2012-05-09T12:14:06-07:00 2011-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2010-07-01 390987025 Community Memorial Hospital of Menomonee Falls Inc COMM 4147770960 W180 N8085 Town Hall Road Menomonee Falls WI 53051 Jeffrey Van De Kreeke 2012-05-09 2010 2016-02-24 21:20:13Z Petasnick William D W180 N8085 Town Hall Road Menomonee Falls WI 53051 312995448 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 1554 206 157618 114 175412913 178537645 5461085 9028823 2891106 9591746 183765104 197158328 50000 47500 0 64859051 68218146 0 232396 110210162 122229121 175119213 190494767 8645891 6663561 305532900 307452791 178937983 161666607 126594917 145786184 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 96626143 112194355 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 approved for 237 beds of which 202 are staffed - and had 9,449 patient admissions and 43,164 patient days related to a wide range of inpatient services, including internal medicine, psychiatry, cardiology, general surgery, orthopedics, rehabilitation services, obstetrics and maternity care, pulmonary medicine, and other specialty care for the twelve months ended June 30, 2011.Community Memorial's heart surgery program is the third largest in southeastern Wisconsin. 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. The growing demand for robotic-assisted laparoscopic surgery has been driven by improved outcomes such as less pain, shorter recovery time and fewer complications. During fiscal year 2011, Community Memorial had 15,093 cardiac procedures.In 2008, the Cancer Care Center at Community Memorial received the prestigious American College of Surgeons Commission on Cancer Outstanding Achievement Award, affirming its commitment to high-quality cancer care. The award recognizes cancer programs that provide the highest quality care to cancer patients and is received by only 66 programs in the US annually. During fiscal year 2011, Community Memorial had 554 cancer registry cases.The Birthing Center at Community Memorial includes 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 2011, Community Memorial had 987 births.In addition to the cardiac, cancer care and birthing services noted above, the Hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including but not limited to the following: - Surgeries: 3,648 - Laboratory Tests: 426,453 - CT Scans: 4,623 - Medical Imaging Exams: 16,615 - MRI's: 902 - Nuclear Medicine Scans: 328 - Ultrasounds: 3,012 52792830 61298706 Outpatient Services:Community Memorial had 92,249 outpatient visits in the twelve months ended June 30, 2011. Community offers a wide variety of ancillary, specialty and subspecialty services including but not limited to the following: - 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 - Thoracic Surgery 4344591 5044583 Emergency Services:Community Memorial's Emergency Department is a Level III Trauma Center and provides around-the-clock emergency care for adults and children throughout northern Waukesha, Milwaukee, and Washington counties. During fiscal year 2011, the emergency department had 20,167 emergency visits, with patients receiving expert care from board-certified emergency physicians and specialists in trauma, neurosurgery, cardiology, orthopedics and others. 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, pharmacists, technicians and more all working in a coordinated, collaborative system. 153763564 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 true true false false false false false true true false false false false true 271 0 true 1554 true true true 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 false false false false true true true true true true true true true true WI X David Dirksmeyer 4147770960 N74W127501 Leatherwood Ct Menomonee Falls WI 53051 Zorbini John 0.00 X 0 325769 34625 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 Stadelmann Douglas J 1.00 X X 0 0 0 Specht-Palmert Christine 1.00 X 0 0 0 Shepherd MD Dennis W 1.00 X 0 0 0 Sanders Paul A 50.00 X 321330 0 38353 Pollard Dennis 45.00 X X 0 476288 42573 Pieters Robert B 1.00 X 0 0 0 Petasnick William D 1.00 X 0 1302731 726685 O'Connell Blaine J 1.00 X 0 598091 32708 Lux Teresa M 50.00 X 219722 0 25148 Jacobson Catherine A 1.00 X 0 426832 5511 Hart Daniel 1.00 X X 0 0 0 Hackett MD James G 1.00 X 0 0 0 Goldberg MD David F 50.00 X 227769 0 32202 Freiberg Kerry J 50.00 X 214276 0 33200 Evenson Rock E 50.00 X 257460 0 38619 Ellis Sharon Q 1.00 X 0 0 0 Debra McClure 50.00 X 273650 0 17231 Bestor William E 0.00 X 331897 0 0 Becker Richard C 1.00 X X 0 0 0 Bast Ronald R 1.00 X X 0 0 0 1846104 3129711 1026855 51 true true false Von Briesen & Roper 411 E Wisconsin Ave Ste 700 Milwaukee WI 53201 Legal 563505 Pyramid Healthcare Solutions PO Box 17389 Clearwater FL 33762 HIM Outsourcing 632546 Medical College of WI 8701 Watertown Plank Rd Milwaukee WI 53206 Physicians 2109229 Critical Care Solutions N74W12501 Leatherwood Ct Menomonee Falls WI 53051 Virtual ICU 543749 Columbia St Marys 4425 N Port Washington Rd Glendale WI 53212 Physicians 3003989 16 114 114 Outpatient Revenue 900099 61298706 61298706 Inpatient Revenue 900099 112194355 112194355 Emergency/Trauma Revenue 900099 5044584 5044584 178537645 4907585 1554499 3353086 5221 5221 0 1002484 466390 536094 536094 76608 459486 115743784 3704889 112535123 2797533 3208661 907356 4116017 4116017 79260 114 38074 41186 41186 0 0 Other Dept Operating Rev 561499 1612384 1531374 81010 Dietary Revenue 561499 657699 657699 Corporate Allocated Rev 561000 6505710 6505710 238673 238673 9014466 197158328 188129228 157618 8871368 47500 47500 0 0 0 573076 573076 0 62736084 57850946 4740110 145028 0 473041 432738 39215 1088 4435945 4058002 367740 10203 282000 282000 878067 601235 276832 0 0 0 0 12881102 11704223 1176879 133312 7372 125940 36044982 35575911 461501 7570 497886 141674 356212 0 4418475 3603708 803279 11488 65691 30305 34489 897 0 116108 97359 18629 120 2211530 1803724 402056 5750 0 7362794 6005095 1338556 19143 8522 8522 State Hospital Assessment 5472253 5472253 Provision for Uncollectable 4810000 4810000 Dues & Subscriptions 308295 107308 200238 749 Corporate Allocations 40780214 15189030 25560824 30360 Clinic Practice Fee 5898963 5898963 58927 35696 23231 190494767 153763564 36498807 232396 539468 7300 7199533 10956674 0 20690343 27698357 0 0 1675089 56000 3726241 3880289 3131291 2556770 164657016 85345915 85642186 79311101 134375008 127517832 0 0 0 48553741 55468468 305532900 307452791 12113961 13245503 6955 6648 69223820 66424522 549764 97043483 81989934 178937983 161666607 X 125905277 144898831 689640 887353 126594917 145786184 305532900 307452791 X 6663561 12527706 X false true true X false false X 4094065 1398548 623704 374633 1066388 340 4674956 3166213 904863 384524 304571 56965 -1 4094065 3670185 484004 -466270 353150 168686 -130 3166213 1.00000 false true true 724692 724692 95689233 35793919 59895314 2096307 1715708 380599 33151773 26607724 6544049 32995011 21228564 11766447 79311101 Senior Management Deferred Compensation 71048 Rounding 1 FH Executive Reitirement 457f 131947 Executive Deferred Compensation 2168463 Due from Employee 36 Due from Affiliates 924482 Collateral held for securties loaned 40906676 55468468 Pension Liability 24121954 Payable under securties lending agreemen 41165484 Market Adjustment - Swaps 3249632 Due to Affiliates 13452864 81989934 Part X Part X : FIN48 Footnote Froedtert Health applies ASC No. 740, Income Taxes (formerly FIN 48), 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, 2011 and 2010, FH does not have an asset or liability recorded for unrecognized tax benefits. Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Pension Adjustment $7174999 Change in Foundation Restricted Net Assets $197713 Transfers to Affiliates $ -2503709 Capital Contributions $ -1113204 Change in Foundation Unrestricted Net Assets $ -1045499 Other $ -10417 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 57869 57869 5803 4120 9902 Special Event Projects 10550 10550 8318 1 7673 7673 6021 76092 76092 5803 4120 24241 34164 41928 true true X true X true X true true false false true true 1184023 1184023 0.00620 9304283 6790203 2514080 0.01320 10488306 6790203 3698103 0.01940 56 14065 2171295 42650 2128645 0.01120 6 693 917077 2000 915077 0.00480 19 3550 325124 23715 301409 0.00160 81 18308 3413496 68365 3345131 0.01760 81 18308 13901802 6858568 7043234 0.03700 1 2847 2847 2 13526 13526 0.00010 2 32035 32035 0.00020 1 2688 2688 1 83639 83639 0.00040 7 134735 134735 0.00070 false 2283044 46789974 58562176 -11772202 X true true 1 0 Community Memorial Hospital

W180 N8085 Town Hall Road Menomonee Falls WI 53051

X X X X Community Memorial Hospital 1 true X X X X X X X X X 10 true true true X X X X X X X X X true true true 200.0000 true 400.0000 true X X X true true X true X X X true X X X X X X X true X true true 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." Froedtert Health strategies are based on the unique needs of each of the communities that we serve. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the FH partners have built important relationships with their local communities, and are committed to providing meaningful outreach programs that link each hospital to their neighbors and patients.In 2011 FY, 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 $40.7 million in uncompensated services. Beyond providing care for the poor, we contributed $58.6 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, and are held accountable for achieving, community benefit goals and strategies are 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 member partners have built important local relationships and are committed to providing 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, 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) 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:-Provide a leadership role in advocating community wide responses to health care needs in the community.-Facilitate and support community and health care partnerships.-Envision, assess and guide new community benefit opportunities.-Identify and describe unmet health needs.-Promote universal access to health care.-Determine allocation of the Community Outreach Services Fund.-Annually submit a community benefit report, which describes the scope of community benefit provided directly and in collaboration with others. 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, northwest Milwaukee, and Ozaukee 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. Today, CMH ranks as one of the top hospitals nationally based on surveys by the Joint Commission on Accreditation of Healthcare Organizations, which reviews all hospitals for safety and quality healthcare practices. The Hospital has 202 staffed beds and a medical staff of 657 physicians in 49 specialties, over 1,400 employees and 320 volunteers caring for 9,845 inpatients, 87,249 outpatients and 19,596 emergency visits in fiscal 2010. Based on demographic and community needs assessments, CMH has led area community based hospitals by establishing programs in hospital based day surgery, cardiac rehabilitation, and the "Right from the Start" birthing program which matches a personal obstetrics case manager with first time expectant mothers. CMH is accredited by Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), the American Association of Cardiovascular & Pulmonary Rehabilitation, the American College of Radiology (ACR), the Intersocietal Commission for Accreditation of Echocardiography, the College of American Pathologists (CAP), the American College of Surgeons (ACS), and is licensed by the State of Wisconsin. And, eight area institutions of higher learning send students to CMH for clinical experiences in health care. CMH is more than a healthcare facility; it is a true community partner, joining forces with other organizations who share our vision and values. Our collaborative initiatives include outreach to youth, elderly and the underserved; satellite rehabilitation clinics offering outpatient therapy; community education in parenting and wellness topics; health screenings and support groups; a program for lab house calls to the homebound; and serving as the medical control center for five area Emergency Medical Service units. In July 2009, the American Diabetes Association acknowledged Community Memorial as having a Recognized Diabetes Self Management Education Program for outpatients. In January 2010, Community Memorial received the Gold Recognition as a Wellness Council of America Well Workplace organization, an award that recognizes quality and excellence in worksite health promotion. Also in 2010, the Cancer Care Center received Accreditation with Commendation from the American College of Surgeons - Commission on Cancer. Community Memorial was also recognized as a Quality Respiratory Care Recognition Hospital in 2010. Only 700 hospitals in the U.S. have been named a QRCR institution. The hospital received certification as a Level III Trauma Center in January 2010 and was awarded certification for its Stroke program from the Joint Commission in February 2010. Part VI - Patient Education of Eligibility for Assistance Community Memorial Hospital (CMH) has a Financial Counselor who performs outreach to all self pay patients. Contact may be in person or via phone call to patient. The patient is screened for eligibility for state/local programs and/or CMH's Financial Assistance program. Information regarding our financial assistance program is also available in our registration areas, in our ED, and is noted on our billing statements. In addition, during our billing call cycle, if a patient indicates they are unable to pay, they are screened for eligibility for Financial Assistance. Part VI - Needs Assessment In the February, 2011 a community health needs assessment was conducted for Froedtert Health Community Memorial Hospital (Menomonee Falls, WI) and Froedtert Health St. Joseph's Hospital (West Bend, WI) by Community Outreach/Public Relations Department staff along with members from the CMH Community Outreach Steering Committee. The community needs assessment team consisted of the following individuals: Andy Dresang, Dianna Forrester, Kerry Freiberg, Jeff Hevey, Amy Maurer, Deb McCann, Geoff Mertens, Mandie Reedy, Timothy Smykal, Sally Slusser, Lisa Susen-Sullivan and John Wandschneider.The community health needs assessment findings are a compilation of state, county and community health assessments along with interviews from 35 different community informants ranging from 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. This needs assessment is based upon available statistical data as well as anecdotal information from knowledgeable community informants. Since the assessment was prepared for guiding the CMH community outreach programs, the investigation focused on assessing the needs and service gaps as it pertains to the general population and the disadvantaged populations, i.e., people with disproportionate unmet health needs in the hospital's primary service area. The findings of the Assessment were summarized with the top four strategic priorities being identified as Access to Primary and Specialty Care, Chronic Disease Management, Prevention and Wellness and Mental Health. The Community Outreach Steering Committee re-affirmed the findings and through an interactive process establishing the strategic vision, goals and community outreach priorities for Fiscal Year 2012 through 2015. Number of Hospital Faciltiy - 0 Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services Patients who do not qualify for a self pay discount according to the policy. Number of Hospital Faciltiy - 0 Part V, Line 20 - Explanation of Eligible Assistance Patients Billed More Than Insurance Rates Patient who may qualify for a financial assistance discount, but refuse to comply with the policy are not given a discount. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance According to our self-pay discount policy. 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 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment In the February, 2011 a community health needs assessment was conducted for Froedtert Health Community Memorial Hospital (Menomonee Falls, WI) and Froedtert Health St. Joseph's Hospital (West Bend, WI) by Community Outreach/Public Relations Department staff along with members from the CMH Community Outreach Steering Committee. Number of Hospital Faciltiy - 0 Part V, Line 3 - Account Input from Person Who Represent the Community The community health needs assessment findings are a compilation of state, county and community health assessments along with interviews from 35 different community informants ranging from 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. This needs assessment is based upon available statistical data as well as anecdotal information from knowledgeable community informants. Since the assessment was prepared for guiding the CMH community outreach programs, the investigation focused on assessing the needs and service gaps as it pertains to the general population and the disadvantaged populations, i.e., people with disproportionate unmet health needs in the hospital's primary service area. The findings of the Assessment were summarized with the top four strategic priorities being identified as Access to Primary and Specialty Care, Chronic Disease Management, Prevention and Wellness and Mental Health. The Community Outreach Steering Committee re-affirmed the findings and through an interactive process establishing the strategic vision, goals and community outreach priorities for Fiscal Year 2012 through 2015. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it; the account is referred back for a financial assistance review. Part III, Line 8 - Explanation Of Shortfall As Community Benefit Community Memorial Hospital believes that all of the $11,772,202 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 Line 1 - 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.Line 2 - 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. Line 3 - 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 - 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) 20500 0 Various Community Outreach Health Clinic W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 501(c)(3) 27000 0 Support operations of clinic 10 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 your 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 239090 69704 16975 16114 18511 360394 Sanders Paul A 255890 48347 17093 15503 22850 359683 Pollard Dennis 333730 128486 14072 12880 29693 518861 Petasnick William D 948461 334370 19900 675099 51586 2029416 O'Connell Blaine J 454374 125145 18572 15925 16783 630799 Lux Teresa M 161122 45700 12900 10753 14395 244870 Jacobson Catherine A 218832 208000 5511 432343 Goldberg MD David F 222769 5000 12720 19482 259971 Freiberg Kerry J 137149 40754 36373 13675 19525 247476 Evenson Rock E 151619 36009 69832 15572 23047 296079 Debra McClure 273068 582 6971 10260 290881 Bestor William E 331897 331897 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. Applicable severance payments are reflected in Schedule J, Part II. Riteway Bus Services See Sch O 55852 Transportation Services false Carrie Fitzgerald Hart See Sch O 144068 Employment false Schedule L - Part IV (b) Carrie Fitzgerald Hart - Husband, Daniel Hart, is a directorRiteway Bus Services - Entity more than 35% owned by Ron Bast, director. Part VII - Section A 1a, Column B Approximate hours per week spent working on related entities:Petasnick - 55 hoursPollard - 6 hoursZorbini - 50 hoursFreiberg - 1 hourJacobson - 55 hoursO'Connell - 55 hoursPieters - 1 hourEllis - 1 hourTemplin - 1 hourBecker - 1 hourHart - 1 hourBast - 3 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 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 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 Governing Documents, COI Policy and Financial Statements are 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/Directors/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 Froedtert Health 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 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 Horizon Ventures Limited LLC W180 N8085 Town Hall Road Menomonee Falls WI 53051 391855822 Lessor of Medical Office Building WI 600000 NA 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 N74 W12501 Leatherwood Court Menomonee Falls WI 530514480 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 1 NA false FHHP LLC 9200 W Wisconsin Ave Milwaukee WI 53226 452221564 Health Care WI na n/a 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 W Wisconsin Ave 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 W180N8085 Town Hall Road Menomonee Falls WI 53051 391635059 Inactive WI NA C 1.00000 false true true false false false false false true false false true true true true true true true