Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | IN ADDITION TO BEING A 70-BED HOSPITAL, FWBH 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 FWBH 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. FROEDTERT WEST BEND HEALTH CENTER, LOCATED ADJACENT TO FWBH, 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, FWBH PROVIDED A VARIETY OF OUTPATIENT TREATMENTS AND PROCEDURES DURING THE FISCAL YEAR INCLUDING: OPERATIONS: 2,860 CT SCANS: 12,431 MRIS: 4,089 RADIOLOGICAL DIAGNOSTIC EXAMS: 12,399 ULTRASOUNDS: 4,528 INTERVENTIONAL RADIOLOGY PROCEDURES: 1,966 LABORATORY TESTS: 224,281 NUCLEAR MEDICINE SCANS: 2,716 REHABILITATION TREATMENTS: 20,738 AMBULATORY SURGERY VISITS: 3,971 GI VISITS: 266 SLEEP CENTER VISITS: 0 |
| FORM 990, PART III, LINE 4B | FWBH 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 90 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. FWBH 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 FWBH IS WASHINGTON COUNTY'S LEADING BIRTH CENTER, WITH 735 DELIVERIES AND 1,466 NURSERY DAYS DURING FISCAL YEAR 2023. 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 FWBH, 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, FROEDTERT WEST BEND HOSPITAL HAD 3,087 ADMISSIONS AND 19,905 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: 574 CT SCANS: 3,954 MRIS: 575 RADIOLOGICAL DIAGNOSTIC EXAMS: 6,351 ULTRASOUNDS: 961 INTERVENTIONAL RADIOLOGY PROCEDURES: 708 LABORATORY TESTS: 168,446 NUCLEAR MEDICINE SCANS: 167 REHABILITATION TREATMENTS: 36,215 |
| FORM 990, PART VI, SECTION A, LINE 2 | ALLEN ERICSON, SHELLY WAALA, AMY MILLER, MD, ADAM SMITH: BUSINESS RELATIONSHIP WITH MARK BEHL. |
| FORM 990, PART VI, SECTION A, LINE 6 | FH IS THE SOLE CORPORATE MEMBER OF SJH. |
| FORM 990, PART VI, SECTION A, LINE 7A | FH AS THE SOLE CORPORATE MEMBER OF SJH HAS THE FINAL APPROVAL OF ELECTION OF ALL BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | 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, SECTION B, LINE 11B | 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 AUDIT COMMITTEE AND BOARD OF DIRECTORS. FINALLY, THE 990 IS FILED AS REQUIRED. |
| FORM 990, PART VI, SECTION B, LINE 12C | 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 AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | LINE 15A - COMPENSATION OF CEO, EXECUTIVE DIRECTORS, AND TOP MANAGEMENT IS PAID BY FH, 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 RECORDKEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. LINE 15B - COMPENSATION OF SEVERAL OFFICERS IS PAID BY FH, A RELATED ORGANIZATION, BUT A REVIEW IS PERFORMED. IN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S OFFICERS, INDEPEDENT COMPENSATION CONSULTANTS ARE UTILITZED, COMPENSATION STUDIES ARE COMPLETED TO GATHER COMPARATIVE DATA, PERSONS WITH A CONFLICT OF INTEREST REGARDING THE COMPENSATION ARRANGEMENTS AT ISSUE ARE NOT INVOLED IN THE DECISION MAKING PROCESS, AND AMOUNTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMITTEE OF THE FH (THE RELATED ORGANIZATION) BOARD OF DIRECTORS. IN ADDITION, THERE IS CONTEMPRANEOUS DOCUMENTATION AND RECORD KEEPING FOR DELIVERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | 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. |
| FORM 990, PART IX, LINE 11G | LANDSCAPE AND SNOW REMOVAL: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 371,495. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 371,495. PURCHASE SERVICE GENERAL: PROGRAM SERVICE EXPENSES 5,761,253. MANAGEMENT AND GENERAL EXPENSES 190,308. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,951,561. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 1,194,263. MANAGEMENT AND GENERAL EXPENSES 2,679,382. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,873,645. TEMP PERSONNEL: PROGRAM SERVICE EXPENSES 7,028,737. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,028,737. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,728,366. MANAGEMENT AND GENERAL EXPENSES 111,689. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,840,055. OTHER: PROGRAM SERVICE EXPENSES 95,522. MANAGEMENT AND GENERAL EXPENSES 605,725. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 701,247. CONSULTING: PROGRAM SERVICE EXPENSES 7,992. MANAGEMENT AND GENERAL EXPENSES 46,864. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,856. OTHER PROFESSIONAL: PROGRAM SERVICE EXPENSES 971,602. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 971,602. |
| FORM 990, PART XI, LINE 9: | KRAEMER TRUST ANNUAL DISTRIBUTION -9,203. TRANSFER FROM AFFILIATES 25,877,028. |
| Software ID: | |
| Software Version: |