2022-06-13T17:00:23-05:00 2021-07-31 390859910 BAKER TILLY US LLP 777 E WISCONSIN AVENUE 32ND FLOOR MILWAUKEE WI 53202 990 2020-08-01 391139101 ROGERS MEMORIAL HOSPITAL INC ROGE 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 JOANNE HORVATH CHIEF FINANCIAL OFFICER 2626464411 2022-06-13 1 JOANNE HORVATH XXX-XX-XXXX TROY MARINE CPA P00187863 4147775500 2022-06-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z PATRICK HAMMER 34700 VALLEY ROAD OCONOMOWOC WI 53066 361487437 0 X WWW.ROGERSBH.ORG X 1907 WI WE PROVIDE HIGHLY EFFECTIVE MENTAL HEALTH AND ADDICTION TREATMENT THAT HELPS PEOPLE REACH FULL POTENTIAL FOR HEALTH AND WELL-BEING. 17 14 3356 14 184395 0 108896 105489 287030348 329941253 2691770 5644211 0 0 289831014 335690953 4198413 3885690 0 0 178118029 201908612 0 0 0 71615297 78712261 253931739 284506563 35899275 51184390 448245539 501256001 214753933 200517048 233491606 300738953 X OUR VISION:WE ENVISION A FUTURE WHERE PEOPLE HAVE THE TOOLS TO RISE ABOVE THE CHALLENGES OF MENTAL ILLNESS, ADDICTION, AND STIGMA TO LEAD HEALTHY LIVES. WE BRING THIS VISION TO LIFE BY CONSTANTLY ELEVATING THE STANDARD FOR BEHAVIORAL HEALTHCARE, DEMONSTRATING OUR EXCEPTIONAL TREATMENT OUTCOMES, AND ACTING WITH COMPASSION AND RESPECT.OUR VALUES:EXCELLENCE - WE ARE COMMITTED TO CONTINUOUS IMPROVEMENT INCLUDING RECRUITMENT AND RETENTION OF HIGHLY TALENTED EMPLOYEES WHO DELIVER CLINICALLY EFFECTIVE TREATMENTS WITH THE BEST POSSIBLE OUTCOMES.COMPASSION - WE ARE DEDICATED TO A HEALTHY CULTURE WHERE EMPLOYEES, PATIENTS, AND FAMILIES EXPERIENCE EMPATHY, ENCOURAGEMENT, AND RESPECT.ACCOUNTABILITY - WE EMBRACE OUR RESPONSIBILITY TO OUR PATIENTS, FAMILIES, REFERRING PROVIDERS, PAYORS AND COMMUNITY MEMBERS TO PROVIDE CARE THAT IS HIGH QUALITY, COST EFFECTIVE AND SUSTAINABLE. 0 0 222758275 3885690 329756858 WE ARE A NOT-FOR-PROFIT INDEPENDENT PROVIDER OF SPECIALIZED MENTAL HEALTH AND ADDICTION SERVICES FOR ADULTS, TEENS AND CHILDREN. OFFERING TREATMENT IN NINE STATES, WE ARE ONE OF THE LARGEST SPECIALTY BEHAVIORAL HEALTHCARE SYSTEMS IN THE U.S. TO MEET THE NEEDS OF PATIENTS, WE OFFER THREE LEVELS OF CARE: INPATIENT, RESIDENTIAL AND OUTPATIENT. IN FISCAL YEAR 2021 WE SERVED OUR COMMUNITY WITH 64,552 INPATIENT DAYS, 93,866 RESIDENTIAL PATIENT DAYS AND 285,870 OUTPATIENT PATIENT DAYS. THIS REPRESENTS AN 18% INCREASE INCREASE OVER THE PRIOR FISCAL YEAR. THIS YEAR WE RESPONDED TO THE COVID-19 PANDEMIC BY CONTINUING TO OFFER TELEHEALTH CARE TO ELIGIBLE PATIENTS AND MAINTAINING AND ADOPTING EXTENSIVE SAFETY PROTOCALS. THIS ALLOWS US TO CONTINUE TO MEET PATIENTS DEMAND DURING THEIR MOST CRITICAL TIME OF NEED. OVER THE NEXT 3 YEARS, WE PLAN TO OPEN 2 CLINIC LOCATIONS PER YEAR TO SERVE MORE PATIENTS NATIONWIDE. 222758275 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 275 0 1 3356 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 17 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X JOANNE HORVATH 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 PATRICK HAMMER CEO - RBHS/ BOARD MEMBER 1.00 40.00 X X 0 1392490 175968 KHAZI MUQEET MEDICAL DIRECTOR 40.00 1.00 X 902814 0 43991 PAUL MUELLER CEO - THROUGH 06/2021 40.00 1.00 X 790186 0 143147 AHMED NUMAN MEDICAL DIRECTOR 40.00 1.00 X 783780 0 11400 MOHAMMED IQBAL MEDICAL DIRECTOR 40.00 1.00 X 706514 0 51060 BRAD SMITH MEDICAL DIRECTOR 40.00 1.00 X 656639 0 43371 HEMALATHA RAJANNA MEDICAL DIRECTOR 40.00 1.00 X 617917 0 8854 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/ BOARD MEMBER 40.00 1.00 X X 568220 0 53484 JERRY HALVERSON CHIEF MEDICAL OFFICER/ BOARD MEMBER 40.00 1.00 X X 523950 0 47487 ARNOLD STUEBER CFO - THROUGH 06/2021 1.00 1.00 X 0 446687 110588 KIMBERLY EFFERTZ COO 40.00 1.00 X 408484 0 63829 JAY KELLISON COO - THROUGH 12/2020 40.00 1.00 X 449918 0 19673 SCOTT JOHNSON COO 40.00 1.00 X 272424 0 75841 MAEVE O'NEIL CRO 40.00 1.00 X 175754 0 28169 PATRICK ANDRITSCH BOARD CHAIR 3.00 3.00 X X 0 0 0 BARB GORMACKI BOARD VICE-CHAIR 3.00 3.00 X X 0 0 0 CHRIS FITZPATRICK BOARD TREASURER 3.00 3.00 X X 0 0 0 WILLIAM T MULLIGAN BOARD SECRETARY 3.00 3.00 X X 0 0 0 BARBARA ZABAWA BOARD MEMBER - THROUGH 08/2020 0.00 0.00 X 0 0 0 BOB OLSON BOARD MEMBER 1.00 1.00 X 0 0 0 DANIEL BADER BOARD MEMBER 1.00 1.00 X 0 0 0 ERIK CARDENAS BOARD MEMBER 1.00 1.00 X 0 0 0 GINA MARKSON BOARD MEMBER 1.00 1.00 X 0 0 0 KAMILAH WILLIAMS-KEMP BOARD MEMBER 1.00 1.00 X 0 0 0 KEVIN FLANAGAN BOARD MEMBER 1.00 1.00 X 0 0 0 MARTIN BORELL BOARD MEMBER 1.00 1.00 X 0 0 0 MAUREEN STAPLETON BOARD MEMBER 1.00 1.00 X 0 0 0 MICHAEL SEVI BOARD MEMBER 1.00 1.00 X 0 0 0 NICK BAUER BOARD MEMBER 1.00 1.00 X 0 0 0 6856600 1839177 876862 247 0 1 0 CATCON INC 833 E MICHIGAN STREET SUITE 1000 MILWAUKEE WI 53202 CONSTRUCTION SERVICE 4714571 PROJECT4SERVICES LLC 7772 W HAWTHRONE RD MEQUON WI 53097 CONSTRUCTION SERVICE 3395428 HHS CULINARY & NUTRITION SOLUTIONS LLC 12495 SILVER CREEK ROAD DRIPPING SPRINGS TX 78620 FOOD SERVICE 3094212 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 HEALTH INFORMATION TECHNOLOGY 2989077 CIELO INC 200 S EXECUTIVE DRIVE SUITE 400 BROOKFIELD WI 53005 RECRUITING SERVICE 2930253 138 105489 105489 OUTPATIENT REVENUE 621420 129654244 129654244 RESIDENTIAL REVENUE 623220 103341011 103341011 INPATIENT REVENUE 622210 86678885 86678885 MANAGEMENT SERVICES 541610 9144105 8993817 150288 PROVIDER RELIEF FUNDS 900099 1088901 1088901 34107 34107 329941253 2169673 2169673 29271022 25692620 103864 3578402 -103864 3474538 3474538 335690953 329756858 184395 5644211 X 3885690 3885690 3188936 218434 2970502 163209935 143309050 19900885 4899840 4305992 593848 19555602 16884198 2671404 11054299 9613461 1440838 4321500 4321500 164405 164405 112888 112888 137181 137181 29780568 11481365 18299203 1606172 87004 1519168 6737466 2588770 4148696 147659 147659 6562119 5979274 582845 527158 217971 309187 80106 80106 4268265 3926804 341461 14394016 13242496 1151520 2632829 71566 2561263 BAD DEBT EXPENSE 3500921 3500921 FOOD 2987769 2954092 33677 DUE/FEES/SUBSCRIPTIONS 747178 407020 340158 CHARITABLE DONATION 4061 4061 284506563 222758275 61748288 0 123591473 131105631 30504333 37664006 2605512 3263823 248613043 91903471 151054416 156709572 83521786 111611290 8835844 9729229 48132175 51172450 448245539 501256001 24380699 35810306 103025000 100970000 41671968 26105198 45676266 37631544 214753933 200517048 X 218452952 284820367 15038654 15918586 233491606 300738953 448245539 501256001 X 51184390 11283477 4779480 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 112888 112888 0 PART II-B, LINE 1: PORTIONS OF ASSOCIATION DUES ALLOCATED FOR LOBBYING EXPENSES OF WHA $37,724 (11.3%) TOTALING $4,262.81. ROGERS MEMORIAL HOSPITAL ALSO EMPLOYS MICHAEL BEST FOR $108,625 WHO COMMUNICATES ON THE HOSPITALS' BEHALF. 2888541 14034 808297 91914 3618958 2699307 27302 217800 55868 2888541 2529486 131917 116018 78114 2699307 2401177 1839 186974 60504 2529486 2169064 93526 181954 43367 2401177 0.00000 0.61950 0.38050 0 1 1 10098386 10098386 157760746 51134584 106626162 7127381 4301742 2825639 58311901 36467145 21844756 15314629 15314629 156709572 INTEREST IN NET ASSETS - ROGERS MEMORIAL FOUNDATION 15918586 DUE FROM RELATED ORGANIZATIONS 11309376 LEASE RIGHT OF USE ASSETS, NET 23944488 51172450 AR CREDIT BALANCES 643002 DEFERRED COMPENSATION 8023816 DUE TO ROGERS BEHAVIORAL HEALTH SYSTEMS, INC. 543287 LEASE LIABILITY 28421439 37631544 X PART V, LINE 4: THE ENDOWED FUND HELPS SUPPORT PATIENT CARE GRANTS FOR INDIVIDUALS WHO CAN'T PAY FOR TREATMENT. SOME OF THE SPECIFIC RESTRICTIONS ON THE ENDOWED FUNDS ARE FOR OCD TREATMENT, CHILD AND ADOLESCENT PROGRAMS, EATING DISORDERS, SPIRITUAL CARE, AND CAPITAL IMPROVEMENTS. AN ENDOWED FUND OFFERS LASTING FINANCIAL RESOURCES THAT EXTEND THE VALUE OF A DONOR'S GIFT. THROUGH CAREFUL INVESTMENT MANAGEMENT, INCOME GENERATED FROM THE FUND ENABLES ROGERS FOUNDATION TO MOVE FORWARD WITH PLANS, PROJECTS, AND RESEARCH THAT IMPROVE THE HEALTH AND WELL-BEING OF PATIENTS SUFFERING FROM MENTAL HEALTH AND ADDICTION CHALLENGES TODAY AND IN THE FUTURE. PART X, LINE 2: ROGERS MEMORIAL HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(2) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. ROGERS MEMORIAL HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THE RETURN IS FILED IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME TAX (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 1521125 0 0 0 0 0 0 1521125 0 1521125 1 0 1 1 0 0 PART III ACCOUNTING METHOD: FORM 990, SCHEDULE F, PART IV: ROGERS MEMORIAL HOSPITAL, INC. INVESTS IN DOMESTIC AND FOREIGN LIMITED PARTNERSHIPS THAT MAY OWN AN INTEREST IN A FOREIGN CORPORATION, PASSIVE FOREIGN INVESTMENT COMPANY, OR FOREIGN PARTNERSHIP. NEVERTHELESS, ROGERS MEMORIAL HOSPITAL, INC.'S INVESTMENT ACTIVITIES MAY NOT REACH THE THRESHOLDS REQUIRED FOR FILING THE FORMS 926, 5471, 8621, 8865. TO THE EXTENT THAT ROGERS MEMORIAL HOSPITAL, INC. IS REQUIRED TO COMPLETE ONE OF THESE FOREIGN FORMS, IT HAS BEEN FILED WITH THE ANNUAL FORM 990-T. 1 1 X 1 X 1 X 1 1 1 0 1 1 3881960 3881960 0.01380 76247968 36949811 39298157 0.13980 80129928 36949811 43180117 0.15360 1542039 1542039 0.00550 29654 29654 0.00010 218984 218984 0.00080 1790677 1790677 0.00640 81920605 36949811 44970794 0.16000 1 3500921 2291419 4728839 -2437420 X 1 1 3 1 ROGERS MEMORIAL HOSPITAL - OCONOMOWOC 34700 VALLEY ROAD OCONOMOWOC WI 53006 WWW.ROGERSBH.ORG X 2 ROGERS MEMORIAL HOSPITAL - WEST ALLIS 11101 W LINCOLN AVEUE MILWAUKEE WI 53227 WWW.ROGERSBH.ORG X 3 ROGERS MEMORIAL HOSPITAL - BROWN DEER 4600 WEST SCHROEDER DRIVE SUITE 2 BROWN DEER WI 53223 WWW.ROGERSBH.ORG X ROGERS MEMORIAL HOSPITAL - OCONOMOWOC 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 18 1 SEE PART V, SECTION B, LINE 7D 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X X X X X X X 1 X 0 X X 1 X 0 0 ROGERS MEMORIAL HOSPITAL - WEST ALLIS 2 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 18 1 SEE PART V, SECTION B, LINE 7D 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X X X X X X X 1 X 0 X X 1 X 0 0 ROGERS MEMORIAL HOSPITAL - BROWN DEER 3 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 18 1 SEE PART V, SECTION B, LINE 7D 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X SEE SUPPLEMENTAL INFORMATION PART V, PAGE 8 X X X X X X X 1 X 0 X X 1 X 0 0 ROGERS MEMORIAL HOSPITAL - OCONOMOWOC PART V, SECTION B, LINE 5: YES, WE SURVEYED COMMUNITY MEMBERS AND REVIEWED OTHER HOSPITAL AND GOVERNMENTAL SURVEYS CONDUCTED TO ASSESS THE COMMUNITY NEED. ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 5: YES, WE SURVEYED COMMUNITY MEMBERS AND REVIEWED OTHER HOSPITAL AND GOVERNMENTAL SURVEYS CONDUCTED TO ASSESS THE COMMUNITY NEED. ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 5: YES, WE SURVEYED COMMUNITY MEMBERS AND REVIEWED OTHER HOSPITAL AND GOVERNMENTAL SURVEYS CONDUCTED TO ASSESS THE COMMUNITY NEED. ROGERS MEMORIAL HOSPITAL - OCONOMOWOC PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/4215/6449/5496/2019_CHNA.V4.CLEAN_BRAND.PDF ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/4215/6449/5496/2019_CHNA.V4.CLEAN_BRAND.PDF ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/4215/6449/5496/2019_CHNA.V4.CLEAN_BRAND.PDF ROGERS MEMORIAL HOSPITAL - OCONOMOWOC PART V, SECTION B, LINE 11: THE ADVISORY COMMITTEE MADE THE DECISION TO ADDRESS THE FOLLOWING PRIORITIES AS IDENTIFIED BY THE LATEST CHNA:1) ACCESS TO MENTAL HEALTH AND ADDICTION SERVICES - BY GROWING THE CHARITABLE GIVING FUND TO INCREASE ACCESS TO TREATMENT AND SERVICES FOR THOSE WITH LIMITED RESOURCES, INCREASE THE ROGERS BEHAVIORAL HEALTH FOUNDATION'S ANGEL FUND PROGRAM TO SUPPORT THE TRAVEL AND ACCOMMODATION EXPENSES THAT PATIENTS AND FAMILIES MAY ENCOUNTER WHILE SEEKING TREATMENT, EXPAND THE CAPACITY OF OUR MENTAL HEALTH AND ADDICTION PROGRAMS TO BE ABLE TO SERVE MORE PEOPLE, BROADEN THE SPECTRUM OF PROGRAMING TO SERVE INDIVIDUALS WITH MORE COMPLEX CASES, IMPROVE THE EASE OF TRANSFERS FROM EMERGENCY ROOMS FOR THOSE WHO ARE IN NEED OF URGENT MENTAL HEALTH AND ADDICTION SERVICES, AND EXPAND TELEMEDICINE SERVICES TO ADDITIONAL LOCATIONS AND PROGRAMS TO HELP ALLEVIATE ACCESS BARRIERS TO MENTAL HEALTH PROFESSIONALS. 2) EDUCATION AND STIGMA REDUCTION - BY PROVIDING TRAINING, COACHING, AND SUPPORT TO INCREASE THE DISTRIBUTION AND USE OF STIGMA REDUCTION PROGRAMMING WITH IN ROGERS AND WITH COMMUNITY PARTNERS, ONLINE AND OTHER ADAPTATIONS, PROVIDE CONSULTATION AND FACILITATIVE LEADERSHIP TO WISE, INVESTIGATE OPPORTUNITIES THAT PROVIDE INCREASED EDUCATION FOR MENTAL HEALTH PROFESSIONALS, SUCH AS INTERNSHIPS, RESIDENCIES AND OTHER BEHAVIORAL HEALTH CAREER TRAINING OPPORTUNITIES, CREATE AND OFFER ADDITIONAL RESOURCES FOR FAMILY AND COMMUNITY EDUCATION ABOUT EVIDENCE-BASED TREATMENT PRACTICES AND HOW TO OFFER SUPPORT AFTER TREATMENT, FINALLY, INCREASE AVAILABILITY TO COMPASSION RESILIENCE TRAINING RESOURCES TO TREATMENT PROVIDERS AND CARETAKERS OF THOSE WITH MENTAL HEALTH CHALLENGES. 3) CONTINUUM OF CARE - BY IMPROVING ACCESSIBILITY AND TYPES OF COMMUNITY SUPPORT GROUPS, PROVIDE TRANSITIONAL HOUSING OPTIONS FOR ADDICTION RECOVERY, AND INCREASE THE USE OF "STEP DOWN" PROGRAMS WITHIN ROGERS RESIDENTIAL, PARTIAL HOSPITALIZATION AND INTENSIVE OUTPATIENT LEVELS OF CARE. ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 11: THE ADVISORY COMMITTEE MADE THE DECISION TO ADDRESS THE FOLLOWING PRIORITIES AS IDENTIFIED BY THE LATEST CHNA:1) ACCESS TO MENTAL HEALTH AND ADDICTION SERVICES - BY GROWING THE CHARITABLE GIVING FUND TO INCREASE ACCESS TO TREATMENT AND SERVICES FOR THOSE WITH LIMITED RESOURCES, INCREASE THE ROGERS BEHAVIORAL HEALTH FOUNDATION'S ANGEL FUND PROGRAM TO SUPPORT THE TRAVEL AND ACCOMMODATION EXPENSES THAT PATIENTS AND FAMILIES MAY ENCOUNTER WHILE SEEKING TREATMENT, EXPAND THE CAPACITY OF OUR MENTAL HEALTH AND ADDICTION PROGRAMS TO BE ABLE TO SERVE MORE PEOPLE, BROADEN THE SPECTRUM OF PROGRAMING TO SERVE INDIVIDUALS WITH MORE COMPLEX CASES, IMPROVE THE EASE OF TRANSFERS FROM EMERGENCY ROOMS FOR THOSE WHO ARE IN NEED OF URGENT MENTAL HEALTH AND ADDICTION SERVICES, AND EXPAND TELEMEDICINE SERVICES TO ADDITIONAL LOCATIONS AND PROGRAMS TO HELP ALLEVIATE ACCESS BARRIERS TO MENTAL HEALTH PROFESSIONALS. 2) EDUCATION AND STIGMA REDUCTION - BY PROVIDING TRAINING, COACHING, AND SUPPORT TO INCREASE THE DISTRIBUTION AND USE OF STIGMA REDUCTION PROGRAMMING WITH IN ROGERS AND WITH COMMUNITY PARTNERS, ONLINE AND OTHER ADAPTATIONS, PROVIDE CONSULTATION AND FACILITATIVE LEADERSHIP TO WISE, INVESTIGATE OPPORTUNITIES THAT PROVIDE INCREASED EDUCATION FOR MENTAL HEALTH PROFESSIONALS, SUCH AS INTERNSHIPS, RESIDENCIES AND OTHER BEHAVIORAL HEALTH CAREER TRAINING OPPORTUNITIES, CREATE AND OFFER ADDITIONAL RESOURCES FOR FAMILY AND COMMUNITY EDUCATION ABOUT EVIDENCE-BASED TREATMENT PRACTICES AND HOW TO OFFER SUPPORT AFTER TREATMENT, FINALLY, INCREASE AVAILABILITY TO COMPASSION RESILIENCE TRAINING RESOURCES TO TREATMENT PROVIDERS AND CARETAKERS OF THOSE WITH MENTAL HEALTH CHALLENGES. 3) CONTINUUM OF CARE - BY IMPROVING ACCESSIBILITY AND TYPES OF COMMUNITY SUPPORT GROUPS, PROVIDE TRANSITIONAL HOUSING OPTIONS FOR ADDICTION RECOVERY, AND INCREASE THE USE OF "STEP DOWN" PROGRAMS WITHIN ROGERS RESIDENTIAL, PARTIAL HOSPITALIZATION AND INTENSIVE OUTPATIENT LEVELS OF CARE. ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 11: THE ADVISORY COMMITTEE MADE THE DECISION TO ADDRESS THE FOLLOWING PRIORITIES AS IDENTIFIED BY THE LATEST CHNA:1) ACCESS TO MENTAL HEALTH AND ADDICTION SERVICES - BY GROWING THE CHARITABLE GIVING FUND TO INCREASE ACCESS TO TREATMENT AND SERVICES FOR THOSE WITH LIMITED RESOURCES, INCREASE THE ROGERS BEHAVIORAL HEALTH FOUNDATION'S ANGEL FUND PROGRAM TO SUPPORT THE TRAVEL AND ACCOMMODATION EXPENSES THAT PATIENTS AND FAMILIES MAY ENCOUNTER WHILE SEEKING TREATMENT, EXPAND THE CAPACITY OF OUR MENTAL HEALTH AND ADDICTION PROGRAMS TO BE ABLE TO SERVE MORE PEOPLE, BROADEN THE SPECTRUM OF PROGRAMING TO SERVE INDIVIDUALS WITH MORE COMPLEX CASES, IMPROVE THE EASE OF TRANSFERS FROM EMERGENCY ROOMS FOR THOSE WHO ARE IN NEED OF URGENT MENTAL HEALTH AND ADDICTION SERVICES, AND EXPAND TELEMEDICINE SERVICES TO ADDITIONAL LOCATIONS AND PROGRAMS TO HELP ALLEVIATE ACCESS BARRIERS TO MENTAL HEALTH PROFESSIONALS. 2) EDUCATION AND STIGMA REDUCTION - BY PROVIDING TRAINING, COACHING, AND SUPPORT TO INCREASE THE DISTRIBUTION AND USE OF STIGMA REDUCTION PROGRAMMING WITH IN ROGERS AND WITH COMMUNITY PARTNERS, ONLINE AND OTHER ADAPTATIONS, PROVIDE CONSULTATION AND FACILITATIVE LEADERSHIP TO WISE, INVESTIGATE OPPORTUNITIES THAT PROVIDE INCREASED EDUCATION FOR MENTAL HEALTH PROFESSIONALS, SUCH AS INTERNSHIPS, RESIDENCIES AND OTHER BEHAVIORAL HEALTH CAREER TRAINING OPPORTUNITIES, CREATE AND OFFER ADDITIONAL RESOURCES FOR FAMILY AND COMMUNITY EDUCATION ABOUT EVIDENCE-BASED TREATMENT PRACTICES AND HOW TO OFFER SUPPORT AFTER TREATMENT, FINALLY, INCREASE AVAILABILITY TO COMPASSION RESILIENCE TRAINING RESOURCES TO TREATMENT PROVIDERS AND CARETAKERS OF THOSE WITH MENTAL HEALTH CHALLENGES. 3) CONTINUUM OF CARE - BY IMPROVING ACCESSIBILITY AND TYPES OF COMMUNITY SUPPORT GROUPS, PROVIDE TRANSITIONAL HOUSING OPTIONS FOR ADDICTION RECOVERY, AND INCREASE THE USE OF "STEP DOWN" PROGRAMS WITHIN ROGERS RESIDENTIAL, PARTIAL HOSPITALIZATION AND INTENSIVE OUTPATIENT LEVELS OF CARE. ROGERS MEMORIAL HOSPITAL - OCONOMOWOC PART V, SECTION B, LINE 16J: NOTIFIED INDIVIDUALS THROUGH COMMUNICATIONS REGARDING THEIR BILLS. ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 16J: NOTIFIED INDIVIDUALS THROUGH COMMUNICATIONS REGARDING THEIR BILLS. ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 16J: NOTIFED INDIVIDUALS THROUGH COMMUNICATIONS REGARDING THEIR BILLS. PART V, SECTION B, LINE 16A-16 - WEBSITE LINKS FAP:HTTPS://ROGERSBH.ORG/WHAT-EXPECT/FINANCING-YOUR-CARE/FINANCIAL-ASSISTANCE-PROGRAMFAP APPLICATION FORM:HTTPS://ROGERSBH.ORG/APPLICATION/FILES/2615/8169/6988/FINANCIAL_ASSISTANCE_APPLICATION_02072020.PDFPLAN LANGUAGE SUMMARY:HTTPS://ROGERSBH.ORG/WHAT-EXPECT/FINANCING-YOUR-CARE/FINANCIAL-ASSISTANCE-PROGRAM 17 1 - ROGERS MEMORIAL HOSPITAL - MADISON 406 SCIENCE DRIVE SUITE 110 MADISON WI 53711 CENTER FOR EATING AND ANXIETY DISORDERS, AND COGNITIVE-BEHAVIORAL THERAPY 2 - ROGERS BEHAVIORAL HEALTH - SKOKIE 4711 GOLF ROAD SUITE 600 SKOKIE IL 60076 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, AND MOOD DISORDERS 3 - ROGERS BEHAVIORAL HEALTH - MINNEAPOLIS 6442 CITY WEST PARKWAY SUITE 200 EDEN PRAIRIE MN 55344 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 4 - ROGERS BEHAVIORAL HEALTH - APPLETON 4531 W COLLEGE AVE 300 APPLETON WI 54914 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 5 - ROGERS BEHAVIORAL HEALTH - TAMPA 2002 N LOIS AVE SUITE 400 TAMPA FL 33607 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, AND MOOD DISORDERS 6 - ROGERS BEHAVIORAL HEALTH - SAN FRANCISCO 420 N WIGET LANE BUILDING 2 WALNUT CREEK CA 94598 CENTER FOR OCD, ANXIETY AND MOOD DISORDERS 7 - ROGERS BEHAVIORAL HEALTH - NASHVILLE 4230 HARDING ROAD SUITE 707 NASHVILLE TN 37205 CENTER FOR OCD, ANXIETY AND EATING DISORDERS 8 - ROGERS BEHAVIORAL HEALTH - HINSDALE 907 NORTH ELM STREET SUITE 300 HINSDALE IL 60521 CENTER FOR MOOD DISORDERS, OCD, ANXIETY, PTSD, MENTAL HEALTH 9 - ROGERS MEMORIAL HOSPITAL - KENOSHA 9916 75TH STREET KENOSHA WI 53142 TREATMENT CENTER FOR CHILDREN AND ADOLESCENTS 10 - ROGERS BEHAVIORAL HEALTH - PHILADELPHIA 1 WINDING DRIVE SUITE 106 PHILADELPHIA PA 19131 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 11 - ROGERS BEHAVIORAL HEALTH - ST PAUL 576 BEILENBERG DRIVE SUITE 180 WOODBURY MN 55125 CENTER FOR OCD, ANXIETY, DEPRESSION RECOVERY, MENTAL HEALTH 12 - ROGERS BEHAVIORAL HEALTH - SAN DIEGO 17140 BERNARDO CENTER DRIVE SAN DIEGO CA 92128 CENTER FOR OCD, ANXIETY, AND DEPRESSION RECOVERY 13 - ROGERS BEHAVIORAL HEALTH - MIAMI 5805 BLUE LAGOON DRIVE SUITE 440 MIAMI FL 33126 CENTER FOR OCD, ANXIETY, DEPRESSION, MOOD DISORDERS, MENTAL HEALTH 14 - ROGERS BEHAVIORAL HEALTH - LOS ANGELES 5140 WEST GOLDLEAF CIRCLE SUITE 250 LOS ANGELES CA 90056 CENTER FOR OCD, ANXIETY, AND DEPRESSION RECOVERY 15 - ROGERS BEHAVIORAL HEALTH - ATLANTA 50 GLENLAKE PARKWAY NORTHEAST SUITE 200 SANDY SPRINGS GA 30328 CENTER FOR OCD, ANXIETY, DEPRESSION, MOOD DISORDERS, MENTAL HEALTH, AND DEPR 16 - ROGERS BEHAVIORAL HEALTH - SEATTLE 1215 114TH AVENUE SE BELLEVUE WA 98004 CENTER FOR OCD, ANXIETY, AND DEPRESSION RECOVERY 17 - ROGERS BEHAVIORAL HEALTH - SHEBOYGAN 1108 S WILDWOOD AVE SHEBOYGAN WI 53081 CENTER FOR OCD & ANXIETY, MENTAL HEALTH & ADDICTION RECOVERY, MENTAL HEALTH PART I, LINE 6A: COMMUNITY BENEFIT WISCONSIN STATE ASSOCIATION SURVEY PART I, LINE 7: LINES A - E: CONSISTENT WITH THE MISSION OF THE HOSPITAL, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO ARE UNINSURED AND WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES. THE HOSPITAL PROVIDES DISCOUNTS FROM ESTABLISHED CHARGES TO SELF-PAY PATIENTS WITHOUT REGARD TO THE PATIENT'S ABILITY TO PAY AND CONSIDERS THESE DISCOUNTS A PART OF THEIR COMMUNITY BENEFIT. PATIENTS WHO MEET CERTAIN CRITERIA FOR COMMUNITY CARE, GENERALLY BASED ON FEDERAL POVERTY GUIDELINES, ARE PROVIDED CARE WITHOUT CHARGE OR AT A REDUCED RATE, DETERMINED BASED ON QUALIFYING CRITERIA AS DEFINED IN THE HOSPITAL'S COMMUNITY CARE POLICY AND FROM APPLICATIONS COMPLETED BY PATIENTS AND THEIR FAMILIES.LINES E AND I: THESE ARE COSTS DEVELOPED BASED ON THE ESTIMATED TIME AND RESOURCES UTILIZED IN PROVIDING THESE COMMUNITY BENEFITS. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,500,921. PART III, LINE 2: BAD DEBT EXPENSE IS OBTAINED THROUGH OUR INTERNAL COSTING SYSTEM, REVIEWED AND VALIDATED BY OUR REVENUE CYCLE TEAM AND MEASURED AGAINST A ROLLING CLOSED CLAIMS ANALYSIS. PART III, LINE 4: FROM THE ATTACHED AUDITED FINANCIAL STATEMENTS, PAGE 14 PATIENT SERVICE REVENUE: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATION OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE A RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THESE ADVERSE CHANGES FOR THE YEARS ENDED JULY 31, 2021 AND 2020 WAS NOT SIGNIFICANT.SETTLEMENTS WITH THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS DUE TO AUDITS, REVIEWS OR INVESTIGATIONS ARE CONSIDERED VARIABLE CONSIDERATION AND ARE INCLUDED IN THE DETERMINATION OF THE ESTIMATED TRANSACTION PRICE FOR PROVIDING PATIENT CARE. THESE SETTLEMENTS ARE ESTIMATED BASED ON THE TERMS OF THE PAYMENT AGREEMENT WITH THE PAYOR, CORRESPONDENCE FROM THE PAYOR, AND THE HOSPITAL'S HISTORICAL SETTLEMENT ACTIVITY, INCLUDING AN ASSESSMENT TO ENSURE THAT IT IS PROBABLE THAT A SIGNIFICANT REVERSAL IN THE AMOUNT OF CUMULATIVE REVENUE RECOGNIZED WILL NOT OCCUR WHEN THE UNCERTAINTY ASSOCIATED WITH THE RETROACTIVE ADJUSTMENT IS SUBSEQUENTLY RESOLVED. PART III, LINE 8: DATA REPORTED AS MEDICARE ALLOWABLE COSTS WERE TAKEN DIRECTLY FROM THE MEDICARE COST REPORT. THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT AS A HOSPITAL THAT SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS (INCLUDING MEDICARE) INDICATES THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY AND THEREFORE IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. PART III, LINE 9B: ROGERS MEMORIAL HOSPITAL RECOGNIZES THE NEED FOR THE MEDICALLY INDIGENT TO RECEIVE NECESSARY SERVICES. PATIENT CARE IS NOT AFFECTED BY HIS/HER INABILITY TO PAY REGARDLESS OF FINANCIAL STATUS, RACE, COLOR, CREED, SEXUAL ORIENTATION, HANDICAP, SEX OR NATIONAL ORIGIN. SERVICES ARE RENDERED IN A CARING, RESPECTFUL AND CONCERNED MANNER. TO ENSURE THAT THE PHILOSOPHY OF THE HOSPITAL IS UPHELD, A CONSISTENT METHOD OF DETERMINING ELIGIBILITY FOR COMMUNITY CARE HAS BEEN DEVELOPED. IT IS THE POLICY OF ROGERS MEMORIAL HOSPITAL TO WRITE OFF ACCOUNTS THAT QUALIFY FOR CHARITY CARE, THUS THERE ARE NO COLLECTION EFFORTS RELATED TO THOSE THAT QUALIFY FOR CHARITY CARE. COMMUNITY CARE IS NOT TO BE USED AS A SUBSTITUTE FOR BAD DEBT. ONLY THOSE PATIENTS WHO MEET THE CRITERIA ARE ELIGIBLE FOR COMMUNITY CARE RELIEF. THOSE PATIENTS WHO DO NOT MEET THE CRITERIA AND REFUSE TO COOPERATE WITH COLLECTION EFFORTS WILL BE PURSUED TO THE EXTENT DEEMED NECESSARY BY MANAGEMENT FOR COLLECTION AND IF STILL UNCOLLECTIBLE, WILL BE WRITTEN OFF TO BAD DEBT. PART VI, LINE 2: WE COLLABORATE WITH OTHER PROVIDERS THROUGH PARTNERSHIPS AND CONSULTING RELATIONSHIPS WITH THE MEDICAL COLLEGE OF WISCONSIN, CHILDREN'S HOSPITAL OF WISCONSIN, FROEDTERT HEALTH, COMMUNITY MEMORIAL HOSPITAL AND COLUMBIA ST. MARY'S, IN ORDER TO BRING QUALITY BEHAVIORAL HEALTH SERVICES TO WISCONSIN RESIDENTS. PART VI, LINE 3: PRIOR TO RECEIVING SERVICES, THERE ARE A NUMBER OF WAYS A PATIENT CAN BE IDENTIFIED AND EVALUATED FOR FINANCIAL ASSISTANCE PRIOR TO, DURING, OR FOLLOWING CARE. THE FOLLOWING IS A NON-EXHAUSTIVE LIST OF EXAMPLES FOR IDENTIFICATION PRIOR TO RECEIVING SERVICES: PATIENTS OR THEIR REPRESENTATIVES MAY REQUEST FINANCIAL ASSISTANCE, ROGERS' EMPLOYEES MAY ROGERS MEMORIAL HOSPITAL, INC. 39-1139101 REFER PATIENTS TO A FINANCIAL COUNSELOR OR PATIENT FINANCIAL SERVICES REPRESENTATIVE, FINANCIAL COUNSELORS AND/OR PFS STAFF MAY IDENTIFY FINANCIAL NEED THROUGH CONVERSATIONS WITH PATIENTS REGARDING BILLING AND PAYMENT OPTIONS, REFERRING PHYSICIANS MAY REFER PATIENTS, COLLECTION AGENCIES OR ATTORNEYS MAY REFER PATIENTS BACK TO ROGERS, LOCAL GOVERNMENTS AGENCIES MAY REFER PATIENTS. PART VI, LINE 4: ROGERS MEMORIAL HOSPITAL OPERATES FACILITIES IN THE WISCONSIN COMMUNITIES OF OCONOMOWOC, WEST ALLIS, BROWN DEER, KENOSHA, DELAFIELD, MADISON, AND APPLETON TO PROVIDE INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH AND PSYCHIATRIC SERVICES TO PATIENTS PRIMARILY FROM THE MIDWEST. THE HOSPITAL PROVIDES SERVICES RELATING TO RECOVERY FROM ADDICTIONS, ABUSE, DISRUPTIVE BEHAVIOR, EATING AND OBSESSIVE COMPULSIVE DISORDERS; GENERAL PSYCHIATRY FOR ADULTS, ADOLESCENTS, AND CHILDREN; AND ADOLESCENT EXTENDED CARE.ROGERS SERVES A DIVERSE COMMUNITY, OPERATING IN 18 CITIES AND 9 DIFFERENT STATES ACROSS THE UNITED STATES. WITH OVER 26,130 ADMITS IN FY2021, APPROXIMATELY 69% WERE PATIENTS FROM WISCONSIN WHILE 31% WERE SOURCED FROM OTHER STATES. PATIENTS FROM SOUTHEAST WISCONSIN (MILWAUKEE, WAUKESHA, OZAUKEE, RACINE, SHEBOYGAN, AND WASHINGTON COUNTIES) MADE UP ABOUT 36% OF ALL PATIENT ADMITS. ROGERS CONTINUES TO SERVE PATIENTS IN THIS PRIMARY SERVICE AREA WHILE REACHING MORE PATIENTS NATIONWIDE. PART VI, LINE 5: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON PART III OF FORM 990. 1 ROGERS MEMORIAL HOSPITAL FOUNDATION INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 391363507 501(C)(3) 2700000 1069190 COST IN-KIND SERVICES PROVIDES SUPPORT TO THE RMHF TO ASSIST IN CARRYING OT ITS EXEMPT PURPOSE UNITED WAY OF GREATER MILWAUKEE & WAUKESHA COUNTY PO BOX 88110 MILWAUKEE WI 53288 390806190 501(C)(3) 10000 CORPORATE CAMPAIGN INTERNATIONAL OCD FOUNDATION PO BOX 961029 BOSTON MA 02196 222894564 501(C)(3) 12500 PARTNERSHIP AND SUPPORT OCD WISCONSIN FOUNDATION PO BOX 623 OCONOMOWOC WI 53066 462074424 501(C)(3) 7500 PARTNERSHIP AND SUPPORT IAEDP FOUNDATION PRESIDENT'S COUNCIL MEMBERSHIP PO BOX 1295 PERKIN IL 61555 800760370 501(C)(3) 10000 PARTNERSHIP AND SUPPORT NTL ASSOC OF ANOREXIA NERVOSA & ASSOC DISORDERS PO BOX 409047 CHICAGO IL 60640 362938021 501(C)(3) 10000 PARTNERSHIP AND SUPPORT THE OVERTURE CENTER FOUNDATION INC 201 STATE STREET MADISON WI 53703 010645482 501(C)(3) 10000 PARTNERSHIP AND SUPPORT RIGHTWAY CLUB INC 4627 S 12TH ST SHEBOYGAN WI 53081 391416500 501(C)(3) 10000 PARTNERSHIP AND SUPPORT MILWAUKEE FILM INC 2230 N FARWELL AVE MILWAUKEE WI 53205 263049630 501(C)(3) 10000 PARTNERSHIP AND SUPPORT MINNESOTA ASSOCIATION FOR CHILDREN'S MENTAL HEALTH 23 EMPIRE DR SUITE 1000 SAINT PAUL MN 55103 411727185 501(C)(3) 6500 PARTNERSHIP AND SUPPORT MULTI-SERVICE EATING DISORDERS ASSOCIATION 1320 CENTER STREET SUITE 101 NEWTON MA 02459 043224394 501(C)(3) 5000 PARTNERSHIP AND SUPPORT NAMI WAUKESHA 217 WISCONSIN AVE WAUKESHA WI 53186 391485627 501(C)(3) 5000 PARTNERSHIP AND SUPPORT WISHOPE INC 223 WISCONSIN AVE WAUKESHA WI 53186 833544716 501(C)(3) 5000 PARTNERSHIP AND SUPPORT AUTISM SPEAKS INC 1060 STATE ROAD PRINCETON NJ 08540 202329938 501(C)(3) 5000 PARTNERSHIP AND SUPPORT THE SHUL 9540 COLLINS AVE SURFSIDE FL 33154 592302315 501(C)(3) 5000 PARTNERSHIP AND SUPPORT THE MILE HALL FOUNDATION 1922 TICE VALLEY BLVD 2443 WALNUT CREEK CA 94595 843451430 501(C)(3) 5000 PARTNERSHIP AND SUPPORT 16 0 PART I, LINE 2: AS GRANTS ARE MADE PRIMARILY TO ROGERS MEMORIAL HOSPITAL FOUNDATION, MONITORING OF THESE TRANSACTIONS ARE PERFORMED BY OFFICERS OF THE HOSPITAL WITH OVERSIGHT BY THE BOARD. FOR ASSISTANCE PROVIDED TO NON-ROGERS' AFFILIATES, THE GRANTEE ORGANIZATIONS GENERALLY PROVIDE AN ACKNOWLEDGEMENT LETTER INDICIATING HOW THE FUNDS WERE USED FOR THEIR INTENDED PURPOSE. X 0 0 X X X X X 1 1 0 0 0 0 0 0 0 PATRICK HAMMER CEO - RBHS/ BOARD MEMBER 0 717678 0 672762 0 2050 0 145506 0 30462 0 1568458 0 0 KHAZI MUQEET MEDICAL DIRECTOR 756394 0 146070 0 350 0 11272 0 32719 0 946805 0 0 0 PAUL MUELLER CEO - THROUGH 06/2021 506436 0 282980 0 770 0 104919 0 38228 0 933333 0 0 0 AHMED NUMAN MEDICAL DIRECTOR 389711 0 392669 0 1400 0 11400 0 0 0 795180 0 0 0 MOHAMMED IQBAL MEDICAL DIRECTOR 346174 0 359597 0 743 0 11400 0 39660 0 757574 0 0 0 BRAD SMITH MEDICAL DIRECTOR 431559 0 224310 0 770 0 11400 0 31971 0 700010 0 0 0 HEMALATHA RAJANNA MEDICAL DIRECTOR 384884 0 232695 0 338 0 7183 0 1671 0 626771 0 0 0 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/ BOARD MEMBER 444235 0 122585 0 1400 0 11400 0 42084 0 621704 0 0 0 JERRY HALVERSON CHIEF MEDICAL OFFICER/ BOARD MEMBER 420408 0 103052 0 490 0 11400 0 36087 0 571437 0 0 0 ARNOLD STUEBER CFO - THROUGH 06/2021 0 331852 0 114485 0 350 0 71400 0 39188 0 557275 0 0 KIMBERLY EFFERTZ COO 289489 0 118225 0 770 0 31408 0 32421 0 472313 0 0 0 JAY KELLISON COO - THROUGH 12/2020 365659 0 80897 0 3362 0 6522 0 13151 0 469591 0 0 0 SCOTT JOHNSON COO 225130 0 46944 0 350 0 30720 0 45121 0 348265 0 0 0 MAEVE O'NEIL CRO 155217 0 19827 0 710 0 4462 0 23707 0 203923 0 0 0 PART I, LINE 1A HEALTH AND SOCIAL MEMBERSHIPS FOR CERTAIN OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED INDIVIDUALS ARE INCLUDED IN TAXABLE COMPENSATION AS THESE FEES ARE PAID BY ROGERS MEMORIAL HOSPITAL. $3,958 PAUL MUELLER $3,958 PAT HAMMER $3,372 ARNOLD STUEBER PART I, LINES 4A-B SOME EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDER YEAR. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. ROGERS MEMORIAL HOSPITAL, INC. PROVIDES A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO ELIGIBLE EMPLOYEES. DURING FY2021, PATRICK HAMMER, PAUL MUELLER, KIMBERLY EFFERTZ, ARNOLD STUEBER, AND SCOTT JOHNSON PARTICIPATED IN THIS PLAN. THERE WERE NO AMOUNTS PAID DURING THE YEAR. A WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY SERIES 2014 A & B 391337855 97712DEV4 2014-08-15 55065129 BUILDING IMPROVEMENTS TO VARIOUS SITES 0 0 0 B WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY SERIES 2019 A&B 391337855 97712D2C9 2019-08-28 46574029 BUILDING IMPROVEMENTS TO VARIOUS SITES 0 0 0 A 13000000 55082968 757709 21301703 33023556 2016 1 1 1 1 B 2000000 46799562 214561 26215408 6686259 13692527 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY SERIES 2014 DATE THE REBATE COMPUTATION WAS PERFORMED: 10/31/2019 FORM 990, SCHEDULE K, PART 2, LINE 3, COLUMN (A) THE TOTAL PROCEEDS OF ISSUE AND THE ISSUE PRICE DIFFER DUE TO THE INCLUSION OF INTEREST EARNED IN THE TOTAL PROCEEDS OF ISSUE. FORM 990, SCHEDULE K, PART 2, LINE 3, COLUMN (B) THE TOTAL PROCEEDS OF ISSUE AND THE ISSUE PRICE DIFFER DUE TO THE INCLUSION OF INTEREST EARNED IN THE TOTAL PROCEEDS OF ISSUE. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIR, VICE CHAIR, SECRETARY AND TREASURER. IN THE EVENT OF EMERGENCY BUSINESS WHICH REQUIRES PROMPT ATTENTION, THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY TO MEET AS NECESSARY BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND IS DELEGATED FULL AUTHORITY OF THE BOARD OF DIRECTORS TO APPOINT AND DENY APPOINTMENT TO THE MEDICAL STAFF (DEFINED BELOW) AND FOR ALL OTHER PURPOSES EXCEPT AS MAY BE LIMITED BY THESE BYLAWS OR BY RESOLUTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ROGERS BEHAVIORAL HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A PER THE BY-LAWS, ADDITIONAL MEMBERS OF THE BOARD OF DIRECTORS SHALL BE DETERMINED BY THE SOLE CORPORATE MEMBER FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS MUST BE APPROVED BY THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ROGERS BEHAVIORAL HEALTH SYSTEM: 1) SELLING OF DISPOSING OF A MATERIAL PART OF THE CORPORATION'S ASSETS, 2) LENDING OR BORROWING MONEY OTHER THAN PURSUANT TO AN APPROVED LINE OF CREDIT, 3) GRANTING A MORTGAGE OR SUBJECTING TO ANOTHER SECURITY INTEREST IN ANY MATERIAL PORTION OF THE CORPORATION'S ASSETS, 4) ENTERING INTO CONTRACTS OR AGREEMENTS WITH PERSONS WHICH, INDIVIDUALLY, OR AS TO THE SAME PARTY, IN AGGREGATE CALL FOR THE PAYMENT BY THE CORPORATION OF AMOUNTS WHICH ARE GREATER THAN SUCH AMOUNTS WHICH ARE APPROVED BY RESOLUTION OF THE MEMBER FROM TIME TO TIME. THE MEMBER MAY ESTABLISH LIMITATIONS OF DIFFERING SIZES FOR DIFFERENT TYPES OF EXPENDITURES AND AREAS TO WHICH THESE LIMITS ARE NOT APPLICABLE,5) UNDERTAKING MAJOR CENTRAL IMPROVEMENTS TO OR OTHERWISE REHABILITATING THE CORPORATION'S PROPERTIES, 6) CONFESSING A JUDGEMENT AGAINST THE CORPORATION, 7) MAKING ANY CHANGES OR AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO COMPLETES A DETAILED REVIEW OF THE 990 PRIOR TO MAKING THE 990 AVAILABLE TO THE BOARD MEMBERS. THE FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS THROUGH THE BOARD'S WEBSITE SO THEY CAN REVIEW AND COMMENT ON IT PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ROGER'S MEMORIAL HOSPITAL'S DIRECTORS AND OFFICERS SHALL, SHOULD A CONFLICT OF INTEREST ARISE AT ANY TIME, PROMPTLY DISCLOSE SUCH CONFLICT IN WRITING TO THE CHAIRPERSON OF THE BOARD OF DIRECTOR'S; AND IN MATTERS WHERE A MEMBER HAS A CONFLICT THAT REQUIRES A VOTE, ABSTAIN. ANNUALLY, THE CONFLICT OF INTEREST FORM WILL BE SUBMITTED TO THE CHAIRMAN OF THE BOARD. IN ADDITION, EACH ADMINISTRATIVE STAFF MEMBER, MEDICAL STAFF OFFICER, MEDICAL/ADMINISTRATIVE AGENT, AND EMPLOYEE INVOLVED IN PURCHASING SUPPLIES AND EQUIPMENT FOR THE HOSPITAL SHALL HAVE A CONFLICT OF INTEREST STATEMENT ON FILE IN THE PRESIDENT'S OFFICE AND THOSE STATEMENTS SHALL BE UPDATED ANNUALLY AND WHENEVER THERE IS A NEED FOR ADDITIONS AND DELETIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS DETERMINED BY INDUSTRY ANALYSIS AND IS SUPPORTED BY AN ANALYSIS BY AN EXTERNAL CONSULTANT. APPROVAL OF THE RESULTS IS BY THOSE BOARD MEMBERS WITHOUT CONFLICT OF INTEREST AND THE APPROVAL IS DOCUMENTED. OTHER KEY OFFICERS' COMPENSATION IS DETERMINED BY INDUSTRY ANALYSIS SIMILAR TO THE PROCESS USED TO DETERMINE THE CEO'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 ROGER'S MEMORIAL HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AS THEY ARE ATTACHED TO THE FILED IRS FORM 990 AND SUBSEQUENTLY PUBLISHED ONLINE BY THE IRS. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 11,481,365. MANAGEMENT AND GENERAL EXPENSES 18,299,203. TOTAL EXPENSES 29,780,568. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS ROGERS MEMORIAL HOSPITAL FOUNDATION 4,781,281. LOSS ON INTEREST RATE SWAP -1,801. PARTNERS IN BEHAVIORAL HEALTH 34700 VALLEY ROAD OCONOMOWOC WI 53066 391832142 TO ASSIST IN PROVIDING BEHAVIORAL HEALTH SERVICES WI 34107 0 ROGERS MEMORIAL HOSPITAL ROGERS BEHAVIORAL HEALTH MANAGEMENT LLC 34700 VALLEY ROAD OCONOMOWOC WI 53066 853690429 MANAGEMENT SERVICES WI 9027924 9027926 ROGERS MEMORIAL HOSPITAL ROGERS BEHAVIORAL HEALTH - SHEBOYGAN LLC 34700 VALLEY ROAD OCONOMOWOC WI 53066 863243766 OPERATE AN OUTPATIENT CLINIC WI 0 0 ROGERS MEMORIAL HOSPITAL ROGERS BEHAVIORAL HEALTH SYSTEM INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 263902724 TO ASSIST ITS SUBSIDIARIES IN PROVIDING BEHAVIORAL HEALTH SERVICES WI 501(C)(3) LINE 12B, II N/A 0 ROGERS MEMORIAL HOSPITAL FOUNDATION INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 391363507 TO SUPPORT ALL ENTITITES OF ROGER'S BEHAVIORAL HEALTH SYSTEM, INC. WI 501(C)(3) LINE 7 ROGERS BEHAVIORAL HEALTH SYSTEM INC 0 ROGERS BEHAVIORAL HEALTH - GEORGIA INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 844421252 PROVIDE MENTAL HEALTH AND ADDICTION TREATMENT GA 501(C)(3) LINE 10 ROGERS MEMORIAL HOSPITAL INC 1 ROGERS BEHAVIORAL HEALTH - WASHINGTON INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 852221921 PROVIDE SUBSTANCE ABUSE AND MENTAL HEALTH CLINICS WA 501(C)(3) LINE 10 ROGERS MEMORIAL HOSPITAL INC 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 ROGERS MEMORIAL HOSPITAL FOUNDATION INC B 2700000 FMV OF GRANTS PAID ROGERS MEMORIAL HOSPITAL FOUNDATION INC C 3901349 FMV OF GRANTS RECEIVED ROGERS MEMORIAL HOSPITAL FOUNDATION INC L 1069147 FMV OF SERVICES RENDERED ROGERS BEHAVIORAL HEALTH SYSTEM INC M 1602000 FMV OF SERVICES RENDERED