2013-01-31T13:31:44-06:00 2012-03-31 420714325 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021919 990 2011-04-01 391536207 MEDICAL SERVICES INC MEDI 7159344321 11040 N STATE ROAD 77 HAYWARD WI 548436391 TIM GULLINGSRUD 7159344321 2013-01-28 1 MARY BETH SANTORI P00023783 2187278253 2011 2016-02-25 16:41:14Z HAYWARD AREA MEMORIAL HOSPITAL & WATER'S EDGE TIM GULLINGSRUD 11040 N STATE ROAD 77 HAYWARD WI 548436391 36474642 0 X WWW.HAMHNH.COM X 1986 WI TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS 11 9 325 122 0 0 193747 104317 31925592 35070911 276497 203051 167635 991728 32563471 36370007 0 0 0 0 15946296 16549571 0 0 0 13724832 16709205 29671128 33258776 2892343 3111231 46973734 48744243 21236850 19896128 25736884 28848115 X CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA 1 0 28527551 35809088 OUR 25 BED CRITICAL ACCESS HOSPITAL IS FLANKED BY MEDICAL CLINICS AND A LONG TERM CARE CENTER. THERE ARE 18 FULL-TIME PHYSICIANS ON THE MEDICAL STAFF AND THE HOSPITAL AND NURSING HOME EMPLOY CLOSE TO 300 INDIVIDUALS. OUR STAFF HAS IMMEDIATE CONTACT WITH SPECIAISTS IN LARGE HOSPITALS FOR CONSULTATION.THE EMERGENCY DEPARTMENT IS STAFFED BY PHYSICIANS AND NURSES 24 HOURS-A-DAY WITH ADDITIONAL PERSONNEL AT DESIGNATED TIMES. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. HIGHLY SKILLED PHYSICIANS AND MEDICAL PROFESSIONALS FROM LARGER HOSPITALS ACROSS THE NATION ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. 28527551 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 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 0 1 11 0 1 325 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 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 BARBARA PEICKERT 40.00 X X 177203 0 23209 STEVE GILLIS 1.00 X X 0 0 0 KAREN GUSTAFSON 1.00 X 0 0 0 HEIDI HABEL 1.00 X 0 0 0 DAN HYMANS 1.00 X 0 259771 37151 PATRICIA JOHNSON 1.00 X X 0 0 0 BRENT KELLEY DO 1.00 X 0 0 0 KATHY RASMUSSEN 1.00 X X 0 0 0 BARBARA KOERPEL-DUFFY 1.00 X X 0 0 0 HARRY MALCOLM MD 1.00 X 0 0 0 DODSON THOMPSON DO 1.00 X 0 0 0 TIM GULLINGSRUD 40.00 X X 34560 0 5701 JULIE KAHL 1.00 X 0 0 0 LES WHITEAKER 40.00 X 0 193277 33681 SUSAN BAUER 40.00 X 155897 0 28312 SUZANNE ULMER 40.00 X 163241 0 26366 ROBERT TERRY 40.00 X 152497 0 28814 ALLISON FARLEY 40.00 X 117801 0 25164 STEVEN KRASEAN 40.00 X 112680 0 31353 913879 453048 239751 11 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 PROFESSIONAL FEES/RENT 1645265 WAPITI MEDICAL GROUP PO BOX 92 NEWELL SD 57760 ER DOCTORS 1017248 IMTIAZ MOHAMED 1110 VALLEY DRIVE DULUTH MN 55804 ER DOCTOR 256448 DMS IMAGING PO BOX 86 MINNEAPOLIS MN 55489 MRI PROFESSIONAL FEES 213840 NORTHLAND TRANSCRIPTION SERVICE PO BOX 39 9079 E BILLER LOOP SOLON SPRINGS WI 54873 TRANSCRIPTION 133530 10 104317 104317 NET PATIENT SERVICE RE 621500 35029815 35029815 DIABETES 621500 41096 41096 35070911 192950 192950 332346 78795 253551 253551 253551 35941 25840 10101 10101 10101 MEDICARE INCENTIVE PAY 900099 649089 649089 MISCELLANEOUS 900099 53922 53922 CAFETERIA 900099 35166 35166 738177 36370007 35809088 0 456602 240673 240673 12211634 10981758 1229876 448895 401777 47118 2753089 2454199 298890 895280 791390 103890 63525 63525 111737 111737 38395 38395 810836 810836 1604296 1604296 791408 791408 2473124 2473124 115803 115803 HOSPITAL SUPPLIES & OTH 5195790 5195790 PROVISION FOR DOUBTFUL 2657782 2657782 NURSING SUPPLIES & OTHE 1517535 1517535 OTHER GENERAL SERVICE S 1262788 1262788 66186 66186 33258776 28527551 4731225 0 16746288 18376936 4476858 5226808 203333 134375 747232 800697 292311 251362 40004396 17299302 23446451 22705094 728327 753810 332934 495161 46973734 48744243 4083689 3773292 17153161 16122836 21236850 19896128 X 25736884 28848115 25736884 28848115 46973734 48744243 3111231 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1264 1264 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 28432390 9680306 18752084 8683861 6755855 1928006 2842346 863141 1979205 22705094 36370007 33258776 3111231 3111231 36438703 78797 78797 36359906 10101 10101 36370007 33327470 78795 78795 33248675 10101 10101 33258776 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 78,797. PART XII, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT 10,101. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 78,795. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF EQUIPMENT 10,101. 1 1 1 X 1 X 150.000000000000 1 1 0 1 1 295711 295711 0.00970 7775010 7110249 664761 0.02170 8070721 7110249 960472 0.03140 100864 16175 84689 0.00280 1175850 856183 319667 0.01040 28430 28430 0.00090 1305144 872358 432786 0.01410 9375865 7982607 1393258 0.04550 1 2657782 10003693 9801573 202120 X 1 1 1 NONE 1 1 HAYWARD AREA MEMORIAL HOSPITAL

11040 N STATE ROAD 77 HAYWARD WI 54843

X X X X HAYWARD AREA MEMORIAL HOSPITAL 1 1 1 100.000000000000 1 150.000000000000 1 1 1 X X X X X 1 X 0 1 X 0 0 2 WATER'S EDGE

11040 N STATE ROAD 77 HAYWARD WI 54843

NURSING HOME 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, SPEECH THERAPY, AND DIABETES EDUCATION. PART I, L7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $2,657,782. PART II: 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, MORE ENERGY, 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 4: MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS OF ACCOUNTS. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED.COSTING METHOD IS COST TO CHARGE RATIO. PART III, LINE 8: HAYWARD AREA MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $320,002 AND ALLOWABLE COSTS OF $702,479 RESULTING IN A SHORTFALL OF $382,477. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE.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: 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 BUSINESS OFFICE 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. PART I, LINE 6A: THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT IN WI. PART VI, LINE 2: FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT. 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 AND UNDERAGE ALCOHOL USE. 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 THE BUSINESS FOR ASSISTANCE WITH THE OVERDUE BILL. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH THE BILLING OFFICE AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 4: HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICAID POPULATION. HAYWARD SERVES A HIGH MEDICAID AND HIGH MEDICARE POPULATION WITH THE TWO ACCOUNTING FOR 68% OF GROSS REVENUES AND 55% OF NET PATIENT SERVICES 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 12 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. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X 0 0 0 0 0 0 0 0 0 BARBARA PEICKERT 177203 0 0 0 0 0 5625 0 17584 0 200412 0 0 0 DAN HYMANS 0 259771 0 0 0 0 0 11803 0 25348 0 296922 0 0 LES WHITEAKER 0 193277 0 0 0 0 0 8504 0 25177 0 226958 0 0 SUSAN BAUER 155897 0 0 0 0 0 8256 0 20056 0 184209 0 0 0 SUZANNE ULMER 163241 0 0 0 0 0 7941 0 18425 0 189607 0 0 0 ROBERT TERRY 152497 0 0 0 0 0 8803 0 20011 0 181311 0 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 IN FEBRUARY 2011, HAYWARD AREA MEMORIAL HOSPITAL AND WATER'S EDGE OPENED A NEW SERVICE 20 UNIT RCAC (RESIDENTIAL CARE APARTMENT COMPLEX). THE RCAC IS ATTACHED TO THE NEW WATER'S EDGE CARE CENTER AND ALSO CONNECTED TO THE MAIN HOSPITAL MEDICAL BUILDING. THE 20 UNIT RCAC CONSISTS OF 16 SINGLE BEDROOM APARTMENTS AND 4 TWO BEDROOM APARTMENTS. PAYMENT FOR THE RCAC (ASSISTED LIVING APARTMENTS) IS SELF PAY. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ISSUES OR CONCERNS ARE DISCUSSED AT THE COMPLIANCE COMMITTEE MEETING WITH COMPLIANCE OFFICER, COMMITTEE MEMBERS AND ADMINISTRATION. POLICIES ARE REVIEWED YEARLY AND PRESENTED TO REGULATORY COMPLIANCE COMMITTEE FOR REVIEW AND APPROVAL. 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. FORM 990, PART VI, SECTION C, LINE 18 A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. FORM 990, PART VI, SECTION C, LINE 19 A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. ALL OTHER DOCUMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR, WITH THE EXCEPTION OF THE GOVERNING DOCUMENTS THAT ARE CONFIDENTIAL. MEMORIAL MEDICAL CENTER INC 1615 MAPLE LANE ASHLAND WI 54806 237013497 MEDICAL SERVICES WI 501(C)(3) 3 REGIONAL ENTERPRISES INC 1 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) 11 N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) 11 REGIONAL ENTERPRISES INC 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 REGIONAL ENTERPRISES INC L 2215720 VALUE OF SERVICES REGIONAL ENTERPRISES INC Q 77730 ACCOUNTS PAYABLE MEMORIAL MEDICAL CENTER INC L 159365 VALUE OF SERVICES MEMORIAL MEDICAL CENTER INC Q 25411 ACCOUNTS PAYABLE