2018-08-09T18:14:48-05:00 2017-09-30 381357951 PLANTE & MORAN PLLC 27400 Northwestern Highway Southfield MI 48034 990 2016-10-01 390910727 WAUKESHA MEMORIAL HOSPITAL INC WAUK 2629282496 725 AMERICAN AVENUE WAUKESHA WI 53188 RONALD J FARR CHIEF FINANCIAL/ADMIN OFFICER 2629282496 2018-07-26 1 David Lowenthal P00378651 2483522500 2018-07-26 2016 2022-09-23 18:48:47Z PROHEALTH WAUKESHA MEMORIAL HOSPITAL SUSAN EDWARDS 725 AMERICAN AVENUE WAUKESHA WI 53188 498327031 0 X WWW.PROHEALTHCARE.ORG X 1956 WI PROVIDER OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES. 14 13 2904 380 2788982 -1931542 1436910 2061641 475812598 492017870 2293397 1989151 1975128 1943929 481518033 498012591 25020000 17400000 0 0 147659131 141328852 0 0 0 290990936 303133508 463670067 461862360 17847966 36150231 502796777 493326924 395025015 372269695 107771762 121057229 CONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 445266369 17400000 489354029 WAUKESHA MEMORIAL HOSPITAL FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. WAUKESHA MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. WAUKESHA MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 47,819 DAYS OF INPATIENT CARE AND APPROXIMATELY 336,530 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2017. SEE SCHEDULE H FOR ILLUSTRATION OF ITS PROGRAM SERVICE ACCOMPLISHMENTS. 445266369 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 207 0 1 2904 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 WI X RONALD FARR 2629284740 N17 W24100 RIVERWOOD DRIVE SUITE WAUKESHA WI 531881131 SUSAN EDWARDS PRESIDENT & CEO 2.00 50.00 X X 0 1309663 832068 MIKE ERWIN VICE CHAIRPERSON 2.00 8.00 X X 0 0 0 MARK MOHR CHAIRPERSON 2.00 8.00 X X 0 0 0 BETTY ARNDT SECRETARY 2.00 8.00 X X 0 0 0 JULIE SCHROEDER TREASURER 2.00 8.00 X X 0 0 0 DAVID ROELKE DIRECTOR 2.00 8.00 X 0 0 0 DOUG HASTAD DIRECTOR 2.00 8.00 X 0 0 0 E JOHN RAASCH DIRECTOR 2.00 8.00 X 0 0 0 RALPH RAMIREZ DIRECTOR 2.00 8.00 X 0 0 0 SUE BELLEHUMER DIRECTOR 2.00 8.00 X 0 0 0 KEN RIESCH DIRECTOR 2.00 8.00 X 0 0 0 GARY BEYER DIRECTOR 2.00 8.00 X 0 0 0 JOHN HALLETT DIRECTOR 2.00 8.00 X 0 0 0 JIM GANNON DIRECTOR 2.00 8.00 X 0 0 0 RONALD FARR CHIEF FINANCIAL/ADMIN OFFICER 2.00 50.00 X 0 644036 181999 JOHN ROBERTSTAD CHIEF COMMUNITY LIAISON 2.00 46.00 X 55258 638900 57266 KENNETH PRICE CHIEF OPERATING OFFICER 2.00 50.00 X 0 411672 145979 KARIN KULTGEN VP MEDICAL AFFAIRS 40.00 0.00 X 382446 0 34618 ERIC HENDEE CHIEF PHYSICIST 40.00 0.00 X 211080 0 40787 MICHAEL E KOWALOK PHYSICIST 40.00 0.00 X 193311 0 20388 JOHN MAY VP - AMBULATORY 40.00 0.00 X 344905 0 42037 MARGARET M PFITZINGER VP CLINICAL OPERATIONS 40.00 0.00 X 198208 0 38828 JULIET UGARTE HOPKINS PHYSICIAN ADVISOR 40.00 0.00 X 259126 0 41117 1644334 3004271 1435087 84 0 1 0 JH FINDORFF & SON INC PO BOX 1647 MADISON WI 53701 CONSTRUCTION SERVICES 10517869 INDIANA UNIVERSITY HEALTH 2227 RELIABLE PARKWAY CHICAGO IL 60686 Cardiothoracic Services 5205169 EPIC SYSTEMS PO BOX 88314 MILWAUKEE WI 532880314 SOFTWARE MAINTENANCE 2668441 MEDICAL COLLEGE OF WI PO BOX 13308 MILWAUKEE WI 53213 FAMILY MEDICINE RESIDENT PROGRAM 2506778 J M BRENNAN INC 2101 W ST PAUL AVE MILWAUKEE WI 53223 CONSTRUCTION SERVICES 1815061 90 1706425 355216 2061641 NET PATIENT REV. 622110 472746539 472746539 MEDICAL SERVICE LAB 621500 8120696 5467741 2652955 HOSPITAL JOINT VENTURE 622310 3925751 3925751 ORTHO SURGERY CENTER 621400 2310009 2310009 SURGERY CENTER 621400 1178679 1178679 3736196 3725310 10886 492017870 1408237 64119 1344118 158030 97008 61022 61022 61022 798346 217432 580914 580914 580914 CAFETERIA 722210 1844576 1844576 GIFT SHOP 453220 38331 38331 1882907 498012591 489354029 2788982 3807939 X 17400000 17400000 428573 428573 110435401 105856618 4578783 1011536 965848 45688 21872190 20884296 987894 7581152 7418195 162957 130514399 122454002 8060397 13639076 13633699 5377 6080937 4892242 1188695 10290377 10290377 43205919 43205919 DRUGS & PHARMACEUTICALS 37177338 37177338 MEDICAL SUPPLIES 34272031 34272031 MEDICAID PROVIDER TAXES 12556594 12556594 BAD DEBTS 10604328 10604328 4792509 3654882 1137627 461862360 445266369 16595991 0 3474154 4183811 628170 54227587 56571870 6499127 6543240 8283018 5823843 937603292 559339102 384664720 378264190 14012276 6227785 12265416 12270465 18742309 23441720 502796777 493326924 52038762 55115810 102610 107406 9054661 5404778 333828982 311641701 395025015 372269695 X 106740182 119953852 1031580 1103377 107771762 121057229 502796777 493326924 X 36150231 -579016 -22285748 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 6710388 6710388 0.00000 0.00000 0.00000 26093574 26093574 480152273 212605000 267547273 2781387 2669909 111478 423043189 344064193 78978996 5532869 5532869 378264190 ACCRUED POSTRETIREMENT MEDICAL 98828 FAIR VALUE-INTEREST RATE SWAP 17133929 ASSET RETIREMENT OBLIGATION 37865 ACCUMULATED MIN PENSION LIABILITY 11394320 INTERCOMPANY NOTES PAYABLE 272154237 OTHER LONG TERM LIABILITY 303583 LEASES PAYABLE 9388837 DEFERRED COMPENSATION LIABILITY 1130102 311641701 1 1 X 1 X 1 X 0 1 0 1 1 1122116 1122116 0.00250 46109435 21812073 24297362 0.05380 47231551 21812073 25419478 0.05630 25 160459 2427596 1923 2425673 0.00540 9 2080 4241862 4241862 0.00940 1 291 8789216 2087920 6701296 0.01490 0 0 8 27889 1431823 1431823 0.00320 43 190719 16890497 2089843 14800654 0.03290 43 190719 64122048 23901916 40220132 0.08920 2 348 1993 1993 0.00000 3 675 135877 135877 0.00030 1 33 8360 8360 0.00000 1 221 41771 41771 0.00010 1 7 118836 118836 0.00030 8 1284 306837 306837 0.00070 1 10800124 957805 88700869 115467596 -26766727 X 1 1 1 PROHEALTH ALIGNED LLC AMBULATORY SURGERY CENTER 0.51000 0.49000 2 THE ORTHOPEDIC SURGERY CENTER LLC ORTHOPEDIC SURGICAL SERVICES 0.49000 0.49000 2 1 WAUKESHA MEMORIAL HOSPITAL INC 725 AMERICAN AVENUE WAUKESHA WI 53188 WWW.PROHEALTHCARE.ORG #41 X X X X 2 REHABILITATION HOSPITAL OF WISCONSIN LLC 1625 COLDWATER CREEK DRIVE WAUKESHA WI 53188 X INPATIENT REHABILITATION WAUKESHA MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X X 16 1 1 0 1 X FULL WEBSITE LISTED IN PART V SECTION C X X 1 16 1 SEE PART V, SECTION B, LINE 7D DISCLOSURE 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX X WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX X WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX X X X X X X X 1 X 0 X X X X 1 X 0 0 REHABILITATION HOSPITAL OF WISCONSIN LLC 2 0 0 0 0 1 X 150.000000000000 250.000000000000 X X X 1 1 X X X 1 X X X 1 X 0 X X X X 1 X 0 0 WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 3j: TO ACCURATELY ASSESS THE HEALTH NEEDS OF OUR COMMUNITY, PROHEALTH CARE COMPILED DATA AND INFORMATION FROM A VARIETY OF SOURCES. OUR RESEARCH INCLUDED INFORMATION FROM EXPERTS AND COMMUNITY MEMBERS, INCLUDING PEOPLE WHOS PERSPECTIVES ARE OFTEN UNDER-REPRESENTED.-COMMUNITY HEALTH SURVEY: A TELEPHONE-BASED SURVEY OF 400 CONSUMERS COMMISSIONED BY THE MILWAUKEE HEALTH CARE PARTNERSHIP (WWW.MKEHCP.ORG), OF WHICH PROHEALTH CARE IS A MEMBER. THE FULL REPORT OF THIS SURVEY CAN BE FOUND AT PROHEALTHCARE.ORG-IN-PERSON INTERVIEWS WITH COMMUNITY LEADERS: MORE THAN 50 INTERVIEWS WERE CONDUCTED WITH LEADERS OF VARIOUS NON-PROFIT ORGANIZATIONS, SCHOOLS, CIVIC AND BUSINESS LEADERS -COMMUNITY FEEDBACK: TWO INTERACTIVE FEEDBACK SESSIONS WITH HOSPITAL ADVOCATES (COMMUNITY MEMBERS) WERE CONDUCTED. THE ADVOCATES REVIEWED PERTINENT DATA AND 'VOTED' ON THEIR TOP CONCERNS FOR OUR COMMUNITY.-COMPILATION OF "SECONDARY DATA" USING A VARIETY OF SOURCES, INFORMATION WAS GATHERED, INCLUDING:-HEALTH STATISTICS SUCH AS LEADING CAUSES OF ILLNESS, DEATH AND DISABILITY-SAFETY STATISTICS SUCH AS CRIME RATES -SOCIO-ECONOMIC INDICATORS SUCH AS AVERAGE INCOMES, EDUCATION LEVELS, EMPLOYMENT RATES AND HOUSING WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 5: SEE PART V, SECTION B, LINE 3J DISCLOSURESUMMARY DATA AND A REVIEW OF MAJOR ISSUES WAS PRESENTED TO THE HOSPITAL ADVOCATES COMMITTEE. EACH COMMITTEE MEMBER PROVIDED FEEDBACK VIA A 'VOTING' METHODOLOGY. THIS FEEDBACK, ALONG WITH THE DATA FROM THE CONSUMER TELEPHONE SURVEY AND KEY INFORMANT INTERVIEWS SERVED AS ADVISORY RECOMMENDATIONS WHEN OUR PROHEALTH COMMUNITY BENEFIT COMMITTEE MADE THEIR PRIORITY DECISIONS USING IDENTIFIED CRITERIA IN A TWO-STEP NARROWING PROCESS. OUR NINE MEMBER COMMUNITY BENEFIT COMMITTEE IS A BOARD-LEVEL GROUP OF GOVERNMENTAL, COMMUNITY AND BUSINESS LEADERS IN OUR SERVICE AREA AND ARE RESPONSIBLE FOR OVERSIGHT OF OUR CHNA. WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 6a: OCONOMOWOC MEMORIAL HOSPITAL AND REHABILITATION HOSPITAL OF WISCONSIN LLC WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 7d: THE CHNA, WHICH INCLUDES THE IMPLEMENTATION STRATEGY, IS AVAILABLE AT WWW.PROHEALTHCARE.ORG/ABOUT-US-COMMUNITY-BENEFIT.ASPX AND TO COMMUNITY MEMBERS UPON REQUEST. WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 11: WE HAVE A COMPREHENSIVE IMPLEMENTATION/ACTION PLAN FOR EACH OF THE DEFINED PRIORITY AREAS. PROGRESS AND OUTCOMES FOR INDIVIDUAL TACTICS WITHIN THAT PLAN ARE MONITORED AND PRESENTED TO THE COMMUNITY BENEFIT COMMITTEE ON A QUARTERLY BASIS. WE FOUND THAT MANY NEEDS INTERSECTED WITH OTHER IDENTIFIED PRIORITIES (FOR EXAMPLE NEEDS OF THE ELDERLY, CHRONIC CONDITIONS AND THE LACK OF PHYSICAL ACTIVITY) AND AIMED TO DEVELOP STRATEGIES THAT ADDRESSED MULTIPLE ISSUES. NEEDS THAT WERE FOUND TO BE SIGNIFICANT BUT ARE NOT SPECIFICALLY ADDRESSED IN OUR CHNA PLAN ARE AT LEAST PARTIALLY ADDRESSED IN OUR ONGOING ACTIVITIES (E.G. ACCESS IS ADDRESS VIA OUR PARTNERSHIP/SUPPORT OF OUR LOCAL FQHC) OR ARE BEING ADDRESSED COLLABORATIVELY WITH COUNTY-WIDE INITIATIVES FOR WHICH WE ARE STRONG PARTNERS AND CONTRIBUTORS (E.G. WAUKESHA COUNTY CHIPP AND THRIVING WAUKESHA COUNTY). SEE PART VI LINE 2 FOR FURTHER DISCUSSION OF THE PRIORITY NEEDS IDENTIFIED. WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 13b: The hospital provides charity care or reduced cost care for a variety of patients in need. Some of these patients in need may technically have income in excess of minimum federal poverty guidelines. For additional details on the criteria used by the hospital facility to determine eligibility, please refer to the Financial Assistance Policy available on the hospital's website at: www.prohealthcare.org/patient-guest-services-billing-and-insurance.aspx REHABILITATION HOSPITAL OF WISCONSIN LLC Part V, Section B, Line 13b: The hospital provides charity care or reduced cost care for a variety of patients in need. Some of these patients in need may technically have income in excess of minimum federal poverty guidelines. For additional details on the criteria used by the hospital facility to determine eligibility, please refer to the Financial Assistance Policy available on the hospital's website at: www.prohealthcare.org/patient-guest-services-billing-and-insurance.aspx WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 13h: THE FACILITY ALSO CONSIDERS THE FOLLOWING IN THE FINANCIAL ASSISTANCE POLICY: SIZE OF THE PATIENT'S FAMILY WILL BE DETERMINED BY THE NUMBER OF DEPENDENTS CLAIMED ON THE APPLICANT'S TAX RETURNS OR IDENTIFIED AS PART OF THE HOUSEHOLD, HOUSEHOLD INCOME WILL INCLUDE ALL INCOME FROM ANY SOURCE INCLUDING WAGES AND SALARIES AND OTHER SOURCES OF INCOME INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING:-ALL PENSIONS FROM STATE, FEDERAL OR PRIVATE SOURCES-INCOME FROM ANNUITIES, IRAS, TSAS, 401(K)S-STOCKS, OR BONDS-VETERANS BENEFITS-SOCIAL SECURITY PAYMENTS-REGULARLY RECEIVED INSURANCE CHECKS SUCH AS UNEMPLOYMENT BENEFITS AND WORKMAN'S COMPENSATION-ALIMONY/CHILD SUPPORT-RETURNS ON INVESTMENTS/NET RENTS AND NET PROFITS FROM BUSINESS WAUKESHA MEMORIAL HOSPITAL, INC Part V, Section B, Line 16j: REFERENCE TO THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE BACK OF ALL PATIENT STATEMENTS. ALSO THROUGH CUSTOMER RELATIONS VERBAL REMINDER OF THE FINANCIAL ASSISTANCE POLICY ARE PROVIDED WHEN DISCUSSING OPEN BALANCES. REHABILITATION HOSPITAL OF WISCONSIN LLC Part V, Section B, Line 16j: Notified patients of financial assistance policy and offered application if patient or family member expressed financial hardship. PART V, SECTION B, LINE 22: PURSUANT TO PROHEALTH CARE, INC.'S FINANCIAL ASSISTANCE POLICY, WAUKESHA MEMORIAL HOSPITAL, INC. AND REHABILITATION HOSPITAL OF WISCONSIN, LLC USE THE LOOK-BACK METHOD TO CALCULATE AMOUNTS GENERALLY BILLED TO SELF-PAY PATIENTS. AMOUNTS GENERALLY BILLED TO SELF-PAY PATIENTS CONSIST OF GROSS CHARGES LESS A DISCOUNT (UNINSURED DISCOUNT). THIS UNINSURED DISCOUNT IS EQUIVALENT TO THE DISCOUNT PROVIDED BY THE THREE LARGEST PRIVATE HEALTH INSURERS OVER THE LAST YEAR AND IS APPLIED TO GROSS CHARGES FOR UNINSURED PATIENTS WHO REQUIRE EMERGENT OR MEDICALLY NECESSARY SERVICES. 3 1 - REHAB HOSPITAL OF WI OUTPATIENT CLINIC 1625 COLDWATER CREEK DRIVE WAUKESHA WI 53188 OUTPATIENT REHABILATION CLINIC 2 - PROHEALTH ALIGNED LLC 1111 DELAFIELD ST SUITE 100 WAUKESHA WI 53188 AMBULATORY SURGERY CENTER 3 - THE ORTHOPEDIC SURGERY CENTER LLC W238 N 1610 BUSSE ROAD SUITE 100 WAUKESHA WI 53188 ORTHOPEDIC SURGERY CENTER Part I, Line 6a: A COMMUNITY BENEFIT REPORT IS COMPLETED BY PROHEALTH CARE, INC. (EIN 39-1486873), THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. Part I, Line 7: THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE AMOUNTS ON LINES 7A-7D. THIS WAS CALCULATED BY USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE HOSPITAL'S FINANCIAL COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS ON LINES 7E-7I Part I, Ln 7 Col(f): $10,604,328 OF BAD DEBT EXPENSES FROM WAUKESHA MEMORIAL HOSPITAL, INC. WAS INCLUDED ON FORM 990, PART, IX, LINE 25. ADDITIONALLY, THERE WAS BAD DEBT EXPENSE OF $195,796 RELATED TO REHABILITATION HOSPITAL OF WISCONSIN, LLC. BOTH AMOUNTS WERE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE. Part II, Community Building Activities: WAUKESHA MEMORIAL HOSPITAL HAS FOSTERED A WIDE VARIETY OF PARTNERSHIPS WITH NUMEROUS AGENCIES AND INITIATIVES THAT BENEFIT OUR ENTIRE COMMUNITY BEYOND THOSE THAT ARE DIRECTLY ASSOCIATED WITH HEALTH. OUR EFFORTS TO HELP BUILD A SAFE AND VIBRANT COMMUNITY ARE IN SOME WAYS, JUST AS IMPORTANT AS OUR TREMENDOUS EFFORTS TO IMPROVE COMMUNITY HEALTH. WE BELIEVE COMMUNITY BUILDING IS ABOUT NEIGHBORHOODS AND ONE EXAMPLE OF THAT IS OUR SUPPORT OF LOCAL NEIGHBORHOOD GROUPS THAT ADDRESS SAFETY, PROPERTY APPEARANCE AND CONNECTIVITY OF RESIDENTS. WE PROVIDE FUNDING FOR BEAUTIFICATION AND THE CLEANUP OF COMMON PROPERTIES AND STREETS, AS WELL AS THE LAND, EXPERTISE AND RESOURCES FOR COMMUNITY RAIN AND CROP GARDENS. AS PART OF OUR LEADERSHIP VOLUNTEERISM PROGRAM, WE PROVIDE ASSISTANCE AT LOCAL LIBRARIES AND LITERACY PROGRAMS, AND HAVE A STRONG PRESENCE FOR NEIGHBORHOOD SAFETY INITIATIVES. INVOLVEMENT WITH YOUTH IS A YEAR-ROUND FOCUS AS WE ASSEMBLE AND DISTRIBUTE BACK-PACKS TO LOW INCOME CHILDREN, MAKING SURE THEIR SCHOOL YEAR GETS OFF TO A GOOD START AND WE VOLUNTEER AT LOCAL HIGH SCHOOLS FOR HEALTH CAREER AWARENESS AND "SAFE PROM/GRADUATION" EVENTS. WE ARE THE MAJOR SPONSOR OF "LEADERSHIP WAUKESHA", A PROGRAM THAT FOCUSES ON THE DEVELOPMENT OF EMERGING LEADERS IN OUR COUNTY. WE SUPPORT HOMELESS SHELTERS, ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION/CONTINUUM OF CARE AND THE COUNTY'S HISPANIC COLLABORATIVE NETWORK. WE ARE TREMENDOUSLY PROUD OF OUR WORK WITH EASTER SEALS AND THE WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT, SERVING AS WAUKESHA COUNTY'S ONLY SITE FOR PROJECT SEARCH, A WORKFORCE TRAINING PROGRAM FOR DEVELOPMENTALLY/PHYSICALLY DISABLED INDIVIDUALS. Part III, Line 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON PART III LINE 2 IS THE BAD DEBT EXPENSE REPORTED ON FORM 990 PART IX FOR WAUKESHA MEMORIAL HOSPITAL PLUS ITS SHARE OF THE BAD DEBT EXPENSE OF REHABILITATION HOSPITAL OF WISCONSIN LLC. Part III, Line 3: THE BAD DEBT COST WAS REVIEWED BY THE HOSPITAL'S REVENUE CYCLE TEAM AND THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE QUALIFIED UNDER OUR FINANCIAL ASSISTANCE PROGRAM IS 30% OF TOTAL BAD DEBTS. Part III, Line 4: BAD DEBT EXPENSE FOOTNOTE FOR WAUKESHA MEMORIAL HOSPITAL, INC: ACCOUNTS RECEIVABLE FROM PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ARE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. NET ACCOUNTS RECEIVABLE IS BASED ON EXPECTED PAYMENT RATE FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES.FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. 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 CORPORATION 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 DIFFERNECE 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 IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.BAD DEBT EXPENSE FOOTNOTE FOR REHABILITATION HOSPITAL OF WISCONSIN LLC:ACCOUNTS RECEIVABLE PRIMARILY CONSIST OF AMOUNTS DUE FROM THIRD-PARTY PAYORS AND PATIENTS. THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING RECEIVABLES IS CRITICAL TO ITS RESULTS OF OPERATIONS AND CASH FLOWS. TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THE PRIMARY UNCERTAINTY OF SUCH ALLOWANCES LIES WITH UNINSURED PATIENT RECEIVABLES AND DEDUCTIBLES, CO-PAYMENTS OR OTHER AMOUNTS DUE FROM INDIVIDUAL PATIENTS. THE HOSPITAL'S POLICY TO RECORD AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON A PERCENTAGE OF NET RECEIVABLES BY AGE OF BALANCE AFTER DISCHARGE DATE.THE HOSPITAL HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE HOSPITAL UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE, REVENUE TRENDS BY PAYOR CLASSIFICATION AND REVENUE DAYS IN ACCOUNTS RECEIVABLE. INDIVIDUAL PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES.BAD DEBT EXPENSE IS RECORDED FOR FINANCIAL STATEMENT PURPOSES BASED ON UNCOLLECTED REVENUE, BUT THE RELATED COST COULD BE DETERMINED BY APPLYING COST TO CHARGE RATIOS FROM THE MEDICARE COST REPORT. DISCOUNTS ARE RECORDED TO AN APPROPRIATE CONTRA REVENUE ACCOUNT INCLUDING CHARITY CARE WHEN APPLICABLE; PAYMENTS RECEIVED AFTER AN ACCOUNT HAS BEEN WRITTEN OFF WOULD DECREASE BAD DEBT EXPENSE. MOST OF THE PATIENTS FOR WHICH BAD DEBT EXPENSE IS RECORDED WOULD PROBABLY QUALIFY FOR SOME LEVEL OF FINANCIAL ASSISTANCE ACCORDING TO HOSPITAL POLICIES, BUT MANY CHOOSE NOT TO COMPLETE THE NECESSARY FINANCIAL ASSISTANCE APPLICATION SO THAT THIS CAN BE PROPERLY DETERMINED. Part III, Line 8: THE SHORTFALL ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO AS REPORTED ON THE MEDICARE COST REPORT. Part III, Line 9b: PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE WILL HAVE A CHARITY DISCOUNT APPLIED TO THEIR BALANCES AT THE TIME OF BILLING. IF THIS RESULTS IN NO BALANCE DUE FORM THE PATIENT, THEN THE PATIENT WILL NOT RECEIVE A STATEMENT. IF A BALANCE REMAINS AFTER THE DISCOUNT PERCENTAGE IS APPLIED, THE PATIENT WILL RECEIVE A STATEMENT FOR THE BALANCE DUE. THE STATEMENT CYCLE IS CONSISTENT FOR ALL PATIENTS. Part VI, Line 2: COMMUNITY NEEDS ARE IDENTIFIED BASED UPON A REVIEW OF STATE, COUNTY AND COMMUNITY HEALTH DATA AND ASSESSMENTS. THIS INCLUDES SUCH DOCUMENTS AS: THE STATE HEALTH PLAN, THE COUNTY HEALTH REPORT CARD, THE WAUKESHA COMMUNITY HEALTH SURVEY, THE HEALTHY PEOPLE 2020 PLAN AND VARIOUS OTHER ASSESSMENTS, SUCH AS THE YOUTH BEHAVIORAL RISK SURVEYS, UNITED WAY/UNIVERSITY OF WISCONSIN SURVEY OF WAUKESHA COUNTY. WE ANALYZE THE DATA, IDENTIFY THE PRESSING NEEDS, AND PROACTIVELY PLAN AND IMPLEMENT COMMUNITY BENEFIT INITIATIVES TO ADDRESS THESE NEEDS. ADDITIONALLY, WE HAVE ACTIVELY PARTNERED WITH OUR COUNTY HEALTH DEPARTMENT IN THEIR COMMUNITY HEALTH IMPROVEMENT PLAN AND PROCESS (CHIPP) ASSESSMENT AND SPEARHEADED A NUMBER OF COUNTY-WIDE IMPLEMENTATION STRATEGIES. THE MOST RECENT NEEDS ASSESSMENT WAS COMPLETED IN MAY 2016 AND THE IMPLEMENTATION PLAN WAS ADOPTED IN JUNE 2016. WE ALSO SHARE IN PARTNERSHIP WITH THE CHNA IMPLEMENTATION PLANS FOR THE REHABILITATION HOSPITAL OF WISCONSIN. THROUGH DATA ANALYSIS AND COMMUNITY DISCUSSION, WE SAW A NUMBER OF OVER-ARCHING THEMES THAT PROMPTED US TO CHOOSE THE FOLLOWING PRIORITY AREAS:PRIORITY AREA:NEEDS OF THE ELDERLYCORRELATED COMMUNITY HEALTH NEED: -MENTAL HEALTH ISSUES INCLUDING DEPRESSION, DEMENTIA AND ALZHEIMER'S DISEASE-AODA ISSUES (ALCOHOL AND OTHER DRUGS) ADVERSE EFFECTS FROM POLYPHARMACY-PREVALENCE OF CHRONIC CONDITIONS-ACCIDENTAL INJURY-SOCIAL VULNERABILITY AND ISOLATION-OBESITY-ACCESS: SCARCITY OF PROVIDERS SPECIALIZING IN GERONTOLOGYPRIORITY AREA: ALCOHOL AND OTHER DRUGSCORRELATED COMMUNITY HEALTH NEED:-BINGE DRINKING-PRESCRIPTION DRUG OVERDOSE/MISUSE-HEROIN AND OPIOID DEATHS/HOSPITALIZATIONS-ACCESS: SCARCITY OF PROVIDERSPRIORITY AREA:MENTAL HEALTHCORRELATED COMMUNITY HEALTH NEED:-SUICIDE RATE-ALZHEIMER'S DISEASE-DEPRESSION-ACCESS: SCARCITY OF PROVIDERSPRIORITY AREA:CHRONIC DISEASECORRELATED COMMUNITY HEALTH NEED: -CARDIOVASCULAR DISEASE-CANCER-DIABETES-OBESITY-ALZHEIMER'S DISEASE-OTHERSFOR MORE INFORMATION, PLEASE GO TO HTTP://WWW.PROHEALTHCARE.ORG/ABOUT-US-COMMUNITY-BENEFIT.ASPX Part VI, Line 3: EVERY PATIENT WITH A SELF PAY BALANCE RECEIVES A STATEMENT WHICH CONVEYS THE AVAILABILITY OF COMMUNITY (CHARITY) CARE AND A CONTACT NUMBER FOR FURTHER INFORMATION. PATIENTS THAT ARE UNINSURED RECEIVE AN UNINSURED DISCOUNT WHICH IS LISTED ON THE FIRST STATEMENT THAT THEY RECEIVE. PATIENTS RECEIVE A TOTAL OF FOUR STATEMENTS. EACH STATEMENT CONTAINS VERBIAGE REFERENCING THE HOSPITAL'S COMMUNITY CARE PROGRAM AND A CONTACT NUMBER FOR FURTHER INFORMATION. IF SOMEONE HAS BEEN FOUND ELIGIBLE FOR SOME LEVEL OF CHARITY CARE, THE ELIGIBILITY PERIOD IS THREE MONTHS SO ANY SUBSEQUENT ACCOUNTS DURING THAT TIMEFRAME WOULD BE DISCOUNTED AT WHATEVER LEVEL OF CHARITY CARE THE PATIENT IS DEEMED ELIGIBLE. PATIENTS MAY REAPPLY FOR COMMUNITY CARE WHEN THEIR ELIGIBILITY PERIOD HAS EXPIRED. SELF PAY PATIENTS MAY ALSO BE INFORMED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM WHILE THEY ARE INPATIENTS. SOCIAL WORK AND/OR THE BUSINESS OFFICE MAY MAKE CONTACT WITH THESE PATIENTS DURING THEIR STAY TO INFORM THEM OF THE COMMUNITY CARE PROGRAM AND ASSIST THEM WITH COMPLETION OF THE APPLICATION.INFORMATION IS AVAILABLE AT REGISTRATION AREAS RELATED TO OUR COMMUNITY CARE PROGRAM. THIS INFORMATION CONTAINS CONTACT INFORMATION FOR THE HOSPITAL'S CENTRAL BUSINESS OFFICE WHERE PATIENTS CAN RECEIVE ASSISTANCE IN OBTAINING AND COMPLETING APPLICATIONS. Part VI, Line 4: PROHEALTH CARE SERVES ABOUT 285,000 PEOPLE EACH YEAR IN WAUKESHA COUNTY AND PORTIONS OF SURROUNDING COUNTIES. IN EVERY FEDERAL POPULATION CENSUS, WAUKESHA COUNTY HAS RECORDED AN INCREASE IN POPULATION. SINCE 1950, THE POPULATION GREW FROM 85,901 TO OVER 390,000. WAUKESHA COUNTY HAS AN AGING POPULATION WITH 15.9% OVER THE AGE OF 65 AND A MEDIAN AGE OF 43.1 YEARS WHICH FAR SURPASSES STATE AVERAGES AND IS THE HIGHEST MEDIAN AGE OF PEER COUNTIES. THE RATE OF RETIREMENT IS LIKELY TO SURPASS THE RATE OF ENTRY INTO THE WORKFORCE BETWEEN 2015 AND 2020. THE RACIAL MAKEUP OF THE WAUKESHA COUNTY COMMUNITY IS AS FOLLOWS: WHITE 93.9%, HISPANIC OR LATINO 4.5%, ASIAN 3.1%, BLACK 1.4%. MEDIAN HOUSEHOLD INCOME IS $75,850, WITH 5.8% OF PEOPLE LIVING BELOW THE POVERTY LEVEL. THE LARGEST POCKET OF THOSE LIVING IN POVERTY IS IN THE URBAN ENVIRONMENT OF THE CITY OF WAUKESHA WITH A RATE OF 11.70%. UNEMPLOYMENT IN WAUKESHA COUNTY STOOD AT 3.1% IN OCTOBER, 2015. WAUKESHA COUNTY IS LARGE (580 SQUARE MILES) AND DIVERSE, INCLUDING URBAN, SUBURBAN AND RURAL AREAS. THE PRESENCE OF SOME HIGH INCOME COMMUNITIES IN WAUKESHA COUNTY OFTEN GIVES A MISTAKEN IMPRESSION OF OVERALL WEALTH. OFTEN OVERLOOKED IS A GROWING POPULATION OF LOW INCOME, NON-ENGLISH SPEAKING, VULNERABLE AND MARGINALIZED CITIZENS WHO FACE ENORMOUS ODDS IN ACCESSING HEALTH CARE. THE WAUKESHA COUNTY MEDICAID POPULATION HAS NEARLY TRIPLED IN 10 YEARS, AND NOW REPRESENTS 8.33% OF THE POPULATION. BETWEEN 2000 AND 2010, THE LATINO/A POPULATION IN WAUKESHA COUNTY GREW BY 6,620 RESIDENTS. DOWNTOWN WAUKESHA WAS DECLARED A "MEDICALLY UNDERSERVED" AREA AND A "HEALTH-PROFESSIONAL SHORTAGE AREA" BY THE FEDERAL GOVERNMENT IN 2008. AS AN UNDERSERVED AREA, MEDICAL OPTIONS FOR INDIVIDUALS, PARTICULARLY THOSE WITHOUT HEALTH INSURANCE OR WITH PUBLIC INSURANCE, ARE SEVERELY LIMITED BECAUSE PRIVATE SERVICE PROVIDERS OFTEN REFUSE TO CARE FOR THESE INDIVIDUALS. CONSEQUENTLY, PROHEALTH CARE EMBARKED ON A FUND-RAISING INITIATIVE TO SUPPORT THE FORMATION OF AN FEDERALLY QUALIFIED HEALTH CENTER (FQHC) IN DOWNTOWN WAUKESHA. THAT HEALTH CENTER OPENED IN LATE 2012 AND IS FINANCIALLY SUPPORTED BY PROHEALTH CARE. Part VI, Line 5: WAUKESHA MEMORIAL HOSPITAL IS GOVERNED BY A COMMUNITY BOARD. WE ARE PROUD OF THE NUMEROUS AND STRONG PARTNERSHIPS WE HAVE FORMED WITH A WIDE VARIETY OF NOT-FOR-PROFIT HEALTH AND HUMAN SERVICES AGENCIES AS WE WORK TOGETHER TO FORGE A STRONGER, HEALTHIER COMMUNITY. WE ARE ACTIVELY INVOLVED WITH PROGRAMMING, BOARD OVERSIGHT AND ONGOING FINANCIAL SUPPORT OF THE WAUKESHA COMMUNITY HEALTH CENTER, THE ONLY FEDERALLY-QUALIFIED HEALTH CENTER IN OUR AREA. WE ALSO PROVIDE FINANCIAL SUPPORT AS WELL AS IN-KIND SUPPORT TO TWO FREE CLINICS SERVING OUR AREA. WE WERE INSTRUMENTAL IN FORMING SEVERAL KEY AGENCIES DESIGNED TO MEET AN URGENT COMMUNITY NEED. FOR EXAMPLE, THROUGH OUR LEADERSHIP AND SUPPORT, THE WAUKESHA COUNTY COMMUNITY DENTAL CLINIC WAS FORMED AND WE HAVE PROVIDED ONGOING FINANCIAL SUPPORT AND PROVIDED CLINICAL AND OFFICE SPACE SO THIS AGENCY CAN CARRY OUT ITS MISSION. THE SAME IS TRUE FOR SAFE BABIES HEALTHY FAMILIES (PROVIDING SERVICES FOR AT RISK PREGNANT WOMEN AND THEIR CHILDREN) AND STILLWATERS CANCER SUPPORT SERVICES. WE PROVIDE SPACE AND CLINICAL EXPERTISE TO THE LOCAL 'MEALS ON WHEELS' PROGRAM, SERVING AT-RISK ELDERLY AND DISABLED INDIVIDUALS. SEVERAL OF OUR STAFF ARE ACTIVELY INVOLVED WITH THE HEALTH DEPARTMENT'S CHIPP AND SERVE ON A VARIETY OF COMMITTEES FOR THE AREA'S DEPARTMENT OF HEALTH AND HUMAN SERVICES. WE HOST COMMUNITY-WIDE HEALTH FAIRS OFFERING A WIDE VARIETY OF FREE SCREENINGS AND OFFER AN ONGOING AND IMPRESSIVE MENU OF FREE COMMUNITY EDUCATION CLASSES (INCLUDING EVIDENCE-BASED SELF-HELP WORKSHOPS). PROHEALTH CARE REACHES OUT INTO OUR COMMUNITY TO MEET THE NEEDS OF ITS RESIDENTS. FROM THE ALZHEIMER'S ASSOCIATION TO WAUKESHA DRUG FREE COMMUNITIES, AND DOZENS OF AGENCIES IN BETWEEN, PROHEALTH CARE IS THERE, PROVIDING VOLUNTEERS, FINANCIAL SUPPORT AND PARTNERSHIPS THAT HELP TO IMPROVE THE HEALTH OF OUR COMMUNITY. Part VI, Line 6: OUR HOSPITAL IS A MEMBER OF THE PROHEALTH CARE HEALTH SYSTEM WHICH SERVES AS OUR PARENT COMPANY. WHILE COMMUNITY BENEFIT RESPONSIBILITIES RESIDE WITH OUR HOSPITAL BOARD, THE PARENT COMPANY PLAYS A KEY ROLE IN COORDINATING COMMUNITY NEEDS ASSESSMENTS, COMMUNITY BENEFIT PROGRAM PLANNING, AND EVALUATION.A DESCRIPTION OF EACH AFFILIATES ROLE IN PROMOTING HEALTH WITHIN THE COMMUNITIES SERVED IS AS FOLLOWS:PROHEALTH CARE, INC. - HELPS TO MANAGE THE HOSPITALS TO ENSURE THEY CAN PROMOTE HEALTH AND WELLNESS WITHIN THE COMMUNITY.NATIONAL REGENCY OF NEW BERLIN, INC. - OWNS AND OPERATES SENIOR LIVING CENTERS AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.PROHEALTH HOME CARE, INC. - PROVIDES HOSPICE AND HOME HEALTH CARE SERVICES AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.PROHEALTH CARE FOUNDATION, INC. - SUPPORTS THE CHARITABLE MISSION OF WAUKESHA MEMORIAL HOSPITAL AND OCONOMOWOC MEMORIAL HOSPITAL SO THAT IT MAY PROVIDE HEALTH SERVICES WITHIN THE COMMUNITY.PROHEALTH CARE MEDICAL ASSOCIATES, INC. - PHCMA OPERATES VARIOUS CLINIC AND URGENT CARE LOCATIONS THROUGHOUT WAUKESHA COUNTY AND THE SURROUNDING COMMUNITIES. PHCMA FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PHCMA PROVIDED 430,607 CLINIC VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2017.OCONOMOWOC MEMORIAL HOSPITAL, INC. - PROVIDES CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. OCONOMOWOC MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. OCONOMOWOC MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 7,941 DAYS OF INPATIENT CARE AND APPROXIMATELY 69,244 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2017. Part VI, Line 7, Reports Filed With States WI 1 PROHEALTH CARE INC N17 W24100 RIVERWOOD DR STE 200 WAUKESHA WI 531881131 391486873 501(C)(3) 17400000 N/A N/A TO ASSIST PROHEALTH CARE, INC. IN ITS CHARITABLE MISSION. 1 0 Part I, Line 2: ALL GRANTS ARE APPROVED AND PROCESSED BY THE ORGANIZATION'S MANAGEMENT. X X X X 0 1 0 0 0 1 1 0 0 SUSAN EDWARDS PRESIDENT & CEO 0 878773 0 430890 0 0 0 805877 0 26191 0 2141731 0 0 RONALD FARR CHIEF FINANCIAL/ADMIN OFFICER 0 465048 0 178988 0 0 0 140273 0 41726 0 826035 0 0 JOHN ROBERTSTAD CHIEF COMMUNITY LIAISON 55258 424008 0 214892 0 0 1085 14998 4612 36571 60955 690469 0 0 KENNETH PRICE CHIEF OPERATING OFFICER 0 295861 0 115811 0 0 0 112089 0 33890 0 557651 0 0 KARIN KULTGEN VP MEDICAL AFFAIRS 281940 0 100506 0 0 0 10928 0 23690 0 417064 0 0 0 ERIC HENDEE CHIEF PHYSICIST 203620 0 7460 0 0 0 8577 0 32210 0 251867 0 0 0 MICHAEL E KOWALOK PHYSICIST 187382 0 5929 0 0 0 9684 0 10704 0 213699 0 0 0 JOHN MAY VP - AMBULATORY 254819 0 90086 0 0 0 12000 0 30037 0 386942 0 0 0 MARGARET M PFITZINGER VP CLINICAL OPERATIONS 168357 0 29851 0 0 0 6702 0 32126 0 237036 0 0 0 JULIET UGARTE HOPKINS PHYSICIAN ADVISOR 229140 0 29986 0 0 0 7213 0 33904 0 300243 0 0 0 Part I, Line 3 THIS ENTITY RELIED ON A RELATED ORGANIZATION THAT USED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR OFFICERS AND DIRECTORS: 1. COMPENSATION COMMITTEE 2. COMPENSATION STUDY 3. APPROVAL OF THE BOARD ANNUALLY APPROVING COMPENSATION AMOUNTS 4. INDEPENDENT COMPENSATION CONSULTANT Part I, Line 4b PROHEALTH CARE INC. (PHC) MAINTAINS TWO SUPPLEMENTAL RETIREMENT PLANS (SERPS) FOR A SELECT GROUP OF EXECUTIVES OF PHC AND ITS AFFILIATED ENTITIES. THESE SERPS ARE UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION PLANS THAT ARE INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THESE SERPS ARE TAXABLE TO THE PARTICIPATING EXECUTIVES WHEN SUCH AMOUNTS ARE VESTED. Part I, Line 6 PROHEALTH CARE HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION AND RELATED ORGANIZATIONS (COLLECTIVELY THE "SYSTEM"). THE PLAN RELATES FINANCIAL REWARD TO THE SYSTEM'S ACHIEVEMENT OF CERTAIN FINANCIAL AND NON-FINANCIAL OBJECTIVES. THE PRIMARY PURPOSE OF THE PLAN IS TO SUPPORT THE SYSTEM'S MISSION TO ACHIEVE CONTINUED GROWTH AND DEMONSTRATE VALUE THROUGH: (1) A SEAMLESS CONTINUUM OF PATIENT CENTERED CARE; (2) NATIONALLY RECOGNIZED OUTCOMES; (3) RESPONSIBLE AND EFFICIENT USE OF HEALTH CARE RESOURCES; AND (4) A FOCUS ON THE HEALTH OF OUR COMMUNITY. A WISCONSIN HEALTH & EDUCATIONAL FACILITIES 391337855 97710BB50 2011-02-16 32039358 CURRENT REFUND BONDS ISSUED 11/14/95 & CURRENT REFUND BONDS ISSUED 5/13/99. 0 0 0 A 26634580 32039358 597186 31442172 2001 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 A 0 PART I, A - COL. C THE CUSIP # OF 97710BB50 ON FORM 8038 WAS NOT THE NUMBER ON THE BOND OF THE LATEST MATURITY. THE NUMBER FOR THE LATEST MATURITY IS CORRECTLY REPORTED ON SCHEDULE K. PART I, A - COL. E THE TOTAL ISSUE PRICE ON FORM 8038 IS $35,678,572.65. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. PART II, A - LINE 3 SALE PROCEEDS OF ISSUE IN AMOUNT OF $32,039,358 PLUS ZERO INVESTMENT PROCEEDS. PART II, A - LINE 6 PROCEEDS IN THE AMOUNT OF $31,442,172.63 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 2/16/11; BALANCE ON 9/30/17 IS ZERO. PART II, A - LINE 13 YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 11/14/95 WAS 1995 AND YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 5/13/99 WAS 2001. Form 990, Part VI, Section A, line 6 PROHEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER. Form 990, Part VI, Section A, line 7a ACCORDING TO THE GOVERNING DOCUMENTS, THE BOARD OF THE FILING ORGANIZATION IS THE SAME AS THE BOARD OF THE SOLE CORPORATE MEMBER, PROHEALTH CARE, INC. Form 990, Part VI, Section A, line 7b PROHEALTH CARE, INC. HOLDS CERTAIN RESERVED POWERS OVER THE (NON-STOCK) CORPORATION, INCLUDING APPROVAL OF STRATEGIC PLANNING, ANNUAL OPERATING AND CAPITAL BUDGETS, BORROWING, TRANSFER, LEASE, PLEDGE OR SALE OF ASSETS. Form 990, Part VI, Section B, line 11b AFTER THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S TAX PREPARERS AND PRIOR TO FILING THE FORM 990, SELECT EXECUTIVE MEMBERS OF THE ORGANIZATION AND THE AUDIT & COMPLIANCE COMMITTEE PERFORMED A REVIEW. THEN THE ORGANIZATION'S TAX PREPARERS MADE A PRESENTATION TO THE AUDIT COMMITTEE, WHO THEN FORMALLY APPROVED THE FORM 990, AND THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THE RETURN, WHICH WAS SUBSEQUENTLY FILED BY THE ORGANIZATION. Form 990, Part VI, Section B, line 12c ALL OFFICERS, VICE-PRESIDENTS, MANAGERS AND ABOVE, AS WELL AS BOARD MEMBERS ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE TRACKED IN THE CORPORATE COMPLIANCE DEPARTMENT. THEY ARE REVIEWED AND ANY PERSON IDENTIFIED AS HAVING A POTENTIAL CONFLICT OF INTEREST IS GIVEN DIRECTION AS TO WHAT STEPS SHOULD BE TAKEN TO MITIGATE THE CONCERN. ALL EMPLOYEES ARE EDUCATED ANNUALLY. THE STEPS TAKEN WHEN A CONFLICT ARISES ARE AS FOLLOWS: FOR THE BOARD OF DIRECTORS, THE RESTRICTION IS NOT BEING ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTING RELATED TO ANY DECISION WHERE THE BOARD MEMBER HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST. FOR LEADERS, RESEARCHERS, AND EMPLOYEES, RECOMMENDATIONS ARE MADE FROM COMPLIANCE MANAGER TO LEADERSHIP AND/OR HUMAN RESOURCES. RESTRICTIONS CAN RANGE FROM ANY OF THE FOLLOWING: DISCLOSING POTENTIAL CONFLICTS OF INTEREST TO PATIENTS; NOT BEING ABLE TO BE INVOLVED IN DISCUSSION OR DECISION MAKING ON SPECIFIC TOPICS; AND NOT BEING ABLE TO WORK AT PROHEALTH IN THE SPECIFIC ROLE WHERE THE REPORTED CONFLICT EXISTS. IF THE RECOMMENDATION IS CHALLENGED, THE MATTER GOES TO THE SENIOR EXECUTIVE TEAM FOR A DECISION. Form 990, Part VI, Section B, line 15 AN INDEPENDENT, EXTERNAL COMPENSATION REVIEW IS CONDUCTED FOR THE POSITIONS OF CEO/PRESIDENT, EXECUTIVE DIRECTOR, VICE-PRESIDENT, SENIOR VICE-PRESIDENT AND ABOVE. THE RESULTS OF THE COMPENSATION REVIEW ARE PRESENTED TO THE BOARD'S EXECUTIVE COMMITTEE FOR APPROVAL. ANY MEMBER OF THE EXECUTIVE COMMITTEE WHOSE SALARY IS INCLUDED IN THE SALARY REVIEW IS RECUSED FROM THE APPROVAL PROCESS FOR HIS/HER SALARY APPROVAL. THIS PROCESS WAS LAST DONE IN 2017. Form 990, Part VI, Section C, line 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: THE PROCESS IS TO HAVE ALL JOINT VENTURE ARRANGEMENTS REVIEWED BY THE LEGAL DEPARTMENT TO ENSURE IT MEETS ALL LEGAL REQUIREMENTS AND TO ENSURE THAT WAUKESHA MEMORIAL HOSPITAL, INC. MAY RETAIN ITS EXEMPT STATUS. Form 990, Part IX, line 11g PHYSICIAN FEES: Program service expenses 4,565,213. Management and general expenses 143,803. Fundraising expenses 0. Total expenses 4,709,016. PHMG PHYSICIAN SUBSIDY: Program service expenses 12,220,940. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,220,940. LINEN SERVICES: Program service expenses 1,590,798. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,590,798. OUTSIDE SERVICES: Program service expenses 7,421,369. Management and general expenses 991,125. Fundraising expenses 0. Total expenses 8,412,494. PHC SERVICES: Program service expenses 83,700,641. Management and general expenses 6,925,469. Fundraising expenses 0. Total expenses 90,626,110. MAINTENANCE CONTRACTS: Program service expenses 12,283,194. Management and general expenses 0. Fundraising expenses 0. Total expenses 12,283,194. OUTSIDE PATIENT SERVICES: Program service expenses 671,478. Management and general expenses 0. Fundraising expenses 0. Total expenses 671,478. OUTSIDE SERVICES STRATEGIC: Program service expenses 369. Management and general expenses 0. Fundraising expenses 0. Total expenses 369. Form 990, Part XI, line 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 7,163,387. CHANGE IN MINIMUM PENSION LIABILITY 4,470,983. INVESTMENT FUNDING TO RELATED ORGANIZATIONS -8,286,915. EQUITY TRANSFER FROM RELATED ORGANIZATIONS 520,000. OTHER CHANGES 71,797. TRANSFER TO PHC-PARENT -26,225,000. FORM 990, PART XII, LINE 2C THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OCONOMOWOC MEMORIAL HOSPITAL INC 791 SUMMIT AVENUE OCONOMOWOC WI 53066 390794174 HOSPITAL WI 501(c)(3) Line 3 PROHEALTH CARE INC 1 PROHEALTH CARE FOUNDATION INC 725 AMERICAN AVENUE WAUKESHA WI 53188 391314542 CHARITABLE SUPPORT WI 501(c)(3) Line 7 PROHEALTH CARE INC 1 PROHEALTH HOME CARE INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 200067392 HEALTHCARE WI 501(c)(3) Line 3 PROHEALTH CARE INC 1 NATIONAL REGENCY OF NEW BERLIN INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 391077992 HEALTHCARE WI 501(c)(3) Line 10 PROHEALTH CARE INC 1 PROHEALTH CARE INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 391486873 MANAGEMENT WI 501(c)(3) Line 12b, II N/A 0 PROHEALTH CARE MEDICAL ASSOCIATES INC n17 W24100 RIVERWOOD DR SUITE 200 wAUKESHA WI 53188 391083015 HEALTHCARE WI 501(c)(3) Line 3 PROHEALTH CARE INC 1 PROHEALTH ALIGNED LLC (DBA PROHEALTH CARE MORELAND SURGERY CENTER) 1111 DELAFIELD STREET STE 100 WAUKESHA WI 53188 263324572 SURGERY CENTER WI WAUKESHA MEMORIAL HOSPITAL INC RELATED 1374148 3518840 0 1 0.50000 REHABILITATION HOSPITAL OF WISCONSIN LLC 1625 COLDWATER CREEK DRIVE WAUKESHA WI 53188 262332250 INPATIENT REHABILITATION WI WAUKESHA MEMORIAL HOSPITAL INC RELATED 2556978 3899718 0 1 0.49000 THE ORTHOPEDIC SURGERY CENTER LLC W238 N1610 BUSSE ROAD WAUKESHA WI 53188 208356016 ORTHOPEDIC SURGICAL SERVICES WI WAUKESHA MEMORIAL HOSPITAL INC RELATED 1113992 1721853 0 1 0.49000 PROHEALTH SOLUTIONS LLC 2000 PEWAUKEE RD SUITE C WAUKESHA WI 53188 273863494 ACCOUNTABLE CARE ORGANIZATION WI N/A LAKE COUNTRY ENDOSCOPY CENTER 1185 CORPORATE CENTER DR OCONOMOWOC WI 53066 261572986 ENDOSCOPY SERVICES WI N/A WAUKESHA IMAGING LLC N17 W24100 RIVERWOOD DR STE 200 WAUKESHA WI 53188 392036860 RADIOLOGY SERVICES WI N/A PHCOAW CO-MANAGEMENT COMPANY LLC N17 W24100 RIVERWOOD DR STE 200 WAUKESHA WI 53188 811823911 MANAGEMENT SERVICES WI N/A GI SPECIALISTS LLC (DBA Moreland Endoscopy Center) 1111 DELAFIELD STREET WAUKESHA WI 53188 205269133 GI SERVICES WI N/A WAUKESHA HEALTH SYSTEM INC N17 W24100 RIVERWOOD DRIVE SUITE 20 WAUKESHA WI 53188 391507910 HEALTHCARE WI N/A C 0 EMPATHIA PACIFIC INC 31416 AGOURA RD STE 180 WESTLAKE VILLAGE CA 91361 953070501 HEALTHCARE CA N/A C 0 NATIONAL AVENUE DEVELOPMENT CORPORATION N17 W24100 RIVERWOOD DRIVE SUITE 20 WAUKESHA WI 53188 391417226 HEALTHCARE WI N/A C 0 EMPATHIA INC N17 W24100 RIVERWOOD DRIVE SUITE 20 WAUKESHA WI 53188 391567366 HEALTHCARE WI N/A C 0 1 1 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 PROHEALTH CARE MEDICAL ASSOCIATES INC A 2036653 Actual Amount Received REHABILITATION HOSPITAL OF WISCONSIN LLC A 1198272 Actual Amount Received PROHEALTH CARE INC B 17400000 Actual Amount Incurred PROHEALTH CARE FOUNDATION INC C 1706425 Actual Amount Received WAUKESHA HEALTH SYSTEM INC K 74545 Actual Amount Incurred PROHEALTH CARE MEDICAL ASSOCIATES INC K 557480 Actual Amount Incurred NATIONAL REGENCY OF NEW BERLIN INC K 250155 Actual Amount Incurred REHABILITATION HOSPITAL OF WISCONSIN LLC L 230039 Actual Amount Received PROHEALTH CARE INC L 52895 actual Amount received PROHEALTH CARE INC M 90626110 Actual Amount Incurred WAUKESHA HEALTH SYSTEM INC M 847965 Actual Amount Incurred PROHEALTH SOLUTIONS LLC M 511099 Actual Amount Incurred PROHEALTH CARE MEDICAL ASSOCIATES INC P 12756625 Actual Amount Incurred OCONOMOWOC MEMORIAL HOSPITAL INC Q 3120044 Actual Amount Received WAUKESHA HEALTH SYSTEM INC Q 235815 Actual Amount Received PROHEALTH CARE MEDICAL ASSOCIATES INC Q 4432194 Actual Amount Received PROHEALTH HOME CARE INC Q 175198 Actual Amount Received NATIONAL REGENCY OF NEW BERLIN INC Q 124995 Actual Amount Received PROHEALTH CARE INC R 34511915 Actual Amount Incurred REHABILITATION HOSPITAL OF WISCONSIN LLC S 2888063 Actual Amount Received OCONOMOWOC MEMORIAL HOSPITAL INC S 520000 Actual Amount Received PROHEALTH ALIGNED LLC (DBA MSC) S 878267 Actual Amount Received THE ORTHOPEDIC SURGERY CENTER LLC S 2444789 Actual Amount Received WAUKESHA HEALTH SYSTEM INC A 106143 Actual Amount Received PROHEALTH SOLUTIONS LLC L 941000 Actual Amount Received