2021-11-09T09:03:38-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 100 MARITIME DRIVE SUITE 2B MANITOWOC WI 54220 990 2020-01-01 390806395 HOLY FAMILY MEMORIAL INC HOLY 9203202011 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 STEVE LITTLE PRESIDENT / CEO 9203203470 2021-11-09 1 STEVE LITTLE 999009999 LACEY SILBERNAGEL P01245590 9206845500 2021-11-04 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z STEVE LITTLE 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 123206025 0 X WWW.HFMHEALTH.ORG X 1899 WI HEALTH 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. 16 7 977 226 -7358 872 368641 351602 122083347 117912551 1483523 4662536 212110 28031 124147621 122954720 37564 24026 0 0 68072856 66263579 0 0 21865 55033134 59537440 123143554 125825045 1004067 -2870325 183919607 179865777 68862057 69170072 115057550 110695705 X HOLY 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. 0 0 102003997 24026 122589005 HOLY 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. 102003997 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 124 0 1 977 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X X TROY DAY VP AND CFO 9203202011 2300 WESTERN AVENUE MANITOWOC WI 542211450 X MICHELLE L BIRSCHBACH VICE CHAIR 2.00 X X 0 0 0 DEREK R BOWN DC DIRECTOR 40.00 X 115473 0 28409 MATTHEW L CAMPBELL MD DIRECTOR 40.00 X 354610 0 35642 JEFFREY S DUNN CHAIR 2.00 X X 0 0 0 SISTER MARLITA HENSELER DIRECTOR 2.00 X 0 0 0 ERICK M KAHLENBERG TREASURER 2.00 X X 0 0 0 MARILYNN A KAUFMANN PHD RN CHAIR 2.00 X X 0 0 0 SISTER ELAINE TURBA DIRECTOR 2.00 X 0 0 0 KATHY ZUCCHI DIRECTOR 2.00 X 0 0 0 BRETT W NORELL DIRECTOR, PRESIDENT, CEO 40.00 X X 783860 0 101090 ANNETTE M KAMINSKY APNP DIRECTOR 40.00 X 144975 0 13515 SISTER NANCY KINATE SECRETARY 2.00 X X 0 0 0 SISTER MARY FRANCES MAHER DIRECTOR 2.00 X 0 0 0 PRADEEP GIRIYAPPA MD DIRECTOR 40.00 X 263540 0 28023 CANDICE GIESEN DIRECTOR 2.00 X 0 0 0 ROBERT H GREENE MD DIRECTOR 40.00 X 245062 0 37881 MILAN JORDAN MD DIRECTOR 40.00 X 419179 0 39627 CHUCK KRUEGER TREASURER 2.00 X X 0 0 0 VERONICA MCFARLANE APNP DIRECTOR 40.00 X 129816 0 13095 GENNY SHIELDS DIRECTOR 2.00 X 0 0 0 KENLYN T GRETZ DIRECTOR 2.00 X 0 0 0 DEAN M POLLNOW MD EXECUTIVE VP, CMO 40.00 X 777663 0 80138 TROY D DAY VP FINANCE, CFO 40.00 X 365619 0 50099 THOMAS VEESER VP, CNO 40.00 X 283123 0 70425 JEREMY R ANCLAM MD PHYSICIAN PROVIDER 40.00 X 661745 0 25549 KIRK D DIMITRIS MD PHYSICIAN PROVIDER 40.00 X 1722222 0 29986 RYAN M DOPIRAK MD PHYSICIAN PROVIDER 40.00 X 913275 0 30069 DAVID K MIKOLYZK MD PHYSICIAN PROVIDER 40.00 X 832711 0 30142 JOHN L TROTTER MD PHYSICIAN PROVIDER 40.00 X 639704 0 25484 MARK P HERZOG FORMER DIRECTOR 40.00 X 158824 0 1920 WILLIAM D HAMPTON DO FORMER DIRECTOR 40.00 X 173587 0 19380 8984988 0 660474 88 1 1 0 XTEND HEALTHCARE LLC 90 VOLUNTEER DR STE 150 HENDERSONVILLE TN 37075 BILLING SERVICES 3620221 MEDICAL SOLUTIONS LLC 1010 N 102 ST STE 300 OMAHA NE 68114 TEMPORARY STAFFING 1870885 COMPLETERX LTD 3200 WILCREST DRIVE STE 250 HOUSTON TX 77042 PHARMACY SERVICES 979025 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 IT SERVICES 715957 ALL STAR RECRUITING LOCUMS LLC PO BOX 936725 ATLANTA GA 311936725 TEMPORARY STAFFING 662256 17 71125 280477 351602 INTEGRATED HEALTH CARE 900099 102512191 102512191 LAB 621500 8822426 8818346 4080 PHARMACY 446110 6577934 6577934 117912551 4680534 4680534 162388 127959 34429 34429 34429 15020 33018 -17998 -17998 -17998 20725 71125 15685 5040 5040 75412 74643 769 769 INVESTMENT HFHS 900003 -12207 -12207 -12207 122954720 122589005 -7358 21471 24026 24026 4504401 2842570 1661831 49781460 45024559 4740505 16396 729865 574574 155011 280 8125390 7246378 878635 377 3122463 2731491 390065 907 871619 220373 651246 822003 690 821313 169769 169769 4574903 4550220 24683 181342 9387 171955 398690 363233 35434 23 4505853 1558841 2947012 1910398 1910398 143629 119700 23929 105364 92226 13138 1555974 1555974 6828852 4914634 1914218 695834 564236 131598 SUPPLIES 18006964 17909455 97502 7 PURCHASED SERVICES 11872186 4076344 7795146 696 MAINTENANCE 2694099 2637401 56698 WISCONSIN PROVIDER ASSE 2392332 2392332 1807629 684955 1119495 3179 125825045 102003997 23799183 21865 6506200 7276233 6231543 6538018 15796927 10933773 1979878 1968334 8387620 5657410 205900925 132093086 77951933 73807839 63796746 71252977 1047523 423758 1571435 1583640 649802 423795 183919607 179865777 20696460 12870496 42083 25559 48123014 46061930 500 10212087 68862057 69170072 X 111265199 106807485 3792351 3888220 115057550 110695705 183919607 179865777 X -2870325 2473911 -3965431 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 0 0 1 19636 19636 0 PART II-B, LINE 1: EXPLANATION: 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. 0 0 3792351 170642 265013 339786 3888220 3157405 726675 264841 356570 3792351 3160846 203946 -91795 115592 3157405 2811732 350741 242832 244459 3160846 2566566 314437 105388 174659 2811732 0.88000 0.09000 0.03000 0 1 1 5465349 5465349 112096193 70732331 41363862 86686549 60332554 26353995 1652834 1028201 624633 73807839 AMOUNTS DUE TO MEDICARE FOR ACCELERATED PAYMENTS 10212087 10212087 125428631 2473911 2473911 122954720 0 122954720 125825045 0 125825045 0 125825045 PART V, LINE 4: HOLY 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. SAMARITAN DAY 82260 61535 20725 3500 11644 LOVE LIGHTS 9590 9590 541 91850 71125 20725 3500 12185 15685 5040 1 1 1 X 1 X 1 1 0 1 1 144 97028 97028 0.00080 10187 12992772 4921950 8070822 0.06410 10331 13089800 4921950 8167850 0.06490 25833 1453421 1453421 0.01160 157 10161 10161 0.00010 615 112293 112293 0.00090 26605 1575875 1575875 0.01260 36936 14665675 4921950 9743725 0.07750 4 3225 3225 0.00000 0 600 600 0.00000 0 686 686 0.00000 0 284 284 0.00000 1 12 12 0.00000 5 4807 4807 0.00000 1 1903897 401722 41392796 62119321 -20726525 X 1 1 1 1 HOLY FAMILY MEMORIAL INC 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 WWW.HFMHEALTH.ORG X X X HOLY FAMILY MEMORIAL INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X WWW.HFMHEALTH.ORG X SEE PART V, PAGE 8 1 19 1 SEE PART V, PAGE 8 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X WWW.HFMHEALTH.ORG/COMMUNITY-CARE/ X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X X 1 X 0 X 1 0 0 HOLY FAMILY MEMORIAL, INC PART 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, INC PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH AURORA MEDICAL CENTER - MANITOWOC COUNTY. HOLY FAMILY MEMORIAL, INC PART 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, INC PART 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, INC PART 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 7B HEALTHIESTMC.ORG; MANITOWOCCOUNTYWI.GOV/DEPARTMENTS/HEALTH-DEPARTMENT/ PART V SECTION B, LINE 10A HFMHEALTH.ORG; HEALTHIESTMC.ORG; CO.MANITOWOC.WI.US/DEPARTMENTS/HEALTH-DEPARTMENT/ PART V SECTION B, LINE 16B FAP APPLICATION WEBSITE: HTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2020/06/COMMUNITYCAREAPPLICATION062620.PDF PART V SECTION B, LINE 16C FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2020/09/PLAIN-LANGUAGE-SUMMARY-UPDATED-092320.PDF PART V SECTION B, LINE 22D HOLY FAMILY MEMORIAL USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. 1 1 - HOLY FAMILY HEALTH SERVICES INC 1650 S 41ST STREET MANITOWOC WI 54220 RETAIL PHARMACY 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 F THE 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 STATES WI,NE,OH 1 FOOD ASSISTANCE FOR THE NEEDY 25 250 COST FOOD VOUCHERS MEDICAL ITEMS, SUPPLIES FOR THE NEEDY 36 8253 COST MEDICAL IMPLEMENTS & RX ITEMS TRANSPORTATION ASSISTANCE FOR NEEDY 86 2038 COST TAXI FARES & OTHER TRANSPORT WELLNESS FUND MEMBERSHIPS FOR NEEDY 71 13485 COST MEMBERSHIP & COACHING SCHEDULE I, PART I, QUESTION 2 HOLY 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. 1 X X X X 1 0 0 0 0 0 0 1 0 KIRK D DIMITRIS MD PHYSICIAN PROVIDER 749961 0 972240 0 21 0 0 0 32078 0 1754300 0 0 0 RYAN M DOPIRAK MD PHYSICIAN PROVIDER 780601 0 132376 0 298 0 0 0 33719 0 946994 0 0 0 BRETT W NORELL DIRECTOR, PRESIDENT, CEO 445808 0 284364 0 53688 0 78048 0 24278 0 886186 0 0 0 DAVID K MIKOLYZK MD PHYSICIAN PROVIDER 741112 0 91543 0 56 0 0 0 31517 0 864228 0 0 0 DEAN M POLLNOW MD EXECUTIVE VP, CMO 271247 0 300021 0 206395 0 62464 0 18704 0 858831 0 0 0 JEREMY R ANCLAM MD PHYSICIAN PROVIDER 495241 0 166101 0 403 0 0 0 25549 0 687294 0 0 0 JOHN L TROTTER MD PHYSICIAN PROVIDER 624465 0 0 0 15239 0 0 0 28384 0 668088 0 0 0 MILAN JORDAN MD DIRECTOR 414557 0 3202 0 1420 0 8550 0 32313 0 460042 0 0 0 TROY D DAY VP FINANCE, CFO 273706 0 70325 0 21588 0 50099 0 1236 0 416954 0 0 0 MATTHEW L CAMPBELL MD DIRECTOR 353813 0 0 0 797 0 8550 0 29135 0 392295 0 0 0 THOMAS VEESER VP, CNO 188325 0 56250 0 38548 0 41783 0 29768 0 354674 0 0 0 PRADEEP GIRIYAPPA MD DIRECTOR 252494 0 10960 0 86 0 8134 0 21805 0 293479 0 0 0 ROBERT H GREENE MD DIRECTOR 244561 0 0 0 501 0 7739 0 33546 0 286347 0 0 0 WILLIAM D HAMPTON DO FORMER DIRECTOR 165023 0 8533 0 31 0 0 0 21747 0 195334 0 0 0 MARK P HERZOG FORMER DIRECTOR 0 0 0 0 158824 0 0 0 1920 0 160744 0 0 0 ANNETTE M KAMINSKY APNP DIRECTOR 103214 0 41475 0 286 0 4414 0 9648 0 159037 0 0 0 PART I, LINE 4A MARK P. HERZOG 154,326 DEAN M. POLLNOW 102,497 PART I, LINE 7 A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION OF PERSONALLY RENDERED SERVICES. A WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 97712D4N0 2017-08-11 32431768 SEE SCHEDULE K, PART VI 0 0 0 B WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 2014-12-19 7830000 SEE SCHEDULE K, PART VI 0 0 0 C WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 2016-10-19 10000000 SEE SCHEDULE K, PART VI 0 0 0 A 1174000 32431768 438557 5051739 2017 1 0 1 1 B 1976000 7830000 18000 2006 1 0 1 1 C 4250000 10000000 39050 9960950 2016 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 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. HOLY FAMILY HEALTH SERVICES HFM DIRECTORS SERVE BOTH ORGANIZATIONS 32874 INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED 0 SUSAN BOWN SPOUSE OF DIRECTOR 26249 EMPLOYMENT 0 DAWN KRUEGER SPOUSE OF DIRECTOR 63306 EMPLOYMENT 0 MATTHEW MCFARLANE SPOUSE OF DIRECTOR 294062 EMPLOYMENT 0 PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS 1(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 ORGANIZATION FORM 990, PART VI, SECTION A, LINE 6 GOVERNING 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 7A GOVERNING 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 7B GOVERNING 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 11B POLICIES: 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 12C POLICIES: 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 15 POLICIES: 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 19 DISCLOSURE: 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. FRANCISCAN SISTERS OF CHRISTIAN CHARITY 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 HOLDING CO. WI 501(C)(3) LINE 1 N/A 0 ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 1 N/A 0 GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 FRANCISCAN CARE SERVICES INC 430 N MONITOR ST WEST POINT NE 68788 470486026 HEALTHCARE NE 501(C)(3) LINE 3 N/A 0 FSCC HOLY FAMILY CONVENT 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGIOUS WI 501(C)(3) LINE 1 N/A 0 HOLY FAMILY HEALTH SERVICES 1650 S 41ST STREET MANITOWOC WI 54220 391572253 PHARMACY WI HFM INC C -12207 1874272 1.00000 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT J 56777 ACTUAL REVENUE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES P 108850 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES P 592458 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC P 1217200 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS P 8361158 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - EXPENSE REIMBURSEMENT P 98221 ACTUAL EXPENSE HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSSUPPLIES Q 1166558 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - EXCESS CARES ACT AMOUNTS N 4061300 BDGT VS ACTUAL LOST REVENUE