2012-05-11T08:23:58-05:00 2011-06-30 WIPLFLI LLP 3703 OAKWOOD HILLS PARKWAY EAU CLAIRE WI 54702 990 2010-07-01 390831153 CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT INC CUMB 7158222741 1110 7TH AVENUE CUMBERLAND WI 54829 ANGIE MARTENS 7158222741 2012-05-10 1 HOLLY POKRANDT CPA 7158323407 2012-05-10 2010 2016-02-24 21:20:13Z ANGIE MARTENS 1110 7TH AVENUE CUMBERLAND WI 54829 20116922 0 X WWW.CUMBERLANDHEALTHCARE.COM X 1955 WI CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. IS COMMITTED TO CREATING A HEALTHIER COMMUNITY THROUGH PROVIDING AN ARRAY OF HIGH-QUALITY ACUTE CARE, AMBULATORY, AND SKILLED NURSING FACILITY SERVICES TO RESIDENTS OF THE SERVICE AREA. 7 4 299 127 0 0 148581 91978 19770180 19963622 70279 36229 0 0 19989040 20091829 5018 1368 0 0 12407206 13147355 0 0 0 7075566 7247443 19487790 20396166 501250 -304337 16586783 16282101 6379899 6379554 10206884 9902547 X THE PRIMARY FUNCTION OF CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. (CMH-ECU) IS THE PROVISION OF HIGH QUALITY COMMUNITY-BASED HEALTH CARE TO ALL PEOPLE WITHOUT REGARD TO DISABILITY, RACE, CREED, COLOR, NATIONAL ORIGIN OR ABILITY TO PAY. QUALITY CARE ENCOMPASSES CURATIVE, RESTORATIVE, SUPPORTIVE AND PREVENTATIVE ASPECTS. IN PROVIDING THIS CARE, THE RIGHTS, DIGNITY AND PRIVACY OF THE PATIENT/RESIDENT WILL BE HELD IN HIGHEST REGARD. QUALITY HEALTH CARE CAN BEST BE PROVIDED BY FOSTERING A QUALITY WORK ENVIRONMENT TO ATTRACT AND RETAIN COMPETENT AND CARING EMPLOYEES. CMH-ECU ACCEPTS A LEADERSHIP ROLE IN THE COMMUNITY IN ASSESSING NEEDS, INSTITUTING CHANGES TO MEET THOSE NEEDS, AND PLANNING WITH OTHER AGENCIES FOR CONTINUITY AND COMPREHENSIVE HEALTH CARE IN A COST EFFECTIVE MANNER. 0 0 14669368 17300208 CUMBERLAND MEMORIAL HOSPITAL-EXTENDED CARE UNIT, INC. IS AN INDEPENDENT, NONPROFIT, COMMUNITY-BASED FACILITY THAT SERVES NORTHWEST WISCONSIN. CUMBERLAND MEMORIAL HOSPITAL BECAME A CRITICAL ACCESS HOSPITAL ON AUGUST 19, 2005, LICENSED FOR 25 ACUTE CARE BEDS (INCLUDING 3 IN THE BIRTHPLACE), AND 10 PSYCHIATRIC BEDS. AMONG THE MANY KINDS OF SERVICES PROVIDED ARE SURGERY, RADIOLOGY, LABORATORY, EMERGENCY ROOM, BEHAVIORAL HEALTH, THERAPY, AND NURSERY. ACUTE CARE DAYS TOTALED 1,763 IN 2011, SWING BED DAYS TOTALED 1,079, NEWBORN DAYS TOTALED 129, AND BEHAVIORAL HEALTH DAYS TOTALED 1,896. DURING FISCAL YEAR 2011, CUMBERLAND MEMORIAL HOSPITAL PROVIDED 63 INPATIENT AND 392 OUTPATIENT SURGERIES ALONG WITH 247 SCOPE PROCEDURES. THERE WERE ALSO 2,796 EMERGENCY ROOM VISITS. 3188940 2492905 CUMBERLAND EXTENDED CARE UNIT, A 50 BED SKILLED NURSING HOME, IS DEDICATED TO MEETING THE PHYSICAL, MENTAL, EMOTIONAL, AND SPIRITUAL NEEDS OF THE RESIDENTS AND FAMILIES SERVED. TOTAL NURSING HOME DAYS IN FISCAL YEAR 2011 WERE 15,683. 131510 170509 THE LAKEWOOD REGENCY APARTMENTS ARE ATTACHED TO THE CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT. THESE SPACIOUS APARTMENTS WERE DESIGNED AS A COMFORTABLE AND CONVENIENT LIVING CHOICE FOR SENIORS KEEPING SOCIAL INTEREST AND PERSONAL SAFETY IN MIND. THE OCCUPANCY PERCENTAGE FOR 2011 WAS APPROXIMATELY 85%. 17989818 1 1 0 1 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 299 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ANGIE MARTENS 7158222741 1110 7TH AVENUE CUMBERLAND WI 54829 CHARLES CHRISTENSEN 2.00 X X 2925 0 0 TOM LINGEN MD 1.00 X 2625 0 0 RAY HALL 1.00 X 2925 0 0 CANDY COTONE 1.00 X X 2925 0 0 ANN HENDRICKS 1.00 X X 0 0 0 JOSEPH LESCHISIN 1.00 X 0 0 0 MATT GORES 1.00 X 0 0 0 MARTIN PETERS 1.00 X X 2850 0 0 DEB KUNFERMAN 40.00 X 233086 0 8195 MARY ANN CLARK 40.00 X 112933 0 16649 ANGIE MARTENS 40.00 X 75227 0 3287 DR CHARLES MAYO II 40.00 X 239250 0 44729 RICHARD NERBUN 40.00 X 114464 0 32784 JEFFREY KUEHN 40.00 X 199845 0 34951 DONALD FULLERTON 40.00 X 185384 0 41177 LAURIE POLUBINSKY 40.00 X 241914 0 11000 1416353 0 192772 8 0 1 0 CUMBERLAND CLINIC 1475 WEBB STREET CUMBERLAND WI 54829 ER PHYSICIANS 644837 ABM JANITORIAL SERVICES 75 REMITTANCE DRIVE SUITE 3011 CHICAGO IL 606753011 HOUSEKEEPING 217088 SHARED MEDICAL 2020 W NEWTON ST RICE LAKE WI 54868 RADIOLOGY 204557 DMS IMAGING 11600 96TH AVENUE NORTH MAPLE GROVE MN 55369 MRI 158749 UNIVERSAL HOSPITAL SERVICES 7700 FRANCE AVE SOUTH 275 EDINA MN 55435 RADIOLOGY 156041 7 5263 86715 91978 HOSPITAL REVENUE 621990 17300208 17300208 NURSING HOME REVENUE 623000 2492905 2492905 APARTMENT REVENUE 623990 170509 170509 19963622 32636 32636 9899 9899 18787 25093 -6306 -6306 -6306 20091829 19963622 0 36229 1368 1368 720112 276738 443374 9245177 8846798 398379 220191 213787 6404 2289804 2102271 187533 672071 616276 55795 24728 24728 76777 76777 1904467 1874397 30070 118539 118539 1903672 1686651 217021 101739 101739 564790 564790 977170 977170 102765 102765 PROVISION FOR BAD DEBTS 671702 671702 REPAIRS & MAINTENACE 350386 309380 41006 MEDICAID ASSESSMENTS 290101 290101 DUES, SUBSCRIPTIONS, & 113001 86319 26682 EQUIPMENT RENT & LEASES 47606 36860 10746 20396166 17989818 2406348 0 692691 443379 4413368 4951837 2911908 2980767 351724 338989 52675 67059 19168493 11754881 7778706 7413612 0 385711 86458 16586783 16282101 1544899 1889554 4835000 4490000 6379899 6379554 X 10206884 9902547 10206884 9902547 16586783 16282101 -304337 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1700 1700 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: CUMBERLAND MEMORIAL HOSPITAL, INC. PAYS AN ANNUAL ASSOCIATION MEMBERSHIP TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. WHA HAS NOTIFIED CMH THAT APPROXIMATELY $1,700 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. 295897 295897 11460025 6334799 5125226 7412571 5420082 1992489 7413612 20091829 20396166 -304337 0 -304337 20115988 24159 24159 20091829 0 20091829 20420325 24159 24159 20396166 0 20396166 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FACILITY IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE FACILITY IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE FACILITY 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 FACILITY'S POLICY IS TO RECOGNIZE INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED JUNE 30, 2011 AND 2010, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE FACILITY IN THE FINANCIAL STATEMENTS. THE FACILITY RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2011 OR 2010. FEDERAL RETURNS FOR THE YEARS ENDED JUNE 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIETARY REVENUE NETTED AGAINST DIETARY EXPENSES 24,159. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIETARY EXPENSES NETTED AGAINST DIETARY REVENUE 24,159. 1 1 1 X 1 X 150.000000000000 1 1 1 0 1 1 180950 180950 0.00920 4301748 4120662 181086 0.00920 4482698 4120662 362036 0.01840 142700 142700 0.00720 16500 16500 0.00080 7000 7000 0.00040 166200 166200 0.00840 4648898 4120662 528236 0.02680 0 399732 31979 5459281 5608615 -149334 X 1 1 1 1 CUMBERLAND MEMORIAL HOSPITAL INC

1110 7TH AVENUE CUMBERLAND WI 54829

X X X X NA 1 2 CUMBERLAND EXTENDED CARE UNIT

1110 7TH AVENEUE CUMBERLAND WI 54829

SKILLED NURSING FACILITY LAKEWOOD REGENCY APARTMENTS

1110 7TH AVENEUE CUMBERLAND WI 54829

SENIOR LIVING APARTMENTS PART I, LINE 7: THE COSTING METHOD USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICES 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, COL. F: THE CALCULATED PERCENT OF TOTAL EXPENSES EXCLUDES BAD DEBT EXPENSE TOTALING $671,702. PART II: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S 'COMMUNITY BENEFIT,' THIS IS A WORK IN PROGRESS. OUR HOSPITAL PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, WE BELIEVE THAT WE PROVIDE A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. OUR HOSPITAL, LIKE MOST RURAL HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY - CARE THAT WITHOUT OUR HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY.BEYOND INPATIENT HOSPITALIZATIONS, WE PROVIDE LOCAL ACCESS TO MANY HEALTH SERVICES: PSYCHIATRIC SERVICES, AMBULANCE SERVICES, BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES & URGENT CARE, EXTENDED CARE, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH, AND SURGICAL SERVICES. PART III, LINE 4: THE COSTING METHOD USED IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS DIVIDED BY GROSS PATIENT SERVICE REVENUE. THE COST OF BAD DEBT AMOUNTS IS CONSIDERED A COMMUNITY BENEFIT BECAUSE IT REFLECTS THE COST OF SERVICES PROVIDED TO UNINSURED COMMUNITY MEMBERS AND DEDUCTIBLES OR COINSURANCE AMOUNTS FOR INSURED PATIENTS WHO ARE UNABLE TO PAY FOR A PORTION OF SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS. THE FACILITY BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYOR, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON PATIENT ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT. THE FACILITY DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS. THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO THE PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, 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 PATIENT ACCOUNTS RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE. PART III, LINE 8: THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT EXPENSE BECAUSE SERVICES PROVIDED TO MEDICARE BENEFICIARIES ARE TYPICALLY PROVIDED TO ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, 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 SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE COST-TO-CHARGE RATIOS USED TO CALCULATE THE COST OF MEDICARE SERVICES WERE TAKEN FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE PATIENT IS ASKED TO FILL OUT A CHARITY CARE APPLICATION DURING THE COLLECTION PROCESS PRIOR TO SENDING TO A COLLECTION AGENCY. IF THE PAPERWORK IS NOT RECEIVED THE ACCOUNT IS HANDLED THROUGH THE NORMAL COLLECTION PROCESS. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITY THROUGH SURVEYS AND BY RECOGNIZING WHY CERTAIN PATIENTS ARE REFERRED OUT OF THE AREA. THE ORGANIZATION THEN ATTEMPTS TO GET SPECIALISTS IN THE IDENTIFIED AREAS INTO THE FACILITY TO SEE PATIENTS AND MEET THEIR NEEDS. THE ORGANIZATION IS ALSO PARTICIPATING IN A COUNTY-WIDE HEALTHCARE NEEDS ASSESSMENT PROGRAM AND PLANS TO USE THE INFORMATION FROM THIS PROGRAM IN THE FUTURE TO MEET THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: IF A PATIENT IS IDENTIFIED AS UNINSURED, HOSPITAL STAFF WORKS WITH THE PATIENT OR THEIR FAMILY TO DETERMINE IF THEY ARE ELIGIBLE FOR ANY TYPE OF GOVERNMENT PROGRAM OR QUALIFY FOR THE HOSPITAL'S CHARITY CARE PROGRAM. PART VI, LINE 4: THE ORGANIZATION SERVES THE COMMUNITIES OF CUMBERLAND, WI AND ALMENA, WI AND SURROUNDING COMMUNITIES WITHIN A 20 MILE RADIUS. APPROXIMATELY 11.9% OF THE PERSONS RESIDING IN THE COMMUNITY LIVE BELOW POVERTY LEVEL. THE MEDIAN HOUSEHOLD INCOME IS $42,601. PERSONS 65 YEARS OR OLDER MAKE UP 18.2% OF THE POPULATION AND PERSONS UNDER AGE 18 MAKE UP 22.1% OF THE POPULATION. PART VI, LINE 6: A MAJORITY OF OUR ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. OUR ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. WE ALSO PARTICIPATE IN COMMUNITY HEALTH FAIRS AND PROVIDE SERVICE AT SPORTING EVENTS. THE ORGANIZATION ALSO PROVIDES AMBULANCE AND EMERGENCY MEDICAL TECHNICIAN COVERAGE AT COMMUNITY EVENTS, PARTICIPATES IN THE BARRON COUNTY FREE CLINIC, AND SPONSORS A WOMEN'S EXPO EACH YEAR. SURPLUS FUNDS ARE INVESTED BACK INTO THE FACILITY AND ITS EQUIPMENT TO ENSURE THE NEEDED SERVICES ARE CONTINUED TO BE PROVIDED IN THIS COMMUNITY. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X X 0 0 0 0 0 0 0 0 0 DEB KUNFERMAN 183086 0 50000 0 0 0 7000 0 1195 0 241281 0 0 0 DR CHARLES MAYO II 239250 0 0 0 0 0 7459 0 37270 0 283979 0 0 0 JEFFREY KUEHN 199845 0 0 0 0 0 8208 0 26743 0 234796 0 0 0 DONALD FULLERTON 185384 0 0 0 0 0 5787 0 35390 0 226561 0 0 0 LAURIE POLUBINSKY 241914 0 0 0 0 0 0 0 11000 0 252914 0 0 0 CITY OF CUMBERLAND 396005423 230849FE6 2008-10-23 5166566 REMODELING PROJECT 0 0 0 2021303 5166566 517000 103400 2524863 2009 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER REVIEWED THE RETURN. THE BOARD MEMBERS OF CUMBERLAND MEMORIAL HOSPITAL AND EXTENDED CARE UNIT, INC. WERE THEN NOTIFIED WHEN FORM 990 WAS AVAILABLE FOR REVIEW AND GIVEN AN OPPORTUNITY TO COMMENT BEFORE SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT,INC. REQUIRES ITS BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. OFFICERS AND KEY EMPLOYEES OF CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. SIGN A CODE OF CONDUCT STATEMENT. IN THE CODE OF CONDUCT STATEMENT IT MENTIONS THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 EFFECTIVE JULY 1, 2008, WAGE SCALES WERE SET FOR ALL NON-UNION EMPLOYEES. THESE SCALES WOULD INCLUDE ALL HIGHLY COMPENSATED EMPLOYEES. THE SCALES WERE SET BASED ON AN AREA SURVEY OF 6 OTHER HEALTHCARE FACILITIES. IT WAS THE GOAL OF THE CUMBERLAND MEMORIAL HOSPITAL-EXTENDED CARE UNIT, INC. TO SET SCALES THAT RAN AT ABOUT THE MIDLEVEL OF ALL FACILITIES SURVEYED FOR MOST POSITIONS. THESE SCALES ARE EVALUATED ON A YEARLY BASIS USING THE SALARY SURVEY TOOL AVAILABLE THROUGH THE ST. CROIX VALLEY EMPLOYER'S ASSOCIATION. THE ONLY TIME AN EMPLOYEE HOURLY WAGE MAY EXIST OUTSIDE OF THE SCALE IS IF THE EMPLOYEE IS AT THE TOP OF THE SCALE YET THEIR MERIT INCREASE OF UP TO 1% FOR THE YEAR BRINGS THEM TO A WAGE OUTSIDE OF THE SCALE. THE CEO, OFFICERS AND KEY EMPLOYEE'S SALARY ARE APPROVED BY THE BOARD OF DIRECTORS (THOSE WITHOUT CONFLICT) ANNUALLY AND THE CEO APPROVES ALL OTHER EMPLOYEES' SALARIES ANNUALLY ALSO. DOCUMENTATION IS MAINTAINED IN PERSONNEL FILES. FORM 990, PART VI, SECTION C, LINE 18 CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES ITS FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OVERSIGHT OF THE AUDIT AND INDEPENDENT ACCOUNTANT FORM 990, PART XI, LINE 2C CUMBERLAND MEMORIAL HOSPITAL & EXTENDED CARE UNIT INC.'S ENTIRE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE BOARD OF DIRECTORS ANNUALLY AND ANY QUESTIONS OR CONCERNS REGARDING THEM ARE ADDRESSED BY THE INDEPENDENT ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.