2014-08-14T14:20:42-05:00 2013-09-30 381357951 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2012-10-01 390910727 WAUKESHA MEMORIAL HOSPITAL INC WAUK 2629282496 725 AMERICAN AVENUE WAUKESHA WI 53188 RONALD FARR 2629282496 2014-08-12 1 DAVID LOWENTHAL P00378651 2483522500 2012 2015-11-30 17:44:51Z SUSAN EDWARDS 725 AMERICAN AVENUE WAUKESHA WI 53188 467956145 0 X WWW.PROHEALTHCARE.ORG X 1956 WI PROVIDER OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES. 12 9 2914 430 2823723 -344326 4208350 1424641 437502571 431462556 13144261 33254390 5532710 1787006 460387892 467928593 27193336 20374573 0 0 135368239 139172445 0 0 0 259795822 257795231 422357397 417342249 38030495 50586344 750447287 805868769 361000320 316340282 389446967 489528487 CONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 392877709 20374573 428613305 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 58,666 DAYS OF INPATIENT CARE AND APPROXIMATELY 274,238 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013. SEE SCHEDULE H FOR ILLUSTRATION OF ITS PROGRAM SERVICE ACCOMPLISHMENTS. 392877709 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 1 0 0 0 0 0 1 1 1 0 0 1 296 0 1 2914 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 1 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 GARY BEYER MD 2.00 4.00 X X 24000 0 0 SUSAN EDWARDS 2.00 50.00 X X 0 1062296 748997 TED GARVEY 2.00 4.00 X X 0 0 0 EILEEN GILLESPIE 2.00 4.00 X X 0 0 0 ED LUMP 2.00 4.00 X X 0 0 0 JOHN ROBERTSTAD 32.00 12.00 X X 617785 0 272942 MIKE BARRY 2.00 4.00 X 0 0 0 PAUL BOSTROM 2.00 4.00 X 0 0 0 CLIFF BROOKS 2.00 4.00 X 0 0 0 CHARLOTTE HALL 2.00 4.00 X 0 0 0 RICHARD NEILS 2.00 4.00 X 0 0 0 ARCH PEQUET 2.00 4.00 X 0 0 0 TIM WESTLAKE 2.00 4.00 X 0 0 0 DAVID EBEL 2.00 50.00 X 0 0 0 NANINE NELSON 2.00 50.00 X 0 478402 208280 JAMES GARDNER 40.00 0.00 X 464280 0 63030 KENNETH PRICE 40.00 0.00 X 328976 0 55048 CATHERINE RAPP 40.00 0.00 X 282934 0 38209 MARY JO O'MALLEY 40.00 0.00 X 255221 0 34956 DEAN REIN 40.00 0.00 X 118746 92681 37659 ERIC HENDEE 40.00 0.00 X 206553 0 43505 MOHAMMAD KHARBAT 40.00 0.00 X 184647 0 31329 MARY CASEY 40.00 0.00 X 152039 0 43655 DEBRA ENDEAN 40.00 0.00 X 151641 0 35770 2786822 1633379 1613380 66 0 1 0 RILEY CONSTRUCTION CO INC 5301-99TH AVE KENOSHA WI 53144 CONSTRUCTION SERVICES 12678184 FINDORFF INC PO BOX 575 MADISON WI 53701 CONSTRUCTION SERVICES 6254183 MEDICAL COLLEGE OF WI PO BOX 13308 MILWAUKEE WI 53213 MEDICAL SERVICES 3595197 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 53288 MAINTENANCE CONTRACTS 3521400 ADVANCED ICU CARE INC PO BOX 671773 DALLAS TX 75267 HEALTHCARE SERVICES 1569692 66 1266320 158321 1424641 NET PATIENT REV. 622110 416904577 416904577 MEANINGFUL USE 900099 3634868 3634868 MEDICAL SERVICE LAB 621500 2849251 2849251 HOSPITAL JOINT VENTURE 622310 2128840 2128840 SURGERY CENTER 621400 1566333 1566333 4378687 4378687 431462556 33200123 33200123 45773 9975 35798 35798 24778 11020 71844 17577 54267 54267 54267 CAFETERIA 722210 1762735 1762735 GIFT SHOP 453220 38779 38779 PASS-THROUGH INCOME 900099 -50306 -50306 1751208 467928593 428613305 2823723 35066924 X 20374573 20374573 1139823 1139823 105768202 104091285 1676917 7955211 7745613 209598 16728446 16287696 440750 7580763 7457876 122887 104562632 86026902 18535730 16175294 16166799 8495 4769023 4382762 386261 12252342 12252342 32530607 32530607 MEDICAL SUPPLIES 34486025 34485985 40 DRUGS & PHARMACEUTICALS 20887857 20887857 MEDICAID PROVIDER TAXES 13775995 13775995 BAD DEBTS 13015603 13015603 5339853 3395814 1944039 417342249 392877709 24464540 0 516365 512250 12792321 10461182 56245729 56552150 6289663 8036858 4938143 5489553 686720307 407895887 258329039 278824420 273261901 310964639 8925389 9278045 129148737 125749672 750447287 805868769 46265248 42391690 201704893 195427377 34008321 33441881 79021858 45079334 361000320 316340282 X 388628994 488784731 817973 743756 389446967 489528487 750447287 805868769 X 50586344 16674576 32820600 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6710388 6710388 6625195 88002 -2809 6710388 6542035 84926 -1766 6625195 5498739 1045116 -1820 6542035 5293708 236781 -31750 5498739 1.00000 0 1 1 22617283 22617283 310865386 147231357 163634029 2697048 2487273 209775 339575191 258177257 81397934 10965399 10965399 278824420 DEFERRED FINANCING 1256730 DEBT SERVICE RESERVE FUND -628202 ACCRUED INTEREST RECEIVABLE 595097 DUE FROM AFFILIATES 11265663 OTHER ASSETS 4206467 DEPRECIATION RESERVE 108362555 INSURANCE RECOVERY 691362 125749672 ACCRUED POSTRETIREMENT MEDICAL 108513 FAIR VALUE-INTEREST RATE SWAP 18090231 ASSET RETIREMENT OBLIGATION 282335 ACCUMULATED MIN PENSION LIABILITY 24892940 INSURANCE LIABILITY 716362 OTHER LONG TERM LIABILITIES 988953 45079334 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO SUPPORT WAUKESHA MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: FIN48 DISCLOSURE: PHC, WMH, OMH, NATIONAL REGENCY, PHCMA, 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. 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, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2010. 1 1 X 1 X 1 X 0 1 0 1 1 6025728 6025728 0.01490 36811467 20565383 16246084 0.04020 42837195 20565383 22271812 0.05510 30 63387 6706464 4047 6702417 0.01660 8 2937 5437829 4078049 1359780 0.00340 2 0 6877081 2162010 4715071 0.01170 1 100 336159 336159 0.00080 9 7110 1464181 120338 1343843 0.00330 50 73534 20821714 6364444 14457270 0.03580 50 73534 63658909 26929827 36729082 0.09090 1 80 26232 26232 0.00010 1 925 57254 8106 49148 0.00010 1 0 4200 4200 0.00000 1 34 882 882 0.00000 1 129 6025 6025 0.00000 1 24 10068 10068 0.00000 6 1192 104661 8106 96555 0.00020 1 13059331 1332953 90641340 139565186 -48923846 X 1 1 1 PROHEALTH ALIGNED LLC AMBULATORY SURGERY CENTER 0.51000 0.49000 2 THE ORTHOPEDIC SURGERY CENTER LLC ORTHOPEDIC SURGICAL SERVICES 0.30000 0.70000 2 1 WAUKESHA MEMORIAL HOSPITAL INC

725 AMERICAN AVENUE WAUKESHA WI 53188

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 1 X X X X X X X X 12 1 1 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X 1 1 X X X X X X X 1 1 X X X X X 1 X 0 0 REHABILITATION HOSPITAL OF WISCONSIN LLC 2 0 1 1 150.000000000000 1 250.000000000000 1 X X X 1 1 X 1 X X 0 X X 0 X 0 0 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. 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, L7 COL(F): $13,015,603 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 $43,728 RELATED TO REHABILITATION HOSPITAL OF WISCONSIN, LLC. BOTH AMOUNTS WERE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE. PART II: WAUKESHA/OCONOMOWOC MEMORIAL HOSPITALS HAVE PARTNERSHIPS WITH VARIOUS ORGANIZATIONS THROUGHOUT THE COMMUNITIES WE SERVE. ONE EXAMPLE IS THE PARTNERSHIPS WE HAVE WITH THE LOCAL CHAMBERS OF COMMERCE WITHIN OUR SERVICE AREA BY PROVIDING LEADERSHIP AND HEALTH RELATED OUTREACH TOWARDS STRENGTHENING COMMUNITY DEVELOPMENT. WE ARE THE MAJOR SPONSOR FOR "LEADERSHIP WAUKESHA", A PROGRAM THAT FOCUSES ON THE DEVELOPMENT OF EMERGING LEADERS IN OUR COUNTY. ADDITIONALLY, WE PROVIDE LAND, RESOURCES AND EXPERTISE FOR LOCAL COMMUNITY GARDENS. WE PROVIDE DELIVERY OF EMERGENCY CARE IN THE COMMUNITY AND OFFER/SUPPORT NUMEROUS SERVICES AIMED AT OUR YOUTH INCLUDING SPONSORSHIP OF SAFE "AFTER PROM" ACTIVITIES. WE SUPPORT AREA HOMELESS SHELTERS AND ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION AND HISPANIC COLLABORATIVE NETWORK. 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. WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 1J: WAUKESHA MEMORIAL HOSPITAL'S CHNA ALSO INCLUDES INFORMATION ABOUT ITS ACTIVE PARTICIPATION AND PARTNERSHIP IN THE WAUKESHA COUNTY HEALTH AND HUMAN SERVICES CHIPP (COMMUNITY HEALTH IMPROVEMENT PLAN AND PROCESS). WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 7: ADDITIONAL COMMUNITY NEEDS IDENTIFIED INCLUDED MENTAL HEALTH, AODA AND ACCESS TO CARE. AS THESE ARE THE NEEDS CHOSEN BY THE WAUKESHA COUNTY HHS, WE CHOSE NOT TO DUPLICATE. RATHER, WE ARE ACTIVELY PARTNERING WITH THE COUNTY TO ADDRESS THESE NEEDS IN ADDITION TO OTHER NEEDS WE IDENTIFIED AS A PART OF OUR CHNA. WAUKESHA MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 14G: THE POLICY IS AVAILABLE UPON REQUEST OR ON OUR WEBSITE. A PHONE NUMBER IS PROVIDED ON OUR BILLING STATEMENTS, AND IN THE EMERGENCY DEPARTMENT AND ADMITTING AREAS FOR A PATIENT TO CALL IF THEY HAVE A FINANCIAL NEED. REHABILITATION HOSPITAL OF WISCONSIN LLC PART V, SECTION B, LINE 16E: ASSIGNMENT OF ACCOUNTS TO COLLECTION AGENCY. REHABILITATION HOSPITAL OF WISCONSIN LLC PART V, SECTION B, LINE 20D: 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 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 COLLECTING AND ANALYZING PRIMARY DATA FOR OUR FORMAL CHNA AS REQUIRED BY THE AFFORDABLE CARE ACT. 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 1960, THE POPULATION OF THE COUNTY HAS MORE THAN DOUBLED. WAUKESHA COUNTY HAS AN AGING POPULATION WITH 14.7% OVER THE AGE OF 65 AND A MEDIAN AGE OF 42.0 YEARS. 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: CAUCASIAN (NON-HISPANIC) 94.1%, HISPANIC OR LATINO 4.4%, ASIAN 3.0%, BLACK 1.4%. MEDIAN HOUSEHOLD INCOME IS $75,689, WITH 5.0% OF PEOPLE LIVING BELOW THE POVERTY LEVEL. UNEMPLOYMENT IN WAUKESHA COUNTY STOOD AT 5.4% IN AUGUST 2013. THE PRESENCE OF SOME HIGH INCOME COMMUNITIES IN WAUKESHA COUNTY OFTEN GIVES A MISTAKEN IMPRESSION. 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, FROM ABOUT 9,451 PEOPLE IN 2000 TO MORE THAN 30,000 IN 2011. THE HISPANIC POPULATION HAS SEEN A 42% INCREASE IN THE PAST 8 YEARS. 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. PART VI, LINE 5: OCONOMOWOC/WAUKESHA MEMORIAL HOSPITAL HAS PARTNERSHIPS WITH VARIOUS NON-PROFIT ORGANIZATIONS AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITY. WE ARE ACTIVELY INVOLVED WITH PROGRAMMING AND ONGOING FINANCIAL SUPPORT OF THE WAUKESHA COMMUNITY HEALTH CENTER, THE NEW AND ONLY FEDERALLY-QUALIFIED HEALTH CENTER SERVING OUR AREA. WE PROVIDE ONGOING FINANCIAL AND IN-KIND SUPPORT TO THE AREA FREE CLINICS. SEVERAL OF OUR STAFF ARE ACTIVITY INVOLVED WITH THE HEALTH DEPARTMENT'S CHIPP AND SERVE ON A VARIETY OF COMMITTEES FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. OUR OUTREACH NURSING PROGRAM SUPPORTS MORE THAN 70 AREA PARTNER AGENCIES. FROM COMMUNITY-WIDE HEALTH FAIRS OFFERING A WIDE VARIETY OF FREE SCREENINGS TO OUR ONGOING PROVISION OF OPERATIONAL SPACE FOR THE WAUKESHA COUNTY COMMUNITY DENTAL CLINIC AND MULTIPLE OTHER NON-PROFITS, WE PROVIDE BROAD SUPPORT TO SAFETY NET ORGANIZATIONS IN OUR AREA. WE ALSO PROVIDE OTHER, DIVERSE SUPPORT IN THE COMMUNITY SUCH AS NUMEROUS SERVICES AIMED AT OUR YOUTH INCLUDING SPONSORSHIP OF SAFE "AFTER PROM" ACTIVITIES. WE SUPPORT AREA HOMELESS SHELTERS AND ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION AND HISPANIC COLLABORATIVE NETWORK. 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. - OPERATES 18 CLINIC AND URGENT CARE LOCATIONS THROUGHOUT WAUKESHA COUNTY AND THE SURROUNDING COMMUNITIES. PROHEALTH CARE MEDICAL ASSOCIATES FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PROHEALTH CARE MEDICAL ASSOCIATES PROVIDED 393,313 CLINIC VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013.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 9,926 DAYS OF INPATIENT CARE AND APPROXIMATELY 66,602 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013. REPORTS FILED WITH STATES PART VI, LINE 7 WI 1 PROHEALTH CARE INC N17 W24100 RIVERWOOD DR STE 200 WAUKESHA WI 531881131 391486873 501(C)(3) 20374573 N/A N/A TO ASSIST PROHEALTH CARE, INC. IN ITS CHARITABLE MISSION. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 710875 0 348385 0 3036 0 731425 0 17572 0 1811293 0 313385 JOHN ROBERTSTAD 435968 0 176743 0 5074 0 241099 0 31843 0 890727 0 176743 0 NANINE NELSON 0 352255 0 124984 0 1163 0 177592 0 30688 0 686682 0 124984 JAMES GARDNER 338940 0 107788 0 17552 0 34504 0 28526 0 527310 0 107788 0 KENNETH PRICE 240236 0 77479 0 11261 0 26208 0 28840 0 384024 0 77479 0 CATHERINE RAPP 208071 0 65151 0 9712 0 35833 0 2376 0 321143 0 65151 0 MARY JO O'MALLEY 185104 0 59023 0 11094 0 19431 0 15525 0 290177 0 59023 0 DEAN REIN 118122 35857 0 50322 624 6502 4225 1753 26477 5204 149448 99638 0 50322 ERIC HENDEE 203609 0 2944 0 0 0 17953 0 25552 0 250058 0 2944 0 MOHAMMAD KHARBAT 165721 0 18746 0 180 0 6802 0 24527 0 215976 0 18746 0 MARY CASEY 135508 0 15541 0 990 0 13233 0 30422 0 195694 0 15541 0 DEBRA ENDEAN 135154 0 15906 0 581 0 5771 0 29999 0 187411 0 15906 0 PART I, LINE 4B PART I, LINE 4B: NAMES: JAMES GARDNER KENNETH PRICE CATHERINE RAPP MARY JO O'MALLEY DEAN REIN SUSAN EDWARDS NANINE NELSON PROHEALTH CARE INC. (PHC) MAINTAINS A SUPPLEMENTAL RETIREMENT PLAN (SERP) FOR A SELECT GROUP OF EXECUTIVES OF PHC AND ITS AFFILIATED ENTITIES. THE SERP IS AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION PLAN THAT IS INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THE SERP 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. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I 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 5. WRITTEN EMPLOYEMENT CONTRACT A WISCONSIN HEALTH & EDUCATIONAL FACILITIES 391337855 97710BDJ8 2008-08-14 107960000 CURRENT REFUND BONDS ISSUED 4/25/01 & CURRENT REFUND BONDS ISSUED 6/9/04. 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES 391337855 97710BGZ9 2009-04-30 66126415 RENOVATION TO HOSPITAL FACILITY & CONSTRUCTION OF PARKING STRUCTURE. 0 0 0 C 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 7043823 108443475 865989 659057 106918429 2007 1 0 1 1 B 5992655 59515749 6029422 860774 58654976 2010 0 0 1 1 C 10295000 32039358 597186 31442173 2001 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 PART I, A - COL. C CUSIP #: THE CUSIP # OF 97710BDH2 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 ISSUE PRICE: THE TOTAL ISSUE PRICE ON FORM 8038 IS $122,535,000. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. PART I, B - COL. C CUSIP #: THE CUSIP # OF 97710BGW6 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, B - COL. E ISSUE PRICE: THE TOTAL ISSUE PRICE ON FORM 8038 IS $134,951,867.50. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. PART I, C - COL. C CUSIP #: 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, C - COL. E ISSUE PRICE: 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 TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $108,443,475.00 ALLOCABLE TO REPORTING ORGANIZATION PLUS ZERO INVESTMENT PROCEEDS. PART II, A - LINE 6 PROCEEDS IN REFUNDING ESCROWS: PROCEEDS IN THE AMOUNT OF $106,918,428.56 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 8/14/08; BALANCE ON 9/30/13 IS ZERO. PART II, A - LINE 7 ISSUANCE COSTS FROM PROCEEDS: $865,989.17 OF PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION USED FOR ISSUANCE COSTS; $659,057.27 USED FOR CREDIT ENHANCEMENT. PART II, A - LINE 13 YEAR OF SUBSTANTIAL COMPLETION: YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 4/25/01 WAS 2003 AND YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 6/09/04 WAS 2007. PART II, B - LINE 3 TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $66,126,415.08 ALLOCABLE TO REPORTING ORGANIZATION PLUS $1,975.67 OF INVESTMENT PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION LESS SALE PROCEEDS IN THE AMOUNT OF $6,612,641.51 DEPOSITED IN REASONABLY REQUIRED RESERVE FUND ALLOCABLE TO REPORTING ORGANIZATION. PART II, C - LINE 3 TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $32,039,358 PLUS ZERO INVESTMENT PROCEEDS. PART II, C - LINE 6 PROCEEDS IN REFUNDING ESCROWS: PROCEEDS IN THE AMOUNT OF $31,442,172.63 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 2/16/11; BALANCE ON 9/30/13 IS ZERO. PART II, C - LINE 13 YEAR OF SUBSTANTIAL COMPLETION: 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. IN 2012, PHC REFUNDED A PORTION OF THE 2009 BOND ISSUE, THE WMH PORTION IS INCLUDED IN THE BONDS RETIRED. ASSOCIATED WITH THE REFUNDING THE 2009 DEBT SERVICE RESERVE FUND WAS REDUCED BY $1,190,243.80 OF WHICH $583,219.46 IS WMH'S ALLOCATED REDUCTION. WAUKESHA HEALTH SYSTEM INC BOARD MEMBER, JOHN ROBERTSTAD, IS AN OFFICER OF WAUKESHA HEALTH SYSTEM 4951446 WAUKESHA HEALTH SYSTEM PROVIDES RENT AND REIMBURSEMENT OF EXPENSES TO WMH. 0 THE ORTHOPEDIC SURGERY CENTER BOARD MEMBER JOHN ROBERTSTAD IS AN OFFICER OF THE ORTHOPEDIC SURGERY CENTER 1096832 INVESTMENT DISTRIBUTIONS 0 PROHEALTH ALIGNED LLC (DBA MSC) JOHN ROBERTSTAD AND KENNETH PRICE ARE DIRECTORS OF PROHEALTH ALIGNED 1678665 INVESTMENT DISTRIBUTIONS 0 PROHEALTH SOLUTIONS ARCH PEQUET AND JOHN ROBERTSTAD ARE BOARD MEMBERS OF PROHEALTH SOLUTIONS 535500 PROHEALTH SOLUTIONS PROVIDES PHYSICIAN SERVICES TO WAUKESHA MEMORIAL HOSPITAL. 0 WAUKESHA SURGICAL SPECIALISTS BOARD MEMBER ARCH PEQUET, IS THE PRESIDENT OF WAUKESHA SURGICAL SPECIALISTS 236860 WAUKESHA SURGICAL SPECIALISTS PROVIDES MEDICAL SERVICES TO WAUKESHA MEMORIAL HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 3 DAVID EBEL WAS COMPENSATED BY WARBIRD CONSULTING, A MANAGEMENT COMPANY, FOR SERVICES AS INTERIM CFO FOR WAUKESHA MEMORIAL HOSPITAL, INC. AND RELATED ORGANIZATIONS. WARBIRD CONSULTING WAS NOT PAID ANY COMPENSATION IN CALENDAR YEAR 2012, AS SERVICES DID NOT COMMENCE UNTIL 2013. BEGINNING IN MAY 2013, COMPENSATION WAS PAID TO WARBIRD CONSULTING BY PROHEALTH CARE, INC., THE PARENT ORGANIZATION. 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 COMMITEE 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 2013. 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. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 5,983,517. MANAGEMENT AND GENERAL EXPENSES 143,103. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,126,620. PHCMA SUBSIDIES: PROGRAM SERVICE EXPENSES 4,747,098. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,747,098. LINEN SERVICES: PROGRAM SERVICE EXPENSES 1,171,051. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,171,051. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 6,915,746. MANAGEMENT AND GENERAL EXPENSES 2,047,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,963,164. PHC SERVICES: PROGRAM SERVICE EXPENSES 66,242,386. MANAGEMENT AND GENERAL EXPENSES 7,278,575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,520,961. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 967,104. MANAGEMENT AND GENERAL EXPENSES 9,066,634. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,033,738. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 8,585,153. CHANGE IN MINIMUM PENSION LIABILITY 24,235,447. 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 FUNDRAISING 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 9 PROHEALTH CARE INC 1 PROHEALTH CARE INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 391786873 MANAGEMENT WI 501(C)(3) LINE 11C, III-FI 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 MSC) 1111 DELAFIELD STREET STE 100 WAUKESHA WI 53188 263324572 SURGERY CENTER WI WAUKESHA MEMORIAL HOSPITAL INC RELATED 1756297 4721654 0 1 0.51000 REHABILITATION HOSPITAL OF WISCONSIN LLC 1625 COLDWATER CREEK DRIVE WAUKESHA WI 53188 262332250 INPATIENT REHABILITATION WI WAUKESHA MEMORIAL HOSPITAL INC RELATED 7774102 3325959 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 1180914 2241309 0 1 0.30000 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 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 FOUNDATION INC C 1266320 ACTUAL AMOUNT RECEIVED PROHEALTH CARE MEDICAL ASSOCIATES INC A 976466 ACTUAL AMOUNT RECEIVED REHABILITATION HOSPITAL OF WISCONSIN A 1173025 ACTUAL AMOUNT RECEIVED WAUKESHA HEALTH SYSTEM INC A 27712 ACTUAL AMOUNT RECEIVED WAUKESHA HEALTH SYSTEM INC K 84000 ACTUAL COSTS INCURRED PROHEALTH CARE MEDICAL ASSOCIATES INC K 484548 ACTUAL COSTS INCURRED NATIONAL REGENCY OF NEW BERLIN INC K 639731 ACTUAL COSTS INCURRED PROHEALTH ALIGNED LLC K 395453 ACTUAL COSTS INCURRED PROHEALTH CARE INC M 73520961 ACTUAL COSTS INCURRED PROHEALTH SOLUTIONS M 577500 ACTUAL COSTS INCURRED REHABILITATION HOSPITAL OF WISCONSIN L 140305 ACTUAL AMOUNT RECEIVED OCONOMOWOC MEMORIAL HOSPITAL INC P 117210 ACTUAL COSTS INCURRED PROHEALTH CARE MEDICAL ASSOCIATES INC P 4667903 ACTUAL COSTS INCURRED OCONOMOWOC MEMORIAL HOSPITAL INC Q 14361301 ACTUAL AMOUNT RECEIVED PROHEALTH CARE INC Q 4347039 ACTUAL AMOUNT RECEIVED WAUKESHA HEALTH SYSTEM INC Q 4830352 ACTUAL AMOUNT RECEIVED PROHEALTH CARE MEDICAL ASSOCIATES INC Q 23432261 ACTUAL AMOUNT RECEIVED PROHEALTH HOME CARE INC Q 1112097 ACTUAL AMOUNT RECEIVED EMPATHIA PACIFIC INC Q 1434630 ACTUAL AMOUNT RECEIVED PROHEALTH CARE INC B 20374573 ACTUAL COSTS INCURRED PROHEALTH ALIGNED LLC S 1678665 ACTUAL AMOUNT RECEIVED ORTHOPEDIC SURGERY CENTER S 1096832 ACTUAL AMOUNT RECEIVED REHABILITATION HOSPITAL OF WISCONSIN S 955815 ACTUAL AMOUNT RECEIVED