2011-05-13T16:41:41-05:00 2010-06-30 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2009-07-01 390816845 United Hospital System Inc UNIT 2626562334 6308 8th Avenue Kenosha WI 53143 Charles Talbert 2626562334 2011-05-13 1 JAY ADKISSON 4144319300 2011-05-13 2009 2016-02-24 21:20:13Z Charles Talbert 6308 8th Avenue Kenosha WI 53143 278402997 0 X www.unitedhospitalsystem.org X 1910 WI UNITED HOSPITAL SYSTEM, INC. is committed to living out the healing ministries of the Judeo-Christian faiths by providing exceptional and compassionate healthcare services that promotes the dignity and well-being of the people we serve. This is our Mission and our reason for being. We strive to recruit and retain the best physicians and staff and purchase the best diagnostic and curative medical equipment that our financial resources will permit. We also strive to be accessible to all members of our community with emergent and urgent healthcare needs, irrespective of their ability to pay. This is our committment to the quality, accessibility and affordability fundamentals affecting the delivery of healthcare. 15 12 2443 516 281648 -51267 36072 30988 260857325 276606527 -5727256 425963 25030 33678 255191171 277097156 15853 21695 0 117696480 133086264 0 0 109947485 117323416 227659818 250431375 27531353 26665781 263672767 292432389 84846266 108291941 178826501 184140448 UNITED HOSPITAL SYSTEM, INC. IS A COMPREHENSIVE REGIONAL HEALTHCARE SYSTEM THAT HAS SERVED SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS COMMUNITIES FOR MORE THAN 100 YEARS. UNITED HOSPITAL SYSTEM PROVIDES SERVICES PRIMARILY THROUGH THE KENOSHA MEDICAL CENTER CAMPUS AND THE ST. CATHERINE'S MEDICAL CENTER CAMPUS AND SEVERAL OTHER CLINIC LOCATIONS. UNITED HOSPITAL SYSTEM IS COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. 0 0 206596346 276324879 ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO ITS COMMUNITY. 206596346 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 70 0 1 2443 1 1 1 0 0 0 0 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 0 1 1 1 1 1 WI X Corporation 2626562334 6308 8TH AVENUE Kenosha WI 53143 James Arneson 2.00 X 0 0 0 F Gregory Campbell 2.00 X 0 0 0 Robert A Cornog 2.00 X X 0 0 0 Richard O Schmidt Jr 45.00 X X X 898206 0 134524 Edward C Emma 2.00 X 0 0 0 Harold W Mayer 2.00 X 0 0 0 George W Anderson 2.00 X 0 0 0 A James Cicchini 2.00 X 0 0 0 james Concannon MD 2.00 X 0 0 0 Don E Kaelber 2.00 X 0 0 0 Raymond Knight MD 2.00 X X 381048 0 34583 Robert Lee Jr 2.00 X 0 0 0 Joseph F Madrigrano Sr 2.00 X 0 0 0 Lawrence Reif MD 2.00 X 0 0 0 W Harley Sobin MD 2.00 X X 1052127 0 34583 William Petasnick 2.00 X 0 0 0 Linda Wohlgemuth 45.00 X X 366861 0 45767 Charles Talbert 45.00 X X 355330 0 56652 Susan Ventura 45.00 X 369261 0 45767 Ashwani Sethi MD 40.00 X 1053743 0 34583 Mario Garretto MD 40.00 X 998854 0 84583 Carroll Martin MD 40.00 X 524944 0 16025 Alfred Habel MD 40.00 X 427333 0 34583 James Shapiro MD 40.00 X 840889 0 16164 7268596 0 537814 99 0 1 0 Eclipsys Corp PO Box 8538 133 Philadelphia PA 19171 IS Services 2881044 Waukesha Health Systems Inc PO Box 1108 Waukesha WI 53187 IS Services 2377786 Riley Construction Co Inc 5301 99th Street Kenosha WI 53144 Building 1230240 Quest Diagnostics 3924 Collection Center Drive Chicago IL 60693 Medical 1009690 Wheaton Franciscan Healthcare PO Box 14668 Milwaukee WI 53214 Laundry 624066 29 30988 30988 net patient service re 623000 270999316 270999316 other operating revenu 623990 5607211 5325563 281648 276606527 1652243 1652243 38039 1243414 20905 -1243414 17134 -1226280 -1226280 75200 41522 33678 33678 277097156 276324879 281648 459641 21695 21695 7268596 7268596 97597376 88422133 9175243 4594047 4162155 431892 16745608 6106138 10639470 6880637 5780618 1100019 290880 158976 131904 48119572 45786742 2332830 5836604 5698811 137793 554596 187658 366938 1649449 1484504 164945 12985407 11686866 1298541 1073981 422671 651310 BAD DEBTS 15280290 15280290 OUTSIDE SERVICES 8902563 3287316 5615247 State Hospital Assessme 7622909 7622909 REPAIRS 6896597 4976670 1919927 OTHER EXPENSES 1769954 1742819 27135 6340614 3767375 2573239 250431375 206596346 43835029 0 46197702 41553861 33822054 32052045 3223584 3194388 2975937 3117303 227171143 138985732 81871217 88185411 78940515 84808870 16641758 39520511 263672767 292432389 28098657 28025271 28391392 27593209 28356217 52673461 84846266 108291941 X 176852983 182142414 459822 481569 1513696 1516465 178826501 184140448 263672767 292432389 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1973518 46211 21695 1998034 1955842 33529 15853 1973518 0.76000 0.24000 0 0 5519546 5519546 112462305 68194308 44267997 98011939 69513518 28498421 11177353 1277906 9899447 88185411 Other Assets 540381 Due from Affiliate 38980130 39520511 Deferred Compensation 6643149 Pension Liability 46030312 52673461 277097156 250431375 26665781 5659695 -27011529 -21351834 5313947 277075461 0 277075461 21695 21695 277097156 250825092 393717 393717 250431375 0 250431375 Part X: Description of Uncertain Tax Positions Under FIN 48: In order to account for any uncertain tax positions, the Corporation determines whether it is more likely than not that a tax position will be sustained upon examination on the technical merits of the position, assuming that taxing authority has full knowledge of all information. If the tax position does not meet the more likely than not recognition threshold, the benefit of that position is not recognized in the financial statements. The Corporation recorded no assets or liabilities related to uncertain tax positions in 2010. Part XI, Line 8 - Other Adjustments: CHANGE IN MINIMUM PENSION OBLIGATION: -21267711. revenue sharing with affiliate: -5374617. MACRS DEPRECIATION ADJUSTMENT: -415412. TEMPORARILY RESTRICTED EARNINGS: 43442. PERMENANTLY RESTRICTED EARNINGS: 2769. Part XII, Line 4b - Other Adjustments: Net Assets Released from Restrictions: 21695. Part XIII, Line 2d - Other Adjustments: macrs depreciation adjustment: 415412. Scholarships: -21695. Golf Outing 75200 75200 41522 75200 75200 41522 41522 33678 1 1 X 1 X 1 X 1 1 1 0 1 0 3601485 3601485 0.01440 37911323 25979934 11931389 0.04760 41512808 25979934 15532874 0.06200 369 17196 510704 510704 0.00200 125 986390 986390 0.00390 125 150727 150727 0.00060 369 17446 1647821 1647821 0.00650 369 17446 43160629 25979934 17180695 0.06850 12 832 832 0.00000 50200 50200 0.00020 10 832 832 0.00000 22 51864 51864 0.00020 1 5562026 278101 52484815 67535229 -15050414 X 1 1 Kenosha Medical Center Campus

6308 8th Avenue Kenosha WI 53143

X X X Saint Catherine's Medical Center Campus

9555 76th Street Pleasant Prairie WI 53158

X X X Kenosha Northside Clinic

3601 30th Avenue Suite 205 Kenosha WI 53143

Outpatient Physician Clinic Paddock Lake Family Medicine Clinic

7322 236th Avenue Paddock Lake WI 53168

Outpatient Physician Clinic The Gurnee Clinic

1790 Nations Drive Suite 106 Gurnee IL 60031

Outpatient Physician Clinic LakeView RecPlex

9900 Terwall Terrace Pleasant Prairie WI 53158

Rehabilitation Clinic Vernon Elementary School - Pool Area

8518 22nd Avenue Kenosha WI 53143

Rehabilitation Clinic Part III, Line 4: Management provides for probable uncollectible amounts, primarily uninsured patients and amounts patients are personally responsible for, through a charge to operations and a credit to a valuation allowance based on its assessment of historical collection experience and the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable. Worksheet A in the instructions was used to determine the costing methodology. Part III, Line 8: The costing methodology used was the cost to charge ratio and the cost report. Part III, Line 9b: Our collection process is the same for all patients, regardless if they qualify for charity care. We bill all insurances. Patient does not receive a copy of the bill until it is their balance. We send three statements from our financial system. We have an outside collection agency send out our required final request letters. From this point the outstanding balance is handled by the collection agency. The account does stay active on our financial system for one year. At that time the outstanding balance is moved over to a bad debt status. Part VI, Line 2: No information available Part VI, Line 3: When statements are sent from our financial system, there is a phone number for the patient to call for assistance with their balances. Patients call and we work with them to set up payment arrangements. If they express any concerns for financial needs we offer to send them a Community Care application. Part VI, Line 4: Kenosha County is a fast growing lakeshore coummunity in Southeastern Wisconsin. Located between Chicago and Milwaukee, Kenosha county boasts a diverse economy. Kenosha is the fourth largest city in the State of Wisconsin with 98,187 residents. Of the state's five largest cities, only Madison has grown faster. Kenosha is now the seventh largest county in Wisconsin in terms of population with 165,382 residents. Kenosha County's median household income ($54,464) substantially exceeds the state and national income figures ($52,249 and $52,175 respectively). United Hospital System serves people in southeastern Wisconsin and northern Illinois through its two hospital campuses, St Catherine's Medical Center and Kenosha Medical Center. Aurora Medical Center also has a hosptial campus in Kenosha. Part VI, Line 5: Many staff members are utilized to promote the health of the community and the general well-being of the community we serve. Through our Emergency Preparedness Committee, staff are always planning and preparing to be ready to meet the needs of the community as events occur. Additionally, a variety of staff work with local schools and other organizations to give talks promoting health and careers in healthcare. A number of staff members are involved in mentoring programs within the local schools. Recognizing the importance of sustaining and growing our economy, we participate in our local Business Alliance. 1 Scholarship financial assistance to individuals pursuing degrees in the healthcare field. 40 21695 X 0 0 0 0 0 0 0 0 0 Richard O Schmidt Jr 640333 0 248000 0 9873 0 114039 0 20485 0 1032730 0 0 0 Raymond Knight MD 378000 0 0 0 3048 0 14039 0 20544 0 415631 0 0 0 W Harley Sobin MD 263016 0 788079 0 1032 0 14039 0 20544 0 1086710 0 0 0 Linda Wohlgemuth 304342 0 60197 0 2322 0 39039 0 6728 0 412628 0 0 0 Charles Talbert 293885 0 57881 0 3564 0 39039 0 17613 0 411982 0 0 0 Susan Ventura 306742 0 60197 0 2322 0 39039 0 6728 0 415028 0 0 0 Ashwani Sethi MD 453000 0 600191 0 552 0 14039 0 20544 0 1088326 0 0 0 Mario Garretto MD 523000 0 474822 0 1032 0 64039 0 20544 0 1083437 0 0 0 Carroll Martin MD 520000 0 0 0 4944 0 14039 0 1986 0 540969 0 0 0 Alfred Habel MD 426973 0 0 0 360 0 14039 0 20544 0 461916 0 0 0 James Shapiro MD 260000 0 580337 0 552 0 14039 0 2125 0 857053 0 0 0 Robert Lee Director of Organization 213039 Services provided by Lee Plumbing in which Robert Lee is the owner. 0 A James Cicchini Director of Organization 431986 Services provided by Cicchini Asphalt LLC in which A. James Cicchini is the owner. 0 Form 990, Part VI, Section B, line 11 Form 990 is reviewed by the Organization's CFO and Controller prior to filing. Form 990, Part VI, Section B, line 12c United Hospital System's written conflict of interest policy for the board is reviewed annually by each board member, and any potential conflicts of interest are disclosed at that time. The written conflict of interest policy for employees is reviewed during orientation and periodically at organization meetings, and is incorporated into the performance standards of their annual evaluations. Form 990, Part VI, Section B, line 15 The compensation for the President, CEO and General Counsel and the compensation for the vice presidents reporting directly to the President, CEO and General Counsel are determined by the Board Executive Committee which serves as the Board Compensation Committee. The Board Compensation Committee contracts with the healthcare compensation firm named The Groves Group, LLC, and has utilized the President of the Groves Group, LLC as the compensation consultant since 2005. The compensation consultant utilizes a methodology that evaluates internal and external equity after evaluating the responsibilities of each position and makes a recommendation to the Board Compensation Committee. The Board Compensation Committee has followed the detailed recommendations of the compensation consultant annually since 2005 and the compensation consultant has been retained through 2015. Form 990, Part VI, Section C, line 18 These documents are made available upon request. Form 990 and 990-T are also made available on Guidestar. Form 990, Part VI, Section C, line 19 These documents are made available upon request. Form 990, Part XI, Line 2c, Financial Statements and Reporting: The process the committee uses for oversight of the audit and selection of an independent accountant has not changed from the prior year. kenosha health service corp 6308 8th Avenue Kenosha WI 53143 391491236 Healthcare WI -77992 669021 St Catherine's Hospital Inc 6308 8th Avenue Kenosha WI 53143 390855075 Healthcare WI 501(c)(3) Line 11b, II UHS Inc 6308 8th Avenue Kenosha WI 53143 391956749 Healthcare WI 501(c)(3) Line 9 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 St Catherine's Hospital Inc J 4656800 St Catherine's Hospital Inc Q 5374617