TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Zwygart Christopher Director-Chair	1.00	X	X	0	0	0
(2) O'Meara Kristine Dir-Vice Chair	1.00	X	X	0	0	0
(3) Olson David President	50.00	X	X	0	56,923	2,492
(4) Laird Michael President	50.00	X	X	414,441	0	101,574
(5) Hauser Mark Dir-Treas/Sec	1.00	X	X	0	0	0
(6) Smale Jeffery Dir/Doctor	1.00	X		0	437,055	38,794
(7) Petasnick William D Dir/FH CEO	1.00	X		0	6,573,439	67,765
(8) O'Meara Charles Director	1.00	X		0	0	0
(9) Martin Mary Dir/Pat Care Sv	40.00	X		122,126	0	10,826
(10) Leitheiser Richard Director	1.00	X		0	0	0
(11) Komas Ron Director	1.00	X		0	0	0
(12) Jacobson Catherine Dir/FH Pres	1.00	X		0	797,937	135,753
(13) Herdrich Gary MD Dir/Doctor	1.00	X		0	548,632	32,293
(14) Gardner Patrick MD Director	1.00	X		0	0	0
(15) Bloedorn Michael Director	1.00	X		0	0	0
(16) Bast Ronald Director	1.00	X		0	0	0
(17) Van De Kreeke Jeffrey FH CFO	1.00		X	0	339,273	102,777

(A) Name and business address	(B) Description of services	(C) Compensation
Wheaton Franciscan Services 400 West River Woods Parkway Milwaukee,WI53212	Laundry Services	169,227
United Dynacare LLC 9200 West Wisconsin Avenue Milwaukee,WI53226	Laboratory Services	270,363
Medical College of WI 8701 Watertown Plank Rd Milwaukee,WI53226	Physician Services	1,991,546
Diagnostic Services of Washington County 1715 West Paradise Drive West Bend,WI53095	Pathology Services	309,530
Advanced HRO Solutions Inc 1585 W Oakmont Rd Hoffman Estates,IL60169	Staffing Services	263,161
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 9

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	555,180		555,180
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	26,807,049	24,946,474	1,860,575
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,134		4,134
9	Other employee benefits .......	8,514		8,514
10	Payroll taxes ...........	1,966,419	1,810,124	156,295
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	46,043		46,043
c	Accounting ...........	21,870	21,870
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	6,447,048	5,692,303	754,745
12	Advertising and promotion ....	8,459		8,459
13	Office expenses .......	393,539	245,542	147,997
14	Information technology ......	51,265	47,617	3,648
15	Royalties ..	0
16	Occupancy ...........	1,948,368	1,211,885	736,483
17	Travel ............	50,698	25,482	25,216
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	96,902	46,482	50,420
20	Interest ...........	3,022,960	1,880,281	1,142,679
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	5,272,675	3,135,095	2,137,580
23	Insurance ..............	6,971		6,971
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	State Hospital Assessment	2,156,154	2,156,154
b	Provision for Uncollectible	3,738,531	3,738,531
c	Medical Supplies	15,649,922	15,622,422	27,500
d	Corporate Allocated Expense	16,787,545	6,771,407	10,016,138
e
f	All other expenses	878,667	399,249	479,418
25	Total functional expenses. Add lines 1 through 24f	85,918,913	67,750,918	18,167,995	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	20,681	1	2,019
2	Savings and temporary cash investments .......	7,419,268	2	5,237,304
3	Pledges and grants receivable, net .........		3	0
4	Accounts receivable, net .........	9,659,269	4	9,398,418
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6	0
7	Notes and loans receivable, net .............	550,000	7	250,000
8	Inventories for sale or use ..............	1,906,352	8	1,873,009
9	Prepaid expenses and deferred charges ............	1,824,544	9	1,386,522
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	128,917,972
b	Less: accumulated depreciation. .....	10b	51,590,174	66,276,290	10c	77,327,798
11	Investments—publicly traded securities ..........	32,909,261	11	30,780,247
12	Investments—other securities. See Part IV, line 11 ......		12	0
13	Investments—program-related. See Part IV, line 11 ..		13	0
14	Intangible assets .........		14	0
15	Other assets. See Part IV, line 11 ...........	552,552	15	217,085
16	Total assets. Add lines 1 through 15 (must equal line 34)...	121,118,217	16	126,472,402
	17	Accounts payable and accrued expenses .	7,053,785	17	6,476,931
18	Grants payable ..........		18
19	Deferred revenue ..........		19	115,000
20	Tax-exempt bond liabilities ..........	56,507,472	20	55,822,923
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	1,489,399	25	4,593,826
26	Total liabilities. Add lines 17 through 25.....	65,050,656	26	67,008,680
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	55,891,204	27	59,315,827
28	Temporarily restricted net assets .....	176,357	28	147,895
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	56,067,561	33	59,463,722
34	Total liabilities and net assets/fund balances .....	121,118,217	34	126,472,402

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization St Josephs Community Hospital of West Bend Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization St Josephs Community Hospital of West Bend Inc
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	4,814,698		4,814,698
b	Buildings ................	46,759,065	8,263,453	38,495,612
c	Leasehold improvements ............	3,232,071	1,445,776	1,786,295
d	Equipment ................	57,576,935	41,471,571	16,105,364
e	Other .................	16,535,203	409,374	16,125,829
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				77,327,798

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Due to Affiliates		4,593,826








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		4,593,826
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Part X	Part X : FIN48 Footnote	Froedtert Health applies ASC No. 740, Income Taxes, which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. ASC No. 740 prescribes a more-likely-than-not recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken. Under ASC No. 740, tax positions are evaluated for recogniton, derecogniton, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2012 and 2011, Froedtert Health does not have an asset or liability recorded for unrecognized tax positions.
Part XI, Line 8	Part XI, Line 8: Other Changes in Net Assets or Fund Balances	Transfers to Affiliates $316140 Contributions $410

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..			1,397,306		1,397,306	1.700 %
b Medicaid (from Worksheet 3, column a) .....			7,602,442	9,860,337	-2,257,895
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....			8,999,748	9,860,337	-860,589	1.700 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	17	5,616	240,633		240,633	0.290 %
f Health professions education (from Worksheet 5) ..	3	260	286,206		286,206	0.350 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	4	16	49,718		49,718	0.060 %
jTotal Other Benefits ...	24	5,892	576,557		576,557	0.700 %
kTotal. Add lines 7d and 7j. ..	24	5,892	9,576,305	9,860,337	-284,032	2.400 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	1	8,485	8,485	0.010 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	2	10,192	10,192	0.010 %
7	Community health improvement advocacy
8	Workforce development	1	12,222	12,222	0.010 %
9	Other
10	Total	4	30,899	30,899	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense........

2,350,918

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

25,257,421

Enter Medicare allowable costs of care relating to payments on line 5.....

33,663,350

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-8,405,929

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
0	St Josephs Comm Hospital 3200 Pleasant valley Road West Bend,WI530953868	X	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

St Josephs Comm Hospital

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1	Yes
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3	Yes
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4	Yes
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5	Yes
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7	Yes
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.0000% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.0000% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
	Part VI - Additional Information	Part V, Line 2: The last year a Needs Assessment was conducted at St. Joseph's Community Hospital of West Bend was 2012.
	Part V - Explanation of Number of Facility Type	St. Joseph's Community Hospital of West Bend is the only facility listed under this reporting of the IRS Form 990, Schedule H.
	Part VI - States Where Community Benefit Report Filed	WI
	Part VI - Affilated Health Care System Roles and Promotion	Every year, the Froedtert Health partners engage in a variety of outreach activities in collaboration with key leaders and organizations in their communities that help improve health and quality of life. Much more than the provision of charity care, the American Hospital Association defines community benefit as "promoting and protecting the health and well-being of the entire community through responsive programs and services." In fiscal year 2012, Froedtert, Community Memorial and St. Joseph's Hospitals made significant investments in the health of their communities. Patients who couldn't pay for their medical care received more than $49.2 million in uncompensated services. Beyond providing care for the poor, we contributed $76.7 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities.Froedtert Health members develop community benefit strategies and goals based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the hospitals have built important local relationships that provide meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes, health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert Health, visit www.froedterthealth.org.
	Part VI - Explanation Of How Organization Furthers Its Exempt Purpose	St. Joseph's Community Hospital of West Bend provides healthy community initiatives that support the community. These initiatives include but are not limited to, community education classes, complimentary fitness classes, community volunteering, speakers bureau opportunities and community health fairs.Community Health Education ProgramsSt. Joseph's Hospital regularly schedules educational classes for the community. The services offered are readily accessible to the general public and are free of charge. These programs provide information on a wide variety of health concerns including chronic disease prevention / management. In addition, St. Joseph's Hospital offers a speakers bureau that is a free service to the community. Our knowledgeable health professionals provide credible, up-to-date information on a variety of healthcare topics for groups and organizations. Every 15 MinutesSpeeding, recklessness and drug or alcohol use are common risk factors among children and teens killed in motor vehicle and transport crashes, according to the Wisconsin Child Death Review Council. Changes in behavior can help prevent death and injury from vehicle crashes, one of the top five causes of preventable death in Wisconsin children.To drive home a powerful message about the consequences of drinking and driving and to help prevent death from drunk driving crashes, St. Joseph's Hospital collaborates with the Washington County Injury Prevention Coalition in the "Every 15 Minutes" program. The program involves not only a mock crash but multiple scenarios that are videotaped by high school students and presented at a moving and emotional assembly at school the next day. The hospital has been part of the "Every 15 Minutes" program since 2006, as the receiving hospital for mock crash victims arriving by local EMS ambulance and Flight for Life. The Emergency Care Center provides staffing to treat the mock victims in a realistic way. Physicians, nurses, EMTs, technicians and other staff are involved. Hospital staff are also involved in the planning and communications. In a safe and caring way, the program confronts high school students with the real-life consequences of drunk driving and has been positively received by students and community. United Way Employee CampaignSt. Joseph's Hospital collaborates with the United Way of Washington County to address community needs in the areas of health, education and quality of life. St. Joseph's Hospital hosts an annual workplace giving campaign to support United Way.For more information on specific community outreach efforts, please refer to the 2012 St. Joseph's Hospital Community Benefit Report located at stjosephswb.com.Healthy People Project of Washington CountySt. Joseph's Hospital, through leadership representation on the Healthy People Project of Washington County and the committees dedication, are successfully impacting the health of many in our community. These efforts are being done through collaborative partners, such as Washington County Planning and Parks, Washington County Injury Prevention Coalition, and various local municipalities. The Healthy People Project of Washington County is one of only 118 communities throughout the country (and one of five in Wisconsin) selected as a Pioneering Healthier Communities coalition. Albrecht Free ClinicThe Albrecht Free Clinic provides free medical care to uninsured and underinsured residents of Washington County. Through the support of St. Joseph's Hospital, the clinic is able to serve patients for chronic illness and acute care issues. Services provided by St. Joseph's Hospital at no cost to the patient would be: x-rays, labs, MRI and CT Scans. On an average, over 3,300 patients seek medical services per year. In addition to services related to the patients' direct care, St. Joseph's Hospital provides assistance in providing medical supplies, IT services, and rental space at a cost of $90,772 (4,896 sq ft). Sendik's Healthy Eating ProgramSt. Joseph's Hospital in partnership with Sendik's Food Market, West Bend, offers an educational five-week healthy eating program. The program is designed to help people adopt healthy eating habits in five key areas: fats, carbohydrates, fruits and vegetables, proteins and beverages. The program is offered free-of-charge and presented by a St. Joseph's hospital registered dietitian. In addition to the educational five-week healthy eating program, St. Joseph's hospital is providing monthly health option recipes and tips through our "Let's eat for the health of it!" program. Recipes are critiqued by our registered dietitians. Sexual Assault Nurse Examiner (SANE) Available 24 Hours a DayWhen emergencies take on the even more traumatic element of sexual assault, the specially trained SANE program staff has created a safe haven at St. Joseph's for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patient's experience. They care for victims of all ages, races and populations to provide timely: - Emotional support - Physical examination and wellness check - Collection of medical-forensic evidence - Assistance with reporting the crime to police, when requested (mandatory reporting for children) - Assistance with concerns about sexually transmitted infection and pregnancy - Assistance with safety planning - Development of a medical follow-up plan SANE nurses are available to speak to groups and organizations. They are also able to serve as expert witnesses if called to testify at a trial.Board of DirectorsThe Board of Directors is made up of medical and business professionals, all of whom reside in the hospital's primary service area. They are dedicated to leveraging the benefits of our community through our hospital's mission. They value the unique character and needs of the patients and communities we serve and the physicians who provide specialty care. St. Joseph's Hospital's community board demonstrates our commitment to quality and service.
	Part VI - Community Building Activities	To promote the health of our communities, Froedtert Health St. Joseph's Hospital participates in numerous community building activities that are recognized in the community, which are not part of Part I Charity Care Community Benefits. These activities include:1. Physical Improvements and Housing: contributions toward neighborhood housing improvement for the underserved.2. Coalition Building: collaboration with county service agencies includes work with the Washington County Injury Prevention Coalition on the Every 15 Minutes anti-drunk driving program for teens. Froedtert Health St. Joseph's Hospital's SANE (Sexual Assault Nurse Examiner Program) works closely with volunteers from the area Women's Shelter to care for victims of sexual assault and SANE nurses collaborate with a county coalition to promote awareness, education and prevention of sexual assaults. 3. Economic Development: Leadership participates in local chamber of commerce boards focusing on economic development.4. Diversity: training that recruits health professionals in our traditionally underserved community. 5. Other: Contributions to local organization of equipment, lease space and supplies.
	Part VI - Community Information	St. Joseph's Community Hospital of West Bend has been dedicated to serving residents of West Bend and Washington County since 1930 when it was established through the efforts of visionary community leaders and volunteers. As an important part of the community fabric, the hospital continues to meet the changing health and wellness of people who live in and around Washington County. To better serve those needs in a modern, accessible, safe and efficient setting, the hospital built a new replacement facility on US 45 and Hwy PV in August 2005. St. Joseph's Hospital lives its mission to provide personalized, trusted care to its patients and families through strong, locally available services including 24-hour emergency care and cancer care, robust quality and customer service programs and its ability, as a member of Froedtert Health, to link patients with the resources of an academic medical center. An eight bedroom hospice on the hospital campus, the first of its kind in county, has served more than 600 terminally ill patients and their families since 2006.The hospital focuses on the acute and chronic health and wellness needs of residents of Washington County and areas outside the county, with 47,678 residents in its primary service area and 79,158 residents in its secondary service are a total of 126,836 residents (2010 data). The hospital's attention to the changing needs or our patients has led to additions and changes in services. By 2015, the population is expected to grow from 47,678 to 49,122 in the primary service area. Based on the US Census data, the population served by SJH is 96.91% Caucasian, .59% African American, .50% Asian, and 2.00% other races. 36% of households have a household income less than $50,000. 10% of the population does not have a high school diploma and 38% whose highest education level is a high school diploma. 21% of the population has a Bachelor's Degree or higher education. The most common occupations for the population is 27% manufacturing, 15% sales/office and 10% health care.
	Part VI - Patient Education of Eligibility for Assistance	St. Joseph's Community Hospital of West Bend informs and educates patients regarding financial assistance and government program eligibility in a number of ways. Its communication efforts also address special needs of patients and their families, such as hearing or visual impairment or language interpretation.Information on hospital-based financial support policies and government programs are made available to patients during the pre-registration and registration processes through brochures, signage and direct contact with financial counselors, social workers / case managers and registration staff. Patient billing statements also inform patients that financial assistance is available. The Hospital website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. The Hospital has made financial assistance forms and information available in Spanish. Financial counselors screen uninsured patients for government program eligibility and social services staff are available to assist patients with enrollment processes. Patients who are uninsured, those covered by government programs and those with limited financial means may also be eligible for charity care or discounts through the Hospital's financial assistance program. Financial counselors make every effort to determine a patient's eligibility prior to or at the time of admission or service. However, determination for financial assistance can be made during any stage of the patient's stay after stabilization, or the collection cycle.
	Part VI - Needs Assessment	In December, 2011 Froedtert Health St. Joseph's Hospital West Bend collaborated with JKV Research, LLC along with Aurora Health Care, Children's Hospital of Wisconsin, Columbia St. Mary's Health System and Washington County Health Department to conduct a Community Health Needs Assessment in Washington County. The research from the needs assessment provides valuable behavioral data, lifestyle habits, and the prevalence of risk factors and disease conditions of Washington County residents. The methodology of the study included the following data gathering processes: - Gather data on behavioral and lifestyle habits of the adult population and household-level data. - Gather data on the prevalence of risk factors and disease conditions of the adult population. - Compare health data of residents to previous health studies. - Compare health data to national and state measurements.CHNA Methodology: - 18 minute telephone survey of area residents - 400 completions from November 29 through December 19, 2011 - Two-fold sampling 1) RDD landline sample of listed & unlisted #s (n=300) - Respondents randomly selected based on number of adults in household - Weighting based on number of adults and number of residential phone numbers in HH 2) Cell phone only sample (n=100) - Adult answering the phone designated as the respondent - All data post-stratified by age and gender of adult residents as of 2010 Census proportions. - Margin of error: 5%The full report of the findings can be found at www.stjosephswb.com. In addition to the Washington County Community Health Needs Assessment, St. Joseph's Hospital conducted key informant interviews with 26 individuals representing school district representatives, public health officials, non-profit health and human service professionals, churches, police/fire departments, free clinics and business professionals throughout Washington County. Following extensive interviews with key community stakeholders, findings from the assessment were categorized into eight areas: Access to Primary and Specialty Care, Chronic Disease Management, Mental Health Services, Prevention and Wellness, Alcohol, Drug, Tobacco, Abuse, Dental Services, Transportation and Other. Of those eight health needs categories, four were identified as the focus for community outreach activities in 2012 through 2016 based on select criteria: Community Health Priorities, Disproportionate Unmet Needs, Public Health Concerns and Scope of Services. The most critically documented health needs were identified: - Access to Care - Obesity/Nutrition - Lack of Physical Exercise - Chronic Disease Management - AODA - Dental CareWashington County Health Department Community Health Improvement Plan 2011 - 2015St. Joseph's Hospital is a partner with Washington County Public Health Department's Community Health Improvement Plan. The plan which was adopted by the county board in 2012 focuses on the following community health needs: - Improve Dietary Quality - Increase Breastfeeding - Increase Physical Activity - Obesity - Enhance state and community capacity to improve population level health.St. Joseph's hospital is very active in the Health People Project of Washington County's strategic plan with goals to improve access to fruit and vegetable consumption and increase physical activity as a means to decrease obesity. For more information on this initiative please go to www.getmovingwashingtoncounty.com.
Number of Hospital Faciltiy - 0	Part V, Line 11h - Other Factors Used in Determing Amounts Charged Patients	Out of pocket maximum discount.
Number of Hospital Faciltiy - 0	Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment	Washington County Health Needs Assessment Collaboration:JKV ResearchFroedtert Health St. Joseph's Community Hospital of West BendAurora Health CareColumbia St. Mary's Health SystemChildren's Hospital of WisconsinWashington County Public Health Department
Number of Hospital Faciltiy - 0	Part V, Line 3 - Account Input from Person Who Represent the Community	In fiscal year 2012 and in partnership with the Washington County Community Health Needs Assessment, the following individuals/agencies were consulted to provide feedback on identified community health needs:Albrecht Free Clinic - Jenny Zaskowski, Executive DirectorHartford Jt 1 School District - Joan Schultz, Pupil Service AdministratorHartford Parks and Recreation Department - Mike Herman, DirectorInterfaith Caregivers of Washington County - Debbie Genthe, Executive DirectorUniversity of Wisconsin Extension Washington County - Marma McIntee, Family Living CoordinatorWashington County Mental Health Department - Jim Strachota, DirectorWashington County Public Health Department - Linda Walter, Health OfficerThe Council on AODA - Mary Simon, Executive DirectorVolunteer Center of Washington County - Betsy Wilcox, Executive DirectorEconomic Development of Washington County - Christian Tscheschlok, Executive DirectorSt. Gabriel Church - Sandy Hennes, RNSt. Mary's Catholic Parish Holy Hill - Arlene Barron, RN and Parish NurseWashington County WIC - Carol Birkeland, Executive DirectorKettle Moraine YMCA - Aaron Schmidt, Associate DirectorAging and Disability Resource Center - Linda Olson, ADRC DirectorFriends of Abused Families - Lisa Krenke, Executive DirectorCasa Guadalupe Education Center - Mary Lynn Bennett, Executive DirectorHabitat for Humanity Washington Co. - Russ Wanta, Executive DirectorWest Bend Police Department - Gus Unertl, CaptainWashington County Sheriffs Department - Dale Schmidt, SheriffWest Bend Chamber of Commerce - Craig Farrell, Executive DirectorHartford Area Chamber of Commerce - Barb Laabs, Executive Director
	Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	In alignment with the Froedtert Health financial assistance policy regarding the billing, collection and support for patients with payment obligations, St. Joseph's Community Hospital of West Bend makes every effort to adhere to the policy and is committed to implementing and applying the policy for assisting patients with limited means in a professional, consistent manner. Staff members who work closely with patients (including those working in patient registration and admitting, financial assistance, customer service, billing and collections) are trained regularly about these policies with an emphasis on treating all patients with dignity and respect regardless of their insurance or their ability to pay for services.
	Part III, Line 8 - Explanation Of Shortfall As Community Benefit	St. Joseph's Community Hospital of West Bend believes that all of the $8,405,929 shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries.
	Part III, Line 4 - Bad Debt Expense	St. Joseph's Community Hospital of West Bend reports accounts receivable for services rendered at net realizable amounts from third-party payers, patients, and others. The Hospital provides an allowance for uncollectible accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions and trends. The ratio of patient care cost to charges is applied to the bad debt attributable to patient accounts to calculate the estimated cost of bad debt attributable to patient accounts that is reported on line 2. Discounts and payments on patient accounts are recorded as an adjustment to revenue, not bad debt expense. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit.
	Part I, Line 7, Column F - Explanation of Bad Debt Expense	Our total expense from Form 990, Part IX, line 25, column (A) was $85,918,913. The bad debt expense included in this amount was $3,738,531. This left us with a total expense of $82,180,382 for the purposes of calculating line 7, column (f).
	Part I, Line 7 - Explanation of Costing Methodology	Charity Care and certain other community benefits costs were determined by using internal information to reduce the various activities to cost. We present cost information consistently in the different venues that it appears.

Schedule H (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) Van De Kreeke Jeffrey	(i) (ii)	259,313	58,221	21,739	85,447	17,330	442,050
(2) Smale Jeffery	(i) (ii)	419,938		17,117	14,700	24,094	475,849
(3) Petasnick William D	(i) (ii)	769,113	672,530	5,131,796	15,925	51,840	6,641,204	4,891,208
(4) Malzewski Michael	(i) (ii)	189,901	20,483	1,479	12,985	25,512	250,360
(5) Less Timothy	(i) (ii)	178,504		812	11,088	23,976	214,380
(6) Lauenstein Debra	(i) (ii)	126,956	11,664	1,089	7,045	3,266	150,020
(7) Laird Michael	(i) (ii)	344,432	65,838	4,171	76,787	24,787	516,015
(8) Jacobson Catherine	(i) (ii)	629,796	163,401	4,740	110,234	25,519	933,690
(9) Herdrich Gary MD	(i) (ii)	529,784		18,848	15,925	16,368	580,925
(10) Herdeman Charles	(i) (ii)	125,589		565	9,962	15,674	151,790
(11) Arshad Ijaz	(i) (ii)	624,154	25,000	17,373	13,475	31,299	711,301

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
Sch J, Part III, Additional Information	Part III, Additional Information	Part II, Column (B)(ii): Bonus and incentive compensation amounts include incentive compensation and amounts paid to individuals in lieu of participation in 457(f) deferred compensation plan for the purchase of benefits.
Sch J, Part I, Line 7	Part I, Line 7: Non-Fixed payments not listed above	Certain management employees partcipate in an incentive compensation plan that includes non-fixed elements. Upon the attainment of a certain financial threshold, incentive compensation is available for meeting identified goals in the areas of financial performance, operational efficiencies, quality improvements, customer satisfaction, strategic growth and partnership initiatives. In some cases the determination of whether a goal is met is absolute while others require a certain amount of discretion to determine if goal is met. In addition, the incentive compensation includes a purely discretionary component.
Sch J, Part I, Line 1b	Part I, Line 1b: Reason for not following policy regarding payment provisions for expenses	Expenses reimbursed pursuant to written contract between St. Joseph's Community Hospital of West Bend and the President, which was approved by the Board of Directors. Each year as part of annual review by Compensation Committee, the expense reimbursement is reviewed.
Sch J, Part I, Line 1a	Part I, Line 1a: Relevant information in regards to selections on 1a.	Social club dues reimbursed for organization's President because social club used for business purposes.

Schedule J (Form 990) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Identifier	Return Reference	Explanation
	Part VII - Section A 1a, Column B	Approximate hours per week spent working on related entities:Bast - 2 hoursHerdrich - 61 hoursJacobson - 48 hoursKomas - 1 hourLaird - 1 hourLeitheiser - 1 hourMalzewski - 41 hoursOlson - 2 hoursPetasnick - 53 hoursSmale - 58 hoursVan De Kreeke - 50 hoursZwygart - 1 hour
	Part IV, Line 24a	Even though the liability is on the books of St. Joseph's Community Hospital of West Bend, Inc.,this question was answered no, as Schedule K will be completed on the Form 990 of the parent corporation, Froedtert Health, Inc.
Form 990, Part VI, Line 19	Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	Froedtert Health's quarterly financial information, which includes St. Joseph's Community Hospital of West Bend, Inc., is made available to the public through the Digital Assurance Corporation, Inc. website. St. Joseph's Community Hospital of West Bend, Inc. governing documents and conflict of interest policy is made available to the public through the corporate office upon request.
Form 990, Part VI, Line 12c	Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts	On an annual basis all officers, directors, trustees, and key employees are required to complete a conflict of interest disclosure document. The data is compiled, and the Vice President-Chief Compliance Officer (CCO), the Vice President-General Counsel and/or delegate review all forms and notifications to determine if any conflicts of interest exists in the disclosure documents. If it is determined that a conflict of interest exists, then the person making the disclosure shall be relieved of his/her obligations on behalf of a Froedtert Health affiliate with respect to the transaction or arrangement that creates the conflict of interest. A report of all conflicts of interest will be made by the CCO at least once annually to the Finance Committee of the Board of Directors.
Form 990, Part VI, Line 11	Form 990, Part VI, Line 11: Form 990 Review Process	Froedtert Health accounting staff prepare Form 990 which is reviewed by the Corporation's financial leaders and legal counsel. The 990 is then reviewed by KPMG, the Corporation's outside accounting firm. Next, the 990 is provided to the Corporation's Finance Committee and Board of Directors. Finally, the 990 is filed as required.
Form 990, Part VI, Line 7b	Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	Froedtert Health has the following reserved powers over the activities of St.Joseph's Community Hospital:1. Approve any strategic plans; capital and operating budgets; borrowing or loan of funds; debt incurrence; proposed capital expenditures; all affiliations, partnerships, joint ventures, acquisitions, divestitures, dissolutions, sales, mergers and similar corporate transactions;2. Approve amendments to the Articles of Incorporation and Corporate Bylaws and approve appointment of members of Boards of Directors;3. Negotiate managed care contracts;4. Manage and direct investments and engage in consolidated cash management.
Form 990, Part VI, Line 7a	Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	Froedtert Health, as the member of St. Joseph's Community Hospital of West Bend, Inc. has the final approval of election of all board members.
Form 990, Part VI, Line 6	Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	Froedtert Health is the member of St. Joseph's Community Hospital of West Bend, Inc.
Form 990, Part VI, Line 4	Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents	Amended and Restated Corporate Bylaws - effective 7/1/11- Conformance to format for system entities and reserved powers of system parent.- Gives Ex Officio directors the right to vote.- Creates a category of directors emeriti.- Elimates provisions that had expired.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) West Bend Surgery Center LLC 1710 Vogt Drive West Bend,WI53095 39-1954169	Surgical Services	WI	West Bend Clinic Inc

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Froedtert Physician Partners Inc 9200 W Wisconsin Ave Milwaukee,WI53226 27-2042610	Healthcare Services	WI	501(c)(3)	3	Froedtert Health Inc		No
(2) Froedtert Health Inc 9200 W Wisconsin Ave Milwaukee,WI53226 39-2014409	Management Services	WI	501(c)(3)	Ln 11, type 1	NA		No
(3) Comm Outpatient Health Svcs of MF Inc W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1743056	Outpatient Medical and Dental Services	WI	501(c)(3)	3	Community Memorial Hospital of MF Inc		No
(4) Community Memorial Foundation of MF Inc W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1635057	Health and welfare promotion	WI	501(c)(3)	Ln 11, type 1	Community Memorial Hospital of MF Inc		No
(5) QHS 1 Inc 19601 W Bluemound 2nd Flr Brookfield,WI53045 20-2636686	Health Care Services	WI	501(c)(3)	Ln 11, type 1	Froedtert Health Inc		No
(6) Froedtert Hospital Foundation Inc 9200 W Wisconsin Ave Milwaukee,WI532263596 39-1431192	Health, welfare, research, & education promotion	WI	501(c)(3)	Ln 11, type 1	Froedtert Memorial Lutheran Hospital		No
(7) West Bend Clinic Inc 1700 W Paradise Drive West Bend,WI53095 39-2034294	Health Care Services	WI	501(c)(3)	3	Froedtert Health Inc		No
(8) St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend,WI530953868 39-2034296	Health and welfare promotion	WI	501(c)(3)	Ln 11, type 1	St Josephs Hospital		No
(9) Community Memorial Hospital of MF Inc W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-0987025	Hospital	WI	501(c)(3)	3	Froedtert Health Inc		No
(10) Froedtert Memorial Lutheran Hosp Inc 9200 W Wisconsin Ave Milwaukee,WI53226 39-6105970	Hospital	WI	501(c)(3)	3	Froedtert Health Inc		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) FHHP LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 45-2221564	Healthcare	WI	NA				No			No
(2) Fitness Development Associates LLC 9200 W Wisconsin Ave Milwaukee,WI53226 39-1936497	Real estate	WI	NA				No			No
(3) Milwaukee Ctr for Diagnostic Imag LLC 5775 Wayzata Boulevard Ste 400 St Louis Park,MN55416 41-1748361	Healthcare	WI	NA				No			No
(4) FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Ave Milwaukee,WI53226 26-0629591	Real Estate	WI	NA				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) Progressive Physician Network Inc 9200 W Wisconsin Avenue Milwaukee,WI53226 27-0367127	Management Services	WI	Froedtert Health Inc	C
(2) Community Ventures of MF Inc W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1635059	Inactive	WI	Community Memorial Hosp	C
(3) Kettle Moraine Anesthesiology Inc PO Box 8031 Appleton,WI54912 14-1842439	Health Care	WI	West Bend Clinic	C

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000144
Software Version:	2011v1.5

1	Briefly describe the organization’s mission or most significant activities: St. Joseph's Community Hospital of West Bend, Inc is a health care organization dedicated to improving the health status of residents of West Bend and neighboring communitites. Our mission is to provide personalized and trusted care to our patients and their families.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	6
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	559
6	Total number of volunteers (estimate if necessary) ....	6	173
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	60,411	14,202
9	Program service revenue (Part VIII, line 2g) .........	77,348,367	84,875,970
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,038,756	987,125
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,503,003	3,659,257
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	81,950,537	89,536,554
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	31,548,608	29,341,296
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	46,799,571	56,577,617
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	78,348,179	85,918,913
19	Revenue less expenses. Subtract line 18 from line 12.......	3,602,358	3,617,641
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	121,118,217	126,472,402
21	Total liabilities (Part X, line 26).............	65,050,656	67,008,680
22	Net assets or fund balances. Subtract line 21 from line 20.....	56,067,561	59,463,722

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 35,675,889 including grants of $ ) (Revenue $ 44,693,500 )
	In addition to being a 70-bed hospital, St. Joseph's offers a wide variety of outpatient services to the community, including cancer care services, various diagnostic and therapeutic treatments, outpatient and ambulatory surgeries, and rehab treatments.In 2010, St. Joseph's Hospital's Alyce and Elmore Kraemer Cancer Care Center joined the Froedtert & The Medical College Cancer Network, bringing more cancer expertise to the community. The new St. Joseph's Hospital's 16,000-square-foot Kraemer Cancer Center opened July 9, 2012. Care is conveniently provided close to home, with Medical College specialists working with community physicians to provide advanced, coordinated care, and if needed, access to specialized treatment at Froedtert & The Medical College Clinical Cancer Center in Milwaukee. Cancer network physicians in West Bend include specialists in radiation oncology, urologic oncology, gynecologic oncology and plastic and reconstructive surgery. During the fiscal year, radiation oncology and medical oncology visits totaled 4,301 and 3,298, respectively.Recently, more medical specialties became locally available as the Froedtert & The Medical College Specialty Clinics at St. Joseph's Hospital expanded to include urology, urogynecology, infectious diseases, electrophysiology and cardiology, in addition to the cancer specialties, all of which provide access to leading-edge care to the residents of West Bend and Washington County. In addition to the specialty clinics and cancer care services, St. Joseph's Hospital provided a variety of outpatient treatments and procedures during the fiscal year including:Operations: 2,295CT Scans: 4,129MRIs: 1,822Radiological Diagnostic Exams: 11,073Ultrasounds: 3,181Laboratory Tests: 143,854Nuclear Medicine Scans: 1,685Rehabilitation Treatments: 11,397Ambulatory Surgery Visits: 4,108GI Visits: 679

4b	(Code: ) (Expenses $ 27,894,889 including grants of $ ) (Revenue $ 34,945,737 )
	St. Joseph's Hospital is a health care organization dedicated to improving the health status of residents of West Bend and neighboring communities regardless of ability to pay. The hospital has been serving residents of Washington County for more than 80 years and today offers a wide range of inpatient services. In 2005 St. Joseph's opened a new 70-bed hospital that earned national recognition for a design emphasizing patient safety and quality. The 143-acre hospital campus also includes the Kathy Hospice, Froedtert Health West Bend Clinic-South and the Froedtert & The Medical College of Wisconsin Specialty Clinics.St. Joseph's Hospital is an acute care general hospital with 70 licensed and staffed beds, providing a wide range of inpatient services, including general and orthopedic surgery, general medicine, intensive care services, obstetrics and maternity care, and inpatient hospice care.The New Life Center at St. Joseph's Hospital is Washington County's leading birth center, with 652 deliveries and 1,821 patient days during fiscal year 2012. Convenient and comfortable, the center offers experienced nurses, tastefully appointed labor, delivery, recovery and postpartum rooms, a special care nursery and a dedicated C-section suite. The inpatient hospice care unit, the Kathy Hospice, is a separate 8-bed building located on the campus of St. Joseph's Hospital, and provides a peaceful and comfortable environment for individuals in need of end-of-life care. The home-like hospice was the first of its kind in Washington County, and experienced 143 admissions and 2,652 patient days during the fiscal year.In addition to the newborn and hospice services, St. Joseph's Hospital had 2,849 admissions and 10,760 patient days related to medical, surgical and intensive care inpatient services. In conjunction with inpatient stays, the hospital provided a variety of inpatient ancillary treatments and procedures during the fiscal year including, but not limited, to:Operations: 861CT Scans: 1,582MRIs: 238Radiological Diagnostic Exams: 7,616Ultrasounds: 1,831Laboratory Tests: 123,186Nuclear Medicine Scans: 249Rehabilitation Treatments: 23,259

4c	(Code: ) (Expenses $ 4,180,140 including grants of $ ) (Revenue $ 5,236,733 )
	The Emergency Care Center at St. Joseph's Hospital provides high-quality care for all types of emergencies, 24 hours a day, augmented by its close ties to Froedtert & the Medical College Level I Trauma Center. Staffed by board-certified emergency medicine physicians and emergency certified RNs, the center served more than 16,700 patients in FY 2012. Its designation as a Level III Trauma Center means prompt availability of surgeons and on-call physicians in multiple specialties.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 67,750,918

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Arshad Ijaz MD-Oncology	60.00	X		666,527	0	44,774
(19) Herdeman Charles Pharmacist	40.00	X		126,154	0	25,636
(20) Jeuch Thomas Pharmacist	40.00	X		125,291	0	12,914
(21) Lauenstein Debra Dir-Human Resource	40.00	X		139,709	0	10,311
(22) Less Timothy Medical Physicist	40.00	X		179,316	0	35,064
(23) Malzewski Michael Former - Officer	0.00		X	0	211,863	38,497

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,773,564	8,965,122	659,470

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		14,202
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			14,202
			Business Code
2a	Outpatient Revenue		621,400	44,693,500	44,693,500
b	Inpatient Revenue		621,990	34,945,737	34,945,737
c	Emergency Dept Revenue		621,990	5,236,733	5,236,733
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			84,875,970
3	Investment income (including dividends, interest
	and other similar amounts).....			785,900			785,900
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	1
b	Less: rental expenses
c	Rental income or (loss)	1
d	Net rental income or (loss).......			1	1
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	26,335,536	25
b	Less: cost or other basis and sales expenses	26,081,820	52,516
c	Gain or (loss)	253,716	-52,491
d	Net gain or (loss)..........			201,225			201,225
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	Other Dept Operating Rev		900,099	672,775	672,775
b	Corporate Allocated Rev		900,099	652,661	652,661
c	Clinic Revenue		621,110	1,714,351	1,714,351
d	All other revenue ....			619,469	619,469
e	Total. Add lines 11a–11d ......			3,659,256
12	Total revenue. See Instructions....			89,536,554	88,535,227		987,125


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			20,681	1	2,019
2	Savings and temporary cash investments .......			7,419,268	2	5,237,304
3	Pledges and grants receivable, net .........				3	0
4	Accounts receivable, net .........			9,659,269	4	9,398,418
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6	0
7	Notes and loans receivable, net .............			550,000	7	250,000
8	Inventories for sale or use ..............			1,906,352	8	1,873,009
9	Prepaid expenses and deferred charges ............			1,824,544	9	1,386,522
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	128,917,972
b	Less: accumulated depreciation. .....	10b	51,590,174	66,276,290	10c	77,327,798
11	Investments—publicly traded securities ..........			32,909,261	11	30,780,247
12	Investments—other securities. See Part IV, line 11 ......				12	0
13	Investments—program-related. See Part IV, line 11 ..				13	0
14	Intangible assets .........				14	0
15	Other assets. See Part IV, line 11 ...........			552,552	15	217,085
16	Total assets. Add lines 1 through 15 (must equal line 34)...			121,118,217	16	126,472,402
17	Accounts payable and accrued expenses .			7,053,785	17	6,476,931
18	Grants payable ..........				18
19	Deferred revenue ..........				19	115,000
20	Tax-exempt bond liabilities ..........			56,507,472	20	55,822,923
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			1,489,399	25	4,593,826
26	Total liabilities. Add lines 17 through 25.....			65,050,656	26	67,008,680
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			55,891,204	27	59,315,827
28	Temporarily restricted net assets .....			176,357	28	147,895
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			56,067,561	33	59,463,722
34	Total liabilities and net assets/fund balances .....			121,118,217	34	126,472,402