE SAME, HOWEVER, IF A PATIENT BECOMES DELINQUENT ON A BILL, A LETTER IS SENT TO THE PATIENT ASKING THAT THE PATIENT CONTACT PATIENT FINANCIAL SERVICES FOR ASSISTANCE. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH PATIENT FINANCIAL SERVICES AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 4: HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICARE AND MEDICAID POPULATION. THE MEDICARE AND MEDICAID POPULATION ACCOUNTS FOR 69% OF THE HOSPITAL'S GROSS REVENUES AND 50% OF ITS NET PATIENT SERVICE REVENUES. HAYWARD IS CONSIDERED A SUMMER VACATION DESTINATION THAT BRINGS LARGE CROWDS DURING THE SUMMER MONTHS. THE EMERGENCY DEPARTMENT SERVES A LARGE NUMBER OF PATIENTS THAT RANGE FROM COMMERCIAL INSURANCE, MEDICARE, MEDICAID, IHS (INDIAN HEALTH SERVICES), ETC. HAYWARD HOSPITAL IS FOCUSED ON PROVIDING HIGH QUALITY HEALTHCARE IN A RURAL LOCATION. MANY SERVICES ARE PROVIDED BY HAYWARD HOSPITAL, ALLOWING LESS PATIENT TRAVEL AT A TIME WHEN THE PATIENT IS LIKELY NOT FEELING WELL. THE HAYWARD COMMUNITY IS AN AGING POPULATION AND WE RECOGNIZE THAT NEED AND HAVE COMMITTED MILLIONS OF DOLLARS INTO SERVICES FOR THE OLDER POPULATION. WE BELIEVE HAYWARD HOSPITAL PROVIDES EXCEPTIONAL CARE IN A RURAL LOCATION. PART VI, LINE 5: OPEN MEDICAL STAFF. COMMUNITY CALL PROGRAM FOR MEDICAL STAFF. LOCAL COMMUNITY BOARD WITH 11 VOTING MEMBERS. NONPROFIT STATUS WITH PROFITS (IF ANY) USED FOR ADDITIONAL SERVICES, CAPITAL PURCHASES SUCH AS A CT SCANNER, LAB EQUIPMENT, ELECTRONIC HEALTH RECORD, IMPROVED INPATIENT SERVICES, OB PROGRAM, CONTINUED EDUCATION FOR ALL STAFF, GROWING SENIOR SERVICES PROGRAM AND A FOCUS ON THE NEEDS OF THE COMMUNITY. PART VI, LINE 7, REPORTS FILED WITH STATES WI X X 0 0 0 0 0 0 0 0 0 TIM GULLINGSRUD DIRECTOR/CEO - MSI 215074 0 17865 0 295 0 10184 0 34364 0 277782 0 0 0 JASON DOUGLAS DIRECTOR/PRESIDENT - REI 0 350142 0 26889 0 420 0 13250 0 32375 0 423076 0 0 BRAD ZELLER VICE PRESIDENT - MSI 129457 0 16897 0 94 0 6273 0 33956 0 186677 0 0 0 KENT DUMONSEAU CFO - REI 0 209094 0 17926 0 183 0 10455 0 31064 0 268722 0 0 HEATHER SHEEHAN VICE PRESIDENT - MSI 131164 0 16835 0 86 0 6633 0 33421 0 188139 0 0 0 SUSAN BAUER CRNA 186778 0 0 0 394 0 9650 0 30523 0 227345 0 0 0 MATTHEW VINCENT CRNA 179523 0 0 0 134 0 7082 0 37236 0 223975 0 0 0 MICHAEL LAIRD PHARMACIST 136330 0 0 0 112 0 7153 0 29060 0 172655 0 0 0 ALLISON FARLEY PHARMACY DIRECTOR 146225 0 0 0 123 0 7673 0 33290 0 187311 0 0 0 JULIE BOE CRNA 182590 0 0 0 390 0 3722 0 33461 0 220163 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 REGIONAL ENTERPRISES, INC. IS THE SOLE CORPORATE MEMBER OF MEDICAL SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT OF REI SHALL BE AN EX OFFICIO MEMBER OF THE MSI BOARD WITH FULL VOTING PRIVILEGES. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF MEDICAL SERVICES, INC., REGIONAL ENTERPRISES, INC. HAS THE FOLLOWING RESERVE POWERS: A. TO MAKE, AMEND, OR REPEAL MSI'S BYLAWS AND ARTICLES OF INCORPORATION. B. TO APPROVE ANY CHANGE IN MSI'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR MSI. C. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D. TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $500,000 IN VALUE. E. TO SELECT AND RETAIN AN INDEPENDENT AUDITING FIRM. F. TO APPOVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. G. TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. H. TO AUTHORIZE THE PRESIDENT OF REI TO RECOMMEND TO THE BOARD OF MSI, THE INDIVIDUAL WHO WILL SERVE AS THE CHIEF EXECUTIVE OFFICER FOR MSI, SUBJECT TO RATIFICATION BY THE MSI BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE AND ACCOUNTING TEAM REVIEW THE 990 PRIOR TO FILING TO CONFIRM ACCURACY OF INFORMATION. THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. IF ANY CHANGES ARE MADE, A FINAL COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C 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 MSI A CERTIFICATE REGARDING CONFLICTS OF INTEREST. 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 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. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER MSI 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. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN MSI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO MSI. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO MSI, 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 TIME AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF MSI AND THAT IS NOT FAIR AND REASONABLE TO MSI. 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. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES ABOVE AND THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS 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 INTERMEDIATE SANCTIONS. 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 (SUCH AS COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS IN THE REGION, NATIONAL COMPENSATION STUDIES, COMPETING OFFERS RECEIVED BY THE INSIDER, ASSET APPRAISALS OR RENTAL ANALYSES BY QUALIFIED APPRAISERS AND OTHER INFORMATION THAT MAY BE OBTAINED ABOUT COMPARABLE AGREEMENTS, PURCHASES, SALES AND LEASES). THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY MSI'S MANAGEMENT. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. 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. 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, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: SUSPENSION OF VOTING RIGHTS, RECISION OF ANY AGREEMENTS, AND TERMINATION OF DIRECTOR OR OFFICER STATUS. FORM 990, PART VI, SECTION B, LINE 15 HR WILL RESEARCH SALARY DATA FOR OUR REGION AND PROVIDE ADMINISTRATION WITH A TYPICAL COMPENSATION RANGE. DIFFICULT POSITIONS TO FILL, DEMANDS OF THE POSITION, EXPERIENCE, EDUCATION, PAST WORK HISTORY, AND REFERENCES ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING COMPENSATION. UPDATES TO THE RANGES ARE PUT INTO PLACE AROUND APRIL OR MAY EACH YEAR, IF CHANGES OCCURRED. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR FOR THE SAME PERIOD OF DISCLOSURE SET FORTH IN SECTION 6104(D). THE GOVERNING DOCUMENTS ARE CONFIDENTIAL AND NOT AVAILABLE TO THE PUBLIC. MEMORIAL MEDICAL CENTER INC 1615 MAPLE LANE ASHLAND WI 54806 237013497 MEDICAL SERVICES WI 501(C)(3) LINE 3 REGIONAL ENTERPRISES INC 1 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) LINE 12B, II N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) LINE 12B, II REGIONAL ENTERPRISES INC 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0