2012-05-10T13:58:39-05:00 2011-09-30 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2010-10-01 390848401 COMMUNITY MEMORIAL HOSPITAL INCORPORATED COMM 9208463444 855 S MAIN STREET OCONTO FALLS WI 54154 MICHELE MILLER-CAMPBELL 9208463444 2012-05-10 1 TERRI REXRODE 9206620016 2012-05-10 2010 2016-02-24 21:20:13Z MICHELE MILLER-CAMPBELL 855 S MAIN STREET OCONTO FALLS WI 54154 37830224 0 X WWW.CMHOSPITAL.ORG X 1929 WI COMMUNITY MEMORIAL HOSPITAL, INC. OPERATES AN ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE INPATIENT MEDICAL AND SURGICAL SERVICES AS WELL AS EMERGENCY, PRIMARY CARE PHYSICIAN, AND OUTPATIENT SERVICES. THE HOSPITAL HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL UNDER MEDICARE AND MEDICAID REGULATIONS. THIS DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25. 8 7 416 72 2696892 -425003 410963 249389 37415355 37242847 153678 142453 -70130 -82057 37909866 37552632 0 0 0 0 19697091 20737802 0 0 0 17734851 18213287 37431942 38951089 477924 -1398457 25952413 29769545 12475958 13043656 13476455 16725889 X TO PROVIDE HIGH QUALITY HEALTHCARE, CLOSE TO HOME. 1 1 30161846 34518720 COMMUNITY MEMORIAL HOSPITAL IS AN INDEPENDENT HEALTHCARE SYSTEM SERVING GREATER OCONTO COUNTY WITH A FULL-SERVICE HOSPITAL AND SIX CMH PRIMARY CARE CLINICS LOCATED THROUGHOUT OCONTO COUNTY. THE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH 25 BEDS AND AN ADDITIONAL 3 NURSERY BEDS HAS A 24-HOUR, PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, URGENT CARE, RETAIL PHARMACY, INTENSIVE CARE, INPATIENT AND OUTPATIENT SURGICAL AND DIAGNOSTIC SERVICES, REHABILITATION, ONCOLOGY OUTPATIENT CLINIC, OBSTETRICS, THE CMH CENTER FOR WOMEN'S CARE, AND THE CMH CENTER FOR ORTHOPEDIC CARE. CMH PRIMARY CARE CLINICS ARE LOCATED IN LENA, OCONTO FALLS, OCONTO, GILLETT, SURING, AND MOUNTAIN. COMMUNITY MEMORIAL HOSPITAL IS A NON-PROFIT ORGANIZATION DEDICATED TO OUR MISSION TO PROVIDE HIGH QUALITY HEALTH CARE CLOSE TO HOME. COMMUNITY MEMORIAL HOSPITAL EXTENDS THIS MISSION INTO OUR VALUES OF QUALITY, CARE, COMMUNITY, TRUST, AND RESPECT AND PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTHCARE SERVICES. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2011, THE HOSPITAL HAD 958 DISCHARGES; 91 LIVE BIRTHS; 5,240 VISITS TO THE EMERGENCY ROOM; 1,834 SURGICAL CASES (INCLUDING AMBULATORY); AND 41,013 VISITS TO OUR HOSPITAL-BASED CLINICS.COMMUNITY MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO THEIR AGE, RACE, SEX, OR ABILITY TO PAY FOR SERVICES. DURING FISCAL YEAR 2011, COMMUNITY MEMORIAL HOSPITAL PROVIDED $1,912,688 IN CHARITY CARE, $223,961 IN PATIENT DISCOUNTS FOR GOVERNMENT PROGRAMS OUTSIDE OF TITLE 18 & TITLE 19, AND $1,798,216 IN BAD DEBT WRITE OFFS OF PATIENT ACCOUNTS AS BAD DEBT DUE TO THE PATIENTS' INABILITY TO PAY FOR SERVICES THEY RECEIVED.IN ADDITION TO ITS HOSPITAL AND CLINIC SERVICES, COMMUNITY MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE FREE AND LOW-COST HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE OFFERINGS, COMMUNITY MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES.COMMUNITY MEMORIAL HOSPITAL HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. COMMUNITY MEMORIAL HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, PUBLICITY, SUPPLIES, AND THE MEALS. FOUR CMH SENIOR SPECIALS DINNER SEMINARS WERE HELD IN 2011.COMMUNITY MEMORIAL HOSPITAL IS PLEASED TO PARTNER, PARTICIPATE AND COLLABORATE WITH MANY COMMUNITY PARTNERS FOR VARIOUS INITIATIVES AND EVENTS. COMMUNITY MEMORIAL HOSPITAL PLANNED AND SPONSORED THE 5TH ANNUAL HOT CAKE HUSTLE 5K FUN RUN/WALK SEPTEMBER 17, 2011, A COMMUNITY HEALTH INITIATIVE. WE ALSO PRESENTED THE 3RD ANNUAL OCONTO COUNTY SAFETY FAIR MAY 14, 2011 IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. CMH OFFERED FOUR FREE WORKSHOPS FOR CANCER PATIENTS IN 2011 THROUGH THE AMERICAN CANCER SOCIETY LOOK GOOD FEEL BETTER PROGRAM. CMH HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. COMMUNITY MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR MAJOR FUNDRAISING COMMITTEE AND THE EXECUTIVE COMMITTEE. FOR EACH OF THESE INITIATIVES, COMMUNITY MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES.IN THE COMMUNITY, PARTNER ORGANIZATIONS SEEK THE DIRECTION AND LEADERSHIP OF COMMUNITY MEMORIAL HOSPITAL AND THE CMH PRIMARY CARE CLINICS TO LEAD SEVERAL PROJECTS TO PROVIDE FREE HEALTH INFORMATION AND SERVICES, AND PROMOTE A HEALTHIER LIFESTYLE. IN 2011, CMH COLLABORATED WITH OCONTO COUNTY HEALTH AND HUMAN SERVICES TO IMPLEMENT THE OCONTO COUNTY EMS FREQUENT USER PROGRAM PROJECT TO ADDRESS AND REDUCE THE MISUSE OF EMS SERVICES. THE PROJECT WAS SUPPORTED BY THE WISCONSIN OFFICE OF RURAL HEALTH. COMMUNITY MEMORIAL HOSPITAL PROVIDED PUBLICITY, PLANNING, STAFF, SUPPLIES, AND FACILITIES FOR THE PROGRAM. CMH IS PROUD OF ITS VALUES TO ALWAYS STRIVE TO STRENGTHEN OUR COMMUNITY PARTNERSHIPS TO PROMOTE HEALTH AND WELLNESS. CMH SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. IN ADDITION TO PROVIDING COMPREHENSIVE SPORTS PHYSICAL CLINICS IN WHICH THE FEES ARE DONATED BACK TO THE SCHOOLS OF THE PARTICIPATING STUDENTS, CMH PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE ROUTINELY HOSTED AT THE HOSPITAL. THIS IS A SUMMATION OF SERVICES PROVIDED BY COMMUNITY MEMORIAL HOSPITAL IN THE FISCAL YEAR 2011 30161846 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 76 0 1 416 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 WI X MICHELE MILLER-CAMPBELL CFO 9208463440 855 SOUTH MAIN STREET OCONTO FALLS WI 54154 HOWARD ESLIEN JR 2.00 X X 0 0 0 DANIEL BOETTCHER 2.00 X X 0 0 0 JAN STRANZ 2.00 X X 0 0 0 CRISTY KAEMPFER 2.00 X 0 0 0 DR JUDITH BOWERS 1.00 X 0 0 0 TOM BAYER 1.00 X 0 0 0 KARL APPLETON 2.00 X 0 0 0 DR ISAIAS CUPINO 40.00 X 461926 0 31217 JAMES VANDORNICK 40.00 X 140480 0 60206 LISA KRAUSE 40.00 X 97630 0 41841 DR KEITH ELKINS 40.00 X 348232 0 29751 DR GENADI MALTINSKI 40.00 X 377477 0 0 DR JEFFREY BENTSON 40.00 X 707653 0 31484 DR R SCOTT LIEBL 40.00 X 292896 0 23550 DRLUZ BALMADRID 40.00 X 306671 0 25737 2732965 0 243786 18 0 1 0 EMCARE PHYSICIANS 7032 COLLECTION CENTER DRIVE CHICAGO WI 60693 CONTRACT PHYSICAN LABOR 1028394 BRIM HEALTHCARE PO BOX 636426 CINCINNATI OH 45263 CONTRACT UPPER MANAGEMENT 527531 AMERICOLLECT PO BOX 1566 MANITOWAC WI 54221 COLLECTION SERVICES 323466 ST MARY'S MEDICAL CENTER 1726 SHAWANO AVE GREEN BAY WI 54303 REFERENCE LAB SERVICES 260114 BELLIN HEALTH OUTREACH PO BOX 23400 GREEN BAY WI 54303 REFERENCE LAB SERVICES 243298 8 170594 57950 20845 249389 NET PATIENT SERVICE RE 900099 33511459 33511459 RETAIL PHARMACY REVENU 446110 2696892 2696892 ELECTRONIC HEALTH RECO 900099 503890 503890 ONCOLOGY CONTRACT REVE 621300 419602 419602 OTHER REVENUE 900099 78670 78670 32334 5099 27235 37242847 169147 169147 168841 250898 -82057 -82057 -82057 26694 -26694 -26694 -26694 37552632 34518720 2696892 87631 802083 461926 340157 15567120 13725052 1842068 300437 247568 52869 3099279 2502429 596850 968883 814879 154004 170686 170686 65224 65224 818499 818499 16850 16850 2912435 2154920 757515 218641 218641 6870318 6557189 313129 103827 36983 66844 2066240 1043362 1022878 66929 40228 26701 6626 3726 2900 555301 555301 1196125 1196125 185993 95376 90617 BAD DEBT EXPENSE 2320209 2320209 OTHER EXPENSES 639384 157999 481385 38951089 30161846 8789243 0 2060066 2006109 1807526 2652213 5888123 5276893 68187 14203 284669 1700933 1067433 1231963 614002 564760 24987344 15835756 10260356 9151588 1982080 5366288 265775 173766 1654196 1630829 25952413 29769545 2927918 3026530 305121 8078098 7920236 1042720 948311 427222 843458 12475958 13043656 X 13213180 16554623 263275 171266 13476455 16725889 25952413 29769545 X -1398457 4647891 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7856 7856 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: WHA, RWHC AND AHA DUES 235001 235001 14214838 6400028 7814810 10333873 9248903 1084970 203632 186825 16807 9151588 DUE FROM WOODLANDS 190350 BOND FUNDS 1007303 SECTION 457 PLAN ASSET 433176 1630829 CAPITAL LEASES 49246 DUE TO THIRD PARTY PAYORS 361036 SECTION 457 PLAN LIABILITY 433176 843458 37552632 38951089 -1398457 -203910 4851801 4647891 3249434 37616086 0 37616086 16850 -80304 -63454 37552632 39185137 250898 250898 38934239 16850 16850 38951089 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE HOSPITAL DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE COMBINED FINANCIAL STATEMENTS. THE HOSPITAL RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2011 OR 2010. THE HOSPITAL'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE HOSPITAL IN THE COMBINED FINANCIAL STATEMENTS. FEDERAL INCOME TAX RETURNS FOR THE YEAR ENDED SEPTEMBER 30, 2008, AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN COMMUNITY FOUNDATION -92,009. FUNDING OF FOUNDATION EXPENSES -56,190. CAPITAL CONTRIBUTION 5,000,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSE IN INCOME -250,898. INTERCOMPANY TRANSFER 170,594. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN INCOME 250,898. 1 1 1 X 1 X 1 1 0 1 1 6995744 3787613 3208131 0.08760 124932 42649 82283 0.00220 7120676 3830262 3290414 0.08980 13 1908 40770 3300 37470 0.00100 52 16971 16971 0.00050 65 1908 57741 3300 54441 0.00150 65 1908 7178417 3833562 3344855 0.09130 4 6485 6485 0.00020 6 46798 46798 0.00130 10 3000 3000 0.00010 20 56283 56283 0.00160 1 932601 9506211 8476438 1029773 X 1 0 1 1 COMMUNITY MEMORIAL HOSPITAL

855 SOUTH MAIN STREET OCONTO FALLS WI 54154

X X X X COMMUNITY MEMORIAL HOSPITAL INCORPORATED 1 5 CMH PRIMARY CARE CLINIC

340 NORTH GREEN BAY AVE GILLETT WI 54124

CLINIC CMH PRIMARY CARE CLINIC

200 SOUTH ROSERA STREET LENA WI 54139

CLINIC CMH MEDICAL CENTER

103 FIRST STREET OCONTO WI 54153

CLINIC CMH PRIMARY CARE CLINIC

14353 HWY 32/64 MOUNTAIN WI 54149

CLINIC CMH PRIMARY CARE CLINIC

913 E MAIN STREET SURING WI 54174

CLINIC PART I, LINE 6A: WISCONSIN HOSPITAL ASSOCIATION PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2320209. PART II: THE HOSPITAL PROVIDES EDUCATION TO THE COMMUNITY MEMBERS ABOUT VARIOUS HEALTH ISSUES AT THE HEALTH FAIRS DONE THROUGHOUT THE COUNTY SUCH AS SKIN CANCER SCREENING, HEART FAIR, ETC. TO KEEP THE COMMUNITY AWARE OF HEALTH ISSUES AND HELP THEM BE PROACTIVE IN SEEKING TREATMENT FOR HEALTHCARE CONCERNS. PART III, LINE 4: BAD DEBTS WERE REPORTED ON THE FINANCIAL STATEMENTS AT GROSS CHARGES. THEN THE COST TO CHARGE RATIO WAS USED TO CONVERT THE BAD DEBT AMOUNT FROM A CHARGE BASED NUMBER TO A COST BASED NUMBER. PART III, LINE 8: THE MEDICARE PROGRAM DOES NOT COVER ALL SERVICES PROVIDED TO THEIR PARTICIPANTS AND THE HOSPITAL IS NOT ALLOWED TO COLLECT FROM THE PARTICIPANTS FOR SOME SERVICES BASED ON THE HOSPITAL'S AGREEMENT WITH THE PROGRAM. THEREFORE, NOT ALL REVENUES ARE COVERED BY MEDICARE. IN ADDITION, MEDICARE DOES NOT ALLOW ALL BUSINESS COSTS OF THE HOSPITAL TO BE INCLUDED IN THE COST REPORT, SO THERE ARE ADDITIONAL UNCOVERED COSTS. THE SHORTFALL BY THE MEDICARE PROGRAM COULD BE AVOIDED BY NOT PROVIDING CARE TO MEDICARE PATIENTS; THEREFORE, THIS SHORTFALL SHOULD BE INCLUDED AS A BENEFIT PROVIDED BY THE HOSPITAL.PART I, LINE 7: THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORT IS BASED ON THE AUDITED FINANCIAL STATEMENTS OF COMMUNITY MEMORIAL HOSPITAL AND THE HOSPITAL'S EXPENSING OF COSTS TO THE APPROPRIATE COST CENTER THROUGH THE HOSPITAL'S INTERNAL COMPUTER SYSTEM. PART III, LINE 9B: A POLICY TO IDENTIFY FINANCIAL NEEDS PRIOR TO SENDING TO COLLECTIONS IS CURRENTLY BEING DEVELOPED BUT WAS NOT APPROVED AT THE END OF THE FISCAL YEAR. PATIENTS ARE INFORMED OF THE CHARITY CARE PROGRAM UPON REGISTRATION. THOSE THAT THINK THEY MAY QUALIFY ARE GIVEN AN APPLICATION WHICH IS THEN REVIEWED AND DISCOUNTS ARE APPLIED TO THE ACCOUNT BASED ON FAMILY SIZE AND HOW THERE INCOME FALLS IN THE FEDERAL POVERTY GUIDELINES. PART I, LINE 7, COLUMN (F):BAD DEBT EXPENSE $2,320,209 WAS EXCLUDED FROM THE TOTAL EXPENSES OF $38,951,089 WHEN CALCULATING THE PERCENTAGES IN PART I AS ALLOWED PER THE INSTRUCTIONS. PART III, LINE 9BPATIENTS ARE INFORMED OF THE CHARITY CARE PROGRAM UPON REGISTRATION. THOSE THAT THINK THEY MAY QUALIFY ARE GIVEN AN APPLICATION WHICH IS THEN REVIEWED AND DISCOUNTS ARE APPLIED TO THE ACCOUNT BASED ON FAMILY SIZE AND HOW THERE INCOME FALLS IN THE FEDERAL POVERTY GUIDELINES. PART VI, LINE 2: A COMMUNITY HEALTH ASSESSMENT PLAN IS CURRENTLY BEING DEVELOPED. PART VI, LINE 3: WHEN A PATIENT CALLS TO REGISTER AND INDICATES ANY TYPE OF HARDSHIP OR APPEARS TO REGISTER AND STATES LACK OF INSURANCE OR OTHER FINANCIAL HARDSHIP, THE PATIENT OR THEIR REPRESENTATIVE ARE GIVEN INFORMATION ABOUT THE HOSPITAL'S CHARITY CARE PROGRAM, INCLUDING AN INTRODUCTORY LETTER AND APPLICATION, AS WELL AS INFORMATION ON OTHER PUBLIC PROGRAMS THAT MAY BE AVAILABLE AND CONTACT INFORMATION FOR THOSE PROGRAMS. THE HOSPITAL IS ABLE TO EXPRESS ENROLL PREGNANT WOMEN (UNTIL JUNE 30, 2011) OR CHILDREN IN STATE GOVERNMENT PROGRAMS AS WELL. THIS SAME INFORMATION IS PROVIDED AGAIN TO THE PATIENT AT THE TIME OF BILLING. PART VI, LINE 4: COMMUNITY MEMORIAL HOSPITAL SERVES GREATER OCONTO COUNTY. OCONTO COUNTY, WISCONSIN IS A LARGE, RURAL COUNTY WHICH INCLUDES MEDICALLY UNDERSERVED AREAS AND POPULATIONS AND WHICH CONSISTENTLY FACES ECONOMIC DEVELOPMENT CHALLENGES. RURAL: THE U.S. CENSUS BUREAU ESTIMATED THE 2010 OCONTO COUNTY POPULATION AT 37,660 PERSONS. ACCORDING TO THE U.S. CENSUS BUREAU, THE LARGEST CITY IN THE COUNTY HAD A 2000 POPULATION OF 4,708 AND THE COUNTY ITSELF HAD 37.7 PERSONS PER SQUARE MILE IN 2010. UNDERSERVED: OCONTO COUNTY CONTAINS MEDICALLY UNDERSERVED AREAS AS WELL AS PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS AS DESIGNATED BY THE U.S. DEPT. OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION. NINETEEN MEDICALLY UNDERSERVED AREAS ARE DESIGNATED WITHIN OCONTO COUNTY ACCORDING TO HRSA.THE ONLY OTHER HOSPITAL IN THE CMH SERVICE AREA IS A 4-BED HOSPITAL LOCATED IN OCONTO, THE COUNTY'S LARGEST CITY. OTHER HOSPITALS THAT SERVE THE OCONTO COUNTY COMMUNITY INCLUDING THE NEAREST TERTIARY CARE HOSPITALS ARE LOCATED THIRTY MILES SOUTH IN GREEN BAY.IN A COMMUNITY NEEDS ASSESSMENT SURVEY OF THE CMH SERVICE AREA CONDUCTED IN AUGUST 2007 BY THE LEEDE RESEARCH GROUP, THE LARGEST BARRIERS TO HEALTHCARE CITED BY COMMUNITY MEMBERS ARE FINANCIAL CONSTRAINTS, A LACK OF AFFORDABLE MEDICAL INSURANCE COVERAGE, AND GEOGRAPHICAL/TRANSPORTATION CONSTRAINTS THAT NEGATIVELY IMPACT ACCESS TO MEDICAL FACILITIES. OF THOSE SURVEYED, 30.1% INDICATED THAT LOCATION WAS THEIR PRIMARY CONSIDERATION WHEN SELECTING A DOCTOR AND/OR CLINIC. ACCORDING TO U.S. CENSUS BUREAU 2005-2009 DATA, IN OCONTO COUNTY THE PERCENTAGE OF PERSONS AGE 25 AND OLDER WITH A BACHELOR'S DEGREE OR HIGHER WAS 13.4% COMPARED TO 25.5.% STATEWIDE. PER CAPITA MONEY INCOME FOR THE COUNTY WAS $24,397 COMPARED TO $26,447 IN WISCONSIN. MEDIAN HOUSEHOLD INCOME FOR 2009 WAS $49,037 COMPARED TO $49,994 STATEWIDE. THE FEBRUARY 2012 UNEMPLOYMENT RATE FOR THE COUNTY WAS 9.3% COMPARED TO A STATEWIDE RATE OF 7.9% AND 8.7% NATIONALLY, ACCORDING TO THE STATE OF WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT. THE LATEST POVERTY DATA SHOWS OCONTO COUNTY WITH A POVERTY RATE OF 11.8%. CMH IS PROUD OF ITS COMMITMENT TO PROVIDE SERVICE TO ANY PERSON SEEKING MEDICAL CARE, REGARDLESS OF ABILITY TO PAY. THIS MAKES CMH A VERY SPECIAL PLACE IN TODAY'S HEALTHCARE MARKET. IN ADDITION, THE CMH FAMILY OF HEALTHCARE PROVIDERS HAS A LONG HISTORY OF WORKING COOPERATIVELY WITH LOCAL, STATE AND FEDERAL HEALTHCARE AGENCIES, EDUCATORS, INDUSTRY, AND THE GENERAL PUBLIC TO DEVELOP AND DELIVER EFFECTIVE HEALTHCARE SERVICES TO THE RURAL NORTHEAST WISCONSIN POPULATION. CMH IS DISTINGUISHED BY ITS RELIABLE AND CONSISTENT LEVEL OF SUPERIOR SERVICE AND COMMITMENT TO CONTINUOUS IMPROVEMENT OF ITS PATIENT CARE SERVICES. CMH MEDICAL STAFF MEMBERS ARE COMMITTED PARTNERS IN ENHANCING ORGANIZATIONAL PERFORMANCE AND CONTINUALLY WORKING TO IMPROVE PATIENT CARE. PART VI, LINE 6: THE COMMUNITY MEMORIAL HOSPITAL BOARD OF DIRECTORS CONSIST OF DEDICATED MEMBERS OF THE COMMUNITY WHO PROVIDE EXCEPTIONAL LEADERSHIP, INSIGHT AND POSITIVE DIRECTION IN THE ORGANIZATIONAL MISSION TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY LOCALLY. A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE CMH PRIMARY SERVICE AREA. MEMBERS ARE STAKEHOLDERS IN THE COMMUNITIES SERVED BY COMMUNITY MEMORIAL HOSPITAL WHO PROVIDE DIRECTION AND SUPERVISION TO THE ORGANIZATION. A SIGNIFICANT PORTION OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF COMMUNITY MEMORIAL HOSPITAL, NOR FAMILY MEMBERS THEREOF.AS A NON-PROFIT HEALTHCARE SYSTEM COMMUNITY MEMORIAL HOSPITAL INVESTS IN ITS SERVICES/PROGRAMS AND FACILITY/EQUIPMENT UPGRADES AND REINVESTS ANY PROFITS TO UPDATE OR ENHANCE THE HEALTHCARE SERVICE.CMH MAINTAINS AN OPEN MEDICAL STAFF, EXTENDING PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR MEDICAL AND SURGICAL SERVICES PROVIDED AT THESE FACILITIES.IN ADDITION TO ITS REGULAR HOSPITAL AND CLINIC SERVICES, COMMUNITY MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE LOW-COST AND FREE HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE FREE AND LOW-COST SERVICE OFFERINGS, COMMUNITY MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES.- LOW-COST FLU SHOT CLINICS WERE HELD IN OCTOBER AND NOVEMBER AT EACH OF THE CMH PRIMARY CARE CLINICS. CMH PROVIDED FREE FLU SHOTS TO ITS HOSPITAL VOLUNTEERS. - A PANEL OF FREE SCREENINGS WAS OFFERED AT THE CMH OCONTO MEDICAL CENTER OPEN HOUSE FEBRUARY 24, 2011 THAT INCLUDED BALANCE TESTING, SCOLIOSIS SCREENING, OSTEOPOROSIS SCREENING, D-TAP IMMUNIZATIONS, AND GRIP STRENGTH TESTING. - CMH HELD AN ANNUAL SKIN CANCER SCREENING IN APRIL IN COLLABORATION WITH A REGIONAL PROGRAM WHICH PROVIDES FREE SKIN CANCER EDUCATION AND SCREENING IN AFFILIATION WITH ST. VINCENT HOSPITAL AND THE MARY HENDRICKS JOHNSON FOUNDATION. TOTAL PARTICIPANTS SCREENED WERE 44. - DURING MAY, 2011, CMH PROVIDED ITS ANNUAL HEART FAIR SCREENINGS AT COMMUNITY MEMORIAL HOSPITAL AND THE CMH CLINICS THROUGHOUT OCONTO COUNTY AT AN EXTREMELY REDUCED RATE FOR A CHOLESTEROL SCREENING, GLUCOSE SCREENING, LIPID PANEL, BLOOD PRESSURE CHECK, WEIGHT CHECK, AND HEART HEALTH EDUCATION FROM THE CMH CARDIAC REHABILITATION STAFF. TOTAL PARTICIPANTS SCREENED WERE 258.- ALSO IN MAY, 2011 CMH HELD A FREE OSTEOPOROSIS SCREENING AT THE MOUNTAIN HEALTH FAIR. - DURING JULY AND AUGUST, 2011, CMH OFFERED SPORTS PHYSICAL CLINICS AT ITS SIX CMH PRIMARY CARE CLINICS THROUGHOUT OCONTO COUNTY. STUDENTS RECEIVED COMPREHENSIVE WIAA SPORTS PHYSICALS FOR $20 WHICH CMH THEN DONATED BACK TO THE STUDENTS' SCHOOL SPORTS PROGRAM. - CMH PARTNERED WITH PREVEA HEALTH UROLOGISTS TO OFFER FREE PROSTATE SCREENINGS SEPTEMBER 27, 2011. 52 MEN RECEIVED FREE PROSTRATE SCREENINGS.- CMH HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. IN 2011 CMH CONTINUED ITS NEW EDUCATIONAL SERIES OF SEMINARS FEATURING SPECIALISTS SPEAKING ABOUT HEALTH ISSUES OF SENIOR CITIZENS. THE CMH SENIOR SPECIALS DINNER SEMINARS ARE FREE AND OPEN TO THE PUBLIC. COMMUNITY MEMORIAL HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, THE ADVERTISING TO ANNOUNCE THE SEMINAR, AND THE SUPPLIES FOR THE SEMINAR, AND THE MEALS. FOUR CMH SENIOR SPECIALS DINNER SEMINARS WERE HELD IN 2011 WITH 220 ATTENDEES AND TOPICS INCLUDED DEPRESSION, DIABETES, COLON HEALTH, AND AGING & FRAILTY.COMMUNITY MEMORIAL HOSPITAL IS PLEASED TO LEND ITS DIRECTION AND LEADERSHIP TO COLLABORATE WITH MANY COMMUNITY ORGANIZATIONS FOR VARIOUS INITIATIVES AND EVENTS TO PROVIDE FREE HEALTH INFORMATION AND SERVICES AND PROMOTE A HEALTHIER LIFESTYLE. FOR EACH OF THESE INITIATIVES, COMMUNITY MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES.- CMH OFFERED FOUR FREE WORKSHOPS FOR CANCER PATIENTS IN 2011 THROUGH THE AMERICAN CANCER SOCIETY LOOK GOOD FEEL BETTER PROGRAM. FOURTEEN WOMEN UNDERGOING CANCER TREATMENT PARTICIPATED IN THE 2011 SESSIONS AT WHICH THEY EACH RECEIVED A FREE KIT FILLED WITH SKIN CARE ITEMS AND COSMETICS, AND THEY WERE OFFERED A FREE WIG. THE WOMEN ENJOYED SKIN, MAKEUP, AND HAIR LESSONS AND TIPS FROM SPECIALLY TRAINED COSMETOLOGISTS TO HELP THEM MANAGE APPEARANCE-RELATED SIDE EFFECTS OF CANCER TREATMENT.- CMH HOSTS A DIABETES SUPPORT GROUP THAT MEETS MONTHLY AT COMMUNITY MEMORIAL HOSPITAL.- IN JUNE 2011, CMH STARTED A FREE, MONTHLY COOKING CLASS FOR FAMILIES DEALING WITH DIABETES. - THE CMH CENTER FOR WOMEN'S CARE HOSTS THE SHARE PREGNANCY AND INFANT LOSS SUPPORT PROGRAM WITH A SUPPORT GROUP FOR FAMILIES TOUCHED BY MISCARRIAGE, STILLBIRTH, OR EARLY INFANT DEATH THAT MEETS MONTHLY AT COMMUNITY MEMORIAL HOSPITAL. THE GROUP ALSO HAS AN ANNUAL WALK OF ANGELS EVENT AT COMMUNITY MEMORIAL HOSPITAL THAT INCLUDES EXTENDED FAMILY AND FRIENDS FOR FELLOWSHIP, REFLECTION, AND A BALLOON RELEASE. - CMH HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. - SEVERAL TIMES THROUGHOUT 2011 CMH OFFERED A LOW-COST BABYSITTING COURSE THROUGH THE NATIONALLY RECOGNIZED SAFE SITTER PROGRAM.- CMH HELD THE THIRD ANNUAL OCONTO COUNTY SAFETY FAIR MAY 14, 2011 IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. APPROXIMATELY 400 PEOPLE ATTENDED THE FREE EVENT AND ENJOYED INTERACTIVE DISPLAYS INCLUDING DISTRACTED DRIVING AND FIRE SAFETY.- COMMUNITY MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR OFAC GOLF COMMITTEE AND THE EXECUTIVE COMMITTEE. - CMH LED A COUNTY-WIDE EMS PROJECT TO ADDRESS THE MOST FREQUENT AND MOST COSTLY MISUSE OF EMS SERVICES. THIS EMS FREQUENT USER PROJECT, WITH SUPPORT FROM THE WISCONSIN OFFICE OF RURAL HEALTH, ENCOMPASSED HOSPITAL EMERGENCY DEPARTMENT AND COUNTY BEHAVIORAL HEALTH.- COMMUNITY MEMORIAL HOSPITAL PLANNED AND SPONSORS THE ANNUAL HOTCAKE HUSTLE 5K FUN RUN/WALK, A COMMUNITY HEALTH INITIATIVE. THE EVENT HAS HAD OVER 200 RUNNERS AND WALKERS.- THE CMH SEXUAL ASSAULT NURSE EXAMINER (SANE) PROGRAM IS AVAILABLE 27/7 TO PROVIDE CARE AND ASSISTANCE TO ANYONE 12 AND OLDER WHO HAS BEEN SEXUALLY ASSAULTED. IN APRIL, 2011, THE SANE STAFF AT CMH HELD A CLOTHING DRIVE FOR SEXUAL ASSAULT AWARENESS MONTH TO ENCOURAGE COMMUNITY AWARENESS AND SUPPORT FOR VICTIMS.- CMH SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. CMH PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE HOSTED EACH YEAR AT THE HOSPITAL. COMMUNITY MEMORIAL HOSPITAL PROVIDES ITS COMMUNITY ROOM LARGE CONFERENCE ROOM AS WELL AS ITS OTHER MEETING AREAS FREE-OF-CHARGE TO COMMUNITY GROUPS. SOME OF THE MANY LOCAL GROUPS THAT MEET AT COMMUNITY MEMORIAL HOSPITAL INCLUDE 4H CLOVER, RELAY FOR LIFE, OVEREATERS ANONYMOUS, CEMETERY ASSOCIATION, WEIGHT WATCHERS, QUILTING GROUPS, THE COUNTY FAIR BOARD, THE COUNTY FAIREST OF THE FAIR COMMITTEE, UW EXTENSION, BREAST CANCER SUPPORT GROUP, AND THE OCONTO FALLS LIONESS CLUB.EXCESS FUNDS OF THE ORGANIZATION ARE BEING USED TO UPDATE THE TECHNOLOGY USED IN THE FACILITY TO PROVIDE UP TO DATE PATIENT CARE TO COMMUNITY MEMBERS AND TO ENHANCE THE SERVICES PROVIDED TO THE COMMUNITY. IN FISCAL YEAR 2011, THE HOSPITAL ADDED A SECOND GENERAL SURGEON TO THE STAFF OF THE FACILITY, OPENED A CLINIC FOR BREAST SURGERY AND RECONSTRUCTIONS, UPDATED PATIENT BEDS USED IN THE HOSPITAL TO MAINTAIN PATIENT SAFETY, AND ADDED OTHER EQUIPMENT SUCH AS A PEDIATRIC COLONOSCOPE, A NEW JAUNDICE METER, AND REPLACED A SURGERY TABLE ALL TO CONTINUE TO PROVIDE QUALITY CARE TO OUR PATIENTS. COMMUNITY MEMORIAL HOSPITAL HAS LONG BEEN A CORNERSTONE OF THE GREATER OCONTO COUNTY COMMUNITY AND PROVIDES AN ESSENTIAL SERVICE TO OCONTO COUNTY RESIDENTS. CMH IS PROUD OF ITS MISSION TO PROVIDE HIGH QUALITY HEALTH CARE CLOSE TO HOME, AND ALWAYS STRIVES TO STRENGTHEN ITS COMMUNITY PARTNERSHIPS TO PROMOTE HEALTH AND WELLNESS. PART VI, LINE 7: CMH IS AFFILIATED WITH ST. VINCENT & ST. MARY'S HOSPITALS AND PREVEA HEALTH. THE AFFILIATION ALLOWS CMH TO EXPAND HEALTH CARE RESOURCES AVAILABLE TO THE GREATER OCONTO COUNTY COMMUNITY. MORE SPECIALTY SERVICES ARE AVAILABLE AT CMH. THE ROLE OF CMH WITHIN THE AFFILIATION IS TO PROVIDE HOSPITAL AND CLINIC FACILITIES AND PERSONNEL, AND TO COLLABORATE WITH PARTNERS TO IDENTIFY OPPORTUNITIES TO BETTER AND MORE EFFICIENTLY SERVE THE HEALTH CARE NEEDS OF THE COMMUNITY. THE ROLE OF ST. VINCENT & MARY' MARY'S HOSPITALS IS TO PROVIDE MANAGEMENT COLLABORATION, ADMINISTRATIVE SUPPORT, AND CAPITAL INVESTMENT WHICH SUPPORTS EMR. THE ROLE OF PREVEA HEALTH IS TO ASSIST CMH IN EXPANDING THE AVAILABILITY OF PHYSICIAN SPECIALISTS IN THE CMH SERVICE AREA. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X 0 0 0 0 0 0 0 0 0 DR ISAIAS CUPINO 391931 0 69719 0 276 0 3571 0 27646 0 493143 0 0 0 JAMES VANDORNICK 140480 0 0 0 0 0 0 0 60206 0 200686 0 0 0 DR KEITH ELKINS 314692 0 33360 0 180 0 2105 0 27646 0 377983 0 0 0 DR GENADI MALTINSKI 0 0 0 0 377477 0 0 0 0 0 377477 0 0 0 DR JEFFREY BENTSON 607573 0 100000 0 80 0 0 0 31484 0 739137 0 0 0 DR R SCOTT LIEBL 285000 0 7500 0 396 0 0 0 23550 0 316446 0 0 0 DRLUZ BALMADRID 285780 0 20099 0 792 0 2055 0 23682 0 332408 0 0 0 PART I, LINE 5 PHYSICIAN AND MIDLEVEL COMPENSATION CONTRACTS HAVE A BASE SALARY PLUS A PERCENTAGE OF REVENUES IN EXCESS OF THE BASE RELATIVE VALUE UNITS PERFORMED. WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VKA5 2003-01-15 3490000 ACQUISITION, CONSTRUCTION, IMPROVEMENT, AND EQUIPING HOSPITAL FACILITIES 0 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97710VKB3 2003-01-15 5605000 ACQUISITION, CONSTRUCTION, IMPROVEMENT, AND EQUIPING HOSPITAL FACILITIES 0 0 0 3445154 293583 46266 315020 2784783 2006 0 0 1 1 5470872 465730 73469 500248 4472409 2006 0 0 1 1 0 1 0 0 1 0.04990 0.04990 0 0 1 0 0 1 0.04990 0.04990 0 0 0 0 0 0 0 0 0 0 0 0 0 NEW WOMEN'S HEALTHCARE ASSOCIATES X 139094 14203 0 1 1 14203 NEW CENTER FOR WOMAN'S CARE CURRENT BOARD MEMBER OWNS ORGANIZATION (JUDITH BOWERS) 54013 CONTRACTED PHYSCIAN 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ADDED CMH BREAST SURGERY CLINIC TO CLINIC PRACTICES IN SEPTEMBER OF 2011. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 URGENT CARE CLINIC OPERATED BY THE HOSPITAL WAS REPLACED WITH PREVEA URGENT CARE, ANOTHER ORGANIZATION THAT NOW LEASES SPACE AT COMMUNITY MEMORIAL HOSPITAL. EMERGENCY ROOM PHYSICIAN STAFFING SWITCHED FROM EMCARE TO PREVEA. PREVEA IS NOW BILLING FOR THE PHYSICIAN COMPONENT OF THE EMERGENCY ROOM VISITS, WHICH WERE DONE BY THE HOSPITAL UNDER EMCARE. FORM 990, PART VI, SECTION A, LINE 4 ON MAY 17, 2011 THE HOSPITAL ENTERED A AFFILIATION AGREEMENT WITH ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. AND ST. VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS. ST. MARY'S AND ST. VINCENT OBTAINED A 24% INTERST IN COMMUNITY MEMORIAL IN EXCHANGE FOR A CAPITAL CONTRIBUTION. THE PARTIES ENTERED INTO THIS AGREEMENT AND THE STRATEGIC AFFILIATION OF CLINIC AND HOSPITAL OPERATIONS IN ORDER: I)TO IMPROVE THE HEALTH STATUS OF THE POPULATION OF OCONTO FALLS, WISCONSIN AND SURROUNDING COMMUNITIES; II) TO IMPROVE THE QUALITY AND ACCESSIBILITY OF PRIMARY AND TERTIARY HEALTH CARE SERVICES FOR RESIDENTS OF THE LOCAL COMMUNITIES; III) TO EXPAND THE HEALTH CARE SERVICES AVAILABLE IN THE LOCAL COMMUNITIES AND REGIONALLY BY WAY OF INFORMATION TECHNOLOGY INTEGRATION, INCREASED MANAGEMENT COLLABORATION, CAPITAL INVESTMENT IN PROJECTS, AND BY PROVIDING PERSONNEL AND EXPERTISE WITH RESPECT TO VARIOUS HEALTH CARE SERVICE LINES; IV) TO ESTABLISH RELATIONSHIPS AMONG THE PARTIES WHICH WOULD PROVIDE EACH PARTY WITH ACCESS TO THE MANAGERIAL EXPERTISE OF THE OTHER PARTY; AND V) TO PROVIDE ASSISTANCE WITH PHYSICIAN RECRUITMENT AND EXPANSION OF THE AVAILABILITY OF PHYSICIAN SPECIALISTS IN COMMUNITY MEMORIAL'S SERVICE AREA. FORM 990, PART VI, SECTION B, LINE 11 BECAUSE THE DUE DATE IS GOING TO FALL BEFORE THE NEXT BOARD MEETING, THE FORM WILL BE PRESENTED TO THE BOARD AT THE MOST RECENT BOARD MEETING FOLLOWING THE DATE OF FILING BY THE CFO. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL STATEMENT IS DISTRIBUTED TO THE BOARD MEMBERS FOR REVIEW AND SIGNATURE. THIS PROCESS WAS LAST COMPLETED IN SEPTEMBER OF 2011 AND IS DONE ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 MGMA SURVEY DATA AND A POSITION REVIEW PROCESS IS DONE BY THE PERSON THE INDIVIDUAL REPORTS TO. THE INFORMATION IS THEN PRESENTED TO THE BOARD OF DIRECTORS, AN INDEPENDENT PARTY, AT THEIR MONTHLY MEETING FOR THEIR FINAL APPROVAL. DECISIONS MADE AT THE BOARD OF DIRECTORS MEETINGS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT ON INTEREST POLICY AVAILABLE TO THE PUBLIC AT THIS TIME. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -203,910. CHANGE IN INTEREST IN COMMUNITY FOUNDATION -92,009. FUNDING OF FOUNDATION EXPENSES -56,190. CAPITAL CONTRIBUTION 5,000,000. TOTAL TO FORM 990, PART XI, LINE 5: 4,647,891. CMA ANESTHESIA LLC 855 SOUTH MAIN STREET OCONTO FALLS WI 54154 201543181 ANESTHESIA BILLING SERVICES WI N/A COMMUNITY HEALTHCARE FOUNDATION 855 SOUTH MAIN STREET OCONTO FALLS WI 54154 391700944 FUNDRAISING FOR LOCAL NONPROFIT ORGNAIZATIONS WI 501(C)(3) LINE 7 COMMUNITY MEMORIAL HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 COMMUNITY HEALTHCARE FOUNDATION O 56190 COST