2014-05-09T15:05:51-05:00 2013-06-30 861065772 Deloitte Tax LLP 111 S Wacker Drive Chicago IL 606064301 990 2012-07-01 391351584 Alexian Village of Milwaukee Inc ALEX 4143559300 9301 N 76th Street Milwaukee WI 532231074 Gary Mohn 4143559300 2014-05-09 1 Laura Gillespie P00855604 3124861000 2012 2015-11-30 17:44:51Z Gary Mohn 9301 N 76th Street Milwaukee WI 532231074 24494572 0 0928 X alexianbrothers.net X 1980 WI Continuing Care Retirement Community and Skilled Nursing Facility. 5 2 0 146 0 0 45868 111433 11812499 23416287 125909 966852 0 0 11984276 24494572 0 0 0 0 5687543 10074177 0 0 7718 5177466 11962818 10865009 22036995 1119267 2457577 42926795 44071094 18092583 16706496 24834212 27364598 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 8160903 9364354 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 93. In 2013, 12,865 days of care were provided to Medicaid recipients. 7,370 days were provided to Medicare recipients. For Medicaid residents we were reimbursed approximately $314,851 less than our costs. 3281393 4111924 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 2013 approximately $82,118 of charity care was provided. In addition, we were reimbursed approximately $1,029,733 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 8234760 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. 775504 1705249 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. 775504 1705249 18119235 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X John Brannan 4143559300 9301 N 76th Street Milwaukee WI 532231074 X Gary Mohn 40.00 0.00 X X 0 314279 67647 Edward M Brady CPA CVA 1.00 0.00 X X 0 0 0 Mark Larson 1.00 0.00 X 0 0 0 Brother Daniel McCormick CFA 1.00 0.00 X 0 0 0 John Turongian 0.00 40.00 X 0 339442 50851 Mark Frey 0.00 40.00 X 0 1434790 179527 James Sances 0.00 40.00 X 0 1697343 148158 Ken Marx 0.00 40.00 X 0 39053 3243 Donna Gauthier 0.00 40.00 X 0 71007 15381 Jim Lewandowski 0.00 40.00 X 0 468370 805832 Tom McCormick 40.00 0.00 X 0 125203 27188 Renee Bielinski 40.00 0.00 X 118064 0 12421 Debbie Curran 40.00 0.00 X 113390 0 16083 Linda Paulson 40.00 0.00 X 136161 0 19046 367615 4489487 1345377 3 0 1 0 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 Therapy Services 1115691 United Health Care 22561 Network Place Chicago IL 606731225 Health Insurance 692557 PMSI Construction W186 N7141 Macy Road Menomonee Falls WI 53051 Construction 289453 Northern Exposure Landscaping 9850 N Wasauke Road Mequon WI 53097 Landscaping 220889 Ideal Plumbing Heating 5070 N 35th Street Milwaukee WI 53209 Plumbing 191263 7 111433 111433 Health Care Center-SNF 623000 9364354 9364354 Life Care-Independent 623990 8234760 8234760 CBRF/Assisted Living 623000 4111924 4111924 Adult Day Care 623990 875083 875083 Other Resident Service 623000 763292 763292 66874 66874 23416287 966852 966852 24494572 23416287 0 966852 8179643 7262669 910974 6000 242312 81858 160274 180 983068 872866 110202 669154 548924 119846 384 8750 8750 15637 15637 504226 439309 64917 5694 5694 769002 587869 181006 127 8689 8683 6 1298011 1280084 17914 13 33669 24779 8890 30026 11710 18316 319529 319529 1325330 1325330 58026 58026 Purch. Serv-Touchpoint 3456863 2090590 1366273 Management Fees 1862681 1366273 495452 956 Purchased Serv-Medical 1109239 1109239 Medical Supplies 550929 550929 606517 247277 359188 52 22036995 18119235 3910042 7718 409012 138069 1132154 1855475 149050 153540 222253 166789 28682425 1912440 25224376 26769985 12904221 12826951 2885729 2160285 42926795 44071094 1905786 2199924 16186797 14506572 18092583 16706496 X 24732015 27189592 69482 142291 32715 32715 24834212 27364598 42926795 44071094 X 2457577 72809 X X 0 1 X 1 0 X 88131 103267 149588 45868 111433 498287 21827648 22465859 22728492 11812499 23416287 102250785 21915779 22569126 22878080 11858367 23527720 102749072 0 0 0 102749072 227714 225264 329052 125909 966852 1874791 227714 225264 329052 125909 966852 1874791 218450 182840 149787 551077 22361943 22977230 23356919 11984276 24494572 105174940 0.97690 0.98960 0.01780 0.00280 X Schedule A, Part IV, Supplemental Information: 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 56921 810 57731 52124 4929 132 56921 52612 -488 0 52124 47669 5443 500 52612 38075 10096 502 47669 1.00000 0 0 1290000 1290000 21655061 1316243 20338818 5737364 596197 5141167 26769985 Beneficial Interest in Alexian Brothers Health System, Inc. Investment Trust 12660562 F Unemployment Insurance Bond 166389 F 12826951 Deferred Accommodation Fees 14429562 Reserve for Insurance Losses 25133 Security Deposits 51877 14506572 Description of Intended Use of Endowment Funds: Part V, Line 4: Permanently restricted for employee scholarships. Part X, Line 2: Alexian Village of Milwaukee, Inc. does not file a separate audit report, but is part of the Alexian Brothers Health System consolidated audit report. There is no ASC 740 (fka FIN 48) footnote for the current year. 1 1 0 0 0 0 0 0 0 Gary Mohn 0 240396 0 60045 0 13838 0 29691 0 37956 0 381926 0 13838 John Turongian 0 273039 0 55523 0 10880 0 22993 0 27858 0 390293 0 10880 Mark Frey 0 1110138 0 263024 0 61628 0 137956 0 41571 0 1614317 0 44628 James Sances 0 358665 0 213760 0 1124918 0 126943 0 21215 0 1845501 0 33210 Jim Lewandowski 0 328372 0 88552 0 51446 0 779279 0 26553 0 1274202 0 33988 Tom McCormick 0 123203 0 0 0 2000 0 14771 0 12417 0 152391 0 0 Linda Paulson 133859 0 0 0 2302 0 2886 0 16160 0 155207 0 0 0 Part I, Line 3 Alexian Brothers Health System, a related organization of Alexian Village of Milwaukee, Inc., uses all of the items in Schedule J, Part I, Line 3 to establish the compensation of the organization's CEO/Executive Director. Supplemental Information Part III Part I, Line 4a: The following individuals listed in Schedule J were paid the referenced amount of change in control in calendar 2012. 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: James Sances - $1,091,708 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. The amount paid in calendar 2012 was included in income in Schedule J for the following individual: Jim Lewandowski - $19,123 Form 990, Part VI, Section A, line 2 Gary Mohn, John Turongian, Mark Frey, James Sances, Donna Gauthier, Ken Marx and Jim Lewandowski 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 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 meeting 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 conflict 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, 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, a related organization, reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at 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 employees 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 who 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 A: Officers and certain key employees for Alexian Village of Milwaukee, Inc. provide services to Alexian Brothers Health System (the National Member) and its subsidiaries. Hours worked are not tracked on an entity by entity basis, and a 40 hour work week is used as a proxy for all individuals listed on Part VII if employed by the filing organization or a related organization (even though more hours may be worked on average). Therefore, all officers, directors, trustees, and key employee hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employee, Highest Compensated Employees represent aggregate hours worked per week for all entities. Form 990, Part VII, Section A: Compensation amount for John Turongian represents payment for services rendered to Alexian Brothers Senior Ministries, a related entity and compensation amount for Mark Frey represents payment for services rendered to Alexian Brothers Health System, a related entity. The amounts are not for services as a board member of Alexian Village of Milwaukee, Inc. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers for Operating purposes 72,809. 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 audits the financial statements. Part VIII, Line 3; Part X, Line 12: The amount reflected as dividends and interest reflects Alexian Village of Milwaukee, Inc.'s share of interest, dividends and realized gains/losses from Alexian Village of Milwaukee, Inc.'s beneficial share in the Alexian Brothers Health System, Inc. Investment Trust (ABHSIT). ABHSIT is a related entity whose purpose is to pool the investments of the not-for-profit entities in ABHS and acts as an internal mutual fund. Details of gains and losses are shown on the Form 990 of ABHSIT. 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 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 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 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 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 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 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 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 Alexian Brothers of St Louis Inc 3040 W Salt Creek Lane Arlington Heights IL 60005 430653236 Acute care hospital (sponsorship transferred in 1997) MO Section 501(c)(3) Schedule A, Line 11c 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 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 7 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 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 Workplace Solutions LLC 1100 E Woodfield Road Schaumburg IL 60173 364095007 Provision of EAP services 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 0 1 0 Alexian Brothers Health System P 1263379 FMV Alexian Brothers Senior Ministries P 496408 FMV Alexian Brothers Health System R 1390464 FMV