2011-05-11T14:09:03-07:00 2010-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2009-07-01 390987025 Community Memorial Hospital of Menomonee Falls Inc COMM 4147770960 W180 N8085 Town Hall Road Menomonee Falls WI 53051 Jeff Van De Kreeke 2011-05-11 2009 2016-02-24 21:20:13Z William D Petasnick 323297635 false false X www.communitymemorial.com X 1959 WI To improve quality of life and meet the comprehensive needs of the community by providing high-quality, safe, cost-effective health services while serving our patients with compassionate, dignified and state-of-the art care. 14 9 1681 226 414194 0 171927411 175412913 -4655714 5461085 2700570 2891106 169972267 183765104 48474 50000 0 83130264 64859051 0 239618 101482167 110210162 184660905 175119213 -14688638 8645891 264948156 305532900 135959927 178937983 128988229 126594917 To improve quality of life and meet the comprehensive needs of the community by providing high-quality, safe, cost-effective health services. Our exceptional employees, volunteers and dedicated medical staff work collaboratively to serve our patients with compassionate, dignified and state-of-the art care. false false 97769035 115656102 Inpatient Services:Community Memorial Hospital was founded in 1964 by citizens of the community it serves and specializes in cardiovascular services, women's health, cancer care, and advanced surgical procedures. Combining next-generation technology with personalized care, Community Memorial strives to enhance and improve the quality of life in Waukesha, Washington, Milwaukee and Ozaukee counties.Community Memorial Hospital is approved for 237 beds of which 202 are staffed - and had 9,845 patient admissions and 45,455 patient days related to a wide range of inpatient services, including orthopedics, internal medicine, general surgery, cardiology, intensive care services, obstetrics and maternity care, and other specialty care for the twelve months ended June 30, 2010.Community Memorial's heart surgery program is the third largest in southeastern Wisconsin. The Heart and Vascular Center is staffed with experienced cardiac professionals utilizing the state-of-the-art technology to treat patients. In 2008, surgeons began using the da Vinci Robotic Surgery system to perform minimally invasive procedures. The growing demand for robotic-assisted laparoscopic surgery has been driven by improved outcomes such as less pain, shorter recovery time and fewer complications. During fiscal year 2010, Community Memorial had 16,558 cardiac procedures.In 2008, the Cancer Care Center at Community Memorial received the prestigious American College of Surgeons Commission on Cancer Outstanding Achievement Award, affirming its commitment to high-quality cancer care. The award recognizes cancer programs that provide the highest quality care to cancer patients and is received by only 66 programs in the US annually. During fiscal year 2010, Community Memorial had 505 cancer registry cases.The Birthing Center at Community Memorial includes 13 specialty equipped rooms and provides the full spectrum of prenatal services for both normal and high-risk pregnancies. Staffing is provided by leading obstetricians and board-certified neonatologists from the Medical College of Wisconsin. During fiscal year 2010, Community Memorial had 975 births.In addition to the cardiac, cancer care and birthing services noted above, the Hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including but not limited to the following: - Surgeries: 3,759 - CT Scans: 5,047 - MRI's: 893 - Medical Imaging Exams: 16,942 - Ultrasounds: 2,940 - Laboratory Tests: 410,103 - Nuclear Medicine Scans: 597 - EKG's: 10,150 - Dialysis: 749 46802720 55365384 Outpatient Services:Community Memorial had 87,249 outpatient visits in the twelve months ended June 30, 2010. Community offers a wide variety of ancillary, specialty and subspecialty services including but not limited to the following: - Allergy/Immunology - Cardiology - Clinical Genetics - Dermatology - Electrophysiology - Endocrinology - Family Practice - Gastroenterology - Gerontology - Gynecologic Oncology - Gynecology - Hand Surgery - Hematology - Infectious Disease - Internal Medicine - Interventional Radiology - Magnetic Resonance Imaging - Neonatology - Nephrology - Neurosurgery - Nuclear Medicine - Occupational Medicine - Oncology - Ophthalmology - Oral Surgery - Otolaryngology - Pathology - Pediatrics - Pedodontics - Perinatology - Periodontics - Physical Medicine and Rehabilitation - Plastic/Reconstructive Surgery - Podiatry - Psychiatry - Psychology - Pulmonary Medicine - Radiology - Radiation Oncology - Rheumatology - Thoracic Surgery - Urology - Vascular Surgery - Thoracic Surgery 3712261 4391427 Emergency Services:The Emergency Department at Community Memorial Hospital provides expert care 24/7 for adults and children throughout northern Waukesha, Milwaukee, and Washington counties. The facility is a Level III Trauma Center, and is staffed by board-certified emergency physicians, as well as specialists in trauma, neurosurgery, cardiology and orthopedics. During fiscal year 2010, the emergency department had 19,597 emergency visits. 148284016 true false false false false false false false false true true false true false false false false false false true false true true false true false false false false false false false false true true false false false false false true true false false false true 296 0 true 1681 true true true false false false false false false false false false 0 false false false false false false false false 14 9 false false false false true true true true true false false false true true true true true true true true true false WI X David Dirksmeyer 4147770960 N74W127501 Leatherwood Ct Menomonee Falls WI 530514490 Zorbini John 0. 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X 279452 0 22153 Hart Daniel 1.00 X X 0 0 0 Freiberg Kerry J 40.00 X 213710 0 19570 Evenson Rock E 40.00 X 222110 0 31558 Ellis Sharon Q 1.00 X 0 0 0 Dittmar Clarence H 1.00 X 0 0 0 Bestor William E 40.00 X 873073 0 21786 Becker Richard C 1.00 X X 0 0 0 Bast Ronald R 1.00 X X 0 0 0 2073979 4264617 932669 45 true true false Transolutions Inc 5019 Paysphere Circle Chicago IL 60674 Transcription 1093612 Siemens Medical Solutions 51 Valley Stream Parkway Malvern PA 19355 Equipment Servicing 580924 Pyramid Healthcare Solutions PO BOx 17389 Clearwater FL 33762 HIM Outsourcing 635923 Medical College of WI 8701 Watertown Plank Rd Milwaukee WI 53206 Physicians 973126 Columbia St Marys 4425 N Port Washington Rd Glendale WI 53212 Physicians 1352394 26 0 Outpatient Revenue 900099 55365384 55365384 Inpatient Revenue 900099 115656102 115656102 Emergency/Trauma Revenue 900099 4391427 4391427 175412913 4688555 1584706 3103849 13334 13334 0 1205120 633660 571460 571460 332519 238941 139620402 3300 138747650 116856 872752 -113556 759196 759196 66762 34365 32397 32397 0 0 Other Dept Operating Rev 561499 699988 618313 81675 Dietary Revenue 561499 701944 701944 Corporate Allocated Rev 561000 728502 728502 156815 156815 2287249 183765104 178344434 414194 5006476 50000 50000 0 0 0 0 0 60341928 56736136 3460726 145066 0 208845 196356 11988 501 4308278 4050643 247295 10340 269590 269590 505881 374129 131752 0 0 0 0 12632429 11337995 1293819 615 107280 901 106379 34022924 33336339 675642 10943 418337 80239 338098 0 4312762 3517489 784060 11213 55440 20500 34598 342 0 72940 57599 15216 125 2613143 2131280 475069 6794 0 8084099 6593391 1469689 21019 3630 3630 State Hospital Assessment 5206073 5206073 Provision for Uncollectable 3152000 3152000 Dues & Subscriptions 311275 94187 215771 1317 Corporate Allocations 31843309 14500231 17311735 31343 Clinic Practice Fee 6504735 6504735 94315 70573 23742 175119213 148284016 26595579 239618 866444 539468 4968487 7199533 0 20539627 20690343 0 0 2249584 1675089 1484406 3726241 3365285 3131291 168610475 82968289 91749630 85642186 97300440 134375008 0 0 0 42424253 48553741 264948156 305532900 23627086 12113961 6955 51484652 69223820 2074804 549764 58773385 97043483 135959927 178937983 X 128442230 125905277 545999 689640 128988229 126594917 264948156 305532900 X false true true X false false X 3166213 353474 384524 -189853 4094064 3670185 505082 -466268 542781 3166218 1.00000 false true true 2455851 2455851 100885133 35239575 65645558 2384844 1796379 588465 31685497 25012726 6672771 31199150 20919609 10279541 85642186 Senior Management Deferred Compensation 5748 M&I Collateral Sec Loan 36727265 Executive Deferred Compensation 1737122 Due from Employee 36 Due from Affiliates 380356 48553741 Pension Liability 36608831 Payable under securties lending agreemen 37343867 Market Adjustment - Swaps 4256915 Due to Affiliates 18833870 97043483 Part X Part X : FIN48 Footnote Effective January 1, 2007, F&CH adopted ASC No. 740, Income Taxes (formerly FIN 48), which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. ASC No. 740 prescribes a more-likely than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under ASC No. 740, tax positions will be evaluated for recognition, derecognition, and measurement using consistent criteria and will provide more information about the uncertainty in income tax assets and liabilities. At the date of adoption and as of June 30, 2010 and 2009, F&CH does not have an asset or liability recorded. Part V, Line 4 Part V, Line 4: Intended uses of the endowment fund. The funds are held by Community Memorial Foundation of Menomonee Falls (CMF), a related organization. The board designated endowment was created to support long range financial needs of Community Memorial Hospital of Menomonee Falls, Inc and its affiliates. false Cheery Cherry Fall Fair 53279 53279 6262 4065 10532 Holiday Nuts & Candy 8212 8212 6817 61491 61491 6262 4065 17349 27676 33815 true true X true X true X true true false false true true 1365144 1365144 0.00780 7371484 4428927 2942557 0.01680 8736628 4428927 4307701 0.02460 73 24242 2442484 78627 2363857 0.01350 7 730 1054502 11500 1043002 0.00600 32 4975 448935 22987 425948 0.00240 112 29947 3945921 113114 3832807 0.02190 112 29947 12682549 4542041 8140508 0.04650 1 80975 80975 0.00050 1 80975 80975 0.00050 false 1502732 48448676 58245425 -9796749 X true true Community Memorial Hospital

W180 N8085 Town Hall Road Menomonee Falls WI 53051

X X X X Financial Assistance and Billing HighlightsPolicy: Community Memorial Hospital (CMH) is committed to providing the community with quality healthcare without regard to economic status, race, color, sex, faith or national origin of the recipient. Patients with insufficient resources to meet their financial responsibilities may be given a Financial Assistance discount to relieve all or a portion of the obligation to make payment for services rendered at CMH.CommunicationCMH will communicate to patients the availability of Financial Assistance. They will provide uninsured patients information to ensure each patient understands the financial obligations he/she is incurring by receiving healthcare services. Brochures, available to all patients at registration, explain the hospital policy for billing and payment of services. Also information is available on each hospital's website. Patients also have the opportunity to speak with a financial counselor and the hospital will assist patients in identifying and applying for government assistance programs for which the patient may be eligible.EligibilityCMH reserves the right to review each application for financial assistance on its own merits and to consider other extenuating circumstances in the decision to approve or deny a patient's application for financial assistance. The applicant's gross family income will be compared to the annual Federal Poverty guidelines set forth by the U.S. Department of Health and Human Services. Applicants whose gross family income is equal to or less than 400% of the current year's poverty guidelines will not pay for more than 15% of their annual gross income on any single account during the approved eligibility time frame.DiscountsCMH recognizes that patients without any insurance coverage are billed at full charges, and as the hospitals offer discounts to other payers, several options for discounted billing are in place for these self pay patients. Total charges to self pay patients will be discounted 20% before any bill is submitted for payment. This discount will be noted on each patient's bill. An additional 20% discount will be extended to self pay patients if estimated charges are paid in advance of service. Self pay patients who have not prepaid, will receive a 10% prompt pay discount if the bill is paid in full within 15 days of receipt. Charity Care and certain other community benefits costs were determined by using internal information to reduce the various activities to cost. We try to present cost information consistently in the different venues that it appears. Community Memorial Hospital reports accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and others. Community Memorial Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions and trends.The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. The total revenues and costs associated with Medicare services are respectively $50,105,000 and $68,266,000. This results in a total Medicare shortfall of $18,161,000. Community Memorial Hospital believes that all of the $18,161,000 shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it, the account is referred back for a financial assistance review. Community Memorial Hospital is the only facility listed under this reporting of the IRS Form 990, Schedule H. In August 2007, the Community Outreach Steering Committee of Community Memorial Hospital (CMH) wanted to again explore how it can measurably improve the health and wellness of people who live in the hospital's service area. A review was conducted of research reports and data provided by various state, county and local agencies regarding health related issues of the area's population. This assessment indicated that the optimal goal of the community outreach efforts would be to help alleviate obesity, alcohol and tobacco addiction, and the mismanagement of diabetes and asthma among at risk populations in the area.Focus group discussions were conducted with professionals who work with at risk populations in regard to obesity, addiction and/or chronic disease management in the CHM service area. The discussions explored the causes of these problems and possible ways to reduce them. Methodology was: 1.Four focus group sessions were conducted with professionals who work with at risk populations in regard to obesity, addiction, chronic disease management or related fields in the CMH service area. 2.Qualified participants were identified and recruited by the Community Outreach department at CMH. 3.CMH contracted with a professional research group to develop the discussion topic outline and moderate sessions. 4.The research group analyzed the discussions and the findings are reported.Specific objectives of the focus group discussions included: 1.The causes, influences and factors that contribute to obesity, alcohol and tobacco addiction, and the mismanagement of diabetes and asthma. 2.What has been done and what is being done now to help reduce these problems, and the level of success to these efforts. 3.Possible solutions to alleviate obesity, alcohol and tobacco addiction, and the mismanagement of diabetes and asthma. Solutions are to be collaborative efforts among community groups/agencies/organizations, supported by the public, aimed at at risk populations, and provide measurable results. 4.The need and effectiveness of a possible central listing of resources in the community for help with these problems. 5.Work site programs to help alleviate obesity, alcohol and tobacco addiction, and the mismanagement of diabetes and asthma. Community Memorial Hospital (CMH) has a Financial Counselor who performs outreach to all self pay patients. Contact may be in person or via phone call to patient. The patient is screened for eligibility for state/local programs and/or CMH's Financial Assistance program. Information regarding our financial assistance program is also available in our registration areas, in our ED, and is noted on our billing statements. In addition, during our billing call cycle, if a patient indicates they are unable to pay, they are screened for eligibility for Financial Assistance. Since its founding in 1964 by the citizens of the community it serves, Community Memorial Hospital (CMH) has focused on the emerging healthcare and wellness needs of over half a million people in the four county region of Waukesha, Washington, northwest Milwaukee, and Ozaukee Counties. Our growth has been guided by listening carefully to people we serve, and designing and expanding our services to meet their changing needs. The population served by CMH is 88% Caucasian, 5.5% African American, 3.5% Asian American, 1.5% Hispanic/Latino, 0.5% Asian American, and 1% other. Today, CMH ranks as one of the top hospitals nationally based on surveys by the Joint Commission on Accreditation of Healthcare Organizations, which reviews all hospitals for safety and quality healthcare practices. The Hospital has 202 staffed beds and a medical staff of 657 physicians in 49 specialties, over 1,400 employees and 320 volunteers caring for 9,845 inpatients, 87,249 outpatients and 19,597 emergency visits in fiscal 2010. Based on demographic and community needs assessments, CMH has led area community based hospitals by establishing programs in hospital based day surgery, cardiac rehabilitation, and the "Right from the Start" birthing program which matches a personal obstetrics case manager with first time expectant mothers. CMH is accredited by Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), the American Association of Cardiovascular & Pulmonary Rehabilitation, the American College of Radiology (ACR), the Intersocietal Commission for Accreditation of Echocardiography, the College of American Pathologists (CAP), the American College of Surgeons (ACS), and is licensed by the State of Wisconsin. Eight area institutions of higher learning send students to CMH for clinical experiences in health care. CMH is more than a healthcare facility; it is a true community partner, joining forces with other organizations who share our vision and values. Our collaborative initiatives include outreach to youth, elderly and the underserved; satellite rehabilitation clinics offering outpatient therapy; community education in parenting and wellness topics; health screenings and support groups; a program for lab house calls to the homebound; and serving as the medical control center for five area Emergency Medical Service units. In July 2009, the American Diabetes Association acknowledged Community Memorial as having a Recognized Diabetes Self Management Education Program for outpatients. In January 2010, Community Memorial received the Gold Recognition as a Wellness Council of America Well Workplace organization, an award that recognizes quality and excellence in worksite health promotion. Also in 2010, the Cancer Care Center received Accreditation with Commendation from the American College of Surgeons - Commission on Cancer. Community Memorial was also recognized as a Quality Respiratory Care Recognition Hospital in 2010. Only 700 hospitals in the U.S. have been named a QRCR institution. The hospital received certification as a Level III Trauma Center in January 2010 and was awarded certification for its Stroke program from the Joint Commission in February 2010.The Community Outreach Health Clinic (COHC) was established by CMH in 2000 to provide quality, affordable health care to the uninsured and underinsured in our service area. COHC's rapid growth since its opening has demonstrated the need for such a service in CMH's service area. In order to promote the health of the community we serve, our hospital participates in community building activities which are not a part of Part I Charity Care and Other Community Benefits, and are not included elsewhere on Schedule H. Workforces development: Our hospital has a diversity recruiting officer who trains and recruits health professionals needed in our traditionally underserved community. The Community Outreach Steering Committee (COSC) actualizes the mission of Community Memorial Hospital (CMH) through community benefit activities that improve the quality of life and enhance wellness resources which meet identified comprehensive health needs of the communities served. The Community Outreach Steering Committee is appointed annually by the hospital president and is advisory to the CMH Board and Administration. Membership appointments are made each June with members serving one year terms. The COSC meets quarterly and is composed of hospital and board representatives plus community members representing the various constituencies of the total service area. Functions include: - Provide a leadership role in advocating community wide responses to health care needs in the community. - Facilitate and support community and health care partnerships. - Envision, assess and guide new community benefit opportunities. - Identify and describe unmet health needs. - Promote universal access to health care. - Determine allocation of the Community Outreach Services Fund. - Annually submit a community benefit report, which describes the scope of community benefit provided directly and in collaboration with others. Every year, the Froedtert & Community Health partners engage in a variety of outreach activities in collaboration with key leaders and organizations in their communities that help improve health and quality of life. Much more than the provision of charity care, the American Hospital Association defines community benefit as "promoting and protecting the health and well being of the entire community through responsive programs and services." Froedtert & Community Health strategies are based on the unique needs of each of the communities that we serve. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the F&CH partners have built important relationships with their local communities, and are committed to providing meaningful outreach programs that link each hospital to their neighbors and patients.In FY2010, Froedtert, Community Memorial and St. Joseph's Hospitals made significant investments in the health of their communities. Patients who couldn't pay for their medical care received more than $36 million in uncompensated services. Beyond providing care for the poor, we contributed $54 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities. Froedtert & Community Health members develop, and are held accountable for achieving community benefit goals, and strategies are based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the member partners have built important local relationships and are committed to providing meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert & Community Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes, health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert & Community Health, visit www.froedterthealth.org. WI true Community Outreach Health Clinic W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 501(c)(3) 28500 0 Support the operations of the clinic All other grants 5000 501(c)(3) 21500 0 Various 10 0 Grantmaker's Description of How Grants are Used Organizations submit grant requests to the Community Outreach Steering Committee (the Committee). On a quarterly basis the fund allocations are determined. Each organization selected for funds receives an award letter detailing the expectations and conditions of the grant money. In order to comply with applicable tax laws, regulations and the Community Outreach Services Fund policy, the Community Outreach Services Fund provides grant support to organizations with the understanding that:1) Grant funds distributed will be used only for the purposes designated in the award letter.2) No funds will be used for any political campaign or to support attempts to influence legislation of any governmental body. 3) If the organization loses exempt status, any unexpended funds will be returned to the Community Outreach Steering Committee.4) Adequate accounting records of the expenditures of funds will be maintained by the organization.5) This is a one time-only support distribution. In addition, the Committee includes a "Final Report Form" with each organization's award letter. The form requires the organization to provide a brief description of the activity and measurable outcomes/benefits, an expenditure report, and future plans. The Committee requests that each organization submit the "Final Report Form" to the Committee within thirty days after the completion of the project for which the funds were intended or within a maximum of one year from the receipt of funds. X false true X X X X X false true false false false false false true false false Zorbini John 237657 123940 15906 19119 396622 105075 Unger Michael J 149561 126706 12650 16225 305142 111400 Sanders Paul A 176351 33016 11361 21384 242112 25360 Pollard Dennis 282703 152152 11875 29076 475806 82062 Petasnick William D 1131447 1866561 610010 57237 3665255 1846999 O'Connell Blaine J 393660 76497 13800 18959 502916 746647 McClure Debra 279030 422 12382 9771 301605 Freiberg Kerry J 142771 70939 9190 10380 233280 54653 Evenson Rock E 141957 80153 9571 21987 253668 61971 Bestor William E 400951 472122 5750 16036 894859 221078 Sch J, Part I, Line 7 Part I, Line 7: Non-Fixed payments not listed above Certain management employees participate in an incentive compensation plan that includes some non-fixed elements. Upon the attainment of a certain financial threshold, incentive compensation is available for meeting identified goals in the areas of financial performance, operational efficiencies, quality improvements, customer satisfaction, strategic growth and partnership initiatives. In some cases the determination of whether a goal is met is absolute while others require a certain amount of discretion to determine if goal is met. In addition, the incentive compensation includes a purely discretionary component. Sch J, Part I, Line 1b Part I, Line 1b: Reason for not following policy regarding payment provisions for expenses Health club membership subsidy/discount is a benefits program applicable to all employees and is documented in the benefit program documents. Dining club membership is specified in the written employment contract which was approved by the Compensation Committee. Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Discounted or subsidized health club membership is available to all employees. Riteway Bus Services See Sch O 110807 Shuttle Bus Services false Stacy Werner See Sch O 23606 Employment false Carrie Fitzgerald Hart See Sch O 117822 Employment false Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Financial Information: The Health Systems quarterly financial information is made available to the public through Digital Assurance Corporation, Inc. website.Governing Documents and COI Policy: Documents are available to the public through the corporate office upon request. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees In establishing the compensation of the organizations CEO/Directors/Top Management, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, and amounts are reviewed and approved by the Compensation Committee of the Board of Directors. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts On an annual basis all officers, directors, trustees, key employees are required to complete a conflict of interest disclosure document. The data is compiled, and the Vice President - Chief Compliance Officer (CCO), the Vice President - General Counsel and/or delegate will review all forms and notifications to determine if any conflicts of interests exist in the disclosure documents. If it is determined that a conflict of interest exists, then the person making the disclosure shall be relieved of his/her obligations on behalf of an F&CH affiliate with respect to the transaction or arrangement that creates the conflict of interest. A report of all conflicts of interest will be made by the CCO at least once annually to the Finance Committee of the Board of Directors. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process Froedtert & Community Health accounting staff prepare form 990 which is reviewed by the Corporation's financial leaders and legal counsel. The 990 is then reviewed by KPMG, the Corporation's outside accounting firm. Next, the 990 is reviewed by the Corporation's Board of Directors. Finally, the 990 is filed as required. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Froedtert & Community Health, as the member of Community Memorial Hospital of Menomonee Falls, has the final approval of election of all board members. Form 990, Part VI, Line 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Froedtert & Community Health is the member of Community Memorial Hospital of Menomonee Falls. West Bend Surgery Center LLC 1710 Vogt Drive West Bend WI 53095 391954169 Surgical Services WI West Bend Clinic Inc F&CH Heart Institute LLC 9220 West Wisconsin Ave Milwaukee WI 532263596 Inactive WI Froedtert & Community Health Inc Horizon Ventures Limited LLC W180 N8085 Town Hall Road Menomonee Falls WI 53051 391855822 Lessor of Medical Office Building WI 916000 7879000 NA Froedtert Physician Partners Inc 9200 W Wisconsin Ave Milwaukee WI 53226 272042610 Health Care Services WI 501(c)(3) 3 Froedtert & Community Health Inc Quality Health Solutions Inc N74 W12501 Leatherwood Court Menomonee Falls WI 530514480 202636686 Health Care Services WI 501(c)(3) Ln 11, Type 1 Froedtert & Community Health Inc Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 391431192 Health, Welfare, Research and Education Promotion WI 501(c)(3) Ln 11, Type 1 Froedtert Memorial Lutheran Hospital St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend WI 530953686 392034296 Health and Welfare Promotion WI 510(c)(3) Ln 11, Type 1 St Josephs Community Hospital Inc West Bend Clinic Inc 1700 W Paradise Drive West Bend WI 53095 392034294 Health Care Services WI 501(c)(3) 3 Froedtert & Community Health Inc St Josephs Community Hospital Inc 3200 Pleasant Valley Road West Bend WI 530953868 390806302 Hospital Care Services WI 501(c)(3) 3 Froedtert & Community Health Inc Froedtert Memorial Lutheran Hospital Inc 9200 West Wisconsin Avenue Milwuakee WI 532263522 396105970 Hospital WI 501(c)(3) 3 Froedtert & Community Health Inc Community Memorial Foundation W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635057 Health and Welfare promotion WI 501(c)(3) Ln 11, Type 1 NA Community Outpatient Health Services W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 Outpatient Medical and Dental Services WI 501(c)(3) 3 NA Froedtert & Community Health Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 392014409 Management Services WI 501(c)(3) Ln 11, Type 1 NA Fitness Development Associates LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 391936497 Real Estate WI NA false false Milwaukee Center of Diagnostic Imaging 5775 Wayzata Boulevard Suite 400 St Louis Park MN 55416 411748361 Health Care WI NA false false FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 260629591 Real Estate WI na false false Progressive Physician Network Inc 9200 W Wisconsin Ave Milwaukee WI 53226 270367127 Management Services WI Froedtert & Community Health Inc C Kettle Moraine Anesthesiology Inc PO Box 8031 Appleton WI 54912 141842439 Health Care WI West Bend Clinic Inc C Community Ventures of Menomonee Falls W180N8085 Town Hall Road Menomonee Falls WI 53051 391635059 Inactive WI NA C 1.00000 false true true false false false false false false false false false true true true true true true