2024-05-07T11:21:42-05:00 2023-06-30 135565207 KPMG LLP 191 WEST NATIONWIDE BLVD SUITE 500 COLUMBUS OH 432152568 990 2022-07-01 392034296 ST JOSEPH'S COMMUNITY FOUNDATION INC STJO 2623345533 3200 PLEASANT VALLEY RD WEST BEND WI 53095 ALICIA M MAITLAND SVP - FINANCE 2623345533 2024-05-07 1 ALICIA MAITLAND XXX-XX-XXXX 0 MOLLIE P LONGHOUSE P00294881 6142492300 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z FROEDTERT WEST BEND HOSPITAL FOUNDATION ALLEN ERICSON 3200 PLEASANT VALLEY RD WEST BEND WI 53095 8799908 0 X WWW.FROEDTERT.COM/ST-JOSEPHS/FOUNDATION X 2002 WI TO IMPROVE THE HEALTH, WELLNESS AND EDUCATION OF THE COMMUNITY THROUGH THE DEVELOPMENT AND STEWARDSHIP OF PHILANTHROPIC RESOURCES IN SUPPORT OF ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND. 12 11 0 34 0 0 266843 193752 0 0 1064095 789753 -15984 33517 1314954 1017022 313143 286125 0 0 165438 198116 0 0 232333 36168 67422 514749 551663 800205 465359 21771634 23330780 604585 402357 21167049 22928423 X TO IMPROVE THE HEALTH, WELLNESS AND EDUCATION OF THE COMMUNITY THROUGH THE DEVELOPMENT AND STEWARDSHIP OF PHILANTHROPIC RESOURCES IN SUPPORT OF ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND. 0 0 230300 227000 0 SEE SCHEDULE O 59125 59125 0 ST. JOSEPH'S COMMUNITY FOUNDATION, INC. ISSUES SCHOLARSHIPS EACH YEAR FROM MONEY DONATED TO THE FOUNDATION FROM AN OUTSIDE DONOR. CURRENT YEAR SCHOLARSHIP EXPENSES TOTALED $59,125. 289425 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X X DAVE DIRKSMEYER 4148053000 N74W12501 LEATHERWOOD CT MENOMONEE FALLS WI 53051 ERICSON ALLEN DIRECTOR & SJH PRESIDENT 1.00 49.00 X X 0 1476512 164713 BREUER JOHN DIRECTOR 1.00 0.00 X 0 0 0 CHLUPP CHRIS DIRECTOR 1.00 0.00 X 0 0 0 FELTZ CHAD DIRECTOR (START JUL22) 1.00 0.00 X 0 0 0 GAMBUCCI JACCI DIRECTOR 1.00 0.00 X 0 0 0 HANSON TROY DIRECTOR 1.00 0.00 X 0 0 0 HERDRICH GARY DIRECTOR 1.00 0.00 X 0 0 0 SIEVERS DAREN DIRECTOR 1.00 0.00 X 0 0 0 SMITH AUSTIN DIRECTOR 1.00 0.00 X 0 0 0 ZUERN TOM DIRECTOR (START JUL22) 1.00 0.00 X 0 0 0 DAHLBERG AMY DIRECTOR & BOD V.CHAIR 1.00 0.00 X X 0 0 0 MILLER DAN DIRECTOR & BOD CHAIR 1.00 0.00 X X 0 0 0 MALZEWSKI MICHAEL TREASURER (TERM JUN23) 1.00 49.00 X 0 352212 43529 ALATALO DARCY FORMER - OFFICER (TREAS) 0.00 50.00 X 0 165323 30787 0 1994047 239029 0 1 1 0 0 68692 25000 100060 4524 193752 638633 638633 7919032 7767912 151120 151120 151120 48491 68692 14974 33517 33517 1017022 0 0 823270 X 227000 227000 59125 59125 184748 18475 166273 13368 1337 12031 1990 199 1791 MINOR EQUIPMENT 25463 2546 22917 HOSPITAL SUPPORT 14255 1286 12969 PRINTING & PUBLICATIONS 12976 1298 11678 ALL OTHER EXPENSE 7545 3300 4245 5193 519 4674 551663 289425 29905 232333 332197 251578 0 0 38664 21862 800 800 0 0 0 0 0 0 0 0 0 0 27248 27248 0 0 21399973 23056540 0 0 0 0 0 0 0 0 21771634 23330780 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 604585 402357 604585 402357 X 20771572 22507946 395477 420477 21167049 22928423 21771634 23330780 X 465359 1144036 151979 X 0 1 X 1 0 X 144283 227165 221662 266842 193752 1053704 144283 227165 221662 266842 193752 1053704 88010 965694 971440 1140403 902082 466968 638633 4119526 -9730 -9446 -22079 -15984 33517 -23722 5149508 0.18750 0.18480 X THERE ARE TWO REQUIREMENTS THAT ST. JOSEPH'S COMMUNITY FOUNDATION MUST FULFILL IN ORDER TO SATISFY THE FACTS-AND-CIRCUMSTANCES TEST SET FORTH IN TREAS. REG. 1.170A-9 (F) (3) (II). FIRST, THEY MUST DERIVE AT LEAST 10% OF ITS SUPPORT FROM GOVERNMENTAL UNITS OR FROM DIRECT OR INDIRECT CONTRIBUTIONS FROM THE GENERAL PUBLIC, OR A COMBINATION OF BOTH. ST. JOSEPH'S COMMUNITY FOUNDATION RECEIVED 18.75% OF ITS TOTAL SUPPORT FROM GOVERNMENT UNITS AND THE PUBLIC AND THEREFORE, ST. JOSEPH'S COMMUNITY FOUNDATION HAS SATISFIED THIS FIRST REQUIREMENT. SECOND, ST. JOSEPH'S COMMUNITY FOUNDATION MUST MAINTAIN A CONTINUOUS AND BONAFIDE FUNDRAISING PROGRAM OR CARRY ON PROGRAMS DESIGNED TO ATTRACT SUPPORT FROM GOVERNMENTAL UNITS OR OTHER PUBLIC CHARITIES DESCRIBED IN IRC 170 (B) (1) (A) (I) THROUGH (VI). ST. JOSEPH'S COMMUNITY FOUNDATION MAINTAINS SEVERAL FUNDRAISING PROGRAMS AND INITIATIVES, EACH OF WHICH IS DESIGNED TO ATTRACT SUPPORT FROM THE PUBLIC. ST. JOSEPH'S COMMUNITY FOUNDATION CONDUCTS A MID-YEAR AND YEAR-END DIRECT MAIL CONTRIBUTIONS SOLICITATION PROGRAM, AN ANNUAL STAFF GIVING CAMPAIGN, A GRATEFUL PATIENT PROGRAM WHICH INVOLVES WORKING WITH INDIVIDUALS WHO HAVE BENEFITTED FROM THE CARE THEY RECEIVED AT ST. JOSEPH'S COMMUNITY HOSPITAL, AND A MEMORIAL DONATION PROGRAM OR WORKING WITH FAMILIES WHO HAVE LOST A LOVED ONE. ST. JOSEPH'S COMMUNITY FOUNDATION ALSO CONDUCTS VARIOUS FUNDRAISING EVENTS EACH YEAR TO BENEFIT SPECIFIC CARE PROGRAMS OF ST. JOSEPH'S COMMUNITY HOSPITAL. ST. JOSEPH'S COMMUNITY FOUNDATION MAINTAINS A VERY CLOSE RELATIONSHIP WITH ST. JOSEPH'S COMMUNITY HOSPITAL, AN EXEMPT CHARITABLE ORGANIZATION UNDER IRC 501 (A) AS DESCRIBED IN IRC 501 (C) (3), AND CLASSIFIED AS A PUBLICLY SUPPORTED PUBLIC CHARITY UNDER IRC 509 (A) (1) AND DESCRIBED IN IRC 170 (B) (1) (A) (III). ST JOSEPH'S COMMUNITY HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ST. JOSEPH'S COMMUNITY FOUNDATION'S SUPPORT IN RECOGNITION OF THE NEED TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITIES SERVED BY ST. JOSEPH'S COMMUNITY HOSPITAL AND ST. JOSEPH'S COMMUNITY FOUNDATION. ST. JOSEPH'S COMMUNITY FOUNDATION IS ACCOUNTABLE TO ST. JOSEPH'S COMMUNITY HOSPITAL FOR HOW THE FOUNDATION EXPENDS ITS FUNDS BY VIRTUE OF THE FACT THAT ST. JOSEPH'S COMMUNITY HOSPITAL APPOINTS AND APPROVES A MAJORITY OF ST. JOSEPH'S COMMUNITY FOUNDATION'S BOARD OF DIRECTORS AND RETAINS OTHER APPROVAL RIGHTS OVER THE FOUNDATION'S OPERATIONS.IN ADDITION TO SATISFYING THE TWO REQUIREMENTS SET FORTH ABOVE, THERE ARE ADDITIONAL RELEVANT FACTS AND CIRCUMSTANCES WHICH DEMONSTRATE THAT ST. JOSEPH'S COMMUNITY FOUNDATION QUALIFIES AS A "PUBLICLY SUPPORTED" PUBLIC CHARITY UNDER IRC 509 (A) (1) AND 170 (B) (1) (A) (VI). 1. ST. JOSEPH'S COMMUNITY FOUNDATION'S TOTAL SUPPORT EXCEEDS THE MINIMUM 10% "THRESHOLD" BY A SUBSTANTIAL PORTION. MOREOVER, HISTORICALLY THE TOTAL SUPPORT RECEIVED BY ST. JOSEPH'S COMMUNITY FOUNDATION IS FROM A CONSIDERABLE AND REPRESENTATIVE NUMBER OF DONORS LOCATED THROUGHOUT THE VARIOUS COMMUNITIES SERVED BY ST. JOSEPH'S COMMUNITY FOUNDATION. 2. ST. JOSEPH'S COMMUNITY FOUNDATION'S BOARD OF DIRECTORS IS COMPRISED OF INDIVIDUALS WHO INCLUDE COMMUNITY AND CIVIC LEADERS, COMMUNITY BUSINESS EXECUTIVES, PHYSICIANS AND OTHER INDIVIDUALS WHO REPRESENT THE BROAD INTERESTS OF THE PUBLIC. 3. ST. JOSEPH'S COMMUNITY FOUNDATION PROVIDES CONTINUING SUPPORT TO ST. JOSEPH'S COMMUNITY HOSPITAL, AND OTHER HEALTH CARE FACILITIES AND ORGANIZATIONS WHICH MAKE THEIR HEALTH CARE SERVICES AVAILABLE TO THE GENERAL PUBLIC WITH THE MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES SERVED BY SUCH ORGANIZATIONS. 4. ST. JOSEPH'S COMMUNITY FOUNDATION HAS VOLUNTEERS COMPRISED OF INDIVIDUALS FROM THE GENERAL PUBLIC WHO VOLUNTEER THEIR TIME AND SKILLS IN CARRYING OUT VARIOUS ACTIVITIES AND FUNCTIONS OF THE FOUNDATION. 5. IN ADDITION TO RECEIVING FUNDS FROM THE GENERAL PUBLIC, ST. JOSEPH'S COMMUNITY FOUNDATION RECEIVES A SIGNIFICANT AMOUNT OF SUPPORT FROM ITS "PARENT ORGANIZATION, ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND. PART II, LINE 10 - OTHER INCOME NATURE AND SOURCE 2022 2021 2020 2019 2018 NET FUNDRAISING TOTAL $33,517 ($15,984) ($22,079) ($9,446) ($9,730) RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 2100 2100 2100 2100 2100 2100 2100 2100 2100 2100 1.00000 0 1 1 27248 27248 0 0 DUE TO AFFILIATES 402357 402357 X PART V, LINE 4: FOR PERMANENTLY RESTRICTED ENDOWMENT FUNDS, THE INTENT OF THE FUNDS DEPENDS ON THE RESTRICTION THAT APPLIES TO THAT PARTICULAR ENDOWMENT, AS PRESCRIBED BY THE DONOR. DEPENDING ON THE PARTICULAR ENDOWMENT, THE INTENDED USE INCLUDES FELLOWSHIPS, RESEARCH AND EDUCATIONAL RESOURCES FOR THE COMMUNITY. PART X, LINE 2: FROEDTERT HEALTH, INC., THE PARENT ENTITY INTO WHICH ST. JOSEPH'S COMMUNITY FOUNDATION INC.'S FINANCIAL 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, 2023 AND 2022, ST. JOSEPH'S COMMUNITY FOUNDATION DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. 0 ABOVE & BEYOND 117183 68692 48491 14974 117183 68692 48491 14974 14974 33517 1 ALBRECHT FREE CLINIC 908 W WASHINGTON STREET WEST BEND WI 53095 391839654 501 (C) 3 55000 0 HEALTHY SMILES CHANGE LIVES INTERFAITH CAREGIVERS OF WASHINGTON COUNTY 2374A W WASHINGTON STREET WEST BEND WI 53095 020657722 501 (C) 3 25000 0 HEALTHY AGING IN PLACE CASA GUADALUPE EDUCATION CENTER 419 ROOSEVELT DRIVE WEST BEND WI 53090 204483105 501 (C) 3 40000 0 HEALTHY LATINOS, HEALTHY FUTURES ELEVATE INC N169W21005 MEADOW LANE JACKSON WI 53209 391256286 501 (C) 3 20000 0 SUBSTANCE ABUSE DIVERSION PROGRAM FRIENDS INC PO BOX 117 WEST BEND WI 53095 391308555 501 (C) 3 10000 0 OUTREACH & PREVENTION(SEX ASSAULT/LGBTQ) BOYS AND GIRLS CLUBS OF WASHINGTON COUNTY 925 N SILVERBROOK DRIVE WEST BEND WI 53090 391773689 501 (C) 3 10000 0 HEALTHY MINDS & BODY INITIATIVE KETTLE MORAINE YMCA 1111 W WASHINGTON STREET WEST BEND WI 53095 391175559 501 (C) 3 12000 0 MENTAL HEALTH AT THE Y THE YOUTH AND FAMILY PROJECT INC 630 ELM STREET WEST BEND WI 53095 510149160 501 (C) 3 15000 0 CROSSROADS YOUTH PROGRAM OUTREACH COMMUNITY SMILES DENTAL 210 NW BARSTOW STREET WAUKESHA WI 53188 300436162 501 (C) 3 30000 0 DENTAL CARE FOR CHILDREN FAMILY PROMISE 724 ELM STREET 100 WEST BEND WI 53095 270740203 501 (C) 3 10000 0 HEALTH SERVICES AND HOUSING FOR HOMELESS 10 0 SCHOLARSHIPS 12 59125 FMV N/A PART I, LINE 2: APPLICATIONS FOR FUNDING ARE AVAILABLE VIA AN INDEPENDENT WEBSITE ON AN ANNUAL BASIS FOR 501 (C) (3) NON-PROFIT ORGANIZATIONS. REQUESTS ARE LIMITED TO PROJECTS THAT WILL SIGNIFICANTLY IMPROVE THE HEALTH AND WELL-BEING OF PEOPLE LIVING IN WASHINGTON COUNTY AND MAY INCLUDE CAPITAL PROJECTS. APPLICANTS ARE GIVEN APPROXIMATELY ONE MONTH TO SUBMIT THEIR APPLICATION AND SUPPORTING DOCUMENTATION. THE APPLICATIONS THEN GO TO A COMMITTEE OF INDIVIDUALS FROM LOCAL COMMUNITIES, AS WELL AS INDIVIDUALS FROM THE FROEDTERT HEALTH, INC. SYSTEM. THE HEALTHY COMMUNITY FUND COMMITTEE WILL REVIEW APPROPRIATE APPLICATION REQUESTS AND DETERMINE IF THE PROGRAM/PROJECT MEETS REQUIREMENTS. AFTER A FORMAL RANKING PROCESS, IT WILL BE DETERMINED IF SUPPORT WILL BE GRANTED, AND AT WHAT LEVEL, GIVEN THE AVAILABLE RESOURCES AND COMMITTEE'S CURRENT PRIORITIES. THE RECOMMENDATION OF THE HEALTHY COMMUNITY FUND COMMITTEE THEN GOES TO THE ST. JOSEPH'S COMMUNITY FOUNDATION, INC. BOARD AND THE FROEDTERT HEALTH, INC. PRESIDENT FOR APPROVAL. ONCE THE ORGANIZATIONS WERE NOTIFIED OF FUNDING AND GIVEN THE MONEY, THEY WERE ASKED TO SUBMIT A REPORT TO THE ST. JOSEPH'S COMMUNITY FOUNDATION, INC. BOARD SHOWING THE PROGRESS OF THEIR PROJECT. 0 1 0 0 0 0 0 0 0 ERICSON ALLEN DIRECTOR & SJH PRESIDENT 0 533946 0 791959 0 150607 0 129558 0 35155 0 1641225 0 125130 MALZEWSKI MICHAEL TREASURER (TERM JUN23) 0 256759 0 67118 0 28335 0 20750 0 22779 0 395741 0 0 ALATALO DARCY FORMER - OFFICER (TREAS) 0 141978 0 22081 0 1264 0 9677 0 21110 0 196110 0 0 PART I, LINE 3 THE PRESIDENT/CEO'S PERFORMANCE IS REVIEWED BY THE BOARD CHAIR ANNUALLY. THE BOARD OF ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. APPROVES ANY SALARY AND/OR BENEFIT CHANGES. SALARIES ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE FROEDTERT HEALTH, INC. (A RELATED ORGANIZATION) BOARD OF DIRECTORS, UTILIZING VARIOUS COMPENSATION STUDIES AND COMPARATIVE DATA. PART I, LINE 4B 457(F) DISTRIBUTIONS: ERICSON, ALLEN - $125,130 457(F) PLAN PARTICIPANTS: ERICSON, ALLEN 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, AND OTHER MISCELLANEOUS COMPENSATION. FORM 990, PART III, LINE 4A ST. JOSEPH'S COMMUNITY FOUNDATION, INC., IS A NONSTOCK, NONPROFIT CORPORATION THAT RECEIVES GIFTS AND BEQUESTS, RAISES FUNDS FOR SPECIFIC PROJECTS OR NEEDS, ADMINISTERS AND INVESTS FUNDS, AND DISBURSES PAYMENTS TO FURTHER THE MISSION AND PURPOSES OF ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. DURING FY 2023, ST. JOSEPH'S COMMUNITY FOUNDATION, INC. PAID THE FOLLOWING AMOUNTS TO AREA ORGANIZATIONS: - $55,000 TO ALBRECHT FREE CLINIC FOR HEALTH SMILES CHANGE LIVES (ACCESS DENTAL) - $25,000 TO INTERFAITH CAREGIVERS OF WASHINGTON COUNTY FOR HEALTHY AGING IN PLACE (ACCESS HEALTHCARE/COMMUNITY SERVICES/TRANSPORTATION) - $40,000 TO CASA GUADALUPE EDUCATION CENTER FOR HEALTHY LATINOS, HEALTHY FUTURES (CHRONIC DISEASE) - $20,000 TO ELEVATE INC. FOR ELEVATE U (AODA/MENTAL HEALTH) - $10,000 TO FRIENDS INC. FOR SUPPORTING MENTAL WELLNESS (SEXUAL ABUSE & ASSAULT) - $10,000 TO BOYS AND GIRLS CLUB OF WASHINGTON COUNTY FOR HEALTHY MINDS & BODY INITIATIVE (MENTAL HEALTH) - $30,000 TO COMMUNITY SMILES DENTAL FOR LOW INCOME DENTAL CARE (ACCESS DENTAL) - $10,000 TO FAMILY PROMISE OF WASHINGTON COUNTY (HOUSING) - $12,000 TO KETTLE MORAINE YMCA (MENTAL HEALTH) - $15,000 TO THE YOUTH AND FAMILY PROJECT INC. FOR CROSSROADS YOUTH PROGRAM OUTREACH (MENTAL HEALTH) ADDITIONALLY, ST. JOSEPH'S COMMUNITY FOUNDATION, INC. PAID THE FOLLOWING AMOUNT TO INTERNAL PROGRAMS: - $3,300 TO THE ABOVE & BEYOND CANCER CENTER FUNDRAISER EVENT (CANCER CENTER) FORM 990, PART VI, SECTION A, LINE 6 ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC., IS THE SOLE CORPORATE MEMBER OF ST. JOSEPH'S COMMUNITY FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC., AS THE SOLE CORPORATE MEMBER OF ST. JOSEPH'S COMMUNITY FOUNDATION, HAS THE FINAL APPROVAL OF ELECTION OF ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B FROEDTERT HEALTH, INC., AS THE SOLE CORPORATE MEMBER OF ST. JOSEPH'S COMMUNITY HOSPITAL, AND ST. JOSEPH'S COMMUNITY HOSPITAL, AS THE SOLE MEMBER OF ST. JOSEPH'S COMMUNITY FOUNDATION, EACH RETAIN AUTHORITIES AS DEFINED IN CORPORATE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B FROEDTERT HEALTH, INC. ACCOUNTING STAFF PREPARE FORM 990 WHICH IS REVIEWED BY THE FROEDTERT HEALTH FINANCIAL LEADERS. THE 990 IS THEN REVIEWED BY KPMG, FROEDTERT HEALTH'S OUTSIDE ACCOUNTING FIRM. NEXT, THE 990 IS PROVIDED TO THE FROEDTERT HEALTH AUDIT COMMITTEE AND BOARD OF DIRECTORS. FINALLY, THE 990 IS FILED AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE DOCUMENT. THE DATA IS COMPILED, AND THE FROEDTERT HEALTH, INC., VICE PRESIDENT - CHIEF COMPLIANCE OFFICER (CCO), 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 DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THEN THE PERSON MAKING THE DISCLOSURE SHALL BE RELIEVED OF HIS/HER OBLIGATIONS ON BEHALF OF ST. JOSEPH'S COMMUNITY FOUNDATION, 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, INC. CCO AT LEAST ONCE ANNUALLY TO THE FROEDTERT HEALTH AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT/CEO'S PERFORMANCE IS REVIEWED BY THE BOARD CHAIR ANNUALLY. THE BOARD OF ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. APPROVES ANY SALARY AND/OR BENEFIT CHANGES. THE INITIAL SALARY WAS DETERMINED BY THE SYSTEM CEO AND OUTSIDE CONSULTANT, USING COMPARATIVE DATA. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL INFORMATION: THE FROEDTERT HEALTH, INC. QUARTERLY FINANCIAL INFORMATION 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. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY: DOCUMENTS ARE AVAILABLE TO THE PUBLIC THROUGH THE CORPORATE OFFICE UPON REQUEST. FORM 990, PART IX, LINE 9 BENEFIT COSTS FOR ST. JOSEPH'S COMMUNITY FOUNDATION, INC. ARE RECORDED AT THE CORPORATE LEVEL OF FROEDTERT HEALTH, INC. AND GET ABSORBED BY ST. JOSEPH'S COMMUNITY HOSPITAL OF WEST BEND, INC. FORM 990, PART XI, LINE 9: FORGIVENESS OF RECEIVABLE FROM FOUNDATION 217,554. TRANSFER TO AFFILIATES -65,575. FROEDTERT HEALTH INC 9200 WEST WISCONSIN AVENUE MILWAUKEE WI 532263596 392014409 MGMT SERVICES WI 501(C)3 LN 12, III N/A 0 ST JOSEPH'S COMMUNITY HOSPITAL-WEST BEND 3200 PLEASANT VALLEY ROAD WEST BEND WI 53095 390806302 HOSPITAL WI 501(C)3 3 FH INC 0 FROEDTERT HOSPITAL FOUNDATION INC 9200 WEST WISCONSIN AVENUE MILWAUKEE WI 53226 391431192 HEALTH PROMO WI 501(C)3 LN 7 FMLH 0 COMMUNITY MEMORIAL FOUNDATION W180 N8085 TOWN HALL ROAD MENOMONEE FALLS WI 53051 391635057 HEALTH PROMO WI 501(C)3 LN 10 CMH 0 FROEDTERT MEMORIAL LUTHERAN HOSPITAL 9200 WEST WISCONSIN AVENUE MILWAUKEE WI 53226 396105970 HOSPITAL WI 501(C)3 3 FH INC 0 COMMUNITY MEMORIAL HOSPITAL OF MF INC W180 N8085 TOWN HALL ROAD MENOMONEE FALLS WI 53051 390987025 HOSPITAL WI 501(C)3 3 FH INC 0 COMMUNITY OUTPATIENT HEALTH SERVICES W180 N8085 TOWN HALL RD MENOMONEE FALLS WI 53051 391743056 O/P SERVICES WI 501(C)3 3 CMH 0 QHS 1 INC 9200 W WISCONSIN AVENUE MILWAUKEE WI 53226 202636686 HLTHCARE SRVS WI 501(C)3 LN 12, I FH INC 0 HOLY FAMILY MEMORIAL INC 2300 WESTERN AVENUE MANITOWOC WI 54221 390806395 HOSPITAL WI 501(C)3 3 FH INC 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1