STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

PROHEALTH WAUKESHA MEMORIAL HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PROHEALTH WAUKESHA MEMORIAL HOSPITAL INC (EIN 39-0910727)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-09
IRS object ID
201212229349301761
Schema version
2010v3.4
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-09T17:24:35-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 307AddressLine1
CitySOUTHFIELDCity
StateMIState
ZIP Code480370307ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390910727EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WAUKESHA MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWAUKNameControl
Phone2629284740Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1725 AMERICAN AVENUEAddressLine1
CityWAUKESHACity
StateWIState
ZIP Code53188ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameNANINE M NELSONName
TitleCHIEF FINANCIAL OFFICERTitle
Phone2629284740Phone
Date Signed2012-08-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSUSAN MIENCIERName
Phone2483522500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSUSAN EDWARDSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1725 AMERICAN AVENUEAddressLine1
CityWAUKESHACity
StateWIState
ZIP Code53188ZIPCode
FieldValueIRS element (for citing)
Gross Receipts464399847GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PROHEALTHCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionPROVISION OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees3099TotalNbrEmployees
Total Nbr Volunteers462TotalNbrVolunteers
Total Gross UBI9074996TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1898420ContributionsGrantsPriorYear
Contributions Grants Current Year2467085ContributionsGrantsCurrentYear
Program Service Revenue Prior Year448733179ProgramServiceRevenuePriorYear
Program Service Revenue CY447897566ProgramServiceRevenueCY
Investment Income Prior Year4974621InvestmentIncomePriorYear
Investment Income Current Year8449476InvestmentIncomeCurrentYear
Other Revenue Prior Year4972834OtherRevenuePriorYear
Other Revenue Current Year5584836OtherRevenueCurrentYear
Total Revenue Prior Year460579054TotalRevenuePriorYear
Total Revenue Current Year464398963TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year15886500GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY35100002GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year152229990SalariesEtcPriorYear
Salaries Etc Current Year141727462SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year616482TotalFundrsngExpCurrentYear
Other Expense Prior Year250762886OtherExpensePriorYear
Other Expenses Current Year254046816OtherExpensesCurrentYear
Total Expenses Prior Year418879376TotalExpensesPriorYear
Total Expenses Current Year430874280TotalExpensesCurrentYear
Revenues Less Expenses Prior Year41699678RevenuesLessExpensesPriorYear
Revenues Less Expenses CY33524683RevenuesLessExpensesCY
Total Assets BOY671907482TotalAssetsBOY
Total Assets EOY686540701TotalAssetsEOY
Total Liabilities BOY342083034TotalLiabilitiesBOY
Total Liabilities EOY349906482TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY329824448NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY336634219NetAssetsOrFundBalancesEOY
Mission DescriptionCONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense357407075Expense
Grants35100002Grants
Revenue443552644Revenue
DescriptionWAUKESHA MEMORIAL HOSPITAL FULFILLS ITS EXEMPT PURPOSE BY PROVIDING 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 65,534 DAYS OF INPATIENT CARE AND APPROXIMATELY 289,915 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2011. SEE SCHEDULE H FOR ILLUSTRATION OF ITS PROGRAM SERVICE ACCOMPLISHMENTS.Description
Total Program Service Expense357407075TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096332NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3099NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse1MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonNANINE NELSONNamePerson
Telephone Number2629284740TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1N17 W24100 RIVERWOOD DRIVE SUITEAddressLine1
CityWAUKESHACity
StateWIState
ZIP Code531881131ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
BETTY ARNDT
DIRECTOR2.00X000
DIXON BENZ
DIRECTOR2.00X000
MARIE KINGSBURY
DIRECTOR2.00X000
JAMES GANNON
TREASURER2.00X000X
E JOHN RAASCH
DIRECTOR2.00X000
DAVID SCHMITT MD
DIRECTOR (PARTIAL YEAR)2.00X2400000
DR DOUGLAS HASTAD
DIRECTOR2.00X000
RALPH RAMIREZ
DIRECTOR2.00X000
KENNETH RIESCH
DIRECTOR2.00X000
JANE NEUMANN MD
DIRECTOR2.00X4000013033925713
EDWARD OLSON
PRESIDENT (PARTIAL YEAR)40.00X500944061587X
ARCHEBALD PEQUET MD
SECRETARY2.00X5236000X
DAN D'ANGELO DDS
VICE CHAIRMAN2.00X000X
THOMAS E DALUM
CHAIRMAN2.00X000X
NANINE NELSON
ASSIST. TREASURER/CFO (PART YR)2.00X032223745418X
GARY BEYER MD
DIRECTOR2.00X2199800
JOHN ROBERTSTAD
PRESIDENT (PARTIAL YEAR)32.00X0389368474761X
SUSAN EDWARDS
PRESIDENT/CEO (PARTIAL YR)2.000187698183487X
REXFORD W TITUS III
PRESDIENT/CEO (PARTIAL YR)2.00088117977290X
ROBERT W MLYNAREK
CFO (PARTIAL YEAR)2.00041576442806X
DR JAMES GARDNER MD
VP - MEDICAL AFFAIRS40.00365852046724X
CATHY RAPP
VP - CHIEF NURSING OFFICER40.00187116023057X
KENNETH PRICE
VP - CHIEF OPERATING EX.40.00247470042355X
ERIC G HENDEE
CHIEF PHYSICIST40.00191076035133X
JOSEPH T BOTTICELLI
DIRECTOR-PHARMACY (PARTIAL YEAR)40.00166467015165X
FREDERICK L SYRJANEN
VP - CONTINUUM OF CARE40.00167207031447X
BARBARA J MATHISON
EXECUTIVE DIRECTOR (PARTIAL YEAR)40.00167079027744X
MARY JANE REICHART
EXECUTIVE DIRECTOR (PARTIAL YEAR)40.00161389033313X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2292958TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2326585TotalReportableCompFrmRltdOrgs
Total Other Compensation1166000TotalOtherCompensation
Number Individuals GT100 K68NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CG SCHMIDT INC
11777 WEST LAKE PARK DRIVEMILWAUKEEWI53224CONSTRUCTION SERVICES3773428
MEDICAL COLLEGE OF WI
PO BOX 13308MILWAUKEEWI53213MEDICAL SERVICES3393974
EPIC SYSTEMS
PO BOX 88314MILWAUKEEWI53288COMPUTER/MAINTENANCE3350384
GE HEALTHCARE IITS USA
PO GOX 277475ATLANTAGA30384MEDICAL SERVICES2419220
ENGBERG ANDERSON
320 EAST BUFFALO STREETMILWAUKEEWI53202ARCHITECTS1710152
FieldValueIRS element (for citing)
Number Of Contractors GT100 K55NumberOfContractorsGT100K
Related Organizations784433RelatedOrganizations
All Other Contributions1682652AllOtherContributions
Total Contributions2467085TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REV.622110436606904436606904
MEDICAL SERVICE LAB62150091314329131432
SURGERY CENTER62140021592302159230
FieldValueIRS element (for citing)
Total Program Service Revenue447897566TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8449476TotalRevenueColumn
Exclusion$8,449,476ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Personal7041Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Personal884Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Personal6157Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column6157TotalRevenueColumn
Unrelated Business Revenue6157UnrelatedBusinessRevenue

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA722210825365$825,365
GIFT SHOP45322029397$29,397
INCOME FROM PASSTHROUG900099-62593-62593

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column4786510TotalRevenueColumn
Related Or Exempt Function Income4786510RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue5578679TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column464398963TotalRevenueColumn
Related Or Exempt Function Income443552644RelatedOrExemptFunctionIncome
Unrelated Business Revenue9074996UnrelatedBusinessRevenue
Exclusion$9,304,238ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total35077002Total
Program Services35077002ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total23000Total
Program Services23000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1649646Total
Program Services231720ProgramServices
Management And General1417926ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total110065937Total
Program Services105330072ProgramServices
Management And General4234296ManagementAndGeneral
Fundraising501569Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4603911Total
Program Services4350307ProgramServices
Management And General232934ManagementAndGeneral
Fundraising20670Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total17798309Total
Program Services16817899ProgramServices
Management And General900501ManagementAndGeneral
Fundraising79909Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7609659Total
Program Services7383245ProgramServices
Management And General193574ManagementAndGeneral
Fundraising32840Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total260156Total
Management And General260156ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total107850Total
Management And General107850ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total85925978Total
Program Services23080703ProgramServices
Management And General62777895ManagementAndGeneral
Fundraising67380Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total16629713Total
Program Services16108959ProgramServices
Management And General516193ManagementAndGeneral
Fundraising4561Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4862739Total
Program Services4409185ProgramServices
Management And General453554ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total13814828Total
Program Services13814828ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total37056975Total
Program Services37056975ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
MEDICAL SUPPLIES37768675377686193026
DRUGS & PHARMACEUTICALS2070028320700283
BAD DEBTS1897884818978848
MEDICAID PROVIDER TAXES1413131914131319
EDUCATION & TRAINING244801210836325361429

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3564651Total
Program Services1933275ProgramServices
Management And General1723278ManagementAndGeneral
Fundraising-91902Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total430874280Total
Program Services357407075ProgramServices
Management And General72850723ManagementAndGeneral
Fundraising616482Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY71472BOY
EOY655830EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4325885BOY
EOY11479327EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY51911201BOY
EOY49923043EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8088091BOY
EOY6712048EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4572023BOY
EOY5297761EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis643776192LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec387772663LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY255136142BOY
EOY256003529EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY217255007BOY
EOY226726098EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY130547661BOY
EOY129743065EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY671907482BOY
EOY686540701EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY37815944BOY
EOY41825977EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY244018219BOY
EOY241262003EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY60248871BOY
EOY66818502EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY342083034BOY
EOY349906482EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY329274808BOY
EOY336270386EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY549640BOY
EOY363833EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY329824448BOY
EOY336634219EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY671907482BOY
EOY686540701EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses33524683ReconcilationRevenueExpenses
Reconcilation Other Changes-26714912ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6542035BeginningOfYearBalance
Contributions84926Contributions
Investment Earnings Or Losses-1766InvestmentEarningsOrLosses
End Of Year Balance6625195EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5498739BeginningOfYearBalance
Contributions1045116Contributions
Investment Earnings Or Losses-1820InvestmentEarningsOrLosses
End Of Year Balance6542035EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5293708BeginningOfYearBalance
Contributions236781Contributions
Investment Earnings Or Losses-31750InvestmentEarningsOrLosses
End Of Year Balance5498739EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis15390400OtherCostOrOtherBasis
Book Value15390400BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis275463661OtherCostOrOtherBasis
Depreciation126464983Depreciation
Book Value148998678BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2631648OtherCostOrOtherBasis
Depreciation2351437Depreciation
Book Value280211BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis321821847OtherCostOrOtherBasis
Depreciation258956243Depreciation
Book Value62865604BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis28468636OtherCostOrOtherBasis
Book Value28468636BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings256003529TotalOfBookValueLandBuildings

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED FINANCING1998872
DEBT SERVICE RESERVE FUND664852
ACCRUED INTEREST RECEIVABLE378198
DUE FROM AFFILIATES8876807
INVESTMENT IN OAW ASC2506473
OTHER ASSETS4066824
DEPRECIATION RESERVE104992502
ASSETS LIMITED TO USE6258537
FieldValueIRS element (for citing)
Total Book Value Other Assets129743065TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ACCRUED POSTRETIREMENT MEDICAL$246,435
FAIR VALUE-INTEREST RATE SWAP$24,648,326
ASSET RETIREMENT OBLIGATION$648,105
ACCUMULATED MIN PENSION LIABILITY$41,275,636
FieldValueIRS element (for citing)
Total Of Amounts66818502TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:TO SUPPORT WAUKESHA MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:FIN 48 DISCLOSURE: FEDERAL INCOME TAX - PHC, WMH, OMH, NATIONAL REGENCY, 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 STOCK CORPORATION AND IS SUBJECT TO INCOME TAXES. WHS ACCOUNTS FOR INCOME TAXES UNDER THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED RELATED TO THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE ACCOUNTING STANDARD THAT REFERS TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IS EFFECTIVE FOR FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2006 FOR NONPUBLIC ENTITIES THAT HOLD PUBLIC DEBT. THE STANDARD ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED ON THE CONSOLIDATED FINANCIAL STATEMENT. COMPANIES MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. THE CORPORATION ADOPTED THIS STANDARD AS OF OCTOBER 1, 2007. THE ADOPTION DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION IS SUBJECT TO EXAMINATION BY TAXING AUTHORITIES; HOWEVER, NO EXAMINATIONS ARE IN PROGRESS. MANAGEMENT BELIEVES THE CORPORATION IS NOT SUBJECT TO TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2008.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent0FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4726946TotalCommunityBenefitExpense
Net Community Benefit Expense4726946NetCommunityBenefitExpense
Percent Of Total Expense0.01120PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense39109929TotalCommunityBenefitExpense
Direct Offsetting Revenue24875533DirectOffsettingRevenue
Net Community Benefit Expense14234396NetCommunityBenefitExpense
Percent Of Total Expense0.03380PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense43836875TotalCommunityBenefitExpense
Direct Offsetting Revenue24875533DirectOffsettingRevenue
Net Community Benefit Expense18961342NetCommunityBenefitExpense
Percent Of Total Expense0.04500PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served132806PersonsServed
Total Community Benefit Expense2932059TotalCommunityBenefitExpense
Direct Offsetting Revenue8932DirectOffsettingRevenue
Net Community Benefit Expense2923127NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served23499PersonsServed
Total Community Benefit Expense7332325TotalCommunityBenefitExpense
Direct Offsetting Revenue3628508DirectOffsettingRevenue
Net Community Benefit Expense3703817NetCommunityBenefitExpense
Percent Of Total Expense0.00880PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense4308353TotalCommunityBenefitExpense
Direct Offsetting Revenue1638571DirectOffsettingRevenue
Net Community Benefit Expense2669782NetCommunityBenefitExpense
Percent Of Total Expense0.00630PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense485097TotalCommunityBenefitExpense
Net Community Benefit Expense485097NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs9NumberOfActivitiesOrPrograms
Persons Served33315PersonsServed
Total Community Benefit Expense1179319TotalCommunityBenefitExpense
Net Community Benefit Expense1179319NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Persons Served189620PersonsServed
Total Community Benefit Expense16237153TotalCommunityBenefitExpense
Direct Offsetting Revenue5276011DirectOffsettingRevenue
Net Community Benefit Expense10961142NetCommunityBenefitExpense
Percent Of Total Expense0.02600PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Persons Served189620PersonsServed
Total Community Benefit Expense60074028TotalCommunityBenefitExpense
Direct Offsetting Revenue30151544DirectOffsettingRevenue
Net Community Benefit Expense29922484NetCommunityBenefitExpense
Percent Of Total Expense0.07100PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense11000TotalCommunityBuildingExpense
Net Community Building Expense11000NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served300PersonsServed
Total Community Building Expense19521TotalCommunityBuildingExpense
Net Community Building Expense19521NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense9272TotalCommunityBuildingExpense
Net Community Building Expense9272NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served21PersonsServed
Total Community Building Expense6368TotalCommunityBuildingExpense
Net Community Building Expense6368NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served342PersonsServed
Total Community Building Expense9483TotalCommunityBuildingExpense
Net Community Building Expense9483NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense192TotalCommunityBuildingExpense
Net Community Building Expense192NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served663PersonsServed
Total Community Building Expense55836TotalCommunityBuildingExpense
Net Community Building Expense55836NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$6,700,226BadDebtExpenseAmount
Amount Attributable To2002603AmountAttributableTo
Amount Reimbursed By Medicare94732773AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare143729983CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-48997210MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy0WrittenDebtCollectionPolicy

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
2 PROHEALTH ALIGNED LLC
AMBULATORY SURGERY CENTER0.510000.49000
3 ORTHOPEDIC SURGERY CENTER
ORTHOPEDIC SURGICAL SERVICES0.300000.70000
FieldValueIRS element (for citing)
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalTeaching HospitalTeachingHospitalEr OtherErOtherOtherOther
WAUKESHA MEMORIAL HOSPITAL INC
1725 AMERICAN AVENUEWAUKESHAWI53188XXXX
REHABILITATION HOSPITAL OF WISCONSIN LLC
31625 COLDWATER CREEK DRIVEWAUKESHAWI53188XINPATIENT REHABILITATION

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber
WAUKESHA MEMORIAL HOSPITAL INC
1
REHABILITATION HOSPITAL OF WISCONSIN LLC
2

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PROHEALTH ALIGNED LLC
1111 DELAFIELD ST SUITE 100WAUKESHAWI53188AMBULATORY SURGERY CENTER
THE ORTHOPEDIC SURGERY CENTER LLC
W238 N 1610 BUSSE ROAD SUITE 100WAUKESHAWI53188ORTHOPEDIC SURGERY CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationReturn ReferenceReturnReferenceIdentifierIdentifier
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. THIS WAS CALCULATED BY USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS.
PART I, LINE 7G: N/A
PART I, L7 COL(F): $18,978,848 OF BAD DEBT EXPENSES FROM WAUKESHA MEMORIAL HOSPITAL, INC. WAS INCLUDED ON FORM 990, PART, IX, LINE 25. ADDITIONALLY, THERE WAS BAD DEBT EXPENSE OF $14,838 RELATED TO REHABILITATION HOSPITAL OF WISCONSIN, LLC. BOTH AMOUNTS WERE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE.
PART II: WAUKESHA MEMORIAL HOSPITAL HAS PARTNERSHIPS WITH VARIOUS ORGANIZATIONS THROUGHOUT THE COMMUNITIES WE SERVE. EXAMPLES INCLUDE THE PARTNERSHIPS WE HAVE WITH LOCAL CHAMBERS OF COMMERCE. WAUKESHA MEMORIAL WORKS WITH THE CHAMBERS TO PROVIDE LEADERSHIP ON HEALTH-RELATED OUTREACH ACTIVITIES AIMED AT STRENGTHENING COMMUNITY DEVELOPMENT. ANOTHER EXAMPLE IS OUR LONGSTANDING RELATIONSHIP WITH THE UNITED WAY OF WAUKESHA COUNTY. EVERY YEAR WMH PROVIDES LEADERSHIP IN THE UNITED WAY FUND RAISING CAMPAIGN. UNITED WAY HELPS SUPPORT MANY HEALTH AND HUMAN SERVICES ORGANIZATIONS. WITHOUT THE FUNDS THAT UNITED WAY PROVIDES, MANY OF THESE ORGANIZATIONS COULDN'T AFFORD TO CONTINUE SERVICES TO VULNERABLE AND INDIGENT POPULATIONS, AND THAT WOULD MAKE ACCESS TO CARE AND SERVICES MORE DIFFICULT.
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 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 FINANCIAL ASSISTANCE 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 USED IS THE COST TO CHARGE RATIO AS REPORTED ON THE MEDICARE COST REPORT.
PRACTICES WERE OUTLINED; POLICY IS IN DEVELOPMENTPART V, LINE 15E
ALL PATIENTS ARE BILLED THE SAME; AS OF 10/1/2011 WE IMPLEMENTED AN UNINSURED DISCOUNT THAT IS APPLIED AT THE TIME OF BILLING FOR ALL PATIENTS WHO LACK INSURANCE COVERAGE.PART V, LINE 19D
UNINSURED DISCOUNT WENT INTO EFFECT AS OF 10/1/2011. PRIOR TO THAT, DISCOUNTS WERE GIVEN TO SELF PAY PATIENTS IF THEY MADE PROMPT PAYMENTS OR SET UP PAYMENT ARRANGEMENTS.PART V, LINE 21
PART VI, LINE 2: COMMUNITY NEEDS ARE IDENTIFIED BASED ON A REVIEW OF STATE, COUNTY AND COMMUNITY HEALTH ASSESSMENTS. THIS INCLUDES SUCH DOCUMENTS AS THE STATE HEALTH PLAN, THE COUNTY HEALTH REPORT CARD, THE WAUKESHA COMMUNITY HEALTH SURVEY, THE HEALTH COMMUNITY 2010 DATA PACKAGE AND VARIOUS OTHER NEEDS ASSESSMENTS, SUCH AS THE UNITED WAY/UNIVERSITY OF WISCONSIN SURVEY OF WAUKESHA COUNTY. TO COMPLEMENT ALL OF THESE DATA SOURCES, WE ALSO PERIODICALLY PERFORM A SERVICE GAP ANALYSIS WITH OUR 20+ EMPLOYED COMMUNITY OUTREACH NURSES AS WELL AS LOCAL NON-PROFIT AGENCIES WITH WHICH WE PARTNER. WE THEN ANALYZE THE DATA, IDENTIFY PRESSING NEEDS, AND PROACTIVELY IMPLEMENT COMMUNITY BENEFIT INITIATIVES TO ADDRESS THESE NEEDS.
PART VI, LINE 3: 1. SELF-PAY PATIENTS RECEIVE A LETTER FROM US OUTLINING THE AVAILABILITY OF COMMUNITY CARE AND OUR PROMPT-PAY DISCOUNT POLICY. THE LETTER IS SENT WITHIN A WEEK OF OUTPATIENT SERVICE OR INPATIENT DISCHARGE AND PROVIDES OUR CONTACT INFORMATION. PATIENTS WITHOUT INSURANCE AND PATIENTS WITH BALANCES AFTER INSURANCE RECEIVE TWO ADDITIONAL LETTERS, EACH OF WHICH INCLUDES INFORMATION ABOUT COMMUNITY CARE AND CONTACT INFORMATION.2. PRIOR TO AN ACCOUNT GOING TO COLLECTION, IF WE HAVEN'T HAD ANY CONTACT FROM THE PATIENT ON A BALANCE OVER $10,000, AN ATTEMPT TO CONTACT VIA TELEPHONE IS MADE. 3. IF SOMEONE HAS BEEN FOUND ELIGIBLE FOR SOME LEVEL OF COMMUNITY CARE, THE ELIGIBILITY PERIOD IS SIX MONTHS SO ANY SUBSEQUENT ACCOUNTS DURING THAT TIMEFRAME WOULD BE DISCOUNTED AT WHATEVER LEVEL OF COMMUNITY CARE IS ELIGIBLE. 4. THROUGH THE EFFORTS OF HOSPITAL SOCIAL WORKERS AND OTHERS, WE SOMETIMES ARE ABLE TO DETERMINE THAT A PATIENT HAS NO ASSETS. IN THOSE SITUATIONS, WE DO A PRESUMPTIVE APPLICATION AND GRANT COMMUNITY CARE BASED ON THE INFORMATION WE WERE ABLE TO FIND. 5. WE DO NOT AUTOMATICALLY GIVE COMMUNITY CARE JUST BECAUSE WE FEEL THEY MAY QUALIFY. WE NEED TO HAVE COMPLETED PAPERWORK SUSTAINING THEIR INCOME AND ASSETS. IF THEY HAVE A VIABLE ADDRESS WE SEND AT LEAST TWO LETTERS ASKING THEM TO CONTACT US; IF THEY HAVE A HIGH BALANCE ACCOUNT, WE ALSO TRY TO CONTACT THEM VIA TELEPHONE.
PART VI, LINE 4: PROHEALTH CARE SERVES ABOUT 285,000 PEOPLE EACH YEAR IN WAUKESHA COUNTY AND PORTIONS OF THE SURROUNDING JEFFERSON, WALWORTH, RACINE AND DODGE COUNTIES. PROHEALTH CARE FUNCTIONS IN A CROWDED HEALTH CARE MARKETPLACE WITH SIX OTHER PROVIDERS AND CURRENTLY HOLDS 44.1% MARKET SHARE IN WAUKESHA COUNTY. IN EVERY FEDERAL POPULATION CENSUS, WAUKESHA COUNTY HAS RECORDED AN INCREASE IN POPULATION. SINCE 1960, THE POPULATION OF THE COUNTY HAS MORE THAN DOUBLED, AND THE U.S. CENSUS PREDICTS MODERATE POPULATION GROWTH (3%) OVER THE NEXT FIVE YEARS. WAUKESHA COUNTY HAS AN AGING POPULATION WITH THE RATE OF RETIREMENT 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: WHITE 94.6%, HISPANIC OR LATINO 3.7%, ASIAN 2.6%, BLACK 1.5%, OTHER .3%. MEDIAN HOUSEHOLD INCOME IS $75,754 WITH 4.1% OF PEOPLE LIVING BELOW THE POVERTY LEVEL. WAUKESHA COUNTY HAS THE SECOND HIGHEST MEDIAN HOME PRICE IN THE STATE WITH 19% OF HOUSEHOLDS PAYING MORE THAN 30 PERCENT OF THEIR GROSS MONTHLY INCOME ON HOUSING. THE PRESENCE OF SOME VERY UPSCALE 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 29,395 IN 2010. THE HISPANIC POPULATION HAS SEEN A 42% INCREASE IN THE PAST 8 YEARS. FORTY DIFFERENT LANGUAGES ARE SPOKEN BY STUDENTS IN THE WAUKESHA PUBLIC SCHOOLS. THE FIVE AREA HOMELESS SHELTERS REACHED CAPACITY EARLY IN 2009, REQUIRING AN ADDITIONAL EMERGENCY SHELTER BE ADDED. 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 SINCE PRIVATE SERVICE PROVIDERS OFTEN REFUSE TO CARE FOR THESE INDIVIDUALS.
PART VI, LINE 6: BECAUSE OF THE RELATIVELY RURAL NATURE OF OUR SERVICE AREA, OUR COMMUNITY BENEFIT PROGRAM MAKES A CONSCIOUS EFFORT TO REACH OUT AND FIND DISADVANTAGED, UNDERSERVED POPULATIONS. THESE TARGET POPULATIONS INCLUDE NON-ENGLISH SPEAKING, UNINSURED OR UNDERINSURED, ISOLATED AND FRAIL ELDERLY, HOMELESS, AND MENTALLY DISABLED. WE INCLUDE COMMUNITY MEMBERS ON OUR GOVERNMENT BOARD AND COMMUNITY BENEFIT STEERING COMMITTEE. WE ALSO MAKE EXTENSIVE USE OF COMMUNITY PARTNER AGENCIES IN PLANNING, DESIGN AND OPERATION OF COMMUNITY BENEFIT PROGRAMS.
PART VI, LINE 7: 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.
WIPART VI, LINE 7REPORTS FILED WITH STATES

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1PROHEALTH CARE INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1N17 W24100 RIVERWOOD DR STE 200AddressLine1
CityWAUKESHACity
StateWIState
ZIP Code531881131ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient391486873EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant35007002AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance
Purpose Of GrantTO ASSIST WAUKESHA MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION.PurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPTypeOfGrant
Number Of Recipients21NumberOfRecipients
Amount Of Cash Grant23000AmountOfCashGrant
Method Of ValuationFMVMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: SCHOLARSHIPS CHECKS ARE PAID BY SCHOLARSHIP AMERICA. SCHOLARSHIP AMERICA MAKES THE CHECKS PAYABLE TO THE INSTITUTION ATTENDED BY THE STUDENT.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JANE NEUMANN MD
4000012870700016320115740141394000015605200
EDWARD OLSON
422321000786230265760350110562531000
NANINE NELSON
029398300028254019160026258036765500
JOHN ROBERTSTAD
0362340000270280445864028897086412900
SUSAN EDWARDS
016737100020327017924504242037118500
REXFORD W TITUS III
0771901000109278041307035983095846900
ROBERT W MLYNAREK
038738200028382027211015595045857000
DR JAMES GARDNER MD
310012000558400200430266810412576000
CATHY RAPP
1806960006420021499015580210173000
KENNETH PRICE
225008000224620155200268350289825000
ERIC G HENDEE
18815900029170130510220820226209000
JOSEPH T BOTTICELLI
165861000606040610111040181632000
FREDERICK L SYRJANEN
146789000204180100990213480198654000
BARBARA J MATHISON
142528000245510102740174700194823000
MARY JANE REICHART
14053200020857098800234330194702000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1ACOUNTRY CLUB MEMBERSHIPS: EDWARD OLSON - BENEFIT WAS NOT INCLUDED IN TAXABLE INCOME AS MEMBERSHIP IS FOR BUSINESS USE ONLY.
PART I, LINE 4BNAME PLAN REXFORD W TITUS III - SERP PLAN PARTICIPANT ROBERT MLYNAREK - SERP PLAN PARTICIPANT EDWARD OLSON - SERP PLAN PARTICIPANT SUSAN EDWARDS - SERP PLAN PARTICIPANT NANINE NELSON - SERP PLAN PARTICIPANT JOHN ROBERTSTAD - SERP PLAN PARTICIPANT 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 IIISCHEDULE 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 5. WRITTEN EMPLOYEMENT CONTRACTSUPPLEMENTAL INFORMATION

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
WISCONSIN HEATH & EDUCATIONAL FACILITIES
39133785597710BDJ82008-08-14107960000CURRENT REFUND BONDS ISSUED 4/25/01 & CURRENT REFUND BONDS ISSUED 6/9/04.000
WISCONSIN HEATH & EDUCATIONAL FACILITIES
39133785597710BGZ92009-04-3066126415RENOVATION TO HOSPITAL FACILITY & CONSTRUCTION OF PARKING STRUCTURE.000
WISCONSIN HEATH & EDUCATIONAL FACILITIES
39133785597710BB502011-02-1632039358CURRENT REFUND BONDS ISSUED 11/14/95 & CURRENT REFUND BONDS ISSUED 5/13/99.000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount In Reserve FundAmountInReserveFundCapital ExpendituresCapitalExpenditures
334087510844347586598965905710691842920071011
5951574986077420100011661264258654976
2450000320393585971863144217320011011

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
010001
000001
000001

Form990 Schedule K Part V Form990ScheduleKPartV (16 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PART I, A - COL. CCUSIP #: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 - COL. EISSUE 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.
PART I, B - COL. CCUSIP #: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 - COL. EISSUE 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.
PART I, C - COL. CCUSIP #: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 - COL. EISSUE 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.
PART II, A - LINE 1AMOUNT OF BONDS RETIRED:PRINCIPAL PAYMENTS OF ISSUE MADE AS OF 9/30/11 IN AMOUNT OF $3,775,000.00 ALLOCABLE TO REPORTING ORGANIZATION IN THE AMOUNT OF $3,340,875.
PART II, A - LINE 3TOTAL PROCEEDS OF ISSUE:SALE PROCEEDS OF ISSUE IN AMOUNT OF $108,443,475.00 ALLOCABLE TO REPORTING ORGANIZATION PLUS ZERO INVESTMENT PROCEEDS.
PART II, A - LINE 6PROCEEDS IN REFUNDING ESCROWS:PROCEEDS IN THE AMOUNT OF $106,918,428.56 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 8/14/08; BALANCE ON 9/30/10 IS ZERO.
PART II, A - LINE 7ISSUANCE COSTS FROM PROCEEDS:$865,989.17 OF PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION USED FOR ISSUANCE COSTS; $659,057.27 USED FOR CREDIT ENHANCEMENT.
PART II, A - LINE 13YEAR OF SUBSTANTIAL COMPLETION:YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 4/25/01 WAS 2003 AND YEAR OF SUBSTANTIAL COMPLETION OF PROJECTS FINANCED WITH REFUNDED PRIOR BONDS ISSUED 6/09/04 WAS 2007.
PART II, B - LINE 3TOTAL PROCEEDS OF ISSUE:SALE PROCEEDS OF ISSUE IN AMOUNT OF $66,126,415.08 ALLOCABLE TO REPORTING ORGANIZATION PLUS $1,975.67 OF INVESTMENT PROCEEDS ALLOCABLE TO REPORTING ORGANIZATION LESS SALE PROCEEDS IN THE AMOUNT OF $6,612,641.51 DEPOSITED IN REASONABLY REQUIRED RESERVE FUND ALLOCABLE TO REPORTING ORGANIZATION.
PART II, C - LINE 1AMOUNT OF BONDS RETIRED:PRINCIPAL PAYMENTS OF ISSUE MADE AS OF 9/30/11 IN AMOUNT OF $2,730,000 ALLOCABLE TO REPORTING ORGANIZATION IN THE AMOUNT OF $2,450,000.
PART II, C - LINE 3TOTAL PROCEEDS OF ISSUE:SALE PROCEEDS OF ISSUE IN AMOUNT OF $32,039,358 PLUS ZERO INVESTMENT PROCEEDS.
PART II, C - LINE 6PROCEEDS IN REFUNDING ESCROWS:PROCEEDS IN THE AMOUNT OF $31,442,172.63 ALLOCABLE TO REPORTING ORGANIZATION DEPOSITED IN REFUNDING ESCROWS ON 2/16/11; BALANCE ON 9/30/11 IS ZERO.
PART II, C - LINE 13YEAR 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.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonR R INSURANCENamePerson
FieldValueIRS element (for citing)
RelationshipKENNETH RIESCH, DIRECTOR, IS THE PRESIDENT/OWNER OF R&R INSURANCERelationship
Amount Of Transaction1504770AmountOfTransaction
Description Of TransactionR & R INSURANCE PROVIDES INSURANCE SERVICES TO WAUKESHA MEMORIAL HOSPITAL, INC.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 5DURING THE YEAR, MANAGEMENT DISCOVERED THAT A MAINTENANCE DEPARTMENT EMPLOYEE HAD EMBEZZLED APPROXIMATELY $1.4 MILLION OVER A FIVE-YEAR PERIOD THROUGH A FALSE BILLING SCHEME INVOLVING A PAINTING COMPANY OWNED BY HIS SPOUSE. WMH LEADERSHIP TERMINATED THE EMPLOYEE AND NOTIFIED POLICE. FOLLOWING AN INVESTIGATION, IN MAY 2012, THE FORMER EMPLOYEE WAS CHARGED WITH SIX COUNTS OF THEFT OF MOVABLE PROPERTY. AS OF THE DATE OF THIS FILING, THE FORMER EMPLOYEE REMAINS FREE ON BOND PENDING TRIAL. THE FULL AMOUNT OF THE LOSS WAS COVERED BY WMH'S INSURANCE POLICIES. MODIFIED AUTHORIZATION AND ACCESS PROCESSES HAVE BEEN PUT IN PLACE IN RESPONSE TO THIS EVENT.
FORM 990, PART VI, SECTION A, LINE 6PROHEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7BPROHEALTH 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 11AFTER THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S TAX PREPARERS AND PRIOR TO FILING THE FORM 990, SELECT EXECUTIVE MEMBERS OF THE ORGANIZATION PERFORMED A REVIEW; THEN THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THE RETURN, WHICH WAS SUBSEQUENTLY FILED BY THE ORGANIZATION.
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 OF INTEREST 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 12C
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 2011.FORM 990, PART VI, SECTION B, LINE 15
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
FORM 990 PART VII: THE FOLLOWING OFFICERS AND DIRECTORS HAVE WORKED FOR RELATED ORGANIZATIONS. THESE INDIVIDUALS ARE AS FOLLOWS: OFFICERS/DIRECTORS AVG. HRS. / WEEK EMPLOYED BY RELATED ENTITY ---------------------------------------------------------------------- JANE NEUMANN, MD GREATER THAN 40.00 PROHEALTH CARE, INC. NANINE NELSON GREATER THAN 40.00 PROHEALTH CARE, INC. REXFORD W TITUS, III GREATER THAN 40.00 PROHEALTH CARE, INC. ROBERT W MLYNAREK GREATER THAN 40.00 PROHEALTH CARE, INC. SUSAN EDWARDS GREATER THAN 40.00 PROHEALTH CARE, INC. NANINE NELSON GREATER THAN 40.00 PROHEALTH CARE, INC. JOHN ROBERTSTAD GREATER THAN 40.00 OCONOMOWOC MEMORIAL HOSPITAL, INC.
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -12,093,469. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -3,171,442. CHANGE IN MINIMUM PENSION LIABILITY -11,450,001. TOTAL TO FORM 990, PART XI, LINE 5: -26,714,912.FORM 990, PART XI, LINE 5:
THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
OCONOMOWOC MEMORIAL HOSPITAL INC
791 SUMMIT AVENUEOCONOMOWOCWI53066390794174HOSPITALWI501(C)(3)LINE 3PROHEALTH CARE INC1
WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC
725 AMERICAN AVENUEWAUKESHAWI53188391314542FUNDRAISINGWI501(C)(3)LINE 7WAUKESHA MEMORIAL HOSPITAL INC1
PROHEALTH HOME CARE INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188200067392HEALTHCAREWI501(C)(3)LINE 3PROHEALTH CARE INC1
NATIONAL REGENCY OF NEW BERLIN INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188391077992HEALTHCAREWI501(C)(3)LINE 9PROHEALTH CARE INC1
PROHEALTH CARE INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188391786873MANAGEMENTWI501(C)(3)LINE 11C, III-FI0N/A
OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC
791 SUMMIT AVENUEOCONOMOWOCWI53066391271647FUNDRAISINGWI501(C)(3)LINE 7OCONOMOWOC MEMORIAL HOSPITAL INC1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PROHEALTH ALIGNED LLC (DBA MSC)BusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11111 DELAFIELD STREET STE 100AddressLine1
CityWAUKESHACity
StateWIState
ZIP Code53188ZIPCode
FieldValueIRS element (for citing)
EIN263324572EIN
Primary ActivitySURGERY CENTERPrimaryActivity
Legal Domicile StateWILegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WAUKESHA MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income2490000ShareOfTotalIncome
Share Of EOY Assets4399611ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner1GeneralOrManagingPartner
Percentage Ownership0.51000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
WAUKESHA HEALTH SYSTEM INC
N17 W24100 RIVERWOOD DRIVE SUITE 20WAUKESHAWI53188391507910HEALTHCAREWIN/AC
EMPATHIA PACIFIC INC
31416 AGOURA RD STE 180WESTLAKE VILLAGECA91361953070501HEALTHCARECAN/AC
MEDICAL ASSOCIATES INC
N17 W24100 RIVERWOOD DRIVE SUITE 20WAUKESHAWI53188391083015HEALTHCAREWIN/AC
NATIONAL AVENUE DEVELOPMENT CORPORATION
N17 W24100 RIVERWOOD DRIVE SUITE 20WAUKESHAWI53188391417226HEALTHCAREWIN/AC
WAUKESHA HEALTH CARE INC
N17 W24100 RIVERWOOD DRIVE SUITE 20WAUKESHAWI53188391773598HEALTHCAREWIN/AC
EMPATHIA INC
N17 W24100 RIVERWOOD DRIVE SUITE 20WAUKESHAWI53188391567366HEALTHCAREWIN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (20 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC
C784433ACTUAL AMOUNT RECEIVED
WAUKESHA HEALTH SYSTEM INC
J84000ACTUAL COSTS INCURRED
WAUKESHA HEALTH CARE INC
J437300ACTUAL COSTS INCURRED
NATIONAL REGENCY OF NEW BERLIN INC
J648968ACTUAL COSTS INCURRED
WAUKESHA HEALTH CARE INC
I895985ACTUAL AMOUNT RECEIVED
PROHEALTH CARE INC
L51743328ACTUAL COSTS INCURRED
OCONOMOWOC MEMORIAL HOSPITAL INC
O354569ACTUAL COSTS INCURRED
PROHEALTH CARE INC
O175429ACTUAL COSTS INCURRED
WAUKESHA HEALTH SYSTEM INC
O73152ACTUAL COSTS INCURRED
WAUKESHA HEALTH CARE INC
O7014411ACTUAL COSTS INCURRED
MEDICAL ASSOCIATES INC
O209157ACTUAL COSTS INCURRED
OCONOMOWOC MEMORIAL HOSPITAL INC
P12203805ACTUAL COSTS INCURRED
PROHEALTH CARE INC
P6947154ACTUAL COSTS INCURRED
WAUKESHA HEALTH SYSTEM INC
P8696417ACTUAL COSTS INCURRED
WAUKESHA HEALTH CARE INC
P18505954ACTUAL COSTS INCURRED
MEDICAL ASSOCIATES INC
P2981421ACTUAL COSTS INCURRED
PROHEALTH HOME CARE INC
P955872ACTUAL COSTS INCURRED
EMPATHIA PACIFIC INC
P1767664ACTUAL COSTS INCURRED
NATIONAL REGENCY OF NEW BERLIN INC
P362735ACTUAL COSTS INCURRED
PROHEALTH CARE INC
B35077002ACTUAL COSTS INCURRED