2020-04-29T15:21:42-05:00 2019-07-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 777 E WISCONSIN AVENUE 32ND FLOOR MILWAUKEE WI 53202 990 2018-08-01 391139101 ROGERS MEMORIAL HOSPITAL INC ROGE 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 ARNOLD STUEBER CHIEF FINANCIAL OFFICER 2626464411 2020-04-23 1 TROY MARINE CPA P00187863 4147775500 2020-04-15 104.190.122.166 2020-04-23 11:18:54 CD P 1C40C474E7DEB989202A97D331D649435C652DD4 F6719D0144B06E6FC05F7FF323A3B40607EDAFB2 2018 2020-09-23 17:36:50Z ARNOLD STUEBER 34700 VALLEY ROAD OCONOMOWOC WI 53066 248947419 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. 15 12 2675 15 4520530 0 575164 79627 203166820 234124615 1253489 1670094 0 0 204995473 235874336 2452305 2582012 0 0 131242370 148984773 0 0 0 52591296 62817625 186285971 214384410 18709502 21489926 265546539 307898322 101037962 113647171 164508577 194251151 X WE EXIST TO OFFER EXEMPLARY BEHAVIORAL HEALTHCARE SERVICES, INCLUDING TREATMENT, RESEARCH, EDUCATION, TRAINING AND CONSULTATION BUILT ON OUR CENTURY-LONG HERITAGE. WE ARE DEDICATED TO THE DELIVERY OF QUALITY CARE USING A SKILLED TEAM APPROACH THAT RESPECTS THE DIGNITY OF EACH INDIVIDUAL. OUR SUCCESS IS DEMONSTRATED IN PREMIER QUALITY CARE, SUCCESSFUL OUTCOMES, FINANCIAL INTEGRITY, PERSONAL AND ORGANIZATIONAL GROWTH, AND COMMUNITY WELL-BEING. 0 0 173859132 2582012 228772406 WE ARE A NOT-FOR-PROFIT INDEPENDENT PROVIDER OF SPECIALIZED MENTAL HEALTH AND ADDICTION SERVICES FOR ADULTS, TEENS AND CHILDREN. OFFERING TREATMENT IN SEVEN STATES, WE ARE ONE OF THE LARGEST SPECIALTY BEHAVIORAL HEALTHCARE SYSTEMS IN THE U.S. TO MEET THE NEED OF PATIENTS, WE OFFER THREE LEVELS OF CARE: INPATIENT, RESIDENTIAL AND OUTPATIENT. IN FISCAL YEAR 2019 WE SERVED OUR COMMUNITY WITH 61,476 INPATIENT DAYS 65,789 RESIDENTIAL PATIENT DAYS AND 186,973 OUTPATIENT PATIENT DAYS. THIS REPRESENTS A 13.7% INCREASE OVER THE PRIOR YEAR. IN 2019 WE EXPANDED RESIDENTIAL SERVICES IN OCONOMOWOC AND INCREASED PROGRAMING CAPACITY AT SEVERAL OF OUR EXISTING LOCATIONS. OVER THE NEXT 4 YEARS WE PLAN TO OPEN 3 CLINIC LOCATIONS PER YEAR TO SERVE MORE PATIENTS NATIONWIDE. 173859132 1 1 0 1 0 0 0 0 0 1 1 1 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 1 0 0 0 0 0 0 0 1 1 1 0 0 1 197 0 1 2675 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X ARNOLD STUEBER 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 CALVIN SCHMIDT BOARD CHAIR 3.00 3.00 X X 0 0 0 BARB GROMACKI BOARD VICE CHAIR 3.00 3.00 X X 0 0 0 NICK BAUER BOARD TREASURER 3.00 3.00 X X 0 0 0 BILL MULLIGAN BOARD SECRETARY 3.00 3.00 X X 0 0 0 RICK ANDRITSCH BOARD MEMBER 1.00 1.00 X 0 0 0 CHRIS FITZPATRICK BOARD MEMBER 1.00 1.00 X 0 0 0 BARBARA ZABAWA BOARD MEMBER 1.00 1.00 X 0 0 0 DANIEL BADER BOARD MEMBER 1.00 1.00 X 0 0 0 KAMILAH WILLIAMS-KEMP BOARD MEMBER 1.00 1.00 X 0 0 0 BOB OLSON BOARD MEMBER 1.00 1.00 X 0 0 0 GINA MARKSON MAGNUS BOARD MEMBER 1.00 1.00 X 0 0 0 MARTIN BORELL BOARD MEMBER 1.00 1.00 X 0 0 0 KEVIN FLANAGAN BOARD MEMBER 1.00 1.00 X 0 0 0 MAUREEN STAPLETON BOARD MEMBER 1.00 1.00 X 0 0 0 JON LEHRMANN BOARD MEMBER 1.00 1.00 X 0 0 0 PATRICK HAMMER CEO - RBHS/ BOARD MEMBER 1.00 40.00 X X 0 1059885 85699 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/ BOARD MEMBER 40.00 1.00 X X 481057 0 49386 JERRY HALVERSON CHIEF MEDICAL OFFICER/ BOARD MEMBER 40.00 1.00 X X 446125 0 45041 PAUL MUELLER CEO - RMH 40.00 0.00 X 666134 0 95584 ARNOLD STUEBER CFO 1.00 40.00 X 0 255890 40171 TERESA SCHULTZ CHIEF REGULATORY OFFICER 40.00 0.00 X 259963 0 21414 JAMES KUBICEK COO - BROWN DEER 40.00 0.00 X 293549 0 40829 SCOTT JOHNSON COO - ECM 40.00 0.00 X 224163 0 40715 KIMBERLY EFFERTZ COO - OCONOMOWOC 40.00 0.00 X 230635 0 41206 CAROLINE MCHALE COO - RES SERVICES 40.00 0.00 X 198846 0 36196 JAY KELLISON COO - SAN FRAN 40.00 0.00 X 374503 0 18103 ANGIE CRAWFORD COO- WEST ALLIS (EFF. 05/2019) 40.00 0.00 X 227633 0 20369 ELIZABETH GILBERT COO - WEST ALLIS (TO 05/2019) 40.00 0.00 X 214685 0 11834 AHMED NUMAN MEDICAL DIRECTOR 40.00 0.00 X 770605 0 11000 KHAZI MUQEET MEDICAL DIRECTOR 40.00 0.00 X 776989 0 11944 BRAD SMITH MEDICAL DIRECTOR 40.00 0.00 X 511424 0 40953 PETER LAKE MEDICAL DIRECTOR 40.00 0.00 X 540659 0 47649 ROGER LUHN MEDICAL DIRECTOR 40.00 0.00 X 469283 0 44835 MICHAEL HEDRICK FORMER EXECUTIVE VP CFO 0.00 0.00 X 0 222372 0 6686253 1538147 702928 155 1 1 0 VJS CONSTRUCTIONS SERVICES INC W233N2847 ROUNDY CIRCLE W PEWAUKEE WI 53072 CONSTRUCTION SERVICE 15840946 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 HEALTH INFORMATION TECHNOLOGY 3654242 CIELO INC 200 S EXECUTIVE DRIVE SUITE 400 BROOKFIELD WI 53005 RECRUITING SERVICE 2582490 GORDON FOOD SERVICE INC 10901 38TH STREET KENOSHA WI 53144 FOOD SERVICE 2210690 BEAR CONSTRUCTION COMPANY 1501 ROHLWING ROAD ROLLING MEADOWS IL 60008 CONSTRUCTION SERVICE 1427301 116 79627 79627 OUTPATIENT REVENUE 621420 81687180 81687180 INPATIENT REVENUE 622210 79596924 79596924 RESIDENTIAL REVENUE 623220 67488302 67488302 MANAGEMENT SERVICES 541610 4487136 4487136 OTHER OPERATING REVENUE 621300 865073 33394 831679 234124615 2040274 2040274 12702903 12946451 126632 -243548 -126632 -370180 -370180 235874336 228772406 4520530 2501773 2582012 2582012 6686253 3254396 3431857 116442912 103879654 12563258 2402856 1672762 730094 15410287 13256439 2153848 8042465 7032681 1009784 671303 671303 154069 154069 60250 60250 507038 507038 17686468 11849933 5836535 950729 43940 906789 6651146 4094619 2556527 239894 26497 213397 7536118 3926956 3609162 825729 486294 339435 92098 92098 2413151 1930520 482631 11715606 8526709 3188897 1852602 32795 1819807 BAD DEBT EXPENSE 7897889 7897889 FOOD 3094282 2940669 153613 DUE/FEES/SUBSCRIPTIONS 469253 424367 44886 214384410 173859132 40525278 0 46149852 33849585 24020164 27920969 1407524 1986449 214153272 64316458 129718708 149836814 41326826 62557454 15394637 16046078 7528828 15700973 265546539 307898322 23590273 25607299 48505000 47505000 25196270 34350145 3746419 6184727 101037962 113647171 X 157928034 183749178 4511704 0 2068839 10501973 164508577 194251151 265546539 307898322 X 21489926 2521907 5730741 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 1 65231 65231 0 PART II-B, LINE 1: PORTIONS OF ASSOCIATION DUES ALLOCATED FOR LOBBYING EXPENSES OF WHA $36,625 (13.6%), TOTALING $4,981. ROGERS MEMORIAL HOSPITAL, INC. EMPLOYS AN INDIVIDUAL, MARY PANZER, FOR $60,250 WHO COMMUNICATED WITH LEGISLATORS. 2529486 131917 116018 78114 2699307 2401177 1839 186974 60504 2529486 2169064 93526 181954 43367 2401177 2173390 5208 21697 31231 2169064 1923542 251287 42097 43536 2173390 0.00000 0.81530 0.18470 0 1 1 9514159 9514159 127639743 37564384 90075359 5880264 3203086 2677178 50077376 23548988 26528388 21041730 21041730 149836814 ALTERNATIVE INVESTMENTS 16046078 F 16046078 INTEREST IN NET ASSETS - ROGERS MEMORIAL FOUNDATION 10501973 DUE FROM RELATED ORGANIZATIONS 5199000 15700973 AR CREDIT BALANCES 766764 DEFERRED COMPENSATION 4874677 DUE TO ROGERS BEHAVIORAL HEALTH SYSTEMS, INC. 543286 6184727 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 DONORS 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: THE HOSPITAL FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THIS 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 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 INVESTMENTS 3468418 0 0 0 0 0 0 3468418 0 3468418 1 0 1 1 0 0 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 2440828 2440828 0.01180 55396155 34410450 20985705 0.10160 57836983 34410450 23426533 0.11340 1104320 1104320 0.00530 55568 22353 33215 0.00020 281702 281702 0.00140 1441590 22353 1419237 0.00690 59278573 34432803 24845770 0.12030 1 3915433 3119763 5817857 -2698094 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 WITHIN 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 WITHIN 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 WITHIN 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 OFCARE. 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-AND-CHARITABLE-CARE-POLICYFAP APPLICATION FORM:HTTPS://ROGERSBH.ORG/APPLICATION/FILES/4914/9748/6210/FINANCIAL_ASSISTANCE_APPLICATION.PDFPLAN LANGUAGE SUMMARY:HTTPS://ROGERSBH.ORG/WHAT-EXPECT/FINANCING-YOUR-CARE/FINANCIAL-ASSISTANCE-PROGRAM 13 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 - TAMPA 2002 N LOIS AVE SUITE 400 TAMPA FL 33607 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, AND MOOD DISORDERS 3 - ROGERS BEHAVIORAL HEALTH - CHICAGO 4711 GOLF ROAD SUITE 600 SKOKIE IL 60076 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, AND MOOD DISORDERS 4 - ROGERS BEHAVIORAL HEALTH - MINNEAPOLIS 6442 CITY WEST PARKWAY SUITE 200 EDEN PRAIRIE MN 55344 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 5 - ROGERS MEMORIAL HOSPITAL - KENOSHA 9916 75TH STREET KENOSHA WI 53142 TREATMENT CENTER FOR CHILDREN AND ADOLESCENTS 6 - ROGERS BEHAVIORAL HEALTH - NASHVILLE 4230 HARDING ROAD SUITE 707 NASHVILLE TN 37205 CENTER FOR OCD, ANXIETY AND EATING DISORDERS 7 - ROGERS BEHAVIORAL HEALTH - APPLETON 4531 W COLLEGE AVE 300 APPLETON WI 54914 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 8 - ROGERS BEHAVIORAL HEALTH - PHILADELPHIA 1 WINDING DRIVE SUITE 106 PHILADELPHIA PA 19131 CENTER FOR OCD, ANXIETY, EATING, DEPRESSION, PTSD, AND MOOD DISORDERS 9 - ROGERS BEHAVIORAL HEALTH - SAN FRANCISCO 420 N WIGET LANE BUILDING 2 WALNUT CREEK CA 94598 CENTER FOR OCD, ANXIETY AND MOOD DISORDERS 10 - ROGERS BEHAVIORAL HEALTH - HINSDALE 907 NORTH ELM STREET SUITE 300 HINSDALE IL 60521 CENTER FOR MOOD DISORDERS, OCD, ANXIETY, PTSD, MENTAL HEALTH 11 - ROGERS BEHAVIORAL HEALTH - MIAMI 5805 BLUE LAGOON DRIVE SUITE 440 MIAMI FL 33126 CENTER FOR OCD, ANXIETY, DEPRESSION, MOOD DISORDERS, 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 - ST PAUL 576 BEILENBERG DRIVE SUITE 180 WOODBURY MN 55125 CENTER FOR OCD, ANXIETY, DEPRESSION 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.LINE H: RESEARCH AND RELATED COSTS ARE DIRECTLY ASSIGNED BASED ON UTILIZATION OF RESOURCES. 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 $7,897,889. PART I, LN 7 COL(F): ROGERS MEMORIAL HOSPITAL UTILIZED A COST TO CHARGE RATIO FOR DETERMINING COST OF BAD DEBT EXPENSE. THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A CHARGE TO GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM 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 LIKELIHOOD 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. CERTAIN AMOUNTS OF BAD DEBT EXPENSE COULD BE ATTRIBUTED TO CHARITY CARE AS ALL RELEVANT INFORMATION IS NOT READILY AVAILABLE FOR ALL PATIENTS. IF, AT THE TIME OF ADMISSION AND BEFORE BILLING, PATIENTS WHO KNEW THEY COULD NOT PAY FOR SERVICES REQUESTED ASSISTANCE UP FRONT OR THE HOSPITAL BECAME AWARE UPON ADMISSION THAT A PATIENT WOULD BE UNABLE TO PAY, THEY WOULD HAVE HAD THOSE PATIENTS APPLY FOR CHARITY CARE INSTEAD OF HAVING THE FACTS COME TO LIGHT AFTER THE PATIENT HAD BEEN BILLED AND NOT BEEN ABLE TO PAY. PART III, LINE 2: COST TO CHARGE RATIO 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 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 16 CITIES AND 6 DIFFERENT STATES ACROSS THE UNITED STATES. WITH OVER 22,000 ADMITS IN FY2019, APPROXIMATELY 77% WERE PATIENTS FROM WISCONSIN WHILE 23% WERE SOURCED FROM OTHER STATES. PATIENTS FROM SOUTHEAST WISCONSIN (MILWAUKEE, WAUKESHA, OZAUKEE, RACINE AND WASHINGTON COUNTIES) MADE UP ABOUT 49%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) 1400000 1146012 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) 11000 CORPORATE CAMPAIGN OCONOMOWOC AREA SCHOOL DISTRICT 915 E SUMMIT AVE OCONOMOWOC WI 53066 396003743 115 10000 GALE DOUGLAS FIELDHOUSE PROJECT KATHY'S HOUSE 600 NORTH 103RD ST WAUWATOSA WI 53226 392022115 501(C)(3) 15000 HOME FOR HEALING CAMPAIGN 4 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. X 0 0 X X X X X 1 1 0 0 0 0 0 0 0 PATRICK HAMMER CEO - RBHS/ BOARD MEMBER 0 640202 0 279000 0 140683 0 57184 0 28515 0 1145584 0 0 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/ BOARD MEMBER 405085 0 75000 0 972 0 11000 0 38386 0 530443 0 0 0 JERRY HALVERSON CHIEF MEDICAL OFFICER/ BOARD MEMBER 362933 0 67500 0 15692 0 11000 0 34041 0 491166 0 0 0 PAUL MUELLER CEO - RMH 436649 0 225330 0 4155 0 57762 0 37822 0 761718 0 0 0 ARNOLD STUEBER CFO 0 202658 0 45000 0 8232 0 7500 0 32671 0 296061 0 0 TERESA SCHULTZ CHIEF REGULATORY OFFICER 205352 0 47621 0 6990 0 4126 0 17288 0 281377 0 0 0 JAMES KUBICEK COO - BROWN DEER 239133 0 53699 0 717 0 11000 0 29829 0 334378 0 0 0 SCOTT JOHNSON COO - ECM 181960 0 41891 0 312 0 9217 0 31498 0 264878 0 0 0 KIMBERLY EFFERTZ COO - OCONOMOWOC 186948 0 42970 0 717 0 9458 0 31748 0 271841 0 0 0 CAROLINE MCHALE COO - RES SERVICES 160965 0 37569 0 312 0 6104 0 30092 0 235042 0 0 0 JAY KELLISON COO - SAN FRAN 303344 0 67953 0 3206 0 5654 0 12449 0 392606 0 0 0 ANGIE CRAWFORD COO- WEST ALLIS (EFF. 05/2019) 184723 0 42598 0 312 0 7006 0 13363 0 248002 0 0 0 ELIZABETH GILBERT COO - WEST ALLIS (TO 05/2019) 174218 0 39750 0 717 0 8648 0 3186 0 226519 0 0 0 AHMED NUMAN MEDICAL DIRECTOR 410034 0 359700 0 871 0 11000 0 0 0 781605 0 0 0 KHAZI MUQEET MEDICAL DIRECTOR 421244 0 355713 0 32 0 10049 0 1895 0 788933 0 0 0 BRAD SMITH MEDICAL DIRECTOR 390689 0 119120 0 1615 0 11000 0 29953 0 552377 0 0 0 PETER LAKE MEDICAL DIRECTOR 422327 0 107253 0 11079 0 11000 0 36649 0 588308 0 0 0 ROGER LUHN MEDICAL DIRECTOR 361905 0 97230 0 10148 0 11000 0 33835 0 514118 0 0 0 MICHAEL HEDRICK FORMER EXECUTIVE VP CFO 0 30450 0 0 0 191922 0 0 0 0 0 222372 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. $3,962 PAUL MUELLER $3,962 PAT HAMMER 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 FY2019, PATRICK HAMMER AND PAUL MUELLER PARTICIPATED IN THIS PLAN. AMOUNTS PAID TO EACH PARTICIPANT WERE $58,884 AND $44,897, RESPECTIVELY, DURING CALENDAR YEAR 2018. A WISCONSIN HEALTH & EDUCATION FACILITIES AUTHORITY SERIES 2014 A & B 391337855 97712DEV4 2014-08-15 55065129 BUILDING IMPROVEMENTS TO VARIOUS SITES 0 0 0 A 2315000 55065129 24173555 757709 21283864 8850000 2016 1 1 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 VJS CONSTRUCTION COMPANY PATRICK ANDRITSCH, BOARD MEMBER 15840946 CONSTRUCTION FEES 0 MEDICAL COLLEGE OF WISCONSIN JON LEHRMANN, BOARD MEMBER 362459 FELLOWSHIP 0 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. THE EXECUTIVE COMMITTEE MUST IMMEDIATELY NOTIFY THE MEMBERS OF THE BOARD OF DIRECTORS OF ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE. 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 DIRECTORS; 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 WITH 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 XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS ROGERS MEMORIAL HOSPITAL FOUNDATION 5,730,741. PARTNERS IN BEHAVIORAL HEALTH 34700 VALLEY ROAD OCONOMOWOC WI 53066 391832142 TO ASSIST IN PROVIDING BEHAVIORAL HEALTH SERVICES WI 33394 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 NA 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 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 1400000 FMV OF GRANTS PAID ROGERS MEMORIAL HOSPITAL FOUNDATION INC C 1682916 FMV OF GRANTS RECEIVED ROGERS MEMORIAL HOSPITAL FOUNDATION INC L 1146014 FMV OF SERVICES RENDERED ROGERS BEHAVIORAL HEALTH SYSTEM INC M 1867353 FMV OF SERVICES RENDERED