ST CLARE MEMORIAL HOSPITAL INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- ST CLARE MEMORIAL HOSPITAL INC (EIN 39-0848401)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-05-14
- IRS object ID
- 202041359349304569
- Schema version
- 2018v3.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-14T22:01:01-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive Suite 2600 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390848401 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Clare Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCL | BusinessNameControlTxt |
| Phone | 9208463444 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICIA ALLEN | PersonNm |
| Person Title | DIVISION CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Signature | 2020-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Mallory Fairless | PreparerPersonNm |
| PTIN | P01321579 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THERESE B PANDL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $32,485,032 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://www.stclarememorial.org/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITYFRANCISCAN HEALTH CARE MINISTRY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 173 | TotalEmployeeCnt |
| Total Volunteers | 36 | TotalVolunteersCnt |
| Total Gross UBI | $5,391,571 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $108,800 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,198 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $31,502,874 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,436,041 | CYProgramServiceRevenueAmt |
| PY Investment Income | $36,800 | PYInvestmentIncomeAmt |
| CY Investment Income | $41,664 | CYInvestmentIncomeAmt |
| PY Other Revenue | $14,316 | PYOtherRevenueAmt |
| CY Other Revenue | $6,129 | CYOtherRevenueAmt |
| PY Total Revenue | $31,662,790 | PYTotalRevenueAmt |
| CY Total Revenue | $32,485,032 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,212,487 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,685,904 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,778,134 | PYOtherExpensesAmt |
| CY Other Expenses | $24,254,416 | CYOtherExpensesAmt |
| PY Total Expenses | $34,990,621 | PYTotalExpensesAmt |
| CY Total Expenses | $34,940,320 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$3,327,831 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,455,288 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,781,639 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,275,513 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,516,614 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,976,736 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,265,025 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$701,223 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ST. CLARE MEMORIAL HOSPITAL, INC. OPERATES AN ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE INPATIENT MEDICAL AND SURGICAL SERVICES AS WELL AS EMERGENCY, PRIMARY CARE PHYSICIAN, AND OUTPATIENT SERVICES. THE HOSPITAL HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL UNDER MEDICARE AND MEDICAID REGULATIONS. THIS DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $28,828,645 | ExpenseAmt |
| Revenue | $27,044,470 | RevenueAmt |
| Desc | ST. CLARE MEMORIAL HOSPITAL SERVES THE GREATER OCONTO COUNTY WITH A FULL-SERVICE HOSPITAL AND SIX PRIMARY CARE CLINICS LOCATED THROUGHOUT OCONTO COUNTY. THE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH A LICENSURE OF 25 BEDS AND HAS A 24-HOUR, PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, URGENT CARE, RETAIL PHARMACY, INTENSIVE CARE, INPATIENT AND OUTPATIENT SURGICAL AND DIAGNOSTIC SERVICES, REHABILITATION, WOUND THERAPY AND THE CENTER FOR WOMEN'S CARE. THE ST. CLARE PRIMARY CARE CLINICS ARE LOCATED IN LENA, OCONTO FALLS, GILLETT, SURING AND MOUNTAIN. ST. CLARE MEMORIAL HOSPITAL IS A NON-PROFIT ORGANIZATION DEDICATED TO OUR MISSION TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. ST.CLARE MEMORIAL HOSPITAL EXTENDS THIS MISSION INTO OUR VALUES OF QUALITY, CARE, COMMUNITY, TRUST, AND RESPECT AND PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING THE FISCAL YEAR ENDING JUNE 30, 2019, THE HOSPITAL HAD 380 DISCHARGES; 4,248 VISITS TO THE EMERGENCY ROOM; 615 SURGERIES AND 17,338 OUTPATIENT VISITS. ST. CLARE MEMORIAL HOSPITAL PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO THEIR AGE, RACE, SEX OR ABILITY TO PAY FOR SERVICES. DURING FISCAL YEAR 2019, ST. CLARE MEMORIAL HOSPITAL PROVIDED $768,409 IN CHARITY CARE AND $802,823 IN BAD DEBT WRITE OFFS OF PATIENT ACCOUNTS DUE TO THE PATIENTS' INABILITY TO PAY FOR SERVICES THEY RECEIVED. IN ADDITION TO ITS HOSPITAL AND CLINIC SERVICES. ST. CLARE MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE FREE AND LOW-COST HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE OFFERINGS, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. THE HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, PUBLICITY, SUPPLIES, AND THE MEALS. THREE ST. CLARE MEMORIAL HOSPITAL SEMINARS WERE HELD IN 2019. ST. CLARE MEMORIAL HOSPITAL IS PLEASED TO PARTNER, PARTICIPATE AND COLLABORATE WITH MANY COMMUNITY PARTNERS FOR VARIOUS INITIATIVES AND EVENTS. ST. CLARE MEMORIAL HOSPITAL PLANNED AND SPONSORED INCLUDING A COMMUNITY HEALTH INITIATIVE. WE ALSO PRESENTED THE OCONTO COUNTY SAFETY FAIR IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. ST. CLARE MEMORIAL HOSPITAL HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. ST. CLARE MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR MAJOR FUND RAISING COMMITTEE AND THE EXECUTIVE COMMITTEE. FOR EACH OF THESE INITIATIVES, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. IN ADDITION TO PROVIDING COMPREHENSIVE SPORTS PHYSICAL CLINICS IN WHICH THE FEES ARE DONATED BACK TO THE SCHOOLS OF THE PARTICIPATING STUDENTS, ST. CLARE MEMORIAL HOSPITAL PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE ROUTINELY HOSTED AT THE HOSPITAL. ST. CLARE MEMORIAL HOSPITAL ALSO DONATED TO THE CONSTRUCTION OF NEW PICKLEBALL COURTS FOR THE OCONTO FALLS AREA. | Desc |
| Total Program Service Expenses | $28,828,645 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 173 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | Yes (true) | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kevin Sevcik | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204338694 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 835 S Van Buren St | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| CHRISTY KAEMPFER | ||||||||
| 2018 & 2019 Chair | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL BOETTCHER | ||||||||
| 2018 & 2019 Vice Chair | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Chris Brabant | ||||||||
| President | 40.0 | 0 | Yes (X) | Yes (X) | $0 | $124,302 | $21,467 | |
| JAN STRANZ | ||||||||
| 2018 & 2019 Secretary | 2.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THERESE B PANDL | ||||||||
| PRES / CEO EASTERN WISCONSIN DIVISION | 6.0 | 54.0 | Yes (X) | Yes (X) | $0 | $924,387 | $174,302 | |
| DR JAMES CLEMENS | ||||||||
| BOARD MEMBER/PHYSICIAN | 2.0 | 40.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL W COTTRELL | ||||||||
| Board Member/ HSHS CFO | 1.0 | 59.0 | Yes (X) | $0 | $828,161 | $189,746 | ||
| DR ROBERT CUTLAN | ||||||||
| BOARD MEMBER/PHYSICIAN | 2.0 | 40.0 | Yes (X) | $0 | $884,694 | $23,340 | ||
| SR MaryAnn Falbe OSF | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| GREG JONES | ||||||||
| BOARD MEMBER | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| PETER MANNIX | ||||||||
| BOARD MEMBER | 1.0 | 59.0 | Yes (X) | $0 | $499,239 | $158,591 | ||
| MICHAEL NELESSEN | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.3 | 59.7 | Yes (X) | $0 | $329,829 | $110,463 | ||
| DANIEL DEGROOT | ||||||||
| Ex-Officio Board Member/COO | 40.0 | 0.5 | Yes (X) | $94,439 | $0 | $3,769 | ||
| PAULA HAFEMANN | ||||||||
| CHIEF NURSING OFFICER | 20.0 | 21.0 | Yes (X) | $0 | $330,528 | $88,145 | ||
| GREG SIMIA | ||||||||
| DIVISION CFO | 5.0 | 35.0 | Yes (X) | $0 | $456,456 | $89,224 | ||
| CHERYL BURKEL EMMERS | ||||||||
| CRNA | 40.0 | 0 | $285,041 | $0 | $54,128 | Yes (X) | ||
| GRAM COTTON | ||||||||
| CRNA | 40.0 | 0 | $289,347 | $0 | $23,878 | Yes (X) | ||
| DAVID MISKULIN | ||||||||
| PHARMACIST | 40.0 | 0 | $137,459 | $0 | $27,959 | Yes (X) | ||
| Richard McNutt | ||||||||
| Physician | 40.0 | 0 | $151,438 | $0 | $6,486 | Yes (X) | ||
| Maura May White | ||||||||
| CRNA | 40.0 | 0 | $184,315 | $0 | $27,725 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,142,039 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,377,596 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $999,223 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Infinity Healthcare | |||||
| 111 E Wisconsin Ave | Milwaukee | WI | 53202 | Physician Services | $2,081,281 |
| IEI General Contrators | |||||
| 1725 Midway Rd | De Pere | WI | 54115 | Construction | $917,719 |
| General & Vascular Consult LLC | |||||
| 840 S Madison St | Green Bay | WI | 54301 | Physician Services | $466,667 |
| NEW Surgical Associates | |||||
| 670 Cormier Rd | Green Bay | WI | 54304 | Physician Services | $194,375 |
| August Winter & Sons Inc | |||||
| 2323 N Roemer Rd | Appleton | WI | 54911 | Construction | $153,422 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,198 | GovernmentGrantsAmt |
| Total Contributions | $1,198 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621990 | $19,933,513 | $19,933,513 | |
| PHARMACY REVENUE | 446110 | $12,351,981 | $6,960,410 | $5,391,571 |
| OTHER | 900099 | $150,547 | $150,547 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,436,041 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,787 | TotalRevenueColumnAmt |
| Exclusion | $19,787 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,129 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,129 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,129 | TotalRevenueColumnAmt |
| Exclusion | $6,129 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $21,877 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $21,877 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,877 | TotalRevenueColumnAmt |
| Exclusion | $21,877 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,485,032 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $27,044,470 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $5,391,571 | UnrelatedBusinessRevenueAmt |
| Exclusion | $47,793 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,208 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $98,208 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,142,379 | TotalAmt |
| Program Services | $6,826,114 | ProgramServicesAmt |
| Management And General | $1,316,265 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,920 | TotalAmt |
| Program Services | $197,093 | ProgramServicesAmt |
| Management And General | $40,827 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,207,397 | TotalAmt |
| Program Services | $1,828,608 | ProgramServicesAmt |
| Management And General | $378,789 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,107 | TotalAmt |
| Management And General | $1,107 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,586 | TotalAmt |
| Management And General | $6,586 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,944,840 | TotalAmt |
| Program Services | $9,708,294 | ProgramServicesAmt |
| Management And General | $236,546 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,604 | TotalAmt |
| Program Services | $27,375 | ProgramServicesAmt |
| Management And General | $59,229 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,301 | TotalAmt |
| Program Services | $213,164 | ProgramServicesAmt |
| Management And General | $77,137 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,791 | TotalAmt |
| Program Services | $7,670 | ProgramServicesAmt |
| Management And General | $74,121 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $488,107 | TotalAmt |
| Program Services | $84,459 | ProgramServicesAmt |
| Management And General | $403,648 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,006 | TotalAmt |
| Program Services | $40,813 | ProgramServicesAmt |
| Management And General | $48,193 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $218,209 | TotalAmt |
| Management And General | $218,209 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,619,330 | TotalAmt |
| Program Services | $711,403 | ProgramServicesAmt |
| Management And General | $907,927 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,511 | TotalAmt |
| Program Services | $8,236 | ProgramServicesAmt |
| Management And General | $53,275 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $7,519,136 | $7,502,651 | $16,485 |
| EQUIPMENT & MAINTENANCE | $137,356 | $119,323 | $18,033 |
| BAD DEBT | $802,823 | $802,823 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,907,709 | TotalAmt |
| Program Services | $750,619 | ProgramServicesAmt |
| Management And General | $2,157,090 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,940,320 | TotalAmt |
| Program Services | $28,828,645 | ProgramServicesAmt |
| Management And General | $6,111,675 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,706 | BOYAmt |
| EOY | $1,102,214 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $781,618 | BOYAmt |
| EOY | $612,726 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,883,633 | BOYAmt |
| EOY | $6,576,787 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,377,969 | BOYAmt |
| EOY | $1,236,711 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,570 | BOYAmt |
| EOY | $34,596 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,197,728 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,152,546 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,658,227 | BOYAmt |
| EOY | $12,045,182 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,293,916 | BOYAmt |
| EOY | $1,667,297 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,781,639 | BOYAmt |
| EOY | $23,275,513 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,225,088 | BOYAmt |
| EOY | $16,407,890 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,990,878 | BOYAmt |
| EOY | $6,597,967 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,648 | BOYAmt |
| EOY | $970,879 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,516,614 | BOYAmt |
| EOY | $23,976,736 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,920,334 | BOYAmt |
| EOY | -$1,200,146 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,691 | BOYAmt |
| EOY | $488,923 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,000 | BOYAmt |
| EOY | $10,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,265,025 | BOYAmt |
| EOY | -$701,223 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,781,639 | BOYAmt |
| EOY | $23,275,513 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,455,288 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $21,608 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$532,568 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $2,318 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,318 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | ST. CLARE MEMORIAL HOSPITAL, INC. ("THE HOSPITAL") IS A MEMBER OF THE WISCONSIN HEALTH ASSOCIATION ("WHA") AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 22.73% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 13.6% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. |
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | ST. CLARE MEMORIAL HOSPITAL, INC. ("THE HOSPITAL") IS A MEMBER OF THE WISCONSIN HEALTH ASSOCIATION ("WHA") AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 22.73% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 13.60% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $428,317 | OtherCostOrOtherBasisAmt |
| Book Value | $428,317 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,285,956 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,464,680 | DepreciationAmt |
| Book Value | $6,821,276 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $86,732 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,885 | DepreciationAmt |
| Book Value | $55,847 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,582,366 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,656,981 | DepreciationAmt |
| Book Value | $2,925,385 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,814,357 | OtherCostOrOtherBasisAmt |
| Book Value | $1,814,357 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,045,182 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASES | $11,194 |
| DUE TO MEDICARE | $230,507 |
| ACCRUED BENEFIT LIABILITY | $600,927 |
| RETIREMENT OBLIGATION-ASBESTOS | $57,666 |
| Advance Pain Mgmt | $70,585 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $970,879 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501(c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely than not Kiara, Inc. will not realize the majority of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2019 and 2018 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2019 and 2018, HSHS does not have any liabilities for unrecognized tax benefits. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $411,268 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $411,268 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,357,840 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,281,221 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,076,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0608 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $373,755 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $197,309 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $176,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0052 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,142,863 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,478,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,664,333 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0780 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,167 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,167 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0006 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,024 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,024 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0003 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,349 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,349 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0012 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $69,540 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $69,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $5,212,403 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,478,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,733,873 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0801 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,383 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,383 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0002 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $865 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $865 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,190 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $9,438 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,438 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0003 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $802,823 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $140,352 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,940,065 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,088,611 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,148,546 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 SOUTH MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.stclarememorial.org/ | WebsiteAddressTxt |
| State License | 1012 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.stclarememorial.org/www-sco/media/SCO-PDFs/About/CHNA-SCO.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.stclarememorial.org/www-sco/media/SCO-PDFs/About/CHIP-SCO.pdf | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.hshs.org/fap | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.hshs.org/fap | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.hshs.org/fap | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. Hospital Sisters Health System and HSHS St. Clare Memorial Hospital are committed to promoting and defending human dignity, caring for persons living in poverty and other vulnerable persons, promoting the common good, and stewarding resources. We believe that the CHNA process must be informed by input from the poor and vulnerable populations we seek to serve. To ensure that the needs of these groups were adequately represented from Oconto County, we included representatives from HSHS St. Clare Memorial Hospital, Bellin Health Oconto Hospital, Oconto County Health & Human Services, United Way, local food pantries, Aging and Disability Resource Center, local school districts, and Newcap. These organizations serve the under-resourced in our community, including low-income seniors, children living in poverty, and families who struggle with shelter and food insecurity. Representatives of these organizations, who work directly with their constituents, have extensive knowledge and quantifiable data regarding the needs of their service populations. Actively including these organizations in the CHNA process was critical to ensure that the needs of the most vulnerable persons in our communities were being shared and addressed in the CHNA process and development of related implementation strategies. HSHS St. Clare Memorial Hospital led the planning, implementation and completion of the Community Health Needs Assessment in partnership with Bellin Health Oconto Hospital and Oconto County Public Health. Internal HSHS St. Clare Memorial Hospital spent 12 months developing the CHNA, identifying and prioritizing community health needs for its service area and formulating an implementation plan to guide ongoing population health initiatives with like-missioned partners and collaborators. These planning and development activities included the following steps: Convene the HSHS Eastern Wisconsin Division community benefit team Determine internal capacity for the collaborative process Allocate monetary resources to support the community-wide effort Present to senior leadership to gain permission for colleagues to track and document community benefit efforts in CBISA Define the role of the Community Benefits Facilitator, inclusive of the EMS Liaison role Share the results of the needs assessment and obtain feedback for the implementation plan from the Hospital Advisory Committee Present the CHNA and implementation plan to HSHS St. Clare Memorial Board for approval External HSHS St. Clare Memorial Hospital leveraged existing relationships to gain additional insights into community health needs in HSHS St. Clare Memorial Hospital's service area. External components and steps included: Creating a regional steering committee consisting of HSHS St. Clare Memorial Hospital, Bellin Health Oconto Hospital and Oconto County Public Health. In FY2019 the steering team expanded to include Oconto County Economic Development Corporation and Oconto County Sheriff's Office. Led community forums with individuals and groups including school superintendents, business owners, EMS personnel, law enforcement, parent groups, county board supervisors, circuit judge, and the community college. Conducted a youth risk behavior survey in all five school districts in the county. Gathered statistics from various data sources reflecting the health of Oconto County. |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. Yes, Bellin Health Oconto Hospital. |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. Yes, Oconto County Department of Public Health |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. The following health needs were identified based on burden, scope, severity and urgency of the health need; the health disparities associated with the health need; the importance the community places on addressing the health need; the community assets and resources that could be leveraged through strategic collaboration in HSHS St. Clare Memorial Hospital's service area; the secondary data sources; and local expertise and input. Alcohol and other drug abuse (AODA) Physical activity and nutrition Mental health HSHS St. Clare Memorial has partnered with the community wide action planning teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address the identified priority community health needs. The implementation strategies and interventions will include, but are not limited to, the following initiatives categories. Physical Activity and Nutrition Goal: In partnership with the Oconto County Health Department and other organizations, create an environment that empowers residents to embrace healthy food choices and increase physical activity. FY2019 Outcomes: Additional phases of the Oconto Falls Area Trail System continue to be developed. As a result of the previous expansion of the trail system, the City of Oconto Falls funded and installed a significant length of sidewalk connecting the 450 feet of sidewalk from HSHS St. Clare Memorial Hospital to the rest of the city sidewalks and the elementary school. Most importantly this completed a safe path for students walking to school and for colleagues from St. Clare who enjoy walking on their breaks. HSHS St. Clare Memorial Hospital continues to be a sponsor for Run for the Trails, an annual run where proceeds are used to maintain the Oconto Falls Area Trail System. In 2019, we increased our presence and engagement by including a "Race the Doc" challenge with two of our family medicine doctors. The annual Community Health/Safety Fair provides education on various topics regarding health and physical activity. Forty vendors attended this year's event and more than 200 community members participated. A food drive was conducted promoting our Donate a Healthy Plate initiative. Free blood pressure and cholesterol screenings were offered to any visitors to the fair, a new event for this year. The Produce to Pantries initiative supports fresh produce options at the county food pantries. HSHS St. Clare Hospital has participated in this program in the past. Produce to Pantries ran from May to October. Largely supported by campus colleagues, the additional raised garden beds have produced over 200 lbs. of fresh vegetables allowing to serve many of the 200 families that visit two of the area pantries. The Donate a Healthy Plate Toolkit was designed to help food pantry donors, pantry staff, and organizers of food drives to promote healthy food pantry donations in our community. It can also be used to educate the community on types of healthy foods that are encouraged to be donated to local food pantries. Data shows that Oconto County residents are struggling with food insecurity. By increasing the amount of healthy foods at local pantries it is our hope that we will help decrease obesity and the chronic diseases associated with food insecurity. The toolkits were shared with all county food pantries, as well as being marketed throughout the county. Toolkits are available at community libraries and at all Bellin and Prevea Medical Clinics in the county. Posters and brochures have been developed and shared at events throughout the county including health fairs, back to school events at local schools, and community celebrations. The toolkit is also posted on social media sites as well as the Oconto County Public Health website. The Healthy Oconto County Physical Activity and Nutrition workgroup coordinated a community effort to develop and plan an area Farmer's Market. A team, tasked with operationalizing the Oconto County Farmer's Market, was formed and plans to launch the market in the spring of 2020. Alcohol and Other Drug Abuse (AODA) Goal: In partnership with Oconto County Health and Human Services, Prevea Behavioral Health and Bellin Health, HSHS St. Clare Memorial Hospital will create a responsible substance use culture. FY2019 Outcomes: The AODA workgroup includes representation from diverse organizations within the county. Active membership of the group includes: school districts, health care systems, community members, local health department, behavioral health providers, United Way, local law enforcement, and Alliance for Wisconsin Youth. Over six months, an extensive amount of time was spent in reviewing state and county AODA data, Youth Risk Behavior Survey, community conversations survey, and input from members of the diverse workgroup. Three strategies for change include increase access to treatment, decrease access to AOD, and creating a culture of health and action teams were identified. Achievable objectives and action steps have been outlined. As a member of the Increase Access to Treatment team, HSHS St. Clare Memorial Hospital spent significant time exploring the potential of creating an in-patient detoxification unit within the hospital. Mental Health Goal: In partnership with the Oconto County Health Department and other organizations, create awareness of and access to mental health services in the community that will support positive mental health. FY2019 Outcomes: HSHS St. Clare Memorial Hospital plays a supportive role in mental health services. Although there is not a workgroup established to address mental health, there is work being done to address the need. Prevea Behavioral Health offers Behavioral Care at the Medical Office Building on the campus of HSHS St. Clare Memorial Hospital. Through a HOPE grant, new telehealth equipment has been purchased and installed in the five rural health clinics in our area. Once all the regulatory issues have been addressed, this service will begin, meeting a need that is severely underserved. As an outcome of the prioritization process, Access to Care was identified as a community health priority. Due to a lack of county-wide resource, a formal Access to Care work group has not yet been established. However, access is a component of each of the above identified community health priorities vs. being a standalone health priority. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - St. Clare Memorial Hospital. Presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 7. Wisconsin Department of Health Services Housing Assistance Program 8. Participation in Women, Infants and Children programs (WIC); 9. Supplemental Nutrition Assistance Program (SNAP) eligibility; 10. Illinois Free Lunch and Breakfast Program; 11. Wisconsin Free Lunch Program; 12. Low Income Home Energy Assistance Program (LIHEAP); 13. Wisconsin Home Energy Assistance Program (WHEAP); 14. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 15. Receipt of grant assistance for medical services |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HSHS St Clare Memorial Hospital Prevea Lena Health Center | ||||
| 200 SOUTH ROSERA STREET | LENA | WI | 54139 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Mountain Health Center | ||||
| 14353 HWY 32/64 | MOUNTAIN | WI | 54149 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Gillett Health Center | ||||
| 340 NORTH GREEN BAY AVE | GILLETT | WI | 54124 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Suring Health Center | ||||
| 913 E MAIN STREET | SURING | WI | 54174 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Oconto Falls Health Center | ||||
| 835 SMain St | Oconto Falls | WI | 54154 | Clinic |
| Prevea Oconto Falls Health Center - Medical Services Building | ||||
| 853 S Main St | Oconto Falls | WI | 54154 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 7 SCHEDULE H, PART 1, COL F | The bad debt expense included on Form 990, Part IX, Line 25, column (A) was subtracted prior to and for the purpose of calculating the percentage in Part I, Line 7, column (f) is $802,823. |
| Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation | 802823 |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FY2019 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET 2. |
| Schedule H, Part II Community Building Activities | The community building activities that the hospital tracked and reported in our community benefit report are a portion of our total community benefit efforts. They consist primarily of actively participating in and supporting the work of community groups to advance community awareness about health issues while supporting the areas of identified need in the community. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors who do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria up to 400% of the federal poverty level will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for Doubtful Accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations. The Hospital reports bad debt in accordance with Generally Accepted Accounting Principles (GAAP). |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | HSHS St. Clare Hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 19 in the HSHS Consolidated Audit Report. Please also reference Footnote 2Q on page 14 for an explanation of how the financials account for bad debt. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. The hospital Medicare shortfall at cost calculated by using the cost to charge ratio for fiscal year 2019 was $5,148,546. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. |
| Schedule H, Part V, Section B, Line 16a FAP website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16a URL: http://www.hshs.org/fap; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16b URL: http://www.hshs.org/fap; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16c URL: http://www.hshs.org/fap; |
| Schedule H, Part VI, Line 2 Needs assessment | HSHS St. Clare Memorial Hospital is continually assessing the health care needs of the community through many avenues. Hospital colleagues represent the hospital on a variety of community groups which provides an opportunity to reach and serve the medically underserved, low income and minority populations within our community. Through this representation, the hospital becomes aware of emerging needs and is able to address these needs directly or indirectly. In addition, feedback is solicited through patient surveys and the Patient Family Engagement Council. The hospital maintains a close relationship with our public health department which is also is an ongoing resource regarding the health status of our community. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | HSHS St. Clare Memorial Hospital's Financial Assistance Program brochure and application are available on the hospital website in both English and Spanish. The Financial Assistance Program is available to all patients regardless of whether they are insured or uninsured and information is prominently displayed in the hospital ED and lobby waiting areas. The application may be obtained in the Patient Access department. Each hospital billing statement includes instructions for patients who need financial assistance. These patients are directed to follow up with our Patient Accounts Customer service. Applications are mailed based on screening. Point of Service uninsured patients: Registration provides the Financial Assistance application packet for any uninsured patient that presents to our ED. M - F 8a to 4:30p, patients are screened by a Financial Counselor either prior to service or upon arrival for their appointment. After normal business hours, the Registrar will provide the Financial Assistance packet. Inpatients are visited in their room by a Financial Counselor M - F 8a to 4:30pm. All patients presenting and discharged during off hours are contacted by a contracted service to screen for possible assistance through other government agency programs or Financial Assistance. Financial Counselors work with the patients through the Financial Assistance application process and make referrals to the hospital contracted agency for assistance with the eligibility and application process for any government programs. A system called Search America is sometimes utilized after failed follow-up attempts to reach the patient have been made to determine if the patient has the ability to pay. This system includes a federal poverty level determination and provides credit information which allows the user to see the probability of a patient's ability to pay. After assessing the information, a presumptive determination is made as to whether the patient qualifies for financial assistance based on charity guidelines or if collection efforts will be continued. |
| Schedule H, Part VI, Line 4 Community information | HSHS St. Clare Memorial Hospital is a critical access hospital located in Oconto Falls, Wisconsin. Oconto Falls is located approximately 30 miles north of Green Bay in the northeast portion of the state and has a population of 1,329. Oconto County is primarily a rural county, and 81.3% of its 37,830 residents live in rural areas. Northeastern Wisconsin is less diverse than the nation, being 93.7% white/Caucasian, whom reside in the hospitals service area, Two percent include Hispanic members of the community, an increase from last year. HSHS St. Clare Memorial Hospital's service area median household income in $55,762, which is approximately $3200 lower than the national average. In Oconto County, the percentage of children living below the federal poverty level is 12.0%. Thirty-five percent of public school children are eligible for free/reduced lunch. About 9% of Oconto County Residents live at or below the federal poverty level. Per the 2015 County Health Rankings, 5.1% of Oconto County's population is uninsured. The percent of persons without health insurance under the age of 65 in the hospital's service area is 6.3%. Uninsured individuals generally receive much less care, either preventive or for acute and chronic conditions, than insured individuals. Within Oconto County more than 11.5% are covered by Medicaid/Badger Care Plus. Oconto County is considered a primary care health professional shortage area with one primary care physician for every 3,400 residents. Oconto County is also considered a mental health professional shortage area, but not a dental health professional shortage area or a medically underserved area per HRSA. HSHS St. Clare Memorial Hospital is one of two critical access hospitals in Oconto County, the other being Bellin Oconto Hospital. HSHS St. Clare Memorial Hospital does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. The hospital serves all of Oconto County as well as portions of Marinette and Shawano counties. |
| Schedule H, Part VI, Line 5 Promotion of community health | As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), St. Clare Memorial Hospital (SCO) is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1921, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Oconto Falls and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS SCO is responding to community need. At every Board of Directors meeting, a written report on community benefit activities was provided. An educational session for the Board is also held to better understand the recent Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP). HSHS SCO has a Patient Family Engagement Council that meets quarterly and provides patient and community feedback on services offered at SCO. Consistent with its exempt purpose, HSHS SCO has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS SCO reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. Examples of the reinvestment of HSHS St. Clare Memorial Hospital's surplus funds include: Donation to low income apartment building Ridgeview Apartments is a U.S. Department of Housing and Urban Development (HUD) property adjacent to our hospital. Due to our demographics and the Sisters' mission, we provided $6,971 in funding allowing residents to remain in safe and affordable housing based on their income. Annual Community Health & Safety Fair The fair is a county-wide event to bring awareness to health and safety topics for all ages. Participating vendors are inclusive of area health care providers and organizations that promote wellness and safety. The fair benefits all, from young to old, showcasing a teddy bear clinic, AED training, advance directives, and blood pressure screening to name a few. Approximately 300 community members attended the event, hosted at the local elementary school. Oconto Falls Area Ambulance funding for communication equipment St. Clare knows the value of communication, especially in a rural environment. Lack of adequate funds for our service agencies means lack of service to our patients. Because of this financial challenge, St. Clare funds five emergency medical service agencies within Oconto County. To cover the cost of communication equipment, HSHS SCO provides $2,575 annually. Advanced Directives program support HSHS SCO extends advanced directive education and formal planning to any interested community members. HSHS SCO invested $2,403 towards this service. HSHS SCO also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2019, HSHS SCO provided more than $2.7 million in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in FY2019, HSHS SCO provided $140,000 (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than $5 million (at cost) in excess of Medicare payment for health care services. HSHS SCO provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by HSHS SCO and they often relieve a burden that would otherwise be carried by government. |
| Schedule H, Part VI, Line 6 Affiliated health care system | Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 16 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. In FY2019, HSHS collectively provided $211.7 million in Community Benefit (9.2% of total hospital expenses). This amount included $27.7 million provided for Financial Assistance (a.k.a. Charity Care) and $142.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $279.9 million. HSHS hospitals also recorded $41.1 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THERESE B PANDL | ||||||||||||||
| PRES / CEO EASTERN WISCONSIN DIVISION | $0 | $702,210 | $0 | $46,929 | $0 | $175,248 | $0 | $144,623 | $0 | $29,679 | $0 | $1,098,689 | $0 | $139,297 |
| MICHAEL W COTTRELL | ||||||||||||||
| Board Member/ HSHS CFO | $0 | $657,185 | $0 | $15,342 | $0 | $155,634 | $0 | $158,581 | $0 | $31,165 | $0 | $1,017,907 | $0 | $127,730 |
| DR ROBERT CUTLAN | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $0 | $884,244 | $0 | $0 | $0 | $450 | $0 | $0 | $0 | $23,340 | $0 | $908,034 | $0 | $0 |
| PETER MANNIX | ||||||||||||||
| BOARD MEMBER | $0 | $385,199 | $0 | $8,843 | $0 | $105,197 | $0 | $122,337 | $0 | $36,254 | $0 | $657,830 | $0 | $97,302 |
| ANN M CARR | ||||||||||||||
| TREASURER | $0 | $268,272 | $0 | $4,360 | $0 | $57,197 | $0 | $89,873 | $0 | $20,590 | $0 | $440,292 | $0 | $28,431 |
| PAULA HAFEMANN | ||||||||||||||
| CHIEF NURSING OFFICER | $0 | $294,736 | $0 | $16,512 | $0 | $19,280 | $0 | $69,430 | $0 | $18,715 | $0 | $418,673 | $0 | $0 |
| GREG SIMIA | ||||||||||||||
| DIVISION CFO | $0 | $415,076 | $0 | $0 | $0 | $41,380 | $0 | $60,580 | $0 | $28,644 | $0 | $545,680 | $0 | $0 |
| CHERYL BURKEL EMMERS | ||||||||||||||
| CRNA | $280,177 | $0 | $0 | $0 | $4,864 | $0 | $28,102 | $0 | $26,026 | $0 | $339,169 | $0 | $0 | $0 |
| GRAM COTTON | ||||||||||||||
| CRNA | $284,873 | $0 | $0 | $0 | $4,474 | $0 | $5,982 | $0 | $17,896 | $0 | $313,225 | $0 | $0 | $0 |
| DAVID MISKULIN | ||||||||||||||
| PHARMACIST | $136,679 | $0 | $0 | $0 | $780 | $0 | $2,585 | $0 | $25,374 | $0 | $165,418 | $0 | $0 | $0 |
| Richard McNutt | ||||||||||||||
| Physician | $151,438 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,486 | $0 | $157,924 | $0 | $0 | $0 |
| Maura May White | ||||||||||||||
| CRNA | $181,035 | $0 | $50 | $0 | $3,230 | $0 | $5,966 | $0 | $21,759 | $0 | $212,040 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS; THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUMENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED and TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ANN M. CARR -- $29,653 MICHAEL W. COTTRELL -- $84,073 THERESE B. PANDL -- $89,819 PETER MANNIX -- $48,406 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANN M. CARR -- $28,430 MICHAEL W. COTTRELL -- $127,730 THERESE B. PANDL -- $139,297 PETER MANNIX -- $ 97,302 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part IV, Line 10 Endowment Funds | The organization maintains temporarily and permanently restricted net assets on its balance sheet. Such funds are held by Hospital Sisters of St. Francis Foundation, Inc., a related tax-exempt organization. While these funds are held to further one or more exempt purposes of the filing organization, they are not maintained exclusively for the filing organization. The board of directors of Hospital Sisters of St. Francis Foundation, Inc. maintains ownership and ultimately authority and discretion over the use of these funds. Based on the above, the related amounts have not been reported as endowment funds on Part V of Schedule D. |
| Form 990, Part IV, Line 24a Tax Exempt Bonds | HSHS ST CLARE OCONTO FALLS HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMEBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. |
| Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES |
| Form 990, Part VI, Line 16b JOINT VENTURES | HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. CLARE MEMORIAL HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ALL HSHS HOSPITALS TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD THE ORGANIZATION'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | PER ARTICLE 5.5 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH AND MAY IN ITS DISCRETION EXERCISE THE FULL POWERS, DUTIES, RESPONSIBILITIES, AND AUTHORITY OF THE BOARD EXCEPT WHERE PROHIBITED BY LAW AND SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BYLAWS OR THE BOARD OF DIRECTORS. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF THREE TO SIX MEMBERS, INCLUDING THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE PRESIDENT AND OTHER MEMBERS SELECTED FROM AMONG THE DIRECTORS BY THE BOARD. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE CORPORATE MEMBER OF ST. CLARE MEMORIAL HOSPITAL (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. CLARE MEMORIAL HOSPITAL (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (I) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (O) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL HSHS EXECUTIVES, (the top management official, other officers and key employees). INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES (derived from a full market review conducted every other year) TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. The process for reviewing compensation by the compensation committee is completed each fiscal year. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 19 Required documents available to the public | BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. |
| Form 990, Part IX, Line 11g Other Fees | PROF FEES-MEDICAL PHYSICIAN - Total Expense: 8693885, Program Service Expense: 8594243, Management and General Expenses: 99642, Fundraising Expenses: ; OUTSIDE SERVICES - Total Expense: 1233284, Program Service Expense: 1114051, Management and General Expenses: 119233, Fundraising Expenses: ; Professional Fees - Allocated - Total Expense: 15499, Program Service Expense: , Management and General Expenses: 15499, Fundraising Expenses: ; Shared Services - Total Expense: 2172, Program Service Expense: , Management and General Expenses: 2172, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | THE ORGANIZATION'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED INVESTMENT FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124, "ACCOUNTING FORCERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | RECOGNITION OF CHANGE IN PENSION FUNDED STATUS - -683415; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 150847; |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261417684 | HEALTHCARE | IL | -$1,945,270 | $3,230,896 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371668647 | HEALTHCARE | IL | $563,783 | $11,970,191 | KCIN |
| HSHS ACO LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 320465666 | HEALTHCARE & SOCIAL ASSISTANCE | IL | -$381,285 | $458,242 | KCIN |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HOSPITAL SISTERS HEALTH SYSTEM | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371058692 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | NA | false |
| HOSPITAL SISTERS OF ST FRANCIS FOUNDATION | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371186514 | HEALTHCARE | IL | 501(c)(3) | 7 | HSHS | Yes (true) |
| HOSPITAL SISTERS HEALTHCARE WEST INC | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3) | Type I | HSSI | Yes (true) |
| SACRED HEART HOSPITAL | ||||||||||
| 990 WEST CLAIREMONT AVENUE | EAU CLAIRE | WI | 54701 | 390807060 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST ANTHONY'S HOSPITAL | ||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST ELIZABETH'S HOSPITAL | ||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 370663567 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST NICHOLAS HOSPITAL | ||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOHN'S HOSPITAL | ||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 9515 HOLY CROSS LANE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 390810545 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 111 SPRING STREET | STREATOR | IL | 61364 | 362169181 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST MARY'S MEDICAL CENTER | ||||||||||
| 1762 SHAWANO AVENUE | GREEN BAY | WI | 54303 | 390818682 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST VINCENT HOSPITAL | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 51301 | 390817529 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 12866 TROXLER AVENUE | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST FRANCIS HOSPITAL | ||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| HOSPITAL SISTERS SERVICES INC | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSHS | Yes (true) |
| HSHS MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 263956318 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSSI | Yes (true) |
| HSHS WISCONSIN MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 264515959 | HEALTHCARE | WI | 501(c)(3) | Type III-FI | HSSI | Yes (true) |
| ORANGE CROSS AMBULANCE INC | ||||||||||
| 919 ASHLAND AVENUE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3) | 10 | ST NICHOLAS | Yes (true) |
| UNITY LIMITED PARTNERSHIP | ||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3) | 10 | HSSI | Yes (true) |
| PRAIRIE EDUCATION & RESEARCH COOPERATIVE | ||||||||||
| 317 NORTH 5TH STREET | SPRINGFIELD | IL | 62701 | 371157915 | HEALTHCARE | IL | 501(c)(3) | 4 | HSSI | Yes (true) |
| HSHS HOLY FAMILY HOSPITAL | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 370792770 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| UTLAUT MEMORIAL FOUNDATION | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 371140166 | FUNDRAISING | IL | 501(c)(3) | Type II | HSSI | Yes (true) |
| HSHS GOOD SHEPHERD HOSPITAL INC | ||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 370512290 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST | ||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 371778753 | TRUST | IL | 501(a) | GSS | Yes (true) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | Address Line2USAddress/AddressLine2Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAIN CENTER OF WISCONSIN | ||||||||||||||
| 4131 W LOOMIS ROAD | SUITE 300 | GREENFIELD | WI | 53221 | 263155343 | HEALTHCARE | WI | ST VINCENT | Related | $742,948 | $556,009 | false | false | 0.5 |
| PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC | ||||||||||||||
| 4131 W LOOMIS ROAD | SUITE 300 | GREENFIELD | WI | 53221 | 364717036 | HEALTHCARE | WI | ST CLARE | Related | $26,375 | $142,266 | false | false | 0.5 |
| CARPENTER STREET HOTEL LLC | ||||||||||||||
| 525 NORTH SIXTH STREET | SPRINGFIELD | IL | 62702 | 364128127 | HOTEL | IL | LASANTE INC | N/A | 0 | |||||
| SPRINGFIELD URGENT CARE REAL ESTATE LLC | ||||||||||||||
| PO BOX 19456 | SPRINGFIELD | IL | 627949456 | 030413258 | RENTAL REAL ESTATE | IL | LASANTE INC | N/A | 0 | |||||
| PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC | ||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261479945 | MEDICAL | IL | HSHS | Related | -$6,697 | $9,753 | false | Yes (true) | 1 | |
| SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP | ||||||||||||||
| 4000 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 823633320 | REAL ESTATE | IL | ST ELIZABETH'S | Related | $337,078 | $1,174,120 | false | false | 0.5 | |
| PRAIRIE HEART INSTITUTE ST JOHN'S | ||||||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 371321197 | HEALTHCARE | IL | HSHS | Related | $0 | $0 | false | false | 1 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIARA INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163401 | HEALTHCARE | IL | HSHS | C Corporation | 1 | Yes (true) | |||||
| LASANTE WISCONSIN INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 391572196 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| LASANTE INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163400 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| PRAIRIE CARDIOVASCULAR | |||||||||||||||
| 619 EAST MASON SUITE 4P57 | SPRINGFIELD | IL | 62701 | 371071858 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| PREVEA HEALTH SERVICES INC | |||||||||||||||
| 2710 EXECUTIVE DRIVE | GREEN BAY | WI | 54304 | 391839351 | HEALTHCARE | WI | HSSI | C Corporation | 0.5 | Yes (true) | |||||
| PREVEA CLINIC INC | |||||||||||||||
| 2710 EXECUTVE DRIVE | GREEN BAY | WI | 54304 | 391839349 | HEALTHCARE | WI | PHSI | C Corporation | Yes (true) | ||||||
| RENAISSANCE QUALITY INSURANCE LTD | |||||||||||||||
| 980669953 | SELF-INSURANCE | HSSI | C Corporation | 1 | Yes (true) | PO BOX 1159 | GRAND CAYMAN | CJ | KY11102 | CJ | |||||
| OJV INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 460873384 | HEALTHCARE | IL | LASANTE INC | C Corporation | Yes (true) | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES | ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION. |
| Schedule R, Part VII Related Organizations | Due to the increasingly complex organization structure of Hospital Sisters Health System and Affiliates, the filing organization has elected to report all organizations within Hospital Sisters Health System as related, regardless of ownership interest or "control" as defined by the instructions to Schedule R. The intent of this reporting is to promote transparency and increase consistency across the numerous Form 990 submissions by Hospital Sisters Health System and Affiliates. |