2013-05-10T06:24:30-07:00 2012-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2011-07-01 390806302 St Josephs Community Hospital of West Bend Inc STJO 2623345533 3200 Pleasant Valley Road West Bend WI 53095 Scott R Hawig 2013-05-10 false 2011 2016-02-24 21:20:13Z Catherine Jacobson 115670890 false false X www.stjosephswb.com X 1930 WI St. Joseph's Community Hospital of West Bend, Inc is a health care organization dedicated to improving the health status of residents of West Bend and neighboring communitites. Our mission is to provide personalized and trusted care to our patients and their families. 13 6 559 173 0 60411 14202 77348367 84875970 1038756 987125 3503003 3659257 81950537 89536554 0 0 31548608 29341296 0 0 46799571 56577617 78348179 85918913 3602358 3617641 121118217 126472402 65050656 67008680 56067561 59463722 St. Joseph's Community Hospital of West Bend, Inc is a health care organization dedicated to improving the health status of residents of West Bend and neighboring communitites. Our mission is to provide personalized and trusted care to our patients and their families. false false 35675889 44693500 In addition to being a 70-bed hospital, St. Joseph's 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 Alyce and Elmore 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 4,301 and 3,298, respectively.Recently, more medical specialties became locally available as the Froedtert & The Medical College Specialty Clinics at St. Joseph's Hospital expanded to include urology, urogynecology, infectious diseases, electrophysiology and cardiology, in addition to the cancer specialties, all of which provide access to 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: 2,295CT Scans: 4,129MRIs: 1,822Radiological Diagnostic Exams: 11,073Ultrasounds: 3,181Laboratory Tests: 143,854Nuclear Medicine Scans: 1,685Rehabilitation Treatments: 11,397Ambulatory Surgery Visits: 4,108GI Visits: 679 27894889 34945737 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, Froedtert Health West Bend Clinic-South and the Froedtert & The Medical College of Wisconsin Specialty Clinics.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 inpatient hospice care.The New Life Center at St. Joseph's Hospital is Washington County's leading birth center, with 652 deliveries and 1,821 patient days during fiscal year 2012. 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 143 admissions and 2,652 patient days during the fiscal year.In addition to the newborn and hospice services, St. Joseph's Hospital had 2,849 admissions and 10,760 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: 861CT Scans: 1,582MRIs: 238Radiological Diagnostic Exams: 7,616Ultrasounds: 1,831Laboratory Tests: 123,186Nuclear Medicine Scans: 249Rehabilitation Treatments: 23,259 4180140 5236733 The Emergency Care Center at St. Joseph's Hospital provides high-quality care for all types of emergencies, 24 hours a day, augmented by its close ties to Froedtert & the Medical College Level I Trauma Center. Staffed by board-certified emergency medicine physicians and emergency certified RNs, the center served more than 16,700 patients in FY 2012. Its designation as a Level III Trauma Center means prompt availability of surgeons and on-call physicians in multiple specialties. 67750918 true true false false false false false false false false 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 false true true false false false false true 182 0 false 559 true false false false false false false false false false false false 0 false false false false false false false false false false false X 13 6 false false true false true true true true true false false false true true true true true true true true false false WI X X David Dirksmeyer 4147770960 N74 W12501 Leatherwood Ct Menomonee Falls WI 53051 Zwygart Christopher 1.00 X X 0 0 0 O'Meara Kristine 1.00 X X 0 0 0 Olson David 50.00 X X 0 56923 2492 Laird Michael 50.00 X X 414441 0 101574 Hauser Mark 1.00 X X 0 0 0 Smale Jeffery 1.00 X 0 437055 38794 Petasnick William D 1.00 X 0 6573439 67765 O'Meara Charles 1.00 X 0 0 0 Martin Mary 40.00 X 122126 0 10826 Leitheiser Richard 1.00 X 0 0 0 Komas Ron 1.00 X 0 0 0 Jacobson Catherine 1.00 X 0 797937 135753 Herdrich Gary MD 1.00 X 0 548632 32293 Gardner Patrick MD 1.00 X 0 0 0 Bloedorn Michael 1.00 X 0 0 0 Bast Ronald 1.00 X 0 0 0 Van De Kreeke Jeffrey 1.00 X 0 339273 102777 Arshad Ijaz 60.00 X 666527 0 44774 Herdeman Charles 40.00 X 126154 0 25636 Jeuch Thomas 40.00 X 125291 0 12914 Lauenstein Debra 40.00 X 139709 0 10311 Less Timothy 40.00 X 179316 0 35064 Malzewski Michael 0.00 X 0 211863 38497 1773564 8965122 659470 16 true true false Wheaton Franciscan Services 400 West River Woods Parkway Milwaukee WI 53212 Laundry Services 169227 United Dynacare LLC 9200 West Wisconsin Avenue Milwaukee WI 53226 Laboratory Services 270363 Medical College of WI 8701 Watertown Plank Rd Milwaukee WI 53226 Physician Services 1991546 Diagnostic Services of Washington County 1715 West Paradise Drive West Bend WI 53095 Pathology Services 309530 Advanced HRO Solutions Inc 1585 W Oakmont Rd Hoffman Estates IL 60169 Staffing Services 263161 9 14202 14202 Outpatient Revenue 621400 44693500 44693500 Inpatient Revenue 621990 34945737 34945737 Emergency Dept Revenue 621990 5236733 5236733 84875970 785900 785900 0 0 1 1 1 1 26335536 25 26081820 52516 253716 -52491 201225 201225 0 0 0 Other Dept Operating Rev 900099 672775 672775 Corporate Allocated Rev 900099 652661 652661 Clinic Revenue 621110 1714351 1714351 619469 619469 3659256 89536554 88535227 987125 0 0 0 0 555180 555180 0 26807049 24946474 1860575 4134 4134 8514 8514 1966419 1810124 156295 0 46043 46043 21870 21870 0 0 0 6447048 5692303 754745 8459 8459 393539 245542 147997 51265 47617 3648 0 1948368 1211885 736483 50698 25482 25216 0 96902 46482 50420 3022960 1880281 1142679 0 5272675 3135095 2137580 6971 6971 State Hospital Assessment 2156154 2156154 Provision for Uncollectible 3738531 3738531 Medical Supplies 15649922 15622422 27500 Corporate Allocated Expense 16787545 6771407 10016138 878667 399249 479418 85918913 67750918 18167995 0 20681 2019 7419268 5237304 0 9659269 9398418 0 0 550000 250000 1906352 1873009 1824544 1386522 128917972 51590174 66276290 77327798 32909261 30780247 0 0 0 552552 217085 121118217 126472402 7053785 6476931 115000 56507472 55822923 1489399 4593826 65050656 67008680 X 55891204 59315827 176357 147895 56067561 59463722 121118217 126472402 X 3617641 -221480 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4814698 4814698 46759065 8263453 38495612 3232071 1445776 1786295 57576935 41471571 16105364 16535203 409374 16125829 77327798 Due to Affiliates 4593826 4593826 Part X Part X : FIN48 Footnote Froedtert Health 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, 2012 and 2011, Froedtert Health does not have an asset or liability recorded for unrecognized tax positions. Part XI, Line 8 Part XI, Line 8: Other Changes in Net Assets or Fund Balances Transfers to Affiliates $316140 Contributions $410 true true X true X true X true true true false true true 1397306 1397306 0.01700 7602442 9860337 -2257895 8999748 9860337 -860589 0.01700 17 5616 240633 240633 0.00290 3 260 286206 286206 0.00350 4 16 49718 49718 0.00060 24 5892 576557 576557 0.00700 24 5892 9576305 9860337 -284032 0.02400 1 8485 8485 0.00010 2 10192 10192 0.00010 1 12222 12222 0.00010 4 30899 30899 0.00030 false 2350918 25257421 33663350 -8405929 X true true 1 0 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 true true true X X X X true true true 200.0000 true 400.0000 true X X X true true X true false X X X X true X false false Part VI - Additional Information Part V, Line 2: The last year a Needs Assessment was conducted at St. Joseph's Community Hospital of West Bend was 2012. 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 - States Where Community Benefit Report Filed WI Part VI - Affilated Health Care System Roles and Promotion Every year, the Froedtert Health partners engage in a variety of outreach activities in collaboration with key leaders and organizations in their communities that help improve health and quality of life. Much more than the provision of charity care, the American Hospital Association defines community benefit as "promoting and protecting the health and well-being of the entire community through responsive programs and services." In fiscal year 2012, Froedtert, Community Memorial and St. Joseph's Hospitals made significant investments in the health of their communities. Patients who couldn't pay for their medical care received more than $49.2 million in uncompensated services. Beyond providing care for the poor, we contributed $76.7 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.froedterthealth.org. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose St. Joseph's Community Hospital of West Bend provides healthy community initiatives that support the community. These initiatives include but are not limited to, community education classes, complimentary fitness classes, community volunteering, speakers bureau opportunities and community health fairs.Community Health Education ProgramsSt. Joseph's 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. Joseph's 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. Joseph's 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 drunk driving and has been positively received by students and community. United Way Employee CampaignSt. Joseph's Hospital collaborates with the United Way of Washington County to address community needs in the areas of health, education and quality of life. St. Joseph's Hospital hosts an annual workplace giving campaign to support United Way.For more information on specific community outreach efforts, please refer to the 2012 St. Joseph's Hospital Community Benefit Report located at stjosephswb.com.Healthy People Project of Washington CountySt. Joseph's Hospital, through leadership representation on the Healthy People Project of Washington County and the committees dedication, are successfully impacting the health of many in our community. These efforts are being done through collaborative partners, such as Washington County Planning and Parks, Washington County Injury Prevention Coalition, and various local municipalities. The Healthy People Project of Washington County is one of only 118 communities throughout the country (and one of five in Wisconsin) selected as a Pioneering Healthier Communities coalition. Albrecht Free ClinicThe Albrecht Free Clinic provides free medical care to uninsured and underinsured residents of Washington County. Through the support of St. Joseph's Hospital, the clinic is able to serve patients for chronic illness and acute care issues. Services provided by St. Joseph's Hospital at no cost to the patient would be: x-rays, labs, MRI and CT Scans. On an average, over 3,300 patients seek medical services per year. In addition to services related to the patients' direct care, St. Joseph's Hospital provides assistance in providing medical supplies, IT services, and rental space at a cost of $90,772 (4,896 sq ft). Sendik's Healthy Eating ProgramSt. Joseph's Hospital in partnership with Sendik's Food Market, West Bend, offers an educational five-week healthy eating program. The program is designed to help people adopt healthy eating habits in five key areas: fats, carbohydrates, fruits and vegetables, proteins and beverages. The program is offered free-of-charge and presented by a St. Joseph's hospital registered dietitian. In addition to the educational five-week healthy eating program, St. Joseph's hospital is providing monthly health option recipes and tips through our "Let's eat for the health of it!" program. Recipes are critiqued by our registered dietitians. 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. Joseph's for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patient's 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.Board of DirectorsThe Board of Directors is made up of medical and business professionals, all of whom reside in the hospital's primary service area. They are dedicated to leveraging the benefits of our community through our hospital's mission. They value the unique character and needs of the patients and communities we serve and the physicians who provide specialty care. St. Joseph's Hospital's community board demonstrates our commitment to quality and service. Part VI - Community Building Activities To promote the health of our communities, Froedtert Health St. Joseph's Hospital participates in numerous community building activities that are recognized in the community, which are not part of Part I Charity Care Community Benefits. These activities include:1. Physical Improvements and Housing: contributions toward neighborhood housing improvement for the underserved.2. 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. Froedtert Health St. Joseph's Hospital's SANE (Sexual Assault Nurse Examiner Program) works closely with volunteers from the area Women's 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. 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. Other: Contributions to local organization of equipment, lease space and supplies. Part VI - Community Information St. Joseph's Community Hospital of West Bend 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. St. Joseph's Hospital lives its mission to provide personalized, trusted care to its patients and families through strong, locally available services including 24-hour emergency care and cancer care, robust quality and customer service programs and its ability, as a member of Froedtert Health, to link patients with the resources of an academic medical center. An eight bedroom hospice on the hospital campus, the first of its kind in county, has served more than 600 terminally ill patients and their families since 2006.The hospital focuses on the acute and chronic health and wellness needs of residents of Washington County and areas outside the county, with 47,678 residents in its primary service area and 79,158 residents in its secondary service are a total of 126,836 residents (2010 data). The hospital's attention to the changing needs or our patients has led to additions and changes in services. By 2015, the population is expected to grow from 47,678 to 49,122 in the primary service area. Based on the US Census data, the population served by SJH is 96.91% Caucasian, .59% African American, .50% Asian, and 2.00% other races. 36% of households have a household income less than $50,000. 10% of the population does not have a high school diploma and 38% whose highest education level is a high school diploma. 21% of the population has a Bachelor's Degree or higher education. The most common occupations for the population is 27% manufacturing, 15% sales/office and 10% health care. 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 - Needs Assessment In December, 2011 Froedtert Health St. Joseph's Hospital West Bend collaborated with JKV Research, LLC along with Aurora Health Care, Children's Hospital of Wisconsin, Columbia St. Mary's 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. The methodology of the study included the following data gathering processes: - 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 sampling 1) 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%The full report of the findings can be found at www.stjosephswb.com. In addition to the Washington County Community Health Needs Assessment, St. Joseph's 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 - AODA - Dental CareWashington County Health Department Community Health Improvement Plan 2011 - 2015St. Joseph's Hospital is a partner with Washington County Public Health Department's 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 - Enhance state and community capacity to improve population level health.St. Joseph's hospital is very active in the Health People Project of Washington County's 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. Number of Hospital Faciltiy - 0 Part V, Line 11h - Other Factors Used in Determing Amounts Charged Patients Out of pocket maximum discount. Number of Hospital Faciltiy - 0 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment Washington County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health St. Joseph's Community Hospital of West BendAurora Health CareColumbia St. Mary's Health SystemChildren's Hospital of WisconsinWashington County Public Health Department Number of Hospital Faciltiy - 0 Part V, Line 3 - Account Input from Person Who Represent the Community In fiscal year 2012 and in partnership with the Washington County Community Health Needs Assessment, the following individuals/agencies were consulted to provide feedback on identified community health needs:Albrecht Free Clinic - Jenny Zaskowski, Executive DirectorHartford Jt 1 School District - Joan Schultz, Pupil Service AdministratorHartford Parks and Recreation Department - Mike Herman, DirectorInterfaith Caregivers of Washington County - Debbie Genthe, Executive DirectorUniversity of Wisconsin Extension Washington County - Marma McIntee, Family Living CoordinatorWashington County Mental Health Department - Jim Strachota, DirectorWashington County Public Health Department - Linda Walter, Health OfficerThe Council on AODA - Mary Simon, Executive DirectorVolunteer Center of Washington County - Betsy Wilcox, Executive DirectorEconomic Development of Washington County - Christian Tscheschlok, Executive DirectorSt. Gabriel Church - Sandy Hennes, RNSt. Mary's Catholic Parish Holy Hill - Arlene Barron, RN and Parish NurseWashington County WIC - Carol Birkeland, Executive DirectorKettle Moraine YMCA - Aaron Schmidt, Associate DirectorAging and Disability Resource Center - Linda Olson, ADRC DirectorFriends of Abused Families - Lisa Krenke, Executive DirectorCasa Guadalupe Education Center - Mary Lynn Bennett, Executive DirectorHabitat for Humanity Washington Co. - Russ Wanta, Executive DirectorWest Bend Police Department - Gus Unertl, CaptainWashington County Sheriffs Department - Dale Schmidt, SheriffWest Bend Chamber of Commerce - Craig Farrell, Executive DirectorHartford Area Chamber of Commerce - Barb Laabs, Executive Director Part III, Line 9b - Provisions On Collection Practices For Qualified Patients In alignment with the Froedtert Health 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 III, Line 8 - Explanation Of Shortfall As Community Benefit St. Joseph's Community Hospital of West Bend believes that all of the $8,405,929 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 care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. Part III, Line 4 - Bad Debt Expense St. Joseph's Community Hospital of West Bend reports accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and others. 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. As a not-for-profit, patient 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 $85,918,913. The bad debt expense included in this amount was $3,738,531. This left us with a total expense of $82,180,382 for the purposes of calculating line 7, column (f). 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. We present cost information consistently in the different venues that it appears. X false true X X X X false true false false false false false true false false Van De Kreeke Jeffrey 259313 58221 21739 85447 17330 442050 Smale Jeffery 419938 17117 14700 24094 475849 Petasnick William D 769113 672530 5131796 15925 51840 6641204 4891208 Malzewski Michael 189901 20483 1479 12985 25512 250360 Less Timothy 178504 812 11088 23976 214380 Lauenstein Debra 126956 11664 1089 7045 3266 150020 Laird Michael 344432 65838 4171 76787 24787 516015 Jacobson Catherine 629796 163401 4740 110234 25519 933690 Herdrich Gary MD 529784 18848 15925 16368 580925 Herdeman Charles 125589 565 9962 15674 151790 Arshad Ijaz 624154 25000 17373 13475 31299 711301 Sch J, Part III, Additional Information Part III, Additional Information Part II, Column (B)(ii): Bonus and incentive compensation amounts include incentive compensation and amounts paid to individuals in lieu of participation in 457(f) deferred compensation plan for the purchase of benefits. Sch J, Part I, Line 7 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. Sch J, Part I, Line 1b Part I, Line 1b: Reason for not following policy regarding payment provisions for expenses Expenses reimbursed pursuant to written contract between St. Joseph's Community Hospital of West Bend and the President, which was approved by the Board of Directors. Each year as part of annual review by Compensation Committee, the expense reimbursement is reviewed. Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. Social club dues reimbursed for organization's President because social club used for business purposes. Part VII - Section A 1a, Column B Approximate hours per week spent working on related entities:Bast - 2 hoursHerdrich - 61 hoursJacobson - 48 hoursKomas - 1 hourLaird - 1 hourLeitheiser - 1 hourMalzewski - 41 hoursOlson - 2 hoursPetasnick - 53 hoursSmale - 58 hoursVan De Kreeke - 50 hoursZwygart - 1 hour Part IV, Line 24a Even though the liability is on the books of St. Joseph's Community Hospital of West Bend, Inc.,this question was answered no, as Schedule K will be completed on the Form 990 of the parent corporation, Froedtert Health, Inc. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available Froedtert Health'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. 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. Form 990, Part VI, Line 12c 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 Vice President-Chief Compliance Officer (CCO), the 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 a Froedtert Health affiliate 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 Finance Committee of the Board of Directors. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process Froedtert Health accounting staff prepare Form 990 which is reviewed by the Corporation's financial leaders and legal counsel. The 990 is then reviewed by KPMG, the Corporation's outside accounting firm. Next, the 990 is provided to the Corporation's Finance Committee and Board of Directors. Finally, the 990 is filed as required. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders Froedtert Health has the following reserved powers over the activities of St.Joseph's Community Hospital:1. Approve any strategic plans; capital and operating budgets; borrowing or loan of funds; debt incurrence; proposed capital expenditures; all affiliations, partnerships, joint ventures, acquisitions, divestitures, dissolutions, sales, mergers and similar corporate transactions;2. Approve amendments to the Articles of Incorporation and Corporate Bylaws and approve appointment of members of Boards of Directors;3. Negotiate managed care contracts;4. Manage and direct investments and engage in consolidated cash management. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Froedtert Health, 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 6 Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder Froedtert Health is the member of St. Joseph's Community Hospital of West Bend, Inc. Form 990, Part VI, Line 4 Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents Amended and Restated Corporate Bylaws - effective 7/1/11- Conformance to format for system entities and reserved powers of system parent.- Gives Ex Officio directors the right to vote.- Creates a category of directors emeriti.- Elimates provisions that had expired. West Bend Surgery Center LLC 1710 Vogt Drive West Bend WI 53095 391954169 Surgical Services WI West Bend Clinic Inc Froedtert Physician Partners Inc 9200 W Wisconsin Ave Milwaukee WI 53226 272042610 Healthcare Services WI 501(c)(3) 3 Froedtert Health Inc false Froedtert Health Inc 9200 W Wisconsin Ave Milwaukee WI 53226 392014409 Management Services WI 501(c)(3) Ln 11, type 1 NA false Comm Outpatient Health Svcs of MF Inc 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 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 QHS 1 Inc 19601 W Bluemound 2nd Flr Brookfield WI 53045 202636686 Health Care Services WI 501(c)(3) Ln 11, type 1 Froedtert Health Inc false Froedtert Hospital Foundation Inc 9200 W Wisconsin Ave Milwaukee WI 532263596 391431192 Health, welfare, research, & education promotion WI 501(c)(3) Ln 11, type 1 Froedtert Memorial Lutheran Hospital false West Bend Clinic Inc 1700 W Paradise Drive West Bend WI 53095 392034294 Health Care Services 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 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 Froedtert Memorial Lutheran Hosp Inc 9200 W Wisconsin Ave Milwaukee WI 53226 396105970 Hospital WI 501(c)(3) 3 Froedtert Health Inc false FHHP LLC 9200 W Wisconsin Avenue Milwaukee WI 53226 452221564 Healthcare WI NA false false Fitness Development Associates LLC 9200 W Wisconsin Ave Milwaukee WI 53226 391936497 Real estate WI NA false false Milwaukee Ctr for Diagnostic Imag LLC 5775 Wayzata Boulevard Ste 400 St Louis Park MN 55416 411748361 Healthcare WI NA false false FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Ave Milwaukee WI 53226 260629591 Real Estate WI NA false false Progressive Physician Network Inc 9200 W Wisconsin Avenue Milwaukee WI 53226 270367127 Management Services WI Froedtert Health Inc C Community Ventures of MF Inc W180 N8085 Town Hall Road Menomonee Falls WI 53051 391635059 Inactive WI Community Memorial Hosp C Kettle Moraine Anesthesiology Inc PO Box 8031 Appleton WI 54912 141842439 Health Care WI West Bend Clinic C false false false false false false false false true false false true true true true true true true