2011-07-29T13:07:18-05:00 2010-09-30 RSM McGladrey Inc 700 Missabe Building Duluth MN 55802 990 2009-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 LES WHITEAKER 7156855515 2011-07-28 1 Mary Beth Santori 2187278253 2009 2016-02-24 21:20:13Z LES WHITEAKER 1615 MAPLE LANE ASHLAND WI 54806 57652092 0 X WWW.ASHLANDMMC.COM X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 15 14 431 158 0 0 69585 71271 54951467 57047294 479296 426212 119120 107245 55619468 57652022 0 0 27208867 27959742 0 0 21782719 22979667 48991586 50939409 6627882 6712613 56445047 62117336 13666718 12626394 42778329 49490942 PROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE TO THE RESIDENTS OF ASHLAND COUNTY, WISCONSIN AND SURROUNDING AREA. 0 0 43409167 57154539 PROVIDE HIGH QUALITY INPATIENT AND OUTPATIENT CARE TO THE RESIDENTS OF ASHLAND COUNTY, WISCONSIN AND SURROUNDING AREA. 43409167 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 45 0 1 431 1 1 1 0 0 0 0 0 0 0 0 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 254865 0 57254 MATTHEW ANICH 1.00 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 0 0 0 PATRICIA SCHRAUFNAGEL 1.00 X 0 0 0 KATHY GANG MD 1.00 X 0 0 0 BARBARA BARRY 1.00 X 0 0 0 THOMAS JOKINEN 1.00 X 0 0 0 CHRIS IVERSON 1.00 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 5321 0 0 DANIEL H ADAMS 40.00 X 166182 0 52844 LESLIE J WHITEAKER 40.00 X 179325 0 44151 DANIEL GARDNER 40.00 X 128499 0 36164 WILLIAM MATTILA 40.00 X 127153 0 44191 PATRICK MARSHALL 40.00 X 112025 0 32056 CARL BAUER 40.00 X 100425 0 25138 KATHRYN TUTTLE 40.00 X 104291 0 37531 1178086 0 329329 8 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 COMPUTER SUPPORT FEES 1575289 TAMARACK PROFESSIONAL GROUP 1615 MAPLE LANE ASHLAND WI 54806 ER FEES 1522577 SUPERIOR ANESTHESIA ASSOCIATES 301 ELLIS AVENUE SUITE 3 ASHLAND WI 54806 ANESTHESIA SERVICES 1122515 JAMES LEAN MD 1615 MAPLE LANE ASHLAND WI 54806 PSYCH PROF FEES 350844 LAKE SUPERIOR LAUNDRY 1701 NORTH 6TH STREET SUPERIOR WI 54880 LAUNDRY SERVICE 168081 6 31826 39445 71271 PATIENT SERV REV 621500 56859582 56859582 CAFETERIA 722210 190352 190352 OTHER OPERATING REVENU 900099 16860 16860 HEALTHY FAMILIES PROGR 624100 -19500 -19500 57047294 426282 426282 107245 107245 107245 107245 70 -70 -70 -70 57652022 57154539 0 426212 754621 754621 20123048 17836173 2286875 789890 752410 37480 4802748 4033075 769673 1489435 1282837 206598 14440423 13382651 1057772 227923 194230 33693 2992688 2550287 442401 205223 205223 PROVISION FOR BAD DEBTS 3377504 3377504 CONSULTING 1388384 1388384 COMPLIANCE 137055 137055 COLLECTION FEES 127942 127942 PHYSICIAN RECRUITING 68874 68874 13651 13651 50939409 43409167 7530242 0 17770073 21424633 7791186 8134870 2286610 2962990 1909759 2085670 155227 187293 56006041 36542778 20048984 19463263 6307448 7341508 175760 517109 56445047 62117336 5033449 5684944 6513269 4691450 2120000 2250000 13666718 12626394 X 42778329 49490942 42778329 49490942 56445047 62117336 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 127376 127376 21168916 14040157 7128759 30861562 20321938 10539624 3848187 2180683 1667504 19463263 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2250000 2250000 57652022 50939409 6712613 0 6712613 57652022 0 57652022 0 57652022 50939409 0 50939409 0 50939409 Part X: Description of Uncertain Tax Positions Under FIN 48: 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 322976 322976 0.00680 10363742 6609222 3754520 0.07890 10686718 6609222 4077496 0.08570 14772 14772 0.00030 5106 5106 0.00010 836400 337212 499188 0.01050 89990 89990 0.00190 946268 337212 609056 0.01280 11632986 6946434 4686552 0.09850 1 3377504 0 16056669 16106633 -49964 X 1 0 MEMORIAL MEDICAL CENTER

1615 MAPLE LANE ASHLAND WI 54806

X X X X Part I, Line 7: Costs are calculated using financial data and the Cost to Charge Ratio from the as filed 2010 Medicare Cost Report. Part I, Line 7g: Subsidized health services include labor & delivery and observation beds. Part I, Line 7f: Bad debt expense from financial statements IS $3,377,504. 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. 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 $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. 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 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. 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. WI X X X X 0 0 0 0 0 0 0 0 0 DANIEL HYMANS 254865 0 0 0 0 0 33627 0 23627 0 312119 0 0 0 DANIEL H ADAMS 166182 0 0 0 0 0 29381 0 23463 0 219026 0 0 0 LESLIE J WHITEAKER 179325 0 0 0 0 0 20686 0 23465 0 223476 0 0 0 DANIEL GARDNER 128499 0 0 0 0 0 14118 0 22046 0 164663 0 0 0 WILLIAM MATTILA 127153 0 0 0 0 0 17967 0 26224 0 171344 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. 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 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) 509(A)(3) N/A REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) 509(A)(3) REGIONAL ENTERPRISES INC TAMARACK PROFESSIONAL GROUP INC 1615 MAPLE LANE ASHLAND WI 54806 391198085 HEALTH CARE WI 501(C)(3) 509(A)(3) REGIONAL ENTERPRISES INC 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 1 0 0 0 1 0 1 0 0 1 1 1 1 0 0