2013-08-13T16:25:41-05:00 2012-09-30 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2011-10-01 391487306 SAN CAMILLO INC SANC 4142598320 10200 W BLUEMOUND ROAD WAUWATOSA WI 53226 KEVIN SCHWAB 4142581814 2013-08-13 1 JAY ADKISSON CPA P01360892 4144319300 2013-08-09 2011 2016-02-24 21:20:13Z KEVIN SCHWAB 10200 W BLUEMOUND ROAD WAUWATOSA WI 53226 13187916 0 0928 X WWW.STCAM.COM X 1923 WI BY PROVIDING SERVICES TO THE POOR, THE SICK AND THE ELDERLY WITH A SENSE OF COMPASSION AND LOVE, ST. CAMILLUS OFFERS HOPE AND MEANING TO THOSE WHO ARE SUFFERING, COMFORT AND SECURITY TO THOSE WHO ARE AGING, AND SERENITY TO THOSE WHO ARE DYING, TAKING INTO ACCOUNT EACH PERSON'S INNATE DIGNITY, UNIQUE NEEDS, AND GOD-GIVEN RIGHTS. 13 13 0 20 0 0 1375 4117 12417849 13158624 3027 3345 26558 21830 12448809 13187916 0 0 0 0 3404471 3322028 0 0 0 7332362 7385119 10736833 10707147 1711976 2480769 49672065 52381305 37468274 37741562 12203791 14639743 X BY PROVIDING SERVICES TO THE POOR, THE SICK AND THE ELDERLY WITH A SENSE OF COMPASSION AND LOVE, ST. CAMILLUS OFFERS HOPE AND MEANING TO THOSE WHO ARE SUFFERING, COMFORT AND SECURITY TO THOSE WHO ARE AGING, AND SERENITY TO THOSE WHO ARE DYING, TAKING INTO ACCOUNT EACH PERSON'S INNATE DIGNITY, UNIQUE NEEDS, AND GOD-GIVEN RIGHTS. 0 0 6233951 8074131 OPERATES A 277 UNIT INDEPENDENT LIVING FACILITY FOR SENIOR RESIDENTS 3925682 5084493 OPERATES A 122 UNIT ASSISTED LIVING FACILITY PROVIDING HEALTHCARE AND OTHER SERVICES TO THE FRAIL ELDERLY 10159633 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X X SAN CAMILLO INC 4142581814 10200 W BLUEMOUND ROAD WAUWATOSA WI 53226 HARRY WHELPLEY 20.00 X X 0 0 0 FR RICHARD O'DONNELL MI 20.00 X X 0 0 0 FR EUGENE DUTKIEWICZ SJ 20.00 X X 0 0 0 FR LOUIS LUSSIER MI 2.00 X 0 0 0 PAULA HOGAN 2.00 X 0 0 0 FR PEDRO TRAMONTIN MI 2.00 X 0 0 0 BR MARIO CRIVELLO MI 2.00 X 0 0 0 ATTY FREDERICK A MUTH JR 2.00 X 0 0 0 MARK SLESAR 2.00 X 0 0 0 NICK LAUBUSCH 2.00 X 0 0 0 ROSEMARIE MATHEUS 2.00 X 0 0 0 JIM WESSON 2.00 X 0 0 0 DAN MATTES 2.00 X 0 0 0 RICK L JOHNSON 40.00 X 0 233911 10562 KEVIN SCHWAB 40.00 X 0 152241 7119 MARIE D'AMICO 40.00 X 0 119083 3100 0 505235 20781 0 0 1 0 MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 363327 1 4117 4117 MONTHLY SERVICE FEES 900099 10962942 10962942 AMORTIZATION REVENUE 900099 1208722 1208722 SUPPORTING SERVICES 900099 816911 816911 RESIDENT SERVICES 900099 170049 170049 13158624 3345 3345 21830 0 21830 21830 21830 13187916 13158624 0 25175 2794015 2654314 139701 344568 327340 17228 183445 174273 9172 2398673 2278739 119934 15788 2842 12946 547801 520411 27390 5655 5372 283 594818 565077 29741 1223896 1162701 61195 899 854 45 280577 266548 14029 1103829 1048638 55191 88791 84351 4440 RAW FOOD / GROCERIES 901840 856748 45092 MAINTENANCE 130825 124284 6541 BAD DEBT 13813 13122 691 77914 74019 3895 10707147 10159633 547514 0 1150 850 56180 62462 46208 36501 105678 33396 42171097 27206827 13108196 14964270 2730109 2553795 33624544 34730031 49672065 52381305 371094 359046 775787 864651 5580000 5055000 30741393 31462865 37468274 37741562 X 12203791 14639743 12203791 14639743 49672065 52381305 X 2480769 -44817 X 0 1 1 X 0 X 3767 2200 2591 1375 4117 14050 10837539 12072305 12349255 12417849 13243427 60920375 10841306 12074505 12351846 12419224 13247544 60934425 0 0 0 60934425 82319 84577 32071 29311 25175 253453 82319 84577 32071 29311 25175 253453 10923625 12159082 12383917 12448535 13272719 61187878 0.99590 0.99380 0.00410 0.00620 X 1037314 1037314 27486604 18302385 9184219 854317 780738 73579 10129285 7786991 2342294 2663577 336713 2326864 14964270 DUE FROM RELATED PARTY 34730031 34730031 REFUNDABLE ENTRANCE FEES 22268775 RESIDENT FUNDS HELD FOR SAFE KEEPING 1374 DUE TO RELATED PARTY 9192716 31462865 13187916 10707147 2480769 -44817 -44817 2435952 13138982 -44817 -44817 13183799 4117 4117 13187916 10707147 0 10707147 0 10707147 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE SYSTEM AND ITS CONSOLIDATED AFFILIATES DETERMINE WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE SYSTEM AND ITS CONSOLIDATED AFFILIATES RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2012 OR 2011. FEDERAL TAX RETURNS FOR TAX YEARS 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE ORGANIZATION HAS CERTAIN ACTIVITIES WHICH ARE CONSIDERED UNRELATED TO THEIR EXEMPT PURPOSE AND, ACCORDINGLY, ARE TAXABLE IN ACCORDANCE WITH THE CODE. THESE ACTIVITIES ARE NOT SIGNIFICANT AND NO PROVISION FOR TAXES HAS BEEN RECORDED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -44,817. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST SWAP AGREEMENTS -44,817. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FROM RELATED ORGANIZATIONS 4,117. X X X X X 0 0 0 0 0 0 0 0 0 RICK L JOHNSON 0 208783 0 25128 0 0 0 10562 0 0 0 244473 0 0 KEVIN SCHWAB 0 140241 0 12000 0 0 0 7119 0 0 0 159360 0 0 WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 2012-02-29 5580000 REFINANCE 1995 BONDS 0 0 0 525000 5580000 33883 5546117 2012 1 0 0 0 0 0 0 0 0.00000 0.00000 0.00000 1 1 1 1 US BANK 0 0 0 0 0 X FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS A SINGLE CLASS OF MEMBERS AND THE SOLE MEMBER OF THAT CLASS IS ST. CAMILLUS HEALTH SYSTEM, INC., A WISCONSIN NONSTOCK CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER ST. CAMILLUS HEALTH SYSTEM, INC., ELECTS THE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS SHALL NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF THE MEMBER: TO DEFINE THE PHILOSOPHY, MISSION AND PURPOSE OF THE CORPORATION AND TO ADOPT, AMEND OR REPEAL ANY STATEMENTS OF MISSION OR PHILOSOPHY FOR THE CORPORATION; TO ADOPT, APPROVE, RESTATE, REVISE, OR AMEND THESE AMENDED AND RESTATED ARTICLES OF INCORPORATION AND THE BY-LAWS OF THE CORPORATION; TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE THE DIRECTORS OF THE CORPORATION AND DETERMINE THE NUMBER (WHICH MAY NOT BE LESS THAN THREE) OF SUCH DIRECTORS; TO AUTHORIZE OR MAKE OTHER DECISIONS RELATING TO THE TRANSFER OR SALE OF OR CREATION OF AN ENCUMBRANCE (E.G. MORTGAGE, PLEDGE OR GRANT OF SECURITY INTEREST) UPON FIXED ASSETS OF THE CORPORATION WITH A VALUE IN EXCESS OF $500,000; TO AUTHORIZE THE INCURRENCE BY THE CORPORATION OF DEBT FOR MONEY BORROWED IN AMOUNTS IN EXCESS OF $500,000; TO ADOPT AMEND OR REPEAL ANY PLAN OF DISSOLUTION, CONSOLIDATION OR MERGER OF THE CORPORATION, ANY CONTRACT OR AGREEMENT FOR THE MANAGEMENT OF THE CORPORATION OR ANY SALE OR LEASE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; TO CREATE, ACQUIRE, SELL, PURCHASE, DISSOLVE OR MAKE OTHER DISPOSITION OF ANY ENTITY OWNED OR CONTROLLED OR TO BE OWNED OR CONTROLLED BY THE CORPORATION OR ANY OWNERSHIP INTEREST IN ANY SUCH ENTITY; TO APPROVE ANY ACTIONS OR EXERCISE ANY POWER RESERVED TO THE CORPORATION AS A MEMBER OR SHAREHOLDER OF ANOTHER ENTITY; TO APPROVE THE INITIAL ELECTION BY THE BOARD OF DIRECTORS OF THE CHIEF EXECUTIVE OFFICER AND THE CHIEF OPERATING OFFICER OF THE CORPORATION (BUT NOT SUBSEQUENT RE-ELECTIONS OF THOSE PERSONS TO SERVE CONSECUTIVE TERMS IN SUCH RESPECTIVE OFFICES) AND TO REMOVE THE CHIEF EXECUTIVE OFFICER AND THE CHIEF OPERATING OFFICER OF THE CORPORATION WHETHER OR NOT SUCH REMOVAL IS APPROVED BY THE BOARD OF DIRECTORS; AND TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT OF THE CORPORATION AND TO DETERMINE THE TERM OF THE PRESIDENT'S APPOINTMENT, SUCH TERM NOT TO EXCEED THREE YEARS. FORM 990, PART VI, SECTION B, LINE 11 THE CEO, CFO AND CONTROLLER REVIEW THE 990 BEFORE IT IS FILED WITH THE IRS. A COPY IS KEPT ON HAND FOR PUBLIC VIEWING. FORM 990, PART VI, SECTION B, LINE 12C THE PARTIES THAT ARE INVOLVED ARE ASKED TO DISCLOSE ANY CHANGES THAT WOULD IMPACT THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS SALARIES WHICH ARE THEN COMPARED TO MANAGEMENT RESOURCE ASSOCIATION DATA. THE ORGANIZATION ALSO COMPARES THEIR SALARIES TO OTHER COMPANIES THAT ARE SIMILAR IN NATURE VIA 990'S. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -44,817. TOTAL TO FORM 990, PART XI, LINE 5: -44,817. ST CAMILLUS HEALTH SYSTEM INC 10101 W WISCONSIN AVENUE WAUWATOSA WI 53226 390806167 ADMINISTRATIVE AND MANAGEMENT SERVICES WI 501(C)(3) 11(B) N/A 0 ST CAMILLUS COMMUNITIES INC 10101 W WISCONSIN AVENUE WAUWATOSA WI 53226 391843041 RESIDENTIAL FACILITIES WI 501(C)(3) 11(B) ST CAMILLUS HEALTH SYSTEM INC 0 ORDER OF ST CAMILLUS FOUNDATION INC 10200 W BLUEMOUND ROAD WAUWATOSA WI 53226 391925879 FUND-RAISING SUPPORT WI 501(C)(3) 11(B) ST CAMILLUS HEALTH SYSTEM INC 0 ST CAMILLUS HEALTH CENTER INC 10101 W WISCONSIN AVENUE WAUWATOSA WI 53226 391079224 HEALTH SERVICES WI 501(C)(3) 9 ST CAMILLUS HEALTH SYSTEM INC 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1