2026-03-27T15:13:16-05:00 2025-06-30 393647910 WIPFLI ADVISORY LLC 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2024-07-01 390816845 FROEDTERT SOUTH INC FROE 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 THOMAS J KELLEY VP & CFO 2625778113 2026-03-18 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2026-03-18 2024 2025-03-06 01:10:19Z THOMAS J KELLEY 6308 8TH AVENUE KENOSHA WI 531435082 498697480 0 X WWW.FROEDTERTSOUTH.COM X 1910 WI FROEDTERT SOUTH, INC. IS A COMPREHENSIVE REGIONAL HEALTHCARE SYSTEM THAT HAS SERVED SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS COMMUNITIES FOR MORE THAN 100 YEARS. FROEDTERT SOUTH PROVIDES SERVICES PRIMARILY THROUGH THE FROEDTERT KENOSHA HOSPITAL AND THE FROEDTERT PLEASANT PRAIRIE HOSPITAL AND SEVERAL OTHER CLINIC LOCATIONS.WE, AT FROEDTERT SOUTH, ARE COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. 13 8 2468 13 26994 0 92096 96564 415248445 480961416 8627163 5846315 42720 42305 424010424 486946600 14000 17250 0 0 199159323 218092336 0 0 0 201833231 248679720 401006554 466789306 23003870 20157294 668655400 727819306 73815386 88565882 594840014 639253424 X FROEDTERT SOUTH, INC. IS COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL-BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. WE STRIVE TO RECRUIT AND RETAIN THE BEST PHYSICIANS AND STAFF AND PURCHASE THE BEST DIAGNOSTIC AND CURATIVE MEDICAL EQUIPMENT THAT OUR FINANCIAL RESOURCES WILL PERMIT. WE ALSO STRIVE TO BE ACCESSIBLE TO ALL MEMBERS OF OUR COMMUNITY WITH EMERGENT AND URGENT HEALTHCARE NEEDS, IRRESPECTIVE OF THEIR ABILITY TO PAY. THIS IS OUR COMMITMENT TO THE QUALITY, ACCESSIBILITY AND AFFORDABILITY FUNDAMENTALS AFFECTING THE DELIVERY OF HEALTHCARE. 0 0 421426127 17250 480934422 ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO ITS COMMUNITY. 2024 CHARITY CARE $4,469,756. CHARITY CARE IS DEFINED AS FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO THOSE WHO CANNOT AFFORD TO PAY AND WHO MEET ALL CRITERIA FOR FINANCIAL ASSISTANCE. CHARITY CARE IS BASED ON ACTUAL COSTS, NOT CHARGES, AND DOES NOT INCLUDE BAD DEBT. UNREIMBURSED COST OF PUBLIC PROGRAMS $38,190,739. UNREIMBURSED COST OF PUBLIC PROGRAMS IS DEFINED AS THE SHORTFALL EXPERIENCED WHEN PAYMENTS RECEIVED ARE BELOW THE COST OF TREATING PUBLIC BENEFICIARIES THROUGH MEDICAID AND OTHER LOCAL PUBLIC PROGRAMS. COMMUNITY HEALTH IMPROVEMENT SERVICES $518,354. COMMUNITY HEALTH IMPROVEMENT SERVICES ARE DEFINED AS CLINICAL AND NON-CLINICAL SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH, WHICH ARE PROVIDED TO THE COMMUNITY FOR FREE OR FOR FEES THAT DID NOT COVER COSTS. FINANCIAL CONTRIBUTIONS $3,760. FINANCIAL CONTRIBUTIONS ARE DEFINED AS CONTRIBUTIONS, INCLUDING CASH, NON-CASH ITEMS SUCH AS FOOD, FURNITURE, EQUIPMENT, SUPPLIES, AND LOANED STAFF FOR VOLUNTEER AND CHARITABLE PURPOSES, MADE TO INDIVIDUALS, COMMUNITY GROUPS, OR NONPROFIT ORGANIZATIONS FOR CHARITABLE PURPOSES. HEALTH PROFESSIONS EDUCATION $4,700. HEALTH PROFESSIONS EDUCATION IS DEFINED AS DIRECT COSTS INCURRED FOR ACCREDITED TRAINING AND EDUCATION PROGRAMS FOR PHYSICIANS, NURSES, ALLIED HEALTH PROFESSIONALS AND TECHNICIANS (DOES NOT INCLUDE ONGOING EDUCATION FOR STAFF). COMMUNITY BUILDING ACTIVITIES $340,270. COMMUNITY BUILDING ACTIVITIES ARE DEFINED AS PROGRAMS THAT, WHILE NOT DIRECTLY RELATED TO HEALTH CARE, PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL ISSUES. COSTS FOR THESE ACTIVITIES INCLUDE CASH AND IN-KIND DONATIONS. COMMUNITY BENEFIT OPERATIONS $1,410. COMMUNITY BENEFIT OPERATIONS ARE DEFINED AS COSTS ASSOCIATED WITH DEDICATED STAFF AND COMMUNITY HEALTH NEEDS AND/OR ASSETS ASSESSMENT, AS WELL AS, OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGY AND OPERATIONS. TOTAL BENEFIT TO THE COMMUNITY FOR 2024 $43,528,989. 421426127 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 55 0 2468 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 13 8 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X JENS EMERSON 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 45.00 2.00 X X 1739035 0 137785 MARIO GARRETTO MD DIRECTOR/PHYSICIAN 40.00 X 892364 0 32175 THOMAS AMBRO MD DIRECTOR/PHYSICIAN 40.00 X 512806 0 33247 MIKE GENTILE CHAIRMAN 2.00 2.00 X X 0 0 0 BRIAN ALBRECHT DIRECTOR 2.00 X 0 0 0 IMRAN ANDRABI DIRECTOR (FROM JULY 2024) 2.00 2.00 X 0 0 0 TODD BATTLE DIRECTOR (THRU JULY 2024) 2.00 X 0 0 0 BRYCE GARTLAND DIRECTOR (FROM APR 2025) 2.00 2.00 X 0 0 0 ROBERT LEE JR DIRECTOR 2.00 X 0 0 0 THOMAS P MAHONEY DIRECTOR 2.00 X 0 0 0 MICHAEL PITTS DIRECTOR 2.00 X 0 0 0 DAVID R RILEY DIRECTOR 2.00 X 0 0 0 IAN SCHWARTZ DIRECTOR (THRU APRIL 2025) 2.00 2.00 X 0 0 0 MELISSA THOMPSON DIRECTOR (FROM JAN 2025) 2.00 X 0 0 0 GARY ZAID MD DIRECTOR 2.00 X 0 0 0 LINDA WOHLGEMUTH ASST SECRETARY/SVP-COO 45.00 X 766725 0 51333 THOMAS KELLEY ASST TREASURER/VP-CFO 45.00 X 738126 0 67906 SUSAN VENTURA SVP/COO 45.00 X 375468 0 50332 DAVID A KNIGHT PHYSICIAN 40.00 X 1304033 0 18382 BRIAN C HILL PHYSICIAN 40.00 X 1075272 0 33380 GOYA V RAIKAR PHYSICIAN 40.00 X 1031906 0 27349 GEORGE T POULLETTE PHYSICIAN 40.00 X 825364 0 42345 SYED K MEHDI PHYSICIAN 40.00 X 835401 0 13823 10096500 0 508057 408 0 1 0 VITUITY-WI ANESTHESIA 2100 POWELL ST SUITE 400 EMERYVILLE CA 94608 MEDICAL SERVICES STAFF 7606216 AYA HEALTHCARE PO BOX 674907 DALLAS TX 75267 MEDICAL SERVICES STAFF 4374624 AEROTEK COMMERCIAL STAFFINF SERVICES PO BOX 198531 ATLANTA GA 303848531 ENVIRONMENTAL SERVICES 4255790 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 681031231 MEDICAL SERVICES STAFF 4219715 AMERGIS 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 MEDICAL SERVICES STAFF 2966952 85 73455 23109 96564 NET PATIENT SERVICE REVENUE 623000 471508203 471508203 OTHER OPERATING REVENUE 623990 9453213 9426219 26994 480961416 5778211 5778211 11211361 578738 11721995 0 -510634 578738 68104 68104 23545 73455 28885 -5340 -5340 GIFT SHOP INCOME 459420 47645 47645 47645 486946600 480934422 26994 5888620 X 17250 17250 5423068 4806203 616865 179797384 160942702 18854682 5100691 3909346 1191345 15876324 12168165 3708159 11894869 9116639 2778230 346272 346272 111549 111549 67831384 66971328 860056 285327 27176 258151 398835 60914 337921 10052251 1426974 8625277 7132978 7118339 14639 584224 158455 425769 28264389 25437951 2826438 1479078 191100 1287978 SUPPLIES 55649285 54853393 795892 DRUGS 43234128 43234128 BAD DEBTS 20042588 20042588 PROVIDER TAX ASSESSMENT 6158700 6158700 7108732 4784776 2323956 466789306 421426127 45363179 0 13293796 25565496 85094892 69337600 7782688 8467306 7668699 10614314 614937644 394422454 223319118 220515190 319140890 383055995 12355317 10263405 668655400 727819306 42308582 52845392 184250 210626 31322554 35509864 73815386 88565882 X 592042880 636382466 2797134 2870958 594840014 639253424 668655400 727819306 X 20157294 24402017 -145901 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2797134 91074 17250 2870958 2667769 143365 14000 2797134 2592142 111627 36000 2667769 2829624 -214732 22750 2592142 2528391 314283 13050 2829624 0.00000 0.52939 0.47061 0 0 17872465 17872465 415269536 263599136 151670400 13408869 10903823 2505046 165672743 119919495 45753248 2714031 2714031 220515190 DEFERRED COMPENSATION 33784414 AMOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 1050375 OPERATING LEASE LIABILITY 675075 35509864 491171763 24402017 -20176854 4225163 486946600 0 486946600 446758353 0 446758353 20030953 20030953 466789306 PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE RESTRICTED FOR EDUCATION SCHOLARSHIP GRANTS AND VARIOUS HEALTH CARE PROGRAMS. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE FOR HOSPITAL DEVELOPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 1,327,174. SCHOLARSHIPS INCLUDED IN INCOME -17,250. BAD DEBT EXPENSE -20,042,588. PERIODIC BENEFIT COST -1,473,075. FUNDRAISING EXPENSES 28,885. PART XII, LINE 4B - OTHER ADJUSTMENTS: SCHOLARSHIPS INCLUDED IN INCOME 17,250. BAD DEBT EXPENSE 20,042,588. FUNDRAISING EXPENSES -28,885. GOLF OUTING 97000 73455 23545 24941 3944 97000 73455 23545 24941 3944 28885 -5340 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 4469756 4469756 0.01000 59135044 20944305 38190739 0.08550 63604800 20944305 42660495 0.09550 519764 519764 0.00120 4700 4700 0.00000 3760 3760 0.00000 528224 528224 0.00120 64133024 20944305 43188719 0.09670 13760 13760 0.00000 74730 74730 0.00020 245200 245200 0.00050 6580 6580 0.00000 340270 340270 0.00070 1 4466979 0 51959349 70660231 -18700882 X 1 1 1 1 FROEDTERT PLEASANT PRAIRIE HOSPITAL 9555 76TH STREET PLEASANT PRAIRIE WI 53158 WWW.FROEDTERTSOUTH.COM 305 X X X FROEDTERT PLEASANT PRAIRIE HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X 1 23 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X X X X X X 1 X 0 X X X 1 X 0 0 FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY HEALTH SURVEY - NEARLY 1,000 PEOPLE COMPLETED AN ANONYMOUS ONLINE SURVEY THAT INCLUDED 124 QUESTIONS THAT COVERED TOPICS SUCH AS INDIVIDUAL AND FAMILY HEALTH BEHAVIORS, ENVIRONMENTAL HEALTH, MENTAL HEALTH, AND QUESTIONS ABOUT THE KENOSHA COUNTY COMMUNITY.COMMUNITY CONVERSATIONS - A TOTAL OF 85 PEOPLE PARTICIPATED IN COMMUNITY CONVERSATIONS THAT INTENTIONALLY CENTERED THE VOICES OF INDIVIDUALS FROM HISTORICALLY UNDERREPRESENTED GROUPS, INCLUDING MEMBERS OF AFRICAN AMERICAN, LATINO, LGBTQ+, YOUTH AND RURAL COMMUNITIES.REVIEW OF EXISTING DATA - A COMPREHENSIVE REVIEW OF EXISTING DATA WAS CONDUCTED USING A VARIETY OF SOURCES INCLUDING: UNITED STATES CENSUS BUREAU DATA, COUNTY HEALTH RANKINGS AND ROADMAPS, AND A VARIETY OF DATA COLLECTED BY KENOSHA COUNTY PUBLIC HEALTH.ALL INFORMANTS WERE MADE AWARE THAT PARTICIPATION WAS VOLUNTARY AND THAT RESPONSES WOULD BE SHARED WITH UJIMA UNITED, LLC FOR ANALYSIS AND REPORTING. BASED ON THE SUMMARIES PROVIDED TO UJIMA UNITED, LLC, THE REPORT PRESENTS THE RESULTS OF THE 2022 KEY INFORMANT INTERVIEWS FOR KENOSHA COUNTY. FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 6A: FROEDTERT SOUTH, AURORA HEALTH CARE, HEALTH ADVISORY COUNCIL, HEALTH EQUITY TASK FORCE, AND THE KENOSHA COUNTY BOARD OF HEALTH. FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 6B: FROEDTERT SOUTH, AURORA HEALTH CARE, HEALTH ADVISORY COUNCIL, HEALTH EQUITY TASK FORCE, AND THE KENOSHA COUNTY BOARD OF HEALTH ALONG WITH NJM MANAGEMENT SERVICES AND UJIMA UNITED, LLC.FROEDTERT SOUTH:PART V, SECTION B, LINE 7A:HTTPS://WWW.FROEDTERTSOUTH.COM/ABOUT-US/COMMUNITY-BENEFITS/PART V, SECTION B, LINE 7B:HTTPS://WWW.FROEDTERTSOUTH.COM/ABOUT-US/COMMUNITY-BENEFITS/ FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 11: USING THESE CRITERIA, FROEDTERT SOUTH PRIORITIZED THE FOLLOWING SIGNIFICANT HEALTH NEEDS TO ADDRESS IN THE 2023-2025 IMPLEMENTATION STRATEGY: ACCESS TO AFFORDABLE HEALTH CARE.GOAL: ENHANCE ACCESS TO AFFORDABLE HEALTHCARE IN KENOSHA COUNTY. STRATEGY 1: DEVELOP A RESOURCE GUIDE TO ENHANCE AWARENESS OF EXISTING HEALTHCARE SERVICES AND RESOURCES IN KENOSHA COUNTY. STRATEGY 2: INCREASE THE NUMBER OF OPPORTUNITIES FOR PEOPLE TO ACCESS CARE IN THEIR OWN COMMUNITIES BY PROMOTING AND FACILITATING HEALTH FAIRS AND MOBILE CLINIC SERVICES STRATEGY 3: INCREASE AWARENESS OF AND EDUCATION TO THE COMMUNITY ABOUT TELEHEALTH SERVICES. STRATEGY 4: DEVELOP A PLAN TO PROMOTE HEALTHCARE AS A PROFESSION AMOUNT YOUNG PEOPLE WHOSE IDENTITIES ARE UNDER-REPRESENTED IN HEALTHCARE PROFESSIONS. AFFORDABLE AND SAFE HOUSINGGOAL: IMPROVE ACCESS TO SAFE AND AFFORDABLE HOUSING IN KENOSHA COUNTY. STRATEGY 1: WE WILL ASSESS THE EXISTING HOUSING INSPECTION PROCESS TO IDENTIFY GAPS IN CURRENT REGULAR SAFETY INSPECTIONS ON RENTAL UNITS IN KENOSHA COUNTY. STRATEGY 2: DEVELOP A "HOUSING FOR ALL" PLAN WITH KEY RECOMMENDATIONS TO IMPROVE HOUSING AFFORDABILITY FOR ALL INCOME LEVELS IN KENOSHA COUNTY STRATEGY 3: DEVELOP AND DISTRIBUTE AN ENHANCED HOUSING RESOURCE GUIDE FOR KENOSHA COUNTY MENTAL HEALTH SUBSTANCE USE.GOAL: OPTIMIZE MENTAL HEALTH AMOUNT MEMBERS OF THE KENOSHA COUNTY COMMUNITY, PREVENT AND DECREASE THE MISUSE OF ALCOHOL, TOBACCO, AND OTHER DRUGS STRATEGY 1: WORK TO RAISE AWARENESS AND REDUCE STIGMA AROUND MENTAL HEALTH AND SUBSTANCE USE BY SHARING STORIES OF KENOSHA COUNTY RESIDENTS STRATEGY 2: ESTABLISH A YOUTH LEADERSHIP PROGRAM TO TRAIN PEER EDUCATORS AND AMBASSADORS WHO WILL WORK TO PREVENT THE USE OF ALCOHOL, TOBACCO, AND OTHER DRUGS AMOUNT YOUTH. STRATEGY 3: PROMOTE COMMUNITY CONNECTEDNESS BY DEVELOPING A PROGRAM THAT SUPPORTS COMMUNITIES TO HOST NEIGHBORHOOD EVENTS AND ACTIVITIES. FROEDTERT KENOSHA HOSPITAL: PART V, SECTION B, LINE 22B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL NOT BE CHARGED INDIVIDUALLY MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE ("AGB"). FURTHERMORE, CHARGES FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE LESS THAN THE GROSS CHARGES FOR SUCH SERVICES. THE ORGANIZATION CALCULATES ONE OR MORE AGB PERCENTAGES USING THE "LOOK-BACK METHOD AND INCLUDING MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE ORGANIZATION, ALL INACCORDANCE WITH 501(R). THESE CALCULATIONS ARE MADE AS FOLLOWS:1. THE ORGANIZATION DETERMINES AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (A) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES BY (B) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.2. "GROSS CHARGES" MEANS THE ORGANIZATION'S FULL, ESTABLISHED PRICE FOR MEDICAL CARE THAT THE ORGANIZATION CONSISTENTLY AND UNIFORMLY CHARGES PATIENTS BEFORE APPLYING ANY CONTRACTUAL ALLOWANCES, DISCOUNTS, OR DEDUCTIONS.3. THE "AGB PERIOD" MEANS EACH PRIOR 12-MONTH PERIOD ENDING ON DECEMBER 31ST.4. THE ORGANIZATION WILL BEGIN TO APPLY THE ANNUALLY DETERMINED AGB PERCENTAGE WITHIN 120 DAYS FOLLOWING THE END OF THE AGB PERIOD THAT WAS USED IN CALCULATION THE AGB PERCENTAGE.5. ANY CAPITALIZED TERMS NOT DEFINED IN THIS DOCUMENT WILL HAVE THE MEANING ASSIGNED TO SUCH TERM IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FROEDTERT PLEASANT PRAIRIE HOSPITAL: PART V, SECTION B, LINE 22B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL NOT BE CHARGED INDIVIDUALLY MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE ("AGB"). FURTHERMORE, CHARGES FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE LESS THAN THE GROSS CHARGES FOR SUCH SERVICES. THE ORGANIZATION CALCULATES ONE OR MORE AGB PERCENTAGES USING THE "LOOK-BACK METHOD AND INCLUDING MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE ORGANIZATION, ALL INACCORDANCE WITH 501(R). THESE CALCULATIONS ARE MADE AS FOLLOWS:1. THE ORGANIZATION DETERMINES AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (A) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES BY (B) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.2. "GROSS CHARGES" MEANS THE ORGANIZATION'S FULL, ESTABLISHED PRICE FOR MEDICAL CARE THAT THE ORGANIZATION CONSISTENTLY AND UNIFORMLY CHARGES PATIENTS BEFORE APPLYING ANY CONTRACTUAL ALLOWANCES, DISCOUNTS, OR DEDUCTIONS.3. THE "AGB PERIOD" MEANS EACH PRIOR 12-MONTH PERIOD ENDING ON DECEMBER 31ST.4. THE ORGANIZATION WILL BEGIN TO APPLY THE ANNUALLY DETERMINED AGB PERCENTAGE WITHIN 120 DAYS FOLLOWING THE END OF THE AGB PERIOD THAT WAS USED IN CALCULATION THE AGB PERCENTAGE.5. ANY CAPITALIZED TERMS NOT DEFINED IN THIS DOCUMENT WILL HAVE THE MEANING ASSIGNED TO SUCH TERM IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. 6 1 - FROEDTERT PRAIRIE RIDGE 9697 ST CATHERINES DRIVE PLEASANT PRAIRIE WI 53158 OUTPATIENT PHYSICIAN CLINIC 2 - FROEDTERT SOMERS CLINIC 3400 MARKET LANE KENOSHA WI 53144 OUTPATIENT PHYSICIAN CLINIC 3 - FROEDTERT PLEASANT PRAIRIE CLINIC 10256 OLD GREEN BAY RD PLEASANT PRAIRIE WI 53158 OUTPATIENT PHYSICIAN CLINIC 4 - FROEDTERT KENOSHA CLINIC 6308 8TH AVENUE KENOSHA WI 53143 OUTPATIENT PHYSICIAN CLINIC 5 - FROEDTERT PADDOCK LAKE CLINIC 7322 236TH AVENUE SALEM WI 53168 OUTPATIENT PHYSICIAN CLINIC 6 - GURNEE CLINIC 103 S GREENLEAF ST GURNEE IL 60031 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: THE COST METHOD USED TO CALCULATE THE COST OF THE COMMUNITY BENEFIT PROGRAMS WAS THE COST-TO-CHARGE RATIO. WORKSHEET 2 WAS USED TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $20,042,588. PART II, COMMUNITY BUILDING ACTIVITIES: MANY STAFF MEMBERS ARE UTILIZED TO PROMOTE THE HEALTH OF THE COMMUNITY AND THE GENERAL WELL-BEING OF THE COMMUNITY WE SERVE. THROUGH OUR EMERGENCY PREPAREDNESS COMMITTEE, STAFF ARE ALWAYS PLANNING AND PREPARING TO BE READY TO MEET THE NEEDS OF THE COMMUNITY AS EVENTS OCCUR. ADDITIONALLY, A VARIETY OF STAFF WORK WITH LOCAL SCHOOLS AND OTHER ORGANIZATIONS TO GIVE TALKS PROMOTING HEALTH AND CAREERS IN HEALTHCARE. A NUMBER OF STAFF MEMBERS ARE INVOLVED IN MENTORING PROGRAMS WITHIN THE LOCAL SCHOOLS. RECOGNIZING THE IMPORTANCE OF SUSTAINING AND GROWING OUR ECONOMY, WE PARTICIPATE IN OUR LOCAL BUSINESS ALLIANCE. PART III, LINE 2: THE ORGANIZATIONS UTILIZED THE HMFA #15 METHODOLOGY FOR DETERMINING BAD DEBT EXPENSE. PART III, LINE 3: SINCE THE ORGANIZATION UTILIZES HMFA #15, THERE IS NO PORTION OF THE BAD DEBT THAT WOULD BE CONSIDERED CHARITY CARE. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION EXPERIENCE AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. WORKSHEET A IN THE INSTRUCTIONS WAS USED TO DETERMINE THE COSTING METHODOLOGY. PART III, LINE 8: MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: OUR COLLECTION PROCESS IS THE SAME FOR ALL PATIENTS. IF A PATIENT EXPRESSES A NEED FOR FINANCIAL ASSISTANCE WE OFFER THE FINANCIAL ASSISTANCE APPLICATION. WE BILL ALL INSURANCES. PATIENT DOES NOT RECEIVE A COPY OF THE BILL UNTIL IT IS THEIR BALANCE. OUR EXTENDED BUSINESS OFFICE SENDS THREE STATEMENTS AND OUR REQUIRED FINAL REQUEST STATEMENT. FROM THIS POINT THE OUTSTANDING BALANCE IS HANDLED BY THE COLLECTION AGENCY. THE ACCOUNT DOES STAY ACTIVE ON OUR FINANCIAL SYSTEM FOR ONE YEAR. AT THAT TIME THE OUTSTANDING BALANCE IS MOVED OVER TO A BAD DEBT STATUS. PART VI, LINE 2: IN AN EFFORT TO UNDERSTAND AND ASSIST IN ADDRESSING THE NEEDS OF THE COMMUNITY WE SERVE, FROEDTERT SOUTH HAS INVOLVEMENT IN A VARIETY OF COMMUNITY COMMITTEES. FROEDTERT SOUTH HAS MULTIPLE STAFF, MANAGEMENT AND ADMINISTRATIVE LEVEL EMPLOYEES PARTICIPATE IN COMMITTEES THAT ARE SET UP TO ASSESS AND ADDRESS NEEDS IN THE COMMUNITY SUCH AS A HEALTHY LIFESTYLE COMMITTEE, MENTAL HEALTH COMMITTEE, INJURY PREVENTION COMMITTEE, SUICIDE PREVENTION COMMITTEE, INFANT MORTALITY COMMITTEE. THROUGH OUR PARTICIPATION IN COMMUNITY COMMITTEES WE GAIN AN UNDERSTANDING ABOUT THE NEEDS OF THE COMMUNITY AS WELL AS THE OPPORTUNITY TO WORK TOGETHER TO ADDRESS THE NEEDS. PART VI, LINE 3: WHEN STATEMENTS ARE SENT FROM OUR EXTENDED BUSINESS OFFICE, THERE IS A PHONE NUMBER FOR THE PATIENT TO CALL FOR ASSISTANCE WITH THEIR BALANCES. PATIENTS CALL AND THEY WORK WITH THEM TO SET UP PAYMENT ARRANGEMENTS. IF THEY EXPRESS ANY CONCERNS FOR FINANCIAL NEEDS THEY OFFER TO SEND THEM A COMMUNITY CARE APPLICATION. PART VI, LINE 4: KENOSHA COUNTY IS A FAST GROWING LAKESHORE COMMUNITY IN SOUTHEASTERN WISCONSIN. LOCATED BETWEEN CHICAGO AND MILWAUKEE, KENOSHA COUNTY BOASTS A DIVERSE ECONOMY. KENOSHA IS THE FOURTH LARGEST CITY IN THE STATE OF WISCONSIN WITH 99,578 RESIDENTS REPORTED BY THE UNITED STATES CENSUS BUREAU IN THE 2024 POPULATION ESTIMATES. KENOSHA IS NOW THE EIGHTH LARGEST COUNTY IN WISCONSIN IN TERMS OF POPULATION WITH 168,754 RESIDENTS. FROEDTERT SOUTH SERVES PEOPLE IN SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS THROUGH ITS HOSPITAL LOCATION, FROEDTERT PLEASANT PRAIRIE HOSPITAL AND MULTIPLE CLINIC SITES. ADVOCATE AURORA MEDICAL CENTER ALSO HAS A HOSPITAL CAMPUS IN KENOSHA. PART VI, LINE 5: FROEDTERT SOUTH IS COMMITTED TO IMPROVING THE HEALTH OF OUR PATIENTS AND NEIGHBORS. WE OFFER A VARIETY OF COMMUNITY OUTREACH PROGRAMS TO HELP THE GENERAL PUBLIC MAINTAIN GOOD HEALTH. THESE INCLUDE FREE COMMUNITY EDUCATION SEMINARS, HEALTH SCREENINGS, AND VARIOUS SUPPORT GROUPS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SCHOLARSHIPS 12 17250 PART I, LINE 2: THE MANAGER OF COMMUNITY RELATIONS EVALUATES APPLICANTS IN ACCORDANCE WITH SCHOLARSHIP PROGRAM REQUIREMENTS. RECIPIENTS ARE THEN MONITORED TO ENSURE COMPLIANCE REQUIREMENTS ARE MET, SUCH AS GPA. TRADITIONAL ACCOUNTING RECORDS ARE MAINTAINED FOR ANY DISBURSEMENTS. X X 0 1 0 0 0 0 0 1 0 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 1184979 0 521082 0 32974 0 117250 0 20535 0 1876820 0 0 0 DAVID A KNIGHT PHYSICIAN 581031 0 651086 0 71916 0 17250 0 1132 0 1322415 0 0 0 BRIAN C HILL PHYSICIAN 553721 0 453496 0 68055 0 17250 0 16130 0 1108652 0 0 0 GOYA V RAIKAR PHYSICIAN 823079 0 0 0 208827 0 17250 0 10099 0 1059255 0 0 0 MARIO GARRETTO MD DIRECTOR/PHYSICIAN 604598 0 237498 0 50268 0 17250 0 14925 0 924539 0 0 0 GEORGE T POULLETTE PHYSICIAN 301877 0 481159 0 42328 0 17250 0 25095 0 867709 0 0 0 SYED K MEHDI PHYSICIAN 767156 0 0 0 68245 0 5300 0 8523 0 849224 0 0 0 LINDA WOHLGEMUTH ASST SECRETARY/SVP-COO 616118 0 122179 0 28428 0 42250 0 9083 0 818058 0 0 0 THOMAS KELLEY ASST TREASURER/VP-CFO 613877 0 122179 0 2070 0 42250 0 25656 0 806032 0 0 0 THOMAS AMBRO MD DIRECTOR/PHYSICIAN 421327 0 0 0 91479 0 17250 0 15997 0 546053 0 0 0 SUSAN VENTURA SVP/COO 300510 0 61090 0 13868 0 41572 0 8760 0 425800 0 0 0 PART I, LINE 4B INDIVIDUAL ELIGIBLE EMPLOYEES MAY PARTICIPATE IN A 457F PLAN. THE ORGANIZATION DOES NOT CONTRIBUTE TO THIS PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATE IN THE PLAN: RICHARD SCHMIDT, ANDREW HARRON, NEIL SHEPLER, SUSAN VENTURA, LINDA WOHLGEMUTH, AND THOMAS KELLEY. PART I, LINE 7 REPORTS DISCRETIONARY INCENTIVE AMOUNTS THAT WERE APPROVED BY THE BOARD BASED UPON PERFORMANCE. DAVID RILEY DIRECTOR 2885824 SERVICES PROVIDED BY RILEY CONSTRUCTION COMPANY, INC. DAVID RILEY OWNS RILEY CONSTRUCTION COMPANY, INC. 0 ROBERT LEE DIRECTOR 532005 SERVICES PROVIDED BY LEE ELECTRICAL, INC. ROBERT LEE OWNS LEE ELECTRICAL, INC. 0 SCHEDULE L, PART IV: THE ORGANIZATION DISCLOSED TRANSACTIONS WITH INTERESTED PERSONS ON SCHEDULE L. PRIOR TO ENTERING ANY CONTRACTS, IT FOLLOWED ITS WRITTEN CONFLICT OF INTEREST POLICY, WITH INTERESTED PERSONS RECUSED, AND CONDUCTED ROBUST COMPETITIVE RFP AND BID PROCESSES. CONTRACTS WERE AWARDED BASED ON PRICE, QUALIFICATIONS, AND ABILITY TO MEET TIMELINES. FORM 990, PART VI, SECTION A, LINE 7B EACH CLASS A MEMBER OF FROEDTERT SOUTH, INC. SHALL HAVE THE FOLLOWING RIGHTS TO BE EXECUTED ONLY UPON THE MUTUAL AGREEMENT OF BOTH CLASS A MEMBERS: - TO INITIATE, ADOPT AND APPROVE AND AMEND FROEDTERT SOUTH, INC.'S GOVERNING DOCUMENTS; - TO ADOPT, AMEND AND APPROVE THE MISSION, VISION, VALUES, PHILOSOPHY AND OBJECTS OF FROEDTERT SOUTH, INC. - TO APPROVE THE SALE (WHETHER BY DIRECT SALE, LEASE, LEASE FINANCING, PLEDGE OR OTHERWISE) OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF FROEDTERT SOUTH, INC. AND ANY OTHER CONTROLLED CORPORATION, THE PURCHASE (WHETHER BY DIRECT PURCHASE, LEASE, LEASE FINANCING OR OTHERWISE), SALE OR OTHER DISPOSITION OF PROPERTY INVOLVING A MATERIAL DOLLAR AMOUNT, AND ANY LONG-TERM BORROWING (FOR A TERM OF MORE THAN ONE YEAR) BY FROEDTERT SOUTH, INC. OR ANY OTHER CONTROLLED CORPORATION INVOLVING A MATERIAL DOLLAR AMOUNT; - TO APPROVE THE DISSOLUTION, MERGER, CONSOLIDATION, AFFILIATION OR INTEGRATION (OR TRANSACTION OF SIMILAR IMPORT) OF FROEDTERT SOUTH, INC. WITH OR INTO ANY OTHER PERSON, OR TRANSFER OF ANY MEMBERSHIP INTEREST BY ANY CLASS A MEMBER; - TO APPROVE THE FORMATION AND GOVERNANCE OF ANY NEW CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES (INVOLVING CAPITALIZATION INVOLVING A MATERIAL DOLLAR AMOUNT) IN WHICH FROEDTERT SOUTH, INC. OR ANY OTHER CONTROLLED CORPORATION HAS AN INTEREST THROUGH MEMBERSHIP, VOTING STOCK OR OTHER EQUITY PARTICIPATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO, CFO AND CONTROLLER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C FROEDTERT'S SOUTH'S WRITTEN CONFLICT OF INTEREST POLICY FOR THE BOARD IS REVIEWED ANNUALLY BY EACH BOARD MEMBER, AND ANY POTENTIAL CONFLICTS OF INTEREST ARE DISCLOSED AT THAT TIME. THE WRITTEN CONFLICT OF INTEREST POLICY FOR EMPLOYEES IS REVIEWED DURING ORIENTATION AND PERIODICALLY AT ORGANIZATION MEETINGS, AND IS INCORPORATED INTO THE PERFORMANCE STANDARDS OF THEIR ANNUAL EVALUATIONS. IF A CONFLICT ARISES, DEPENDING UPON THE NATURE OF THE FINANCIAL INTEREST AND WORK DONE BY THE BOARD, SEVERAL ACTIONS MAY BE CONSIDERED: THE BOARD MEMBER WITH A FINANCIAL INTEREST WOULD NEED TO VOLUNTARILY EXCUSE HIM OR HERSELF FROM THE DELIBERATIONS OR VOTING ON SUCH A MATTER; OR, IF NECESSARY, THE BOARD WOULD DETERMINE THAT THE SUBJECT'S FINANCIAL INTEREST WAS AN ACTUAL CONFLICT OF INTEREST, IN WHICH CASE THE BOARD MEMBER WOULD BE INFORMED BY THE BOARD CHAIRPERSON THAT HE OR SHE WOULD NOT BE ALLOWED TO VOTE IN ANY SUCH MATTERS DUE TO THIS REAL OR PERCEIVED CONFLICT OF INTEREST. MINUTES OF THE BOARD MEETING WOULD DOCUMENT THIS DECISION PROCESS, AND REFLECT WHATEVER ACTION(S) ARE ULTIMATELY TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE PRESIDENT, CEO AND GENERAL COUNSEL AND THE COMPENSATION FOR THE VICE PRESIDENTS REPORTING DIRECTLY TO THE PRESIDENT, CEO AND GENERAL COUNSEL ARE DETERMINED BY THE BOARD EXECUTIVE COMMITTEE WHICH SERVES AS THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE CONTRACTS WITH THE HEALTHCARE COMPENSATION FIRM NAMED THE GROVES GROUP, LLC, AND HAS UTILIZED THE PRESIDENT OF THE GROVES GROUP, LLC AS THE COMPENSATION CONSULTANT SINCE 2005. THE COMPENSATION CONSULTANT UTILIZES A METHODOLOGY THAT EVALUATES INTERNAL AND EXTERNAL EQUITY AFTER EVALUATING THE RESPONSIBILITIES OF EACH POSITION AND MAKES A RECOMMENDATION TO THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE HAS FOLLOWED THE DETAILED RECOMMENDATIONS OF THE COMPENSATION CONSULTANT ANNUALLY SINCE 2005 AND THE COMPENSATION CONSULTANT HAS BEEN RETAINED THROUGH 2024. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES FEES: PROGRAM SERVICE EXPENSES 33,172,749. MANAGEMENT AND GENERAL EXPENSES 860,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,032,805. NONEMPLOYEE STAFF FEES: PROGRAM SERVICE EXPENSES 17,229,162. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,229,162. SERVICE CONTRACT FEES: PROGRAM SERVICE EXPENSES 16,569,417. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,569,417. FORM 990, PART XI, LINE 9: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 1,327,174. PERIODIC BENEFIT COST -1,473,075. FSINC INC 6308 8TH AVENUE KENOSHA WI 53143 391956749 HEALTHCARE WI 501(C)(3) LINE 12B, II FROEDTERT SOUTH INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0