2016-08-02T15:08:05-05:00 2015-09-30 420714325 RSM US LLP 227 W FIRST ST STE 700 DULUTH MN 558021926 990 2014-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 KENT DUMONSEAU CFO 7156855515 2016-06-27 1 MARY BETH SANTORI P00023783 2187275025 2014 2016-12-15 16:53:06Z JASON DOUGLAS 1615 MAPLE LANE ASHLAND WI 54806 70971161 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 14 13 437 164 67956 14225 75261 56584 63729229 67690397 674946 1139417 128823 106618 64608259 68993016 0 45605 0 0 28449841 29333739 0 0 0 27902183 27083626 56352024 56462970 8256235 12530046 99146014 111198428 16793640 17773076 82352374 93425352 X MEMORIAL MEDICAL CENTER WILL REACH OUT AS A TRUSTED PARTNER PROVIDING THE HEALTHCARE SERVICES PEOPLE NEED TO ACHIEVE INDEPENDENT AND PRODUCTIVE LIVES. COLLABORATING WITH OUR COMMUNITIES, WE WILL PROVIDE LEADERSHIP IN INTEGRATING HEALTH SERVICES FOR THE GREATER SOUTH SHORE REGION OF LAKE SUPERIOR. 0 0 46028020 45605 67622441 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. 46028020 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 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 69 0 1 437 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 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 X MATTHEW ANICH CHAIR 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 SECRETARY 1.00 2.00 X X 0 0 0 PATRICIA SCHRAUFNAGEL VICE CHAIR 1.00 1.00 X X 0 0 0 THOMAS JOKINEN BOARD MEMBER 1.00 X 0 0 0 CHRISTINE IVERSON TREASURER 1.00 1.00 X X 0 0 0 T JAY JONES BOARD MEMBER 1.00 X 0 0 0 WILLIAM SLOAN BOARD MEMBER 1.00 1.00 X 0 0 0 THOMAS CUNNINGHAM MD BOARD MEMBER 1.00 X 0 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 37.00 3.00 X X 266909 0 35920 STEVE BITZER BOARD MEMBER 1.00 X 0 0 0 PEGGY VAN HOLLEN-KMAN BOARD MEMBER 1.00 X 0 0 0 DEBORAH DRYER MD MEDICAL STAFF PRESIDENT 1.00 X X 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER - MMC 40.00 X 167967 0 34839 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 24.00 16.00 X 0 187731 34503 DANIEL GARDNER PSYCHOLOGIST 40.00 X 134000 0 32212 WILLIAM MATTILA PHARMACY DIRECTOR 40.00 X 160028 0 38568 PATRICK MARSHALL PHARMACIST 40.00 X 142718 0 29813 KATHRYN TUTTLE DIRECTOR OF NURSING 40.00 X 135763 0 36862 CARL BAUER DIRECTOR OF REHABILITATION SERVICES 40.00 X 137014 0 17997 1144399 187731 260714 10 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 IS/ACCTNG/COMLIANCE 3617754 TAMARACK 1615 MAPLE LANE ASHLAND WI 54806 ER PRO-FEES 1576242 SUPERIOR ANESTHESIA ASSOCIATES 301 ELLIS AVENUE SUITE 3 ASHLAND WI 54806 ANESTHESIA SERVICES 1399895 JAMES LEAN N4884 CLIFFORD DRIVE ONALASKA WI 54650 PSYCH PRO-FEES 447944 ESSENTIA HEALTH 1625 MAPLE LANE ASHLAND WI 54806 PHYSICIAN ON-CALL SERVICES 331167 12 50521 6063 5963 56584 PATIENT SERV REV 621500 67272344 67204388 67956 CAFETERIA 722210 230983 230983 MEDICARE EHR INCENTIVE PAYMENTS 524114 148406 148406 OTHER OPERATING REVENUE 900099 38664 38664 67690397 432772 432772 106618 0 106618 106618 106618 2684640 150 1975099 3046 709541 -2896 706645 706645 68993016 67622441 67956 1246035 25000 25000 20605 20605 608104 608104 21456800 19231432 2225368 849584 770768 78816 4843068 4127935 715133 1576183 1379199 196984 185284 185284 336767 336767 3137489 3137489 1708530 1708530 184141 148772 35369 3058162 2449115 609047 140195 140195 OTHER PROFESSIONAL SERV 8577036 8577036 NURSING SUPPLIES & OTHE 5583445 5583445 PROVISION FOR BAD DEBTS 1898177 1898177 GENERAL SERVICES SUPPLI 1816536 1816536 457864 457864 56462970 46028020 10434950 0 55016015 55749388 8842917 7879106 3003950 2055365 2122618 2191105 305085 399247 75470286 48519018 21444929 26951268 8016573 15782385 393927 190564 99146014 111198428 5490949 8495675 9856828 8494245 1445863 783156 16793640 17773076 X 82352374 93425352 82352374 93425352 99146014 111198428 12530046 -1457068 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 4128 4128 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. 189441 189441 27702460 18906115 8796345 37842630 27206789 10635841 9735755 2406114 7329641 26951268 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 508496 ADVANCES 274660 783156 X 65640667 -1457068 -1457068 67097735 1895281 1895281 68993016 54567689 2896 2896 54564793 1898177 1898177 56462970 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 2012. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,898,177. LOSS ON DISPOSAL OF PROPERTY -2,896. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY 2,896. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR DOUBTFUL RECEIVABLES 1,898,177. 1 1 1 X 1 X 1 1 1 0 1 1 423614 423614 0.00780 11878923 10794749 1084174 0.01990 12302537 10794749 1507788 0.02770 18042 18042 0.00030 9765 9765 0.00020 5071495 4237175 834320 0.01530 108293 108293 0.00200 5207595 4237175 970420 0.01780 17510132 15031924 2478208 0.04550 1 1898177 0 18198469 18011056 187413 X 1 0 1 1 MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 X X X X MEMORIAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 12 1 0 1 1 X WWW.ASHLANDMMC.COM X 1 12 0 0 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X WWW.ASHLANDMMC.COM 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, COMMUNITY LISTENING SESSIONS AND A STAKEHOLDER PRIORITIZING SESSION. OVER 500 RESPONSES WERE RECEIVED FROM THE SURVEYING PROCESS. SIX PUBLIC LISTENING SESSIONS WERE HELD THROUGHOUT THE SERVICE AREA. OVER 50 PEOPLE ATTENDED THE STAKEHOLDER PRIORITIZING SESSION, INCLUDING LAW ENFORCEMENT, SOCIAL SERVICES, NON-PROFIT AGENCIES, HEALTHCARE PROVIDERS, SCHOOL PERSONNEL 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: THE NEEDS ASSESSMENT IS PROVIDED ON BAYFIELD COUNTY AND ASHLAND COUNTY WEBSITES AS WELL. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COORDINATED TEAM OF MEMORIAL MEDICAL CENTER, INC. STAFF AND COUNTY HEALTH PROFESSIONALS FROM THE TWO COUNTIES INVOLVED DETERMINED THAT IT WAS ESSENTIAL TO CONCENTRATE ON THE NUMBER 1 HEALTH ISSUE IDENTIFIED TO REALLY MAKE AN IMPACT ON THE OVERALL COMMUNITY. PRIOR TO MOVING FORWARD ON THE NEW PLAN, EFFORTS WERE MADE TO FIRST EVALUATE THE PROGRESS MADE DURING THE 2013-2015 CHIP CYCLE. ALCOHOL AND OTHER DRUG ABUSE WAS DETERMINED AS THE TOP PRIORITY AND BECAME THE FOCUS FOR HEALTH ENTITIES AND STAKEHOLDERS DURING THIS TIMEFRAME. INFORMATION GATHERED FROM THIS EXPERIENCE WILL BE USED TO INCREASE THE IMPACT MADE ON COMMUNITIES THROUGH EXAMINING POSITIVE OUTCOMES AND LESSONS LEARNED. THREE GOALS WERE SET WHEN EMBARKING ON THE DECREASE OF ALCOHOL USE AND ABUSE IN ASHLAND AND BAYFIELD COUNTIES. MMC STAFF PLAYED A KEY ROLE WITHIN ALL OF THESE GOALS AND PROVIDED FINANCING AND HUMAN CAPITAL TO ACHIEVE THESE GOALS. GOAL 1 FOCUSED AROUND CREATING AN ELECTRONIC ALCOHOL AND OTHER DRUG ABUSE RESOURCE GUIDE FOR PROVIDERS AND THE COMMUNITY AT-LARGE TO USE: THIS WAS ACCOMPLISHED THROUGH THE CREATION OF ONELESSDAY.ORG WHICH LAUNCHED IN JULY 2014. THE WEBSITE INCLUDES AN INTERACTIVE MAP WITH INFORMATION ON MORE THAN FIFTY RESOURCES FOR THE RECOVERY COMMUNITY. AN ASSESSMENT QUIZ FOR INDIVIDUALS AND A FLOW CHART IS AVAILABLE TO HELP THOSE WITH LOVED ONES IN RECOVERY NAVIGATE THE SYSTEM. SUCCESS WAS MEASURED THROUGH WEBSITE HITS WHICH INCLUDED 405 SESSIONS, 263 UNIQUE VISITS AND AN AVERAGE TIME SPENT OF 2 MINUTES AND 30 SECONDS ALL WITHIN THE FIRST TWELVE MONTHS. MEMORIAL MEDICAL CENTER DEDICATED MARKETING AND COMMUNICATIONS STAFF TO OVERSEE PRODUCTION AND CONTENT CREATION OF THE SITE. THEY ALSO FUNDED AN OUTSIDE CONTRACTOR TO PROGRAM THE SITE. ONCE THE SITE WAS LIVE, AN MMC STAFF PERSON WAS RESPONSIBLE FOR UPDATING THE SITE WITH NEW PROVIDER INFORMATION AS IT BECAME AVAILABLE. THEY ALSO DESIGNED, IMPLEMENTED AND FUNDED AN EXTENSIVE PUBLIC AWARENESS CAMPAIGN TO EDUCATE THE COMMUNITY ABOUT THIS NEW RESOURCE. THE CAMPAIGN FEATURED PRINT AND DIGITAL ADS, BILLBOARDS, MOVIE THEATER ADVERTISING, COASTERS AND OTHER PRINTED COLLATERAL FOR REGIONAL BUSINESSES, AND ADS ON REGIONAL BAR ROOM BATHROOM DOORS. AS PART OF MMC'S COMMUNITY OUTREACH, THE HOSPITAL PARTNERED WITH OTHER COMMUNITY COALITIONS TO SPONSOR AND SUPPORT EVENTS, SUCH AS ONE FOCUSED ON EDUCATING MOTHERS TO MAKE HEALTHY CHOICES AND ONE TO EDUCATE LOCAL POLITICAL LEADERS ON HEALTH ISSUES IN THE COMMUNITY AND HOW ADVOCACY CAN HAVE A POSITIVE IMPACT. THE SECOND GOAL WAS TO INCREASE ALCOHOL PREVENTION AND EDUCATION PROGRAMS WITHIN ASHLAND AND BAYFIELD COUNTIES. CURRENT ALCOHOL AND OTHER DRUG ABUSE EDUCATION WERE ASSESSED AT SCHOOL DISTRICTS IN THE TWO COUNTY REGION. RELATIONSHIPS WERE FORMED WITH THE LARGEST SCHOOL DISTRICT TO BETTER UNDERSTAND OBSTACLES WITHIN THE CURRENT CURRICULUM AND AN AODA PROVIDER AT MMC SPENT TIME WITHIN THE SCHOOL DISTRICT EDUCATION CHILDREN ABOUT A NUMBER OF TOPICS INCLUDING ADDICTION. THE THIRD GOAL WAS TO PROVIDE AN OPTION FOR SOBER ACTIVITIES AND PLACES OF RECREATION WITHIN ASHLAND AND BAYFIELD COUNTIES. UPON FURTHER RESEARCH AND DISCUSSION, THE GROUP DETERMINED THE BEST WAY TO ACHIEVE THIS GOAL WOULD BE TO PROMOTE EXISTING SOBER EVENTS WITHIN COMMUNITIES LOCATED WITHIN THE TWO COUNTY SERVICE AREA. MMC DEDICATED MARKETING AND COMMUNICATION STAFF TIME TO OVERSEE PRODUCTION OF A SAFE & SOBER SYMBOL. THIS SYMBOL WAS USED ON A NUMBER OF REGIONAL EVENT POSTERS. IT WAS ALSO SHOWCASED FOR 6-MONTHS ON SOBER EVENTS WITHIN THE COMMUNITY EVENTS CALENDAR IN THE REGION'S LARGEST DAILY NEWSPAPER. INCLUDE SYMBOL THESE GOALS WERE SET BY A LARGER REGIONAL CHIP COALITION. OVER THE COURSE OF THREE YEARS, MORE THAN 65 REGIONAL STAKEHOLDERS WERE INVOLVED IN THE PROCESS. TO ASSIST IN KEEPING THIS COMMUNITY COLLABORATION MOVING FORWARD, MMC FUNDED A MULTI-YEAR FACILITATOR POSITION DEDICATED ENTIRELY TO CHIP. ASIDE FROM THE GOALS SET BY THE REGIONAL CHIP COALITION, MMC ALSO CHOSE TO PARTICIPATE IN A PILOT PROGRAM BY THE RURAL WISCONSIN HEALTH COOPERATIVE. MMC WAS ONE OF FOUR HOSPITALS TO IMPLEMENT A PROGRAM TARGETING BINGE DRINKING IN RURAL WISCONSIN BY PROVIDING A VOLUNTARY SCREENING TO PATIENTS IN COMING INTO URGENT CARE OR THE EMERGENCY DEPARTMENT DURING A SPECIFIED TIME PERIOD. THROUGH ALL THE ACCOMPLISHMENTS IT WAS STILL APPARENT THAT MORE IS NEEDED TO SUPPORT THE COMMUNITIES OF ASHLAND AND BAYFIELD COUNTIES OVERCOME THE CHALLENGES ASSOCIATED WITH ALCOHOL USE AND ABUSE. A FEW LESSONS LEARNED THAT WILL CARRY INTO THE 2015-2017 CHIP PROCESS INCLUDE A NEED FOR QUANTIFIABLE INFORMATION, A NEED FOR EVIDENCE-BASED STRATEGIES, MEASURABLE GOALS AND A NEED FOR CONTINUED MOMENTUM AND DEDICATION TO ACHIEVING GOALS. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16I: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 22D: DETERMINING THE ABILITY TO PAY:THE APPLICANT'S ABILITY TO PAY FOR ALL OR A PORTION OF THE HOSPITAL'S BUDGETED FINANCIAL REQUIREMENTS FOR COMMUNITY CARE USING THE FOLLOWING CRITERIA WHICH WILL BE APPLIED CONSISTENTLY AND EQUITABLY.1. ELIGIBILITY FOR HEALTH AND MEDICAL CARE INSURANCE COVERAGE.2. PERSONAL OR FAMILY INCOME BASED ON FEDERAL POVERTY LEVEL GUIDELINES.3. SIZE OF THE PATIENT'S FAMILY.4. RESOURCES- INCLUDING: CASH, BANK ACCOUNTS, STOCKS, U.S. SAVINGS BONDS, LAND, PERSONAL PROPERTY, CARS. EXCLUDING: LIFE INSURANCE, LAND/HOME LIVING ON, HOUSEHOLD GOODS, PERSONAL PROPERTY, ONE CAR, PREPAID BURIAL.5. OTHER FINANCIAL OBLIGATIONS TO INCLUDE MEDICAL BILLS AND LIVING EXPENSES.ELIGIBILITY IS DETERMINED BY THE FOLLOWING INCOME GUIDELINES (2013 HHS POVERTY GUIDELINES). ELIGIBILITY MAY ALSO BE BASED ON ASSETS SUCH AS SAVINGS AND CHECKING ACCOUNTS, RECREATIONAL VEHICLES (MOTOR HOME, MOTORCYCLE, ATV, ETC.) AND ANY REAL ESTATE OTHER THAN YOUR HOME.FAMILY SIZE: 50 % ELIGIBILITY: 30% ELIGIBILITY:1 $11,670 $17,5052 $15,730 $23,5953 $19,790 $29,685 4 $23,850 $35,7755 $27,910 $41,8656 $31,970 $47,955 PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.ASHLANDMMC.COM PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2015 MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE LABOR & DELIVERY, PHYSICAL THERAPY, PSYCHIATRIC/PSYCHOLOGICAL SERVICES, AND OBSERVATION BEDS. PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $1,898,177. PART I, LINE 6A THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT. PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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 HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS 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 HOSPITAL 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 AND OTHER RECEIVABLES HAS DECREASED FROM 44.3 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2014 TO 30.5 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2015. 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 6 OF THE ATTACHED AUDITED FINANCIAL STATEMENT FOR COMPLETE FOOTNOTE REGARDING PATIENT ACCOUNTS RECEIVABLE.PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT ORIGINAL CHARGE FOR THE SERVICE PROVIDED, LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. PART III, LINE 8: MEMORIAL MEDICAL CENTER, INC. IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST (LESS 2% MEDICARE SEQUESTRATION). THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $487,018 AND ALLOWABLE COSTS OF $1,061,603 RESULTING IN A SHORTFALL OF $574,584. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE. THE MEDICARE ADVANTAGE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $3,592,974 AND ALLOWABLE COSTS OF $3,789,239 RESULTING IN A SHORTFALL OF $196,265.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 VI, LINE 2: 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: 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: 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: 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: MEMORIAL MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 OREDOCKER FOUNDATION PO BOX 212 ASHLAND WI 54806 562675717 501(C)(3) 25000 ASHLAND HIGH SCHOOL FITNESS ROOM 1 0 SCHOLARSHIPS 13 20605 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. 1 X X X X 0 0 0 0 0 0 0 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 266909 0 0 0 0 0 4808 0 31112 0 302829 0 0 0 KAREN HANSEN CHIEF OPERATING OFFICER - MMC 167967 0 0 0 0 0 7375 0 27464 0 202806 0 0 0 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 0 187731 0 0 0 0 0 3523 0 30980 0 222234 0 0 DANIEL GARDNER PSYCHOLOGIST 134000 0 0 0 0 0 6972 0 25240 0 166212 0 0 0 WILLIAM MATTILA PHARMACY DIRECTOR 160028 0 0 0 0 0 7674 0 30894 0 198596 0 0 0 PATRICK MARSHALL PHARMACIST 142718 0 0 0 0 0 7485 0 22328 0 172531 0 0 0 KATHRYN TUTTLE DIRECTOR OF NURSING 135763 0 0 0 0 0 6843 0 30019 0 172625 0 0 0 CARL BAUER DIRECTOR OF REHABILITATION SERVICES 137014 0 0 0 0 0 6820 0 11177 0 155011 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 3943552 10000000 10000000 0 0 0 0 B 1513421 3827785 3827785 0 0 0 0 C 123433 123433 0 0 0 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 X 1 455 FMV X RECUMBENT BIKE 1 5508 FMV 0 0 0 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 11 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, 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 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 18 THE FORM 1023, 990, AND 990-T ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION. 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 VII, SECTION A JASON DOUGLAS: TIME ALLOCATION: REI MEDICAL CLINICS, INC: 1 HOUR PER WEEK REGIONAL ENTERPRISES, INC: 1 HOUR PER WEEK MEDICAL SERVICES, INC: 1 HOUR PER WEEK MEMORIAL MEDICAL CENTER: 37 HOURS PER WEEK COMPENSATION RELATED TO REI MEDICAL CLINICS, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO REGIONAL ENTERPRISES, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO MEDICAL SERVICES, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO MEMORIAL MEDICAL CENTER: REPORTABLE COMPENSATION = $266,909 OTHER COMPENSATION = $ 35,920 TIMOTHY GULLINGSRUD: TIME ALLOCATION: REI MEDICAL CLINICS, INC: 1 HOUR PER WEEK REGIONAL ENTERPRISES, INC: 1 HOUR PER WEEK MEDICAL SERVICES, INC: 38 HOURS PER WEEK COMPENSATION RELATED TO REI MEDICAL CLINICS, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO REGIONAL ENTERPRISES, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO MEDICAL SERVICES, INC: REPORTABLE COMPENSATION = $212,792 OTHER COMPENSATION = $ 41,092 KENT DUMONSEAU: TIME ALLOCATION: REI MEDICAL CLINICS, INC: 1 HOUR PER WEEK REGIONAL ENTERPRISES, INC: 1 HOUR PER WEEK MEDICAL SERVICES, INC: 14 HOUR PER WEEK MEMORIAL MEDICAL CENTER: 24 HOURS PER WEEK COMPENSATION RELATED TO REI MEDICAL CLINICS, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO REGIONAL ENTERPRISES, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO MEDICAL SERVICES, INC: REPORTABLE COMPENSATION = $0 OTHER COMPENSATION = $0 COMPENSATION RELATED TO MEMORIAL MEDICAL CENTER: REPORTABLE COMPENSATION = $187,731 OTHER COMPENSATION = $ 34,503 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 11B, II N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) LINE 11B, II REGIONAL ENTERPRISES INC 0 TAMARACK PROFESSIONAL GROUP INC 1615 MAPLE LANE ASHLAND WI 54806 391198085 HEALTH CARE WI 501(C)(3) LINE 11B, II REGIONAL ENTERPRISES INC 0 MMC DEVELOPMENT CORP INC 1615 MAPLE LANE ASHLAND WI 54806 391360035 SUPPORT WI 501(C)(3) LINE 8 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0