2011-08-11T13:55:56-05:00 2010-09-30 PLANTE & MORAN PLLC PO BOX 307 SOUTHFIELD MI 480370307 990 2009-10-01 391486873 PROHEALTH CARE INC PROH 2629284740 N17 W24100 RIVERWOOD DRIVE No 130 WAUKESHA WI 531881131 NANINE M NELSON 2629284740 2011-08-10 1 2483522500 2009 2016-02-24 21:20:13Z SUSAN EDWARDS N17 W24100 RIVERWOOD DRIVE No 130 WAUKESHA WI 531881131 93830705 0 X WWW.PROHEALTHCARE.ORG X 1983 WI MANAGEMENT OF RELATED TAX EXEMPT HOSPITALS AND OTHER HEALTHCARE DELIVERY ENTITIES. 15 12 869 12 206347 0 19131000 72569710 74489742 231975 209963 0 72801685 93830705 0 0 52610176 54981877 0 0 20191509 23777298 72801685 78759175 0 15071530 76694867 36553805 26609631 26433569 50085236 10120236 TO PROMOTE HEALTH AND DELIVER EXTRAORDINARY HEALTH CARE IN THE COMMUNITIES WE SERVE. 0 0 69503881 0 74283395 PROHEALTH CARE PROVIDES SUPPORT TO WAUKESHA AND OCONOMOWOC MEMORIAL HOSPITALS. AMONG THE SERVICES PROVIDED ARE ADMINISTRATION, FINANCIAL AND PATIENT ACCOUNTING, DECISION SUPPORT, INFORMATION SYSTEMS, PUBLIC RELATIONS, HUMAN RESOURCES, MATERIALS AND FACILITIES MANAGEMENT, AND EDUCATION. SEE ATTACHED COMMUNITY BENEFIT REPORT FOR AN ILLUSTRATION OF OUR SYSTEM'S ACCOMPLISHMENTS. 69503881 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 114 0 1 869 1 1 1 0 0 0 0 0 0 0 0 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X NANINE NELSON 2629284740 N17 W24100 RIVERWOOD DRIVE SUITE WAUKESHA WI 531881131 JEAN CRUIKSHANK 2.00 X 0 0 0 TOM DALUM 2.00 X 0 0 0 MAC DORN 2.00 X 0 0 0 MARGARET FARROW 2.00 X 0 0 0 HELEN FORSTER 2.00 X 0 0 0 MIKE GALLAGHER 2.00 X 0 0 0 MARIE KINGSBURY 2.00 X 0 0 0 RONALD FICKEL MD 2.00 X 0 245949 26634 PAUL TODD MD 2.00 X 0 429320 23282 TOM PACKEE 2.00 X 0 0 0 JANET SWANDBY 2.00 X X 0 0 0 REXFORD W TITUS III 40.00 X X 810907 0 331932 SUSAN EDWARDS 40.00 X X 0 0 0 DAN D'ANGELO DDS 2.00 X X 0 0 0 DIXON BENZ 2.00 X X 0 0 0 E JOHN RAASCH 2.00 X X 0 0 0 ROBERT W MLYNAREK 40.00 X 404879 0 40009 NANINE M NELSON 40.00 X 314761 0 41430 JANET A SCHULZ 40.00 X 330021 0 48013 GARY E BUERSTATTE 40.00 X 245274 0 27103 NADINE T GUIRL 40.00 X 250337 0 14604 PETER GEISS 40.00 X 357460 0 39712 LORNA J GRANGER 40.00 X 335629 0 19475 JAMES E LYONS 40.00 X 280805 0 40201 CLYDE CHUMBLEY MD 40.00 X 486684 0 39736 RODNEY C DYKEHOUSE 40.00 X 288768 0 25938 MATT WADE 40.00 X 251192 0 43654 FREDERICK A MEIER 40.00 X 171740 0 7430 CLARE O'SHEEL 40.00 X 171478 0 15477 THOMAS E SCHWARTZ 40.00 X 170758 0 11056 4870693 675269 795686 45 0 1 0 R&R INSURANCE SERVICES INC PO BOX 1610 WAUKESHA WI 53187 INSURANCE SERVICES 2233309 STANDARD REGISTER PO BOX 91047 CHICAGO IL 60693 PRINTING SERVICES 1110266 WITI-TV 3609 SOULUTIONS CENTER CHICAGO IL 60677 MEDIA/ADVERTISING 717566 WISN-TV HEARST-ARGYLE TELEVISION DRAWER 51 MILWAUKEE WI 53278 MEDIA/ADVERTISING 545301 YES MEN CORPORATION OF AMERICA 305 N PLANKINTON AVE STE 313 MILWAUKEE WI 53203 MARKETING SERVICES 447223 35 19131000 19131000 SUPPORT SERVICES 561000 74344267 74283395 60872 TRANSPORTATION 480000 145475 145475 74489742 209963 209963 93830705 74283395 206347 209963 6663796 5838152 825644 35612100 31199761 4412339 2636081 2309207 326874 7383833 6469240 914593 2686067 2353263 332804 389274 341043 48231 27704 24271 3433 7920721 6939343 981378 2659438 2329934 329504 2646471 2318573 327898 1460247 1279322 180925 353899 310051 43848 323891 283761 40130 496661 435125 61536 104753 91774 12979 LOSS ON DEBT FORGIVENES 3958470 3958470 BILLING & COLLECTION 2280271 1997745 282526 REPAIRS & MAINTENANCE 736135 644928 91207 DUES & SUBSCRIPTIONS 318363 278918 39445 Change in prov. uncolle 101000 101000 78759175 69503881 9255294 0 -399765 3858943 4459935 10325600 8800097 843890 498651 8324608 2624254 5157371 5700354 11053768 7970402 48938426 6041000 76694867 36553805 7134605 9311947 19475026 17121622 26609631 26433569 X 50085236 10120236 50085236 10120236 76694867 36553805 X 0 1 1 X 0 X X X 0 0 0 WAUKESHA MEMORIAL HOSPITAL INC 390910727 3 1 1 1 0 OCONOMOWOC MEMORIAL HOSPITAL INC 390794174 3 1 1 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 27704 27704 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: A THIRD PARTY VENDOR PROVIDES ADVICE TO THE ORGANIZATION REGARDING ONGOING OPPORTUNITIES TO ADVANCE THE PROHEALTH CARE VALUE PROPOSITION MESSAGE WITH GOVERNMENT LEADERS OF INFLUENCE, BUSINESS LEADERS OF INFLUENCE AND BUSINESS ORGANIZATIONS. ADDITIONALLY, THE THIRD PARTY VENDOR PROVIDES CONSISTENT MONITORING OF STATE POLICY AND POLITICAL ENVIRONMENTS, COMMUNICATES WITH KEY LEGISLATORS AND AGENCIES AS NECESSARY, AND WORKS WITH STATE ASSOCIATIONS AS APPROPRIATE TO AID IN GOVERNMENT RELATIONS ACTIVITIES. 2732052 2732052 323064 39903 283161 1677394 569316 1108078 2806265 2012244 794021 785833 2791 783042 5700354 INVESTMENT IN WHS/OCC/MA 5841000 C INVESTMENT IN UM CSC 200000 C 6041000 ACCRUED MINIMUM PENSION 6532184 ACCRUED POSTRETIREMENT MEDICAL 271880 DEFERRED COMPENSATION 21848 ACCRUED MINIMUM SERP LIABILITY 10295710 17121622 93830705 78759175 15071530 -55036530 -55036530 -39965000 Part XI, Line 8 - Other Adjustments: EARNINGS IN AFFILIATED ORGANIZATIONS: -44878530. CUMULATIVE EFFECT OF CHANGE IN ACCOUNTING PRINCIPLE: 6973000. CAPITAL CONTRIBUTIONS TO RELATED ORGANIZATIONS: -17131000. FIN48 DISCLOSURE: FEDERAL INCOME TAX - PHC, WMH, OMH, NATIONAL REGENCY, AND PHHC ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ALL OF THESE ENTITIES ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. WHS IS A FOR-PROFIT STOCK CORPORATION AND IS SUBJECT TO INCOME TAXES. WHS ACCOUNTS FOR INCOME TAXES UNDER THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED RELATED TO THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE ACCOUNTING STANDARD THAT REFERS TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IS EFFECTIVE FOR FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2006 FOR NONPUBLIC ENTITIES THAT HOLD PUBLIC DEBT. THE STANDARD ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED ON THE CONSOLIDATED FINANCIAL STATEMENT. COMPANIES 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 STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. THE CORPORATION ADOPTED THIS STANDARD AS OF OCTOBER 1, 2007. THE ADOPTION DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 RONALD FICKEL MD 0 132404 0 91092 0 22453 0 15534 0 11100 0 272583 0 0 PAUL TODD MD 0 408802 0 0 0 20518 0 12911 0 10371 0 452602 0 0 REXFORD W TITUS III 801720 0 0 0 9187 0 304669 0 27263 0 1142839 0 0 0 ROBERT W MLYNAREK 383208 0 0 0 21671 0 23517 0 16492 0 444888 0 0 0 NANINE M NELSON 300629 0 0 0 14132 0 19511 0 21919 0 356191 0 0 0 JANET A SCHULZ 304493 0 0 0 25528 0 19547 0 28466 0 378034 0 0 0 GARY E BUERSTATTE 229517 0 0 0 15757 0 16375 0 10728 0 272377 0 0 0 NADINE T GUIRL 249675 0 0 0 662 0 5877 0 8727 0 264941 0 0 0 PETER GEISS 340803 0 0 0 16657 0 20972 0 18740 0 397172 0 0 0 LORNA J GRANGER 320960 0 0 0 14669 0 5895 0 13580 0 355104 0 0 0 JAMES E LYONS 270485 0 0 0 10320 0 28458 0 11743 0 321006 0 0 0 CLYDE CHUMBLEY MD 476393 0 0 0 10291 0 17731 0 22005 0 526420 0 0 0 RODNEY C DYKEHOUSE 271152 0 0 0 17616 0 763 0 25175 0 314706 0 0 0 MATT WADE 232693 0 0 0 18499 0 17427 0 26227 0 294846 0 0 0 FREDERICK A MEIER 157260 0 0 0 14480 0 3370 0 4060 0 179170 0 0 0 CLARE O'SHEEL 156731 0 0 0 14747 0 11137 0 4340 0 186955 0 0 0 THOMAS E SCHWARTZ 169660 0 0 0 1098 0 2824 0 8232 0 181814 0 0 0 Part I, Line 1a COUNTRY CLUB MEMBERSHIPS: MEMBERSHIPS USED EXCLUSIVELY FOR BUSINESS PURPOSES REXFORD W TITUS III - BENEFIT WAS NOT INCLUDED IN TAXABLE INCOME AS MEMBERSHIP IS FOR BUSINESS ONLY. Part I, Line 4a NAME PLAN REXFORD W TITUS III - SERP PLAN PARTICIPANT GARY BUERSTATTE - SERP PLAN PARTICIPANT NADINE GUIRL - SERP PLAN PARTICIPANT JAMES LYONS - SERP PLAN PARTICIPANT ROBERT MLYNAREK - SERP PLAN PARTICIPANT CLYDE CHUMBLEY - SERP PLAN PARTICIPANT PROHEALTH CARE INC. (PHC) MAINTAINS A SUPPLEMENTAL RETIREMENT PLAN (SERP) FOR A SELECT GROUP OF EXECUTIVES OF PHC AND ITS AFFILIATED ENTITIES. THE SERP IS AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION PLAN THAT IS INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THE SERP ARE TAXABLE TO THE PARTICIPATING EXECUTIVES WHEN SUCH AMOUNTS ARE VESTED. Form 990, Part VI, Section B, line 11 AFTER THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S TAX PREPARERS AND PRIOR TO FILING THE FORM 990, SELECT EXECUTIVE MEMBERS OF THE ORGANIZATION PERFORMED A REVIEW; THEN THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THE RETURN AS FILED BY THE ORGANIZATION. Form 990, Part VI, Section B, line 12c ALL OFFICERS, VICE-PRESIDENTS, MANAGERS AND ABOVE, AS WELL AS BOARD MEMBERS ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE TRACKED IN THE CORPORATE COMPLIANCE DEPARTMENT. THEY ARE REVIEWED AND ANY PERSON IDENTIFIED AS HAVING A POTENTIAL CONFLICT IS GIVEN DIRECTION AS TO WHAT STEPS SHOULD BE TAKEN TO MITIGATE THE CONCERN. ALL EMPLOYEES ARE EDUCATED ANNUALLY. THE STEPS TAKEN WHEN A CONFLICT ARISES ARE AS FOLLOWS: FOR THE BOARD OF DIRECTORS, THE RESTRICTION IS NOT BEING ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTING RELATED TO ANY DECISION WHERE THE BOARD MEMBER HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST. FOR LEADERS, RESEARCHERS, AND EMPLOYEES, RECOMMENDATIONS ARE MADE FROM COMPLIANCE MANAGER TO LEADERSHIP AND/OR HUMAN RESOURCES. RESTRICTIONS CAN RANGE FROM ANY OF THE FOLLOWING; DISCLOSING POTENTIAL CONFLICTS OF INTEREST TO PATIENTS, NOT BEING ABLE TO BE INVOLVED IN DISCUSSION OR DECISION MAKING ON SPECIFIC TOPICS, AND TO NOT BEING ABLE TO WORK AT PHC IN SPECIFIC ROLE WHERE REPORTED CONFLICT EXISTS. IF THE RECOMMENDATION IS CHALLENGED, THE CASE IS ESCALATED TO CONFLICT OF INTEREST COMMITTEE. Form 990, Part VI, Section B, line 15 AN INDEPENDENT, EXTERNAL COMPENSATION REVIEW IS CONDUCTED FOR THE POSITIONS OF OFFICER, EXECUTIVE DIRECTOR, VICE-PRESIDENT, AND SENIOR VICE-PRESIDENT. THE RESULTS OF THE COMPENSATION REVIEW ARE PRESENTED TO THE BOARD'S EXECUTIVE COMMITTEE FOR APPROVAL. ANY MEMBER OF THE EXECUTIVE COMMITTEE WHOSE SALARY IS INCLUDED IN THE SALARY REVIEW IS RECUSED FROM THE APPROVAL PROCESS FOR HIS/HER SALARY APPROVAL. THIS PROCESS WAS LAST DONE IN 2010. Form 990, Part VI, Section C, line 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990 PART VII: THE FOLLOWING OFFICERS AND DIRECTORS HAVE WORKED FOR RELATED ORGANIZATIONS. THESE INDIVIDUALS ARE AS FOLLOWS: OFFICERS/DIRECTORS AVG. HRS. / WEEK EMPLOYED BY RELATED ENTITY ---------------------------------------------------------------------- RONALD FICKEL, MD GREATER THAN 40.00 WAUKESHA HEALTH CARE, INC. PAUL TODD, MD GREATER THAN 40.00 MEDICAL ASSOCIATES, INC. FORM 990, PART XI, LINE 2C THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT YEAR. OCONOMOWOC MEMORIAL HOSPITAL INC 791 SUMMIT AVENUE OCONOMOWOC WI 53066 390794174 HOSPITAL WI 501(c)(3) Line 3 N/A WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC 725 AMERICAN AVENUE WAUKESHA WI 53188 391314542 FUNDRAISING WI 501(c)(3) Line 11a, I WAUKESHA MEMORIAL HOSPITAL INC PROHEALTH HOME CARE INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 200067392 HEALTHCARE WI 501(c)(3) Line 3 N/A NATIONAL REGENCY OF NEW BERLIN INC N17 W24100 RIVERWOOD DR SUITE 200 WAUKESHA WI 53188 391077992 HEALTHCARE WI 501(c)(3) Line 11c, III-FI N/A WAUKESHA MEMORIAL HOSPITAL INC 725 AMERICAN AVENUE WAUKESHA WI 53188 390910727 HOSPITAL WI 501(c)(3) Line 3 N/A OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC 791 SUMMIT AVENUE OCONOMOWOC WI 53066 391271647 FUNDRAISING WI 501(c)(3) Line 7 OCONOMOWOC MEMORIAL HOSPITAL INC PROHEALTH ALIGNED LLC (DBA MSC) 1111 DELAFIELD STREET STE 1 WAUKESHA WI 53188 263324572 SURGERY CENTER WI N/A WAUKESHA HEALTH SYSTEM INC N17 W24100 RIVERWOOD DRIVE STE 200 WAUKESHA WI 53188 391507910 HEALTHCARE WI N/A C -1721168 33257158 1.00000 EMPATHIA PACIFIC INC 31416 AGOURA RD STE 180 WESTLAKE VILLAGE CA 91361 953070501 HEALTHCARE CA EMPATHIA INC C -147692 1005099 1.00000 MEDICAL ASSOCIATES INC N17 W24100 RIVERWOOD DRIVE STE 200 WAUKESHA WI 53188 391083015 HEALTHCARE WI WAUKESHA HEALTH SYSTEM INC C -21144847 37766159 1.00000 NATIONAL AVENUE DEVELOPEMNT CORPORATION N17 W24100 RIVERWOOD DRIVE STE 200 WAUKESHA WI 53188 391417226 HEALTHCARE WI WAUKESHA HEALTH SYSTEM INC C 51502 1226567 1.00000 WAUKESHA HEALTH CARE INC N17 W24100 RIVERWOOD DRIVE STE 200 WAUKESHA WI 53188 391773598 HEALTHCARE WI WAUKESHA HEALTH SYSTEM INC C -16296271 53707594 1.00000 EMPATHIA INC N17 W24100 RIVERWOOD DRIVE STE 200 WAUKESHA WI 53188 391567366 HEALTHCARE WI WAUKESHA HEALTH SYSTEM INC C 933205 18074904 1.00000 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 OCONOMOWOC MEMORIAL HOSPITAL INC K 12736520 WAUKESHA HEALTH SYSTEM INC O 1731117 OCONOMOWOC MEMORIAL HOSPITAL INC J 138677 WAUKESHA MEMORIAL HOSPITAL INC K 54048033 EMPATHIA PACIFIC INC O 282159 WAUKESHA HEALTH CARE INC O 187956 WAUKESHA HEALTH SYSTEM INC P 589540 EMPATHIA PACIFIC INC P 155914 WAUKESHA HEALTH CARE INC P 1044624 WAUKESHA HEALTH CARE INC K 954874 MEDICAL ASSOCIATES INC K 5690412 WAUKESHA MEMORIAL HOSPITAL INC O 17599885 OCONOMOWOC MEMORIAL HOSPITAL INC O 451097 MEDICAL ASSOCIATES INC O 51845 MEDICAL ASSOCIATES INC Q 12725464 WAUKESHA MEMORIAL HOSPITAL INC C 15863500 OCONOMOWOC MEMORIAL HOSPITAL INC C 3267500 WAUKESHA MEMORIAL HOSPITAL INC P 1314146 OCONOMOWOC MEMORIAL HOSPITAL INC P 823134 PROHEALTH HOME CARE INC P 154675 WAUKESHA HEALTH CARE INC Q 4405536