2013-08-13T11:09:08-05:00 2012-09-30 420714325 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021919 990 2011-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 LES WHITEAKER 7156855515 2013-08-09 1 MARY BETH SANTORI P00023783 2187275025 2011 2016-02-24 21:20:13Z LES WHITEAKER 1615 MAPLE LANE ASHLAND WI 54806 67410796 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 14 13 434 160 0 0 45164 74083 57638141 61164524 334471 432469 96013 77720 58113789 61748796 0 0 0 0 28692078 28735570 0 0 0 23872840 23996908 52564918 52732478 5548871 9016318 69319088 84564268 14667319 19910408 54651769 64653860 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 44526670 61242244 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. 44526670 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 47 0 1 434 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X LES WHITEAKER 7156855515 1615 MAPLE LANE ASHLAND WI 54806 X DANIEL HYMANS 40.00 X X 281771 0 37151 MATTHEW ANICH 1.00 X X 0 0 0 SCOTT WARREN MD 1.00 X 0 0 0 JOHN OUJIRI MD 1.00 X 0 0 0 ANNE SULLIVAN 1.00 X X 0 0 0 PATRICIA SCHRAUFNAGEL 1.00 X X 0 0 0 THOMAS JOKINEN 1.00 X 0 0 0 CHRISTINE IVERSON 1.00 X X 0 0 0 DON MARCOUILLER 1.00 X 0 0 0 T JAY JONES 1.00 X 0 0 0 MARC BARBEAU 1.00 X 0 0 0 WILLIAM SLOAN 1.00 X 0 0 0 DONALD PATTON MD 1.00 X 0 0 0 THOMAS CUNNINGHAM MD 1.00 X 0 0 0 DANIEL H ADAMS 40.00 X 180783 0 33679 LESLIE J WHITEAKER 40.00 X 206883 0 33681 DANIEL GARDNER 40.00 X 127966 0 30107 WILLIAM MATTILA 40.00 X 145535 0 35392 PATRICK MARSHALL 40.00 X 128739 0 30418 KATHRYN TUTTLE 40.00 X 119965 0 34106 STUART SHEETS 40.00 X 250905 0 14981 1442547 0 249515 11 0 1 0 SUPERIOR ANESTHESIA ASSOCIATES 301 ELLIS AVENUE SUITE 3 ASHLAND WI 54806 ANESTHESIA SERVICES 1287535 ESSENTIA HEALTH - ASHLAND 1615 MAPLE LANE ASHLAND WI 54806 ER ON-CALL SERVICES 308167 JAMES LEAN MD 1615 MAPLE LANE ASHLAND WI 54806 PSYCH PROF FEES 304064 LAKE SUPERIOR LAUNDRY 1701 NORTH 6TH STREET SUPERIOR WI 54880 LAUNDRY SERVICE 157310 KEITH HENRY 1615 MAPLE LANE ASHLAND WI 54806 PATHOLOGY FEES 130000 5 13333 60750 74083 PATIENT SERV REV 621500 59141539 59141539 MEDICAID EHR INCENTIVE 524114 1800000 1800000 CAFETERIA 722210 206403 206403 OTHER OPERATING REVENU 900099 16582 16582 61164524 425870 425870 77720 0 77720 77720 77720 5662000 6599 5662000 0 0 6599 6599 6599 61748796 61242244 0 432469 772548 772548 21065620 18695037 2370583 878659 780072 98587 4423650 3865948 557702 1595093 1370541 224552 47216 47216 57750 57750 1841329 1841329 1235081 1235081 109818 92451 17367 2986241 2497503 488738 164389 164389 OTHER PROFESSIONAL SERV 7102949 7102949 NURSING SUPPLIES & OTHE 4843015 4843015 PROVISION FOR BAD DEBTS 3648709 3648709 GENERAL SERVICES SUPPLI 1630445 1630445 329966 329966 52732478 44526670 8205808 0 30871949 38941649 7608828 7393822 4364078 4242635 2016087 1976249 195212 153214 64732995 41027384 22629310 23705611 613496 6197730 1020128 1953358 69319088 84564268 6354089 5812271 6533230 13698137 1780000 400000 14667319 19910408 X 54651769 64653860 54651769 64653860 69319088 84564268 X 9016318 985773 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4589 4589 0 EXPLANATION OF LOBBYING ACTIVITIES: 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. 127376 127376 27892270 15782991 12109279 32336235 22794167 9542068 4377114 2450226 1926888 23705611 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 400000 400000 61748796 52732478 9016318 985773 985773 10002091 62734569 985773 985773 61748796 0 61748796 52732478 0 52732478 0 52732478 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2009. 1 1 1 X 1 X 1 1 0 1 1 569077 569077 0.01160 10826493 9931589 894904 0.01820 21627062 16838183 4788879 0.09760 33022632 26769772 6252860 0.12740 15853 13544 2309 0.00000 8101 8101 0.00020 9355578 7307617 2047961 0.04170 55731 55731 0.00110 9435263 7321161 2114102 0.04300 42457895 34090933 8366962 0.17040 1 3648709 0 15624499 15578634 45865 X 1 0 1 1 MEMORIAL MEDICAL CENTER

1615 MAPLE LANE ASHLAND WI 54806

X X X X MEMORIAL MEDICAL CENTER 1 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X X X X 1 0 1 0 0 PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2012 MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE LABOR & DELIVERY, BLOOD STORING, PHYSICAL THERAPY, PSYCHIATRIC/PSYCHOLOGICAL SERVICES, CARDIAC REHAB, EMERGENCY, AND OBSERVATION BEDS. PART I, L7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $3,648,709. PART III, LINE 4: 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.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 8: MEMORIAL MEDICAL CENTER, INC. IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $448,939 AND ALLOWABLE COSTS OF $1,104,905 RESULTING IN A SHORTFALL OF $655,966. 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. MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 13G: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER. 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. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X X 0 0 0 0 0 0 0 0 0 DANIEL HYMANS 281771 0 0 0 0 0 11803 0 25348 0 318922 0 0 0 DANIEL H ADAMS 180783 0 0 0 0 0 8504 0 25175 0 214462 0 0 0 LESLIE J WHITEAKER 206883 0 0 0 0 0 8504 0 25177 0 240564 0 0 0 DANIEL GARDNER 127966 0 0 0 0 0 6641 0 23466 0 158073 0 0 0 WILLIAM MATTILA 145535 0 0 0 0 0 7253 0 28139 0 180927 0 0 0 PATRICK MARSHALL 128739 0 0 0 0 0 6844 0 23574 0 159157 0 0 0 KATHRYN TUTTLE 119965 0 0 0 0 0 5989 0 28117 0 154071 0 0 0 STUART SHEETS 250905 0 0 0 0 0 4443 0 10538 0 265886 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 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 THE COMPLIANCE OFFICER AND COMPLIANCE COMMITTEE MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. 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. 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. FORM 990, PART VII, SECTION A DANIEL HYMANS: TIME ALLOCATION: REI MEDICAL CLINICS, INC: 1 HOUR PER WEEK REGIONAL ENTERPRISES, INC: 1 HOUR PER WEEK MEMORIAL MEDICAL CENTER: 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 MEMORIAL MEDICAL CENTER: REPORTABLE COMPENSATION = $281,771 OTHER COMPENSATION = $ 37,151 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 985,773. MEDICAL SERVICES INC 11040 N STATE ROAD 77 HAYWARD WI 54843 391536207 HEALTH CARE WI 501(C)(3) LINE 4 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 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 REGIONAL ENTERPRISES INC L 2232375 VALUE OF SERVICES TAMARACK PROFESSIONAL GROUP L 1675620 VALUE OF SERVICES MEDICAL SERVICES K 311015 VALUE OF SERVICES REGIONAL ENTERPRISES INC Q 500430 CASH