2012-05-09T10:24:29-07:00 2011-06-30 KPMG LLP 191 W Nationwide Blvd Suite 500 Columbus OH 43215 990 2010-07-01 390806302 St Josephs Community Hospital of West Bend Inc STJO 2623345533 3200 Pleasant Valley Road West Bend WI 53095 Jeffrey Van De Kreeke 2012-05-09 2010 2016-02-24 21:20:13Z Petasnick William D 3200 Pleasant Valley Road West Bend WI 53095 102332223 false false X www.stjosephswb.com X 1930 WI 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. 9 8 669 163 0 17441 60411 75153387 77348367 575227 1038756 2654206 3503003 78400261 81950537 0 0 31296180 31548608 0 0 44498140 46799571 75794320 78348179 2605941 3602358 114850401 121118217 66662731 65050656 48187670 56067561 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. false false 31195373 38506394 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 27453240 33887246 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 4013998 4954727 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. 62662611 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 163 0 false 669 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 9 8 false false false false true true true true true false false false true true true true true true true true false false WI X David Dirksmeyer 4147770960 N74 W12501 Leatherwood Ct Menomonee Falls WI 53051 Zwygart Christopher 1.00 X X 0 0 0 Petasnick William D 1.00 X 0 1302731 726685 O'Meara Kristine 1.00 X X 0 0 0 O'Connell Blaine 1.00 X 0 598091 32708 Miller Greg 1.00 X 0 0 0 Malzewski Michael 50.00 X 107284 109142 37190 Less Timothy 50.00 X 198549 0 33613 Leitheiser Richard 1.00 X 0 0 0 Lauenstein Debra 50.00 X 142041 0 10817 Laird Michael 50.00 X 372364 0 37621 Komas Ron 1.00 X 0 0 0 Jeuch Thomas 50.00 X 135099 0 11538 Jacobson Catherine 1.00 X 0 426832 5511 Hauser Mark 1.00 X X 0 0 0 Bloedorn Michael 1.00 X 0 0 0 Bast Ronald 1.00 X 0 0 0 Arshad Ijaz 50.00 X 665816 0 40836 1621153 2436796 936519 13 false true false 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 8 60411 60411 Outpatient Revenue 621400 38506394 38506394 Inpatient Revenue 621990 33887246 33887246 ER Revenue 621990 4954727 4954727 77348367 727630 727630 0 0 0 20690292 2520 20122741 258945 567551 -256425 311126 311126 0 0 0 Medical Office Building 621110 921058 921058 Corporate Allocated Rev 900099 364616 364616 Clinic Revenue 621110 1823785 1823785 393544 393544 3503003 81950537 80851370 1038756 0 0 0 0 336187 336187 0 25449837 23669577 1780260 1194463 984913 209550 2771286 2333366 437920 1796835 1661219 135616 0 -15160 -15160 62870 62870 0 0 0 6981674 6304655 677019 26390 26390 14151685 13968205 183480 36301 25507 10794 0 1666809 1036755 630054 42290 11580 30710 0 51213 25656 25557 3219799 2002715 1217084 0 5364545 3146741 2217804 7357 7357 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 116089 59963 56126 78348179 62662611 15685568 0 24267 20681 1915314 7419268 0 7150087 9659269 0 0 850000 550000 1735837 1906352 1904854 1824544 113430648 47154358 68946397 66276290 29954721 32909261 0 0 0 2368924 552552 114850401 121118217 8174775 7053785 57240984 56507472 1246972 1489399 66662731 65050656 X 48019916 55891204 167754 176357 48187670 56067561 114850401 121118217 X 3602358 4277533 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4814698 4814698 46609036 7004276 39604760 3204271 1233113 1971158 56734955 38508298 18226657 2067688 408671 1659017 66276290 Due to Affiliates 1489399 1489399 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 true true X true X true X true true true false true true 1222361 1222361 0.01640 7817489 7970767 -153278 9039850 7970767 1069083 0.01640 9 2357 373737 373737 0.00500 2 138 165891 165891 0.00220 4 36008 36008 0.00050 15 2495 575636 575636 0.00770 15 2495 9615486 7970767 1644719 0.02410 1 7323 7323 0.00010 1 6714 6714 0.00010 2 14037 14037 0.00020 false 1222361 16206541 23477441 -7270900 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 11 true true true X X X X X X X X false true true 200.0000 true 400.0000 true X X X true true X true X X X true X X X X X X X true X true true 1 Kathy Hospice

3232 Pleasant Valley Drive West Bend WI 53095

Inpatient hospice. 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. Number of Hospital Faciltiy - 0 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. 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. X X false true X X X X false true false false false false false true false false Petasnick William D 948461 334370 19900 675099 51586 2029416 O'Connell Blaine 454374 125145 18572 15925 16783 630799 Malzewski Michael 93367 86562 100 21922 13817 658 12985 12305 11900 119589 134027 Less Timothy 183222 100 15227 11088 22525 232162 Lauenstein Debra 125939 15068 1034 7045 3772 152858 Laird Michael 263125 88333 20906 13475 24146 409985 Jacobson Catherine 218832 208000 5511 432343 Arshad Ijaz 649635 16181 13475 27361 706652 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. 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 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 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 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. 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 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 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 WI NA N/A false false Milwaukee Ctr for Diagnostic Imag LLC 5775 Wayzata Boulevard Ste 400 St Louis Park MN 55416 411748361 Healthcare WI NA N/A false false FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Ave Milwaukee WI 53226 260629591 Real Estate WI NA N/A 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