2024-07-30T11:17:58-05:00 2023-09-30 381357951 PLANTE & MORAN PLLC 3000 TOWN CENTER SUITE 100 SOUTHFIELD MI 48075 990 2022-10-01 390794174 PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC OCON 2629282496 791 SUMMIT AVENUE OCONOMOWOC WI 530663844 ANDREW GUTIERREZ CHIEF FINANCIAL OFFICER 2629282496 2024-07-26 1 1 DAVID LOWENTHAL P00378651 2483522500 2024-06-28 2022 2024-08-08 14:25:15Z SUSAN EDWARDS 791 SUMMIT AVENUE OCONOMOWOC WI 530663844 131924128 0 X WWW.PROHEALTHCARE.ORG X 1948 WI PROVIDE GENERAL ACUTE CARE AND SUPPORT ACTIVITIES. 3 2 1030 92 1490298 0 673035 207800 130321596 130984914 172527 -7552 312030 385847 131479188 131571009 0 0 0 0 34800547 33272007 0 0 0 90414211 95647705 125214758 128919712 6264430 2651297 122249630 114962435 111769831 110805309 10479799 4157126 CONTINUOUSLY IMPROVING THE HEALTH OF OUR COMMUNITY. 0 0 111050373 129494616 PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 8,909 DAYS OF INPATIENT CARE AND APPROXIMATELY 85,554 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2023. 111050373 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 72 0 1 1030 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 WI X ANDREW GUTIERREZ 2629282453 N17 W24100 RIVERWOOD DRIVE SUITE WAUKESHA WI 53188 SUSAN EDWARDS PRESIDENT AND CEO - PHC 2.00 50.00 X X 0 2193635 681826 GARY BEYER CHAIRPERSON 2.00 8.00 X X 0 0 0 JOHN HALLETT VICE CHAIRPERSON 2.00 8.00 X X 0 0 0 ANDREW GUTIERREZ CHIEF FINANCIAL OFFICER 2.00 50.00 X 0 515387 142213 KENNETH PRICE CHIEF OPERATING OFFICER 2.00 48.00 X 0 886988 311188 SHARON REHNBERG MGR PATIENT CARE 40.00 0.00 X 137402 0 24864 BENJAMIN DIAMADUROS PHARMACIST - INPATIENT 40.00 0.00 X 150056 0 20796 TARA SCHWEFEL PHARMACIST - INPATIENT 36.00 0.00 X 174538 0 6429 SHAWN RUTKA PHARMACIST - INPATIENT 40.00 0.00 X 152152 0 50970 AARON RAABE PHARMACIST - INPATIENT 40.00 0.00 X 205307 0 49571 819455 3596010 1287857 24 0 1 0 PHCOAW CO-MANAGEMENT COMPANY N17W24100 RIVERWOOD DR STE 130 WAUKESHA WI 53188 MANAGEMENT SERVICES 1106109 SUPERIOR HEALTH LINENS 2905 SYENE RD MADISON WI 53713 LINEN SERVICE 421617 PAUL CRANDALL & ASSOCIATES 1645 N PORT WASHINGTON RD GRAFTON WI 53024 CONSTRUCTION SERVICES 287247 OCONOMOWOC LANDSCAPE SUPPLY N68W376850 COUNTY ROAD K OCONOMOWOC WI 53066 PROFESSIONAL SERVICES 252711 ENVIRONMENT CONTROL OF WI 2902 AGRICULTURE DRIVE MADISON WI 537186876 PROFESSIONAL SERVICES 244524 9 196800 11000 207800 PATIENT SERVICES 621110 128243253 128243253 PHARMACY SALES 456110 1047102 1047102 LCEC JOINT VENTURE 621110 864425 864425 NON-PATIENT MEDICAL SERVICES 621500 443196 443196 PHS DISTRIBUTION 621110 300500 300500 86438 86438 130984914 23899 23899 259062 211140 47922 47922 47922 110528 141979 -31451 -31451 -31451 CAFETERIA SALES 722514 337925 337925 337925 131571009 129494616 1490298 378295 X 26635873 25582005 1053868 854601 854601 3822984 3793999 28985 1958549 1958549 1044605 1044605 13179737 13014896 164841 938498 675385 263113 4858733 4858733 2150663 2101841 48822 15529 15529 59629 59629 3122604 3122604 22787467 6631153 16156314 8677782 8649835 27947 301482 301482 SURGICAL IMPLANTS 9471864 9471864 DRUGS 8026568 8026568 MEDICAL SUPPLIES 6140626 6140626 BAD DEBT EXPENSE 3240311 3240311 11631607 11506158 125449 128919712 111050373 17869339 0 9978096 2293036 15374603 16970629 2874780 3131958 226837 267936 220840037 131513373 90372107 89326664 742839 707264 2680368 2264948 122249630 114962435 14150617 14425243 27818 10059 97591396 96370007 111769831 110805309 X 10142263 3832160 337536 324966 10479799 4157126 122249630 114962435 X 2651297 26030 -9000000 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 304133 304133 304133 304133 304133 304133 304133 304133 304133 304133 0.00000 1.00000 0.00000 0 1 1 2030526 2030526 163556734 91424789 72131945 2469703 1804329 665374 48781771 38259978 10521793 4001303 24277 3977026 89326664 INTERCOMPANY NOTE PAYABLE 96110631 LEASE PAYABLE 259376 96370007 PART V, LINE 4: PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL USES FUNDS FROM THE ENDOWMENT TO FURTHER ITS CHARITABLE MISSION. 1 1 X 1 X 1 X 1 1 0 1 1 97552 97552 0.00080 10753280 2834292 7918988 0.06300 10850832 2834292 8016540 0.06380 24 45628 445208 36495 408713 0.00330 8 330 976399 976399 0.00780 7 7871 106211 106211 0.00080 39 53829 1527818 36495 1491323 0.01190 39 53829 12378650 2870787 9507863 0.07570 1 2052 2052 0.00000 3 467 34686 34686 0.00030 1 1040 1040 0.00000 1 16 3327 3327 0.00000 6 483 41105 41105 0.00030 1 3240311 245582 21783800 28912793 -7128993 X 1 1 1 LAKE COUNTRY ENDOSCOPY CENTER LLC DIAGNOSTIC CENTER 0.50000 0.50000 1 1 PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL INC 791 SUMMIT AVENUE OCONOMOWOC WI 530663844 WWW.PROHEALTHCARE.ORG #113 X X X PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X X 22 1 1 0 1 X HTTPS://TINYURL.COM/Y9C7P5JJ X X 1 22 1 HTTPS://TINYURL.COM/Y9C7P5JJ 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X X 1 X HTTPS://TINYURL.COM/Y892WQSN X HTTPS://TINYURL.COM/Y892WQSN X HTTPS://TINYURL.COM/Y892WQSN X X X X X X X 1 X 0 X X X X 1 X 0 0 PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 3J: DATA AND RESEARCH INCLUDED INFORMATION FROM COMMUNITY MEMBERS, PUBLIC HEALTH OFFICIALS, COMMUNITY LEADERS/EXPERTS, AND NON-PROFIT ORGANIZATIONS REPRESENTING VULNERABLE POPULATIONS IN OUR SERVICE AREA. THE FOLLOWING INFORMATION/DATA WAS COLLECTED AND TAKEN INTO CONSIDERATION FOR ASSESSING AND ADDRESSING COMMUNITY HEALTH NEEDS:- COMMUNITY HEALTH SURVEY: A TELEPHONE-BASED SURVEY OF 400 CONSUMERS COMMISSIONED BY THE MILWAUKEE HEALTH CARE PARTNERSHIP (WWW.MKEHCP.ORG), OF WHICH PROHEALTH CARE IS A MEMBER. THIS COMPREHENSIVE SURVEY PROVIDES VALUABLE BEHAVIORAL DATA, LIFESTYLE HABITS, AND THE PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS OF WAUKESHA COUNTY RESIDENTS. THE FULL REPORT OF THIS SURVEY CAN BE FOUND AT PROHEALTHCARE.ORG.- KEY INFORMANT INTERVIEWS: MORE THAN 50 INTERVIEWS WERE CONDUCTED WITH LEADERS OF VARIOUS NON-PROFIT ORGANIZATIONS, SCHOOLS, CIVIC AND BUSINESS LEADERS. THESE KEY INFORMANTS REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED, INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS. THE FULL KEY INFORMANT RESULTS CAN BE FOUND AT PROHEALTHCARE.ORG.- COMMUNITY FEEDBACK: A SURVEY OF HOSPITAL ADVOCATES (COMMUNITY MEMBERS) WAS CONDUCTED. THE ADVOCATES REVIEWED PERTINENT DATA AND 'VOTED' ON THEIR TOP CONCERNS FOR OUR COMMUNITY.- COMPILATION OF "SECONDARY DATA REPORTS": USING A VARIETY OF SOURCES, INFORMATION WAS GATHERED, INCLUDING:- SOCIAL DETERMINANTS OF HEALTH DATA AND TRENDS INCLUDING INCOME, EDUCATIONAL LEVEL, HOUSING AND EMPLOYMENT- HEALTH STATISTICS SUCH AS LEADING CAUSES OF ILLNESS, DEATH AND DISABILITY- WAUKESHA COUNTY HEALTH RANKINGS- PUBLIC SAFETY STATISTICS SUCH AS CRIME RATES PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: SEE PART V, SECTION B, LINE 3J DISCLOSURESUMMARY DATA AND A REVIEW OF MAJOR ISSUES WAS PRESENTED TO THE HOSPITAL ADVOCATES COMMITTEE. EACH COMMITTEE MEMBER PROVIDED FEEDBACK VIA A 'VOTING' METHODOLOGY. THIS FEEDBACK, ALONG WITH THE DATA FROM THE CONSUMER TELEPHONE SURVEY AND KEY INFORMANT INTERVIEWS SERVED AS ADVISORY RECOMMENDATIONS WHEN OUR PROHEALTH COMMUNITY BENEFIT COMMITTEE MADE THEIR PRIORITY DECISIONS USING IDENTIFIED CRITERIA IN A TWO-STEP NARROWING PROCESS. OUR TEN MEMBER COMMUNITY BENEFIT COMMITTEE IS A BOARD-LEVEL GROUP OF GOVERNMENTAL, COMMUNITY AND BUSINESS LEADERS IN OUR SERVICE AREA AND ARE RESPONSIBLE FOR OVERSIGHT OF OUR CHNA. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: PROHEALTH WAUKESHA MEMORIAL HOSPITAL AND REHABILITATION HOSPITAL OF WISCONSIN LLC. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: THE CHNA AS WELL AS SEPARATE IMPLEMENTATION STRATEGY, IS AVAILABLE AT HTTPS://WWW.PROHEALTHCARE.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/CHNA/PRINTED COPIES ALSO AVAILABLE TO COMMUNITY MEMBERS ON REQUEST. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE FACILITY CONTINUES TO FOCUS ITS COMMUNITY OUTREACH PROGRAMS ON THE PRIORITY NEEDS DETERMINED FROM THE MOST RECENT CHNA. THE ENTITY FEELS ALL NEEDS ARE BEING ADDRESSED EITHER THROUGH DIRECT OUTREACH OR ENSURING OTHER COMMUNITY LEADERS ARE AWARE OF SIMILAR NEEDS AND THOSE PATIENTS OR USERS ARE PROVIDED WITH THOSE COMMUNITY RESOURCES IF NOT OFFERED BY THE FACILITY. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 13B: THE HOSPITAL PROVIDES CHARITY CARE OR REDUCED COST CARE FOR A VARIETY OF PATIENTS IN NEED. SOME OF THESE PATIENTS IN NEED MAY TECHNICALLY HAVE INCOME IN EXCESS OF MINIMUM FEDERAL POVERTY GUIDELINES. FOR ADDITIONAL DETAILS ON THE CRITERIA USED BY THE HOSPITAL FACILITY TO DETERMINE ELIGIBILITY, PLEASE REFER TO THE FINANCIAL ASSISTANCE POLICY AVAILABLE ON THE HOSPITAL'S WEBSITE AT: HTTPS://WWW.PROHEALTHCARE.ORG/PATIENTS-FAMILIES/BILLING-AND-INSURANCE/ PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE FACILITY ALSO CONSIDERS THE FOLLOWING IN THE FAP: SIZE OF THE PATIENT'S FAMILY WILL BE DETERMINED BY THE NUMBER OF DEPENDENTS CLAIMED ON THE APPLICANT'S TAX RETURNS OR IDENTIFIED AS PART OF THE HOUSEHOLD, HOUSEHOLD INCOME WILL INCLUDE ALL INCOME FROM ANY SOURCE INCLUDING WAGES AND SALARIES AND OTHER SOURCES OF INCOME INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING ;- ALL PENSIONS FROM STATE, FEDERAL OR PRIVATE SOURCES- INCOME FROM ANNUITIES, IRAS, TSAS, 401(K)S- STOCKS, OR BONDS- VETERANS BENEFITS- SOCIAL SECURITY PAYMENTS- REGULARLY RECEIVED INSURANCE CHECKS SUCH AS UNEMPLOYMENT BENEFITS AND WORKMAN'S COMPENSATION- ALIMONY; CHILD SUPPORT- RETURNS ON INVESTMENTS; NET RENTS AND NET PROFITS FROM BUSINESS. PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: REFERENCE TO THE FAP IS AVAILABLE ON THE BACK ALL PATIENT STATEMENTS. ALSO THROUGH CUSTOMER RELATIONS VERBAL REMINDER OF THE FAP ARE PROVIDED WHEN DISCUSSING OPEN BALANCES. PART V, SECTION B, LINE 22 BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS. TO CALCULATE THE AGB, THE HOSPITAL FACILITIES USES THE "LOOK-BACK" METHOD DESCRIBED IN 26 C.F.R. 501 (R)-4(B)(2). IN THIS METHOD, THE HOSPITAL FACILITIES USE DATA BASED ON CLAIMS SENT TO MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE COMMERCIAL INSURERS FOR ALL MEDICARE CARE OVER THE PAST YEAR TO DETERMINE THE PERCENTAGE OF GROSS CHARGES THAT IS TYPICALLY PAID BY THESE INSURERS. THE AGB PERCENTAGE IS THEN MULTIPLIED BY GROSS CHARGES FOR EMERGENCY AND MEDICALLY NECESSARY CARE TO DETERMINE THE AGB. THE HOSPITAL FACILITIES RE-CALCULATE THE PERCENTAGE EACH YEAR. FOR FISCAL YEAR 2023, THE AGB PERCENTAGE FOR PROHEALTH WAUKESHA MEMORIAL HOSPITAL IS 28.37% AND FOR PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL IS 27.55%. EACH YEAR THE HOSPITAL FACILITIES WILL UPDATE THESE AMOUNTS. 1 1 - LAKE COUNTRY ENDOSCOPY CENTER LLC 1185 CORPORATE CENTER DR OCONOMOWOC WI 53066 ENDOSCOPY CENTER PART I, LINE 6A: A COMMUNITY BENEFIT REPORT IS COMPLETED BY PROHEALTH CARE, INC. (EIN 39-1486873), THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. PART I, LINE 7: THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE AMOUNTS ON LINES 7A-7D. THIS WAS CALCULATED BY USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE HOSPITAL'S FINANCIAL COST REPORTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS ON LINES 7E-7I PART I, LN 7 COL(F): $3,240,311 OF BAD DEBT EXPENSES WAS INCLUDED ON FORM 990, PART IX, LINE 25 BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE. PART II, COMMUNITY BUILDING ACTIVITIES: PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL HAS FOSTERED A WIDE VARIETY OF PARTNERSHIPS WITH NUMEROUS AGENCIES AND INITIATIVES THAT BENEFIT OUR ENTIRE COMMUNITY BEYOND THOSE THAT ARE DIRECTLY ASSOCIATED WITH HEALTH. OUR EFFORTS TO HELP BUILD A SAFE AND VIBRANT COMMUNITY ARE IN SOME WAYS JUST AS IMPORTANT AS OUR TREMENDOUS EFFORTS TO IMPROVE COMMUNITY HEALTH. WE BELIEVE COMMUNITY BUILDING STARTS IN OUR OWN NEIGHBORHOODS AND ONE EXAMPLE OF THAT IS OUR SUPPORT OF LOCAL NEIGHBORHOOD GROUPS AND COALITIONS THAT ADDRESS SAFETY, PROPERTY APPEARANCE AND CONNECTIVITY OF RESIDENTS. WE PROVIDE FUNDING FOR BEAUTIFICATION AND CLEAN-UP OF COMMON PROPERTIES AND STREETS, AS WELL AS THE LAND EXPERTISE AND RESOURCES FOR COMMUNITY RAIN AND CROP GARDENS. AS PART OF OUR LEADERSHIP VOLUNTEERISM PROGRAM, WE PROVIDE ASSISTANCE AT LOCAL LIBRARIES AND LITERACY PROGRAMS AND HAVE A STRONG PRESENCE WITH MEMBERSHIPS IN A NUMBER OF CIVIC AND SERVICE ORGANIZATIONS. INVOLVEMENT WITH YOUTH IS A YEAR-ROUND FOCUS AS WE ASSEMBLE AND DISTRIBUTE BACKPACKS TO LOW INCOME CHILDREN AND ASSIST WITH THE DISTRIBUTION OF BLESSINGS IN A BACKPACK TO CHILDREN IN OUR LOCAL SCHOOLS. WE REGULARLY ADDRESS AND MENTOR LOCAL HIGH SCHOOL STUDENTS IN A VARIETY OF HEALTH CARE CAREER AWARENESS EVENTS AND INITIATIVES. WE ARE THE MAJOR SPONSOR OF "LEADERSHIP WAUKESHA", A PROGRAM THAT FOCUSES ON THE DEVELOPMENT OF EMERGING LEADERS IN OUR COUNTY. WE SUPPORT HOMELESS SHELTERS, ARE ACTIVE MEMBERS OF THE HOUSING ACTION COALITION AND THE COUNTY'S HISPANIC COLLABORATIVE NETWORK. WE ARE TREMENDOUSLY PROUD OF OUR WORK WITH TRANSCEN, SERVING AS A HOST SITE FOR PROJECT SEARCH, A WORKFORCE TRAINING PROGRAM FOR DEVELOPMENTALLY/PHYSICALLY DISABLED INDIVIDUALS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON PART III LINE 2 IS THE BAD DEBT EXPENSE REPORTED ON FORM 990 PART IX. PART III, LINE 3: THE BAD DEBT COST WAS REVIEWED BY THE HOSPITAL'S REVENUE CYCLE TEAM AND THE AMOUNT OF BAD DEBT ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE QUALIFIED UNDER OUR FINANCIAL ASSISTANCE PROGRAM IS 7.6% OF TOTAL BAD DEBTS. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO QUALIFYING INDIVIDUALS AS PART OF OUR FINANCIAL ASSISTANCE POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO SELF-PAY PATIENTS. ESTIMATES FOR EXPLICIT PRICE CONCESSIONS ARE BASED ON PROVIDER CONTRACTS, PAYMENT TERMS FOR RELEVANT PROSPECTIVE PAYMENT SYSTEMS, AND HISTORICAL EXPERIENCE ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE CORPORATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE CORPORATION RECORDS SIGNIFICANT IMPLICIT PRICE CONCESSIONS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 8: THE SHORTFALL ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. COSTING METHODOLOGY USED IS THE COST TO CHARGE RATIO AS REPORTED ON THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE WILL HAVE A CHARITY DISCOUNT APPLIED TO THEIR BALANCES AT THE TIME OF BILLING. IF THIS RESULTS IN NO BALANCE DUE FORM THE PATIENT, THEN THE PATIENT WILL NOT RECEIVE A STATEMENT. IF A BALANCE REMAINS AFTER THE DISCOUNT PERCENTAGE IS APPLIED, THE PATIENT WILL RECEIVE A STATEMENT FOR THE BALANCE DUE. THE STATEMENT CYCLE IS CONSISTENT FOR ALL PATIENTS. PART VI, LINE 2: A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS A DISCIPLINED APPROACH TO USING LOCAL DATA TO IDENTIFY BARRIERS TO THE HEALTH AND WELL-BEING OF ITS RESIDENTS. OUR PROCESS FOR THIS ASSESSMENT BEGAN WITH DATA COLLECTION, AGGREGATION AND ANALYSIS. WE DEVELOPED A DATA COMPENDIUM WHICH WAS STUDIED BY OUR BOARD-LEVEL COMMUNITY BENEFITS COMMITTEE. AFTER RECEIVING COMMUNITY FEEDBACK FROM OUR HOSPITAL ADVOCATES GROUP, THE COMMITTEE USED CRITERIA-BASED VOTING TO DEFINE THE MOST PRESSING PROBLEMS OUR COMMUNITY IS FACING. A TARGETED IMPLEMENTATION STRATEGY SUGGESTS THE DEVELOPMENT OF RESOURCES AND PROGRAMS WHERE THEY ARE MOST NEEDED AND CAN BE MOST EFFECTIVE. BECAUSE OF THIS WORK, WE HAVE A MUCH CLEARER UNDERSTANDING OF THE HEALTH OF OUR COMMUNITY AND HOW WE ARE BEST ABLE TO PARTNER WITH OTHERS TO IMPROVE THE HEALTH STATUS OF OUR RESIDENTS. AND, BY USING DATA-DRIVEN MEASURES, WE CAN DETERMINE IF WE ARE MAKING REAL PROGRESS IN THE AREAS IDENTIFIED AS THE HIGHEST PRIORITY. FOLLOWING DISCUSSION AND DEBATE, THREE OVERARCHING THEMES EMERGED AS PRIORITY AREAS:NUTRITION AND OBESITY- NOTABLE DECREASES IN THOSE WHO REPORT MEETING DAILY FRUIT AND VEGETABLE SERVING RECOMMENDATIONS- 70% OF CONSUMERS IN WAUKESHA COUNTY REPORT THEY ARE OVERWEIGHT- 28% OF RESIDENTS ARE CONSIDERED OBESESUBSTANCE ABUSE- DISPENSING OF PRESCRIBED OPIOIDS CONTINUES TO DECREASE- NOTABLE INCREASE IN DRUG RELATED DEATH AND DEATHS DUE TO OVERDOSE- SIGNIFICANT INCREASE IN DEATHS RELATED TO FENTANYL- EXCESSIVE ALCOHOL USEMENTAL HEALTH- SIGNIFICANT INCREASE IN THOSE THAT REPORTED POOR MENTAL HEALTH DAYS IN WAUKESHA COUNTY- RANKED #1 CONCERN IN KEY INFORMANT INTERVIEWS- AFTER ACCOUNTING FOR AGE DIFFERENCES, THE VETERAN SUICIDE RATE IN WISCONSIN IS SIGNIFICANTLY HIGHER THAN THE NATIONAL GENERAL POPULATIONS SUICIDE RATEFOR MORE INFORMATION ABOUT OUR CHNA, PLEASE VISIT HTTPS://WWW.PROHEALTHCARE.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT/CHNA/. PART VI, LINE 3: EVERY PATIENT WITH A SELF PAY BALANCE RECEIVES A STATEMENT WHICH CONVEYS THE AVAILABILITY OF COMMUNITY (CHARITY) CARE AND A CONTACT NUMBER FOR FURTHER INFORMATION. PATIENTS THAT ARE UNINSURED RECEIVE AN UNINSURED DISCOUNT WHICH IS LISTED ON THE FIRST STATEMENT THAT THEY RECEIVE. PATIENTS RECEIVE A TOTAL OF FOUR STATEMENTS. EACH STATEMENT CONTAINS VERBIAGE REFERENCING THE HOSPITAL'S COMMUNITY CARE PROGRAM AND A CONTACT NUMBER FOR FURTHER INFORMATION. IF SOMEONE HAS BEEN FOUND ELIGIBLE FOR SOME LEVEL OF CHARITY CARE, THE ELIGIBILITY PERIOD IS THREE MONTHS SO ANY SUBSEQUENT ACCOUNTS DURING THAT TIMEFRAME WOULD BE DISCOUNTED AT WHATEVER LEVEL OF CHARITY CARE THE PATIENT IS DEEMED ELIGIBLE. PATIENTS MAY REAPPLY FOR COMMUNITY CARE WHEN THEIR ELIGIBILITY PERIOD HAS EXPIRED. SELF PAY PATIENTS MAY ALSO BE INFORMED OF THE HOSPITAL'S COMMUNITY CARE PROGRAM WHILE THEY ARE INPATIENTS. SOCIAL WORK AND/OR THE BUSINESS OFFICE MAY MAKE CONTACT WITH THESE PATIENTS DURING THEIR STAY TO INFORM THEM OF THE COMMUNITY CARE PROGRAM AND ASSIST THEM WITH COMPLETION OF THE APPLICATION.INFORMATION IS AVAILABLE AT REGISTRATION AREAS RELATED TO OUR COMMUNITY CARE PROGRAM. THIS INFORMATION CONTAINS CONTACT INFORMATION FOR THE HOSPITAL'S CENTRAL BUSINESS OFFICE WHERE PATIENTS CAN RECEIVE ASSISTANCE IN OBTAINING AND COMPLETING APPLICATIONS. PART VI, LINE 4: ESTABLISHED IN 1914, PROHEALTH OCONOMOWOWOC MEMORIAL HOSPITAL SERVES THE RESIDENTS OF WAUKESHA COUNTY AND SURROUNDING COMMUNITIES. THE HOSPITAL'S SERVICE AREA IS DEFINED AS A ZIP-CODE BASED GEOGRAPHIC AREA REFLECTING 85 PERCENT OF INPATIENT AND OUTPATIENT ACTIVITY. THIS AREA CONSISTS OF WAUKESHA COUNTY AS WELL AS EAST TROY AND ELKHORN (NORTHERN WALWORTH COUNTY), WATERFORD AND BURLINGTON (NORTHEAST RACINE COUNTY) AS WELL AS WATERTOWN (EASTERN JEFFERSON COUNTY). IN EVERY FEDERAL POPULATION CENSUS, WAUKESHA COUNTY HAS RECORDED AN INCREASE IN POPULATION. SINCE 1950, THE COUNTY'S POPULATION HAS GROWN FROM 85,901 TO MORE THAN 400,000, AND THE GROWTH IS CONTINUING. WAUKESHA COUNTY IS LARGE (580 SQUARE MILES) AND DIVERSE, INCORPORATING URBAN, SUBURBAN AND RURAL AREAS. THE COUNTY'S POPULATION IS AGING, WITH A MEDIAN AGE OF 43.2 YEARS, WHICH FAR SURPASSES STATE AVERAGES. PROJECTIONS INDICATE THE POPULATION OF THOSE 65 AND OVER WILL MAKE UP OVER 30 PERCENT OF THE COUNTY'S POPULATION BY 2040. WAUKESHA COUNTY IS AMONG THE MOST AFFLUENT COUNTIES IN WISCONSIN WITH A MEDIAN HOUSEHOLD INCOME OF $87,277, BUT A GROWING NUMBER OF PEOPLE LIVE BELOW THE POVERTY LEVEL WITH THE LARGEST POCKET OF THOSE LIVING IN POVERTY IN THE CITY OF WAUKESHA. PART VI, LINE 5: PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL IS GOVERNED BY A COMMUNITY BOARD. WE ARE PROUD OF THE NUMEROUS AND STRONG PARTNERSHIPS WE HAVE FORMED WITH A WIDE VARIETY OF NOT-FOR-PROFIT HEALTH AND HUMAN SERVICES AGENCIES AS WE WORK TOGETHER TO FORGE A STRONGER, HEALTHIER COMMUNITY. WE ARE ACTIVELY INVOLVED IN SUPPORTING TWO FREE CLINICS SERVING OUR AREA, THE LAKE AREA FREE CLINIC AND THE WAUKESHA FREE CLINIC AT CARROLL UNIVERSITY. WE PROVIDE BOTH FINANCIAL AND IN-KIND SUPPORT TO THESE CLINICS. WE WERE INSTRUMENTAL IN FORMING SEVERAL KEY AGENCIES DESIGNED TO MEET AN URGENT COMMUNITY NEED. FOR EXAMPLE, THROUGH OUR LEADERSHIP AND SUPPORT, THE WAUKESHA COUNTY COMMUNITY DENTAL CLINIC WAS FORMED AND WE HAVE PROVIDED ONGOING FINANCIAL SUPPORT AND PROVIDED CLINICAL AND OFFICE SPACE SO THIS AGENCY CAN CARRY OUT ITS MISSION. WE PROVIDE TRAINED THERAPISTS AT HIGH SCHOOL ATHLETIC GAMES FREE-OF-CHARGE TO SCHOOL SYSTEMS IN AN EFFORT TO REDUCE INJURY. WE PROVIDE FREE OR REDUCED COST TRANSPORTATION FOR PATIENTS THAT REQUIRE ASSISTANCE GETTING TO FREE CLINICS FOR MEDICAL APPOINTMENTS. SEVERAL OF OUR STAFF ARE ACTIVELY INVOLVED WITH THE HEALTH DEPARTMENT'S CHIPP AND SERVE ON A VARIETY OF COMMITTEES FOR THE AREA'S DEPARTMENT OF HEALTH AND HUMAN SERVICES. WE HOST COMMUNITY-WIDE HEALTH FAIRS OFFERING A WIDE VARIETY OF FREE SCREENINGS AND OFFER AN ONGOING AND IMPRESSIVE MENU OF FREE COMMUNITY EDUCATION CLASSES (INCLUDING EVIDENCE-BASED SELF-HELP WORKSHOPS). PROHEALTH CARE REACHES OUT INTO OUR COMMUNITY TO MEET THE NEEDS OF ITS RESIDENTS. FROM THE ALZHEIMER'S ASSOCIATION TO WAUKESHA COUNTY HEROIN TASK FORCE, AND DOZENS OF AGENCIES IN BETWEEN, PROHEALTH CARE IS THERE, PROVIDING VOLUNTEERS, FINANCIAL SUPPORT AND PARTNERSHIPS THAT HELP TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 6: 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. PROHEALTH CARE FOUNDATION, INC. - SUPPORTS THE CHARITABLE MISSION OF PROHEALTH WAUKESHA MEMORIAL HOSPITAL AND PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL SO THAT IT MAY PROVIDE HEALTH SERVICES WITHIN THE COMMUNITY. PROHEALTH MEDICAL GROUP, INC. - PHMG OPERATES VARIOUS CLINIC AND URGENT CARE LOCATIONS THROUGHOUT WAUKESHA COUNTY AND THE SURROUNDING COMMUNITIES. PHMG FULFILLS ITS EXEMPT PURPOSE BY PROVIDING CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PHMG PROVIDED 550,083 VISITS (CLINIC, URGENT CARE, AND VIRTUAL VISITS) AS WELL AS 18,091 IMAGING PROCEDURES DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2023.PROHEALTH WAUKESHA MEMORIAL HOSPITAL, INC. - PROVIDES CARE AND SERVICES TO ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY. PROHEALTH WAUKESHA MEMORIAL HOSPITAL ALSO USES ITS RESOURCES TO ADDRESS VARIOUS COMMUNITY NEEDS. PROHEALTH WAUKESHA MEMORIAL HOSPITAL PROVIDED APPROXIMATELY 49,777 DAYS OF INPATIENT CARE AND APPROXIMATELY 351,104 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2023. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 1 0 0 0 0 0 1 0 SUSAN EDWARDS PRESIDENT AND CEO - PHC 0 1184879 0 731247 0 277509 0 644097 0 37729 0 2875461 0 277509 KENNETH PRICE CHIEF OPERATING OFFICER 0 498039 0 280082 0 108867 0 257829 0 53359 0 1198176 0 108867 ANDREW GUTIERREZ CHIEF FINANCIAL OFFICER 0 342349 0 173038 0 0 0 96614 0 45599 0 657600 0 0 AARON RAABE PHARMACIST - INPATIENT 157871 0 47436 0 0 0 7575 0 41996 0 254878 0 0 0 SHAWN RUTKA PHARMACIST - INPATIENT 148779 0 3373 0 0 0 7996 0 42974 0 203122 0 0 0 TARA SCHWEFEL PHARMACIST - INPATIENT 140257 0 34281 0 0 0 5213 0 1216 0 180967 0 0 0 BENJAMIN DIAMADUROS PHARMACIST - INPATIENT 130304 0 19752 0 0 0 7564 0 13232 0 170852 0 0 0 SHARON REHNBERG MGR PATIENT CARE 127093 0 10309 0 0 0 6600 0 18264 0 162266 0 0 0 PART I, LINE 3 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 PART I, LINE 4B PROHEALTH CARE INC. (PHC) MAINTAINS A SUPPLEMENTAL RETIREMENT PLAN (SERP) FOR A SELECT GROUP OF EXECUTIVES OF PHC AND ITS AFFILIATED ENTITIES. THIS SERP IS AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION PLAN THAT IS INTENDED TO COMPLY WITH SECTION 457(F) OF THE INTERNAL REVENUE CODE. BENEFITS UNDER THIS SERP ARE TAXABLE TO THE PARTICIPATING EXECUTIVES WHEN SUCH AMOUNTS ARE VESTED. SERP PAYMENTS DURING THE YEAR ARE AS FOLLOWS: SUSAN EDWARDS: $277,509 KENNETH PRICE: $108,867 PART I, LINE 7 PROHEALTH CARE HAS A LEADERSHIP INCENTIVE PROGRAM FOR LEADERS OF THE CORPORATION AND RELATED ORGANIZATIONS (COLLECTIVELY THE "SYSTEM"). THE PLAN RELATES FINANCIAL REWARD TO THE SYSTEM'S ACHIEVEMENT OF CERTAIN FINANCIAL AND NON-FINANCIAL OBJECTIVES. THE PRIMARY PURPOSE OF THE PLAN IS TO SUPPORT THE SYSTEM'S MISSION TO ACHIEVE CONTINUED GROWTH AND DEMONSTRATE VALUE THROUGH: (1) A SEAMLESS CONTINUUM OF PATIENT CENTERED CARE; (2) NATIONALLY RECOGNIZED OUTCOMES; (3) RESPONSIBLE AND EFFICIENT USE OF HEALTH CARE RESOURCES; AND (4) A FOCUS ON THE HEALTH OF OUR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 6 PROHEALTH CARE, INC. IS THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE GOVERNING DOCUMENTS, THE BOARD OF THE FILING ORGANIZATION IS THE SAME AS THE BOARD OF THE SOLE CORPORATE MEMBER, PROHEALTH CARE, INC. 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 11B 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 AND THE AUDIT & COMPLIANCE COMMITTEE PERFORMED A REVIEW. THEN THE ORGANIZATION'S TAX PREPARERS MADE A PRESENTATION TO THE AUDIT COMMITTEE, WHO THEN FORMALLY APPROVED THE FORM 990, AND THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THE RETURN, WHICH WAS SUBSEQUENTLY 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 NOT BEING ABLE TO WORK AT PROHEALTH IN THE SPECIFIC ROLE WHERE THE REPORTED CONFLICT EXISTS. IF THE RECOMMENDATION IS CHALLENGED, THE MATTER GOES TO THE SENIOR EXECUTIVE TEAM FOR A DECISION. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT, EXTERNAL COMPENSATION REVIEW IS CONDUCTED FOR THE POSITIONS OF CEO, SENIOR EXECUTIVE TEAM MEMBERS, AND VICE-PRESIDENTS. 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 2023. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS & CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: THE PROCESS IS TO HAVE ALL JOINT VENTURE ARRANGEMENTS REVIEWED BY THE LEGAL DEPARTMENT TO ENSURE IT MEETS ALL LEGAL REQUIREMENTS AND TO ENSURE THAT OCONOMOWOC MEMORIAL HOSPITAL, INC. MAY RETAIN ITS EXEMPT STATUS. FORM 990, PART IX, LINE 11G AGENCY STAFFING: PROGRAM SERVICE EXPENSES 7,558,951. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,558,951. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 4,284,848. MANAGEMENT AND GENERAL EXPENSES 164,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,449,689. LINEN SERVICES: PROGRAM SERVICE EXPENSES 424,402. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 424,402. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 484,298. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 484,298. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 168,292. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 168,292. ALL OTHER: PROGRAM SERVICE EXPENSES 94,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,105. FORM 990, PART XI, LINE 9: EQUITY TRANSFER TO PHC TAX-EXEMPT ORGANIZATION -9,000,000. FORM 990, PART XII, LINE 2C: THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT YEAR. 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