PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC (EIN 39-0794174)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-08-11
- IRS object ID
- 201112239349302171
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-08-11T13:55:56-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 307 | AddressLine1 |
| City | SOUTHFIELD | City |
| State | MI | State |
| ZIP Code | 480370307 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390794174 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONOMOWOC MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | OCON | NameControl |
| Phone | 2629284740 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NANINE M NELSON | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 2629284740 | Phone |
| Date Signed | 2011-08-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2483522500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SUSAN EDWARDS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 105878348 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.OCONOMOWOCMEMORIAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE GENERAL ACUTE CARE AND SUPPORT ACTIVITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 996 | TotalNbrEmployees |
| Total Nbr Volunteers | 476 | TotalNbrVolunteers |
| Total Gross UBI | 2833640 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -512019 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 509095 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 489341 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 106396726 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 102539138 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -2512827 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1111969 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1446027 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1435636 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 105839021 | TotalRevenuePriorYear |
| Total Revenue Current Year | 105576084 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 3267500 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 36537596 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 34874944 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 67811080 | OtherExpensePriorYear |
| Other Expenses Current Year | 65905991 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 104348676 | TotalExpensesPriorYear |
| Total Expenses Current Year | 104048435 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1490345 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1527649 | RevenuesLessExpensesCY |
| Total Assets BOY | 168207666 | TotalAssetsBOY |
| Total Assets EOY | 169746053 | TotalAssetsEOY |
| Total Liabilities BOY | 114936815 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 113173430 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 53270851 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 56572623 | NetAssetsOrFundBalancesEOY |
| Mission Description | OCONOMOWOC MEMORIAL HOSPITAL ... PARTNERING TO DELIVER COMPASSIONATE, RESPECTFUL, EXTRAORDINARY, AND LIFE-ENHANCING HEALTHCARE WITHIN OUR COMMUNITY -- ONE PERSON AT A TIME. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 96435505 | Expense |
| Grants | 3267500 | Grants |
| Revenue | 100804002 | Revenue |
| Description | OCONOMOWOC MEMORIAL HOSPITAL FULFILLS ITS EXEMPT PURPOSE BY PROVIDING 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. | Description |
| Total Program Service Expense | 96435505 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 112 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 996 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NANINE NELSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2629284740 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | N17 W24100 RIVERWOOD DRIVE SUITE | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53188 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| EDWARD J LUMP | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| RICHARD NEILS MD | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| GLENN ROSKILLY | ||||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | |||
| MICHAEL G BARRY | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| JASON DAVORAK | ||||||||
| DIRECTOR (PARTIAL YEAR) | 2.00 | X | 0 | 0 | 0 | |||
| THOMAS R PACKEE | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| TED GARVEY | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| MATTHEW S MACLEAN | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| CHARLOTTE HALL | ||||||||
| DIRECTOR (PARTIAL YEAR) | 4.00 | X | 0 | 0 | 0 | |||
| MAC DORN | ||||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X | ||
| HELEN FORSTER | ||||||||
| VICE CHAIRPERSON | 2.00 | X | 0 | 0 | 0 | X | ||
| JOHN R ROBERTSTAD | ||||||||
| PRESIDENT & CEO - OMH | 40.00 | X | 366616 | 0 | 41346 | X | ||
| JANET R SWANDBY | ||||||||
| CHAIRPERSON | 3.00 | X | 0 | 0 | 0 | X | ||
| REXFORD W TITUS III | ||||||||
| DIRECTOR,PRESIDENT/CEO (PARTIAL YR) | 2.00 | 0 | 810907 | 331932 | X | |||
| SUSAN EDWARDS | ||||||||
| PRESIDENT/CEO (PARTIAL YR) | 2.00 | 0 | 0 | 0 | X | |||
| MARY LEE RATZEL | ||||||||
| SECRETARY | 2.00 | 0 | 0 | 0 | X | |||
| ROBERT W MLYNAREK | ||||||||
| CHIEF FINANCIAL OFFICER | 2.00 | 0 | 404879 | 40009 | X | |||
| PATRICIA SCHROEDER KASHOU | ||||||||
| FORMER KEY EMPLOYEE | 40.00 | 47347 | 0 | 2585 | X | |||
| BARBARA J PINEKENSTEIN | ||||||||
| EXECUTIVE VP- CHIEF NURSING OFFICER | 40.00 | 217182 | 0 | 6300 | X | |||
| MARY JO O'MALLEY | ||||||||
| VP - OPERATIONS | 40.00 | 160798 | 0 | 31909 | X | |||
| MOHAMMAD S KHARBAT | ||||||||
| DIRECTOR-PHARMACY | 40.00 | 148861 | 0 | 14966 | X | |||
| NICKOLAS G ARGEROUDIS | ||||||||
| DIRECTOR-BUSINESS DEVELOPMENT | 40.00 | 132678 | 0 | 35809 | X | |||
| MARK A ZWASKA | ||||||||
| PHARMACIST | 40.00 | 125307 | 0 | 28845 | X | |||
| STEVEN J STROHBUSCH | ||||||||
| EXECUTIVE DIRECTOR-ORTHOPEDICS | 40.00 | 124301 | 0 | 18046 | X | |||
| GARY V SIUTA | ||||||||
| PHARMACIST | 40.00 | 122639 | 0 | 13877 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1398382 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1215786 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 563039 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CG SCHMIDT | |||||
| 11777 W LAKE PARK DRIVE | MILWAUKEE | WI | 53224 | CONSTRUCTION SERVICE | 31237688 |
| GE MEDICAL SYSTEMS INF TECH | |||||
| 5517 COLLECTION CENTER DR | CHICAGO | IL | 60693 | MEDICAL IT SERVICES | 1106823 |
| GE MEDICAL SYSTEMS | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | MAINTANENCE SERVICES | 604909 |
| GE HEALTHCARE | |||||
| PO BOX 640200 | PITTSBURGH | PA | 15264 | MAINTANENCE SERVICES | 573035 |
| KITCHENS TO GO LLC | |||||
| 131 W JEFFERSON AVE STE 223 | NAPERVILLE | IL | 60540 | CONSTRUCTION SERVICE | 418000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 24 | NumberOfContractorsGT100K |
| Related Organizations | 322287 | RelatedOrganizations |
| Government Grants | 94806 | GovernmentGrants |
| All Other Contributions | 72248 | AllOtherContributions |
| Total Contributions | 489341 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 622110 | 98486299 | 98486299 | |
| LABORATORY REVENUE | 621500 | 2191561 | 2191561 | |
| PHARMACY SALES | 446110 | 1861278 | 1219199 | 642079 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 102539138 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1104944 | TotalRevenueColumn |
| Exclusion | $1,104,944 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 327816 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 302264 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 25552 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25552 | TotalRevenueColumn |
| Related Or Exempt Function Income | 25552 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7025 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7025 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7025 | TotalRevenueColumn |
| Exclusion | $7,025 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | 1072952 | 1072952 | |
| CAFETERIA SALES | 722210 | 336366 | $336,366 | |
| BABY PORTRAITS | 812900 | 766 | $766 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1410084 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 105576084 | TotalRevenueColumn |
| Related Or Exempt Function Income | 100804002 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2833640 | UnrelatedBusinessRevenue |
| Exclusion | $1,449,101 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3267500 | Total |
| Program Services | 3267500 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1172631 | Total |
| Management And General | 1172631 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25109819 | Total |
| Program Services | 24496962 | ProgramServices |
| Management And General | 612857 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1049862 | Total |
| Program Services | 978540 | ProgramServices |
| Management And General | 71322 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5636345 | Total |
| Program Services | 5253442 | ProgramServices |
| Management And General | 382903 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1906287 | Total |
| Program Services | 1800225 | ProgramServices |
| Management And General | 106062 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35700 | Total |
| Management And General | 35700 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16800 | Total |
| Management And General | 16800 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22922031 | Total |
| Program Services | 20434007 | ProgramServices |
| Management And General | 2488024 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18905 | Total |
| Management And General | 18905 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18679065 | Total |
| Program Services | 18505377 | ProgramServices |
| Management And General | 173688 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73796 | Total |
| Program Services | 73436 | ProgramServices |
| Management And General | 360 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2865909 | Total |
| Program Services | 1133575 | ProgramServices |
| Management And General | 1732334 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64971 | Total |
| Program Services | 52413 | ProgramServices |
| Management And General | 12558 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69872 | Total |
| Program Services | 24696 | ProgramServices |
| Management And General | 45176 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5095916 | Total |
| Program Services | 5095916 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7801253 | Total |
| Program Services | 7698344 | ProgramServices |
| Management And General | 102909 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 417523 | Total |
| Management And General | 417523 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 4126460 | 4126460 | |
| MEDICAID PROVIDER TAXES | 3020427 | 3020427 | |
| DUES, FEES & LICENSES | 321074 | 155002 | 166072 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 376289 | Total |
| Program Services | 319183 | ProgramServices |
| Management And General | 57106 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104048435 | Total |
| Program Services | 96435505 | ProgramServices |
| Management And General | 7612930 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 288720 | BOY |
| EOY | 1286400 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12644510 | BOY |
| EOY | 9304916 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38281 | BOY |
| EOY | 4557 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2382851 | BOY |
| EOY | 2340762 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 519141 | BOY |
| EOY | 590332 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 187694003 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 77185161 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100650358 | BOY |
| EOY | 110508842 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43088048 | BOY |
| EOY | 36767506 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27142 | BOY |
| EOY | 170999 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8568615 | BOY |
| EOY | 8771739 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 168207666 | BOY |
| EOY | 169746053 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11360641 | BOY |
| EOY | 9428313 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8061 | BOY |
| EOY | 8061 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 92782626 | BOY |
| EOY | 92055766 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 311803 | BOY |
| EOY | 22313 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10473684 | BOY |
| EOY | 11658977 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114936815 | BOY |
| EOY | 113173430 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46595660 | BOY |
| EOY | 49041739 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6368279 | BOY |
| EOY | 7209662 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 306912 | BOY |
| EOY | 321222 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53270851 | BOY |
| EOY | 56572623 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 168207666 | BOY |
| EOY | 169746053 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 306912 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 14310 | InvestmentEarningsOrLosses |
| End Of Year Balance | 321222 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 317404 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -10492 | InvestmentEarningsOrLosses |
| End Of Year Balance | 306912 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2030526 | OtherCostOrOtherBasis |
| Book Value | 2030526 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 121459787 | OtherCostOrOtherBasis |
| Depreciation | 29800831 | Depreciation |
| Book Value | 91658956 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4141462 | OtherCostOrOtherBasis |
| Depreciation | 2880048 | Depreciation |
| Book Value | 1261414 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 59253928 | OtherCostOrOtherBasis |
| Depreciation | 43981906 | Depreciation |
| Book Value | 15272022 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 808300 | OtherCostOrOtherBasis |
| Depreciation | 522376 | Depreciation |
| Book Value | 285924 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 110508842 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (7 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ACCOUNTS RECEIVABLE FOUNDATION | 146822 |
| ACCRUED INTEREST RECEIVABLE | 48802 |
| BENEFICIAL INTEREST IN PERPETUAL TRUST | 321222 |
| DEFERRED FINANCING | 530656 |
| MISCELLANEOUS RECEIVABLES | 356093 |
| INTEREST IN THE NET ASSETS OF OMHF, INC. | 6380446 |
| DUE FROM AFFILIATES | 987698 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 8771739 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED MINIMUM PENSION | $8,093,095 |
| ACCRUED POSTRETIREMENT | $179,563 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENT | $74,992 |
| INTEREST RATE SWAPS, AT FAIR VALUE | $2,991,205 |
| ASSET RETIREMENT OBLIGATION | $320,122 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11658977 | TotalOfAmounts |
| Total Revenue | 105576084 | TotalRevenue |
| Total Expenses | 104048435 | TotalExpenses |
| Excess Or Deficit For Year | 1527649 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 232035 | NetUnrealizedGLOnInvestments |
| Other | $1,542,088 | OtherAmount |
| Total Adjustments | 1774123 | TotalAdjustments |
| Excess Or Deficit Per FS | 3301772 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Line 4: | Description of Intended Use of Endowment Funds: | OCONOMOWOC MEMORIAL HOSPITAL USES FUNDS FROM THE ENDOWMENT TO FURTHER ITS CHARITABLE MISSION. |
| Part X: | Description of Uncertain Tax Positions Under FIN 48: | FIN48 DISCLOSURE: FEDERAL INCOME TAX - PHC, WMH, OMH, NATIONAL REGENCY, AND PHHC ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. ALL OF THESE ENTITIES ARE, HOWEVER, SUBJECT TO FEDERAL AND STATE INCOME TAXES ON ANY UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 511 OF THE CODE. WHS IS A FOR-PROFIT STOCK CORPORATION AND IS SUBJECT TO INCOME TAXES. WHS ACCOUNTS FOR INCOME TAXES UNDER THE ASSET AND LIABILITY METHOD. UNDER THIS METHOD, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED RELATED TO THE FUTURE TAX CONSEQUENCES ATTRIBUTABLE TO DIFFERENCES BETWEEN THE CONSOLIDATED FINANCIAL STATEMENT CARRYING AMOUNTS OF EXISTING ASSETS AND LIABILITIES AND THEIR RESPECTIVE TAX BASES AND OPERATING LOSS AND TAX CREDIT CARRYFORWARDS. DEFERRED TAX ASSETS AND LIABILITIES ARE MEASURED USING ENACTED TAX RATES EXPECTED TO APPLY TO TAXABLE INCOME IN THE YEARS IN WHICH THOSE TEMPORARY DIFFERENCES ARE EXPECTED TO BE RECOVERED OR SETTLED. THE ACCOUNTING STANDARD THAT REFERS TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IS EFFECTIVE FOR FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2006 FOR NONPUBLIC ENTITIES THAT HOLD PUBLIC DEBT. THE STANDARD ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED ON THE CONSOLIDATED FINANCIAL STATEMENT. COMPANIES MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE STANDARD ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. THE CORPORATION ADOPTED THIS STANDARD AS OF OCTOBER 1, 2007. THE ADOPTION DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS. |
| Part XI, Line 8 - Other Adjustments: | EQUITY CHANGE IN INTEREST OF NET ASSETS OF RELATED ORGANIZATION: 651088. PENSION-RELATED CHANGES: 891000. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 927355 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 927355 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 24962226 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19480491 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5481735 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05680 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25889581 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19480491 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6409090 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06640 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 51 | NumberOfActivitiesOrPrograms |
| Persons Served | 44954 | PersonsServed |
| Total Community Benefit Expense | 686487 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11013 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 675474 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00700 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 24 | NumberOfActivitiesOrPrograms |
| Persons Served | 1326 | PersonsServed |
| Total Community Benefit Expense | 436953 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 436953 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00450 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 214153 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 214153 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 20 | PersonsServed |
| Total Community Benefit Expense | 365235 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 365235 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00380 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 104 | NumberOfActivitiesOrPrograms |
| Persons Served | 46300 | PersonsServed |
| Total Community Benefit Expense | 1702828 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11013 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1691815 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01750 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 104 | NumberOfActivitiesOrPrograms |
| Persons Served | 46300 | PersonsServed |
| Total Community Benefit Expense | 27592409 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 19491504 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8100905 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08390 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 6630 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6630 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 11349 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11349 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 17979 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 17979 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,934,114 | BadDebtExpenseAmount |
| Amount Attributable To | 580234 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 17977617 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 32833327 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -14855710 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 0 | WrittenDebtCollectionPolicy |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE COUNTRY ENDOSCOPY CENTER LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | DIAGNOSTIC CENTER | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.50000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.50000 | PhysicansProfitOrOwnership |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OCONOMOWOC MEMORIAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 791 SUMMIT AVENUE | AddressLine1 |
| City | OCONOMOWOC | City |
| State | WI | State |
| ZIP Code | 530663844 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: N/A | IncomeBasedCriteria |
| Annual Community Benefit Expln | Part I, Line 6a: ProHealth Care, Inc. | AnnualCommunityBenefitExpln |
| Costing Method Used | Part I, Line 7: The cost-to-charge ratio was used to calculate amounts. This was calculated by using Worksheet 2 of the Schedule H Instructions. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: N/A | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: $4,246,460 of Bad Debt Expenses was included on Form 990, Part IX, line 25 but subtracted for purposes of calculating the percentage. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: BAD DEBT EXPENSE FOOTNOTE: An allowance for uncollectible accounts is established on an aggregate basis by using historical write-off rate factors applied to unpaid accounts based on aging. Loss rate factors are based on historical loss experience and are adjusted for economic conditions and other trends affecting the Hospital's ability to collect outstanding amounts. Uncollectible amounts are written off against the allowance for doubtful accounts in the period they are determined to be uncollectible. The bad debt cost was reviewed by the hospital's revenue cycle team and the amount of bad debt estimated to be attributable to patients who would have qualified under our charity care program is 30% of total bad debts. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The shortfall on Line 7 should not be treated as community benefit. Costing methodology is the cost to charge ratio as reported on the Medicare cost report. | ShortfallAsCommunityBenefit |
| Needs Assessment | Part 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 Assistance | Part 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 inpatient discharge and provides our contact information. 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, an 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 Information | Part VI, Line 4: ProHealth Care serves about 285,000 people each year in Waukesha County and portions of the surrounding Jefferson, Walworth, Racine and Dodge Counties. ProHealth Care functions in a crowded health care marketplace with six other providers and currently holds 44.1% market share in Waukesha County. In every federal population census, Waukesha County has recorded an increase in population. Since 1960, the population of the county has more than doubled, and the U.S. Census predicts moderate population growth (3%) over the next five years. Waukesha County has an aging population with the rate of retirement likely to surpass the rate of entry into the workforce between 2015 and 2020. The racial makeup of the Waukesha County community is as follows: White 94.6%, Hispanic or Latino 3.7%, Asian 2.6%, Black 1.5%, Other .3%. Median household income is $75,754 with 4.1% of people living below the poverty level. Waukesha County has the second highest median home price in the state with 19% of households paying more than 30 percent of their gross monthly income on housing. The presence of some very upscale communities in Waukesha County often gives a mistaken impression. Often overlooked is a growing population of low income, non-English speaking, vulnerable and marginalized citizens who face enormous odds in accessing health care. The Waukesha County Medicaid population has nearly tripled in 10 years, from about 9,451 people in 2000 to more than 29,395 in 2010. The Hispanic population has seen a 42% increase in the past 8 years. Forty different languages are spoken by students in the Waukesha Public Schools. The five area homeless shelters reached capacity early in 2009, requiring an additional emergency shelter be added. Downtown Waukesha was declared a "medically underserved" area and a "health-professional shortage area" by the federal government in 2008. As an underserved area, medical options for individuals, particularly those without health insurance or with public insurance, are severely limited since private service providers often refuse to care for these individuals. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Oconomowoc 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 OMH partners with. Every year OMH 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 Information | Part VI, Line 6: Because of the relatively rural nature of our service area, our community benefit program makes a conscious effort to reach out and find disadvantaged, underserved populations. These target populations include non English speaking, uninsured or underinsured, isolated and frail elderly, homeless, and mentally disabled. We include community members on our government board and Community Benefit Steering Committee. We also make extensive use of community partner agencies in planning, design and operation of community benefit programs. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: Our hospital is a member of the ProHealth Care health system which serves as our parent company. While community benefit responsibilities reside with our hospital board, the parent company plays a key role in coordinating community needs assessments, community benefit program planning, and evaluation.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.WAUKESHA MEMORIAL HOSPITAL, INC. - PROVIDES 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. | AffiliatedHealthCareSystem |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROHEALTH CARE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | N17 W24100 RIVERWOOD DR STE 200 | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 531881131 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 391486873 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 3267500 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
| Description Of Non Cash Assistance | N/A | DescriptionOfNonCashAssistance |
| Purpose Of Grant | TO ASSIST OCONOMOWOC MEMORIAL HOSPITAL IN ITS CHARITABLE MISSION. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN R ROBERTSTAD | |||||||||||||
| 361836 | 0 | 0 | 0 | 4780 | 0 | 21774 | 0 | 19572 | 0 | 407962 | 0 | 0 | 0 |
| REXFORD W TITUS III | |||||||||||||
| 0 | 801720 | 0 | 0 | 0 | 9187 | 0 | 304669 | 0 | 27263 | 0 | 1142839 | 0 | 0 |
| ROBERT W MLYNAREK | |||||||||||||
| 0 | 383208 | 0 | 0 | 0 | 21671 | 0 | 23517 | 0 | 16492 | 0 | 444888 | 0 | 0 |
| BARBARA J PINEKENSTEIN | |||||||||||||
| 183896 | 0 | 15000 | 0 | 18286 | 0 | 0 | 0 | 6300 | 0 | 223482 | 0 | 0 | 0 |
| MARY JO O'MALLEY | |||||||||||||
| 144200 | 0 | 0 | 0 | 16598 | 0 | 11994 | 0 | 19915 | 0 | 192707 | 0 | 0 | 0 |
| MOHAMMAD S KHARBAT | |||||||||||||
| 148768 | 0 | 0 | 0 | 93 | 0 | 3261 | 0 | 11705 | 0 | 163827 | 0 | 0 | 0 |
| NICKOLAS G ARGEROUDIS | |||||||||||||
| 83777 | 0 | 0 | 0 | 48901 | 0 | 9335 | 0 | 26474 | 0 | 168487 | 0 | 0 | 0 |
| MARK A ZWASKA | |||||||||||||
| 122285 | 0 | 0 | 0 | 3022 | 0 | 15499 | 0 | 13346 | 0 | 154152 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | MEMBERSHIPS USED EXCLUSIVELY FOR BUSINESS PURPOSES JOHN ROBERTSTAD - BENEFIT WAS NOT INCLUDED IN TAXABLE INCOME AS MEMBERSHIP IS FOR BUSINESS ONLY. | |
| Part I, Line 4a | NAME PLAN REXFORD W TITUS III - SERP PLAN PARTICIPANT JOHN ROBERTSTAD - SERP PLAN PARTICIPANT ROBERT MLYNAREK - SERP PLAN PARTICIPANT | |
| Part III | SCHEDULE 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 CONTRACT | Supplemental Information |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||
| 391337855 | 97710BDJ8 | 2008-08-14 | 14575000 | see sch. o | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||
| 391337855 | 97710BGZ9 | 2009-04-30 | 68825452 | see sch. o | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount In Reserve FundAmountInReserveFund | Capital ExpendituresCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|
| 198170 | 198170 | 2007 | 1 | 0 | 1 | 1 | ||
| 61944963 | 895907 | 2010 | 0 | 0 | 0 | 1 | 6882545 | 61049056 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 1 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 1 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 1 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CATHERINE ROBERTSTAD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | WIFE OF JOHN ROBERTSTAD, BOARD MEMBER & CEO OF OCONOMOWOC MEMORIAL HOSPITAL | Relationship |
| Amount Of Transaction | 40307 | AmountOfTransaction |
| Description Of Transaction | EMPLOYED BY OCONOMOWOC MEMORIAL HOSPITAL | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | PROHEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER. |
| Form 990, Part VI, Section A, line 7b | PROHEALTH 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 11 | AFTER 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 12c | ALL OFFICERS, VICE-PRESIDENTS, MANAGERS AND ABOVE, AS WELL AS BOARD MEMBERS ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST FORM. ALL REPORTED POTENTIAL CONFLICTS OF INTEREST ARE TRACKED IN THE CORPORATE COMPLIANCE DEPARTMENT. THEY ARE REVIEWED AND ANY PERSON IDENTIFIED AS HAVING A POTENTIAL CONFLICT 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 15 | AN 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 19 | FINANCIAL 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 ---------------------------------------------------------------------- ROBERT MLYNAREK GREATER THAN 40.00 PROHEALTH CARE, INC. REXFORD W TITUS, III GREATER THAN 40.00 PROHEALTH CARE, INC. | |
| FORM 990, PART XI, LINE 2C | THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT 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 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 addition and renovations to existing hospital facility. SCHEDULE K, PART II, A - line 1 Total Proceeds of Issue: sale proceeds of issue in amount of $14,091,525.00 allocable to reporting orgainzation plus zero investment proceeds less sale proceeds deposited in refunding escrows allocable to reporting organization in the amount of $13,893,355.12. SCHEDULE K, PART II, A - line 3 Proceeds in Refunding Escrows: Proceeds in the amount of $13,893,355.12 allocable to reporting organization deposited in refunding escrows on 8/14/08; balance on 9/30/10 is zero. SCHEDULE K, PART II, A 5 Issuance Costs from Proceeds: $112,529.67 of proceeds allocable to reporting organization used for issuance costs; $85,640.21 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 2001 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 $68,825,452.42 allocable to reporting organization plus $2,056.31 of investment proceeds allocable to reporting organization less sale proceeds in the amount of $6,882,545.24 deposited in reasonably required reserve fund allocable to reporting organization. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|
| WAUKESHA MEMORIAL HOSPITAL INC | ||||||||||
| 725 AMERICAN AVENUE | WAUKESHA | WI | 53188 | 390910727 | HOSPITAL | WI | 501(c)(3) | Line 3 | PROHEALTH CARE INC | |
| WAUKESHA MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 725 AMERICAN AVENUE | WAUKESHA | WI | 53188 | 391314542 | FUNDRAISING | WI | 501(c)(3) | Line 11a, I | WAUKESHA MEMORIAL HOSPITAL INC | |
| PROHEALTH HOME CARE INC | ||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 200067392 | HEALTHCARE | WI | 501(c)(3) | Line 3 | PROHEALTH CARE INC | |
| NATIONAL REGENCY OF NEW BERLIN INC | ||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 531881131 | 391077992 | HEALTHCARE | WI | 501(c)(3) | Line 11c, III-FI | PROHEALTH CARE INC | |
| PROHEALTH CARE INC | ||||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 531881131 | 391786873 | MANAGEMENT | WI | 501(c)(3) | Line 11c, III-FI | N/A | |
| OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 791 SUMMIT AVENUE | OCONOMOWOC | WI | 53066 | 391271647 | FUNDRAISING | WI | 501(c)(3) | Line 7 | OCONOMOWOC MEMORIAL HOSPITAL INC | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PROHEALTH ALIGNED LLC (DBA MSC) | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 DELAFIELD STREET STE 1 | AddressLine1 |
| City | WAUKESHA | City |
| State | WI | State |
| ZIP Code | 53188 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263324572 | EIN |
| Primary Activity | SURGERY CENTER | PrimaryActivity |
| Legal Domicile State | WI | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| WAUKESHA HEALTH SYSTEM INC | ||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391507910 | HEALTHCARE | WI | N/A | C |
| EMPATHIA PACIFIC INC | ||||||||
| 31416 AGOURA RD STE 180 | WESTLAKE VILLAGE | CA | 91361 | 953070501 | HEALTHCARE | CA | N/A | C |
| MEDICAL ASSOCIATES INC | ||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391083015 | HEALTHCARE | WI | N/A | C |
| NATIONAL AVENUE DEVELOPEMNT CORPORATION | ||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391417226 | HEALTHCARE | WI | N/A | C |
| WAUKESHA HEALTH CARE INC | ||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391773598 | HEALTHCARE | WI | N/A | C |
| EMPATHIA INC | ||||||||
| N17 W24100 RIVERWOOD DRIVE SUITE 20 | WAUKESHA | WI | 53188 | 391567366 | HEALTHCARE | WI | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (17 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC | |
| C | 308391 |
| PROHEALTH CARE INC | |
| I | 138677 |
| WAUKESHA HEALTH CARE INC | |
| I | 102623 |
| WAUKESHA HEALTH CARE INC | |
| J | 94656 |
| PROHEALTH CARE INC | |
| L | 12736520 |
| WAUKESHA MEMORIAL HOSPITAL INC | |
| O | 12515004 |
| PROHEALTH CARE INC | |
| O | 823134 |
| WAUKESHA HEALTH SYSTEM INC | |
| O | 234242 |
| WAUKESHA HEALTH CARE INC | |
| O | 1629850 |
| MEDICAL ASSOCIATES INC | |
| O | 1127236 |
| WAUKESHA MEMORIAL HOSPITAL INC | |
| P | 1487442 |
| PROHEALTH CARE INC | |
| P | 451097 |
| WAUKESHA HEALTH SYSTEM INC | |
| P | 2006657 |
| WAUKESHA HEALTH CARE INC | |
| P | 223663 |
| PROHEALTH HOME CARE INC | |
| P | 197185 |
| OCONOMOWOC MEMORIAL HOSPITAL FOUNDATION INC | |
| P | 362433 |
| PROHEALTH CARE INC | |
| B | 3267500 |