2024-11-12T12:03:18-06:00 2023-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 790 N WATER ST SUITE 2000 MILWAUKEE WI 53202 990 2023-08-01 852221921 ROGERS BEHAVIORAL HEALTH - WASHINGTON INC ROGE 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 CHRIS JAGODITZ CHIEF FINANCIAL OFFICER 2626464411 2024-11-07 1 1 SHELBY NETZ CPA P01405265 4147775500 2024-11-07 2023 2024-10-15 13:58:12Z CINDY MEYER 34700 VALLEY ROAD OCONOMOWOC WI 53066 2032720 0 X N/A X 2020 WA WE PROVIDE HIGHLY EFFECTIVE MENTAL HEALTH AND ADDICTION TREATMENT THAT HELPS PEOPLE REACH THEIR FULL POTENTIAL FOR HEALTH AND WELL-BEING. 4 0 0 0 0 0 0 0 4955396 2032720 0 0 0 0 4955396 2032720 0 0 0 0 0 0 0 0 0 4955396 2032720 4955396 2032720 0 0 2333258 4190506 2333258 4190506 0 0 WE PROVIDE HIGHLY EFFECTIVE MENTAL HEALTH AND ADDICTION TREATMENT THAT HELPS PEOPLE REACH THEIR FULL POTENTIAL FOR HEALTH AND WELL-BEING. 0 0 2032720 2032720 PROVIDING HIGHLY EFFECTIVE MENTAL HEALTH AND ADDICTION TREATMENT THAT HELPS PEOPLE REACH THEIR FULL POTENTIAL FOR HEALTH AND WELL-BEING. WE ARE A NOT-FOR-PROFIT INDEPENDENT PROVIDER OF SPECIALIZED MENTAL HEALTH AND ADDICTION SERVICES FOR ADULTS, TEENS AND CHILDREN. OFFERING TREATMENT IN NINE STATES, WE ARE ONE OF THE LARGEST SPECIALTY BEHAVIORAL HEALTHCARE SYSTEMS IN THE U.S. THE SEATTLE CLINIC OPENED IN MARCH OF 2021. IN STUB YEAR 2023, WE SERVED OUR COMMUNITY WITH 1,761 PARTIAL HOSPITAL DAYS AND 833 INTENSIVE OUTPATIENT DAYS. 2032720 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 2626464411 34700 VALLEY ROAD OCONOMOWOC WI 53066 CYNTHIA MEYER CEO 1.00 40.00 X X 0 583138 51364 STEPHANIE EKEN ASSISTANT CMO 1.00 40.00 X 0 463275 57125 JERRY HALVERSON CMO/BOARD MEMBER 1.00 40.00 X 0 423693 58795 SEAN LENOUE SR. MEDICAL DIRECTOR 1.00 40.00 X 0 301334 50490 CHRIS JAGODITZ CFO 1.00 40.00 X 0 305090 10134 EMILY RUSSART VP ACCOUNTING/CONTROLLER 1.00 40.00 X 0 192065 44691 PATRICK HAMMER FORMER FORMER CEO - RBHS 0.00 0.00 X 0 1486317 26468 JOHN BOYD FORMER FORMER CEO 0.00 0.00 X 0 732937 29810 BRADLEY RIEMANN CHIEF CLIN OFF./BOARD MEMBER - TERM. 07/2023 0.00 0.00 X 0 600546 52892 0 5088395 381769 0 1 1 0 ROGERS BEHAVIORAL HEALTH MANAGEMENT LLC 34700 VALLEY ROAD OCONOMOWOC WI 53066 MANAGEMENT FEES 1836517 1 PATIENT REVENUE 621110 2032720 2032720 2032720 2032720 2032720 0 0 MANAGEMENT FEES 1836517 1836517 BAD DEBT EXPENSE 195791 195791 CHARITY CARE ALLOWANCE 412 412 2032720 2032720 0 0 515126 605816 1818132 3584690 2333258 4190506 1350 14271 2331908 4176235 2333258 4190506 X 0 0 0 0 0 0 0 0 2333258 4190506 0 0 X 0 1 X 1 0 X 1707149 4684299 4955396 2032720 13379564 1707149 4684299 4955396 2032720 13379564 0 0 0 13379564 1707149 4684299 4955396 2032720 13379564 X SCHEDULE A, PART III, COLUMN (E): THE ORGANIZATION CHANGED ITS TAX YEAR END FROM JULY 31 TO DECEMBER 31 AND FILED A SHORT PERIOD FORM 990 COVERING THE PERIOD AUGUST 1, 2023 TO DECEMBER 31, 2023 FOR THIS PERIOD. 0 DUE FROM ROGERS MEMORIAL HOSPITAL, INC. 3584690 3584690 DUE TO ROGERS BEHAVIORAL HEALTH MANAGEMENT COMPANY 3415390 DUE TO ROGERS MEMORIAL HOSPITAL, INC. 16799 DUE TO ROGERS BEHAVIORAL HEALTH PRACTICE - WASHINGTON P.C. 744046 4176235 X PART X, LINE 2: ROGERS BEHAVIORAL HEALTH - WASHINGTON, INC. IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 509(A)(2) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. ROGERS BEHAVIORAL HEALTH - WASHINGTON, INC. FILES A FORM 990 (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX) ANNUALLY. WHEN THE RETURN IS FILED IT IS HIGHLY CERTAIN THAT SOME POSITIONS TAKEN WOULD BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, WHILE OTHERS ARE SUBJECT TO UNCERTAINTY ABOUT THE MERITS OF THE POSITION TAKEN OR THE AMOUNT OF THE POSITION THAT WOULD ULTIMATELY BE SUSTAINED. EXAMPLES OF TAX POSITIONS INCLUDE SUCH MATTERS AS THE FOLLOWING: THE TAX EXEMPT STATUS OF THE ENTITY AND VARIOUS POSITIONS RELATIVE TO POTENTIAL SOURCES OF UNRELATED BUSINESS INCOME TAX (UBIT). UBIT IS REPORTED ON FORM 990T, AS APPROPRIATE. THE BENEFIT OF A TAX POSITION IS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IN THE PERIOD DURING WHICH, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES THAT IT IS MORE LIKELY THAN NOT THAT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION, INCLUDING THE RESOLUTION OF APPEALS OR LITIGATION PROCESSES, IF ANY. 1 1 0 0 0 0 0 0 0 PATRICK HAMMER FORMER FORMER CEO - RBHS 0 227230 0 1020103 0 238984 0 12200 0 14268 0 1512785 0 213409 JOHN BOYD FORMER FORMER CEO 0 517504 0 70620 0 144813 0 13200 0 16610 0 762747 0 0 BRADLEY RIEMANN CHIEF CLIN OFF./BOARD MEMBER - TERM. 07/2023 0 324360 0 59381 0 216805 0 12142 0 40750 0 653438 0 0 CYNTHIA MEYER CEO 0 522292 0 58585 0 2261 0 13200 0 38164 0 634502 0 0 STEPHANIE EKEN ASSISTANT CMO 0 386403 0 53871 0 23001 0 12922 0 44203 0 520400 0 0 JERRY HALVERSON CMO/BOARD MEMBER 0 376287 0 24216 0 23190 0 13200 0 45595 0 482488 0 0 SEAN LENOUE SR. MEDICAL DIRECTOR 0 278513 0 0 0 22821 0 9061 0 41429 0 351824 0 0 CHRIS JAGODITZ CFO 0 287827 0 16785 0 478 0 9317 0 817 0 315224 0 0 EMILY RUSSART VP ACCOUNTING/CONTROLLER 0 140030 0 24888 0 27147 0 6577 0 38114 0 236756 0 0 PART I, LINE 3 THE CEO IS PAID BY ROGERS MEMORIAL HOSPITAL, INC., A RELATED ORGANIZATION. ROGERS MEMORIAL HOSPITAL, INC. USES THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B SOME EMPLOYEES RECEIVED A SEVERANCE PAYMENT DURING THE CALENDER YEAR. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. ROGERS MEMORIAL HOSPITAL, INC., PROVIDES A SUPPLEMENTAL NON-QUALIFIED RETIRMENT PLAN TO ELIGIBLE EMPLOYEES. DURING 2023, PATRICK HAMMER, JOHN BOYD, BRADLEY RIEMANN, CINDY MEYER, AND CHRIS JAGODITZ PARTICIPATED IN THIS PLAN. $213,409 WAS PAID TO PATRICK HAMMER. THE OTHER INDIVIDUALS DID NOT HAVE AMOUNTS VESTED AND PAID DURING THIS TIME. FORM 990, PART VI, SECTION B, LINE 11B THE CFO OF ROGERS BEHAVIORAL HEALTH SYSTEM COMPLETES A DETAILED REVIEW OF THE FORM 990 PRIOR TO MAKING THE 990 AVAILABLE TO BOARD MEMBERS. THE FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS ELECTRONICALLY VIA THE BOARD'S WEBSITE FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE DIRECTORS AND OFFICERS OF ROGERS BEHAVIORAL HEALTH - WASHINGTON, INC. SHALL, SHOULD A CONFLICT ARISE AT ANY TIME, PROMPTLY DISCLOSE SUCH CONFLICT IN WRITING TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS; AND IN MATTERS WHERE A MEMBER HAS A CONFLICT THAT REQUIRES A VOTE, ABSTAIN. ANNUALLY, THE CONFLICT OF INTEREST FORM WILL BE SUBMITTED TO THE CHAIRMAN OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ROGERS BEHAVIORAL HEALTH - WASHINGTON, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. ROGERS BEHAVIORAL HEALTH SYSTEM 34700 VALLEY ROAD OCONOMOWOC WI 53066 263902724 COORDINATE HEALTH CARE EFFORTS OF THE HOSPITAL AND FOUNDATION WI 501(C)(3) LINE 12B, II N/A 0 ROGERS MEMORIAL HOSPITAL INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 391139101 PROVIDE INPATIENT AND OUTPATIENT PSYCHIATRIC SERVICES TO PATIENTS WI 501(C)(3) LINE 3 ROGERS BEHAVIORAL HEALTH SYSTEM INC 0 ROGERS MEMORIAL HOSPITAL FOUNDATION INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 391363507 TO SUPPORT ALL ENTITITES OF ROGERS BEHAVIORAL HEALTH SYSTEM, INC. WI 501(C)(3) LINE 7 ROGERS MEMORIAL HOSPITAL INC 0 ROGERS BEHAVIORAL HEALTH - GEORGIA INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 844421252 PROVIDE MENTAL HEALTH AND ADDICTION TREATMENT GA 501(C)(3) LINE 10 ROGERS MEMORIAL HOSPITAL INC 0 ROGERS BEHAVIORAL HEALTH - COLORADO INC 34700 VALLEY ROAD OCONOMOWOC WI 53066 873488063 PROVIDE MENTAL HEALTH AND ADDICTION TREATMENT CO 501(C)(3) LINE 10 ROGERS MEMORIAL HOSPITAL INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0