2015-05-08T13:14:03-07:00 2014-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2013-07-01 390987025 Community Memorial Hospital of Menomonee Falls Inc COMM 4147770960 W180 N8085 Town Hall Road Menomonee Falls WI 53051 Scott R Hawig CFO 2015-05-08 true Mollie Longhouse P00294881 6142492300 2013 2016-02-25 16:41:14Z Jacobson Catherine A W180 N8085 Town Hall Road Menomonee Falls WI 53051 189319330 false false X www.froedtert.com X 1959 WI Community Memorial Hospital advances the health of the communities we serve through exceptional care enhanced by innovation and discovery. X 18 14 1443 235 0 193539 178272452 180019335 6461842 1687780 10155074 7174158 194889368 189074812 49964 60042 0 67273584 66370728 0 255229 109874721 132210218 177198269 198640988 17691099 -9566176 321723931 142934547 135901625 45002703 185822306 97931844 X Community Memorial Hospital advances the health of the communities we serve through exceptional care enhanced by innovation and discovery. false false 88267894 103292010 Inpatient Services:Community Memorial Hospital was founded in 1964 by citizens of the community it serves. The hospital is accredited by The Joint Commission. Combining next-generation technology with personalized care, Community Memorial Hospital strives to enhance and improve the quality of life in Waukesha, Washington, Milwaukee and Ozaukee counties. Community Memorial Hospital is approved for 237 beds of which 202 are staffed and had 8,603 patient admissions and 38,889 patient days related to a wide range of inpatient services, including hospitalist services, general surgery, internal medicine, rehabilitation services, psychiatry, obstetrics and maternity care, cardiology, and other specialty care for the twelve months ended June 30, 2014.Community Memorial Hospital's Heart and Vascular Center is nationally recognized for its excellent outcomes and superior service to patients. At the Heart and Vascular Center, dedicated physicians work as a team with cardiac nurses and other specialized staff to provide the full spectrum of heart care services, from diagnostic tests and surgical procedures to cardiac rehabilitation. Our extensive system of heart and vascular specialists collaborate to ensure that patients receive comprehensive, high-quality care. Our partnership with Froedtert & The Medical College of Wisconsin allow us to offer patients the most advanced surgical and non-surgical treatments available. During fiscal year 2014, Community Memorial had 10,298 cardiology procedures. Community Memorial Hospital's Cancer Care Center is accredited by the American College of Surgeons Commission on Cancer and the American College of Radiology. As a select location in the Froedtert & The Medical College of Wisconsin Cancer Network, Community Memorial provides the excellent care to which patients are accustomed, while offering access to the specialty expertise of Froedtert Hospital, eastern Wisconsin's only academic medical center. Through a connection to Froedtert Hospital, patients at Community Memorial have access to expanded services: nationally and internationally known specialists who focus on specific cancers, advanced treatments and technologies, and clinical trials that may provide further options. Medical College of Wisconsin cancer specialists are joined by radiation therapists, oncology nurses, genetic counselors, registered dietitians, psycho-oncology specialists, and support service specialists at Community Memorial Hospital's Cancer Care Center all of whom are keenly attuned to the needs, hopes and fears of cancer patients. Each patient's care is coordinated with specialists from many areas of Community Memorial Hospital, who help and support patients and their families through the physical, emotional and economic phases of treatment. By combining clinical research methods with the most advanced treatments, our doctors are battling cancer from every angle possible giving patients a stronger reason to believe in a full recovery. During fiscal year 2014, Community Memorial had 789 cancer registry cases.At Community Memorial Hospitals Birthing Center, we are committed to relationship-centered birthing care. The Birthing Center includes 13 specialty equipped rooms and provides the full spectrum of prenatal services for both normal and high-risk pregnancies. The Level II Neonatal Intensive Care Unit has the technology needed to provide long-term care for babies. During fiscal year 2014, Community Memorial had 978 births.In addition to the cardiac, cancer care and birthing services noted above, the Hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including but not limited to the following: Surgeries: 3,372 Laboratory Tests: 355,356 CT Scans: 3,975 MRIs: 612 Nuclear Medicine Scans: 302 Ultrasounds: 1,799 54252485 63486825 Outpatient Services:Community Memorial had 90,107 outpatient visits in the twelve months ended June 30, 2014. Community offers a wide variety of ancillary, specialty and subspecialty services including but not limited to the following: - Allergy/Immunology - Cardiology - Clinical Genetics - Dermatology - Electrophysiology - Endocrinology - Family Practice - Gastroenterology - Gerontology - Gynecologic Oncology - Gynecology - Hand Surgery - Hematology - Infectious Disease - Internal Medicine - Interventional Radiology - Magnetic Resonance Imaging - Neonatology - Nephrology - Neurosurgery - Nuclear Medicine - Occupational Medicine - Oncology - Ophthalmology - Oral Surgery - Otolaryngology - Pathology - Pediatrics - Pedodontics - Perinatology - Periodontics - Physical Medicine and Rehabilitation - Plastic/Reconstructive Surgery - Podiatry - Psychiatry - Psychology - Pulmonary Medicine - Radiology - Radiation Oncology - Rheumatology - Thoracic Surgery - Urology - Vascular Surgery 11314631 13240500 Emergency Services:Community Memorials Emergency Department is a Level III Trauma Center and provides care for individuals with emergent, urgent, and non-urgent problems. During fiscal year 2014, the emergency department had 21,547 emergency visits, with patients receiving expert care from board-certified emergency physicians and nurses certified in Advanced Cardiac Life Support, stroke and trauma care. Our Emergency Department is strengthened by the availability of and access to highly trained specialists in trauma, neurosurgery, cardiology, cardiothoracic surgery including robotic surgery, orthopaedics, respiratory, obstetrics, gynecology, psychiatry and other specialties when the need arises.Community Memorial Hospital is a Certified Advanced Primary Stroke Center, the highest level of stroke care recognized by the Joint Commission, demonstrating its ability to provide care from a multi-disciplinary team of neurologists, neurosurgeons, emergency department specialists, radiologists, nurses, therapists, pharmacists, technicians and more all working in a coordinated, collaborative system. With our new telestroke technology (secure videoconferencing), our physicians are able to consult in real-time with board-certified stroke neurologists from the Froedtert & The Medical College of Wisconsin academic medical center. This technology allows for faster diagnosis and treatment of stroke patients. 6605610 60042 7729954 160440620 true true false false false false false false false true true false false true true true false true false false false false false false true false true true true false true false false false false false false false false false false true true false false true true true true false false false true 225 0 true 1443 true false false false false false false false false 0 false false false false false false false false false false X 18 14 true false true false true true true true true false false true true true true true true true true true true X X David Dirksmeyer 4147770960 N74W127501 Leatherwood Ct Menomonee Falls WI 53051 X Aggarwal Anil MD Director 1.00 0.00 X 0 0 0 Becker Richard C Director 1.00 0.00 X 0 0 0 Ellis Sharon Q Director 1.00 1.00 X 0 0 0 Fitzgerald Mark Director 1.00 0.00 X 0 0 0 Goldberg MD David F Dir,VP Med Afrs 50.00 0.00 X 377948 0 70981 Greco Patricia Dir,VP Med Afrs 1.00 0.00 X 0 0 0 Hackett MD James G Director 1.00 0.00 X 0 0 0 Hart Daniel Director 1.00 1.00 X 0 0 0 Jacobson Catherine A Dir,FH Pres/CEO 1.00 49.00 X 0 1165252 232857 Lux Theresa M Dir,VP Pt Care 50.00 1.00 X 284507 0 43937 Mays Cedric Director 1.00 0.00 X 0 0 0 Nelson Eric Director 1.00 0.00 X 0 0 0 Shepherd MD Dennis W Executive Dir. 1.00 0.00 X 0 0 0 Templin Susan Director 1.00 1.00 X 0 0 0 Turtenwald Robyn Director 1.00 0.00 X 0 0 0 White MD Michael G Director 1.00 0.00 X 0 0 0 Bast Ronald R Dir&Vice Chair 1.00 2.00 X X 0 0 0 Pieters Robert B Dir&Chair 1.00 1.00 X X 0 0 0 Pollard Dennis Dir&President 1.00 47.00 X X 0 673914 123448 Specht-Palmert Christine Dir&Secretary 1.00 0.00 X X 0 0 0 Stadelmann Douglas J Dir&Secretary 1.00 0.00 X X 0 0 0 Hawig Scott FH CFO 1.00 49.00 X 0 711280 113726 Ericson Allen Chief Operating Officer 5.00 46.00 X 0 405338 88360 Ehn Diane VP Qlty & Perf Exc 40.00 0.00 X 186881 0 39859 Evenson Rock E VP Pln & Prg Dvlp 50.00 0.00 X 224956 0 52490 McClure Debra Nurse Anesthetist 50.00 1.00 X 287867 0 17385 Newkirk Garret Pharmacist 40.00 0.00 X 174308 0 33278 Sanders Paul A Sr VP, Clncl Srvcs 50.00 0.00 X 320475 0 34858 VanDeKreeke Jeffrey Former - Officer (CFO) 0.00 47.00 X 0 405455 71772 1856942 3361239 922951 60 true true false Medical College of WI 8701 Watertown Plank Milwaukee WI 53206 Physicians & Medical 5180879 Boldt Procurement LLC 2525 N Roemer Rd Appleton WI 54911 Contracting 780273 United Dynacare 9200 W Wisconsin Ave Milwaukee WI 53226 Lab 730155 C&A Industries PO Box 3037 Omaha NE 68137 Temp Help 340236 Fresenius Management 16343 Collections Center Dr Chicago IL 60693 Dialysis treatments 319025 14 193539 26580 193539 Emergency/Trauma Revenue 900099 13240500 13240500 Inpatient Revenue 900099 103292010 103292010 Outpatient Revenue 900099 63486825 63486825 180019335 1781434 1754838 26596 0 0 0 100030 193684 -93654 -93654 -93654 99016 50834 48182 48182 0 0 Corporate Allocated Rev 561000 3322327 3322327 Dietary Revenue 561499 681020 681020 Other Dept Operating Rev 561499 2287740 2287740 834889 365049 469840 7125976 189074812 187749289 1131984 X 60042 60042 0 0 0 835249 835249 0 61262252 57970250 3140113 151889 0 -35496 -33217 -2190 -89 4308723 4032103 265848 10772 293700 293700 68878 68878 0 0 0 0 10970201 9282453 1680124 7624 76444 4982 71462 988858 481491 499850 7517 429880 87904 340041 1935 0 3363020 2768370 586734 7916 85214 41972 42857 385 0 140167 120494 18753 920 2302049 1895000 401630 5419 0 8827447 7266576 1540093 20778 3988 3988 Corporate Allocated Expense 43310773 19952006 23323276 35491 Medical Supplies 33823135 33655886 164006 3243 Affil Support - Comm Phys 21726323 16924806 4801517 State Hospital Assessment 5183756 5183756 616385 448058 166898 1429 198640988 160440620 37945139 255229 7125 7425 26309775 7403702 0 22202533 22204635 0 0 20000 10000 3877301 4014952 1630172 1187611 192446776 101646037 85300681 90800739 127899248 0 0 0 0 54477096 17305483 321723931 142934547 10485948 8119042 4199 3481 55729972 69681506 36880180 135901625 45002703 X 184547067 96218364 1275239 1713480 185822306 97931844 321723931 142934547 X -9566176 -78324286 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5105247 456977 638515 450133 69038 5681568 4688829 379734 440545 397266 6595 5105247 4674956 265167 80003 321940 9357 4688829 4094065 1398548 623704 374633 1066388 340 4674956 3166213 904863 384524 304571 56965 -1 4094065 1.00000 false true true 80711 80711 111131620 47655825 63475795 2054573 1737769 316804 41894520 27397633 14496887 37285352 24854810 12430542 90800739 Collateral held for securties loaned Due from Affiliates 4076430 Employee Receivable -505 Executive Deferred Compensation Froedtert Health Executive 457f Senior Management Deferred Compensation Swap Collateral 17305483 Due to Affiliates 4887849 Est Settlements - Third Party Payors 675139 Pension Liability 31317191 Rounding 1 36880180 X Part V, Line 4: Intended uses of the endowment fund. The funds are held by Community Memorial Foundation of Menomonee Falls (CMF), a related organization. The board designated endowment was created to support long range financial needs of Community Memorial Hospital of Menomonee Falls, Inc and its programs. Part X : FIN48 Footnote Froedtert Health, Inc. (FH) applies ASC No. 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. ASC No. 740 prescribes a more-likely-than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under ASC No. 740, tax positions are evaluated for recognition, derecognition, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2014 and 2013, Community Memorial Hospital of Menomonee Falls does not have an asset or liability recorded for unrecognized tax positions. false Otis Spunkmeyer Cookies 36696 36696 13403 Cheery Cherry Fall Fair 35221 35221 200 164 4350 2760 500 6002 2 19299 19299 4214 8890 91216 91216 200 164 4350 20377 500 14892 40483 50733 true true X true X true X true true true false true true 1789144 1789144 0.00900 15529692 6417741 9111951 0.04590 17318836 6417741 10901095 0.05490 46 13230 1309581 10923 1298658 0.00650 4 763 656720 656720 0.00330 15 1789 351362 351362 0.00180 65 15782 2317663 10923 2306740 0.01160 65 15782 19636499 6428664 13207835 0.06650 1 10436 10436 0.00010 2 7196 7196 1 10425 10425 0.00010 4 146 112532 112532 0.00060 8 146 140589 140589 0.00080 false 5105000 67694774 102664141 -34969367 X true true 1 1 Community Memorial Hospital W180 N8085 Town Hall Road Menomonee Falls WI 53051 X X X Community Memorial Hospital 1 true X X X X X X X X 12 true true true X See Part V additional notes X See Part V additional notes X X X X X X X X X X X false false false true true 200.0000 true 400.0000 true X X X X X X true true X X true false X X X X X true X false false Part V, Line 3 - Account Input from Person Who Represent the Community In Fiscal Year 2012, Community Memorial Hospitals Community Outreach Department and Community Outreach Steering Committee conducted key informant interviews with the following non-profit health and human service agencies:Addiction Resource Council of Waukesha CountyAlbrecht Free ClinicCommunity Outreach Health Clinic at Community Memorial Hospital Falls Area Community ServicesGermantown Area Chamber of Commerce Village of Germantown Fire Department Germantown Police Department Germantown Park & Recreation DepartmentGermantown School District Gloria Dei Lutheran Church Hartford Jt 1 School District Hartford Parks and Recreation DepartmentHope Network Inc.Interfaith Caregivers of Washington County Interfaith Senior Programs Waukesha County Menomonee Falls Chamber of CommerceMenomonee Falls Community Education & Recreation Department Menomonee Falls Fire DepartmentMenomonee Falls Police DepartmentMenomonee Falls School District Safe Babies Healthy FamiliesSt. Boniface Food Pantry St. Pauls United Church of Christ Stillwaters Cancer Support ServicesSussex Area Chamber of CommerceSussex Area Outreach ServicesSussex Hamilton School District Tri-County YMCA in Menomonee FallsUniversity of Wisconsin Extension Washington County Washington County Mental Health DepartmentWashington County Public Health DepartmentWaukesha County Community Dental Clinic Waukesha County Mental Health DepartmentWaukesha County Public Health Department Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment Washington County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health Froedtert Health Community Memorial HospitalAurora Health CareColumbia St. Marys Health SystemChildrens Hospital of WisconsinWashington County Public Health DepartmentWaukesha County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health Froedtert Health Community Memorial HospitalAurora Health CareColumbia St. Marys Health SystemProHealth CareWheaton Franciscan HealthcareWaukesha County Public Health DepartmentJKV Research was hired by the participating Health Care Systems and Health Departments to lead the CHNA process for Waukesha, Washington and Milwaukee Counties. The total cost of each CHNA conducted was divided up by each of the participating health systems and health departments. Each health system and health department was assigned to conduct key informant interviews within their service area. Part V, Line 5c - Description of Making Needs Assessment Widely Available The full version of the report and other supporting documents can be found on Froedtert Healths website. Waukesha County: http://www.froedterthealth.org/upload/docs/community-memorial/community-giving/Benefit/waukesha-county-community-health-survey-report.pdf Washington County: http://www.froedterthealth.org/upload/docs/community-memorial/community-giving/Benefit/washington-county-community-health-survey-report.pdf Additional Websites:Washington County Public Health Department - http://www.co.washington.wi.us/uploads/docs/washington-county-community-health-survey-report-march-2012.pdf Waukesha County Public Health Department http://www.waukeshacounty.gov/uploadedFiles/Media/PDF/Health_and_Human_Services/Public_Health/2012%20Community%20Health%20Survey%20Report.pdf Part V, Line 6i - Describe Other Needs Identified See attached Community Health Improvement Plan for Community Memorial Hospital. The report is available online at www.froedtert.com/community-memorial. OverviewThis Implementation Strategy serves as the community health improvement component of Community Memorial Hospitals community engagement strategy, focusing on Access to Primary and Specialty Care, Chronic Disease Management, Alcohol and Other Drug Abuse and Prevention and Wellness.Community Memorial Hospitals community engagement framework is to improve the quality of life in the communities we serve through health care programs and services that are measurable, accessible, and culturally appropriate.Program: Community Outreach Health Clinic Free Clinic for UninsuredHealth Need: Access to primary and specialty care for uninsured individualsInternal Resources: Lab and Radiology departments, Community Physicians, Case Management, Community Memorial FoundationCommunity Partners: Aurora Advanced Healthcare, Waukesha County Community Health Center, Progressive Community Health Center, Waukesha County Community Dental Clinic, United Way of Waukesha County, United Way of Greater MilwaukeeObjectives/Outcomes: Reduced avoidable Emergency Department visits and admissions for the low income and uninsured, Increase referral process for uninsured populations from CMH Emergency Department to the Outreach Clinic, Provide free or reduced ancillary services to Community Outreach Health clinic patients, Facilitate referrals to Specialty Care physicians and other health professionals, Reduce access barriers for uninsured populations in Washington and Waukesha CountiesProgram: Bobbie Nick Voss Colorectal Cancer Screening ProgramHealth Need: Decrease in blood stool test in past yearInternal Resources: Community Memorial Foundation, Gastroenterologist, Surgical Services, Pathology, Community Outreach Health Clinic Staff and PhysiciansCommunity Partners: Bobbie Nick Voss Charitable FundsObjectives/Outcomes: Increase care navigation and facilitate access for vulnerable populations through health education and colonoscopy screeningsProgram: Subsidized TransportationHealth Need: Affordable and accessible transportationInternal Resources: Emergency Department, Community Engagement, Nursing Administration, Case ManagementCommunity Partners: Personalized Transportation Services, Yellow Cab Taxi, Washington County Shared Ride Taxi, American United, Mobile Medical SpecialistsObjectives/ Outcomes: Provide affordable and accessible medical transportation to individuals at or below 200% Federal Poverty LevelProgram: Prostate Screening ProgramHealth Need: Decrease in Prostate Cancer Screening in the past two years in Washington and Waukesha CountiesInternal Resources: Cancer Center, Community Physicians, Community Engagement, Community Memorial Foundation, Marketing and CommunicationsCommunity Partners: ZERO Mobile non-profit prostate screening organizationObjectives/Outcomes: Increase the amount of men having PSA and Digital exam every two yearsProgram: Community Influenza ClinicsHealth Need: Decrease in populations not receiving the Influenza Vaccination in both Washington and Waukesha Counties lower than state and national averagesInternal Resources: Community Engagement, Community Outreach Health Clinic, Community Memorial Foundation, Outpatient Pharmacy, Hospital LeadershipCommunity Partners; Sussex Food Pantry, St. Boniface Food Pantry, Menomonee Falls Food PantryObjectives/Outcomes: Increase the amount of vulnerable populations receiving the Influenza Vaccination and decrease the amount of Influenza related hospitalizations for Community Outreach Health Clinic patientsProgram: Every 15 Minute ProgramHealth Need: Increase in binge drinking higher than state and national average and increase in population reported driving while under the influence or was a passengerInternal Resources: Emergency Department Staff, Community Engagement, Emergency Preparedness Coordinator, Communications and Marketing, Nursing Administration, Security, Radiology, Community Outreach Steering Committee GrantCommunity Partners: Germantown School District, Menomonee Falls School District, Germantown Police, Fire and EMS, Menomonee Falls Police, Fire and EMS, Flight for LifeObjectives/Outcomes: Increase awareness of dangers related to distracted driving, Increase awareness of distractions related to inattentive driving as measured by post survey, Reduce youth underage drinking and driving, Reduce traffic related impairment accidents and deaths in Washington and Waukesha CountiesProgram: Drug Free Communities Waukesha County Annual Drug CollectionHealth Need: Increase in the misuse of prescription, over the counter and other drugs in Waukesha CountyInternal Resources: Community Outreach Steering Committee Grant, Community Memorial Hospital Campus, Community Engagement, Environmental Services, Pharmacy, Hospital LeadersCommunity Partners: Menomonee Falls Police and Citizen Academy, Cambridge Major Laboratories, ProHealth Care, Drug Enforcement Agency, Waukesha County Drug UnitObjectives/ Outcomes: Reduce prescription drug abuse in Waukesha County, Reduce youth alcohol use in 14-20 year olds, Properly dispose of unused or expired medications, Utilize CMHs Drug Repository program for proper disposal or reutilization of unexpired cancer & chronic disease management medicationsProgram: Community Outreach Health Clinic Diabetes Case Management ProgramHealth Need: Washington County 9% and Waukesha County 7% of population diabeticInternal Partners: Community Outreach Health Clinic Nurse Practitioners, Endocrinologists and Ophthalmologists, COHC Volunteer Clinical Dietician, Community Memorial FoundationCommunity Partners: Tri-County YMCA Diabetes Management Program, Rx Assist Prescription Assistance Program, Progressive Community Health Centers, National Association of Free ClinicsObjectives/Outcomes: Improve Hemoglobin A1c levels to 7% or less and monitor improvement for all pre-diabetic and diabetic patients, Promote a healthy diet for patients to reduce the chances of needing insulin, Educate proper use of insulin and importance of continuous monitoring, Improve physical activity, Decrease Retinopathy in diabetic populationsProgram: Living Well with Chronic ConditionsHealth Need: Washington County 28% and Waukesha County 26% with high blood pressure, Washington County 21% and Waukesha County 25% with high blood cholesterol, Washington County 9% and Waukesha County 7% with diabetesInternal Resources: Community Education Department, Wellness Works, Community Outreach Health Clinic, Community Engagement, Nursing Administration, Communications and Marketing, Community Physicians ClinicsCommunity Partners: Wisconsin Institute for Healthy Aging, Sussex Outreach Services, Menomonee Falls Food Pantry, St. Boniface Food PantryOutcomes/Objectives: Increase COHC patient engagement in self-management of chronic disease, Decrease in ED utilization for chronic disease related visits, Increase in self-management as measured by pre and post survey, Increase communication with physician and medical team, Increase physical activityProgram: Community Memorial Hospital Community GardenHealth Need: Decrease in recommended fruit and vegetable intake in Washington and Waukesha CountiesInternal Resources: Community Engagement, Volunteer Services, Grounds, Community Outreach Health ClinicCommunity Partners: Sussex Food Pantry, St. Boniface Food Pantry, Menomonee Falls Food Pantry, Shady Lane Nursery, Menomonee Falls Community Education and Recreation, UW-Extension Washington County, UW-Extension Waukesha County, Tri-County YMCAObjectives/Outcomes: Promote awareness/education of healthy nutrition, Increase the number of fruit and vegetable intake as measured by the Community Health Needs Assessment in Washington and Waukesha Counties, Provide healthy food options for diabetic and obese populations utilizing the Community Outreach Health Clinic and area food pantries Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why Community Memorial Hospitals community health improvement initiatives are targeted for the broad community, especially vulnerable populations (uninsured/underinsured) in the hospitals primary and secondary service areas. Community Memorial Hospitals mission is to advance the health of the communities we serve through exceptional care enhanced by innovation and discovery. The Community Outreach Steering Committee prioritized community health improvement programs, activities and services that reflect the hospitals mission and scope of care: Access to Primary and Specialty Care, AODA, Chronic Disease Management and Health focused Prevention and Wellness programs. The following needs are not being addressed by Community Memorial Hospital:Oral & Dental Health Services: Community Memorial Hospital does not have dedicated resources to provide dental services in Washington and Waukesha Counties. There are other local organizations/dental offices dedicated to improve access to dental care.Teen Pregnancy: United Way, Public Health, Safe Babies Healthy Families, the Hope Network and a number of other community organizations are working on this health issue.Health Literacy and Navigation: Other community organizations are working to increase awareness of health services and health seeking behaviors among low income individuals.Cigarette Use: Community Memorial Hospital supports the Multi-Jurisdictional Coalition of Tobacco Free Community Partnership Dodge, Jefferson and Waukesha Counties.Mental Health: Community Memorial Hospital does not have the dedicated resources. There are other local health and human service agencies and organizations dedicated to this issue. Part V, Line 12h - Other Factors Used in Determing Amounts Charged Patients Out of Pocket Maximum Discount Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A summary of the Financial Assistance Policy is available on the Community Memorial Hospital website. Part V, Line 18e - Other Actions Took Before Any Collection Actions We request additional documentation when an individual has submitted an incomplete financial assistance application. Part I, Line 6a - Related Organization Community Benefit Report Every year, Community Memorial Hospital produces an annual community benefit report highlighting community outreach programs, patient impact stories and investments in the communities we serve. The report is mailed to over 150 area non-profits, chambers of commerce, hospital partners, Community Memorial Hospital Board of Directors, Community Memorial Hospital leaders and staff, government officials, business leaders and other community members. A copy of the 2014 report can be found at www.froedtert.com/community-memorial. Part I, Line 7 - Explanation of Costing Methodology Charity Care and certain other community benefits costs were determined by using internal information to reduce the various activities to cost. The costing methodology follows what is laid out in the instructions from the IRS.As a not-for-profit, emergency medical care and other medically necessary care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part I, Line 7, Column F - Explanation of Bad Debt Expense Our total expense from Form 990, Part IX, line 25, column (A) was $198,640,988. Bad debt expense is included in Form 990, Part VIII, Statement of Revenue, Lines 2a-2c as required by ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. Therefore, bad debt expense is not included on Form 990, Part IX, Statement of Functional Expenses, Line 25, Column (A). Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions and trends. The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense. Part III, Line 4 - Bad Debt Expense Patients accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of patients accounts receivable, Froedtert Health, Inc. (FH) analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, FH analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), FH records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.FH recognizes patient service revenue associated with services provided to patients who have third-party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, FH recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates, if negotiated or provided by policy). On the basis of historical experience, a significant portion of FHs uninsured patients will be unable or unwilling to pay for the services provided. Thus, FH records a significant provision for bad debts related to uninsured patients in the period the services are provided.See also page 26 and 27 of attached financial statements. Part III, Line 8 - Explanation Of Shortfall As Community Benefit Community Memorial Hospital believes that all of the shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. The hospital provides emergency medical care or other medically necessary care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries.The costing methodology used to determine the Medicare allowable costs is based on a calculation developed by the American Hospital Association in which the data is derived from the annual filed Medicare cost report. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients In alignment with the Froedtert Health financial assistance policy regarding the billing, collection and support for patients with payment obligations, Community Memorial Hospital makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) are trained regularly about these policies with an emphasis on treating all patients with dignity and respect regardless of their insurance or their ability to pay for services. Part VI - Needs Assessment In February 2012, Community Memorial Hospital collaborated with JKV Research, LLC along with Aurora Health Care, Childrens Hospital of Wisconsin, Columbia St. Marys Health System, ProHealth Care, Wheaton Franciscan Healthcare, Washington County Health Department and Waukesha County Health Department to conduct a Community Health Needs Assessment (CHNA) in Washington and Waukesha Counties. The research from the needs assessment provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Waukesha County residents. CHNA Overview/Objectives: Gather data on behavioral and lifestyle habits of the adult population and household-level data. Gather data on the prevalence of risk factors and disease conditions of the adult population. Compare health data of residents to previous health studies. Compare health data to national and state measurements.CHNA Methodology: 18 minute telephone survey of area residents 400 completions from February 21 through April 3, 2012 Two-fold sampling 1) RDD landline sample of listed & unlisted #s (n=300) Respondents randomly selected based on number of adults in household Weighting based on number of adults and number of residential phone numbers in household 2) Cell phone only sample (n=100) Adult answering the phone designated as the respondent All data post-stratified by age and gender of adult residents as of 2010 Census proportions. Margin of error: 5%In addition to the Washington/Waukesha County Community Health Needs Assessments, Community Memorial Hospital conducted key informant interviews with 35 individuals representing school district representatives, public health officials, non-profit health and human service professionals, churches, police/fire departments, free clinics and business professionals throughout Waukesha and Washington Counties. Following extensive interviews with key community stakeholders, findings from the assessment were categorized into eight areas: Access to Primary and Specialty Care, Chronic Disease Management, Mental Health Services, Prevention and Wellness, Alcohol, Drug, Tobacco, Abuse, Dental Services, Transportation and Other. Of those eight health needs categories, four were identified as the focus for community outreach activities in 2012 through 2016 based on select criteria: Community Health Priorities, Disproportionate Unmet Needs, Public Health Concerns and Scope of Services. The most critically documented health needs were identified: Access to Primary and Specialty Care AODA Prevention and Wellness Chronic Disease ManagementWaukesha County Health Department Community Health Improvement Plan 2012 2016In April 2011, Community Memorial Hospital Community Engagement Staff are active members in the Waukesha County Public Health Departments Community Health Improvement Planning Process (CHIPP). The CHIPP consists of a steering committee representing all health systems in Waukesha County as well as representation from area non-profit health and human service agencies. The steering committees role is to determine the top health priorities in the county and create an implementation plan to address community and health needs for Waukesha County Public Health Department to execute through 2015. Through the work of the CHIPP Steering Committee, three implementation teams were established to determine programs, impact strategies and outcomes to address root causes in Access to Care, Mental Health and Alcohol and Other Drug Abuse in Waukesha County. The following priorities/strategies are currently being executed by the task force and in partnership with Community Memorial Hospital and strategic partners: Access to Care Community Advocate Training Mental Health Waukesha County Jail and Health & Human Services Discharge Coordination of Care Waukesha County Centralized Intake System Emergency Detention Utilization Survey AODA SBIRT Screening Process Naloxone Intervention Program Underage Drinking Diversion Risk Reduction & Adolescent Health Screening Initiative Heroin and Illicit Drug Task ForceThe CHIPP Steering Committee meets semi-annually to review the progress of strategies and outcomes for the identified priority areas. Task Force Teams must provide reports on their progress and address any implementation barriers during each meeting. Through Fiscal Year 2014, all strategies are working towards or have met desired outcome goals. Part VI - Patient Education of Eligibility for Assistance Community Memorial Hospital informs and educates patients regarding financial assistance and government program eligibility in a number of ways. Its communication efforts also address special needs of patients and their families, such as hearing or visual impairment or language interpretation.Information on hospital-based financial support policies and government programs are made available to patients during the pre-registration and registration processes through brochures, signage and direct contact with financial counselors, social workers / case managers and registration staff. Patient billing statements also inform patients that financial assistance is available. The Community Memorial Hospital website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. Community Memorial Hospital has made financial assistance forms and information available in Spanish. Financial counselors screen uninsured patients for government program eligibility and social services staff are available to assist patients with enrollment processes. Patients who are uninsured, those covered by government programs and those with limited financial means may also be eligible for charity care or discounts through the Hospital's financial assistance program. Financial counselors make every effort to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial assistance can be made during any stage of the patient's stay after stabilization, or the collection cycle. Part VI - Community Information Since its founding in 1964 by the citizens of the community it serves, Community Memorial Hospital (CMH) has focused on the emerging healthcare and wellness needs of over 400,000 people in the three county region of Waukesha, Washington, and northwest Milwaukee Counties. The area served is generally suburban with an average income of $50,000-$99,999 and a large population on Medicare. There are three additional hospitals (ProHealth Care, Wheaton Franciscan, & Aurora) and one FQCH (Waukesha Community Health Center)serving the community. Part VI - Community Building Activities To promote the health of our communities, Community Memorial Hospital participates in numerous community building activities, which are not included elsewhere on Schedule H. These activities include:1) Economic Development: Participation in local chamber of commerce boards focused on economic development to improve the local economy and local job opportunities.2) Community Support: Participation in local emergency preparedness and youth focused coalitions to improve the communities ability to respond to an emergency and to improve the community environment for youth to set them up for greater success.3) Coalition Building: Participation in local community groups and coordination of fundraising for the local United Way Agencies to support others that are addressing health issues that are out of our scope.4) Community Health Improvement Advocacy: Participation in creating the Community Health Improvement Plan with the local health departments to increase collaborative work in our communities.5) Workforce Development: Diversity training and minority internship programs that recruit health professionals in our traditionally underserved communities to diversify our workforce population to better serve our communities. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose Community Memorial Hospitals community health improvement initiatives are targeted for the broad community, especially vulnerable populations (uninsured/underinsured) in the hospitals primary and secondary service areas. Community Memorial Hospitals mission is to advance the health of the communities we serve through exceptional care enhanced by innovation and discovery. The hospitals Community Outreach Steering Committee and Community Engagement staff prioritized community health improvement programs, activities and services that reflect the hospitals mission and scope of care: Access to Primary and Specialty Care, AODA/Mental Health, Chronic Disease Management and Prevention/Wellness.Drug CollectionAs part of our commitment to improve the quality of life in our community and address drug/heroin addiction in our communities, Community Memorial Hospital partnered with Waukesha County Drug Free Communities Coalition to host six drug collections since October 2009. At the collections, area residents dropped off 5,350 pounds of prescription and over-the-counter medications. Over 3,500 area households participated in the collections. This year alone, it took over 25 staff and 100 hours to make the collections possible. Flu ClinicsCommunity Memorial Hospital offers flu clinics for uninsured populations utilizing services at three food pantries and free clinic in Community Memorial Hospitals service area. During the fall of Fiscal Year 2014, 122 people were immunized at four locations with a community benefit value of over $3,000. Each of the clinics was staffed by hospital pharmacists and support staff who were certified by the state to administer immunizations.Athletic Trainer When athletes at Menomonee Falls and Germantown High Schools prepare to compete, there is a Certified Athletic Trainer with them every step of the way. This service is provided by experienced athletic trainers from Community Memorial Hospital.The trainers work at the school each day, working evenings as well as Saturdays to provide training room, practice and event coverage. They prepare athletes for their activities, which might include stretching, taping and treatment as needed. During Fiscal Year 2014, 1,025 students were served at the two high schools with a community benefit value of over $56,000. United Way Employee Giving Campaign Community Memorial Hospital collaborates with United Way of Waukesha County to address community needs in the areas of meeting basic needs, developing self-reliance, strengthening communities and community support. Community Memorial Hospital hosts an annual workplace giving campaign to support all local United Ways. Over 150 hours were spent coordinating the Fiscal Year 2014 campaign. In addition to an employee campaign, Community Memorial Hospital matches donations up to $10,000. Community Health & Wellness Initiative Community GardenCommunity Memorial Hospitals on-campus garden is providing produce to low-income populations residing in the hospitals service area that may not readily have access to fresh vegetables.A community health survey conducted by the hospital in 2012 identified a need for affordable and healthy nutrition options for patients utilizing services in the Community Outreach Health Clinic and clients of three area food pantries.The community garden is a great way to help those who have chronic conditions or access nutritious vegetables through the hospital's community partners. This falls harvest, which included tomatoes, cucumbers, zucchini, peppers and beans, was distributed directly to patients who use the Outreach Clinic and Sussex, Germantown and Menomonee Falls food pantry clients. In Fiscal Year 2014, over 1,300 pounds of produce was donated. Community Outreach Health ClinicThe Community Outreach Health Clinic is a facility where uninsured populations at or below 200% federal poverty level can seek free medical care. The clinic serves people who do not have medical insurance or the ability to pay for medical care. The clinic provides quality, limited medical care with dignity and confidentiality using the services of three part-time paid Nurse Practitioners and over 80 health care volunteers including, physicians, nurses, pharmacists, technicians and other professional staff. In Fiscal Year 2014, the clinic served 1,880 individuals.Community Health ScreeningsCommunity Memorial Hospital offers free blood pressure, skin cancer, prostate cancer and sports injury screenings. With the goal to empower people and the community to make better decisions and take actions to improve and maintain their health, our community health screenings provide much needed access to services for many of our community members. In Fiscal Year 2014, Community Memorial Hospital provided free health screenings for 209 people. Bobbie Nick Voss Colonoscopy ProgramCommunity Memorial Hospital has partnered with Bobbie Nick Voss Charitable Funds since 2008 to provide free colonoscopies to patients (age 50 and above) in the Community Outreach Health Clinic that show signs or symptoms of colorectal related health conditions. In Fiscal Year 2014, 18 patients received a colonoscopy at no cost.Living Well with Chronic ConditionsLiving Well with Chronic Conditions Workshop is a six week series that teaches individuals with chronic conditions to become better self-managers of their health. Topics covered include: techniques to deal with problems such as frustration, fatigue, pain and isolation; appropriate exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of medications; communicating effectively with family, friends and health professionals; nutrition; decision making; and evaluating new treatments. The program is highly interactive and designed to enhance current treatment or disease specific education that patients are already receiving. Community Memorial Hospital offered two, six week workshops in Fiscal Year 2014 helping 27 individuals better manage their symptoms and live a healthier life.ACA Insurance Marketplace and Enrollment AssistanceFroedtert Health (parent company of Community Memorial Hospital) recognized the need to help individuals navigate the new choices available to them through the Affordable Care Acts Insurance Marketplace and Medicaid reforms. Our network of certified application counselors assisted 123 individuals in enrollment in Medicaid and 148 individuals into a Marketplace Insurance Plan. In addition, our certified application counselors answered thousands of phone calls and assisted with questions. Froedtert Health also partnered with the Milwaukee Enrollment Network which represented health systems, free clinics, health departments and other non-profit organizations to reach out to people throughout Milwaukee, Washington and Waukesha Counties in securing adequate and affordable health insurance. Leadership Volunteerism/Community SupportAs an indication of Community Memorial Hospitals executive teams commitment to the community, 75 hospital leaders provided more than 1,000 hours of support to local initiatives, not-for-profit organizations and community events that align with the hospitals mission and directly support identified community needs. Subsidized Transportation ProgramThe Subsidized Medical Transportation Program at Community Memorial Hospital contracts with local transportation organizations in order to provide transportation to and from the hospital service locations for ambulatory/non-ambulatory eligible patients (200% federal poverty level or below) who have difficulty arranging their own transportation and lack the financial resources to purchase transportation. In Fiscal Year 2014, Community Memorial Hospital provided 647 subsidized rides to 412 patients.Community Outreach Steering Committee GrantsCommunity Memorial Hospitals commitment includes grants to local not-for-profit organizations that support community health improvement efforts focused on access to primary care, chronic disease management, mental health and prevention and wellness in the hospitals service area. In 2014, seven local non-profit organizations received grants totaling $50,000 from the Community Outreach Steering Committee. Award recipients include: Citizen Advocates of Washington County (Mental Health/Access to Care) Community Outreach Health Clinic (Access to Care/Chronic Disease Management) NAMI Waukesha County (Mental Health/AODA) Safe Babies Health Families (Access to Care) Tri-County YMCA (Prevention and Chronic Disease Management) Valley View School PTO (Prevention and Wellness) Waukesha County Community Dental Clinic (Access to Care/Dental)Health Care Career AcademyThe Healthcare Career Academy provides qualified students entering their junior or senior year at Menomonee Falls High School, Germantown High School and Sussex Hamilton High School with the opportunity to expand their knowledge base as it relates to a wide array of professional healthcare career options. The th Part VI - Affilated Health Care System Roles and Promotion Affiliated Health SystemFroedtert & the Medical College of Wisconsin Community Memorial Hospital, founded in 1964 by the citizens of Menomonee Falls and surrounding communities, is a full-service hospital that specializes in cancer care, heart and vascular care, orthopaedics, womens health and advanced surgical procedures. Community Memorial Hospital is part of the Froedtert & the Medical College of Wisconsin health care network, which also includes Froedtert Memorial Lutheran Hospital, Milwaukee; St Josephs Community Hospital of West Bend; and more than 30 primary and specialty care health centers and clinics.For more information about Froedtert Health, visit www.froedterthealth.org.Promotion of Community HealthThe Community Outreach Steering Committee (COSC), which is a subcommittee of the hospitals Board of Directors, actualizes the mission of Community Memorial Hospital through community benefit activities that improve the quality of life and enhance wellness resources, which meet identified comprehensive health needs of the communities served. The COSC is appointed annually by the hospital president and is advisory to the Community Memorial Hospital Board and Administration. Membership appointments are made each June with members serving one year terms. The COSC meets quarterly and is composed of hospital and board representatives, plus community members representing the various constituencies of the total service area. Functions include: Provide a leadership role in advocating community wide responses to health care needs in the community. Facilitate and support community and health care partnerships. Envision, assess and guide new community benefit opportunities. Identify and describe unmet health needs. Promote universal access to health care. Determine allocation of the Community Outreach Services Fund, which awards $50,000 annually towards area non-profits efforts to improve health disparities focused on Access to Care, Mental Health/AODA, Chronic Disease Management and Prevention and Wellness in the communities Community Memorial Hospital serves.Addressing Needs Through Targeted OutreachCommunity Memorial Hospital develops and executes community outreach programming and activities based on identified community health needs. Since 1990, Community Memorial Hospital conducts needs assessments every three years in order to determine priorities and strategies in addressing community health disparities. Every needs assessment cycle, Community Memorial Hospital Community Engagement staff along with the hospitals COSC develops a Community Health Improvement Plan that is incorporated into the hospitals overall strategic plan to address the most critical needs in the communities we serve. The plan is reviewed annually by the COSC. Community Memorial Hospital Community Outreach staff, leaders and external community partners work collaboratively to develop key goals and strategies to address community health needs. Progress towards community outreach programs/activities and goals are reported quarterly through the COSC, Physician Advisory Council, Leadership Meetings and the Board of Directors. Based on the results from the 2012 Community Health Needs Assessment, programs and activities are focused around the following identified health needs: Access to Primary and Specialty Care AODA Chronic Disease Management Prevention and WellnessFor more information on specific community outreach efforts, please refer to the 2014 Community Benefit Report by going to http://www.froedtert.com/upload/docs/giving/community-benefit/community-benefit-report.pdf Froedtert Health is comprised of Froedtert Hospital in Milwaukee County, Community Memorial Hospital in Waukesha County and St. Josephs Hospital in Washington County, along with our affiliated physician group that practice at satellite clinics around each hospital. Community Memorial Hospital has several independent physicians with privileges to care for patients in our facility. Community Memorial Hospital has an open medical staff and physicians must go through the credentialing process and apply for privileges. CMH has exclusivity rights for certain departments in the hospital, such as Radiology, Emergency and Anesthesia services. Froedtert, Community Memorial and St. Josephs Hospitals made significant investments in the health of their communities. Patients who couldnt pay for their medical care received more than $85 million in uncompensated services. Beyond providing care for the poor, we contributed $72.9 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities.Froedtert Health members develop community benefit strategies and goals based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the hospitals have built important local relationships that provide meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes, health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert Health, visit www.froedtert.com. Part VI - States Where Community Benefit Report Filed WI Part V - Explanation of Number of Facility Type Community Memorial Hospital is the only facility listed under this reporting of the IRS Form 990, Schedule H. Part VI - Additional Information Community Benefit Data is reported annually to the Wisconsin Hospital Association. true Community Outreach Health Clinic W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 25000 0 Support operations of clinic Other Grants 5000 9200 W Wisconsin Avenue Milwaukee WI 53226 25042 0 Various United Way of Waukesha County PO Box 1041 Waukesha WI 53187 390886376 10000 0 Support organizations mission 3 0 Grantmaker's Description of How Grants are Used Organizations submit grant requests to the Community Outreach Steering Committee (the Committee). On a quarterly basis the fund allocations are determined. Each organization selected for funds receives an award letter detailing the expectations and conditions of the grant money. In order to comply with applicable tax laws, regulations and the Community Outreach Services Fund policy, the Community Outreach Services Fund will provide grant support to organizations with the understanding that:1) Grant funds distributed will be used only for the purposes designated in the award letter.2) No funds will be used for any political campaign or to support attempts to influence legislation of any governmental body. 3) If the organization loses exempt status, any unexpended funds will be returned to the Community Outreach Steering Committee.4) Adequate accounting records of the expenditures of funds will be maintained by the organization.5) This is a one time grant distribution. Future funding requests will be considered on a case by case basis. In addition, the Committee includes a Final Report Form with each organizations award letter. The form requires the organization to provide a brief description of the activity and measurable outcomes/benefits, an expenditure report, follow up actions to the Committees recommendations, and future plans. The Committee requests that each organization submit the Final Report Form to the Committee within thirty days after the completion of the project for which the funds were intended or within a maximum of one year from the receipt of funds. X X X true true X X X X X false true false false false false false true false false Ehn Diane VP Qlty & Perf Exc 141475 44757 649 24183 15676 226740 Ericson Allen Chief Operating Officer 309279 69156 26903 61417 26943 493698 Evenson Rock E VP Pln & Prg Dvlp 149271 56931 18754 28210 24280 277446 Goldberg MD David F Dir,VP Med Afrs 264593 94728 18627 42000 28981 448929 Hawig Scott FH CFO 490031 193593 27656 87175 26551 825006 Jacobson Catherine A Dir,FH Pres/CEO 788962 374772 1518 202750 30107 1398109 Lux Theresa M Dir,VP Pt Care 198228 67789 18490 33950 9987 328444 McClure Debra Nurse Anesthetist 271971 15896 5875 11510 305252 Newkirk Garret Pharmacist 160055 13950 303 9172 24106 207586 Pollard Dennis Dir&President 422777 225557 25580 96089 27359 797362 Sanders Paul A Sr VP, Clncl Srvcs 212136 99788 8551 14714 20144 355333 VanDeKreeke Jeffrey Former - Officer (CFO) 287555 98578 19322 60000 11772 477227 Part I, Line 1a: Relevant information in regards to selections on 1a. Housing:Hawig, Scott - $39,106Social club dues:Pollard, Dennis - $662Gross up social club dues:Pollard, Dennis - $400 Part I, Line 7: Non-Fixed payments not listed above Certain management employees participate in an incentive compensation plan that includes some non-fixed elements. Upon the attainment of a certain financial threshold, incentive compensation is available for meeting identified goals in the areas of financial performance, operational efficiencies, quality improvements, customer satisfaction, strategic growth and partnership initiatives. In some cases the determination of whether a goal is met is absolute while others require a certain amount of discretion to determine if goal is met. In addition, the incentive compensation includes a purely discretionary component. Part III, Additional Information Part II, Column (B)(ii): Bonus and incentive compensation amounts include incentive compensation and amounts paid to individuals in lieu of participation in 457(f) deferred compensation plans. WI Renal Care Grou See Part V 355196 Dialysis services false Schedule L, Part V Supplemental Information WI Renal Care Group: Former CMH Officer Jeff Van De Kreeke was on Interested Person's management committee. X Stone/Calendars/Misc Items 1 26580 Donor's FMV false true false Long Term Investments & Restricted Assets 2013-07-01 127918322 Balance Sheet Basis 392014409 Froedtert Health Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) Net Long Term Debt 2013-07-01 -55488753 Balance Sheet Basis 392014409 Froedtert Health Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) Swap Liability 2013-07-01 -4558617 Balance Sheet Basis 392014409 Froedtert Health Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) false false false false Sch N, Part III, Additional Information Effective July 1, 2013, Froedtert Health Inc., the parent corporation of Community Memorial Hospital, adopted an internal accounting policy for certain balance sheet and income statement matters that are centrally managed at the parent corporation. The policy states that assets and liabilities related to centrally managed programs will be accounted for on the parent corporations consolidated balance sheet and will not be allocated to any affiliate balance sheets. Community Memorial Hospital implemented the new policy effective July 1, 2013 and has transferred all centrally managed assets and liabilities resulting in the disclosure on Schedule N. The charitable operations of Community Memorial Hospital were not impacted by this accounting change. Form 990, Part III, Line 4d: Other Program Services Description OTHER PROGRAM SERVICES 4: As part of operating an acute care hospital and providing health care services to the community, other revenue is derived in the following areas:Corporate Allocated Revenue - revenue passed through from Froedtert Health, a related party.Other Department Operating Revenue - revenue derived from different services through the process of providing patient care and in the normal operation of a medical facility. Included in this category are items such as intercompany revenue from medical and administrative services provided to the other Froedtert Health entities, meaningul use revenue, medical staff application fees, and revenue from classes, pump rentals, and other wellness services.Investment Income - revenue derived from investments in affiliates (Menomonee Falls Ambulatory Surgery Center, Vanguard Health Services, & Community Memorial Foundation). Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Scott Hawig, Catherine Jacobson, Robert Pieters, Dennis Pollard, Daniel Hart, Sharon Ellis, Susan Templin, and Ronald Bast all have business relationships. Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents Articles of Incorporation and Bylaws were amended and restated to reflect termination of definitive agreement that created original health care system. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Froedtert Health, Inc. is the sole member of Community Memorial Hospital of Menomonee Falls, Inc. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Froedtert Health, Inc., as the member of Community Memorial Hospital of Menomonee Falls, has the final approval of election of all board members. Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders Froedtert Health, Inc., as the sole member of Community Memorial Hospital of Menomonee Falls, Inc., retains certain reserved powers and authorities with respect to specific governance matters, and strategic and mission-related initiatives of Community Memorial Hospital. Form 990, Part VI, Line 11b: Form 990 Review Process Froedtert Health, Inc. accounting staff prepare Form 990 which is reviewed by the Froedtert Health financial leaders and legal counsel. The 990 is then reviewed by KPMG, Froedtert Health's outside accounting firm. Next, the 990 is provided to the Froedtert Health Finance Committee and Board of Directors. Finally, the 990 is filed as required. Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts On an annual basis all officers, directors, trustees, key employees are required to complete a conflict of interest disclosure statement. The data is compiled, and the Froedtert Health Vice President-Chief Compliance Officer (CCO), the Senior Vice-President-General Counsel and/or delegate will review all forms and notifications to determine if any conflicts of interest exist in the disclosure documents. If it is determined that a conflict of interest exists, then the person making the disclosure shall be relieved of his/her obligations on behalf of Community Memorial Hospital with respect to the transaction or arrangement that creates the conflict of interest. A report of all conflicts of interest will be made by the CCO at least annually to the Froedtert Health Finance Committee of the Board of Directors. Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees Compensation of Top Management is paid by a related organization but a review is performed. In establishing the compensation of the organization's Top Management, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, persons with a conflict of interest regarding the compensation arrangements at issue are not involved in the decision making process, and amounts are reviewed and approved by the Compensation Committee of the FH (the related organization) Board of Directors.In addition, there is contemporaneous documentation and recordkeeping for deliberations and decisions regarding the compensation arrangements. Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Froedtert Health, Inc's quarterly financial information is made available to the public online through the Digital Assurance Corporation, Inc. website. Anyone can register to receive ongoing access to and notifications regarding financial statements at the online website. Additionally, Governing Documents and Conflict of Interest Policy are made available to the public through the corporate office upon request. Other Changes In Net Assets Or Fund Balances - Other Decreases Capital Contributions = -$2791896 Other Changes In Net Assets Or Fund Balances - Other Decreases Change in APB other than net periodic benefit = -$5784931 Other Changes In Net Assets Or Fund Balances - Other Increases Change in Foundation Restricted Net Assets = $438241 Other Changes In Net Assets Or Fund Balances - Other Decreases Change in Foundation unrestricted net assets = -$210939 Other Changes In Net Assets Or Fund Balances - Other Increases Other = $25239 Other Changes In Net Assets Or Fund Balances - Other Decreases Transfer to affiliates = -$70000000 Part IX 24a Corporate Allocations Froedtert Health allocates its revenues and expenses to Froedtert Memorial Lutheran Hospital, Community Memorial Hospital of Menomonee Falls, St. Joseph's Community Hospital, and Froedtert & The Medical College of Wisconsin Community Physicians. The allocation is calculated by applying an allocation metric to each accounting unit at Froedtert Health, including a flat percentage, percentage of gross revenue to total, percentage of supply expense to total, etc. Each entity then receives its portion of the Froedtert Health allocation on a monthly basis. Part VII - Section A 1a Columns C-F Individuals listed as 'former' but receiving compensation during the year is due to the fact the individual is currently, or was during the tax year, still employed by the organization, but is no longer in the role of director, officer, key employee, etc. in the current year. Such individual was reported as such on the organization's 990 in the previous five years. Inception Health LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 202636740 Healthcare Services WI Froedtert Health Inc Froedtert Health Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 392014409 Management Services WI 501(c)(3) Ln 11, Type 111 NA false Community Outpatient Health Services W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 Outpatient Medical and Dental Services WI 501(c)(3) 3 Community Memorial Hospital of MF true Community Memorial Foundation W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635057 Health and Welfare promotion WI 501(c)(3) Ln 11, Type 1 Community Memorial Hospital of MF true Froedtert Memorial Lutheran Hospital Inc 9200 West Wisconsin Avenue Milwuakee WI 532263522 396105970 Hospital WI 501(c)(3) 3 Froedtert Health Inc false St Josephs Community Hospital Inc 3200 Pleasant Valley Road West Bend WI 530953868 390806302 Hospital Care Services WI 501(c)(3) 3 Froedtert Health Inc false St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend WI 530953868 392034296 Health and welfare promotion WI 501(c)(3) Ln 11, Type 1 St Josephs Comm Hosp of West Bend Inc false Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 391431192 Health, welfare, research & educ promo WI 501(c)(3) Ln 11, Type 1 Froedtert Memorial Lutheran Hospital Inc false QHS 1 Inc 19601 W Bluemound Rd Brookfield WI 53045 202636686 Healthcare Services WI 501(c)(3) Ln 11, Type 1 Froedtert Health Inc false false true true false false false false false false false false false true true true true true true true Schedule R, Part V, Line 2 Any transactions listed on Schedule R, Part V, Line 1 and not on Schedule R, Part V, Line 2 are between related 501(c)(3) organizations and therefore, are not reported in this section.