2024-05-31T08:45:01-05:00 2023-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2022-10-01 237013497 MEMORIAL MEDICAL CENTER INC MEMO 7156855515 1615 MAPLE LANE ASHLAND WI 54806 KENT DUMONSEAU CFO 7156855515 2024-05-30 1 KENT DUMONSEAU 999009999 0 X JULIE BOYER P01278549 2187275025 2024-05-30 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z TAMARACK HEALTH ASHLAND MEDICAL CENTER LUKE BEIRL 1615 MAPLE LANE ASHLAND WI 54806 191175729 0 X WWW.TAMARACKHEALTH.ORG X 1968 WI INPATIENT AND OUTPATIENT MEDICAL SERVICES. 15 12 666 75 15905 1945 2504179 153071 142196909 151601269 2645225 2658425 602898 704270 147949211 155117035 340005 277565 0 0 59281154 64193429 0 0 0 70578493 77934483 130199652 142405477 17749559 12711558 223847463 250093039 47733118 52577576 176114345 197515463 X MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER WILL REACH OUT AS A TRUSTED PARTNER TO IMPROVE THE HEALTH AND WELLNESS FOR PEOPLE OF OUR SOUTH SHORE REGION OF LAKE SUPERIOR. 0 0 125805077 277565 151885583 MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER (AMC) IS A CRITICAL ACCESS HOSPITAL WITH OVER 60 FULL-TIME PHYSICIANS ON STAFF AND OVER 700 EMPLOYEES. LOCATED IN THE CITY OF ASHLAND, AMC SERVES AS A REGIONAL MEDICAL REFERRAL CENTER FOR PATIENTS FROM SEVEN NORTHWESTERN WISCONSIN COUNTIES AND THE NEIGHBORING GOGEBIC COUNTY OF MICHIGAN.AMC OFFERS INPATIENT AND OUTPATIENT SERVICES INCLUDING:MEDICAL-SURGICAL; INTENSIVE CARE; OBSTETRICS INCLUDING LABOR, DELIVERY, POSTPARTUM AND RECOVERY (LDPR) SUITES; BEHAVIORAL HEALTH; AND 24-HOUR EMERGENCY CARE.INPATIENT AND OUTPATIENT SURGERIES INCLUDE: ORTHOPEDIC, UROLOGY, OPHTHALMOLOGY, ENT, PODIATRY, GASTROENTEROLOGY, AND OB/GYN IN ADDITION TO GENERAL SURGERY. SUPPORT DIAGNOSTIC SERVICES INCLUDE: LABORATORY; RADIOLOGY WITH MRI, CT AND DIAGNOSTIC ULTRASOUND; PAIN MANAGEMENT; NUTRITIONAL SERVICES; PHARMACY; ENDOSCOPY SUITES AND A SLEEP DISORDER CENTER. REHABILITATION SERVICES INCLUDE: CARDIAC REHABILITATION AND CARDIOPULMONARY REHABILITATION; PHYSICAL THERAPY AND SPORTS MEDICINE.LIFELINE EMERGENCY RESPONSE SYSTEM, HOSPICE SERVICES AND SOCIAL SERVICES ARE ALSO AVAILABLE WITHIN AMC. AN ADDITIONAL BUILDING ON THE AMC CAMPUS HOUSES THE BEHAVIORAL HEALTH SERVICES PROVIDING INPATIENT AND OUTPATIENT AODA AND MENTAL HEALTH CARE AND THERAPIES.AMC OPENED AS A PRIVATE, NOT-FOR-PROFIT HOSPITAL IN 1972, COMBINING THE SERVICES PREVIOUSLY PROVIDED BY TRINITY HOSPITAL AND ASHLAND COMMUNITY HOSPITAL, BOTH LOCATED IN ASHLAND. AMC IS THE ONLY HOSPITAL LOCATED IN ASHLAND, BAYFIELD AND IRON COUNTIES. 125805077 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 103 0 1 666 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X KENT DUMONSEAU 7156855515 1615 MAPLE LANE ASHLAND WI 54806 JASON DOUGLAS PRESIDENT/CEO - MMC 37.00 3.00 X X 641559 0 59634 NATHAN SCHOEPPACH MEDICAL STAFF PRESIDENT 5.00 0.00 X 80841 0 0 MATTHEW ANICH BOARD MEMBER 1.00 2.00 X 0 0 0 THOMAS CUNNINGHAM MD BOARD MEMBER 1.00 1.00 X 1211 0 0 KAREN HANSEN BOARD MEMBER/FORMER COO 5.00 0.00 X 238311 0 12966 DANI MIKULA BOARD MEMBER 1.00 0.00 X 0 0 0 PATRICIA SCHRAUFNAGEL BOARD MEMBER 1.00 1.00 X 0 0 0 RICHARD SETZKE BOARD MEMBER 1.00 0.00 X 0 0 0 AISTIS TUMAS MD BOARD MEMBER 1.00 0.00 X 1200 0 0 PEGGY VAN HOLLEN-KMAN BOARD MEMBER 1.00 0.00 X 0 0 0 TYLER WICKMAN BOARD MEMBER 1.00 0.00 X 0 0 0 TAYLOR PEARSON SECRETARY 1.00 0.00 X X 0 0 0 THOMAS JOKINEN TREASURER 1.00 1.00 X X 0 0 0 JOHN SMYLIE VICE CHAIR 1.00 2.00 X X 0 0 0 CHRISTINE IVERSON CHAIR 1.00 1.00 X X 0 0 0 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 1.00 39.00 X 0 409610 57855 JESSICA NUUTINEN CHIEF OPERATING OFFICER 38.00 2.00 X 251539 0 48112 MANDEEP SINGH PSYCHIATRIST 40.00 0.00 X 566235 0 59159 JUSTIN CUMMINS PHYSICIAN 40.00 0.00 X 1041174 0 54579 MATTHEW BETTENDORF PHYSICIAN 32.00 0.00 X 601514 0 59340 DAN METCALF PHYSICIAN 32.00 0.00 X 640155 0 59897 SAM KUCHINKA PHYSICIAN 40.00 0.00 X 555551 0 60610 4619290 409610 472152 80 0 1 0 REGIONAL ENTERPRISES INC DBA TAMARACK 1615 MAPLE LANE ASHLAND WI 54806 IS/ACCOUNTING/ COMPLIANCE 5628803 MARKET & JOHNSON PO BOX 630 EAU CLAIRE WI 54702 CONSTRUCTION COMPANY 4109156 ESSENTIA HEALTH 532 EAST 1ST ST DULUTH MN 55805 CALL COVERAGE/PRO- FEES/SERVICE AGREEMEN 3471139 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 55485 LOCUM PRO-FEES 1831978 CMDI PO BOX 64756 ST PAUL MN 551640756 RADIOLOGY IMAGING 767885 37 39500 113571 153071 PATIENT SERVICE REVENUE 621500 151524710 151508805 15905 OTHER PROGRAM REVENUE 621500 58432 58432 OTHER OPERATING REVENUE 900099 18127 18127 151601269 1723843 1723843 786153 694528 91625 91625 91625 36280702 18046 35349093 15073 931609 2973 934582 934582 CAFETERIA 722210 328331 328331 EARNINGS IN CMDI 900099 284314 284314 612645 155117035 151869678 15905 3078381 X 252065 252065 25500 25500 1141969 41345 1100624 48601176 45759132 2842044 2119926 1983553 136373 9199822 8560785 639037 3130536 2888849 241687 391089 391089 86213 86213 11024 11024 19263060 18716001 547059 510348 397 509951 2491516 1812525 678991 1751908 1510144 241764 535949 425933 110016 746785 643729 103056 9065829 7825371 1240458 426712 162 426550 DRUGS 16565135 16565135 MEDICAL SUPPLIES 12004080 11997101 6979 ADMINISTRATIVE EXPENSE 5895542 5895542 IMPLICIT PRICE CONCESSI 2897508 2897508 5291785 3899842 1391943 142405477 125805077 16600400 0 42686576 30949406 18993744 20289402 690546 899224 3394585 3371605 1140486 1704326 152206892 61836561 88702867 90370331 65001845 97262616 249288 469281 609583 532583 2377943 4244265 223847463 250093039 8457050 11727869 33085731 31958165 6190337 8891542 47733118 52577576 X 176114345 197444926 70537 176114345 197515463 223847463 250093039 X 12711558 8304015 385545 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11024 11024 0 PART II-B, LINE 1: MEMORIAL MEDICAL CENTER DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. 629483 629483 49880906 19119080 30761826 90625360 39486731 51138629 11071143 3230750 7840393 90370331 COLLABORATIVE AGREEMENT 6508968 THIRD-PARTY PAYOR SETTLEMENTS 375000 LEASE LIABILITIES 1480777 FINANCE LEASE 526797 8891542 X 161600642 8304015 -2511963 5792052 155808590 -691555 -691555 155117035 140199524 691555 691555 139507969 2897508 2897508 142405477 PART X, LINE 2: NONPROFIT 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. NONPROFIT 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. GENERALLY, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2020. PART XI, LINE 2D - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS -2,897,508. GAIN ON INTEREST RATE SWAPS 385,545. PART XI, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFICATION OF RENTAL EXPENSES -694,528. GAIN ON DISPOSAL OF PROPERTY 2,973. PART XII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON DISPOSAL OF PROPERTY -2,973. RECLASSIFICATION OF RENTAL EXPENSES 694,528. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 2,897,508. 1 1 X 1 X 1 X 1 1 1 0 1 1 659770 659770 0.00470 21089350 14930888 6158462 0.04410 21749120 14930888 6818232 0.04880 18796 18796 0.00010 12808497 8330557 4477940 0.03210 285065 285065 0.00200 13112358 8330557 4781801 0.03420 34861478 23261445 11600033 0.08300 1 2897508 43217264 44073179 -855915 X 1 1 1 2 MEMORIAL MEDICAL CENTER INC DBA TAMARACK HEALTH AMC 1615 MAPLE LANE ASHLAND WI 54806 WWW.TAMARACKHEALTH.ORG 1065 X X X X N/A MEMORIAL MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X 1 21 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 MEMORIAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: FOR ALL OF OUR CHNA'S WE CONDUCT A COMMUNITY-WIDE SURVEY TO THE TRI-COUNTY AREA IN WHICH WE SERVE. WE CONDUCTED THIS SURVEY IN SUMMER 2021 IN A ROBUST ONLINE FORMAT AS WELL AS VIRTUAL FOCUS GROUPS, WHICH HADN'T BEEN CONDUCTED IN PREVIOUS SURVEYS. THERE IS A SURVEY AND PLAN BEING DEVELOPED STARTING SPRING 2024. MEMORIAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: ASHLAND MEDICAL CENTER CONDUCTED THE CHNA ALONG WITH THE AREA HEALTH DEPARTMENTS: ASHLAND COUNTY HEALTH AND HUMAN SERVICES, THE BAYFIELD COUNTY HEALTH DEPARTMENT, AND THE IRON COUNTY HEALTH DEPARTMENT. MEMORIAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 7D: PAPER COPIES ARE AVAILABLE BY REQUEST FROM THE MARKETING OFFICE AT AMC BY CALLING (715) 685-5182. MEMORIAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 11: DURING THE 2022 TAX YEAR, SEVERAL ACTIVITIES WERE DONE TO ADDRESS THE CHNA GOAL OF "COLLABORATION" "AWARENESS AND "ACTIVITY," INCLUDING:1) PARTNERSHIP WITH THE "PARTNERS IN RECOVERY" CENTER IN ASHLAND FOR RESIDENTS GOING THROUGH AND/OR LIVING THROUGH RECOVERY (INCLUDING DRUGS, ALCOHOL, AND OTHER SUBSTANCES). THIS INCLUDED:-THE ANNUAL RECOVERY AND PREVENTION PICNIC WAS HELD ON JUNE 3. THIS WAS DONE IN PARTNERSHIP AND COLLABORATION WITH VOICES FOR RECOVERY CHEQUAMEGON BAY, AREA HEALTH DEPARTMENTS, AND LOCAL NATIVE AMERICAN TRIBES.-THE VIRTUAL 5K WALK/RUN PROMOTED AND MADE AWARE OF THE CHEQUAMEGON BAY OVERDOSE AWARENESS DAY ON AUGUST 31. THIS MEETS ALL THREE GOAL CATEGORIES IDENTIFIED IN THE CHIP [COLLABORATION, AWARENESS, ACTIVITY] AND INCLUDED PLANNING/INVOLVEMENT WITH THE FOLLOWING AGENCIES AND NONPROFITS: VOICES FOR RECOVERY CHEQUAMEGON BAY, ASHLAND COUNTY OVERDOSE FATALITY REVIEW COMMITTEE, BAD RIVER BANK OF LAKE SUPERIOR CHIPPEWA, BAYFIELD COUNTY HUMAN SERVICES, BAYFIELD COUNTY TREATMENT COURT, CHEQUAMEGON COALITION ON EMERGING DRUGS, ESSENTIA HEALTH, MEMORIAL MEDICAL CENTER, AND THE ASHLAND COUNTY WELLNESS AND RECOVERY COURT.-MEMORIAL MEDICAL CENTER ALSO FINANCIALLY IMPACTED THE PARTNERS OF RECOVERY CENTER.-MEMORIAL MEDICAL CENTER (NOW TAMARACK HEALTH ASHLAND MEDICAL CENTER) HAS "RECOVERY YOGA" EVENTS PLANNED FOR 2024 TO ADDRESS THE "ACTIVITY" GOAL ADDRESSED IN THE LAST CHIP. ONGOING DISCUSSION AND PLANNING TOOK PLACE WITH MUNICIPALITIES AND LAW ENFORCEMENT AGENCIES ABOUT STARTING AND SECURING A CHILD ADVOCACY CENTER FOR CHILDREN IN ABUSE SITUATIONS WHERE LAW ENFORCEMENT AND MEDICAL PROFESSIONALS ARE INVOLVED. THIS IS AN ONGOING PROJECT. -COMMUNITY CLEAN-UP ACTIVITIES IN MAY AND JUNE - HOSPITAL STAFF HELPED CLEAN AREAS OF THE COMMUNITY IN COLLABORATION WITH THE CITY OF ASHLAND (THIS INCLUDED PROPER DISPOSAL OF SHARPS NEEDLES, ETC).2) MEMORIAL MEDICAL CENTER (NOW TAMARACK HEALTH ASHLAND MEDICAL CENTER) ALSO SPONSORED SEVERAL AREA EVENTS THAT HAD A DIRECT IMPACT AND FOCUS ON HEALTH AND WELLNESS. THIS ADDRESSED ALL OUR GOALS OF [COLLABORATION, AWARENESS, ACTIVITY]. THESE INCLUDED, BUT WERE NOT LIMITED TO:-THE WHISTLESTOP MARATHON-BOOK ACROSS THE BAY-CHILDREN'S SKI CAMP IN DULUTH-BIG TOP CHAUTAUQUA YOUTH EVENTS -55+ EVENT FOR SENIORS-YOUTH SPORTS ACTIVITIES VIA SPONSORSHIP-MMC ALSO COLLABORATED WITH THE ASHLAND FIRE DEPARTMENT AND OTHER AGENCIES FOR A CAR SEAT CLINIC ON APRIL 19 TO ENSURE PROPER CAR SEAT INSTALLATION. -BAY DAYS IN JULY 2023 ALSO ADDRESSED HEALTH SAFETY INFORMATION TO HUNDREDS OF PEOPLE, AND FREE BIKE HELMETS WERE HANDED OUT TO CHILDREN AND ADULTS.MANY OF THE EVENTS DESCRIBED ABOVE ADDRESSED SEVERAL OF THE KEY HEALTH CONCERNS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDING: CHRONIC DISEASE, MENTAL HEALTH ISSUES, OBESITY, SUBSTANCE USE AND ABUSE, NUTRITION, INJURY, COMMUNICABLE DISEASE, AND PHYSICAL HEALTH. WE RECOGNIZE THAT BY USING THE GOALS OF "COLLABORATION", "AWARENESS", AND "ACTIVITY" - WE CAN HAVE A GREATER IMPACT ON ADDRESSING THESE CONCERNS WHEN WE PARTNER WITH EXISTING ORGANIZATIONS WHO ARE ALREADY MAKING AN IMPACT ON THESE HEALTH ISSUES. THERE WERE ALSO SOME OTHER ISSUES IDENTIFIED IN THE SURVEY THAT HAVE NOT YET BEEN ADDRESSED INCLUDING: ORAL HEALTH, REPRODUCTIVE & SEXUAL ISSUES, TOBACCO USE, AND GROWTH & DEVELOPMENT. WE HAVE NOT YET IDENTIFIED AGENCIES AND ORGANIZATIONS WITH WHOM WE CAN COLLABORATE. WE DECIDED TO FOCUS EFFORTS ON THE TOP THREE IDENTIFIED HEALTH CONCERNS. MEMORIAL MEDICAL CENTER, INC. PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 7B, CHNA REPORT - OTHER WEBSITE: HTTPS://CO.ASHLAND.WI.US/INDEX.ASP?SEC=B77F5C3A-9D66-4656-B09F-63B28DF12119&DE=DEBD1C96-ADCF-4ECC-ABF2-234591ABB8E9 PART V, LINE 10A, IMPLEMENTATION PLAN WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/PATIENTS-VISITORS/BILLING-SERVICES/FINANCIAL-ASSISTANCE/ PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/PATIENTS-VISITORS/BILLING-SERVICES/FINANCIAL-ASSISTANCE/ PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/PATIENTS-VISITORS/BILLING-SERVICES/FINANCIAL-ASSISTANCE/ 1 1 - TAMARACK HEALTH SUPERIOR CLINIC 3631 TOWER AVENUE SUPERIOR WI 54880 CLINIC PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2023 MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE CARDIAC REHABILITATION, THERAPY SERVICES (PT, OT, AND SPEECH), PSYCHIATRIC/PSYCHOLOGICAL SERVICES AND BEHAVIORAL HEALTH INPATIENT, AND OBSERVATION BEDS. PART I, LN 7 COL(F): IMPLICIT PRICE CONCESSIONS FROM FINANCIAL STATEMENTS IS $2,897,508. PART III, LINE 2: REVENUES ARE BASED UPON THE ESTIMATED AMOUNTS THE HOSPITAL EXPECTS TO BE ENTITLED TO RECEIVE FROM PATIENTS, INCLUDING PAYMENTS MADE BY THIRD-PARTY PAYORS ON BEHALF OF PATIENTS. ESTIMATES OF CONTRACTUAL ALLOWANCES UNDER MANAGED CARE AND COMMERCIAL INSURANCE PLANS ARE BASED UPON THE PAYMENT TERMS SPECIFIED IN THE RELATED CONTRACTUAL AGREEMENTS. REVENUES RELATED TO UNINSURED PATIENTS AND UNINSURED COPAYMENTS AND DEDUCTIBLE AMOUNTS FOR PATIENTS WHO HAVE HEALTH CARE COVERAGE MAY HAVE DISCOUNTS APPLIED (UNINSURED DISCOUNTS AND CONTRACTUAL DISCOUNTS). THE HOSPITAL ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY AND OTHER THIRD-PARTY PAYOR REVENUES AT THE ESTIMATED AMOUNTS THE HOSPITAL EXPECTS TO COLLECT.UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE (ASU) NO. 2014-09, WHEN THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME, THE RIGHT IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THE HOSPITAL HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE HOSPITAL'S RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE, THE ESTIMATED UNCOLLECTIBLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT ACCOUNTS RECEIVABLE RATHER THAN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE HOSPITAL DETERMINES THIS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH CERTAIN CLASSES OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. THE FINANCIAL STATEMENT EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH.THE PRIMARY COLLECTIONS RISKS RELATE TO UNINSURED PATIENT ACCOUNTS, INCLUDING PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE CARRIER HAS PAID THE AMOUNTS COVERED BY THE APPLICABLE AGREEMENT, BUT THE PATIENT RESPONSIBILITY AMOUNTS (DEDUCTIBLES AND COPAYMENTS) REMAIN OUTSTANDING. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED IMPLICIT PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGING OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. PART III, LINE 3: AT MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER IMPLICIT PRICE CONCESSIONS ARE CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY. PART III, LINE 4: SEE FOOTNOTE 1 ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE COSTING METHODOLOGY USED IN DETERMINING THE MEDICARE ALLOWABLE COST REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6: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 III, LINE 9B: MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER'S BILLING AND COLLECTION POLICY STATES:A. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, MMC MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS (ECAS), TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.B. ALL PATIENTS WILL BE OFFERED A PLAIN LANGUAGE SUMMARY (APPENDIX A) AND AN APPLICATION FORM (APPENDIX B) FOR FINANCIAL ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) AS PART OF THE DISCHARGE OR INTAKE PROCESS FROM A HOSPITAL.C. AT LEAST THREE SEPARATE STATEMENTS FOR COLLECTION OF SELF-PAY ACCOUNTS SHALL BE MAILED OR EMAILED TO THE LAST KNOWN ADDRESS OF EACH RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT NO ADDITIONAL STATEMENTS NEED BE SENT AFTER A RESPONSIBLE INDIVIDUAL(S) SUBMITS A COMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP OR HAS PAID IN-FULL. AT LEAST 60 DAYS SHALL HAVE ELAPSED BETWEEN THE FIRST AND LAST OF THE REQUIRED THREE MAILINGS. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS, THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE. ALL SINGLE PATIENT ACCOUNT STATEMENTS OF SELF-PAY ACCOUNTS WILL INCLUDE BUT NOT LIMITED TO:1. AN ACCURATE SUMMARY OF THE HOSPITAL SERVICES COVERED BY THE STATEMENT;2. THE CHARGES FOR SUCH SERVICES;3. THE AMOUNT REQUIRED TO BE PAID BY THE RESPONSIBLE INDIVIDUAL(S) (OR, IF SUCH AMOUNT IS NOT KNOWN, A GOOD FAITH ESTIMATE OF SUCH AMOUNT AS OF THE DATE OF THE INITIAL STATEMENT); AND4. A CONSPICUOUS WRITTEN NOTICE THAT NOTIFIES AND INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE HOSPITAL FAP INCLUDING THE TELEPHONE NUMBER OF THE DEPARTMENT AND DIRECT WEBSITE ADDRESS WHERE COPIES OF DOCUMENTS MAY BE OBTAINED.D. AT LEAST ONE OF THE STATEMENTS MAILED OR EMAILED WILL INCLUDE WRITTEN NOTICE THAT INFORMS THE RESPONSIBLE INDIVIDUAL(S) ABOUT THE ECAS THAT ARE INTENDED TO BE TAKEN IF THE RESPONSIBLE INDIVIDUAL(S) DOES NOT APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP OR PAY THE AMOUNT DUE BY THE BILLING DEADLINE. SUCH STATEMENT MUST BE PROVIDED TO THE RESPONSIBLE INDIVIDUAL(S) AT LEAST 30 DAYS BEFORE THE DEADLINE SPECIFIED IN THE STATEMENT. A PLAIN LANGUAGE SUMMARY WILL ACCOMPANY THIS STATEMENT. IT IS THE RESPONSIBLE INDIVIDUAL(S) OBLIGATION TO PROVIDE A CORRECT MAILING ADDRESS AT THE TIME OF SERVICE OR UPON MOVING. IF AN ACCOUNT DOES NOT HAVE A VALID ADDRESS, THE DETERMINATION FOR "REASONABLE EFFORT" WILL HAVE BEEN MADE.E. RESPONSIBLE INDIVIDUAL(S) PROPENSITY TO PAY WILL BE SCORED BASED ON THAT ASSESSMENT OF THE RESPONSIBLE INDIVIDUAL(S) LIKELIHOOD TO PAY AND DOLLAR AMOUNT OF THE SELF-PAY ACCOUNT.F. MMC OFFERS PAYMENT PLANS THAT BEAR NO INTEREST. GENERALLY, BALANCE REQUIRE A MINIMUM PAYMENT OF $25.00 PER MONTH AND MUST BE PAID IN FULL WITHIN 24 MONTHS.G. PRIOR TO INITIATION OF ANY ECAS, AN ORAL ATTEMPT WILL BE MADE TO CONTACT RESPONSIBLE INDIVIDUAL(S) BY TELEPHONE AT THE LAST KNOWN TELEPHONE NUMBER, IF ANY, AT LEAST ONCE DURING THE SERIES OF MAILED OR EMAILED STATEMENTS IF THE ACCOUNT REMAINS UNPAID. DURING ALL CONVERSATIONS, THE PATIENT OR RESPONSIBLE INDIVIDUAL(S) WILL BE INFORMED ABOUT THE FINANCIAL ASSISTANCE THAT MAY BE AVAILABLE UNDER THE FAP.H. ECAS MAY BE COMMENCED AS FOLLOWS:1. IF ANY RESPONSIBLE INDIVIDUAL(S) FAIL TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE FAP BY 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT, AND THE RESPONSIBLE PARTIES HAVE RECEIVED A STATEMENT WITH A BILLING DEADLINE DESCRIBED IN SECTION III.E ABOVE, THEN MMC OR COLLECTION AGENCY MAY INITIATE ECAS.2. IF ANY RESPONSIBLE INDIVIDUAL(S) SUBMITS AN INCOMPLETE APPLICATION FOR FINANCIAL ASSISTANCE UNDER THE FAP PRIOR TO THE APPLICATION DEADLINE, THEN ECAS MAY NOT BE INITIATED UNTIL AFTER EACH OF THE FOLLOWING STEPS HAS BEEN COMPLETED:A. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH A WRITTEN NOTICE THAT DESCRIBES THE ADDITIONAL INFORMATION OR DOCUMENTATION REQUIRED UNDER THE FAP IN ORDER TO COMPLETE THE APPLICATION FOR FINANCIAL ASSISTANCE, WHICH NOTICE WILL INCLUDE A COPY OF THE PLAIN LANGUAGE SUMMARY.B. PFS PROVIDES THE RESPONSIBLE INDIVIDUAL(S) WITH AT LEAST 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT MMC OR COLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S) IF THE FAP APPLICATION IS NOT COMPLETED OR PAYMENT IS NOT MADE; PROVIDED, HOWEVER, THAT THE COMPLETION DEADLINE FOR PAYMENT MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.C. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION COMPLETES THE APPLICATION FOR FINANCIAL ASSISTANCE, AND PFS DETERMINES DEFINITIVELY THAT THE RESPONSIBLE INDIVIDUAL(S) IS INELIGIBLE FOR ANY FINANCIAL ASSISTANCE UNDER THE FAP, MMC WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL AND INCLUDE A 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT MMC OR COLLECTION AGENCY MAY INITIATE AGAINST THE RESPONSIBLE INDIVIDUAL(S); PROVIDED, HOWEVER, THAT THE BILLING DEADLINE MAY NOT BE SET PRIOR TO 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT.D. IF THE RESPONSIBLE INDIVIDUAL(S) WHO HAS SUBMITTED THE INCOMPLETE APPLICATION FAILS TO COMPLETE THE APPLICATION BY THE COMPLETION DEADLINE SET IN THE NOTICE PROVIDED PURSUANT TO SECTION III.G.3.B ABOVE, THEN ECAS MAY BE INITIATED.E. IF AN APPLICATION, COMPLETE OR INCOMPLETE, FOR FINANCIAL ASSISTANCE UNDER THE FAP IS SUBMITTED BY A RESPONSIBLE INDIVIDUAL(S), AT ANY TIME PRIOR TO THE APPLICATION DEADLINE, MMC WILL SUSPEND ECAS WHILE SUCH FINANCIAL ASSISTANCE APPLICATION IS PENDING.I. AFTER THE COMMENCEMENT OF ECAS IS PERMITTED UNDER SECTION III.G ABOVE, COLLECTION AGENCIES SHALL BE AUTHORIZED TO REPORT UNPAID ACCOUNTS TO CREDIT AGENCIES, AND TO FILE JUDICIAL OR LEGAL ACTION, GARNISHMENT, OBTAIN JUDGMENT LIENS AND EXECUTE UPON SUCH JUDGMENT LIENS USING LAWFUL MEANS OF COLLECTION; PROVIDED, HOWEVER, THAT PRIOR APPROVAL OF PFS SHALL BE REQUIRED BEFORE INITIAL LAWSUITS MAY BE INITIATED. MMC AND EXTERNAL COLLECTION AGENCIES MAY ALSO TAKE ANY AND ALL LEGAL OTHER ACTIONS INCLUDING BUT NOT LIMITED TO TELEPHONE CALLS, EMAILS, TEXTS, MAILING NOTICES, AND SKIP TRACING TO OBTAIN PAYMENT FOR MEDICAL SERVICES PROVIDED.IV. POLICY AVAILABILITYCONTACT OUR BUSINESS OFFICE AT 715-685-5500 FOR INFORMATION REGARDING ELIGIBILITY OR THE PROGRAMS THAT MAY BE AVAILABLE TO YOU, TO REQUEST A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TO BE MAILED TO YOU, OR IF YOU NEED A COPY OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY TRANSLATED TO SPANISH. FULL DISCLOSURE OF THE FAP, FAP APPLICATION FORM, OR COLLECTION POLICY MAY BE FOUND AT WWW.ASHLANDMMC.COM. A PAPER COPY OF OUR FAP, FAP APPLICATION FORM, OR COLLECTION POLICY CAN BE OBTAINED AT OUR FACILITY LOCATED AT 1615 MAPLE LANE, ASHLAND, WI 54806 AT THE REGISTRATION DESK. PART VI, LINE 2: NEEDS ASSESSMENT:MEMORIAL MEDICAL CENTER WORKED WITH A MULTIDISCIPLINARY GROUP OF AREA HEALTH AGENCIES AND ORGANIZATIONS TO SURVEY, IDENTIFY, PRIORITIZE AND IMPACT AREAS OF GREAT HEALTH CONCERNS IN THE COMMUNITIES WE SERVE. WHILE THE CHNA PROCESS INCLUDES DATA COLLECTION THROUGH SURVEYS, FOLLOWED BY ANALYZING THE DATA TO CREATE A CHNA PLAN, THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) COMMITTEE DID AN ADDITIONAL LAYER OF ASSESSMENT TO REALLY ENSURE IMPACTS WERE BEING MADE IN THE COMMUNITIES. STAKEHOLDER QUESTIONNAIRES WERE SENT TO AREA AGENCIES, GROUPS, BUSINESSES, SCHOOLS, ETC. FOR FEEDBACK ON THE PLAN'S IMPACT TO MEASURE HOW AGENCIES VIEW THE EFFICACY OF THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE AND ITS PLANS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: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: COMMUNITY INFORMATION:MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER SERVES AN 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: PROMOTION OF COMMUNITY HEALTH:MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND 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 6: AFFILIATED HEALTH CARE SYSTEM:MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 ASHLAND PARKS AND RECREATION DEPARTMENT 400 4TH AVE WEST ASHLAND WI 54806 396005387 GOVERNMENT 10000 0 GENERAL SUPPORT SCHOOL DISTRICT OF ASHLAND 2000 BEASER AVE ASHLAND WI 54806 396008441 GOVERNMENT 8500 0 GENERAL SUPPORT TOWN OF GRAND VIEW 22010 GRAND VIEW BLVD GRAND VIEW WI 54839 396006065 GOVERNMENT 10000 0 GENERAL SUPPORT GENESIS 1990 INC 220 W 4TH AVE ASHLAND WI 54806 391701690 501(C)(3) 15000 0 GENERAL SUPPORT ASHLAND AREA DEVELOPMENT CORP 422 3RD ST W RM/STE 101 ASHLAND WI 54806 391483663 501(C)(3) 15000 0 GENERAL SUPPORT ASHLAND SKI TRAIL ASSOCIATION 1121 19TH AVE W ASHLAND WI 54806 391860366 501(C)(3) 20000 0 GENERAL SUPPORT FRIENDS OF THE APOSTLE ISLANDS PO BOX 1574 BAYFIELD WI 54814 200079065 501(C)(3) 10000 0 GENERAL SUPPORT NORTHLAND COLLEGE 1411 ELLIS AVE ASHLAND WI 54806 390806428 501(C)(3) 15000 0 GENERAL SUPPORT ASHLAND AREA CHAMBER OF COMMERCE PO BOX 746 ASHLAND WI 54806 390137565 501(C)(6) 15000 0 GENERAL SUPPORT BAYFIELD COUNTY SHERIFF'S OFFICE 615 N 2ND AVE E WASHBURN WI 54891 396005670 GOVERNMENT 15880 0 GENERAL SUPPORT 9 1 SCHOLARSHIPS 13 25500 PART I, LINE 2: THE HOSPITAL REQUIRES RECIPIENTS TO PROVIDE DOCUMENTATION SUPPORTING EXPENDITURE OF RELATED GRANT FUNDS RECEIVED. EXPENDITURES ARE REQUIRED TO QUALIFY FOR THE PURPOSE THE GRANT/AWARD WAS GIVEN OR THE FUNDS ARE REQUIRED TO BE RETURNED. X X X X 0 0 0 0 0 0 0 0 0 JUSTIN CUMMINS PHYSICIAN 868494 0 172320 0 360 0 15250 0 39329 0 1095753 0 0 0 JASON DOUGLAS PRESIDENT/CEO - MMC 486235 0 154358 0 966 0 15250 0 44384 0 701193 0 0 0 DAN METCALF PHYSICIAN 624603 0 15000 0 552 0 15250 0 44647 0 700052 0 0 0 MATTHEW BETTENDORF PHYSICIAN 601214 0 0 0 300 0 15250 0 44090 0 660854 0 0 0 MANDEEP SINGH PSYCHIATRIST 390830 0 175045 0 360 0 15250 0 43909 0 625394 0 0 0 SAM KUCHINKA PHYSICIAN 301779 0 253539 0 233 0 15250 0 45360 0 616161 0 0 0 KENT DUMONSEAU VICE PRESIDENT/CFO - REI 0 317750 0 91500 0 360 0 15250 0 42605 0 467465 0 0 JESSICA NUUTINEN CHIEF OPERATING OFFICER 251005 0 0 0 534 0 12550 0 35562 0 299651 0 0 0 KAREN HANSEN BOARD MEMBER/FORMER COO 203310 0 35001 0 0 0 10165 0 2801 0 251277 0 0 0 A ASHLAND COUNTY WISCONSIN 396005666 2014-12-29 7120000 CONSTRUCT AND EQUIP FACILITY 0 0 0 B ASHLAND COUNTY WISCONSIN 396005666 2019-12-06 10000000 CONSTRUCT AND EQUIP FACILITY 0 0 0 C BAYFIELD COUNTY WISCONSIN 396005670 2019-12-23 7500000 CONSTRUCT AND EQUIP FACILITY 0 0 0 D ASHLAND COUNTY WISCONSIN 396005666 2020-01-07 7500000 CONSTRUCT AND EQUIP FACILITY 0 0 0 A 3478728 7120000 123433 6996567 2016 0 0 1 1 B 468831 10000000 89469 9910531 2021 0 0 1 1 C 351624 7500000 73679 7426321 2021 0 0 1 1 D 351894 7500000 70625 7429375 2021 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 A BAYFIELD COUNTY WISCONSIN 396005670 2020-01-22 5000000 CONSTRUCT AND EQUIP FACILITY 0 0 0 A 234408 5000000 53750 4946250 2021 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 REGIONAL ENTERPRISES, INC. DBA TAMARACK HEALTH IS THE SOLE CORPORATE MEMBER OF MEMORIAL MEDICAL CENTER, INC. DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A REGIONAL ENTERPRISES, INC. DBA TAMARACK HEALTH MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW, REI, AS THE SOLE MEMBER OF AMC, SHALL HAVE THE FOLLOWING RESERVE POWERS: A) THE POWER TO MAKE, AMEND, OR REPEAL AMC'S BYLAWS AND ARTICLES OF INCORPORATION. B) TO APPROVE ANY CHANGE IN AMC'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR AMC. C) TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D) TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $1,000,000 IN VALUE. E) TO SELECT AND RETAIN AN INDEPENDENT AUDITING FIRM. F) TO APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY AMC. G) TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF AMC. H) BASED ON A RECOMMENDATION FROM THE BOARD OF DIRECTORS OF AMC, TO APPOINT AND MONITOR THE PERFORMANCE OF THE PRESIDENT/CEO OF REI, WHO SHALL ALSO SIMULTANEOUSLY SERVE AS THE PRESIDENT/CEO OF AMC. FORM 990, PART VI, SECTION B, LINE 11B 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 A. DEFINITIONS 1. AN "INTERESTED PERSON" MEANS ANY CURRENT DIRECTOR, PRINCIPAL OFFICER OR MEMBER OF A COMMITTEE THAT REPORTS TO THE BOARD OF DIRECTORS. IF A PERSON MEETS THE DEFINITION OF AN INTERESTED PERSON FOR REI OR ANY OF ITS AFFILIATED CORPORATIONS, THAT PERSON SHALL BE CONSIDERED AN INTERESTED PERSON FOR ALL CORPORATIONS WITH THE REI SYSTEM. 2. AN "INSIDER" MEANS ANY PERSON WHO IS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF REI. FOR PURPOSES OF APPLYING THE PROCEDURES OF THIS POLICY, THE FOLLOWING WILL BE CONSIDERED INSIDERS: ANY INTERESTED PERSON AS DEFINED HEREIN; THE MANAGERS AT REI AND ITS AFFILIATED CORPORATIONS; AND MEMBERS OF THE VARIOUS MEDICAL STAFFS AT MEMBERS' HOSPITALS. FOR PURPOSES OF THIS PROTOCOL, A "MANAGER" INCLUDES ANY PERSON WHO MANAGES A DISCRETE SEGMENT OR ACTIVITY OF REI, OR ANY OF ITS AFFILIATES, THAT REPRESENTS A SUBSTANTIAL PORTION (I.E., 10% OR MORE) OF THE ACTIVITIES, ASSETS, INCOME, OR EXPENSES OF REI OR SUCH AFFILIATE AS COMPARED TO THE ORGANIZATION AS A WHOLE. FINALLY, ANYONE WHO HAS BEEN AN INTERESTED PERSON AT ANY TIME IN THE PAST FIVE (5) YEARS AND ANYONE WHO WAS A MEMBER OF ANY MEDICAL STAFF OF A MEMBER HOSPITAL AT SOME TIME IN THE PAST FIVE (5) YEARS, SHALL BE CONSIDERED AN INSIDER. 3. FOR PURPOSES OF THIS POLICY, "FAMILY" OF AN INSIDER SHALL MEAN: A. SUCH INDIVIDUAL'S SPOUSE AND THE PARENTS AND SIBLINGS OF THE SPOUSE; B. SUCH INDIVIDUAL'S PARENTS, GRANDPARENTS, SIBLINGS (WHOLE OR HALF BLOOD OR BY ADOPTIONS), CHILDREN, GRANDCHILDREN AND GREAT GRANDCHILDREN; AND C. SPOUSES OF SUCH INDIVIDUAL'S GRANDPARENTS, SIBLINGS, CHILDREN, GRANDCHILDREN, AND GREAT GRANDCHILDREN. B. DISCLOSURE 1. EACH DIRECTOR AND OFFICER SHALL DISCLOSE TO THE BOARD OF DIRECTORS, OR TO THE OTHER MEMBERS OF ANY COMMITTEE CONSIDERING A PROPOSED BUSINESS TRANSACTION OR ARRANGEMENT, THE EXISTENCE AND NATURE OF ANY FINANCIAL INTEREST SUCH PERSON OR A MEMBER OF SUCH PERSON'S FAMILY MAY HAVE WITH RESPECT TO SUCH PROPOSED TRANSACTION OR ARRANGEMENT. EACH DIRECTOR AND PRINCIPAL OFFICER SHALL PROMPTLY MAKE DISCLOSURES AS MAY BE NECESSARY TO KEEP THE BOARD OR COMMITTEE FULLY APPRISED OF SUCH PERSON'S FINANCIAL INTERESTS. DISCLOSURE SHALL ALSO BE ACCOMPLISHED ON AN ANNUAL BASIS BY HAVING EACH DIRECTOR AND PRINCIPAL OFFICER EXECUTE AND DELIVER TO REI A CERTIFICATE REGARDING CONFLICTS OF INTEREST IN SUBSTANTIALLY THE FORM ATTACHED TO THIS POLICY. 2. THE REQUIREMENT THAT INTERESTED PERSONS DISCLOSE THEIR FINANCIAL INTERESTS SUBSTANTIALLY REQUIRES EACH DIRECTOR AND PRINCIPAL OFFICER TO DISCLOSE ANY INSIDER TRANSACTION IN WHICH HE OR SHE, HIS/HER FAMILY MEMBERS OR A CONTROLLED ENTITY ARE INVOLVED. THIS OCCURS BECAUSE THE DEFINITION OF A FINANCIAL INTEREST IS BROADER THAN THE DEFINITION OF AN INSIDER TRANSACTION. HOWEVER, NOT ALL FINANCIAL INTERESTS DISCLOSED WILL RESULT IN A CONFLICT OF INTEREST OR AN INSIDER TRANSACTION. A TRANSACTION INVOLVING A DIRECTOR OR OFFICER WILL FALL INTO ONE OF THE FOLLOWING THREE CATEGORIES: (I) IT NEITHER INVOLVES AN INTERESTED PERSON NOR IS AN INSIDER TRANSACTION, (II) IT INVOLVES AN INTERESTED PERSON, BUT IS NOT AN INSIDER TRANSACTION; OR (III) IT INVOLVES AN INTERESTED PERSON AND IS AN INSIDER TRANSACTION. C. RESPONSE TO DISCLOSURES IF ANY DIRECTOR OR PRINCIPAL OFFICER DISCLOSES A POTENTIAL FINANCIAL INTEREST TO THE BOARD OF DIRECTORS OR ANY COMMITTEE REGARDING A PROPOSED TRANSACTION OR ARRANGEMENT, THE BOARD OR COMMITTEE SHALL FIRST DETERMINE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT COULD BE CONSIDERED AN INSIDER TRANSACTION. IF THE BOARD OR COMMITTEE IS CERTAIN THAT THE TRANSACTION OR ARRANGEMENT WILL NOT INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW ONLY THE PROCEDURES SET FORTH IN SECTION III(C)(1) BELOW. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES IN BOTH SECTION III(C)(1) AND SECTION III(C)(2). 1. PROCEDURES FOR DISCLOSURES OF ANY FINANCIAL INTEREST THAT MAY RESULT IN A CONFLICT OF INTEREST ON THE PART OF AN INTERESTED PERSON THAT DOES NOT MEET THE DEFINITION OF AN INSIDER TRANSACTION A. THE INTERESTED PERSON SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DETERMINED NO CONFLICT EXISTS, THE INTERESTED PERSON MAY REJOIN THE MEETING AND PARTICIPATE IN THE DISCUSSIONS AND ACTIONS REGARDING THIS AGENDA ITEM. B. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER REI CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. I. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THAT BODY SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN REI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO REI. II. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO REI, THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. FURTHER ACTION BY THE BOARD OR COMMITTEE SHALL BE TABLED UNTIL SUCH TIMES AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. C. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF REI AND THAT IS NOT FAIR AND REASONABLE TO REI. D. ONCE DISCUSSION AND/OR ACTION REGARDING THE AGENDA ITEM RELATING TO THE DIRECTOR'S FINANCIAL INTEREST HAS BEEN COMPLETED, THE INTERESTED PERSON MAY REJOIN THE BOARD OR COMMITTEE MEETING. 2. PROCEDURES FOR DISCLOSURE OF ANY FINANCIAL INTEREST THAT MAY RESULT IN A CONFLICT OF INTEREST THAT IS ALSO A POTENTIAL INSIDER TRANSACTION A. THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. IN ADDITION, THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL ALSO DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS A PART OF THIS CONSIDERATION, THE BOARD OR COMMITTEE SHALL ALSO CONSIDER WHETHER THEIR ACTION COULD BE CONSTRUED TO BE AN EXCESS BENEFIT TRANSACTION SUBJECT TO THE INTERMEDIATE SANCTIONS DISCUSSED ABOVE. B. IN DETERMINING WHETHER A TRANSACTION OR ARRANGEMENT IS AN EXCESS BENEFIT TRANSACTION, THE BOARD OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT SHOULD REVIEW APPROPRIATE DATA AS TO COMPARABILITY. THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY REI'S MANAGEMENT. C. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. D. RECORDS OF PROCEEDINGS 1. THE MINUTES OF THE BOARD AND COMMITTEE MEETINGS SHALL CONTAIN: A. THE NAMES OF PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST WITH RESPECT TO ANY PROPOSED TRANSACTION OR ARRANGEMENT WITH REI, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. B. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO BE A PARTY TO AN INSIDER TRANSACTION, THE NATURE OF THE INSIDER'S RELATIONSHIP TO REI, AND A RECORD OF ALL VOTES TAKEN IN CONNECTION WITH THE BOARD'S DECISION AS TO WHETHER THE INSIDER TRANSACTION WAS AN EXCESS BENEFIT TRANSACTION. C. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO ANY TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO PROPOSED TRANSACTION OR A ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN APPROVING OR REJECTING ANY PROPOSED TRANSACTION OR ARRANGEMENT. 2. REI SHALL DOCUMENT THE BASIS FOR ITS DETERMINATION REGARDING WHETHER ANY INSIDER TRANSACTION IS AN EXCESS BENEFIT TRANSACTION. E. VIOLATIONS OF THE PROTOCOL 1. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR OR PRINCIPAL OFFICER HAS FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL INFORM THE DIRECTOR OR PRINCIPAL OFFICER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE DIRECTOR OR PRINCIPAL OFFICER AN OPPORTUNITY TO EXPLAIN WHY DISCLOSURE WAS NOT MADE. 2. IF, AFTER HEARING THE RESPONSE OF THE DIRECTOR OR PRINCIPAL OFFICER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE DIRECTOR HAS IN FACT FAILED TO DISCLOSE A FINANCIAL INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND/OR CORRECTIVE ACTION. THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE WITH THE ABOVE CONFLICT OF INTEREST POLICY BY PROVIDING A QUESTIONNAIRE TO BOARD MEMBERS ANNUALLY AS WELL AS REVIEWING THE POLICY ANNUALLY WITH THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 AMC PARTICIPATES IN SALARY SURVEYS SPECIFIC TO ADMINISTRATOR POSITIONS. AMC ALSO HAS AN INDEPENDENT COMPENSATION CONSULTING FIRM TO GATHER FAIR MARKET COMPENSATION DATA FOR ALL C LEVEL 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 AMC 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, IN CONJUNCTION WITH SALARY SURVEY INFORMATION. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATION FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 18,716,001. MANAGEMENT AND GENERAL EXPENSES 547,059. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,263,060. FORM 990, PART XI, LINE 9: GAIN ON INTEREST RATE SWAPS 385,545. MEDICAL SERVICES INC DBA TAMARACK HEALTH HAYWARD MEDICAL CENTER 11040 N STATE ROAD 77 HAYWARD WI 54843 391536207 HEALTH CARE WI 501(C)(3) LINE 3 REGIONAL ENTERPRISES INC DBA TAMARACK HEALTH 0 REGIONAL ENTERPRISES INC DBA TAMARACK HEALTH 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) LINE 12A, I MEMORIAL MEDICAL CENTER INC DBA TAMARACK HEALTH ASHLAND MEDICAL CENTER 1 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) LINE 12A, I REGIONAL ENTERPRISES INC DBA TAMARACK HEALTH 0 REGIONAL WELLNESS FUND OF MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 391360035 SUPPORT WI 501(C)(3) PF N/A 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 REGIONAL ENTERPRISES INC DBA TAMARACK HEALTH M 5845038 ACTUAL VALUE