2015-05-13T13:30:00-05:00 2014-06-30 861065772 Deloitte Tax LLP 111 South Wacker Drive Chicago IL 606064301 990 2013-07-01 391351584 Alexian Village of Milwaukee Inc ALEX 4143559300 9301 N 76th Street Milwaukee WI 532231074 Gary Mohn CEO 4143559300 2015-05-12 1 Laura Gillespie P00855604 3124861000 2015-05-06 2013 2016-02-25 16:41:14Z Gary Mohn 9301 N 76th Street Milwaukee WI 532231074 24910453 0 0928 X alexianbrothers.net X 1980 WI Continuing Care Retirement Community and Skilled Nursing Facility. 5 3 362 133 0 0 111433 282130 23416287 24088035 966852 540288 0 0 24494572 24910453 0 0 0 0 10074177 10606354 0 0 3778 11962818 13306674 22036995 23913028 2457577 997425 44071094 45452131 16706496 16230353 27364598 29221778 X Alexian Village of Milwaukee, Inc. ("AVM") carries out the healing mission of the Catholic Church as an Alexian Brothers ministry by identifying and developing effective responses to the health and housing needs of those we are called to serve. 0 0 10754552 9362514 AVM is a Continuing Care Retirement Community, which includes a Skilled Nursing Facility (SNF). Our SNF, inspired by the healing mission of the Alexian Brothers to the elderly, provides a continuum of care to residents that maximizes dignity and independence. Rooted in the Catholic tradition of caring, the staff is committed to promoting the well-being of those we serve through the delivery of quality care. The SNF has 108 beds with an average occupancy of 94. In FY2014, 12,689 days of care were provided to Medicaid recipients. 5,802 days were provided to Medicare recipients. For Medicaid residents we were reimbursed approximately $320,000 less than our costs, and gave back to the community over $306,000 in other types of programs and services, serving over 24,600 individuals. 3281393 4462647 AVM has an Assisted Living Facility (AL). Licensed as a Community Based Residential Facility (CBRF) this area cares for 79 persons each day. The residents need support 24 hours a day ranging from simple assistance to those with severe signs of dementia. Regardless of one's ability to pay, AVM continues to provide care for its residents. In 2014 approximately $122,000 of charity care was provided. In addition, we were reimbursed approximately $1,184,900 for medicaid residents living in this area. For all levels of care we maintain an active Pastoral Care staff that visits residents frequently, provides daily mass and pastoral counseling. All religions are supported. 5901435 8697227 AVM includes Independent Apartments. AVM has 241 independent apartments and averages 268 persons. Most AVM residents have a Life Care contract whereby AVM agrees to provide services in our SNF and AL areas at their apartment rent plus a small additional fee, for the rest of the resident's life. Rental contracts are also available. On all levels of care, where reimbursement is less than cost, AVM absorbs the difference in meeting its mission to the community. This is regardless of race, creed, sex, origin, handicap, age or ability to pay. Residents and employees are active in providing support to our local community through such things as tutoring, and providing meals to the homeless. Regardless of one's ability to pay, AVM continues to provide care for its residents. 1379596 1565647 Alexian Village of Milwaukee, Inc. offers Adult Day Care and other programs that serve an average of 63 clients per day. The Adult Day Care is a social model that offers services for the surrounding community. Over 85% of the clients qualify for the Medicaid program. The services offered to the community include educational, fitness, memory and wellness programs. Strengthened by community, prayer, commitment to the poor, and the legacy of its founders, the Alexian Brothers witness the healing Christ by a holistic approach to promoting health and care for the sick, dying, aged and unwanted. 1379596 1565647 21316976 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 69 0 1 362 1 0 0 0 0 0 0 0 0 0 0 X 5 3 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X Paula R Miller 4143559300 9301 N 76th Street Milwaukee WI 532231074 X Gary Mohn Ex-Officio Member & President/CEO 25.00 25.00 X X 0 248477 58314 Edward M Brady CPA CVA Director 1.00 0.00 X 0 0 0 Mark Kontos start 713 Director 1.00 0.00 X 0 0 0 Mark Larson Director 1.00 0.00 X 0 0 0 John Turongian end 114 Director 1.00 50.00 X 0 259070 48066 Mark Frey Ex-Officio Member 1.00 50.00 X 0 1498371 49865 Ken Marx end 114 Secretary/Treasurer 1.00 50.00 X 0 190506 42107 John Brannan start 114 Secretary/Treasurer 50.00 1.00 X 0 70741 3964 Donna Gauthier Assistant Secretary 1.00 40.00 X 0 74489 15715 Scott Peterson Vice President, Human Resources 1.00 50.00 X 0 342755 38484 Renee Bielinski Director of Nursing 50.00 0.00 X 128217 0 12437 Debbie Curran Health Center Director 50.00 0.00 X 127725 0 16163 Linda Paulson Marketing Director 50.00 0.00 X 135971 0 25609 Mary Krenzelok Marketing Director 50.00 0.00 X 100462 0 11568 Jim Lewandowski Former Key Employee 0.00 0.00 X 0 722305 15727 492375 3406714 338019 4 1 1 0 Alexian Brothers Health System 3040 W Salt Creek Lane Chicago IL 60657 Management Services 1162601 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 Therapy Services 645712 Alexian Brothers Senior Ministries 12250 Weber Hill road St Louis MO 63127 Management Services 590693 Stu's Flooring Ltd PO Box 210857 Milwaukee WI 53221 Flooring (Sch O) 103308 4 282130 282130 Health Care Center-SNF 623000 9362514 9362514 Life Care-Independent 623990 8697227 8697227 CBRF/Assisted Living 623000 4462647 4462647 Adult Day Care 623990 858421 858421 Other Resident Service 623000 500223 500223 207003 207003 24088035 540288 540288 24910453 24088035 0 540288 X 8677054 7507159 1166719 3176 295730 255866 39769 95 995313 861145 134168 638257 559960 78073 224 619 619 5675 5675 5594542 5497387 97148 7 7350 7350 555075 371430 183572 73 14457 14451 6 1393979 1393979 32359 20766 11593 26554 9841 16713 557480 557480 1538620 1538620 47632 47632 Management Fees 2036201 2036201 Taxes 299272 299272 1196859 707142 489520 197 23913028 21316976 2592274 3778 138069 72941 1855475 1941507 153540 127868 166789 53311 31104655 3582744 26769985 27521911 12826951 14706672 2160285 1027921 44071094 45452131 2199924 1602763 14506572 14627590 16706496 16230353 X 27189592 29031501 142291 157562 32715 32715 27364598 29221778 44071094 45452131 X 997425 904554 -44799 X X 0 1 X 1 0 X 103267 149588 45868 111433 282130 692286 22465859 22728492 11812499 23416287 24088035 104511172 22569126 22878080 11858367 23527720 24370165 105203458 0 0 0 105203458 225264 329052 125909 966852 540288 2187365 225264 329052 125909 966852 540288 2187365 182840 149787 332627 22977230 23356919 11984276 24494572 24910453 107723450 0.97660 0.97690 0.02030 0.01780 X Schedule A, part III: For the year ended 6/30/12, the organization filed a short period return due to a change of accounting period. Thus, the amounts in column 2011 of Schedule A reflect the tax year 1/1/2012 - 6/30/2012 activity. Prior balances have been rolled backward. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 57731 5869 63600 56921 810 57731 52124 4929 132 56921 52612 -488 0 52124 47669 5443 500 52612 1.00000 0 0 1530000 1530000 22543729 2395711 20148018 7030926 1187033 5843893 27521911 Interest in Investments Held by Ascension Health Alliance 14540114 F Unemployment Insurance Bond 166558 F 14706672 Deferred Accommodation Fees 14543497 Reserve for Insurance Losses 25133 Security Deposits 58960 14627590 X Part V, Line 4: Permanently restricted for employee scholarships. Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Alexian Village of Milwaukee, Inc.: The System accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2014. 1 1 0 0 0 0 0 0 0 Gary Mohn Ex-Officio Member & President/CEO 0 199745 0 34606 0 14126 0 28332 0 29982 0 306791 0 14126 John Turongian end 114 Director 0 222982 0 20058 0 16030 0 23254 0 24812 0 307136 0 16030 Mark Frey Ex-Officio Member 0 712178 0 693941 0 92252 0 14702 0 35163 0 1548236 0 74752 Ken Marx end 114 Secretary/Treasurer 0 175708 0 10027 0 4771 0 14158 0 27949 0 232613 0 0 Scott Peterson Vice President, Human Resources 0 302795 0 39960 0 0 0 14311 0 24173 0 381239 0 0 Linda Paulson Marketing Director 133612 0 0 0 2359 0 8760 0 16849 0 161580 0 0 0 Jim Lewandowski Former Key Employee 0 0 0 0 0 722305 0 0 0 15727 0 738032 0 722305 Part I, Line 3 Alexian Brothers Health System, a related organization of Alexian Village of Milwaukee, Inc., uses the following methods to establish the compensation of the organization's President/CEO: - Compensation committee, - Independent compensation consultant, - Form 990 of other organizations, - Compensation survey or study, and - Approval by the Board or Compensation Committee. Part I, Line 4a: The following individual listed in Schedule J received the referenced amount of change in control payments in calendar year 2013. The payments under a change-of-control arrangement are made in connection with retirement that changed the terms of employment resulting from a change in control of the organization: Jim Lewandowski - $689,832 Part I, Line 4b: Alexian Brothers Health System offers a Supplemental Employee Retirement Plan to all employees who participate in the executive benefits program and whose compensation exceeds the IRS allowable limit for a qualified pension plan. The purpose of the plan is to restore retirement benefits that are restricted because of compensation limits for the executives. No distributions from the supplemental nonqualified retirement plan were made in the current year. Form 990, Part VI, Section A, line 2 John Turongian, Mark Frey, Ken Marx, Donna Gauthier, Scott Peterson and Gary Mohn have a business relationship due to joint employment by a common health system entity. Form 990, Part VI, Section A, line 6 Alexian Village of Milwaukee, Inc. has two classes of corporate members, Alexian Brothers Health System (the "National Member") and Alexian Brothers Senior Ministries (the "Area Member"). Form 990, Part VI, Section A, line 7a Alexian Brothers Health System has the authority to appoint and remove Directors and Executive Officers of Alexian Village of Milwaukee, Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Alexian Village of Milwaukee, Inc.'s financial information or corporation as a whole are subject to approval by the National Member, Alexian Brothers Health System. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board members are provided the Form 990 and management team members are available to answer any Board Member's questions. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO, Executive Director, or top management official, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee of the Board of Governors of Alexian Brothers Health System reviewed and approved the compensation. In the review of the compensation, the compensation of the CEO, Executive Director, or top management official was compared to the compensation of those in positions in other similarly situated organizations that hold the same or a similar title. During the review and approval of the compensation, the documentation of the decision was recorded in the Compensation Committee minutes. The individual was not present when his compensation was decided. In determining compensation of other officers or key employee of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to other similarly situated organizations' employees that hold the same or similar title. During the review and approval of the compensation by the Compensation Committee, documentation of the decision was recorded in the minutes. Form 990, Part VI, Section C, line 19 The financial statements of Alexian Village of Milwaukee, Inc. are available through the National Reporting Municipal Services Information Repository (NRMSIR). Conflicts of Interest statements and the governing documents of Alexian Village of Milwaukee, Inc. are not made available to the public. Form 990, Part VII, Section B: Explanation of Compensation paid to Stu's Flooring: Stu's Flooring, Ltd. provided flooring services. The payments made to Stu's Flooring, Ltd. included both materials and services. Form 990, Part IX, line 11g Purchased Services - Touchpoint - Environmental Services: Program service expenses 650,851. Management and general expenses 0. Fundraising expenses 0. Total expenses 650,851. Purchased Services - Touchpoint - Dietary/Food Services: Program service expenses 3,070,694. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,070,694. Purchased Services - Laundry/Linen Services: Program service expenses 197,055. Management and general expenses 0. Fundraising expenses 0. Total expenses 197,055. Purchased Services - Medical: Program service expenses 1,247,900. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,247,900. Purchased Services - Other: Program service expenses 310,486. Management and general expenses 18,303. Fundraising expenses 7. Total expenses 328,796. Other Fees-for-Service: Program service expenses 20,401. Management and general expenses 78,845. Fundraising expenses 0. Total expenses 99,246. Form 990, Part XI, line 9: Other UGL changes 219. Assets Released/Funds Used -134,552. Transferred from Alexian Elderly Services, Inc. 89,534. Part XI, Line 2b - Audit Disclosure: The financial statements of Alexian Village of Milwaukee, Inc. were audited on a consolidated basis. The Audit Committee of the Board of Governors of Alexian Brothers Health System has been delegated the responsibility to oversee the audited financial statements and the selection of the independent accountants that audit the financial statements. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Alexian Brothers Health System 3040 W Salt Creek Lane Arlington Heights IL 60005 363260495 Supports provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Alexian Brothers Bonaventure House 825 Wellington Avenue Chicago IL 60657 363527899 Housing and supportive care services for persons with HIV/AIDS IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Health System Inc Investment Trust 3040 W Salt Creek Lane Arlington Heights IL 60005 363801585 Manages pooled investments of related not-for-profit entities IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers of San Jose Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 941530037 Acute care hospital (sold in 1998) TX Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Senior Ministries 3040 W Salt Creek Lane Arlington Heights IL 60005 364484290 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 431295333 HUD housing MO Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Hospital Network 3040 W Salt Creek Lane Arlington Heights IL 60005 363276552 Supports the provision of healthcare services for related corporations IL Section 501(c)(3) Schedule A, Line 11c Alexian Brothers Health System 1 Alexian Brothers Community Services 425 Cumberland Street Suite 110 Chattanooga TN 37404 364344423 Provides comprehensive & coordinated community based services IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Senior Neighbors 250 East 10th Street Chattanooga TN 37402 620646376 Supports the provision of community services for senior citizens TN Section 501(c)(3) Schedule A, Line 7 Alexian Brothers Health System 1 Alexian Village of Tennessee 437 Alexian Way Signal Mountain TN 37377 621136742 Continuing care retirement community TN Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Elderly Services Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 392039667 Community outreach WI Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Lansdowne Village 4624 Lansdowne St Louis MO 63116 431470362 Skilled nursing facility MO Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Sherbrooke Village 4005 Ripa Avenue St Louis MO 63125 431592502 Skilled nursing facility MO Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Savelli Properties Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363308965 Owns or leases properties where healthcare services are delivered IL Section 501(c)(2) N/A Alexian Brothers Health System 1 Alexian Brothers Center for Mental Health 3436 N Kennicott Avenue Arlington Heights IL 60004 363045007 Outpatient community mental health services IL Section 501(c)(3) Schedule A, Line 9 Alexian Brothers Health System 1 Alexian Brothers Behavioral Health Hospital 1650 Moon Lake Blvd Hoffman Estates IL 60194 364251848 Behavioral health hospital IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 St Alexius Medical Center 1555 Barrington Road Hoffman Estates IL 60194 364251846 Acute care hospital IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers Specialty Group 3040 W Salt Creek Lane Arlington Heights IL 60005 800710751 Specialty physician practice group IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers Ambulatory Group 3040 W Salt Creek Lane Arlington Heights IL 60005 364336931 Physician services IL Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Brothers Medical Center 800 Biesterfield Road Elk Grove Village IL 60007 362596381 Acute care hospital TX Section 501(c)(3) Schedule A, Line 3 Alexian Brothers Health System 1 Alexian Rehabilitation Services LLC 935 Beisner Road Elk Grove Village IL 60007 300221481 Rehabilitation hospital IL N/A Illinois NeuroMeg Center LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 870783164 Provision of NeuroMeg services IL N/A Elk Grove MOB Limited Partnership 3040 W Salt Creek Lane Arlington Heights IL 60005 363853289 Medical office building IL N/A Bonaventure Medical Foundation LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 363978153 Manages managed care contracts DE N/A Neurosciences Equipment LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 861115516 Ownership of Gamma Knife IL N/A St Alexius Center for Sleep Health LLC 1300 S Main Street Lombard IL 60148 205876371 Operation of sleep lab IL N/A Thelen Corporation 3040 W Salt Creek Lane Arlington Heights IL 60005 363266316 Owns/leases property; joint venture partner IL N/A C 0 Alexian Brothers Health Providers Association Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 363853286 Messenger model IPA IL N/A C 0 Alexian Brothers Corpus Christi Housing Project LLC 3040 W Salt Creek Lane Arlington Heights IL 60005 943465394 Tax credit financed housing IL N/A C 0 Alexian Village of Elk Grove 3040 W Salt Creek Lane Arlington Heights IL 60005 352211303 Tax credit financed housing IL N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 Alexian Brothers Health System P 1720049 FMV Alexian Brothers Senior Ministries Q 590693 FMV Alexian Elderly Services Inc S 89534 FMV Alexian Brothers Health System S 1721036 FMV