Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
A For the 2023 calendar year, or tax year beginning 07-01-2023 , and ending 06-30-2024
BCheck if applicable:
CName of organization
St Joseph's Community Hospital of West Bend Inc
 
 
Doing business as
FROEDTERT WEST BEND HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
3200 PLEASANT VALLEY ROAD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WEST BEND, WI53095
D Employer identification number

39-0806302
E Telephone number

G Gross receipts $ 149,257,306
F Name and address of principal officer:
ALLEN ERICSON
3200 PLEASANT VALLEY ROAD
WEST BEND,WI53095
I
Tax-exempt status: (   ) (insert no.) or
J
Website:
WWW.FROEDTERT.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number  
K Form of organization:  
L Year of formation: 1930
M State of legal domicile: WI
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 12
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 9
5 Total number of individuals employed in calendar year 2023 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 95
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 8,825 11,498
9 Program service revenue (Part VIII, line 2g) ......... 123,918,269 139,174,927
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -13,627 9,157
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 9,821,053 10,044,397
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 133,734,520 149,239,979
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 48,318,674 51,155,363
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) 0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 101,025,763 105,037,563
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 149,344,437 156,192,926
19 Revenue less expenses. Subtract line 18 from line 12....... -15,609,917 -6,952,947
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 87,047,860 87,361,250
21 Total liabilities (Part X, line 26)............. 7,875,916 7,425,085
22 Net assets or fund balances. Subtract line 21 from line 20..... 79,171,944 79,936,165
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
Signature of officer Date
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name

Firm's EIN
Firm's address



Phone no.
May the IRS discuss this return with the preparer shown above? See Instructions. ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2023)
Form 990 (2023)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. DBA FROEDTERT WEST BEND HOSPITAL (FWBH) IS A HEALTH CARE ORGANIZATION SERVING RESIDENTS OF WEST BEND AND WASHINGTON COUNTY. OUR MISSION IS TO ADVANCE THE HEALTH OF THE PEOPLE OF DIVERSE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL CARE ENHANCED BY INNOVATION AND DISCOVERY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 60,234,112 including grants of $ 0 ) (Revenue $ 67,783,994 )
SEE SCHEDULE O - OUTPATIENT SERVICES
4b (Code:   ) (Expenses $ 44,695,620 including grants of $ 0 ) (Revenue $ 50,297,872 )
SEE SCHEDULE O - INPATIENT SERVICES
4c (Code:   ) (Expenses $ 18,743,685 including grants of $ 0 ) (Revenue $ 21,093,061 )
THE EMERGENCY CARE CENTER AT ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. DBA FROEDTERT WEST BEND HOSPITAL (FWBH) 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 21,000 PATIENTS IN FY 2024. 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.
(Code:   ) (Expenses $ 8,930,571 including grants of $ 0 ) (Revenue $ 10,049,949 )
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 REVENEUE 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 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, GIFT SHOP AND SMALL STONES OPERATIONS, MEDICALL STAFF APPRECIATION 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 FWBH 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. 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 BASED FROM FTCH, A RELATED PARTY.
4d Other program services (Describe in Schedule O.)
(Expenses $ 8,930,571 including grants of $   ) (Revenue $ 10,049,949 )
4e Total program service expenses132,603,988
Form 990 (2023)
Form 990 (2023)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. ...
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II.........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D,
Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment
List of Attached Documents:
// Content
......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D,
Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII
......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
List of Attached Documents:
// Content
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
List of Attached Documents:
// Content
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
List of Attached Documents:
// Content
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
Form 990 (2023)
Form 990 (2023)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
Form 990 (2023)
Form 990 (2023)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, or any disqualified or other person engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2023)
Form 990 (2023)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
12
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
9
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
WI
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
DAVID DIRKSMEYERN74 W12501 LEATHERWOOD CT   MENOMONEE FALLS,WI53051 (414) 805-3000
Form 990 (2023)
Form 990 (2023)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Allen Ericson......................................................................
Director & SJH President
41.0
.................
9.0
X   X       0 875,006 174,074
(2) Noelle Braun......................................................................
Director & BOD V.Chair
1.0
.................
0
X   X       0 0 0
(3) Peter Rettler......................................................................
Director & BOD Chair
1.0
.................
1.0
X   X       0 0 0
(4) Steven Volkert......................................................................
Director & BOD Secretary
1.0
.................
0
X   X       0 0 0
(5) Carey Cameron MD......................................................................
Director (Start Nov23)
1.0
.................
0
X           0 0 0
(6) Eric Conley......................................................................
Director & FMLH President (Start Jul23; Term Apr24)
1.0
.................
49.0
X           0 1,403,238 212,976
(7) Mark Bosbous MD......................................................................
Director
1.0
.................
0
X           0 0 0
(8) Matt Weston......................................................................
Director
1.0
.................
0
X           0 0 0
(9) Michael DeGere DPM......................................................................
Director & Chief Medical Officer (Start Jul23)
1.0
.................
49.0
X           0 472,454 94,185
(10) Michael Faley......................................................................
Director (Start Jul23; Term May24)
1.0
.................
0
X           0 0 0
(11) Michelle Arneson DO......................................................................
Director (Start Jul23)
1.0
.................
0
X           0 0 0
(12) Patrick Patton......................................................................
Director (Start Jul23)
1.0
.................
0
X           0 0 0
(13) Shelly Waala......................................................................
Director & VP Patient Care Svc
1.0
.................
49.0
X           0 380,354 72,808
(14) Susan Bartow......................................................................
Director (Start Jul23)
1.0
.................
0
X           0 0 0
(15) Adam Smith......................................................................
Treasurer
1.0
.................
49.0
    X       0 416,956 71,989
(16) Jeffrey Van De Kreeke......................................................................
Former - Officer (Treas)
0.0
.................
50.0
          X 0 196,046 12,200


Form 990 (2023)
Form 990 (2023)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total..............
c Total from continuation sheets to Part VII, Section A..
d Total (add lines 1b and 1c)......... 0 3,744,054 638,232
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual
...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(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 $100,000 of compensation from the organization 0
Form 990 (2023)
Form 990 (2023)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a 0
b Membership dues..1b 0
c Fundraising events..1c 11,498
d Related organizations1d 0
e Government grants (contributions)1e 0
f All other contributions, gifts, grants, and similar amounts not included above1f 0
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f....... 11,498
 Program Service RevenueAmt Business Code
2a Outpatient Revenue 621400 67,783,994 67,783,994    
b Inpatient Revenue 621990 50,297,872 50,297,872    
c Emergency Dept Revenue 621990 21,093,061 21,093,061    
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f ..... 139,174,927
 OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ...... 11,978     11,978
4 Income from investment of tax-exempt bond proceeds        
5 Royalties...........        
(i) Real (ii) Personal
6a Gross rents 6a 0  
b Less: rental expenses 6b    
c Rental income or (loss) 6c 0 0
d Net rental income or (loss)....... 0     0
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 7a    
b Less: cost or other basis and sales expenses 7b   2,821
c Gain or (loss) 7c 0 -2,821
d Net gain or (loss)......... -2,821     -2,821
8a Gross income from fundraising events (not including $ 11,498of contributions reported on line 1c). See Part IV, line 18 ....
8a 8,954
b Less: direct expenses ... 8b 14,506
c Net income or (loss) from fundraising events.. -5,552   -5,552
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..        
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..        
 OtherRevenueMiscAmt
Business Code
11a Intercompany Revenue 621110 5,459,132 5,459,132    
b Other Department Operating Revenue 900099 2,367,151 2,367,151    
c Corporate Allocated Revenue 900099 1,716,612 1,716,612    
d All other revenue .... 507,054 507,054 0 0
e Total. Add lines 11a–11d ...... 10,049,949
12 Total revenue. See instructions..... 149,239,979 149,224,876 0 3,605
Form 990 (2023)
Form 990 (2023)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 0 0
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 0 0
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. ............. 0 0
4 Benefits paid to or for members ....... 0 0
5 Compensation of current officers, directors, trustees, and key employees ........... 0 0 0 0
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 0 0 0
7 Other salaries and wages........ 47,712,760 45,044,312 2,668,448 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0 0 0 0
9 Other employee benefits ....... 0 0 0 0
10 Payroll taxes ........... 3,442,603 3,300,271 142,332 0
11 Fees for services (non-employees):        
a Management ...... 0 0 0 0
b Legal ......... 12,593 0 12,593 0
c Accounting ........... 0 0 0 0
d Lobbying ........... 0 0 0 0
e Professional fundraising services. See Part IV, line 17 0 0
f Investment management fees ...... 0 0 0 0
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 19,072,052 15,594,466 3,477,586 0
12 Advertising and promotion .... 0 0 0 0
13 Office expenses ....... 395,579 370,518 25,061 0
14 Information technology ...... 122,234 81,947 40,287 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 1,529,507 901,150 628,357 0
17 Travel ............ 34,372 22,812 11,560 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials . 0 0 0 0
19 Conferences, conventions, and meetings .... 26,425 23,266 3,159 0
20 Interest ........... 1,925,429 1,134,418 791,011 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization .. 3,880,062 2,850,540 1,029,522 0
23 Insurance ... 0 0 0 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 26,958,044 26,928,066 29,978 0
b Affiliated Support - CP 24,436,775 20,091,916 4,344,859 0
c Corporate Allocated Exp 23,199,713 12,938,763 10,260,950 0
d State Hospital Assessment 2,731,551 2,731,551 0 0
e All other expenses 713,227 589,992 123,235 0
25 Total functional expenses. Add lines 1 through 24e 156,192,926 132,603,988 23,588,938 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).        
Form 990 (2023)
Form 990 (2023)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 2,623 1 2,420
2 Savings and temporary cash investments ......... -69,648 2 -88,219
3 Pledges and grants receivable, net ...... 0 3 0
4 Accounts receivable, net ............. 15,472,181 4 17,180,681
5 Loans and other receivables from 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 .......
0 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 ........... 0 7  
8 Inventories for sale or use ............ 2,183,584 8 2,286,936
9 Prepaid expenses and deferred charges ...... 245,207 9 205,906
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 159,458,915
b Less: accumulated depreciation 10b 91,856,704 69,059,036 10c 67,602,211
11 Investments—publicly traded securities . 134,877 11 151,315
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 20,000 15 20,000
16 Total assets. Add lines 1 through 15 (must equal line 33)... 87,047,860 16 87,361,250
Liabilities 17 Accounts payable and accrued expenses ..... 5,876,911 17 5,495,813
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 0
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 1,999,005 25 1,929,272
26 Total liabilities. Add lines 17 through 25.. 7,875,916 26 7,425,085
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 79,005,678 27 79,753,460
28 Net assets with donor restrictions ........... 166,266 28 182,705
Organizations that do not follow FASB ASC 958, check here right arrow 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 ........... 79,171,944 32 79,936,165
33 Total liabilities and net assets/fund balances ........ 87,047,860 33 87,361,250
Form 990 (2023)
Form 990 (2023)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
149,239,979
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
156,192,926
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-6,952,947
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
79,171,944
5
Net unrealized gains (losses) on investments ...............
5
23,970
6
Donated services and use of facilities .................
6
0
7
Investment expenses .....................
7
0
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
7,693,198
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
79,936,165
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Uniform Guidance, 2 C.F.R. Part 200, Subpart F?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2023)
Form 990 (2023)
Additional Data


Software ID: 23017437
Software Version: 2023v6.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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
2023
Open to Public
Inspection
Name of the organization
St Joseph's 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.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4
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:

5
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.)
6
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7
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.)
8
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9
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:
10
An organization that normally receives: (1) more than 33 1/3% 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 33 1/3% 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.)
11
12
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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
a
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.
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.
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.
d
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.
e
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.
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(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
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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  
12
12
 
13
First 5 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
14
14
 
15
15
 
16a
33 1/3% support test—2023. 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
b
33 1/3% support test—2022. 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—2023. 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
b
10%-facts-and-circumstances test—2022. 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
18
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) 2023

Schedule A (Form 990) 2023
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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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.)..            
14
First 5 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
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
33 1/3% support tests-2023. 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
b
33 1/3 % support tests—2022. 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
20
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) 2023

Schedule A (Form 990) 2023
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
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.
1
 
 
2
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).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
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.
3b
 
 
c
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.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
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.
4b
 
 
c
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.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c 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).
5a
 
 
b
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?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
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.
6
 
 
7
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) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
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.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on 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.
9c
 
 
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
 
 
b
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) 2023

Schedule A (Form 990) 2023
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, 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.
1
 
 
2
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.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
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).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
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?
1
 
 
2
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).
2
 
 
3
By reason of the relationship described in line 2 above, 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.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
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.
2a
 
 
b
Did the activities described on line 2a, above 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.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
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?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
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.
3b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
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 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  
7
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) 2023

Schedule A (Form 990) 2023
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 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 2023 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-2023
(iii)
Distributable
Amount for 2023
1 Distributable amount for 2023 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions.
 
3 Excess distributions carryover, if any, to 2023:
a From 2018.......  
b From 2019.......  
c From 2020.......  
d From 2021.......  
e From 2022.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2023 distributable amount  
i Carryover from 2018 not applied (see
instructions)
 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2023 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2023 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2023, 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 2023. 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 2024. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a Excess from 2019.....  
b Excess from 2020.....  
c Excess from 2021.....  
d Excess from 2022.....  
e Excess from 2023.....  
Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023
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) 2023


Additional Data


Software ID: 23017437
Software Version: 2023v6.0
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
right arrow 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.
right arrow Attach to Form 990.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
St Joseph's 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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 July 25, 2006, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow  
4
Number of states where property subject to conservation easement is located right arrow  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow $  
8
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)? .............................
9
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.
1a
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.
b
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 .........................right arrow $  
(ii)
Assets included in Form 990, Part X ...............................right arrow $  
2
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:
a
Revenue included on Form 990, Part VIII, line 1 ..........................right arrow $  
b
Assets included in Form 990, Part X ...............................right arrow $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
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  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
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 2,100 2,100 2,100 2,100
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ...
         
f Administrative expenses ....          
g End of year balance ...... 2,100 2,100 2,100 2,100 2,100
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment right arrow0 %
b
Permanent endowment right arrow100 %
c
Term endowment right arrow0 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
No
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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 ....   72,814,767 28,707,350 44,107,417
c Leasehold improvements   10,014,562 5,312,529 4,702,033
d Equipment ....   64,745,238 57,836,825 6,908,413
e Other .....   7,069,650   7,069,650
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..right arrow 67,602,211
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 3
Part VII
Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)right arrow  
Part VIII
Investments - Program 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)right arrow  
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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........right arrow  
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  
DUE TO AFFILIATES 1,929,272








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)right arrow 1,929,272
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) 2022

Schedule D (Form 990) 2022
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
Schedule D, Part V, Line 4 Intended uses of endowment funds THE FUNDS ARE HELD BY ST. JOSEPH'S COMMUNITY HOSPITAL FOUNDATION, INC., A RELATED ORGANIZATION, AND ARE RESTRICTED FOR USE BY KATHY HOSPICE.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FROEDTERT THEDACARE HEALTH INC. (FTCH), THE PARENT ENTITY INTO WHICH FWBH 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, 2024 AND 2023, FWBH DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS.
Schedule D (Form 990) 2022


Additional Data


Software ID: 23017437
Software Version: 2023v6.0




SCHEDULE G (Form 990)
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 arrowAttach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
St Joseph's 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.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
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?
b
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)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
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) 2023
Schedule G (Form 990) 2023
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.









VerticalRevenue
(a) Event #1

Love Lights
(event type)
(b) Event #2

 
(event type)
(c) Other events

 
(total number)
(d) Total events
(add col. (a) through col. (c))

1

Gross receipts . . . . .

6,260

 

 

6,260

2

Less: Contributions . . . .

6,260

 

 

6,260
3 Gross income (line 1 minus
line 2) . . . . . .

0

0

0

0



VerticalDirectExpenses
4 Cash prizes . . . . .        
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . .        
8 Entertainment . . . .        
9 Other direct expenses . . .        
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow  
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow  
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.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1

Gross revenue . . . . .

 

 

 

 
VerticalDirectExpenses

2

Cash prizes . . . . .

 

 

 

 

3

Noncash prizes . . . .

 

 

 

 

4

Rent/facility costs . . . .

 

 

 

 

5

Other direct expenses . . .

 

 

 

 


6


Volunteer labor . . . .
%
%
%


7

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

 

8

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

 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
YesNo
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
YesNo
b
If "Yes," explain:
 
Schedule G (Form 990) 2023
Schedule G (Form 990) 2023
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
YesNo
12
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
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
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 $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
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) 2023
Additional Data


Software ID: 23017437
Software Version: 2023v6.0
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
St Joseph's Community Hospital of West Bend Inc
 
Employer identification number

39-0806302
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
b
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: . . . . . . . .
3b
Yes
 
%
c
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.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
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) . . .
    622,442 0 622,442 0.40 %
b Medicaid (from Worksheet 3, column a) . . . . .     14,269,920 5,782,715 8,487,205 5.43 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 14,892,362 5,782,715 9,109,647 5.83 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 21 53,068 690,697 0 690,697 0.44 %
f Health professions education (from Worksheet 5) . . . 4 348 373,693 0 373,693 0.24 %
g Subsidized health services (from Worksheet 6) . . . . 1 365 6,162 0 6,162 0 %
h Research (from Worksheet 7) . 0 0 0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 11 21,278 528,422 0 528,422 0.34 %
j Total. Other Benefits . . 37 75,059 1,598,974 0 1,598,974 1.02 %
k Total. Add lines 7d and 7j . 37 75,059 16,491,336 5,782,715 10,708,621 6.86 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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 (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing 0 0 0 0 0 0 %
2 Economic development 1 0 11,635 0 11,635 0.01 %
3 Community support 1 0 2,724 0 2,724 0 %
4 Environmental improvements 0 0 0 0 0 0 %
5 Leadership development and
training for community members
0 0 0 0 0 0 %
6 Coalition building 1 0 11,080 0 11,080 0.01 %
7 Community health improvement advocacy 0 0 0 0 0 0 %
8 Workforce development 4 602 60,044 0 60,044 0.04 %
9 Other 0 0 0 0 0 0 %
10 Total 7 602 85,483 0 85,483 0.05 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,710,803
3
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. ......
3
0
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
21,701,181
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
36,788,710
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-15,087,529
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

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) 2023
Schedule H (Form 990) 2023
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)
Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 ST JOSEPH'S COMMUNITY HOSPITAL
3200 PLEASANT VALLEY ROAD
WEST BEND,WI530953868
froedtert.com/locations/hospital/west-bend-hospital
44
X X         X   DBA FROEDTERT WEST BEND HOSPITAL  
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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 JOSEPH'S COMMUNITY 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):
1
Yes No
Community Health Needs Assessment
1 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?........................ 1   No
2 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............... 2   No
3 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...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 22
5 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 ................. 5 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.................................. 6a Yes  
b 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. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 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. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 23
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.froedtert.com/community-engagement
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 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   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c 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) 2023
Schedule H (Form 990) 2023
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
ST JOSEPH'S COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 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):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.froedtert.com/financial-services
b
www.froedtert.com/financial-services
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 6
Part VFacility Information (continued)

Billing and Collections
ST JOSEPH'S COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 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?.................................. 17 Yes  
18 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:
a
b
c
d
e
f
19 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 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):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
ST JOSEPH'S COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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
Schedule H, Part V, Section B, Line 3 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. FWBH PARTNERS WITH THE WASHINGTON COUNTY HEALTH DEPARTMENT ON THE CHNA PROCESS IN ADDITION TO THE COUNTY'S COMMUNITY HEALTH IMPROVEMENT PLAN.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. CHNA Process and Report In 2022, a CHNA was conducted to 1) determine current community health needs in Washington County, 2) gather input from persons who represent the broad interest of the community and identify community assets, 3) identify and prioritize significant health needs, and 4) develop implementation strategies to address the prioritized health needs. Froedtert West Bend Hospital assessed the health needs of the communities it serves through a comprehensive data collection process from a number of key sources. Data and research included information from community members, public health officials, community leaders/experts, and non-profit organizations representing vulnerable populations in our service area. The following information/data sources were collected and taken into consideration for assessing and addressing community health needs: Community Health Survey: A phone and online survey of 578 residents was conducted by Froedtert West Bend Hospital in collaboration with community partners. The full report of these surveys can be found at https://www.froedtert.com/community-engagement/west-bend-hospital. Key Stakeholder Interviews: Froedtert West Bend Hospital Community Engagement team and leaders conducted 23 phone interviews with community leaders of various school districts, non-profit organizations, health and human service department and business leaders. A list of organizations can be found in Appendix H of the CHNA. The full key stakeholder interview results can be found at https://www.froedtert.com/community-engagement/west-bend-hospital. Secondary Data Report: Utilizing multiple county and community-based publicly available reports, information was gathered regarding: mortality/morbidity data, injury hospitalizations, Washington County Health Rankings, public safety/crime reports and socio-economic/social driver data. Internal Hospital Data: Internal data was gathered from Froedtert West Bend Hospital's service area to gain a better understanding of specific health needs impacting the hospital's patient population. Froedtert West Bend Hospital is committed to addressing community health needs collaboratively with local partners. Froedtert West Bend Hospital used the following methods to gain community input from June to November 2022 on the significant health needs of the Froedtert West Bend Hospital community. These methods provided additional perspectives on how to select and address top health issues facing Froedtert West Bend Hospital's community. Input from Community Members Key Stakeholder Interviews: Key organizations with specific knowledge and information relevant to the scope of the identified significant health needs ("informants") in Froedtert West Bend Hospital's community, including Washington County, were identified by organizations and professionals that represent the broad needs of the community and organizations that serve low-income and underserved populations. A list of key stakeholders can be found in Appendix H of the CHNA. These local partnering organizations also invited the stakeholder to participate in and conducted the interviews. The interviewers used a standard interview script that included the following elements: Social Determinants of Health: * Top Rank, Second Rank * How has COVID-19 impacted this issue? * If the community rallied behind one major effort to radically improve this issue, what would that initiative be? * Which community stakeholders are critical to addressing this issue? Health Conditions/Behaviors: * Top Rank, Second Rank * What populations in our communities are most affected by this issue? How are they affected? * What are the existing strategies to address the health issue? What is working well? * What additional strategies are needed to address this issue? What is keeping our community from doing what needs to be done to improve this issue? * Which community stakeholders are critical to addressing this issue? * If the community rallied behind one major effort to radically improve this issue, what would that initiative be? * How has COVID-19 impacted this issue? Additional Questions/Comments * How would you suggest organizations reach out to community members to implement health initiatives? * Do you have any additional comments you would like to share? Underserved Population Input: Froedtert West Bend Hospital is dedicated to reducing health disparities. Gathering input from community members who are medically underserved, from low-income and minority populations, and/or from organizations that represent those populations, is important in addressing community health needs. With that in mind, Froedtert West Bend Hospital gained input from: * Community Health Survey: When appropriate, data was stratified by gender, age, education household income level and marital status. * Key Stakeholder Interviews: The key stakeholder interviews included input from members of organizations representing medically underserved, low-income and minority populations. Summary of Community Member Input The top five Washington County health issues/behaviors and social needs ranked most consistently or most often cited in the community health survey and by key stakeholders were: Community Health Survey (Health Issues/Behaviors): * Mental Health, Mental Conditions and Suicide * Alcohol Abuse and Drug/Substance Use * Nutrition, Physical Activity and Obesity * Access to Affordable Health Care * Tobacco and Vaping Products Community Health Survey (Social Needs): * Economic Stability and Employment * Food Insecurity * Education Access and Quality * Safe and Affordable Housing * Accessible and Affordable Transportation Key Stakeholder Interviews (Health Issues/Behaviors): * Mental Health, Mental Conditions and Suicide * Alcohol and Substance Use * Nutrition, Physical Activity and Obesity * Maternal, Infant and Child Health * Chronic Diseases Key Stakeholder Interviews (Social Needs): * Economic Stability and Employment * Family Support * Access to Social Services * Affordable Childcare * Safe and Affordable Housing After adoption of the CHNA Report and Implementation Strategy, Froedtert West Bend Hospital publicly shares both documents with community partners, key stakeholder, hospital board members, public schools, non-profits, hospital coalition members, the Washington Ozaukee Public Health Department and the general public. Documents are made available via email, hard copies are made available at applicable meetings, and electronic copies are made available by PDF for download on https://www.froedtert.com/community-engagement/west-bend-hospital. Feedback and public comments are always welcomed and encouraged. Use the contact form on the Froedtert & the Medical College of Wisconsin health network website at https://www.froedtert.com/contact, or call Froedtert ThedaCare Health, Inc.'s Community Engagement leadership/staff at 414-777-3787. Froedtert West Bend Hospital received no comments or issues with the previous Community Health Needs Assessment Report and Implementation Strategy. Washington County Key Informant Interview Organizations: 4C Family Center of Washington County - Nonprofit that provides programs for parents, youth and families. Aging and Disability Resource Center of Washington County- Provides information, assistance, and access to services and community resources for seniors and adults with disabilities Albrecht Free Clinic - Free medical and dental clinic for uninsured Boys and Girls Club of Washington County - Nonprofit youth serving agency providing youth academic and recreational programming. Casa Guadalupe Education Center - Nonprofit serving Latinx community Elevate, Inc.- Nonprofit providing prevention, intervention and recovery support around substance abuse and mental health Germantown School District - Provides services for youth and participates in the Youth Risk Behavioral Survey Interfaith Caregivers of Washington County - Provides services for seniors. Kettle Moraine YMCA - Nonprofit providing services that help people improve their health and well-being Kewaskum School District - Provides public education for youth. Moraine Park Technical College- Higher education institute NAMI Washington County- Provides mental health services through resources, education, and recovery support service in a safe and social atmosphere. Senior Citizens Activities, Inc- Provides programs and activities for seniors to socialize Threshold Inc - Provides services for people with disabilities. United Way of Washington County - Engages, convenes, and mobilizes community resources to address root causes of local health and human services needs
Schedule H, Part V, Section B, Line 5 Facility , 2 Facility , 2 - FROEDTERT WEST BEND HOSPITAL. UW Madison- Extension - Designs educational programs focused on agriculture, community development, human development & relationships, nutrition education, 4-H youth development, and positive youth development. Washington County - Government agency. Washington County Economic Development Corp. - Provides support for local business and economic growth. Washington County Human Services Department - Provides community programs to individuals and families challenged by disability, economic hardship and safety concerns. Washington County Sheriff's Department - Law enforcement agency. Washington Ozaukee Public Health Department - Government department that prevents disease and promotes health. Washington Ozaukee Workforce Development Board - Provides support for local business and economic growth. West Bend School District - Provides public education for youth.
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. Froedtert West Bend Hospital collaborates with the other hospital systems and organizations to assess the health needs of the communities it serves through a comprehensive data collection process from a number of key sources. This shared CHNA serves as the foundation for Froedtert West Bend Hospital and is the basis for creation of an implementation strategy to improve health outcomes and reduce disparities in Washington County and the hospital's primary service area. Washington County Collaborative Partners: Froedtert & the Medical College of Wisconsin Ascension Wisconsin Advocate Aurora Health After completion of the shared CHNA, the data was taken into consideration in order for Froedtert West Bend Hospital to create an independent CHNA and Implementation Strategy specific to the hospitals service area and community health needs.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. Froedtert West Bend Hospital collaborates with the other hospital systems and organizations to assess the health needs of the communities it serves through a comprehensive data collection process from a number of key sources. This shared CHNA serves as the foundation for Froedtert West Bend Hospital and is the basis for creation of an implementation strategy to improve health outcomes and reduce disparities in Washington County and the hospital's primary service area. Washington County Organizations: Washington Ozaukee Public Health Department JKV Research After completion of the shared CHNA, the data was taken into consideration in order for Froedtert West Bend Hospital to create an independent CHNA and Implementation Strategy specific to the hospitals service area and community health needs.
Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. THE FULL VERSION OF THE MOST RECENT AND PAST CHNA SUMMARIES, REPORTS AND OTHER SUPPORTING DOCUMENTS CAN BE FOUND ON FROEDTERT THEDACARE HEALTH'S WEBSITE: HTTPS://WWW.FROEDTERT.COM/COMMUNITY-ENGAGEMENT ADDITIONALLY, THE WASHINGTON COUNTY NEEDS ASSESSMENT AND COUNTY HEALTH IMPROVEMENT PLAN CAN BE FOUND AT THE FOLLOWING WEBSITE: WASHINGTON OZAUKEE PUBLIC HEALTH DEPARTMENT WEBSITE: https://www.washozwi.gov/Strategy
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. Community Health Improvement Plan for Froedtert West Bend Hospital is available online at: https://www.froedtert.com/community-engagement The Fiscal Year 2024 - 2026 Implementation Strategy/Community Health Improvement Plan was reviewed and adopted by the Froedtert West Bend Hospital Board of Directors on 8/29/2023. The CHNA was reviewed by the Froedtert West Bend Hospital CHNA/Implementation Strategy Advisory Committee, which consists of members from the Community Initiatives Committee, Washington County community partners, the Washington Ozaukee Public Health Department and hospital and health system leadership and staff. Committee members were selected based on their specific knowledge of health needs and resources in Washington County for a collective analysis of the CHNA findings. Under the direction of the Department of Community Engagement leadership team and a trained meeting facilitator, the planning process included four steps in prioritizing Froedtert West Bend Hospital's significant health needs: * Review the 2022 Community Health Needs Assessment results for identification and prioritization of community health needs. * Review previous 2021 - 2023 Implementation Strategy programs and results. * Rank and selected priority areas. * Brainstorm evidence-based strategies, partnerships and programs to address community health needs. During a facilitated workout session in February 2023, members of the CHNA/Implementation Strategy Advisory Committee were asked to rate each health need based on the following criteria, to identify the significant health needs: * Alignment: the degree to which the health issue aligns with Froedtert ThedaCare Health's mission and strategic priorities. * Feasibility: the degree to which the hospital can address the need through direct programs, clinical strengths and dedicated resources. * Partnerships: the degree to which there are current or potential community partners/coalitions. * Health Equity: the degree to which disparities exist and can be addressed. * Measurable: the degree to which measurable impact can be made to address the issue. * Upstream: the degree to which the health issue is upstream from and a root cause of other health issues. Based on those results, three overarching significant health needs were identified as priorities for Froedtert West Bend Hospital's Implementation Strategy for fiscal 2024-2026: * Mental Health * Chronic Disease * Equitable Access to Health Services Significant Health Needs Not Addressed * Alcohol Use and Substance Use: Froedtert West Bend Hospital collaborates with the local health department and local non-profits to address alcohol use and substance use through the substance use coalition and Healthy Community Fund. * Obesity: Obesity was not identified as a stand-alone significant health need but this issue will be included under chronic disease prevention. * Safe and Affordable Housing: As part of the Froedtert & the Medical College of Wisconsin health network, Froedtert West Bend Hospital will continue to support housing through the Housing Navigation Program, charitable giving and community partnerships. * Affordable Childcare: Other organizations in the community are addressing this need. * Economic Stability and Employment: Froedtert West Bend Hospital supports economic stability and employment by partnering with the Washington County Economic Development Corporation, Moraine Park Technical College and local chambers. Froedtert West Bend Hospital Summary of Implementation Strategy Froedtert West Bend Hospital has completed a separate Implementation Strategy that addresses the hospital's implementation strategy to meet the community health needs identified in this CHNA. The following is a summary of that separate, more comprehensive Implementation Strategy report. The key programs, strategies and dedicated hospital resources intended to address identified significant community health needs are addressed below. Community Engagement and Froedtert West Bend Hospital have dedicated full time employees and budgeted funds toward serving the needs of the Froedtert West Bend Hospital communities. To access a copy of the full Implementation Strategy, please go to https://www.froedtert.com/community-engagement. Coalition Participation, Charitable Giving and Sponsorship, Health Care Career Exploration, Educational Trainings and Referral Applications CHNA Significant Health Need: Mental Health Goal: Support mental health and well-being through evidence-based, community-led prevention programs and navigation of support services that are equitable, high-quality, culturally responsive and linguistically appropriate, specifically for priority populations. Objective: * Support mental health outreach, education and prevention programs by June 30, 2026. * Improve access to mental health services and navigation to community resources by June 30, 2026. Froedtert West Bend Hospital Actions: * Actively participate on the Washington Ozaukee Mental Health Coalition. * Support mental health efforts through the Healthy Community Fund. * Expand behavioral health care career exploration to offer at least two presentations or speakers for middle school or high school students per year. * Collaborate with community organizations to conduct at least one educational training to increase awareness and skills to address mental health concerns, improve individual self-care and provide community with support, tools and resources. * Utilize and promote Impact 211 as a central access point for people who need mental health support. * Explore the expansion of SilverCloud to the community. Froedtert West Bend Hospital Available Resources: * Community Engagement Leadership/Staff * Behavioral Health Services * Froedtert West Bend Hospital Healthy Community Fund * Froedtert ThedaCare Health Sponsorship * Workforce Development * The Department of Psychiatry and Behavioral Health Medical College of Wisconsin * Inception Health Froedtert West Bend Hospital Collaborative Partners: * Washington Ozaukee Public Health Department - Partner to promote and implement mental health initiatives. * Washington County School Districts - Partner to expose youth to behavioral health care careers. * National Association of Mental Illness (NAMI) Washington County - Partner to provide educational trainings in the community. * Impact 211 - Partner to increase awareness of resources. * Washington County Non-Profit Organizations - Partner to promote and implement mental health initiatives. * First Responders - Partner to conduct front line mental health trainings. * Elevate, Inc. - Partner to provide education and resources. * Albrecht Free Clinic - Partner to provide community prevention programs/services to low income and uninsured individuals. * Casa Guadalupe Education Center - Partner to provide community prevention programs/services to Hispanic/Latino population. * West Bend Senior Center - Partner to provide mental health programs to elderly populations. * Washington County Human Services - Partner to provide mental health services. Coalition Participation FY 2024 Outcomes/Progress: * Participating on the Mental Wellness Coalition through the Washington Ozaukee Health Department - 381 lives touched through the Washington Ozaukee Mental Health Coalition. - Focus areas include: - Reduce Stigma & Awareness Campaign - Increase Mental Health services for youth - Raise awareness and increase utilization of mental health crisis services - Promoting 988, 911, 211 Healthy Community Fund FY 2024 Outcomes/Progress: In Fiscal Year 2024, Froedtert West Bend Hospital, through its foundation, awarded $238,644 to seven Washington County Nonprofits that are positively impacting 2,162 lives throughout the county. Below is a summary of awards and grantees focused on behavioral health prevention: Elevate - Individualized Intervention Programs (AODA) At Elevate we believe healthy individuals build strong communities. Mission is to guide and empower individuals and families to effectively address substance use and mental health challenges. Funding will be used to build Elevate's school strategy of intervention programming to improve youth mental health and reduce their risk for substance abuse by targeting youth with high rates of absenteeism from school as well as other high-risk behavior. Amount awarded: $32,000 People Served: 11 The Youth and Family Project Inc - Crossroads Youth Program Outreach (Mental Health) The Youth and Family Project is a community based, human service, nonprofit agency founded in 1975.
Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - FROEDTERT WEST BEND HOSPITAL. The agency's mission is to provide support, guidance and understanding to help people in need realize their individual goals of independence and personal well-being and for them to achieve a safe, stable living environment. The Youth and Family Project partnered with the Family Center of Washington County to offer the Crossroads Youth Program. This program will address issues associated with childhood trauma and provide a continuum of services to children facing difficult life events: peer support and individual counseling. Amount awarded: $15,000 People Served: 113 Educational Trainings FY 2024 Outcomes/Progress: * 3 collaborative partners in FY24: NAMI Washington County, Washington Ozaukee County Health Department, Aurora Health Care * 15 people attended the blood pressure screening at the West Bend Senior Center and received education. * Community Action Coalition for South Central Wisconsin (CAC) hosted a series of free, virtual Mental Health First Aid trainings in which 11 community partners attended Mental Health Care Career Exploration FY 2024 Outcomes/Progress: * 149 students attended 4 presentations in FY24: Hartford Union High School and West Bend High Schools. Increased knowledge by 27%. Impact 211 Promotion/Trainings FY 2024 Outcomes/Progress: * In collaboration with Impact211, 4 virtual trainings were offered to community partners. Of those trainings 21 people participated. SilverCloud Expansion FY 2024 Outcomes/Progress: * Coordinated a SilverCloud workgroup made up of representatives from Community Engagement, Behavioral Health and Inception Health. Will be engaging Marketing and Communications. * Developed an action plan and secured funding to launch pilot. * Determined a pilot will launch in January 1, 2025 in Washington and Ozaukee Counties. February 1, 2025 will expand into Milwaukee, Manitowoc and Waukesha Counties. * Will launch a resiliency and stress program, open for all community members. Community Collaborations, Charitable Giving, Cancer and Chronic Disease Screenings and Referrals CHNA Significant Health Need: Chronic Disease Prevention Goal: To reduce the burden of chronic diseases in Washington County. Objective: * Increase preventative screening, navigation to resources and treatment of chronic diseases specifically for priority populations in high need zip codes by June 30, 2026. Froedtert West Bend Hospital Actions: * Implement at least three prevention opportunities in partnership with community organizations that target either low income, elderly or Hispanic/ Latino populations. * Support chronic disease prevention efforts through the Healthy Community Fund. * Yearly conduct one cancer screening in partnership with community organizations and the Froedtert & the Medical College of Wisconsin Cancer Network. * Conduct at least two chronic disease community screenings across zip codes 53090 (West Bend), 53095 (West Bend) and 53027 (Hartford). * Support population health and health equity by addressing gaps in medical care, screenings, education and navigation to resources related to breast and colon cancer, pneumococcal vaccines, diabetes, hypertension and readmissions. Froedtert West Bend Hospital Available Resources: * Froedtert Cancer Network Care Navigator * Froedtert West Bend Hospital's Community Foundation * Froedtert & MCW Community Physicians * Froedtert & MCW Cancer Care Network Physicians * Community Education Coordinator * Froedtert West Bend Hospital Healthy Community Fund * Froedtert ThedaCare Health Sponsorship Froedtert West Bend Hospital Collaborative Partners: * Albrecht Free Clinic - Partner to provide community chronic disease prevention programs/services to low income and uninsured individuals. * Casa Guadalupe Education Center - Partner to provide community chronic disease prevention programs/services to Hispanic/Latino populations. * Washington Ozaukee Public Health Department - Partner to promote and implement chronic disease prevention efforts. * Kettle Moraine YMCA - Partner to promote and implement chronic disease prevention efforts. Chronic Disease Prevention Programs/Outreach FY 2024 Outcomes/Progress: * Wellness in Our Parks: 52 participants (Yoga at the West Bend Library) * Screen Free Week: 1,998 lives impacted & 15 partners * MOWA | Riveredge | West Bend Library | Kettle Moraine YMCA | Boys & Girls Club | EMT/Fire Departments (4) | Skateland | Kewaskum Library | Hartford Library | Aurora Health Care | Pike Lake | Germantown Library Healthy Community Fund FY 2024 Outcomes/Progress: In Fiscal Year 2024, Froedtert West Bend Hospital, through its foundation, awarded $238,644 to seven Washington County Nonprofits that are positively impacting 2,162 lives throughout the county. Below is a summary of awards and grantees focused on chronic disease prevention: Casa Guadalupe Education Center - Healthy Latinos, Healthy Futures (Chronic Disease) 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: $40,000 People Served: 480 Community Cancer Screening FY 2024 Outcomes/Progress: * Skin, Hair and Nails screening scheduled for Oct. 2023 at Casa Guadalupe health fair was canceled. Community Chronic Disease Screening FY 2024 Outcomes/Progress: * 37 screened for chronic disease in FY24 through monthly blood pressure screenings at West Bend Senior Center. Population Health and Health Equity FY 2024 Outcomes/Progress: * Overall composite current performance: 84.3% (target: 92.4%) * Breast cancer screening composite measure: 74.3% (target: 77.1%) * Colorectal cancer screening composite measure: 63.7% (target: 73.2%) * Pneumococcal vaccination composite measure: 85.3% (target: 86.2%) * Controlling high blood pressure composite measure: 64.9% (target: 73.6%) * HbA1c Poor Control composite measure: 72.2% (target: 80%) * 30-day readmissions composite measure: 15.3% (target: 13.3%) Charitable Giving, Impact Connect, Population Health and Health Equity, Health Care Career Exploration. CHNA Significant Health Need: Equitable Access to Health Services Goal: * To improve equitable access to comprehensive community and hospital-based services that deliver inclusive, culturally and linguistically competent care. Objective: * Enhance a strong, equitable safety net of services that improves access to care among priority populations by June 30, 2026. Froedtert West Bend Hospital Actions: * Allocate funds to support equitable access to health services through the Healthy Community Fund. * Continue to implement and expand the social determinants of health screening tool within primary and specialty care. * Support population health and health equity by addressing gaps in medical care, screenings, education and navigation to resources related to breast and colon cancers, pneumococcal vaccines, diabetes, hypertension, and readmissions * Expand the Froedtert ThedaCare Health Community Health Worker program to Froedtert West Bend Hospital. * Offer at least two opportunities to educate middle or high school students about health care careers per year. Froedtert West Bend Hospital Available Resources: * Community Engagement leadership/staff * Froedtert West Bend Hospital Healthy Community Fund * Froedtert & MCW Community Physicians * Community Health Worker * Population Health and Health Equity Froedtert West Bend Hospital Collaborative Partners: * Albrecht Free Clinic - Partner to provide health and dental care to underserved populations. * Casa Guadalupe Education Center - Partner to navigate and provide services to Hispanic/Latino populations. * United Way of Washington County - Partner to fund organizations to increase access to care. * Washington County School Districts - Partner to provide health care career exploration opportunities. * Washington County Human Services - Partner to provide behavioral health services.
Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - FROEDTERT WEST BEND HOSPITAL. Healthy Community Fund FY 2024 Outcomes/Progress: In Fiscal Year 2024, Froedtert West Bend Hospital, through its foundation, awarded $238,644 to seven Washington County Nonprofits that are positively impacting 2,162 lives throughout the county. Below is a summary of awards and grantees focused on access to care: Albrecht Free Clinic (Lakeshore Community Health Center)- Healthy Smiles Change Lives (Access - Dental) 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. As a result of many post- pandemic challenges, Albrecht Free Clinic transitioned dental services to Lakeshore Community Health Care in August 2022. funds from the Healthy Community Fund will help offset the cost of a paid, part-time nurse practitioner, a part-time bilingual CHN, and specialty dental care for qualifying AFC medical patients. Amount awarded: $75,000 People Served: 556 Interfaith Caregivers of Washington County - Healthy Aging In Place (Access to Healthcare / Community Services / Transportation) 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: $25,000 People Served: 509 Community Smiles Dental - Dental Care Access for Low-Income Washington County Children (Access - Dental) Community Smiles Dental provides affordable dental care to residents in Milwaukee, Ozaukee, Washington, and Waukesha Counties. We are the only safety net dental clinic in the region dedicated to providing affordable dental care and a dental home to low-income children and pregnant women. Our two clinics, located in Waukesha and Menomonee Falls, provide comprehensive dental care to low-income families in a setting that mirrors a professional dental practice. The goal of this project is to increase access to affordable, routine, dental care for low-income residents of Washington County. Based on an annual 25% growth rate in our Washington County patient census experienced over each of the past four years, we anticipate that CSD will serve 450 unique Washington County patients during 2024. Amount awarded: $31,644 People served: 268 Family Promise - Health Services and Housing for Homeless (Housing) Since 2010, Family Promise of Washington County has been serving homeless families and individuals. Family Promise is a national organization with over 200 affiliates throughout the United States. Funding from the Healthy Community Fund will be used for coordinated health services, emergency shelter, and housing for the homeless through the continuum of care provided by Family Promise of Washington County. Amount awarded: $20,000 People served: 225 Impact Connect/UniteUs FY 2024 Outcomes/Progress: * 2,728 screened and 70 referrals in FY24 * Of those screened at Froedtert West Bend Hospital, 927 were patients who identified as underserved and 14 were referred. * In an effort of outreach to community partners of Froedtert West Bend Hospital by UniteUs, the following partners are live on the platform; Casa Guadalupe Education Center, Interfaith Caregivers of Washington Count, and The Threshold. Population Health and Health Equity FY 2024 Outcomes/Progress: * Overall composite current performance: 84.3% (target: 92.4%) * Breast cancer screening composite measure: 74.3% (target: 77.1%) * Colorectal cancer screening composite measure: 63.7% (target: 73.2%) * Pneumococcal vaccination composite measure: 85.3% (target: 86.2%) * Controlling high blood pressure composite measure: 64.9% (target: 73.6%) * HbA1c Poor Control composite measure: 72.2% (target: 80%) * 30-day readmissions composite measure: 15.3% (target: 13.3%) Community Health Work Program FY 2024 Outcomes/Progress: * CHW program will be supported under the Enterprise Care Coordination (ECC) service line as they have the expertise to support the CHWs with patient referrals, data reports, team huddles, EPIC access, etc. * No plans at this time to expand to Washington County due to the transition and ECC/social work can manage the current case load. Health Care Career Exploration FY2024 Outcomes/Progress: * 505 students attended 7 presentations and College Career Fair at West Bend High School, Slinger High School, Hartford Union High School and Kewaskum High School Other Engagement Programs and Initiatives Community Engagement proactively addresses the social, cultural and economic determinants that underpin health and seeks to build partnerships with others to find solutions. Froedtert & 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. Froedtert West Bend Hospital Community Engagement programming and health improvement activities are supported through staff resources, budgeted dollars for programming and community partnerships. Nursing and Other Health Professions Education Froedtert West Bend Hospital recognizes the value of preparing tomorrow's health care today. Each year, Froedtert West Bend Hospital nurses, technicians and other health professionals provide Washington County students' clinical rotations, preceptorships, and continuing education opportunities. FY 2024 Outcomes/Progress: * Froedtert West Bend Hospital staff provided 3,024 hours of preceptorship time to 168 students in nursing roles. * Froedtert West Bend Hospital staff provided 1,889 hours of preceptorship time to 78 students in professional/technical roles. Project Search Project 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. FY 2024 Outcomes/Progress: * 1 young adult completed the program. He spent time as an intern in our Food n Nutrition, Environmental Services and Ambulatory Surgery departments. United Way Employee Campaign (Addresses all areas in Implementation Plan) Froedtert West Bend Hospital 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. Froedtert West Bend Hospital hosts an annual workplace giving campaign to support United Way and its affiliated organizations. FY 2024 Outcomes/Progress: * 51 hours from staff and leaders to coordinate three week campaign. * $24,504 restricted corporate gift to United Way of Washington County * $38,344.71 corporate match * Overall dollars raised by staff, leaders and physicians - $1,220,269.21 Sexual 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 Froedtert West Bend Hospital for comprehensive, compassionate care. SANE staff are registered nurses with advanced training in medical-forensic examination and in the psychological and emotional trauma patient's experience. They care for victims of all ages, races and populations to provide timely emotional support. 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. Services provided: * Physical examination and wellness check * Collection of medical-forensic evidence * Assistance with reporting the crime to police, when requested (mandatory reporting for children)
Schedule H, Part V, Section B, Line 11 Facility , 4 Facility , 4 - FROEDTERT WEST BEND HOSPITAL. * Assistance with concerns about sexually transmitted infection and pregnancy * Assistance with safety planning * Development of a medical follow-up plan FY2024 Outcomes/Progress: * SANE nurses screened 19 patients and provided referrals and case management after initial consultation. ACA Insurance Marketplace and Enrollment Assistance (Access to Care and Navigation) Froedtert ThedaCare Health (parent company of Froedtert West Bend Hospital) recognized the need to help individuals navigate the new choices available to them through the Affordable Care Act's Insurance Marketplace and Medicaid reforms. Our overall health network of certified application counselors screen and enroll individuals in Public Assistance and Marketplace Insurance Plans. In addition, our certified application counselors answered thousands of phone calls and assisted with questions. Froedtert ThedaCare Health 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, Manitowoc, Washington and Waukesha Counties in securing adequate and affordable health insurance. FY2024 Outcomes/Progress: * Our network of certified application counselors assisted a total of 5,857 individuals with approximately 232 for Froedtert West Bend Hospital. Leadership Volunteerism/Community Support (Froedtert in Action) (Community Building) As an indication of Froedtert West Bend Hospital's executive team's 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 hospital's mission and directly support identified community needs. FY 2024 Outcomes/Progress: * More than 28 leaders provided 571 hours of support to local initiatives through volunteering at not-for-profit organizations and community events Drives FY2024 Outcomes/Progress: * Holiday Drive: 565 items collected by Froedtert West Bend Hospital with 40 total volunteer hours. * Healthy Shelves: 1,500 pounds of food was collected across the health network with 12 total volunteer hours from Froedtert West Bend Hospital staff. For more information on Froedtert West Bend Hospital Community Benefit programs, please visit https://www.froedtert.com/community-engagement or see attached Report to the Community.
Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. IN ALIGNMENT WITH THE FTCH FINANCIAL ASSISTANCE POLICY FWBH 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, FWBH 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.
Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. OUT OF POCKET MAXIMUM DISCOUNT.
Schedule H, Part V, Section B, Line 20 Facility , 1 Facility , 1 - FROEDTERT WEST BEND HOSPITAL. WE REQUEST ADDITIONAL DOCUMENTATION WHEN AN INDIVIDUAL HAS SUBMITTED AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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?3
Name and address Type of Facility (describe)
1 ST JOSEPH'S HOSPITAL KCC
3200 PLEASANT VALLEY RD
WEST BEND,WI53095
CANCER CENTER
2 THE KATHY HOSPICE
3232 PLEASANT VALLEY RD
WEST BEND,WI53095
INPATIENT HOSPICE FACILITY
3 ST JOSEPH SLEEP CENTER
1201 OAK STREET
WEST BEND,WI53095
SLEEP CENTER
4
5
6
7
8
9
10
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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
Schedule H, Part I, Line 3c IN ALIGNMENT WITH THE FTCH FINANCIAL ASSISTANCE POLICY FROEDTERT WEST BEND HOSPITAL 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, FROEDTERT WEST BEND HOSPITAL 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.
Schedule H, Part I, Line 6a EVERY YEAR, FROEDTERT THEDACARE HEALTH 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, FROEDTERT WEST BEND HOSPITAL BOARD OF DIRECTORS, FROEDTERT WEST BEND HOSPITAL LEADERS AND STAFF, GOVERNMENT OFFICIALS, BUSINESS LEADERS AND OTHER COMMUNITY MEMBERS. A COPY OF THE MOST RECENT REPORT CAN BE FOUND AT HTTPS://WWW.FROEDTERT.COM/ABOUT/ANNUAL-REPORTS
Schedule H, Part I, Line 7 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.
Schedule H, Part I, Line 7f OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $156,192,926. 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).
Schedule H, Part VI, Line 7 COMMUNITY BENEFIT DATA IS REPORTED ANNUALLY TO THE WISCONSIN HOSPITAL ASSOCIATION.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount 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.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology 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.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote GENERALLY PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. FTCH ALSO PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. FTCH ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FTCH PROVIDES CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, FTCH HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURED BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS FTCH EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. SEE ALSO PAGE 29-31 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs FROEDTERT WEST BEND HOSPITAL BELIEVES THAT ALL OF THE $15,087,529 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.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IN ALIGNMENT WITH THE FTCH FINANCIAL ASSISTANCE POLICY AND CREDIT AND COLLECTION POLICY REGARDING THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS, FROEDTERT WEST BEND HOSPITAL 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.
Schedule H, Part V, Section B, Line 16a FAP website - ST. JOSEPH'S COMMUNITY HOSPITAL: Line 16a URL: www.froedtert.com/financial-services;
Schedule H, Part V, Section B, Line 16b FAP Application website - ST. JOSEPH'S COMMUNITY HOSPITAL: Line 16b URL: www.froedtert.com/financial-services;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. JOSEPH'S COMMUNITY HOSPITAL: Line 16c URL: www.froedtert.com/financial-services;
Schedule H, Part VI, Line 2 Needs assessment In 2022, a CHNA was conducted to 1) determine current community health needs in Washington County, 2) gather input from persons who represent the broad interest of the community and identify community assets, 3) identify and prioritize significant health needs, and 4) develop implementation strategies to address the prioritized health needs. Froedtert West Bend Hospital assessed the health needs of the communities it serves through a comprehensive data collection process from a number of key sources. Data and research included information from community members, public health officials, community leaders/experts, and non-profit organizations representing vulnerable populations in our service area. The following information/data sources were collected and taken into consideration for assessing and addressing community health needs: Community Health Survey: A phone and online survey of 578 residents was conducted by Froedtert West Bend Hospital in collaboration with community partners. The full report of these surveys can be found at https://www.froedtert.com/community-engagement/west-bend-hospital. Key Stakeholder Interviews: Froedtert West Bend Hospital Community Engagement team and leaders conducted 23 phone interviews with community leaders of various school districts, non-profit organizations, health and human service department and business leaders. A list of organizations can be found in Appendix H of the CHNA. The full key stakeholder interview results can be found at https://www.froedtert.com/community-engagement/west-bend-hospital. Secondary Data Report: Utilizing multiple county and community-based publicly available reports, information was gathered regarding: mortality/morbidity data, injury hospitalizations, Washington County Health Rankings, public safety/crime reports and socio-economic/social driver data. Internal Hospital Data: Internal data was gathered from Froedtert West Bend Hospital's service area to gain a better understanding of specific health needs impacting the hospital's patient population. Froedtert West Bend Hospital is committed to addressing community health needs collaboratively with local partners. Froedtert West Bend Hospital used the following methods to gain community input from June to November 2022 on the significant health needs of the Froedtert West Bend Hospital community. These methods provided additional perspectives on how to select and address top health issues facing Froedtert West Bend Hospital's community. Input from Community Members Key Stakeholder Interviews: Key organizations with specific knowledge and information relevant to the scope of the identified significant health needs ("informants") in Froedtert West Bend Hospital's community, including Washington County, were identified by organizations and professionals that represent the broad needs of the community and organizations that serve low-income and underserved populations. A list of key stakeholders can be found in Appendix H of the CHNA. These local partnering organizations also invited the stakeholder to participate in and conducted the interviews. The interviewers used a standard interview script that included the following elements: Social Determinants of Health: * Top Rank, Second Rank * How has COVID-19 impacted this issue? * If the community rallied behind one major effort to radically improve this issue, what would that initiative be? * Which community stakeholders are critical to addressing this issue? Health Conditions/Behaviors: * Top Rank, Second Rank * What populations in our communities are most affected by this issue? How are they affected? * What are the existing strategies to address the health issue? What is working well? * What additional strategies are needed to address this issue? What is keeping our community from doing what needs to be done to improve this issue? * Which community stakeholders are critical to addressing this issue? * If the community rallied behind one major effort to radically improve this issue, what would that initiative be? * How has COVID-19 impacted this issue? Additional Questions/Comments * How would you suggest organizations reach out to community members to implement health initiatives? * Do you have any additional comments you would like to share? Underserved Population Input: Froedtert West Bend Hospital is dedicated to reducing health disparities. Gathering input from community members who are medically underserved, from low-income and minority populations, and/or from organizations that represent those populations, is important in addressing community health needs. With that in mind, Froedtert West Bend Hospital gained input from: * Community Health Survey: When appropriate, data was stratified by gender, age, education household income level and marital status. * Key Stakeholder Interviews: The key stakeholder interviews included input from members of organizations representing medically underserved, low-income and minority populations. Summary of Community Member Input The top five Washington County health issues/behaviors and social needs ranked most consistently or most often cited in the community health survey and by key stakeholders were: Community Health Survey (Health Issues/Behaviors): * Mental Health, Mental Conditions and Suicide * Alcohol Abuse and Drug/Substance Use * Nutrition, Physical Activity and Obesity * Access to Affordable Health Care * Tobacco and Vaping Products Community Health Survey (Social Needs): * Economic Stability and Employment * Food Insecurity * Education Access and Quality * Safe and Affordable Housing * Accessible and Affordable Transportation Key Stakeholder Interviews (Health Issues/Behaviors): * Mental Health, Mental Conditions and Suicide * Alcohol and Substance Use * Nutrition, Physical Activity and Obesity * Maternal, Infant and Child Health * Chronic Diseases Key Stakeholder Interviews (Social Needs): * Economic Stability and Employment * Family Support * Access to Social Services * Affordable Childcare * Safe and Affordable Housing After adoption of the CHNA Report and Implementation Strategy, Froedtert West Bend Hospital publicly shares both documents with community partners, key stakeholder, hospital board members, public schools, non-profits, hospital coalition members, the Washington Ozaukee Public Health Department and the general public. Documents are made available via email, hard copies are made available at applicable meetings, and electronic copies are made available by PDF for download on https://www.froedtert.com/community-engagement/west-bend-hospital. Feedback and public comments are always welcomed and encouraged. Use the contact form on the Froedtert & the Medical College of Wisconsin health network website at https://www.froedtert.com/contact, or call Froedtert ThedaCare Health, Inc.'s Community Engagement leadership/staff at 414-777-3787. Froedtert West Bend Hospital received no comments or issues with the previous Community Health Needs Assessment Report and Implementation Strategy.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Froedtert ThedaCare Health 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 FTCH website contains information regarding pricing, how to understand your hospital bill, and how to apply for Financial Assistance. Froedtert ThedaCare Health has made financial assistance forms and information available in Spanish, Arabic, Russian, and Hmong. 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 Froedtert ThedaCare Health 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.
Schedule H, Part VI, Line 4 Community information Overview Froedtert West Bend Hospital, 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, Washington County, and surrounding areas. Froedtert West Bend Hospital, specializing in birthing services, cancer care, emergency care, orthopaedics, surgical services and women's health, is part of the Froedtert & Medical College of Wisconsin health network, which also includes Froedtert ThedaCare Hospital, Milwaukee; Froedtert Menomonee Falls Hospital, Menomonee Falls; and more than 40 primary and specialty care health centers and clinics. Mission Statement The Froedtert & the Medical College of Wisconsin health network advances the health of the people of the diverse communities we serve through exceptional care enhanced by innovation and discovery. Froedtert West Bend Hospital Service Area and Demographics For the purpose of the Community Health Needs Assessment, the community is defined as Washington County because we derive 85.5% of discharges occur from this geography. All programs, activities, and partnerships under the CHNA will be delivered in Washington County. However, Froedtert West Bend Hospital's total service area consists of Washington County as well as zip codes in eastern Dodge County. Froedtert West Bend Hospital determines its primary and secondary service areas by completing an annual review and analysis of hospital discharges and market share according to various determinants. The Froedtert West Bend Hospital total service area in Washington County consists of 15 zip codes: 53001 (Adell), 53002 (Allenton), 53010 (Campbellsport), 53011 (Cascade), 53021 (Fredonia), 53027 (Hartford), 53037 (Jackson), 53040 (Kewaskum), 53048 (Lomira), 53050 (Mayville), 53075 (Random Lake), 53086 (Slinger), 53090 (West Bend), 53091 (Theresa), and 53095 (West Bend). HOUSEHOLD INCOME CY24 - PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA UNDER $24,999 - 12.81% AND 11.21% $25,000 - $49,999 - 14.87% AND 15.84% $50,000 - $99,999 - 29.63% AND 31.55% $100,000 AND UP - 42.69% AND 41.40% TOTAL HOUSEHOLDS - 42,400 AND 14,921 SOURCE: ESRI BAO PAYER SOURCE FY23 - PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA COMMERCIAL/MANAGED CARE - 28.30% AND 31.40% MEDICAID - 11.10% AND 8.40% MEDICARE - 56.90% AND 56.80% OTHER GOVERNMENT - 1.30% AND 2.00% OTHER SELF PAY - 2.40% AND 1.50% SOURCE: WHA RACE CY24 - PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA WHITE - 91.29% AND 92.84% AFRICAN AMERICAN - 1.27% AND 0.98% ASIAN/HAWAIIAN/PACIFIC ISLANDER - 1.08% AND 0.53% NATIVE AMERICAN - 0.29% AND 0.29% TWO OR MORE RACES - 4.69% AND 3.79% OTHER - 1.38% AND 1.57% HISPANIC - 4.29% AND 4.21% TOTAL POPULATION - 101,199 AND 35,968 SOURCE: ESRI BAO PAYER SOURCE FY24 Q3 - PRIMARY SERVICE AREA AND SECONDARY SERVICE AREA COMMERCIAL/MANAGED CARE - 26.00% AND 34.80% MEDICAID - 7.40% AND 8.60% MEDICARE - 62.90% AND 49.60% OTHER GOVERNMENT - 1.30% AND 1.40% OTHER SELF PAY - 2.40% AND 5.60% SOURCE: WHA DESCRIPTION OF COMMUNITY BUILDING ACTIVITIES To promote the health of our communities, Froedtert West Bend Hospital participates in numerous community building activities, which are not included elsewhere on Schedule H. These activities include: 1. Coalition Building: Froedtert ThedaCare Health Community Engagement staff participate on the community health coalition through the Washington Ozaukee Public Health Department. Froedtert West Bend Hospital's SANE (Sexual Assault Nurse Examiner Program) works closely with volunteers from the area Women's Shelter to care for victims of sexual assault and SANE nurses collaborate with a county coalition to promote awareness, education and prevention of sexual assaults. Other committees include the CTC Transportation Committee, Injury Prevention Coalition and AARP Network of Age. 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.
Schedule H, Part VI, Line 5 Promotion of community health The Board of Directors at Froedtert West Bend Hospital is made up of medical and business professionals, all of whom reside in the hospital's primary service area. They are dedicated to leveraging the benefits of our community through our hospital's mission. They value the unique character and needs of the patients and communities we serve and the physicians who provide specialty care. Froedtert West Bend Hospital's community board demonstrates our commitment to quality and service. Annually, the board reviews and approves the hospital's Community Health Improvement Plan. Additionally, Froedtert West Bend Hospital supports the Healthy Community Fund, administered through Froedtert ThedaCare Health Community Engagement, 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: Froedtert West Bend Hospital develops and executes community outreach programming and activities based on identified community health needs. Every needs assessment cycle, Froedtert West Bend Hospital Community Engagement staff along with the hospital's community partners and other leaders develops a Community Health Improvement Plan that is incorporated into the hospital's overall strategic plan to address the most critical needs in the communities we serve. The plan is reviewed annually by the Froedtert West Bend Hospital Board of Directors. Froedtert West Bend Hospital 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 Froedtert West Bend Hospital Board of Directors, Physician Advisory Council, Froedtert ThedaCare Health Community Engagement Steering Committee, Leadership Meetings, Froedtert West Bend Hospital Community Foundation and Healthy Community Fund Boards. Based on those results, three overarching significant health needs were identified as priorities for Froedtert West Bend Hospital's Implementation Strategy for fiscal 2024-2026: * Mental Health * Chronic Disease * Equitable Access to Health Services For more information on specific community outreach efforts, Implementation Strategy and Community Health Needs Assessments, please go to Froedtert ThedaCare Health's website at http://www.froedtert.com.
Schedule H, Part VI, Line 6 Affiliated health care system Froedtert & the Medical College of Wisconsin Froedtert West Bend Hospital located in Southeast Wisconsin, 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, Washington County, and surrounding areas. Froedtert West Bend Hospital, specializing in birthing services, cancer care, emergency care, orthopaedics, surgical services and women's health, is part of the Froedtert & Medical College of Wisconsin health network, which also includes Froedtert ThedaCare Hospital, Milwaukee; Froedtert Menomonee Falls Hospital, Menomonee Falls; and more than 40 primary and specialty care health centers and clinics. In the Southeast region, Froedtert Memorial Lutheran Hospital, Froedtert Menomonee Falls Hospital, Froedtert West Bend Hospital, Froedtert Health Neighborhood Hospital, LLC, and Holy Family Memorial made significant investments in the health of their communities. Patients who couldn't pay for their medical care received more than $188 million in uncompensated services. Beyond providing care for the uninsured/underinsured patients, we contributed $177 million to improve access to care, teach future healthcare professionals, develop new medical therapies and participate in local partnerships aimed at reducing health disparities. Our health network members develop community benefit strategies and goals based on the unique needs of each of their communities. By conducting regular community needs assessments that monitor critical public health issues, and actively seeking community input, the hospitals have built important local relationships that provide meaningful outreach programs that link each hospital to their neighbors and patients. As a not-for-profit health system, Froedtert ThedaCare Health reinvests its surplus funds back into the community through programs to serve the poor and uninsured, teach future healthcare professionals, develop new medical therapies, manage chronic conditions like diabetes, health education and promotion initiatives, and participate in local partnerships aimed at reducing health disparities. For more information about Froedtert ThedaCare Health, visit www.froedtert.com
Schedule H (Form 990) 2023
Additional Data


Software ID: 23017437
Software Version: 2023v6.0
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic Attach to Form 990.
medium right arrow graphic Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
St Joseph's Community Hospital of West Bend Inc
 
Employer identification number

39-0806302
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 .....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
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, 1099-MISC compensation, and/or 1099-NEC (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
(i) Base
compensation
(ii) Bonus & incentive
compensation
(iii) Other reportable compensation
1Allen Ericson
Director & SJH President
(i)

(ii)
0
-------------
564,706
0
-------------
142,952
0
-------------
167,348
0
-------------
137,340
0
-------------
36,734
0
-------------
1,049,080
0
-------------
139,594
2Eric Conley
Director & FMLH President (Start Jul23; Term Apr24)
(i)

(ii)
0
-------------
766,153
0
-------------
494,021
0
-------------
143,064
0
-------------
176,458
0
-------------
36,518
0
-------------
1,616,214
0
-------------
115,894
3Michael DeGere DPM
Director & Chief Medical Officer (Start Jul23)
(i)

(ii)
0
-------------
363,118
0
-------------
84,153
0
-------------
25,183
0
-------------
57,290
0
-------------
36,895
0
-------------
566,639
0
-------------
0
4Shelly Waala
Director & VP Patient Care Svc
(i)

(ii)
0
-------------
283,270
0
-------------
62,474
0
-------------
34,610
0
-------------
37,518
0
-------------
35,290
0
-------------
453,162
0
-------------
31,460
5Jeffrey Van De Kreeke
Former - Officer (Treas)
(i)

(ii)
0
-------------
0
0
-------------
0
0
-------------
196,046
0
-------------
12,200
0
-------------
0
0
-------------
208,246
0
-------------
0
6Adam Smith
Treasurer
(i)

(ii)
0
-------------
314,773
0
-------------
101,071
0
-------------
1,112
0
-------------
49,435
0
-------------
22,554
0
-------------
488,945
0
-------------
0
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
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
Schedule J, Part I, Line 3 COMPENSATION OF CEO/EXECUTIVE DIRECTOR ESTABLISHED BY RELATED ORGANIZATION, FROEDTERT THEDACARE HEALTH, THROUGH USE OF COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Schedule J, Part I, Line 4a SEVERANCE OR CHANGE-OF-CONTROL PAYMENT SEVERANCE: VAN DE KREEKE, JEFFREY - $196,046
Schedule J, Part I, Line 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN 457(F) DISTRIBUTIONS: CONLEY, ERIC - $115,894 ERICSON, ALLEN - $139,594 WAALA, SHELLY - $31,460 457(F) PLAN PARTICIPANTS: CONLEY, ERIC DEGERE, MICHAEL ERICSON, ALLEN SMITH, ADAM WAALA, SHELLY
Schedule J, Part I, Line 7 BONUS COMPENSATION IS PAID BASED UPON ATTAINMENT OF SPECIFIC GOALS RELATED TO THE ORGANIZATION'S STRATEGY, 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 THEDACARE 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, Part II, Column (B)(ii) BONUS AND INCENTIVE COMPENSATION AMOUNTS INCLUDE INCENTIVE COMPENSATION PAID.
Schedule J, Part II, Column (B)(iii) OTHER REPORTABLE COMPENSATION INCLUDES 457(F) DEFERRED COMPENSATION PLAN DISTRIBUTIONS PAID TO INDIVIDUALS AND OTHER MISCELLANEOUS COMPENSATION.
Schedule J (Form 990) 2023

Additional Data


Software ID: 23017437
Software Version: 2023v6.0
SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
St Joseph's Community Hospital of West Bend Inc
 
Employer identification number

39-0806302
Return Reference Explanation
Form 990, Part I, Line 1 ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. DBA FROEDTERT WEST BEND HOSPITAL (FWBH) IS A HEALTH CARE ORGANIZATION SERVING RESIDENTS OF WEST BEND AND WASHINGTON COUNTY. OUR MISSION IS TO ADVANCE THE HEALTH OF THE PEOPLE OF DIVERSE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL CARE ENHANCED BY INNOVATION AND DISCOVERY.
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: 3,087 CT SCANS: 13,654 MRIS: 3,918 ULTRASOUNDS: 5,070 INTERVENTIONAL RADIOLOGY PROCEDURES: 1,720 LABORATORY TESTS: 224,272 NUCLEAR MEDICINE SCANS: 2,981 AMBULATORY SURGERY VISITS: 3,923 GI VISITS: 586 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 697 DELIVERIES AND 1,379 NURSERY DAYS DURING FISCAL YEAR 2024. 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 3,359 ADMISSIONS AND 14,227 PATIENT DAYS RELATED TO MEDICAL, SURGICAL, MODIFIED AND INTENSIVE CARE INPATIENT SERVICES. IN CONJUNCTION WITH INPATIENT STAYS, THE HOSPITAL PROVIDED A VARIETY OFINPATIENT ANCILLARY TREATMENTS AND PROCEDURES DURING THE FISCAL YEAR INCLUDING, BUT NOT LIMITED, TO: OPERATIONS: 583 CT SCANS: 4,171 MRIS: 603 RADIOLOGICAL DIAGNOSTIC EXAMS: 6,240 ULTRASOUNDS: 1,034 INTERVENTIONAL RADIOLOGY PROCEDURES: 642 LABORATORY TESTS: 162,523 NUCLEAR MEDICINE SCANS: 154 REHABILITATION TREATMENTS: 37,419
Form 990, Part III, Line 4d Description of other program services (Expenses $ 8,930,571 including grants of $ 0)(Revenue $ 10,049,949) 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 REVENEUE 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 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, GIFT SHOP AND SMALL STONES OPERATIONS, MEDICALL STAFF APPRECIATION 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 FWBH 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. 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 BASED FROM FTCH, A RELATED PARTY.
Form 990, Part VI, Line 6 Classes of members or stockholders FTCH IS THE SOLE CORPORATE MEMBER OF SJH.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body FTCH AS THE SOLE CORPORATE MEMBER OF SJH HAS THE FINAL APPROVAL OF ELECTION OF ALL BOARD MEMBERS.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders FTCH, 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 THE SJH BYLAWS.
Form 990, Part VI, Line 11b Review of form 990 by governing body FTCH ACCOUNTING STAFF PREPARE FORM 990 WHICH IS REVIEWED BY FTCH'S FINANCIAL LEADERS. THE 990 IS THEN REVIEWED BY KPMG, FTCH'S OUTSIDE ACCOUNTING FIRM. NEXT, THE 990 IS PROVIDED TO THE FTCH AUDIT COMMITTEE AND BOARD OF DIRECTORS. FINALLY, THE 990 IS FILED AS REQUIRED.
Form 990, Part VI, Line 12c Conflict of interest policy 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 FTCH. 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 FTCH AUDIT COMMITTEE OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 15a Process to establish compensation of top management official COMPENSATION OF CEO, EXECUTIVE DIRECTORS, AND TOP MANAGEMENT IS PAID BY FTCH, 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 FTCH (THE RELATED ORGANIZATION) BOARD OF DIRECTORS IN ADDITION, THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS.
Form 990, Part VI, Line 15b Process to establish compensation of other employees COMPENSATION OF SEVERAL OFFICERS IS PAID BY FTCH, 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 FTCH (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, Line 19 Required documents available to the public FTCH'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 VIII, Line 11d Other Miscellaneous Revenue Other Revenue - Total Revenue: 507054, Related or Exempt Function Revenue: 507054, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees Temp Personnel - Total Expense: 4355856, Program Service Expense: 4355856, Management and General Expenses: , Fundraising Expenses: ; Physician Fees - Total Expense: 3023487, Program Service Expense: 3023487, Management and General Expenses: , Fundraising Expenses: ; General Contract Services - Total Expense: 6027272, Program Service Expense: 5820703, Management and General Expenses: 206569, Fundraising Expenses: ; Other Purchase Services - Total Expense: 734507, Program Service Expense: 104928, Management and General Expenses: 629579, Fundraising Expenses: ; Consulting - Total Expense: 15443, Program Service Expense: 750, Management and General Expenses: 14693, Fundraising Expenses: ; Other Professional Fees - Total Expense: 1000113, Program Service Expense: 1000113, Management and General Expenses: , Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 3359188, Program Service Expense: 1288629, Management and General Expenses: 2070559, Fundraising Expenses: ; Landscape and Snow Removal - Total Expense: 556186, Program Service Expense: 0, Management and General Expenses: 556186, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances Kraemer Trust Annual Distribution - -7532; Transfer from Affiliates - 7700730;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2023


Additional Data


Software ID: 23017437
Software Version: 2023v6.0
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
St Joseph's Community Hospital of West Bend Inc
 
Employer identification number

39-0806302
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (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











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


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1)FROEDTERT MEMORIAL LUTHERAN HOSPITAL
9200 W WISCONSIN AVE

MILWAUKEE,WI53226
39-6105970
HOSPITAL WI 501(c)(3) 3 FTCH INC
 
 
No
(2)COMMUNITY MEMORIAL HOSPITAL OF MF
W180 N8085 TOWN HALL ROAD

MENOMONEE FALLS,WI53051
39-0987025
HOSPITAL WI 501(c)(3) 3 FTCH INC
 
 
No
(3)FROEDTERT WEST BEND HOSPITAL FOUNDATION INC
3200 PLEASANT VALLEY ROAD

WEST BEND,WI530953868
39-2034296
HEALTH & WLFR WI 501(c)(3) 7 SJCH INC
 
Yes
 
(4)FROEDTERT THEDACARE HEALTH INC
9200 W WISCONSIN AVE

MILWAUKEE,WI53226
39-2014409
MGMT SERVICE WI 501(c)(3) Type III-FI NA
 
 
No
(5)COMMUNITY OUTPATIENT HEALTH SVC OF MF
W180 N8085 TOWN HALL ROAD

MENOMONEE FALLS,WI53051
39-1743056
OUTPT MED/DNT WI 501(c)(3) 3 CMH INC
 
 
No
(6)FROEDTERT MENOMONEE FALLS HOSPITAL FOUNDATION INC
W180 N8085 TOWN HALL ROAD

MENOMONEE FALLS,WI53051
39-1635057
HEALTH & WLFR WI 501(c)(3) 10 CMH INC
 
 
No
(7)FROEDTERT HOSPITAL FOUNDATION INC
9200 W WISCONSIN AVE

MILWAUKEE,WI53226
39-1431192
HEALTH & WLFR WI 501(c)(3) 7 FMLH INC
 
 
No
(8)HOLY FAMILY MEMORIAL INC
2300 WESTERN AVE

MANITOWOC,WI54221
39-0806395
HOSPITAL WI 501(c)(3) 3 FTCH INC
 
 
No
(9)FH ENTERPRISE SERVICE HOLDINGS INC
9200 WEST WISCONSIN AVE

MILWAUKEE,WI53226
20-2636686
HEALTHCARE SVCS WI 501(c)(3) Type I FTCH INC
 
 
No
(10)THEDACARE REGIONAL MEDICAL CENTER - NEENAH INC
PO BOX 8025

APPLETON,WI549128025
39-0830664
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(11)THEDACARE MEDICAL CENTER - NEW LONDON INC
PO BOX 8025

APPLETON,WI549128025
39-0869788
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(12)THEDACARE MEDICAL CENTER - WAUPACA INC
PO BOX 8025

APPLETON,WI549128025
39-0871113
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(13)THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC
PO BOX 8025

APPLETON,WI549128025
39-0824015
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(14)THEDACARE MEDICAL CENTER - SHAWANO INC
PO BOX 8025

APPLETON,WI549128025
39-0807068
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(15)THEDACARE MEDICAL CENTER - BERLIN INC
PO BOX 8025

APPLETON,WI549128025
39-0806359
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(16)THEDACARE MEDICAL CENTER - WILD ROSE INC
PO BOX 8025

APPLETON,WI549128025
39-6089134
HOSPITAL WI 501(c)(3) 3 THEDACARE INC
 
 
No
(17)THEDACARE FAMILY OF FOUNDATIONS INC
PO BOX 8025

APPLETON,WI549128025
46-4112255
FOUNDATION WI 501(c)(3) 7 THEDACARE INC
 
 
No
(18)THEDACARE INC
PO BOX 8025

APPLETON,WI549128025
39-1509362
HEALTHCARE WI 501(c)(3) 10 FTCH INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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?



(k)
Percentage
ownership


Yes No Yes No
(1) WISCONSIN DIAGNOSTIC LABORATORIES LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
39-1896819
LABORATORY SVC WI NA
 
N/A       No     No  
(2) D1 SPORTS TRAINING OF MILWAUKEE LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
47-3322294
SPORTS THERAPY WI NA
 
N/A       No     No  
(3) FMLH MCW REAL ESTATE VENTURES LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
26-0629591
REAL ESTATE WI NA
 
N/A       No     No  
(4) DREXEL TOWN SQUARE SURGERY CENTER LLC

7901 S 6TH ST SECOND FLOOR
OAK CREEK,WI53226
81-4904300
SURGICAL SERV WI NA
 
N/A       No     No  
(5) FROEDTERT SURGERY CENTER LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
20-1499345
SURGICAL SERV WI NA
 
N/A       No     No  
(6) MENOMONEE FALLS AMBULATORY SURG CENTER

W180 N8045 HALL HALL ROAD
MENOMONEE FALLS,WI53095
39-1745697
SURGICAL SERV WI NA
 
N/A       No     No  
(7) THP-FROEDTERT HEALTH VENTURE LLC

1415 LOUISIANA STREET
HOUSTAN,TX77002
82-3559342
HEALTHCARE SRVC TX NA
 
N/A       No     No  
(8) F&MCW NETWORK LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
81-4382585
HEALTHCARE SRVC WI NA
 
N/A       No     No  
(9) FROEDTERT & MED COLLEGE OF WI ACO LLC

8710 WATERTOWN PLANK ROAD
MILWAUKEE,WI53226
83-3159534
HEALTHCARE SRVC WI NA
 
N/A       No     No  
(10) WEST BEND SURGERY CENTER LLC

3212 PLEASANT VALLEY RD
WEST BEND,WI53095
39-1954169
SURGICAL SVC WI NA
 
N/A       No     No  
(11) NATIONAL LABORATORY NETWORK LLC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
88-3305667
LABORATORY SVC WI NA
 
N/A       No     No  
(12) N APPLETON AMBULATORY CARE CENTER BUILDING COMPANY LLC

2500 E CAPITOL DR
APPLETON,WI54911
26-2497187
RENTAL WI NA
 
N/A       No     No  
(13) ENCIRCLE REALCO LLC

65 HIDDEN RAVINES DRIVE SUITE 100
POWELL,OH43065
85-3472736
PROPERTY HOLDING OH NA
 
N/A       No     No  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HART'S MILLS INSURANCE COMPANY

 
 
98-1311808
SELF INSURANCE CJ NA
 
C Corporation         No
(2) NETWORK HEALTH INC

1570 MIDWAY PLACE
MENASHA,WI54952
46-2966177
HEALTH INSURANCE WI NA
 
C Corporation         No
(3) NETWORK HEALTH INSURANCE CORPORATION

1570 MIDWAY PLACE
MENASHA,WI54952
39-2020474
HEALTH INSURANCE WI NA
 
C Corporation         No
(4) NETWORK HEALTH PLAN

1570 MIDWAY PLACE
MENASHA,WI54952
39-1422058
HEALTH INSURANCE WI NA
 
C Corporation         No
(5) FH INVESTMENT HOLDINGS INC

9200 W WISCONSIN AVE
MILWAUKEE,WI53226
99-1422017
HEALTH SERVICES WI NA
 
C Corporation         No
(6) HOLY FAMILY HEALTH SERVICES INC

1650 SOUTH 4TH STREET
MANITOWOC,WI54220
39-1572253
HEALTH SERVICES WI NA
 
C Corporation         No


Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
 
No
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
Yes
 
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved





Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2023

Additional Data


Software ID: 23017437
Software Version: 2023v6.0