2015-05-08T13:27:59-07:00 2014-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2013-07-01 390806302 St Josephs Community Hospital of West Bend Inc STJO 2623345533 3200 Pleasant Valley Road West Bend WI 53095 Scott R Hawig CFO 2015-05-08 true Mollie Longhouse P00294881 6142492300 2013 2016-02-25 16:41:14Z Jacobson Catherine 3200 Pleasant Valley Road West Bend WI 53095 118973203 false false X www.froedtert.com X 1930 WI St. Joseph's Community Hospital of West Bend, Inc is a health care organization serving residents of West Bend and Washington County. Our mission is to advance the health of communities we serve through exceptional care enhanced by innovation and discovery. X 12 9 703 170 0 691054 92990948 113394739 1140406 -57604 4319228 4818766 98450582 118846955 0 0 29584404 34129034 0 0 62337118 88310568 91921522 122439602 6529060 -3592647 132974592 100085778 68762606 14899666 64211986 85186112 X St. Joseph's Community Hospital of West Bend, Inc is a health care organization serving residents of West Bend and Washington County. Our mission is to advance the health of communities we serve through exceptional care enhanced by innovation and discovery. false false 50630556 62358080 In addition to being a 70-bed hospital, St. Joseph's Hospital offers a wide variety of outpatient services to the community, including cancer care services, various diagnostic and therapeutic treatments, outpatient and ambulatory surgeries, and rehab treatments.In 2010, St. Joseph's Hospital's Kraemer Cancer Care Center joined the Froedtert & The Medical College Cancer Network, bringing more cancer expertise to the community. The new St. Joseph's Hospital's 16,000-square-foot Kraemer Cancer Center opened July 9, 2012. Care is conveniently provided close to home, with Medical College specialists working with community physicians to provide advanced, coordinated care, and if needed, access to specialized treatment at Froedtert & The Medical College Clinical Cancer Center in Milwaukee. Cancer network physicians in West Bend include specialists in radiation oncology, urologic oncology, gynecologic oncology and plastic and reconstructive surgery. During the fiscal year, radiation oncology and medical oncology visits totaled 5,130 and 7,328, respectively.St. Joseph's Health Center, located adjacent to the Hospital, offers expertise in gynecological cancer, urological cancer, urology, plastic surgery, cardiology, obstetrics and gynecology, pediatrics, allergy and immunology, and electrophysiology Physicians at the Health Center work closely with the Hospital, performing surgical procedures, utilizing lab, radiology and other ancillary services of the Hospital all of which provide leading-edge care to the residents of West Bend and Washington County. In addition to the specialty clinics and cancer care services, St. Joseph's Hospital provided a variety of outpatient treatments and procedures during the fiscal year including:Operations: 2,219CT Scans: 6,270MRIs: 3,395Radiological Diagnostic Exams: 10,097Ultrasounds: 4,057Laboratory Tests: 130,396Nuclear Medicine Scans: 1,928Rehabilitation Treatments: 9,133Ambulatory Surgery Visits: 3,593GI Visits: 697The West Bend Surgery Center is an ambulatory surgery center committed to providing high quality surgical care and excellence in patient care to all ages. Outfitted with state of the art equipment and advanced technology, the surgical center performs outpatient procedures and surgeries by an experienced team of physicians and nurses. In FY2014, surgery center visits totaled 4,586 in the areas of pain management, ear nose and throat, general surgery, gynecology, opthalmology, plastics and orthopaedics. 33348127 41072533 St. Joseph's Hospital is a health care organization dedicated to improving the health status of residents of West Bend and neighboring communities regardless of ability to pay. The hospital has been serving residents of Washington County for more than 80 years and today offers a wide range of inpatient services. In 2005 St. Joseph's opened a new 70-bed hospital that earned national recognition for a design emphasizing patient safety and quality. The 143-acre hospital campus also includes the Kathy Hospice, the Kraemer Cancer Center and the The St. Joseph's Health Center.St. Joseph's Hospital is an acute care general hospital with 70 licensed and staffed beds, providing a wide range of inpatient services, including general and orthopedic surgery, general medicine, intensive care services, obstetrics and maternity care, and residential hospice care.The New Life Center at St. Joseph's Hospital is Washington County's leading birth center, with 759 deliveries and 1,974 patient days during fiscal year 2014. The Hospital offers a state of the art facility combined with a high level of professional, compassionate care. The staff includes perinatologists and neonatologists available to provide expert, individualized care for women experiencing high-risk pregnancy. Convenient and comfortable, the center offers experienced nurses, tastefully appointed labor, delivery, recovery and postpartum rooms, a special care nursery and a dedicated C-section suite. The inpatient hospice care unit, the Kathy Hospice, is a separate 8-bed building located on the campus of St. Joseph's Hospital, and provides a peaceful and comfortable environment for individuals in need of end-of-life care. The home-like hospice was the first of its kind in Washington County, and experienced 155 admissions and 2,549 patient days during the fiscal year.In addition to the newborn and hospice services, St. Joseph's Hospital had 2,784 admissions and 11,594 patient days related to medical, surgical and intensive care inpatient services. In conjunction with inpatient stays, the hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including, but not limited, to:Operations: 774CT Scans: 1,873MRIs: 311Radiological Diagnostic Exams: 7,152Ultrasounds: 1,131Laboratory Tests: 147,454Nuclear Medicine Scans: 238Rehabilitation Treatments: 30,187 8090198 9964126 The Emergency Care Center at St. Joseph's Hospital provides compassion, responsiveness, expertise, a convenient location along with advanced technology in adminstering high-quality care for all types of emergencies, 24 hours a day, augmented by its seamless coordination with Froedtert & the Medical College of Wisconsin's adult Level I Trauma Center. Staffed by board-certified emergency medicine physicians and emergency certified RNs, the center served more than 15,700 patients in FY 2014. Its designation as a Level III Trauma Center means prompt availability of surgeons and on-call physicians in multiple specialties, making it the premier emergency care provider in the Washington County area for infants, children and adults. 3912513 4818766 95981394 true true false false false false false false false true true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false false true true true true false false false true 156 0 true 703 true false false false false false false false false 0 false false false false false false false false false false X 12 9 true false true false true true true true true false false true true true true true true true true false X X David Dirksmeyer 4147770960 N74 W12501 Leatherwood Ct Menomonee Falls WI 53051 Bast Ronald Director 1.00 2.00 X 0 0 0 Gardner Patrick MD Director 1.00 0.00 X 0 0 0 Herdrich Gary MD Dir&Chief Staff 1.00 0.00 X 0 0 0 Jacobson Catherine Dir&FH Pres/CEO 1.00 49.00 X 0 1165252 232857 Johnston Brenda Director 1.00 0.00 X 0 0 0 Leitheiser Richard Director 1.00 1.00 X 0 0 0 Lux Theresa M Dir&CNO 1.00 50.00 X 0 284507 43937 Neitzke Ted Director 1.00 0.00 X 0 0 0 O'Meara Charles Director 1.00 0.00 X 0 0 0 Tschechlok Christian Director 1.00 0.00 X 0 0 0 Wolter Brian MD Dir&V.Chf Staff 1.00 0.00 X 0 0 0 Wundrock John Director 1.00 1.00 X 0 0 0 Ericson Allen Dir&Pres 45.00 6.00 X X 405338 0 88360 Komas Ron Dir&Secretary 1.00 1.00 X X 0 0 0 Zwygart Christopher Dir&Chair 1.00 0.00 X X 0 0 0 Hawig Scott CFO 1.00 49.00 X 0 711280 113726 Knoll Thomas Treasurer 1.00 42.00 X 0 171605 34021 Bangalore Nitish S Pharmacy Manager 40.00 0.00 X 143151 0 14019 Herdeman Charles Pharmacist 40.00 0.00 X 160456 0 27476 Less Timothy Medical Physicist 40.00 0.00 X 188921 0 20846 Schultz Karl Dir of Operations 40.00 0.00 X 146632 0 16316 Wieseckel Dianne Pharmacist 40.00 0.00 X 130499 0 22908 Malzewski Michael Former - Officer (AVP Finance) 0.00 40.00 X 0 246795 41262 Olson David Former - Officer (President) 0.00 51.00 X 0 484419 110512 VanDeKreeke Jeffrey Former - Officer (CFO) 0.00 47.00 X 0 405455 71772 1174997 3469313 838012 18 true true false Medical College of WI 9200 W Wisconsin Avenue Milwaukee WI 53226 Physician Services 1988782 Wisconsin Radiology Specialists SC PO Box 2350 Brookfield WI 53008 Physician Services 971255 Infinity Healthcare Physicians SC 111 E Wisconsin Avenue Milwaukee WI 53202 Physician Services 140963 United Dynacare LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 Lab Services 155322 4 671054 20000 691054 Emergency Dept Revenue 621990 9964126 9964126 Inpatient Revenue 621990 41072533 41072533 Outpatient Revenue 621400 62358080 62358080 113394739 10242 10242 0 0 1 1 1 1 58402 126248 -67846 -67846 -67846 0 0 0 Corporate Allocated Rev 900099 706458 706458 Intercompany Revenue 621110 2076064 2076064 Other Dept Operating Rev 900099 1276917 1276917 759326 759326 4818765 118846955 118213505 -57604 0 0 0 0 534278 534278 0 31250572 30098336 1152236 1977 1977 0 2342207 2248182 94025 0 21661 21661 0 0 0 0 7647681 5665485 1982196 2792 2792 332019 232794 99225 523403 96022 427381 0 2366507 1384170 982337 53013 36382 16631 0 53905 43901 10004 2686906 1571571 1115335 0 6251913 4567878 1684035 25920 25920 Affiliate Support-Comm Phys 22342673 17404942 4937731 Medical Supplies 20645466 20579050 66416 Corporate Allocated Expense 20538838 9375684 11163154 State Assessment 2478369 2478369 2339502 198628 2140874 122439602 95981394 26458208 0 1920 1670 9909805 4120101 0 12244108 13329915 0 0 0 2008435 2430457 682113 229044 137202852 58456332 79200291 78746520 27426934 91040 0 0 0 1500986 1137031 132974592 100085778 8532063 8179710 115000 115000 58426605 1688938 6604956 68762606 14899666 X 64068318 85038503 143668 147609 64211986 85186112 132974592 100085778 X -3592647 24566773 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1108639 107155 127883 85501 1258176 938525 84893 85393 172 1108639 823312 96529 18831 147 938525 812159 11198 45 823312 1.00000 false true true 4814698 4814698 59118193 11254573 47863620 5834624 2633926 3200698 65964368 44159162 21805206 1470969 408671 1062298 78746520 Due to Affiliates 6604956 6604956 X Part V, Line 4: Intended uses of the endowment fund. The funds are held by St. Joseph's Community Hospital Foundation, a related organization. The investment gains generated by the St. Joseph's Community Hospital Foundation are intended to provide a perpetual and dependable source of revenue for the Kathy Hospice, a home-like hospice center owned and operated by St. Joseph's Hospital, and may be utilized to assist St. Joseph's Hospital with any current deficients of operational expenses it assumes on behalf of Kathy Hospice each year. Part X : FIN48 Footnote Froedtert Health, Inc. 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 recogniton, derecogniton, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2014 and 2013, St. Joseph's Community Hospital does not have an asset or liability recorded for unrecognized tax positions. true true X true X true X true true true false true true 1484421 1484421 0.01210 11568145 9737251 1830894 0.01500 13052566 9737251 3315315 0.02710 25 5638 306951 306951 0.00250 5 176 110937 110937 0.00090 7 300 62458 62458 0.00050 37 6114 480346 480346 0.00390 37 6114 13532912 9737251 3795661 0.03100 1 1733 1733 2 350 3697 3697 3 7889 7889 0.00010 6 350 13319 13319 0.00010 false 6009330 28487849 51400561 -22912712 X true true 1 1 St Josephs Comm Hospital 3200 Pleasant Valley Road West Bend WI 530953868 X X X St Josephs Comm Hospital 1 true X X X X X X X X X 12 true true true X http://www.froedterthealth.org X http://www.co.washington.wi.us X X X X X X X X X X X false false false true true 200.0000 true 400.0000 true X X X X X X true true X X true false X X X X X true X false false Part V, Line 3 - Account Input from Person Who Represent the Community In Fiscal Year 2012, St. Josephs Hospitals Community Outreach Staff conducted key informant interviews with the following non-profit health and human service agencies:Aging and Disability Resource CenterAlbrecht Free ClinicCasa Guadalupe Education CenterEconomic Development of Washington CountyFriends of Abused FamiliesHabitat for Humanity Washington CountyHartford Area Chamber of CommerceHartford Jt 1 School DistrictHartford Parks and Recreation DepartmentInterfaith Caregivers of Washington CountyKettle Moraine YMCASt. Gabriel ChurchSt. Marys Catholic Parish Holy HillThe Council on AODAUniversity of Wisconsin Extension Washington CountyVolunteer Center of Washington CountyWashington County Mental Health DepartmentWashington County Public Health DepartmentWashington County Sheriffs DepartmentWashington County WICWest Bend Chamber of CommerceWest Bend Police Department Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment Washington County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health Froedtert Health St. Josephs HospitalAurora Health CareColumbia St. Marys Health SystemChildrens Hospital of WisconsinWashington County Public Health DepartmentJKV Research was hired by the participating Health Care Systems and Washington County Public Health Department to lead the CHNA process for Washington County. The total cost of the CHNA conducted was divided up by each of the participating health systems and health departments. Each health system and health department was assigned to conduct key informant interviews within their service area. Part V, Line 5c - Description of Making Needs Assessment Widely Available The full version of the report and other supporting documents can be found on Froedtert Healths website - http://www.froedterthealth.org/upload/docs/community-memorial/community-giving/Benefit/washington-county-community-health-survey-report.pdfAdditional Websites:Washington County Public Health Department - http://www.co.washington.wi.us/uploads/docs/washington-county-community-health-survey-report-march-2012.pdf Part V, Line 6i - Describe Other Needs Identified See attached Community Health Improvement Plan for St. Josephs Hospital. The report is available online at www.froedtert.com./st-josephs OverviewThis Implementation Strategy serves as the community health improvement component of St. Josephs Community Hospital community engagement strategy, focusing on Access to Primary and Specialty Care, Chronic Disease Management, AODA/Mental Health and Physical Activity & Obesity.St. Josephs Hospital community engagement framework is to improve the quality of life in the communities we serve through health care programs and services that are measurable, accessible, and culturally appropriate.Program: Subsidized TransportationHealth Need: Affordable and Accessible Transportation for low-income populationsInternal Resources: Case Management, Nursing Administration, Emergency DepartmentCommunity Partners: Washington County Shared Ride TaxiObjectives/Outcomes: Provide affordable and accessible medical transportation to SJH patients at or below 200% federal poverty level.Albrecht Free ClinicHealth Need: 8% of Washington County Residents Uninsured, Unmet Medical Care, Routine Procedures, Access to Primary and Specialty CareInternal Resources: Employed and contracted physicians, Lab and Radiology Departments, Case Management and Emergency DepartmentCommunity Partners: Albrecht Free Clinic, Washington County Healthy Community Fund, Washington County Health Department and Aurora Health CareObjectives/Outcomes: Referral process for uninsured from Emergency Dept. to Albrecht Free Clinic, Provide vouchers for ancillary services for AFC patients, provide vouchers for specialty care, recruitment and deployment of physicians to volunteer time and talents at AFC.Prostate Screening ProgramHealth Need: Decrease in percentage of men having Prostate Cancer Screening in Washington County past few years.Internal Resources: Kraemer Cancer Center, Physicians, SJH Community Foundation and MarketingCommunity Partners: ZERO End of Prostate Cancer, Albrecht Free Clinic, Washington County Health Dept, American Cancer Society and Casa Guadalupe Education Center Objectives/Outcomes: Increase amount of men having PSA and Digital Exam every two years.Colorectal Screening Awareness:Health Need: Decrease in blood stool test in past year, 69% of population age 50 and older had colonoscopy in the past 10 yearsInternal Resources: Kraemer Cancer Center, Oncologists/Gastroenterologists, Marketing, SJH Community FoundationCommunity Partners: American Cancer Society, Albrecht Free Clinic and Casa Guadalupe Education Center, Washington County Public HealthObjectives/Outcomes: Increase number of populations reporting having a colonoscopy age 50 and above and provide care navigation and facilitate access for vulnerable populations through education and colonoscopy screening.Sexual Assault Nurse ExaminerHealth Need: 4% of population reported being afraid for their safetyInternal Resources: Emergency Department, SANE Nurses, SJH Community FoundationCommunity Partners: Friends of Abused Families, Washington County Fire/EMS/Police and Sheriff DepartmentsObjectives/Outcomes: Provide forensic evaluations, assessment and emotional support to victims and track and facilitate referrals to medical and other non-profit agenciesEvery 15 MinutesHealth Need: Increase in binge drinking, 3% of population reported driving while under the influence or was a passengerInternal Resources: Emergency Department, Safety and Security, Marketing & Communications, Nursing StaffCommunity Partners: West Bend School District, Kewaskum School District, Washington County Sheriffs Department, West Bend Fire/EMS, Flight for Life, Washington County Injury Prevention CoalitionObjectives/Outcomes: Reduce youth underage drinking and driving, reduce traffic related impairment accidents and deathsPrevention Network of Washington CountyHealth Need: Increase in binge drinking, 3% of population reported driving while under the influence or was a passenger and increase in opiate/drug related incidence and death in Washington CountyInternal Resources: Behavioral Health Services, Emergency Department, Case Management and Social WorkersCommunity Partners: West Bend ACTS, Elevate Inc, Germantown Youth Futures, STAND, Hartford Project CareObjectives/Outcomes: Reduce youth substance abuse (alcohol, prescription drugs, opiates), increase Washington County youth involved in AODA prevention efforts and strengthen collaboration among communities, private non-profit agencies and other organizationsHealthy People Project of Washington CountyHealth Need: Increase in populations reporting they are overweight, decrease in number of populations reporting getting recommended physical activity, and decrease in amount of recommended fruit/vegetable intakeInternal Resources: Community Engagement staff, physicians and leadersCommunity Partners: Washington County Healthy Community Fund, Albrecht Free Clinic, Kettle Moraine YMCA, Aurora Health Care, UW-Extension Washington County and Washington County Public Health Dept.Objectives/Outcomes: Increase the number of individuals reporting moderate to vigorous physical activity, increase the daily amount of fruit and vegetable intake and decrease the number of individuals reporting being overweight or obeseLiving Well with Chronic ConditionsHealth Need: 28% of Washington County residents with high blood pressure, 21% with high cholesterol and 9% with diabetes.Internal Resources: Community Education Dept and Community Engagement StaffCommunity Partners: Wisconsin Institute for Healthy Aging, Washington County Aging and Disability Resource Center, Albrecht Free Clinic, Kettle Moraine YMCA and Casa Guadalupe Education CenterObjectives/Outcomes: Increase patient engagement in self-management of chronic disease and decrease in ED utilization for chronic disease managementHeart 360Health Need:28% of population with high blood pressure especially Hispanic populationInternal Resources: Community Engagement and SJH Nurses and Support StaffCommunity Partners: Casa Guadalupe Education Center, American Heart Association, Kettle Moraine YMCA, United Way of Washington CountyObjectives/Outcomes: Increase awareness and understanding of blood pressure numbers and what they mean, improve cardiovascular health, reduce cardiovascular disease & stroke Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why Areas Not AddressedOral & Dental Health Services: St. Josephs Hospital does not have dedicated resources to provide dental services in Washington County. There are other local organizations/dental offices dedicated to improve access to dental care.Teen Pregnancy: United Way, Washington County Public Health and a number of non-profit agencies are working on this issue.Health Literacy and Navigation: Other community organizations are working to increase awareness of health services and health seeking behaviors among low-income individuals United Way of Washington CountyCigarette Use: St. Josephs Hospital supports the Multi-Jurisdictional Coalitions of Tobacco Free Community Partnership of Washington County.Mental Health: We do not have the dedicated resources; however, St. Josephs Hospital leaders and staff are partnering with local agencies on strategies and tactics to address this issue throughout the county. Washington County Behavioral Health has dedicated staff and facilities address this issue.Every year, St. Josephs Hospital produces an annual community benefit report highlighting community outreach programs, patient impact stories and investments in the communities we serve. The report is mailed to over 100 area non-profits, chambers of commerce, St. Josephs Hospital Board of Directors, St. Josephs Hospital leaders and staff, government officials, business leaders and other community members. A copy of the 2014 report can be found at www.froedtert.com/st-josephs Part V, Line 12h - Other Factors Used in Determing Amounts Charged Patients Out of pocket maximum discount. Part V, Line 14g - Other Means Hospital Facility Publicized the Policy A summary of the Financial Assistance Policy is available on the St. Joseph's Hospital website. Part V, Line 18e - Other Actions Took Before Any Collection Actions We request additional documentation when an individual has submitted an incomplete financial assistance application. Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) In alignment with the Froedtert Health financial assistance policy St. Joseph's Hospital 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 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 200% of the FPL may qualify for a 100% discount. Patients who meet the requirements and have a gross income between 200% and 400% of the FPL may qualify for a discount on a sliding scale. In addition to income, St. Joseph's Hospital also takes certain assets into consideration. Assets protected from financial evaluation include a portion of a household's retirement assets, cash, savings assets and home equity. 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 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 $122,439,602. 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 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 4 - Bad Debt Expense Patients accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectibility of patients accounts receivable, Froedtert Health, Inc. (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), FH 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, FH 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 FHs 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 26 and 27 of attached financial statements. Part III, Line 8 - Explanation Of Shortfall As Community Benefit St. Joseph's Community Hospital of West Bend believes that all of the $22,912,712 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 Froedtert Health, Inc. financial assistance policy regarding the billing, collection and support for patients with payment obligations, St. Joseph's Community Hospital of West Bend makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) are trained regularly 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. Part VI - Needs Assessment In December, 2011 St. Josephs Hospital West Bend collaborated with JKV Research, LLC along with Aurora Health Care, Childrens Hospital of Wisconsin, Columbia St. Marys Health System and Washington County Health Department to conduct a Community Health Needs Assessment in Washington County. The research from the needs assessment provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Washington 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 residents 400 completions from November 29 through December 19, 2011 Two-fold sampling1) RDD landline sample of listed & unlisted #s (n=300)- Respondents randomly selected based on number of adults in household - Weighting based on number of adults and number of residential phone numbers in HH 2) Cell phone only sample (n=100) Adult answering the phone designated as the respondent - All data post-stratified by age and gender of adult residents as of 2010 Census proportions. Margin of error: 5%In addition to the Washington County Community Health Needs Assessment, St. Josephs Hospital conducted key informant interviews with 26 individuals representing school district representatives, public health officials, non-profit health and human service professionals, churches, police/fire departments, free clinics and business professionals throughout Washington County. Following extensive interviews with key community stakeholders, findings from the assessment were categorized into eight areas: Access to Primary and Specialty Care, Chronic Disease Management, Mental Health Services, Prevention and Wellness, Alcohol, Drug, Tobacco, Abuse, Dental Services, Transportation and Other. Of those eight health needs categories, four were identified as the focus for community outreach activities in 2012 through 2016 based on select criteria: Community Health Priorities, Disproportionate Unmet Needs, Public Health Concerns and Scope of Services. The most critically documented health needs were identified:- Access to Care- Obesity/Nutrition- Lack of Physical Exercise- Chronic Disease Management- AODAWashington County Health Department Community Health Improvement Plan 2012 2016St. Josephs Hospital is a partner with Washington County Public Health Departments Community Health Improvement Plan. The plan which was adopted by the county board in 2012 focuses on the following community health needs:- Improve Dietary Quality- Increase Breastfeeding- Increase Physical Activity- Obesity (Healthy People Project of Washington County)- Enhance state and community capacity to improve population level health.St. Josephs hospital is very active in the Healthy People Project of Washington Countys strategic plan with goals to improve access to fruit and vegetable consumption and increase physical activity as a means to decrease obesity. For more information on this initiative please go to www.getmovingwashingtoncounty.com. Part VI - Patient Education of Eligibility for Assistance St. Joseph's Community Hospital of West Bend 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 Hospital website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. The Hospital 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 Hospital's 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 - Community Information St. Josephs Hospital has been dedicated to serving residents of West Bend and Washington County since 1930 when it was established through the efforts of visionary community leaders and volunteers. As an important part of the community fabric, the hospital continues to meet the changing health and wellness of people who live in and around Washington County. To better serve those needs in a modern, accessible, safe and efficient setting, the hospital built a new replacement facility on US 45 and Hwy PV in August 2005. The following data highlights St. Josephs Hospitals primary and secondary service area in relationship to income, race/ethnicity and payer mix:Household Income CY14 and Primary Service %Under $24,999 - 15.23%$25,000-$49,999 - 21.06%$50,000-$99,999 - 38.26%$100,000 and up - 25.45%Ethnicity CY14 and Primary Service %White - 95.95%African American - 0.72%Asian/Hawaiian/Pacific Islander - 0.72%Native American - 0.33%Two or more races - 1.37%Other - 0.91%Hispanic* - 2.90%Payor Source FY14 and Primary Service %Commercial/Managed Care - 36.93%Medicare - 49.28%Medicaid - 9.25%Other Government - 1.11%Other Self Pay - 3.43%Notes:Household Income & Ethnicity Data CY2014Payer Source FY2014*In the 2010 Census, respondents are instructed to answer both the Hispanic origin and race questions. The instructions specifically say that "Hispanic origins are not races." Therefore, the two groups are categorized separately.There is one additional health care system serving residents in Washington County Aurora Health Care. Part VI - Community Building Activities To promote the health of our communities, St. Josephs Hospital participates in numerous community building activities, which are not included elsewhere on Schedule H. These activities include:1. Coalition Building: Collaboration with county service agencies includes work with the Washington County Injury Prevention Coalition on the Every 15 Minutes anti-drunk driving program for teens. St. Josephs Hospitals SANE (Sexual Assault Nurse Examiner Program) works closely with volunteers from the area Womens Shelter to care for victims of sexual assault and SANE nurses collaborate with a county coalition to promote awareness, education and prevention of sexual assaults. 2. Community Support: Participation in local emergency preparedness and youth focused coalitions to improve the communities ability to respond to an emergency and to improve the community environment for youth to set them up for greater success.3. Economic Development: Leadership participates in local chamber of commerce boards focusing on economic development.4. Diversity: Training that recruits health professionals in our traditionally underserved community. 5. 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. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose St. Josephs Hospitals community health improvement initiatives are targeted for the broad community, especially vulnerable populations (uninsured/underinsured) in the hospitals primary and secondary service areas. St. Josephs Hospitals mission is to advance the health of the communities we serve through exceptional care enhanced by innovation and discovery. The hospitals Board of Directors and Community Engagement staff 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 Obesity/Physical Activity. Community Health Education Programs/Support Groups St. Josephs Hospital regularly schedules educational classes for the community. The services offered are readily accessible to the general public and are free of charge. These programs provide information on a wide variety of health concerns including chronic disease prevention/management. In addition, St. Josephs Hospital offers a speakers bureau that is a free service to the community. Our knowledgeable health professionals provide credible, up-to-date information on a variety of healthcare topics for groups and organizations. Every 15 MinutesSpeeding, 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, St. Josephs Hospital collaborates with the Washington County Injury Prevention Coalition 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 2006, 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 staff 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. United Way Employee CampaignSt. Josephs Hospital collaborates with the United Way of Washington County to address community needs in the areas of access to health care, creating healthy beginnings and making healthy choices. St. Josephs Hospital hosts an annual workplace giving campaign to support United Way and its affiliated organizations. Close to 40 hours were spent coordinating the Fiscal Year 2014 campaign. In addition to an employee campaign, St. Josephs Hospital matches donations up to $8,000.Healthy People Project of Washington CountySt. Josephs Hospital, through leadership representation on the Healthy People Project of Washington County is successfully impacting the health of Washington County residents through improving access to healthier food choices and increasing physical activity. Areas of focus in Fiscal Year 2014 include bike to work days, safe routes to schools, community gardens, farmers markets and farm to school program increasing fruit and vegetable intake with elementary schools throughout the county. Over 16,000 students in Washington County have been impacted by this initiative. Albrecht Free ClinicThe Albrecht Free Clinic provides free medical care to uninsured and underinsured residents of Washington County. Through the support of St. Josephs Hospital, the clinic is able to serve patients for chronic illness and acute care issues. Services provided by St. Josephs Hospital at no cost to patients include: x-rays, labs, MRI and CT Scans. In Fiscal Year 2014, Albrecht Free Clinic served over 2,500 individuals. Community Health ScreeningsSt. Josephs Hospital offers free blood pressure, skin cancer and prostate cancer 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. In Fiscal Year 2014, St. Josephs Hospital conducted health screenings for 177 people. Living Well with Chronic ConditionsLiving 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. St. Josephs Hospital implemented the program in the spring of 2014 helping 14 individuals better manage their symptoms and live a healthier life.Sexual Assault Nurse Examiner (SANE) Available 24 Hours a DayWhen emergencies take on the even more traumatic element of sexual assault, the specially trained SANE program staff has created a safe haven at St. Josephs for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patients experience. They care for victims of all ages, races and populations to provide timely:Emotional support Physical examination and wellness check Collection of medical-forensic evidence Assistance with reporting the crime to police, when requested (mandatory reporting for children) Assistance with concerns about sexually transmitted infection and pregnancy Assistance with safety planning Development of a medical follow-up plan SANE nurses are available to speak to groups and organizations. They are also able to serve as expert witnesses if called to testify at a trial. In Fiscal Year 2014, SANE staff provided screenings for 13 individuals.ACA Insurance Marketplace and Enrollment AssistanceFroedtert Health (parent company of St. Josephs Hospital) recognized the need to help individuals navigate the new choices available to them through the Affordable Care Acts Insurance Marketplace and Medicaid reforms. Our network of certified application counselors assisted 123 individuals in enrollment in Medicaid and 148 individuals into a Marketplace Insurance Plan. In addition, our certified application counselors answered 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. Subsidized Transportation ProgramThe Subsidized Medical Transportation Program at St. Josephs Hospital provides transportation to and from the hospital service locations for eligible persons (200% federal poverty level or below) who have difficulty arranging their own transportation and lack the financial resources to purchase transportation. In FY2014, St. Josephs Hospital provided over 5,308 subsidized rides to 1,594 people who needed transportation to receive their health care. Leadership Volunteerism/Community SupportAs an indication of St. Josephs Hospitals executive teams commitment to the community, 15 hospital leaders provided more than 150 hours of support to local initiatives, not-for-profit organizations and community events that align with the hospitals mission and directly support identified community needs. Job Shadow ProgramSt. Josephs Hospital recognizes the value of preparing tomorrows health care today. Each year, St. Josephs Hospital nurses, technicians and other health professionals provide Washington County college and high school students job shadowing experiences in clinical care or ancillary care areas of choice. In Fiscal Year 2014, St. Josephs Hospital staff provided 125 hours of preceptorship time to 26 students in six departments. Heart 360St. Josephs Hospital partnered with the American Heart Association, Casa Guadalupe Education Center, Kettle Moraine YMCA and area churches and business to provide a four-month program called Check, Change and Control, targeted for Hispanic Residents in Washington County. St. Josephs Hospital nurses provided free blood pressure checks Part VI - Affilated Health Care System Roles and Promotion Promotion of Community HealthThe Board of Directors at St. Josephs Hospital is made up of medical and business professionals, all of whom reside in the hospitals primary service area. They are dedicated to leveraging the benefits of our community through our hospitals mission. They value the unique character and needs of the patients and communities we serve and the physicians who provide specialty care. St. Josephs Hospitals community board demonstrates our commitment to quality and service. Annually, the board reviews and approves the hospitals Community Health Improvement Plan.Additionally, St. Josephs Hospital supports the Healthy Community Fund, administered through St. Josephs Community Foundation, which was created in 2008 to support community programs or projects throughout Washington County that positively affect the health and wellness of those living and working within the area. The fund awarded $230,540 in grants to 11 area non-profit organizations in Fiscal Year 2014.Addressing Needs Through Targeted Outreach:St. Josephs Hospital develops and executes community outreach programming and activities based on identified community health needs. Every needs assessment cycle, St. Josephs Hospital Community Engagement staff along with the hospitals community partners and other leaders 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 St. Josephs Hospital Board of Directors. St. Josephs 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 annually to the St. Josephs Hospital Board of Directors, Physician Advisory Council, Leadership Council, Leadership Meetings, St. Josephs Hospital Community Foundation and Healthy Community Fund Boards. Based on the results from the 2012 Community Health Needs Assessment, programs and activities are focused around the following identified health needs:-Access to Primary and Specialty Care-AODA-Chronic Disease Management-Obesity and Physical ActivityFor more information on specific community outreach efforts, please refer to the 2014 Community Benefit Report by going to http://www.froedtert.com/upload/docs/giving/community-benefit/community-benefit-report.pdf Affiliated Health Care System RolesFroedtert Health is comprised of Froedtert Hospital in Milwaukee County, Community Memorial Hospital in Waukesha County and St. Josephs Hospital in Washington County, along with our employed physician group that practice at satellite clinics around each hospital. St. Josephs Hospital has an open medical staff and physicians must go through the credentialing process and apply for privileges. SJH has exclusivity rights for certain departments in the hospital, such as Radiology, 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 $85 million in uncompensated services. Beyond providing care for the poor, we contributed $72.9 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 Part VI - States Where Community Benefit Report Filed WI Part V - Explanation of Number of Facility Type St. Joseph's Community Hospital of West Bend is the only facility listed under this reporting of the IRS Form 990, Schedule H. Part VI - Additional Information Part VI - States Where Community Benefit Report FiledCommunity Benefit Data is reported annually to the Wisconsin Hospital Association.Sch H, Part VI-Explanation of How Organization Furthers Exempt PurposeThe task force was convened to understand and address the local problem in a strategic yet timely manner. St. Josephs Hospital, along with other community members including, law enforcement, elected officials, county agencies and community members came together in a collaborative manner to immediately begin to identify and understand common problems and applicable resources. The Task Force identified four specific target areas: prevention, treatment, advocacy and law enforcement/courts. Prevention focuses on education and awareness of the risks and harm related to abuse through methods such as community forums, parent discussion groups and showing of the documentary, The Hungry Heart. St. Josephs Hospitals emergency room medical director, spoke at the informational community forum that was held in May 2014 at the West Bend High School auditorium with 500 community members in attendance. For more information on St. Josephs Hospital Community Benefit programs, please visit www.froedterthealth.com/st-josephs or see attached Community Benefit Report. X true true X X X X X false true false false false false false true false false Bangalore Nitish S Pharmacy Manager 136837 6033 281 5535 8484 157170 Ericson Allen Dir&Pres 309279 69156 26903 61417 26943 493698 Hawig Scott CFO 490031 193593 27656 87175 26551 825006 Herdeman Charles Pharmacist 151070 9386 11002 16474 187932 Jacobson Catherine Dir&FH Pres/CEO 788962 374772 1518 202750 30107 1398109 Knoll Thomas Treasurer 144995 12795 13815 8748 25273 205626 Less Timothy Medical Physicist 188029 892 11636 9210 209767 Lux Theresa M Dir&CNO 198228 67789 18490 33950 9987 328444 Malzewski Michael Former - Officer (AVP Finance) 207092 27175 12528 14814 26448 288057 Olson David Former - Officer (President) 352237 130664 1518 81500 29012 594931 Schultz Karl Dir of Operations 125525 10783 10324 6960 9356 162948 VanDeKreeke Jeffrey Former - Officer (CFO) 287555 98578 19322 60000 11772 477227 Wieseckel Dianne Pharmacist 130374 125 22908 153407 Part I, Line 1a: Relevant information in regards to selections on 1a. Housing:Hawig, Scott - $39,106 Part I, Line 7: Non-Fixed payments not listed above Certain management employees partcipate in an incentive compensation plan that includes non-fixed elements. Upon the attainment of a certain financial threshold, incentive compensation is available for meeting identified goals in the areas of financial performance, operational efficiencies, quality improvements, customer satisfaction, strategic growth and partnership initiatives. In some cases the determination of whether a goal is met is absolute while others require a certain amount of discretion to determine if goal is met. In addition, the incentive compensation includes a purely discretionary component. Long Term Investments and Restricted Assets 2013-07-01 27339845 Balance Sheet Basis 392014409 Froedtert Health Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) Net Long Term Debt 2013-07-01 -57865179 Balance Sheet Basis 392014409 Froedtert Health Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 501(c)(3) false false false false Sch N, Part III, Additional Information Effective July 1, 2013, Froedtert Health Inc., the parent corporation of St. Joseph's Hospital, adopted an internal accounting policy for certain balance sheet and income statement matters that are centrally managed at the parent corporation. The policy states that assets and liabilities related to centrally managed programs will be accounted for on the parent corporations consolidated balance sheet and will not be allocated to any affiliate balance sheets. St. Joseph's Hospital implemented the new policy effective July 1, 2013 and has transferred all centrally managed assets and liabilities resulting in the disclosure on Schedule N. 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:Intercompany Revenue - consists of revenue derived from medical and administrative services provided to the Froedtert and Medical College of Wisconsin Community Physicians and the West Bend Surgery Center, related parties. Services include transcription, laboratory services, medical supply purchasing, medical office building space, dietary services, and housekeeping services. All of these services support the delivery of healthcare to the community.Other Department Operating Revenue - is 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 baby photo income, meaningul use revenue, medical staff application fees, and class revenue.Dietary Services - is derived from cafeteria sales, vending machine sales, guest tray sales an employee meals. Dietary services are necessary to support services to patient families while thier 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. Miscellaneous Revenue - is 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, NSF check charges, sale of medical records, and taxable dietary sales.Medical Office Building Revenue - payment received from the medical office building tenants for services provided such maintenance, housekeeping and dietary.Rebates and Discounts - is the result of volume purchases of patient care supplies and the result of using specific vendors or receiving a discount by paying invoices within a specific time period.Corporate Allocated Revenue - revenue passed through from Froedtert Health, a related party. Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et Allen Ericson, Richard Leitheiser, Thomas Knoll, John Wundrock and Christopher Zwygart - Business Relationship Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents Articles of Incorporation and Bylaws were amended and restated to reflect termination of definitive agreement that created original health care system. Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Froedtert Health, Inc. is the sole member of St. Joseph's Community Hospital of West Bend, Inc. Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Froedtert Health, Inc. as the member of St. Joseph's Community Hospital of West Bend, Inc. 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 Froedtert Health, Inc., as the sole member of St. Joseph's Community Hospital, has certain reserved powers and authorities with respect to the operations and management of St. Joseph's Hospital, as set forth in St. Joseph's bylaws. Form 990, Part VI, Line 11b: Form 990 Review Process Froedtert Health, Inc. accounting staff prepare Form 990 which is reviewed by the Froedtert Health financial leaders and legal counsel. The 990 is then reviewed by KPMG, Froedtert Health's outside accounting firm. Next, the 990 is provided to the Froedtert Health 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, and key employees are required to complete a conflict of interest disclosure document. The data is compiled, and the Froedtert Health Vice President-Chief Compliance Officer (CCO), the Senior Vice President-General Counsel and/or delegate review all forms and notifications to determine if any conflicts of interest exists 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 St. Joseph's Hospital 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 once annually to the Froedtert Health Finance Committee of the Board of Directors. Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management Compensation of Top Managment is paid by 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 Froedtert Health (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 Froedtert Health, Inc.'s quarterly financial information, which includes St. Joseph's Community Hospital of West Bend, Inc., is made available to the public through the Digital Assurance Corporation, Inc. website. Anyone can register to receive ongoing access to and notifications regarding financial statements at the online website. St. Joseph's Community Hospital of West Bend, Inc. governing documents and conflict of interest policy is made available to the public through the corporate office upon request. Other Changes In Net Assets Or Fund Balances - Other Increases Contributions = $3942 Other Changes In Net Assets Or Fund Balances - Other Decreases Transfer to affiliates = -$1576214 Other Changes In Net Assets Or Fund Balances - Other Increases Transfers from Affiliates = $25000001 Other Changes In Net Assets Or Fund Balances - Other Increases WBSC Transfer = $1139044 West Bend Surgery Center LLC 1710 Vogt Drive West Bend WI 53095 391954169 Surgical Services WI 7004885 3074827 St Josephs Community Hospital of WB Inception Health LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 202636740 Healthcare services WI Froedtert Health Inc Froedtert Memorial Lutheran Hosp Inc 9200 W Wisconsin Ave Milwaukee WI 53226 396105970 Hospital WI 501(c)(3) 3 Froedtert Health Inc false Community Memorial Hospital of MF Inc W180 N8085 Town Hall Road Menomonee Falls WI 53051 390987025 Hospital WI 501(c)(3) 3 Froedtert Health Inc false St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend WI 530953868 392034296 Health and welfare promotion WI 501(c)(3) Ln 11, type 1 St Josephs Hospital true Froedtert Health Inc 9200 W Wisconsin Ave Milwaukee WI 53226 392014409 Management Services WI 501(c)(3) Ln 11, type 111 NA false Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee WI 532263596 391431192 Health, welfare, research & educ promo WI 501(c)(3) Ln 11, Type 1 Froedtert Memorial Lutheran Hospital Inc false Community Memorial Foundation of MF Inc W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635057 Health and welfare promotion WI 501(c)(3) Ln 11, Type 1 Community Memorial Hospital of MF Inc false Community Outpatient Health Services W180 N8085 Town Hall Road Menomonee Falls WI 53051 391743056 Outpatient Medical and Dental Services WI 501(c)(3) 3 Community Memorial Hospital of MF false QHS 1 Inc 19601 W Bluemound Brookfield WI 53045 202636686 Healthcare services WI 501(c)(3) Ln 11, Type 1 Froedtert Health Inc false false true false false false false true true false true false false true true true true true true true Schedule R, Part V, Line 2 Any transactions listed on Schedule R, Part V, Line 1 and not on Schedule R, Part V, Line 2 are between related 501(c)(3) organizations and therefore, are not reported in this section.