2011-08-14T00:11:40-05:00 2010-12-31 DELOITTE TAX LLP 555 EAST WELLS STREET SUITE 1400 MILWAUKEE WI 53202 990 2010-01-01 390806367 MERITER HOSPITAL INC MERI 6084176000 202 SOUTH PARK STREET MADISON WI 537151596 KEVIN BOREN 6084176210 2011-08-13 1 4142713000 2010 2016-02-24 21:20:13Z JAMES WOODWARD 202 SOUTH PARK STREET MADISON WI 537151596 525868083 0 X WWW.MERITER.COM X 1898 WI MERITER HOSPITAL IS A NOT FOR PROFIT, LOCALLY GOVERNED COMMUNITY HOSPITAL. MERITER HOSPITAL PROVIDES A COMPREHENSIVE ARRAY OF PATIENT-FOCUSED INPATIENT AND OUTPATIENT SERVICES TO MEET THE HEALTH-RELATED NEEDS OF OUR COMMUNITY. 19 15 3127 656 143637 50950 319481 508463 354537707 355327823 6127584 10087792 4586399 5145114 365571171 371069192 85531 134143 0 0 171814356 176990665 0 0 922541 158394668 158317004 330294555 335441812 35276616 35627380 490600734 527282205 236982819 230538522 253617915 296743683 X MERITER HOSPITAL IS DEDICATED TO PROVIDING EXCEPTIONAL HEALTH CARE AND LIVING BY ITS MISSION TO HEAL, TEACH AND SERVE. 1 0 301248782 134143 358514548 MERITER HOSPITAL IS A 448-BED COMMUNITY HOSPITAL THAT WAS RECOGNIZED IN 2010 AS A THOMPSON REUTER 100 TOP HOSPITALS AND PATIENTS RATED IN THE TOP 10 PERCENT IN THE NATION IN TERMS OF THEIR OVERALL HOSPITAL RATING AND WILLINGNESS TO RECOMMEND TO FAMILY AND FRIENDS. THIS YEAR MERITER DEDICATED SIGNIFICANT TIME AND RESOURCES TO IMPLEMENT AN ELECTRONIC MEDICAL RECORD SYSTEM INCLUDING MYCHART, MERITER CARE AND CARE EVERYWHERE IN FURTHER EFFORTS TO IMPROVE PATIENT SAFETY, QUALITY CARE AND OPERATIONAL EFFICIENCY. AS WISCONSIN'S FIFTH LARGEST HOSPITAL, MERITER HOSPITAL SERVES THE COMMUNITY BY PROVIDING A COMPREHENSIVE ARRAY OF SERVICES AND IS PROUD TO DELIVER MORE BABIES THAN ANY OTHER HOSPITAL IN THE STATE; TO RECEIVE CYCLE III ACCREDITATION FROM THE SOCIETY OF CHEST PAIN CENTERS; BE AWARDED A THREE-YEAR ACCREDITATION IN COMPUTED TOMOGRAPHY (CT). MERITER MEDICAL STAFF PROVIDES PATIENTS WITH THE GREATEST CHOICE OF HEALTH CARE PROVIDERS INCLUDING MERITER MEDICAL GROUP, UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION PHYSICIANS AND CERTIFIED NURSE-MIDWIVES AND WIDE ARRAY OF INDEPENDENT MEDICAL PROVIDERS. MERITER PROVIDES SOLUTIONS TO MANY HEALTH CARE NEEDS SUCH AS THE REGION'S ONLY HOSPITAL-BASED DENTAL CLINIC, CHILD AND ADOLESCENT PSYCHIATRY SERVICES, SEXUAL ASSAULT NURSE EXAMINER (SANE) SERVICES; AND SUPPORT TO NEW FAMILIES THROUGH THE BREASTFEEDING HELP LINE AND MOTHER-BABY HOUR, A FREE EDUCATIONAL SUPPORT PROGRAM. 301248782 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 X 145 0 1 3127 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X LINDA HOFF 6084175811 202 SOUTH PARK STREET MADISON WI 53715 X JAMES WOODWARD 10.00 X X 70823 637413 43986 LONDA DEWEY 6.00 X X 12500 12500 0 GARY WOLTER 6.00 X X 0 0 0 DAVE BOYER 6.00 X X 0 0 0 PHIL BLAKE 4.00 X 0 0 0 BRADLEY MANNING MD 4.00 X 0 0 0 HOLLY CREMER-BERKENSTADT 4.00 X 0 0 0 PAUL PEERCY PHD 4.00 X 0 0 0 PAT RICHTER 4.00 X 0 0 0 CATHERINE DURHAM 4.00 X 0 0 0 DAVE ANDERSON 4.00 X 0 0 0 JOAN BURKE 4.00 X 0 0 0 KLAUS DIEM MD 4.00 X 0 0 0 VIRGINIA GRAVES 4.00 X 0 0 0 GEORGE KAMPERSCHROER 4.00 X 0 0 0 RICH LYNCH 4.00 X 0 0 0 LAURENCE ROTHSTEIN MD 4.00 X 0 0 0 JULIE SCHURR MD 4.00 X 0 0 0 EILEEN MERSHART 4.00 X 0 0 0 MICHEAL GOLDROSEN MD 4.00 X 0 0 0 BARBARA SWAN 4.00 X 0 0 0 SUSAN TOTH MD 4.00 X 0 0 0 LYNNE MYERS 35.00 X 0 381455 28773 LINDA HOFF 30.00 X 0 454921 38835 TIMOTHY RIDDLE 35.00 X 166093 0 1968 KEVIN BOREN 30.00 X 0 129638 5309 GEOFFREY R PRIEST MD 40.00 X 0 413572 46792 KERRA GUFFEY 35.00 X 0 315059 30142 TIMOTHY PRINCE 25.00 X 0 220052 146861 SUE ERICKSON 25.00 X 0 207292 43782 PATRICIA GRUNWALD 35.00 X 0 282935 43004 BRUCE SLATER 40.00 X 0 232380 7599 MARY M NICK 40.00 X 0 279288 22589 MARGO FRANCISCO 40.00 X 0 205066 9324 KEVIN SNITCHLER 40.00 X 0 204349 22194 LOUIS S BRYSH 40.00 X 248137 0 35896 TIM SIO X 0 154543 10265 MILES MEYER X 0 132922 25310 497553 4263385 562629 89 1 1 0 JH FINDORFF AND SON INC 300 SOUTH BEDFORD STREET MADISON WI 53703 CONSTRUCTION 17036435 UNIVERSITY OF WISCONSIN HOSPITAL AND CLI 750 HIGHLAND AVENUE MADISON WI 53278 INTERNS, RESIDENTS, MED-FLIGHTS, TEACHIN 4895214 EPIC 1979 MILKY WAY LANE VERONA WI 53593 INFORMATION SYSTEMS 2280868 UNIVERSITY OF WISCONSIN 600 HIGHLAND AVENUE MADISON WI 53278 INTERNS AND RESIDENTS 1980450 UW MEDICAL FOUNDATION 1685 HIGHLAND AVENUE MADISON WI 53278 INTERNS AND RESIDENTS 1709057 62 508463 508463 PATIENT SERVICE REVENU 621400 348224299 348224299 MNGT CONTRACT REV 621110 2085733 2085733 CAFETERIA REVENUE 722210 1098016 1591 1096425 CHILD CARE REVENUE 624410 854643 854643 PARKING REVENUE 722210 843106 843106 2222026 1195153 90865 936008 355327823 8209950 6133 8203817 2567459 2553866 13593 13593 45048 -31455 152888952 983150 151072806 921454 1816146 61696 1877842 1877842 461117 250765 210352 210352 INCOME FROM UNCONSOLID 900099 4921169 4921169 4921169 371069192 358514548 143637 11902544 106143 106143 28000 28000 497553 235730 261823 136811282 132218492 4592790 6493005 6274840 218165 23118183 22341412 776771 10070642 9732268 338374 15829408 318499 15510909 322336 322336 10329135 10027509 301626 288548 279488 9060 1141517 840370 301147 10375617 10049823 325794 147780 143140 4640 5795618 5795618 896141 896141 23179380 22451547 727833 1008491 976824 31667 SUPPLIES 48105036 46594538 1510498 STATE REVENUE ASSESSMEN 11323919 11323919 TEST FEES 10650490 10650490 BAD DEBTS PROVISION 5846551 5662969 183582 EQUIPMENT RENTAL AND MA 5403363 5233697 169666 7673674 5759084 1888190 26400 335441812 301248782 33270489 922541 2223091 107505 30801641 25992088 36008720 39510233 33617194 56307170 3743260 3317243 2801880 3350287 436716044 243339682 175190475 193376362 176615234 171865494 29599239 33455823 490600734 527282205 45136603 37084997 6041 167426862 173166910 4337407 4052091 20075906 16234524 236982819 230538522 X 246308252 290773794 7036661 5666887 273002 303002 253617915 296743683 490600734 527282205 X 35627380 7498388 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 13431 0 1 18641 32072 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE AMOUNT ON LINE I IS A PORTION OF ANNUAL MEMBERSHIP DUES PAID TO THE WHA AND AHA ATTRIBUTABLE TO LOBBYING. WHA - $7,346 AHA - $11,294 4900484 4900484 219841521 109569261 110272260 585405 135017 450388 184993922 133635404 51358518 26394712 26394712 193376362 INVESTMENT IN JOINT VENTURES 20873969 OTHER LONG-TERM ASSETS 4172743 DUE FROM MERITER FOUNDATION 6486492 LOAN RECEIVABLE NET OF CURRENT 1922619 33455823 RETIREMENT LIABILITIES 15315770 INSURANCE RESERVCES 611000 ASSET RETIREMENT OBLIGATION 307754 16234524 FIN 48 FOOTNOTE: ASC 740-10, INCOME TAXES-OVERALL ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER ASC 740-10, COMPANIES MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. ASC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. THE CORPORATION HAS ANALYZED THE REQUIREMENTS OF ASC 740-10 AND THE ADOPTION DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. IT IS THE CORPORATION'S POLICY TO RECORD INTEREST AND PENALTIES ON UNCERTAIN TAX PROVISIONS AS INCOME TAX EXPENSE. AS OF DECEMBER 31, 2010, THE CORPORATION HAS NO ACCRUED INTEREST OR PENALTIES RELATED TO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 15888 6623883 6623883 0.01970 25786 51491523 26415429 25076094 0.07480 572 1150963 896501 254462 0.00080 42246 59266369 27311930 31954439 0.09530 83 118001 624615 5905 618710 0.00180 81 9012 6503564 42640 6460924 0.01930 6 2820 4514000 4514000 0.01350 106 10144 564813 564813 0.00170 276 139977 12206992 48545 12158447 0.03630 276 182223 71473361 27360475 44112886 0.13160 16 953 30231 30231 0.00010 2 4481 4481 0.00000 6 3 8876 8876 0.00000 2 10 925 925 0.00000 4 12 35562 35562 0.00010 30 978 80075 80075 0.00020 0 2373700 0 68503383 82432625 -13929242 X 1 1 1 1 MERITER HOSPITAL INC

202 S PARK STREET MADISON WI 53715

X X X X X NA 1 PART I, LINE 3C: MERITER HOSPITAL USES A FAMILY INCOME LIMIT OF 300% TO 500% OF FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIILITY FOR DISCOUNTED CARE. PART I, LINE 6A: A COMMUNITY BENEFIT REPORT IS FILED ON BEHALF OF MERITER HEALTH SERVICES; MERITER HOSPITAL IS A SUBSIDIARY. THE COMMUNITY BENEFIT TEXT IN THIS RETURN IS RELATED TO THE HOSPITAL. PART I, L7 COL(F): BAD DEBT EXPENSE OF $5,846,551 IS INCLUDED IN PART IX, LINE 25, COLUMN A, BUT EXCLUDED FOR PURPOSES OF CALCULATING THE COST TO CHARGE RATIO. PART II: MERITER IS A STRONG PARTNER IN THE HEALTH OF THE COMMUNITY AND BELIEVES THAT A HEALTHY COMMUNITY MEANS MORE THAN A NEIGHBORHOOD WITH CONTROLLED BLOOD PRESSURES. A HEALTHY COMMUNITY POSSESSES INTERCONNECTED AND COLLABORATIVE NEIGHBORHOODS; SAFE WATER, AND A STRONG AND DIVERSE WORKFORCE. THROUGH PARTNERSHIPS WITH AREA AGENCIES AND NON-PROFIT ORGANIZATIONS, MERITER STRIVES TO ENSURE THAT HEALTHY NEIGHBORHOODS ARE CONSIDERED THE NORM AS OPPOSED TO THE RARE PLACE. MERITER SUPPORTS THRIVING AND CONNECTED NEIGHBORHOODS THROUGH ITS SPONSORSHIP AND INVOLVEMENT IN SOUTH METROPOLITAN PLANNING COUNCIL, SOUTH WISCONSIN HMONG ASSOCIATION, BAYVIEW FOUNDATION AND OTHERS. THESE GROUPS CREATE ACTIVITIES THAT INVOLVE WHOLE FAMILIES AND OFTEN FOCUS ON RAISING AWARENESS OF COMMUNITY RESOURCES AND NEIGHBORHOOD ASSETS. FOR EXAMPLE, THE SOUTH METROPOLITAN PLANNING COUNCIL PARTNERED WITH MULTIPLE ORGANIZATIONS AND AGENCIES TO HOST A COMMUNITY FESTIVAL WHICH ATTRACTED AREA RESIDENTS AS WELL AS OTHERS TO THE SOUTH SIDE OF MADISON. FOR MANY YEARS, THE NEIGHBORHOODS ON MADISON'S SOUTH SIDE HAVE LONG BEEN VIEWED AS UNSAFE. HOWEVER, THE FESTIVAL WHICH FEATURED AREA RESTAURANTS, A FARMER'S MARKET, DANCE, MUSIC AND CHILDREN'S ACTIVITIES, PROVIDED ALL WHO ATTENDED WITH A DIFFERENT PICTURE OF THIS AREA. FURTHERING MERITER'S COMMITMENT TO THE COMMUNITY IS ITS CONTINUED INVOLVEMENT WITH THE COMMUNITY'S MED-DROP PROGRAM. THIS PROGRAM HELPS REDUCE UNWANTED MEDICINES IN THE HOMES BY PROVIDING A PLACE WHERE RESIDENTS CAN TAKE THEIR UNWANTED, UNUSED AND EXPIRED MEDICATIONS FOR PROPER DISPOSAL. THE MED-DROP PROGRAM CONTINUES TO EXPAND AND NOW IS HOUSED AT SOME MADISON POLICE STATIONS, ALLOWING FOR ACCESS 24-HRS IN THE DAY, 7 DAYS A WEEK. MERITER HAS BEEN INSTRUMENTAL IN PROVIDING WEBSITE AND ADMINISTRATIVE SUPPORT AS WELL AS STAFF TO ASSIST IN PROMOTIONS AND MEDIA RELATIONS TO ALERT THE PUBLIC TO THE INCREASED ACCESS. BY REDUCING ACCESS TO UNWANTED MEDICINES, MERITER IS HELPING REDUCE THE INCIDENCE OF ACCIDENTAL OVERDOSES AND ACCIDENTAL INGESTION OF MEDICATIONS AS WELL AS PROTECT THE WATER WAYS FROM PHARMACEUTICAL POLLUTANTS. FINALLY, MERITER IS WORKING WITH COMMUNITY GROUPS SUCH AS THE URBAN LEAGUE TO FUND TRAINING PROGRAMS, SCHOLARSHIPS AND TUTORING PROGRAMS. THROUGH SUPPORT OF EDUCATIONAL PROGRAMS, MERITER IS HELPING INCREASE JOB OPPORTUNITIES FOR AREA RESIDENTS, THEREBY INCREASING JOB SECURITY. PART III, LINE 4: THE HOSPITAL REPORTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS AND TRENDS.COSTING METHODOLOGY: THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. THE RATIO OF COSTS TO CHARGES IS BASED ON WORKSHEET 3 OF SCHEDULE H.AS A NOT-FOR-PROFIT TAX EXEMPT HOSPITAL, WE MUST PROVIDE NECESSARY PATIENT CARE SERVICES TO ALL, REGARDLESS OF THE ABILITY TO PAY FOR THAT CARE. THIS BROAD SCOPE FOR PROVIDING CARE QUALIFIES BAD DEBTS AS A COMMUNITY BENEFIT.AFTER MAKING EVERY EFFORT ON OUR PART TO ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE FORMS, WE WILL REMIT THE REMAINING UNCOLLECTIBLE ACCOUNTS TO A COLLECTION AGENCY. THE COLLECTION AGENCY MAKES FURTHER EFFORTS TO UNDERSTAND THE CIRCUMSTANCES OF WHY THE RECEIVABLES ARE NOT ABLE TO BE COLLECTED. FINANCIAL STATEMENT FOOTNOTE: AUDITED FINANCIAL STATEMENT FOOTNOTES DO NOT HAVE A SPECIFIC REFERENCE TO BAD DEBT EXPENSE. A COST TO CHARGE RATIO WAS USED.THE HOSPITAL REPORTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS AND TRENDS. PART III, LINE 8: THE MEDICARE SHORTFALL WAS NOT INCLUDED AS COMMUNITY BENEFIT. PART III, LINE 9B: WE NOTIFY PATIENTS OF THEIR FINANCIAL RESPONSIBILITY AS WELL AS OUR CHARITY CARE POLICY. OUR COLLECTION AGENCIES ARE EDUCATED ON OUR FAHHCP (FINANCIAL ASSISTANCE FOR HEALTH CARE PROGRAM), AND WE FOLLOW WHA BILLING GUIDELINES. OUR POLICY STATES "PATIENT ACCOUNTS IN THE PROCESS OF FINANCIAL AID REVIEW WILL NOT KNOWINGLY BE SENT TO COLLECTIONS." PART VI, LINE 2: MERITER UTILIZES A HEALTHY COMMUNITIES MODEL BASED OFF OF THE STATE OF WISCONSIN'S HEALTHIER WISCONSIN 2010 AS WELL AS UNITED WAY AND SAFE COMMUNITIES DATA. ALL ORGANIZATIONS USE PUBLICALLY AVAILABLE DATA TO ASSESS THE HEALTH CONDITION OF THE COUNTY. THE MERITER HEALTH SERVICES PRESIDENT IS INVOLVED IN THE UNITED WAY'S HEALTH COUNCIL, WHICH IDENTIFIES SPECIFIC HEALTH ISSUES THEN DEVELOPS SOLUTIONS. IN ADDITION TO UNITED WAY, MERITER EMPLOYEES WORK VERY CLOSELY WITH SAFE COMMUNITIES TO DETERMINE AND ADDRESS SPECIFIC HEALTH NEEDS. IN ADDITIONAL TO PUBLICLY AVAILABLE DATA, SAFE COMMUNITIES ALSO UTILIZES DE-IDENTIFIED HOSPITAL DATA TO DETERMINE MORE SPECIFIC NEEDS OR OBTAIN ADDITIONAL INFORMATION RELATED TO SPECIFIC ISSUES AT HAND. PART VI, LINE 3: WE NOTIFY PATIENTS OF THEIR FINANCIAL RESPONSIBILITY AS WELL AS OUR CHARITY CARE POLICY. OUR COLLECTION AGENCIES ARE EDUCATED ON OUR FAHHCP (FINANCIAL ASSISTANCE FOR HEALTH CARE PROGRAM), AND WE FOLLOW WHA BILLING GUIDELINES. OUR POLICY STATES "PATIENT ACCOUNTS IN THE PROCESS OF FINANCIAL AID REVIEW WILL NOT KNOWINGLY BE SENT TO COLLECTIONS." PART VI, LINE 4: MERITER CONSIDERS ITS PRIMARY SERVICE AREA TO BE DANE COUNTY (76% OF DISCHARGES). THE SECONDARY SERVICE AREAS ARE ADAMS, COLUMBIA, CRAWFORD, DODGE, GRANT, GREEN, IOWA, JEFFERSON, JUNEAU, LAFAYETTE, MARQUETTE, RICHLAND, ROCK, SAUK, VERNON AND WALWORTH COUNTIES. THE POPULATION OF DANE COUNTY IS 488,073 WITH A MEDIAN HOUSEHOLD INCOME OF $58,002 (2010 CENSUS). THE COUNTY IS 81.9% WHITE (NON HISPANIC), 5.2% ARE BLACK, 4.7% ARE ASIAN, AND 5.9% ARE HISPANIC OR LATINO. 13.1% OF RESIDENTS ARE BELOW THE POVERTY LINE. PART VI, LINE 6: MERITER'S COMMITMENT TO COMMUNITY HEALTH IS INCORPORATED INTO ITS MISSION STATEMENT - WE ARE COMMITTED TO PROVIDING A "LIFETIME OF HEALTHCARE" AND TO "SERVE THE COMMUNITIES. COMMUNITY HEALTH IS INCORPORATED IN ALL THAT MERITER DOES.MERITER HEALTH SERVICES UTILIZES A COMMUNITY BASED BOARD OF DIRECTORS AS WELL AS SEVERAL OTHER COMMITTEES STAFFED BY COMMUNITY MEMBERS, INCLUDING THE QUALITY & PUBLIC SERVICE COMMITTEE, WHICH OVERSEES THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAMS. THE MEMBERS OF THE BOARD AND THE COMMITTEE ARE VALUABLE COMPONENTS IN IDENTIFYING AND ASSESSING THE PROGRAMS AND PARTNERSHIPS OF THE ORGANIZATION.MERITER RE-INVESTS IN THE COMMUNITY HEALTH IN A VARIETY OF WAYS INCLUDING SPONSORSHIP AND PARTNERSHIPS WITH NON-PROFIT ORGANIZATIONS TO ADDRESS HEALTH NEEDS OF THE COMMUNITY, OR THROUGH THE DEVELOPMENT OF PROGRAMS GEARED TOWARDS IMPROVING HEALTH AND PREVENTING ILLNESS AND INJURY. ADDITIONALLY, MERITER PROVIDES MANY SERVICES THAT WILL NEVER BE PROFIT OR BREAK-EVEN SERVICES INCLUDING IN-PATIENT PSYCHIATRIC SERVICES, IN-PATIENT ADDICTION MEDICINE, A DENTAL CLINIC, AND EMERGENCY SERVICE. THERE ARE NO OTHER HEALTH CARE PROVIDERS IN DANE COUNTY PROVIDING IN-PATIENT PSYCHIATRIC SERVICES OR ADDICTION MEDICINE. OUR DENTAL CLINIC SEES PREDOMINANTLY PATIENTS ON MEDICAL ASSISTANCE. OUR EMERGENCY ROOM RECEIVED A HIGHER PERCENTAGE OF PATIENTS NEEDING ALCOHOL AND DRUG DETOXIFICATION AS WELL AS PSYCHIATRIC SERVICES. PART VI, LINE 7: MERITER HOSPITAL IS PART OF THE MERITER HEALTH SYSTEM GROUP. THERE ARE NO OTHER HOSPITALS UNDER THE MERITER HEALTH SYSTEM UMBRELLA. REPORTS FILED WITH STATES PART VI, LINE 7 WI 1 MERITER FOUNDATION INC 202 SOUTH PARK STREET MADISON WI 53715 237098688 501 (C)(3) 38220 N/A N/A HOSPITAL PROGRAMS CENTER FOR NURSING EXCELLENCE 3001 W BELTLINE HWY MADISON WI 53713 271081808 501 (C)(3) 50000 N/A N/A HOSPITAL PROGRAMS 2 HOSPITAL SCHOLARSHIPS 18 28000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE MADE UPON A SPECIFIC PROJECT REQUEST AND ONLY MADE TO ORGANIZATIONS THAT WE HAVE A WORKING RELATIONSHIP WITH AND SHARE A COMMON GOAL OF COMMUNITY BENEFIT. GRANTS ARE ONLY MADE TO 501 (C ) (3) ORGANIZATIONS WHICH MUST COMPLETE FORM 990S AND ANNUAL REPORTS. PART III - SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS WHO HAVE SUBMITTED REQUIRED APPLICATION AND SUPPORTING DOCUMENTATION. A SELECTION COMMITTEE REVIEWS THE REQUESTS, EVALUATES EACH APPLICATION BASED UPON FINANCIAL NEED, ACADEMIC RECORD, EXTRA CURRICULAR WORK/VOLUNTEERING, RECOMMENDATION AND ESSAY. CHECKS ARE ISSUED TO THE ACADEMIC INSTITUTION ON THE STUDENT'S BEHALF. X 0 1 X X X X X 1 1 0 0 0 0 0 1 0 JAMES WOODWARD 48223 434006 16451 148063 6149 55344 1557 14015 2841 25573 75221 677001 0 0 LYNNE MYERS 0 289207 0 69064 0 23184 0 14919 0 13854 0 410228 0 0 LINDA HOFF 0 316435 0 95595 0 42891 0 23719 0 15116 0 493756 0 0 TIMOTHY RIDDLE 8054 0 20257 0 137782 0 466 0 1502 0 168061 0 0 0 GEOFFREY R PRIEST MD 0 311032 0 74667 0 27873 0 22066 0 24726 0 460364 0 0 KERRA GUFFEY 0 239103 0 58293 0 17663 0 14796 0 15346 0 345201 0 0 TIMOTHY PRINCE 0 119716 0 29530 0 70806 0 131085 0 15776 0 366913 0 0 SUE ERICKSON 0 154665 0 36441 0 16186 0 23311 0 20471 0 251074 0 0 PATRICIA GRUNWALD 0 208732 0 49945 0 24258 0 29915 0 13089 0 325939 0 0 BRUCE SLATER 0 208973 0 22576 0 831 0 5259 0 2340 0 239979 0 0 MARY M NICK 0 210523 0 50835 0 17930 0 17000 0 5589 0 301877 0 0 MARGO FRANCISCO 0 174641 0 30198 0 227 0 7875 0 1449 0 214390 0 0 KEVIN SNITCHLER 0 170844 0 32850 0 655 0 7327 0 14867 0 226543 0 0 LOUIS S BRYSH 216049 0 30750 0 1338 0 21720 0 14176 0 284033 0 0 0 TIM SIO 0 0 0 0 0 154543 0 10265 0 0 0 164808 0 154543 MILES MEYER 0 0 0 0 0 132922 0 11942 0 13368 0 158232 0 132922 PART I, LINE 1A BUSINESS CLUB DUES WERE PAID FOR TWO PEOPLE. THE BUSINESS CLUB IS AN IRS SECTION 501(C)(7). PART I, LINE 1B IF BENEFITS PAID ARE NOT PART OF AN ESTABLISHED COMPENSATION OR BENEFIT PROGRAM, THE VP OF HUMAN RESOURCES (HR) WORKS WITH OUR HR CONSULTING FIRM TO ENSURE THAT TOTAL COMPENSATION IS WITHIN THE ORGANIZATION'S PHILOSOPHY AND IS REASONABLE. DEPARTURES FROM THE ESTABLISHED GUIDELINES MUST BE REVIEWED BY THE EXTERNAL CONSULTANT, PROPOSED TO THE COMPENSATION COMMITTEE OF THE BOARD, AND APPROVED IN ADVANCE. PART I, LINES 4A-B SEVERANCE PAYMENTS WERE RECEIVED BY THE FOLLOWING INDIVIDUALS: M. MEYER $158,232 T. SIO $164,808 AMOUNTS LISTED INCLUDE EMPLOYEE DEFERRALS, WHERE APPLICABLE: J. WOODWARD $47,903 L. MYERS $72,236 L. HOFF $30,139 K. BOREN $6,100 S. ERICKSON $9,494 P. GRUNWALD $67,021 K. GUFFEY $17,067 G. PRIEST $25,632 T. PRINCE $11,594 PART I, LINE 7 SYSTEM WIDE PERFORMANCE MEASURES, WITH A FINANCIAL THRESHOLD COMPONENT, MUST BE MET TO QUALIFY FOR THE OVERALL INCENTIVE. ONCE MET, VARIOUS ESTABLISHED GOALS ARE MEASURED WHICH INCLUDE SPECIFIC PERFORMANCE IMPROVEMENT SAVINGS, DAYS CASH ON HAND, OPERATING MARGIN. WI HEALTH & EDU FACILITIES AUTH ADJ RATE REV BONDS #2008A 391337855 97710BBH4 2008-05-21 23750000 CURRENT REFUNDING OF 2006 SERIES A, ISSUANCE COSTS, CREDIT ENHANCEMENT 0 0 0 WI HEALTH & EDU FACILITIES AUTH ADJ RATE REV BONDS # 2008B 391337855 97710BBJ1 2008-05-21 28400000 CURRENT REFUNDING OF 2006 SERIES B, ISSUANCE COSTS, CREDIT ENHANCEMENT 0 0 0 WI HEALTH & EDU FACILITIES AUTH ADJ RATE REV BONDS # 2008C 391337855 97710BBK7 2008-05-21 34940000 CURRENT REFUNDING OF 2006 SERIES C, ISSUANCE COSTS, CREDIT ENHANCEMENT 0 0 0 WI HEALTH & EDU FACILITIES AUTH RATE REV BONDS SERIES 2009 391337855 97710BKL5 2009-07-28 50000000 CONSTRUCT AND EQUIP HOSPITAL FACILITIES, ISSUANCE COSTS AND FUNDING OF DEBT 0 0 0 23750000 1369247 22380752 2009 1 0 1 1 28400000 28400000 2009 1 0 1 1 34940000 34940000 2009 1 0 1 1 50000000 3649677 1627314 44898623 2012 0 0 1 1 0 1 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0.01000 0.00000 0.01000 1 0 1 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 PIPER JAFFRAY 0 0 0 0 0 0 1 1 PIPER JAFFRAY 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 RICHARD LYNCH BOARD MEMBER 17036435 CONSTRUCTIONMR. LYNCH, A MERITER HEALTH SERVICES AND MERITER HOSPITAL BOARD MEMBER, IS PRESIDENT OF THE FINDORFF ORGANIZATIONS REPORTED ON SCHEDULE L. THE TRANSACTIONS LISTED RELATE TO CONSTRUCTION CONTRACTS THAT WERE COMPLETED AT ARM'S LENGTH COMMERCIAL TERMS.THE DOLLARS FOR THIS TRANSACTION ARE REPORTED ON THE MERITER HOSPITAL FORM 990. MR. LYNCH RECUSES HIMSELF FROM CONSTRUCTION RELATED VOTES. 0 GARY WOLTER PAST BOARD CHAIR 2600000 UTILITIESPAST BOARD CHAIR IS CHAIRMAN, PRESIDENT, AND CEO OF UTILITY PROVIDER FOR MERITER HOSPITAL. ALL TRANSACTIONS ARE ENTERED INTO AT ARMS' LENGTH. 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 IN 2010, MERITER CONTINUED TO MEET PATIENT NEEDS BY IMPLEMENTING A NEW PEDIATRIC CARE MODEL WHICH INVOLVED OPENING A NEW PEDIATRIC CENTER TO PROVIDE EMERGENCY, OBSERVATION AND INPATIENT CARE; OPENING A NEW DIGESTIVE HEALTH CENTER, PROVIDING GREATER PATIENT PRIVACY AND SERVICE FOR PREVENTION, EARLY DETECTION AND TREATMENT OF GASTROINTESTINAL DISEASE; AND PROVIDING LEADING EDGE ORTHOPEDIC CARE WITH THE INTRODUCTION OF MAKOPLASTY KNEE REPLACEMENT PROCEDURE. FORM 990, PART VII & SCHEDULE J FORM 990 RULES FOR REPORTING EMPLOYEE VOLUNTARY DEFERRALS OF INCOME DISTORTS THE ACCURACY OF THE PRESENTATION OF THE EMPLOYEE'S BASE COMPENSATION. THEREFORE, THE VOLUNTARY DEFERRALS FOR TWO EXECUTIVES ARE REPORTED HERE. L. MYERS AND P. GRUNWALD DEFERRED $49,533 AND $52,692 OF THEIR BASE COMPENSATION, RESPECTIVELY. FORM 990, PART VI, SECTION A, LINE 2 L. DEWEY AND G. WOLTER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 MERITER HEALTH SERVICES (MHS) IS THE SOLE VOTING MEMBER OF MERITER HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE VOTING MEMBER OF MERITER HOSPITAL, MHS ELECTS THE MEMBERS OF THE MERITER HOSPITAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE THE PRIOR AUTHORIZATION OR APPROVAL OF THE MHS BOARD AS VOTING MEMBER OF THE CORPORATION,: (A) MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; (B) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OF THE CORPORATION; (C) A SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION; (D) THE ESTABLISHMENT, FORMATION, ACQUISITION, MERGER, CONSOLIDATION OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION OF THE CORPORATION; (E) THE ADOPTION OF THE AGGREGATE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION; (F) AGGREGATE BORROWING FOR PERIODS OF ONE (1) YEAR OR LESS FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME; AND AGGREGATE BORROWING FOR PERIODS OF MORE THAN ONE (1) YEAR FOR ANY PURPOSE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME. FOR THE PURPOSE OF THIS SUBPARAGRAPH, THE TERM AGGREGATE BORROWING MEANS BORROWINGS NOT PREVIOUSLY INCLUDED IN THE OPERATING AND/OR CAPITAL BUDGETS, AND INCLUDES BUT IS NOT LIMITED TO LEASE AGREEMENTS AND CONTRACTS FOR SALE; (G) THE PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, AND ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE ESTABLISHED BY THE VOTING MEMBER FROM TIME TO TIME, NOT PREVIOUSLY INCLUDED IN THE CAPITAL BUDGET; (H) THE APPOINTMENT OF THE INDEPENDENT AUDITOR AND CORPORATE COUNSEL. FORM 990, PART VI, SECTION B, LINE 11 MERITER CONTRACTS WITH AN OUTSIDE PUBLIC ACCOUNTING FIRM TO PREPARE ALL INCOME TAX RETURNS. MERITER'S ACCOUNTING DEPARTMENT STAFF COMPLETES AND THE CORPORATE CONTROLLER REVIEWS THE COMPREHENSIVE TAX ORGANIZER PROVIDED BY THE TAX FIRM. THE CORPORATE CONTROLLER AND THE TAX FIRM WORK TOGETHER TO PREPARE THE TAX RETURNS TO REFLECT INFORMATION THAT AFFECTS THE FORM 990. APPROXIMATELY ONE TO TWO WEEKS PRIOR TO FILING, THE RETURNS WILL BE POSTED TO THE BOARD GOVERNANCE INTERNAL WEB SITE ACCOMPANIED BY A MEMO HIGHLIGHTING THE KEY POINTS OF INTEREST FOR THE FILING YEAR AND CONTAINING THE ANTICIPATED FILING DATE IN ADDITION TO PROVIDING CONTACT INFORMATION FOR FURTHER INQUIRY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL BOARD OF DIRECTORS CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ON A PROACTIVE BASIS, DECLARATIONS OF POTENTIAL CONFLICTS OF INTEREST ARE SIGNED WHEN EACH DIRECTOR JOINS THE BOARD AND ANNUALLY THEREAFTER. THE CEO AND BOARD CHAIR MONITOR THE POTENTIAL CONFLICTS DISCLOSED BY BOARD MEMBERS AND MANAGE ATTENDANCE AT MEETINGS AND PARTICIPATION IN VOTES ACCORDING TO THE ISSUE ON THE AGENDA. INDIVIDUAL DIRECTORS ALSO MONITOR THEIR POTENTIAL CONFLICTS AND RECUSE THEMSELVES FROM BOARD DISCUSSION AND/OR VOTES AS REQUIRED BY THE CIRCUMSTANCES. THE PROCESS OF MANAGING CONFLICTS OF INTEREST IS RECORDED IN THE MEETING MINUTES. BELOW IS THE 2009 CONFLICT OF INTEREST DISCLOSURE: DRS. DIEM, ROTHSTEIN AND PRIEST ARE MEMBERS OF PHYSICIAN PLUS INVESTMENT GROUP LLP WHICH IS A 1/3 OWNER OF PHYSICIANS PLUS INSURANCE CORPORATION WHERE MERITER HEALTH SERVICES OWNS THE REMAINING 2/3. DR. ROTHSTEIN IS THE MANAGING PARTNER OF PPIG LLP AND DR. PRIEST IS A NON-VOTING MEMBER OF SAME. DRS. MANNING AND DIEM, MERITER HOSPITAL BOARD MEMBERS, ARE ALSO MEMBERS OF UW MEDICAL FOUNDATION, AND DR. TOTH IS A UW PHYSICIAN. MERITER PAYS TEACHING STIPENDS TO UW MEDICAL FOUNDATION PHYSICIANS. DR. SCHURR IS WITH MELIUS SCHURR AND CALDWELL, AND DR. GOLDROSEN IS WITH ASSOCIATED PHYSICIANS, BOTH OF WHICH HAVE MERITER PRIVILEGES. FORM 990, PART VI, SECTION B, LINE 15 THE MERITER HEALTH SERVICES BOARD OF DIRECTORS APPROVES EXECUTIVE COMPENSATION PHILOSOPHY AND STRATEGY. THE BOARD OF DIRECTORS AUTHORIZES A SUB-COMMITTEE OF THE BOARD TO MAKE COMPENSATION DECISIONS WHILE RETAINING OVERSIGHT OF SAID COMMITTEE. AN EXTERNAL HUMAN RESOURCES CONSULTING FIRM IS ENGAGED BY THE BOARD OF DIRECTORS' SUB-COMMITTEE. THIS FIRM COLLECTS AND REVIEWS ALL ORGANIZATIONAL INFORMATION, COMPENSATION DATA, AND BACKGROUND INFORMATION MATCHING ALL EXECUTIVE POSITIONS TO SURVEY BENCHMARKS. USING THIS INFORMATION THE CONSULTING FIRM PRODUCES ESTIMATED MARKET VALUES FOR EACH EXECUTIVE AND RECOMMENDS ANY NECESSARY CHANGES WITH EXECUTIVE COMPENSATION TO THE BOARD COMMITTEE FOR THEIR DECISION. FORM 990, PART VI, SECTION C, LINE 18 BECAUSE THE ORGANIZATION FILED ITS FORM 1023 BEFORE JULY 1987 AND DID NOT HAVE A COPY OF FORM 1023 ON THAT DATE, IT IS NOT REQUIRED TO MAKE ITS FORM 1023 AVAILABLE FOR PUBLIC INSPECTION. FORM 990, PART VI, SECTION C, LINE 19 AS PRIVATE CORPORATIONS, THE GOVERNING DOCUMENTS ARE NOT MADE PUBLIC. THE CONFLICT OF INTEREST POLICY IS NOT GENERALLY MADE PUBLIC, BUT WOULD BE DISCLOSED TO INTERESTED PARTIES IN THE CONTEXT OF ANY ISSUE THAT MIGHT ARISE. FINANCIAL INFORMATION CONTAINED WITHIN THE 990S IS AVAILABLE TO THE PUBLIC ON GUIDESTAR AND IS AVAILABLE UPON REQUEST OF ADMINISTRATION. FORM 990, PART VII- HOURS FROM RELATED ORG: ALL MERITER HEALTH SERVICES SYSTEM EMPLOYEES REPORTED ON THIS FORM 990 WORK, ON AVERAGE, A MINIMUM OF 40 HOURS PER WEEK BUT IN MOST CASES MORE THAN 40 HOURS PER WEEK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,498,388. FORM 990, PART XII, LINE 2C: CHANGE IN REVIEW PROCEDURE THERE HAS BEEN NO CHANGE IN THE REVIEW PROCEDURE. MERITER HEALTH SERVICES INC 202 SOUTH PARK STREET MADISON WI 537151596 391412318 PARENT OF MERITER ENTITIES, SUPPORT NONPROFIT SUBSIDIARIES WI SECTION 501(C)(3) LINE 11B, II NONE 0 MERITER FOUNDATION INC 202 SOUTH PARK STREET MADISON WI 537151596 237098688 FOUNDATION FOR MERITER HOSPITAL WI SECTION 501(C)(3) LINE 7 MERITER HEALTH SERVICES INC 0 MERITER MEDICAL GROUP 202 SOUTH PARK STREET MADISON WI 537151596 050545222 CLINICAL SUPPORT OF MERITER HOSPITAL WI SECTION 501(C)(3) LINE 11B, II MERITER HOSPITAL INC 0 SHARED MAGNETIC RESONANCE IMAGING FACILITY 1104 JOHN NOLEN DR MADISON WI 53713 391534744 MEDICAL TECHNOLOGY WI SECTION 501(C)(3) LINE 11A, I MERITER HOSPITAL INC 0 MERITER REAL ESTATE LLC 202 SOUTH PARK STREET MADISON WI 537151596 201455471 REAL ESTATE MANAGEMENT WI MERITER HOSPITAL INC RELATED 237203 22488 0 1 0.99000 MERITER UWMF PHYSICIAN CONTRACTING LLC 202 SOUTH PARK STREET MADISON WI 537151596 391998819 HEALTH SERVICES WI N/A MERITER HEALTH ENTERPRISES 202 SOUTH PARK STREET MADISON WI 537151596 391293620 HEALTH CARE RELATED SERVICES WI N/A C HCP CORPORATION 202 SOUTH PARK STREET MADISON WI 537151596 391177562 RENTAL PROPERTIES WI MERITER HOSPITAL INC C 34255 620979 1.00000 MERITER MANAGEMENT SERVICES INC 202 SOUTH PARK STREET MADISON WI 537151596 391458235 MANAGEMENT COMPANY WI N/A C PHYSICIANS PLUS INSURANCE CORP 22 E MIFFLIN ST SUITE 200 MADISON WI 53703 391565691 INSURANCE WI N/A C 1 0 1 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 MERITER MANAGEMENT SERVICES INC A 113551 FAIR VALUE MERITER FOUNDATION INC C 1316861 COST MERITER MANAGEMENT SERVICES INC D 1762946 COST MERITER MEDICAL GROUP D 46583546 COST MERITER HEALTH ENTERPRISES I 1305314 FAIR VALUE MERITER HEALTH SERVICES I 21721 FAIR VALUE MERITER MANAGEMENT SERVICES INC I 640321 FAIR VALUE MERITER FOUNDATION INC L 896141 FAIR VALUE MERITER HEALTH ENTERPRISES L 10978683 FAIR VALUE MERITER HEALTH SERVICES L 769518 FAIR VALUE MERITER MANAGEMENT SERVICES INC L 14741391 FAIR VALUE MERITER MEDICAL GROUP K 252337 FAIR VALUE MERITER FOUNDATION INC I 81898 FAIR VALUE MERITER FOUNDATION INC B 38220 COST MERITER HEALTH ENTERPRISES K 2107318 FAIR VALUE