2025-12-09T12:26:44-06:00 2024-03-31 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2023-04-01 391536207 MEDICAL SERVICES INC MEDI 7159344321 11040 N STATE ROAD 77 HAYWARD WI 548436391 LUKE BEIRL CEO 7159344321 2025-11-17 1 0 JULIE BOYER P01278549 2187275025 2025-11-17 2023 2025-03-06 01:10:19Z X TAMARACK HEALTH HAYWARD MEDICAL CENTER LUKE BEIRL 11040 N STATE ROAD 77 HAYWARD WI 548436391 98063409 0 X HTTPS:WWW.TAMARACKHEALTH.ORG X 1986 WI TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA 12 11 596 78 0 0 25076 48855 76023726 85494646 -111410 1150126 161460 161272 76098852 86854899 0 0 0 0 39098235 46152652 0 0 0 31546277 35455267 70644512 81607919 5454340 5246980 114127248 127173544 16987532 22012122 97139716 105161422 X CONTINUOUSLY IMPROVE THE HEALTH STATUS OF THE PEOPLE OF THE HAYWARD AREA 0 0 71830846 85525764 TAMARACK HEALTH HAYWARD MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL, 50 BED NURSING HOME, AND 40 APARTMENT RCAC FACILITY. THE HOSPITAL CAMPUS ALSO CONTAINS TWO ATTACHED PRIMARY CARE CLINICS; ONE THAT IS OWNED AND OPERATED BY TAMARACK HEALTH HAYWARD MEDICAL CENTER AND ANOTHER THAT IS OWNED AND OPERATED BY ESSENTIA HEALTH. THESE CLINICS EMPLOY APPROXIMATELY 18 FULL-TIME PHYSICIANS, AND ADDITIONAL PART-TIME SPECIALTY CARE PHYSICIANS WHO DO ROUNDS AND SEE PATIENTS AT THE HOSPITAL THROUGHOUT THE MONTH. THE HOSPITAL, NURSING HOME AND ASSISTED LIVING EMPLOY CLOSE TO 605 EMPLOYEES. IN FY '23-'24 THE HOSPITAL HAD 899 INPATIENT ADMISSIONS AND 3,010 IP DAYS, 626 OBSERVATION ADMISSIONS WITH 17,832 HOURS OF CARE, AND 40 TCU ADMISSIONS WITH 320 CENSUS DAYS OF CARE. THE NURSING HOME HAD 42 ADMISSIONS WITH 13,659 CENSUS DAYS, AND THE ASSISTED LIVING HAD 14,014 RESIDENT DAYS WITH AN AVERAGE MONTHLY CENSUS OF 38.29 FOR THE FISCAL YEAR WITH 40 TOTAL APARTMENTS. THE EMERGENCY ROOM IS STAFFED BY A PHYSICIAN 24/7/365 SEEING 9,373 PATIENTS. AIR AND GROUND AMBULANCES ARE AVAILABLE FOR THOSE REQUIRING A HIGHER LEVEL OF TRAUMA CARE. AS A RESULT OF A 2015 COMMUNITY HEALTH NEEDS ASSESSMENT, AN URGENT CARE WAS OPENED IN 2017. IT SERVED 6,523 PATIENTS DURING ITS SEVENTH FULL FISCAL YEAR OF OPERATION. THE OPERATING ROOM PERFORMED 1,294 CASES AND ENDOSCOPY PERFORMED 1,036 PROCEDURES. THE HOSPITAL HAS ADDED SEVERAL SPECIALTY SERVICES OVER THE LAST SEVERAL YEARS. ORTHOPEDICS OPENED IN APRIL 2018 WITH A SPORTS MEDICINED CERTIFIED SURGEON ADDED IN FEBRUARY 2020. WOUND CARE WAS ADDED IN LATE 2018. UROLOGY WAS ADDED IN AUGUST 2019. IN FY '20-'21, PODIATRY, GENERAL SURGERY, AND ADVANCED PAIN MANAGEMENT WERE ADDED. EAR, NOSE, AND THROAT (ENT) WAS ADDED IN FY '22-'23. OUR SPECIALTY SERVICES PROGRAMS HAD 9,529 CLINIC VISITS AND 809 SURGERIES IN FY '23-'24. A FAMILY MEDICINE/PRIMARY CARE CLINIC WAS OPENED IN MAY 2022 AND WAS CERTIFIED AS A RURAL HEALTH CLINIC (RHC) IN DECEMBER 2022. IT SERVED 8,046 PATIENTS IN ITS FIRST FULL YEAR OF OPERATION. RADIOLOGY EXAMS TOTAL 31,483, AND LAB EXAMS TOTAL 97,946 PER YEAR. HAYWARD MEDICAL CENTER PERFORMED 140 DELIVERIES LAST YEAR WITH 245 NEWBORN DAYS. HAYWARD IS A POPULAR VACATION HOME DESTINATION AND ATTRACTS TOURISTS THROUGHOUT THE YEAR. HAYWARD IS ALSO A POPULAR RECREATIONAL AREA ATTRACTING MOUNTAIN BIKERS, SKIERS, BOATING, FISHING, AND GENERAL OUTDOOR ACTIVITIES. MEDICAL PROFESSIONALS ARE ATTRACTED TO THIS POPULAR RECREATIONAL AREA BY THE QUALITY OF LIFE THEY FIND HERE. 71830846 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 44 0 1 596 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X HEATHER SHEEHAN 7159344245 11040 N STATE ROAD 77 HAYWARD WI 548436391 JASON DOUGLAS FORMER PRES/DIR-REI TIL 2/2/24 1.00 39.00 X X 0 697867 61557 LUKE BEIRL DIRECTOR/CEO-MSI/INTERIM PRES-REI 37.00 3.00 X X 431444 0 71159 MARY HANSEN DIRECTOR 1.00 X 0 0 0 GREGG LUNDBERG DIRECTOR 1.00 X 0 0 0 HARRY MALCOLM MD DIRECTOR 1.00 X 0 0 0 STACEY MCKINNEY DIRECTOR 1.00 X 0 0 0 DODSON THOMPSON DO DIRECTOR 1.00 X 0 0 0 BENJAMIN TURNER MD DIRECTOR 1.00 X 0 0 0 JOHN WILL DIRECTOR 1.00 X 0 0 0 JOHN GARRETT TREASURER 1.00 1.00 X X 0 0 0 KYLAH ECKES SECRETARY 1.00 1.00 X X 0 0 0 NED WOLF VICE CHAIR 1.00 2.00 X X 0 0 0 RICH HOBAN CHAIR 1.00 2.00 X X 0 0 0 KENT DUMONSEAU CFO - REI 1.00 39.00 X 0 437418 60058 HEATHER SHEEHAN COO 39.00 1.00 X 237096 0 59977 AINDREA LINDSAY CCO 40.00 X 225604 0 58484 BRIAN DONAHUE PHYSICIAN 40.00 X 1021001 0 66689 PAUL TONKIN PHYSICIAN 40.00 X 868415 0 65987 DAVID LYNN PHYSICIAN 40.00 X 627423 0 67479 SARAH FOWLER PHYSICIAN 40.00 X 547392 0 66159 MATTHEW VINCENT CRNA 40.00 X 466314 0 65403 4424689 1135285 642952 57 0 1 0 REGIONAL ENTERPRISES INC 1615 MAPLE LANE ASHLAND WI 54806 PRO FEES/RENT 3449142 MARKET & JOHNSON 2350 GALLOWAY STREET PO BOX 63 EAU CLAIRE WI 54702 CONTRACTOR FOR BUILDING PROJECTS 3287208 MEDICAL SOLUTIONS PO BOX 310737 DES MOINES IA 50331 TRAVEL STAFFING 957559 RIVER VALLEY ARCHITECTS INC 3300 BIRCH STREET SUITE 1A EAU CLAIRE WI 54703 ARCHITECT FOR BUILDING PROJECTS 795380 MEDICAL STAFFING SOLUTIONS INC PO BOX 101 RICE LAKE WI 54868 TRAVEL STAFFING 772602 19 23323 25532 10117 48855 HOSPITAL 621500 78869632 78869632 NURSING HOME 623000 4751311 4751311 ASSISTED LIVING 623000 1867326 1867326 DIABETES 621500 6377 6377 85494646 1346457 1346457 40213 36828 3385 3385 3385 10718489 256862 10929607 242075 -211118 14787 -196331 -196331 CAFETERIA 900099 126769 126769 MISCELLANEOUS 900099 31118 31118 157887 86854899 85525764 0 1280280 1109094 1109094 33884377 32171741 1712636 1474729 1397030 77699 7412707 6967251 445456 2271745 2098578 173167 255339 255339 99554 99554 6130 6130 4353602 4058171 295431 202637 1030 201607 1262537 904109 358428 3449484 3449484 1131100 1078823 52277 481989 389726 92263 193635 182017 11618 5631102 5293236 337866 249594 249594 DRUGS 6541241 6541241 MEDICAL SUPPLIES 4770610 4769718 892 IMPLICIT PRICE CONCESSI 2963540 2963540 REPAIRS & MAINTENANCE 1781902 1739220 42682 2081271 1275415 805856 81607919 71830846 9777073 0 7505 5743 25740926 23232943 10206252 12267115 2475088 2504063 1484526 1598117 92849484 40992041 45363376 51857443 6798130 11251665 9819450 7789692 12231995 16666763 114127248 127173544 6135907 8331319 10397825 13125886 453800 554917 16987532 22012122 X 97139716 105161422 97139716 105161422 114127248 127173544 X 5246980 3258863 -484137 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6130 6130 0 PART II-B, LINE 1: TAMARACK HEALTH HAYWARD 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. 502065 502065 60576661 28343820 32232841 19126727 10912493 8214234 12644031 1735728 10908303 51857443 MUTUAL FUNDS 5650420 F ALTERNATIVE INVESTMENTS 2139272 F 7789692 ASSETS LIMITED AS TO USE 16211154 INTEREST RATE SWAP 455609 16666763 THIRD-PARTY PAYOR SETTLEMENTS 554917 554917 X 86688126 3258863 -3447677 -188814 86876940 -22041 -22041 86854899 78666420 22041 22041 78644379 2963540 2963540 81607919 PART X, LINE 2: THE COMPANY IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. 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 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 OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2021. PART XI, LINE 2D - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS -2,963,540. LOSS ON INTEREST RATE SWAPS -484,137. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -36,828. GAIN ON DISPOSAL OF FIXED ASSETS 14,787. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 36,828. GAIN ON DISPOSAL OF FIXED ASSETS -14,787. PART XII, LINE 4B - OTHER ADJUSTMENTS: IMPLICIT PRICE CONCESSIONS 2,963,540. NORTH AMERICA - CANADA AND MEXICO, BUT NOT THE UNITED STATES 0 0 INVESTMENT 452250 CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENT 2135426 0 0 0 0 0 0 2587676 0 2587676 0 0 0 0 1 0 1 1 X 1 X 1 X 1 1 0 1 1 508759 508759 0.00650 12741265 9898887 2842378 0.03610 13250024 9898887 3351137 0.04260 29966 29966 0.00040 13347329 9706120 3641209 0.04630 128856 128856 0.00160 13506151 9706120 3800031 0.04830 26756175 19605007 7151168 0.09090 11310 11310 0.00010 11310 11310 0.00010 1 2963540 0 19951437 20743938 -792501 X 1 1 1 1 TAMARACK HEALTH HAYWARD MEDICAL CENTER 11040 N STATE ROAD 77 HAYWARD WI 54843 HTTPS://WWW.TAMARACKHEALTH.ORG/ 1040 X X X X N/A TAMARACK HEALTH HAYWARD MEDICAL CENTER 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 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 1 X 0 X X X X 1 X 0 0 TAMARACK HEALTH HAYWARD MEDICAL CENTER PART V, SECTION B, LINE 5: THE PROCESS BEGAN IN MARCH 2021, WHEN TAMARACK HEALTH HAYWARD MEDICAL CENTER CREATED A 14 QUESTION DIGITAL SURVEY. SURVEY QUESTIONS WERE DRAFTED BASED ON THE GOALS OF WISCONSIN'S HEALTHIEST WISCONSIN 2020 PLAN AND MIRRORED SEVERAL OF THE SURVEY QUESTIONS FROM THE ORGANIZATION'S 2018 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY.ONLINE SURVEYS WERE DISTRIBUTED VIA EMAIL, USING TARGETED SOCIAL MEDIA CHANNELS AND LINKED TO THE HOSPITALS'S WEBSITE.SURVEY AWARENESS WAS ALSO PROMOTED VIA A PRESS RELEASE, SOCIAL MEDIA ANNOUNCEMENTS AND THE LOCAL RADIO PROGRAM LIFESTYLES NORTH. DUE TO THE COVID-19 PANDEMIC THERE WERE A FEW POPULATIONS WHERE PAPER SURVEYS WERE WARRENTED INCLUDING 200 DISTRIBUTED TO SAWYER COUNTY SENIOR RESOURCE CENTER MEALS ON WHEELS PARTICIPANTS. THEIR SURVEY RESULTS WERE MANUALLY ENTERED INTO THE SURVEY MONKEY DATABASE TOOL.THERE WERE OVER 770 SURVEY RESPONSES, WHICH SIGNIFICANTLY SURPASSED PREVIOUS SURVEYS (2018 SURVEY-547 RESPONDENTS). SURVEY DATA COLLECTED INCLUDED DEMOGRAPHICS OF AGE, RACE, GENDER, INCOME LEVEL AND ZIP CODE.INTERNAL RECIPIENTS OF SURVEY:HMC STAFF, PROVIDERS, VOLUNTEERS AND PARTNERSWATER'S EDGE TENANTS, RESIDENTS AND FAMILIESHMC FAMILY ADVISORY COUNCILHMC BOARD OF DIRECTORSSAWYER COUNTY EMPLOYEESEXTERNAL SURVEY DISTRIBUTION:AREA SCHOOLS FOR DISTRIBUTION TO STAFF AND FAMILIES (HAYWARD, LCO, WINTER, NORTHWOODS, BIRCHWOOD)ESSENTIA HEALTH-HAYWARD AND NORTHLAKES CLINIC-HAYWARD STAFFNORTHWEST CONNECTION FAMILY RESOURCE CENTERGREATER HAYWARD AREA MINISTERIAL ASSOCIATIONREGIONAL CHAMBERS OF COMMERCE FOR DISTRIBUTION TO BUSINESS MEMBERS (HAYWARD, CABLE, WINTER)SAWYER COUNTY/LCO ECONOMIC DEVELOPMENTAMERICAN BIRKEBEINER SKI FOUNDATION VOLUNTEERS AND OTHER AREA VOLUNTEER DISTRIBUTION LISTS. TAMARACK HEALTH HAYWARD MEDICAL CENTER PART V, SECTION B, LINE 6B: SAWYER COUNTY HEALTH AND HUMAN SERVICES TAMARACK HEALTH HAYWARD MEDICAL CENTER PART V, SECTION B, LINE 7D: HMC DID A SOCIAL MEDIA POST AS WELL AS GAVE PAPER COPIES OF THE REPORT TO THE PARTNERING ORGANIZATIONS THAT IT WORKED ON THE CHNA WITH, FOR AVAILABILITY AT THEIR LOCATIONS. TAMARACK HEALTH HAYWARD MEDICAL CENTER PART V, SECTION B, LINE 11: TAMARACK HEALTH HAYWARD MEDICAL CENTER PARTNERED WITH SAWYER COUNTY PUBLIC HEALTH TO COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT AND DEVELOP AND IMPLEMENT THE 2023-2025 COMMUNITY HEALTH IMPROVEMENT PLAN. THIS PARTNERSHIP IS SUPPORTED BY THE FACT THAT APPROXIMATELY 68% OF ALL TAMARACK HEALTH HAYWARD MEDICAL CENTER PATIENTS ORIGINATE FROM COMMUNITIES LOCATED IN SAWYER COUNTY.PLAN IMPLEMENTATION1. CREATE A HEALTH AND WELLNESS COUNTY WIDE RESOURCE DATABASE TO SHARE SERVICES, EDUCATIONAL OPPORTUNITIES, PROGRAMS, SUPPORT GROUPS, ETC. THAT ARE AVAILABLE IN SAWYER COUNTY. THIS PROJECT WILL BE PARTIALLY FUNDED BY SAWYER COUNTY PUBLIC HEALTH DEPARTMENT THROUGH A RECENT GRANT APPLICATION AND SUPPORTED BY TAMARACK HEALTH HAYWARD MEDICAL CENTER WITH RESOURCES AND FUNDING. IN ADDITION, THIS RESOURCE MAY ALSO SUPPORT SMALL EMPLOYERS WITHIN THE COUNTY WHO DO NOT HAVE THE MEANS TO PROVIDE AN EMPLOYEE ASSISTANCE PROGRAM. 2. CREATE COMMUNITY ACTION GROUP(S) FOR EACH AGE AND FOCUS AREA. GROUPS WILL PRIORITIZE IDENTIFIED FOCUS AREAS, DEVELOPING GOALS AND CREATING ACTIONABLE STEPS TO IMPROVE THE IDENTIFIED NEEDS. THESE COMMUNITY GROUPS WILL BE BY INVITATION AND/OR VOLUNTEERING TO SERVE. THE HOPE IS THAT AS A COMMUNITY WE WILL CULTIVATE A COMMITTEE THAT HAS A BROAD BASE OF COUNTY REPRESENTATION, PROMOTES DIVERSITY IN RACE AND GENDER AND CONSTITUTES A VARIETY OF BACKGROUNDS AND LIFE EXPERIENCE. 3. EXPLORE OFFERING CHRONIC DISEASE MANAGEMENT SKILL BUILDING USING THE STANFORD CURRICULUM OF LIVING BETTER WITH CHRONIC DISEASE FOR YOUNG ADULTS THROUGH SENIORS. IMPLEMENTATION WOULD INVOLVE TRAINING COMMUNITY LEADERS TO SERVE AS GROUP FACILITATORS. GROUPS MAY BE DIVIDED BASED ON AGE, DIAGNOSIS, OR SKILL. YEAR 2 PROGRESS: APRIL 1, 2023 - MARCH 31, 2024GOAL 1: CREATE A HEALTH AND WELLNESS COUNTY WIDE RESOURCE DATABASE TO SHARE SERVICES, EDUCATIONAL OPPORTUNITIES, PROGRAMS, SUPPORT GROUPS, ETC. THAT ARE AVAILABLE IN SAWYER COUNTY.-TAMARACK HEALTH HAYWARD MEDICAL CENTER CONTRIBUTED $5000 TO SAWYER COUNTY PUBLIC HEALTH IN ORDER TO SUPPORT THE INITIAL WEBSITE DEVELOPMENT AND ANNUAL MAINTENANCE FOR THE FIRST YEAR.-SAWYER COUNTY NETWORK OF CARE WEBSITE LAUNCHED FEBRUARY 2023 HTTPS://SAWYER.WI.NETWORKOFCARE.ORG/FAMILY/HEALTHIER TOGETHER WEBSITE COMMUNICATION PLAN: BUILD AWARENESS AMONG VARIOUS AUDIENCES COMMUNICATION PRIORITIES1. GENERATE AWARENESS ABOUT THE AVAILABILITY OF THE SAWYER COUNTY HEALTHIER TOGETHER WEBSITE, HTTPS://SAWYER.WI.NETWORKOFCARE.ORG/FAMILY/ 2. CONNECT THE SC NETWORK OF CARE WEBSITE TO THE 2023-2025 CHIP'S FIRST PRIORITY: CREATE A HEALTH AND WELLNESS COUNTY WIDE RESOURCE DATABASE TO SHARE SERVICES, EDUCATIONAL OPPORTUNITIES, PROGRAMS, SUPPORT GROUPS, ETC. THAT ARE AVAILABLE IN SAWYER COUNTY. THIS PROJECT WILL BE PARTIALLY FUNDED BY SAWYER COUNTY PUBLIC HEALTH DEPARTMENT THROUGH A RECENT GRANT APPLICATION AND SUPPORTED BY TAMARACK HEALTH HAYWARD MEDICAL CENTER WITH RESOURCES AND FUNDING. IN ADDITION, THIS RESOURCE MAY ALSO SUPPORT SMALL EMPLOYERS WITHIN THE COUNTY WHO DO NOT HAVE THE MEANS TO PROVIDE AN EMPLOYEE ASSISTANCE PROGRAM. 3. EDUCATE VARIOUS AUDIENCES ON THE INFORMATION AND RESOURCES AVAILABLE ON THE HEALTHIER TOGETHER WEBSITE.4. SOLICIT WEBSITE CONTENT IMPROVEMENTS INCLUDING: A. SERVICE AND RESOURCE LISTINGS B. CALENDAR AND EVENT LISTINGS C. UPDATED CONTACTS FOR AGENCIES, SERVICES AND BUSINESSES5. HIGHLIGHT OPPORTUNITIES FOR AGENCIES AND BUSINESSES TO USE AND PROMOTE.PHASE 1 - BUILD INTERNAL AWARENESS POSTERS AND RACK CARDS CREATED AND SHARED DIGITAL + PRINTED COPIES MADE FOR COMMUNITY DISTRIBUTION. -JUNE 2023 - HEALTHIER TOGETHER POSTERS & RACK CARDS DEVELOPMENT AND PRINTING 500 RACK CARDS & 150 POSTERS ($194.40) -JULY 2023 - PRINTING OF ADDITIONAL HEALTHIER TOGETHER RACK CARDS 250 ($41.12) INITIAL INTERNAL AUDIENCES INCLUDING SAWYER COUNTY, LCO TRIBAL ENTITIES AND TAMARACK HEALTH HAYWARD MEDICAL CENTER:-SAWYER COUNTY PUBLIC HEALTH STAFF-BIZHIKI WELLNESS CENTER LEADERS-SAWYER COUNTY HEALTH & HUMAN SERVICES STAFF-HMC PATIENT FAMILY ADVISORY COUNCIL-HMC BOARD OF DIRECTORS NEW BOARD MEMBER ORIENTATION-HMC LEADERS FROM EMERGENCY DEPARTMENT, FAMILY MEDICINE, OBSTETRICS, SOCIAL SERVICES AND INFUSION -HMC STAFF-HMC MEDICAL STAFF-HMC VOLUNTEERSPHASE 2 - BUILD AGENCY & BUSINESS AWARENESS -COMMUNITY HEALTH IMPROVEMENT PLAN STEERING COMMITTEE-COMMUNITY HEALTH IMPROVEMENT PLAN WORK GROUPS-HAYWARD CHAMBER OF COMMERCE MEMBERS-HAYWARD CHAMBER OF COMMERCE STAFF (INCLUDING GREETERS)-AREA CLINICS INCLUDING ESSENTIA HEALTH, NORTHLAKES CLINICPHASE 3 - BUILD COMMUNITY AWARENESSPRESS RELEASE DISTRIBUTION-SAWYER COUNTY RECORD-SAWYER COUNTY GAZETTE-WRLS-HMC WEBSITE & SOCIAL MEDIA-SAWYER COUNTY PUBLIC HEALTH SOCIAL MEDIA-SHARED WITH TOWN BOARDSGOAL 2: CREATE COMMUNITY ACTION GROUP(S) FOR EACH AGE AND FOCUS AREA. GROUPS WILL PRIORITIZE IDENTIFIED FOCUS AREAS, DEVELOPING GOALS AND CREATING ACTIONABLE STEPS TO IMPROVE THE IDENTIFIED NEEDS.-IN THE SECOND YEAR, THE WORK GROUPS WERE LAUNCHED. THE STEERING TEAM EXPANDED ON THE INFORMATION PROVIDED BY THE CONVENING COMMITTEE TO GENERATE LISTS OF POSSIBLE PARTICIPATING AGENCIES AND INDIVIDUALS. INVITATIONS WERE EXTENDED AND THE GROUPS BEGAN MEETING.CHILDREN & YOUNG ADULTS: HEALTH EDUCATION PREVENTION INITIAL REPRESENTATION FROM:-SAWYER COUNTY PUBLIC HEALTH-TAMARACK HEALTH HAYWARD MEDICAL CENTER-HAYWARD COMMUNITY SCHOOL DISTRICT-LCO SCHOOL DISTRICT-WINTER SCHOOL DISTRICT-AMERICAN BIRKEBEINER SKI FOUNDATION-LCO BOYS & GIRLS CLUB THE WORKGROUP MET MONTHLY FROM MARCH 2023 JUNE 2023 AND THEN TRANSITIONED TO EVERY OTHER MONTH. THE GROUPS FIRST PRIORITY WAS TO CONDUCT TO CONDUCT A GAP ANALYSIS OF PROGRAMS AND RESOURCES. THIS GROUP IS STRUGGLING TO MAINTAIN ENGAGEMENT AND A REEXAMINATION IS OCCURRING TO REVIEW PURPOSE AND NEED.FENTANYL AWARENESS CAMPAIGNREPRESENTATIVES FROM HMC INCLUDE KRISTA KURTTI, EMERGENCY DEPARTMENT NURSE MANAGER AND PEGGY LEBLANC, CLINICAL DIRECTOR.SAWYER COUNTY PUBLIC HEALTH REPRESENTATIVES INCLUDE JOYCE KNOWLTON & JESSICA BJORK.THE GROUP SUPPORTS A BROAD COMMUNITY CAMPAIGN ABOUT THE DANGERS OF FENTANYL. COMMUNICATION TOOLS INCLUDE POSTERS HUNG IN AREA BUSINESSES, YARD SIGNS AT BUSINESSES AND HOMES. OUTDOOR BILLBOARDS. THEY ARE PLANNING A SPRING 2024 EVENT AND HAVE BEEN WORKING ON MAKING NARCAN AVAILABLE IN VARIOUS SETTINGS WERE DRUG USE MAY BE COMMON. OVER 900 INDIVIDUAL CONTACTS MADE DURING A THREE-MONTH PERIOD AT SEVERAL COMMUNITY FUNCTIONS AND OUTREACH EVENTS INCLUDING:-NATIONAL NIGHT OUT EVENTS - AUGUST 2023-COMMUNITY PRESENTATIONS - OCT. 5, 2023 AT ST. JOSEPH'S CATHOLIC CHURCH IN HAYWARD-SCHOOL PRESENTATIONS - GRADES 6-12 FOR WINTER AND HAYWARD SCHOOLS-TEACHER IN-SERVICES - OCT. 19, 2023 - PRESENTED TO HAYWARD MIDDLE AND HIGH SCHOOL STAFF-HAYWARD HURRICANES FOOTBALL GAME - FALL 2023-BUSINESS EVENT FOR WOMEN-FALL COMMUNITY HEALTH FAIROVERDOSE DATA MANAGEMENT - MARK MANNING, HMC EMERGENCY OPERATIONS COORDINATOR SERVES ON COMMITTEEADULTS: ALCOHOL & DRUG RECOVERY GROUPS/SERVICESRATHER THAN STARTING A NEW GROUP THE STEERING TEAM REQUESTED INCLUSION IN THE GIWII-MINOBIMAADIZIMIN PREVENTION COALITION (ALCOHOL AND DRUG RECOVERY). IT HAS SINCE ESTABLISHED MEMBERSHIP AND REPRESENTATION; HOWEVER, THAT CONTINUES TO BE AN ONGOING AND EVOLVING INITIATIVE.SAWYER COUNTY PUBLIC HEALTH HAS PRESENTED ITS GAP ANALYSIS TO THE GROUP, WHICH COVERED PREVENTION, HARM REDUCTION, TREATMENT, AND RECOVERY.THE GROUP BEGAN MEETING MONTHLY IN MAY 2023. INITIAL REPRESENTATION FROM:-FOR THE GIWII-MINOBIMAADIZIMIN PREVENTION COALITION (ALCOHOL AND DRUG RECOVERY):-LCO EMERGENCY SHELTER-CHAMBER OF COMMERCE-LCO AGING AND DISABILITY SERVICES-LCO BEHAVIORAL HEALTH (PROJECT AWARE GRANT, COIPP GRANT, ETC.)-CO COMPREHENSIVE COMMUNITY SERVICES (CCS)-SAWYER COUNTY PUBLIC HEALTH-LCO INDIAN CHILD WELFARE AND FAMILY SERVICES-FOREVER JOY (NON-PROFIT)-LCO CLINIC-NORTHLAKES CLINIC-TAMARACK HEALTH HAYWARD MEDICAL CENTER-SAWYER COUNTY HOUSING-LCO K-12-WINTER SCHOOL DISTRICT-HAYWARD SERENITY CLUB-TRIBAL GOVERNANCE BOARD-4H, YOUTH DEVELOPMENTADULTS: MENTAL HEALTH TRAUMA INFORMED CARETHE MENTAL HEALTH & TRAUMA-INFORMED CARE WORKGROUP WAS INITIALLY DELAYED. IN AUGUST 2023, CHIP CHAMPIONS CHERIE MORGAN, TAMARACK HEALTH HAYWARD MEDICAL CENTER, JULIA LYONS, SAWYER COUNTY HEALTH & HUMAN SERVICES DIRECTOR AND YASMIN AJIRNIAR, SAWYER COUNTY COMMUNITY HEALTH COORDINATOR HELD A PLANNING MEETING AND EXTENDED INVITATIONS TO LAUNCH THE GROUP IN SEPTEMBER 2023. INITIAL REPRESENTATION FROM:-SAWYER COUNTY PUBLIC HEALTH-SAWYER COUNTY HEALTH & HUMAN SERVICES-TAMARACK HEALTH HAYWARD MEDICAL CENTERTHE GROUPS FIRST PRIORITY IS TO ORGANIZE A PILOT TRAUMA INFORMED CARE TRAINING PROGRAM TO BE OFFERED AT HMC AND SCHHS WITH A PRIORITY TO LAUNCH IN EARLY 2024. SEE PART V, PAGE 8 FOR CONTINUATION. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-RESOURCES/FINANCIAL-ASSISTANCE/ PART V, LINE 16B, FAP APPLICATION FORM WEBSITE: HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/TAMARACK-SITE-442/MEDIA/0A1484802ECC409D82EACF99E7B0418C/2024-TAMARACK-HEALTH-FINANCIAL-ASSISTANCE-APPLICATION.PDF PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY: HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/TAMARACK-SITE-442/MEDIA/09C736140135424986D7B809BA1F2B6B/2024-TAMARACK-HEALTH-FAP-PLAIN-LANGUAGE-SUMMARY.PDF PART V, LINE 16I, FAP TRANSLATION: DUE TO THE SMALL SIZES OF THE LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS OF THE COMMUNITIES SERVED BY THE ORGANIZATION, THE ORGANIZATION WAS NOT REQUIRED TO TRANSLATE THE FINANCIAL ASSISTANCE POLICY (FAP), THE FAP APPLICATION FORM, OR THE PLAIN LANGUAGE SUMMARY OF THE FAP TO OTHER LANGUAGES. PART V, LINE 7A, CHNA - HOSPITAL'S WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, LINE 10, IMPLEMENTATION PLAN WEBSITE: HTTPS://WWW.TAMARACKHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, SECTION B, LINE 11, CONTINUED: GOAL 3: EXPLORE OFFERING CHRONIC DISEASE MANAGEMENT SKILL BUILDING USING THE STANFORD CURRICULUM OF LIVING BETTER WITH CHRONIC DISEASE FOR YOUNG ADULTS THROUGH SENIORS.-TAMARACK HEALTH CONTINUES TO EXPAND PRIMARY CARE ACCESS HAYWARD AND ARE ALSO LOOKING AT OPPORTUNITIES IN NEW MARKETS. AS EXPANSION PROJECTS STABILIZE, WE HOPE TO ENGAGE PROVIDERS, CLINIC LEADERS AND MEDICAL PROFESSIONALS TO BEGIN TO ADDRESS THIS NEED.COMMUNITY HEALTH NEEDS NOT ADDRESSED/ADDITIONAL IDENTIFIED PRIORITIES: THE COMMUNITY HEALTH IMPROVEMENT PLAN COMMITTEE IDENTIFIED SEVERAL OTHER HEALTH CONCERNS PREVALENT IN OUR COMMUNITIES WHICH INCLUDED, BUT WERE NOT LIMITED TO: COMMUNICABLE DISEASE, INJURY AND VIOLENCE, NUTRITION, GROWTH AND DEVELOPMENT, PHYSICAL HEALTH, TABACCO USE. ENVIRONMENTAL AND OCCUPATION, ORAL HEALTH, REPRODUCTIVE AND SEXUAL ISSUES, ETC.STAKEHOLDERS WERE ASKED TO RANK THESE HEALTH CONCERNS BY PRIORITY, AND WHILE ALL ARE IMPORTANT AND DEMAND TO BE ACKNOWLEDGED, THE COMMITTEE DECIDED TO USE AVAILABLE RESOURCES IN THE MOST EFFICIENT WAY POSSIBLE. THIS MEANT PRIORITIZING THREE ISSUES FOR THE GREATEST IMPACT, RATHER THAN TRYING TO DO A LITTLE IN EACH AREA. 2 1 - WATER'S EDGE 11040 N STATE ROAD 77 HAYWARD WI 54843 NURSING HOME 2 - 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 RESPIRATORY THERAPY, REHAB SERVICES, OBSERVATION BEDS, NURSING HOME AND ASSISTED LIVING. PART I, LN 7 COL(F): IMPLICIT PRICE CONCESSIONS FROM FINANCIAL STATEMENTS IS $2,963,540. PART II, COMMUNITY BUILDING ACTIVITIES: MANY PROGRAMS HAVE BEEN DESIGNED TO HELP PATIENTS OF THE COMMUNITY. BLOOD DRIVES, LIFELINE, PALS CLASSES, NRP CLASS, MOM & INFANT MONTHLY NETWORK MEETINGS, PRENATAL YOGA, PARKINSON'S SUPPORT GROUP, ALSO COURSE, AND ACLS CLASSES ARE EXAMPLES OF THE COMMUNITY ACTIVITIES HAYWARD HOSPITAL IS CURRENTLY INVOLVED IN. IN ADDITION, COMMUNITY BENEFIT OPERATIONS THAT THE HOSPITAL IS INVOLVED WITH INCLUDE COMMUNITY SUPPERS, BIRKIE MEDICAL DIRECTORSHIP, BIRKIE MEDICAL TEAM, NATIONAL NIGHT OUT, AND TEAM DINNERS. THE ACTIVITIES HAVE BEEN REPORTED ON SCHEDULE H, PART I, LINE 7E.WORKFORCE DEVELOPMENT - HMC PURCHASED A LARGE, MULTI-ROOM HOME IN DECEMBER 2018 TO HOUSE MEDICAL STUDENTS AND LOCUM PROVIDERS WITH THE INTENT TO ATTRACT MEDICAL STUDENTS TO COME TO HAYWARD FOR THEIR RESIDENCY AND SEEK EMPLOYMENT IN THE HAYWARD AREA AFTER GRADUATION. PART III, LINE 2: REVENUES GENERALLY RELATE TO CONTRACTS WITH PATIENTS IN WHICH THE PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO THE PATIENTS. REVENUES ARE RECORDED DURING THE PERIOD THE PERFORMANCE OBLIGATIONS TO PROVIDE HEALTH CARE SERVICES ARE SATISFIED. THE COMPANY'S PERFORMANCE OBLIGATIONS FOR INPATIENT SERVICES ARE GENERALLY SATISFIED OVER PERIODS THAT AVERAGE APPROXIMATELY THREE DAYS, AND REVENUES ARE RECOGNIZED BASED ON CHARGES INCURRED IN RELATION TO TOTAL EXPECTED CHARGES. PERFORMANCE OBLIGATIONS FOR OUTPATIENT SERVICES ARE GENERALLY SATISFIED OVER A PERIOD OF LESS THAN ONE DAY.REVENUES ARE BASED UPON THE ESTIMATED AMOUNTS THE COMPANY 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 COMPANY ALSO RECORDS ESTIMATED IMPLICIT PRICE CONCESSIONS (BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE) RELATED TO UNINSURED ACCOUNTS TO RECORD SELF-PAY REVENUES AT THE ESTIMATED AMOUNTS THE COMPANY 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 COMPANY HAS THE UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS ARE RECEIVABLES IF THE COMPANY'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 COMPANY 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 TAMARACK HEALTH HAYWARD 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 8 OF THE 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: TAMARACK HEALTH HAYWARD MEDICAL CENTER'S BILLING AND COLLECTION POLICY STATES:A. SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF THIS POLICY, HMC MAY TAKE ANY AND ALL LEGAL ACTIONS, INCLUDING EXTRAORDINARY COLLECTION ACTIONS, 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 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. HMC OFFERS PAYMENT PLANS THAT BEAR NO INTEREST.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 HMC 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 HMC 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, HMC WILL INFORM THE RESPONSIBLE INDIVIDUAL(S) IN WRITING THE DENIAL AND INCLUDE A 30 DAYS' PRIOR WRITTEN NOTICE OF THE ECAS THAT HMC 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, HMC 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. HMC 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 715-934-4267 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.HAYWARDMEMORIALHOSPITAL.COM/FINANCIAL-SERVICES/ . A PAPER COPY OF OUR FAP, FAP APPLICATION FORM, OR COLLECTION POLICY CAN BE OBTAINED AT OUR FACILITY LOCATED AT 11040N STATE RD. 77, HAYWARD, WI 54843 AT THE REGISTRATION DESK.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. COMMUNITY CARE INFORMATION IS ALSO INCLUDED IN ALL ADMISSION FOLDERS AND ALL ROOMS HAVE INFORMATIONAL BINDERS WITH CHARITY CARE INFORMATION. OUR FINANCIAL ASSISTANCE POLICY IS ALSO AVAILABLE ON OUR WEBSITE ALONG WITH THE APPLICATION. PART VI, LINE 2: NEEDS ASSESSMENT:FACILITY STAFF PARTICIPATE IN THE COMMUNITY NEEDS ASSESSMENT PROCESS WITH THE SAWYER COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH CLINICS, ASSISTED LIVING FACILITY, AND PHYSICIANS FROM THE COMMUNITY. 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, UNDERAGE ALCOHOL USE, TRANSPORT ISSUES, TELEHEALTH, PATIENT ADVOCACY PROGRAM, AND REDUCED COST CLINIC. SENIOR LEADERS OF THE ORGANIZATION, ALONG WITH OUR BOARD OF DIRECTORS, CONTINUALLY EVALUATE THE NEED FOR ADDITIONAL SERVICES IN OUR COMMUNITY. WE ALSO HAVE A PATIENT FAMILY ADVISORY COMMITTEE (PFAC) WE UTILIZE TO PROVIDE COMMUNITY/PATIENT FEEDBACK REGARDING SERVICES/NEEDS, ETC. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: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 PATIENT FINANCIAL SERVICES FOR ASSISTANCE. PATIENTS HAVE THE OPTION TO DISCUSS PAYMENT OPTIONS WITH PATIENT FINANCIAL SERVICES AND POSSIBLE ELIGIBILITY FOR CHARITY CARE. PART VI, LINE 4: COMMUNITY INFORMATION:HAYWARD WISCONSIN IS LOCATED IN NORTHERN WISCONSIN AND CONSISTS OF A HIGH MEDICARE AND MEDICAID POPULATION. THE MEDICARE AND MEDICAID POPULATION ACCOUNTS FOR 67% OF THE HOSPITAL'S GROSS REVENUES AND 54% OF ITS NET PATIENT SERVICE 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, IHS (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 5: PROMOTION OF COMMUNITY HEALTH: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. PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM:MEDICAL SERVICES, INC. IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 BRIAN DONAHUE PHYSICIAN 1004417 0 15000 0 1584 0 16500 0 50189 0 1087690 0 0 0 PAUL TONKIN PHYSICIAN 853055 0 15000 0 360 0 16500 0 49487 0 934402 0 0 0 JASON DOUGLAS FORMER PRES/DIR-REI TIL 2/2/24 0 532971 0 163930 0 966 0 16500 0 45057 0 759424 0 0 DAVID LYNN PHYSICIAN 612063 0 15000 0 360 0 16500 0 50979 0 694902 0 0 0 SARAH FOWLER PHYSICIAN 537610 0 8750 0 1032 0 16500 0 49659 0 613551 0 0 0 MATTHEW VINCENT CRNA 422401 0 43675 0 238 0 16500 0 48903 0 531717 0 0 0 LUKE BEIRL DIRECTOR/CEO-MSI/INTERIM PRES-REI 353732 0 77496 0 216 0 16500 0 54659 0 502603 0 0 0 KENT DUMONSEAU CFO - REI 0 344418 0 92448 0 552 0 16500 0 43558 0 497476 0 0 HEATHER SHEEHAN COO 200016 0 36902 0 178 0 10328 0 49649 0 297073 0 0 0 AINDREA LINDSAY CCO 189444 0 35901 0 259 0 9766 0 48718 0 284088 0 0 0 PART I, LINE 3 JASON DOUGLAS, PRESIDENT OF RELATED ORGANIZATION REGIONAL ENTERPRISES INC., DETERMINES CEO LUKE BEIRL'S SALARY AND COMPENSATION. HE UTILIZED DATA PREPARED BY THE INDEPENDENT COMPENSATION CONSULTANT WHICH INCLUDES 990 COMPARABILITY DATA. A TOWN OF HAYWARD WISCONSIN 396031517 2020-07-15 10000000 PROPERTY AND EQUIPMENT 0 0 0 B TOWN OF HAYWARD WISCONSIN 396031517 2020-07-15 3100000 REFINANCE 0 0 0 C TOWN OF HAYWARD WISCONSIN 396031517 2023-09-07 10000000 PROPERTY AND EQUIPMENT 0 0 0 D CITY OF HAYWARD WISCONSIN 396005464 2023-09-07 3200000 PROPERTY AND EQUIPMENT 0 0 0 A 1577250 10000000 149019 9850981 2021 0 0 1 1 B 2265304 3100000 62793 3037207 2010 1 0 1 1 C 10000000 179412 833923 8986664 2024 0 0 0 1 D 3200000 57412 3142588 2024 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 JOHNSON BANK 11.000000000000 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 C 0 0 1 0 1 1 JOHNSON BANK 15.000000000000 0 0 0 0 1 D 0 0 1 0 1 1 JOHNSON BANK 15.000000000000 0 0 0 0 1 A 1 B 1 C 1 D 1 SARAH DUMONSEAU FAMILY MEMBER OF OFFICER KENT DUMONSEAU 137786 EMPLOYMENT 0 HALEY STELLMACHER FAMILY MEMBER OF OFFICER LUKE BEIRL 99705 EMPLOYMENT 0 PAGE 1, ITEM B - AMENDED RETURN EXPLANATION FOLLOWING THE INITIAL SUBMISSION OF FORM 990, MEDICAL SERVICES, INC. (MSI) IDENTIFIED PREVIOUSLY UNREPORTED FOREIGN INVESTMENTS. UPON DISCOVERY, MSI PROMPTLY INITIATED CORRECTIVE MEASURES TO ADDRESS THIS INADVERTENT OVERSIGHT. AS A RESULT, FORM 990 HAS BEEN AMENDED TO ACCURATELY REFLECT THESE FOREIGN INVESTMENTS. THE FOLLOWING SECTIONS HAVE BEEN UPDATED ACCORDINGLY: 1. PART IV, LINE 14B 2. SCHEDULE F 3. FORM 8865 MSI REMAINS COMMITTED TO MAINTAINING TRANSPARENCY AND COMPLIANCE WITH ALL APPLICABLE REPORTING REQUIREMENTS. FORM 990, PART VI, SECTION A, LINE 6 REGIONAL ENTERPRISES, INC. IS THE SOLE CORPORATE MEMBER OF MEDICAL SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT OF REI SHALL BE AN EX OFFICIO MEMBER OF THE MSI BOARD WITH FULL VOTING PRIVILEGES. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE MEMBER OF MEDICAL SERVICES, INC., REGIONAL ENTERPRISES, INC. HAS THE FOLLOWING RESERVE POWERS: A. TO MAKE, AMEND, OR REPEAL MSI'S BYLAWS AND ARTICLES OF INCORPORATION. B. TO APPROVE ANY CHANGE IN MSI'S PHILOSOPHY, MISSION OR VISION STATEMENTS, AND APPROVE THE LONG-RANGE GOALS AND STRATEGIC PLAN FOR MSI. C. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGET. D. TO APPROVE ALL BUILDING PROGRAMS THAT EXCEED $500,000 IN VALUE. E. TO SELECT AND RETAIN AN INDEPENDENT AUDITING FIRM. F. TO APPOVE THE PURCHASE, SALE, LEASE, DISPOSITION, OR ALIENATION OF ANY REAL PROPERTY OWNED BY MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. G. TO APPROVE ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES OF MSI. ANY SUCH ACTION SHALL BE JOINTLY APPROVED BY THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER OF ASHLAND, WISCONSIN. H. TO AUTHORIZE THE PRESIDENT OF REI TO RECOMMEND TO THE BOARD OF MSI, THE INDIVIDUAL WHO WILL SERVE AS THE CHIEF EXECUTIVE OFFICER FOR MSI, SUBJECT TO RATIFICATION BY THE MSI BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FINANCE AND ACCOUNTING TEAM REVIEW THE 990 PRIOR TO FILING TO CONFIRM ACCURACY OF INFORMATION. THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. IF ANY CHANGES ARE MADE, A FINAL COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C 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 MSI A CERTIFICATE REGARDING CONFLICTS OF INTEREST. 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 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. THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER MSI 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. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN MSI'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO MSI. IF THE BOARD OR COMMITTEE BELIEVES AN ALTERNATE TRANSACTION COULD BE CONSIDERED THAT WOULD BE MORE ADVANTAGEOUS TO MSI, 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 TIME AS THE DISINTERESTED PERSON HAS BEEN ABLE TO REPORT HIS OR HER FINDINGS TO THE APPROPRIATE GOVERNING BODY. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS NOT IN THE BEST INTERESTS OF MSI AND THAT IS NOT FAIR AND REASONABLE TO MSI. 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. IF THE TRANSACTION OR ARRANGEMENT INVOLVES OR MAY INVOLVE AN INSIDER, THE BOARD OR COMMITTEE SHALL FOLLOW THE PROCEDURES ABOVE AND THE INSIDER SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE INSIDER TRANSACTION IS DISCUSSED. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE WHETHER THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION COULD CONSTITUTE AN INSIDER TRANSACTION. AS 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 INTERMEDIATE SANCTIONS. 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 (SUCH AS COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS IN THE REGION, NATIONAL COMPENSATION STUDIES, COMPETING OFFERS RECEIVED BY THE INSIDER, ASSET APPRAISALS OR RENTAL ANALYSES BY QUALIFIED APPRAISERS AND OTHER INFORMATION THAT MAY BE OBTAINED ABOUT COMPARABLE AGREEMENTS, PURCHASES, SALES AND LEASES). THE BOARD OR COMMITTEE MAY RELY ON SUCH INFORMATION OR DATA PROVIDED BY MSI'S MANAGEMENT. THE BOARD OR COMMITTEE SHALL NOT APPROVE ANY TRANSACTION OR ARRANGEMENT THAT IS AN EXCESS BENEFIT TRANSACTION. 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. 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, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO: SUSPENSION OF VOTING RIGHTS, RECISION OF ANY AGREEMENTS, AND TERMINATION OF DIRECTOR OR OFFICER STATUS. 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. UPDATES TO THE RANGES ARE PUT INTO PLACE AROUND JULY OR AUGUST EACH YEAR, IF CHANGES OCCURRED. DURING FY 2024, A COMPENSATION CONSULTANT WAS HIRED TO REVIEW THE COMPENSATION OF JASON DOUGLAS AND KENT DUMONSEAU. JASON DOUGLAS, PRESIDENT OF RELATED ORGANIZATION REGIONAL ENTERPRISES INC., DETERMINES CEO LUKE BEIRL'S SALARY AND COMPENSATION. HE UTILIZED DATA PREPARED BY THE INDEPENDENT COMPENSATION CONSULTANT WHICH INCLUDES 990 COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST FROM THE PUBLIC RELATIONS DIRECTOR FOR THE SAME PERIOD OF DISCLOSURE SET FORTH IN SECTION 6104(D). THE GOVERNING DOCUMENTS ARE CONFIDENTIAL AND NOT AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: LOSS ON INTEREST RATE SWAPS -484,137. 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