TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Abernathy Edna...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(2) Beckman Marshall MD...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(3) Binzak Rick...................................................................... Director	1.00 ................. 1.00	X		0	0	0
(4) Burch Ryan DO...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(5) Christianson Brad...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(6) Goldberg David F MD...................................................................... Dir&VP Med Afrs	50.00 ................. 0.00	X		498,338	0	58,480
(7) Greco Patricia...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(8) Johnson Chad...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(9) Klein Kathleen...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(10) Pollard Dennis...................................................................... Dir&FH COO	1.00 ................. 46.00	X		0	1,143,035	154,233
(11) Raman Anuradha...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(12) Ruzinski Anna...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(13) Shepherd Dennis MD...................................................................... Director	1.00 ................. 1.00	X		0	0	0
(14) Templin Susan...................................................................... Director	1.00 ................. 1.00	X		0	0	0
(15) Waala Shelly...................................................................... Dir&VP Pt Care	50.00 ................. 1.00	X		275,634	0	55,137
(16) Woloszyk David...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(17) Lux Theresa M...................................................................... Dir&CMH Pres	50.00 ................. 1.00	X	X	428,152	0	92,295

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(18) Mays Cedric........................................................................ Dir&BOD Sec	1.00 .......................0.00	X	X			0	0	0
(19) Nelson Eric........................................................................ Dir&BOD Chair	1.00 .......................0.00	X	X			0	0	0
(20) Specht-Palmert Christine........................................................................ Dir&BOD V.Chair	1.00 .......................0.00	X	X			0	0	0
(21) Ceelen John........................................................................ Treasurer	1.00 .......................50.00		X			0	545,785	123,640
(22) Ehn Diane........................................................................ VP Qlty & Perf Exc	40.00 .......................0.00			X		284,814	0	59,529
(23) Evenson Rock E........................................................................ VP Business Ops	50.00 .......................0.00			X		276,426	0	53,821
(24) McClure Debra........................................................................ Nurse Anesthetist	50.00 .......................0.00			X		356,158	0	18,090
(25) Newkirk Garret........................................................................ Dir of Pharmacy	40.00 .......................0.00			X		211,088	0	39,126
(26) Petry Patricia........................................................................ CHD Dir Wom Hlth	40.00 .......................0.00			X		213,944	0	23,045
(27) Ericson Allen........................................................................ Former - Officer (COO)	0.00 .......................46.00				X	0	722,415	142,952
(28) Hawig Scott........................................................................ Former - Officer (CFO)	0.00 .......................48.00				X	0	1,234,468	171,331
(29) Knoll Thomas........................................................................ Former - Officer (Treas)	0.00 .......................42.00				X	0	197,440	39,168
(30) VanDeKreeke Jeffrey........................................................................ Former - Officer (CFO)	0.00 .......................46.00				X	0	511,807	83,586

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Community Memorial Hospital of Menomonee Falls Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Community Memorial Hospital of Menomonee Falls Inc		Employer identification number 39-0987025

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Community Memorial Hospital of Menomonee Falls Inc			Employer identification number 39-0987025
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	6,349,289	5,821,106	5,966,427	5,681,568	5,105,247
b	Contributions ...	1,445,855	888,427	1,056,822	1,384,817	456,977
c	Net investment earnings, gains, and losses	370,233	717,895	-56,083	68,760	638,515
d	Grants or scholarships ...	348,721	261,912	309,173	431,060	450,133
e	Other expenditures for facilities and programs ...	603,819	819,952	839,278	724,411	69,038
f	Administrative expenses ....	4	-3,725	-2,391	13,247
g	End of year balance ......	7,212,833	6,349,289	5,821,106	5,966,427	5,681,568

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

100.000 %

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	80,711		80,711
b	Buildings ....	133,770,838	64,626,127	69,144,711
c	Leasehold improvements	6,659,642	2,269,943	4,389,699
d	Equipment ....	59,508,921	40,156,353	19,352,568
e	Other .....	46,944,236	33,393,094	13,551,142
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				106,518,831

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)Due from Affiliates				142,023
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				10,727,605

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	22,371,831
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part V, Line 4: Intended uses of the endowment fund.

The funds are held by Community Memorial Foundation of Menomonee Falls, Inc. (CMF), a related organization. The board designated endowment was created to support long range financial needs of CMH and its programs.

Part X : FIN48 Footnote

Froedtert Health, Inc. (FH), the parent entity into which CMH's financial results are consolidated, applies ASC No. 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. ASC No. 740 prescribes a more-likely than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under ASC No. 740, tax positions are evaluated for recognition, derecognition, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2018 and 2017, FH does not have an asset or liability recorded for unrecognized tax positions.

Schedule D (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Otis Spunkmeyer Cookies (event type)	(b) Event #2 Cheery Cherry Fall Fair (event type)	(c) Other events 2 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	40,691	36,003	39,162	115,856
2	Less: Contributions . . . .		2,050		2,050
3	Gross income (line 1 minus line 2) . . . . . .	40,691	33,953	39,162	113,806

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .		5,012		5,012
7	Food and beverages . . .		499	5,706	6,205
8	Entertainment . . . .
9	Other direct expenses . . .	11,630	8,539	25,458	45,627
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				56,844
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				56,962

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 25000.0000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			1,258,050		1,258,050	0.470 %
b	Medicaid (from Worksheet 3, column a) . . . . .			24,105,244	9,933,080	14,172,164	5.280 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			25,363,294	9,933,080	15,430,214	5.750 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	38	13,630	1,292,897	2,360	1,290,537	0.480 %
f	Health professions education (from Worksheet 5) . . .	5	616	3,324,638	240,594	3,084,044	1.150 %
g	Subsidized health services (from Worksheet 6) . . . .	1	745	126,039		126,039	0.050 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	17	2,653	1,164,590		1,164,590	0.430 %
j	Total. Other Benefits . .	61	17,644	5,908,164	242,954	5,665,210	2.110 %
k	Total. Add lines 7d and 7j .	61	17,644	31,271,458	10,176,034	21,095,424	7.860 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1		11,316		11,316
3	Community support	1	617	1,564		1,564
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy	1		11,621		11,621
8	Workforce development	4	679	156,517	5,435	151,082	0.060 %
9	Other
10	Total	7	1,296	181,018	5,435	175,583	0.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,524,212

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

51,634,077

Enter Medicare allowable costs of care relating to payments on line 5.....

75,598,862

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-23,964,785

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Community Memorial Hospital W180 N8085 Town Hall Road Menomonee Falls,WI53051 www.froedtert.com	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.froedtert.com/community-engagement

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.froedtert.com/community-engagement

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.0000%
and FPG family income limit for eligibility for discounted care of 400.0000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.froedtert.com/financial-services

The FAP application form was widely available on a website (list url):

www.froedtert.com/financial-services

A plain language summary of the FAP was widely available on a website (list url):
Same as 16a & 16b.

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Community Memorial Hospital
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, Line 5 - Account Input from Persons Who Represent the Community	The Waukesha County and Washington County Key Informant Interview Report is a summary of public health priorities for both counties, as identified in 2015 by a range of providers, policy-makers, and other local experts and community members (key informants). These findings are a critical supplement to the Waukesha and Washington County Community Health Surveys conducted through a partnership between Froedtert Health (Community Memorial Hospital) and Aurora Health Care, ProHealth Care, Childrens Hospital of Wisconsin, Wheaton Franciscan and Milwaukee Healthcare Partnership. The key informant interviews incorporate input from persons representing the broad interests of the community served, and from those who possess special knowledge of or expertise in public health.Key informants in Washington and Waukesha Counties were identified by the participating healthcare systems, Milwaukee Healthcare Partnership and supporting Health Departments. Through this collaboration, the CHNA team invited the informants to participate, and conducted the interviews using a standard interview script that included the following elements: Ranking of up to five public health issues, based on the focus areas presented in Wisconsins State Health Plan, that are the most important issues for the County; and For those five public health issues:o Existing strategies to address the issueo Barriers/challenges to addressing the issueo Additional strategies neededo Key groups in the community that hospitals should partner with to improve community healthAll informants were made aware that participation was voluntary and that responses would be shared with the Center for Urban Population Health for analysis and reporting. Based on the information provided to the Center for Urban Population Health.Waukesha County Key Informant Interviews:Addiction Resource Council, Inc. City of New Berlin Fire Department City of New Berlin Police Department Community Outreach Health Clinic Delafield Chamber of Commerce Family Service of Waukesha Hamilton School District Hartland Chamber of Commerce Hope Center, Inc. HOPE Network, Inc. Interfaith Senior Programs Kettle Moraine School District La Casa de Esperanza Lake Area Free Clinic Menomonee Falls Area Food Pantry Menomonee Falls Chamber of Commerce, Inc. Mukwonago Food Pantry and Mukwonago Food Pantry Resource Center NAMI Waukesha, Inc. New Berlin Food Pantry Oconomowoc Area School District Oconomowoc Chamber of CommerceSafe Babies Healthy FamiliesSaint Josephs Medical Clinic Inc.School District of Menomonee FallsSchool District of New BerlinSchool District of WaukeshaStillwaters Cancer Support ServicesSussex Outreach ServicesUnited Way of Greater Milwaukee & Waukesha CountyVillage of Menomonee Falls Police & Fire DepartmentWaukesha County BoardWaukesha County Business AllianceWaukesha County Community Dental ClinicWaukesha County Department of Health and Human ServicesYMCA at Pabst FarmsYMCA of Greater Waukesha CountyWashington County Key Informants Interviews: Aurora Health Care Parish Nurse Program/Still Waters Community United United Way Washington County Casa Guadalupe Education Center Germantown Rec. Dept. St. Boniface Food Pantry Washington County Mental Health West Bend Chamber of Commerce Hartford Parks & Recreation Germantown Police Department West Bend School District Germantown High School Kettle Moraine YMCA Elevate Inc Albrecht Free Clinic Washington County Health Department
Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment	Washington County Health Needs Assessment Collaboration:Froedtert Health (Community Memorial Hospital) (Hospital/Health System)Aurora Health Care (Hospital/Health System)Childrens Hospital of Wisconsin (Hospital/Health System)Waukesha County Health Needs Assessment Collaboration:Froedtert Health (Community Memorial Hospital) (Hospital/Health System)Aurora Health Care (Hospital/Health System)ProHealth Care (Hospital/Health System)Wheaton Franciscan Healthcare (Hospital/Health System)
Part V, Line 7d - Description of Making Needs Assessment Widely Available	The full version of the report and other supporting documents can be found on Froedtert Healths website: Waukesha County: Waukesha County Community Health Survey Summary 2015: http://www.froedtert.com/upload/docs/community-memorial/community-giving/benefit/waukesha-county-community-health-survey-summary-2015.pdfWaukesha Key Informant Report 2015: http://www.froedtert.com/upload/docs/community-memorial/community-giving/benefit/waukesha-key-informant-report-2015.pdfWaukesha Secondary Data Report 2015: http://www.froedtert.com/upload/docs/community-memorial/community-giving/benefit/waukesha-secondary-data-report-2015.pdfWaukesha County Community Health Survey Summary 2017: https://www.froedtert.com/sites/default/files/files/2018-07/waukesha-county-community-health-survey-summary-2017.pdfWaukesha Key Informant Report 2017: https://www.froedtert.com/community-memorial/community-engagement Washington County: 2016 Washington County Community Health Survey Report: http://www.froedtert.com/upload/docs/giving/community-benefit/2016-washington-county-community-health-survey-report.pdf2016 Washington County Key Informant Results: http://www.froedtert.com/upload/docs/giving/community-benefit/2016-washington-county-key-informant-results.pdf2016 Washington County Secondary Data Source: http://www.froedtert.com/upload/docs/giving/community-benefit/2016-washington-county-secondary-data-sources.pdfAdditional Community Health Needs Assessments are posted on Washington-Ozaukee Public Health Department and Waukesha County Health Department websites:Washington County Public Health Department - http://www.co.washington.wi.us/uploads/docs/2015-cha.pdfWaukesha County Public Health Department - https://www.waukeshacounty.gov/HealthAndHumanServices/PublicHealth/chipp/
Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why	Community Memorial Hospitals community health improvement initiatives are targeted for the broad community, especially vulnerable populations (uninsured/underinsured) in the hospitals primary and secondary service areas. Community Memorial Hospitals mission is to advance the health of the communities we serve through exceptional care enhanced by innovation and discovery. The Community Outreach Steering Committee prioritized community health improvement programs, activities and services that reflect the hospitals mission and scope of care: Access to Primary and Specialty Care, AODA, Chronic Disease Management and Health focused Prevention and Wellness programs. The following needs are not being addressed by Community Memorial Hospital:Oral & Dental Health Services: Community Memorial Hospital does not have dedicated resources to provide dental services in Washington and Waukesha Counties. There are other local organizations/dental offices dedicated to improve access to dental care.Teen Pregnancy: United Way, Public Health, Safe Babies Healthy Families, the Hope Network and a number of other community organizations are working on this health issue.Health Literacy and Navigation: Other community organizations are working to increase awareness of health services and health seeking behaviors among low income individuals.Cigarette Use: Community Memorial Hospital supports the Multi-Jurisdictional Coalition of Tobacco Free Community Partnership Dodge, Jefferson and Waukesha Counties.Mental Health: Community Memorial Hospital does not have the dedicated resources. There are other local health and human service agencies and organizations dedicated to this issue.
Part V, Line 13b - Criteria For Providing Discounted Care If Not FPG	In alignment with the Froedtert Health financial assistance policy, Community Memorial Hospital of Menomonee Falls,Inc. reserves the right to review each application for financial assistance on its own merits and to consider other extenuating circumstances in the decision to approve or deny a patient's application for financial assistance. The applicant's gross family income will be determined using Modified Adjusted Gross Income (MAGI). Modified Adjusted Gross Income includes both earned income and passive income received and compared to the annual Federal Poverty guidelines set forth by the U.S. Department of Health and Human Services. A patient who has an annual gross income equal to or less than 400% of the current year's poverty guidelines will not pay more than 15% of their annual gross income on any single account during the approved eligibility timeframe. Patients who meet the requirements and have a gross income equal or less than 250% of the FPG may qualify for a 100% discount. Patients who meet the requirements and have a gross income between 250% and 400% of the FPG may qualify for a discount on a sliding scale. In addition to income, Community Memorial Hospital of Menomonee Falls,Inc. also takes certain assets into consideration. Assets protected from financial evaluation include a household's retirement assets, home equity, and a portion of cash and savings assets.
Part V, Line 13h - Other Factors Used in Determing Amounts Charged Patients	Out of Pocket Maximum Discount
Part V, Line 20e - Other Actions Took Before Any Collection Actions	We request additional documentation when an individual has submitted an incomplete financial assistance application.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	In alignment with the Froedtert Health financial assistance policy, Community Memorial Hospital of Menomonee Falls,Inc reserves the right to review each application for financial assistance on its own merits and to consider other extenuating circumstances in the decision to approve or deny a patient's application for financial assistance. The applicant's gross family income will be determined using Modified Adjusted Gross Income (MAGI). Modified Adjusted Gross Income includes both earned income and passive income received and compared to the annual Federal Poverty guidelines set forth by the U.S. Department of Health and Human Services. A patient who has an annual gross income equal to or less than 400% of the current year's poverty guidelines will not pay more than 15% of their annual gross income on any single account during the approved eligibility timeframe. Patients who meet the requirements and have a gross income equal or less than 250% of the FPL may qualify for a 100% discount. Patients who meet the requirements and have a gross income between 250% and 400% of the FPL may qualify for a discount on a sliding scale. In addition to income, Community Memorial Hospital of Menomonee Falls,Inc. also takes certain assets into consideration. Assets protected from financial evaluation include a household's retirement assets, home equity, and a portion of cash and savings assets.
Part I, Line 6a - Related Organization Community Benefit Report	Every year, Community Memorial Hospital produces an annual report to the community highlighting community outreach programs, patient impact stories and investments in the communities we serve. The report is mailed to over 150 area non-profits, chambers of commerce, hospital partners, Community Memorial Hospital Board of Directors, Community Memorial Hospital leaders and staff, government officials, business leaders and other community members. A copy of the most recent report can be found at https://www.froedtert.com/about/annual-reports
Part I, Line 7 - Explanation of Costing Methodology	Charity Care and certain other community benefits costs were determined by using internal information to reduce the various activities to cost. The costing methodology follows what is laid out in the instructions from the IRS.As a not-for-profit, emergency medical care and other medically necessary care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit.
Part I, Line 7, Column F - Explanation of Bad Debt Expense	Our total expense from Form 990, Part IX, line 25, column (A) was $268,386,117. Bad debt expense is included in Form 990, Part VIII, Statement of Revenue, Lines 2a-2c as required by ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. Therefore, bad debt expense is not included on Form 990, Part IX, Statement of Functional Expenses, Line 25, Column (A).
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions and trends. The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit	The financial assistance policy allows for accounts in bad debt to be approved for financial assistance if the patient meets the criteria. There are possible financial assistance accounts in bad debt, although the exact percentage is unknown as we do not have the appropriate tools to determine this percentage accurately.
Part III, Line 4 - Bad Debt Expense	Patients accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of patients accounts receivable, FH analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, FH analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). 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), Froedtert Health, Inc. records a significant provision for bad debts 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. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. FH recognizes patient service revenue associated with services provided to patients who have third party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, Froedtert Health, Inc. recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates, if negotiated or provided by policy). On the basis of historical experience, a significant portion of FH's uninsured patients will be unable or unwilling to pay for the services provided. Thus, FH records a significant provision for bad debts related to uninsured patients in the period the services are provided. See also page 30 of the attached audited financial statements.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit	CMH believes that all of the shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. The hospital provides emergency medical care or other medically necessary care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries.The costing methodology used to determine the Medicare allowable costs is based on a calculation developed by the American Hospital Association in which the data is derived from the annual filed Medicare cost report.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	In alignment with the FH Financial Assistance policy and Credit and Collection policy regarding the billing, collection and support for patients with payment obligations, CMH makes every effort to adhere to the policy and is committed to implementing and applying the policies for assisting those patients who may qualify for Financial Assistance in a professional and consistent manner. Staff members who work closely with patients such as Patient Financial Services Customer Service and Financial Counseling staff, as well as those involved in billing and collections are trained about these policies with an emphasis on treating all patients with dignity and respect regardless of their insurance or their ability to pay for services. Other staff who may have interactions with patients, such as admitting staff are also aware of the policy, and able to provide patients a copy of an application upon request and also are committed to treating patients with dignity and respect regardless of their insurance or their ability to pay for services.
Part VI, Line 2 - Needs Assessment	In February 2015, Community Memorial Hospital collaborated with JKV Research, LLC along with Aurora Health Care, Childrens Hospital of Wisconsin, Columbia St. Marys Health System, ProHealth Care, Wheaton Franciscan Healthcare, Washington County Health Department and Waukesha County Health Department to conduct a Community Health Needs Assessment (CHNA) in Washington and Waukesha Counties. The research from the needs assessment provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Waukesha County residents. CHNA Overview/Objectives:Gather data on behavioral and lifestyle habits of the adult population and household-level data. Gather data on the prevalence of risk factors and disease conditions of the adult population.Compare health data of residents to previous health studies.Compare health data to national and state measurements.CHNA Methodology:18 minute telephone survey of area residents400 completions from February 2 through February 23, 2015Two-fold sampling1) RDD landline sample of listed & unlisted #s (n=300)Respondents randomly selected based on number of adults in householdWeighting based on number of adults and number of residential phone numbers in household2) Cell phone only sample (n=100)Adult answering the phone designated as the respondentAll data post-stratified by age and gender of adult residents as of 2010 Census proportions.Margin of error: 5%Key Informant Interviews/Process (Waukesha County):The Key Informant Report presents a summary of public health priorities for Waukesha County, as identified in 2015 by a range of providers, policy-makers, and other local experts and community members (key informants). These findings are a critical supplement to the Waukesha County Community Health Survey conducted through a partnership between Aurora Health Care, Childrens Hospital of Wisconsin, Columbia St. Marys Health System, Froedtert Health, ProHealth Care and Wheaton Franciscan Healthcare. The Community Health Needs Assessment incorporates input from persons representing the broad interests of the community served, and from those who possess special knowledge of or expertise in public health.Key informants in Waukesha County were identified by the five organizations listed above. They invited the informants to participate, and conducted the interviews from March to June 2015. The interviewers used a standard interview script that included the following elements:Ranking of up to five public health issues, based on the focus areas presented in Wisconsins State Health Plan, that are the most important issues for the County; andFor those five public health issues:o Existing strategies to address the issueo Barriers/challenges to addressing the issueo Additional strategies neededo Key groups in the community that hospitals should partner with to improve community healthAll informants were made aware that participation was voluntary and that responses would be shared with the Center for Urban Population Health for analysis and reporting. Based on the summaries provided to the Center for Urban Population Health, this report presents the results of the 2015 key informant interviews for Waukesha County.The report first presents a summary of the health issue rankings, including a list of the five issues which were ranked most frequently by respondents. The next section describes the themes that presented themselves across the top ranked health topics. Finally, a summary of the strategies, barriers, and partners described by participants is provided as well.Limitations: Thirty-eight key informant interviews were conducted with 50 respondents in Waukesha County. Some interviews incorporated the views of more than one person from an agency or organization. The report relies on the opinions and experiences of a limited number of experts identified as having the communitys pulse. However, responses may not be representative of the overall perception of community strengths and needs. It is possible that the results would have been substantially different if a different set of informants had been interviewed. Results should be interpreted with caution and in conjunction with other Waukesha County data (e.g., community health surveys and secondary data reports).Focus Area RankingIn 38 interviews (Waukesha County), a total of 50 key informants were asked to rank up to five of the major health-related issues in their county from a list of 13 focus areas identified in the State Health Plan. Importantly, not every informant ranked five issues, and some did not include an order ranking (e.g., included check marks, but no numbers). Those without an order ranking are included as being ranked in the top five, but are excluded from the top issue ranking.Additionally, CMH service area extends into southern Washington County. In determining health priorities and plans, the hospital used data from the Washington County Community Health Needs Assessment that was conducted in 2014. Fifteen key informant interviews were conducted in Washington County. Same processes were followed as the Waukesha CHNA.Hospital Implementation StrategyImplementation Plan Development/Selection ProcessCommunity Memorial Hospitals Community Engagement strategies are guided by the Community Outreach Steering Committee (COSC) which is a subcommittee of the hospitals Board of Directors. The COSC actualizes the mission of Community Memorial Hospital (CMH) through community engagement activities that improve the quality of life and enhance wellness resources which meet identified comprehensive health needs of the communities served. The Community Outreach Steering Committee is appointed annually by the hospital president and is advisory to the CMH Board and Administration. Membership appointments are made each June with members serving one year terms. The COSC meets quarterly and is composed of hospital and board representatives plus community members representing the various constituencies of the total service area. Functions include:Provide a leadership role in advocating community wide responses to health care needs in the communityFacilitate and support community and health care partnershipsEnvision, assess and guide new community benefit opportunitiesIdentify and describe unmet health needsPromote universal access to health careUnder the direction of the Community Engagement Leadership Team and trained meeting facilitator; the planning process included five steps in developing the Implementation Plan:1.Reviewed the Community Health Needs Assessment results for identification and prioritization of community health needs (Waukesha and Washington Counties)2.Reviewed previous Implementation Plan programs and results3.Reviewed current hospital and community health improvement initiatives and strategies4.Ranked and selected priority areas5.Select evidence-based strategies, partnerships and programs to address community health needsAfter several facilitated workout sessions in September 2015, findings from the assessment were categorized into ten areas: Access to Care and Resource Navigation, Chronic Disease Management, Mental Health Services, Nutrition, Obesity and Physical Activity, Oral Health, Alcohol, Drug, Tobacco, Abuse and Other identified needs. To identify the top ranked priorities, members of the Advisory Committee were asked to rate each priority based on the following criteria: feasibility of Community Memorial Hospital to address the need (direct programs, clinical strengths and dedicated resources), alignment with Froedtert Healths strategic priorities, current or potential community partners/coalitions and each need has achievable and measurable outcomes. Of those ten health needs categories, three overarching themes were identified as the focus for Community Memorial Hospitals Implementation Plan for fiscal 2016 2018: Access to Care and Navigation Mental Health/Alcohol and Other Drug AbuseChronic Disease ManagementImplementation Strategy EvaluationCommunity Memorial Hospitals Community Engagement team along with the Community Outreach Steering Committee will regularly monitor and report on progress towards the Implementation Strategy objectives and provide quarterly reports to the Hospitals Board of Directors and health systems Community Engagement Steering Committee. Additional progress on the Implementation Plan will be reported annually through the hospitals IRS Form 990 Schedule H filing and other reporting sources associated with strategic partners and community coalitions.
Part VI, Line 3 - Patient Education of Eligibility for Assistance	Community Memorial Hospital of Menomonee Falls,Inc. informs and educates patients regarding financial assistance and government program eligibility in a number of ways. Its communication efforts also address special needs of patients and their families, such as hearing or visual impairment or language interpretation.Information on hospital-based financial support policies and government programs are made available to patients during the pre-registration and registration processes through brochures, signage and direct contact with financial counselors, social workers / case managers and registration staff. Patient billing statements also inform patients that financial assistance is available. The Froedtert Health,Inc. website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. Community Memorial Hospital of Menomonee Falls,Inc. has made financial assistance forms and information available in Spanish. Financial counselors screen uninsured patients for government program eligibility and social services staff are available to assist patients with enrollment processes. Patients who are uninsured, those covered by government programs and those with limited financial means may also be eligible for charity care or discounts through the Community Memorial Hospital of Menomonee Falls,Inc. financial assistance program. Financial counselors make every effort to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial assistance can be made during any stage of the patient's stay after stabilization, or the collection cycle.
Part VI, Line 4 - Community Information	Froedtert & the Medical College of Wisconsin Community Memorial Hospital, founded in 1964 by the citizens of Menomonee Falls and surrounding communities, is a full-service hospital that specializes in cancer care, heart and vascular care, orthopaedics, womens health and advanced surgical procedures. Since its founding, Community Memorial (CMH) has focused on the emerging healthcare and wellness needs of over 400,000 people in the three county region of Waukesha, Washington, and northwest Milwaukee Counties. The following data highlights Community Memorial Hospitals primary and secondary service area in relationship to income, race/ethnicity and payer mix:Household Income CY17 -Primary Service Area and Secondary Service AreaUnder $24,999 - 19.34% and 11.78%$25,000 - $49,999 - 23.20% and 17.51%$50,000 - $99,999 - 33.78% and 32.39%$100,000 and up - 23.68% and 38.32%Total Households - 114,328 and 60,944 Source: DataBayEthnicity CY17 - Primary Service Area and Secondary Service AreaWhite -67.04% and 87.85%African American - 24.29% and 4.86%Asian/Hawaiian/Pacific Islander - 4.48% and 4.47%Native American - 0.38% and 0.30%Two or more races - 2.55% and 1.87%Other -1.26% and 0.65%Hispanic* - 3.75% and 2.78%Total Population - 294,797 and 151,531 Source: DataBayPayer Source FY17 - Primary Service Area and Secondary Service AreaCommercial/Managed Care - 27.66% and 38.66%Medicare - 50.87% and 51.39%Medicaid - 19.70% and 8.60%Other Government - 0.23% and 0.38%Other Self Pay - 1.54% and 0.97%Source: DataBayNotes: Household Income & Ethnicity Data CY 2017Payer Source FY 2017*In the 2010 Census, respondents are instructed to answer both the Hispanic origin and race questions. The instruction specifically says that Hispanic origins are not races. Therefore, the two groups are categorized separately.There are three additional health care systems serving the community (ProHealth Care, Aurora Health Care and Wheaton Franciscan) and one Federally Qualified Health Center (Waukesha County Community Health Center operated by Sixteenth Street Community Health Centers).
Part VI, Line 4 - Community Building Activities	To promote the health of our communities, Community Memorial Hospital participates in numerous community building activities, which are not included elsewhere on Schedule H. These activities include:1.Economic Development: 4 leaders participate in local chamber of commerce boards focused on economic development to improve the local economy and local job opportunities.2.Community Support: 30 hours were dedicated to supporting youth focused coalitions to improve the community environment for youth to set them up for greater success.3.Community Health Improvement Advocacy: Participation in creating the Community Health Improvement Plan with the local health departments to increase collaborative work in our communities.4.Workforce Development: Diversity training and minority internship programs that recruit health professionals in our traditionally underserved communities to diversify our workforce population to better serve our communities. Work with high school students to increase their interest in health care careers and includes things such as HealthCare Career Academy, hospital tours, career events and observation experiences.
Part VI, Line 5 - Promotion of Community Health	Community Memorial Hospitals (CMH) community health improvement initiatives are targeted for the broad community, especially vulnerable populations (uninsured/underinsured) in the hospitals primary and secondary service areas. CMHs mission is to advance the health of the communities we serve through exceptional care enhanced by innovation and discovery. The hospitals Community Outreach Steering Committee and Community Engagement staff prioritized community health improvement programs, activities and services that reflect the hospitals mission and scope of care: Access Care and Navigation of Community Resources, Chronic Disease Management, Alcohol and Other Drug Abuse/Mental Health.See activities described in Part V, Section B, Line 11 as well as the Other Community Engagement Programs and Initiatives below:Other Community Engagement Programs and Initiatives:Community Engagement proactively addresses the social, cultural and economic determinants that underpin health and seeks to build partnerships with others to find solutions. Froedtert & the Medical College of Wisconsin are committed to making a positive, sustained difference in our community. Community Engagement will strengthen the economic vitality and quality of life of those communities we serve. CMHs Community Engagement programming and health improvement activities are supported through staff resources, budgeted dollars for programming and community partnerships. Other Community Engagement Programs and Initiatives:Community Engagement proactively addresses the social, cultural and economic determinants that underpin health and seeks to build partnerships with others to find solutions. Froedtert & the Medical College of Wisconsin are committed to making a positive, sustained difference in our community. Community Engagement will strengthen the economic vitality and quality of life of those communities we serve. Community Memorial Hospitals Community Engagement programming and health improvement activities are supported through staff resources, budgeted dollars for programming and community partnerships. Flu Clinics (Chronic Disease)Community Memorial Hospital offers flu clinics for uninsured populations utilizing services at three food pantries, the Touched Twice Free Clinic Event and the free clinic in Community Memorial Hospitals service area. FY 2016 Outcomes/ProgressDuring the fall of Fiscal Year 2016, 73 people were immunized at four locations. Each of the clinics was staffed by hospital pharmacists and support staff who were certified by the state to administer immunizations. FY 2017 Outcomes/ProgressDuring the fall of Fiscal Year 2017, 123 people were immunized at five locations. Each of the clinics was staffed by hospital pharmacists and support staff who were certified by the state to administer immunizations. FY 2018 Outcomes/ProgressDuring the fall of Fiscal Year 2018, 117 people were immunized at five locations. Each of the clinics was staffed by hospital pharmacists and support staff who were certified by the state to administer immunizations. United Way Employee Giving Campaign (Community Development)Community Memorial Hospital collaborates with United Way of Greater Milwaukee and Waukesha County to address community needs in the areas of meeting basic needs, developing self-reliance, strengthening communities and community support. Community Memorial Hospital hosts an annual workplace giving campaign to support all local United Ways. FY 2016 Outcomes/ProgressThe implementation of the campaign took 692 hours of staff time to coordinate. As a health system, Froedtert staff, physicians, and leaders raised $452,211.FY 2017 Outcomes/ProgressThe implementation of the campaign took close of 500 hours of staff time to coordinate. As a health system, Froedtert staff, physicians, and leaders raised $489,061.FY 2018 Outcomes/ProgressThe implementation of the campaign took 429 hours of staff time to coordinate. As a health system, Froedtert staff, physicians, and leaders raised $494,773.Community Health & Wellness Initiative Community Garden (Prevention and Wellness)Community Memorial Hospitals on-campus garden is providing produce to low-income populations residing in the hospitals service area that may not readily have access to fresh vegetables. The community garden is a great way to help those who have chronic conditions access nutritious vegetables. The summer and falls harvest, which included tomatoes, cucumbers, zucchini, peppers and beans, were distributed directly to patients who use the Outreach Clinic and Sussex, Germantown and Menomonee Falls food pantry clients. FY 2016 Outcomes/Progress1,118 pounds of produce was donated and benefited hundreds of people.FY 2017 Outcomes/Progress1,148 pounds of produce was donated and benefited hundreds of people. FY 2018 Outcomes/Progress1,478 pounds of produce was donated and benefited hundreds of people.Community Health Screenings (Prevention and Wellness)Community Memorial Hospital offers free blood pressure, skin cancer and heart screenings. With the goal to empower people and the community to make better decisions and take actions to improve and maintain their health, our community health screenings provide much needed access to services for many of our community members. FY 2016 Outcomes/ProgressCommunity Memorial Hospital provided free health screenings for 494 people. FY 2017 Outcomes/ProgressCommunity Memorial Hospital provided free health screenings for 188 people. FY 2018 Outcomes/ProgressCommunity Memorial Hospital provided free health screenings for 165 people. Bobbie Nick Voss Colonoscopy Program (Access and Chronic Disease) Community Memorial Hospital partners with Bobbie Nick Voss Charitable Funds to provide free colonoscopies to patients (age 50 and above) in the Community Outreach Health Clinic that show signs or symptoms of colorectal related health conditions. FY 2016 Outcomes/Progress9 patients received a colonoscopy at no cost. FY 2017 Outcomes/Progress3 patients received a colonoscopy at no cost. FY 2018 Outcomes/Progress5 patients received a colonoscopy at no cost. Living Well with Chronic Conditions (Chronic Disease)Living Well with Chronic Conditions Workshop is a six week series that teaches individuals with chronic conditions to become better self-managers of their health. Topics covered include: techniques to deal with problems such as frustration, fatigue, pain and isolation; appropriate exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of medications; communicating effectively with family, friends and health professionals; nutrition; decision making; and evaluating new treatments. The program is highly interactive and designed to enhance current treatment or disease specific education that patients are already receiving. FY 2016 Outcomes/ProgressCommunity Memorial Hospital offered two, six week workshops helping 25 individuals better manage their symptoms and live a healthier life.FY 2017 Outcomes/ProgressCommunity Memorial Hospital offered one, six week workshops helping 21 individuals better manage their symptoms and live a healthier life.FY 2018 Outcomes/ProgressCommunity Memorial Hospital offered two, six week workshops helping 13 individuals better manage their symptoms and live a healthier life.Every 15 Minutes (Alcohol and Other Drug Abuse)Speeding, recklessness and drug or alcohol use are common risk factors among children and teens killed in motor vehicle and transport crashes, according to the Wisconsin Child Death Review Council. Changes in behavior can help prevent death and injury from vehicle crashes, one of the top five causes of preventable death in Wisconsin children. To drive home a powerful message about the consequences of drinking and driving and to help prevent death from drunk driving crashes, Community Memorial Hospital collaborates with local high schools in the Every 15 Minutes program. The program involves not only a mock crash, but multiple scenarios that are videotaped by high school students and presented at a moving and emotional assembly at school the next day. The hospital has been part of the Every 15 Minutes program since 2010, as the receiving hospital for mock crash victims arriving by local EMS ambulance and Flight for Life. The Emergency Care Center provides staffing to treat the mock victims in a realistic way. Physicians, nurses, EMTs, technicians and other staff are involved. Hospital staffs are also involved in the planning and communications. In a safe and caring way, the program confronts high school students with the real-life consequences of drug and/or alcohol use while driving and has been positively received by students and community. FY 2016 OutcomesCoordinated the program with Germantown High School affecting 500 students.FY 2017 Outcomes/ProgressNo events took place this year.FY 2018 Outcomes/ProgressPlanning is underway for 2 programs to take place in FY 2019 Germantown High School & Menomonee F
Part VI, Line 6 - Affilated Health Care System	Affiliated Health SystemThe Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma Center at Froedtert Hospital, Milwaukee, an internationally recognized training and research center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes five hospitals, more than 1,600 physicians and nearly 40 health centers and clinics, draws patients from throughout the Midwest and the nation.Community Memorial Hospital has an open medical staff and physicians must go through the credentialing process and apply for privileges. CMH has exclusivity rights for certain departments in the hospital, such as Emergency and Anesthesia services. Froedtert, Community Memorial and St. Josephs Hospitals made significant investments in the health of their communities. Patients who couldnt pay for their medical care received more than $122 million in uncompensated services. Beyond providing care for the poor, we contributed $116.7 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities.Froedtert Health members develop community benefit strategies and goals based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the hospitals have built important local relationships that provide meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes, health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert Health, visit www.froedtert.com Promotion and Community HealthThe Community Outreach Steering Committee (COSC), which is a subcommittee of the hospitals Board of Directors, actualizes the mission of Community Memorial Hospital through community benefit activities that improve the quality of life and enhance wellness resources, which meet identified comprehensive health needs of the communities served. The COSC is appointed annually by the hospital president and is advisory to the Community Memorial Hospital Board and Administration. Membership appointments are made each June with members serving one year terms. The COSC meets quarterly and is composed of hospital and board representatives, plus community members representing the various constituencies of the total service area. Functions include:Provide a leadership role in advocating community wide responses to health care needs in the community.Facilitate and support community and health care partnerships.Envision, assess and guide new community benefit opportunities.Identify and describe unmet health needs.Promote universal access to health care.Determine allocation of the Community Outreach Services Fund, which awards $50,000 annually towards area non-profits efforts to improve health disparities focused on Access to Care/Navigation, Mental Health/AODA and Chronic Disease Management in the communities Community Memorial Hospital serves.Addressing Needs Through Targeted Outreach:Community Memorial Hospital develops and executes community outreach programming and activities based on identified community health needs. Since 1990, Community Memorial Hospital conducts needs assessments every three years in order to determine priorities and strategies in addressing community health disparities. Every needs assessment cycle, Community Memorial Hospital Community Engagement staff along with the hospitals COSC develops a Community Health Improvement Plan that is incorporated into the hospitals overall strategic plan to address the most critical needs in the communities we serve. The plan is reviewed annually by the COSC. Community Memorial Hospital Community Outreach staff, leaders and external community partners work collaboratively to develop key goals and strategies to address community health needs. Progress towards community outreach programs/activities and goals are reported quarterly through the COSC, Physician Advisory Council, Leadership Meetings and the Board of Directors. Based on the results from the 2015 Community Health Needs Assessment, programs and activities are focused around the following identified health needs:Access to Care and Navigation of Community ResourcesAODA/Mental HealthChronic Disease Management (Prevention/Treatment)For more information on specific community outreach efforts, please refer to the 2018 Froedtert Health Report to the Community at https://www.froedtert.com/about/annual-reports
Part VI, Line 7 - States Filing of Community Benefit Report	WI
Part V - Explanation of Number of Facility Type	Community Memorial Hospital of Menomonee Falls,Inc. is the only facility listed under this reporting of the IRS Form 990, Schedule H.
Part VI - Additional Information	Community Benefit Data is reported annually to the Wisconsin Hospital Association.Part V, Section B, Line 11 (Continued)Community Paramedicine Program in Partnership with Town of Lisbon Fire and RescueCHNA Area of Focus: Access to Care and Navigation / Chronic Disease ManagementCHNA Community Health Need/ Rationale: 33% of Waukesha County residents reported having High Blood Pressure 26% of Waukesha County residents reported having High Blood Cholesterol 7% of Waukesha County residents reported having Heart Disease or related condition 9% of population reported having diabetes 8% of population has Asthma 8% of population did not take medications for their medical condition due to cost Goal: Reduce readmission rates and increase timely access to care for individuals living with Chronic Conditions (Pneumonia, Congestive Heart Failure, AMI, Diabetes and Stroke).Objectives: Provide wellness checks within 48 72 hours of discharge for high risk populations for 65% of patients that qualify for program. Froedtert Health Resources: CMH/CP Staff, Physicians and Nurse Practitioners Community Outreach Health Clinic Case Management/Care Transition Coordinators Community Memorial Foundation Quality Department Froedtert Health Collaborative Partners: Menomonee Falls Fire DepartmentTown of Lisbon Fire DepartmentThe Community Paramedicine program is a partnership with Community Memorial Hospital (CMH) and Town of Lisbon Fire and Rescue Paramedics. After reviewing internal data and latest Community Health Needs Assessment, CMH has high readmission rates for populations suffering from Congestive Heart Failure, Pneumonia, Ischemic Stroke, AMI and Diabetes. Looking at evidenced based solutions to the problem, Community Memorial Hospitals Community Engagement Department identified the Community Paramedicine program as a strategy to address the issue. The Community Paramedicine Pilot Program Proposal was drafted and presented in November 2015 to the Froedtert Health Healthcare Value Council for approval. The plan was approved and a multidisciplinary team from SJH and Froedtert Health began to work on the operational/implementation plan. Community Memorial Foundation is providing $50,000 in grant funding to launch the pilot program. The Paramedics will follow up with the patient in their homes within 48 72 hours post discharge and provide up to three post discharge visits. The paramedics will provide safety inspection of the home, review medications and adherence, connect to community resources, monitor vitals and communicate current state back to the patients care team. FY2016 Outcome/Progress:Developed contract between CMH and Town of Lisbon Fire & RescueCompleted program policies and procedures for all stakeholdersIdentified key health/diagnosis indicators for referral into programDetermined Medical Directorship, Clinical Support and Operational Leadership from Froedtert HealthDeveloped education plan and courses for assigned paramedics Developed intake and discharge process from hospital to community paramedicsFY 2017 Outcomes/Progress: Credentialing/Approval of Program Medical Director in April 2017Developed EPIC protocols and builds for order entry and communication of results for physicians and paramedics. Developed HIM Process for scanning paramedic charts for inclusion into EPIC.Developed program materials and patient communicationsFY2018 Outcomes/Progress:CMH Program put on hold. Lisbon and Menomonee Falls Fire Departments did not have the labor force to participate in the program. Looking into new model for FY 2019.Cancer Education, Outreach and Community Health NavigationCNHA Area of Focus: Access to Care/NavigationCHNA Community Health Need/ Rationale: Lack of awareness of what services and programs exist for community members in Washington and Waukesha Counties Fragmented coordination of care amongst non-profit organizations Difficult to navigate resources in Washington and Waukesha Counties Goal: Expand assistance and support for the Community Health Worker network to improve access to healthcare services for vulnerable populations.Objectives: Increase self-management of high risk populations by addressing social determinants of health in CMHs service area Froedtert Health Resources: Community Engagement staffFroedtert Health Collaborative Partners: Community Outreach Health ClinicWaukesha County Public Health DepartmentWashington County Human ServicesFY 2017 Outcomes/Progress: Due to budgetary constraints and other priorities, the Community Health Navigator program did not launch in FY 2017. Decision was made to utilize funds and partnerships for a Community Dental Initiative.Cancer Care Navigation, Awareness, Prevention, Screenings Community Memorial Cancer CenterCHNA Area of Focus: Chronic Disease CancerSkinProstateColorectal (Bobbie Nick Voss Colorectal Screening Program)CHNA Community Health Need/ Rationale: Washington and Waukesha County cancer incidence rate is higher than state average Cancer is leading cause of death in Waukesha and Washington Counties Difficulty in navigating programs and services in CMHs service area Goal: Decrease the cancer mortality rate in Washington and Waukesha CountiesObjective: Implement programs to increase cancer awareness, screening and early detection at CMH and organizations across the hospitals service area Froedtert Health Resources: CMH Cancer Center Nurses and Clinical Psychologist Community Memorial Foundation Froedtert & MCW Community Physicians Froedtert & MCW Cancer Care Network Physicians Direct Financial Support through Froedtert Healths Charitable Gifts and Sponsorship Committee Froedtert Health Collaborative Partners:American Cancer SocietyBobbie Nick Voss Charitable FundsFY 2016 Outcomes/Progress:Due to budgetary constraints and other priorities, the Community Health Navigator program did not launch in FY 2016. Looking at implementation in Fiscal Year 2017.FY 2017 Outcomes/Progress: 3 colonoscopies provided to uninsured patients referred from the Community Outreach Health Clinic.10 individuals were screened for prostate cancer. 20% of individuals screened were referred on for further evaluation. 6 presentations to the Tri-County YMCA Livestrong program about health topics (Nutrition & Lymphedema) touching 23 individuals.3 Community class about cancer related health topics.4 different health topic classes presented at community sites to a total of 94 people.Navigation results from Jackie Grams, Oncology Social Worker and Cancer Navigator include 106 patients that were screened and referred to community resources/assistance. Referrals include insurance resources, government assistance programs, transportation, food pantries and community based outpatient behavioral health services.FY2018 Outcomes/Progress:5 colonoscopies provided to uninsured patients referred from the Community Outreach Health Clinic.8 individuals were screened for head and neck cancer. 1 individual screened was referred on for further evaluation. 6 presentations to the Tri-County YMCA Livestrong program about health topics (Nutrition & Lymphedema) touching 31 individuals.4 Community classes about cancer related health topics.5 different health topic classes presented at community sites to a total of 173 people.Navigation results from Jackie Grams, Oncology Social Worker and Cancer Navigator include 79 patients that were screened and referred to community resources/assistance. Referrals include insurance resources, government assistance programs, transportation, food pantries and community based outpatient behavioral health services.Evidence Based Community Education and Wellness Programs - Living Well Series, Service Line Outreach and Support GroupsCHNA Area of Focus: Chronic DiseaseCHNA Community Health Need/ Rationale: 33% of Waukesha County residents reported having High Blood Pressure and 26% High Blood Cholesterol 7% of Waukesha County residents reported having Heart Disease or related condition 9% of population reported having diabetes 8% of population did not take medications for their medical condition due to cost Goal: Reduce morbidity and mortality from chronic conditionsObjectives: Increase self-management for individuals living with chronic conditions and reinforce healthy lifestyles to encourage behavior change Froedtert Health Resources: Community Engagement Staff Certified Living Well InstructorsCase ManagementInpatient/Outpatient DepartmentsFroedtert Health Collaborative Partners:Wisconsin Institute for Healthy Aging Waukesha County Aging and Disability Resource Center Interfaith Senior Programs Waukesha County Menomonee Falls, Sussex and Germantown Food Pantries Area Community Education and Recreation Departments Continued on Schedule O

Schedule H (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number
39-0987025

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Addiction Resource Council 741 N Grand Ave Suite 200 Waukesha,WI53186	39-1174092	501(c)(3)	15,000	Outreach and Support Programs
(2) Community Memorial Foundation W180 N8085 N Town Hall Road Menomonee Falls,WI53051	39-1635057	501(c)(3)	22,500	Support Operations of the Hospital
(3) NAMI Of Waukesha County 217 Wisconsin Avenue Ste 300 Waukesha,WI53186	39-1485627	501(c)(3)	7,500	Outreach and Support Programs

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Grantmaker's Description of How Grants are Used

Organizations submit grant requests to the Community Outreach Steering Committee (the Committee). On a quarterly basis the fund allocations are determined. Each organization selected for funds receives an award letter detailing the expectations and conditions of the grant money. In order to comply with applicable tax laws, regulations and the Community Outreach Services Fund policy, the Community Outreach Services Fund will provide grant support to organizations with the understanding that:1) Grant funds distributed will be used only for the purposes designated in the award letter.2) No funds will be used for any political campaign or to support attempts to influence legislation of any governmental body. 3) If the organization loses exempt status, any unexpended funds will be returned to the Community Outreach Steering Committee.4) Adequate accounting records of the expenditures of funds will be maintained by the organization.5) This is a one time grant distribution. Future funding requests will be considered on a case by case basis. In addition, the Committee includes a Final Report Form with each organizations award letter. The form requires the organization to provide a brief description of the activity and measurable outcomes/benefits, an expenditure report, follow up actions to the Committee's recommendations, and future plans. The Committee requests that each organization submit the Final Report Form to the Committee within thirty days after the completion of the project for which the funds were intended or within a maximum of one year from the receipt of funds.

Schedule I (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Ceelen John Treasurer	(i) (ii)	------------- 391,618	------------- 134,477	------------- 19,690	------------- 89,990	------------- 33,650	------------- 669,425	-------------
2Ehn Diane VP Qlty & Perf Exc	(i) (ii)	209,581 -------------	53,055 -------------	22,178 -------------	38,357 -------------	21,172 -------------	344,343 -------------	20,130 -------------
3Ericson Allen Former - Officer (COO)	(i) (ii)	------------- 455,211	------------- 155,459	------------- 111,745	------------- 110,364	------------- 32,588	------------- 865,367	------------- 90,773
4Evenson Rock E VP Business Ops	(i) (ii)	179,357 -------------	50,348 -------------	46,721 -------------	31,998 -------------	21,823 -------------	330,247 -------------	25,438 -------------
5Goldberg David F MD Dir&VP Med Afrs	(i) (ii)	348,019 -------------	89,872 -------------	60,447 -------------	50,523 -------------	7,957 -------------	556,818 -------------	40,737 -------------
6Hawig Scott Former - Officer (CFO)	(i) (ii)	------------- 604,376	------------- 485,654	------------- 144,438	------------- 140,011	------------- 31,320	------------- 1,405,799	------------- 125,298
7Knoll Thomas Former - Officer (Treas)	(i) (ii)	------------- 169,892	------------- 26,097	------------- 1,451	------------- 10,056	------------- 29,112	------------- 236,608	-------------
8Lux Theresa M Dir&CMH Pres	(i) (ii)	295,920 -------------	83,077 -------------	49,155 -------------	80,215 -------------	12,080 -------------	520,447 -------------	30,225 -------------
9McClure Debra Nurse Anesthetist	(i) (ii)	331,453 -------------	-------------	24,705 -------------	6,021 -------------	12,069 -------------	374,248 -------------	-------------
10Newkirk Garret Dir of Pharmacy	(i) (ii)	182,351 -------------	27,774 -------------	963 -------------	11,121 -------------	28,005 -------------	250,214 -------------	-------------
11Petry Patricia CHD Dir Wom Hlth	(i) (ii)	184,058 -------------	27,333 -------------	2,553 -------------	12,054 -------------	10,991 -------------	236,989 -------------	-------------
12Pollard Dennis Dir&FH COO	(i) (ii)	------------- 551,674	------------- 443,348	------------- 148,013	------------- 127,428	------------- 26,805	------------- 1,297,268	------------- 120,405
13VanDeKreeke Jeffrey Former - Officer (CFO)	(i) (ii)	------------- 333,669	------------- 88,621	------------- 89,517	------------- 68,980	------------- 14,606	------------- 595,393	------------- 67,190
14Waala Shelly Dir&VP Pt Care	(i) (ii)	208,117 -------------	38,515 -------------	29,002 -------------	25,132 -------------	30,005 -------------	330,771 -------------	-------------

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Part I, Line 1a: Relevant information in regards to selections on 1a.

Health club dues:Evenson, Rock - $120Newkirk, Garret - $120

Part III, Additional Information

Part I, Line 7: Bonus compensation is paid based upon attainment of specific goals related to the organization's service, quality, and financial strength. The amount of compensation is calculated using specified percentages of base salary for achievement of particular goal levels. However, the Froedtert Health System Board Committee which administers the bonus compensation program has discretion over whether to pay the bonus in any given year or to amend, change, or terminate the program at any time.

Schedule J (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Community Memorial Hospital of Menomonee
Falls Inc

Employer identification number

39-0987025

Return Reference	Explanation
Form 990, Part III, Line 4d: Other Program Services Description	OTHER PROGRAM SERVICES 4: As part of operating an acute care hospital and providing health care services to the community, other revenue is derived in the following areas:Other Department Operating Revenue - revenue derived from different services through the process of providing patient care and in the normal operation of a medical facility. Included in this category are items such as meaningful use revenue, medical staff application fees, and revenue from classes, pump rentals, and other wellness services.Dietary Revenue revenue derived from cafeteria sales, vending machine sales, guest tray sales and employee meals. Dietary services are necessary to support services to patient families while their loved one is receiving care in the Hospital. The revenue from employee meals is a benefit provided by the Hospital as an employer and it allows our staff to remain on site for patient care. Corporate Allocated Revenue - revenue passed through from Froedtert Health (FH), a related party.Investment Income - revenue derived from investments in affiliates (Menomonee Falls Ambulatory Surgery Center and Vanguard Health Services).Intercompany Revenue consists of revenue derived from medical and administrative services provided to the other FH entities. All of these services support the delivery of healthcare to the community. Miscellaneous Revenue - revenue derived from different services through the process of providing patient care in the normal operation of a medical facility. Included in this category are items such as recycling revenue, taxable sales, and sale of medical records.
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et	Teri Lux, Shelly Waala, John Ceelen: all have Business Relationship with Scott Hawig and Dennis PollardDennis Pollard & Scott Hawig: Business Relationship
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Froedtert Health,Inc. is the sole corporate member of CMH.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	FH, as the sole corporate member of CMH has the final approval of election of all board members.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	FH as the sole corporate member of CMH, retains certain reserved powers and authorities with respect to specific governance matters, and strategic and mission-related initiatives of CMH.
Form 990, Part VI, Line 11b: Form 990 Review Process	FH accounting staff prepare Form 990 which is reviewed by the FH financial leaders. The 990 is then reviewed by KPMG, FH's outside accounting firm. Next, the 990 is provided to the FH Finance Committee and Board of Directors. Finally, the 990 is filed as required.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	On an annual basis all officers, directors, trustees, key employees are required to complete a conflict of interest disclosure statement. The data is compiled, and the FH Vice President-Chief Compliance Officer (CCO), the Senior Vice-President-General Counsel and/or delegate will review all forms and notifications to determine if any conflicts of interest exist in the disclosure documents. If it is determined that a conflict of interest exists, then the person making the disclosure shall be relieved of his/her obligations on behalf of CMH with respect to the transaction or arrangement that creates the conflict of interest. A report of all conflicts of interest will be made by the CCO at least annually to the FH Finance Committee of the FH Board of Directors.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	Compensation of Top Management is paid by FH, a related organization, but a review is performed. In establishing the compensation of the organization's Top Management, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, persons with a conflict of interest regarding the compensation arrangements at issue are not involved in the decision making process, and amounts are reviewed and approved by the Compensation Committee of the FH (the related organization) Board of Directors.In addition, there is contemporaneous documentation and recordkeeping for deliberations and decisions regarding the compensation arrangements.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	Compensation of Top management is paid by FH, a related organization, but a review is performed. In establishing the compensation of the organization's Officers and Key Employees, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, persons with a conflict of interest regarding the compensation arrangements at issue are not involved in the decision making process, and amounts are reviewed and approved by the Compensation Committee of the FH (the related organization) Board of Directors.In addition, there is contemporaneous documentation and recordkeeping for deliberations and decisions regarding the compensation arrangements.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	FH's quarterly financial information is made available to the public online through the Digital Assurance Corporation, Inc. website. Anyone can register to receive ongoing access to and notifications regarding financial statements at the online website. Additionally, Governing Documents and Conflict of Interest Policy are made available to the public through the corporate office upon request.
Other Changes In Net Assets Or Fund Balances - Other Decreases	Capital Contributions = -$7825560
Other Changes In Net Assets Or Fund Balances - Other Increases	Change in APB other than net periodic benefit costs = $7504214
Other Changes In Net Assets Or Fund Balances - Other Decreases	Change in Foundation restricted net assets = -$444454
Other Changes In Net Assets Or Fund Balances - Other Increases	Change in Foundation unrestricted net assets = $574446
Other Changes In Net Assets Or Fund Balances - Other Increases	Transfer from Affiliates = $24636528
Other Changes In Net Assets Or Fund Balances - Other Decreases	Transfer to affiliates = -$15000
Part IX 24b Corporate Allocations	FH allocates certain revenues and expenses to FMLH, CMH, SJH & CP. The allocation is calculated by applying an allocation metric to each accounting unit at FH. Each entity then receives its portion of the FH allocation on a monthly basis.
Part VII - Section A 1a Columns C-F	Individuals listed as 'former' but receiving compensation during the year is due to the fact the individual is currently, or was during the tax year, still employed by the organization, but is no longer in the role of director, officer, key employee, etc. in the current year. Such individual was reported as such on the organization's 990 in the previous five years.
Schedule H, Part V, Section B, Line 11 (Continued)	Evidence Based Community Education and Wellness Program - Living Well Series, Service Outline Outreach and Support Groups CHNA Area of Focus: Chronic DiseaseFY 2016 Outcomes/Progress: 25 people participated in the Living Well with Chronic Conditions workshop. Wisconsin Institute for Healthy Aging follows class participants and found that participants have reduced healthcare expenditures, more appropriate utilization of health care resources and better health outcomes. 227 people received a blood pressure screening at 9 community events.40 people participated in a Carotid Artery Heart Screening. 10% of individuals screened were referred on for further evaluation.68 people participated in an Abdominal Aortic Aneurysm Heart Screening. 1 individual screened was referred on for further evaluation.76 people participated in a Peripheral Artery Disease Heart Screening. 8% of individuals screened were referred on for further evaluation.83 people participated in a Skin Cancer Screening. FY 2017 Outcomes/Progress: 21 people participated in the Living Well with Chronic Conditions workshop. Wisconsin Institute for Healthy Aging follows class participants and found that participants have reduced healthcare expenditures, more appropriate utilization of health care resources and better health outcomes. 29 people participated in the Be Strong Stay Strong program. This is an evidence based program that meets 2 times a week for 10 weeks. Research indicates that it improves muscle mass, strength and bone density. In addition, individuals who regularly strength train often have better blood glucose control, decreased arthritic symptoms, sleep better, and have decreased symptoms of depression.120 people received a blood pressure screening at 10 community events.47 people participated in a Peripheral Artery Disease Heart Screening. 6% of individuals screened were referred on for further evaluation. 11 people participated in a Cardiac Wellness Screening. 82% of individuals screened were identified as pre-hypertension /hypertension and overweight/obese. Education and coaching was provided to all individuals. 10 individuals were screened for prostate cancer. 20% of individuals screened were referred on for further evaluation. FY 2018 Outcomes/Progress:13 people participated in the Living Well with Chronic Conditions workshop. Wisconsin Institute for Healthy Aging follows class participants and found that participants have reduced healthcare expenditures, more appropriate utilization of health care resources and better health outcomes. 57 people participated in the Be Strong Stay Strong program. This is an evidence based program that meets 2 times a week for 10 weeks. Research indicates that it improves muscle mass, strength and bone density. In addition, individuals who regularly strength train often have better blood glucose control, decreased arthritic symptoms, sleep better, and have decreased symptoms of depression.157 people received a blood pressure screening at 14 community events.8 individuals were screened for head and neck cancer. 1 individual screened was referred on for further evaluation. CNHA Area of Focus: Mental Health/Alcohol and Other Drug AbuseCHNA Community Health Need/ Rationale: 39% of Washington County and 29% of Waukesha County residents reported binge drinking 4% of Waukesha County residents reported having a Mental Health Condition 6% of Waukesha County residents have problems with alcohol consumption Issues with navigating and accessing Mental Health/AODA treatment services especially uninsured/underinsured Goal: Improve the behavioral health of Waukesha CountyObjectives: Increase community awareness of mental health and alcohol and other drug abuse problems and collaborate for better case management and navigation of treatment Froedtert Health Resources: Community Engagement leadership/staffGrant support through the Community Outreach Steering CommitteeFroedtert Health Behavioral Health ServicesFroedtert Health Collaborative Partners:Waukesha County Health and Human Services and Public Health Departments Lead Agencies NAMI Addiction Resource Council (Waukesha County) Health care systems in Waukesha County Waukesha County School Districts Menomonee Falls Police DepartmentDrug Collection (AODA/Mental Health)As part of our commitment to improve the quality of life in our community and address drug/heroin addiction in our communities, Community Memorial Hospital partnered with Waukesha County Drug Free Communities Coalition, New Berlin Police Department and the Menomonee Falls Police Department to host a drug collection. FY 2016 Outcomes/Progress:At the collections, area residents dropped off 1,081 pounds of prescription and over-the-counter medications and 754 area households participated in the collection. This year alone, it took 22 staff and over 200 hours to make the collections possible. FY 2017 Outcomes/Progress: At the collections, area residents dropped off 1,230 pounds of prescription and over-the-counter medications and 640 area households participated in the collection. This year alone, it took 47 staff and over 140 hours to make the collections possible. FY 2018 Outcomes/Progress:At the collections, area residents dropped off 2,120 pounds of prescription and over-the-counter medications and 470 area households participated in the collection. This year alone, it took 32 staff and over 140 hours to make the collections possible. Community Memorial Hospital and Froedtert Health is a member of the Waukesha County Community Health Improvement Plan and Process (CHIPP) Team/Steering Committee, a consortium led by Waukesha County Health and Human Services and Division of Public Health. FY 2017 Outcomes/ProgressIn January 2017 the CHIPP Steering Committee officially kicked-off to plan and develop Mental Health/AODA strategies for the next five years. FY 2018 Outcomes/ProgressThe first draft of the plan was completed in December 2017 and implementation to begin thereafter. Reviewed by the Community Outreach Steering Committee at Community Memorial Hospital and added to the Implementation Strategy for FY 2018.Areas Not AddressedTeen Pregnancy: United Way, Public Health, Safe Babies Healthy Families, the Hope Network and a number of other community organizations are working on this health issue.Health Literacy and Navigation: Other community organizations are working to increase awareness of health services and health seeking behaviors among low income individuals.Cigarette Use: Community Memorial Hospital supports the Multi-Jurisdictional Coalition of Tobacco Free Community Partnership Dodge, Jefferson and Waukesha Counties.Mental Health: Community Memorial Hospital does not have the dedicated resources, although partners with many organizations throughout the service area to address certain areas of need. There are other local health and human service agencies and organizations dedicated to this issue in CMHs service area.
Schedule H, Part VI, Line 5 (Continued)	Supplemental information - Describe how the organization further its exempt purpose:Other Community Engagement Programs and Iniatives: Financial Assistance & Affordable Care Financial Counseling (Access to Care)Froedtert Health (parent company of Community Memorial Hospital) recognized the need to help individuals navigate financial resources including the new choices available to them through the Affordable Care Acts Insurance Marketplace and Medicaid reforms. These certified application counselors answer thousands of phone calls and assisted with questions. Froedtert Health also partnered with the Milwaukee Enrollment Network which represented health systems, free clinics, health departments and other non-profit organizations to reach out to people throughout Milwaukee, Washington and Waukesha Counties in securing adequate and affordable health insurance. FY 2016 Outcomes/ProgressOur network of certified application counselors assisted 2,311 individuals. FY 2017 Outcomes/ProgressOur network of certified application counselors assisted 3,857 individuals. FY 2018 Outcomes/ProgressOur network of certified application counselors assisted 3,255 individuals. Leadership Volunteerism/Community Support (Community Development)As an indication of Community Memorial Hospitals executive teams commitment to the community, hospital leaders provided support to local initiatives, not-for-profit organizations and community events that align with the hospitals mission and directly support identified community needs. FY 2016 Outcomes/Progress75 CMH leaders provided over 1000 hours to community organizations and coalitions. FY 2017 Outcomes/ProgressCMH leaders provided over 350 hours to 20 + community organizations and coalitions. FY 2018 Outcomes/ProgressCMH leaders provided over 250 hours to 40 + community organizations and coalitions. Subsidized Transportation Program (Access to Care)The Subsidized Medical Transportation Program at Community Memorial Hospital contracts with local transportation organizations in order to provide transportation to and from the hospital service locations for ambulatory/non-ambulatory eligible patients (200% federal poverty level or below) who have difficulty arranging their own transportation and lack the financial resources to purchase transportation. FY 2016 Outcomes/ProgressCommunity Memorial Hospital provided 499 subsidized rides to 396 patients. FY 2017 Outcomes/ProgressCommunity Memorial Hospital provided 445 subsidized rides to 402 patients. FY 2018 Outcomes/ProgressCommunity Memorial Hospital provided 521 subsidized rides to 464 patients. Community Outreach Steering Committee Grants (All Implementation Priority Areas)Community Memorial Hospitals commitment includes grants to local not-for-profit organizations that support community health improvement efforts focused on access to primary care, chronic disease management, mental health and prevention and wellness in the hospitals service area. FY 2016 Outcomes/ProgressTen local non-profit organizations received restricted grants totaling $50,000 from the Community Outreach Steering Committee. Award recipients include:Your Choice to Live (AODA Community Education) AODA Focus AreaKennedy Middle School Safe Cultures Committee (Your Choice Drug & Alcohol Awareness Program) AODA Focus AreaWaukesha County Community Dental Clinic (Adult Dental/Outreach) Access to Care and Oral HealthMenomonee Falls Police Department (DARE/Safety Education Program) - AODANAMI Waukesha County (SSI/SSDI & Outreach) Mental HealthGermantown Police Department (Every 15 Minutes Program) - AODATri-County YMCA (Livestrong) Chronic Disease ManagementAddiction Resource Council (Outreach & Individual/Family Support) - AODAEaster Seals Southeastern Wisconsin (Safe Babies Healthy Families) Access to Care and Navigation of Community ResourcesCommunity Outreach Health Clinic (Annual Operating Expenses) Access to CareFY 2017 Outcomes/ProgressNine local non-profit organizations received restricted grants totaling $50,000 from the Community Outreach Steering Committee. Award recipients include: Waukesha County UW- Extension(Strong Women Program) Chronic Disease ManagementWaukesha County Community Dental Clinic (Access to affordable oral health for low-income uninsured adults) Access to Care & Oral HealthSchool District of Menomonee Falls (Wake Up Call: Stairway to Heroin Educational Series) - AODANAMI Waukesha County (SSI/SSDI Outreach & Access to Recovery Program) Mental HealthYMCA of Greater Waukesha County (Livestrong) Chronic Disease ManagementGermantown School District (Understanding the Teenage Brain & AODA Prevention AODAHope Network for Single Mothers (Healthy Babies Program) Access to CareERAs Senior Network (The Caregiver Connection ) Access to CareAddiction Resource Council (Outreach & Individual/Family Support) - AODAFY 2018 Outcomes/ProgressFour local non-profit organizations received restricted grants totaling $50,000 from the Community Outreach Steering Committee. Award recipients include:NAMI Waukesha County (Expediting SSI Program of Waukesha County Mental HealthYMCA of Greater Waukesha County (Livestrong) Chronic Disease Management Addiction Resource Council (Outreach & Individual/Family Support) AODACommunity Outreach Health Clinic (Clinic operations) Chronic Disease ManagementHealth Care Career Academy (Health Professionals Education)The Healthcare Career Academy provides qualified students entering their junior or senior year at Menomonee Falls High School, Germantown High School and Sussex Hamilton High School with the opportunity to expand their knowledge base as it relates to a wide array of professional healthcare career options. The two-week program allows students to shadow and learn from professionals in various clinical and ancillary departments throughout the hospital. Through observation, hands-on experience and classroom discussion, students are able to expand their awareness and interest in healthcare careers. FY 2016 Outcomes/Progress24 students participated in the program.FY 2017 Outcomes/Progress24 students participated in the program.FY 2018 Outcomes/Progress24 students participated in the program.High School Health Care Career ExplorationFY 2016 Outcomes/ProgressCommunity Memorial Hospital hosted 2 different high school career day events that included presentations, tours and hands on activities with attendance of 87 students. Community Memorial Hospital participated in the Waukesha County Business Alliance Health Care Careers Expo and provided 16 staff at the event that attracted 400 high school students. FY 2017 Outcomes/ProgressCommunity Memorial Hospital hosted 5 different high school career day events that included presentations, tours and hands on activities with attendance of 181 students. Community Memorial Hospital participated in the Waukesha County Business Alliance Health Care Careers Expo and provided 21 staff at the event that attracted 450 high school students. FY 2018 Outcomes/ProgressCommunity Memorial Hospital hosted 1 high school career day events that included presentations, tours and hands on activities with attendance of 40 students. Community Memorial Hospital participated in the Waukesha County Business Alliance Health Care Careers Expo and provided 15 staff at the event that attracted 496 high school students.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

1	Briefly describe the organization’s mission or most significant activities: Community Memorial Hospital of Menomonee Falls, Inc. (CMH) advances the health of the communities we serve through exceptional care enhanced by innovation and discovery.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	2,124
6	Total number of volunteers (estimate if necessary) .............	6	166
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	62,640	89,611
9	Program service revenue (Part VIII, line 2g) .........	203,432,621	235,113,658
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-233,069	114,605
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	24,258,878	32,127,234
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	227,521,070	267,445,108
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	50,000	50,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	82,865,534	92,472,181
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 476,574
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	149,734,191	175,863,936
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	232,649,725	268,386,117
19	Revenue less expenses. Subtract line 18 from line 12.......	-5,128,655	-941,009
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	157,838,883	150,853,125
21	Total liabilities (Part X, line 26).............	59,765,884	29,290,961
22	Net assets or fund balances. Subtract line 21 from line 20.....	98,072,999	121,562,164

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 110,315,494 including grants of $ ) (Revenue $ 124,659,684 )
	Inpatient Services:CMH, founded in 1964 by the citizens of the community it serves, is a full-service hospital that specializes in cancer care, heart and vascular care, orthopaedics, womens health and advanced surgical procedures. The hospital is accredited by The Joint Commission. CMH enjoys a national reputation of excellence as a provider of top quality health care services and has received many awards for innovations. Combining next-generation technology with personalized care, CMH strives to enhance and improve the quality of life in Waukesha, Washington, Milwaukee and Ozaukee counties. CMH is approved for 237 beds of which 202 are staffed and had 9,470 patient admissions and 36,036 patient days related to a wide range of inpatient services, including hospitalist services, psychiatry, rehabilitation services, obstetrics and maternity care, critical care medicine, orthopedics, internal medicine, general surgery, and other specialty care for the twelve months ended June 30, 2018.CMHs Cancer Care Center is accredited by the American College of Surgeons Commission on Cancer and the American College of Radiology. As a select location in the Froedtert & the Medical College of Wisconsin Cancer Network, CMH provides the excellent care to which patients are accustomed, while offering access to the specialty expertise of Froedtert Memorial Lutheran Hospital, Inc. (FMLH), eastern Wisconsin's only academic medical center. Through a connection to Froedtert & the Medical College of Wisconsin, patients at CMH have access to expanded services: nationally and internationally known specialists who focus on specific cancers, advanced treatments and technologies, and clinical trials that may provide further options. Medical College of Wisconsin cancer specialists are joined by radiation therapists, oncology nurses, genetic counselors, registered dietitians, psycho-oncology specialists, and support service specialists at CMH's Cancer Care Center all of whom are keenly attuned to the needs, hopes and fears of cancer patients. Each patient's care is coordinated with specialists from many areas of CMH, who help and support patients and their families through the physical, emotional and economic phases of treatment. By combining clinical research methods with the most advanced treatments, our doctors are battling cancer from every angle possible giving patients a stronger reason to believe in a full recovery. During fiscal year 2018, CMH had 643 cancer registry cases.CMHs Heart and Vascular Center is nationally recognized for its excellent outcomes and superior service to patients. At the Heart and Vascular Center, dedicated physicians work as a team with cardiac nurses and other specialized staff to provide the full spectrum of heart care services, from diagnostic tests and surgical procedures to cardiac rehabilitation. Our extensive system of heart and vascular specialists collaborate to ensure that patients receive comprehensive, high-quality care. During fiscal year 2018, CMH had 13,129 cardiology procedures. At CMHs Birthing Center, we are committed to relationship-centered birthing care. The Birthing Center includes 13 specialty equipped suites and provides the full spectrum of prenatal services for both normal and high-risk pregnancies. The Level II NICU has the technology needed to provide long-term care for babies. During fiscal year 2018, CMH had 774 births.In addition to the cardiac, cancer care and birthing services noted above, CMH is the Froedtert & Medical College of Wisconsin Center of Excellence for elective joint replacements. The Hospital also provided a variety of inpatient ancillary treatments and procedures during the fiscal year including but not limited to the following: - Surgeries: 3,506 - Laboratory Tests: 367,164 - CT Scans: 4,741 - MRIs: 794 - Nuclear Medicine Scans: 341 - Ultrasounds: 1,770

4b	(Code: ) (Expenses $ 74,919,563 including grants of $ ) (Revenue $ 84,661,263 )
	Outpatient Services:CMH had 108,469 outpatient visits in the twelve months ended June 30, 2018. CMH offers a wide variety of ancillary, specialty and subspecialty services including but not limited to the following: - Allergy/Immunology - Cardiology - Clinical Genetics - Dermatology - Electrophysiology - Endocrinology - Family Practice - Gastroenterology - Gerontology - Gynecologic Oncology - Gynecology - Hand Surgery - Hematology - Infectious Disease - Internal Medicine - Interventional Radiology - Magnetic Resonance Imaging - Neonatology - Nephrology - Neurosurgery - Nuclear Medicine - Occupational Medicine - Oncology - Ophthalmology - Oral Surgery - Otolaryngology - Pathology - Pediatrics - Pedodontics - Perinatology - Periodontics - Physical Medicine and Rehabilitation - Plastic/Reconstructive Surgery - Podiatry - Psychiatry - Psychology - Pulmonary Medicine - Radiology - Radiation Oncology - Rheumatology - Thoracic Surgery - Urology - Vascular Surgery

4c	(Code: ) (Expenses $ 28,409,913 including grants of $ 50,000 ) (Revenue $ 32,104,019 )
	As part of operating an acute care hospital and providing health care services to the community, other revenue is derived in the following areas:Other Department Operating Revenue - revenue derived from different services through the process of providing patient care and in the normal operation of a medical facility. Included in this category are items such as meaningful use revenue, medical staff application fees, and revenue from classes, pump rentals, and other wellness services.Dietary Revenue revenue derived from cafeteria sales, vending machine sales, guest tray sales and employee meals. Dietary services are necessary to support services to patient families while their loved one is receiving care in the Hospital. The revenue from employee meals is a benefit provided by the Hospital as an employer and it allows our staff to remain on site for patient care. Corporate Allocated Revenue - revenue passed through from Froedtert Health (FH), a related party.Investment Income - revenue derived from investments in affiliates (Menomonee Falls Ambulatory Surgery Center and Vanguard Health Services).Intercompany Revenue consists of revenue derived from medical and administrative services provided to the other FH entities. All of these services support the delivery of healthcare to the community. Miscellaneous Revenue - revenue derived from different services through the process of providing patient care in the normal operation of a medical facility. Included in this category are items such as recycling revenue, taxable sales, and sale of medical records.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 22,824,826 including grants of $ ) (Revenue $ 25,792,711 )
4e	Total program service expenses236,469,796

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,544,554	4,354,950	1,114,433

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	4,730
d	Related organizations		1d	84,881
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g	6,763

h Total. Add lines 1a-1f.......		89,611

		Business Code
2a	Emergency/Trauma Revenue	900099	25,792,711	25,792,711
b	Inpatient Revenue	900099	124,659,684	124,659,684
c	Outpatient Revenue	900099	84,661,263	84,661,263
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		235,113,658

3 Investment income (including dividends, interest, and othersimilar amounts) ......			117,891	33,017		84,874
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	13,335		7a
b	Less: cost or other basis and sales expenses	16,621		7b
c	Gain or (loss)	-3,286		7c
d	Net gain or (loss).........			-3,286			-3,286
8a	Gross income from fundraising events (not including $ 4,730of contributions reported on line 1c). See Part IV, line 18 ....
			8a	117,193
b	Less: direct expenses ...		8b	60,960
c	Net income or (loss) from fundraising events..			56,233			56,233
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Corporate Allocated Rev		561000	2,598,940	2,598,940
b	Dietary Revenue		561499	798,951	798,951
c	Intercompany Revenue		900099	28,094,805	28,094,805
d	All other revenue ....			578,305	578,305
e	Total. Add lines 11a–11d ......			32,071,001
12	Total revenue. See instructions.....			267,445,108	267,217,676		137,821

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	50,000	50,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	980,675		980,675
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	85,696,967	80,675,320	4,757,788	263,859
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	10,601	9,890	679	32
10	Payroll taxes ...........	5,783,938	5,396,067	370,230	17,641
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	290,194		290,194
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	20,369,645	17,583,829	2,721,391	64,425
12	Advertising and promotion ....	11,447	8,539	2,908
13	Office expenses .......	1,237,821	937,808	290,551	9,462
14	Information technology ......	177,565	127,403	23,294	26,868
15	Royalties ..	0
16	Occupancy ...........	2,663,612	2,176,134	483,781	3,697
17	Travel ............	59,286	36,399	21,263	1,624
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	150,435	134,040	13,865	2,530
20	Interest ...........	2,214,646	1,809,335	402,237	3,074
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	12,228,228	9,990,292	2,220,962	16,974
23	Insurance ...	2,904	2,904
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	72,816,947	72,609,434	200,722	6,791
b	Corporate Allocated Expenses	36,389,532	21,670,538	14,661,430	57,564
c	Affiliate Support-Comm Phys	21,331,401	17,542,944	3,788,457
d	State Hospital Assessment	5,116,228	5,116,228
e	All other expenses	804,045	592,692	209,320	2,033
25	Total functional expenses. Add lines 1 through 24e	268,386,117	236,469,796	31,439,747	476,574
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			8,528	1	9,775
2	Savings and temporary cash investments .........			3,402,569	2	8,834
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			21,153,067	4	27,408,332
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............			4,065,282	8	5,642,013
9	Prepaid expenses and deferred charges ......			486,748	9	537,735
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	246,964,348
b	Less: accumulated depreciation	10b	140,445,517	104,453,346	10c	106,518,831
11	Investments—publicly traded securities .				11	0
12	Investments—other securities. See Part IV, line 11 .....				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets ...............				14	0
15	Other assets. See Part IV, line 11 ...........			24,269,343	15	10,727,605
16	Total assets. Add lines 1 through 15 (must equal line 33)...			157,838,883	16	150,853,125

17	Accounts payable and accrued expenses .....	5,211,709	17	6,916,235
18	Grants payable ...		18
19	Deferred revenue .........	3,115	19	2,895
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	54,551,060	25	22,371,831
26	Total liabilities. Add lines 17 through 25..	59,765,884	26	29,290,961

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	98,072,999	32	121,562,164
33	Total liabilities and net assets/fund balances ........	157,838,883	33	150,853,125

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Froedtert Health Inc 9200 West Wisconsin Avenue Milwaukee,WI532263596 39-2014409	Management Services	WI	501(c)(3)	12	NA		No
(2)Community Outpatient Health Services W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1743056	Outpatient Medical and Dental Services	WI	501(c)(3)	3	Community Memorial Hospital of MF	Yes
(3)Community Memorial Foundation W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1635057	Health and Welfare promotion	WI	501(c)(3)	10	Community Memorial Hospital of MF	Yes
(4)Froedtert Memorial Lutheran Hospital Inc 9200 West Wisconsin Avenue Milwuakee,WI532263522 39-6105970	Hospital	WI	501(c)(3)	3	Froedtert Health Inc		No
(5)St Josephs Community Hospital Inc 3200 Pleasant Valley Road West Bend,WI530953868 39-0806302	Hospital Care Services	WI	501(c)(3)	3	Froedtert Health Inc		No
(6)St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend,WI530953868 39-2034296	Health and welfare promotion	WI	501(c)(3)	7	St Josephs Comm Hosp of West Bend Inc		No
(7)Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee,WI532263596 39-1431192	Health, welfare, research & educ promo	WI	501(c)(3)	10	Froedtert Memorial Lutheran Hospital Inc		No
(8)QHS 1 Inc 9200 W Wisconsin Avenue Milwaukee,WI53226 20-2636686	Healthcare Services	WI	501(c)(3)	12	Froedtert Health Inc		No

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Wisconsin Diagnostic Laboratories LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 39-1896819	Laboratory Services	WI	N/A				No			No
(2) D1 Sports Training of Milwaukee LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 47-3322294	Sports Therapy	WI	N/A				No			No
(3) FHHP LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 45-2221564	Health Care Services	WI	N/A				No			No
(4) FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 26-0629591	Real Estate	WI	N/A				No			No
(5) Waukesha Surgery Center LLC 2400 Golf Road Pewaukee,WI53072 81-1166201	Surgical Services	WI	N/A				No			No	75.000 %
(6) Drexel Town Square Surgery Center LLC 7901 S 6th Street Second Floor Oak Creek,WI53154 81-4904300	Surgical Services	WI	N/A				No			No
(7) Froedtert Surgery Center LLC 9200 W Wisconsin Ave Milwuakee,WI53226 20-1499345	Surgical Services	WI	N/A				No			No
(8) Menomonee Falls Ambulatory Surgery LLP W180 N8045 Town Hall Road Menomonee Falls,WI53051 39-1745697	Surgical Services	WI	N/A				No			No
(9) THP-Froedtert Health Venture LLC 1415 Louisiana St Fl 27th Houston,TX77002 82-3559342	Health Care Services	TX	N/A				No			No
(10) F&MCW Network LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 81-4382585	Health Care Services	WI	N/A				No			No

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Community Outpatient Health Services	q	120,827	Cash Transfer
(2) Community Memorial Foundation	c	603,819	Cash Transfer
(3) Community Memorial Foundation	q	10,249	Cash Transfer

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No