2011-10-06T14:02:55-05:00 2010-12-31 990 2010-01-01 391351584 Alexian Village of Milwaukee Inc ALEX 4143559300 9301 N 76th Street Milwaukee WI 53223 Gary Mohn 4143559300 2011-10-06 2010 2016-03-07 17:11:31Z Gary Mohn 9301 N 76th Street Milwaukee WI 53223 22794390 0 0928 X alexianbrothershealth.org X 1980 WI 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. 6 4 429 205 0 0 88131 103267 21827648 22465859 227714 225264 0 0 22143493 22794390 0 0 0 0 11651455 11596672 0 0 7062 8826711 9926513 20478166 21523185 1665327 1271205 39989228 42306124 25602007 26148385 14387221 16157739 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 8823377 9568171 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 maximizes 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 103. In 2010, 11,803 days of care were provided to Medicaid recipients. 6,131 days were provided to Medicare recipients. For Medicaid residents we were reimbursed approximately $773,375 less than our costs. 3306400 3586702 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 2010 approximately $157,000 of charity care was provided. 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. 5841572 8644367 AVM includes Independent Apartments. AVM has 245 independent apartments and averages about 270 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. 681467 666619 AVM offers Adult Day Care and other programs. The Adult Day Care Center is a social model that offers services for the surrounding community. Over half of the clients qualify for the Medicaid program. Other services offered to the community include educational, fitness, memory and wellness programs. Strengthened by community, prayer, committment 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. 681467 666619 18652816 1 1 0 0 0 0 0 0 1 1 1 0 1 1 1 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 60 0 1 429 1 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 WI X Tom McCormick 4143559300 9301 N 76th Street Milwaukee WI 53223 X Mark Larsen 1.00 X 0 0 0 Curt Gielow 1.00 X 0 0 0 Edward M Brady CPA CVA 1.00 X X 0 0 0 Jean Casey 1.00 X X 0 0 0 Brother Daniel McCormick 1.00 X 0 0 0 Gary Mohn 40.00 X X 0 232614 55225 Curtis Paulsen 1.00 X X 0 0 0 Kevin Mulhearn 1.00 X 0 287117 178935 Virginia Golembiewski 1.00 X 0 67752 15425 James Lewandowski 1.00 X 0 358777 63763 Tom McCormick 40.00 X 0 106898 19313 Debbie Curran 40.00 X 111222 0 2706 111222 1053158 335367 1 0 1 0 Aegis Therapy PO Box 8103 Fort Smith AR 72902 Therapy Services 1035074 Security Officers Service 6001 W Center Street Suite 205 Milwaukee WI 53210 Security Services 185151 HLS-Wheeling 45 W Hintz Road Wheeling IL 600906073 Laundry Services 148277 3 103267 103267 Health Care Center-SNF 623000 9350283 9350283 Life Care-Independent 623990 8014144 8014144 0 CBRF/Assisted Living 623000 3428627 3428627 Other Resident Service 623000 1024907 1024907 Adult Day Care 623990 647898 647898 22465859 225264 225264 22794390 22465859 0 225264 9291268 8540296 745650 5322 335361 308255 26914 192 1297537 1197395 99399 743 672506 622878 49243 385 27672 27672 18895 18895 693775 518354 175421 106385 184 106201 395347 309193 86105 49 101935 101877 58 1557757 1509853 47877 27 24392 15649 8743 13193 10129 3064 136960 136960 2040712 1978371 62305 36 233811 233811 Purchased Serv-Medical 1110686 1110686 0 0 Food 1035046 998372 36674 0 Management Fees 780254 0 780254 0 Medical Supplies 593766 593766 0 0 Purchased Service-Other 459776 74185 385370 221 596151 494479 101643 29 21523185 18652816 2863307 7062 316848 67506 1250954 1989825 172100 152800 206131 194421 58861820 35218127 23414604 23643693 12128353 12847523 2500238 3410356 39989228 42306124 1497309 1510371 9600000 8700000 14504698 15938014 25602007 26148385 X 14288083 16079114 69138 48615 30000 30010 14387221 16157739 39989228 42306124 X 1271205 499313 X X 0 1 1 X 0 X 417165 112556 848824 88131 103267 1569943 19870167 21005101 21713565 21609198 22465859 106663890 20287332 21117657 22562389 21697329 22569126 108233833 0 0 0 108233833 671318 771608 -620049 227714 225264 1275855 671318 771608 -620049 227714 225264 1275855 177909 185401 230075 218450 182840 994675 21136559 22074666 22172415 22143493 22977230 110504363 0.97950 0.97290 0.01150 0.01730 X Schedule A, Part IV, Supplemental Information: Part III Line 12 Rental of Space and Equipment RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 47669 5443 500 52612 38075 10096 502 47669 0.62000 0.38000 1 0 1071250 1071250 28350227 17372668 10977559 29440343 17845459 11594884 23643693 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 12435870 F Trustee Held Assets 246863 F Unemployment Insurance Bond 164790 F 12847523 Deferred Finance Charges 83399 Land for Future Development 451036 Temporarily Restricted Assets 48615 Permanently Restricted Assets 30010 Intercompany Receivable 1002959 Accommodation Fees Receivable 1794337 3410356 Deferred Accommodation Fees 15773412 Reserve for Insurance Losses 49432 Security Deposits 115170 15938014 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: AVM Does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. The text of the FIN48 ASC(740) footnote in this audit report is as follows: On January 1, 2008 the Corporations adopted Interpretation No. 48, Accounting for Uncertainty in Income Taxes, included in FASB ASC Subtopic 740-10, Income Taxes-Overall. ASC Subtopic 740 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10. the Corporations must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% liklihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes and accounting in interim periods and requires increased disclosures. As of December 31, 2010 and 2009, the Corporations do not have a liability for unrecognized tax benefits. 1 1 0 0 0 0 0 0 0 Gary Mohn 0 185314 0 31311 0 15989 0 26764 0 28461 0 287839 0 12535 Kevin Mulhearn 0 215278 0 26812 0 45027 0 152365 0 26570 0 466052 0 31632 James Lewandowski 0 272185 0 50985 0 35607 0 32953 0 30810 0 422540 0 12292 Part I, Lines 4a-b 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 2010 was included in income in Schedule J for the following individuals: Jim Lewandowski $4,547.35 Part I, Line 4a. Kevin Mulhearn received a severance payment from Alexian Brothers Health System in 2010 of $13,394.88. Supplemental Information Part III Part I, Line 3 AVM 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 ABHS, 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. Julie Pommering See Below 109674 See Below 0 Part IV, Column (b) Relationship Sister to Board Member PArt IV, Column (d) Description Employed by AVM Form 990, Part VI, Section A, line 6 Alexian Village of Milwaukee, Inc. 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 AVM; 5. The annual capital and operating budget and strategic plan of AVM; and 6. Other certain reserved powers which Alexian Brothers Health System may designate. Form 990, Part VI, Section B, line 11 AVM 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. AVM'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 AVM'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 ABHS reviews all compensation disclosures for each entity in ABHS. 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 ABHS Board of Governors. This Committee reviews the Compensation disclosures for all entities in the System. AVM's board reports to the ABHS Board of Governors, which has ultimate oversight of the activities of all entities within the System. The Audit Committee of the ABHS 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 a rotating basis. It then reports back to the ABHS 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 2010 Form 990 for AVM. Form 990, Part VI, Section B, line 12c AVM collects annual attestations from Board members, officers, directors, and key employees. The attestations are reviewed by the AVM compliance officer and any conflicts are shared with the AVM Chief Executive Officer. The conflicts are also reviewed by the System's Vice President of Compliance and Internal Audit. The Audit Committee of the ABHS Board of Governors monitors and receives reports on the completion of this process. Form 990, Part VI, Section B, line 15b AVM 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 ABHS, 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 AVM's financial statements are available through the National Reporting Municipal Services Information Repository (NRMSIR). Conflicts of Interest and AVM's governing documents are not made available to the public. Reasonable Efforts Form 990, Part VII, Column E Payroll records are kept that identify which officers/key employees are paid by a related entity. These documents also show the organization being charged for the officer's/key employee's services. Hours Worked Form 990, Part VII, Column E and F Disclosure for estimated hours per week devoted to related organizations for which compensation was reported: Kevin Mulhearn worked 40 hours per week for Alexian Brothers Senior Ministries Virginia Golembiewski 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 499,313. Form 990, Part VIII, Line 3; Schedule D, Part VII The amounts reflected as dividends and interest reflects AVM's share of interest, dividends and realized gains/losses from AVM's 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 60005 362606768 Religious order of Roman Catholic men TX 501(c)(3) 1 N/A 0 Brothers of St Alexius Health and Welfare Fund Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 362976617 Provides for health & welfare payments for religious sponsor TX 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 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Supports the provision of healthcare services for related corporations for w IL 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 60005 363801585 Manages pooled investments of related not-for-profit entities IL 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 60005 364390471 Manages pooled investments of related not-for-profit entities IL 501(c)(3) 11 III FI Alexian Brothers of America Inc 1 The Alexian Brothers Hospital School of Nurses 3040 W Salt Creek Lane Arlington Heights IL 60005 Inactive Corporation IL 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers of Chicago 3040 W Salt Creek Lane Arlington Heights IL 60005 Inactive Corporation IL 501(c)(3) 9 Alexian Brothers of America Inc 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 941530037 Acute care hospital (sold in 1998) TX 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 431295333 HUD housing MO 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Ste 110 Chattanooga TN 37404 364344423 Provides comprehensive and coordinated community based services IL 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 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 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 60005 364484290 Supports the provision of healthcare for related corporations IL 501(c)(3) 11 III FI Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 392039667 Community Outreach WI 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled Nursing Facility MO 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 501(c)(3) 9 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 60005 363276552 Supports the provision of healthcare services for related corporations IL 501(c)(3) 11 III FI Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX 501(c)(3) 3 Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363308965 Owns or leases properties where healthcare services are delivered IL 501(c)(2) NA Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3350 W Salt Creek Lane Arlington Heights IL 60005 363045007 Outpatient community mental health services IL 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 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 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 60005 364336931 Physician Services IL 501(c)(3) 3 Alexian Brothers Health System 1 Chicago Catholic Healthcare System Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363693486 Inactive Corporation IL 501(c)(3) 9 Alexian Brothers Hospital Network 1 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 430653236 Acute care hospital (sponsorship transferred in 1997) MO 501(c)(3) 3 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Elk Grove Village IL 60007 300221481 Rehabilitation hospital IL N/A N/A 0 0 Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 870783164 Provision of NeuroMeg services IL N/A N/A 0 0 Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 60005 363853289 Medical Office Building IL N/A N/A 0 0 Workplace Solutions LLC 1100 East Woodfield Rd Schaumburg IL 60173 364095007 Provision of EAP services IL N/A N/A 0 0 Bonaventure Medical Foundation LLC 3040 Salt Creek Ln Arlington Heights IL 60005 363978153 Manages managed care contracts DE N/A N/A 0 0 Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 861115516 Ownership of Gamma Knife IL N/A N/A 0 0 Alexian Cardiovascular Inst Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 300307978 Lease and subslease of 64-slice CT equipment IL N/A N/A 0 0 St Alexius Center for Sleep Health LLC 665 W North Ave Lombard IL 60148 205876371 Operation of sleep labs IL N/A N/A 0 0 Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 60005 363266316 Owns/leases property; joint venture partner IL N/A C Edessa Insurance Company LTD 3040 W Salt Creek Lane Arlington Heights IL 60005 Captive Insurer located in Bermuda BD N/A C Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363853286 Messenger model IPA IL N/A C Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 60005 352211303 Tax Credit Financed Housing IL N/A C Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 943465394 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 735758 Actual Alexian Brothers Health System P 760238 Actual Transactions with Related Organizations Part V, Line 2 AVM 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.