2021-05-06T13:18:48-05:00 2020-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-07-01 390816845 FROEDTERT SOUTH INC FROE 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 THOMAS J KELLEY VP & CFO 2625778113 2021-05-04 1 TERRI REXRODE CPA MST P00096513 9206620016 2021-05-04 2019 2022-09-23 18:48:47Z THOMAS J KELLEY 6308 8TH AVENUE KENOSHA WI 531435082 594010632 0 X WWW.FROEDTERTSOUTH.COM X 1910 WI FROEDTERT SOUTH, INC. IS COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL-BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. WE STRIVE TO RECRUIT AND RETAIN THE BEST PHYSICIANS AND STAFF AND PURCHASE THE BEST DIAGNOSTIC AND CURATIVE MEDICAL EQUIPMENT THAT OUR FINANCIAL RESOURCES WILL PERMIT. WE ALSO STRIVE TO BE ACCESSIBLE TO ALL MEMBERS OF OUR COMMUNITY WITH EMERGENT AND URGENT HEALTHCARE NEEDS, IRRESPECTIVE OF THEIR ABILITY TO PAY. THIS IS OUR COMMITTMENT TO THE QUALITY, ACCESSIBILITY AND AFFORDABILITY FUNDAMENTALS AFFECTING THE DELIVERY OF HEALTHCARE. 14 11 2887 109 154375 0 561278 212098 338796713 326901041 3891012 1246764 -17099 -35203 343231904 328324700 3125 14300 0 0 171936148 175968457 0 0 0 156466444 159421778 328405717 335404535 14826187 -7079835 533648652 529495112 94289723 82513565 439358929 446981547 X FROEDTERT SOUTH, INC. IS A COMPREHENSIVE REGIONAL HEALTHCARE SYSTEM THAT HAS SERVED SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS COMMUNITIES FOR MORE THAN 100 YEARS. FROEDTERT SOUTH PROVIDES SERVICES PRIMARILY THROUGH THE FROEDTERT KENOSHA HOSPITAL AND THE FROEDTERT PLEASANT PRAIRIE HOSPITAL AND SEVERAL OTHER CLINIC LOCATIONS.WE, AT FROEDTERT SOUTH, ARE COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. 0 0 280005759 14300 326746666 ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO ITS COMMUNITY. 2019 CHARITY CARE $3,793,145 CHARITY CARE IS DEFINED AS FREE OR DISCOUNTED HEALTH SERVICES PROVIDED TO THOSE WHO CANNOT AFFORD TO PAY AND WHO MEET ALL CRITERIA FOR FINANCIAL ASSISTANCE. CHARITY CARE IS BASED ON ACTUAL COSTS, NOT CHARGES, AND DOES NOT INCLUDE BAD DEBT. UNREIMBURSED COST OF PUBLIC PROGRAMS $30,231,948. UNREIMBURSED COST OF PUBLIC PROGRAMS IS DEFINED AS THE SHORTFALL EXPERIENCED WHEN PAYMENTS RECEIVED ARE BELOW THE COST OF TREATING PUBLIC BENEFICIARIES THROUGH MEDICAID AND OTHER LOCAL PUBLIC PROGRAMS. COMMUNITY HEALTH IMPROVEMENT SERVICES $840,427. COMMUNITY HEALTH IMPROVEMENT SERVICES ARE DEFINED AS CLINICAL AND NON-CLINICAL SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH, WHICH ARE PROVIDED TO THE COMMUNITY FOR FREE OR FOR FEES THAT DID NOT COVER COSTS. FINANCIAL CONTRIBUTIONS $295,729. FINANCIAL CONTRIBUTIONS ARE DEFINED AS CONTRIBUTIONS, INCLUDING CASH, NON-CASH ITEMS SUCH AS FOOD, FURNITURE, EQUIPMENT, SUPPLIES, AND LOANED STAFF FOR VOLUNTEER AND CHARITABLE PURPOSES, MADE TO INDIVIDUALS, COMMUNITY GROUPS, OR NONPROFIT ORGANIZATIONS FOR CHARITABLE PURPOSES. HEALTH PROFESSIONS EDUCATION $3,329. HEALTH PROFESSIONS EDUCATION IS DEFINED AS DIRECT COSTS INCURRED FOR ACCREDITED TRAINING AND EDUCATION PROGRAMS FOR PHYSICIANS, NURSES, ALLIED HEALTH PROFESSIONALS AND TECHNICIANS (DOES NOT INCLUDE ONGOING EDUCATION FOR STAFF). COMMUNITY BUILDING ACTIVITIES $350,157. COMMUNITY BUILDING ACTIVITIES ARE DEFINED AS PROGRAMS THAT, WHILE NOT DIRECTLY RELATED TO HEALTH CARE, PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL ISSUES. COSTS FOR THESE ACTIVITIES INCLUDE CASH AND IN-KIND DONATIONS. COMMUNITY BENEFIT OPERATIONS $6,659. COMMUNITY BENEFIT OPERATIONS ARE DEFINED AS COSTS ASSOCIATED WITH DEDICATED STAFF AND COMMUNITY HEALTH NEEDS AND/OR ASSETS ASSESSMENT, AS WELL AS, OTHER COSTS ASSOCIATED WITH COMMUNITY BENEFIT STRATEGY AND OPERATIONS. TOTAL BENEFIT TO THE COMMUNITY FOR 2019 $35,521,394. 280005759 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 75 0 2887 1 1 1 0 0 0 0 1 1 0 0 0 0 1 0 X 14 11 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X JENS EMERSON 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 45.00 2.00 X X 1426039 0 147453 DAVID KNIGHT PHYSICIAN 40.00 X 1282764 0 23284 NEIL BHAMB PHYSICIAN 40.00 X 799421 0 33780 NEIL SHEPLER PHYSICIAN 40.00 X 748677 0 43039 KEVIN FULLIN PHYSICIAN 40.00 X 681303 0 35964 MARIO GARRETTO MD DIRECTOR/PHYSICIAN 40.00 X 664081 0 37202 PHILLIP CHUNG PHYSICIAN 40.00 X 646524 0 37229 SUSAN VENTURA SVP/COO 45.00 X 617643 0 55430 LINDA WOHLGEMUTH ASST SECRETARY/SVP-COO 45.00 X 616584 0 55077 THOMAS KELLEY ASST TREASURER/VP-CFO 45.00 X 565721 0 72188 THOMAS AMBRO MD DIRECTOR/PHYSICIAN 40.00 X 340026 0 52744 DR F GREGORY CAMPBELL CHAIRMAN 2.00 2.00 X X 0 0 0 TODD BATTLE DIRECTOR 2.00 X X 0 0 0 ROBERT LEE JR DIRECTOR 2.00 X X 0 0 0 THOMAS P MAHONEY DIRECTOR 2.00 X X 0 0 0 HAROLD W MAYER DIRECTOR 2.00 X X 0 0 0 DAVID R RILEY DIRECTOR 2.00 X X 0 0 0 MIKE GENTILE DIRECTOR 2.00 X 0 0 0 CATHERINE JACOBSON DIRECTOR 2.00 2.00 X 0 0 0 MICHAEL PITTS DIRECTOR 2.00 X 0 0 0 DEAN THOMAS DIRECTOR 2.00 2.00 X 0 0 0 GARY ZAID MD DIRECTOR/PHYSICIAN 2.00 X 0 0 0 8388783 0 593390 172 0 1 0 RILEY CONSTRUCTION 5301 99TH AVE KENOSHA WI 53144 BUILDING CONSTRUCTION 23665766 AEROTEK COMMERCIAL STAFFING PO BOX 198531 ATLANTA GA 30384 STAFFING 3311245 ALLSCRIPTS HEALTHCARE 24630 NETWORK PLACE CHICAGO IL 60673 IS SERVICES 2631395 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 STAFFING 1842340 INFINITY HEALTHCARE 7032 COLLECTION CENTER CHICAGO IL 60693 MEDICAL 1632919 53 49685 162413 212098 NET PATIENT SERVICE REVENUE 623000 314295560 314295560 OTHER OPERATING REVENUE 623990 12444402 12290027 154375 MEDICAL OFFICE RENTAL 900099 161079 161079 326901041 2685099 2685099 264157954 22300 263918589 1700000 239365 -1677700 -1438335 -1438335 18065 49685 65695 -47630 -47630 14075 1648 12427 12427 328324700 326746666 154375 1211561 14300 14300 5091388 4178879 912509 135566431 113076828 22489603 6398838 4267711 2131127 19763098 11653767 8109331 9148702 7628985 1519717 236895 236895 105000 105000 29633655 26668684 2964971 391283 82607 308676 1405679 824007 581672 11107145 2185136 8922009 6361502 6212818 148684 473522 155219 318303 26356975 23721278 2635697 972261 268666 703595 SUPPLIES 31964362 30937724 1026638 DRUGS 27773355 27773355 BAD DEBTS 8047119 8047119 PROVIDER TAX ASSESSMENT 6865688 6865688 7727337 5442988 2284349 335404535 280005759 55398776 0 24083525 50205435 52259843 44414533 10000000 5000000 5867944 7539542 6400325 6822229 563064503 313623385 249768545 249441118 168268124 149690755 17000346 16381500 533648652 529495112 29592420 30377565 10000000 5000000 54697303 47136000 94289723 82513565 X 436933535 444453156 2425394 2528391 439358929 446981547 533648652 529495112 X -7079835 1104233 13598220 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2425394 117297 14300 2528391 2360682 67837 3125 2425394 2296413 76069 11800 2360682 2168810 136903 9300 2296413 2050490 125683 7363 2168810 0.00000 0.60120 0.39880 0 0 17348877 17348877 385457326 195672747 189784579 154757296 117950638 36806658 5501004 5501004 249441118 DEFERRED COMPENSATION 22030544 PENSION LIABILITY 25105456 47136000 334965734 1104233 5536801 6641034 328324700 0 328324700 327343116 0 327343116 8061419 8061419 335404535 PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE RESTRICTED FOR EDUCATION SCHOLARSHIP GRANTS AND VARIOUS HEALTH CARE PROGRAMS. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE FOR HOSPITAL DEVELOPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE 5,641,437. SCHOLARSHIPS INCLUDED IN INCOME -14,300. BAD DEBT EXPENSE -8,047,119. PERIODIC BENEFIT COST 7,956,783. PART XII, LINE 4B - OTHER ADJUSTMENTS: SCHOLARSHIPS INCLUDED IN INCOME 14,300. BAD DEBT EXPENSE 8,047,119. GOLF OUTING 67750 49685 18065 1938 43323 20434 67750 49685 18065 1938 43323 20434 65695 -47630 1 1 X 1 X 250.000000000000 1 X 1 1 1 0 1 1 3793145 3793145 0.01160 52043097 21811149 30231948 0.09240 55836242 21811149 34025093 0.10400 847086 847086 0.00260 3329 3329 0.00000 295729 295729 0.00090 1146144 1146144 0.00350 56982386 21811149 35171237 0.10750 13329 13329 0.00000 274752 274752 0.00080 57415 57415 0.00020 4661 4661 0.00000 350157 350157 0.00100 1 3770899 0 50027770 72154419 -22126649 X 1 1 2 1 FROEDTERT KENOSHA HOSPITAL 6308 8TH AVENUE KENOSHA WI 53143 WWW.FROEDTERTSOUTH.COM 22 X X X 2 FROEDTERT PLEASANT PRAIRIE HOSPITAL 9555 76TH STREET PLEASANT PRAIRIE WI 53158 WWW.FROEDTERTSOUTH.COM 305 X X X FROEDTERT KENOSHA HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, PAGE 8 X X 1 19 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X X X X X X 1 X 0 X X X X 1 X 0 0 FROEDTERT PLEASANT PRAIRIE HOSPITAL 2 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE PART V, PAGE 8 X X 1 19 1 SEE PART V, PAGE 8 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X HTTP://WWW.FROEDTERTSOUTH.COM/PATIENTS-VISITORS/BILLING/ X X X X X X 1 X 0 X X X X 1 X 0 0 FROEDTERT KENOSHA HOSPITAL PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, 25 INTERVIEWS AND TWO FOCUS GROUPS, A TOTAL OF 39 KEY INFORMANTS WERE CONDUCTED WITH KEY INFORMANTS IN KENOSHA COUNTY WHO WERE IDENTIFIED BY THE KENOSHA COUNTY DIVISION OF HEALTH, FROEDTERT SOUTH, AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, KENOSHA COMMUNITY HEALTH CENTER, AND UNITED WAY OF KENOSHA COUNTY. AMONG THE KEY INFORMANTS WERE LEADERS FROM PUBLIC HEALTH, EDUCATION, AND COMMUNITY ORGANIZATIONS. THESE KEY INFORMANTS REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED, INCLUDING MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS. THE INTERVIEWERS USED A STANDARD INTERVIEW SCRIPT THAT INCLUDED THE FOLLOWING ELEMENTS: RANKING OF UP TO FIVE PUBLIC HEALTH ISSUES, BASED ON THE FOCUS AREAS PRESENTED IN WISCONSIN'S STATE HEALTH PLAN, THAT ARE THE MOST IMPORTANT ISSUES FOR THE COUNTY; AND FOR THOSE FIVE PUBLIC HEALTH ISSUES: O EXISTING STRATEGIES TO ADDRESS THE ISSUE. O BARRIERS AND CHALLENGES TO ADDRESSING THE ISSUE. O ADDITIONAL STRATEGIES NEEDED. O KEY GROUPS IN THE COMMUNITY THAT HOSPITALS SHOULD PARTNER WITH TO IMPROVE COMMUNITY HEALTH. O IDENTIFICATION OF SUBGROUPS OR SUBPOPULATIONS WHERE EFFORTS COULD BE TARGETED. O WAYS EFFORTS CAN BE TARGETED TOWARD EACH SUBGROUP OR SUBPOPULATION. ALL INFORMANTS WERE MADE AWARE THAT PARTICIPATION WAS VOLUNTARY AND THAT RESPONSES WOULD BE SHARED WITH THE CENTER FOR URBAN POPULATION HEALTH FOR ANALYSIS AND REPORTING. BASED ON THE SUMMARIES PROVIDED TO THE CENTER FOR URBAN POPULATION HEALTH, THE REPORT PRESENTS THE RESULTS OF THE 2019 KEY INFORMANT INTERVIEWS FOR KENOSHA COUNTY. FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, 25 INTERVIEWS AND TWO FOCUS GROUPS, A TOTAL OF 39 KEY INFORMANTS WERE CONDUCTED WITH KEY INFORMANTS IN KENOSHA COUNTY WHO WERE IDENTIFIED BY THE KENOSHA COUNTY DIVISION OF HEALTH, FROEDTERT SOUTH, AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, KENOSHA COMMUNITY HEALTH CENTER, AND UNITED WAY OF KENOSHA COUNTY. AMONG THE KEY INFORMANTS WERE LEADERS FROM PUBLIC HEALTH, EDUCATION, AND COMMUNITY ORGANIZATIONS. THESE KEY INFORMANTS REPRESENT THE BROAD INTEREST OF THE COMMUNITY SERVED, INCLUDING MEDICALLY UNDERSERVED, LOW INCOME AND MINORITY POPULATIONS. THE INTERVIEWERS USED A STANDARD INTERVIEW SCRIPT THAT INCLUDED THE FOLLOWING ELEMENTS: RANKING OF UP TO FIVE PUBLIC HEALTH ISSUES, BASED ON THE FOCUS AREAS PRESENTED IN WISCONSIN'S STATE HEALTH PLAN, THAT ARE THE MOST IMPORTANT ISSUES FOR THE COUNTY; AND FOR THOSE FIVE PUBLIC HEALTH ISSUES: O EXISTING STRATEGIES TO ADDRESS THE ISSUE. O BARRIERS AND CHALLENGES TO ADDRESSING THE ISSUE. O ADDITIONAL STRATEGIES NEEDED. O KEY GROUPS IN THE COMMUNITY THAT HOSPITALS SHOULD PARTNER WITH TO IMPROVE COMMUNITY HEALTH. O IDENTIFICATION OF SUBGROUPS OR SUBPOPULATIONS WHERE EFFORTS COULD BE TARGETED. O WAYS EFFORTS CAN BE TARGETED TOWARD EACH SUBGROUP OR SUBPOPULATION. ALL INFORMANTS WERE MADE AWARE THAT PARTICIPATION WAS VOLUNTARY AND THAT RESPONSES WOULD BE SHARED WITH THE CENTER FOR URBAN POPULATION HEALTH FOR ANALYSIS AND REPORTING. BASED ON THE SUMMARIES PROVIDED TO THE CENTER FOR URBAN POPULATION HEALTH, THE REPORT PRESENTS THE RESULTS OF THE 2019 KEY INFORMANT INTERVIEWS FOR KENOSHA COUNTY. FROEDTERT KENOSHA HOSPITAL PART V, SECTION B, LINE 6A: AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND FROEDTERT PLEASANT PRAIRIE HOSPITAL FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 6A: AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND FROEDTERT KENOSHA HOSPITAL FROEDTERT KENOSHA HOSPITAL PART V, SECTION B, LINE 6B: AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, UNITED WAY OF KENOSHA COUNTY, FROEDTERT PLEASANT PRAIRIE HOSPITAL, AND KENOSHA COUNTY PUBLIC HEALTH DEPARTMENT ALONG WITH JKV RESEARCH, LLC, AND CENTER FOR URBAN POPULATION HEALTHFROEDTERT KENOSHA HOSPITAL:PART V, SECTION B, LINE 7A:HTTP://WWW.FROEDTERTSOUTH.COM/ABOUT/COMMUNITY-BENEFITS/ FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 6B: AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, UNITED WAY OF KENOSHA COUNTY, FROEDTERT KENOSHA HOSPITAL, AND KENOSHA COUNTY PUBLIC HEALTH DEPARTMENT ALONG WITH JKV RESEARCH, LLC, AND CENTER FOR URBAN POPULATION HEALTHFROEDTERT PLEASANT PRAIRIE HOSPITAL:PART V, SECTION B, LINE 7A:HTTP://WWW.FROEDTERTSOUTH.COM/ABOUT/COMMUNITY-BENEFITS/ FROEDTERT KENOSHA HOSPITAL PART V, SECTION B, LINE 7D: FROEDTERT SOUTH WORKED IN COLLABORATION WITH SEVERAL UNRELATED HOSPITAL ORGANIZATIONS FACILITIES, GOVERNMENTAL DEPARTMENTS, AND NONPROFIT ORGANIZATIONS, INCLUDING AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND THE KENOSHA COMMUNITY HEALTH CENTER TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR CALENDAR YEARS 2020 THROUGH 2022, AND ADOPTED AN IMPLEMENTATION STRATEGY TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA PRIOR TO THE EXTENDED DEADLINE DATE OF DECEMBER 31, 2020 (AS EXTENDED BY THE IRS PURSUANT TO NOTICE 2020-56). CONSISTENT WITH THE REQUIREMENTS OF SECTION 501(R)(3), FROEDTERT SOUTH'S CHNA [1] DEFINED THE COMMUNITY IT SERVES, [2] ASSESSED THE HEALTH NEEDS OF THE KENOSHA COUNTY COMMUNITY, [3] INCLUDED SIGNIFICANT FEEDBACK FROM INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE KENOSHA COUNTY COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, [4] WAS DOCUMENTED IN A WRITTEN REPORT THAT WAS ADOPTED FOR THE HOSPITAL FACILITY AND [5] WAS MADE WIDELY AVAILABLE TO THE PUBLIC IN PAPER FORMAT AT THE HOSPITAL FACILITIES, FOR PUBLIC INSPECTION, AND UPON REQUEST PRIOR TO THE EXTENDED DEADLINE DATE OF DECEMBER 31, 2020. HOWEVER, FROEDTERT SOUTH WAS UNABLE TO MAKE THE CHNA WIDELY AVAILABLE, VIA THE FROEDTERT SOUTH WEBSITE UNTIL SHORTLY AFTER THE DECEMBER 31, 2020, DATE RESULTING FROM A REBUILD OF ITS FACILITY WEBSITE, WHICH DID NOT GO LIVE UNTIL SHORTLY AFTER THE EXTENDED DEADLINE DATE. HAVING SAID THAT, CHNA SURVEY AND REPORT FOR CALENDAR YEARS 2020 THROUGH 2022 CONDUCTED WITH AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND THE KENOSHA COMMUNITY HEALTH CENTER WAS PUBLISHED AND MADE WIDELY AVAILABLE VIA THEIR RESPECTIVE WEBSITES ON, OR BEFORE, DECEMBER 31, 2020.FROEDTERT KENOSHA HOSPITAL:PART V, SECTION B, LINE 10A:HTTP://WWW.FROEDTERTSOUTH.COM/ABOUT/COMMUNITY-BENEFITS/ FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 7D: FROEDTERT SOUTH WORKED IN COLLABORATION WITH SEVERAL UNRELATED HOSPITAL ORGANIZATIONS FACILITIES, GOVERNMENTAL DEPARTMENTS, AND NONPROFIT ORGANIZATIONS, INCLUDING AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND THE KENOSHA COMMUNITY HEALTH CENTER TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR CALENDAR YEARS 2020 THROUGH 2022, AND ADOPTED AN IMPLEMENTATION STRATEGY TO MEET THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA PRIOR TO THE EXTENDED DEADLINE DATE OF DECEMBER 31, 2020 (AS EXTENDED BY THE IRS PURSUANT TO NOTICE 2020-56). CONSISTENT WITH THE REQUIREMENTS OF SECTION 501(R)(3), FROEDTERT SOUTH'S CHNA [1] DEFINED THE COMMUNITY IT SERVES, [2] ASSESSED THE HEALTH NEEDS OF THE KENOSHA COUNTY COMMUNITY, [3] INCLUDED SIGNIFICANT FEEDBACK FROM INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE KENOSHA COUNTY COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH, [4] WAS DOCUMENTED IN A WRITTEN REPORT THAT WAS ADOPTED FOR THE HOSPITAL FACILITY AND [5] WAS MADE WIDELY AVAILABLE TO THE PUBLIC IN PAPER FORMAT AT THE HOSPITAL FACILITIES, FOR PUBLIC INSPECTION, AND UPON REQUEST PRIOR TO THE EXTENDED DEADLINE DATE OF DECEMBER 31, 2020. HOWEVER, FROEDTERT SOUTH WAS UNABLE TO MAKE THE CHNA WIDELY AVAILABLE, VIA THE FROEDTERT SOUTH WEBSITE UNTIL SHORTLY AFTER THE DECEMBER 31, 2020, DATE RESULTING FROM A REBUILD OF ITS FACILITY WEBSITE, WHICH DID NOT GO LIVE UNTIL SHORTLY AFTER THE EXTENDED DEADLINE DATE. HAVING SAID THAT, CHNA SURVEY AND REPORT FOR CALENDAR YEARS 2020 THROUGH 2022 CONDUCTED WITH AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, AND THE KENOSHA COMMUNITY HEALTH CENTER WAS PUBLISHED AND MADE WIDELY AVAILABLE VIA THEIR RESPECTIVE WEBSITES ON, OR BEFORE, DECEMBER 31, 2020.FROEDTERT PLEASANT PRAIRIE HOSPITAL:PART V, SECTION B, LINE 10A:HTTP://WWW.FROEDTERTSOUTH.COM/ABOUT/COMMUNITY-BENEFITS/ FROEDTERT KENOSHA HOSPITAL PART V, SECTION B, LINE 11: USING THESE CRITERIA, FROEDTERT SOUTH PRIORITIZED THE FOLLOWING SIGNIFICANT HEALTH NEEDS TO ADDRESS IN THE 2020-2022 IMPLEMENTATION STRATEGY: REDUCE BARRIERS FOR PATIENTS TO ACCESS CARE.O GOAL: ACCESS AND IMPROVE ACCESS TO CARE FOR MEDICALLY UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES AND POPULATIONS. STRATEGY 1: INCREASE PATIENT CAPACITY WITHIN THE FROEDTERT SOUTH MEDICAL GROUP THROUGH RECRUITMENT AND RETENTION OF PHYSICIANS AND MID-LEVEL PROVIDERS WITHIN THE FROEDTERT SOUTH MEDICAL GROUP. STRATEGY 2: ENHANCE AND EXPAND TELEMEDICINE OPPORTUNITIES. STRATEGY 3: ENHANCE AWARENESS OF AVAILABLE SERVICES OFFERED THROUGH FROEDTERT SOUTH AND THE FROEDTERT SOUTH MEDICAL GROUP. STRATEGY 4: WORK IN COLLABORATION WITH INTERNAL AND EXTERNAL RESOURCES TO ASSIST PATIENTS AS IT RELATES TO DETERMINING ELIGIBILITY FOR MEDICAID, CHIP AND ACA MARKETPLACE ENROLLMENT, INCLUDING SPECIAL ENROLLMENT PERIODS, AND ELIGIBILITY TO ASSIST IN REMOVING BARRIERS TO CARE. FOCUS ON HEALTH OUTREACH AND EDUCATION - CORONAVIRUS/COVID-19 PANDEMIC RESPONSEO GOAL: INCREASE THE AMOUNT OF OUTREACH AND EDUCATION RESOURCES AVAILABLE TO KENOSHA COUNTY RESIDENTS DURING THE COVID-19 PANDEMIC. STRATEGY 1: LAUNCH A DRIVE-THRU COVID-19 TESTING FACILITY TO AID THE COMMUNITY WITH ACCESSIBLE, AND CONVENIENT, COVID-19 TESTING. STRATEGY 2: ENHANCE AND EXPAND TELEMEDICINE OPPORTUNITIES IN ORDER TO PROVIDE NECESSARY CARE FOR PATIENTS WHILE MINIMIZING THE TRANSMISSION RISK OF COVID-19. STRATEGY 3: IMPLEMENT APPROPRIATE PROTOCOLS, INCLUDING A COVID-19 TESTING PROTOCOL FOR PATIENTS SCHEDULED FOR ELECTIVE SURGICAL CASES AND PROCEDURES. STRATEGY 4: DEVELOP A COVID-19 VACCINATION CLINIC TO AID THE KENOSHA COUNTY HEALTH DEPARTMENT IN AN EFFORT TO OBTAIN HERD IMMUNITY WITHIN KENOSHA COUNTY. INCREASE AWARENESS OF PREVENTION METHODS, SCREENINGS, AND CARE FOR CHRONIC DISEASES.O GOAL: EXPAND AND TARGET EDUCATIONAL PROGRAMS TO REACH A LARGER AUDIENCE IN THE AT-RISK POPULATIONS. STRATEGY 1: IMPLEMENT THE EPIC ELECTRONIC HEALTH RECORD TO PROVIDE A GREATER ABILITY TO COMMUNICATE INFORMATION TO PATIENTS OF FROEDTERT SOUTH VIA MYCHART, AND OTHER, SIMILAR MECHANISMS. STRATEGY 2: ENHANCE AND EXPAND THE USE OF RECALL/FOLLOW-UP MECHANISMS TO IMPROVE THE ABILITY FOR FROEDTERT SOUTH TO ENSURE PATIENTS ARE RECEIVING ROUTINE PREVENTATIVE CARE AS RECOMMENDED BY THE U.S. PREVENTATIVE TASK FORCE. STRATEGY 3: INCREASE THE KNOWLEDGE OF HIGH-RISK POPULATIONS ON WAYS TO MANAGE CHRONIC DISEASES. FROEDTERT PLEASANT PRAIRIE HOSPITAL PART V, SECTION B, LINE 11: USING THESE CRITERIA, FROEDTERT SOUTH PRIORITIZED THE FOLLOWING SIGNIFICANT HEALTH NEEDS TO ADDRESS IN THE 2020-2022 IMPLEMENTATION STRATEGY: REDUCE BARRIERS FOR PATIENTS TO ACCESS CARE.O GOAL: ACCESS AND IMPROVE ACCESS TO CARE FOR MEDICALLY UNDERSERVED AND VULNERABLE GROUPS OF ALL AGES AND POPULATIONS. STRATEGY 1: INCREASE PATIENT CAPACITY WITHIN THE FROEDTERT SOUTH MEDICAL GROUP THROUGH RECRUITMENT AND RETENTION OF PHYSICIANS AND MID-LEVEL PROVIDERS WITHIN THE FROEDTERT SOUTH MEDICAL GROUP. STRATEGY 2: ENHANCE AND EXPAND TELEMEDICINE OPPORTUNITIES. STRATEGY 3: ENHANCE AWARENESS OF AVAILABLE SERVICES OFFERED THROUGH FROEDTERT SOUTH AND THE FROEDTERT SOUTH MEDICAL GROUP. STRATEGY 4: WORK IN COLLABORATION WITH INTERNAL AND EXTERNAL RESOURCES TO ASSIST PATIENTS AS IT RELATES TO DETERMINING ELIGIBILITY FOR MEDICAID, CHIP AND ACA MARKETPLACE ENROLLMENT, INCLUDING SPECIAL ENROLLMENT PERIODS, AND ELIGIBILITY TO ASSIST IN REMOVING BARRIERS TO CARE. FOCUS ON HEALTH OUTREACH AND EDUCATION - CORONAVIRUS/COVID-19 PANDEMIC RESPONSEO GOAL: INCREASE THE AMOUNT OF OUTREACH AND EDUCATION RESOURCES AVAILABLE TO KENOSHA COUNTY RESIDENTS DURING THE COVID-19 PANDEMIC. STRATEGY 1: LAUNCH A DRIVE-THRU COVID-19 TESTING FACILITY TO AID THE COMMUNITY WITH ACCESSIBLE, AND CONVENIENT, COVID-19 TESTING. STRATEGY 2: ENHANCE AND EXPAND TELEMEDICINE OPPORTUNITIES IN ORDER TO PROVIDE NECESSARY CARE FOR PATIENTS WHILE MINIMIZING THE TRANSMISSION RISK OF COVID-19. STRATEGY 3: IMPLEMENT APPROPRIATE PROTOCOLS, INCLUDING A COVID-19 TESTING PROTOCOL FOR PATIENTS SCHEDULED FOR ELECTIVE SURGICAL CASES AND PROCEDURES. STRATEGY 4: DEVELOP A COVID-19 VACCINATION CLINIC TO AID THE KENOSHA COUNTY HEALTH DEPARTMENT IN AN EFFORT TO OBTAIN HERD IMMUNITY WITHIN KENOSHA COUNTY. INCREASE AWARENESS OF PREVENTION METHODS, SCREENINGS, AND CARE FOR CHRONIC DISEASES.O GOAL: EXPAND AND TARGET EDUCATIONAL PROGRAMS TO REACH A LARGER AUDIENCE IN THE AT-RISK POPULATIONS. STRATEGY 1: IMPLEMENT THE EPIC ELECTRONIC HEALTH RECORD TO PROVIDE A GREATER ABILITY TO COMMUNICATE INFORMATION TO PATIENTS OF FROEDTERT SOUTH VIA MYCHART, AND OTHER, SIMILAR MECHANISMS. STRATEGY 2: ENHANCE AND EXPAND THE USE OF RECALL/FOLLOW-UP MECHANISMS TO IMPROVE THE ABILITY FOR FROEDTERT SOUTH TO ENSURE PATIENTS ARE RECEIVING ROUTINE PREVENTATIVE CARE AS RECOMMENDED BY THE U.S. PREVENTATIVE TASK FORCE. STRATEGY 3: INCREASE THE KNOWLEDGE OF HIGH-RISK POPULATIONS ON WAYS TO MANAGE CHRONIC DISEASES. FROEDTERT KENOSHA HOSPITAL: PART V, SECTION B, LINE 22B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL NOT BE CHARGED INDIVIDUALLY MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE ("AGB"). FURTHERMORE, CHARGES FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE LESS THAN THE GROSS CHARGES FOR SUCH SERVICES. THE ORGANIZATION CALCULATES ONE OR MORE AGB PERCENTAGES USING THE "LOOK-BACK METHOD AND INCLUDING MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE ORGANIZATION, ALL INACCORDANCE WITH 501(R). THESE CALCULATIONS ARE MADE AS FOLLOWS:1. THE ORGANIZATION DETERMINES AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (A) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES BY (B) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.2. "GROSS CHARGES" MEANS THE ORGANIZATION'S FULL, ESTABLISHED PRICE FOR MEDICAL CARE THAT THE ORGANIZATION CONSISTENTLY AND UNIFORMLY CHARGES PATIENTS BEFORE APPLYING ANY CONTRACTUAL ALLOWANCES, DISCOUNTS, OR DEDUCTIONS.3. THE "AGB PERIOD" MEANS EACH PRIOR 12-MONTH PERIOD ENDING ON DECEMBER 31ST.4. THE ORGANIZATION WILL BEGIN TO APPLY THE ANNUALLY DETERMINED AGB PERCENTAGE WITHIN 120 DAYS FOLLOWING THE END OF THE AGB PERIOD THAT WAS USED IN CALCULATION THE AGB PERCENTAGE.5. ANY CAPITALIZED TERMS NOT DEFINED IN THIS DOCUMENT WILL HAVE THE MEANING ASSIGNED TO SUCH TERM IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FROEDTERT PLEASANT PRAIRIE HOSPITAL: PART V, SECTION B, LINE 22B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL NOT BE CHARGED INDIVIDUALLY MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE FOR SUCH CARE ("AGB"). FURTHERMORE, CHARGES FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY WILL BE LESS THAN THE GROSS CHARGES FOR SUCH SERVICES. THE ORGANIZATION CALCULATES ONE OR MORE AGB PERCENTAGES USING THE "LOOK-BACK METHOD AND INCLUDING MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS THAT PAY CLAIMS TO THE ORGANIZATION, ALL INACCORDANCE WITH 501(R). THESE CALCULATIONS ARE MADE AS FOLLOWS:1. THE ORGANIZATION DETERMINES AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (A) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBLES BY (B) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.2. "GROSS CHARGES" MEANS THE ORGANIZATION'S FULL, ESTABLISHED PRICE FOR MEDICAL CARE THAT THE ORGANIZATION CONSISTENTLY AND UNIFORMLY CHARGES PATIENTS BEFORE APPLYING ANY CONTRACTUAL ALLOWANCES, DISCOUNTS, OR DEDUCTIONS.3. THE "AGB PERIOD" MEANS EACH PRIOR 12-MONTH PERIOD ENDING ON DECEMBER 31ST.4. THE ORGANIZATION WILL BEGIN TO APPLY THE ANNUALLY DETERMINED AGB PERCENTAGE WITHIN 120 DAYS FOLLOWING THE END OF THE AGB PERIOD THAT WAS USED IN CALCULATION THE AGB PERCENTAGE.5. ANY CAPITALIZED TERMS NOT DEFINED IN THIS DOCUMENT WILL HAVE THE MEANING ASSIGNED TO SUCH TERM IN THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. 6 1 - FROEDTERT SOMERS CLINIC 3400 MARKET LANE KENOSHA WI 53144 OUTPATIENT PHYSICIAN CLINIC 2 - FROEDTERT PRAIRIE RIDGE 9697 ST CATHERINES DRIVE PLEASANT PRAIRIE WI 53158 OUTPATIENT PHYSICIAN CLINIC 3 - FROEDTERT PADDOCK LAKE CLINIC 7322 236TH AVENUE SALEM WI 53168 OUTPATIENT PHYSICIAN CLINIC 4 - LAKEVIEW RECPLEX 9900 TERWALL TERRACE PLEASANT PRAIRIE WI 53158 REHABILITATION CLINIC 5 - YMCA PHYSICAL THERAPY 7101 53RD STREET KENOSHA WI 53144 REHABILITATION CLINIC 6 - RCW ADMINISTRATIVE BUILDING 5000 68TH AVE KENOSHA WI 53144 ADMINISTRATIVE BUILDING PART I, LINE 7: THE COST METHOD USED TO CALCULATE THE COST OF THE COMMUNITY BENEFIT PROGRAMS WAS THE COST-TO-CHARGE RATIO. WORKSHEET 2 WAS USED TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $8,047,119. PART II, COMMUNITY BUILDING ACTIVITIES: MANY STAFF MEMBERS ARE UTILIZED TO PROMOTE THE HEALTH OF THE COMMUNITY AND THE GENERAL WELL-BEING OF THE COMMUNITY WE SERVE. THROUGH OUR EMERGENCY PREPAREDNESS COMMITTEE, STAFF ARE ALWAYS PLANNING AND PREPARING TO BE READY TO MEET THE NEEDS OF THE COMMUNITY AS EVENTS OCCUR. ADDITIONALLY, A VARIETY OF STAFF WORK WITH LOCAL SCHOOLS AND OTHER ORGANIZATIONS TO GIVE TALKS PROMOTING HEALTH AND CAREERS IN HEALTHCARE. A NUMBER OF STAFF MEMBERS ARE INVOLVED IN MENTORING PROGRAMS WITHIN THE LOCAL SCHOOLS. RECOGNIZING THE IMPORTANCE OF SUSTAINING AND GROWING OUR ECONOMY, WE PARTICIPATE IN OUR LOCAL BUSINESS ALLIANCE. PART III, LINE 2: THE ORGANIZATIONS UTILIZED THE HMFA #15 METHODOLOGY FOR DETERMINING BAD DEBT EXPENSE. PART III, LINE 3: SINCE THE ORGANIZATION UTILIZES HMFA #15, THERE IS NO PORTION OF THE BAD DEBT THAT WOULD BE CONSIDERED CHARITY CARE. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION EXPERIENCE AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. WORKSHEET A IN THE INSTRUCTIONS WAS USED TO DETERMINE THE COSTING METHODOLOGY. PART III, LINE 8: SCHEDULE H PART III SECTION B LINE 6 REPORTS "ALLOWABLE COSTS OF CARE" AS TAKEN FROM THE MOST RECENTLY FILED MEDICARE COST REPORT AVAILABLE AT THE TIME THE COMMUNITY BENEFIT REPORT IS PUBLISHED. THE MEDICARE COST REPORT CALCULATES ITS ALLOWABLE TOTAL COSTS BASED ON APPLICABLE MEDICARE REGULATIONS. MEDICARE AND MEDICAID COST IS DETERMINED USING INDIVIDUAL COST CENTER COST-TO-CHARGE RATIOS. THIS COST TO CHARGE RATIO IS DETERMINED USING ALL PAYER COST AND ALL PAYER CHARGES. THE COST TO CHARGE RATIO IS APPLIED TO THE ACTUAL MEDICARE AND MEDICAID CHARGES TO DETERMINE THE MEDICARE AND MEDICAID COST. THIS ORGANIZATION HAS ADOPTED THE COST AND CHARGE PRACTICES AS RECOMMENDED BY THE CATHOLIC HEALTH ASSOCIATION AND THE WISCONSIN, IOWA, OR ILLINOIS HOSPITAL ASSOCIATION AS APPLICABLE, AND THEREFORE, DOES NOT COUNT ANY MEDICARE SHORTFALL NUMBERS IN ITS ANNUAL REPORTING OF COMMUNITY BENEFIT AMOUNTS. PART III, LINE 9B: OUR COLLECTION PROCESS IS THE SAME FOR ALL PATIENTS. IF A PATIENT EXPRESSES A NEED FOR FINANCIAL ASSISTANCE WE OFFER THE FINANCIAL ASSISTANCE APPLICATION. WE BILL ALL INSURANCES. PATIENT DOES NOT RECEIVE A COPY OF THE BILL UNTIL IT IS THEIR BALANCE. OUR EXTENDED BUSINESS OFFICE SENDS THREE STATEMENTS AND OUR REQUIRED FINAL REQUEST STATEMENT. FROM THIS POINT THE OUTSTANDING BALANCE IS HANDLED BY THE COLLECTION AGENCY. THE ACCOUNT DOES STAY ACTIVE ON OUR FINANCIAL SYSTEM FOR ONE YEAR. AT THAT TIME THE OUTSTANDING BALANCE IS MOVED OVER TO A BAD DEBT STATUS. PART VI, LINE 2: IN AN EFFORT TO UNDERSTAND AND ASSIST IN ADDRESSING THE NEEDS OF THE COMMUNITY WE SERVE, FROEDTERT SOUTH HAS INVOLVEMENT IN A VARIETY OF COMMUNITY COMMITTEES. FROEDTERT SOUTH HAS MULTIPLE STAFF, MANAGEMENT AND ADMINISTRATIVE LEVEL EMPLOYEES PARTICIPATE IN COMMITTEES THAT ARE SET UP TO ASSESS AND ADDRESS NEEDS IN THE COMMUNITY SUCH AS A HEALTHY LIFESTYLE COMMITTEE, MENTAL HEALTH COMMITTEE, INJURY PREVENTION COMMITTEE, SUICIDE PREVENTION COMMITTEE, INFANT MORTALITY COMMITTEE. THROUGH OUR PARTICIPATION IN COMMUNITY COMMITTEES WE GAIN AN UNDERSTANDING ABOUT THE NEEDS OF THE COMMUNITY AS WELL AS THE OPPORTUNITY TO WORK TOGETHER TO ADDRESS THE NEEDS. PART VI, LINE 3: WHEN STATEMENTS ARE SENT FROM OUR EXTENDED BUSINESS OFFICE, THERE IS A PHONE NUMBER FOR THE PATIENT TO CALL FOR ASSISTANCE WITH THEIR BALANCES. PATIENTS CALL AND THEY WORK WITH THEM TO SET UP PAYMENT ARRANGEMENTS. IF THEY EXPRESS ANY CONCERNS FOR FINANCIAL NEEDS THEY OFFER TO SEND THEM A COMMUNITY CARE APPLICATION. PART VI, LINE 4: KENOSHA COUNTY IS A FAST GROWING LAKESHORE COUMMUNITY IN SOUTHEASTERN WISCONSIN. LOCATED BETWEEN CHICAGO AND MILWAUKEE, KENOSHA COUNTY BOASTS A DIVERSE ECONOMY. KENOSHA IS THE FOURTH LARGEST CITY IN THE STATE OF WISCONSIN WITH 100,164 RESIDENTS REPORTED BY THE UNITED STATES CENSUS BUREAU IN THE 2018 POPULATION ESTIMATES. KENOSHA IS NOW THE EIGHTH LARGEST COUNTY IN WISCONSIN IN TERMS OF POPULATION WITH 169,561 RESIDENTS. FROEDTERT SOUTH SERVES PEOPLE IN SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS THROUGH ITS TWO HOSPITAL LOCATIONS, FROEDTERT PLEASANT PRAIRIE HOSPITAL AND FROEDTERT KENOSHA HOSPITAL. ADVOCATE AURORA MEDICAL CENTER ALSO HAS A HOSPITAL CAMPUS IN KENOSHA. PART VI, LINE 5: FROEDTERT SOUTH IS COMMITTED TO IMPROVING THE HEALTH OF OUR PATIENTS AND NEIGHBORS. WE OFFER A VARIETY OF COMMUNITY OUTREACH PROGRAMS TO HELP THE GENERAL PUBLIC MAINTAIN GOOD HEALTH. THESE INCLUDE FREE COMMUNITY EDUCATION SEMINARS, HEALTH SCREENINGS, AND VARIOUS SUPPORT GROUPS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SCHOLARSHIPS 10 14300 X X 0 1 0 0 0 0 0 0 0 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 973967 0 428292 0 23780 0 119236 0 28217 0 1573492 0 0 0 DAVID KNIGHT PHYSICIAN 572350 0 709943 0 471 0 19236 0 4048 0 1306048 0 0 0 NEIL BHAMB PHYSICIAN 799139 0 0 0 282 0 19236 0 14544 0 833201 0 0 0 NEIL SHEPLER PHYSICIAN 255013 0 491842 0 1822 0 19236 0 23803 0 791716 0 0 0 KEVIN FULLIN PHYSICIAN 664142 0 17161 0 0 0 19236 0 16728 0 717267 0 0 0 MARIO GARRETTO MD DIRECTOR/PHYSICIAN 644942 0 15153 0 3986 0 19236 0 17966 0 701283 0 0 0 PHILLIP CHUNG PHYSICIAN 608451 0 37500 0 573 0 19236 0 17993 0 683753 0 0 0 SUSAN VENTURA SVP/COO 507593 0 100423 0 9627 0 44236 0 11194 0 673073 0 0 0 LINDA WOHLGEMUTH ASST SECRETARY/SVP-COO 506534 0 100423 0 9627 0 44236 0 10841 0 671661 0 0 0 THOMAS KELLEY ASST TREASURER/VP-CFO 503540 0 61423 0 758 0 44236 0 27952 0 637909 0 0 0 THOMAS AMBRO MD DIRECTOR/PHYSICIAN 338358 0 0 0 1668 0 19236 0 33508 0 392770 0 0 0 PART I, LINE 4B INDIVIDUAL ELIGIBLE EMPLOYEES MAY PARTICIPATE IN A 457F PLAN. THE ORGANIZATION DOES NOT CONTRIBUTE TO THIS PLAN. THE FOLLOWING INDIVIDUALS PARTICIPATE IN THE PLAN: RICHARD SCHMIDT, NEIL SHEPLER, SUSAN VENTURA, LINDA WOHLGEMUTH, AND THOMAS KELLEY. ROBERT LEE DIRECTOR 276210 SERVICES PROVIDED BY LEE PLUMBING MECHANICAL CONTRACTOR, INC. ROBERT LEE OWNS LEE PLUMBING MECHANICAL CONTRACTOR, INC. 0 DAVID RILEY DIRECTOR 14755981 SERVICES PROVIDED BY RILEY CONSTRUCTION COMPANY, INC. DAVID RILEY OWNS RILEY CONSTRUCTION COMPANY, INC. 0 ROBERT LEE DIRECTOR 445513 SERVICES PROVIDED BY LEE ELECTRICAL, INC. ROBERT LEE OWNS LEE ELECTRICAL, INC. 0 FORM 990, PART VI, SECTION A, LINE 7B EACH CLASS A MEMBER OF FROEDTERT SOUTH, INC. SHALL HAVE THE FOLLOWING RIGHTS TO BE EXECUTED ONLY UPON THE MUTUAL AGREEMENT OF BOTH CLASS A MEMBERS: - TO INITIATE, ADOPT AND APPROVE AND AMEND FROEDTERT SOUTH, INC.'S GOVERNING DOCUMENTS; - TO ADOPT, AMEND AND APPROVE THE MISSION, VISION, VALUES, PHILOSOPHY AND OBJECTS OF FROEDTERT SOUTH, INC. - TO APPROVE THE SALE (WHETHER BY DIRECT SALE, LEASE, LEASE FINANCING, PLEDGE OR OTHERWISE) OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF FROEDTERT SOUTH, INC. AND ANY OTHER CONTROLLED CORPORATION, THE PURCHASE (WHETHER BY DIRECT PURCHASE, LEASE, LEASE FINANCING OR OTHERWISE), SALE OR OTHER DISPOSITION OF PROPERTY INVOLVING A MATERIAL DOLLAR AMOUNT, AND ANY LONG-TERM BORROWING (FOR A TERM OF MORE THAN ONE YEAR) BY FROEDTERT SOUTH, INC. OR ANY OTHER CONTROLLED CORPORATION INVOLVING A MATERIAL DOLLAR AMOUNT; - TO APPROVE THE DISSOLUTION, MERGER, CONSOLIDATION, AFFILIATION OR INTEGRATION (OR TRANSACTION OF SIMILAR IMPORT) OF FROEDTERT SOUTH, INC. WITH OR INTO ANY OTHER PERSON, OR TRANSFER OF ANY MEMBERSHIP INTEREST BY ANY CLASS A MEMBER; - TO APPROVE THE FORMATION AND GOVERNANCE OF ANY NEW CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES (INVOLVING CAPITALIZATION INVOLVING A MATERIAL DOLLAR AMOUNT) IN WHICH FROEDTERT SOUTH, INC. OR ANY OTHER CONTROLLED CORPORATION HAS AN INTEREST THROUGH MEMBERSHIP, VOTING STOCK OR OTHER EQUITY PARTICIPATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE ORGANIZATION'S CEO, CFO AND CONTROLLER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C FROEDTERT SOUTH'S WRITTEN CONFLICT OF INTEREST POLICY FOR THE BOARD IS REVIEWED ANNUALLY BY EACH BOARD MEMBER, AND ANY POTENTIAL CONFLICTS OF INTEREST ARE DISCLOSED AT THAT TIME. THE WRITTEN CONFLICT OF INTEREST POLICY FOR EMPLOYEES IS REVIEWED DURING ORIENTATION AND PERIODICALLY AT ORGANIZATION MEETINGS, AND IS INCORPORATED INTO THE PERFORMANCE STANDARDS OF THEIR ANNUAL EVALUATIONS. IF A CONFLICT ARISES, DEPENDING UPON THE NATURE OF THE FINANCIAL INTEREST AND WORK DONE BY THE BOARD, SEVERAL ACTIONS MAY BE CONSIDERED: THE BOARD MEMBER WITH A FINANCIAL INTEREST WOULD NEED TO VOLUNTARILY EXCUSE HIM OR HERSELF FROM THE DELIBERATIONS OR VOTING ON SUCH A MATTER; OR, IF NECESSARY, THE BOARD WOULD DETERMINE THAT THE SUBJECT'S FINANCIAL INTEREST WAS AN ACTUAL CONFLICT OF INTEREST, IN WHICH CASE THE BOARD MEMBER WOULD BE INFORMED BY THE BOARD CHAIRPERSON THAT HE OR SHE WOULD NOT BE ALLOWED TO VOTE IN ANY SUCH MATTERS DUE TO THIS REAL OR PERCEIVED CONFLICT OF INTEREST. MINUTES OF THE BOARD MEETING WOULD DOCUMENT THIS DECISION PROCESS, AND REFLECT WHATEVER ACTION(S) ARE ULTIMATELY TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE PRESIDENT, CEO AND GENERAL COUNSEL AND THE COMPENSATION FOR THE VICE PRESIDENTS REPORTING DIRECTLY TO THE PRESIDENT, CEO AND GENERAL COUNSEL ARE DETERMINED BY THE BOARD EXECUTIVE COMMITTEE WHICH SERVES AS THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE CONTRACTS WITH THE HEALTHCARE COMPENSATION FIRM NAMED THE GROVES GROUP, LLC, AND HAS UTILIZED THE PRESIDENT OF THE GROVES GROUP, LLC AS THE COMPENSATION CONSULTANT SINCE 2005. THE COMPENSATION CONSULTANT UTILIZES A METHODOLOGY THAT EVALUATES INTERNAL AND EXTERNAL EQUITY AFTER EVALUATING THE RESPONSIBILITIES OF EACH POSITION AND MAKES A RECOMMENDATION TO THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE HAS FOLLOWED THE DETAILED RECOMMENDATIONS OF THE COMPENSATION CONSULTANT ANNUALLY SINCE 2005 AND THE COMPENSATION CONSULTANT HAS BEEN RETAINED THROUGH 2019. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION OBLIGATION 5,641,437. PERIODIC BENEFIT COST 7,956,783. FSINC INC 6308 8TH AVENUE KENOSHA WI 53143 391956749 HEALTHCARE WI 501(C)(3) LINE 12B, II FROEDTERT SOUTH INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0