2012-08-13T14:32:16-05:00 2011-09-30 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021919 990 2010-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 LES WHITEAKER 7156855515 2012-08-09 1 MARY BETH SANTORI 2187278253 2010 2016-02-24 21:20:13Z LES WHITEAKER 1615 MAPLE LANE ASHLAND WI 54806 58126765 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 15 14 424 156 0 0 71271 45164 57047294 57638141 426212 334471 107245 96013 57652022 58113789 0 0 0 0 27959742 28692078 0 0 0 22979667 23872840 50939409 52564918 6712613 5548871 62117336 69319088 12626394 14667319 49490942 54651769 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 44412462 57734154 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. 44412462 1 1 0 0 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 1 0 0 0 1 52 0 1 424 1 1 1 0 0 0 0 0 0 0 0 0 X 15 14 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 DANIEL HYMANS 40.00 X X 260314 0 59177 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 KATHY GANG MD 1.00 X 16233 0 0 BARBARA BARRY 1.00 X 0 0 0 THOMAS JOKINEN 1.00 X 0 0 0 CHRIS 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 F DANIEL ROCHMAN MD 1.00 X 0 0 0 DANIEL H ADAMS 40.00 X 174245 0 54807 LESLIE J WHITEAKER 40.00 X 185670 0 46571 DANIEL GARDNER 40.00 X 119823 0 36877 WILLIAM MATTILA 40.00 X 132114 0 46701 PATRICK MARSHALL 40.00 X 114850 0 33937 KATHRYN TUTTLE 40.00 X 108722 0 39744 STUART SHEETS 40.00 X 180761 0 27474 1292732 0 345288 8 0 1 0 SUPERIOR ANESTHESIA ASSOCIATES 301 ELLIS AVENUE SUITE 3 ASHLAND WI 54806 ANESTHESIA SERVICES 1236855 JAMES LEAN MD 1615 MAPLE LANE ASHLAND WI 54806 PSYCH PROF FEES 308406 ESSENTIA HEALTH - ASHLAND 1615 MAPLE LANE ASHLAND WI 54806 ER ON-CALL SERVICES 307407 LAKE SUPERIOR LAUNDRY 1701 NORTH 6TH STREET SUPERIOR WI 54880 LAUNDRY SERVICE 168481 KEITH HENRY 1615 MAPLE LANE ASHLAND WI 54806 PATHOLOGY FEES 130000 5 25064 20100 45164 PATIENT SERV REV 621500 56529624 56529624 MEDICAID EHR INCENTIVE 524114 890477 890477 CAFETERIA 722210 207238 207238 OTHER OPERATING REVENU 900099 25302 25302 HEALTHY FAMILIES PROGR 624100 -14500 -14500 57638141 295549 295549 96013 96013 96013 96013 51898 12976 51898 -12976 38922 38922 58113789 57734154 0 334471 797017 16233 780784 20926693 18542955 2383738 830193 786782 43411 4539593 3815460 724133 1598582 1374361 224221 1311872 1311872 97239 82158 15081 2973015 2511921 461094 177384 177384 OTHER PROFESSIONAL SERV 7380968 7380968 NURSING SUPPLIES & OTHE 5059400 5059400 PROVISION FOR BAD DEBTS 3259784 3259784 CONSULTING 1639225 1639225 GENERAL SERVICES SUPPLI 1582440 1582440 391513 391513 52564918 44412462 8152456 0 21424633 30871949 8134870 7608828 2962990 4364078 2085670 2016087 187293 195212 60824749 38195439 19463263 22629310 7341508 613496 517109 1020128 62117336 69319088 5684944 6354089 4691450 6533230 2250000 1780000 12626394 14667319 X 49490942 54651769 49490942 54651769 62117336 69319088 X 5548871 -388044 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 127376 127376 21168279 14951145 6217134 31457594 20981373 10476221 8071500 2262921 5808579 22629310 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1780000 1780000 58113789 52564918 5548871 -388044 -388044 5160827 57725745 -388044 -388044 58113789 0 58113789 52564918 0 52564918 0 52564918 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. 1 1 1 X 1 X 1 1 0 1 1 569150 569150 0.01150 10566920 7427453 3139467 0.06370 20609282 18905077 1704205 0.03460 31745352 26332530 5412822 0.10980 17329 7091 10238 0.00020 5971 5971 0.00010 10628437 8549216 2079221 0.04220 10651737 8556307 2095430 0.04250 42397089 34888837 7508252 0.15230 1 3259784 0 16414445 16478179 -63734 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 2011 MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE LABOR & DELIVERY, OBSERVATION BEDS, BLOOD STORING, PHYSICAL THERAPY, IMPLANTABLE DEVICES CHARGED TO PATIENTS, PSYCHIATRIC/PSYCHOLOGICAL SERVICES, CARDIAC REHAB, AND EMERGENCY. PART I, L7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $3,259,784. 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 SHORTFALL REPORTED IS FROM THE PSYCH PROGRAM. IF THIS SERVICE WAS NOT PROVIDED BY THE HOSPITAL, THE NEED FOR THIS SERVICE WOULD NOT BE MET IN THE COMMUNITY. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $459,350 AND ALLOWABLE COSTS OF $1,147,252 RESULTING IN A SHORTFALL OF $687,901. 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 I, LINE 6A: THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT. 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 AND 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 6: 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 7: 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 260314 0 0 0 0 0 33868 0 25309 0 319491 0 0 0 DANIEL H ADAMS 174245 0 0 0 0 0 29660 0 25147 0 229052 0 0 0 LESLIE J WHITEAKER 185670 0 0 0 0 0 21421 0 25150 0 232241 0 0 0 DANIEL GARDNER 119823 0 0 0 0 0 13282 0 23595 0 156700 0 0 0 WILLIAM MATTILA 132114 0 0 0 0 0 18604 0 28097 0 178815 0 0 0 STUART SHEETS 180761 0 0 0 0 0 22000 0 5474 0 208235 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 FORMS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -388,044. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. MEDICAL SERVICES INC 11040 N STATE ROAD 77 HAYWARD WI 54843 391536207 HEALTH CARE WI 501(C)(3) 170(B)(1)(A)(III) REGIONAL ENTERPRISES INC 1 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) 509(A)(3) N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) 509(A)(3) REGIONAL ENTERPRISES INC 1 TAMARACK PROFESSIONAL GROUP INC 1615 MAPLE LANE ASHLAND WI 54806 391198085 HEALTH CARE WI 501(C)(3) 509(A)(3) REGIONAL ENTERPRISES INC 1 MMC DEVELOPMENT CORP INC 1615 MAPLE LANE ASHLAND WI 54806 391360035 SUPPORT WI 501(C)(3) 170(B)(1)(A)(VI) 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 1854592 VALUE OF SERVICES TAMARACK PROFESSIONAL GROUP L 1647136 VALUE OF SERVICES MEDICAL SERVICES K 345499 VALUE OF SERVICES REGIONAL ENTERPRISES INC Q 326058 CASH