2013-12-23T09:37:06-06:00 2013-06-30 390758449 WIPFLI LLP PO BOX 8010 WAUSAU WI 544028010 990 2012-07-01 390964813 MEMORIAL HEALTH CENTER INC MEMO 7157488100 135 SOUTH GIBSON MEDFORD WI 54451 LORI P PECK 7157488100 2013-12-20 1 KATHLEEN J LABRAKE CPA P00164006 7158453111 2013-12-20 2012 2015-11-30 17:44:51Z GRAHAM COURTNEY 135 SOUTH GIBSON STREET MEDFORD WI 54451 84345917 0 X WWW.MEMHC.ORG X 1958 WI MEMORIAL HEALTH CENTER IS A CRITICAL ACCESS, LEVEL III, TRAUMA CARE HOSPITAL. MEMORIAL HEALTH CENTER (MHC) OFFERS COMPREHENSIVE PRIMARY CARE THROUGH OUR CLINICS IN GILMAN, MEDFORD, PHILLIPS, PRENTICE, AND RIB LAKE. MHC HAS THERAPY CENTERS IN PRENTICE AND MEDFORD, AN ACUTE CARE SWING BED PROGRAM, A KIDNEY CARE CENTER (DIALYSIS CENTER), A PUBLIC FITNESS CENTER, A RETAIL MEDICAL CENTER PHARMACY IN MEDFORD, PLUS A CONTINUUM OF SENIOR CARE SERVICES FROM ASSISTED LIVING TO RESTORATIVE NURSING SERVICES.YOU WILL FIND A WIDE RANGE OF SERVICES, SOME OF WHICH PATIENTS MIGHT NOT NORMALLY EXPECT TO FIND IN A RURAL SETTING. MHC WAS ASPIRUS HEART & VASCULAR INSTITUTE'S FIRST SATELITE CAMPUS; HAS ORTHOPEDIC SURGEONS PERFORMING TOTAL KNEE REPLACEMENTS; OFFERS CHEMOTHERAPY SERVICES FIVE DAYS A WEEK IN OUR CANCER SERVICES CENTER, AND A FULL-ARRAY OF OTHER ASPIRUS NETWORK SPECIALISTS ON-STAFF AND ON-SITE PROVIDING PATIENTS THE HIGHEST VALUE AND QUALITY OF HEALTH CARE SERVICES. 12 8 695 120 1858019 -485238 826916 307780 59221422 62842508 1134356 1964787 57373 103567 61240067 65218642 8910 26671 0 0 34188745 34539289 0 0 0 21219081 24030336 55416736 58596296 5823331 6622346 79056978 84344708 30456940 28237566 48600038 56107142 X TO PROVIDE HEALTH CARE SERVICES OF HIGH VALUE AND PROMOTE HEALTH AND WELLNESS SO THAT WE ARE THE PROVIDER OF CHOICE FOR AREA RESIDENTS. 0 0 30135231 26671 41277919 HOSPITAL SERVICES - MEMORIAL HEALTH CENTER OPERATES A 25-BED CRITICAL ACCESS HOSPITAL IN MEDFORD, WISCONSIN. DURING THE YEAR ENDED JUNE 30, 2013, THE HOSPITAL HAD 2,133 INPATIENT DAYS AND 61,310 OUTPATIENT VISITS. SURGERY, EMERGENCY CARE, RADIOLOGY, LABORATORY, AMBULATORY CARE, AND THERAPIES ARE JUST SOME OF THE OTHER SERVICES THAT MEMORIAL HEALTH CENTER PROVIDES WITHIN THE HOSPITAL. AS A CRITICAL ACCESS HOSPITAL, MEMORIAL HEALTH CENTER PROVIDES ACCESS TO LOCAL HEALTHCARE FOR THE COMMUNITIES OF WHICH WE SERVE.MEMORIAL HEALTH CENTER ALSO PROMISES TO THE COMMUNITY TO PROVIDE HEALTHCARE SERVICES TO THOSE IN NEED REGARDLESS OF THEIR ABILITY TO PAY AS DEFINED IN THE ORGANIZATION'S CHARITY AND COMMUNITY CARE POLICIES AND PROGRAMS. DURING FISCAL YEAR 2013, MEMORIAL HEALTH CENTER'S CHARITY CARE PROGRAM AWARDED $2,084,172 IN FINANCIAL ASSISTANCE THROUGH CHARGE REDUCTIONS TO PATIENTS WHO COULD NOT OTHERWISE AFFORD CARE. (SEE ADDITIONAL INFORMATION ON THE COST OF PROVIDING CHARITY CARE TO PATIENTS IN SCHEDULE H OF THE FORM 990.) IN ADDITION TO PROVIDING CHARITY CARE SERVICES, MEMORIAL HEALTH CENTER ALSO PROVIDES A SIGNIFICANT AMOUNT OF SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS. DURING FISCAL YEAR 2013, APPROXIMATELY 59 PERCENT OF THE PATIENT SERVICES PROVIDED BY MEMORIAL HEALTH CENTER WERE PROVIDED TO MEDICARE AND MEDICAID PROGRAM BENEFICIARIES. THESE SERVICES ARE CONSIDERED A LARGE NEED IN THE COMMUNITY AND MEMORIAL HEALTH CENTER IS OFTEN REIMBURSED AT RATES BELOW THE COST OF PROVIDING THE CARE FOR THESE PATIENTS. 11493299 9671124 CLINIC SERVICES - MEMORIAL HEALTH CENTER OPERATES FIVE OUTPATIENT CLINICS IN THE COMMUNITIES OF MEDFORD, GILMAN, RIB LAKE, PRENTICE AND PHILLIPS (ALL LOCATED WITHIN THE STATE OF WISCONSIN). DURING THE YEAR ENDED JUNE 30, 2013, THE CLINICS HAD 51,347 VISITS. MEMORIAL HEALTH CENTER PROVIDES ACCESS TO PRIMARY CARE PHYSICIANS IN THESE RURAL AND MEDICALLY UNDERSERVED AREAS. THE CLINICS ALSO SERVICE A LARGE PORTION OF ELDERLY, DISABLED, AND LOW INCOME PATIENTS WHO ARE COVERED UNDER THE MEDICARE AND WISCONSIN MEDICAID PROGRAMS. PATIENTS OF THE MEMORIAL HEALTH CENTER CLINICS ARE ALSO ELIGIBLE FOR CHARITY CARE AS DEFINED BY THE ORGANIZATION'S CHARITY CARE POLICY. CHARITY CARE AMOUNTS FOR THE CLINICS ARE INCLUDED IN THE TOTAL NOTED UNDER 4A ABOVE. 5804847 6546058 NURSING HOME AND LONG-TERM CARE SERVICES - MEMORIAL HEALTH CENTER OPERATES A 101-BED SKILLED NURSING FACILITY, 10 CBRF APARTMENTS, AND A 28-UNIT RCAC. DURING THE YEAR ENDED JUNE 30, 2013, THE SNF HAD A DAILY CENSUS OF 87.5, THE CBRF HAD A DAILY CENSUS OF 9.9, AND THE RCAC HAD A DAILY CENSUS OF 26.2. THROUGH THESE SENIOR CARE SERVICES, MEMORIAL HEALTH CENTER PROVIDES CARE AND ASSISTANCE TO THE ELDERLY IN OUR COMMUNITY. A MAJORITY OF THE RESIDENTS RECEIVING NURSING HOME AND LONG-TERM CARE SERVICES AT MEMORIAL HEALTH CENTER RECEIVE CARE UNDER THE WISCONSIN MEDICAID OR FAMILY CARE PROGRAMS. MEMORIAL HEALTH CENTER RECOGNIZES THAT THE COST OF CARING FOR THESE INDIVIDUALS OFTEN EXTENDS BEYOND THE AMOUNT THAT IS PAID TO THE FACILITY BY THE MEDICAID PROGRAM. ADDITIONAL INFORMATION ON THE COST OF PROVIDING SERVICES TO MEDICAID PROGRAM BENEFICIARIES CAN BE FOUND IN SCHEDULE H OF THE FORM 990. 2561663 2555673 RETAIL PHARMACY - MEMORIAL HEALTH CENTER OPERATES A RETAIL PHARMACY THAT PROVIDES ACCESS TO PRESCRIPTION MEDICATION FOR PATIENTS OF MEMORIAL HEALTH CENTER, EMPLOYEES, AND THE COMMUNITY. DURING THE YEAR ENDED JUNE 30, 2013, A TOTAL OF 90,665 PRESCRIPTIONS WERE PROVIDED TO PATIENTS. 2561663 2555673 49995040 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 109 0 1 695 1 1 1 0 0 0 0 0 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X LORI P PECK VP FINANCE CFO 7157488100 135 SOUTH GIBSON STREET MEDFORD WI 54451 X GRAHAM COURTNEY 9.00 1.00 X 0 0 0 DUANE L ERWIN 1.00 X X 0 0 0 SUSAN FRAZIER 32.00 X 188549 0 15320 MICHAEL RIGGLE 1.00 X 0 0 0 ERIK T BRANSTETTER 40.00 X X 677821 0 33976 BRUCE CZECH 1.00 1.00 X X 0 0 0 MARITA HATTEM 1.00 X 0 0 0 F DEAN DANNER JR 1.00 X 0 0 0 JEANNE SCINTO 1.00 X 0 0 0 TERRIE FLANDERMEYER 31.00 X 140088 0 12574 ALECIA HYLTON 40.00 X 274813 0 37198 DEBBIE WOODS 1.00 X X 0 0 0 ROGER LUCAS 1.00 X 0 0 0 DIANE POSTLER-SLATTERY 1.00 X 0 0 0 GREGORY A OLSON 40.00 2.00 X 318006 0 24725 LORI P PECK 40.00 X 177960 0 6652 SCOTT T BUSKERUD 40.00 X 277742 0 33388 AMY A FALKENBERG 40.00 X 336770 0 43272 TROY D SENNHOLZ 45.00 X 330154 0 38136 RYAN DIEGEL 40.00 X 253370 0 31488 MARGARET S YOUNG 40.00 X 353018 0 25583 3328291 0 302312 34 0 1 0 ASPIRUS WAUSAU HOSPITAL INC 333 PINE RIDGE BLVD WAUSAU WI 54401 ECHO, SLEEP LAB, PHYSICIAN, AND OTHER 822310 HUOTARI CONSTRUCTION 675 JENSEN DRIVE MEDFORD WI 54451 CONSTRUCTION SERVICES 605161 MIRON CONTRUCTION COMPANY INC 1471 MCMANON DRIVE NEENAH WI 54956 CONSTRUCTION SERVICES 560206 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 8 FORT LAUDERDALE FL 33308 CONTRACTED PROVIDER SERVICES 481475 ASPIRUS INC 333 PINE RIDGE BLVD WAUSAU WI 54401 IT AND OTHER SUPPORT SERVICES 441133 15 76981 230799 307780 PATIENT SERVICE REVENUE 621110 57844198 57832663 11535 PHARMACY REVENUE 446110 4064595 2218111 1846484 OTHER OPERATING REVENUE 621110 408990 408990 CONTRACT SERVICE REVENUE 621110 272133 272133 CAFETERIA 621990 252592 252592 62842508 810841 810841 145627 42060 103567 103567 103567 20232244 6917 19082652 2563 1149592 4354 1153946 1153946 65218642 60050774 1858019 3002069 X 26671 26671 1941966 1402539 539427 24846187 21018152 3828035 1132177 983094 149083 4906505 3718041 1188464 1712454 1416785 295669 82480 82480 23631 23631 7034226 5451161 1583065 48105 38 48067 258251 113676 144575 391777 391777 1968154 1142376 825778 148717 94017 54700 275663 218891 56772 3208270 2475449 732821 234532 85213 149319 MEDICAL SUPPLIES 8503874 8621945 -118071 LICENSES AND FEES 589731 297712 292019 BAD DEBT EXPENSE 588658 588658 EQUIPMENT RENTAL/MAINT 320624 233071 87553 353643 2107551 -1753908 58596296 49995040 8601256 0 708530 7342662 6314051 233334 7137079 7940856 1040023 873013 884725 597758 47424901 23291386 22810022 24133515 36237793 39826191 1589297 1645720 108320 198818 2227138 1552841 79056978 84344708 5070900 7594620 19310000 18750509 6076040 1892437 30456940 28237566 X 47377350 54819537 1102688 1167605 120000 120000 48600038 56107142 79056978 84344708 X 6622346 521062 363696 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6974 6974 0 PART IV, SUPPLEMENTAL INFORMATION: PART II-B, LINE 1(I), OTHER LOBBYING ACTIVITIES: MEMORIAL HEALTH CENTER PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. AHA AND WHA HAVE NOTIFIED MEMORIAL HEALTH CENTER THAT APPROXIMATELY $2,030 AND $1,705 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. MEMORIAL HEALTH CENTER IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, MEMORIAL HEALTH CENTER PAYS MEMBERSHIP FEES TO THE RWHC. RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND IMPROVE HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. RWHC DETEREMINED THAT APPROXIMATELY $3,239 OF THE FEES PAID BY MEMORIAL HEALTH CENTER IN 2013 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN. 127536 -196 127340 126900 636 127536 131250 756 5106 126900 125787 5463 131250 121695 4092 125787 0.94240 0.05760 0 1 1 227478 227478 29174148 13266736 15907412 12576761 8960176 3616585 5446514 1064474 4382040 24133515 DEFERRED COMPENSATION 1400159 LONG TERM INSURANCE LIABILITY 262895 ASSET RETIREMENT OBLIGATION 222491 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 6892 1892437 X 65587119 521062 956245 1477307 64109812 1108830 1108830 65218642 57606507 42060 42060 57564447 1031849 1031849 58596296 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TERM-ENDOWMENT FUNDS HELD BY MEMORIAL HEALTH CENTER FOUNDATION, INC.; ANY AMOUNT ABOVE $120,000 MAY BE USED TO PURCHASE ITEMS FOR THE COUNTRY GARDENS ASSISTED LIVING FACILITY AT MEMORIAL HEALTH CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES THAT THE INTERNAL REVENUE SERVICE (IRS) CONSIDERS UNRELATED TO ITS EXEMPT PURPOSE AND, THEREFORE, TAXABLE. IF THESE ACTIVITIES RESULT IN NET OPERATING INCOME FOR INCOME TAX PURPOSES, THE ORGANIZATION RECOGNIZES THE ANTICAPTED TAX LIABILITY AND EXPENSE. IF THESE ACTIVITIES RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES, THE ORGANIZATION DOES NOT RECOGNIZE THE TAX BENEFIT FROM THE NET OPERATING LOSSES THAT WOULD BE REALIZED IN THE FUTURE UNLESS IT CAN BE DETERMINED THAT IT IS REASONABLE THAT SUCH AN ESTIMATED BENEFIT WILL BE REALIZED IN THE FUTURE. CURRENTLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL TAX BASES OF REPORTING THE ORGANIZATION'S ASSETS AND LIABILITIES. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. IN 2013 AND 2012, THERE WERE NO PAYMENTS OF INCOME TAX, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2013 OR 2012. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2010 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE IRS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED AS OFFSET TO RENTAL REVENUE 42,060. INTEREST RATE SWAP ADJUSTMENT 914,185. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN NET ASSETS OF MHC FOUNDATION, INC. 76,981. PROVISION FOR BAD DEBTS 588,658. GAIN/LOSS ON SALE OF FIXED ASSETS 4,354. INTEREST RATE SWAP EXPENSE 338,738. LOSS ON EXTINGUISHMENT OF DEBT 100,099. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED AS OFFSET TO RENTAL REVENUE 42,060. PART XII, LINE 4B - OTHER ADJUSTMENTS: GAIN/LOSS ON SALE OF FIXED ASSETS 4,354. PROVISION FOR BAD DEBTS 588,658. INTEREST RATE SWAP EXPENSE 338,738. LOSS ON THE EXTINGUISHMENT OF DEBT 100,099. 1 1 1 X 1 X 0 1 0 1 1 1123072 1123072 0.01940 11382100 9873647 1508453 0.02600 768130 691173 76957 0.00130 13273302 10564820 2708482 0.04670 242973 3720 239253 0.00410 14955 14955 0.00030 17047 17047 0.00030 274975 3720 271255 0.00470 13548277 10568540 2979737 0.05140 59810 59810 0.00100 59810 59810 0.00100 1 311999 0 9387461 9662972 -275511 X 1 0 1 1 MEMORIAL HEALTH CENTER INC

135 SOUTH GIBSON STREET MEDFORD WI 54451

X X X X MEMORIAL HEALTH CENTER INC 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X 1 1 X X 1 X 1 X X X X X 1 X 0 0 11 MEMORIAL HEALTH CENTER - MEDFORD CLINIC

143 SOUTH GIBSON STREET MEDFORD WI 54451

OUTPATIENT CLINIC MEMORIAL NURSING AND REHAB CENTER

135 SOUTH GIBSON STREET MEDFORD WI 54451

SKILLED NURSING FACILITY MEDICAL CENTER PHARMACY

139 SOUTH GIBSON STREET MEDFORD WI 54451

RETAIL PHARMACY MEDFORD THERAPY AND FITNESS

103 SOUTH GIBSON STREET MEDFORD WI 54451

THERAPY FITNESS CENTER COUNTRY GARDENS ASSISTED LIVING

635 WEST CEDAR STREET MEDFORD WI 54451

ASSISTED LIVING FACILITY KIDNEY CARE

111 SOUTH GIBSON STREET MEDFORD WI 54451

DIALYSIS CENTER MEMORIAL HEALTH CENTER - PRENTICE CLINIC

1511 RAILROAD AVENUE PRENTICE WI 54456

OUTPATIENT CLINIC MEMORIAL HEALTH CENTER - PHILLIPS CLINIC

625 PETERSON AVENUE PHILLIPS WI 54555

OUTPATIENT CLINIC PRENTICE THERAPY AND FITNESS

619 BRIDGE STREET PRENTICE WI 54456

THERAPY FITNESS CENTER MEMORIAL HEALTH CENTER - RIB LAKE

1121 HIGHWAY 102 RIB LAKE WI WI 54451

OUTPATIENT CLINIC MEMORIAL HEALTH CENTER - GILMAN CLINIC

320 EAST MAIN STREET MEDFORD WI 54433

OUTPATIENT CLINIC PART I, LINE 3C: PART I, LINE 3C: IN ADDITION TO THE FPG THE APPLICANT MUST PASS THE FOLLOWING TESTS: THE PATIENT/GUARANTOR, HUSBAND OR WIFE, AND DEPENDENTS MAY NOT HAVE PROPERTY IN EXCESS OF:1-LAND AND HOME WITH EQUITY IN EXCESS OF $50,000 (FINANCIAL STATEMENTS AND TAX BILLS ARE REQUIRED). INCOME PRODUCING LAND (E.G. DAIRY FARM) IS EXCLUDED FROM THIS EQUITY CALCULATION. MEMORIAL HEALTH CENTER ALSO HAS A SLIDING SCALE FOR EQUITY EXCEPTIONS THAT GOES TO $100,000 BASED ON WHERE THE PATIENT FALLS WITHIN THE POVERTY GUIDELINES.2-CASH ASSETS IN EXCESS OF $3,000 AT THE TIME OF APPLICATION. MEMORIAL HEALTH CENTER ALSO HAS A SLIDING SCALE FOR CASH EXCEPTIONS THAT GOES TO $7,000 BASED ON WHERE THE PATIENT FALLS WITHIN THE POVERTY GUIDELINES. SPECIFICALLY EXCLUDED FROM CONSIDERATION ARE IRA, PENSION PLANS, AND IRREVOCABLE BURIAL TRUST FUNDS. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 588658. PART II: ONE OF THE LARGER COMMUNITY BUILDING ACTIVITIES MEMORIAL HEALTH CENTER IS INVOLVED IN IS GETTING PHYSICIANS AND HEALTHCARE WORKERS TO OUR AREA TO IMPROVE THE ACCESS TO HEALTHCARE NEEDS IN OUR SERVICE AREA. MEMORIAL HEALTH CENTER ALSO PROMOTES HEALTH CARE RELATED JOBS AND EDUCATION TO THE STUDENTS IN THE COMMUNITY. WHILE THERE IS A GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. MEMORIAL HEALTH CENTER PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. MEMORIAL HEALTH CENTER, LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE ORGANIZATION PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING AND FAMILY CENTER, DIAGNOSTICS, EMERGENCY SERVICES, URGENT CARE, RENAL DIALYSIS, INFUSION SERVICES, SWING BED SERVICES, NURSING HOME SERVICES, ASSISTED LIVING SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, REHABILITATION SERVICES, SPECIALTY MEDICINE, PHARMACY SERVICES, SPEECH PATHOLOGY, SURGICAL SERVICES, WOMEN'S SERVICES, AND AMBULANCE SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS FOR WHICH PATIENTS ARE PERSONALLY RESPONSIBLE, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE ORGANIZATION'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUES. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE ORGANIZATION. THE ORGANIZATION ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE ORGANIZATION. PART III, LINE 8: THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H OF THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE ORGANIZATION AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE, AND REHABILITATION SERVICES PROVDIED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT MEMORIAL HEALTH CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2013 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICES REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING THE SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: MEMORIAL HEALTH CENTER MAKES PATIENTS AWARE OF FINANCIAL ASSISTANCE POLICIES AT VARIOUS POINTS DURING THE SERVICE AND PAYMENT COLLECTION PROCESS. MEMORIAL HEALTH CENTER, INC. PART V, SECTION B, LINE 3: MEMORIAL HEALTH CENTER GATHERED QUALITATIVE INFORMATION AND PERSPECTIVES ON COMMUNITY HEALTH NEEDS THROUGH TWO ROUNDS OF ONE-ON-ONE AND SMALL GROUP INTERIEWS WITH KEY COMMUNITY STAKEHOLDERS. THE PRIMARY GOAL OF THESE INTERVIEWS WAS TO ASCERTAIN A RANGE OF PERSPECTIVES ON THE COMMUNITY'S HEALTH NEEDS. MEMORIAL HEALTH CENTER GATHERED INFORMATION FROM THE FOLLOWING SPECIFIED GROUPS WITHIN THE COMMUNITY:- PEOPLE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH- FEDERAL, TRIBAL, REGIONAL, STATE OR LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES, WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY- LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED POPULATIONS- LEADERS, REPRESENTATIVES OR MEMBERS OF LOW-INCOME POPULATIONS- LEADERS, REPRESENTATIVES OR MEMBERS OF MINORITY POPULATIONS- LEADERS, REPRESENTATIVES OR MEMBERS OF POPULATIONS WITH CHRONIC DISEASE NEEDSINDIVIDUALS FROM EACH GROUP LISTED ABOVE PARTICIPATED IN THE COMMUNITY HEALTH NEEDS PROCESS BY CONTRIBUTING THEIR PERSPECTIVES, OPINIONS AND OBSERVATIONS. IN ADDITION TO INTERVIEWS, MEMORIAL HEALTH CENTER, INC. ALSO CONDUCTED THREE COMMUNITY FORUMS, TITLED "LISTENING SESSIONS" TO GET BROADER INPUT FROM THE GENERAL PUBLIC. THE FORUMS WERE ADVERTISED THROUGH LOCAL NEWSPAPER, RADIO, FLYERS AND WORD-OF-MOUTH. FROM THE INTERVIEWS AND FORUMS, KEY OR PRIORITY NEEDS WERE IDENTIFIED TO BE ADDRESSED AS A RESULT OF THE INFORMATION GATHERED ON HEALTH NEEDS IN THE COMMUNITY AND PRIMARY SERVICE AREA OF MEMORIAL HEALTH CENTER, INC. MEMORIAL HEALTH CENTER, INC. PART V, SECTION B, LINE 7: THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY MEMORIAL HEALTH CENTER; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING THE SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA. MEMORIAL HEALTH CENTER, INC. ALSO CONSIDERED STAFFING RESOURCES IN ADDITION TO FINANCIAL CONSIDERATIONS TO ENSURE THAT THERE ARE ENOUGH PERSONNEL RESOURCES AVAILABLE FOR ANY PROGRAMS THAT MAY NOT CURRENTLY BE OFFERED BY THE HOSPITAL. DUE TO THE FINANCIAL AND STAFFING CONSTRAINTS, THE HOSPITAL HAS DETERMINED THE TOP THREE PRIORITIES THAT THEY WILL FOCUS THEIR ATTENTION ON, AS THESE ISSUES WERE THE MOST CRITICAL AND SIGNIFICANT WORK NEEDS TO BE DONE IN THESE AREAS. OVER THE NEXT THREE YEARS AS THE IMPLEMENTATION STRATEGY IS IMPLEMENTED, THE HOSPITAL PLANS TO CONTINUALLY EVALUATE THE BENEFITS PROVIDED TO COMMUNITY MEMBERS TO ENSURE THAT HEALTH NEEDS ARE MET WHENEVER POSSIBLE. MEMORIAL HEALTH CENTER, INC. PART V, SECTION B, LINE 20D: MEMORIAL HEALTH CENTER PROVIDES DISCOUNTS FROM ITS STANDARD PATIENT CHARGE AMOUNTS FOR ELIGIBLE PATIENTS UNDER ITS FINANCIAL AID DISCOUNT POLICY. QUALIFYING PATIENTS RECEIVING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, AS DEFINED BY THE POLICY, WHO HAVE FAMILY INCOME UP TO 150% OF THE FEDERAL POVERTY GUIDELINES WILL NOT BE CHARGED FOR THESE SERVICES AND QUALIFYING PATIENTS WITH FAMILY INCOME BETWEEN 150% AND 300% OF THE FEDERAL POVERTY GUIDELINES WILL BE OFFERED A DISCOUNT ON A SLIDING SCALE FROM 25% TO 75% OF THE STANDARD CHARGE WITH A MINIMUM PATIENT COPAY OF $10. PATIENTS ALSO WILL BE OFFERED PAYMENT ARRANGEMENTS BASED ON MEMORIAL HEALTH CENTER'S POLICIES, SO IF A COPAY AMOUNT AFTER DISCOUNT IS BURDENSOME TO PAY AT ONE TIME, A PATIENT MAY PAY THESE AMOUNTS OVER TIME. PATIENTS WILL ALSO BE PROVIDED EMERGENCY MEDICAL CARE PRIOR TO PAYMENT DETERMINATIONS AS IT IS THE GOAL OF MEMORIAL HEALTH CENTER THAT CONCERNS OVER A HOSPITAL BILL SHOULD NEVER GET IN THE WAY OF A PATIENT RECEIVING ESSENTIAL HEALTH SERVICES. PART V, SECTION B, LINE 5A: THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE ACCESSED ON THE HOSPITAL'S WEBSITE AT WWW.MEMHC.ORG. PART VI, LINE 2: MEMORIAL HEALTH CENTER UTILIZES SEVERAL METHODS IN ASSESSING COMMUNITY HEALTH CARE NEEDS. SOME OF THEM ARE AS FOLLOWS: WORKING CLOSELY WITH THE LOCAL HEALTH DEPARTMENT, SCHOOL DISTRICT, COUNTY AGING DEPARTMENT AND OTHER ORGANIZATIONS IN THE COMMUNITY; DEMOGRAPHIC DATA FROM SURROUNDING COMMUNITIES; AND EXTERNAL REPORTS, PARTICULARLY THOSE PUBLISHED BY THE LOCAL DEPARTMENT OF HEALTH. MEMORIAL HEALTH CENTER, AT THE END OF FISCAL YEAR 2013, COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND WILL USE THE DATA AND FINDINGS OF THIS REPORT TO GUIDE THE ORGANIZATION IN THE FUTURE TO BE ABLE TO RESPOND TO THOSE NEEDS. PART VI, LINE 3: AT THE TIME OF REGISTRATION ALL PATIENTS WILL BE ASKED IF THEY HAVE HEALTH INSURANCE. IF NOT, THEY WILL BE PROVIDED THE MEMORIAL HEALTH CENTER COMMUNITY CARE APPLICATION AND COMMUNITY CARE PROGRAM GUIDELINES INFORMATION SHEET. ANY PATIENT REQUESTING ADDITIONAL INFORMATION ABOUT THE COMMUNITY CARE PROGRAM WILL BE REFERRED TO A FINANCIAL COUNSELOR, WHO WILL EXPLAIN THE PROGRAM AND ITS ELIGIBILITY CRITERIA. ALL GOVERNMENT ASSISTANCE PROGRAMS SUCH AS MEDICAL ASSISTANCE, BADGER CARE, AND GENERAL RELIEF MUST BE EXHAUSTED BEFORE APPLYING FOR COMMUNITY CARE. THIS INFORMATION IS ASLO AVAILABLE TO PATIENTS DURING THEIR VISIT AT MEMORIAL HEALTH CENTER, ON THE BILLING STATEMENT, AND OFFERED AGAIN DURING THE COLLECTION PROCESS. PART VI, LINE 4: ALTHOUGH MEMORIAL HEALTH CENTER IS LOCATED IN MEDFORD, WISCONSIN, WE HAVE HISTORICALLY DEFINED OUR "COMMUNITY" AS A MUCH BROADER AREA, INCLUDING ALL OF TAYLOR COUNTY, THE SOUTHERN AREA OF PRICE COUNTY, THE NORTHEAST PORTION OF CLARK COUNTY AND THE NORTHWEST CORNER OF MARATHON COUNTY. WITHIN THIS AREA OUR PRIMARY SERVICE AREA CONSISTS OF A 5 TO 20 MILE RADIUS AROUND MEDFORD. IN THE LAST TWO YEARS APPROXIMATELY 60% OF OUR PATIENT VOLUME HAS COME FOR THE PRIMARY AREA AND 95% FROM WITHIN OUR COMMUNITY. TAYLOR AND PRICE COUNTIES ARE LARGELY CAUCASIAN AND ARE ALMOST EXCLUSIVELY RURAL WITH 13.2% OF ADULTS BEING UNINSURED AND 23.8% OF CHILDREN ARE ELIGIBLE FOR FREE SCHOOL LUNCHES. THE MEDIAN HOUSEHOLD INCOMES IN TAYLOR AND PRICE COUNTIES ARE BOTH BELOW THE STATE AVERAGE, WHILE THE STATE AVERAGE IS ALSO BELOW THE NATIONAL AVERAGE. THE MAJOR OCCUPATIONS IN THE COMMUNITY ARE MANUFACTURING, TRADE/TRANSPORTATION/UTILITIES, EDUCATION AND HEALTH, WHICH INCLUDES MEMORIAL HEALTH CENTER. PART VI, LINE 5: MEMORIAL HEALTH CENTER IS IN A PHYSICIAN SHORTAGE AREA AND WORKS HARD TO RECRUIT PROVIDERS TO OUR AREA TO FILL THE NEEDS OF OUR COMMUNITY. WE ALSO HAVE EMPLOYEES THAT ARE REPRESENTING MEMORIAL HEALTH CENTER AND ARE ACTIVE IN OTHER GROUPS TO HELP IN BUILDING COMMUNITY EFFORTS TO IMPROVE HEALTHCARE IN OUR SERVICE AREA. MEMORIAL HEALTH CENTER ALSO GIVES CASH DONATIONS TO PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS IN THE COMMUNITY.THE MAJORITY OF MEMORIAL HEALTH CENTER'S GOVERNING BODY IS COMPRISED OF RESIDENTS THAT ARE IN MEMORAL HEALTH CENTER'S PRIMARY SERVICE ARE WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE FAMILY MEMBERS THEREOF. MEMORIAL HEALTH CENTER ALSO EXTENDS MEDICAL PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO INSURE THAT OUR SERVICE AREA HAS THE HEALTHCARE NEEDED. PART VI, LINE 6: MEMORIAL HEALTH CENTER IS A PARTNER WITH ASPIRUS, INC. A MULTI-SPECIALTY HEALTH SYSTEM WITH A BASE LOCATION IN WAUSAU, WISCONSIN. MEMORIAL HEALTH CENTER WORKS WITH ASPIRUS TO PROMOTE HEALTH AND WELLNESS INITIATIVES IN THE COMMUNITIES THEY SERVE. AS NOTED PREVIOUSLY IN THE FORM 990, A NUMBER OF REPRESENTATIVES FROM ASPIRUS HAVE ROLES ON THE BOARD OF DIRECTORS OF MEMORIAL HEALTH CENTER AND TOGETHER PROMOTE THE MISSION OF ASPIRUS. ASPIRUS IS AN INTEGRATED, COMMUNITY-GOVERNED HEALTHCARE SYSTEM, WHICH LEADS BY ADVANCING INITIATIVES TO IMPROVING THE HEALTH OF ALL IT SERVES. ASPIRUS WORKS COLLABORATIVELY WITH OTHERS WHO SHARE ITS PASSION FOR EXCELLENCE AND COMPASSION FOR PEOPLE. ASPIRUS AND MEMORIAL HEALTH CENTER WORK COLLABORATIVELY TO STREAMLINE PROCESSES TO CONTINUE TO PROVIDE HIGH QUALITY CARE TO MEMBERS OF COMMUNITIES WHICH OTHERWISE WITHOUT THE EFFORTS OF A COMBINED PARTNERSHIP MAY NOT HAVE ACCESS TO THIS CARE LOCALLY. REPORTS FILED WITH STATES PART VI, LINE 7 WI 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AS A MAJOR EMPLOYER AND COMMUNITY SUPPORTER, MEMORIAL HEALTH CENTER, RECEIVES MANY REQUESTS FOR DONATIONS OF BOTH MONEY AND MATERIAL GOODS BY VARIOUS LOCAL AGENCIES AND INDIVIDUALS. AS A NONPROFIT, MEMORIAL HEALTH CENTER MUST CONTINUOUSLY JUSTIFY ITS TAX-EXEMPT STATUS TO THE IRS. MEMORIAL HEALTH CENTER NEEDS TO UTILIZE ITS RESOURCES AND ENDORSE THOSE ACTIVITIES THAT SUPPORT ITS TAX-EXEMPT PURPOSE, WHICH IS TO PROVIDE HEALTH CARE SERVICES AND PROMOTE HEALTH AND WELLNESS TO THE COMMUNITIES IT SERVES. REQUESTS ARE CHANNELED IN A WAY THAT MAXIMIZES BENEFIT TO THE COMMUNITY AND ASSURES COMPLIANCE WITH CORPORATE NOT-FOR-PROFIT RULES. MEMORIAL HEALTH CENTER'S WRITTEN DONATIONS POLICY OUTLINES ACCEPTABLE RECIPIENTS AND APPROPRIATE OBJECTIVES PRIOR TO AWARDING ANY ASSISTANCE. DUE TO THE CHARITABLE NATURE OF THE GRANTS AND ALLOCATIONS AWARDED, NO FORMAL MONITORING IS REQUIRED. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 SUSAN FRAZIER 180012 0 0 0 8537 0 8158 0 7162 0 203869 0 0 0 ERIK T BRANSTETTER 511041 0 145212 0 21568 0 12358 0 21618 0 711797 0 0 0 TERRIE FLANDERMEYER 127459 0 0 0 12629 0 5005 0 7569 0 152662 0 0 0 ALECIA HYLTON 263894 0 0 0 10919 0 12358 0 24840 0 312011 0 0 0 GREGORY A OLSON 258828 0 46567 0 12611 0 12358 0 12367 0 342731 0 0 0 LORI P PECK 146434 0 21257 0 10269 0 6144 0 508 0 184612 0 0 0 SCOTT T BUSKERUD 262064 0 4484 0 11194 0 12358 0 21030 0 311130 0 0 0 AMY A FALKENBERG 330862 0 0 0 5908 0 12358 0 30914 0 380042 0 0 0 TROY D SENNHOLZ 317453 0 1050 0 11651 0 12358 0 25778 0 368290 0 0 0 RYAN DIEGEL 242451 0 0 0 10919 0 10603 0 20885 0 284858 0 0 0 MARGARET S YOUNG 310054 0 40000 0 2964 0 0 0 25583 0 378601 0 0 0 PART I, LINE 1A PART I, LINE 1A: TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - E. BRANSTETTER $8,061; M. YOUNG $925; A. HYLTON $1,277; S. FRAZIER $1,192; T. SENNHOLZ $1,292; T. FLANDERMEYER $3,500; A. FALKENBERG $1,163; L. PECK $1,257; - INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 4B THE ORGANIZATION SPONSORS A NONQUALIFIED TAX EQUALIZED ANNUITY PLAN COVERING EMPLOYED PHYSICIANS. PHYSICIANS ARE ELIGIBLE TO PARTICIPATE IN THE PLAN AFTER ONE YEAR OF SERVICE. PARTICIPANTS IN THE PLAN ARE IMMEDIATELY 100% VESTED. CONTRIBUTIONS TO THE PLAN: E. BRANSTETTER $21,331; T. FLANDERMEYER $11,371. A WI HEALTH & EDUCATION FACILITIES AUTHORITY 391337855 S86951160 2013-04-12 15665000 CONSTRUCT, RENOVATE, AND EQUIP FACILIITIES 0 0 0 A 16902595 16902595 2006 0 1 1 1 A 0 0 0 0 0.00000 0.01000 0.01000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 1 SUE COURTNEY MHC QUALITY DIRECTOR FAMILY MEMBER OF G. COURTNEY, BOARD MEMBER 89319 EMPLOYMENT COMPENSATION 0 UMR INC (SUBSIDIARY OF UNITED HEALTH GROUP INC) BRUCE CZECH IS THE BOARD CHAIR AND CFO OF UMR, INC. 849786 THE ORGANIZAITON CONTRACTS WITH UMR TO ADMINISTER THE SELF-INSURED HEALTH PLAN. 0 MEGAN COURTNEY MHC PHLEBOTOMISTLAB ASSIT FAMILY MEMBER OF G. COURTNEY, BOARD MEMBER 12525 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 DUANE L. ERWIN, MARITA A. HATTEM, JEANNE D. SCINTO, AND F. DEAN DANNER, JR. HAVE A BUSINESS RELATIONSHIP. THESE BOARD MEMBERS ARE EMPLOYED BY ASPIRUS, INC. AND IT'S AFFILIATES. (SEE INFORMATION RELATED TO ASPIRUS, INC. DESCRIBED IN FORM 990, PART VI, SECTION A, LINES 6 AND 7.) FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S CORPORATE MEMBERS ARE MEMORIAL MEMBER ASSOCIATION, INC. AND ASPIRUS, INC., BOTH WISCONSIN NONSTOCK CORPORATIONS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BOARD OF DIRECTORS IS ELECTED AS FOLLOWS: (A) FOUR DIRECTORS ARE APPOINTED BY MEMORIAL MEMBER ASSOCIATION. (B) FOUR DIRECTORS ARE APPOINTED BY ASPIRUS. (C) FOUR DIRECTORS ARE APPOINTED BY OR REPRESENT PHYSICIANS ASSOCIATED WITH THE CORPORATION AS FOLLOWS: (1) TWO PHYSICIAN DIRECTORS ARE PHYSICIANS EMPLOYED BY THE CORPORATION WHO ARE ELECTED BY THE PHYSICIANS EMPLOYED BY THE CORPORATION. (2) ONE PHYSICIAN DIRECTOR IS A MEMBER OF THE ACTIVE MEDICAL STAFF AND IS ELECTED BY THE MEMBERS OF THE MEDICAL STAFF OF THE CORPORATION. (3) ONE PHYSICIAN DIRECTOR IS THE CHIEF OF STAFF. THE CHIEF OF STAFF IS ELECTED BY THE MEDICAL STAFF ON AN ANNUAL BASIS, AND IS SEATED ON THE MEMORIAL HEALTH CENTER BOARD FOR HIS/HER TERM AS CHIEF OF STAFF. FORM 990, PART VI, SECTION A, LINE 7B POWERS RESERVED TO THE CORPORATE MEMBERS: IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW AND EXCEPT AS OTHERWISE PROVIDED, THE CORPORATE MEMBERS HAVE THE FOLLOWING SPECIFIC RIGHTS AND RESPONSIBILITIES: (A) INITIATE AND APPROVE ANY CHANGE IN THE PHILOSOPHY, CHARACTER, OR MISSION OF THE CORPORATION AND APPROVE THE LONG-RANGE GOALS, STRATEGIC PLANS, AND OVERALL PURPOSES. (B) INITIATE AND APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION AND ALL SUBSIDIARIES. (C) INITIATE AND APPROVE THE ADDITION OF NEW MEMBERS OF THE CORPORATION. (D) INITIATE AND APPROVE THE ESTABLISHMENT, TRANSFER AND/OR DISSOLUTION OF ANY SUBSIDIARY CORPORATIONS. (E) INITIATE AND APPROVE BORROWING OF MONEY AND OTHER FORMS OF INDEBTEDNESS IN EXCESS OF $1,000,000. (F) INITIATE AND APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, ENCUMBRANCE OR ALIENATION OF PROPERTY WITH A VALUE IN EXCESS OF $1,000,000. (G) INITIATE AND APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY, OR RELOCATION OF THE FACILITIES. (H) INITIATE AND APPROVE STRATEGIC ALLIANCES AND AFFILIATIONS OF THE CORPORATION. (I) INITIATE AND APPROVE THE DISTRIBUTION OF THE NET PROCEEDS AND ASSETS OF THE CORPORATION IN THE EVENT OF DISSOLUTION. (J) APPROVE THE SELECTION OF THE CEO OF THIS CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 WAS PRESENTED BY THE CFO TO THE FULL BOARD WHO REVIEWED VARIOUS AREAS OF INTEREST AND ASKED ANY QUESTIONS. ANY CHANGES IDENTIFIED DURING THIS REVIEW WERE MADE PRIOR TO FILING THE FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER AND EMPLOYEE SHALL DISCLOSE TO THE APPROPRIATE LEVEL OF MANAGEMENT ANY CIRCUMSTANCE UNDER WHICH THE BOARD MEMBER, EMPLOYEE, OR AN IMMEDIATE FAMILY MEMBER, BY VIRTUE OF A FINANCIAL INTEREST, MAY BE INFLUENCED, OR MAY APPEAR TO BE INFLUENCED, EITHER IN WHOLE OR IN PART, BY ANY PURPOSE OR MOTIVE OTHER THAN THE SUCCESS AND WELL BEING OF THE ORGANIZATION AND ITS SUBSIDIARIES AND THE ACHIEVEMENT OF ITS PUBLIC CHARITABLE PURPOSES. PRIOR TO ENTERING INTO ANY ARRANGEMENT WITH AN OUTSIDE ORGANIZATION, INDIVIDUALS MUST DISCLOSE POTENTIAL CONFLICTS OF INTEREST TO THEIR RESPECTIVE SUPERVISOR; BOARD MEMBERS TO THE BOARD PRESIDENT. EACH CIRCUMSTANCE OF A POTENTIAL CONFLICT OF INTEREST WILL BE REVIEWED ON AN INDIVIDUAL BASIS. THE MANAGER WILL RESPOND IN WRITING (WITH A COPY TO THE PERSONNEL FILE) AFTER CONSULTATION WITH THE APPROPRIATE VICE PRESIDENT AS TO WHETHER THE ARRANGEMENT IS OR IS NOT ACCEPTABLE. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT/CEO'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE USING APPROPRIATE COMPARABILITY DATA FROM REGIONAL, STATE, AND NATIONAL SOURCES WITH AN INDEPENDENT EXTERNAL CONSULTANT REVIEW EVERY THREE YEARS. THE REVIEW AND APPROVAL OF PRESIDENT/CEO COMPENSATION IS SUBSTANTIATED THROUGH MEETING MINUTES AND THE ORGANIZATION'S WRITTEN MARKET ANALYSIS POLICY. OTHER OFFICER AND KEY EMPLOYEE COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE USING APPROPRIATE COMPARABILITY DATA FROM REGIONAL, STATE, AND NATIONAL SOURCES WITH AN INDEPENDENT EXTERNAL CONSULTANT REVIEW. THE REVIEW AND APPROVAL OF COMPENSATION IS SUBSTANTIATED THROUGH MEETING MINUTES AND THE ORGANIZATION'S WRITTEN MARKET ANALYSIS POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. EXPLANATION OF HOURS WORKED: FORM 990, PART VII, SECTION A SOME OFFICERS AND DIRECTORS ALSO PROVIDED SERVICE TO OTHER RELATED ORGANIZATIONS OTHER THAN MEMORIAL HEALTH CENTER, INC. THESE HOURS ARE REFLECTED IN LINE 2 OF COLUMN B. OTHER FEES FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 29,677. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,677. CONTRACTED/PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,270,262. MANAGEMENT AND GENERAL EXPENSES 1,319,119. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,589,381. CUSTOMER RELATIONS: PROGRAM SERVICE EXPENSES 7,957. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,957. PHARMACY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 323,953. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 323,953. LAB PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 518,411. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 518,411. LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,599. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,599. MEDICAL FEES: PROGRAM SERVICE EXPENSES 2,299,302. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,299,302. COLLECTION EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 140,123. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,123. RECRUITMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 123,823. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,823. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: BOND SWAP VALUATION ADJUSTMENT: 914,185. CHANGE IN INTEREST IN NET ASSETS OF MHC FOUNDATION, INC. 64,917. EFFECTIVE RATE OF INTEREST RATE SWAP -615,406. FORM 990, PART XII, LINE 2C MEMORIAL HEALTH CENTER'S BOARD OF DIRECTORS PROVIDE OVERSIGHT OF THE INDEPENDENT ACCOUNTANTS AND THE MEMBERS OF THE BOARD MEET WITH THE ACCOUNTANT BOTH PRIOR TO YEAR-END AND AFTER YEAR-END TO DISCUSS THE AUDIT AND OTHER MATTERS. MEMORIAL HEALTH CENTER ALSO IS PROVIDED ADDITIONAL OVERSIGHT OF ITS AUDIT PROCESS AND SELECTION OF THE INDEPENDENT ACCOUNTANT THROUGH THE AUDIT COMMITTEE OF ASPIRUS, INC. THERE WERE NO CHANGES TO THIS PROCESS DURING THE YEAR ENDED JUNE 30, 2013. MEMORIAL HEALTH CENTER FOUNDATION INC 135 SOUTH GIBSON STREET MEDFORD WI 54451 391777081 CHARITABLE FOUNDATION WI 501(C)(3) LINE 11C, III-FI MEMORIAL MEMBER ASSOCIATION INC 0 MEMORIAL MEMBER ASSOCIATION INC 135 SOUTH GIBSON STREET MEDFORD WI 54451 392016506 MEMBER ASSOCIATION WI 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 1 0 0 0 0 0 0 1 1 1 0 1 1 0 0 MEMORIAL HEALTH CENTER FOUNDATION INC C 76981 CASH RECEIVED