2022-05-12T11:07:49-05:00 2021-06-30 135565207 KPMG LLP 191 WEST NATIONWIDE BLVD SUITE 500 COLUMBUS OH 432152568 990 2020-07-01 392014409 FROEDTERT HEALTH INC FROE 4148053000 9200 W WISCONSIN AVENUE MILWAUKEE WI 53226 JEFF VAN DE KREEKE VP - CORP FINANCE & TREASURY 4148053000 2022-05-04 1 JEFF VAN DE KREEKE XXX-XX-XXXX MOLLIE P LONGHOUSE P00294881 6142492300 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z CATHERINE A JACOBSON 9200 W WISCONSIN AVENUE MILWAUKEE WI 53226 1955003536 0 X WWW.FROEDTERT.COM X 2001 WI FROEDTERT HEALTH, INC. ADVANCES THE HEALTH OF THE PEOPLE OF THE DIVERSE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL CARE ENHANCED BY INNOVATION AND DISCOVERY. 17 15 13789 15 532673 0 0 0 592568162 746994118 50408248 73778284 32485400 60552250 675461810 881324652 0 0 0 0 346166522 413968538 0 0 0 273919599 375455594 620086121 789424132 55375689 91900520 2857726016 3415179967 1413187183 1470493539 1444538833 1944686428 X FROEDTERT HEALTH, INC. ADVANCES THE HEALTH OF THE PEOPLE OF THE DIVERSE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL CARE ENHANCED BY INNOVATION AND DISCOVERY. 1 0 316484418 309318922 HEALTH CARE MANAGEMENT SERVICES IN SUPPORT OF FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC., COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, INC., ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC., FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, FROEDTERT HEALTH PHARMACY SOLUTIONS, FROEDTERT HEALTH HOME INFUSION, VERTU RX, FROEDTERT HEALTH PHARMACY, AND FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS. 207712454 207712454 HUMAN RESOURCE/STAFF SUPPORT TO FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC., COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, INC., ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC., FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, FROEDTERT HEALTH PHARMACY SOLUTIONS, FROEDTERT HEALTH HOME INFUSION, VERTU RX, FROEDTERT HEALTH PHARMACY, AND FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS. 119135624 129195236 OUTPATIENT SERVICES OF FROEDTERT NEIGHBORHOOD HOSPITAL, FROEDTERT HEALTH PHARMACY SOLUTIONS, FROEDTERT HEALTH HOME INRUSION, VERTU RX, WEST BEND SURGERY CENTER, AND FROEDTERT HEALTH PHARMACY. 99075353 160855259 IT SUPPORT EXPENSE - 78,947,012INPATIENT EXPENSE - 774,730EMERGENCY DPT EXPENSE - 19,353,611 TOTAL EXPENSE - 99,075,353 IT SUPPORT REVENUE - 78,947,012INPATIENT REVENUE - 839,861EMERGENCY DPT REVENUE - 20,980,633JT VENTURE REVENUE - 60,087,753 TOTAL REVENUE - 160,855,259 99075353 160855259 742407849 1 0 0 1 0 0 0 0 1 0 1 0 1 1 1 1 0 1 0 1 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 477 0 1 13789 1 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 17 15 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X X DAVID DIRKSMEYER 4148053000 N74 W12501 LEATHERWOOD CT MENOMONEE FALLS WI 53051 JACOBSON CATHERINE DIRECTOR & CEO/PRESIDENT 48.00 2.00 X X 2846002 0 406494 BEHL MARK DIRECTOR & EVP/FH COO 48.00 2.00 X 655929 0 68707 BECHTHOLD KURT D DIRECTOR 1.00 0.00 X 0 0 0 BERKES MARY BETH DIRECTOR 1.00 0.00 X 0 0 0 BLOCK BRUCE T DIRECTOR 1.00 0.00 X 0 0 0 CHINI MARC DIRECTOR 1.00 0.00 X 0 0 0 CROSBY GRADY DIRECTOR 1.00 0.00 X 0 0 0 DEBBINK DIRK DIRECTOR 1.00 0.00 X 0 0 0 FORD DEBORAH DIRECTOR 1.00 0.00 X 0 0 0 LUBAR DAVID J DIRECTOR 1.00 0.00 X 0 0 0 MECKLENBURG GARY A DIRECTOR 1.00 0.00 X 0 0 0 OLIVIERI JOSE DIRECTOR 1.00 0.00 X 0 0 0 PRINCE JOAN PHD DIRECTOR 1.00 0.00 X 0 0 0 SCHLIFSKE JOHN E DIRECTOR 1.00 0.00 X 0 0 0 STANEK MARY ELLEN DIRECTOR 1.00 0.00 X 0 0 0 FREDRICK JACQUELYN DIRECTOR & BOD CHAIR 1.00 0.00 X X 0 0 0 SNYDER JUDSON DIRECTOR & BOD V.CHAIR 1.00 0.00 X X 0 0 0 HAWIG SCOTT TREASURER 50.00 0.00 X 1275435 0 201645 MARQUARDT AMY SECR & SR VP CHIEF LEGAL OFF 50.00 0.00 X 792121 0 162372 BUCK CATHERINE FMLH PRESIDENT 50.00 0.00 X 1055840 0 31739 MCCLELLAN NINA FH CIO 50.00 0.00 X 803074 0 50826 ERICSON ALLEN CHD PRESIDENT 5.00 45.00 X 734676 0 156251 POLLARD DENNIS FH COO 50.00 0.00 X 703233 0 15828 CONLEY ERIC FMLH PRESIDENT 44.00 6.00 X 683205 0 158346 KLAUCK JAMES SR VP ANCILLARY SVCS 50.00 0.00 X 525354 0 132243 LUX TERESA CHD COO 5.00 45.00 X 522964 0 118306 HUMPHREY ERIC FH SR VP/CHIEF HR OFFICER 50.00 0.00 X 470271 0 144392 WEBB DIXON RICHELLE FMLH COO 50.00 0.00 X 430461 0 66215 TRUWIT JONATHON ENTERPRISE CHIEF MEDICAL OFF 50.00 0.00 X 1135791 0 173600 OLSON DAVID SR VP & CHIEF STRATEGY OFF 50.00 0.00 X 928825 0 167506 LODES MARK VP-POP HEALTH & MED ED 50.00 0.00 X 748433 0 106319 BASILOTTO STEPHEN FH SR VP/CHIEF EXPERIENCE OFF 50.00 0.00 X 553420 0 146192 STULAC MOTZEL WENDY VP AMBULATORY SERVICES 50.00 0.00 X 522234 0 53788 BALZER JOHN FORMER - KEY EMP (VP FAC PLAN) 50.00 0.00 X 410007 0 45538 15797275 0 2406307 1317 1 1 0 MEDICAL COLLEGE OF WI 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 PROFESSIONAL SERVICE 93615817 RIGHTSOURCING INC PO BOX 515743 LOS ANGELES CA 900515118 PROFESSIONAL SERVICE 6402046 MILWAUKEE REGIONAL MEDICAL CENTER 9000 W WISCONSIN AVE MILWAUKEE WI 53226 PROFESSIONAL SERVICE 4475944 HOSPITAL BILLING & COLLECTION 118 LUKENS DRIVE NEW CASTLE DE 19720 PROFESSIONAL SERVICE 3812357 OPTIMUM HEALTHCARE IT PO BOX 741383 ATLANTA GA 30374 PROFESSIONAL SERVICE 3417762 102 OTHER MANAGEMENT SUPPORT 541900 309318922 309318922 HUMAN RESOURCES SUPPORT 561300 207712454 207712454 OUTPATIENT REVENUE 621400 129195236 129195236 INFO TECH SUPPORT 518210 78947012 78947012 EMERGENCY DEPT REVENUE 621990 20980633 20980633 839861 839861 746994118 39711573 39711573 1107745595 1072170345 1508539 35575250 -1508539 34066711 34066711 JOINT VENTURE REVENUE 621500 60236969 60018343 218626 EXCEEDENT REVENUE 524292 315281 314047 1234 60552250 881324652 807012461 532673 73779518 X 15202141 15202141 190669350 190669350 48015704 48015704 147564864 147564864 12516479 12516479 4246381 4246381 454399 454399 3500 3500 67235439 67235439 14647299 14647299 10966330 1107742 9858588 4949869 4949869 13810693 11676889 2133804 356617 179235 177382 1005361 1005361 11594600 11594600 32279796 32279796 10065165 10065165 AFFILIATED SUPPORT 130003677 126854415 3149262 SOFTWARE LICENSES & TRA 37062116 37062116 ADMINISTRATIVE EXPENSES 9688369 9688369 REPAIRS AND MAINTENANCE 9630341 9630341 17455642 151044 17304598 789424132 742407849 47016283 0 8162 8462 250617648 125013472 0 0 14628842 20324733 0 0 0 0 8791452 -61799109 15991871 17181784 20159815 24651615 589350131 216457495 380671616 372892636 1686803942 2277364053 0 1153865 232573998 314485516 0 0 247478670 323902940 2857726016 3415179967 215698598 250943655 0 0 0 0 667511739 657884389 401603 241443 0 0 0 0 0 0 529575243 561424052 1413187183 1470493539 X 1444538833 1944686428 0 0 1444538833 1944686428 2857726016 3415179967 X 91900520 262079365 146167710 X 0 1 X 1 0 X X 4 FROEDTERT MEMORIAL LUTHERAN HOSPITAL 396105970 3 1 414530114 0 COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS 390987025 3 1 38058495 0 ST JOSEPH'S COMMUNITY HOSPITAL 390806302 3 1 18519223 0 F&MCW COMMUNITY PHYSICIANS 272042610 3 0 46906442 0 4 518014274 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART-IV LINE-SECTION A LINE 1 DESCRIPTION OF HOW SUPPORTED ORGANIZATIONS ARE DESIGNATED: FROEDTERT HEALTH, INC., HAS FIVE SUPPORTED ORGANIZATIONS. FROEDTERT MEMORIAL LUTHERAN HOSPITAL, COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, AND ST. JOSEPH'S COMMUNITY HOSPITAL ARE LISTED BY NAME AS SUPPORTED ORGANIZATIONS IN FROEDTERT HEALTH, INC.'S BYLAWS. FROEDTERT HEALTH, INC. IS A MEMBER OF FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS, INC. (CP), A PHYSICIAN ORGANIZATION WITH WHICH FROEDTERT HEALTH, INC. HAS HAD A HISTORIC AND CONTINUING RELATIONSHIP. THIS HISTORIC AND CONTINUING RELATIONSHIP IS DEMONSTRATED BY THE FACT THAT FROEDTERT HEALTH, INC. HAS SUPPORTED CP BY PERFORMING VARIOUS FUNCTIONS FOR AND ON BEHALF OF CP, FURTHERING CP'S EXEMPT CHARITABLE HEALTH CARE ACTIVITIES. THIS CLOSE BUSINESS RELATIONSHIP BETWEEN FROEDTERT HEALTH, INC. AND CP OVER THE YEARS HAS RESULTED IN A SUBSTANTIAL IDENTITY OF INTERESTS BETWEEN THE TWO ORGANIZATIONS. PART-IV LINE-SECTION D LINE 3 ROLE THE ORGANIZATION'S SUPPORTED ORGANIZATIONS PLAYED IN INVESTMENT POLICY: THE SUPPORTED ORGANIZATIONS OF FROEDTERT HEALTH, INC. EACH HAVE A SIGNIFICANT VOICE IN THE INVESTMENT POLICIES OF THE ORGANIZATION AND IN THE USE OF FROEDTERT HEALTH, INC.'S INCOME AND ASSETS. THE SUPPORTED ORGANIZATIONS HAVE A COMMONALITY OF MANAGEMENT WITH FROEDTERT HEALTH, INC. AND THEREFORE, FROEDTERT HEALTH, INC. IS RESPONSIVE TO THE NEEDS OF THE SUPPORTED ORGANIZATIONS. PART-IV LINE-SECTION E LINE 3A ORGANIZATION HAS POWER TO APPOINT OR ELECT GOVERNING PERSONS FROEDTERT HEALTH, INC. HAS THE POWER TO APPOINT OR ELECT A MAJORITY OF OFFICERS, DIRECTORS, OR TRUSTEES OF ITS SUPPORTED ORGANIZATIONS. IN THE CASE OF CP, FROEDTERT HEALTH, INC. APPOINTS 50% OF THE CP BOARD AND FROEDTERT HEALTH, INC. MAINTAINS A NUMBER OF RESERVED POWERS WITH RESPECT TO THE OPERATIONS OF CP. PART-IV LINE-SECTION E LINE 3B ROLE PLAYED IN MANAGEMENT OF POLICIES, PROGRAMS, & ACTIVITIES: FROEDTERT HEALTH, INC. EXERCISES A SUBSTANTIAL DEGREE OF DIRECTION OVER THE POLICIES, PROGRAMS, AND ACTIVITIES OF ITS SUPPORTED ORGANIZATIONS. FROEDTERT HEALTH EMPLOYEES SERVE AS MEMBERS OF THE BOARDS OF THE SUPPORTED ORGANIZATIONS, AND FROEDTERT HEALTH ALSO HAS A NUMBER OF RESERVED POWERS OVER THE SUPPORTED ORGANIZATIONS. WITH RESPECT TO FROEDTERT MEMORIAL LUTHERAN HOSPITAL, COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, AND ST. JOSEPH'S COMMUNITY HOSPITAL, FROEDTERT HEALTH MAINTAINS THE RIGHT TO REMOVE THE PRESIDENT OF EACH ORGANIZATION AND APPROVE THE SUCCESSOR; APPROVAL RIGHTS REGARDING FINANCIAL MATTERS SUCH AS STRATEGIC PLANS, BUDGETS, DEBT OBLIGATIONS; APPROVAL RIGHTS OVER CHANGES TO EACH ORGANIZATION'S BYLAWS AND ARTICLES OF INCORPORATION; AND APPROVAL RIGHTS OVER DECISIONS WHICH MATERIALLY IMPACT THE ASSETS OF EACH ORGANIZATION. EACH OF THESE RESERVED POWERS IS IN FACT EXERCISED BY FROEDTERT HEALTH. IN REGARDS TO CP, FROEDTERT HEALTH HAS A 50% MEMBERSHIP INTEREST IN CP. FROEDTERT HEALTH APPOINTS 50% OF CP'S BOARD OF DIRECTORS. ONE OF THE FROEDTERT HEALTH'S APPOINTED BOARD MEMBERS SERVES AS EITHER THE CHAIRPERSON OF THE CP BOARD OF DIRECTORS OR THE VICE CHAIRPERSON OF THE BOARD OF DIRECTORS. FROEDTERT HEALTH HAS A NUMBER OF RESERVED POWERS WITH RESPECT TO CP WHICH INCLUDE THE RIGHT TO APPROVE FINANCIAL MATTERS SUCH AS STRATEGIC PLANS, OPERATING AND CAPITAL BUDGETS (AND MATERIAL DEVIATIONS THEREFROM) AND DEBT OBLIGATIONS; THE RIGHT TO APPROVE THE ENGAGEMENT OF AUDITORS; AND THE RIGHT TO NEGOTIATE AND EXECUTE MANAGED CARE CONTRACTS FOR AND ON BEHALF OF CP. IN ADDITION TO THESE SPECIFICALLY RESERVED AUTHORITIES, FROEDTERT HEALTH EQUALLY SHARES VARIOUS OTHER JOINT POWERS WITH THE OTHER 50% MEMBER WHICH INCLUDE THE APPROVAL OF GOVERNANCE RELATED MATTERS SUCH AS CHANGES TO CP'S BYLAWS AND ARTICLES OF INCORPORATION; APPROVAL OF THE MISSION AND GOALS OF CP ALONG WITH FINAL METRICS USED IN DETERMINING GOAL PERFORMANCE; APPROVAL OF ANY MERGER, DISSOLUTION AND CAPITAL ACQUISTION; AND APPROVAL OF THE APPOINTMENT OF CP'S PRESIDENT. 0 1 0 0 0 0 1 3500 0 0 3500 0 PART II-B, LINE 1: SECTION PART II-B INCLUDED IS DIRECT STATE LOBBYING AND EXPENSES, AND A DEMINIMIS AMOUNT OF DIRECT FEDERAL LOBBYING. 0 1 X 18414161 18414161 56389789 10913642 45476147 55562679 18570974 36991705 197233141 130971966 66261175 261750361 56000913 205749448 372892636 WI RENAL CARE GROUP 4928873 C RYAN PEWAUKEE 903750 C FITNESS DEV ASSOC. 647653 C MKE CTR FOR DIAGNOSTIC 8484211 C UPPER MW CONSOL 200000 C REAL ESTATE VENTURES 5975633 C INVEST IN HEALTHECO 6100000 C INVEST IN HOLY FAMILY 41649093 C MIDWEST DIALYSIS, LLC 10671437 C HORIZON HOME CARE & HOSPICE 12906742 C ACO 264096 C NETWORK HEALTH PLAN 120260865 C NX LEVEL 606359 C CIN 7786805 C FROEDTERT SOUTH 86545000 C NEW ENGLAND RE 100000 C AVIA HOLDINGS 2950000 C XHEALTH 1049999 C RX REVU 250000 C ABUNDUNT VENTURE 1500000 C HELUS/RX REVU 25000 C CHARACTER VC 180000 C SILVERCLOUD HEALTH 500000 C 314485516 COLLATERAL HELD FOR SECURITIES 279018242 SENIOR MANAGEMENT DEFERRED 44884698 323902940 FAIR VALUE OF INTEREST RATE SWAPS 42863184 LEASE OBLIGATIONS 164450732 OTHER LONG TERM LIABILITIES 75091894 PAYABLES UNDER SECURITIES LENDING 279018242 561424052 X PART IV, LINE 2B: EXPLANATION OF ESCROW ACCOUNT LIABILITY ESCROW ACCOUNT LIABILITY CONSISTS OF FUNDS SEPARATELY DEPOSITED AND MAINTAINED WITH EXCEEDENT, LLC TO BE USED IN THIRD PARTY ADMINISTRATION OF HEALTH CARE CLAIMS. PART X, LINE 2: FROEDTERT HEALTH, INC. 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 WILL BE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND WILL PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF JUNE 30, 2021 AND 2020, FROEDTERT HEALTH DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. CENTRAL AMERICA AND THE CARIBBEAN 1 0 INVESTMENTS 9623580 1 0 0 0 1 0 9623580 0 9623580 1 0 1 0 0 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 250.000000000000 1 X 1 0 1 1 79142 79142 0.00010 1090830 144136 946694 0.00120 1169972 144136 1025836 0.00130 29683 29683 0.00000 21621 21621 0.00000 51304 51304 0.00000 1221276 144136 1077140 0.00130 194 194 0.00000 86 86 0.00000 280 280 0.00000 0 235109 641457 1414560 -773103 X 1 1 2 1 FH NEIGHBORHOOD HOSPITAL LLC - NB 4805 S MOORLAND RD NEW BERLIN WI 53151 HTTPS://WWW.FROEDTERT.COM/LOCATIONS/HO 843381796 X X X DBA FROEDTERT COMMUNITY HOSPITAL NEW BERLIN 2 FH NEIGHBORHOOD HOSPITAL LLC - PEW 209 PEWAUKEE RD PEWAUKEE WI 53072 HTTPS://WWW.FROEDTERT.COM/LOCATIONS/HO 843381796 X X X DBA FROEDTERT COMMUNITY HOSPITAL PEWAUKEE FH NEIGHBORHOOD HOSPITALS LLC 2 1 1 0 0 1 X 250.000000000000 400.000000000000 X X X X X X X 1 1 X X X 1 X WWW.FROEDTERT.COM/FINANCIAL-SERVICES X WWW.FROEDTERT.COM/FINANCIAL-SERVICES X SAME AS 16A & B X X X X X X 1 X 0 X X X X X 1 X 0 0 FH NEIGHBORHOOD HOSPITALS LLC PART V, SECTION B, LINE 2: FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC CURRENTLY CONSISTS OF FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE WHICH OPENED IN NOVEMBER AND DECEMBER OF 2020. AN ADDITIONAL TWO HOSPITALS, FROEDTERT COMMUNITY HOSPITAL- OAK CREEK AND FROEDTERT COMMUNITY HOSPITAL- MEQUON, WILL OPEN IN JANUARY AND FEBRUARY OF 2022. ALL FOUR HOSPITALS WILL SHARE ONE EMPLOYER IDENTIFICATION NUMBER.AT THE TIME OF FILING THIS SCHEDULE H 990, FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC WAS NOT REQUIRED TO CONDUCT AND APPROVE A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. A FULL CHNA AND IMPLEMENTATION STRATEGY IS PLANNED TO BE COMPLETED AFTER FROEDTERT COMMUNITY HOSPITAL- MEQUON OPENS AND BEFORE THE REQUIRED THREE YEAR DEADLINE.HOWEVER, KEY PROGRAMS, STRATEGIES AND DEDICATED HOSPITAL RESOURCES INTENDED TO ADDRESS IDENTIFIED SIGNIFICANT COMMUNITY HEALTH NEEDS WERE IMPLEMENTED IN THE FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC SERVICE AREA. COMMUNITY ENGAGEMENT AND FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC HAVE DEDICATED EMPLOYEES AND BUDGETED FUNDS TOWARD SERVING THE NEEDS OF THE FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC COMMUNITIES. COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAMS (CHRONIC DISEASE)FY2021 OUTCOMES/PROGRESS:- 30 INDIVIDUALS SERVED AT THE CARS & COOKOUT HEALTH FAIR- ALL COMMUNITY EDUCATION CLASSES WERE VIRTUAL IN FY21. THERE WAS AN OVERALL TOTAL OF 1,102 PEOPLE SERVED WITH APPROXIMATELY 3 INDIVIDUALS SERVED AT FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE.- ALL SPEAKERS BUREAU OPPORTUNITIES WERE VIRTUAL IN FY21. THERE WAS AN OVERALL TOTAL OF 626 PEOPLE SERVED WITH APPROXIMATELY 2 INDIVIDUALS SERVED AT FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE.- ALL SUPPORT GROUPS WERE VIRTUAL IN FY21. THERE WAS AN OVERALL TOTAL OF 565 PEOPLE SERVED WITH APPROXIMATELY 2 INDIVIDUALS SERVED AT FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE.DRUG COLLECTION (AODA/MENTAL HEALTH)AS PART OF OUR COMMITMENT TO IMPROVE THE QUALITY OF LIFE IN OUR COMMUNITY AND ADDRESS DRUG/HEROIN ADDICTION IN OUR COMMUNITIES, FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN PARTNERED WITH WAUKESHA COUNTY DRUG FREE COMMUNITIES COALITION, AND THE NEW BERLIN POLICE DEPARTMENT TO HOST A DRUG COLLECTION. FY 2021 OUTCOMES/PROGRESS: AT THE COLLECTIONS, AREA RESIDENTS DROPPED OFF 1,240 POUNDS OF PRESCRIPTION AND OVER- THE- COUNTER MEDICATIONS AND 432 AREA HOUSEHOLDS PARTICIPATED IN THE COLLECTION. THIS YEAR, LEADERS AND STAFF DEDICATED OVER 100 IN- KIND HOURS TO MAKE THE COLLECTIONS POSSIBLE. FLU CLINICS (CHRONIC DISEASE)FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE OFFERS FLU CLINICS FOR UNINSURED POPULATIONS.FY 2021 OUTCOMES/PROGRESS: - DURING THE FALL OF FISCAL YEAR 2021, 12 PEOPLE WERE IMMUNIZED AT THE NEW BERLIN FOOD PANTRY. THE CLINIC WAS STAFFED BY HOSPITAL PHARMACISTS AND SUPPORT STAFF WHO WERE CERTIFIED BY THE STATE TO ADMINISTER IMMUNIZATIONS. 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 COMMUNITY HOSPITAL- NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE FOR COMPREHENSIVE, COMPASSIONATE CARE. SANE STAFF ARE REGISTERED NURSES WITH ADVANCED TRAINING IN MEDICAL- FORENSIC EXAMINATION AND IN THE PSYCHOLOGICAL AND EMOTIONAL TRAUMA PATIENTS EXPERIENCE. THEY CARE FOR VICTIMS OF ALL AGES, RACES AND POPULATIONS TO PROVIDE TIMELY EMOTIONAL SUPPORT. 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) - ASSISTANCE WITH CONCERNS ABOUT SEXUALLY TRANSMITTED INFECTION AND PREGNANCY - ASSISTANCE WITH SAFETY PLANNING - DEVELOPMENT OF A MEDICAL FOLLOW- UP PLAN FY2021 OUTCOMES/PROGRESS:- SANE NURSES SCREENED 21 PATIENTS AND PROVIDED REFERRALS AND CASE MANAGEMENT AFTER INITIAL CONSULTATION. PART V, LINE 13B: IN ALIGNMENT WITH THE FROEDTERT HEALTH FINANCIAL ASSISTANCE POLICY FH NEIGHBORHOOD HOSPITALS LLC 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, FH NEIGHBORHOOD HOSPITALS LLC ALSO TAKES CERTAIN ASSETS INTO CONSIDERATION. ASSETS PROTECTED FROM FINANCIAL EVALUATION INCLUDE A HOUSEHOLD'S RETIREMENT ASSETS, HOME EQUITY, AND A PORTION OF CASH AND SAVINGS ASSETS. PART V, LINE 13H: OUT OF POCKET MAXIMUM DISCOUNT PART V, LINE 20E: WE REQUEST ADDITIONAL DOCUMENTATION WHEN AN INDIVIDUAL HAS SUBMITTED AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION. PART I, LINE 3C: IN ALIGNMENT WITH THE FROEDTERT HEALTH, INC. FINANCIAL ASSISTANCE POLICY FH NEIGHBORHOOD HOSPITALS LLC 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 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 FPG MAY QUALIFY FOR A 100% DISCOUNT. PATIENTS WHO MEET THE REQUIREMENTS AND HAVE A GROSS INCOME BETWEEN 250% AND 400% OF THE FPG MAY QUALIFY FOR A DISCOUNT ON A SLIDING SCALE. IN ADDITION TO INCOME, FH NEIGHBORHOOD HOSPITALS LLC ALSO TAKES CERTAIN ASSETS INTO CONSIDERATION. ASSETS PROTECTED FROM FINANCIAL EVALUATION INCLUDE A PORTION OF A HOUSEHOLD'S RETIREMENT ASSETS, CASH, SAVINGS ASSETS AND HOME EQUITY. PART I, LINE 6A: EVERY YEAR, FROEDTERT HEALTH PRODUCES AN ANNUAL REPORT TO THE COMMUNITY HIGHLIGHTING COMMUNITY OUTREACH PROGRAMS, PATIENT IMPACT STORIES AND INVESTMENTS IN THE COMMUNITIES WE SERVE. THE REPORT IS MAILED TO OVER 150 AREA NON-PROFITS, CHAMBERS OF COMMERCE, HOSPITAL PARTNERS, FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC BOARD OF DIRECTORS, FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC 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 PART I, LINE 7F: TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25 COLUMN (A) IS $788,455,420. THIS INCLUDES THE EXPENSES FOR ALL ACTIVITIES OF FROEDTERT HEALTH, INC. (NOT JUST RELATED TO THE COMMUNITY HOSPITALS). THEREFORE, THE PERCENTAGES ON PART I, LINE 7 COLUMN F ARE LOW. PART VI, LINE 3: FH NEIGHBORHOOD HOSPITALS LLC 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 FROEDTERT HEALTH, INC. WEBSITE CONTAINS INFORMATION REGARDING PRICING, HOW TO UNDERSTAND YOUR HOSPITAL BILL, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE. FH NEIGHBORHOOD HOSPITALS LLC HAS MADE FINANCIAL ASSISTANCE FORMS AND INFORMATION AVAILABLE IN SPANISH. FINANCIAL COUNSELORS SCREEN UNINSURED PATIENTS FOR GOVERNMENT PROGRAM ELIGIBILITY AND SOCIAL SERVICES STAFF ARE AVAILABLE TO ASSIST PATIENTS WITH ENROLLMENT PROCESSES. PATIENTS WHO ARE UNINSURED, THOSE COVERED BY GOVERNMENT PROGRAMS AND THOSE WITH LIMITED FINANCIAL MEANS MAY ALSO BE ELIGIBLE FOR CHARITY CARE OR DISCOUNTS THROUGH THE FH NEIGHBORHOOD HOSPITALS LLC'S FINANCIAL ASSISTANCE PROGRAM. FINANCIAL COUNSELORS MAKE EVERY EFFORT TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL ASSISTANCE CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION, OR THE COLLECTION CYCLE. PART VI, LINE 4: 4. COMMUNITY INFORMATIONOVERVIEWFROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC (FROEDTERT COMMUNITY HOSPITAL NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE), PART OF THE FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN HEALTH NETWORK, ARE SMALL-SCALE HOSPITALS PROVIDING PATIENTS HIGH-QUALITY CARE CLOSE TO HOME. AS CMS-CERTIFIED, STATE-LICENSED AND ACCREDITED ACUTE-CARE HOSPITALS, THEY FEATURE AN EMERGENCY DEPARTMENT, INPATIENT BEDS, LABORATORY, PHARMACY AND IMAGING SERVICES. MISSION STATEMENTFROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN ADVANCE THE HEALTH OF THE PEOPLE OF THE DIVERSE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL CARE ENHANCED BY INNOVATION AND DISCOVERY. SERVICE AREA AND DEMOGRAPHICSTHE COMMUNITY IS DEFINED AS NORTHEAST AND SOUTHEAST WAUKESHA COUNTY. ALL PROGRAMS, ACTIVITIES, AND PARTNERSHIPS UNDER THE FUTURE CHNA WILL BE DELIVERED IN WAUKESHA COUNTY. HOWEVER FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC'S TOTAL SERVICE AREA CONSISTS OF WAUKESHA COUNTY, AS WELL AS ZIP CODES IN WESTERN MILWAUKEE COUNTY. FROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC DETERMINES ITS PRIMARY AND SECONDARY SERVICE AREAS BY COMPLETING AN ANNUAL REVIEW AND ANALYSIS OF HOSPITAL DISCHARGES AND MARKET SHARE ACCORDING TO VARIOUS DETERMINANTS.FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE SERVICE AREA REFLECTS THESE ZIP CODES 53029 (HARTLAND), 53045 (BROOKFIELD), 53058 (NASHOTAH), 53072 (PEWAUKEE), 53089 (SUSSEX), 53186 (WAUKESHA), 53188 (WAUKESHA), 53056 (MERTON) FROEDTERT COMMUNITY HOSPITAL- NEW BERLIN SERVICE AREA REFLECTS THESE ZIP CODES 53005 (BROOKFIELD), 53045 (BROOKFIELD), 53051 (MENOMONEE FALLS), 53072 (PEWAUKEE), 53103 (BIG BEND), 53122 (ELM GROVE), 53129 (GREENDALE), 53130 (HALES CORNERS), 53132 (FRANKLIN), 53146 (NEW BERLIN), 53149 (MUKWONAGO), 53150 (MUSKEGO), 53151 (NEW BERLIN), 53185 (WATERFORD), 53186 (WAUKESHA), 53188 (WAUKESHA), 53189 (WAUKESHA), 53213 (MILWAUKEE), 53214 (MILWAUKEE), 53219 (MILWAUKEE), 53220 (MILWAUKEE), 53221 (MILWAUKEE), 53226 (MILWAUKEE), 53227 (MILWAUKEE), 53228 (MILWAUKEE) FROEDTERT NEW BERLIN COMMUNITY HOSPITALHOUSEHOLD INCOME CY20 PRIMARY SERVICE AREAUNDER $24,999 14.44%$25,000-$49,999 19.51%$50,000-$99,999 33.40%$100,000 AND UP 32.65%TOTAL HOUSEHOLDS 242,916FROEDTERT NEW BERLIN COMMUNITY HOSPITAL PAYER SOURCE FY20 PRIMARY SERVICE AREACOMMERCIAL/MANAGED CARE 26.1%MEDICAID 10.0%MEDICARE 60.8%OTHER GOVERNMENT 0.9%OTHER/SELF PAY 2.1% SOURCE: INTELERE FROEDTERT NEW BERLIN COMMUNITY HOSPITAL RACE FY20 PRIMARY SERVICE AREAWHITE 87.38%AFRICAN AMERICAN 2.83%ASIAN/HAWAIIAN/PACIFIC ISLANDER 0.04%NATIVE AMERICA 0.52%TWO OR MORE RACES 2.36%OTHER 2.49%HISPANIC 8.43%TOTAL POPULATION 587,056FROEDTERT NEW BERLIN COMMUNITY HOSPITAL PAYER SOURCE FY21 Q3 PRIMARY SERVICE AREACOMMERCIAL/MANAGED CARE 26.6%MEDICAID 10.2%MEDICARE 60.9%OTHER GOVERNMENT 0.9%OTHER/SELF PAY 1.4% SOURCE: INTELERE FROEDTERT PEWAUKEE COMMUNITY HOSPITALHOUSEHOLD INCOME CY20 PRIMARY SERVICE AREAUNDER $24,999 12.58%$25,000-$49,999 17.27%$50,000-$99,999 29.85%$100,000 AND UP 40.30%TOTAL HOUSEHOLDS 64,696FROEDTERT NEW BERLIN COMMUNITY HOSPITAL PAYER SOURCE FY20 PRIMARY SERVICE AREACOMMERCIAL/MANAGED CARE 28.5%MEDICAID 8.4%MEDICARE 59.88%OTHER GOVERNMENT 0.5%OTHER/SELF PAY 2.7% SOURCE: INTELEREFROEDTERT NEW BERLIN COMMUNITY HOSPITAL RACE FY20 PRIMARY SERVICE AREAWHITE 89.28%AFRICAN AMERICAN 1.81%ASIAN/HAWAIIAN/PACIFIC ISLANDER 0.06%NATIVE AMERICA 0.32%TWO OR MORE RACES 1.93%OTHER 1.89%HISPANIC 7.04%TOTAL POPULATION 162,592FROEDTERT PEWAUKEE COMMUNITY HOSPITAL PAYER SOURCE FY21 Q3 PRIMARY SERVICE AREACOMMERCIAL/MANAGED CARE 30.5%MEDICAID 7.7%MEDICARE 59.5%OTHER GOVERNMENT 1.0%OTHER/SELF PAY 1.4% SOURCE: INTELERE PART VI, LINE 5: 5. PROMOTION OF COMMUNITY HEALTHTHE FROEDTERT COMMUNITY HOSPITAL-PEWAUKEE COMMUNITY ADVISORY COMMITTEE IS ADVISORY TO FROEDTERT COMMUNITY HOSPITAL MANAGEMENT COMMITTEE. FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE COMMUNITY ADVISORY COMMITTEE WILL SERVE AS THOUGHT LEADERS WHO FACILITATE INFORMATION EXCHANGE BETWEEN FROEDTERT HEALTH AND THE GREATER PEWAUKEE COMMUNITY. THE MEMBERS REPRESENT MULTIPLE SECTORS OF THE COMMUNITY AND INCREASED UNDERSTANDING OF THE ROLE FROEDTERT HEALTH IS SERVING THE COMMUNITY. FUNCTIONS:- TO PROVIDE A LEADERSHIP ROLE IN ADVOCATING COMMUNITY-WIDE RESPONSES TO HEALTHCARE NEEDS IN THE HOSPITAL'S PRIMARY SERVICE AREA.- TO FACILITATE AND SUPPORT COMMUNITY, BUSINESS AND HEALTHCARE PARTNERSHIPS.- TO SERVE AS A LIAISON BETWEEN FROEDTERT HEALTH AND THE COMMUNITY TO PROVIDE A CONDUIT OF INFORMATION ABOUT COMMUNITY INITIATIVES AND NEEDS.- TO ACT AS THOUGHT LEADERS ON BEHALF OF THE COMMUNITY IN MATTERS RELATED TO HEALTH AND SOCIAL DETERMINANTS OF HEALTH.- TO UNDERSTAND AND TO PROVIDE GUIDANCE ON FROEDTERT HEALTH'S COMMUNITY ENGAGEMENT INITIATIVES.- TO UNDERSTAND UNMET HEALTH NEEDS IN THE LOCAL COMMUNITY AND HOW FROEDTERT HEALTH ADDRESSES THOSE NEEDS.- ASSIST IN THE DEVELOPMENT AND OUTCOMES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY IN PARTNERSHIP WITH THE COMMUNITY HOSPITAL'S MANAGEMENT TEAM EVERY THREE YEARS.THE FROEDTERT COMMUNITY HOSPITAL-NEW BERLIN COMMUNITY ADVISORY COMMITTEE IS ADVISORY TO FROEDTERT COMMUNITY HOSPITAL MANAGEMENT COMMITTEE. THE FROEDTERT COMMUNITY HOSPITAL-NEW BERLIN COMMUNITY ADVISORY COMMITTEE WILL SERVE AS THOUGHT LEADERS WHO FACILITATE INFORMATION EXCHANGE BETWEEN FROEDTERT HEALTH AND THE GREATER NEW BERLIN COMMUNITY. THE MEMBERS WILL REPRESENT MULTIPLE SECTORS OF THE COMMUNITY AND INCREASE UNDERSTANDING OF THE ROLE OF FROEDTERT HEALTH IN SERVING THE COMMUNITY. FUNCTIONS:- TO PROVIDE A LEADERSHIP ROLE IN ADVOCATING COMMUNITY-WIDE RESPONSES TO HEALTHCARE NEEDS IN THE HOSPITAL'S PRIMARY SERVICE AREA.- TO FACILITATE AND SUPPORT COMMUNITY, BUSINESS AND HEALTHCARE PARTNERSHIPS.- TO SERVE AS A LIAISON BETWEEN FROEDTERT HEALTH AND THE COMMUNITY TO PROVIDE A CONDUIT OF INFORMATION ABOUT COMMUNITY INITIATIVES AND NEEDS.- TO ACT AS THOUGHT LEADERS ON BEHALF OF THE COMMUNITY IN MATTERS RELATED TO HEALTH AND SOCIAL DETERMINANTS OF HEALTH.- TO UNDERSTAND AND TO PROVIDE GUIDANCE ON FROEDTERT HEALTH'S COMMUNITY ENGAGEMENT INITIATIVES.- TO UNDERSTAND UNMET HEALTH NEEDS IN THE LOCAL COMMUNITY AND HOW FROEDTERT HEALTH ADDRESSES THOSE NEEDS.ASSIST IN THE DEVELOPMENT AND OUTCOMES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY IN PARTNERSHIP WITH THE COMMUNITY HOSPITAL'S MANAGEMENT TEAM EVERY THREE YEARS. PART VI, LINE 6: 6. AFFILIATED HEALTH SYSTEMFROEDTERT HEALTH NEIGHBORHOOD HOSPITAL, LLC (FROEDTERT COMMUNITY HOSPITAL NEW BERLIN AND FROEDTERT COMMUNITY HOSPITAL- PEWAUKEE), PART OF THE FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN HEALTH NETWORK, ARE SMALL-SCALE HOSPITALS PROVIDING PATIENTS HIGH-QUALITY CARE CLOSE TO HOME. AS CMS-CERTIFIED, STATE-LICENSED AND ACCREDITED ACUTE-CARE HOSPITALS, THEY FEATURE AN EMERGENCY DEPARTMENT, INPATIENT BEDS, LABORATORY, PHARMACY AND IMAGING SERVICES. FROEDTERT MEMORIAL LUTHERAN HOSPITAL, FROEDTERT MENOMONEE FALLS, FROEDTERT WEST BEND HOSPITALS, 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 $162 MILLION IN UNCOMPENSATED SERVICES. BEYOND PROVIDING CARE FOR THE UNINSURED/UNDERINSURED PATIENTS, WE CONTRIBUTED $109 MILLION TO IMPROVE ACCESS TO CARE, TEACH FUTURE HEALTHCARE PROFESSIONALS, DEVELOP NEW MEDICAL THERAPIES AND PARTICIPATE IN LOCAL PARTNERSHIPS AIMED AT REDUCING HEALTH DISPARITIES.FROEDTERT HEALTH MEMBERS DEVELOP COMMUNITY BENEFIT STRATEGIES AND GOALS BASED ON THE UNIQUE NEEDS OF EACH OF THEIR COMMUNITIES. BY CONDUCTING REGULAR COMMUNITY NEEDS ASSESSMENTS THAT MONITOR CRITICAL PUBLIC HEALTH ISSUES, AND ACTIVELY SEEKING COMMUNITY INPUT, THE HOSPITALS HAVE BUILT IMPORTANT LOCAL RELATIONSHIPS THAT PROVIDE MEANINGFUL OUTREACH PROGRAMS THAT LINK EACH HOSPITAL TO THEIR NEIGHBORS AND PATIENTS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, FROEDTERT HEALTH REINVESTS ITS SURPLUS FUNDS BACK INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, TEACH FUTURE HEALTHCARE PROFESSIONALS, DEVELOP NEW MEDICAL THERAPIES, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND PARTICIPATE IN LOCAL PARTNERSHIPS AIMED AT REDUCING HEALTH DISPARITIES. FOR MORE INFORMATION ABOUT FROEDTERT HEALTH, VISIT WWW.FROEDTERT.COM PART VI, LINE 7: 7. STATE FILING OF COMMUNITY BENEFIT REPORTCOMMUNITY BENEFIT DATA IS REPORTED ANNUALLY TO THE WISCONSIN HOSPITAL ASSOCIATION X X X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 JACOBSON CATHERINE DIRECTOR & CEO/PRESIDENT 1421093 0 1004803 0 420106 0 373599 0 32895 0 3252496 0 416768 0 HAWIG SCOTT TREASURER 747717 0 323453 0 204265 0 170230 0 31415 0 1477080 0 182597 0 TRUWIT JONATHON ENTERPRISE CHIEF MEDICAL OFF 635847 0 299180 0 200764 0 148900 0 24700 0 1309391 0 173640 0 OLSON DAVID SR VP & CHIEF STRATEGY OFF 553638 0 234837 0 140350 0 133166 0 34340 0 1096331 0 115448 0 BUCK CATHERINE FMLH PRESIDENT 293940 0 439234 0 322666 0 22550 0 9189 0 1087579 0 166541 0 MARQUARDT AMY SECR & SR VP CHIEF LEGAL OFF 541010 0 228735 0 22376 0 130145 0 32227 0 954493 0 0 0 ERICSON ALLEN CHD PRESIDENT 507482 0 82804 0 144390 0 123724 0 32527 0 890927 0 121768 0 LODES MARK VP-POP HEALTH & MED ED 503506 0 73200 0 171727 0 72844 0 33475 0 854752 0 150679 0 MCCLELLAN NINA FH CIO 163500 0 0 0 639574 0 45316 0 5510 0 853900 0 241835 0 CONLEY ERIC FMLH PRESIDENT 545710 0 135000 0 2495 0 126339 0 32007 0 841551 0 0 0 BEHL MARK DIRECTOR & EVP/FH COO 339894 0 284076 0 31959 0 62597 0 6110 0 724636 0 0 0 POLLARD DENNIS FH COO 250580 0 389528 0 63125 0 5500 0 10328 0 719061 0 0 0 BASILOTTO STEPHEN FH SR VP/CHIEF EXPERIENCE OFF 457538 0 74739 0 21143 0 113693 0 32499 0 699612 0 0 0 KLAUCK JAMES SR VP ANCILLARY SVCS 369547 0 61533 0 94274 0 99156 0 33087 0 657597 0 71821 0 LUX TERESA CHD COO 399466 0 65752 0 57746 0 103887 0 14419 0 641270 0 36228 0 HUMPHREY ERIC FH SR VP/CHIEF HR OFFICER 467526 0 0 0 2745 0 111810 0 32582 0 614663 0 0 0 STULAC MOTZEL WENDY VP AMBULATORY SERVICES 207086 0 50000 0 265148 0 36649 0 17139 0 576022 0 177195 0 WEBB DIXON RICHELLE FMLH COO 295791 0 107852 0 26818 0 45468 0 20747 0 496676 0 0 0 BALZER JOHN FORMER - KEY EMP (VP FAC PLAN) 288033 0 42959 0 79015 0 22550 0 22988 0 455545 0 0 0 PART I, LINE 1A HOUSING: BEHL, MARK - $17,262 ($11,836 ACTUAL + $5,426 GROSS UP) WEBB DIXON, RICHELLE - $19,212 ($13,117 ACTUAL + $6,095 GROSS UP) SOCIAL CLUB DUES: JACOBSON, CATHERINE - $4,705 HEALTH AND FITNESS (STANDARD EMPLOYEE BENEFIT): BUCK, CATHERINE - $40 KLAUCK, JAMES - $80 PART I, LINES 4A-B SEVERANCE: MCCLELLAN, NINA - $389,936 STULAC MOTZEL, WENDY - $85,188 457(F) DISTRIBUTIONS: ERICSON, ALLEN - $121,768 HAWIG, SCOTT - $182,597 JACOBSON, CATHERINE - $416,768 KLAUCK, JAMES - $71,821 LODES, MARK - $150,679 LUX, TERESA - $36,228 MCCLELLAN, NINA - $241,835 OLSON, DAVID - $115,448 STULAC MOTZEL, WENDY - $177,195 TRUWIT, JONATHON - $173,640 NON-QUALIFIED DISTRIBUTIONS: BUCK, CATHERINE - $239,442 (OF WHICH $166,541 WAS REPORTED AS DEFERRED ON A PRIOR FORM 990) POLLARD, DENNIS - $52,070 (OF WHICH $0 WAS REPORTED AS DEFERRED ON A PRIOR FORM 990) 457(F) PLAN PARTICIPANTS: BASILOTTO, STEPHEN BEHL, MARK CONLEY, ERIC ERICSON, ALLEN HAWIG, SCOTT HUMPHREY, ERIC JACOBSON, CATHERINE KLAUCK, JAMES LODES, MARK LUX, TERESA MARQUARDT, AMY MCCLELLAN, NINA OLSON, DAVID STULAC MOTZEL, WENDY TRUWIT, JONATHON WEBB DIXON, RICHELLE NON-QUALIFIED PARTICIPANTS: BUCK, CATHERINE POLLARD, DENNIS 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 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. PART II, COLUMN (B)(II): BONUS AND INCENTIVE COMPENSATION AMOUNTS INCLUDE INCENTIVE COMPENSATION PAID. PART II, COLUMN (B)(III): OTHER REPORTABLE COMPENSATION INCLUDES 457(F) DEFERRED COMPENSATION PLAN DISTRIBUTIONS PAID TO INDIVIDUALS, AMOUNTS PAID IN LIEU OF 457(F) DEFERRED COMPENSATION PLAN CONTRIBUTIONS, AND OTHER MISCELLANEOUS COMPENSATION. A WISCONSIN HEALTH AND EDUCATION AUTHORITY 391337855 97710B6D9 2012-10-11 167195354 SEE PART VI 0 0 0 B WISCONSIN HEALTH AND EDUCATION AUTHORITY 391337855 97712DWA0 2017-04-20 272670229 SEE PART VI 0 0 0 C WISCONSIN HEALTH AND EDUCATION AUTHORITY 391337855 97712D8U3 2021-06-24 69375000 SEE PART VI 0 0 0 D WISCONSIN HEALTH AND EDUCATION AUTHORITY 391337855 97712D8W9 2021-06-24 80835000 SEE PART VI 0 0 0 A 4780000 168720537 1689952 118390733 48639852 2016 1 1 1 1 B 18370000 272795372 2053047 20275833 250466492 2019 1 1 1 1 C 69375000 533289 68650000 191711 2021 1 0 0 1 D 80835000 616950 80000000 218050 2021 1 0 0 1 A 0 1 0 1 1 0.00020 0.00020 0 0 1 B 0 1 0 1 1 0.00380 0.00380 0 0 1 C 0 1 0 1 1 0.00480 0.00480 0 0 1 D 0 0 0 1 1 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 1 MORGAN STANLEY 26.100000000000 1 0 0 0 1 D 0 1 0 0 1 1 BARCLAYS 27.300000000000 1 0 0 0 1 A 1 B 1 C 1 D 1 PART I, COLUMN F: BOND A: 2012A - BOND ISSUE PROVIDED FUNDS TO REFUND PRIOR BOND ISSUES WITH ISSUE DATES OF SEPTEMBER 15, 2001 & FEBRUARY 5, 2003 AND CONSTRUCTION OF THE FROEDTERT HOSPITAL CENTER FOR ADVANCED CARE. BOND B: 2017A - BOND ISSUE PROVIDED FUNDS TO REFUND PRIOR BOND ISSUES WITH ISSUE DATES OF OCTOBER 22, 2009 (2009C) AND DECEMBER 11, 2013 (2013AB) AND PAY OR REIMBURSE COSTS OF ACQUISITION, CONSTRUCTION, RENOVATION, AND EQUIPPING CERTAIN HOSPITAL FACILITIES INCLUDING, BUT NOT LIMITED TO, A NEW INTEGRATED PROCEDURAL PLATFORM AT FROEDTERT MEMORIAL LUTHERAN HOSPITAL. BOND C: 2021A - BOND ISSUE ISSUE PROVIDED FUNDS TO REFUND PRIOR BOND WITH ISSUE DATE OF DECEMBER 11, 2013 (2013AB). BOND D: 2021B - BOND ISSUE ISSUE PROVIDED FUNDS TO REFUND PRIOR BOND WITH ISSUE DATE OF APRIL 27, 2017 (2017B). PART II, LINE 3, COLUMN A: THE DIFFERENCE BETWEEN THE ISSUE PRICE AND TOTAL PROCEEDS OF THE ISSUE IS THE INTEREST EARNED ON THE INVESTMENT OF $1,525,183. PART II, LINE 3 COLUMN B: THE DIFFERENCE BETWEEN THE ISSUE PRICE AND TOTAL PROCEEDS OF THE ISSUE IS THE INTEREST EARNED ON THE INVESTMENT OF $125,143. PART II, LINE 11, COLUMNS A, B, C, & D: THE OTHER SPENT PROCEEDS RELATE TO THE REFUNDING PROCEEDS OF THE ISSUES NO LONGER IN ESCROW. PART III, LINE 3D, COLUMNS A, B, C, & D: ALL CONTRACTS ARE ROUTINELY REVIEWED BY IN HOUSE COUNSEL. PART IV, LINE 2C, COLUMN A: A REBATE CALCULATION WAS PERFORMED ON 10/01/2017 WITH NO REBATE DUE. FORM 990, PART I, LINE 5 AND PART V, LINE 2 FROEDTERT HEALTH, INC. IS THE COMMON LAW EMPLOYER FOR THE FROEDTERT HEALTH SYSTEM WHICH INCLUDES FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC., FROEDTERT HOSPITAL FOUNDATION, INC., COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, INC., COMMUNITY MEMORIAL FOUNDATION OF MENOMONEE FALLS, INC., ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC., ST. JOSEPH'S COMMUNITY FOUNDATION, INC. AND COMMUNITY OUTPATIENT HEALTH SERVICES OF MENOMONEE FALLS, INC. CENTRALLY MANAGED CORPORATE ACCOUNTING POLICY EFFECTIVE JULY 1, 2013, FROEDTERT HEALTH, INC. ADOPTED AN INTERNAL ACCOUNTING POLICY FOR CERTAIN BALANCE SHEET AND INCOME STATEMENT MATTERS THAT ARE CENTRALLY MANAGAGED BY FROEDTERT HEALTH AS THE PARENT CORPORATION.THE POLICY STATES THAT ASSETS AND LIABILITIES RELATED TO CENTRALLY MANAGED PROGRAMS WILL BE ACCOUNTED FOR ON THE PARENT CORPORATION'S CONSOLIDATED BALANCE SHEET AND WILL NOT BE ALLOCATED TO ANY OF THE AFFILIATE BALANCE SHEETS. AS A RESULT OF THIS NEW POLICY, FROEDTERT HEALTH, INC.'S BALANCE SHEET NOW INCLUDES LONG TERM INVESTMENTS, LONG TERM DEBT, AND THE RELATED SWAP LIABILITY FOR ALL THE CONSOLIDATED AFFILIATES. FORM 990, PART III, LINE 2 FROEDTERT HEALTH, INC. OWNS AND OPERATES A SMALL-SCALE ACUTE NEIGHBORHOOD HOSPITAL WITH MULTIPLE LOCATIONS DESIGNED TO TREAT MEDICAL EMERGENCIES THAT REQUIRE ATTENTION BEYOND AN URGENT CARE CLINIC'S CAPABILITY, AND WHICH GENERATE OUTPATIENT, INPATIENT, AND EMERGENCY DEPARTMENT REVENUE AND EXPENSES. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS OR FAMILY RELATIONSHIP OF OFFICERS, DIRECTORS, ETC. DAVID LUBAR AND KURT BECHTOLD - BUSINESS RELATIONSHIP MARY ELLEN STANEK AND JOHN SCHLIFSKE - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED TO SPECIFY THAT THE PAST CHAIRPERSON OF THE BOARD OF DIRECTORS SHALL SERVE AS AN OFFICER OF THE CORPORATION; AND TO SPECIFY THAT THE PAST CHAIRPERSON OF THE BOARD OF DIRECTORS IS ELIGIBLE TO SERVE A FOURTH THREE-YEAR TERM ON THE BOARD OF DIRECTORS AS AN EX-OFFICIO, VOTING MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS FROEDTERT HEALTH, INC. ACCOUNTING STAFF PREPARE FORM 990 WHICH IS REVIEWED BY FROEDTERT HEALTH, INC. FINANCIAL LEADERS. THE 990 IS THEN REVIEWED BY KPMG, FROEDTERT HEALTH, INC.'S OUTSIDE ACCOUNTING FIRM. NEXT, THE 990 IS PROVIDED TO THE FROEDTERT HEALTH, INC. FINANCE COMMITTEE AND BOARD OF DIRECTORS. FINALLY, THE 990 IS FILED AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS ON AN ANNUAL BASIS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DATA IS COMPILED, AND THE FROEDTERT HEALTH, INC. VICE PRESIDENT-CHIEF COMPLIANCE OFFICER (CCO) AND PRIVACY OFFICER, THE SENIOR VICE-PRESIDENT-GENERAL COUNSEL AND/OR DELEGATE WILL REVIEW ALL FORMS AND NOTIFICATIONS TO DETERMINE IF ANY CONFLICTS OF INTEREST EXIST IN THE DISCLOSURE DOCUMENTS. IF IT IS DETEMINED THAT A CONFLICT OF INTEREST EXISTS, THEN THE INDIVIDUAL MAKING THE DISCLOSURE SHALL BE RELIEVED OF HIS/HER OBLIGATIONS ON BEHALF OF FROEDTERT HEALTH, INC. 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 FROEDTERT HEALTH CCO AT LEAST ANNUALLY TO THE FROEDTERT HEALTH, INC. FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A COMPENSATION REVIEW & APPROVAL PROCESS - CEO & TOP MANAGEMENT IN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO 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 BOARD OF DIRECTORS. IN ADDITION, THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. LINE 15B COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES IN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S OFFICERS & KEY EMPLOYEES, 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 BOARD OF DIRECTORS. IN ADDITION, THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORD KEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE FROEDTERT HEALTH, INC.'S QUARTERLY FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC ONLINE THROUGH THE DIGITAL ASSURANCE CORPORATION, INC. WEBSITE. ANYONE CAN REGISTER TO RECEIVE ONGOING ACCESS TO AND NOTIFICATIONS REGARDING FINANCIAL STATEMENTS AT THE ONLINE WEBSITE. ADDITIONALLY, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE CORPORATE OFFICE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES MEDICAL: PROGRAM SERVICE EXPENSES 8,439,742. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,439,742. CONSULTING & PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 16,807,730. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,807,730. PURCHASED SERVICES GENERAL: PROGRAM SERVICE EXPENSES 41,987,967. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,987,967. FORM 990, PART XI, LINE 9: CHG IN ACC PENSION OTHER THAN NET PER BENEFIT COST 1,410,000. CONTRIBUTED CAPITAL NETWORK HEALTH PLAN -3,142,975. TRANSFER TO HEALTH SYSTEM 143,122,005. UNRESTRICTED CAPITAL CONTRIBUTIONS/DISTRIBUTIONS 5,350,000. CLOSING OPERATIONS WAUKESHA SURGERY CTR -571,320. 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