2011-11-09T09:11:14-06:00 2011-03-31 RSM MCGLADREY INC 700 MISSABE BUILDING DULUTH MN 55802 990 2010-04-01 391536207 MEDICAL SERVICES INC MEDI 7156348911 11040 N STATE ROAD 77 HAYWARD WI 548436391 TIM GULLINGSRUD 7156348911 2011-11-07 1 MARY BETH SANTORI 2187278253 2010 2016-02-24 21:20:13Z TIM GULLINGSRUD 11040 N STATE ROAD 77 HAYWARD WI 548436391 32645343 0 X WWW.HAMHNH.COM X 1986 WI TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS 11 9 318 120 0 0 64062 193747 28796479 31925592 351275 276497 264969 167635 29476785 32563471 0 0 0 0 16228977 15946296 0 0 0 12700569 13724832 28929546 29671128 547239 2892343 37844672 46973734 15000131 21236850 22844541 25736884 TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF HAYWARD, WI AND THE SURROUNDING AREAS 0 0 25474088 31944156 OUR 25 BED CRITICAL ACCESS HOSPITAL IS FLANKED BY MEDICAL CLINICS AND A LONG TERM CARE CENTER. THERE ARE 18 FULL-TIME PHYSICIANS ON THE MEDICAL STAFF AND THE HOSPITAL AND NURSING HOME EMPLOY CLOSE TO 300 INDIVIDUALS. OUR STAFF HAS IMMEDIATE CONTACT WITH SPECIAISTS IN LARGE HOSPITALS FOR CONSULTATION.THE EMERGENCY DEPARTMENT IS STAFFED BY PHYSICIANS AND NURSES 24 HOURS-A-DAY WITH ADDITIONAL PERSONNEL AT DESIGNATED TIMES. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. HIGHLY SKILLED PHYSICIANS AND MEDICAL PROFESSIONALS FROM LARGER HOSPITALS ACROSS THE NATION ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. 25474088 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 14 0 1 318 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X BRAD ZELLER 7159344245 11040 N STATE ROAD 77 HAYWARD WI 54843 BARBARA PEICKERT 40.00 X X 206181 0 33155 STEVE GILLIS 1.00 X X 0 0 0 KAREN GUSTAFSON 1.00 X 0 0 0 HEIDI HABEL 1.00 X 0 0 0 DAN HYMANS 1.00 X 0 260314 37177 PATRICIA JOHNSON 1.00 X X 0 0 0 BRENT KELLEY DO 1.00 X 0 0 0 KATHY RASMUSSEN 1.00 X X 0 0 0 BARBARA KOERPEL-DUFFY 1.00 X X 0 0 0 HARRY MALCOLM MD 1.00 X 0 0 0 DODSON THOMPSON DO 1.00 X 0 0 0 LES WHITEAKER 40.00 X 0 185670 33389 SUSAN BAUER 40.00 X 155500 0 28659 SUZANNE ULMER 40.00 X 161879 0 28208 ROBERT TERRY 40.00 X 149138 0 29971 ALLISON FARLEY 40.00 X 117877 0 27372 STEVEN KRASEAN 40.00 X 116746 0 27672 907321 445984 245603 9 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 PROFESSIONAL FEES/RENT 1464724 WAPITI MEDICAL GROUP PO BOX 92 NEWELL SD 57760 ER DOCTORS 866661 MEMORIAL MEDICAL CENTER 1615 MAPLE LANE ASHLAND WI 54806 PROFESSIONAL FEES 295008 IMTIAZ MOHAMED 1110 VALLEY DRIVE DULUTH MN 55804 ER DOCTOR 249360 DMS IMAGING PO BOX 86 MINNEAPOLIS MN 55489 MRI PROFESSIONAL FEES 232359 10 48032 145715 47900 193747 NET PATIENT SERVICE RE 621500 31863111 31863111 DIABETES 621500 34292 34292 CAFETERIA 722210 28189 28189 31925592 276497 276497 230943 81872 149071 149071 149071 MISCELLANEOUS 900099 18564 18564 18564 32563471 31944156 0 425568 239336 239336 11808924 10564537 1244387 443807 398844 44963 2605546 2311518 294028 848683 746223 102460 68259 68259 33043 33043 28770 28770 7059161 6440272 618889 1393172 1393172 487935 487935 1792749 1792749 128254 128254 PROVISION FOR DOUBTFUL 2732010 2732010 SOCIAL SERVICES 1479 1479 29671128 25474088 4197040 0 13900900 16746288 4322934 4476858 306892 203333 655204 747232 273840 292311 38398325 14951874 17677004 23446451 728327 707898 332934 37844672 46973734 4149083 4083689 10851048 17153161 15000131 21236850 X 22844541 25736884 22844541 25736884 37844672 46973734 2892343 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 62299 62299 18005561 8023099 9982462 8186497 6152659 2033838 12143968 776116 11367852 23446451 32563471 29671128 2892343 0 2892343 32645343 81872 81872 32563471 0 32563471 29753000 81872 81872 29671128 0 29671128 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE COMPANY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. 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 COMPANY HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2008. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 81,872. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 81,872. 1 1 1 X 1 X 1 1 1 0 1 1 257409 0 257409 0.00960 6774594 5378627 1395967 0.05180 7032003 5378627 1653376 0.06140 23638 0 23638 0.00090 182466 44034 138432 0.00510 32154 0 32154 0.00120 238258 44034 194224 0.00720 7270261 5422661 1847600 0.06860 1 2732010 241050 9125456 8805494 319962 X 1 0 1 NONE 1 1 HAYWARD AREA MEMORIAL HOSPITAL

11040 N STATE ROAD 77 HAYWARD WI 54843

X X X X HAYWARD AREA MEMORIAL HOSPITAL 1 1 1 100.000000000000 1 200.000000000000 1 X X X 1 1 X X X X X 1 X 1 X X 1 X 0 1 2 WATER'S EDGE

11040 N STATE ROAD 77 HAYWARD WI 54843

NURSING HOME WATER'S EDGE

11040 N STATE ROAD 77 HAYWARD WI 54843

ASSISTED LIVING FACILITY PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED MEDICARE COST REPORT. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE DIABETES EDUCATION, PAIN MANAGEMENT, AND ONCOLOGY. PART I, L7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $2,732,010. PART II: MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY SUCH AS BREASTFEEDING EDUCATION, BLOOD DRIVES, CHILD BIRTH CLASSES, DISASTER READINESS, DIABETES EDUCATION, HEALTH FAIRS, HABITAT FOR HUMANITY, IN KIND DONATIONS AND CASH DONATIONS AS EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. PART III, LINE 4: MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS AND BY USING HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS OF ACCOUNTS. PATIENT RECEIVABLES ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED.COSTING METHOD IS COST TO CHARGE RATIO. PART III, LINE 8: HAYWARD AREA MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT IS REIMBURSED AT 101% OF COST. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $284,099 AND ALLOWABLE COSTS OF $807,245 RESULTING IN A SHORTFALL OF $523,146. 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 III, LINE 9B: NO, PATIENTS REQUEST ASSISTANCE AND AT THAT POINT RECEIVE THE DOCUMENTS TO APPLY FOR CHARITY CARE. MEDICAL SERVICES, INC DOES POST A LARGE SIGN IN THE LOBBY THAT STATES "THIS HEALTH CARE FACILITY IS REQUIRED TO GIVE A REASONABLE AMOUNT OF ITS SERVICES FREE OR AT A REDUCED CHARGE TO PERSONS WHO CANNOT AFFORD TO PAY FOR MEDICAL CARE. IF YOU ARE NOT ABLE TO PAY FOR ALL OR PART OF THE CARE YOU NEED, PLEASE CONTACT THE ADMISSIONS OR BUSINESS OFFICE OF THIS FACILITY AND ASK ABOUT THE AVAILABILITY OF SUCH CARE". THIS SIGN IS PLACED IN A LOCATION THAT ALL PATIENTS CAN SEE AND ASK FOR DOCUMENTS TO COMPLETE TO START THE CHARITY CARE APPLICATION PROCESS. HAYWARD AREA MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: THE LOWEST NEGOTIATED INSURANCE RATE IS 100% OF GROSS CHARGES. PART I, LINE 6A: THE HOSPITAL FILES A COMMUNITY BENEFIT REPORT IN WI. PART VI, LINE 2: FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT. FOLLOWING THE COMPLETION OF THE ASSESSMENT, VARIOUS WORK GROUPS ARE CONVENED. APPROPRIATE STAFF MEMBERS FROM THE FACILITY THEN WORK WITH COMMUNITY MEMBERS TO DEVELOP PROGRAMS AND APPROACHES TO ADDRESS THE IDENTIFIED HEALTH ISSUES. SOME EXAMPLES INCLUDE ABUSE OF PRESCRIPTION DRUGS, SEXUAL ABUSE PREVENTION PROGRAMS AND UNDERAGE ALCOHOL USE. PART VI, LINE 3: ALL PATIENTS ARE BILLED THE SAME, HOWEVER, IF A PATIENT BECOMES DELINQUENT ON A BILL, A LETTER IS SENT TO THE PATIENT ASKING THAT THE PATIENT CONTACT THE BUSINESS FOR ASSISTANCE WITH THE OVERDUE BILL. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH THE BILLING OFFICE AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 4: HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICAID POPULATION. HAYWARD SERVES A HIGH MEDICAID AND HIGH MEDICARE POPULATION WITH THE TWO ACCOUNTING FOR 68% OF GROSS REVENUES AND 55% OF NET PATIENT SERVICES REVENUES. HAYWARD IS CONSIDERED A SUMMER VACATION DESTINATION THAT BRINGS LARGE CROWDS DURING THE SUMMER MONTHS. THE EMERGENCY DEPARTMENT SERVES A LARGE NUMBER OF PATIENTS THAT RANGE FROM COMMERCIAL INSURANCE, MEDICARE, MEDICAID, HIS (INDIAN HEALTH SERVICES), ETC. HAYWARD HOSPITAL IS FOCUSED ON PROVIDING HIGH QUALITY HEALTHCARE IN A RURAL LOCATION. MANY SERVICES ARE PROVIDED BY HAYWARD HOSPITAL, ALLOWING LESS PATIENT TRAVEL AT A TIME WHEN THE PATIENT IS LIKELY NOT FEELING WELL. THE HAYWARD COMMUNITY IS AN AGING POPULATION AND WE RECOGNIZE THAT NEED AND HAVE COMMITTED MILLIONS OF DOLLARS INTO SERVICES FOR THE OLDER POPULATION. WE BELIEVE HAYWARD HOSPITAL PROVIDES EXCEPTIONAL CARE IN A RURAL LOCATION. PART VI, LINE 6: OPEN MEDICAL STAFF. COMMUNITY CALL PROGRAM FOR MEDICAL STAFF. LOCAL COMMUNITY BOARD WITH 12 VOTING MEMBERS. NONPROFIT STATUS WITH PROFITS (IF ANY) USED FOR ADDITIONAL SERVICES, CAPITAL PURCHASES SUCH AS A CT SCANNER, LAB EQUIPMENT, ELECTRONIC HEALTH RECORD, IMPROVED INPATIENT SERVICES, OB PROGRAM, CONTINUED EDUCATION FOR ALL STAFF, GROWING SENIOR SERVICES PROGRAM AND A FOCUS ON THE NEEDS OF THE COMMUNITY. REPORTS FILED WITH STATES PART VI, LINE 7 WI X X X 0 0 0 0 0 0 0 0 0 BARBARA PEICKERT 206181 0 0 0 0 0 9800 0 23355 0 239336 0 0 0 DAN HYMANS 0 260314 0 0 0 0 0 11868 0 25309 0 297491 0 0 LES WHITEAKER 0 185670 0 0 0 0 0 8239 0 25150 0 219059 0 0 SUSAN BAUER 155500 0 0 0 0 0 8290 0 20369 0 184159 0 0 0 SUZANNE ULMER 161879 0 0 0 0 0 7847 0 20361 0 190087 0 0 0 ROBERT TERRY 149138 0 0 0 0 0 8591 0 21380 0 179109 0 0 0 X 1 47900 TAX VALUE 1 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ISSUES OR CONCERNS ARE DISCUSSED AT THE COMPLIANCE COMMITTEE MEETING WITH COMPLIANCE OFFICER, COMMITTEE MEMBERS AND ADMINISTRATION. POLICIES ARE REVIEWED YEARLY AND PRESENTED TO REGULATORY COMPLIANCE COMMITTEE FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 15 HR WILL RESEARCH SALARY DATA FOR OUR REGION AND PROVIDE ADMINISTRATION WITH A TYPICAL COMPENSATION RANGE. DIFFICULT POSITIONS TO FILL, DEMANDS OF THE POSITION, EXPERIENCE, EDUCATION, PAST WORK HISTORY, AND REFERENCES ARE ALL TAKEN INTO CONSIDERATION WHEN DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. FORM 990, PART VI, SECTION C, LINE 19 A PUBLIC DISCLOSURE COPY OF THE TAX RETURN IS AVAILABLE BY REQUEST. ALL OTHER DOCUMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR, WITH THE EXCEPTION OF THE GOVERNING DOCUMENTS THAT ARE CONFIDENTIAL. FORM 990, PART XI, LINE 2C: ALL FINANCIAL MATTERS GO THROUGH THE FINANCE COMMITTEE. MEMORIAL MEDICAL CENTER INC 1615 MAPLE LANE ASHLAND WI 54806 237013497 MEDICAL SERVICES WI 501(C)(3) 170(B)(1)(A)(III) REGIONAL ENTERPRISES INC 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 391555837 SUPPORT WI 501(C)(3) 509(A)(3) N/A 0 REI MEDICAL CLINICS INC 1615 MAPLE LANE ASHLAND WI 54806 391701306 SUPPORT WI 501(C)(3) 509(A)(3) REGIONAL ENTERPRISES INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0