SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
MEMORIAL MEDICAL CENTER INC
 
Employer identification number

23-7013497
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    423,614   423,614 0.780 %
b Medicaid (from Worksheet 3, column a) . . . . .     11,878,923 10,794,749 1,084,174 1.990 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     12,302,537 10,794,749 1,507,788 2.770 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     18,042   18,042 0.030 %
f Health professions education (from Worksheet 5) . . .     9,765   9,765 0.020 %
g Subsidized health services (from Worksheet 6) . . . .     5,071,495 4,237,175 834,320 1.530 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     108,293   108,293 0.200 %
j Total. Other Benefits . .     5,207,595 4,237,175 970,420 1.780 %
k Total. Add lines 7d and 7j .     17,510,132 15,031,924 2,478,208 4.550 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,898,177
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
18,198,469
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
18,011,056
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
187,413
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

 

No
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 MEMORIAL MEDICAL CENTER
1615 MAPLE LANE
ASHLAND,WI54806
X X     X   X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 12
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 5: AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, COMMUNITY INPUT WAS SOUGHT THROUGH SURVEYING, COMMUNITY LISTENING SESSIONS AND A STAKEHOLDER PRIORITIZING SESSION. OVER 500 RESPONSES WERE RECEIVED FROM THE SURVEYING PROCESS. SIX PUBLIC LISTENING SESSIONS WERE HELD THROUGHOUT THE SERVICE AREA. OVER 50 PEOPLE ATTENDED THE STAKEHOLDER PRIORITIZING SESSION, INCLUDING LAW ENFORCEMENT, SOCIAL SERVICES, NON-PROFIT AGENCIES, HEALTHCARE PROVIDERS, SCHOOL PERSONNEL AND CONCERNED CITIZENS.
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 6B: BAYFIELD COUNTY HEALTH DEPARTMENT AND ASHLAND COUNTY HEALTH & HUMAN SERVICES DEPARTMENT.
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 7D: THE NEEDS ASSESSMENT IS PROVIDED ON BAYFIELD COUNTY AND ASHLAND COUNTY WEBSITES AS WELL.
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE COORDINATED TEAM OF MEMORIAL MEDICAL CENTER, INC. STAFF AND COUNTY HEALTH PROFESSIONALS FROM THE TWO COUNTIES INVOLVED DETERMINED THAT IT WAS ESSENTIAL TO CONCENTRATE ON THE NUMBER 1 HEALTH ISSUE IDENTIFIED TO REALLY MAKE AN IMPACT ON THE OVERALL COMMUNITY. PRIOR TO MOVING FORWARD ON THE NEW PLAN, EFFORTS WERE MADE TO FIRST EVALUATE THE PROGRESS MADE DURING THE 2013-2015 CHIP CYCLE. ALCOHOL AND OTHER DRUG ABUSE WAS DETERMINED AS THE TOP PRIORITY AND BECAME THE FOCUS FOR HEALTH ENTITIES AND STAKEHOLDERS DURING THIS TIMEFRAME. INFORMATION GATHERED FROM THIS EXPERIENCE WILL BE USED TO INCREASE THE IMPACT MADE ON COMMUNITIES THROUGH EXAMINING POSITIVE OUTCOMES AND LESSONS LEARNED. THREE GOALS WERE SET WHEN EMBARKING ON THE DECREASE OF ALCOHOL USE AND ABUSE IN ASHLAND AND BAYFIELD COUNTIES. MMC STAFF PLAYED A KEY ROLE WITHIN ALL OF THESE GOALS AND PROVIDED FINANCING AND HUMAN CAPITAL TO ACHIEVE THESE GOALS. GOAL 1 FOCUSED AROUND CREATING AN ELECTRONIC ALCOHOL AND OTHER DRUG ABUSE RESOURCE GUIDE FOR PROVIDERS AND THE COMMUNITY AT-LARGE TO USE: THIS WAS ACCOMPLISHED THROUGH THE CREATION OF ONELESSDAY.ORG WHICH LAUNCHED IN JULY 2014. THE WEBSITE INCLUDES AN INTERACTIVE MAP WITH INFORMATION ON MORE THAN FIFTY RESOURCES FOR THE RECOVERY COMMUNITY. AN ASSESSMENT QUIZ FOR INDIVIDUALS AND A FLOW CHART IS AVAILABLE TO HELP THOSE WITH LOVED ONES IN RECOVERY NAVIGATE THE SYSTEM. SUCCESS WAS MEASURED THROUGH WEBSITE HITS WHICH INCLUDED 405 SESSIONS, 263 UNIQUE VISITS AND AN AVERAGE TIME SPENT OF 2 MINUTES AND 30 SECONDS ALL WITHIN THE FIRST TWELVE MONTHS. MEMORIAL MEDICAL CENTER DEDICATED MARKETING AND COMMUNICATIONS STAFF TO OVERSEE PRODUCTION AND CONTENT CREATION OF THE SITE. THEY ALSO FUNDED AN OUTSIDE CONTRACTOR TO PROGRAM THE SITE. ONCE THE SITE WAS LIVE, AN MMC STAFF PERSON WAS RESPONSIBLE FOR UPDATING THE SITE WITH NEW PROVIDER INFORMATION AS IT BECAME AVAILABLE. THEY ALSO DESIGNED, IMPLEMENTED AND FUNDED AN EXTENSIVE PUBLIC AWARENESS CAMPAIGN TO EDUCATE THE COMMUNITY ABOUT THIS NEW RESOURCE. THE CAMPAIGN FEATURED PRINT AND DIGITAL ADS, BILLBOARDS, MOVIE THEATER ADVERTISING, COASTERS AND OTHER PRINTED COLLATERAL FOR REGIONAL BUSINESSES, AND ADS ON REGIONAL BAR ROOM BATHROOM DOORS. AS PART OF MMC'S COMMUNITY OUTREACH, THE HOSPITAL PARTNERED WITH OTHER COMMUNITY COALITIONS TO SPONSOR AND SUPPORT EVENTS, SUCH AS ONE FOCUSED ON EDUCATING MOTHERS TO MAKE HEALTHY CHOICES AND ONE TO EDUCATE LOCAL POLITICAL LEADERS ON HEALTH ISSUES IN THE COMMUNITY AND HOW ADVOCACY CAN HAVE A POSITIVE IMPACT. THE SECOND GOAL WAS TO INCREASE ALCOHOL PREVENTION AND EDUCATION PROGRAMS WITHIN ASHLAND AND BAYFIELD COUNTIES. CURRENT ALCOHOL AND OTHER DRUG ABUSE EDUCATION WERE ASSESSED AT SCHOOL DISTRICTS IN THE TWO COUNTY REGION. RELATIONSHIPS WERE FORMED WITH THE LARGEST SCHOOL DISTRICT TO BETTER UNDERSTAND OBSTACLES WITHIN THE CURRENT CURRICULUM AND AN AODA PROVIDER AT MMC SPENT TIME WITHIN THE SCHOOL DISTRICT EDUCATION CHILDREN ABOUT A NUMBER OF TOPICS INCLUDING ADDICTION. THE THIRD GOAL WAS TO PROVIDE AN OPTION FOR SOBER ACTIVITIES AND PLACES OF RECREATION WITHIN ASHLAND AND BAYFIELD COUNTIES. UPON FURTHER RESEARCH AND DISCUSSION, THE GROUP DETERMINED THE BEST WAY TO ACHIEVE THIS GOAL WOULD BE TO PROMOTE EXISTING SOBER EVENTS WITHIN COMMUNITIES LOCATED WITHIN THE TWO COUNTY SERVICE AREA. MMC DEDICATED MARKETING AND COMMUNICATION STAFF TIME TO OVERSEE PRODUCTION OF A SAFE & SOBER SYMBOL. THIS SYMBOL WAS USED ON A NUMBER OF REGIONAL EVENT POSTERS. IT WAS ALSO SHOWCASED FOR 6-MONTHS ON SOBER EVENTS WITHIN THE COMMUNITY EVENTS CALENDAR IN THE REGION'S LARGEST DAILY NEWSPAPER. INCLUDE SYMBOL THESE GOALS WERE SET BY A LARGER REGIONAL CHIP COALITION. OVER THE COURSE OF THREE YEARS, MORE THAN 65 REGIONAL STAKEHOLDERS WERE INVOLVED IN THE PROCESS. TO ASSIST IN KEEPING THIS COMMUNITY COLLABORATION MOVING FORWARD, MMC FUNDED A MULTI-YEAR FACILITATOR POSITION DEDICATED ENTIRELY TO CHIP. ASIDE FROM THE GOALS SET BY THE REGIONAL CHIP COALITION, MMC ALSO CHOSE TO PARTICIPATE IN A PILOT PROGRAM BY THE RURAL WISCONSIN HEALTH COOPERATIVE. MMC WAS ONE OF FOUR HOSPITALS TO IMPLEMENT A PROGRAM TARGETING BINGE DRINKING IN RURAL WISCONSIN BY PROVIDING A VOLUNTARY SCREENING TO PATIENTS IN COMING INTO URGENT CARE OR THE EMERGENCY DEPARTMENT DURING A SPECIFIED TIME PERIOD. THROUGH ALL THE ACCOMPLISHMENTS IT WAS STILL APPARENT THAT MORE IS NEEDED TO SUPPORT THE COMMUNITIES OF ASHLAND AND BAYFIELD COUNTIES OVERCOME THE CHALLENGES ASSOCIATED WITH ALCOHOL USE AND ABUSE. A FEW LESSONS LEARNED THAT WILL CARRY INTO THE 2015-2017 CHIP PROCESS INCLUDE A NEED FOR QUANTIFIABLE INFORMATION, A NEED FOR EVIDENCE-BASED STRATEGIES, MEASURABLE GOALS AND A NEED FOR CONTINUED MOMENTUM AND DEDICATION TO ACHIEVING GOALS.
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16I: THE FINANCIAL ASSISTANCE POLICY IS PUBLISHED IN THE LOCAL NEWSPAPER.
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 22D: DETERMINING THE ABILITY TO PAY:THE APPLICANT'S ABILITY TO PAY FOR ALL OR A PORTION OF THE HOSPITAL'S BUDGETED FINANCIAL REQUIREMENTS FOR COMMUNITY CARE USING THE FOLLOWING CRITERIA WHICH WILL BE APPLIED CONSISTENTLY AND EQUITABLY.1. ELIGIBILITY FOR HEALTH AND MEDICAL CARE INSURANCE COVERAGE.2. PERSONAL OR FAMILY INCOME BASED ON FEDERAL POVERTY LEVEL GUIDELINES.3. SIZE OF THE PATIENT'S FAMILY.4. RESOURCES- INCLUDING: CASH, BANK ACCOUNTS, STOCKS, U.S. SAVINGS BONDS, LAND, PERSONAL PROPERTY, CARS. EXCLUDING: LIFE INSURANCE, LAND/HOME LIVING ON, HOUSEHOLD GOODS, PERSONAL PROPERTY, ONE CAR, PREPAID BURIAL.5. OTHER FINANCIAL OBLIGATIONS TO INCLUDE MEDICAL BILLS AND LIVING EXPENSES.ELIGIBILITY IS DETERMINED BY THE FOLLOWING INCOME GUIDELINES (2013 HHS POVERTY GUIDELINES). ELIGIBILITY MAY ALSO BE BASED ON ASSETS SUCH AS SAVINGS AND CHECKING ACCOUNTS, RECREATIONAL VEHICLES (MOTOR HOME, MOTORCYCLE, ATV, ETC.) AND ANY REAL ESTATE OTHER THAN YOUR HOME.FAMILY SIZE: 50 % ELIGIBILITY: 30% ELIGIBILITY:1 $11,670 $17,5052 $15,730 $23,5953 $19,790 $29,685 4 $23,850 $35,7755 $27,910 $41,8656 $31,970 $47,955
PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
MEMORIAL MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.ASHLANDMMC.COM
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 7: COSTS ARE CALCULATED USING FINANCIAL DATA AND THE COST TO CHARGE RATIO FROM THE AS FILED 2015 MEDICARE COST REPORT.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE LABOR & DELIVERY, PHYSICAL THERAPY, PSYCHIATRIC/PSYCHOLOGICAL SERVICES, AND OBSERVATION BEDS.
PART I, LN 7 COL(F): BAD DEBT EXPENSE FROM FINANCIAL STATEMENTS IS $1,898,177.
PART I, LINE 6A THE ORGANIZATION FILES AN ANNUAL COMMUNITY BENEFIT REPORT.
PART III, LINE 2: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AS A PERCENTAGE OF SELF-PAY AND OTHER RECEIVABLES HAS DECREASED FROM 44.3 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2014 TO 30.5 PERCENT FOR THE YEAR ENDED SEPTEMBER 30, 2015.
PART III, LINE 3: AT MEMORIAL MEDICAL CENTER, INC. BAD DEBT IS CONSIDERED THE UNWILLINGNESS TO PAY, WHILE CHARITY CARE AND FREE CARE ARE INABILITY TO PAY.
PART III, LINE 4: SEE FOOTNOTE 1 ON PAGE 6 OF THE ATTACHED AUDITED FINANCIAL STATEMENT FOR COMPLETE FOOTNOTE REGARDING PATIENT ACCOUNTS RECEIVABLE.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 (LESS 2% MEDICARE SEQUESTRATION). THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $487,018 AND ALLOWABLE COSTS OF $1,061,603 RESULTING IN A SHORTFALL OF $574,584. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE. THE MEDICARE ADVANTAGE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $3,592,974 AND ALLOWABLE COSTS OF $3,789,239 RESULTING IN A SHORTFALL OF $196,265.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 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 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: 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 6: MEMORIAL MEDICAL CENTER IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES WI
Schedule H (Form 990) 2014
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