2019-06-17T15:49:05-05:00 2018-07-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2017-08-01 391139101 ROGERS MEMORIAL HOSPITAL INC ROGE 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 ARNOLD STUEBER CHIEF FINANCIAL OFFICER 2626464411 2019-06-12 1 ZACK FORTSCH P00052725 3126343400 66.98.98.129 2019-06-12 10:57:40 CD P 972ACA630144D1186DE4CD2460E77C4D7B57CBE3 2A28FA2E2A09A40AF4F0A751499BE74D16D20E85 2017 2019-02-21 02:37:17Z ARNOLD STUEBER 34700 VALLEY ROAD OCONOMOWOC WI 53066 206475185 0 X WWW.ROGERSBH.ORG X 1907 WI WE PROVIDE HIGHLY EFFECTIVE MENTAL HEALTH AND ADDICTION TREATMENT THAT HELPS PEOPLE REACH THEIR FULL POTENTIAL FOR HEALTH AND WELL-BEING. 15 10 2544 0 779416 0 334811 575164 176985609 203166820 3189656 1253489 50666 0 180560742 204995473 1913002 2452305 0 0 116671031 131242370 0 0 0 49610034 52591296 168194067 186285971 12366675 18709502 240154326 265546539 96487759 101037962 143666567 164508577 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 130676243 2452305 199771069 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 2018 WE SERVED OUR COMMUNITY WITH 57,753 INPATIENT PATIENT DAYS 62,325 RESIDENTIAL PATIENT DAYS AND 154,887 OUTPATIENT PATIENT DAYS. THIS REPRESENTS A 16.7% INCREASE OVER THE PRIOR YEAR. IN 2018 WE EXPANDED OUTPATIENT SERVICES TO CALIFORNIA AND INCREASED PROGRAMING CAPACITY AT SEVERAL OF OUR EXISTING LOCATIONS.OVER THE NEXT 5 YEARS WE PLAN TO OPEN 3 CLINIC LOCATIONS PER YEAR TO SERVE MORE PATIENTS NATIONWIDE. 130676243 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 0 1 186 0 1 2544 1 1 1 0 0 0 0 0 0 0 0 0 X 15 10 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 X X 0 0 0 PATRICK ANDRITSCH BOARD VICE-CHAIR 3.00 X X 0 0 0 NICK BAUER BOARD TREASURER 3.00 X X 0 0 0 BARBARA GORMACKI BOARD SECRETARY 3.00 X X 0 0 0 DANIEL BADER BOARD MEMBER 1.00 X 0 0 0 MARTIN BORELL BOARD MEMBER 1.00 X 0 0 0 KEVIN FLANAGAN BOARD MEMBER 1.00 X 0 0 0 CHRISTOPHER FITZPATRICK BOARD MEMBER 1.00 X 0 0 0 PATRICK HAMMER CEO - RBHS / BOARD MEMBER 1.00 40.00 X X 0 796011 32466 JERRY HALVERSON CHIEF MEDICAL OFFICER/BOARD MEMBER 40.00 1.00 X X 458456 0 38097 JON LEHRMANN BOARD MEMBER 1.00 X 0 0 0 GINA MARKSON MAGNUS BOARD MEMBER 1.00 X 0 0 0 BILL MULLIGAN BOARD MEMBER 1.00 X 0 0 0 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/BOARD MEMBER 40.00 1.00 X X 437871 0 38124 MAUREEN STAPLETON BOARD MEMBER 1.00 X 0 0 0 MARK MOHR BOARD VICE CHAIR THRU 9/17 3.00 X 0 0 0 MARY PANZER BOARD SECRETARY THRU 9/17 3.00 X 0 0 0 PAUL MUELLER CEO - RMH 40.00 X 546604 0 40676 ARNOLD STUEBER INTERIM CF0-6/14/17, CFO-8/17/17 40.00 X 0 118946 19500 JAMES KUBICEK CHIEF OPERATING OFFICER - BD 40.00 X 272007 0 38407 ELIZABETH GILBERT CHIEF OPERATING OFFICER - WA 40.00 X 189174 0 10157 JAY KELLISON CHIEF OPERATING OFFICER - WC 40.00 X 236780 0 14029 SCOTT JOHNSON CHIEF OPERATING OFFICER - ECM 40.00 X 217615 0 37226 KIMBERLY EFFERTZ CHIEF OPERATING OFFICER - OCON 40.00 X 208166 0 36533 CAROLINE MCHALE CHIEF OPERATING OFFICER - RES SERVICES 40.00 X 153932 0 8210 AHMED NUMAN MEDICAL DIRECTOR 40.00 X 702510 0 15379 KHAZI MUQEET MEDICAL DIRECTOR 40.00 X 615929 0 11498 RAYMOND MOY MEDICAL DIRECTOR 40.00 X 547436 0 0 PETER LAKE MEDICAL DIRECTOR 40.00 X 535481 0 40616 ROGER LUHN MEDICAL DIRECTOT 40.00 X 468908 0 37910 MICHAEL HEDRICK EXECUTIVE VP CFO - THRU 6/14/17 0.00 0.00 X 0 384245 22353 KEITH DEGNER FORMER CFO - RMH- THRU 10/4/16 0.00 X 254330 0 0 SUZANNE HARRISON FORMER VP OF OPERATIONS - OCON 0.00 X 247378 0 11745 ORVIN FILLMAN FORMER VP OF OPERATIONS - MKE 0.00 X 244408 0 18705 JAMES LEDBETTER FORMER VP OF REGIONAL PARTIAL HOS 0.00 X 187743 0 10870 6524728 1299202 482501 18 1 1 0 CERNER CORPORATION 2800 ROCKCREEK PARKWAY NORTH KANSAS CITY MO 64117 HEALTH INFORMATION TECHNOLOGY 3098682 CIELO INC 200 S EXECUTIVE DRIVE SUITE 400 BROOKFIELD WI 53005 RECRUITING SERVICE 2287224 RS COMPANY 1870 ARNOLD INDUSTRIAL PLACE 1050 CONCORD CA 94520 CONSTRUCTION 1908705 VJS CONSTRUCTION SERVICES INC W233N2847 ROUNDY CIRCLE W PEWAUKEE WI 53072 CONSTRUCTION SERVICE 1879492 GORDON FOOD SERVICE INC 10901 38TH STREET KENOSHA WI 53144 FOOD SERVICE 1605039 110 575164 575164 NET PATIENT REVENUE 900099 199771069 199771069 OTHER OPERATING REVENUE 900099 1782665 1782665 MANAGEMENT SERVICES 541610 1613086 833670 779416 203166820 1247015 1247015 717814 768372 0 1479712 717814 -711340 6474 6474 204995473 200604739 779416 3036154 2452305 2452305 6524729 6524729 101770060 81824103 19945957 2992100 2351508 640592 12855592 9840578 3015014 7099889 5783495 1316394 625848 625848 208399 208399 60000 60000 142746 142746 14365469 3606621 10758848 1110732 26033 1084699 7749049 1794672 5954377 289724 140 289584 3609162 3609162 1049886 223873 826013 45434 45434 2930732 1878593 1052139 10908920 6992596 3916324 1405778 236 1405542 BAD DEBT EXPENSE 4600774 4600774 FOOD 2780588 2595291 185297 DUE/FEES/SUBSCRIPTIONS 592588 180675 411913 CHARITABLE DONATION 115467 21 115446 186285971 130676243 55609728 0 35096609 46149852 23516376 24020164 1268440 1407524 184055972 54337264 126103794 129718708 47427486 56721463 6741621 7528828 240154326 265546539 17463023 23590273 49470000 48505000 26022768 25196270 3531968 3746419 96487759 101037962 X 137206302 157928034 4393265 4511704 2067000 2068839 143666567 164508577 240154326 265546539 X 18709502 335447 1797061 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 65110 65110 0 PART II-B, LINE 1: PORTIONS OF ASSOCIATION DUES ALLOCATED FOR LOBBYING EXPENSES OF WHA $35,732 (14.3%) TOTALING $5,110. ROGERS MEMORIAL HOSPITAL, INC. EMPLOYS AN INDIVIDUAL, MARY PANZER, FOR $60,000 WHO COMMUNICATED WITH LEGISLATORS. 2401177 1839 186974 60504 2529486 2169064 93526 181954 43367 2401177 2173390 5208 21697 31231 2169064 1923542 251287 42097 43536 2173390 1263229 565929 94384 1923542 0.00000 0.81790 0.18210 0 1 1 7969141 7969141 119216397 32667360 86549037 5852401 2748171 3104230 45499739 18921733 26578006 5518294 5518294 129718708 AR CREDIT BALANCES 559609 DEFERRED COMPENSATION 2644665 DUE TO ROGERS BEHAVIORAL HEALTH SYSTEM, INC. 542145 3746419 X 202314479 -3249588 -3249588 205564067 -568594 -568594 204995473 179081317 0 179081317 7204654 7204654 186285971 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO SUPPORT HOSPITAL CAPITAL PROJECTS, SPECIFIC PROGRAMS DESIGNATED BY THE DONOR AND PATIENT CARE ASSISTANCE. 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 PROCESS, IF ANY. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -4,600,774. NET ASSETS RELEASED FROM RESTRICTION 1,351,186. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES 142,746. GAIN/LOSS ON DISPOSAL OF PPE -711,340. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,600,774. INVESTMENT MANAGEMENT FEES 142,746. CONTRIBUTIONS/GRANTS 2,461,134. 1 1 X 1 X 1 X 1 1 1 0 1 1 2056650 2056650 0.01100 52631684 37819472 14812212 0.07950 54688334 37819472 16868862 0.09050 1065715 1065715 0.00570 51179 21716 29463 0.00020 179821 179821 0.00100 1296715 21716 1274999 0.00690 55985049 37841188 18143861 0.09740 1 2208371 3220467 4162932 -942465 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 AVENUE 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 15 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 15 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 15 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 15 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 15 1 0 0 1 X SEE PART V, SECTION B, LINE 7D X X 1 15 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 GOVERMENTAL 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 GOVERMENTAL SURVEYS CONDUCTED TO ASSESS THE COMMUNITY NEED. ROGERS MEMORIAL HOSPITAL - OCONOMOWOC PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/2814/9602/3104/2016_CHNA_WRITTEN_REPORT_V2FORMATTED_0.PDF ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/2814/9602/3104/2016_CHNA_WRITTEN_REPORT_V2FORMATTED_0.PDF ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 7D: HTTPS://ROGERSBH.ORG/APPLICATION/FILES/2814/9602/3104/2016_CHNA_WRITTEN_REPORT_V2FORMATTED_0.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 SERVICES - BY BUILDING A CHARITY FUND FOR THOSE WHO HAVE LIMITED RESOURCES, SHIFT/EXPAND SPECIALIZED PROGRAMMING ACROSS LEVELS OF CARE, INCREASE IMPLEMENTATION OF TELEPSYCHIATRY SERVICES, EXPANDING CALL CENTER CAPABILITIES TO HANDLE HIGHER CALL VOLUMES, AND EXPLORE EVENING AND WEEKEND PROGRAMS FOR PARTIAL AND INTENSIVE OUTPATIENT SERVICES; THE COMMUNITY WOULD SEE MORE ACCESSIBLE CARE, A DECREASE IN BARRIERS TO CARE, AND AN IMPROVED PATIENT FLOW INTO OUR LEVELS OF CARE.2) SUBSTANCE USE DISORDER - USING CURRENT TRENDS AND PROVEN METHODS TOEVALUATE THE NEED TO CREATE/STRENGTHEN SERVICES FOR SPECIAL POPULATIONS,REVISE AND EXPAND FAMILY AND FRIEND PROGRAMMING, LOOK INTO APPROPRIATEDELIVERY AND LOCATION OF SUPPORTIVE LIVING FACILITIES, EXPLORE ANDEVALUATE POTENTIAL COMMUNITY PARTNERSHIPS TO SUPPLEMENT AND ENHANCESERVICES PROVIDED BY ROGERS; TARGETED SERVICES WILL BE DESIGNED TO MEET COMMUNITY-SPECIFIC NEEDS AS WELL AS PROVIDE ONGOING INNOVATION ANDBEST-PRACTICES ACROSS ROGERS MEMORIAL HOSPITAL.3) EDUCATION, AWARENESS, ADVOCACY AND STIGMA REDUCTION - BY PROVIDINGFACILITATIVE LEADERSHIP TO WISE, SERVING ON WI DPI DESIGN ANDIMPLEMENTATION TEAM FOR WISCONSIN'S YOUTH MENTAL HEALTH FRAMEWORK, ALSO BYPROVIDING TRAINING TO SCHOOLS, WORKPLACES, CONGREGATIONS AND COMMUNITYORGANIZATIONS, AND BY BUILDING THE CAPACITY OF STAFF IN MENTAL HEALTH ORGANIZATIONS AROUND THE STATE; WE CAN REDUCE STIGMA AND ALLOW PEOPLEACCESS TO CARE AND SUPPORT EARLIER IN THE PROCESS OF THE ILLNESS,POLICYMAKERS WILL LEARN ABOUT HOW TO IMPROVE THE MENTAL HEALTH CARESYSTEM, AND ORGANIZATIONS DEDICATED TO EDUCATION AND STIGMA REDUCTION WITHIMPLEMENTING EVIDENCE-BASED PROGRAMMING AND APPROACHES.4) STAFF MENTAL HEALTH TRAINING - WITH UPDATING TRAINING TOPICS IN AVARIETY OF AREAS, RECRUITING AN EMPLOYEE SAFETY MANAGER, THEIMPLEMENTATION OF TRAINING PROGRAMS TO MINIMIZE INJURIES ASSOCIATED WITHPATIENT CARE AND CRISIS ESCALATION, INCREASED OPPORTUNITIES FOR STUDENTSTO LEARN ABOUT MENTAL HEALTHCARE THROUGH INTERNSHIPS, PRACTICUM ANDRESIDENCY PROGRAMS, TRAINING EMPLOYEES ON ACTIVE LISTENING TECHNIQUES ANDESTABLISHING VIRTUAL TRAINING DELIVERY METHODS IN ALL REGIONAL FACILITIES;ROGERS' EMPLOYEES WILL HAVE GREATER COMPETENCIES AND SKILL SETS AS WELL ASPROVIDE IMPROVED CARE AND PATIENT SAFETY.5) AFTER CARE SUPPORT - BY EXPLORING OPTIONS FOR SUPPORT GROUPS ANDVARYING APPROACHES, ESTABLISHING ROGERS FIRST TRANSITIONAL HOUSING UNIT,AND BY HIRING A SUPPORT GROUP SPECIALIST; WE WILL SEE A DECREASED NUMBEROF RE-ADMISSIONS, IMPROVED PATIENT OUTCOMES AND EXPAND THE HOSPITALS AFTER-DISCHARGE SUPPORT OPTIONS.6) PEER SUPPORT SPECIALIST - EXPLORING THE ROLE OF A PEER SUPPORTSPECIALIST WITHIN INPATIENT AND OUTPATIENT SETTINGS AND ACROSS ADOLESCENTAND ADULT PROGRAMS; ROGERS LOOKS TO DECREASE THE NUMBER OF RE-ADMISSIONSAND IMPROVE PATIENT OUTCOMES. ROGERS MEMORIAL HOSPITAL - WEST ALLIS PART V, SECTION B, LINE 11: THE ADVISORY COMMITTEE MADE THE DECISION TOADDRESS THE FOLLOWING PRIORITIES AS IDENTIFIED BY THE LATEST CHNA:1) ACCESS TO SERVICES - BY BUILDING A CHARITY FUND FOR THOSE WHO HAVE LIMITED RESOURCES, SHIFT/EXPAND SPECIALIZED PROGRAMMING ACROSS LEVELS OF CARE, INCREASE IMPLEMENTATION OF TELEPSYCHIATRY SERVICES, EXPANDING CALL CENTER CAPABILITIES TO HANDLE HIGHER CALL VOLUMES, AND EXPLORE EVENING AND WEEKEND PROGRAMS FOR PARTIAL AND INTENSIVE OUTPATIENT SERVICES; THE COMMUNITY WOULD SEE MORE ACCESSIBLE CARE, A DECREASE IN BARRIERS TO CARE, AND AN IMPROVED PATIENT FLOW INTO OUR LEVELS OF CARE.2) SUBSTANCE USE DISORDER - USING CURRENT TRENDS AND PROVEN METHODS TO EVALUATE THE NEED TO CREATE/STRENGTHEN SERVICES FOR SPECIAL POPULATIONS, REVISE AND EXPAND FAMILY AND FRIEND PROGRAMMING, LOOK INTO APPROPRIATE DELIVERY AND LOCATION OF SUPPORTIVE LIVING FACILITIES, EXPLORE AND EVALUATE POTENTIAL COMMUNITY PARTNERSHIPS TO SUPPLEMENT AND ENHANCE SERVICES PROVIDED BY ROGERS; TARGETED SERVICES WILL BE DESIGNED TO MEET COMMUNITY-SPECIFIC NEEDS AS WELL AS PROVIDE ONGOING INNOVATION AND BEST-PRACTICES ACROSS ROGERS MEMORIAL HOSPITAL.3) EDUCATION, AWARENESS, ADVOCACY AND STIGMA REDUCTION - BY PROVIDING FACILITATIVE LEADERSHIP TO WISE, SERVING ON WI DPI DESIGN AND IMPLEMENTATION TEAM FOR WISCONSIN'S YOUTH MENTAL HEALTH FRAMEWORK, ALSO BY PROVIDING TRAINING TO SCHOOLS, WORKPLACES, CONGREGATIONS AND COMMUNITY ORGANIZATIONS, AND BY BUILDING THE CAPACITY OF STAFF IN MENTAL HEALTH ORGANIZATIONS AROUND THE STATE; WE CAN REDUCE STIGMA AND ALLOW PEOPLE ACCESS TO CARE AND SUPPORT EARLIER IN THE PROCESS OF THE ILLNESS, POLICYMAKERS WILL LEARN ABOUT HOW TO IMPROVE THE MENTAL HEALTH CARE SYSTEM, AND ORGANIZATIONS DEDICATED TO EDUCATION AND STIGMA REDUCTION WITH IMPLEMENTING EVIDENCE-BASED PROGRAMMING AND APPROACHES.4) STAFF MENTAL HEALTH TRAINING - WITH UPDATING TRAINING TOPICS IN A VARIETY OF AREAS, RECRUITING AN EMPLOYEE SAFETY MANAGER, THE IMPLEMENTATION OF TRAINING PROGRAMS TO MINIMIZE INJURIES ASSOCIATED WITH PATIENT CARE AND CRISIS ESCALATION, INCREASED OPPORTUNITIES FOR STUDENTS TO LEARN ABOUT MENTAL HEALTHCARE THROUGH INTERNSHIPS, PRACTICUM AND RESIDENCY PROGRAMS, TRAINING EMPLOYEES ON ACTIVE LISTENING TECHNIQUES AND ESTABLISHING VIRTUAL TRAINING DELIVERY METHODS IN ALL REGIONAL FACILITIES; ROGERS' EMPLOYEES WILL HAVE GREATER COMPETENCIES AND SKILL SETS AS WELL AS PROVIDE IMPROVED CARE AND PATIENT SAFETY. 5) AFTER CARE SUPPORT - BY EXPLORING OPTIONS FOR SUPPORT GROUPS AND VARYING APPROACHES, ESTABLISHING ROGERS FIRST TRANSITIONAL HOUSING UNIT, AND BY HIRING A SUPPORT GROUP SPECIALIST; WE WILL SEE A DECREASED NUMBER OF RE-ADMISSIONS, IMPROVED PATIENT OUTCOMES AND EXPAND THE HOSPITALS AFTER-DISCHARGE SUPPORT OPTIONS.6) PEER SUPPORT SPECIALIST - EXPLORING THE ROLE OF A PEER SUPPORT ROGERS SPECIALIST WITHIN INPATIENT AND OUTPATIENT SETTINGS AND ACROSS ADOLESCENT AND ADULT PROGRAMS; ROGERS LOOKS TO DECREASE THE NUMBER OF RE-ADMISSIONS AND IMPROVE PATIENT OUTCOMES. 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 SERVICES - BY BUILDING A CHARITY FUND FOR THOSE WHO HAVE LIMITED RESOURCES, SHIFT/EXPAND SPECIALIZED PROGRAMMING ACROSS LEVELS OF CARE, INCREASE IMPLEMENTATION OF TELEPSYCHIATRY SERVICES, EXPANDING CALL CENTER CAPABILITIES TO HANDLE HIGHER CALL VOLUMES, AND EXPLORE EVENING AND WEEKEND PROGRAMS FOR PARTIAL AND INTENSIVE OUTPATIENT SERVICES; THE COMMUNITY WOULD SEE MORE ACCESSIBLE CARE, A DECREASE IN BARRIERS TO CARE, AND AN IMPROVED PATIENT FLOW INTO OUR LEVELS OF CARE.2) SUBSTANCE USE DISORDER - USING CURRENT TRENDS AND PROVEN METHODS TO EVALUATE THE NEED TO CREATE/STRENGTHEN SERVICES FOR SPECIAL POPULATIONS, REVISE AND EXPAND FAMILY AND FRIEND PROGRAMMING, LOOK INTO APPROPRIATE DELIVERY AND LOCATION OF SUPPORTIVE LIVING FACILITIES, EXPLORE AND EVALUATE POTENTIAL COMMUNITY PARTNERSHIPS TO SUPPLEMENT AND ENHANCE SERVICES PROVIDED BY ROGERS; TARGETED SERVICES WILL BE DESIGNED TO MEET COMMUNITY-SPECIFIC NEEDS AS WELL AS PROVIDE ONGOING INNOVATION AND BEST-PRACTICES ACROSS ROGERS MEMORIAL HOSPITAL.3) EDUCATION, AWARENESS, ADVOCACY AND STIGMA REDUCTION - BY PROVIDING FACILITATIVE LEADERSHIP TO WISE, SERVING ON WI DPI DESIGN AND IMPLEMENTATION TEAM FOR WISCONSIN'S YOUTH MENTAL HEALTH FRAMEWORK, ALSO BY PROVIDING TRAINING TO SCHOOLS, WORKPLACES, CONGREGATIONS AND COMMUNITY ORGANIZATIONS, AND BY BUILDING THE CAPACITY OF STAFF IN MENTAL HEALTH ORGANIZATIONS AROUND THE STATE; WE CAN REDUCE STIGMA AND ALLOW PEOPLE ACCESS TO CARE AND SUPPORT EARLIER IN THE PROCESS OF THE ILLNESS, POLICYMAKERS WILL LEARN ABOUT HOW TO IMPROVE THE MENTAL HEALTH CARE SYSTEM, AND ORGANIZATIONS DEDICATED TO EDUCATION AND STIGMA REDUCTION WITH IMPLEMENTING EVIDENCE-BASED PROGRAMMING AND APPROACHES.4) STAFF MENTAL HEALTH TRAINING - WITH UPDATING TRAINING TOPICS IN A VARIETY OF AREAS, RECRUITING AN EMPLOYEE SAFETY MANAGER, THE IMPLEMENTATION OF TRAINING PROGRAMS TO MINIMIZE INJURIES ASSOCIATED WITH PATIENT CARE AND CRISIS ESCALATION, INCREASED OPPORTUNITIES FOR STUDENTS TO LEARN ABOUT MENTAL HEALTHCARE THROUGH INTERNSHIPS, PRACTICUM AND RESIDENCY PROGRAMS, TRAINING EMPLOYEES ON ACTIVE LISTENING TECHNIQUES AND ESTABLISHING VIRTUAL TRAINING DELIVERY METHODS IN ALL REGIONAL FACILITIES; ROGERS' EMPLOYEES WILL HAVE GREATER COMPETENCIES AND SKILL SETS AS WELL AS PROVIDE IMPROVED CARE AND PATIENT SAFETY. 5) AFTER CARE SUPPORT - BY EXPLORING OPTIONS FOR SUPPORT GROUPS AND VARYING APPROACHES, ESTABLISHING ROGERS FIRST TRANSITIONAL HOUSING UNIT, AND BY HIRING A SUPPORT GROUP SPECIALIST; WE WILL SEE A DECREASED NUMBER OF RE-ADMISSIONS, IMPROVED PATIENT OUTCOMES AND EXPAND THE HOSPITALS AFTER-DISCHARGE SUPPORT OPTIONS.6) PEER SUPPORT SPECIALIST - EXPLORING THE ROLE OF A PEER SUPPORT SPECIALIST WITHIN INPATIENT AND OUTPATIENT SETTINGS AND ACROSS ADOLESCENT AND ADULT PROGRAMS; ROGERS LOOKS TO DECREASE THE NUMBER OF RE-ADMISSIONS AND IMPROVE PATIENT OUTCOMES. 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 IN COMMUNICATIONS REGARDING THEIR BILLS. ROGERS MEMORIAL HOSPITAL - BROWN DEER PART V, SECTION B, LINE 16J: NOTIFIED INDIVIDUALS IN COMMUNICATIONS REGARDING THEIR BILLS. PART V, SECTION B, LINE 16A - 16C - 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 PART V, SECTION B, LINE 16I - FAP, FAP APPLICATION AND PLS ROGERS MEMORIAL HOSPITAL, INC. HAS TRANSLATED THE FAP INTO SPANISH WHICH IS AVAILABLE UPON REQUEST. ROGERS MEMORIAL HOSPITAL, INC. IS IN THE PROCESS OF FINALIZING THE TRANSLATION OF THE FAP APPLICATION AND PLS. 9 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 AND EATING 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 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 RESOUCES 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 $4,600,774 PART III, LINE 4: 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 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 INABLILITY 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 PSYCIATRIC 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. IN FISCAL YEAR 2018, OVER 16,000 INDIVIDUALS FROM THE STATE OF WISCONSIN WERE ADMITTED TO ROGERS. OF THE 72 WISCONSIN COUNTIES, RESIDENTS FROM 68 OF THESE COUNTIES RECEIVED SERVICES AT ROGERS. MILWAUKEE AND WAUKESHA COUNTY RESIDENTS CONSTITUTED OVER 54 PERCENT OF THE POPULATION SERVED, WHILE 46 PERCENT WERE FROM OTHER WISCONSIN COUNTIES. THIS SERVICES AREA SUGGESTS THAT ROGERS NOT ONLY PROVIDES A SIGNIFICANT SERVICE TO ITS SURROUNDING COMMUNITY BUT ALSO TO THE GREATER WISCONSIN COMMUNITY AS A WHOLE. PART VI, LINE 5: SEE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ON PART III OF FORM 990. 1 ROGERS MEMORIAL HOSPITAL FOUNDATIONINC 34700 VALLEY ROAD OCONOMOWOC WI 53066 391363507 501(C)3 1087000 750592 COST IN KIND SERVICES PROVIDES SUPPORT TO THE RMHF TO ASSIST IN CARRYING OUT ITS EXEMPT PURPOSE ROGERS INHEALTH INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 463960059 501(C)3 468393 COST IN KIND SERVICES PROVIDES SUPPORT TO INHEALTH TO ASSIST IN CARRYING OUT ITS EXEMPT PURPOSE UNITED WAY OF GREATER MILWAUKEE & WUAKESHA COUNTY PO BOX 88110 MILWAUKEE WI 53288 390806190 501(C)3 10000 CORPORATE CAMPAIGN PLEDGE VILLAGE OF SUMMIT POLICE DEPARTMENT 37100 DELAFIELD ROAD SUMMIT WI 53066 115 7200 12067 DONATION OF NEW EXERCISE EQUIPMENT FUNDS TO PURCHASE NEW HANDHELD RADIOS MILWAUKEE PUBLIC MUSEUM 800 WEST WELLS STREET MILWAUKEE WI 53233 391723105 501(C)3 5000 CORPORATE CAMPAIGN PLEDGE 5 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 0 0 0 0 0 0 0 0 PATRICK HAMMER CEO - RBHS / BOARD MEMBER 0 624632 0 170000 0 1379 0 10800 0 21666 0 828477 0 0 JERRY HALVERSON CHIEF MEDICAL OFFICER/BOARD MEMBER 349284 0 97167 0 12005 0 10987 0 27110 0 496553 0 0 0 BRADLEY RIEMANN CHIEF CLINICAL OFFICER/BOARD MEMBER 393204 0 44667 0 0 0 10800 0 27324 0 475995 0 0 0 PAUL MUELLER CEO - RMH 436584 0 105250 0 4770 0 10800 0 29876 0 587280 0 0 0 JAMES KUBICEK CHIEF OPERATING OFFICER - BD 230830 0 40897 0 280 0 10800 0 27607 0 310414 0 0 0 ELIZABETH GILBERT CHIEF OPERATING OFFICER - WA 160661 0 27958 0 555 0 7657 0 2500 0 199331 0 0 0 JAY KELLISON CHIEF OPERATING OFFICER - WC 226203 0 9824 0 753 0 6000 0 8029 0 250809 0 0 0 SCOTT JOHNSON CHIEF OPERATING OFFICER - ECM 168858 0 47842 0 915 0 8696 0 28530 0 254841 0 0 0 KIMBERLY EFFERTZ CHIEF OPERATING OFFICER - OCON 174184 0 33727 0 255 0 8580 0 27953 0 244699 0 0 0 CAROLINE MCHALE CHIEF OPERATING OFFICER - RES SERVIC 138927 0 14171 0 834 0 4537 0 3673 0 162142 0 0 0 AHMED NUMAN MEDICAL DIRECTOR 358733 0 343522 0 255 0 15379 0 0 0 717889 0 0 0 KHAZI MUQEET MEDICAL DIRECTOR 330088 0 285586 0 255 0 10286 0 1212 0 627427 0 0 0 RAYMOND MOY MEDICAL DIRECTOR 221226 0 325955 0 255 0 0 0 0 0 547436 0 0 0 PETER LAKE MEDICAL DIRECTOR 400701 0 126820 0 7960 0 10800 0 29816 0 576097 0 0 0 ROGER LUHN MEDICAL DIRECTOT 354108 0 106862 0 7938 0 10800 0 27110 0 506818 0 0 0 MICHAEL HEDRICK EXECUTIVE VP CFO - THRU 6/14/17 0 219740 0 0 0 164505 0 8390 0 13963 0 406598 0 0 KEITH DEGNER FORMER CFO - RMH- THRU 10/4/16 0 0 3000 0 251330 0 0 0 0 0 254330 0 0 0 SUZANNE HARRISON FORMER VP OF OPERATIONS - OCON 171668 0 0 0 75710 0 5678 0 6067 0 259123 0 0 0 ORVIN FILLMAN FORMER VP OF OPERATIONS - MKE 167302 0 0 0 77106 0 5744 0 12961 0 263113 0 0 0 JAMES LEDBETTER FORMER VP OF REGIONAL PARTIAL HOS 142743 0 45000 0 0 0 4915 0 5955 0 198613 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. $3,962 PAUL MUELLER $3,962 PAT HAMMER PART I, LINE 4A A NUMBER OF EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN B(III). THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. 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 PARTICK ANDRITSCH, BOARD MEMBER 1879492 CONSTRUCTION FEES 0 MEDICAL COLLEGE OF WISCONSIN JON LEHRMANN, BOARD MEMBER 301936 FELLOWSHIP SUPPORT 0 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 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 DIFERING 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 OFFICER 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 OR 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 XI, LINE 9: NET ASSET TRANSFER - INHEALTH 257,144. CHANGE IN INTEREST IN NET ASSETS ROGERS MEMORIAL HOSPITAL FOUNDATION 1,539,917. PARTNERS IN BEHAVIORAL HEALTH 34700 VALLEY ROAD OCONOMOWOC WI 53066 391832142 TO ASSIST IN PROVIDING BEHAVIORAL HEALTH SERVICES WI 12021 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 ENTITIES OF ROGER'S BEHAVIORAL HEALTH SYSTEM, INC. WI 501(C)(3) LINE 10 ROGERS BEHAVIORAL HEALTH SYSTEM INC 1 ROGERS INHEALTH INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 463960059 IMPLEMENTS AND PROMOTES ACCESSIBLE EDUCATION AND PATIENT ADVOCACY RESOURCES WI 501(C)(3) LINE 10 ROGERS BEHAVIORAL HEALTH SYSTEM 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 1087000 FMV OF GRANTS PAID ROGERS MEMORIAL HOSPITAL FOUNDATION INC C 575164 FMV OF GRANTS RECEIVED ROGERS MEMORIAL HOSPITAL FOUNDATION INC L 750592 FMV OF SERVICES RENDERED ROGERS INHEALTH INC L 579906 FMV OF SERVICES RENDERED