TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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) Braun Noelle...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(2) Gardner Patrick MD...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(3) Marble Jeffrey...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(4) Miller Amy MD...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(5) Neitzke Ted...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(6) Olafsson Eric...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(7) O'Meara Charles...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(8) Pollard Dennis...................................................................... Dir&FH COO	1.00 ................. 46.00	X		0	1,143,035	154,233
(9) Rettler Peter...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(10) Volkert Steven...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(11) Waala Shelly...................................................................... Dir&VP Pt Care	1.00 ................. 50.00	X		0	275,634	55,137
(12) Weston Matt...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(13) Wundrock John...................................................................... Director	1.00 ................. 0.00	X		0	0	0
(14) Ericson Allen...................................................................... Dir&SJH Pres	45.00 ................. 1.00	X	X	722,415	0	142,952
(15) Komas Ronald...................................................................... Dir&BOD Secr	1.00 ................. 0.00	X	X	0	0	0
(16) Tschechlok Christian...................................................................... Dir&BOD Chair	1.00 ................. 0.00	X	X	0	0	0
(17) Ceelen John...................................................................... BOD Treas	1.00 ................. 50.00		X	0	545,785	123,640

- 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.
right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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. See section 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 in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. If the organization did not check a 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—2019. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. 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 VI 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB 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)

Revenue included on 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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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 ....	2,100	1,285,114	1,302,962	1,258,176	1,108,639
b	Contributions ...			64,523	82,773	107,155
c	Net investment earnings, gains, and losses			-9,715	17,823	127,883
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...		1,283,014	915	1,148
f	Administrative expenses ....			71,741	54,663	85,501
g	End of year balance ......	2,100	2,100	1,285,114	1,302,962	1,258,176

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

The percentages on 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)

Yes

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

Yes

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,814,698		4,814,698
b	Buildings ....	62,090,818	17,676,753	44,414,065
c	Leasehold improvements	6,555,855	3,749,178	2,806,677
d	Equipment ....	65,477,048	50,678,925	14,798,123
e	Other .....	414,597		414,597
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				67,248,160

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,984,020
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	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 XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
Part V, Line 4: Intended uses of the endowment fund.	The funds are held by St. Joseph's Community Hospital Foundation, Inc., a related organization, and are restricted for use by the Kathy Hospice.
Part X : FIN48 Footnote	Froedtert Health Inc. (FH), the parent entity into which SJH results are consolidated, 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 recognition, derecognition, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2018 and 2017, SJH does not have an asset or liability recorded for unrecognized tax positions.

Return Reference

Explanation

Part V, Line 4: Intended uses of the endowment fund.

The funds are held by St. Joseph's Community Hospital Foundation, Inc., a related organization, and are restricted for use by the Kathy Hospice.

Part X : FIN48 Footnote

Froedtert Health Inc. (FH), the parent entity into which SJH results are consolidated, 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 recognition, derecognition, and measurement using consistent criteria and provide more information about the uncertainty in income tax assets and liabilities. As of June 30, 2018 and 2017, SJH does not have an asset or liability recorded for unrecognized tax positions.

Schedule D (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Nutman Sales (event type)	(b) Event #2 PRN Footwear (event type)	(c) Other events 2 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	14,734	11,794	17,726	44,254
2	Less: Contributions . . . .			500	500
3	Gross income (line 1 minus line 2) . . . . . .	14,734	11,794	17,226	43,754

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .	11,460			11,460
8	Entertainment . . . .
9	Other direct expenses . . .		9,724	10,059	19,783
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				31,243
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				12,511

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Part I

Financial Assistance 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) as a factor in determining 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 25000.0000000 %

Did the organization use FPG as a factor in determining 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 used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining 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

Financial Assistance and Means-Tested Government Programs		(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) . . .			703,162		703,162	0.490 %
b	Medicaid (from Worksheet 3, column a) . . . . .			12,845,979	6,516,573	6,329,406	4.370 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			13,549,141	6,516,573	7,032,568	4.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	24	10,764	1,163,959		1,163,959	0.800 %
f	Health professions education (from Worksheet 5) . . .	4	193	310,483		310,483	0.210 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	10	1,669	375,974		375,974	0.260 %
j	Total. Other Benefits . .	38	12,626	1,850,416		1,850,416	1.270 %
k	Total. Add lines 7d and 7j .	38	12,626	15,399,557	6,516,573	8,882,984	6.130 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	1		1,573	1,573
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	630	4,376	4,376
7	Community health improvement advocacy	1		10,278	10,278	0.010 %
8	Workforce development	5	565	90,077	90,077	0.060 %
9	Other
10	Total	8	1,195	106,304	106,304	0.070 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,853,217

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

27,411,785

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

46,064,624

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

-18,652,839

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	St Josephs Comm Hospital 3200 Pleasant Valley Road West Bend,WI530953868 froedtert.com/st-josephs 44	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	St Josephs Comm Hospital
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 17

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.froedtert.com/community-engagement

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.froedtert.com/st-josephs/st-josephs-benefit-report

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	St Josephs Comm Hospital
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.0000%
and FPG family income limit for eligibility for discounted care of 400.0000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.froedtert.com/financial-services

The FAP application form was widely available on a website (list url):

www.froedtert.com/financial-services

A plain language summary of the FAP was widely available on a website (list url):
Same as 16a & 16b

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	St Josephs Comm Hospital
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	St Josephs Comm Hospital
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, Line 3j - Description of Other Needs Assessment	SJH partners with the Washington County Health Department on the CHNA process in addition to the County's Community Health Improvement Plan.
Part V, Line 5 - Account Input from Persons Who Represent the Community	The Washington County Key Informant Interview Report is a summary of public health priorities for Washington County, as identified in 2016 by a range of providers, policy-makers, and other local experts and community members (key informants). These findings are a critical supplement to the Washington Ozaukee County Community Health Survey conducted through a partnership between FH (SJH) and Aurora Health Care. The key informant interviews incorporate input from persons representing the broad interests of the community served, and from those who possess special knowledge of or expertise in public health.Key informants in Washington County were identified by FH and Aurora Healthcare and Washington Ozaukee County Health Department. Through this collaboration, Froedtert and Aurora invited the informants to participate, and conducted the interviews from June - August 2016. The interviewers used a standard interview script that included the following elements: Ranking of up to five public health issues, based on the focus areas presented in Wisconsins State Health Plan, that are the most important issues for the County; and For those five public health issues: o Existing strategies to address the issue o Barriers/challenges to addressing the issue o Additional strategies needed o Key groups in the community that hospitals should partner with to improve community healthAll informants were made aware that participation was voluntary and that responses would be shared with the Center for Urban Population Health for analysis and reporting. Based on the information provided to the Center for Urban Population Health, this report presents the results of the 2016 key informant interviews for Washington County.The report first presents a summary of the health issue rankings, including a list of the five issues which were ranked most frequently by respondents. The next section describes the themes that presented themselves across the top ranked health topics. Finally, a summary of the strategies, barriers, and partners described by participants is provided as well.Limitations: Twenty key informant interviews were conducted in Washington County. The report relies on the opinions and experiences of a limited number of experts identified as having the communitys pulse. However, responses may not be representative of the overall perception of community strengths and needs. It is possible that the results would have been substantially different if a different set of informants had been interviewed. Results should be interpreted with caution and in conjunction with other Washington County data (e.g., community health surveys and secondary data reports).Name - Title - Organization Heidi Anderson - Community Outreach Nurse - Aurora Health Care Washington County Noelle Braun - Executive Director - Casa Guadalupe Education Center Janean Brudvig - Executive Director - Interfaith Caregivers of Washington County Kristin Brandner - Executive Director -United Way of Washington County Deacon Jim Chrisien - Director - St. Boniface/St. Gabriel Food Pantry Eric Diamond - Client Services Director - Washington County Human Services Department Craig Farrell - Executive Director - West Bend Area Chamber of Commerce Jay Fisher - Executive Director - Boys and Girls Club of Washington County Kathleen Fisher - Executive Director - Family Promise of Washington County Mike Hermann - Director - City of Hartford Parks & Recreation Peter Hoell - Chief of Police - Germantown Police Department Kirsten Johnson - Director/Health Officer - Washington Ozaukee Public Health Department Rob Johnson - Chief Executive Officer/ Executive Director - Kettle Moraine YMCA Sharon Kailas - Pupil Services Director - West Bend School District Gerald W. Kudek - Fire Chief - City of West Bend Fire & Rescue Marc Lehnerer - Assistant Principal - Germantown High School Kate Nickel - Program Director - Friends of Abused Families Mark Schroeder - Director - Germantown Park & Recreation Mary Simon - Executive Director - Elevate, Inc. Jim Strachota -Executive Director - Albrecht Free Clinic
Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment	Washington County Health Needs Assessment Collaboration:SJHAurora Health Care
Part V, Line 11 - Explanation of Needs Not Addressed and Reasons Why	Areas Not AddressedOral & Dental Health Services: St. Josephs Hospital does not have dedicated resources to provide dental services in Washington County. There are other local organizations/dental offices dedicated to improve access to dental care.Teen Pregnancy: United Way, Washington County Public Health and a number of non-profit agencies are working on this issue.Health Literacy and Navigation: Other community organizations are working to increase awareness of health services and health seeking behaviors among low-income individuals United Way of Washington CountyCigarette Use: St. Josephs Hospital supports the Multi-Jurisdictional Coalitions of Tobacco Free Community Partnership of Washington County.Mental Health: We do not have the dedicated resources; however, St. Josephs Hospital leaders and staff are partnering with local agencies on strategies and tactics to address this issue throughout the county. Washington County Behavioral Health has dedicated staff and facilities address this issue.Every year, St. Josephs Hospital produces an annual community benefit report highlighting community outreach programs, patient impact stories and investments in the communities we serve. The report is mailed to over 100 area non-profits, chambers of commerce, St. Josephs Hospital Board of Directors, St. Josephs Hospital leaders and staff, government officials, business leaders and other community members. A copy of the 2014 report can be found at www.froedtert.com/st-josephs
Part V, Line 13b - Criteria For Providing Discounted Care If Not FPG	In alignment with the FH financial assistance policy SJH reserves the right to review each application for financial assistance on its own merits and to consider other extenuating circumstances in the decision to approve or deny a patient's application for financial assistance. The applicant's gross family income will be determined using Modified Adjusted Gross Income (MAGI). Modified Adjusted Gross Income includes both earned income and passive income received and compared to the annual Federal Poverty guidelines set forth by the U.S. Department of Health and Human Services. A patient who has an annual gross income equal to or less than 400% of the current year's poverty guidelines will not pay more than 15% of their annual gross income on any single account during the approved eligibility timeframe. Patients who meet the requirements and have a gross income equal or less than 250% of the FPL may qualify for a 100% discount. Patients who meet the requirements and have a gross income between 250% and 400% of the FPL may qualify for a discount on a sliding scale. In addition to income, SJH also takes certain assets into consideration. Assets protected from financial evaluation include a household's retirement assets, home equity, and a portion of cash and savings assets.
Part V, Line 13h - Other Factors Used in Determing Amounts Charged Patients	Out of pocket maximum discount.
Part V, Line 20e - Other Actions Took Before Any Collection Actions	We request additional documentation when an individual has submitted an incomplete financial assistance application.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. 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	St Josephs Hospital Kraemer Cancer Center 3200 Pleasant Valley Road West Bend,WI53095	Cancer Center
2	West Bend Surgery Center 1710 Vogt Drive West Bend,WI53095	Ambulatory Surgery Center
3	The Kathy Hospice 3232 Pleasant Valley Road West Bend,WI53095	Inpatient Hospice Facility
4	St Josephs Hospital Sleep Center 1201 Oak Street West Bend,WI53095	Sleep Center
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used)	In alignment with the FH financial assistance policy SJH reserves the right to review each application for financial assistance on its own merits and to consider other extenuating circumstances in the decision to approve or deny a patient's application for financial assistance. The applicant's gross family income will be determined using Modified Adjusted Gross Income (MAGI). Modified Adjusted Gross Income includes both earned income and passive income received and compared to the annual Federal Poverty guidelines set forth by the U.S. Department of Health and Human Services. A patient who has an annual gross income equal to or less than 400% of the current year's poverty guidelines will not pay more than 15% of their annual gross income on any single account during the approved eligibility timeframe. Patients who meet the requirements and have a gross income equal or less than 250% of the FPL may qualify for a 100% discount. Patients who meet the requirements and have a gross income between 250% and 400% of the FPL may qualify for a discount on a sliding scale. In addition to income, SJH also takes certain assets into consideration. Assets protected from financial evaluation include a household's retirement assets, home equity, and a portion of cash and savings assets.
Part I, Line 6a - Related Organization Community Benefit Report	Every year, FH produces an annual report to the community highlighting all of the hospitals and clinics efforts in community outreach programs, patient impact stories and investments in the communities we serve. The report is mailed to over 100 area non-profits, chambers of commerce, SJH Board of Directors, SJH leaders and staff, government officials, business leaders and other community members. A copy of the most recent report can be found at www.froedtert.com/about/annual-reports.
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. The costing methodology follows the instructions from the IRS.As a not-for-profit, emergency medical care and other medically necessary 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 $144,945,166. Bad debt expense is included in Form 990, Part VIII, Statement of Revenue, lines 2a-2c as required by ASU 2011-07, Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities. Therefore, bad debt expense is not included on Part IX, Statement of Functional Expenses, Line 25, column (A).
Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense	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.
Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit	The financial assistance policy allows for accounts in bad debts to be approved for financial assistance if the patient meets the criteria. There are possible financial assistance accounts in bad debt, although the exact percentage is unknown as we do not have the appropriate tools to determine this percentage accurately.
Part III, Line 4 - Bad Debt Expense	Patients accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of patients accounts receivable, FH analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, FH analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third party coverage exists for part of the bill), FH records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. FH recognizes patient service revenue associated with services provided to patients who have third party payor coverage on the basis of contractual rates for the services rendered. For uninsured patients that do not qualify for charity care, FH recognizes revenue on the basis of its standard rates for services provided (or on the basis of discounted rates, if negotiated or provided by policy). On the basis of historical experience, a significant portion of FHs uninsured patients will be unable or unwilling to pay for the services provided. Thus, FH records a significant provision for bad debts related to uninsured patients in the period the services are provided. See also pages 30 of the attached audited financial statements.
Part III, Line 8 - Explanation Of Shortfall As Community Benefit	SJH believes that all of the $18,652,839 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 emergency medical care or other medically necessary care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries.The costing methodology used to determine the Medicare allowable costs is based on a calculation developed by the American Hospital Association in which the data is derived from the annual filed Medicare cost report.
Part III, Line 9b - Provisions On Collection Practices For Qualified Patients	In alignment with the FH Financial Assistance policy and Credit and Collection policy regarding the billing, collection and support for patients with payment obligations, SJH makes every effort to adhere to the policy and is committed to implementing and applying the policies for assisting those patients who may qualify for Financial Assistance in a professional and consistent manner. Staff members who work closely with patients such as Patient Financial Services Customer Service and Financial Counseling staff, as well as those involved in billing and collections are trained 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. Other staff who may have interactions with patients, such as Admitting staff are also aware of the policy, and able to provide patients a copy of an application upon request and also are committed to treating patients with dignity and respect regardless of their insurance or their ability to pay for services.
Part VI, Line 2 - Needs Assessment	In June 2016, SJH collaborated with JKV Research, LLC along with Aurora Health Care, Childrens Hospital of Wisconsin, Columbia St. Marys Health System and Washington Ozaukee 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. CHNA Overview/Objectives: 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 June 28 through August 1, 2016 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 household 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%In addition to the Washington County Community Health Needs Assessment, SJH partnered with Aurora Healthcare and conducted key informant interviews with 20 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 2018 through 2020 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:Community Health Survey Illegal Drug Use Alcohol Use or Abuse Overweight or Obesity Access to Health Care Chronic ConditionsKey Informants Alcohol and Other Drug Use Mental Health Chronic Disease Prevention and Management Nutrition Physical ActivityHospital Implementation StrategyImplementation Plan Development/Selection ProcessSJH created an Implementation Plan Advisory Committee consisting of hospital and health system leadership and staff with specific knowledge of health needs and resources in Washington County for a collective analysis of the findings from the Community Health Needs Assessment. Under the direction of the Community Engagement Leadership Team and trained meeting facilitator; the planning process included five steps in developing the Implementation Plan:1. Reviewed the 2016 Community Health Needs Assessment results for identification and prioritization of community health needs 2. Reviewed previous Implementation Plan programs and results3. Reviewed current hospital and community health improvement initiatives and strategies4. Ranked and selected priority areas5. Select evidence-based strategies, partnerships and programs to address community health needsAfter a facilitated workout sessions in February 2017, findings from the assessment were categorized into ten areas: Access to Care and Resource Navigation, Chronic Disease Management, Mental Health Services, Nutrition, Obesity and Physical Activity, Oral Health, Alcohol, Drug, Tobacco, Abuse and Other identified needs. To identify the top ranked priorities, members of the Advisory Committee were asked to rate each priority based on the following criteria: feasibility of SJH to address the need (direct programs, clinical strengths and dedicated resources), alignment with FHs strategic priorities, current or potential community partners/coalitions and each need has achievable and measurable outcomes. Of those ten health needs categories, three overarching themes were identified as the focus for SJH Implementation Plan for fiscal 2018 2020: Access to Care and Navigation of Community Resources Mental Health/Alcohol and Other Drug Abuse Chronic Disease Prevention and ManagementImplementation Strategy EvaluationSJH Community Engagement leadership and staff will regularly monitor and report on progress towards the Implementation Strategy objectives and provide semi-annual reports to the Hospitals Board of Directors and health systems Community Engagement Steering Committee. Additional progress on the Implementation Plan will be reported annually through the hospitals IRS Form 990 Schedule H filing and other reporting sources associated with strategic partners and community coalitions.
Part VI, Line 3 - Patient Education of Eligibility for Assistance	SJH 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 FH website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. SJH 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 SJH 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, Line 4 - Community Information	SJH, founded in 1930 by local doctors, community leaders and the Sisters of the Divine Savior, is a full-service hospital serving residents of West Bend and Washington County. SJH, specializing in birthing services, cancer care, emergency care, orthopaedics, surgical services and womens health, is part of the FH network.As an important part of the community fabric, the SJH 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. The following data highlights SJHs primary and secondary service area in relationship to income, race and payer mix:Household Income CY17 - Primary Service % and Secondary Service %Under $24,999 - 14.52% and 14.01%$25,000-$49,999 - 20.18% and 20.41%$50,000-$99,999 - 38.50% and 43.32%$100,000 and up - 26.80% and 22.26%Race CY17 - Primary Service % and Secondary Service %White - 95.34% and 95.47%African American - 0.83% and 1.91%Asian/Hawaiian/Pacific Islander - 0.79% and 0.44%Native American - 0.37% and 0.39%Two or more races - 1.49% and 0.89%Other - 1.18% and 0.90%Hispanic - 3.64% and 2.34%Payor Source FY17 - Primary Service % and Secondary Service %Commercial/Managed Care - 36.65% and 42.33%Medicare - 53.21% and 46.97%Medicaid - 8.67% and 8.88%Other Government - 0.31% and 0.45%Other Self Pay - 1.16% and 1.37%Payor Source FYTD18Q3 - Primary Service % and Secondary Service %Commercial/Managed Care - 34.78% and 35.79%Medicaid - 9.08% and 9.52%Medicare - 54.175% and 48.69%Other Government - 0.53% and 0.86%Other/Self Pay - 1.45% and 5.14%There is one additional health care system serving residents in Washington County Aurora Health Care.
Part VI, Line 4 - Community Building Activities	To promote the health of our communities, SJH participates in numerous community building activities, which are not included elsewhere on Schedule H. These activities include:1. 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. SJHs SANE (Sexual Assault Nurse Examiner Program) works closely with volunteers from the area Womens 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. 2. Community Support: Participation in local emergency preparedness and youth focused coalitions to improve the communities ability to respond to an emergency and to improve the community environment for youth to set them up for greater success.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. Workforce Development: Diversity training and minority internship programs that recruit health professionals in our traditionally underserved communities to diversify our workforce population to better serve our communities.
Part VI, Line 5 - Promotion of Community Health	Other Engagement Programs and InitiativesCommunity Engagement proactively addresses the social, cultural and economic determinants that underpin health and seeks to build partnerships with others to find solutions. FH is committed to making a positive, sustained difference in our community. Community Engagement will strengthen the economic vitality and quality of life of those communities we serve. SJH Community Engagement programming and health improvement activities are supported through staff resources, budgeted dollars for programming and community partnerships. Every 15 Minutes (Alcohol and Other Drug Abuse)Speeding, 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, SJH collaborates with the local high schools 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 staffs 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 drug and/or alcohol use while driving and has been positively received by students and community. FY2018 OutcomesSchool: Kewaskum School DistrictDate: Thursday, May 3 & Friday, May 4, 2018Number of Students: 630 Freshmen - SeniorsStaff Participation:72 hoursUnited Way Employee Campaign (Addresses all areas in Implementation Plan)SJH collaborates with the United Way of Washington County to address community needs in the areas of access to health care, creating healthy beginnings and making healthy choices. SJH hosts an annual workplace giving campaign to support United Way and its affiliated organizations. Fiscal Year 2018 Outcomes: 308 hours from staff and leaders to coordinate three week campaign. $7,996 restricted corporate gift to United Way of Washington County Overall dollars raised by staff, leaders and physicians - $494,773Sexual Assault Nurse Examiner (SANE) Available 24 Hours a Day (Access to Care and Navigation)When emergencies take on the even more traumatic element of sexual assault, the specially trained SANE program staff has created a safe haven at SJH for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patients 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. FY2018: SANE nurses screened 21 patients and provided referrals and case management after initial consultation.ACA Insurance Marketplace and Enrollment Assistance (Access to Care and Navigation)FH (parent company of SJH) recognized the need to help individuals navigate the new choices available to them through the Affordable Care Acts Insurance Marketplace and Medicaid reforms. Our overall health network of certified application counselors screened and enrolled over 68,600 in Public Assistance and Marketplace Insurance Plans. In addition, our certified application counselors answered thousands of phone calls and assisted with questions. FH also partnered with the Milwaukee Enrollment Network which represented health systems, free clinics, health departments and other non-profit organizations to reach out to people throughout Milwaukee, Washington and Waukesha Counties in securing adequate and affordable health insurance. FY2018 Enrollment Assistance for SJH 2,964 individuals assisted in enrollment with the following programs: T19, Badger Care, Long Term Care, Disability, Emergency T19, Victim of Crime, Charity Care, Marketplace Insurance PlanLeadership Volunteerism/Community Support (Froedtert in Action) (Community Building)As an indication of SJHs executive teams commitment to the community, hospital leaders volunteer their time to support to local initiatives, not-for-profit organizations and community events that align with the hospitals mission and directly support identified community needs. FY2018: More than 38 leaders provided 748 hours of support to local initiatives through volunteering at not-for-profit organizations and community eventsJob Shadow Program (Health Professions Education)SJH recognizes the value of preparing tomorrows health care today. Each year, SJH nurses, technicians and other health professionals provide Washington County college and high school students job shadowing experiences in clinical care or ancillary care areas of choice. FY2018: SJH staff provided 2,920 hours of preceptorship time to 103 students in nursing roles. SJH staff provided 1,193 hours of preceptorship time to 37 students in professional/technical roles.Project SearchProject SEARCH is a nine-month program for young adults that provides training and education for ages 18 and older. The ultimate end goal that Project SEARCH strives for is employment for young adults with physical or cognitive challenges. The cornerstone of the program is total immersion into the business environment. Those selected to participate in the program will learn employable skills in a classroom setting, hands-on job skills and participate in a variety of meaningful rotations and experiences within our organizations environment. They will have the opportunity to complete three rotations lasting 10 weeks each. Outcomes: 7 Interns completed the inaugural program in FY18 7 Interns were placed in part-time or fulltime employment upon commencement included two gaining employment at SJH. 13 SJH staff provided 253 hours to precept and provide hands on learning to the interns and Easterseals staff.Health Care Career Academy (Health Professionals Education)The Healthcare Career Academy provides qualified students entering their junior or senior year at West Bend High Schools with the opportunity to expand their knowledge base as it relates to a wide array of professional healthcare career options. The two-week program allows students to shadow and learn from professionals in various clinical and ancillary departments throughout the hospital. Through observation, hands-on experience and classroom discussion, students are able to expand their awareness and interest in healthcare careers. FY2018: Five Washington County High Schools Participate 34 students and six teachers participated in the program SJH Staff provided 102 hours of support for the program For more information on SJH Community Benefit programs, please visit http://www.froedtert.com/st-josephs/st-joseph-benefit-report or see attached Report to the Community.
Part VI, Line 6 - Affilated Health Care System	Promotion of Community HealthThe Board of Directors at SJH is made up of medical and business professionals, all of whom reside in the hospitals primary service area. They are dedicated to leveraging the benefits of our community through our hospitals mission. They value the unique character and needs of the patients and communities we serve and the physicians who provide specialty care. SJHs community board demonstrates our commitment to quality and service. Annually, the board reviews and approves the hospitals Community Health Improvement Plan.Additionally, SJH supports the Healthy Community Fund, administered through St. Josephs Foundation, which was created in 2008 to support community programs or projects throughout Washington County that positively affect the health and wellness of those living and working within the area. Addressing Needs Through Targeted Outreach:SJH develops and executes community outreach programming and activities based on identified community health needs. Every needs assessment cycle, SJH Community Engagement staff along with the hospitals community partners and other leaders develops a Community Health Improvement Plan that is incorporated into the hospitals overall strategic plan to address the most critical needs in the communities we serve. The plan is reviewed annually by the SJH Board of Directors. SJH Community Engagement staff, leaders and external community partners work collaboratively to develop key goals and strategies to address community health needs. Progress towards community outreach programs/activities and goals are reported annually to the SJH Board of Directors, Physician Advisory Council, FH Community Engagement Steering Committee, Leadership Meetings, St. Josephs Foundation and Healthy Community Fund Boards. Based on the results from the 2017 Community Health Needs Assessment, programs and activities are focused around the following identified health needs: Access to Care and Navigation of Community Resources AODA/Mental Health (Supported Through Community Based Partnerships) Chronic Disease Prevention and ManagementFor more information on specific community outreach efforts, Implementation Strategy and Community Health Needs Assessments, please go to FHs website at http://www.froedtert.com. Affiliated Health Care System RolesThe FH regional health network is a partnership between FH and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma Center at FMLH, Milwaukee, an internationally recognized training and research center engaged in thousands of clinical trials and studies. The FH network, which includes five hospitals, more than 1,600 physicians and nearly 40 health centers and clinics, draws patients from throughout the Midwest and the nation.SJH has an open medical staff and physicians must go through the credentialing process and apply for privileges. SJH has exclusivity rights for certain departments in the hospital, such as Emergency and Anesthesia services. FMLH, CMH and SJH made significant investments in the health of their communities. Patients who couldnt pay for their medical care received more than $122 million in uncompensated services. Beyond providing care for the poor, we contributed $116.7 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities.FH 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, FH 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 FH, visit www.froedtert.com
Part VI, Line 7 - States Filing of Community Benefit Report	WI
Part V - Explanation of Number of Facility Type	SJH is the only facility listed under this reporting of the IRS Form 990, Schedule H.
Part VI - Additional Information	Part VI - Associations Where Community Benefit Report FiledCommunity Benefit Data is reported annually to the Wisconsin Hospital Association.Part V, Line 11 Continuation of Addressing the Significant Needs Identified:Outcomes Albrecht Free Clinic:In FY18, the Community Health Navigator directly impacted 421 individuals. The impacts range from helping individuals with rent assistance, energy assistance, enrolling in health care and food-share, and job placement. Another area that the Community Health Navigator impacted lives was through providing a listening ear when patients needed someone to talk to. This helped them to relieve stress for those without support, and have someone assist them with talking through their problems.Cancer Care Navigation, Awareness, Prevention and Screening CHNA Area of Focus: Chronic Disease (Prevention and Treatment) targeted at Skin, Prostate and Colorectal CancersCHNA Community Health Need/Rationale: Washington County cancer incidence rate is higher than state average Cancer is leading cause of death in Washington County Difficulty in navigating programs and services in Washington CountyGoal: Decrease the cancer mortality rate in Washington CountyObjective: Implement programs to increase cancer awareness, screening and early detectionFH Resources: Kraemer Cancer Center Nurses and Clinical Psychologist St. Josephs Foundation CP Froedtert & MCW Cancer Care Network Physicians Community Education Direct Financial Support through Froedtert Healths Charitable Gifts and Sponsorship CommitteeFH Collaborative Partners: American Cancer Society Impact 211 Commission on CancerFY 2018 Outcomes/Progress:LIVESTRONG Cancer Survivorship Program in Partnership with Kettle Moraine YMCA Three 12 week classes held in FY 18 50 participated in program As part of the program the YMCA conducts assessments, before and after participation that assess functional fitness and quality of life. Participants experienced an 85% increase in cardiovascular endurance from pre to post assessment in the 6-minute walk test, 90% of participants showed an increase in upper and lower body strength in the 1 rep max assessments and 50% increased their single leg balance assessment also from pre to post assessments. Additional data captured from the PROMIS-29, quality of life assessment, shows high levels of satisfaction, strong connections with other group members with plans to continue to exercise after the program. Healing Yoga, Walking Club and Dance Movement Therapyo Healing Yoga 534 participantso Walking Club: 34 participantso Dance Movement Therapy (5 week program): 24 participantsNavigation Results from, Oncology Social Worker/Navigator 57 patients were screened and referred to community resources/assistance in FY 2018. Areas referred: Government Assistance Programs, BadgerCare/Marketplace Insurance, Transportation Assistance, Support Groups, Community Based Behavioral Health services.Head and Neck Cancer Screening: 21 individuals screened 4 referred on for further follow-up with primary care physician or specialistCancer Community Education Classes: Advanced Care Planning 10 attendees HPV and Vaccination 20 attendees Colorectal Cancer 12 attendeesCancer Prevention Outreach (Health Fairs): Mega Colon 1,500 lives touched Prostate Awareness 215 lives touchedEvidence Based Community Education and Wellness ProgramsCHNA Area of Focus: Chronic Disease Management (Prevention)CHNA Community Health Need/Rationale: 26% of Washington County residents reported having High Blood Pressure 8% of Washington County residents reported having Heart Disease or related condition 13% of population reported having diabetes 17% of population did not take medications for their medical condition due to cost Lack of Spanish speaking health professionals to provide adequate education and preventionGoal: Reduce morbidity and mortality from chronic conditionsObjective: Increase self-management for individuals living with chronic conditions and reinforce healthy lifestyles to encourage behavior changeFH Resources: Community Engagement Staff Certified Living Well Instructors Case Management Inpatient/Outpatient DepartmentsFH Collaborative Partners: Wisconsin Institute for Healthy Aging Washington County Aging and Disability Resource Center Casa Guadalupe Education CenterFY2018 Outcomes/Progress:Community Education Classes conducted 11 health education/outreach classes at SJH serving 98 individuals. Classes included presentations by five Physicians, Five Registered Nurses and One Registered Dietician. The following service lines and topics included: Cardiovascular Disease, Stroke, Emergency Care, Otolaryngology, Physical Medicine/Rehabilitation, Palliative Care, Sports Medicine, Womens Health and Nutrition. Living Well with Chronic Conditions and Diabetes: 29 people participated in the Living Well with Chronic Conditions/Diabetes workshops in FY18. Wisconsin Institute for Healthy Aging follows class participants and found that participants have reduced healthcare expenditures, more appropriate utilization of health care resources and better health outcomes. Well Washington County Think Well Behavioral Health Coalition Washington County Public Health Departments Community Health Improvement PlanCHNA Area of Focus: Mental Health/Alcohol and Other Drug AbuseCHNA Community Health Need/Rationale: 34% of Washington County residents reported binge drinking 16% of Washington County residents reported having a Mental Health Condition 3% of population misuse prescription drugs Issues with navigating and accessing Mental Health/AODA treatment services especially uninsured/underinsured AODA/Mental health represents 12% of SJH ED visitsGoal: Improve the behavioral health of Washington CountyObjective: Increase community awareness of mental health and alcohol and other drug abuse problems and collaborate for better case management and navigation of treatment.FH Resources: Community Engagement leadership/staff Grant support through the Washington County Healthy Community Fund FH Behavioral Health ServicesCommunity Coalition Partners: Washington County Health and Human Services Lead Agency NAMI Elevate Inc. Albrecht Free Clinic United Way of Washington County Aurora Healthcare Affiliated Clinical Services UW-Extension Washington County Washington County Sheriffs Department Washington County Department of Corrections Germantown Police Department West Bend School DistrictTHINK WELL ACTION PLAN 2017-2020Goal Statement #1: To improve the mental health culture in Washington County.Objective #1: By 2020, at least one of Washington County Municipality will have engaged in the Cultivate Mental Health Friendly Communities Movement.Objective #2: By 2020, increase the percentage of funding sources dedicated to mental health initiatives throughout Washington County.Objective #3: By 2020, increase peer support networks for individuals and families living with mental health illness.FY 2018 Think Well (Behavioral Health) Outcomes and Objectives:Mental Health Gap Analysis 50 agencies and over 100 individuals interviewed to discuss gaps and barriers of the mental health system in Washington County. Key Themes and Recommendations to focus on in FY2019 Include:- Increased Mental Health Staffing- Additional Facilities- Addressing Stigma- Transitional Housing- Health Promotion for Staff- Increase Awareness of Resources- Education- Workforce DevelopmentWashington County Youth Risk Behavior Survey Conducted YRBS Survey with six high schools and over 1,600 students in Washington County to better understand key factors and indicators involving teen health and well-being. Results of the survey to be released in September 2018 with the development of an action plan to address key findings.Heroin Task ForceThe Washington County Heroin Task Force was launched in February 2014 in response to the rising problem of prescription pain medication and heroin abuse in Washington County. Labeled a nationwide crisis and epidemic, reports from professionals in the community made it clear that we were far from immune. Confronting prescription drug and heroin abuse was essential to protecting the public health and safety of all our residents, including the youth. The task force was convened to understand and address the local problem in a strategic yet timely manner. SJH, along with other community members including, law enforcement, elected officials, county agencies and community members came together in a collaborative manner to immediately begin to identify and understand common problems and applicable resources. The Task Force identified four specific target areas: prevention, treatment, advocacy and law enforcement/courts. Elevate Community Resource Center: http://elevateyou.org/ http://intranet.froedtert.com/community-resourcesSee Schedule O for continuation of Part V, Line 11, Addressing the Significant Needs Identified

Schedule H (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
St Josephs Community Hospital
of West Bend Inc

Employer identification number
39-0806302

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Albrecht Free Clinic 908 W Washington St West Bend,WI53095	39-1839654	501(c)(3)	74,500	0			Comm Hlth Navigator & Annual Appeal
(2) Casa Guadalupe Education Cntr 479 N Main Street West Bend,WI53090	20-4483105	501(c)(3)	24,500	0			Comm Health Navigator Position

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Grantmaker's Description of How Grants are Used

FH restricts grants for the purposes in which the money is intended. FH requires that grants are restricted for the purposes designated in the agreement, no funds will be used for any political campaign or to support attempts to influence legislation of any government body, the organization be a 501(c)(3) tax-exempt in good standing, any unspent funds be returned to FH, and the receiving organization maintain adequate accounting records of the expenditures of the grant funds.FH provides grant funding to organizations that are aligned with its mission and serving the needs of vulnerable populations in alignment with identified Community Health Needs and Health Improvement Priority Areas. Grant recipients are required to submit an annual report that includes fiscal expenditures of the funds granted, program activities to date, impact and outcomes of funding, and number of people served. This information is managed by the FH Community Engagement leadership and outcomes are reported back to the Hospital's Board of Directors and other internal governing committees.

Schedule I (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- 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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

Yes

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

Yes

Indicate which, if any, of the following the filing organization used 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 on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

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

Were any amounts reported on 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" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on 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 (E) amounts for that individual.

(A) Name and Title		(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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(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)
1Bangalore Nitish Pharmacy Manager	(i) (ii)	161,410 -------------	16,642 -------------	4,233 -------------	9,024 -------------	13,435 -------------	204,744 -------------	-------------
2Caulfield Stephanie Pharmacist	(i) (ii)	141,255 -------------	2,240 -------------	572 -------------	7,344 -------------	18,826 -------------	170,237 -------------	-------------
3Ceelen John BOD Treas	(i) (ii)	------------- 391,618	------------- 134,477	------------- 19,690	------------- 89,990	------------- 33,650	------------- 669,425	-------------
4Ericson Allen Dir&SJH Pres	(i) (ii)	455,211 -------------	155,459 -------------	111,745 -------------	110,364 -------------	32,588 -------------	865,367 -------------	90,773 -------------
5Hawig Scott Former - Officer (CFO)	(i) (ii)	------------- 604,376	------------- 485,654	------------- 144,438	------------- 140,011	------------- 31,320	------------- 1,405,799	------------- 125,298
6Herdeman Charles Pharmacist	(i) (ii)	130,531 -------------	6,080 -------------	3,293 -------------	10,842 -------------	21,444 -------------	172,190 -------------	-------------
7Knoll Thomas Former - Officer (Treas)	(i) (ii)	------------- 169,892	------------- 26,097	------------- 1,451	------------- 10,056	------------- 29,112	------------- 236,608	-------------
8Olson David Former - Officer (Pres)	(i) (ii)	------------- 456,356	------------- 304,700	------------- 105,405	------------- 106,668	------------- 33,333	------------- 1,006,462	------------- 100,503
9Pollard Dennis Dir&FH COO	(i) (ii)	------------- 551,674	------------- 443,348	------------- 148,013	------------- 127,428	------------- 26,805	------------- 1,297,268	------------- 120,405
10Pufahl Dean Dir Facility Svcs	(i) (ii)	127,546 -------------	19,207 -------------	1,089 -------------	7,938 -------------	11,507 -------------	167,287 -------------	-------------
11VanDeKreeke Jeffrey Former - Officer (CFO)	(i) (ii)	------------- 333,669	------------- 88,621	------------- 89,517	------------- 68,980	------------- 14,606	------------- 595,393	------------- 67,190
12Waala Shelly Dir&VP Pt Care	(i) (ii)	------------- 208,117	------------- 38,515	------------- 29,002	------------- 25,132	------------- 30,005	------------- 330,771	-------------
13Zuern Anne Amb Surg Svc Mgr	(i) (ii)	135,330 -------------	13,378 -------------	1,140 -------------	9,627 -------------	1,650 -------------	161,125 -------------	-------------

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference

Explanation

Part I, Line 1a: Relevant information in regards to selections on 1a.

Social club dues:Ericson, Allen - $908

Part III, Additional Information

Part I, Line 7: Bonus compensation is paid based upon attainment of specific goals related to the organization's service, quality, and financial strength. The amount of compensation is calculated using specified percentages of base salary for achievement of particular goal levels. However, the Froedtert Health System Board Committee which administers the bonus compensation program has discretion over whether to pay the bonus in any given year or to amend, change, or terminate the program at any time.

Schedule J (Form 990) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

- 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 990-EZ or to provide any additional information.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

St Josephs Community Hospital
of West Bend Inc

Employer identification number

39-0806302

Return Reference	Explanation
Form 990, Part III, Line 4d: Other Program Services Description	OTHER PROGRAM SERVICES 4: As part of operating an acute care hospital and providing health care services to the community, other revenue is derived in the following areas:Intercompany Revenue - consists of revenue derived from medical and administrative services provided to the Froedtert and Medical College of Wisconsin Community Physicians, Inc. (CP). Services include laboratory services, medical office building space, dietary services, and housekeeping services. All of these services support the delivery of healthcare to the community.Other Department Operating Revenue - is revenue derived from different services through the process of providing patient care and in the normal operation of a medical facility. Included in this category are items such as baby photo income, meaningful use revenue, gift shop operations, medical staff application fees, hospice space, and class revenue.Dietary Services - is derived from cafeteria sales, vending machine sales, guest tray sales and employee meals. Dietary services are necessary to support services to patient families while their loved one is receiving care in the Hospital. The revenue from employee meals is a benefit provided by SJH as an employer and it allows our staff to remain on site for patient care. Miscellaneous Revenue - is revenue derived from different services through the process of providing patient care in the normal operation of a medical facility. Included in this category are items such as recycling revenue, NSF check charges, and taxable dietary sales.Medical Office Building Revenue - payment received from the medical office building tenants for services provided such as maintenance, housekeeping and dietary.Rebates and Discounts - is the result of volume purchases of patient care supplies and the result of using specific vendors or receiving a discount by paying invoices within a specific time period.Corporate Allocated Revenue - revenue passed from FH, a related party.
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et	Shelly Walla, Allen Ericson, John Ceelen, Scott Hawig and Dennis Pollard - Business RelationshipDennis Pollard and Scott Hawig - Business Relationship
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder	FH is the sole corporate member of SJH.
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body	FH as the sole corporate member of SJH has the final approval of election of all board members.
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders	FH, as the sole corporate member of SJH has certain powers and authorities with respect to the operations and management of SJH as set forth in SJH bylaws.
Form 990, Part VI, Line 11b: Form 990 Review Process	FH accounting staff prepare Form 990 which is reviewed by FH's financial leaders. The 990 is then reviewed by KPMG, FH's outside accounting firm. Next, the 990 is provided to the FH Finance Committee and Board of Directors. Finally, the 990 is filed as required.
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 FH Vice President-Chief Compliance Officer (CCO), the Senior 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 SJH 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 FH Finance Committee of the Board of Directors.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management	Compensation of CEO, Executive Directors, and Top Management is paid by FH the parent company and a related organization but a review is performed. In establishing the compensation of the organization's CEO, Executive Directors, and Top Management, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, persons with a conflict of interest regarding the compensation arrangements at issue are not involved in the decision making process, and amounts are reviewed and approved by the Compensation Committee of the FH (the related organization) Board of Directors. In addition, there is contemporaneous documentation and record keeping for deliberations and decisions regarding the compensation arrangements.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees	Compensation of several Officers is paid by a related organization but a review is performed. In establishing the compensation of the organization's Officers, independent compensation consultants are utilized, compensation studies are completed to gather comparative data, persons with a conflict of interest regarding the compensation arrangements at issue are not involved in the decision making process, and amounts are reviewed and approved by the Compensation Committee of the FH (the related organization) Board of Directors. In addition, there is contemporaneous documentation and record keeping for deliberations and decisions regarding the compensation arrangements.
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available	FH's quarterly financial information, (which includes the operating results of SJH), is made available to the public through the Digital Assurance Corporation, Inc. website. Anyone can register to receive ongoing access to and notifications regarding financial statements at the online website. SJH governing documents and conflict of interest policy is made available to the public through the corporate office upon request.
Other Changes In Net Assets Or Fund Balances - Other Decreases	Forgiveness of Receivable to St. Joseph's Community Fdtn = -$129185
Other Changes In Net Assets Or Fund Balances - Other Decreases	Kraemer Trust Annual Distribution = -$7455
Other Changes In Net Assets Or Fund Balances - Other Increases	Net asset transfer from affiliates = $1514545
Other Changes In Net Assets Or Fund Balances - Other Decreases	Transfer to affiliates = -$17813727
Schedule H, Part V, Line 11 - Addressing Significant Needs	Elevate, Inc. Too Good for Drugs (Mental Health/Alcohol and Other Drug Abuse)Elevate focuses on strengthening individuals and communities and to provide educational programming, awareness and prevention programs and assistance and supportive services aimed at reducing the risk for behavioral health issues and other high risk behaviors. The best way to combat this issue is through early awareness and evidence based preventions. Funds will be used to implement Too Good for Drugs, which is recognized as a model program through the Federal Government's Substance Abuse and Mental Health Services Administration (SAMHSA), a research-based, skill-building prevention program in the West Bend School District at all five elementary schools at the fourth grade level. Ensuring youth have access to factual information regarding alcohol and drugs in their school setting remains critical for future safe and healthy decision making.Amount Awarded: $25,600 People Served: 364Family Promise of Washington County Homeless Health Services & Housing (Access to Care/Navigation and Mental Health/Alcohol and Other Drug Abuse)Family Promise's mission is to rebuild lives with compassion by providing resources and services that prevent and end homelessness for individuals and families. In February 2018, Family Promise will be opening a new Singles Shelter tripling the client base served by 85 100 clients annually. The funds requested will be used to identify unaddressed behavioral health and physical health needs of individuals who are homeless, connect them to quality healthcare services, encourage follow-through with recommended treatment, and ensure safe and stable housing while seeking services.Amount awarded: $20,600People Served: 100Other Engagement Programs and InitiativesCommunity Engagement proactively addresses the social, cultural and economic determinants that underpin health and seeks to build partnerships with others to find solutions. FH & the Medical College of Wisconsin are committed to making a positive, sustained difference in our community. Community Engagement will strengthen the economic vitality and quality of life of those communities we serve. SJH Community Engagement programming and health improvement activities are supported through staff resources, budgeted dollars for programming and community partnerships. Every 15 Minutes (Alcohol and Other Drug Abuse)Speeding, 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, SJH collaborates with the local high schools 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 staffs 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 drug and/or alcohol use while driving and has been positively received by students and community. FY2018 OutcomesSchool: Kewaskum School DistrictDate: Thursday, May 3 & Friday, May 4, 2018Number of Students: 630 Freshmen - SeniorsStaff Participation:72 hoursUnited Way Employee Campaign (Addresses all areas in Implementation Plan)SJH collaborates with the United Way of Washington County to address community needs in the areas of access to health care, creating healthy beginnings and making healthy choices. SJH hosts an annual workplace giving campaign to support United Way and its affiliated organizations. Fiscal Year 2018 Outcomes: 308 hours from staff and leaders to coordinate three week campaign. $7,996 restricted corporate gift to United Way of Washington County Overall dollars raised by staff, leaders and physicians - $494,773Sexual Assault Nurse Examiner (SANE) Available 24 Hours a Day (Access to Care and Navigation)When emergencies take on the even more traumatic element of sexual assault, the specially trained SANE program staff has created a safe haven at SJH for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patients 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. FY2018: SANE nurses screened 21 patients and provided referrals and case management after initial consultation.ACA Insurance Marketplace and Enrollment Assistance (Access to Care and Navigation)FH (parent company of SJH) recognized the need to help individuals navigate the new choices available to them through the Affordable Care Acts Insurance Marketplace and Medicaid reforms. Our overall health network of certified application counselors screened and enrolled over 68,600 in Public Assistance and Marketplace Insurance Plans. In addition, our certified application counselors answered thousands of phone calls and assisted with questions. FH also partnered with the Milwaukee Enrollment Network which represented health systems, free clinics, health departments and other non-profit organizations to reach out to people throughout Milwaukee, Washington and Waukesha Counties in securing adequate and affordable health insurance. FY2018 Enrollment Assistance for SJH 2,964 individuals assisted in enrollment with the following programs: T19, Badger Care, Long Term Care, Disability, Emergency T19, Victim of Crime, Charity Care, Marketplace Insurance PlanLeadership Volunteerism/Community Support (Froedtert in Action) (Community Building)As an indication of SJHs executive teams commitment to the community, hospital leaders volunteer their time to support to local initiatives, not-for-profit organizations and community events that align with the hospitals mission and directly support identified community needs. FY2018: More than 38 leaders provided 748 hours of support to local initiatives through volunteering at not-for-profit organizations and community eventsJob Shadow Program (Health Professions Education)SJH recognizes the value of preparing tomorrows health care today. Each year, SJH nurses, technicians and other health professionals provide Washington County college and high school students job shadowing experiences in clinical care or ancillary care areas of choice. FY2018: SJH staff provided 2,920 hours of preceptorship time to 103 students in nursing roles. SJH staff provided 1,193 hours of preceptorship time to 37 students in professional/technical roles.Project SearchProject SEARCH is a nine-month program for young adults that provides training and education for ages 18 and older. The ultimate end goal that Project SEARCH strives for is employment for young adults with physical or cognitive challenges. The cornerstone of the program is total immersion into the business environment. Those selected to participate in the program will learn employable skills in a classroom setting, hands-on job skills and participate in a variety of meaningful rotations and experiences within our organizations environment. They will have the opportunity to complete three rotations lasting 10 weeks each. Outcomes: 7 Interns completed the inaugural program in FY18 7 Interns were placed in part-time or fulltime employment upon commencement included two gaining employment at SJH. 13 SJH staff provided 253 hours to precept and provide hands on learning to the interns and Easterseals staff.Health Care Career Academy (Health Professionals Education)The Healthcare Career Academy provides qualified students entering their junior or senior year at West Bend High Schools with the opportunity to expand their knowledge base as it relates to a wide array of professional healthcare career options. The two-week program allows students to shadow and learn from professionals in various clinical
Schedule H, Part V, Line 11 - Addressing Significant Needs Identified	Fiscal Year 2018 Outcomes:Hidden in Plain Sight Traveling Bedroom (Awareness and Prevention Program of Opioid and Drug Use):Moraine Park Technical College- 483 people toured bedroom- 451 people attended lecture series Washington County Fair Park- 267 people toured bedroom, distributed over 300 heroin awareness toolkits and gave away 80 medication lock boxesWest Bend High School Parent Night- 136 people toured bedroomPeers 4 Peers TrainingSpecial training for Washington County High School Students to become aware of tools and resources to help teens in need of help/assistance with AODA issues. Over 137 youth trained in FY2018.SJH Healthy Community Fund Grant Program Restricted annual grant program dedicated to helping non-profit organizations in Washington County support community programs or projects throughout Washington County, Wisconsin, that will positively affect the health and wellness of those living and working within this area. CHNA Area of Focus: Identified Community Health Needs in Washington County (Mental Health, AODA, Chronic Disease, Nutrition, Obesity, Transportation, Dental, Access to Care and Navigation of Community Resources)CHNA Community Health Need/Rationale: Lack of funding for non-profit organizations serving vulnerable populations in Washington County Sustainable funding for evidence-based programs/services focused on prevention, treatment and care managementGoal: Support non-profit organizations and resources that will promote healthy lifestyle choices as well as provide support for programs and services committed to the promotion of health and wellness in Washington CountyObjective: Increase self-management in high risk populations by addressing social determinants in health Expand health resources to assist, support, and navigate through community based clinical services and insurance coverageActions the hospital intends to take to address: Facilitation and management of Healthy Community Fund operations and committee functions Restricted grant funding to non-profit organizations that address community health needs Monitoring outcomes and impact for organizations receiving HCF funding Promotion and awareness of impact of funding with Washington County residents and partnersFH Resources: Community Engagement leadership/staff St. Josephs FoundationFH Collaborative Partners: Washington County Non-Profit Organizations Washington County Community Members to Serve on HCF Committee2018 Outcomes:In Fiscal Year 2018, SJH awarded $239,950 to nine Washington County Non-profits that are positively impacting 1,509 lives throughout the county. Below is a summary of awards and area of focus:Albrecht Free Clinic Healthy Smiles Change Lives (Access to Care/Navigation) The Albrecht Free Clinic provides medical, behavioral and dental services for eligible individuals who are underinsured, uninsured or otherwise unable to afford and access medical care. Healthy oral hygiene and dental care has been identified by the Albrecht Free Clinic as a major emerging community health need of local communities. Funds will support three types of dental care: emergency care, basic restorative and oral hygiene and education. This support will allow the clinic to address dental health for the uninsured and underinsured in Washington County. Amount awarded: $70,000 Dental Appointments: 1,096Big Brothers Big Sisters of Washington County Mentoring for Mental HealthBig Brothers Big Sisters of Washington Countys mission is to "provide children facing adversity with strong and enduring, professionally supported, one-to-one relationships that change their lives for the better, forever." Mentoring for Mental Health program will serve children 6 18 years of age in families facing adversity and pair them with mentors that will provide awareness and education. The long term goal of the program is for the children to manage their illness or issue in a healthy way, avoid seeing drugs/alcohol as a solution and develop strong self-confidence and higher aspirations.Amount awarded: $8,000 People served: 98Boys & Girls Club of Washington County Healthy Choices Initiative (Chronic Disease and Prevention)The Boys & Girls Club serves youth ages 6-17 years in Washington County and promotes character building experiences for children through social, educational and recreational experiences. With the change in the economy and the increasing risk that youth are facing with childhood obesity, the goal of this project is to improve the health and wellness of youth through proper nutrition, education and a positive influence regarding diet and exercise. Funds awarded will specifically provide 20,000 summer program meals at the West Bend, Jackson, Kewaskum and Hartford locations. This program is important to the at-risk youth throughout Washington County and will help to improve their health and provide education regarding proper nutrition.Amount awarded: $25,000 Children impacted: 800Friends Inc. Opening Doors Program (Access to Care and Navigation and Mental Health/Alcohol and Other Drug Abuse)Friends of Abused Families has provided over 39 years of service to Washington County and empowers and provides safety to those affected by domestic and sexual violence through support services and prevention education. The Opening Doors Program supports six critical program areas including: 1. Mental health assessments and treatment2. Substance abuse assessments and treatment3. Security deposits, rent assistance, and utility payment assistance4. Child care costs5. Maintenance and upkeep of the emergency shelter and 24 hour crisis intervention facilitySafe housing and access to 24-hour crisis intervention support are pivotal elements in helping an individual escape a violent relationship and gain access to mainstream resources to prevent further victimization for themselves and any children. Friends of Abused Families is the sole provider of housing and support services for individuals experiencing violence in their homes or relationships in Washington County.Amount awarded: $15,000 People Served: 97Kettle Moraine YMCA Wellness Programs (Chronic Disease Prevention and Management)The Kettle Moraine YMCA is committed to expanding their reach and impact in local communities throughout Washington County by making healthy living initiatives available at an affordable cost since cost is often a barrier for those dealing with health issues. Funds will be used to directly impact their Diabetes Prevention Program through classes, screenings and community programs. This year-long program engages adults who are overweight or pre-diabetic in a group lifestyle intervention to help avoid effects diabetes can have. Funds will support their LIVESTRONG at the YMCA program through classes, pre and post assessments and in supporting survivors. This is a 12-week program for adults with a current or past cancer diagnosis.Amount awarded: $31,500 People Served: 50Interfaith Caregivers of Washington County Senior Transportation Program (Access to Care/Navigation)Interfaith Caregivers helps Washington County residents over the age of 60 with assistance to live safely in their own home. Support is provided to enable seniors to live and thrive in their homes and community by providing transportation to medical appointments, pharmacies, grocery stores/food pantries and exercise and wellness programs. When transportation barriers for seniors are removed, a senior's access to healthcare and other vital services such as nutrition and wellness improve. Transportation expenses include volunteer recruitment and background checks, auto supplies, fuel, insurance, licensing, repairs/maintenance and software to track assisted rides. As the population of Washington County ages, providing support for these services is important so they do not increase to a point where the health of seniors is in jeopardy.Amount Awarded: $22,000 Rides Provided: 8,947Casa Guadalupe Education Center Healthy Latinos, Healthy Futures (Access to Care/Chronic Disease Management)Casa Guadalupe is currently the only bilingual and bi-cultural community based non-profit organization serving Spanish speaking residents in Washington County. Latinos living in Washington County are the most likely group to not have a regular source of health care, resulting in low health literacy which affects the overall health of the community. Funds will support health seminars and programs, outreach initiatives and transportation needs to promote education about health screenings, diabetes prevention, active lifestyles and nutrition for adults and families. Amount awarded: $22,250 People Served: 500

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005038
Software Version:	2017v2.2

1	Briefly describe the organization’s mission or most significant activities: St. Joseph's Community Hospital of West Bend, Inc. (SJH) is a health care organization serving residents of West Bend and Washington County. Our mission is to advance the health of communities we serve through exceptional care enhanced by innovation and discovery.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	600
6	Total number of volunteers (estimate if necessary) .............	6	147
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 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	500	1,500
9	Program service revenue (Part VIII, line 2g) .........	141,993,282	147,909,704
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	75,175	-155,504
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,956,581	4,139,714
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	146,025,538	151,895,414
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	49,000	99,000
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)	39,536,093	41,499,494
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–24e)....	95,207,878	103,346,672
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	134,792,971	144,945,166
19	Revenue less expenses. Subtract line 18 from line 12.......	11,232,567	6,950,248
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	101,667,818	91,858,355
21	Total liabilities (Part X, line 26).............	10,012,138	9,667,085
22	Net assets or fund balances. Subtract line 21 from line 20.....	91,655,680	82,191,270

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 67,769,095 including grants of $ ) (Revenue $ 82,544,179 )
	In addition to being a 70-bed hospital, SJH 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.The SJH 16,000-square-foot Kraemer Cancer Center is conveniently provided close to home, with Medical College of Wisconsin specialists working with community physicians to provide advanced, coordinated care, and if needed, access to specialized treatment at FMLH in Milwaukee. Cancer network physicians in West Bend include specialists in radiation oncology, urologic oncology, gynecologic oncology and plastic and reconstructive surgery. Additionally the Kraemer Cancer Center stays on the forefront of the search for new medications and treatments, offering patients the opportunity to participate in clinical trials for new drugs, therapies, technologies and surgical procedures. Because the cancer center is part of the Cancer Network, eligible patients also have access to select clinical trials conducted through FMLH. During the fiscal year, radiation oncology and medical oncology visits totaled 6,918 and 11,650, respectively.St. Joseph's Health Center, located adjacent to SJH, offers expertise in gynecological cancer, urological cancer, urology, plastic surgery, cardiology, obstetrics and gynecology, pediatrics, allergy and immunology, and electrophysiology. Physicians at the Health Center work closely with the Hospital, performing surgical procedures, utilizing lab, radiology and other ancillary services of the Hospital all of which provide leading-edge care to the residents of West Bend and Washington County. In addition to the specialty clinics and cancer care services, SJH provided a variety of outpatient treatments and procedures during the fiscal year including:Operations: 2,199CT Scans: 8,648MRIs: 3,434Radiological Diagnostic Exams: 10,316Ultrasounds: 3,845Interventional Radiology Procedures: 1,459Laboratory Tests: 160,830Nuclear Medicine Scans: 2,090Rehabilitation Treatments: 13,393Ambulatory Surgery Visits: 3,833GI Visits: 701Sleep Center Visits: 789The West Bend Surgery Center, LLC. (WBSC) is an ambulatory surgery center committed to providing high quality surgical care and excellence in patient care to all ages. Outfitted with state of the art equipment and advanced technology, the surgical center performs outpatient procedures and surgeries by an experienced team of physicians and nurses. In FY2018, surgery center visits totaled 3,847 in the areas of pain management, ear nose and throat, general surgery, gynecology, opthalmology, plastics and orthopaedics.

4b	(Code: ) (Expenses $ 41,035,014 including grants of $ ) (Revenue $ 49,981,508 )
	SJH 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 85 years and today offers a wide range of inpatient services. The 143-acre hospital campus also includes the Kathy Hospice, the Kraemer Cancer Center and The St. Joseph's Health Center.SJH 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 residential hospice care.The New Life Center at SJH is Washington County's leading birth center, with 660 deliveries and 1,666 nursery days during fiscal year 2018. The Hospital offers a state of the art facility combined with a high level of professional, compassionate care. The staff includes perinatologists and neonatologists available to provide expert, individualized care for women experiencing high-risk pregnancy. 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 SJH, and operated by Horizon Home Care and Hospice, which 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.In addition to the newborn and hospice services, St. Joseph's Hospital had 3,201 admissions and 12,525 patient days related to medical, surgical, modified 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: 711CT Scans: 2,361MRIs: 347Radiological Diagnostic Exams: 7,000Ultrasounds: 886Interventional Radiology Procedures: 952Laboratory Tests: 171,133Nuclear Medicine Scans: 131Rehabilitation Treatments: 31,931

4c	(Code: ) (Expenses $ 12,630,339 including grants of $ ) (Revenue $ 15,384,017 )
	The Emergency Care Center at St. Joseph's Community Hospital of West Bend, Inc. (SJH) provides compassion, responsiveness, expertise, a convenient location along with advanced technology in administering high-quality care for all types of emergencies, 24 hours a day, augmented by its seamless coordination with Froedtert Memorial Lutheran Hospital, Inc. (FMLH) adult Level I Trauma Center. Staffed by board-certified emergency medicine physicians and emergency certified RNs, the center served more than 17,600 patients in FY 2018. Its designation as a Level III Trauma Center means prompt availability of surgeons and on-call physicians in multiple specialties, making it the premier emergency care provider in the Washington County area for infants, children and adults.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 3,386,443 including grants of $ ) (Revenue $ 4,124,760 )
4e	Total program service expenses124,820,891

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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) Bangalore Nitish........................................................................ Pharmacy Manager	40.00 .......................0.00	X		182,285	0	22,459
(19) Caulfield Stephanie........................................................................ Pharmacist	40.00 .......................0.00	X		144,067	0	26,170
(20) Herdeman Charles........................................................................ Pharmacist	40.00 .......................0.00	X		139,904	0	32,286
(21) Pufahl Dean........................................................................ Dir Facility Svcs	40.00 .......................0.00	X		147,842	0	19,445
(22) Zuern Anne........................................................................ Amb Surg Svc Mgr	40.00 .......................0.00	X		149,848	0	11,277
(23) Hawig Scott........................................................................ Former - Officer (CFO)	0.00 .......................48.00		X	0	1,234,468	171,331
(24) Knoll Thomas........................................................................ Former - Officer (Treas)	0.00 .......................42.00		X	0	197,440	39,168
(25) Olson David........................................................................ Former - Officer (Pres)	0.00 .......................50.00		X	0	866,461	140,001
(26) VanDeKreeke Jeffrey........................................................................ Former - Officer (CFO)	0.00 .......................46.00		X	0	511,807	83,586

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,486,361	4,774,630	1,021,685

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	1,500
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		1,500

		Business Code
2a	Emergency Dept Revenue	621990	15,384,017	15,384,017
b	Inpatient Revenue	621990	49,981,508	49,981,508
c	Outpatient Revenue	621400	82,544,179	82,544,179
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		147,909,704

3 Investment income (including dividends, interest, and othersimilar amounts) ......			26,278			26,278
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	3,795		7a
b	Less: cost or other basis and sales expenses	185,577		7b
c	Gain or (loss)	-181,782		7c
d	Net gain or (loss).........			-181,782			-181,782
8a	Gross income from fundraising events (not including $ 1,500of contributions reported on line 1c). See Part IV, line 18 ....
			8a	50,900
b	Less: direct expenses ...		8b	35,946
c	Net income or (loss) from fundraising events..			14,954			14,954
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	Corporate Allocated Rev		900099	1,430,568	1,430,568
b	Intercompany Revenue		621110	1,757,946	1,757,946
c	Other Dept Operating Rev		900099	491,100	491,100
d	All other revenue ....			445,146	445,146
e	Total. Add lines 11a–11d ......			4,124,760
12	Total revenue. See instructions.....			151,895,414	152,034,464		-140,550

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	99,000	99,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 ...........	995,458		995,458
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........	37,793,027	36,423,290	1,369,737
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	299	299
10	Payroll taxes ...........	2,710,710	2,598,473	112,237
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	18,689		18,689
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	12,099,266	9,944,479	2,154,787
12	Advertising and promotion ....	226	201	25
13	Office expenses .......	489,269	299,814	189,455
14	Information technology ......	103,281	74,767	28,514
15	Royalties ..	0
16	Occupancy ...........	2,902,568	2,095,654	806,914
17	Travel ............	35,443	23,439	12,004
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	105,648	87,371	18,277
20	Interest ...........	2,553,429	1,843,576	709,853
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	6,573,541	5,721,936	851,605
23	Insurance ...	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	31,865,746	31,819,510	46,236
b	Affiliate Support-Comm Phys	24,218,417	19,917,226	4,301,191
c	Corporate Allocated Expense	18,545,403	10,431,659	8,113,744
d	State Assessment	3,151,233	3,151,233
e	All other expenses	684,513	288,964	395,549
25	Total functional expenses. Add lines 1 through 24e	144,945,166	124,820,891	20,124,275	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).

1	Cash–non-interest-bearing ........			3,170	1	3,120
2	Savings and temporary cash investments .........			12,483,328	2	5,329,653
3	Pledges and grants receivable, net ......				3	0
4	Accounts receivable, net .............			14,735,266	4	16,375,262
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6	0
7	Notes and loans receivable, net ...........				7	0
8	Inventories for sale or use ............			2,543,263	8	2,337,917
9	Prepaid expenses and deferred charges ......			164,198	9	259,854
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	139,353,016
b	Less: accumulated depreciation	10b	72,104,856	71,041,794	10c	67,248,160
11	Investments—publicly traded securities .			118,112	11	131,821
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 ...........			578,687	15	172,568
16	Total assets. Add lines 1 through 15 (must equal line 33)...			101,667,818	16	91,858,355

17	Accounts payable and accrued expenses .....	7,107,408	17	6,683,065
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	2,904,730	25	2,984,020
26	Total liabilities. Add lines 17 through 25..	10,012,138	26	9,667,085

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	91,655,680	32	82,191,270
33	Total liabilities and net assets/fund balances ........	101,667,818	33	91,858,355

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) West Bend Surgery Center LLC 1710 Vogt Drive West Bend,WI53095 39-1954169	Surgical Services	WI	17,578,597	7,654,067	St Josephs Community Hospital of WB

(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 entity?
(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 Memorial Lutheran Hosp Inc 9200 W Wisconsin Ave Milwaukee,WI53226 39-6105970	Hospital	WI	501(c)(3)	3	Froedtert Health Inc		No
(2)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
(3)St Josephs Community Foundation Inc 3200 Pleasant Valley Road West Bend,WI530953868 39-2034296	Health and welfare promotion	WI	501(c)(3)	7	St Josephs Hospital	Yes
(4)Froedtert Health Inc 9200 W Wisconsin Ave Milwaukee,WI53226 39-2014409	Management Services	WI	501(c)(3)	Ln 12, type 111 - FI	NA		No
(5)Froedtert Hospital Foundation Inc 9200 West Wisconsin Avenue Milwaukee,WI532263596 39-1431192	Health, welfare, research & educ promo	WI	501(c)(3)	10	Froedtert Memorial Lutheran Hospital Inc		No
(6)Community Memorial Foundation of MF Inc W180 N8085 Town Hall Road Menomonee Falls,WI53051 39-1635057	Health and welfare promotion	WI	501(c)(3)	10	Community Memorial Hospital of MF Inc		No
(7)Community Outpatient Health Services 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		No
(8)QHS 1 Inc 9200 W Wisconsin Avenue Milwaukee,WI53226 20-2636686	Healthcare services	WI	501(c)(3)	Ln 11, Type 1	Froedtert Health Inc		No

(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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Wisconsin Diagnostic Laboratories LLC 9200 W Wisconsin Ave Milwaukee,WI53226 39-1896819	Laboratory Services	WI	N/A				No			No
(2) D1 Sports Training of Milwaukee LLC 9200 W Wisconsin Ave Milwaukee,WI53226 47-3322294	Sports Therapy	WI	N/A				No			No
(3) FHHP LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 45-2221564	Health Care Services	WI	N/A				No			No
(4) FMLH MCW Real Estate Ventures LLC 9200 W Wisconsin Ave Milwaukee,WI53226 26-0629591	Real Estate	WI	N/A				No			No
(5) Waukesha Surgery Center LLC 2400 Golf Road Pewaukee,WI53072 81-1166201	Surgical Services	WI	N/A				No			No
(6) Drexel Town Square Surgery Center LLC 7901 S 6th Street Second Floor Oak Creek,WI53226 81-4904300	Surgical Services	WI	N/A				No			No
(7) Froedtert Surgery Center LLC 9200 W Wisconsin Ave Milwaukee,WI53226 20-1499345	Surgical Services	WI	N/A				No			No
(8) Menomonee Falls Ambulatory Surg Ctr LLP W180 N8045 Town Hall Road Menomonee Falls,WI53051 39-1745697	Surgical Services	WI	N/A				No			No
(9) THP-Froedtert Health Venture LLC 1415 Louisiana Street FL 27th Houstan,TX77002 82-3559342	Healthcare Services	TX	N/A				No			No
(10) F&MCW Network LLC 9200 W Wisconsin Avenue Milwaukee,WI53226 81-4382585	Healthcare Services	WI	N/A				No			No

(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 V-UBI 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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No