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PROHEALTH WAUKESHA MEMORIAL HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
PROHEALTH WAUKESHA MEMORIAL HOSPITAL INC (EIN 39-0910727)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-11
IRS object ID
201102239349302170
Schema version
2009v1.7
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)
Timestamp2011-08-11T13:55:56-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

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 Date2009-10-01TaxPeriodBeginDate

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 Signed2011-08-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone2483522500Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts460579774GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.WAUKESHAMEMORIAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionPROVISION OF HEALTH CAREActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees3112TotalNbrEmployees
Total Nbr Volunteers430TotalNbrVolunteers
Total Gross UBI12119887TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1899531ContributionsGrantsPriorYear
Contributions Grants Current Year1898420ContributionsGrantsCurrentYear
Program Service Revenue Prior Year437048638ProgramServiceRevenuePriorYear
Program Service Revenue CY448733179ProgramServiceRevenueCY
Investment Income Prior Year-24369280InvestmentIncomePriorYear
Investment Income Current Year4974621InvestmentIncomeCurrentYear
Other Revenue Prior Year5796600OtherRevenuePriorYear
Other Revenue Current Year4972834OtherRevenueCurrentYear
Total Revenue Prior Year420375489TotalRevenuePriorYear
Total Revenue Current Year460579054TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year23000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15886500GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year150927750SalariesEtcPriorYear
Salaries Etc Current Year152229990SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year89830TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year632800TotalFundrsngExpCurrentYear
Other Expense Prior Year248299396OtherExpensePriorYear
Other Expenses Current Year250762886OtherExpensesCurrentYear
Total Expenses Prior Year399339976TotalExpensesPriorYear
Total Expenses Current Year418879376TotalExpensesCurrentYear
Revenues Less Expenses Prior Year21035513RevenuesLessExpensesPriorYear
Revenues Less Expenses CY41699678RevenuesLessExpensesCY
Total Assets BOY600542207TotalAssetsBOY
Total Assets EOY671907482TotalAssetsEOY
Total Liabilities BOY328951442TotalLiabilitiesBOY
Total Liabilities EOY342083034TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY271590765NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY329824448NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROMOTE AND DELIVER EXTRAORDINARY HEALTH CARE IN THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense348010876Expense
Grants15886500Grants
Revenue441586126Revenue
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 69,600 DAYS OF INPATIENT CARE AND APPROXIMATELY 295,400 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2010. SEE SCHEDULE H FOR AN ILLUSTRATION OF ITS PROGRAM SERVICE ACCOMPLISHMENTS.Description
Total Program Service Expense348010876TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
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
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 Employees3112NumberOfEmployees
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
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
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

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 EmployeeHighestCompensatedEmployeeFormerFormer
BETTY ARNDT
DIRECTOR (PARTIAL YEAR)2.00X000
DIXON BENZ
DIRECTOR2.00X000
MARIE KINGSBURY
DIRECTOR2.00X000
JAMES GANNON
TREASURER2.00X000X
E JOHN RAASCH
DIRECTOR2.00X000
DAVID SCHMITT MD
DIRECTOR2.00X2400000
DR DOUGLAS HASTAD
DIRECTOR2.00X000
RALPH RAMIREZ
DIRECTOR2.00X000
KENNETH RIESCH
DIRECTOR2.00X000
JANE NEUMANN MD
DIRECTOR2.00X4000014620017778
EDWARD OLSON
PRESIDENT40.00X4892320141133X
ARCHEBALD PEQUET MD
SECRETARY2.00X5616000X
DAN DANGELO DDS
VICE CHAIRMAN2.00X000X
THOMAS E DALUM
CHAIRMAN2.00X000X
NANINE NELSON
ASSISTANT TREASURER2.00X031476141430X
SUSAN EDWARDS
PRESIDENT/CEO(PART YR)2.00000X
REXFORD W TITUS III
PRESDIENT/CEO (PART YR)2.000810907331932X
ROBERT W MLYNAREK
CHIEF FINANCIAL OFFICER2.00040487940009X
KATHIE STROMBOM
EXECUTIVE VICE PRESIDENT40.00210628012885X
DR JAMES GARDNER MD
VP - MEDICAL AFFAIRS40.00336145043406X
CATHY RAPP
VP - CHIEF NURSING OFFICER40.00180261021481X
KENNETH PRICE
VP - CHIEF OPERATING EX.40.00241062035727X
ERIC G HENDEE
CHIEF PHYSICIST40.00190796035369X
JOSEPH T BOTTICELLI
DIRECTOR-PHARMACY40.00170977019890X
FREDERICK L SYRJANEN
EXECUTIVE DIRECTOR40.00160688018172X
BARBARA J MATHISON
EXECUTIVE DIRECTOR40.00159320026233X
MARY JANE REICHART
EXECUTIVE DIRECTOR40.00153435031168X
ELAINE BANZHAF
FORMER KEY EMPLOYEE2.00343590359X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2412704TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1676747TotalReportableCompFrmRltdOrgs
Total Other Compensation816613TotalOtherCompensation
Number Individuals GT100 K74NumberIndividualsGT100K
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 SERVICES18369629
RICHARD STREET SUPPLY LLC
11777 WEST LAKE PARK DRIVEMILWAUKEEWI53224CONSTRUCTION SERVICES5334692
GE HEALTHCARE IITS USA
PO GOX 277475ATLANTAGA30384MAINTENANCE SERVICES3402629
MEDICAL COLLEGE OF WI
PO BOX 13308MILWAUKEEWI53213MEDICAL SERVICES3362633
LAKE COUNTRY PATHOLOGISTS
5449 MONCHES RDCOLGATEWI53017MEDICAL SERVICES3116117
FieldValueIRS element (for citing)
Number Of Contractors GT100 K55NumberOfContractorsGT100K
Related Organizations1577015RelatedOrganizations
All Other Contributions321405AllOtherContributions
Total Contributions1898420TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REV.622110433935865433935865
MEDICAL SERVICE LAB6215001217533912175339
SURGERY CENTER62140026219752621975
FieldValueIRS element (for citing)
Total Program Service Revenue448733179TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4974621TotalRevenueColumn
Exclusion$4,974,621ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Personal4476Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Personal720Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Personal3756Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column3756TotalRevenueColumn
Unrelated Business Revenue3756UnrelatedBusinessRevenue

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column4969078TotalRevenueColumn
Related Or Exempt Function Income5028286RelatedOrExemptFunctionIncome
Unrelated Business Revenue-59208UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue4969078TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column460579054TotalRevenueColumn
Related Or Exempt Function Income441586126RelatedOrExemptFunctionIncome
Unrelated Business Revenue12119887UnrelatedBusinessRevenue
Exclusion$4,974,621ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total15863500Total
Program Services15863500ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total23000Total
Program Services23000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1843107Total
Program Services246383ProgramServices
Management And General1596724ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total110019467Total
Program Services108724668ProgramServices
Management And General782528ManagementAndGeneral
Fundraising512271Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4141855Total
Program Services4034729ProgramServices
Management And General88147ManagementAndGeneral
Fundraising18979Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total28188530Total
Program Services27457739ProgramServices
Management And General601322ManagementAndGeneral
Fundraising129469Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8037031Total
Program Services7861952ProgramServices
Management And General140284ManagementAndGeneral
Fundraising34795Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total248825Total
Management And General248825ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total65675Total
Management And General65675ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total85011907Total
Program Services21595790ProgramServices
Management And General63349649ManagementAndGeneral
Fundraising66468Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total58503057Total
Program Services57940256ProgramServices
Management And General558787ManagementAndGeneral
Fundraising4014Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4847855Total
Program Services4409511ProgramServices
Management And General438344ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total13959589Total
Program Services13959589ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total32375651Total
Program Services32375651ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
DRUGS & PHARMACEUTICALS2055977520559775
BAD DEBTS1830469518304695
MEDICAID PROVIDER TAXES1276193512761935
MISCELLANEOUS16853094774401343846-135977
EDUCATION & TRAINING258786214200429401646

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2179827Total
Program Services1200063ProgramServices
Management And General978629ManagementAndGeneral
Fundraising1135Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total418879376Total
Program Services348010876ProgramServices
Management And General70235700ManagementAndGeneral
Fundraising632800Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY132210BOY
EOY71472EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3409580BOY
EOY4325885EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY49838903BOY
EOY51911201EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8267918BOY
EOY8088091EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3979361BOY
EOY4572023EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis607023325LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec351887183LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY250105486BOY
EOY255136142EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY254231661BOY
EOY217255007EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY30577088BOY
EOY130547661EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY600542207BOY
EOY671907482EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY43057210BOY
EOY37815944EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY236338304BOY
EOY244018219EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY49555928BOY
EOY60248871EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY328951442BOY
EOY342083034EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY270772162BOY
EOY329274808EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY818603BOY
EOY549640EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY271590765BOY
EOY329824448EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY600542207BOY
EOY671907482EOY
FieldValueIRS element (for citing)
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 Balance5498739BeginningOfYearBalance
Contributions1045116Contributions
Investment Earnings Or Losses-1820InvestmentEarningsOrLosses
End Of Year Balance6542035EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

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 Basis15574920OtherCostOrOtherBasis
Book Value15574920BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis268599240OtherCostOrOtherBasis
Depreciation116000045Depreciation
Book Value152599195BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis2600299OtherCostOrOtherBasis
Depreciation2286905Depreciation
Book Value313394BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis306196155OtherCostOrOtherBasis
Depreciation233600233Depreciation
Book Value72595922BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis14052711OtherCostOrOtherBasis
Book Value14052711BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings255136142TotalOfBookValueLandBuildings

Other Assets OtherAssets (8 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED FINANCING2256684
DEBT SERVICE RESERVE FUND10120510
ACCRUED INTEREST RECEIVABLE418690
DUE FROM AFFILIATES11897073
INVESTMENT IN OAW ASC2664269
OTHER ASSETS2970890
DEPRECIATION RESERVE93517746
ASSETS LIMITED TO USE6701799
FieldValueIRS element (for citing)
Total Book Value Other Assets130547661TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
ACCRUED POSTRETIREMENT MEDICAL$511,910
FAIR VALUE-INTEREST RATE SWAP$21,476,884
ASSET RETIREMENT OBLIGATION$644,251
ACCUMULATED MIN PENSION LIABILITY$31,719,688
CURRENT PORTION OF LONG-TERM DEBT$5,896,138
FieldValueIRS element (for citing)
Total Of Amounts60248871TotalOfAmounts
Total Revenue460579054TotalRevenue
Total Expenses418879376TotalExpenses
Excess Or Deficit For Year41699678ExcessOrDeficitForYear
Net Unrealized GL On Investments13022394NetUnrealizedGLOnInvestments
Prior Period Adjustments4486065PriorPeriodAdjustments
Other-$974,454OtherAmount
Total Adjustments16534005TotalAdjustments
Excess Or Deficit Per FS58233683ExcessOrDeficitPerFS

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:TO SUPPORT WAUKESHA MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION.
Part X:Description of Uncertain Tax Positions Under FIN 48: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.
Part XI, Line 8 - Other Adjustments:CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS: -6395102. CHANGE IN MINIMUM PENSION LIABILITY: 6320743. RECLASS OF EQUITY TRANSACTIONS TO INCOME STMT.: -900095.

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 Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense4190279TotalCommunityBenefitExpense
Net Community Benefit Expense4190279NetCommunityBenefitExpense
Percent Of Total Expense0.01270PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense41002841TotalCommunityBenefitExpense
Direct Offsetting Revenue20661111DirectOffsettingRevenue
Net Community Benefit Expense20341730NetCommunityBenefitExpense
Percent Of Total Expense0.06170PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense45193120TotalCommunityBenefitExpense
Direct Offsetting Revenue20661111DirectOffsettingRevenue
Net Community Benefit Expense24532009NetCommunityBenefitExpense
Percent Of Total Expense0.07440PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs78NumberOfActivitiesOrPrograms
Persons Served166684PersonsServed
Total Community Benefit Expense3339170TotalCommunityBenefitExpense
Direct Offsetting Revenue23945DirectOffsettingRevenue
Net Community Benefit Expense3315225NetCommunityBenefitExpense
Percent Of Total Expense0.01010PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs30NumberOfActivitiesOrPrograms
Persons Served5431PersonsServed
Total Community Benefit Expense2186902TotalCommunityBenefitExpense
Direct Offsetting Revenue4800DirectOffsettingRevenue
Net Community Benefit Expense2182102NetCommunityBenefitExpense
Percent Of Total Expense0.00660PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense1954062TotalCommunityBenefitExpense
Direct Offsetting Revenue1689430DirectOffsettingRevenue
Net Community Benefit Expense264632NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense488153TotalCommunityBenefitExpense
Net Community Benefit Expense488153NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs67NumberOfActivitiesOrPrograms
Persons Served3047PersonsServed
Total Community Benefit Expense1491992TotalCommunityBenefitExpense
Direct Offsetting Revenue2000DirectOffsettingRevenue
Net Community Benefit Expense1489992NetCommunityBenefitExpense
Percent Of Total Expense0.00450PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs179NumberOfActivitiesOrPrograms
Persons Served175162PersonsServed
Total Community Benefit Expense9460279TotalCommunityBenefitExpense
Direct Offsetting Revenue1720175DirectOffsettingRevenue
Net Community Benefit Expense7740104NetCommunityBenefitExpense
Percent Of Total Expense0.02350PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs179NumberOfActivitiesOrPrograms
Persons Served175162PersonsServed
Total Community Benefit Expense54653399TotalCommunityBenefitExpense
Direct Offsetting Revenue22381286DirectOffsettingRevenue
Net Community Benefit Expense32272113NetCommunityBenefitExpense
Percent Of Total Expense0.09790PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense20000TotalCommunityBuildingExpense
Net Community Building Expense20000NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense50661TotalCommunityBuildingExpense
Net Community Building Expense50661NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1560TotalCommunityBuildingExpense
Net Community Building Expense1560NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense5697TotalCommunityBuildingExpense
Net Community Building Expense5697NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Total Community Building Expense77918TotalCommunityBuildingExpense
Net Community Building Expense77918NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$7,827,221BadDebtExpenseAmount
Amount Attributable To2348166AmountAttributableTo
Amount Reimbursed By Medicare93855001AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare148060265CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-54205264MedicareSurplusOrShortfall

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 OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
PROHEALTH ALIGNED LLC
SURGICAL SERVICES0.510000.000000.49000
ORTHOPEDIC SURGERY CENTER LLC
ORTHOPEDIC SURGICAL SERVICES0.300000.000000.70000

Form990 Schedule H Part V Form990ScheduleHPartV (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalTeaching HospitalTeachingHospitalEr24 HoursEr24HoursOtherOther
WAUKESHA MEMORIAL HOSPITAL INC
725 AMERICAN AVENUEWAUKESHAWI53188XXXX
REHABILITATION HOSPITAL OF WI LLC
1625 COLDWATER CREEK DRWAUKESHAWI53188XINPATIENT REHABILITATION

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: N/AIncomeBasedCriteria
Annual Community Benefit ExplnPart I, Line 6a: PROHEALTH CARE, INC.AnnualCommunityBenefitExpln
Costing Method UsedPart 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.CostingMethodUsed
Subsidized Health Services ExplnPart I, Line 7g: N/ASubsidizedHealthServicesExpln
Percent Of Total Expense ExplnPart I, Line 7f: $18,304,695 of Bad Debt Expenses was included on Form 990, Part, IX, Line 25 but subtracted for purposes of calculating the percentage.PercentOfTotalExpenseExpln
Bad Debt FootnotePart 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 charity care program is 30% of total bad debts.BadDebtFootnote
Shortfall As Community BenefitPart 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.ShortfallAsCommunityBenefit
Needs AssessmentPart VI, Line 2: Community Needs are identified based upon 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 Compliment all of these data sources, we also periodically perform a service gap analysis with our 20+ employed parish and community outreach nurses as well as local non-profit agencies with whom we partner. We then analyze the data, Identify the pressing needs, and proactively plan and implement community benefit initiatives to help address these identified steps.NeedsAssessment
Patient Education AssistancePart VI, Line 3: 1. Social workers provide an explanation as to eligiblity under government programs upon admission into the hospital.2. If a patient is self pay, the first letter they receive from us conveys the availability of community care and our prompt pay discount policy. The letter is sent within a week of service of Op service or impatient discharge and provides our contact information. For those patients without insurance and patients with balances after insurance receive two additional letters, each of which includes information and contact number for community care. 3. Prior to an account going to collection, if we haven't had any contact from the patient on a balance over $10,000, and attempt to contact via telephone is made. 4. 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. 5. There are some patients, where between the hospital social work area and/or our own investigation, we are able to determine that a patient has nothing (lives at Salvation Army housing, halfway house, their car, deceased with no family members or estate etc.) we will do a presumptive application and grant Community Care based on the information we were able to find. 6. We do not automatically give community care just because we feel they may qualify. We need to have completed paperwork substaining 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Community Building ActivitiesPart VI, Line 5: Waukesha Memorial Hospital has partnerships with various organizations throughout the communities we serve. One example is the partnerships we have with the local Chambers of Commerce within our service area by providing leadership and health related outreach towards strengthening community development. Another example is our long standing relationship with the United Way of Waukesha County. United Way partners with many health and human services organizations in which WMH partners with. Every year WMH participates and provides leadership in the United Way Fund Raising Campaign. Without the funds that United Way provides many of these organizations couldn't afford to continue services to the vulnerable and indigent populations and that would create a shortage of access.CommunityBuildingActivities
Other InformationPart 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.OtherInformation
Affiliated Health Care SystemPart 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.A DESCRIPTION OF EACH AFFILIATES ROLE IN PROMOTING HEALTH WITHIN THE COMMUNITIES SERVED IS AS FOLLOWS:PROHEALTH CARE, INC. - HELPS TO MANAGE THE HOSPITALS TO ENSURE THEY CAN PROMOTE HEALTH AND WELLNESS WITHIN THE COMMUNITY.NATIONAL REGENCY OF NEW BERLIN, INC. - OWNS AND OPERATES SENIOR LIVING CENTERS AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.PROHEALTH HOME CARE, INC. - PROVIDES HOSPICE AND HOME HEALTH CARE SERVICES AS A MEANS TO PROMOTE HEALTH WITHIN THE COMMUNITY.WAUKESHA MEMORIAL HOSPITAL FOUNDATION, INC. - SUPPORTS THE CHARITABLE MISSION OF WAUKESHA MEMORIAL HOSPITAL SO THAT IT MAY PROVIDE HEALTH SERVICES WITHIN THE COMMUNITY.OCONOMOWOC MEMORIAL HOSPITAL, INC. - SUPPORTS THE CHARITABLE MISSION OF OCONOMOWOC MEMORIAL HOSPITAL SO THAT IT MAY PROVIDE HEALTH SERVICES WITHIN THE COMMUNITY.OCONOMOWOC MEMORIAL HOSPITAL, INC. - PROVIDES CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. OCONOMOWOC MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. OCONOMOWOC MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 11,700 DAYS OF INPATIENT CARE AND APPROXIMATELY 83,400 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2010.AffiliatedHealthCareSystem
Reports Filed With StatesWIReportsFiledWithStates

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 Grant15863500AmountOfCashGrant
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
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 (14 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
400001437910002409011931058474000016397800
EDWARD OLSON
4586300003060201154800256530630365000
NANINE NELSON
030062900014132019511021919035619100
REXFORD W TITUS III
0801720000918703046690272630114283900
ROBERT W MLYNAREK
038320800021671023517016492044488800
KATHIE STROMBOM
1742860003634203324095610223513000
DR JAMES GARDNER MD
318965000171800202850231210379551000
CATHY RAPP
174086000617502056009210201742000
KENNETH PRICE
23370400073580158570198700276789000
ERIC G HENDEE
1905120002840133910219780226165000
JOSEPH T BOTTICELLI
1687060002271042270156630190867000
FREDERICK L SYRJANEN
15031900010369010319078530178860000
BARBARA J MATHISON
15205900072610104970157360185553000
MARY JANE REICHART
14732500061100100950210730184603000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aCOUNTRY CLUB MEMBERSHIPS: MEMBERSHIPS USED EXCLUSIVELY FOR BUSINESS PURPOSES EDWARD OLSON - BENEFIT WAS NOT INCLUDED IN TAXABLE INCOME AS IT WAS FOR BUSINESS USE ONLY
Part I, Line 4aNAME PLAN REXFORD W TITUS III - SERP PLAN PARTICIPANT ROBERT MLYNAREK - SERP PLAN PARTICIPANT EDWARD OLSON - SERP PLAN PARTICIPANT
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 EMPLOYMENT CONTRACTSupplemental Information

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
WISCONSIN HEATH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710BDJ82008-08-14107960000SEE SCH. O00
WISCONSIN HEATH & EDUCATIONAL FACILITIES AUTHORITY
39133785597710BGZ92009-04-3066126415SEE SCH. O00

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount UnspentAmountUnspentCapital ExpendituresCapitalExpenditures
15250466620739152504620071011
59515749661264286077420100001485940553795571

Form990 Schedule K Part III Form990ScheduleKPartIII (2 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

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

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

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 Transaction442454AmountOfTransaction
Description Of TransactionR & R INSURANCE PROVIDES INSURANCE SERVICES TO WAUKESHA MEMORIAL HOSPITAL, INC.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanation
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 AS FILED BY THE ORGANIZATION.
Form 990, Part VI, Section B, line 12cALL OFFICERS, VICE-PRESIDENTS, MANAGERS AND ABOVE, AS WELL AS BOARD MEMBERS ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE TRACKED IN THE CORPORATE COMPLIANCE DEPARTMENT. THEY ARE REVIEWED AND ANY PERSON IDENTIFIED AS HAVING A POTENTIAL CONFLICT IS GIVEN DIRECTION AS TO WHAT STEPS SHOULD BE TAKEN TO MITIGATE THE CONCERN. ALL EMPLOYEES ARE EDUCATED ANNUALLY. THE STEPS TAKEN WHEN A CONFLICT ARISES ARE AS FOLLOWS: FOR THE BOARD OF DIRECTORS, THE RESTRICTION IS NOT BEING ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTING RELATED TO ANY DECISION WHERE THE BOARD MEMBER HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST. FOR LEADERS, RESEARCHERS, AND EMPLOYEES, RECOMMENDATIONS ARE MADE FROM COMPLIANCE MANAGER TO LEADERSHIP AND/OR HUMAN RESOURCES. RESTRICTIONS CAN RANGE FROM ANY OF THE FOLLOWING; DISCLOSING POTENTIAL CONFLICTS OF INTEREST TO PATIENTS, NOT BEING ABLE TO BE INVOLVED IN DISCUSSION OR DECISION MAKING ON SPECIFIC TOPICS, AND TO NOT BEING ABLE TO WORK AT PHC IN SPECIFIC ROLE WHERE REPORTED CONFLICT EXISTS. IF THE RECOMMENDATION IS CHALLENGED, THE CASE IS ESCALATED TO CONFLICT OF INTEREST COMMITTEE.
Form 990, Part VI, Section B, line 15AN INDEPENDENT, EXTERNAL COMPENSATION REVIEW IS CONDUCTED FOR THE POSITIONS OF 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 2010.
Form 990, Part VI, Section C, line 19FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
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.
FORM 990, PART XI, LINE 2CTHE AUDIT PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.
SCHEDULE K, PART I, A - COL. (c) CUSIP #: The CUSIP # of 97710BDH2 on Form 8038 was not the number on the bond of the latest maturity. The number for the latest maturity is correctly reported on Schedule K. SCHEDULE K, PART I, A - COL. (e) ISSUE PRICE: The total issue price on Form 8038 is $122,535,000. The amount reported on Schedule K is only the amount of the issue benefiting the reporting organization. SCHEDULE K, PART I, A - COL. (f) DESCRIPTION OF PURPOSE: Current refund bonds issued on 4/25/01 and current refund bonds issued on 6/09/04. SCHEDULE K, PART I, B - COL. (c) CUSIP #: The CUSIP # of 97710BGW6 on Form 8038 was not the number on the bond of the latest maturity. The number for the latest maturity is correctly reported on Schedule K. SCHEDULE K, PART I, B - COL. (e) ISSUE PRICE: The total issue price on Form 8038 is $134,951,867.50. The amount reported on Schedule K is only the amount of the issue benefiting the reporting organization. SCHEDULE K, PART I, B - COL. (f) DESCRIPTION OF PURPOSE: Construction and equipping of an addition and renovations to existing hospital facility and construction of a parking structure. SCHEDULE K, PART II, A - LINE 1 Total Proceeds of Issue: sale proceeds of issue in amount of $108,443,475.00 allocable to reporting organization plus zero investment proceeds less sale proceeds deposited in refunding escrows allocable to reporting organization in the amount of $106,918,428.56. SCHEDULE K, PART II, A - LINE 3 Proceeds 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. SCHEDULE K, PART II, A - LINE 5 Issuance Costs from Proceeds: $865,989.17 of proceeds allocable to reporting organization used for issuance costs; $659,057.27 used for credit enhancement. SCHEDULE K, PART II, A - LINE 8 Year 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. SCHEDULE K, PART II, B - LINE 1 Total 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.

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/BusinessNameLine1Direct Controlling Entity NADirectControllingEntityNA
OCONOMOWOC MEMORIAL HOSPITAL INC
791 SUMMIT AVENUEOCONOMOWOCWI53066390794174HOSPITALWI501(c)(3)Line 3PROHEALTH CARE INC
WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC
725 AMERICAN AVENUEWAUKESHAWI53188391314542FUNDRAISINGWI501(c)(3)Line 11a, IWAUKESHA MEMORIAL HOSPITAL INC
PROHEALTH HOME CARE INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188200067392HEALTHCAREWI501(c)(3)Line 3PROHEALTH CARE INC
NATIONAL REGENCY OF NEW BERLIN INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188391077992HEALTHCAREWI501(c)(3)Line 11c, III-FIPROHEALTH CARE INC
PROHEALTH CARE INC
N17 W24100 RIVERWOOD DR SUITE 200WAUKESHAWI53188391786873MANAGEMENTWI501(c)(3)Line 11c, III-FIN/A
OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC
791 SUMMIT AVENUEOCONOMOWOCWI53066391271647FUNDRAISINGWI501(c)(3)Line 7OCONOMOWOC MEMORIAL HOSPITAL INC

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 Income2723206ShareOfTotalIncome
Share Of EOY Assets3848785ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner1GeneralOrManagingPartner

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 Royalties0ReceiptOfIntAnnRentsRoyalties
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 Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (21 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC
C1577015
WAUKESHA HEALTH SYSTEM INC
J84000
WAUKESHA HEALTH CARE INC
J427132
MEDICAL ASSOCIATES INC
J57375
NATIONAL REGENCY OF NEW BERLIN INC
J725367
WAUKESHA HEALTH CARE INC
I891555
PROHEALTH CARE INC
L54048033
OCONOMOWOC MEMORIAL HOSPITAL INC
O1487442
PROHEALTH CARE INC
O1314146
WAUKESHA HEALTH SYSTEM INC
O450616
WAUKESHA HEALTH CARE INC
O3930699
MEDICAL ASSOCIATES INC
O356425
OCONOMOWOC MEMORIAL HOSPITAL INC
P12515004
PROHEALTH CARE INC
P17599885
WAUKESHA HEALTH SYSTEM INC
P7933276
WAUKESHA HEALTH CARE INC
P12008121
MEDICAL ASSOCIATES INC
P8708629
PROHEALTH HOME CARE INC
P1473898
EMPATHIA PACIFIC INC
P1722147
NATIONAL REGENCY OF NEW BERLIN INC
P412700
PROHEALTH CARE INC
B15863500