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HOLY FAMILY MEMORIAL INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
HOLY FAMILY MEMORIAL INC (EIN 39-0806395)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-09
IRS object ID
202133139349301818
Schema version
2020v4.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-09T09:03:38-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1100 MARITIME DRIVE SUITE 2BAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390806395EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOLYBusinessNameControlTxt
Phone9203202011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTEVE LITTLEPersonNm
Person TitlePRESIDENT / CEOPersonTitleTxt
Phone9203203470PhoneNum
Signature2021-11-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstSTEVEPersonFirstNm
Person LastLITTLEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLACEY SILBERNAGELPreparerPersonNm
PTINP01245590PTIN
Phone9206845500PhoneNum
Preparation2021-11-04PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSTEVE LITTLEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$123,206,025GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HFMHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1899FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionHEALTH CARE SERVICESHOLY FAMILY MEMORIAL (HFM) IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC, HOME CARE AND HOSPICE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee977TotalEmployeeCnt
Total Volunteers226TotalVolunteersCnt
Total Gross UBI-$7,358TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$872NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$368,641PYContributionsGrantsAmt
CY Contributions Grants$351,602CYContributionsGrantsAmt
PY Program Service Revenue$122,083,347PYProgramServiceRevenueAmt
CY Program Service Revenue$117,912,551CYProgramServiceRevenueAmt
PY Investment Income$1,483,523PYInvestmentIncomeAmt
CY Investment Income$4,662,536CYInvestmentIncomeAmt
PY Other Revenue$212,110PYOtherRevenueAmt
CY Other Revenue$28,031CYOtherRevenueAmt
PY Total Revenue$124,147,621PYTotalRevenueAmt
CY Total Revenue$122,954,720CYTotalRevenueAmt
PY Grants And Similar Paid$37,564PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$24,026CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$68,072,856PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$66,263,579CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$21,865CYTotalFundraisingExpenseAmt
PY Other Expenses$55,033,134PYOtherExpensesAmt
CY Other Expenses$59,537,440CYOtherExpensesAmt
PY Total Expenses$123,143,554PYTotalExpensesAmt
CY Total Expenses$125,825,045CYTotalExpensesAmt
PY Revenues Less Expenses$1,004,067PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,870,325CYRevenuesLessExpensesAmt
Total Assets BOY$183,919,607TotalAssetsBOYAmt
Total Assets EOY$179,865,777TotalAssetsEOYAmt
Total Liabilities BOY$68,862,057TotalLiabilitiesBOYAmt
Total Liabilities EOY$69,170,072TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$115,057,550NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$110,695,705NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$102,003,997ExpenseAmt
Grant$24,026GrantAmt
Revenue$122,589,005RevenueAmt
DescHOLY FAMILY MEMORIAL IS AN INTEGRATED NETWORK PROVIDING HEALTH CARE SERVICES INTENDED TO BENEFIT THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE PRIMARY AND SPECIALTY CLINIC CARE, PREVENTIVE CARE SUCH AS HEALTH SCREENINGS, VACCINATION CLINICS AND HEALTH EDUCATION CLASSES, 24/7 EMERGENCY CARE, WALK-IN, INPATIENT ACUTE CARE, OUTPATIENT CARE, HOME CARE AND HOSPICE, PRESCRIPTIONS, OCCUPATIONAL HEALTH SERVICES, AND MEDICALLY BASED FITNESS AND WELLNESS. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. (CONTINUED ON SCHEDULE O)THESE PARTNERSHIPS INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS, AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY. HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HFM UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES, AND CONSIDERS SITUATIONS WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HFM DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $30,475,000 FOR THE YEAR ENDED DECEMBER 31, 2020. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $97,000. MORE INFORMATION IS AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH IS LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG.Desc
Total Program Service Expenses$102,003,997TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (1)BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document124IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee977EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
DAF Excess Business Holdings0DAFExcessBusinessHoldingsInd
Taxable Distributions0TaxableDistributionsInd
Distribution To Donor0DistributionToDonorInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TROY DAY VP AND CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9203202011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MICHELLE L BIRSCHBACH
VICE CHAIR2.00Yes (X)Yes (X)$0$0$0
DEREK R BOWN DC
DIRECTOR40.00Yes (X)$115,473$0$28,409
MATTHEW L CAMPBELL MD
DIRECTOR40.00Yes (X)$354,610$0$35,642
JEFFREY S DUNN
CHAIR2.00Yes (X)Yes (X)$0$0$0
SISTER MARLITA HENSELER
DIRECTOR2.00Yes (X)$0$0$0
ERICK M KAHLENBERG
TREASURER2.00Yes (X)Yes (X)$0$0$0
MARILYNN A KAUFMANN PHD RN
CHAIR2.00Yes (X)Yes (X)$0$0$0
SISTER ELAINE TURBA
DIRECTOR2.00Yes (X)$0$0$0
KATHY ZUCCHI
DIRECTOR2.00Yes (X)$0$0$0
BRETT W NORELL
DIRECTOR, PRESIDENT, CEO40.00Yes (X)Yes (X)$783,860$0$101,090
ANNETTE M KAMINSKY APNP
DIRECTOR40.00Yes (X)$144,975$0$13,515
SISTER NANCY KINATE
SECRETARY2.00Yes (X)Yes (X)$0$0$0
SISTER MARY FRANCES MAHER
DIRECTOR2.00Yes (X)$0$0$0
PRADEEP GIRIYAPPA MD
DIRECTOR40.00Yes (X)$263,540$0$28,023
CANDICE GIESEN
DIRECTOR2.00Yes (X)$0$0$0
ROBERT H GREENE MD
DIRECTOR40.00Yes (X)$245,062$0$37,881
MILAN JORDAN MD
DIRECTOR40.00Yes (X)$419,179$0$39,627
CHUCK KRUEGER
TREASURER2.00Yes (X)Yes (X)$0$0$0
VERONICA MCFARLANE APNP
DIRECTOR40.00Yes (X)$129,816$0$13,095
GENNY SHIELDS
DIRECTOR2.00Yes (X)$0$0$0
KENLYN T GRETZ
DIRECTOR2.00Yes (X)$0$0$0
DEAN M POLLNOW MD
EXECUTIVE VP, CMO40.00Yes (X)$777,663$0$80,138
TROY D DAY
VP FINANCE, CFO40.00Yes (X)$365,619$0$50,099
THOMAS VEESER
VP, CNO40.00Yes (X)$283,123$0$70,425
JEREMY R ANCLAM MD
PHYSICIAN PROVIDER40.00$661,745$0$25,549Yes (X)
KIRK D DIMITRIS MD
PHYSICIAN PROVIDER40.00$1,722,222$0$29,986Yes (X)
RYAN M DOPIRAK MD
PHYSICIAN PROVIDER40.00$913,275$0$30,069Yes (X)
DAVID K MIKOLYZK MD
PHYSICIAN PROVIDER40.00$832,711$0$30,142Yes (X)
JOHN L TROTTER MD
PHYSICIAN PROVIDER40.00$639,704$0$25,484Yes (X)
MARK P HERZOG
FORMER DIRECTOR40.00$158,824$0$1,920Yes (X)
WILLIAM D HAMPTON DO
FORMER DIRECTOR40.00$173,587$0$19,380Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$8,984,988TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$660,474TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K88IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
XTEND HEALTHCARE LLC
90 VOLUNTEER DR STE 150HENDERSONVILLETN37075BILLING SERVICES$3,620,221
MEDICAL SOLUTIONS LLC
1010 N 102 ST STE 300OMAHANE68114TEMPORARY STAFFING$1,870,885
COMPLETERX LTD
3200 WILCREST DRIVE STE 250HOUSTONTX77042PHARMACY SERVICES$979,025
CERNER CORPORATION
2800 ROCKCREEK PARKWAYKANSAS CITYMO64117IT SERVICES$715,957
ALL STAR RECRUITING LOCUMS LLC
PO BOX 936725ATLANTAGA311936725TEMPORARY STAFFING$662,256
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K17CntrctRcvdGreaterThan100KCnt
Fundraising$71,125FundraisingAmt
All Other Contributions$280,477AllOtherContributionsAmt
Total Contributions$351,602TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
INTEGRATED HEALTH CARE900099$102,512,191$102,512,191
LAB621500$8,822,426$8,818,346$4,080
PHARMACY446110$6,577,934$6,577,934
FieldValueIRS element (for citing)
Total Program Service Revenue$117,912,551TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,680,534TotalRevenueColumnAmt
Related Or Exempt Func Income$4,680,534RelatedOrExemptFuncIncomeAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$162,388RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$127,959RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$34,429RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,429TotalRevenueColumnAmt
Exclusion$34,429ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$15,020OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$33,018OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$17,998OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$17,998TotalRevenueColumnAmt
Exclusion-$17,998ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$20,725FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$71,125ContriRptFundraisingEventAmt
Fundraising Direct Expenses$15,685FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,040TotalRevenueColumnAmt
Exclusion$5,040ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$75,412GrossSalesOfInventoryAmt
Cost Of Goods Sold$74,643CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$769TotalRevenueColumnAmt
Unrelated Business Revenue$769UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescINVESTMENT HFHSDesc
Business900003BusinessCd
Total Revenue Column-$12,207TotalRevenueColumnAmt
Unrelated Business Revenue-$12,207UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total-$12,207OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$122,954,720TotalRevenueColumnAmt
Related Or Exempt Func Income$122,589,005RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$7,358UnrelatedBusinessRevenueAmt
Exclusion$21,471ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$24,026TotalAmt
Program Services$24,026ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,504,401TotalAmt
Program Services$2,842,570ProgramServicesAmt
Management And General$1,661,831ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$49,781,460TotalAmt
Program Services$45,024,559ProgramServicesAmt
Management And General$4,740,505ManagementAndGeneralAmt
Fundraising$16,396FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$729,865TotalAmt
Program Services$574,574ProgramServicesAmt
Management And General$155,011ManagementAndGeneralAmt
Fundraising$280FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,125,390TotalAmt
Program Services$7,246,378ProgramServicesAmt
Management And General$878,635ManagementAndGeneralAmt
Fundraising$377FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,122,463TotalAmt
Program Services$2,731,491ProgramServicesAmt
Management And General$390,065ManagementAndGeneralAmt
Fundraising$907FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$871,619TotalAmt
Program Services$220,373ProgramServicesAmt
Management And General$651,246ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$822,003TotalAmt
Program Services$690ProgramServicesAmt
Management And General$821,313ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$169,769TotalAmt
Management And General$169,769ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,574,903TotalAmt
Program Services$4,550,220ProgramServicesAmt
Management And General$24,683ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$181,342TotalAmt
Program Services$9,387ProgramServicesAmt
Management And General$171,955ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$398,690TotalAmt
Program Services$363,233ProgramServicesAmt
Management And General$35,434ManagementAndGeneralAmt
Fundraising$23FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,505,853TotalAmt
Program Services$1,558,841ProgramServicesAmt
Management And General$2,947,012ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,910,398TotalAmt
Program Services$1,910,398ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$143,629TotalAmt
Program Services$119,700ProgramServicesAmt
Management And General$23,929ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$105,364TotalAmt
Program Services$92,226ProgramServicesAmt
Management And General$13,138ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,555,974TotalAmt
Program Services$1,555,974ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$6,828,852TotalAmt
Program Services$4,914,634ProgramServicesAmt
Management And General$1,914,218ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$695,834TotalAmt
Program Services$564,236ProgramServicesAmt
Management And General$131,598ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SUPPLIES$18,006,964$17,909,455$97,502$7
PURCHASED SERVICES$11,872,186$4,076,344$7,795,146$696
MAINTENANCE$2,694,099$2,637,401$56,698
WISCONSIN PROVIDER ASSE$2,392,332$2,392,332

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,807,629TotalAmt
Program Services$684,955ProgramServicesAmt
Management And General$1,119,495ManagementAndGeneralAmt
Fundraising$3,179FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$125,825,045TotalAmt
Program Services$102,003,997ProgramServicesAmt
Management And General$23,799,183ManagementAndGeneralAmt
Fundraising$21,865FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,506,200BOYAmt
EOY$7,276,233EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$6,231,543BOYAmt
EOY$6,538,018EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$15,796,927BOYAmt
EOY$10,933,773EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,979,878BOYAmt
EOY$1,968,334EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$8,387,620BOYAmt
EOY$5,657,410EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$205,900,925LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$132,093,086LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$77,951,933BOYAmt
EOY$73,807,839EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$63,796,746BOYAmt
EOY$71,252,977EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,047,523BOYAmt
EOY$423,758EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$1,571,435BOYAmt
EOY$1,583,640EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$649,802BOYAmt
EOY$423,795EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$183,919,607BOYAmt
EOY$179,865,777EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$20,696,460BOYAmt
EOY$12,870,496EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$42,083BOYAmt
EOY$25,559EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$48,123,014BOYAmt
EOY$46,061,930EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$500BOYAmt
EOY$10,212,087EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$68,862,057BOYAmt
EOY$69,170,072EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$111,265,199BOYAmt
EOY$106,807,485EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,792,351BOYAmt
EOY$3,888,220EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$115,057,550BOYAmt
EOY$110,695,705EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$183,919,607BOYAmt
EOY$179,865,777EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$2,870,325ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,473,911NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$3,965,431OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$0DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$19,636OtherActivitiesAmt
Total Lobbying Expenditures$19,636TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationEXPLANATION: PART II-B, LINE 1G: HOLY FAMILY MEMORIAL'S CEO MET WITH CONGRESSMAN GROTHMAN TO DISCUSS THE IMPACT OF CONSUMER PROTECTION FOR MEDICAL DEBT COLLECTIONS ACT. HFM'S CEO PARTICIPATED IN THE WHA VIRTUAL ROUNDTABLE WITH CONGRESSMAN GROTHMAN WHERE THERE WAS DISCUSSION ON COVID RELIEF PACKAGES AND AN UPDATE ON HOSPITAL OPERATIONS. CONGRESSMAN GROTHMAN VISITED HFM TO VIEW OUR ED/CCU/MS DURING THE PANDEMIC. EXPLANATION: PART II-B, LINE 1I, OTHER ACTIVITIES: HOLY FAMILY MEMORIAL BELONGS TO THE AMERICAN HOSPITAL ASSOCIATION, THE CATHOLIC HEALTH ASSOCIATION, AND THE WISCONSIN HOSPITAL ASSOCIATION, EACH OF WHICH USE A PERCENTAGE OF DUES FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab0InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,792,351BeginningYearBalanceAmt
Contributions$170,642ContributionsAmt
Investment Earnings Or Losses$265,013InvestmentEarningsOrLossesAmt
Other Expenditures$339,786OtherExpendituresAmt
End Year Balance$3,888,220EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,157,405BeginningYearBalanceAmt
Contributions$726,675ContributionsAmt
Investment Earnings Or Losses$264,841InvestmentEarningsOrLossesAmt
Other Expenditures$356,570OtherExpendituresAmt
End Year Balance$3,792,351EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,160,846BeginningYearBalanceAmt
Contributions$203,946ContributionsAmt
Investment Earnings Or Losses-$91,795InvestmentEarningsOrLossesAmt
Other Expenditures$115,592OtherExpendituresAmt
End Year Balance$3,157,405EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,811,732BeginningYearBalanceAmt
Contributions$350,741ContributionsAmt
Investment Earnings Or Losses$242,832InvestmentEarningsOrLossesAmt
Other Expenditures$244,459OtherExpendituresAmt
End Year Balance$3,160,846EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,566,566BeginningYearBalanceAmt
Contributions$314,437ContributionsAmt
Investment Earnings Or Losses$105,388InvestmentEarningsOrLossesAmt
Other Expenditures$174,659OtherExpendituresAmt
End Year Balance$2,811,732EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.88000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.09000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.03000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,465,349OtherCostOrOtherBasisAmt
Book Value$5,465,349BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$112,096,193OtherCostOrOtherBasisAmt
Depreciation$70,732,331DepreciationAmt
Book Value$41,363,862BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$86,686,549OtherCostOrOtherBasisAmt
Depreciation$60,332,554DepreciationAmt
Book Value$26,353,995BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,652,834OtherCostOrOtherBasisAmt
Depreciation$1,028,201DepreciationAmt
Book Value$624,633BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$73,807,839TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescAMOUNTS DUE TO MEDICARE FOR ACCELERATED PAYMENTSDesc
Amt$10,212,087Amt
FieldValueIRS element (for citing)
Total Liability$10,212,087TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$125,428,631TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$2,473,911NetUnrealizedGainsInvstAmt
Revenue Not Reported$2,473,911RevenueNotReportedAmt
Revenue Subtotal$122,954,720RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$122,954,720TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$125,825,045TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$125,825,045ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$125,825,045TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART V, LINE 4:FormAndLineReferenceDesc
ExplanationHOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT, MAJOR BUILDING IMPROVEMENTS, PROGRAM DEVELOPMENT, AND OPERATIONS.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1SAMARITAN DAYEvent1Nm
Gross Receipts Event1$82,260GrossReceiptsEvent1Amt
Charitable Contri Event1$61,535CharitableContriEvent1Amt
Gross Revenue Event1$20,725GrossRevenueEvent1Amt
Non Cash Prizes Event1$3,500NonCashPrizesEvent1Amt
Other Direct Expenses Event1$11,644OtherDirectExpensesEvent1Amt
Event2LOVE LIGHTSEvent2Nm
Gross Receipts Event2$9,590GrossReceiptsEvent2Amt
Charitable Contri Event2$9,590CharitableContriEvent2Amt
Other Direct Expenses Event2$541OtherDirectExpensesEvent2Amt
Gross Receipts Total$91,850GrossReceiptsTotalAmt
Charitable Contributions Tot$71,125CharitableContributionsTotAmt
Gross Revenue Total Events$20,725GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$3,500NonCashPrizesTotalEventsAmt
Oth Direct Expnss Total Events$12,185OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$15,685DirectExpenseSummaryEventsAmt
Net Income Summary$5,040NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served144PersonsServedCnt
Total Community Benefit Expns$97,028TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$97,028NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served10187PersonsServedCnt
Total Community Benefit Expns$12,992,772TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,921,950DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,070,822NetCommunityBenefitExpnsAmt
Total Expense0.06410TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served10331PersonsServedCnt
Total Community Benefit Expns$13,089,800TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,921,950DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,167,850NetCommunityBenefitExpnsAmt
Total Expense0.06490TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served25833PersonsServedCnt
Total Community Benefit Expns$1,453,421TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,453,421NetCommunityBenefitExpnsAmt
Total Expense0.01160TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served157PersonsServedCnt
Total Community Benefit Expns$10,161TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,161NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served615PersonsServedCnt
Total Community Benefit Expns$112,293TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$112,293NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served26605PersonsServedCnt
Total Community Benefit Expns$1,575,875TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,575,875NetCommunityBenefitExpnsAmt
Total Expense0.01260TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served36936PersonsServedCnt
Total Community Benefit Expns$14,665,675TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,921,950DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,743,725NetCommunityBenefitExpnsAmt
Total Expense0.07750TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs4ActivitiesOrProgramsCnt
Total Community Benefit Expns$3,225TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,225NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Total Community Benefit Expns$600TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$600NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Total Community Benefit Expns$686TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$686NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Total Community Benefit Expns$284TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$284NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$12TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$12NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Total Community Benefit Expns$4,807TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,807NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,903,897BadDebtExpenseAmt
Bad Debt Expense Attributable$401,722BadDebtExpenseAttributableAmt
Reimbursed By Medicare$41,392,796ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$62,119,321CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$20,726,525MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.HFMHEALTH.ORGWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.HFMHEALTH.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART V, PAGE 8OtherWebsiteURLTxt
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, PAGE 8StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.HFMHEALTH.ORG/COMMUNITY-CARE/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, PAGE 8FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, PAGE 8FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 5: HOLY FAMILY MEMORIAL PARTNERED WITH COMMUNITY LEADERS AND OTHER HEALTH ORGANIZATIONS TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT FOR MANITOWOC COUNTY. THE GROUP POOLED RESOURCES TO SHARE THE COSTS OF THE SURVEY, ITS ANALYSIS, AND THE CREATION OF A COLLABORATIVE ASSESSMENT REPORT. THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM CONDUCTED RANDOM SURVEYS OF ADULTS AGE 18 YEARS AND OLDER IN THE COUNTY THROUGH A RANDOM DIGITAL DIAL LANDLINE SAMPLING AND CELL PHONE ONLY SAMPLING. JLV RESOURCE, LLC CONDUCTED THE SURVEY IN CONJUNCTION WITH HOLY FAMILY MEMORIAL, AURORA HEALTH CARE, LAKESHORE CAP, LAKESHORE COMMUNITY HEALTH CARE, UNITED WAY MANITOWOC COUNTY, AND THE MANITOWOC COUNTY HEALTH DEPARTMENT. IN ADDITION, BUSINESS AND COMMUNITY LEADERS AS WELL AS SOCIAL SERVICE LEADERS WERE INVOLVED, INCLUDING THOSE FROM THE HMONG AND HISPANIC COMMUNITIES. RESULTS OF THE ASSESSMENT HAVE BEEN USED BY HEALTHIEST MANITOWOC COUNTY TO DEVELOP A STRATEGIC PLAN AND ACTION STEPS TO ADDRESS THE IDENTIFIED HEALTH NEEDS. HOLY FAMILY MEMORIAL PARTICIPATED IN THE DEVELOPMENT OF THE STRATEGIC PLAN AND COMMUNITY ACTION STEPS. HOLY FAMILY MEMORIAL ALSO DEVELOPED ITS OWN ORGANIZATIONAL-SPECIFIC ACTIONS STEPS.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH AURORA MEDICAL CENTER - MANITOWOC COUNTY.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED COLLABORATIVELY WITH COMMUNITY LEADERS FROM MANITOWOC COUNTY COMING FROM: HOLY FAMILY MEMORIAL, AURORA MEDICAL CENTER - MANITOWOC COUNTY, LAKESHORE CAP, LAKESHORE COMMUNITY HEALTH CARE, UNITED WAY MANITOWOC COUNTY, AND THE MANITOWOC COUNTY PUBLIC HEALTH DEPARTMENT.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 11: HOLY FAMILY MEMORIAL IDENTIFIED THREE SIGNIFICANT NEEDS FOR THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT AND HAS IDENTIFIED TEAMS TO OWN, LEAD, AND MONITOR THE NEWLY IDENTIFIED MAIN GOALS FOR THE FACILITY: 1) IMPROVE SUBSTANCE ABUSE AND CARE SERVICES FOR OUR COMMUNITY; 2) REDUCE PRESCRIPTION AND OVER-THE-COUNTER DRUG ABUSE IN MANITOWOC COUNTY; AND 3) MODEL AND INSPIRE HEALTHY NUTRITION AND EXERCISE TO ADDRESS THE MATTER OF OVERWEIGHT AND OBESITY. ACTIVITIES AND PROGRESS ARE MONITORED ON A QUARTERLY BASIS. OTHER HEALTH NEEDS IN THE COMMUNITY HEALTH NEEDS ASSESSMENT ARE BEING ADDRESSED BY PARTNERSHIPS WITH COMMUNITY GROUPS SUCH AS HEALTHIEST MANITOWOC COUNTY AND OTHERS. THESE INCLUDE ILLEGAL DRUG USE; ACCESS TO HEALTH CARE; CHRONIC DISEASE MANAGEMENT; MENTAL HEALTH OR DEPRESSION; CANCER; VIOLENCE OR CRIME; AFFORDABLE HEALTH CARE; TOBACCO USE; ACCESS TO AFFORDABLE HEALTHY FOOD; AND ENVIRONMENTAL ISSUES.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 20E: PAYMENT GUIDELINES AND THE FINANCIAL ASSISTANCE POLICY ARE POSTED IN PATIENT ROOMS AND LOBBIES, ADMISSION AND REGISTRATION AREAS, AND ARE GIVEN TO ALL SURGERY PATIENTS. IN ADDITION, INFORMATION IS PUBLISHED ON THE BACK OF ALL PATIENT STATEMENTS.
PART V SECTION B, LINE 7BHEALTHIESTMC.ORG; MANITOWOCCOUNTYWI.GOV/DEPARTMENTS/HEALTH-DEPARTMENT/
PART V SECTION B, LINE 10AHFMHEALTH.ORG; HEALTHIESTMC.ORG; CO.MANITOWOC.WI.US/DEPARTMENTS/HEALTH-DEPARTMENT/
PART V SECTION B, LINE 16BFAP APPLICATION WEBSITE: HTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2020/06/COMMUNITYCAREAPPLICATION062620.PDF
PART V SECTION B, LINE 16CFAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2020/09/PLAIN-LANGUAGE-SUMMARY-UPDATED-092320.PDF
PART V SECTION B, LINE 22DHOLY FAMILY MEMORIAL USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line11 - HOLY FAMILY HEALTH SERVICES INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11650 S 41ST STREETAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
FacilityRETAIL PHARMACYFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 6A:HOLY FAMILY MEMORIAL (HFM) PREPARED A COMMUNITY BENEFIT REPORT FOR THE CURRENT YEAR AND MADE IT AVAILABLE TO LOCAL CHURCH, POLITICAL, AND BUSINESS LEADERS, AS WELL AS OTHERS IN THE COMMUNITY IN EARLY 2021. IT WAS ALSO POSTED ON OUR WEBSITE.
PART I, LINE 7:COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HFM'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CANNOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATES THAT ITS PREFERENTIAL TAX STATUS IS DESERVED.
PART I, LINE 7, COLUMN FTHE PERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL EXPENSES REPORTED ON FORM 990 FOR HFM.
PART II, COMMUNITY BUILDING ACTIVITIES:HFM LEADS AND PARTICIPATES IN NUMEROUS INITIATIVES ALL AIMED AT IMPROVING THE OVERALL HEALTH OF THE COMMUNITY. WE BELIEVE THERE ARE SEVERAL MAJOR AREAS THAT CONTRIBUTE TO TRUE COMMUNITY HEALTH. HFM DEDICATES RESOURCES TO ENHANCE THE OVERALL VIBRANCY OF OUR COMMUNITY, MAKING IT AN OVERALL IMPROVED COMMUNITY IN WHICH TO LIVE, LEARN, WORK, AND PLAY. INITIATIVES INCLUDE: 1) HEALTH BEHAVIORS - SUPPORTING COVID-19 EFFORTS, PROVIDING SMOKING CESSATION CLASSES, COMMUNITY EXERCISE CHALLENGES, A MEDICALLY BASED WELLNESS CENTER, AND PROVIDING PRACTICAL AIDS TO ENCOURAGE GOOD NUTRITION PRACTICES; 2) SOCIAL AND ECONOMIC FACTORS - PROVIDING LEADERSHIP ON LOCAL ECONOMIC DEVELOPMENT, CHAMBER OF COMMERCE, AND STABLE WAGES AND BENEFITS TO OUR EMPLOYEES SINCE HFM IS THE LARGEST EMPLOYER IN THE COUNTY; 3) ENVIRONMENTAL FACTORS - REDUCING ENERGY USAGE, PROMOTING AN ACTIVE RECYCLING PROGRAM, AND BEAUTIFICATION OF GROUNDS.
PART III, LINE 2:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING HFM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
PART III, LINE 3:ANY PERSON APPROVED FOR COMMUNITY CARE UNDER HFM'S COMMUNITY CARE PROGRAM HAS UP TO 10 MONTHS (FROM THE FIRST STATEMENT) TO PAY THE REMAINING BALANCE IN FULL. IF THERE IS A BALANCE AT THE END OF THE 10 MONTHS, THE PATIENT WILL RECEIVE A FINAL NOTICE. IF THE BALANCE IS NOT PAID WITHIN 30 DAYS, THE BALANCE WILL BE SENT TO BAD DEBT COLLECTIONS. A HINDSIGHT ANALYSIS IS USED TO ESTIMATE THE PERCENT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER HFM'S FINANCIAL ASSISTANCE POLICY.
PART III, LINE 4:AUDIT STATEMENT NOTE 5, NET PATIENT SERVICE REVENUE DESCRIBES ADJUSTMENTS TO REVENUES BY ESTIMATIONS OF DEDUCTIBLE AND COINSURANCE AMOUNT USING HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. "SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE." (TAKEN FROM PAGE 12 OF THE AUDIT STATEMENT)
PART III, LINE 8:HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH 55.7% OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HFM RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES. THE COST METHODOLOGY USED TO DETERMINE THE ALLOWABLE COSTS OF CARE WAS THE COST TO CHARGE RATIO.
PART III, LINE 9B:PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, CT SCAN, AND EMERGENCY SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, THE ELIGIBILITY SPECIALIST WILL HELP THEM COMPLETE THE APPLICATION PROCESS, AND FOLLOW UP ON THEIR APPLICATION THROUGH TO APPROVAL OR DISAPPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON HOW TO APPLY FOR THOSE PROGRAMS. THE ELIGIBILITY SPECIALIST WILL ALSO PROVIDE SUCH ASSISTANCE.
PART VI, LINE 2:HFM UTILIZES VARIOUS PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF MANITOWOC COUNTY. AS PART OF OUR STRATEGIC PLANNING PROCESS, WE OBTAIN INPUT FROM HUNDREDS OF PEOPLE REGARDING THEIR OPINIONS AND PERCEPTIONS OF THE GREATEST HEALTH CARE NEEDS. THIS DATA IS COLLECTED AND CONSIDERED AS WE EVALUATE ANNUAL TACTICS TO ADDRESS OUR STRATEGIES. ON A TRI-ANNUAL BASIS, HFM IS A KEY PARTICIPANT IN A VERY BROAD CHNA WHICH INCLUDES PRIMARY INPUT FROM THE COMMUNITY MEMBERS, LEADERS AND THOUGHT LEADERS IN ADDITION TO SECONDARY DATA FROM THE URBAN INSTITUTE FOR POPULATION HEALTH AND COUNTY HEALTH RANKINGS AND ROADMAPS. HFM CONDUCTS REGULAR FACE TO FACE AND GROUP SESSIONS WITH AREA EMPLOYERS TO ASCERTAIN HEALTH NEEDS WITHIN INDUSTRY AND BUSINESS. HFM REGULARLY ANALYZES AND REVIEWS DIRECT CUSTOMER INPUT FROM INPATIENT, OUTPATIENT AND RETAIL SURVEYS TO DETERMINE UNMET NEEDS. HFM HOSTS A PATIENT AND FAMILY ADVISORY COUNCIL WHICH MEETS REGULARLY AND PROVIDES INPUT ON CURRENT SERVICES, IDEAS FOR NEW SERVICES, AND HAS OPEN DIALOGUE AND INPUT ON MEMBERS IDEAS FOR COMMUNITY HEALTH NEEDS.
PART VI, LINE 3:INFORMATION ON ELIGIBILITY FOR ASSISTANCE IS AVAILABLE FROM HFM'S WEBSITE, BROCHURES, ADMISSIONS STAFF, COLLECTION CORRESPONDENTS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, AND CT SCANS. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST COMMUNICATES TO SELF PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM IN COMPLETING THE APPLICATION AND FOLLOW UP ON THE APPLICATION THROUGH APPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE FOR APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR OR ELIGIBILITY SPECIALIST IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL ASSIST THOSE PATIENTS TO APPLY FOR THOSE PROGRAMS.
PART VI, LINE 4:HOLY FAMILY MEMORIAL SERVES MANITOWOC COUNTY, A COUNTY LOCATED IN NORTHEAST WISCONSIN ALONG BEAUTIFUL LAKE MICHIGAN, WITH A POPULATION OF APPROXIMATELY 79,000 AS OF 2020. OF THESE, ROUGHLY 30% ARE 25 OR UNDER, 47% ARE 26-60, AND 23% ARE OVER AGE 60. 49.7% OF THE POPULATION IS MALE WHILE 50.3% IS FEMALE. ROUGHLY 93% IDENTIFY AS WHITE, 3% HISPANIC, 2% ASIAN, 1% EACH OF, OTHER RACE, AND TWO OR MORE RACES. ROUGHLY 47% HAVE HOUSEHOLD INCOME $50,000 OR BELOW PER YEAR, 21% HAVE FROM $50,000 TO $75,000; 14% HAVE FROM $75,000 TO $100,000, AND 19% HAVE OVER $100,000. APPROXIMATELY 70% DO NOT HAVE A COLLEGE DEGREE, 10% HAVE AN ASSOCIATES DEGREE, 14% HAVE A BACHELORS DEGREE, AND 6% HOLD A GRADUATE, PROFESSIONAL, OR DOCTORATE DEGREE. THE PREDOMINANT INDUSTRY IN MANITOWOC COUNTY IS MANUFACTURING, COMPRISING ROUGHLY 30% OF OCCUPATIONS FOR INDIVIDUALS OVER AGE 16. HEALTH CARE AND SALES/OFFICE ARE ALSO PROMINENT, MAKING UP ROUGHLY 14% AND 12%, RESPECTIVELY. SMALLER SECTORS MAKING UP APPROXIMATELY 4-6% EACH INCLUDE FOOD SERVICE, AGRICULTURE, CONSTRUCTION, EDUCATION, FINANCE, TRANSPORTATION, AND OTHER.
PART VI, LINE 5:HOLY FAMILY MEMORIAL PROMOTES THE HEALTH OF THE COMMUNITY BY ENGAGING COMMUNITY MEMBERS INTO THE INPUT AND DECISION MAKING PROCESS. HFM'S BOARD OF DIRECTORS IS COMPRISED OF 100% LOCAL PEOPLE WHO HAVE A VESTED INTEREST IN ASSURING THAT HFM DOES ITS PART IN CREATING A HEALTHIER COMMUNITY. OUR MEDICAL AND DENTAL STAFF IS OPEN TO ANY PROVIDER WHO MEETS ESTABLISHED CRITERIA AND COMMITS TO PROVIDE CARE FOR ALL WHO SEEK HELP. HFM HOSTS VARIOUS COMMUNITY GROUPS IN OUR FACILITIES AND PROVIDES THEM WITH MEETING SPACE AND RELATED MEETING SUPPLIES. HFM REGULARLY PARTICIPATES IN A HOST OF COMMUNITY SPONSORED HEALTH AND WELLNESS EVENTS, PROVIDING COMPLIMENTARY SCREENS, COVID VACCINATION CLINICS, AND INFORMATION ON HOW TO ACHIEVE BETTER HEALTH.
PART VI, LINE 6:THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR APPROXIMATELY 250 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH, AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES -- WISCONSIN, NEBRASKA, AND OHIO -- AND HAS EXISTED FOR OVER 125 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR IN THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGH THE PROVISION OF QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF GOD IN OUR COMMUNITIES.
PART VI, LINE 7, REPORTS FILED WITH STATESWI,NE,OH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (4 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
FOOD ASSISTANCE FOR THE NEEDY25$250COSTFOOD VOUCHERS
MEDICAL ITEMS, SUPPLIES FOR THE NEEDY36$8,253COSTMEDICAL IMPLEMENTS & RX ITEMS
TRANSPORTATION ASSISTANCE FOR NEEDY86$2,038COSTTAXI FARES & OTHER TRANSPORT
WELLNESS FUND MEMBERSHIPS FOR NEEDY71$13,485COSTMEMBERSHIP & COACHING

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE I, PART I, QUESTION 2HOLY FAMILY MEMORIAL MAINTAINS FILES OF THE GRANTS AWARDED ALONG WITH THE AMOUNT. AN APPLICATION FORM IS USED (IF APPLICABLE) FOR THE AWARD, WHICH INCLUDES A REVIEW OF INSURANCE AND EMPLOYMENT STATUS. PROVIDENCE FUNDS MAY ALSO BE USED IN EMERGENCY SITUATIONS TO PROVIDE FOOD, HOUSING, CLOTHING, AND MEDICAL SUPPLIES FOR SOMEONE STRANDED DUE TO AN ACCIDENT. GRANTS ARE AWARDED BASED ON MEDICAL AND FINANCIAL NEED.
PART III, COLUMN (B)FOR LINES 1, 2, AND 3, THE RATIO OF A KNOWN COST TO A KNOWN RECIPIENT COUNT FOR EACH TYPE OF ASSISTANCE WAS APPLIED TO THE COSTS THAT DID NOT HAVE A SPECIFIC RECIPIENT NUMBER ASSIGNED FOR THAT ASSISTANCE TYPE TO ARRIVE AT AN ESTIMATED RECIPIENT VALUE FOR EACH ASSISTANCE TYPE.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KIRK D DIMITRIS MD
PHYSICIAN PROVIDER$749,961$0$972,240$0$21$0$0$0$32,078$0$1,754,300$0$0$0
RYAN M DOPIRAK MD
PHYSICIAN PROVIDER$780,601$0$132,376$0$298$0$0$0$33,719$0$946,994$0$0$0
BRETT W NORELL
DIRECTOR, PRESIDENT, CEO$445,808$0$284,364$0$53,688$0$78,048$0$24,278$0$886,186$0$0$0
DAVID K MIKOLYZK MD
PHYSICIAN PROVIDER$741,112$0$91,543$0$56$0$0$0$31,517$0$864,228$0$0$0
DEAN M POLLNOW MD
EXECUTIVE VP, CMO$271,247$0$300,021$0$206,395$0$62,464$0$18,704$0$858,831$0$0$0
JEREMY R ANCLAM MD
PHYSICIAN PROVIDER$495,241$0$166,101$0$403$0$0$0$25,549$0$687,294$0$0$0
JOHN L TROTTER MD
PHYSICIAN PROVIDER$624,465$0$0$0$15,239$0$0$0$28,384$0$668,088$0$0$0
MILAN JORDAN MD
DIRECTOR$414,557$0$3,202$0$1,420$0$8,550$0$32,313$0$460,042$0$0$0
TROY D DAY
VP FINANCE, CFO$273,706$0$70,325$0$21,588$0$50,099$0$1,236$0$416,954$0$0$0
MATTHEW L CAMPBELL MD
DIRECTOR$353,813$0$0$0$797$0$8,550$0$29,135$0$392,295$0$0$0
THOMAS VEESER
VP, CNO$188,325$0$56,250$0$38,548$0$41,783$0$29,768$0$354,674$0$0$0
PRADEEP GIRIYAPPA MD
DIRECTOR$252,494$0$10,960$0$86$0$8,134$0$21,805$0$293,479$0$0$0
ROBERT H GREENE MD
DIRECTOR$244,561$0$0$0$501$0$7,739$0$33,546$0$286,347$0$0$0
WILLIAM D HAMPTON DO
FORMER DIRECTOR$165,023$0$8,533$0$31$0$0$0$21,747$0$195,334$0$0$0
MARK P HERZOG
FORMER DIRECTOR$0$0$0$0$158,824$0$0$0$1,920$0$160,744$0$0$0
ANNETTE M KAMINSKY APNP
DIRECTOR$103,214$0$41,475$0$286$0$4,414$0$9,648$0$159,037$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4AMARK P. HERZOG 154,326 DEAN M. POLLNOW 102,497
PART I, LINE 7A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION OF PERSONALLY RENDERED SERVICES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATION FACILITIES
A39133785597712D4N02017-08-11$32,431,768SEE SCHEDULE K, PART VI000
WISCONSIN HEALTH AND EDUCATION FACILITIES
B3913378552014-12-19$7,830,000SEE SCHEDULE K, PART VI000
WISCONSIN HEALTH AND EDUCATION FACILITIES
C3913378552016-10-19$10,000,000SEE SCHEDULE K, PART VI000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$1,174,000$32,431,768$438,557$5,051,7392017Yes (1)0Yes (1)Yes (1)
B$1,976,000$7,830,000$18,0002006Yes (1)0Yes (1)Yes (1)
C$4,250,000$10,000,000$39,050$9,960,950201600Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A000000Yes (1)
B000000Yes (1)
C000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A00Yes (1)00000Yes (1)
B00Yes (1)0Yes (1)000Yes (1)
C00Yes (1)0Yes (1)000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)
CYes (1)

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, ROW A, COLUMN F:THE PURPOSE OF THE 2017 BOND ISSUE WAS TO REFUND SERIES 2007 AND TO PROVIDE NEW MONEY FOR CONSTRUCTION OF A CLINIC.
PART I, ROW B, COLUMN F:THE PURPOSE OF THE 2014 BOND ISSUE WAS TO REFUND SERIES 2003B, ISSUED ON 09/09/2003.
PART I, ROW C, COLUMN F:THE PURPOSE OF THE 2016 BOND ISSUE WAS TO 1) REPLACE THE ELECTRONIC HEALTH RECORD SYSTEM, INCLUDING THE ACQUISITION OF HARDWARE AND SOFTWARE; AND 2)FINANCE ELIGIBLE FINANCING-RELATED EXPENSES.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
HOLY FAMILY HEALTH SERVICES
HFM DIRECTORS SERVE BOTH ORGANIZATIONS$32,874INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED0
SUSAN BOWN
SPOUSE OF DIRECTOR$26,249EMPLOYMENT0
DAWN KRUEGER
SPOUSE OF DIRECTOR$63,306EMPLOYMENT0
MATTHEW MCFARLANE
SPOUSE OF DIRECTOR$294,062EMPLOYMENT0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONSFormAndLineReferenceDesc
Explanation1(A) HOLY FAMILY HEALTH SERVICES1(B) HFM DIRECTORS SERVE BOTH ORGANIZATIONS1(D) INCOME FROM CONTINUOUS OPERATIONS THAT ARE 100% OWNED2(A) SUSAN BROWN2(B) SPOUSE OF DIRECTOR, DEREK BROWN2(D) EMPLOYMENT BY ORGANIZATION3(A) DAWN KRUEGER3(B) SPOUSE OF DIRECTOR, CHUCK KRUEGER3(D) EMPLOYMENT BY ORGANIZATION4(A) MATTHEW MCFARLANE4(B) SPOUSE OF DIRECTOR, VERONICA MCFARLANE4(D) EMPLOYMENT BY ORGANIZATIONExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6GOVERNING BODY AND MANAGEMENT: HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM.
FORM 990, PART VI, SECTION A, LINE 7AGOVERNING BODY AND MANAGEMENT: HOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM. FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PROVIDERS.
FORM 990, PART VI, SECTION A, LINE 7BGOVERNING BODY AND MANAGEMENT: SOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE BUDGET, MORTGAGE, PHILOSOPHY, MISSION AND VISION, LEASE OR SALE OF REAL ESTATE MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDIT MUST BE APPROVED BY THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11BPOLICIES: THE CHAIR OF THE GOVERNING BOARD REVIEWS FORM 990 PRIOR TO ITS FILING. AN OVERVIEW OF FORM 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, AND CONFLICT OF INTEREST IS PRESENTED TO THE BOARD OR BOARD COMMITTEE. THE COMPENSATION AND EVALUATION SUB-COMMITTEE REVIEWS FORM 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES OF FORM 990 ARE AVAILABLE TO ALL BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 12CPOLICIES: ANNUALLY, GOVERNING BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND SIGN THE CERTIFICATION ON WHICH THEY DISCLOSE ANY CONFLICTS. AT EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION AND VOTING. ALL PHYSICIANS, LEADERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. CONFLICT OF INTEREST IS MONITORED THROUGH HFM'S COMPLIANCE DEPARTMENT.
FORM 990, PART VI, SECTION B, LINE 15POLICIES: HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES IS GOVERNED BY THE COMPENSATION AND EVALUATION SUB-COMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, AND CHIEF MEDICAL OFFICER. SENIOR LEADER SALARY DATA IS EVALUATED ANNUALLY BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM. TOTAL COMPENSATION FOR SENIOR LEADERS (SALARY, BENEFITS, AND INCENTIVE) IS EVALUATED EVERY THREE YEARS BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM (LAST DONE IN OCTOBER 2017). ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS AND MARKET COMPETITIVENESS. THE POLICY REFLECTS HFM'S MISSION AND VALUES AND THE LOCAL COMMUNITY EXPERIENCE BY EMPHASIZING REWARDS BASED ON WELL-ROUNDED ACCOMPLISHMENTS IN THE AREAS OF MISSION AND RELATIONSHIPS, KEY STRATEGIES, AND OPERATIONS, INCLUDING FINANCE.
FORM 990, PART VI, SECTION C, LINE 19DISCLOSURE: HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION IS PUBLICLY AVAILABLE FROM THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE. IN ADDITION, HFM SUBMITS ITS FINANCIAL INFORMATION TO THE STATE OF WISCONSIN ANNUALLY. FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE OBTAINED FROM THE GUIDESTAR WEBSITE.
FORM 990, PART VII, SECTION A, LINES 1 THROUGH 5:HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS INCLUDES FIVE EMPLOYED PROVIDERS. THE COMPENSATION REPORTED FOR THESE DIRECTORS IS FOR THEIR SERVICES AS A PROVIDER.
FORM 990, PART XI, LINE 9:RESTRICTED CONTRIBUTIONS NET OF ASSETS RELEASED 95,869. TRANSFER TO AFFILIATE (EXCESS CARES ACT AMOUNTS TRANSFERRED TO AFFILIATE) -4,061,300.
FORM 990, PART XII, LINE 2C FINANCIAL STATEMENTS AND REPORTING:THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE FISCAL YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
FRANCISCAN SISTERS OF CHRISTIAN CHARITY
1415 SOUTH RAPIDS ROADMANITOWOCWI54220391530622HOLDING CO.WI501(C)(3)LINE 1N/A0
ST PAUL ELDER SERVICES INC
316 EAST 14TH STREETKAUKAUNAWI54130391029149ELDER CAREWI501(C)(3)LINE 1N/A0
GOOD SAMARITAN MEDICAL CENTER
800 FOREST AVENUEZANESVILLEOH43701314379479HEALTHCAREOH501(C)(3)LINE 3N/A0
FRANCISCAN CARE SERVICES INC
430 N MONITOR STWEST POINTNE68788470486026HEALTHCARENE501(C)(3)LINE 3N/A0
FSCC HOLY FAMILY CONVENT
2409 SOUTH ALVERNO ROADMANITOWOCWI54220390808523RELIGIOUSWI501(C)(3)LINE 1N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11650 S 41ST STREETAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
EIN391572253EIN
Primary ActivitiesPHARMACYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HFM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income-$12,207ShareOfTotalIncomeAmt
Share Of EOY Assets$1,874,272ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (8 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT
J$56,777ACTUAL REVENUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES
P$108,850ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES
P$592,458ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC
P$1,217,200ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS
P$8,361,158ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - EXPENSE REIMBURSEMENT
P$98,221ACTUAL EXPENSE
HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSSUPPLIES
Q$1,166,558ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - EXCESS CARES ACT AMOUNTS
N$4,061,300BDGT VS ACTUAL LOST REVENUE