2016-08-03T06:31:44-05:00 2015-09-30 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2014-10-01 390910727 WAUKESHA MEMORIAL HOSPITAL INC WAUK 2629282496 725 AMERICAN AVENUE WAUKESHA WI 53188 RONALD FARR CHIEF FINANCIAL OFFICER 2629282496 2016-07-25 1 DAVID LOWENTHAL P00378651 2483522500 2016-07-25 2014 2016-12-15 16:53:06Z SUSAN EDWARDS 725 AMERICAN AVENUE WAUKESHA WI 53188 448882974 0 X WWW.PROHEALTHCARE.ORG X 1956 WI PROVIDER OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES. 25 23 2751 430 2794379 -1405552 1591390 6033154 441706467 453992483 33906585 2938438 1987278 -14463457 479191720 448500618 17933881 14355604 0 0 135938150 140805351 0 0 0 276341058 269643641 430213089 424804596 48978631 23696022 528328373 545957012 342943200 443452554 185385173 102504458 CONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 404709925 14355604 451216564 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 51,845 DAYS OF INPATIENT CARE AND APPROXIMATELY 298,400 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2015. SEE SCHEDULE H FOR ILLUSTRATION OF ITS PROGRAM SERVICE ACCOMPLISHMENTS. 404709925 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 1 266 0 1 2751 1 1 1 0 0 0 0 0 0 0 0 0 X 25 23 0 0 0 0 1 0 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 BETTY ARNDT SECRETARY - PHC BOARD 2.00 8.00 X X 0 0 0 CHARLOTTE HALL SECRETARY 2.00 8.00 X X 0 0 0 EDWARD J LUMP TREASURER 2.00 8.00 X X 0 0 0 GARY BEYER MD CHAIRPERSON 2.00 8.00 X X 0 0 0 HELEN FORSTER VICE CHAIRPERSON - PART YEAR 2.00 8.00 X X 0 0 0 JANET SWANDBY CHAIRPERSON - PART YEAR 2.00 8.00 X X 0 0 0 JIM GANNON CHAIRPERSON - PHC BOARD 2.00 8.00 X X 0 0 0 JOHN ROBERTSTAD PRESIDENT - PHC HOSPITAL DIVISION 32.00 16.00 X X 2580701 0 87072 JULIE SCHROEDER TREASURER - PHC BOARD 2.00 8.00 X X 0 0 0 SUSAN EDWARDS CEO - PHC 2.00 50.00 X X 0 1234149 794266 TED GARVEY VICE CHAIRPERSON 2.00 8.00 X X 0 0 0 TOM PACKEE SECRETARY - PHC BOARD - PART YEAR 2.00 8.00 X X 0 0 0 MARK MOHR VICE CHAIR - PHC BOARD 2.00 8.00 X X 0 0 0 ARCH PEQUET DIRECTOR 2.00 8.00 X 0 0 0 CLIFF BROOKS DIRECTOR 2.00 8.00 X 0 0 0 DAVID ROELKE DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 DOUG BRUINS DIRECTOR 2.00 8.00 X 0 0 0 DOUG HASTAD DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 ELLEN MURPHY DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 FRED GARCIA DIRECTOR 2.00 8.00 X 0 0 0 JANE HOPP DIRECTOR 2.00 8.00 X 0 0 0 JOHN HALLET DIRECTOR 2.00 8.00 X 0 0 0 JOHN RAASCH DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 MIKE ERWIN DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 PAUL BOSTROM DIRECTOR 2.00 8.00 X 0 0 0 RALPH RAMIREZ DIRECTOR - PHC BOARD 2.00 8.00 X 0 0 0 SANDRA STEARNS DIRECTOR 2.00 8.00 X 0 0 0 TIM WESTLAKE DIRECTOR 2.00 8.00 X 0 0 0 RONALD FARR CFO 2.00 50.00 X 0 537662 44943 JAMES GARDNER VP MEDICAL AFFAIRS 40.00 0.00 X 505657 0 69915 KENNETH PRICE CHIEF ADMIN OFFICER 2.00 50.00 X 0 385639 88805 CHRISTOPHER WILLIAMS PRESIDENT-PHC HOSPITAL DIVISION 40.00 0.00 X 269866 0 27134 ERIC HENDEE CHIEF PHYSICIST - RADIOLOGY 40.00 0.00 X 204840 0 44898 JOHN MAY VP - AMBULATORY 40.00 0.00 X 327385 0 33398 MICHAEL KOWALOK PHYSICIST 40.00 0.00 X 178495 0 19195 VERNA SEITZ PRESIDENT-PHC HOSPITAL DIVISION 40.00 0.00 X 277779 0 12771 4344723 2157450 1222397 73 0 1 0 GILBANE BUILDING CO 5301-99TH AVE KENOSHA WI 53144 CONSTRUCTION SERVICES 27337897 MORTENSON CONSTRUCTION 17975 WEST SARAH LANE BROOKFIELD WI 53045 CONSTRUCTION SERVICES 6707359 FINDORFF INC PO BOX 575 MADISON WI 53701 CONSTRUCTION SERVICES 4569033 MEDICAL COLLEGE OF WI PO BOX 13308 MILWAUKEE WI 53213 PROVIDER SERVICES 3627318 PERFICIENT INC PO BOX 200026 PITTSBURGH PA 15251 CONSULTING SERVICES 2345847 77 5850678 182476 6033154 NET PATIENT REV. 622110 439411846 439411846 MEDICAL SERVICE LAB 621500 8688634 5912715 2775919 HOSPITAL JOINT VENTURE 622310 2478992 2478992 ORTHO SURGERY CENTER 621400 1348259 1348259 SURGERY CENTER 621400 1238922 1238922 825830 825830 453992483 2952991 2952991 75871 43192 32679 32679 18460 14219 324611 339164 -14553 -14553 -14553 CAFETERIA 722210 1925613 1925613 GIFT SHOP 453220 36238 36238 LEGAL LOSS ON BOND DEFEASANCE 523920 -16457987 -16457987 -14496136 448500618 451216564 2794379 -11543479 X 14355604 14355604 1121129 1121129 103666838 99078737 4588101 8236727 7787960 448767 20516820 14807590 5709230 7263837 7113579 150258 112775811 106194870 6580941 14078980 14065803 13177 5505161 5074272 430889 10427373 10427373 41460116 41460116 MEDICAL SUPPLIES 34591887 34591887 DRUGS & PHARMACEUTICALS 26687615 26687615 MEDICAID PROVIDER TAXES 13097493 13097493 BAD DEBTS 6342455 6342455 4676750 3624571 1052179 424804596 404709925 20094671 0 894111 822860 18156414 8375189 53274339 52165325 7577164 6879955 6189834 6729249 889913590 481931348 316982222 407982242 28326631 26683494 9662324 11738120 87265334 24580578 528328373 545957012 68714984 82542336 2500 188849190 23480562 32856868 0 52522158 337427156 342943200 443452554 X 184716962 101629025 668211 875433 185385173 102504458 528328373 545957012 X 23696022 -1417090 -105159647 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 6710388 6710388 6625195 88002 -2809 6710388 6542035 84926 -1766 6625195 0.00000 0.00000 0.00000 22729263 22729263 451814662 176880664 274933998 2711381 2580433 130948 398350635 302470251 95880384 14307649 14307649 407982242 ACCRUED POSTRETIREMENT MEDICAL 104440 FAIR VALUE-INTEREST RATE SWAP 21957856 ASSET RETIREMENT OBLIGATION 99763 ACCUMULATED MIN PENSION LIABILITY 40903757 INTERCOMPANY NOTES PAYABLE 273933438 OTHER LONG TERM LIABILITY 427902 337427156 X PART X, LINE 2: FIN48 DISCLOSURE: PHC, WMH, OMH, NATIONAL REGENCY, PHMG, PHCF, AND PHHC ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ALL OF THESE ENTITIES ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. WHS IS A FOR-PROFIT CORPORATION THAT ACCOUNTS FOR INCOME TAXES UNDER THE ASSET AND LIABILITY METHOD OF ACCOUNTING. A CURRENT TAX LIABILITY OR ASSET IS RECOGNIZED FOR THE ESTIMATED TAXES PAYABLE OR REFUNDABLE ON TAX RETURNS FOR THE YEAR. DEFERRED TAX LIABILITIES OR ASSETS ARE RECOGNIZED FOR THE ESTIMATED FUTURE TAX EFFECTS OF TEMPORARY DIFFERENCES BETWEEN FINANCIAL REPORTING AND TAX ACCOUNTING. PHS IS TREATED AS A PARTNERSHIP FOR INCOME TAX PURPOSES. INCOME AND LOSSES OF PHS ARE PASSED TO ITS MEMBERS. PHS INCOME PASSED THROUGH TO PHC IS NOT CONSIDERED TAXABLE TO PHC UNLESS IT IS CONSIDERED UNRELATED BUSINESS INCOME. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2012. 1 1 X 1 X 1 X 0 1 0 1 1 1707228 1707228 0.00410 44894973 18749799 26145174 0.06250 46602201 18749799 27852402 0.06660 29 41847 4441324 2960 4438364 0.01060 8 3073 6008469 3723880 2284589 0.00550 1 0 1069265 2286402 -1217137 0.00000 0 0 8 21824 1139879 1139879 0.00270 46 66744 12658937 6013242 6645695 0.01880 46 66744 59261138 24763041 34498097 0.08540 2 271 20372 20372 0.00000 4 33 72590 72590 0.00020 1 11352 11352 0.00000 1 335 335 0.00000 2 1619 17439 17439 0.00000 1 10 56418 56418 0.00010 11 1933 178506 178506 0.00030 1 6381316 596985 83914339 146072426 -62158087 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 13 1 1 0 1 X FULL WEBSITE LISTED IN PART V SECTION C X X 1 13 1 SEE PART V, SECTION B, LINE 7D DISCLOSURE 0 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 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 1 X 0 0 WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 3J: THE CHNA RESULTS CAME FROM A 400 PERSON CONSUMER TELEPHONE SURVEY CONDUCTED BY THE UW CENTER FOR URBAN POPULATION HEALTH AT THE REQUEST OF PROHEALTH CARE AND OTHER MILWAUKEE COLLABORATIVE PARTNERS IN ADDITION TO 51 INTERVIEWS ENCOMPASSING A RANGE OF PROVIDERS, POLICY-MAKERS AND OTHER LOCAL EXPERTS. 38 OF THESE INTERVIEWS WERE CONDUCTED AS PART OF THE MILWAUKEE COLLABORATIVE WHILE 13 INTERVIEWS WERE CONDUCTED BY PROHEALTH CARE STAFF ALONE. SECONDARY DATA WAS COLLECTED FROM A WIDE RANGE OF PUBLICLY AVAILABLE SITES AND ORGANIZATIONS INCLUDING STATE AND FEDERAL RESOURCES. HEAVY UTILIZATION OF DATA WAS FROM MEDICARE CHRONIC DISEASE DASHBOARD, CENTER FOR DISEASE CONTROL, WISCONSIN DEPARTMENT OF HEALTH AND HUMAN SERVICES, INCLUDING WISCONSIN BEHAVIORAL RISK FACTOR SURVEY, 2014 AND WISCONSIN EPIDEMIOLOGICAL PROFILE ON ALCOHOL AND OTHER DRUG USE, WAUKESHA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, AMONG SEVERAL OTHERS. THIS HELPED IDENTIFY ADDED DEMOGRAPHICS SUCH AS POPULATIONS WITH ANY DISABILITY, WISCONSIN LEADING CAUSES OF DEATH, HOMELESSNESS AND SPECIFIC LIFESTYLE RISK FACTORS. WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 5: SEE PART V, SECTION B, LINE 3J DISCLOSURE 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: THE FACILITY CONTINUES TO FOCUS ITS COMMUNITY OUTREACH PROGRAMS ON THE PRIORITY NEEDS DETERMINED FROM THE LAST CHNA. THE ENTITY FEELS ALL NEEDS ARE BEING ADDRESSED EITHER THROUGH DIRECT OUTREACH OR ENSURING OTHER COMMUNITY LEADERS ARE AWARE OF SIMILAR NEEDS AND THOSE PATIENTS OR USERS ARE PROVIDED WITH THOSE COMMUNITY RESOURCES IF NOT OFFERED BY THE FACILITY. 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 16I: REFERENCE TO THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE BACK 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 16I: NOTIFIED PATIENTS OF FINANCIAL ASSISTANCE POLICY AND OFFERED APPLICATION IF PATIENT OR FAMILY MEMBER EXPRESSED FINANCIAL HARDSHIP. REHABILITATION HOSPITAL OF WISCONSIN LLC PART V, SECTION B, LINE 22D: THE HOSPITAL HAS NEVER HAD AN EMERGENCY CARE SITUATION REQUIRING THE DETERMINATION OF AN AMOUNT TO BE BILLED FOR SERVICES TO A PATIENT IN THESE CIRCUMSTANCES. IF SUCH A CASE ARISES, THE HOSPITAL WILL CONSULT WITH WAUKESHA MEMORIAL HOSPITAL TO DETERMINE APPROPRIATE EMERGENCY CARE CHARGES AND THEN APPLY PROCEDURES ACCORDING TO CHARITY CARE AND PRIVATE PAY DISCOUNT POLICIES IF THE PATIENT IS ELIGIBLE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16A WEBSITE: WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16B WEBSITE: WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 16C WEBSITE: WWW.PROHEALTHCARE.ORG/PATIENT-GUEST-SERVICES-BILLING-AND-INSURANCE.ASPX 3 REHAB HOSPITAL OF WI OUTPATIENT CLINIC 1625 COLDWATER CREEK DRIVE WAUKESHA WI 53188 OUTPATIENT REHABILATION CLINIC PROHEALTH ALIGNED LLC 1111 DELAFIELD ST SUITE 100 WAUKESHA WI 53188 AMBULATORY SURGERY CENTER THE ORTHOPEDIC SURGERY CENTER LLC W238 N 1610 BUSSE ROAD SUITE 100 WAUKESHA WI 53188 ORTHOPEDIC SURGERY CENTER PART I, LINE 3C: N/A PART I, LINE 6A: PROHEALTH CARE, INC. (EIN 39-1486873) 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, LINE 7G: N/A PART I, LN 7 COL(F): $6,342,455 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 $38,861 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 4: BAD DEBT EXPENSE FOOTNOTE FOR WAUKESHA MEMORIAL HOSPITAL, INC: 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 HOSPITAL'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. 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.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.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 NOT 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 NEEDS ASSESSMENTS, SUCH AS THE UNITED WAY/UNIVERSITY OF WISCONSIN SURVEY OF WAUKESHA COUNTY. ADDITIONALLY, WE HAVE ACTIVELY PARTNERED WITH OUR COUNTY HEALTH DEPARTMENT IN THEIR COMMUNITY HEALTH IMPROVEMENT PLAN AND PROCESS (CHIPP) ASSESSMENT. TO COMPLEMENT ALL OF THESE DATA SOURCES, WE ALSO PERIODICALLY PERFORM A SERVICE GAP ANALYSIS WITH OUR EMPLOYED COMMUNITY OUTREACH NURSES AS WELL AS LOCAL NON-PROFIT AGENCIES WITH WHICH WE PARTNER. WE THEN ANALYZE THE DATA, IDENTIFY THE PRESSING NEEDS, AND PROACTIVELY PLAN AND IMPLEMENT COMMUNITY BENEFIT INITIATIVES TO ADDRESS THESE NEEDS. WE ARE CURRENTLY FINALIZING IMPLEMENTATION PLANS FOR PRIORITIES IDENTIFIED IN OUR 2016 NEEDS ASSESSMENT. DATA COLLECTION AND ANALYSIS FOR THIS ROUND BEGAN IN SPRING 2015. 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 $75850, 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 446,622 CLINIC VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2015.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 8,816 DAYS OF INPATIENT CARE AND APPROXIMATELY 70,446 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2015. 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) 14355604 N/A N/A TO ASSIST PROHEALTH CARE, INC. IN ITS CHARITABLE MISSION. 1 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 JOHN ROBERTSTAD PRESIDENT - PHC HOSPITAL DIVISION 461644 0 227084 0 1891973 0 54862 0 32210 0 2667773 0 1891973 0 SUSAN EDWARDS CEO - PHC 0 803007 0 431142 0 0 0 774636 0 19630 0 2028415 0 0 RONALD FARR CFO 0 400473 0 137189 0 0 0 20607 0 24336 0 582605 0 0 JAMES GARDNER VP MEDICAL AFFAIRS 357758 0 147899 0 0 0 38877 0 31038 0 575572 0 0 0 KENNETH PRICE CHIEF ADMIN OFFICER 0 269157 0 116482 0 0 0 64204 0 24601 0 474444 0 0 CHRISTOPHER WILLIAMS PRESIDENT-PHC HOSPITAL DIVISION 194362 0 75504 0 0 0 5447 0 21687 0 297000 0 0 0 ERIC HENDEE CHIEF PHYSICIST - RADIOLOGY 198032 0 6808 0 0 0 18081 0 26817 0 249738 0 0 0 JOHN MAY VP - AMBULATORY 240116 0 87269 0 0 0 11500 0 21898 0 360783 0 0 0 MICHAEL KOWALOK PHYSICIST 177610 0 885 0 0 0 8750 0 10445 0 197690 0 0 0 VERNA SEITZ PRESIDENT-PHC HOSPITAL DIVISION 201088 0 76691 0 0 0 9601 0 3170 0 290550 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 LINE 4B: NAME CURRENT FISCAL YEAR PAYOUT -JOHN ROBERTSTAD $1,891,973 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 PRO HEALTH 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 8558796 32039358 597186 31442173 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 9/30/14 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 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 11 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, 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 2015. 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 6,257,407. MANAGEMENT AND GENERAL EXPENSES 143,478. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,400,885. PHMG PHYSICIAN SUBSIDY: PROGRAM SERVICE EXPENSES 7,106,797. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,106,797. LINEN SERVICES: PROGRAM SERVICE EXPENSES 1,172,664. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,172,664. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 7,060,488. MANAGEMENT AND GENERAL EXPENSES 1,061,676. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,122,164. PHC SERVICES: PROGRAM SERVICE EXPENSES 73,397,217. MANAGEMENT AND GENERAL EXPENSES 5,375,787. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,773,004. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 11,200,297. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,200,297. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -3,655,709. CHANGE IN MINIMUM PENSION LIABILITY -9,085,213. INVESTMENT CONSIDERATION -56,120,714. 2014 DEBT SERIES PROCEEDS -62,000,000. EQUITY TRANSFER FROM RELATED ORGANIZATIONS 9,543,000. OTHER CHANGES 158,989. TRANSFER FROM PHC-PARENT 16,000,000. FORM 990, PART XII, LINE 2C THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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