ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC (EIN 39-0806302)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-09
- IRS object ID
- 201211309349301201
- Schema version
- 2010v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-09T10:24:29-07:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 191 W Nationwide Blvd Suite 500 | AddressLine1 |
| City | Columbus | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390806302 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Josephs Community Hospital | BusinessNameLine1 |
| Business Name Line2 | of West Bend Inc | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STJO | NameControl |
| Phone | 2623345533 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3200 Pleasant Valley Road | AddressLine1 |
| City | West Bend | City |
| State | WI | State |
| ZIP Code | 53095 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jeffrey Van De Kreeke | Name |
| Title | Sr VP Finance & CFO | Title |
| Date Signed | 2012-05-09 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Petasnick William D | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3200 Pleasant Valley Road | AddressLine1 |
| City | West Bend | City |
| State | WI | State |
| ZIP Code | 53095 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 102332223 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.stjosephswb.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1930 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | St. Josephs'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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 669 | TotalNbrEmployees |
| Total Nbr Volunteers | 163 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 17441 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 60411 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 75153387 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 77348367 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 575227 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1038756 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2654206 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3503003 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 78400261 | TotalRevenuePriorYear |
| Total Revenue Current Year | 81950537 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 31296180 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 31548608 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 44498140 | OtherExpensePriorYear |
| Other Expenses Current Year | 46799571 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 75794320 | TotalExpensesPriorYear |
| Total Expenses Current Year | 78348179 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2605941 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3602358 | RevenuesLessExpensesCY |
| Total Assets BOY | 114850401 | TotalAssetsBOY |
| Total Assets EOY | 121118217 | TotalAssetsEOY |
| Total Liabilities BOY | 66662731 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 65050656 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 48187670 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 56067561 | NetAssetsOrFundBalancesEOY |
| Mission Description | St. Josephs'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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 31195373 | Expense |
| Revenue | 38506394 | Revenue |
| Description | In addition to being a 70 staffed 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. 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 4,390 and 4,423, 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 noted above, 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 noted above, St. Joseph's Hospital provided a variety of outpatient treatments and procedures during the fiscal year including but not limited to the following:Operations: 2,165CT Scans: 4,865MRI's: 1,756Radiological Diagnostic Exams: 10,151Ultrasounds: 2,645Laboratory Tests: 135,348Nuclear Medicine Scans: 1,559Rehabilitation Treatments: 10,658GI Visits: 573 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 27453240 | Expense |
| Revenue | 33887246 | Revenue |
| Description | 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 nearly 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. In November 2010, plans for a 16,000 square foot addition for a new cancer center on the hospital campus were announced, with completion slated for the end of 2012.St. Joseph's Hospital is an acute care general hospital with 70 approved and staffed beds which provides 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 700 deliveries and 1,776 patient days during fiscal year 2011. 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, named 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 182 admissions and 2,274 patient days during the fiscal year.In addition to the newborn and hospice services noted above, St. Joseph's Hospital had 2,942 admissions and 10,466 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 the following:Operations: 821CT Scans: 2,003MRI's: 229Radiological Diagnostic Exams: 7,382Ultrasounds: 1,652Laboratory Tests: 119,601Nuclear Medicine Scans: 304Rehabilitation Treatments: 20,789 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4013998 | Expense |
| Revenue | 4954727 | Revenue |
| Description | 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 RN's, the center served more than 16,500 patients in FY 2011. Its designation as a Level III Trauma Center means prompt availability of surgeons and on-call physicians in multiple specialties. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 62662611 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 163 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | false | ComplianceWithBackupWitholding |
| Number Of Employees | 669 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | David Dirksmeyer | NamePerson |
| Telephone Number | 4147770960 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | N74 W12501 Leatherwood Ct | AddressLine1 |
| City | Menomonee Falls | City |
| State | WI | State |
| ZIP Code | 53051 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Zwygart Christopher | |||||||
| Director-Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Petasnick William D | |||||||
| Director | 1.00 | X | 0 | 1302731 | 726685 | ||
| O'Meara Kristine | |||||||
| Director | 1.00 | X | X | 0 | 0 | 0 | |
| O'Connell Blaine | |||||||
| FCH CFO | 1.00 | X | 0 | 598091 | 32708 | ||
| Miller Greg | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Malzewski Michael | |||||||
| AVP-Finance | 50.00 | 107284 | 109142 | 37190 | X | ||
| Less Timothy | |||||||
| Medical Physicist | 50.00 | 198549 | 0 | 33613 | X | ||
| Leitheiser Richard | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Lauenstein Debra | |||||||
| Dir-Human Resource | 50.00 | 142041 | 0 | 10817 | X | ||
| Laird Michael | |||||||
| President & CEO | 50.00 | X | 372364 | 0 | 37621 | ||
| Komas Ron | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Jeuch Thomas | |||||||
| Pharmacist | 50.00 | 135099 | 0 | 11538 | X | ||
| Jacobson Catherine | |||||||
| CFO | 1.00 | X | 0 | 426832 | 5511 | ||
| Hauser Mark | |||||||
| Director-Treas | 1.00 | X | X | 0 | 0 | 0 | |
| Bloedorn Michael | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Bast Ronald | |||||||
| Director | 1.00 | X | 0 | 0 | 0 | ||
| Arshad Ijaz | |||||||
| MD-Oncology | 50.00 | 665816 | 0 | 40836 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1621153 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2436796 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 936519 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| United Dynacare LLC | |||||
| 9200 West Wisconsin Avenue | Milwaukee | WI | 53226 | Laboratory Services | 240458 |
| Sleep Disorder | |||||
| PO Box 212 | Plymouth | WI | 53073 | Sleep Clinic Service | 334218 |
| Medical College of WI | |||||
| 8701 Watertown Plank Rd | Milwaukee | WI | 53226 | Physician Services | 1127213 |
| E-Freight Couriers LLC | |||||
| PO Box 13885 | Wauwatosa | WI | 53213 | Courier Services | 167104 |
| Diagnostic Services of Washington County | |||||
| 1715 West Paradise Drive | West Bend | WI | 53095 | Pathology Services | 378205 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| All Other Contributions | 60411 | AllOtherContributions |
| Total Contributions | 60411 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Outpatient Revenue | 621400 | 38506394 | 38506394 |
| Inpatient Revenue | 621990 | 33887246 | 33887246 |
| ER Revenue | 621990 | 4954727 | 4954727 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 77348367 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 727630 | TotalRevenueColumn |
| Exclusion | $727,630 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 20690292 | Securities |
| Other | 2520 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 20122741 | Securities |
| Other | 258945 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 567551 | Securities |
| Other | -256425 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 311126 | TotalRevenueColumn |
| Exclusion | $311,126 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Medical Office Building | 621110 | 921058 | 921058 |
| Corporate Allocated Rev | 900099 | 364616 | 364616 |
| Clinic Revenue | 621110 | 1823785 | 1823785 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 393544 | TotalRevenueColumn |
| Related Or Exempt Function Income | 393544 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3503003 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 81950537 | TotalRevenueColumn |
| Related Or Exempt Function Income | 80851370 | RelatedOrExemptFunctionIncome |
| Exclusion | $1,038,756 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 336187 | Total |
| Management And General | 336187 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25449837 | Total |
| Program Services | 23669577 | ProgramServices |
| Management And General | 1780260 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1194463 | Total |
| Program Services | 984913 | ProgramServices |
| Management And General | 209550 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2771286 | Total |
| Program Services | 2333366 | ProgramServices |
| Management And General | 437920 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1796835 | Total |
| Program Services | 1661219 | ProgramServices |
| Management And General | 135616 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -15160 | Total |
| Management And General | -15160 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62870 | Total |
| Program Services | 62870 | ProgramServices |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6981674 | Total |
| Program Services | 6304655 | ProgramServices |
| Management And General | 677019 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26390 | Total |
| Management And General | 26390 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14151685 | Total |
| Program Services | 13968205 | ProgramServices |
| Management And General | 183480 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36301 | Total |
| Program Services | 25507 | ProgramServices |
| Management And General | 10794 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1666809 | Total |
| Program Services | 1036755 | ProgramServices |
| Management And General | 630054 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42290 | Total |
| Program Services | 11580 | ProgramServices |
| Management And General | 30710 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51213 | Total |
| Program Services | 25656 | ProgramServices |
| Management And General | 25557 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3219799 | Total |
| Program Services | 2002715 | ProgramServices |
| Management And General | 1217084 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5364545 | Total |
| Program Services | 3146741 | ProgramServices |
| Management And General | 2217804 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7357 | Total |
| Management And General | 7357 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| State Hospital Assessment | 2142332 | 2142332 | |
| Repairs and Maintenance | 660314 | 392723 | 267591 |
| Provision for Uncollectable | 3791068 | 3791068 | |
| Miscellaneous | 163489 | 11891 | 151598 |
| Corporate Allocations | 8330506 | 1030875 | 7299631 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116089 | Total |
| Program Services | 59963 | ProgramServices |
| Management And General | 56126 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78348179 | Total |
| Program Services | 62662611 | ProgramServices |
| Management And General | 15685568 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24267 | BOY |
| EOY | 20681 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1915314 | BOY |
| EOY | 7419268 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7150087 | BOY |
| EOY | 9659269 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 850000 | BOY |
| EOY | 550000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1735837 | BOY |
| EOY | 1906352 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1904854 | BOY |
| EOY | 1824544 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 113430648 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 47154358 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68946397 | BOY |
| EOY | 66276290 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29954721 | BOY |
| EOY | 32909261 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2368924 | BOY |
| EOY | 552552 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114850401 | BOY |
| EOY | 121118217 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8174775 | BOY |
| EOY | 7053785 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57240984 | BOY |
| EOY | 56507472 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1246972 | BOY |
| EOY | 1489399 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66662731 | BOY |
| EOY | 65050656 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48019916 | BOY |
| EOY | 55891204 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167754 | BOY |
| EOY | 176357 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48187670 | BOY |
| EOY | 56067561 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114850401 | BOY |
| EOY | 121118217 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3602358 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4277533 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4814698 | OtherCostOrOtherBasis |
| Book Value | 4814698 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46609036 | OtherCostOrOtherBasis |
| Depreciation | 7004276 | Depreciation |
| Book Value | 39604760 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3204271 | OtherCostOrOtherBasis |
| Depreciation | 1233113 | Depreciation |
| Book Value | 1971158 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56734955 | OtherCostOrOtherBasis |
| Depreciation | 38508298 | Depreciation |
| Book Value | 18226657 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2067688 | OtherCostOrOtherBasis |
| Depreciation | 408671 | Depreciation |
| Book Value | 1659017 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 66276290 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Due to Affiliates | Description |
| Amount | $1,489,399 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1489399 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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, 2011 and 2010, Froedtert Health does not have an asset or liability recorded for unrecognized tax benefits. |
| Part XI, Line 8 | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | Transfers to Affiliates $2446047 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1222361 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1222361 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01640 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7817489 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7970767 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -153278 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9039850 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7970767 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1069083 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01640 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 2357 | PersonsServed |
| Total Community Benefit Expense | 373737 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 373737 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 138 | PersonsServed |
| Total Community Benefit Expense | 165891 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 165891 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 36008 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 36008 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 15 | NumberOfActivitiesOrPrograms |
| Persons Served | 2495 | PersonsServed |
| Total Community Benefit Expense | 575636 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 575636 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00770 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 15 | NumberOfActivitiesOrPrograms |
| Persons Served | 2495 | PersonsServed |
| Total Community Benefit Expense | 9615486 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7970767 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1644719 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02410 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 7323 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7323 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 6714 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6714 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 14037 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14037 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $1,222,361 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 16206541 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 23477441 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7270900 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 0 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Josephs Comm Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3200 Pleasant valley Road | AddressLine1 |
| City | West Bend | City |
| State | WI | State |
| ZIP Code | 530953868 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Josephs Comm Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Other Factors | X | OtherFactors |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | true | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kathy Hospice | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3232 Pleasant Valley Drive | AddressLine1 |
| City | West Bend | City |
| State | WI | State |
| ZIP Code | 53095 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Inpatient hospice. | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (21 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | Schedule H, Part VI, Line 4 (continued)Some of those collaborations include the Albrecht Free Clinic, United Way of Washington County, Leadership Greater West Bend, the Boys and Girls Club, Economic Development Washington County, the Kettle Moraine YMCA, Friends of Abused Families, Cedar Community, the University of Wisconsin-Washington County, area Rotary and Kiwanis clubs and the American Cancer Society. Hospital leaders and staff serve on the boards of many of these groups. St. Joseph's Hospital also serves as medical control for all 10 EMS (emergency medical services) in and around Washington County, providing oversight and education for all levels of pre-hospital care including emergency medical responders, EMTs and paramedics. The hospital's St. Joseph's Community Foundation, with over 9,400 donors in its database, also supports community health and wellness efforts, as well as the programs that benefit patients at the hospital, hospice and cancer center. | |
| 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." Froedtert Health strategies are based on the unique needs of each of the communities that we serve. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the FH partners have built important relationships with their local communities, and are committed to providing meaningful outreach programs that link each hospital to their neighbors and patients.In 2011 FY, 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 $40.7 million in uncompensated services. Beyond providing care for the poor, we contributed $58.6 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, and are held accountable for achieving, community benefit goals and strategies are 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 member partners have built important local relationships and are committed to providing 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 | Froedtert Health St. Joseph's Hospital 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 fairs.Community Health Education ProgramsFroedtert Health St. 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, Froedtert Health St. Joseph's Hospital offer 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. 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. Froedtert Health St. Joseph's Hospital's community board demonstrates our commitment to quality and service.Workplace Giving CampaignFroedtert Health St. 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. Froedtert Health St. Joseph's Hosptial hosts an annual workplace giving campaign to support United Way. | |
| 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 or Other Community Benefits. There 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. Other: Contributions to local organization of equipment, lease space and supplies.4. Leadership participates in local chamber of commerce boards focusing on economic development.5. Diversity training that recruits health professionals in our traditionally underserved community. | |
| Part VI - Community Information | Froedtert Health St. Joseph's 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. 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 the 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 48,167 residents in its primary service area and 79,847 residents in its secondary service area, a total of 128,014 residents (2010 census data). The hospital's attention to the changing needs of our patients has led to additions and changes in services. By 2015, the population is expected to grow from 2010 by 3.20 percent to 49,706 in the primary service area alone. The percentage of residents ages 50-74 will increase more than any other age group. St. Joseph's has 70 acute beds and a (full- and part-time) staff of 450, including 223 nurses. There are 257 physicians on staff. In addition, 163 volunteers serve the hospital and patients. In fiscal 2011, the hospital had 3,689 admissions, 58,281 outpatient visits and 16,527 emergency visits.Physician growth continues. In 2010, we added 16 new Medical College of Wisconsin physicians to our Medical College of Wisconsin Specialty Clinics at St. Joseph's Hospital, bringing the total to 56 Medical College physicians. With the addition of five new physicians to its sites in Washington County, Froedtert Health Medical Group physicians serving the hospital is now at 75. Overall, Froedtert Health St. Joseph's Hospital has 301 physicians on staff. St. Joseph's Hospital is accredited by the Joint Commission, which reviews all hospitals for safety and quality health-care practices. The hospital's MRI and digital mammography are accredited by the American College of Radiology (ACR). Mammography is also accredited by the FDA under the Mammography Quality Standards Act (MQSA). Echocardiology is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Nuclear Medicine is accredited by the Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL). The hospital's cardio and pulmonary rehabilitation programs are nationally certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).At least seven institutions of higher learning send students to St. Joseph's Hospital for clinical experiences in nursing and other medical fields. They include Moraine Park Technical College, University of Wisconsin-Madison, UW-Oshkosh, UW-Milwaukee, Marquette University, Marian University and Concordia University. Programs include nursing (preceptorships and medical/surgical clinicals), phlebotomy, surgical tech, radiology, physician assistant, health information management and respiratory care. The hospital also provides space to the local technical college for on-site training for EMT classes.St. Joseph's Hospital values its ongoing collaboration with community service organizations, businesses, social service and government agencies that share our commitment to the community, and reach out to youth, older adults and needy. | |
| Part VI - Patient Education of Eligibility for Assistance | Financial Assistance and Billing HighlightsPolicy: St. Joseph's Community Hospital of West Bend (SJH) is committed to providing the community with quality healthcare without regard to economic status, race, color, sex, faith or national origin of the recipient. Patients with insufficient resources to meet their financial responsibilities may be given a Financial Assistance discount to relieve all or a portion of the obligation to make payment for services rendered at SJH.Communication:SJH will communicate to patients the availability of Financial Assistance. They will provide uninsured patients information to ensure each patient understands the financial obligations he/she is incurring by receiving healthcare services. Brochures, available to all patients at registration, explain the hospital policy for billing and payment of services. Also information is available on each hospital's website. Patients also have the opportunity to speak with a financial counselor and the hospital will assist patients in identifying and applying for government assistance programs for which the patient may be eligible.Eligibility:SJH 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. Applicants whose gross family income is equal to or less than 400% of the current year's poverty guidelines will not pay for more than 15% of their annual gross income on any single account during the approved eligibility time frame.Discounts:SJH recognizes that patients without any insurance coverage are billed at full charges, and as the hospitals offer discounts to other payers, several options for discounted billing are in place for these self pay patients. Total charges to self pay patients will be discounted 20% before any bill is submitted for payment. This discount will be noted on each patient's bill. An additional 20% discount will be extended to self pay patients if estimated charges are paid in advance of service. Self pay patients who have not prepaid, will receive a 10% prompt pay discount if the bill is paid in full within 15 days of receipt. | |
| Part VI - Needs Assessment | In February, 2011 a community health needs assessment was conducted for Froedtert Health St. Joseph's Hospital (West Bend, WI) and Froedtert Health Community Memorial Hospital (Menomonee Falls, WI) by Community Outreach / Public Relations Department staff along with members from the CMH Community Outreach Steering Committee. The community needs assessment team consisted of the following individuals: Andy Dresang, Dianna Forrester, Kerry Freiberg, Jeff Hevey, Amy Maurer, Deb McCann, Geoff Mertens, Mandie Reedy, Timothy Smykal, Sally Slusser, Lisa Susen-Sullivan and John Wandschneider.The community health needs assessment findings are a compilation of state, county and community health assessments along with interviews from 26 different community informants ranging from 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. This needs assessment is based upon available statistical data as well as anecdotal information from knowledgeable community informants. Since the assessment was prepared for guiding SJH community outreach programs, the investigation focused on assessing the needs and service gaps as it pertains to the general population and the disadvantaged populations, i.e., people with disproportionate unmet health needs in the hospital's primary service area.The findings of the Assessment were summarized with the top four strategic priorities being identified as Access to Primary and Specialty Care, Chronic Disease Management, Prevention and Wellness and Mental Health. The Executive Committee reaffirmed the findings and a process to establish the strategic vision, goals and community outreach priorities for Fiscal Year 2012 through 2015. | |
| Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services | Patients who do not qualify for a self pay discount according to the policy. | Number of Hospital Faciltiy - 0 |
| Part V, Line 20 - Explanation of Eligible Assistance Patients Billed More Than Insurance Rates | Patients who may qualify for a financial assistance discount but refuse to comply with the policy are not given a discount. | Number of Hospital Faciltiy - 0 |
| Part V, Line 19d - Other Billing Determination of Individuals Without Insurance | According to our self pay discount policy. | 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 7 - Explanation of Needs Not Addressed and Reasons Why | Dental needs not addressed at this time. | Number of Hospital Faciltiy - 0 |
| Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment | Community Memorial Hospital of Menomonee Falls, Inc. | Number of Hospital Faciltiy - 0 |
| Part V, Line 3 - Account Input from Person Who Represent the Community | The community health needs assessment findings are a compilation of state, county and community health assessments along with interviews from 26 different community informants ranging from 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. This needs assessment is based upon available statistical data as well as anecdotal information from knowledgeable community informants. Since the assessment was prepared for guiding SJH community outreach programs, the investigation focused on assessing the needs and service gaps as it pertains to the general population and the disadvantaged populations, i.e., people with disproportionate unmet health needs in the hospital's primary service area. | Number of Hospital Faciltiy - 0 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | Collection policies are the same for all patients. Patients are screened for eligibility for financial assistance before collection procedures begin. If at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it; the account is referred back for a financial assistance review. | |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | St. Joseph's Community Hospital of West Bend believes that all of the shortfall of the $7,270,900 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. St. Joseph's Community 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 $78,348,179. The bad debt expense included in this amount was $3,791,068. This left us with a total expense of $74,557,111 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 try to present cost information consistently in the different venues that it appears. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | false | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Petasnick William D | |||||||||||
| 948461 | 334370 | 19900 | 675099 | 51586 | 2029416 | ||||||
| O'Connell Blaine | |||||||||||
| 454374 | 125145 | 18572 | 15925 | 16783 | 630799 | ||||||
| Malzewski Michael | |||||||||||
| 86562 | 21922 | 658 | 12985 | 11900 | 134027 | 93367 | 100 | 13817 | 12305 | 119589 | |
| Less Timothy | |||||||||||
| 183222 | 100 | 15227 | 22525 | 232162 | 11088 | ||||||
| Lauenstein Debra | |||||||||||
| 125939 | 15068 | 1034 | 3772 | 152858 | 7045 | ||||||
| Laird Michael | |||||||||||
| 263125 | 88333 | 20906 | 24146 | 409985 | 13475 | ||||||
| Jacobson Catherine | |||||||||||
| 218832 | 208000 | 5511 | 432343 | ||||||||
| Arshad Ijaz | |||||||||||
| 649635 | 16181 | 27361 | 706652 | 13475 | |||||||
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. Amount plus tax gross-up included in taxable compensation. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VII - Section A 1a, Column B | Approximate hours per week spent working on related entities:Petasnick - 55 hoursMalzewski - 1 hourJacobson - 55 hoursO'Connell - 55 hoursLaird - 1 hourBast - 3 hoursLeitheiser - 2 hoursKomas - 1 hourZwygart - 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: Other Organization Documents Publicly Available | St. Joseph's Community Hospital of West Bend, Inc. quarterly financial information 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 19 |
| 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 12c |
| 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 11 |
| 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 7a |
| 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 6 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|
| Horizon Ventures Limited LLC | |||||||
| W180 N8085 Town Hall Road | Menomonee Falls | WI | 53051 | 391855822 | Lessor of Medical Office Building | WI | Community Memorial Hospital of MF Inc |
| West Bend Surgery Center LLC | |||||||
| 1710 Vogt Drive | West Bend | WI | 53095 | 391954169 | Surgical Services | WI | West Bend Clinic Inc |
Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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) | Lne 11,type1 | 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) | line 11, type | Community Memorial Hospital of MF Inc | false |
| QHS 1 Inc | ||||||||||
| N74 W12501 Leathwerwood Court | Menomonee Falls | WI | 530514480 | 202636686 | Health Care Services | WI | 501(c)(3) | Line11,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) | Line 11, type | 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 |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Legal Domicile StateLegalDomicileState |
|---|---|---|---|---|---|---|---|---|---|---|
| FHHP LLC | ||||||||||
| 9200 W Wisconsin Avenue | Milwaukee | WI | 53226 | 452221564 | Healthcare | NA | N/A | false | false | |
| Fitness Development Associates LLC | ||||||||||
| 9200 W Wisconsin Ave | Milwaukee | WI | 53226 | 391936497 | Real estate | NA | N/A | false | false | WI |
| Milwaukee Ctr for Diagnostic Imag LLC | ||||||||||
| 5775 Wayzata Boulevard Ste 400 | St Louis Park | MN | 55416 | 411748361 | Healthcare | NA | N/A | false | false | WI |
| FMLH MCW Real Estate Ventures LLC | ||||||||||
| 9200 W Wisconsin Ave | Milwaukee | WI | 53226 | 260629591 | Real Estate | NA | N/A | false | false | WI |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |