2013-05-09T14:44:31-07:00 2012-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2011-07-01 390987025 Community Memorial Hospital of Menomonee Falls Inc COMM 4147770960 W180 N8085 Town Hall Road Menomonee Falls WI 53051 Scott R Hawig 2013-05-09 false 2011 2016-02-25 16:41:14Z Catherine A Jacobson 317139938 false false X www.communitymemorial.com X 1959 WI To improve quality of life and meet the comprehensive needs of the community by providing high-quality, safe, cost-effective health services while serving our patients with compassionate, dignified and state-of-the art care. 16 10 1608 211 0 114 0 178537645 177422513 9028823 5935742 9591746 22078021 197158328 205436276 47500 50000 0 68218146 64494413 0 242127 122229121 118794930 190494767 183339343 6663561 22096933 307452791 308290602 161666607 170021753 145786184 138268849 To improve quality of life and meet the comprehensive needs of the community by providing high-quality, safe, cost-effective health services. Our exceptional employees, volunteers and dedicated medical staff work collaboratively to serve our patients with compassionate, dignified and state-of-the art care. false false 92848449 109547171 Outpatient Services:Community Memorial had 96,213 outpatient visits in the 12 months ended June 30, 2012. Community offers a wide variety of ancillary, specialty and subspecialty services including: - Allergy/Immunology - Cardiology - Clinical Genetics - Dermatology - Electrophysiology - Endocrinology - Family Practice - Gastroenterology - Gerontology - Gynecologic Oncology - Gynecology - Hand Surgery - Hematology - Infectious Disease - Internal Medicine - Interventional Radiology - Magnetic Resonance Imaging - Neonatology - Nephrology - Neurosurgery - Nuclear Medicine - Occupational Medicine - Oncology - Ophthalmology - Oral Surgery - Otolaryngology - Pathology - Pediatrics - Pedodontics - Perinatology - Periodontics - Physical Medicine and Rehabilitation - Plastic/Reconstructive Surgery - Podiatry - Psychiatry - Psychology - Pulmonary Medicine - Radiology - Radiation Oncology - Rheumatology - Thoracic Surgery - Urology - Vascular Surgery 47204257 55693906 Inpatient Services:Community Memorial Hospital was founded in 1964 by citizens of the community it serves and specializes in cardiovascular services, women's health, cancer care, and advanced surgical procedures. Combining next-generation technology with personalized care, Community Memorial strives to enhance and improve the quality of life in Waukesha, Washington, Milwaukee and Ozaukee counties.Community Memorial Hospital is licensed for 235 beds of which 202 are staffed - and had 8,835 patient admissions and 40,475 patient days related to a wide range of inpatient services, including women's health, behavioral health, rehabilitation services, general surgery, cardiology, orthopedics, obstetrics and maternity care, pulmonary medicine, and other specialty care for the 12 months ended June 30, 2012.The Heart and Vascular Center is staffed with experienced cardiac professionals utilizing the state-of-the-art technology to treat patients. In 2008, surgeons began using the da Vinci Robotic Surgery system to perform minimally invasive procedures. Minimally invasive surgery offers many advantages over traditional heart surgery, including less scarring, less pain, minimal blood loss (and less need for transfusion), a greatly reduced risk for infection, shorter hospital stay and faster return to normal activities. During fiscal year 2012, Community Memorial cardiac specialists performed 14,565 cardiology procedures.During the year, the Cancer Care Center at Community Memorial received the Outstanding Achievement Award from the American College of Surgeons Commission on Cancer, affirming its commitment to high-quality cancer care. The award recognizes cancer programs that provide the highest quality care to cancer patients and only 66 programs nationally received this award. During fiscal year 2012, Community Memorial had 584 cancer registry cases.The Birthing Center at Community Memorial offers 13 specialty equipped rooms and provides the full spectrum of prenatal services for both normal and high-risk pregnancies. Staffing is provided by leading obstetricians and board-certified neonatologists from the Medical College of Wisconsin. During fiscal year 2012, Community Memorial had 933 births.In addition to the cardiac, cancer care and birthing services, the hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including: - Surgeries: 3,367 - Laboratory Tests: 379,752 - CT Scans: 3,701 - Medical Imaging Exams: 15,302 - MRIs: 719 - Nuclear Medicine Scans: 369 - Ultrasounds: 2,516 10324570 12181436 Emergency Services:Community Memorial's Emergency Department is a Level III Trauma Center and provides 24/7 emergency care for adults and children throughout northern Waukesha, Milwaukee, and Washington counties. During 2012, the emergency department had 20,761 emergency visits, with patients receiving expert care from board-certified emergency physicians and highly trained specialists in trauma, neurosurgery, cardiology, cardiothoracic surgery including robotic surgery, orthopaedics, respiratory, obstetrics, gynecology, psychiatry and other specialties when the need arises. Community Memorial is accredited by the Joint Commission as a certified advanced Primary Stroke Center, demonstrating its ability to provide care from a multi-disciplinary team of neurologists, neurosurgeons, emergency department specialists, radiologists, nurses, therapists, pharmacists, technicians and more all working in a coordinated, collaborative system. 150377276 true false false false false false false false false true true false false true true true false true false false false false false false true false true true true false true false false false false false false false false false true false false false false false true true false false false false true 253 0 true 1608 true false false false false false false false false false false false 0 false false false false false false false false false false false X 16 10 false false false false true true true true true false false false true true true true true true true true true true WI X X David Dirksmeyer 4147770960 N74W127501 Leatherwood Ct Menomonee Falls WI 53051 Stadelmann Douglas J 1.00 X X 0 0 0 Pollard Dennis 45.00 X X 0 525154 146611 Pieters Robert B 1.00 X X 0 0 0 Hart Daniel 1.00 X X 0 0 0 Bast Ronald R 1.00 X X 0 0 0 White MD Michael G 1.00 X 0 0 0 Turtenwald Robyn 1.00 X 0 0 0 Templin Susan 1.00 X 0 0 0 Specht-Palmert Christine 1.00 X 0 0 0 Shepherd MD Dennis W 1.00 X 0 0 0 Petasnick William D 1.00 X 0 6573439 67765 Lux Teresa M 50.00 X 215196 0 47701 Hackett MD James G 1.00 X 0 0 0 Goldberg MD David F 50.00 X 318793 0 80398 Ellis Sharon Q 1.00 X 0 0 0 Becker Richard C 1.00 X 0 0 0 Van De Kreeke Jeffrey 1.00 X 0 339273 102777 Bestor William E 0.00 X 1645153 0 19329 Evenson Rock E 50.00 X 200137 0 61464 Freiberg Kerry J 50.00 X 210401 0 48456 McClure Debra 50.00 X 294747 0 18295 Sanders Paul A 50.00 X 276406 0 36808 Zorbini John 0.00 X 0 299555 110206 Jacobson Catherine 0.00 X 0 797937 135753 3160833 8535358 875563 56 true true false Von Briesen & Roper 411 E Wisconsin Ave Ste 700 Milwaukee WI 53201 Legal 1495015 United Dynacare 9200 W Wisconsin Ave Milwaukee WI 53226 Lab 791402 Medical College of WI 8701 Watertown Plank Milwaukee WI 53206 Physicians 6931302 Critical Care Solutions N74W12501 Leatherwood Ct Menomonee Falls WI 53051 Virtual ICU 568798 Columbia St Marys 4425 N Port Washington Rd Glendale WI 53212 Physicians 1750493 15 0 Outpatient Revenue 900099 109547171 109547171 Inpatient Revenue 900099 55693906 55693906 Emergency/Trauma Revenue 900099 12181436 12181436 177422513 4914373 1742607 3171766 11694 11694 0 60623 34775 25848 25848 25848 112088025 560721 110871715 767356 1216310 -206635 1009675 1009675 55426 29816 25610 25610 0 0 Other Dept Operating Rev 561499 1978799 1978799 Corporate Allocated Rev 561000 3482189 3482189 Claims & Settlements 900099 15562935 15562935 1002640 1002640 22026563 205436276 200189043 5247233 50000 50000 0 0 0 639903 639903 0 59457862 55670891 3626032 160939 0 151784 140810 10564 410 4244864 3937960 295443 11461 269225 269225 2872564 2437792 434772 0 0 0 0 11016783 9980778 1035088 917 153600 4190 149410 1301712 572402 722575 6735 408598 60014 347929 655 0 3506159 2878975 621988 5196 75718 36096 39393 229 0 125965 108684 17111 170 2446298 2008703 433970 3625 0 8693380 7138302 1542194 12884 7483 7483 State Hospital Assessment 5335907 5335907 Provision for Uncollectible 6713000 6713000 Medical Supplies 33781085 33665809 112477 2799 Corporate Allocated Expense 37932736 15365721 22531814 35201 4154717 3994534 159277 906 183339343 150377276 32719940 242127 7300 7295 10956674 21754257 0 27698357 24095637 0 0 56000 20000 3880289 4149959 2556770 2126284 173808774 92431757 79311101 81377017 127517832 124482090 0 0 0 55468468 50278063 307452791 308290602 13245503 8803747 6648 5940 66424522 63386192 81989934 97825874 161666607 170021753 X 144898831 137302778 887353 966071 145786184 138268849 307452791 308290602 X 22096933 -29614268 X false true true X false false X 4674956 265167 80003 321940 9357 4688829 4094065 1398548 623704 374633 1066388 340 4674956 3166213 904863 384524 304571 56965 -1 4094065 1.00000 false true true 80711 80711 101701573 40471164 61230409 1791466 1611450 180016 33041647 22542545 10499102 37193377 27806598 9386779 81377017 Swap Collateral 3617702 Senior Management Deferred Compensation 520601 Rounding 2 Froedtert Health Executive 457f 219735 Executive Deferred Compensation 106062 Due from Employees Due from Affiliates 445008 Collateral held for securties loaned 33569426 50278063 Swap mark to market 7538027 Pension Liability 46632850 Payable under securities lending agreeme 33569426 Estimated Settlements Due to 3rd Parties 100000 Due to Affiliates 9985571 97825874 Part X Part X : FIN48 Footnote Froedtert Health (FH) applies ASC No. 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. ASC No. 740 prescribes a more likely than not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under ASC No. 740, tax positions are evaluated for recognition, derecognition, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2012 and 2011, FH does not have an asset or liability recorded for unrecognized tax positions. Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Transfers to Affiliates $562357 Change in Foundation Restricted Net Assets $78718 Change in APBO than net periodic benefit costs $ -22602174 Capital Contributions $ -1089500 Change in Foundation Unrestricted Net Assets $ -107 Other $ -15599 Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. The funds are held by Community Memorial Foundation of Menomonee Falls (CMF), a related organization. The board designated endowment was created to support long range financial needs of Community Memorial Hospital of Menomonee Falls, Inc and its affiliates. false Cheery Cherry Fall Fair 38398 38398 4944 2862 850 7982 Special Event Projects 6828 6828 5426 1 6781 6781 5282 52007 52007 4944 2862 850 18690 27346 24661 true true X true X true X true true true false true true 1512065 1512065 0.00860 8024271 4261470 3762801 0.02130 9536336 4261470 5274866 0.02990 46 12636 1605333 37544 1567789 0.00890 4 586 803628 803628 0.00450 16 1981 257490 257490 0.00150 66 15203 2666451 37544 2628907 0.01490 66 15203 12202787 4299014 7903773 0.04480 1 3616 3616 2 8488 8488 1 9094 9094 0.00010 1 4165 4165 3 176 163339 163339 0.00090 8 176 188702 188702 0.00100 false 2723072 44804615 49276903 -4472288 X true true 1 0 Community Memorial Hospital

W180 N8085 Town Hall Road Menomonee Falls WI 53051

X X X Community Memorial Hospital 1 true X X X X X X X X X true true true X X X X X X X X X X true true true 200.0000 true 400.0000 true X X X true true X X X true false X X X X true X false false Part VI - Additional Information Part V, Line 2: The last year a Needs Assessment was conducted at Community Memorial Hospital of Menomonee Falls was 2012. Part V - Explanation of Number of Facility Type Community Memorial Hospital is the only facility listed under this reporting of the IRS Form 990, Schedule H. Part VI - States Where Community Benefit Report Filed WI Part VI - Affilated Health Care System Roles and Promotion Every year, the Froedtert Health partners engage in a variety of outreach activities in collaboration with key leaders and organizations in their communities that help improve health and quality of life. Much more than the provision of charity care, the American Hospital Association defines community benefit as "promoting and protecting the health and well-being of the entire community through responsive programs and services." In FY2012, Froedtert, Community Memorial and St. Joseph's Hospitals made significant investments in the health of their communities. Patients who couldn't pay for their medical care received more than $49.2 million in uncompensated services. Beyond providing care for the poor, we contributed $76.7 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities.Froedtert Health members develop community benefit strategies and goals based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the hospitals have built important local relationships that provide meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes through health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert Health, visit www.froedterthealth.org. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose The Community Outreach Steering Committee (COSC) which is a subcommittee of the hospital's Board of Directors actualizes the mission of Community Memorial Hospital (CMH) through community benefit activities that improve the quality of life and enhance wellness resources which meet identified comprehensive health needs of the communities served. The Community Outreach Steering Committee is appointed annually by the hospital president and is advisory to the CMH Board and Administration. Membership appointments are made each June with members serving one year terms. The COSC meets quarterly and is composed of hospital and board representatives plus community members representing the various constituencies of the total service area. Functions include: o Provide a leadership role in advocating community wide responses to health care needs in the community. o Facilitate and support community and health care partnerships. o Envision, assess and guide new community benefit opportunities. o Identify and describe unmet health needs. o Promote universal access to health care. o Determine allocation of the Community Outreach Services Fund which awards $50,000 annually towards area non-profits efforts to improve health disparities focused on Access to Care, Mental Health/AODA, Chronic Disease Management and Prevention and Wellness in the communities CMH serves. o Annually submit a community benefit report, which describes the scope of community benefit provided directly and in collaboration with others.Addressing Needs Through Targeted Outreach:Community Memorial Hospital develops and executes community outreach programming and activities based on identified community health needs. Since 1990, CMH conducts needs assessments every three to four yeas in order to determine priorities and strategies in addressing community health disparities. Every needs assessment cycle, CMH Community Outreach staff along with the hospital's Community Outreach Steering Committee develops a community benefit plan which is incorporated into the hospital's overall strategic plan to address the most critical needs in the communities we serve. The plan is reviewed annually by the Community Outreach Steering Committee. CMH Community Outreach staff, leaders and external community partners work collaboratively to develop key goals and strategies to address community health needs. Progress towards community outreach programs/activities and goals are reported quarterly through the Community Outreach Steering Committee and the Board of Directors. Based on the results from the 2012 Community Health Needs Assessment, programs and activities are focused around the following identified health needs: - Access to Primary and Specialty Care - Mental Health/AODA - Chronic Disease Management - Prevention and WellnessFor more information on specific community outreach efforts, please refer to the 2012 Community Memorial Hospital Community Benefit Report by going to www.froedterthealth.org/community-memorial-benefit report.Drug Collection:As part of our commitment to improve the quality of life in our community, Community Memorial Hospital partnered with Waukesha County Drug Free Communities Coalition to host four drug collections since October 2009. At the collections, area residents dropped off over 3,000 pounds of prescription and over-the-counter medications. Close to 2,000 area households participated in the collections. This year alone close to 20 staff contributed over 150 hours of their time to make the collections possible. Flu Clinics:Community Memorial Hospital offers flu clinics for the public as part of its commitment to keep the community healthy. During the fall of FY12, over 100 people were immunized at the six area clinics amounting to a community benefit of close to $8,000. Each of the clinics was staffed by hospital pharmacists who were certified by the state to give immunizations.Athletic Trainer:When athletes at Menomonee Falls and Germantown High Schools prepare to compete, there is a Certified Athletic Trainer with them every step of the way. This service is provided by experienced athletic trainers from Community Memorial Hospital.The trainers work at the school each day, working evenings as well as Saturdays to provide training room, practice and event coverage. They prepare the athlete for their activities, which might include stretching, taping and treatment as needed. United Way Employee Giving Campaign:Community Memorial Hospital collaborates with United Way of Waukesha County to address community needs in the areas of meeting basic needs, developing self-reliance, strengthening communities, and community support. Community Memorial Hospital hosts an annual workplace giving campaign to support all local United Ways. Over 150 hours were spent coordinating the FY12 campaign. In addition to an employee campaign, Community Memorial Hospital matches donations up to $10,000. We also have a staff member that dedicated 50 hours to the United Way of Waukesha County's Leadership and Governance Committee and Executive Committee.Community Health & Wellness Initiative:Froedtert Health Community Memorial Hospital's on-campus garden is providing produce to members of the local community who may not readily have access to fresh vegetables.A community health survey conducted by the hospital in 2011 identified a need for affordable and healthy nutrition options for people who use Community Outreach Health Clinic and clients of area food pantries. The garden project is a great way to help those who have chronic conditions access nutritious vegetables through the hospital's community partners. This fall's harvest, which included tomatoes, cucumbers, zucchini, peppers and beans, was distributed directly to patients who use the outreach clinic and Sussex, Germantown and Menomonee Falls food pantry clients. Over 540 pounds of produce was donated this season.Community Outreach Health Clinic:The Community Outreach Health Clinic is a facility where people can seek medical care. The clinic serves people who do not have medical insurance or the ability to pay for medical care. The clinic provides quality, limited medical care with dignity and confidentiality using the services of volunteer professional staff.In Fiscal Year 2012, the clinic served 2,550 individuals representing a 10% increase compared to the prior fiscal year.Community Health Screenings:Community Memorial Hospital offers free blood pressure, skin cancer and sports injury screenings. With the goal to empower people and the community to make better decisions and take actions to improve and maintain their health, our community health screenings provide much needed access to services for many of our community members. In Fiscal Year 2012, Community Memorial Hospital conducted health screenings for close to 200 people. Bobbie Nick Voss Colonoscopies:Thanks to support of the Bobbie Nick Voss Charitable Foundation, Community Memorial was able to provide free colonoscopies to 20 at-risk individuals without health insurance. Funding from the grant allowed Community Memorial's community health educator to raise awareness about colorectal cancer and the importance of early detection at 28 public events - including flu clinics, health fairs, community events and senior forums.Leadership Quality Indicator:As an indication of the Community Memorial executive team's commitment to the community, 75 hospital leaders provided more than 1,000 hours of support to local initiatives, not-for-profit organizations and community events. Subsidized Transportation Program:The Subsidized Medical Transportation Program at Community Memorial Hospital provides transportation to and from the hospital service locations for eligible persons who have difficulty arranging their own transportation and lack the financial resources to purchase transportation. In 2012, Community Memorial provided 783 free or subsidized rides to 500 people who needed transportation to receive their health care. Community Outreach Steering Committee Grants:Community Memorial's commitment includes grants to local not-for-profit organizations that support community health improvement efforts focused on access to primary care, chronic disease management, mental health and prevention and wellness in the hospital's service area. In 2012, seven local non-profit organizations received grants totaling $50,000 from the Community Outreach Steering Committee. Health Care Career Academy:The Healthcare Career Academy provides qualified students entering their junior or senior year at Menomonee Falls High School, Germantown High School and Sussex Hamilton High School with the opportunity to expand their knowledge base as it relates to a wide array of professional healthcare career options. The three-week program allows students to shadow and learn from professionals in various clinical and ancillary departments throughout the hospital. Through observation, hands-on experience and classro Part VI - Community Building Activities To promote the health of our communities, Community Memorial Hospital participates in community building activities which are not included elsewhere on Schedule H. These activities include:1. Economic Development: participation in local chamber of commerce boards focused on economic development.2. Community Support: participation in local emergency preparedness and youth focused coalitions.3. Coalition Building: participation in local community groups and coordination of fundraising for the local United Ways.4. Community Health Improvement Advocacy: participation in creating the community health improvement plan with the local health department.5. Workforce Development: diversity training that recruits health professionals in our traditionally underserved community. Part VI - Community Information Since its founding in 1964 by the citizens of the community it serves, Community Memorial Hospital (CMH) has focused on the emerging healthcare and wellness needs of over 400,000 people in the four county region of Waukesha, Washington, and northwest Milwaukee Counties. Based on the US Census data, the population served by CMH is 77% Caucasian, 16% African American, 3% Asian, and 4% other races. 45% of households have a household income less then $50,000. 7% of the population does not have a high school diploma with 28% whose highest education level is a high school diploma. 34% of the population has a Bachelor's Degree or higher education. The most common occupations for our population is 19% manufacturing, 15% sales/office and 13% health care. Part VI - Patient Education of Eligibility for Assistance Community Memorial Hospital informs and educates patients regarding financial assistance and government program eligibility in a number of ways. Its communication efforts also address special needs of patients and their families, such as hearing or visual impairment or language interpretation.Information on hospital-based financial support policies and government programs are made available to patients during the pre-registration and registration processes through brochures, signage and direct contact with financial counselors, social workers / case managers and registration staff. Patient billing statements also inform patients that financial assistance is available. The Community Memorial Hospital website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. Community Memorial Hospital has made financial assistance forms and information available in Spanish. Financial counselors screen uninsured patients for government program eligibility and social services staff are available to assist patients with enrollment processes. Patients who are uninsured, those covered by government programs and those with limited financial means may also be eligible for charity care or discounts through the Hospital's financial assistance program. Financial counselors make every effort to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial assistance can be made during any stage of the patient's stay after stabilization, or the collection cycle. Part VI - Needs Assessment In February, 2012 Froedtert Health Community Memorial Hospital collaborated with JKV Research, LLC along with Aurora Health Care, Children's Hospital of Wisconsin, Columbia St. Mary's Health System, ProHealth Care, Wheaton Franciscan Healthcare, Washington County Health Department and Waukesha County Health Department to conduct a Community Health Needs Assessment (CHNA) in Washington and Waukesha Counties. The research from the needs assessment provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Waukesha County residents. CHNA Overview/Objectives: o Gather data on behavioral and lifestyle habits of the adult population and household-level data. o Gather data on the prevalence of risk factors and disease conditions of the adult population. o Compare health data of residents to previous health studies. o Compare health data to national and state measurements.CHNA Methodology: o 18 minute telephone survey of area residents o 400 completions from February 21 through April 3, 2012 o Two-fold sampling 1) RDD landline sample of listed & unlisted #s (n=300) o Respondents randomly selected based on number of adults in household o Weighting based on number of adults and number of residential phone numbers in household. 2) Cell phone only sample (n=100) o Adult answering the phone designated as the respondent o All data post-stratified by age and gender of adult residents as of 2010 Census proportions. o Margin of error: 5%The full report of the findings can be found at www.communitymemorial.com. In addition to the Washington/Waukesha County Community Health Needs Assessments, Community Memorial Hospital conducted key informant interviews with 35 individuals representing school district representatives, public health officials, non-profit health and human service professionals, churches, police/fire departments, free clinics and business professionals throughout Waukesha and Washington Counties. Following extensive interviews with key community stakeholders, findings from the assessment were categorized into eight areas: Access to Primary and Specialty Care, Chronic Disease Management, Mental Health Services, Prevention and Wellness, Alcohol, Drug, Tobacco, Abuse, Dental Services, Transportation and Other. Of those eight health needs categories, four were identified as the focus for community outreach activities in 2012 through 2016 based on select criteria: Community Health Priorities, Disproportionate Unmet Needs, Public Health Concerns and Scope of Services. The most critically documented health needs were identified: - Access to Primary and Specialty Care - Mental Health - AODA - Prevention and Wellness - Chronic Disease ManagementIn April 2011, Community Memorial Hospital Community Outreach Staff participated in the Waukesha County Public Health Department's Community Health Improvement Planning Process (CHIPP). The CHIPP consists of a steering committee representing all health systems in Waukesha County as well as representation from area non-profit health and human service agencies. The steering committee's role is to determine the top health priorities in the county and create an implementation plan to address community and health needs for Waukesha County Public Health Department to execute in 2012 - 2016. Through the work of the CHIPP Steering Committee, the following priorities have been determined: - Access to Care - Mental Health - AODAImplementation plans are currently being developed for the three priority areas and will be presented for adoption/implementation at the February 2013 Waukesha County Board Meeting. Number of Hospital Faciltiy - 0 Part V, Line 13g - Other Means Hospital Facility Publicized the Policy Community Memorial Hospital's Community Benefit Fact Sheet, which is available on its website and distributed to community stakeholders, includes highlights of Froedtert Health's financial assistance and billing highlights. Number of Hospital Faciltiy - 0 Part V, Line 11h - Other Factors Used in Determing Amounts Charged Patients Out of Pocket Maximum Discount Number of Hospital Faciltiy - 0 Part V, Line 5c - Description of Making Needs Assessment Widely Available The Community Health Needs Assessments for both Waukesha and Washington Counties are available through Community Memorial Hospital's website at www.communitymemorial.com and is also shared with hospital partners and supporting agencies. Number of Hospital Faciltiy - 0 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment Washington County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health Froedtert Health Community Memorial HospitalAurora Health CareColumbia St. Mary's Health SystemChildren's Hospital of WisconsinWashington County Public Health DepartmentWaukesha County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health Froedtert Health Community Memorial HospitalAurora Health CareColumbia St. Mary's Health SystemProHealth CareWheaton Franciscan HealthcareWaukesha County Public Health Department Number of Hospital Faciltiy - 0 Part V, Line 3 - Account Input from Person Who Represent the Community In fiscal year 2012 and in partnership with the Washington County/Waukesha County Community Health Needs Assessment, the following individuals/agencies were consulted to provide feedback on identified community health needs:Addiction Resource Council of Waukesha County - Claudia Roska, Executive DirectorAlbrecht Free Clinic - Jenny Zaskowski, Executive DirectorCommunity Outreach Health Clinic at Community Memorial Hospital - Linda Smith, APNPFalls Area Community Services - Kathy Wodushek, Executive DirectorGermantown Area Chamber of Commerce - Lynn Grgich, Executive DirectorVillage of Germantown Fire Department - Mathew Karpinski, CaptainGermantown Police Department - Peter Hoell, Police ChiefGermantown Park & Recreation Department - Brett Altergott, Park and Recreation DirectorGermantown School District - Cindy Dieringer, District NurseGloria Dei Lutheran Church - Julie Pekarske, Parish NurseHartford Jt 1 School District - Joan Schultz, Pupil Service AdministratorHartford Parks and Recreation Department - Mike Herman, DirectorHope Network Inc. - Laura Hensel, DirectorInterfaith Caregivers of Washington County - Debbie Genthe, Executive DirectorInterfaith Senior Programs Waukesha County - Margaret Cory, Mobility ManagerMenomonee Falls Chamber of Commerce - Toni Yates, Executive DirectorMenomonee Falls Community Education & Recreation Department - Joan Erickson, DirectorMenomonee Falls Fire Department - Jeff Hevey, Fire ChiefMenomonee Falls Police Department - Anna Ruzinski, Police ChiefMenomonee Falls School District - Julie Italiano-Thomas, District NursePregnancy Support Connection - Nancy Major, Executive DirectorSt. Boniface Food Pantry - Charlene Matson, CoordinatorSt. Paul's United Church of Christ - Laura Blanco, PastorStillwaters Cancer Support Services - Theresa Reagan, Executive DirectorSussex Area Chamber of Commerce - Kahtryn Wagner, Executive DirectorSussex Area Outreach Services - Aaron Schmalze, Executive DirectorSussex Hamilton School District - Kristin Hasbrook, Student Assistance Program CoordinatorTri-County YMCA in Menomonee Falls - Geoff Mertens, Center ExecutiveUniversity of Wisconsin Extension Washington County - Marma McIntee, Family Living CoordinatorWashington County Mental Health Department - Jim Strachota, DirectorWashington County Public Health Department - Linda Walter, Health OfficerWaukesha County Community Dental Clinic - Renee Ramirez, Executive DirectorWaukesha County Mental Health Department - Mike DeMares - ManagerWaukesha County Public Health Department - CHIPP Subcommittee Part III, Line 9b - Provisions On Collection Practices For Qualified Patients In alignment with the Froedtert Health financial assistance policy regarding the billing, collection and support for patients with payment obligations, Community Memorial Hospital makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) are trained regularly about these policies with an emphasis on treating all patients with dignity and respect regardless of their insurance or their ability to pay for services. Part III, Line 8 - Explanation Of Shortfall As Community Benefit Community Memorial Hospital believes that all of the $4,472,288 shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. Part III, Line 4 - Bad Debt Expense Community Memorial Hospital reports accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and others. Community Memorial Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions and trends.The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part I, Line 7, Column F - Explanation of Bad Debt Expense Our total expense from Form 990, Part IX, line 25, column (A) was $183,339,343. The bad debt expense included in this amount was $6,713,000. This left us with a total expense of $176,626,343 for the purposes of calculating line 7, column (f). Part I, Line 7 - Explanation of Costing Methodology Charity Care and certain other community benefits costs were determined by using internal information to reduce the various activities to cost. We try to present cost information consistently in the different venues that it appears. true Other Grants 5000 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) 18000 0 Various Community Outreach Health Clinic W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 501(c)(3) 32000 0 Support operations of clinic 7 0 Grantmaker's Description of How Grants are Used Organizations submit grant requests to the Community Outreach Steering Committee (the Committee). On a quarterly basis the fund allocations are determined. Each organization selected for funds receives an award letter detailing the expectations and conditions of the grant money. In order to comply with applicable tax laws, regulations and the Community Outreach Services Fund policy, the Community Outreach Services Fund will provide grant support to organizations with the understanding that:1) Grant funds distributed will be used only for the purposes designated in the award letter.2) No funds will be used for any political campaign or to support attempts to influence legislation of any governmental body. 3) If the organization loses exempt status, any unexpended funds will be returned to the Community Outreach Steering Committee.4) Adequate accounting records of the expenditures of funds will be maintained by the organization.5) This is a one time grant distribution. Future funding requests will be considered on a case by case basis. In addition, the Committee includes a "Final Report Form" with each organization's award letter. The form requires the organization to provide a brief description of the activity and measurable outcomes/benefits, an expenditure report, and future plans. The Committee requests that each organization submit the "Final Report Form" to the Committee within thirty days after the completion of the project for which the funds were intended or within a maximum of one year from the receipt of funds. X false true X X X X X true true false false false false false true false false Zorbini John 192008 8817 98730 94954 15252 409761 62 Van De Kreeke Jeffrey 259313 58221 21739 85447 17330 442050 Sanders Paul A 174886 66101 35419 14032 22776 313214 Pollard Dennis 402248 96197 26709 120442 26169 671765 Petasnick William D 769113 672530 5131796 15925 51840 6641204 4891208 McClure Debra 269226 5602 19919 5716 12579 313042 Lux Teresa M 161036 37214 16946 37584 10117 262897 674 Jacobson Catherine 629796 163401 4740 110234 25519 933690 Goldberg MD David F 254476 55858 8459 50111 30287 399191 Freiberg Kerry J 169904 32002 8495 37086 11370 258857 137 Evenson Rock E 153343 27971 18823 37233 24231 261601 162 Bestor William E 14329 1630824 19329 1664482 1440599 Sch J, Part III, Additional Information Part III, Additional Information Part II, Column (B)(ii): Bonus and incentive compensation amounts include incentive compensation and amounts paid to individuals in lieu of participation in 457(f) deferred compensation plan for the purchase of benefits. Sch J, Part I, Line 7 Part I, Line 7: Non-Fixed payments not listed above Certain management employees participate in an incentive compensation plan that includes some non-fixed elements. Upon the attainment of a certain financial threshold, incentive compensation is available for meeting identified goals in the areas of financial performance, operational efficiencies, quality improvements, customer satisfaction, strategic growth and partnership initiatives. In some cases the determination of whether a goal is met is absolute while others require a certain amount of discretion to determine if goal is met. In addition, the incentive compensation includes a purely discretionary component. Sch J, Part I, Line 1b Part I, Line 1b: Reason for not following policy regarding payment provisions for expenses Health club membership subsidy/discount is a benefits program applicable to all employees and is documented in the benefit program documents. Dining club membership is specified in the written employment contract which was approved by the Compensation Committee. Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Discounted or subsidized health club membership is available to all employees. Dining Club membership for President used for business purposes. All amounts included in taxable compensation. Carrie Fitzgerald Hart See Schedule O 164058 Employment false Schedule L - Part IV (b) Carrie Fitzgerald Hart - Husband, Daniel Hart, is a director. Part VII - Section A 1a, Column B Approximate hours per week spent working on related entities:Bast - 2 hoursBecker - 1 hourEllis - 1 hourFreiberg - 1 hourHart - 1 hourJacobson - 49 hoursPetasnick - 53 hoursPieters - 1 hourPollard - 6 hoursTemplin - 1 hourVan De Kreeke - 50 hoursZorbini - 40 hours Part VII - Section A 1a Columns C-F Individuals listed as 'former' but receiving compensation during the year is due to the fact the individual is currently, or was during the tax year, still employed by the organization, but is no longer in the role of director, officer, key employee, etc. in the current year, but was reported as such on the organization's 990 in the previous five years. Part IX 24a Corporate Allocations Froedtert Health allocates its revenues and expenses to Froedtert Memorial Lutheran Hospital, Community Memorial Hospital of Menomonee Falls, St. Joseph's Community Hospital, Froedtert Physician Partners and West Bend Clinic. The allocation is calculated by applying an allocation metric to each accounting unit at Froedtert Health, including a flat percentage, percentage of gross revenue to total, percentage of supply expense to total, etc. Each entity then receives its portion of the Froedtert Health allocation on a monthly basis. Part IV, Line 24 Even though the liability is on the books of Community Memorial Hospital of Menemonee Falls, this question was answered no, as Schedule K will be completed on the Form 990 of the parent corporation, Froedtert Health, Inc. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Comunity Memorial Hospital of Menomonee Fall's quarterly financial information is made available to the public through the Digital Assurance Corporation, Inc. website. Additionally, Governing Documents and Conflict of Interest Policy are made available to the public through the corporate office upon request. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees In establishing the compensation of the organizations CEO/Top Management, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, and amounts are reviewed and approved by the Compensation Committee of the Board of Directors. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts On an annual basis all officers, directors, trustees, key employees are required to complete a conflict of interest disclosure statement. The data is compiled, and the Vice President-Chief Compliance Officer (CCO), the Vice-President-General Counsel and/or delegate will review all forms and notifications to determine if any conflicts of interest exist in the disclosure documents. If it is determined that a conflict of interest exists, then the person making the disclosure shall be relieved of his/her obligations on behalf of a FH affiliate with respect to the transaction or arrangement that creates the conflict of interest. A report of all conflicts of interest will be made by the CCO at least annually to the Finance Committee of the Board of Directors. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process Froedtert Health accounting staff prepare Form 990 which is reviewed by the Corporation's financial leaders and legal counsel. The 990 is then reviewed by KPMG, the Corporation's outside accounting firm. Next, the 990 is provided to the Corporation's Finance Committee and Board of Directors. Finally, the 990 is filed as required. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders As the sole corporate member of Froedtert Memorial Lutheran Hospital, Community Memorial Hospital of Menomonee Falls, St. Joseph's Community Hospital of West Bend, West Bend Clinic and Froedtert Physician Partner's, Froedtert Health (FH) retains certain reserved powers over each of these affiliates (the Affiliated Entities). The corporate Bylaws of FH and the Affiliated Entities provide that FH has the authority to direct the activities of FH and the Affiliated Entities, including the following:a) Develop and revise FHs Strategic and Financial Plan, and approve, develop or revise any strategic plans relating to the Affiliated Entities;b) Approve, develop or revise capital and operating budgets for FH and the Affiliated Entities;c) Approve all requests by FH and the Affiliated Entities to borrow or loan funds, incur debt, guarantee a loan, or enter into similar debt obligations in excess of the financial levels specified;d) Make all expenditures of FH and approve all proposed capital expenditures entered into by the Affiliated Entities in excess of the financial levels specified;e) Approve all affiliations, partnerships, joint ventures, acquisitions, divestitures, dissolutions, sales, mergers and similar corporate transactions involving FH and/or an Affiliated Entity;f) Engage in consolidated cash management, transfer and/or consolidate funds of the Affiliated Entities, and direct the members of an obligated group to take actions to cause all the outstanding debt of the obligated group members to be evidenced by notes issued under the same Master Trust Indenture; andg) Develop and revise any capital and operating budget parameters for the Affiliated Entities. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Froedtert Health, Inc., as the member of Community Memorial Hospital of Menomonee Falls, has the final approval of election of all board members. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Froedtert Health, Inc. is the member of Community Memorial Hospital of Menomonee Falls. West Bend Surgery Center LLC 1710 Vogt Drive West Bend WI 53095 391954169 Surgical Services WI West Bend Clinic Inc Froedtert Physician Partners Inc 9200 W Wisconsin Ave Milwaukee WI 53226 272042610 Health Care Services WI 501(c)(3) 3 Froedtert Health Inc false QHS 1 Inc 19601 W Bluemound 2nd Flr Brookfield WI 53045 202636686 Health Care Services WI 501(c)(3) Ln 11, Type 1 Froedtert Health Inc false Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 391431192 Health, Welfare, Research and Education Promotion WI 501(c)(3) Ln 11, Type 1 Froedtert Memorial Lutheran Hospital false St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend WI 530953686 392034296 Health and Welfare Promotion WI 510(c)(3) Ln 11, Type 1 St Josephs Community Hospital Inc false West Bend Clinic Inc 1700 W Paradise Drive West Bend WI 53095 392034294 Health Care Services WI 501(c)(3) 3 Froedtert Health Inc false St Josephs Community Hospital Inc 3200 Pleasant Valley Road West Bend WI 530953868 390806302 Hospital Care Services WI 501(c)(3) 3 Froedtert Health Inc false Froedtert Memorial Lutheran Hospital Inc 9200 West Wisconsin Avenue Milwuakee WI 532263522 396105970 Hospital WI 501(c)(3) 3 Froedtert Health Inc false Community Memorial Foundation W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635057 Health and Welfare promotion WI 501(c)(3) Ln 11, Type 1 Community Memorial Hospital of MF false Community Outpatient Health Services W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 Outpatient Medical and Dental Services WI 501(c)(3) 3 Community Memorial Hospital of MF false Froedtert Health Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 392014409 Management Services WI 501(c)(3) Ln 11, Type 111 NA false FHHP LLC 9200 W Wisconsin Ave Milwaukee WI 53226 452221564 Health Care WI na false false Fitness Development Associates LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 391936497 Real Estate WI NA false false Milwaukee Center of Diagnostic Imaging 5775 Wayzata Boulevard Suite 400 St Louis Park MN 55416 411748361 Health Care WI NA false false FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 260629591 Real Estate WI na false false Progressive Physician Network Inc 9200 West Wisconsin Avenue Milwaukee WI 53226 270367127 Management Services WI Froedtert Health Inc C Kettle Moraine Anesthesiology Inc PO Box 8031 Appleton WI 54912 141842439 Health Care WI West Bend Clinic Inc C Community Ventures of Menomonee Falls W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635059 Inactive WI CMH of MF C 1.00000 false true true false false false false false false false false true true true true true true true