MEMORIAL MEDICAL CENTER INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
MEMORIAL MEDICAL CENTER INC (EIN 23-7013497)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-07-29
IRS object ID
201132109349300913
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-07-29T13:07:18-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1RSM McGladrey IncBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1700 Missabe BuildingAddressLine1
CityDuluthCity
StateMNState
ZIP Code55802ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237013497EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone7156855515Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11615 MAPLE LANEAddressLine1
CityASHLANDCity
StateWIState
ZIP Code54806ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLES WHITEAKERName
TitleVICE-PRESIDENTTitle
Phone7156855515Phone
Date Signed2011-07-28DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMary Beth SantoriName
Phone2187278253Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLES WHITEAKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11615 MAPLE LANEAddressLine1
CityASHLANDCity
StateWIState
ZIP Code54806ZIPCode
FieldValueIRS element (for citing)
Gross Receipts57652092GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.ASHLANDMMC.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1968YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionINPATIENT AND OUTPATIENT MEDICAL SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees431TotalNbrEmployees
Total Nbr Volunteers158TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year69585ContributionsGrantsPriorYear
Contributions Grants Current Year71271ContributionsGrantsCurrentYear
Program Service Revenue Prior Year54951467ProgramServiceRevenuePriorYear
Program Service Revenue CY57047294ProgramServiceRevenueCY
Investment Income Prior Year479296InvestmentIncomePriorYear
Investment Income Current Year426212InvestmentIncomeCurrentYear
Other Revenue Prior Year119120OtherRevenuePriorYear
Other Revenue Current Year107245OtherRevenueCurrentYear
Total Revenue Prior Year55619468TotalRevenuePriorYear
Total Revenue Current Year57652022TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27208867SalariesEtcPriorYear
Salaries Etc Current Year27959742SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21782719OtherExpensePriorYear
Other Expenses Current Year22979667OtherExpensesCurrentYear
Total Expenses Prior Year48991586TotalExpensesPriorYear
Total Expenses Current Year50939409TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6627882RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6712613RevenuesLessExpensesCY
Total Assets BOY56445047TotalAssetsBOY
Total Assets EOY62117336TotalAssetsEOY
Total Liabilities BOY13666718TotalLiabilitiesBOY
Total Liabilities EOY12626394TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY42778329NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY49490942NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE TO THE RESIDENTS OF ASHLAND COUNTY, WISCONSIN AND SURROUNDING AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense43409167Expense
Revenue57154539Revenue
DescriptionPROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE TO THE RESIDENTS OF ASHLAND COUNTY, WISCONSIN AND SURROUNDING AREA.Description
Total Program Service Expense43409167TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109645NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees431NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LES WHITEAKERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7156855515TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11615 MAPLE LANEAddressLine1
CityASHLANDCity
StateWIState
ZIP Code54806ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DANIEL HYMANS
PRESIDENT40.00XX254865057254
MATTHEW ANICH
CHAIR1.00X000
SCOTT WARREN MD
BOARD MEMBER1.00X000
JOHN OUJIRI MD
BOARD MEMBER1.00X000
ANNE SULLIVAN
SECRETARY1.00X000
PATRICIA SCHRAUFNAGEL
VICE CHAIR1.00X000
KATHY GANG MD
BOARD MEMBER1.00X000
BARBARA BARRY
BOARD MEMBER1.00X000
THOMAS JOKINEN
BOARD MEMBER1.00X000
CHRIS IVERSON
TREASURER1.00X000
DON MARCOUILLER
BOARD MEMBER1.00X000
T JAY JONES
BOARD MEMBER1.00X000
MARC BARBEAU
BOARD MEMBER1.00X000
WILLIAM SLOAN
BOARD MEMBER1.00X000
F DANIEL ROCHMAN MD
BOARD MEMBER1.00X532100
DANIEL H ADAMS
VICE-PRESIDENT40.00X166182052844
LESLIE J WHITEAKER
VICE-PRESIDENT40.00X179325044151
DANIEL GARDNER
PSYCHOLOGIST40.00128499036164X
WILLIAM MATTILA
PHARMACY-DRTR40.00127153044191X
PATRICK MARSHALL
PHARMACIST40.00112025032056X
CARL BAUER
REHAB-DRTR40.00100425025138X
KATHRYN TUTTLE
CLINICAL-DRTR40.00104291037531X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1178086TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation329329TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REGIONAL ENTERPRISES INC
1615 MAPLE LANEASHLANDWI54806COMPUTER SUPPORT FEES1575289
TAMARACK PROFESSIONAL GROUP
1615 MAPLE LANEASHLANDWI54806ER FEES1522577
SUPERIOR ANESTHESIA ASSOCIATES
301 ELLIS AVENUE SUITE 3ASHLANDWI54806ANESTHESIA SERVICES1122515
JAMES LEAN MD
1615 MAPLE LANEASHLANDWI54806PSYCH PROF FEES350844
LAKE SUPERIOR LAUNDRY
1701 NORTH 6TH STREETSUPERIORWI54880LAUNDRY SERVICE168081
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Government Grants31826GovernmentGrants
All Other Contributions39445AllOtherContributions
Total Contributions71271TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERV REV6215005685958256859582
CAFETERIA722210190352190352
OTHER OPERATING REVENU9000991686016860
HEALTHY FAMILIES PROGR624100-19500-19500
FieldValueIRS element (for citing)
Total Program Service Revenue57047294TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column426282TotalRevenueColumn
Exclusion$426,282ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real107245Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real107245Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column107245TotalRevenueColumn
Related Or Exempt Function Income107245RelatedOrExemptFunctionIncome

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other70Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-70Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-70TotalRevenueColumn
Exclusion-$70ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column57652022TotalRevenueColumn
Related Or Exempt Function Income57154539RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$426,212ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total754621Total
Management And General754621ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total20123048Total
Program Services17836173ProgramServices
Management And General2286875ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total789890Total
Program Services752410ProgramServices
Management And General37480ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total4802748Total
Program Services4033075ProgramServices
Management And General769673ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1489435Total
Program Services1282837ProgramServices
Management And General206598ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total14440423Total
Program Services13382651ProgramServices
Management And General1057772ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total227923Total
Program Services194230ProgramServices
Management And General33693ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2992688Total
Program Services2550287ProgramServices
Management And General442401ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total205223Total
Management And General205223ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PROVISION FOR BAD DEBTS33775043377504
CONSULTING13883841388384
COMPLIANCE137055137055
COLLECTION FEES127942127942
PHYSICIAN RECRUITING6887468874

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13651Total
Management And General13651ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total50939409Total
Program Services43409167ProgramServices
Management And General7530242ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY17770073BOY
EOY21424633EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7791186BOY
EOY8134870EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2286610BOY
EOY2962990EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1909759BOY
EOY2085670EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY155227BOY
EOY187293EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis56006041LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec36542778LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY20048984BOY
EOY19463263EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6307448BOY
EOY7341508EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY175760BOY
EOY517109EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY56445047BOY
EOY62117336EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5033449BOY
EOY5684944EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY6513269BOY
EOY4691450EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2120000BOY
EOY2250000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY13666718BOY
EOY12626394EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY42778329BOY
EOY49490942EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY42778329BOY
EOY49490942EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY56445047BOY
EOY62117336EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis127376OtherCostOrOtherBasis
Book Value127376BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21168916OtherCostOrOtherBasis
Depreciation14040157Depreciation
Book Value7128759BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis30861562OtherCostOrOtherBasis
Depreciation20321938Depreciation
Book Value10539624BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3848187OtherCostOrOtherBasis
Depreciation2180683Depreciation
Book Value1667504BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings19463263TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionESTIMATED THIRD-PARTY PAYOR SETTLEMENTSDescription
Amount$2,250,000Amount
FieldValueIRS element (for citing)
Total Of Amounts2250000TotalOfAmounts
Total Revenue57652022TotalRevenue
Total Expenses50939409TotalExpenses
Excess Or Deficit For Year6712613ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS6712613ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt57652022TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal57652022RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99057652022TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt50939409TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal50939409ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99050939409TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationNot-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.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense322976TotalCommunityBenefitExpense
Net Community Benefit Expense322976NetCommunityBenefitExpense
Percent Of Total Expense0.00680PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10363742TotalCommunityBenefitExpense
Direct Offsetting Revenue6609222DirectOffsettingRevenue
Net Community Benefit Expense3754520NetCommunityBenefitExpense
Percent Of Total Expense0.07890PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense10686718TotalCommunityBenefitExpense
Direct Offsetting Revenue6609222DirectOffsettingRevenue
Net Community Benefit Expense4077496NetCommunityBenefitExpense
Percent Of Total Expense0.08570PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense14772TotalCommunityBenefitExpense
Net Community Benefit Expense14772NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense5106TotalCommunityBenefitExpense
Net Community Benefit Expense5106NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense836400TotalCommunityBenefitExpense
Direct Offsetting Revenue337212DirectOffsettingRevenue
Net Community Benefit Expense499188NetCommunityBenefitExpense
Percent Of Total Expense0.01050PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense89990TotalCommunityBenefitExpense
Net Community Benefit Expense89990NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense946268TotalCommunityBenefitExpense
Direct Offsetting Revenue337212DirectOffsettingRevenue
Net Community Benefit Expense609056NetCommunityBenefitExpense
Percent Of Total Expense0.01280PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11632986TotalCommunityBenefitExpense
Direct Offsetting Revenue6946434DirectOffsettingRevenue
Net Community Benefit Expense4686552NetCommunityBenefitExpense
Percent Of Total Expense0.09850PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,377,504BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare16056669AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16106633CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-49964MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEMORIAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11615 MAPLE LANEAddressLine1
CityASHLANDCity
StateWIState
ZIP Code54806ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart I, Line 7: Costs are calculated using financial data and the Cost to Charge Ratio from the as filed 2010 Medicare Cost Report.CostingMethodUsed
Subsidized Health Services ExplnPart I, Line 7g: Subsidized health services include labor & delivery and observation beds.SubsidizedHealthServicesExpln
Percent Of Total Expense ExplnPart I, Line 7f: Bad debt expense from financial statements IS $3,377,504.PercentOfTotalExpenseExpln
Bad Debt FootnotePart 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.BadDebtFootnote
Shortfall As Community BenefitPart 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 $373,601 and allowable costs of $1,152,590 resulting in a shortfall of $778,988. 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.ShortfallAsCommunityBenefit
General ExplanationPART I, LINE 6A: THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT.GeneralExplanation
Needs AssessmentPart 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.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Community Building ActivitiesPart VI, Line 5: Memorial Medical Center sponsors an annual Senior Health Fair that attracts several thousand area individuals for free health screenings and other related health information. In addition our staff often is invited to be presenters at area meetings to explain the services that are available to local citizens.CommunityBuildingActivities
Other InformationPart 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).OtherInformation
Affiliated Health Care SystemPart VI, Line 7: Memorial Medical Center is not part of an affiliated health care system.AffiliatedHealthCareSystem
Reports Filed With StatesWIReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DANIEL HYMANS
25486500000336270236270312119000
DANIEL H ADAMS
16618200000293810234630219026000
LESLIE J WHITEAKER
17932500000206860234650223476000
DANIEL GARDNER
12849900000141180220460164663000
WILLIAM MATTILA
12715300000179670262240171344000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6Regional Enterprises, Inc. is the sole corporate member of Memorial Medical Center, Inc.
Form 990, Part VI, Section A, line 7aRegional Enterprises, Inc. may elect one or more members of the governing body.
Form 990, Part VI, Section B, line 11THE 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 12cTHE COMPLIANCE OFFICER AND COMPLIANCE COMMITTEE MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY.
Form 990, Part VI, Section B, line 15MMC 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 18THE FORMS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION.
Form 990, Part VI, Section C, line 19THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION.
FORM 990, PART XI, LINE 2CTHE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
MEDICAL SERVICES INC
11040 N STATE ROAD 77HAYWARDWI54843391536207HEALTH CAREWI501(C)(3)170(B)(1)(A)(III)REGIONAL ENTERPRISES INC
REGIONAL ENTERPRISES INC
1615 MAPLE LANEASHLANDWI54806391555837SUPPORTWI501(C)(3)509(A)(3)N/A
REI MEDICAL CLINICS INC
1615 MAPLE LANEASHLANDWI54806391701306SUPPORTWI501(C)(3)509(A)(3)REGIONAL ENTERPRISES INC
TAMARACK PROFESSIONAL GROUP INC
1615 MAPLE LANEASHLANDWI54806391198085HEALTH CAREWI501(C)(3)509(A)(3)REGIONAL ENTERPRISES INC
MMC DEVELOPMENT CORP INC
1615 MAPLE LANEASHLANDWI54806391360035SUPPORTWI501(C)(3)170(B)(1)(A)(VI)N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets1ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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