PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC (EIN 39-0794174)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-07
- IRS object ID
- 201532199349300013
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-07T08:23:29-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 307 | AddressLine1 |
| City | SOUTHFIELD | City |
| State | MI | State |
| ZIP Code | 480370307 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390794174 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONOMOWOC MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | OCON | BusinessNameControlTxt |
| Phone | 2629282496 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RONALD FARR | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 2629282496 | PhoneNum |
| Signature | 2015-07-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID LOWENTHAL | PreparerPersonNm |
| PTIN | P00378651 | PTIN |
| Phone | 2483522500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-04-25 22:37:26Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SUSAN EDWARDS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $100,158,252 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PROHEALTHCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1948 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE GENERAL ACUTE CARE AND SUPPORT ACTIVITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 23 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 21 | VotingMembersIndependentCnt |
| Total Employee | 1042 | TotalEmployeeCnt |
| Total Volunteers | 347 | TotalVolunteersCnt |
| Total Gross UBI | $2,215,057 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$220,166 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $632,715 | PYContributionsGrantsAmt |
| CY Contributions Grants | $485,436 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $100,576,030 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $96,453,682 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,650,572 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,812,528 | CYInvestmentIncomeAmt |
| PY Other Revenue | $413,956 | PYOtherRevenueAmt |
| CY Other Revenue | $383,397 | CYOtherRevenueAmt |
| PY Total Revenue | $104,273,273 | PYTotalRevenueAmt |
| CY Total Revenue | $100,135,043 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,997,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $2,977,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,808,053 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,821,445 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $66,859,381 | PYOtherExpensesAmt |
| CY Other Expenses | $68,007,770 | CYOtherExpensesAmt |
| PY Total Expenses | $99,664,934 | PYTotalExpensesAmt |
| CY Total Expenses | $99,806,715 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,608,339 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $328,328 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $164,461,358 | TotalAssetsBOYAmt |
| Total Assets EOY | $123,420,808 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $107,536,660 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $109,091,321 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $56,924,698 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,329,487 | NetAssetsOrFundBalancesEOYAmt |
| Mission | CONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $96,948,400 | ExpenseAmt |
| Grant | $2,977,500 | GrantAmt |
| Revenue | $94,238,625 | RevenueAmt |
| Desc | OCONOMOWOC MEMORIAL HOSPITAL FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. OCONOMOWOC MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. OCONOMOWOC MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 9,038 DAYS OF INPATIENT CARE AND APPROXIMATELY 68,208 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2014. | Desc |
| Total Program Service Expenses | $96,948,400 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 96 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1042 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 23 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 21 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RONALD FARR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2629284740 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | N17 W24100 RIVERWOOD DRIVE SUITE | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53188 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (35 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| SUSAN EDWARDS | ||||||||
| CEO - PHC | 2.00 | 50.00 | Yes (X) | Yes (X) | $0 | $960,406 | $768,577 | |
| JOHN ROBERTSTAD | ||||||||
| PRESIDENT - PHC HOSPITAL DIVISION | 8.00 | 36.00 | Yes (X) | Yes (X) | $0 | $544,252 | $70,799 | |
| EDWARD J LUMP | ||||||||
| TREASURER | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHARLOTTE HALL | ||||||||
| SECRETARY | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| EILEEN GILLESPIE | ||||||||
| SECRETARY - PART YEAR | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TED GARVEY | ||||||||
| VICE CHAIRPERSON | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| GARY BEYER | ||||||||
| CHAIRPERSON | 2.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HELEN FORSTER | ||||||||
| VICE CHAIR | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JIM GANNON | ||||||||
| TREASURER - PHC BOARD | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TOM PACKEE | ||||||||
| SECRETARY - PHC BOARD | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN RAASCH | ||||||||
| VICE CHAIR - PART YEAR/DIRECTOR | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JANET SWANDBY | ||||||||
| CHAIRPERSON | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAUL BOSTROM | ||||||||
| DIRECTOR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| CLIFF BROOKS | ||||||||
| DIRECTOR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| TIM WESTLAKE | ||||||||
| DIRECTOR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| ARCH PEQUET | ||||||||
| DIRECTOR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG BRUINS | ||||||||
| DIRECTOR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| BETTY ARNDT | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL G BARRY | ||||||||
| DIRECTOR - PART YEAR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD NEILS MD | ||||||||
| DIRECTOR - PART YEAR | 2.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DIXON BENZ | ||||||||
| DIRECTOR - PHC BOARD - PART YEAR | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DOUG HASTAD | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK MOHR | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| RALPH RAMIREZ | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID ROELKE | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| JULIE SCHROEDER | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| ELLEN MURPHY | ||||||||
| DIRECTOR - PHC BOARD | 1.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| NANINE M NELSON | ||||||||
| CFO - PHC - PART YEAR | 2.00 | 50.00 | Yes (X) | $0 | $410,111 | $23,345 | ||
| RONALD FARR | ||||||||
| CFO | 2.00 | 50.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID EBEL | ||||||||
| INTERIM CFO | 2.00 | 50.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK A ZWASKA | ||||||||
| PHARMACIST | 40.00 | 0.00 | $115,577 | $0 | $24,448 | Yes (X) | ||
| GARY SIUTA | ||||||||
| PHARMACIST | 40.00 | 0.00 | $127,314 | $0 | $23,713 | Yes (X) | ||
| JACOB W MORTAG | ||||||||
| PHARMACIST | 40.00 | 0.00 | $115,414 | $0 | $9,754 | Yes (X) | ||
| DARREN J STAWSKI | ||||||||
| PHARMACIST | 40.00 | 0.00 | $114,772 | $0 | $24,964 | Yes (X) | ||
| JANET L CURTIS | ||||||||
| MANAGER | 40.00 | 0.00 | $112,813 | $0 | $12,343 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $585,890 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,914,769 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $957,943 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HAMILTON BENCHMARK | |||||
| 1330 E WATERFORD AVE | ST FRANCIS | WI | 53235 | FIREPROOFING SERVICES | $414,475 |
| ADVANCED ICU CARE INC | |||||
| PO BOX 671773 | DALLAS | TX | 75267 | PROVIDER STAFFING | $361,047 |
| HEALOGICS WOUND CARE & | |||||
| 3087 MOMENTUM PLACE | CHICAGO | IL | 60689 | WOUND PRODUCTS | $348,005 |
| RILEY CONSTRUCTION CO INC | |||||
| 5301-99TH AVE | KENOSHA | WI | 53144 | CONSTRUCTION SERVICES | $329,359 |
| MEDICAL STAFFING NETWORK | |||||
| PO BOX 840292 | DALLAS | TX | 75284 | STAFFING SERVICE | $303,322 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $256,360 | RelatedOrganizationsAmt |
| Government Grants | $4,201 | GovernmentGrantsAmt |
| All Other Contributions | $224,875 | AllOtherContributionsAmt |
| Total Contributions | $485,436 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 622110 | $89,882,198 | $89,882,198 | |
| PHARMACY SALES | 446110 | $2,973,527 | $1,366,732 | $1,606,795 |
| LABORATORY REVENUE | 621500 | $1,844,598 | $1,236,336 | $608,262 |
| MEANINGFUL USE | 900099 | $1,140,420 | $1,140,420 | |
| RENTAL REVENUE - AFFILIATES | 532000 | $238,314 | $238,314 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $374,625 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $374,625 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $96,453,682 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,783,484 | TotalRevenueColumnAmt |
| Exclusion | $2,783,484 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $43,580 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $21,043 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $22,537 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,537 | TotalRevenueColumnAmt |
| Exclusion | $22,537 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $31,210 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,166 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $29,044 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,044 | TotalRevenueColumnAmt |
| Exclusion | $29,044 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA SALES | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $360,280 | TotalRevenueColumnAmt |
| Exclusion | $360,280 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $580 | TotalRevenueColumnAmt |
| Exclusion | $580 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $360,860 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $100,135,043 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $94,238,625 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $2,215,057 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,195,925 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,977,500 | TotalAmt |
| Program Services | $2,977,500 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,940,696 | TotalAmt |
| Program Services | $21,223,079 | ProgramServicesAmt |
| Management And General | $717,617 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,275,661 | TotalAmt |
| Program Services | $1,233,938 | ProgramServicesAmt |
| Management And General | $41,723 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,002,109 | TotalAmt |
| Program Services | $3,871,212 | ProgramServicesAmt |
| Management And General | $130,897 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,602,979 | TotalAmt |
| Program Services | $1,540,681 | ProgramServicesAmt |
| Management And General | $62,298 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,449,351 | TotalAmt |
| Program Services | $27,261,579 | ProgramServicesAmt |
| Management And General | $1,187,772 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,627,969 | TotalAmt |
| Program Services | $17,563,904 | ProgramServicesAmt |
| Management And General | $64,065 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,748,394 | TotalAmt |
| Program Services | $2,748,394 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,754 | TotalAmt |
| Program Services | $43,232 | ProgramServicesAmt |
| Management And General | $522 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,655 | TotalAmt |
| Program Services | $19,232 | ProgramServicesAmt |
| Management And General | $3,423 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,510,446 | TotalAmt |
| Program Services | $5,510,446 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,404,863 | TotalAmt |
| Program Services | $7,311,436 | ProgramServicesAmt |
| Management And General | $93,427 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $341,046 | TotalAmt |
| Management And General | $341,046 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAID PROVIDER TAXES | $2,751,054 | $2,751,054 | |
| BAD DEBT | $2,687,612 | $2,687,612 | |
| DUES, FEES & LICENSES | $215,893 | $25,811 | $190,082 |
| PHYSICIAN SETTLEMENT | $175,956 | $175,956 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,777 | TotalAmt |
| Program Services | $3,334 | ProgramServicesAmt |
| Management And General | $25,443 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,806,715 | TotalAmt |
| Program Services | $96,948,400 | ProgramServicesAmt |
| Management And General | $2,858,315 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,625,031 | BOYAmt |
| EOY | $6,011,748 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,929,839 | BOYAmt |
| EOY | $10,637,272 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,844,114 | BOYAmt |
| EOY | $2,582,007 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $421,146 | BOYAmt |
| EOY | $278,264 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $197,271,278 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $107,757,053 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,656,057 | BOYAmt |
| EOY | $89,514,225 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,631,225 | BOYAmt |
| EOY | $6,277,415 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $437,099 | BOYAmt |
| EOY | $283,502 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,916,847 | BOYAmt |
| EOY | $7,836,375 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,461,358 | BOYAmt |
| EOY | $123,420,808 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,688,536 | BOYAmt |
| EOY | $8,674,989 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $19,377 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,438,066 | BOYAmt |
| EOY | $77,780,206 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,261,026 | BOYAmt |
| EOY | $11,064,033 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,149,032 | BOYAmt |
| EOY | $11,552,716 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,536,660 | BOYAmt |
| EOY | $109,091,321 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,038,400 | BOYAmt |
| EOY | $13,085,150 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $886,298 | BOYAmt |
| EOY | $892,900 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $351,437 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,924,698 | BOYAmt |
| EOY | $14,329,487 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,461,358 | BOYAmt |
| EOY | $123,420,808 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $328,328 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $938,009 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$43,861,548 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $335,082 | ContributionsAmt |
| Investment Earnings Or Losses | $16,365 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $351,447 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $394,293 | BeginningYearBalanceAmt |
| Other Expenditures | $394,293 | OtherExpendituresAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $326,376 | BeginningYearBalanceAmt |
| Contributions | $20,265 | ContributionsAmt |
| Investment Earnings Or Losses | $47,652 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $394,293 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $326,222 | BeginningYearBalanceAmt |
| Contributions | $33,945 | ContributionsAmt |
| Investment Earnings Or Losses | -$33,791 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $326,376 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $306,912 | BeginningYearBalanceAmt |
| Contributions | $5,000 | ContributionsAmt |
| Investment Earnings Or Losses | $14,310 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $326,222 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,030,526 | OtherCostOrOtherBasisAmt |
| Book Value | $2,030,526 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $124,859,405 | OtherCostOrOtherBasisAmt |
| Depreciation | $47,480,057 | DepreciationAmt |
| Book Value | $77,379,348 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,166,159 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,202,261 | DepreciationAmt |
| Book Value | $963,898 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $67,009,779 | OtherCostOrOtherBasisAmt |
| Depreciation | $58,568,592 | DepreciationAmt |
| Book Value | $8,441,187 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,205,409 | OtherCostOrOtherBasisAmt |
| Depreciation | $506,143 | DepreciationAmt |
| Book Value | $699,266 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $89,514,225 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ACCRUED INTEREST RECEIVABLE | $351,437 |
| DEFERRED FINANCING | $322,977 |
| MISCELLANEOUS RECEIVABLES | $935,643 |
| DUE FROM AFFILIATES | $6,226,318 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,836,375 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED MINIMUM PENSION | $8,718,663 |
| INTEREST RATE SWAPS | $2,582,365 |
| ASSET RETIREMENT OBLIGATION | $251,688 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $11,552,716 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | OCONOMOWOC MEMORIAL HOSPITAL USES FUNDS FROM THE ENDOWMENT TO FURTHER ITS CHARITABLE MISSION. |
| PART X, LINE 2: | FIN48 DISCLOSURE: PHC, WMH, OMH, NATIONAL REGENCY, PHCMA, PHCF, AND PHHC ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ALL OF THESE ENTITIES ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. WHS IS A FOR-PROFIT CORPORATION THAT ACCOUNTS FOR INCOME TAXES UNDER THE ASSET AND LIABILITY METHOD OF ACCOUNTING. A CURRENT TAX LIABILITY OR ASSET IS RECOGNIZED FOR THE ESTIMATED TAXES PAYABLE OR REFUNDABLE ON TAX RETURNS FOR THE YEAR. DEFERRED TAX LIABILITIES OR ASSETS ARE RECOGNIZED FOR THE ESTIMATED FUTURE TAX EFFECTS OF TEMPORARY DIFFERENCES BETWEEN FINANCIAL REPORTING AND TAX ACCOUNTING. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CORPORATION AND RECOGNIZE A TAX LIABILITY IF THE CORPORATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE CORPORATION AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS AND IS CURRENTLY BEING AUDITED FOR THE 2012 TAX PERIOD FOR WAUKESHA MEMORIAL HOSPITAL, INC. MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2011. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $678,875 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $678,875 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,621,065 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,549,749 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,071,316 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06250 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,299,940 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,549,749 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,750,191 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06950 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 23 | ActivitiesOrProgramsCnt |
| Persons Served | 8218 | PersonsServedCnt |
| Total Community Benefit Expns | $596,518 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,614 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $585,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 9 | ActivitiesOrProgramsCnt |
| Persons Served | 312 | PersonsServedCnt |
| Total Community Benefit Expns | $248,210 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $248,210 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00260 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $162,649 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $162,649 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 2868 | PersonsServedCnt |
| Total Community Benefit Expns | $208,971 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $208,971 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 41 | ActivitiesOrProgramsCnt |
| Persons Served | 11398 | PersonsServedCnt |
| Total Community Benefit Expns | $1,216,348 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,614 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,205,734 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 41 | ActivitiesOrProgramsCnt |
| Persons Served | 11398 | PersonsServedCnt |
| Total Community Benefit Expns | $10,516,288 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,560,363 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,955,925 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08200 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,520 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $10,977 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,977 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,600 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,600 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $236 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $236 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $16,333 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,333 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,687,612 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $303,991 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $18,300,950 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $35,388,128 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$17,087,178 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 LAKE COUNTRY ENDOSCOPY CENTER LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | DIAGNOSTIC CENTER | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.50000 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.50000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONOMOWOC MEMORIAL HOSPITAL INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONOMOWOC MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | FULL WEBSITE LISTED IN PART V SECTION C | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| OCONOMOWOC MEMORIAL HOSPITAL | PART V, SECTION B, LINE 1J: OMH'S CHNA ALSO INCLUDE INFORMATION ABOUT THEIR ACTIVE PARTICIPATION AND PARNTERSHIP IN THE WAUKESHA COUNTY HEALTH AND HUMAN SERVICES CHIPP (COMMUNITY HEALTH IMPROVEMENT PLAN AND PROCESS) |
| OCONOMOWOC MEMORIAL HOSPITAL | PART V, SECTION B, LINE 4: WAUKESHA MEMORIAL HOSPITAL AND REHABILITATION HOSPITAL OF WISCONSIN LLC |
| OCONOMOWOC MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5D: THE CHNA IS AVAILABLE AT WWW.PROHEALTHCARE.ORG/ABOUT-US-COMMUNITY-BENEFIT.ASPX |
| OCONOMOWOC MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7: ADDITIONAL COMMUNITY NEEDS IDENTIFIED INCLUDED MENTAL HEALTH, AODA AND ACCESS TO CARE. AS THESE ARE THE NEEDS CHOSEN BY THE WAUKESHA COUNTY HHS, WE CHOSE NOT TO DUPLICATE. RATHER, WE ARE ACTIVELY PARTNERING WITH THE COUNTY TO ADDRESS THESE NEEDS IN ADDITION TO OTHER NEEDS WE IDENTIFIED AS A PART OF OUR CHNA. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE COUNTRY ENDOSCOPY CENTER LLC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1185 CORPORATE CENTER DR | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 53066 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | DIAGNOSITC CENTER | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | N/A |
| PART I, LINE 6A: | PROHEALTH CARE, INC. |
| PART I, LINE 7: | THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE AMOUNTS ON LINES 7A-7D. THIS WAS CALCULATED BY USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE HOSPITAL'S FINANCIAL COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS ON LINES 7E-7I |
| PART I, LINE 7G: | N/A |
| PART I, LN 7 COL(F): | $2,687,612 OF BAD DEBT EXPENSES WAS INCLUDED ON FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | OCONOMOWOC/WAUKESHA MEMORIAL HOSPITALS HAVE PARTNERSHIPS WITH VARIOUS ORGANIZATIONS THROUGHOUT THE COMMUNITIES WE SERVE. ONE EXAMPLE IS THE PARTNERSHIPS WE HAVE WITH THE LOCAL CHAMBERS OF COMMERCE WITHIN OUR SERVICE AREA BY PROVIDING LEADERSHIP AND HEALTH RELATED OUTREACH TOWARDS STRENGTHENING COMMUNITY DEVELOPMENT. WE ARE THE MAJOR SPONSOR FOR "LEADERSHIP WAUKESHA", A PROGRAM THAT FOCUSES ON THE DEVELOPMENT OF EMERGING LEADERS IN OUR COUNTY. ADDITIONALLY, WE PROVIDE LAND, RESOURCES AND EXPERTISE FOR LOCAL COMMUNITY GARDENS. WE PROVIDE DELIVERY OF EMERGENCY CARE IN THE COMMUNITY AND OFFER/SUPPORT NUMEROUS SERVICES AIMED AT OUR YOUTH INCLUDING SPONSORSHIP OF SAFE "AFTER PROM" ACTIVITIES. WE SUPPORT AREA HOMELESS SHELTERS AND ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION AND HISPANIC COLLABORATIVE NETWORK. |
| PART III, LINE 4: | BAD DEBT EXPENSE FOOTNOTE: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ARE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON PART III LINE 2 IS THE BAD DEBT EXPENSE REPORTED ON FORM 990 PART IX.THE BAD DEBT COST WAS REVIEWED BY THE HOSPITAL'S REVENUE CYCLE TEAM AND THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE QUALIFIED UNDER OUR CHARITY CARE PROGRAM IS 30% OF TOTAL BAD DEBTS. |
| PART III, LINE 8: | THE SHORTFALL ON LINE 7 SHOULD NOT BE TREATED AS COMMUNITY BENEFIT. COSTING METHODOLOGY IS THE COST TO CHARGE RATIO AS REPORTED ON THE MEDICARE COST REPORT. |
| PART III, LINE 9B: | PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE WILL HAVE A CHARITY DISCOUNT APPLIED TO THEIR BALANCES AT THE TIME OF BILLING. IF THIS RESULTS IN NO BALANCE DUE FORM THE PATIENT, THEN THE PATIENT WILL NOT RECEIVE A STATEMENT. IF A BALANCE REMAINS AFTER THE DISCOUNT PERCENTAGE IS APPLIED, THE PATIENT WILL RECEIVE A STATEMENT FOR THE BALANCE DUE. THE STATEMENT CYCLE IS CONSISTENT FOR ALL PATIENTS. |
| PART VI, LINE 2: | OUR NEEDS ASSESSMENT WAS A VERY STRUCTURED, RIGOROUS PROCESS INVOLVING STATISTICAL ANALYSIS, FORMAL SURVEYS, INTERVIEWS AND COMMITTEE REVIEWS AND ASSESSMENT. WE ALSO ARE MINDFUL OF ONGOING/EMERGING COMMUNITY NEEDS THAT COME TO US IN A LESS FORMAL MATTER. KEY TO THIS ONGOING FEEDBACK IS INFORMATION RECEIVED FROM OUR COMMUNITY OUTREACH NURSES (STATIONED IN MORE THAN 70 LOCATIONS). ADDITIONALLY, WE HAVE A LEADERSHIP COMMUNITY SERVICE REQUIREMENT, WHICH PLACES LEADERS IN NOT-FOR-PROFIT AGENCIES THROUGHOUT OUR SERVICE AREA. LEADERS BRING FORWARD CONCERNS AND OBSERVATIONS WHICH ASSIST US IN FORMULATING PLANS AND RESPONSES. OUR EXPANSIVE COMMUNITY EDUCATION PROGRAMS ALSO PROVIDE FEEDBACK ON EMERGING NEEDS. |
| PART VI, LINE 3: | EVERY PATIENT WITH A SELF PAY BALANCE RECEIVES A STATEMENT WHICH CONVEYS THE AVAILABILITY OF COMMUNITY (CHARITY) CARE AND A CONTACT NUMBER FOR FURTHER INFORMATION. PATIENTS THAT ARE UNINSURED RECEIVE AN UNINSURED DISCOUNT WHICH IS LISTED ON THE FIRST STATEMENT THAT THEY RECEIVE. PATIENTS RECEIVE A TOTAL OF FOUR STATEMENTS. EACH STATEMENT CONTAINS VERBIAGE REFERENCING THE HOSPITAL'S COMMUNITY CARE PROGRAM AND A CONTACT NUMBER FOR FURTHER INFORMATION. IF SOMEONE HAS BEEN FOUND ELIGIBLE FOR SOME LEVEL OF CHARITY CARE, THE ELIGIBILITY PERIOD IS THREE MONTHS SO ANY SUBSEQUENT ACCOUNTS DURING THAT TIMEFRAME WOULD BE DISCOUNTED AT WHATEVER LEVEL OF CHARITY CARE THE PATIENT IS DEEMED ELIGIBLE. PATIENTS MAY REAPPLY FOR COMMUNITY CARE WHEN THEIR ELIGIBILITY PERIOD HAS EXPIRED. SELF PAY PATIENTS MAY ALSO BE INFORMED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM WHILE THEY ARE INPATIENTS. SOCIAL WORK AND/OR THE BUSINESS OFFICE MAY MAKE CONTACT WITH THESE PATIENTS DURING THEIR STAY TO INFORM THEM OF THE COMMUNITY CARE PROGRAM AND ASSIST THEM WITH COMPLETION OF THE APPLICATION.INFORMATION IS AVAILABLE AT REGISTRATION AREAS RELATED TO OUR COMMUNITY CARE PROGRAM. THIS INFORMATION CONTAINS CONTACT INFORMATION FOR THE HOSPITAL'S CENTRAL BUSINESS OFFICE WHERE PATIENTS CAN RECEIVE ASSISTANCE IN OBTAINING AND COMPLETING APPLICATIONS. |
| PART VI, LINE 4: | PROHEALTH CARE SERVES ABOUT 285,000 PEOPLE EACH YEAR IN WAUKESHA COUNTY AND PORTIONS OF SURROUNDING COUNTIES. IN EVERY FEDERAL POPULATION CENSUS, WAUKESHA COUNTY HAS RECORDED AN INCREASE IN POPULATION. SINCE 1960, THE POPULATION OF THE COUNTY HAS MORE THAN DOUBLED. WAUKESHA COUNTY HAS AN AGING POPULATION WITH 14.7% OVER THE AGE OF 65 AND A MEDIAN AGE OF 42.0 YEARS. THE RATE OF RETIREMENT IS LIKELY TO SURPASS THE RATE OF ENTRY INTO THE WORKFORCE BETWEEN 2015 AND 2020. THE RACIAL MAKEUP OF THE WAUKESHA COUNTY COMMUNITY IS AS FOLLOWS: CAUCASIAN (NON-HISPANIC) 94.1%, HISPANIC OR LATINO 4.4%, ASIAN 3.0%, BLACK 1.4%. MEDIAN HOUSEHOLD INCOME IS $75,689, WITH 5.0% OF PEOPLE LIVING BELOW THE POVERTY LEVEL. UNEMPLOYMENT IN WAUKESHA COUNTY STOOD AT 4.2% AS OF SEPTEMBER 2014. THE PRESENCE OF SOME HIGH INCOME COMMUNITIES IN WAUKESHA COUNTY OFTEN GIVES A MISTAKEN IMPRESSION. OFTEN OVERLOOKED IS A GROWING POPULATION OF LOW INCOME, NON-ENGLISH SPEAKING, VULNERABLE AND MARGINALIZED CITIZENS WHO FACE ENORMOUS ODDS IN ACCESSING HEALTH CARE. THE WAUKESHA COUNTY MEDICAID POPULATION HAS NEARLY TRIPLED IN 10 YEARS, FROM ABOUT 9,451 PEOPLE IN 2000 TO MORE THAN 30,000 IN 2011. THE HISPANIC POPULATION HAS SEEN A 42% INCREASE IN THE PAST 8 YEARS. DOWNTOWN WAUKESHA WAS DECLARED A "MEDICALLY UNDERSERVED" AREA AND A "HEALTH-PROFESSIONAL SHORTAGE AREA" BY THE FEDERAL GOVERNMENT IN 2008. AS AN UNDERSERVED AREA, MEDICAL OPTIONS FOR INDIVIDUALS, PARTICULARLY THOSE WITHOUT HEALTH INSURANCE OR WITH PUBLIC INSURANCE, ARE SEVERELY LIMITED BECAUSE PRIVATE SERVICE PROVIDERS OFTEN REFUSE TO CARE FOR THESE INDIVIDUALS. CONSEQUENTLY, PROHEALTH CARE EMBARKED ON A FUND-RAISING INITIATIVE TO SUPPORT THE FORMATION OF AN FEDERALLY QUALIFIED HEALTH CENTER (FQHC) IN DOWNTOWN WAUKESHA. |
| PART VI, LINE 5: | OCONOMOWOC/WAUKESHA MEMORIAL HOSPITAL HAS PARTNERSHIPS WITH VARIOUS NON-PROFIT ORGANIZATIONS AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITY. WE ARE ACTIVELY INVOLVED WITH PROGRAMMING AND ONGOING FINANCIAL SUPPORT OF THE WAUKESHA COMMUNITY HEALTH CENTER, THE NEW AND ONLY FEDERALLY-QUALIFIED HEALTH CENTER SERVING OUR AREA. WE PROVIDE ONGOING FINANCIAL AND IN-KIND SUPPORT TO THE AREA FREE CLINICS. SEVERAL OF OUR STAFF ARE ACTIVITY INVOLVED WITH THE HEALTH DEPARTMENT'S CHIPP AND SERVE ON A VARIETY OF COMMITTEES FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. OUR OUTREACH NURSING PROGRAM SUPPORTS MORE THAN 70 AREA PARTNER AGENCIES. FROM COMMUNITY-WIDE HEALTH FAIRS OFFERING A WIDE VARIETY OF FREE SCREENINGS TO OUR ONGOING PROVISION OF OPERATIONAL SPACE FOR THE WAUKESHA COUNTY COMMUNITY DENTAL CLINIC AND MULTIPLE OTHER NON-PROFITS, WE PROVIDE BROAD SUPPORT TO SAFETY NET ORGANIZATIONS IN OUR AREA. WE ALSO PROVIDE OTHER, DIVERSE SUPPORT IN THE COMMUNITY SUCH AS NUMEROUS SERVICES AIMED AT OUR YOUTH INCLUDING SPONSORSHIP OF SAFE "AFTER PROM" ACTIVITIES. WE SUPPORT AREA HOMELESS SHELTERS AND ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION AND HISPANIC COLLABORATIVE NETWORK. |
| PART VI, LINE 6: | OUR HOSPITAL IS A MEMBER OF THE PROHEALTH CARE HEALTH SYSTEM WHICH SERVES AS OUR PARENT COMPANY. WHILE COMMUNITY BENEFIT RESPONSIBILITIES RESIDE WITH OUR HOSPITAL BOARD, THE PARENT COMPANY PLAYS A KEY ROLE IN COORDINATING COMMUNITY NEEDS ASSESSMENTS, COMMUNITY BENEFIT PROGRAM PLANNING, AND EVALUATION.A DESCRIPTION OF EACH AFFILIATES ROLE IN PROMOTING HEALTH WITHIN THE COMMUNITIES SERVED IS AS FOLLOWS:PROHEALTH CARE, INC. - HELPS TO MANAGE THE HOSPITALS TO ENSURE THEY CAN PROMOTE HEALTH AND WELLNESS WITHIN THE COMMUNITY.NATIONAL REGENCY OF NEW BERLIN, INC. - OWNS AND OPERATES SENIOR LIVING CENTERS AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.PROHEALTH HOME CARE, INC. - PROVIDES HOSPICE AND HOME HEALTH CARE SERVICES AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.PROHEALTH CARE FOUNDATION, INC. - SUPPORTS THE CHARITABLE MISSION OF WAUKESHA MEMORIAL HOSPITAL AND OCONOMOWOC MEMORIAL HOSPITAL SO THAT IT MAY PROVIDE HEALTH SERVICES WITHIN THE COMMUNITY.PROHEALTH CARE MEDICAL ASSOCIATES, INC. - OPERATES 18 CLINIC AND URGENT CARE LOCATIONS THROUGHOUT WAUKESHA COUNTY AND THE SURROUNDING COMMUNITIES. PROHEALTH CARE MEDICAL ASSOCIATES FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PROHEALTH CARE MEDICAL ASSOCIATES PROVIDED 432,729 CLINIC VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2014.WAUKESHA MEMORIAL HOSPITAL, INC. - PROVIDES CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. WAUKESHA MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. WAUKESHA MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 56,307 DAYS OF INPATIENT CARE AND APPROXIMATELY 280,694 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2014. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROHEALTH CARE INC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | N17 W24100 RIVERWOOD DR STE 200 | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 531881131 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 391486873 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $2,977,500 | CashGrantAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
| Purpose Of Grant | TO ASSIST OCONOMOWOC MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUSAN EDWARDS | ||||||||||||||
| CEO - PHC | $0 | $775,024 | $0 | $185,382 | $0 | $0 | $0 | $750,007 | $0 | $18,570 | $0 | $1,728,983 | $0 | $185,382 |
| JOHN ROBERTSTAD | ||||||||||||||
| PRESIDENT - PHC HOSPITAL DIVISION | $0 | $444,913 | $0 | $97,684 | $0 | $1,655 | $0 | $36,671 | $0 | $34,128 | $0 | $615,051 | $0 | $97,684 |
| NANINE M NELSON | ||||||||||||||
| CFO - PHC - PART YEAR | $0 | $327,182 | $0 | $0 | $0 | $82,929 | $0 | $11,214 | $0 | $12,131 | $0 | $433,456 | $0 | $275,124 |
| GARY SIUTA | ||||||||||||||
| PHARMACIST | $127,071 | $0 | $243 | $0 | $0 | $0 | $7,490 | $0 | $16,223 | $0 | $151,027 | $0 | $243 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | SCHEDULE J, PART I THIS ENTITY RELIED ON A RELATED ORGANIZATION THAT USED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR OFFICERS AND DIRECTORS: 1. COMPENSATION COMMITTEE 2. COMPENSATION STUDY 3. APPROVAL OF THE BOARD ANNUALLY APPROVING COMPENSATION AMOUNTS 4. INDEPENDENT COMPENSATION CONSULTANT |
| PART I, LINES 4A-B | LINE 4A: NANINE NELSON RECEIVED SEVERANCE PAYMENTS TOTALING $82,929 DURING THE 2013 CALENDAR YEAR. PAYMENTS ARE MADE IN BIWEEKLY INSTALLMENTS OVER AN 18 MONTH PERIOD PER THE AGREEMENT BETWEEN NANINE NELSON AND PROHEALTH CARE, INC. LINE 4B: NAME: CURRENT FISCAL YEAR PAYOUT -NANINE NELSON $186,460 -SUSAN EDWARDS PROHEALTH CARE INC. (PHC) MAINTAINS A SUPPLEMENTAL RETIREMENT PLAN (SERP) FOR A SELECT GROUP OF EXECUTIVES OF PHC AND ITS AFFILIATED ENTITIES. THE SERP IS AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION PLAN THAT IS INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THE SERP ARE TAXABLE TO THE PARTICIPATING EXECUTIVES WHEN SUCH AMOUNTS ARE VESTED. |
| PART I, LINE 6 | PRO HEALTH CARE HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION AND RELATED ORGANIZATIONS (COLLECTIVELY THE "SYSTEM"). THE PLAN RELATES FINANCIAL REWARD TO THE SYSTEM'S ACHIEVEMENT OF CERTAIN FINANCIAL AND NON-FINANCIAL OBJECTIVES. THE PRIMARY PURPOSE OF THE PLAN IS TO SUPPORT THE SYSTEM'S MISSION TO ACHIEVE CONTINUED GROWTH AND DEMONSTRATE VALUE THROUGH: (1) A SEAMLESS CONTINUUM OF PATIENT CENTERED CARE; (2) NATIONALLY RECOGNIZED OUTCOMES; (3) RESPONSIBLE AND EFFICIENT USE OF HEALTH CARE RESOURCES; AND (4) A FOCUS ON THE HEALTH OF OUR COMMUNITY. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES | ||||||||
| A | 391337855 | 97710BDJ8 | 2008-08-14 | $14,575,000 | CURRENT REFUND BONDS ISSUED ON 4/25/01 AND ON 6/09/04 | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES | ||||||||
| B | 391337855 | 97710BGZ9 | 2009-04-30 | $68,825,452 | ADDITION AND RENOVATIONS TO EXISTING HOSPITAL FACILITY | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES | ||||||||
| C | 391337855 | 97710BB50 | 2011-02-16 | $3,639,214 | CURRENT REFUND BONDS ISSUED ON 11/14/95 AND ON 5/13/99 | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | In Reserve FundInReserveFundAmt | Capital ExpendituresCapitalExpendituresAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $211,802 | $14,091,525 | $112,530 | $85,640 | $13,893,355 | 2007 | Yes (1) | 0 | Yes (1) | Yes (1) | ||
| B | $61,944,963 | $895,907 | 2010 | 0 | 0 | Yes (1) | Yes (1) | $6,275,521 | $61,049,056 | |||
| C | $446,058 | $3,639,214 | $67,832 | $3,571,383 | 2001 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| C | 0 | 0 | Yes (1) | Yes (1) | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCH K, PART I, LINE A | PART I, A (C) CUSIP #: THE CUSIP # OF 97710BDH2 ON FORM 8038 WAS NOT THE NUMBER ON THE BOND OF THE LATEST MATURITY. THE NUMBER FOR THE LATEST MATURITY IS CORRECTLY REPORTED ON SCHEDULE K. PART I, A (E) ISSUE PRICE: THE TOTAL ISSUE PRICE ON FORM 8038 IS $122,535,000. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. |
| SCH K, PART I, LINE B | PART I, B (C) CUSIP #: THE CUSIP # OF 97710BGW6 ON FORM 8038 WAS NOT THE NUMBER ON THE BOND OF THE LATEST MATURITY. THE NUMBER FOR THE LATEST MATURITY IS CORRECTLY REPORTED ON SCHEDULE K. PART I, B (E) ISSUE PRICE: THE TOTAL ISSUE PRICE ON FORM 8038 IS $134,951,867.50. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. |
| SCH K, PART I, LINE C | PART I, C (C) CUSIP #: THE CUSIP # OF 97710BB50 ON FORM 8038 WAS NOT THE NUMBER ON THE BOND OF THE LATEST MATURITY. THE NUMBER FOR THE LATEST MATURITY IS CORRECTLY REPORTED ON SCHEDULE K. PART I, C (E) ISSUE PRICE: THE TOTAL ISSUE PRICE ON FORM 8038 IS $35,678,572.65. THE AMOUNT REPORTED ON SCHEDULE K IS ONLY THE AMOUNT OF THE ISSUE BENEFITING THE REPORTING ORGANIZATION. |
| SCH K, PART II, COLUMN A | PART II, COL A, LINE 3 - TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $14,091,525 ALLOCABLE TO REPORTING ORGANIZATION PLUS ZERO INVESTMENT PROCEEDS. PART II, COL A, LINE 6 - PROCEEDS IN REFUNDING ESCROWS: PROCEEDS IN THE AMOUNT OF $13,893,355 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 8/14/08; BALANCE ON 9/30/14 IS ZERO. PART II, COL A, LINE 7 - ISSUANCE COSTS FROM PROCEEDS: $112,530 OF PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION USED FOR ISSUANCE COSTS; $85,640 USED FOR CREDIT ENHANCEMENT. PART II, COL A, LINE 13 - YEAR OF SUBSTANTIAL COMPLETION: YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 4/25/01 WAS 2001 AND YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 6/09/04 WAS 2007. |
| SCH K, PART II, COLUMN B | PART II, COL B, LINE 3 - TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $68,825,452 ALLOCABLE TO REPORTING ORGANIZATION PLUS $2,056 OF INVESTMENT PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION LESS SALE PROCEEDS IN THE AMOUNT OF $6,882,545 DEPOSITED IN REASONABLY REQUIRED RESERVE FUND ALLOCABLE TO REPORTING ORGANIZATION. |
| SCH K, PART II, COLUMN C | PART II, COL C, LINE 3 - TOTAL PROCEEDS OF ISSUE: SALE PROCEEDS OF ISSUE IN AMOUNT OF $3,639,214.41 ALLOCABLE TO REPORTING ORGANIZATION PLUS ZERO INVESTMENT PROCEEDS. PART II, COL C, LINE 6 - PROCEEDS IN REFUNDING ESCROWS: PROCEEDS IN THE AMOUNT OF $3,571,383 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 2/16/11; BALANCE ON 9/30/14 IS ZERO. PART II, COL C, LINE 13 - YEAR OF SUBSTANTIAL COMPLETION: YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 11/14/95 WAS 1995 AND YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 5/13/99 WAS 2001. |
| SCH K | IN 2012, PHC REFUNDED A PORTION OF THE 2009 BOND ISSUE, THE OMH PORTION IS INCLUDED IN THE BONDS RETIRED. ASSOCIATED WITH THE REFUNDING THE 2009 DEBT SERVICE RESERVE FUND WAS REDUCED BY $1,190,243.80 OF WHICH $607,024.34 IS OMH'S ALLOCATED REDUCTION. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| LAKE COUNTRY ENDOSCOPY CENTER | |||
| BOARD MEMBER JOHN ROBERTSTAD IS AN OFFICER OF LAKE COUNTRY ENDOSCOPY CENTER | $802,602 | INVESTMENT DISTRIBUTIONS AND RENTAL EXPENSES | 0 |
| WAUKESHA HEALTH SYSTEM INC | |||
| BOARD MEMBER, JOHN ROBERTSTAD, IS AN OFFICER OF WAUKESHA HEALTH SYSTEM | $213,274 | WAUKESHA HEALTH SYSTEM PROVIDES REIMBURSEMENT OF EXPENSES TO OMH. | 0 |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail (2 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| PROHEALTH CARE INC | |||||||||
| INVESTMENT SECURITIES | 2014-08-31 | $14,397,372 | CURRENT QUOTED PRICES OF SECURITIES | 391786873 | N17 W24100 RIVERWOOD DR STE 2 | WAUKESHA | WI | 53188 | 501 (C) (3) |
| PROHEALTH CARE INC | |||||||||
| INVESTMENT SECURITIES | 2014-09-30 | $27,437,999 | CURRENT QUOTED PRICES OF SECURITIES | 391786873 | N17 W24100 RIVERWOOD DR STE 2 | WAUKESHA | WI | 53188 | 501 (C) (3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | Yes (1) | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART II, LINE 2E: | PERSON(S) INVOLVED: SUSAN EDWARDS, JIM GANNON, TOM PACKEE, JOHN RAASCH, JANET SWANDBY, BETTY ARNDT, DIXON BENZ, HELEN FORSTER, ELLEN MURPHY, DOUG HASTAD, MARK MOHR, RALPH RAMIREZ, DAVID ROELKE, AND JULIE SCHROEDER. |
| PART II, LINE 2E: | EXPLANATION OF INVOLVEMENT: THE ABOVE INDIVIDUALS ARE DIRECTORS ON BOTH BOARDS OF OCONOMOWOC MEMORIAL HOSPITAL AND PROHEALTH CARE, INC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | DAVID EBEL WAS COMPENSATED BY WARBIRD CONSULTING, A MANAGEMENT COMPANY, FOR SERVICES AS INTERIM CFO FOR OCONOMOWOC MEMORIAL HOSPITAL, INC. AND RELATED ORGANIZATIONS. COMPENSATION WAS PAID TO WARBIRD CONSULTING BY PROHEALTH CARE, INC., THE PARENT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | PROHEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | PROHEALTH CARE INC. HOLDS CERTAIN RESERVED POWERS OVER THE (NON-STOCK) CORPORATION INCLUDING APPROVAL OF STRATEGIC PLANNING, ANNUAL OPERATING AND CAPITAL BUDGETS, BORROWING, TRANSFER, LEASE, PLEDGE OR SALE OF ASSETS. |
| FORM 990, PART VI, SECTION B, LINE 11 | AFTER THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S TAX PREPARERS AND PRIOR TO FILING THE FORM 990, SELECT EXECUTIVE MEMBERS OF THE ORGANIZATION AND THE AUDIT & COMPLIANCE COMMITTEE PERFORMED A REVIEW. THEN THE ORGANIZATION'S TAX PREPARERS MADE A PRESENTATION TO THE AUDIT COMMITTEE, AND THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THE RETURN, WHICH WAS SUBSEQUENTLY FILED BY THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS, VICE-PRESIDENTS, MANAGERS AND ABOVE, AS WELL AS BOARD MEMBERS ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE TRACKED IN THE CORPORATE COMPLIANCE DEPARTMENT. THEY ARE REVIEWED AND ANY PERSON IDENTIFIED AS HAVING A POTENTIAL CONFLICT IS GIVEN DIRECTION AS TO WHAT STEPS SHOULD BE TAKEN TO MITIGATE THE CONCERN. ALL EMPLOYEES ARE EDUCATED ANNUALLY. THE STEPS TAKEN WHEN A CONFLICT ARISES ARE AS FOLLOWS: FOR THE BOARD OF DIRECTORS, THE RESTRICTION IS NOT BEING ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTING RELATED TO ANY DECISION WHERE THE BOARD MEMBER HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST. FOR LEADERS, RESEARCHERS, AND EMPLOYEES, RECOMMENDATIONS ARE MADE FROM COMPLIANCE MANAGER TO LEADERSHIP AND/OR HUMAN RESOURCES. RESTRICTIONS CAN RANGE FROM ANY OF THE FOLLOWING: DISCLOSING POTENTIAL CONFLICTS OF INTEREST TO PATIENTS; NOT BEING ABLE TO BE INVOLVED IN DISCUSSION OR DECISION MAKING ON SPECIFIC TOPICS; AND NOT BEING ABLE TO WORK AT PROHEALTH IN THE SPECIFIC ROLE WHERE THE REPORTED CONFLICT EXISTS. IF THE RECOMMENDATION IS CHALLENGED, THE MATTER GOES TO THE SENIOR EXECUTIVE TEAM FOR A DECISION. |
| FORM 990, PART VI, SECTION B, LINE 15 | AN INDEPENDENT, EXTERNAL COMPENSATION REVIEW IS CONDUCTED FOR THE POSITIONS OF CEO/PRESIDENT, EXECUTIVE DIRECTOR, VICE-PRESIDENT, SENIOR VICE-PRESIDENT AND ABOVE. THE RESULTS OF THE COMPENSATION REVIEW ARE PRESENTED TO THE BOARD'S EXECUTIVE COMMITTEE FOR APPROVAL. ANY MEMBER OF THE EXECUTIVE COMMITTEE WHOSE SALARY IS INCLUDED IN THE SALARY REVIEW IS RECUSED FROM THE APPROVAL PROCESS FOR HIS/HER SALARY APPROVAL. THIS PROCESS WAS LAST DONE IN 2014. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 16B: | THE PROCESS IS TO HAVE ALL JOINT VENTURE ARRANGEMENTS REVIEWED BY THE LEGAL DEPARTMENT TO ENSURE IT MEETS ALL LEGAL REQUIREMENTS AND TO ENSURE THAT OCONOMOWOC MEMORIAL HOSPITAL, INC. MAY RETAIN ITS EXEMPT STATUS. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 593,670. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 593,670. PHCMA SUBSIDIES: PROGRAM SERVICE EXPENSES 1,525,999. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,525,999. AGENCY STAFFING: PROGRAM SERVICE EXPENSES 177,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,333. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 2,810,840. MANAGEMENT AND GENERAL EXPENSES 118,416. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,929,256. PHC SERVICES: PROGRAM SERVICE EXPENSES 17,731,546. MANAGEMENT AND GENERAL EXPENSES 1,069,356. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,800,902. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 3,863,797. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,863,797. LINEN SERIVES: PROGRAM SERVICE EXPENSES 250,129. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250,129. SEND OUT LAB WORK: PROGRAM SERVICE EXPENSES 308,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 308,265. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF NET ASSETS TO RELATED ORGANIZATION -41,835,371. TRANSFER OF NET ASSETS FROM RELATED ORGANIZATION 351,437. PENSION RELATED CHANGES -2,377,614. |
| FORM 990, PART XII, LINE 2C: | THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WAUKESHA MEMORIAL HOSPITAL INC | |||||||||||
| 725 AMERICAN AVENUE | WAUKESHA | WI | 53188 | 390910727 | HOSPITAL | WI | 501(C)(3) | LINE 3 | PROHEALTH CARE INC | Yes (1) | |
| PROHEALTH CARE FOUNDATION INC | |||||||||||
| 725 AMERICAN AVENUE | WAUKESHA | WI | 53188 | 391314542 | CHARITABLE SUPPORT | WI | 501(C)(3) | LINE 7 | PROHEALTH CARE INC | Yes (1) | |
| PROHEALTH HOME CARE INC | |||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 200067392 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | PROHEALTH CARE INC | Yes (1) | |
| NATIONAL REGENCY OF NEW BERLIN INC | |||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 531881131 | 391077992 | HEALTHCARE | WI | 501(C)(3) | LINE 9 | PROHEALTH CARE INC | Yes (1) | |
| PROHEALTH CARE INC | |||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 531881131 | 391786873 | MANAGEMENT | WI | 501(C)(3) | LINE 11C, III-FI | 0 | N/A | |
| PROHEALTH CARE MEDICAL ASSOCIATES INC | |||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391083015 | HEALTHCARE | WI | 501(C)(3) | LINE 3 | PROHEALTH CARE INC | Yes (1) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PROHEALTH ALIGNED LLC (DBA MSC) | ||||||||||||||
| 1111 DELAFIELD STREET STE 1 | WAUKESHA | WI | 53188 | 263324572 | SURGERY CENTER | WI | N/A | |||||||
| REHABILITATION HOSPITAL OF WISCONSIN LLC | ||||||||||||||
| 1625 COLDWATER CREEK DRIVE | WAUKESHA | WI | 53188 | 262332250 | INPATIENT REHABILITATION | WI | N/A | |||||||
| THE ORTHOPEDIC SURGERY CENTER LLC | ||||||||||||||
| W238 N1610 BUSSE ROAD | WAUKESHA | WI | 53188 | 208356016 | ORTHOPEDIC SURGICAL SERVICES | WI | N/A | |||||||
| PROHEALTH SOLUTIONS LLC | ||||||||||||||
| 2000 PEWAUKEE RD SUITE C | WAUKESHA | WI | 53188 | 273863494 | ACCOUNTABLE CARE ORGANIZATION | WI | N/A | |||||||
| LAKE COUNTRY ENDOSCOPY CENTER | ||||||||||||||
| 1185 CORPORATE CENTER DR | OCONOMOWOC | WI | 53066 | 261572986 | ENDOSCOPY SERVICES | WI | OCONOMOWOC MEMORIAL HOSPITAL INC | RELATED | $373,740 | $449,083 | 0 | 0 | 0.50000 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| WAUKESHA HEALTH SYSTEM INC | |||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391507910 | HEALTHCARE | WI | N/A | C | 0 |
| EMPATHIA PACIFIC INC | |||||||||
| 31416 AGOURA RD STE 180 | WESTLAKE VILLAGE | CA | 91361 | 953070501 | HEALTHCARE | CA | N/A | C | 0 |
| NATIONAL AVENUE DEVELOPMENT CORPORATION | |||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391417226 | HEALTHCARE | WI | N/A | C | 0 |
| EMPATHIA INC | |||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391567366 | HEALTHCARE | WI | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (14 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PROHEALTH CARE FOUNDATION INC | ||
| C | $256,360 | ACTUAL AMOUNT RECEIVED |
| PROHEALTH CARE MEDICAL ASSOCIATES INC | ||
| A | $168,978 | ACTUAL AMOUNT RECEIVED |
| LAKE COUNTRY ENDOSCOPY CENTER | ||
| J | $302,602 | ACTUAL AMOUNT RECEIVED |
| PROHEALTH CARE INC | ||
| M | $18,800,902 | ACTUAL AMOUNT RECEIVED |
| WAUKESHA MEMORIAL HOSPITAL INC | ||
| P | $12,622,152 | ACTUAL COSTS INCURRED |
| WAUKESHA HEALTH SYSTEM INC | ||
| P | $65,580 | ACTUAL COSTS INCURRED |
| PROHEALTH CARE MEDICAL ASSOCIATES INC | ||
| P | $3,910,109 | ACTUAL COSTS INCURRED |
| WAUKESHA MEMORIAL HOSPITAL INC | ||
| Q | $645,644 | ACTUAL AMOUNT RECEIVED |
| PROHEALTH CARE INC | ||
| Q | $5,892,848 | ACTUAL AMOUNT RECEIVED |
| WAUKESHA HEALTH SYSTEM INC | ||
| Q | $147,694 | ACTUAL AMOUNT RECEIVED |
| PROHEALTH HOME CARE INC | ||
| Q | $246,385 | ACTUAL AMOUNT RECEIVED |
| LAKE COUNTRY ENDOSCOPY CENTER | ||
| S | $500,000 | ACTUAL AMOUNT RECEIVED |
| PROHEALTH CARE INC | ||
| B | $2,977,500 | ACTUAL COSTS INCURRED |
| PROHEALTH CARE INC | ||
| R | $41,835,371 | ACTUAL COSTS INCURRED |