2012-10-25T12:44:42-05:00 2011-12-31 861065772 Deloitte Tax LLP 111 South Wacker Drive Chicago IL 60606 990 2011-01-01 391351584 Alexian Village of Milwaukee Inc ALEX 4143559300 9301 N 76th Street Milwaukee WI 532231074 Gary Mohn 4143559300 2012-10-25 1 Laura Gillespie P00855604 3124861000 2011 2016-02-24 21:20:13Z Gary Mohn 9301 N 76th Street Milwaukee WI 532231074 23207132 0 0928 X alexianbrothers.net X 1980 WI AVM carries out the healing mission of the Catholic Church (See Schedule O)as an Alexian Brothers ministry by identifying and developing effective responses to the health and housing needs of those we are called to serve. 6 5 410 180 0 0 103267 149588 22465859 22728492 225264 329052 0 0 22794390 23207132 0 0 0 0 11596672 11668165 0 0 7082 9926513 10436644 21523185 22104809 1271205 1102323 42306124 43174872 26148385 25954967 16157739 17219905 X Alexian Village of Milwaukee, Inc. ("AVM") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health and housing needs of those we are called to serve. 0 0 8568157 9765379 AVM is a Continuing Care Retirement Community, which includes a Skilled Nursing Facility (SNF). Our SNF, inspired by the healing mission of the Alexian Brothers to the elderly, provides a continuum of care to residents that maximize dignity and independence. Rooted in the Catholic tradition of caring, the staff is committed to promoting the well-being of those we serve through the delivery of quality care. The SNF has 108 beds with an average occupancy of 96. In 2011, 10,270 days of care were provided to Medicaid recipients. 7,278 days were provided to Medicare recipients. Reimbursement for Medicaid residents was approximately $704,044 less than costs. 3217405 3712611 AVM has an Assisted Living Facility (AL). Licensed as a Community Based Residential Facility (CBRF) this area cares for 78 persons each day. The residents need support 24 hours a day ranging from simple assistance to those with severe signs of dementia. Regardless of one's ability to pay, AVM continues to provide care for its residents. In 2011 approximately $73,000 of charity care was provided. In addition, we were reimbursed approximately $70,000 for Medicaid residents living in this area. For all levels of care we maintain an active Pastoral Care staff that visits residents frequently, provides daily mass and pastoral counseling. All religions are supported. 6608015 8529445 AVM includes Independent Apartments. AVM has 242 independent apartments and averages 276 persons. Most AVM residents have a Life Care contract whereby AVM agrees to provide services in our SNF and AL areas at their apartment rent plus a small additional fee, for the rest of the resident's life. Rental contracts are also available. On all levels of care, where reimbursement is less than cost, AVM absorbs the difference in meeting its mission to the community. This is regardless of race, creed, sex, origin, handicap, age or ability to pay. Residents and employees are active in providing support to our local community through such things as tutoring, and providing meals to the homeless. Regardless of one's ability to pay, AVM continues to provide care for its residents. 753902 721057 Alexian Village of Milwaukee, Inc. offers Adult Day Care and other programs. The Adult Day Center is a social model that offers services for the surrounding community. Over half of the clients qualify for the Medicaid program. The services offered to the community include educational, fitness, memory and wellness programs. Strengthened by community, prayer, commitment to the poor, and the legacy of its founders, the Alexian Brothers witness the healing Christ by a holistic approach to promoting health and caring for the sick, dying, aged and unwanted. 753902 721057 19147479 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 47 0 1 410 1 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X Tom McCormick 4143559300 9301 N 76th Street Milwaukee WI 532231074 X Gary Mohn 40.00 X X 0 221389 59859 Curtis A Paulsen 1.00 X X 0 0 0 Edward M Brady CPA CVA 1.00 X 0 0 0 Jean Casey 1.00 X 0 0 0 Brother Daniel McCormick CFA 1.00 X 0 0 0 Mark Larson 1.00 X 0 0 0 James Sances 1.00 X 0 642540 143948 Virginia Golembiewski 1.00 X 0 69801 16144 Jim Lewandowski 1.00 X 0 372210 66995 Tom McCormick 40.00 X 0 110563 10687 Debbie Curran 40.00 X 111294 0 4425 Renee Bielinski 40.00 X 116152 0 1107 227446 1416503 303165 2 0 1 0 Aegis Therapy PO Box 8103 Fort Smith AR 72902 Therapy Services 1091420 Security Officers Service 6001 W Center Street Suite 205 Milwaukee WI 53210 Security Services 169372 HLS-Wheeling 45 W Hintz Road Wheeling IL 600906073 Laundry Services 166448 3 149588 149588 Health Care Center-SNF 623000 9467278 9467278 Life Care-Independent 623990 8166092 8166092 CBRF/Assisted living 623000 3527395 3527395 Other Resident Service 623000 846670 846670 Adult Day Care 623990 721057 721057 22728492 329052 329052 23207132 22728492 0 329052 9408217 8594983 807885 5349 296646 271004 25473 169 1283358 1175378 107250 730 679944 621919 57638 387 43673 43673 4878 4878 774023 643554 130469 71757 184 71573 436287 329799 106427 61 106838 106777 61 1650313 1597890 52393 30 26010 17756 8254 12847 11651 1196 21867 21867 2241951 2173006 68906 39 243342 243342 Purchased Svcs-Medical 1192427 1192427 Food 1126951 1095361 31590 Medical Supplies 595055 595055 Purchased Svcs-Other 480072 76799 403044 229 1408353 485504 922822 27 22104809 19147479 2950248 7082 67506 21469 1989825 1468920 152800 149050 194421 206411 64212834 37460078 23643693 26752756 12847523 11483033 3410356 3093233 42306124 43174872 1510371 1492389 8700000 7700000 15938014 16762578 26148385 25954967 X 16079114 17141797 48615 45393 30010 32715 16157739 17219905 42306124 43174872 X 1102323 -40157 X 0 1 1 X 0 X 112556 848824 88131 103267 149588 1302366 21005101 21943640 21827648 22465859 22728492 109970740 21117657 22792464 21915779 22569126 22878080 111273106 0 0 0 111273106 998936 -620049 227714 225264 329052 1160917 998936 -620049 227714 225264 329052 1160917 185401 230075 218450 182840 149787 966553 22301994 22402490 22361943 22977230 23356919 113400576 0.98120 0.97950 0.01020 0.01150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 52612 -488 52124 47669 5443 500 52612 38075 10096 502 47669 41629 -3554 38075 0.62000 0.38000 1 0 1071250 1071250 31312670 18130558 13182112 31828914 19329520 12499394 26752756 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 11067482 F Trustee Held Assets 250451 F Unemployment Insurance Bond 165100 F 11483033 Deferred Finance Charges 69875 Land for Future Development 451036 Temporarily Restricted Assets 45392 Permanently Restricted Assets 32715 Intercompany Receivable 947225 Accommodation Fees Receivable 1546990 3093233 Deferred Accommodation Fees 16651739 Reserve for Insurance Losses 49432 Security Deposits 61407 16762578 Description of Intended Use of Endowment Funds: Part V, Line 4: Permanently restricted for employee scholarships. Description of Uncertain Tax Positions Under FIN 48: Part X: Alexian Village of Milwaukee, Inc. does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There were no uncertain tax positions, and as a result there was no disclosure related to FIN 48 (ASC740) in the December 31, 2011 audit report. 0 1 0 0 0 0 0 0 0 Gary Mohn 0 187253 0 12969 0 21167 0 28978 0 30881 0 281248 0 14824 James Sances 0 477155 0 136544 0 28841 0 115746 0 28202 0 786488 0 28841 Jim Lewandowski 0 280338 0 56701 0 35171 0 35309 0 31686 0 439205 0 12354 Part I, Line 3 Alexian Village of Milwaukee, Inc. follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of Alexian Brothers Health System which is composed of independent board members. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the Compensation Committee. All of the items in Schedule J, Part I, Line 3 are used by the Committee to establish compensation for the CEO of the organization. Supplemental Information Part III Part I, Line 4b: Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The amount accrued in 2011 was included in income in Schedule J for the following individuals: James Sances - $52,060, Jim Lewandowski - $5,297. Julie Pommering See Below 100155 See Below 0 Part IV, Column (b): Sister to Board Member.Part IV, Column (d): Employed by Alexian Village of Milwaukee, Inc. Form 990, Part VI, Section A, line 6 The Organization has two members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Senior Ministries (the "Area Member"). Form 990, Part VI, Section A, line 7a Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Village of Milwaukee, Inc. Form 990, Part VI, Section A, line 7b Alexian Brothers Health System has principal authority with respect to the following matters: 1) Amendment of the Articles of Incorporation and Bylaws as provided by statute, 2) Appointment and removal of Directors and Executive Officers, 3) Adoption, amendment and repeal of fundamental statements of mission, philosophy, spirit, vision, values and charity policy, and the sponsorship of apostolic activities, 4) Any plan of merger, consolidation, dissolution, sale or lease of all or substantially all of the assets of Alexian Village of Milwaukee, Inc., 5) The annual capital and operating budget and strategic plan of Alexian Village of Milwaukee, Inc., and 6) Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 Alexian Village of Milwaukee, Inc. is an affiliate of Alexian Brothers Health System ("ABHS" or "the System"), which is a Catholic health system. ABHS is the National Member and ultimate parent for each entity within the System. Alexian Village of Milwaukee, Inc.'s Form 990 goes through an intensive review process at the System's Corporate level prior to being filed with the IRS. The entire Form 990 is reviewed by Alexian Village of Milwaukee, Inc.'s financial officer and the CEO. The Form 990 is also reviewed at the System Corporate level by the Chief Accounting Officer for the System. The Vice President and General Counsel for the System reviews all sections of the Form 990 with the exception of the compensation section. The Vice President of Human Resources for Alexian Brothers Health System reviews all compensation disclosures for each entity in Alexian Brothers Health System. These reviews were conducted before the Form 990 was signed and filed with the IRS. In addition, there is also a Compensation Committee that reports to the Alexian Brothers Health System Board of Governors. This Committee reviews the Compensation disclosures for all entities in the System. Alexian Village of Milwaukee, Inc.'s board reports to the Alexian Brothers Health System Board of Governors, which has ultimate oversight of the activities of all entities within the System. The Audit Committee of the Alexian Brothers Health System Board of Governors has responsibility for and oversight of the Tax Compliance process. The Audit Committee provides oversight for the Form 990 process for the entire System and reviews detailed Forms 990 for the System on an as requested basis. It then reports back to the Alexian Brothers Health System Board of Governors on the results of these activities. The Forms 990 not reviewed by the Audit Committee are available to the Audit Committee members upon request. The Audit Committee did not review the 2011 Form 990 for Alexian Village of Milwaukee, Inc. Form 990, Part VI, Section B, line 12c Alexian Village of Milwaukee, Inc. collects annual attestations from board members, officers, directors and key employees. The attestations are reviewed by the Alexian Village of Milwaukee, Inc. compliance officer and any conflicts are shared with the Alexian Village of Milwaukee, Inc. Chief Executive Officer. The conflicts are also reviewed by the System's Vice President, Corporate Responsibility Officer. The Audit Committee of the Alexian Brothers Health System Board of Governors monitors and receives reports on the completion of this process. Form 990, Part VI, Section B, line 15 Alexian Village of Milwaukee, Inc. follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation of the CEO and other officers and executives of the Corporation. This function is performed by the Compensation Committee of the Board of Governors of Alexian Brothers Health System which is composed of independent board members. The process includes review of comparability data, retention of an outside compensation consultant, and contemporaneous substantiation of the deliberation and decision through detailed minutes of the Compensation Committee. Form 990, Part VI, Section C, line 19 Alexian Village of Milwaukee, Inc.'s financial statements are available through the National Reporting Municipal Services Information Repository (NRMSIR). Conflicts of Interest and the governing documents of Alexian Village of Milwaukee, Inc. are not made available to the public. Form 990, Part VII: Average hours devoted to related organizations when related compensation is reported: - James Sances worked 40 hours per week for Alexian Brothers Health System; - Virginia Golemblewski worked 40 hours per week for Alexian Brothers Health System; - Jim Lewandowski worked 40 hours per week for Alexian Brothers Health System; - All others listed in Part VII devote 100% of their time to Alexian Village of Milwaukee, Inc. Form 990, Part VII, Coloumn E: Description of reasonable effort made to obtain compensation from related organization: Payroll records are kept that identify which officers/key employees are paid by a related entity. These documents also identify the organization being charged for the officer's/key employee's services. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -40,157. Part VIII, Line 3; Schedule D, Part VII: The amount reflected as dividends and interest reflects Alexian Village of Milwaukee, Inc.'s share of interest, dividends and realized gains from Alexian Village of Milwaukee's, Inc. beneficial share in the Alexian Brothers Health System, Inc. Investment Trust (ABHSIT). ABHSIT is a related entity whose purpose is to pool the investments of the not-for-profit entities in ABHS and acts as an internal mutual fund. Details of gains and losses are shown on the Form 990 of ABHSIT. Alexian Brothers of America Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362606768 Religious order of Roman Catholic men TX Section 501(c)(3) 1 N/A 0 Brothers of St Alexius Health and Welfare Fund Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 362976617 Provides for health & welfare payments for religious sponsor TX Section 501(c)(3) 1 Alexian Brothers of America Inc 1 Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago IL 60657 363527899 Housing and supportive care services for persons with HIV/AIDS IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 600051069 363260495 Supports provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 363801585 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Brothers of America Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 600051069 364390471 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) 11, III-FI Alexian Brothers of America Inc 1 Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights IL 600051069 800710751 Specialty physician practice group IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers of Chicago 3040 W Salt Creek Lane Arlington Heights IL 600051069 Inactive Corporation IL Section 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 941530037 Acute care hospital (sold in 1998) TX Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 431295333 HUD housing MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 37404 364344423 Provides comprehensive & coordinated community based services IL Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 37402 620646376 Supports the provision of community services for senior citizens TN Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 37377 621136742 Continuing care retirement community TN Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 600051069 364484290 Supports the provision of healthcare for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 392039667 Community outreach WI Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 63125 431592502 Skilled nursing facility MO Section 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 430653236 Acute care hospital (sponsorship transferred in 1997) MO Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 600051069 363276552 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) 11, III-FI Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363308965 Owns or leases properties where healthcare services are delivered IL Section 501(c)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3436 N Kennicott Avenue Arlington Heights IL 60004 363045007 Outpatient community mental health services IL Section 501(c)(3) 7 Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 60194 364251848 Behavioral health hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 60194 364251846 Acute care hospital IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 600051069 364336931 Physician services IL Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX Section 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 60007 300221481 Rehabilitation hospital IL N/A Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 870783164 Provision of NeuroMeg services IL N/A Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853289 Medical office building IL N/A Workplace Solutions LLC 1100 E Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP services IL N/A Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 363978153 Manages managed care contracts DE N/A Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 861115516 Ownership of Gamma Knife IL N/A St Alexius Center for Sleep Health LLC 665 W North Avenue Lombard IL 60148 205876371 Operation of sleep lab IL N/A Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 600051069 363266316 Owns/leases property; joint venture partner IL N/A C Edessa Insurance Company Ltd 3040 W Salt Creek Lane Arlington Heights IL 600051069 Captive insurer located in Bermuda BD N/A C Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 600051069 363853286 Messenger model IPA IL N/A C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 600051069 943465394 Tax credit financed housing IL N/A C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 600051069 352211303 Tax credit financed housing IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 Alexian Brothers Health System O 778455 FMV Alexian Brothers Health System P 778455 FMV Alexian Brothers Health System Inc Investment Trust Q 329052 FMV Schedule R, Part V, Line 2: Alexian Village of Milwaukee, Inc. tracks all transactions with related organizations in the general ledger or subsidiary schedules to the general ledger. Amounts are valued based on the fair market value of the transaction.