2024-05-07T11:20:04-05:00 2023-06-30 135565207 KPMG LLP 191 WEST NATIONWIDE BLVD SUITE 500 COLUMBUS OH 432152568 990 2022-07-01 202636686 QHS 1 INC QHS1 4148053000 9200 W WISCONSIN AVE MILWAUKEE WI 53226 ALICIA M MAITLAND SVP - FINANCE 4148053000 2024-05-07 1 ALICIA MAITLAND XXX-XX-XXXX 0 MOLLIE P LONGHOUSE P00294881 6142492300 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z CATHERINE JACOBSON 9200 W WISCONSIN AVE MILWAUKEE WI 53226 393040 0 X N/A X 2005 WI TO HOLD AND MANAGE OWNERSHIP INTERESTS IN HEALTH CARE RELATED ORGANIZATIONS, IN SUPPORT OF THE HEALTH CARE ACTIVITIES OF THE FROEDTERT HEALTH, INC. HEALTHCARE SYSTEM. 2 0 0 0 32595 31595 0 0 614424 393040 50 0 0 0 614474 393040 645 805 0 0 0 0 0 0 0 547 557 1192 1362 613282 391678 -164724 226952 58001 57999 -222725 168953 TO HOLD AND MANAGE OWNERSHIP INTERESTS IN HEALTH CARE RELATED ORGANIZATIONS, IN SUPPORT OF THE HEALTH CARE EXEMPT ACTIVITIES OF THE FROEDTERT HEALTH, INC. HEALTHCARE SYSTEM. 0 0 805 805 393040 SUCCESSFUL MANAGEMENT OF OWNERSHIP INTERESTS IN HEALTH CARE RELATED ORGANIZATIONS, IN SUPPORT OF THE HEALTH CARE EXEMPT ACTIVITIES OF THE FROEDTERT HEALTH, INC. HEALTHCARE SYSTEM. 805 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 2 0 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X DAVID DIRKSMEYER 4148053000 N74 W12501 LEATHERWOOD CT MENOMONEE FALLS WI 53051 JACOBSON CATHERINE DIRECTOR & PRESIDENT 1.00 49.00 X X 0 3435812 441556 HAWIG SCOTT DIRECTOR & TREASURER 1.00 49.00 X X 0 1751870 240154 VAN DE KREEKE JEFFREY FORMER - OFFICER (SECR) 0.00 50.00 X 0 545072 28202 0 5732754 709912 0 1 1 0 0 WDL K-1 INCOME 621500 378422 345827 32595 MFASC K-1 INCOME 621990 14618 14618 393040 393040 360445 32595 0 805 805 MEALS AND ENTERTAINMENT 557 557 1362 805 557 0 3756 3756 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57453 57453 0 0 0 0 0 0 0 0 -225935 165743 0 0 2 0 -164724 226952 58001 57999 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58001 57999 X 0 0 -3316240 -3316240 3093515 3485193 -222725 168953 -164724 226952 391678 0 X 0 1 X 1 0 X X 3 FROEDTERT MEMORIAL LUTHERAN HOSPITAL 396105970 3 0 0 0 COMMUNITY MEMORIAL HOSPITAL OF MF 390987025 3 0 0 0 ST JOSEPH'S COMMUNITY HOSPITAL 390806302 3 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 1: QHS 1, INC. HAS HAD A HISTORIC AND CONTINUING RELATIONSHIP WITH ITS SUPPORTED ORGANIZATIONS WHICH ARE RELATED ORGANIZATIONS THAT ARE OWNED OR CONTROLLED BY FROEDTERT HEALTH, INC., THE SOLE CORPORATE MEMBER OF QHS 1, INC. 0 INVESTMENT IN WDL & MFASC 165743 C 165743 X PART X, LINE 2: FROEDTERT HEALTH, INC., THE PARENT ENTITY INTO WHICH QHS 1, 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, QHS 1, INC. DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. 1 1 0 0 0 0 0 0 0 JACOBSON CATHERINE DIRECTOR & PRESIDENT 0 1547248 0 1497354 0 391210 0 406217 0 35339 0 3877368 0 388747 HAWIG SCOTT DIRECTOR & TREASURER 0 915726 0 643858 0 192286 0 205582 0 34572 0 1992024 0 170501 VAN DE KREEKE JEFFREY FORMER - OFFICER (SECR) 0 184071 0 144602 0 216399 0 19300 0 8902 0 573274 0 0 PART I, LINES 4A-B SEVERANCE: VAN DE KREEKE, JEFFREY - $165,458 457(F) DISTRIBUTIONS: HAWIG, SCOTT - $170,501 JACOBSON, CATHERINE - $388,747 457(F) PLAN PARTICIPANTS: HAWIG, SCOTT JACOBSON, CATHERINE VAN DE KREEKE, JEFFREY NONQUALIFIED DISTRIBUTIONS: VAN DE KREEKE, JEFFREY - $33,370 (OF WHICH $0 WAS REPORTED AS DEFERRED ON A PRIOR FORM 990) NONQUALIFIED PARTICIPANTS: VAN DE KREEKE, JEFFREY PART I, LINE 7 BONUS COMPENSATION IS PAID BASED UPON ATTAINMENT OF SPECIFIC GOALS RELATED TO THE ORGANIZATION'S STRATEGY, SERVICE, QUALITY, AND FINANCIAL STRENGTH. THE AMOUNT OF COMPENSATION IS CALCULATED USING SPECIFIED PERCENTAGES OF BASE SALARY FOR ACHIEVEMENT OF PARTICULAR GOAL LEVELS. HOWEVER, THE FROEDTERT HEALTH SYSTEM BOARD COMMITTEE WHICH ADMINISTERS THE BONUS COMPENSATION PROGRAM HAS DISCRETION OVER WHETHER TO PAY THE BONUS IN ANY GIVEN YEAR OR TO AMEND, CHANGE, OR TERMINATE THE PROGRAM AT ANY TIME. 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. FORM 990, PART VI, SECTION A, LINE 2 CATHERINE JACOBSON, SCOTT HAWIG, JEFFREY VAN DE KREEKE - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 FROEDTERT HEALTH, INC. (FH) IS THE SOLE CORPORATE MEMBER OF QHS 1, INC. FORM 990, PART VI, SECTION A, LINE 7A FH AS THE SOLE CORPORATE MEMBER OF QHS 1, INC., APPOINTS ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B FH AS THE SOLE CORPORATE MEMBER OF QHS 1, INC., HAS CERTAIN RESERVED POWERS AND AUTHORITIES WITH RESPECT TO THE OPERATIONS AND MANAGEMENT OF QHS 1, INC. FORM 990, PART VI, SECTION B, LINE 11B FROEDTERT HEALTH, INC. (FH) ACCOUNTING STAFF PREPARE FORM 990 WHICH IS REVIEWED BY FH'S FINANCIAL LEADERS. THE 990 IS THEN REVIEWED BY KPMG, FH'S OUTSIDE ACCOUNTING FIRM. NEXT, THE 990 IS PROVIDED TO THE FH AUDIT COMMITTEE AND BOARD OF DIRECTORS. FINALLY, THE 990 IS FILED AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE DOCUMENT. THE DATA IS COMPILED, AND THE FH VICE PRESIDENT - CHIEF COMPLIANCE OFFICER (CCO), THE SENIOR VICE PRESIDENT - GENERAL COUNSEL AND/OR DELEGATE 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 A FH AFFILIATE 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 FH CCO AT LEAST ONCE ANNUALLY TO THE FH AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - COMPENSATION OF TOP MANAGEMENT IS PAID BY FH, A RELATED ORGANIZATION, BUT A REVIEW IS PERFORMED. IN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT, INDEPENDENT COMPENSATION CONSULTANTS ARE UTILIZED, COMPENSATION STUDIES ARE COMPLETED TO GATHER COMPARATIVE DATA, PERSONS WITH A CONFLICT OF INTEREST REGARDING THE COMPENSATION ARRANGEMENTS AT ISSUE ARE NOT INVOLVED IN THE DECISION MAKING PROCESS, AND AMOUNTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE FH (THE RELATED ORGANIZATION) BOARD OF DIRECTORS. IN ADDITION, THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. LINE 15B - COMPENSATION OF OFFICERS IS PAID BY A RELATED ORGANIZATION BUT A REVIEW IS PERFORMED. IN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S OFFICERS, INDEPENDENT COMPENSATION CONSULTANTS ARE UTILIZED, COMPENSATION STUDIES ARE COMPLETED TO GATHER COMPARATIVE DATA, PERSONS WITH A CONFLICT OF INTEREST REGARDING THE COMPENSATION ARRANGEMENTS AT ISSUE ARE NOT INVOLVED IN THE DECISION MAKING PROCESS, AND AMOUNTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE FH (THE RELATED ORGANIZATION) BOARD OF DIRECTORS. IN ADDITION, THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE CORPORATE OFFICE UPON REQUEST. 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