2019-05-09T16:06:48-05:00 2018-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2017-07-01 390848401 St Clare Memorial Hospital Inc STCL 9208463444 855 S MAIN STREET OCONTO FALLS WI 54154 Therese B Pandl PRESIDENT & CHIEF EXECUTIVE OFFICER 2019-05-09 true RACHEL SPURLOCK P00520729 3128997000 2017 2019-02-21 02:37:17Z THERESE B PANDL 855 S MAIN STREET OCONTO FALLS WI 54154 31665495 false 0928 X http://www.stclarememorial.org/ X 1929 WI TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITYFRANCISCAN HEALTH CARE MINISTRY. 12 9 213 39 5169176 -1439889 74664 108800 32771661 31502874 112518 36800 34144 14316 32992987 31662790 0 0 0 12454692 10212487 0 0 0 25412164 24778134 37866856 34990621 -4873869 -3327831 23463861 21781639 17729347 19516614 5734514 2265025 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. false false 24618404 26333698 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 OFHEALTH CARE SERVICES. DURING THE FISCAL YEAR ENDING JUNE 30, 2018, THE HOSPITAL HAD 391 DISCHARGES; 4,261 VISITS TO THE EMERGENCY ROOM; 1,238 SURGERIES AND 18,113 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 2018, ST. CLARE MEMORIAL HOSPITAL PROVIDED $711,289 IN CHARITY CARE AND $563,456 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 2018. 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. 24618404 true true false true false false false false false true false false false true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true false false false true 25 0 true 213 true true true false false false false false true false false false X 12 9 false false false false true true true true false false false true true true true true true true true true true X Kevin Sevcik 9204338694 835 S Van Buren St Green Bay WI 54301 THERESE B PANDL PRES / CEO EASTERN WISCONSIN DIVISION 6.0 54.0 X X 0 827189 196689 CHRISTY KAEMPFER 2017 & 2018 Chair 2.0 0 X X 0 0 0 DANIEL BOETTCHER 2017 & 2018 Vice Chair 2.0 0 X X 0 0 0 JAN STRANZ 2017 & 2018 Secretary 2.0 0 X X 0 0 0 PAULA HAFEMANN CHIEF NURSING OFFICER & Interim COO (April to June 2018) 40.0 0.0 X X 0 295934 127650 PETER MANNIX BOARD MEMBER 1.0 60.0 X 0 464721 154860 DR JAMES CLEMENS BOARD MEMBER/PHYSICIAN 2.0 40.0 X 0 0 0 DR ROBERT CUTLAN BOARD MEMBER/PHYSICIAN 2.0 40.0 X 0 0 0 HOWARD ESLIEN BOARD MEMBER 2.0 0 X 0 0 0 SR MaryAnn Falbe OSF BOARD MEMBER 1.0 0 X 0 0 0 GREG JONES BOARD MEMBER 2.0 0 X 0 0 0 MICHEAL NELESSEN BOARD MEMBER 1.0 0 X 0 0 0 GREG SIMIA DIVISION CFO 5.0 35.0 X 0 407912 87050 DANIEL DEGROOT Ex-Officio Board Member/COO 40.0 0.5 X 227164 0 13583 ANN M CARR TREASURER 0.3 59.7 X 0 318511 120197 GRAM COTTON CRNA 40.0 0 X 275454 0 39687 JASON MURPHY CRNA 40.0 0 X 258566 0 72728 CHERYL BURKEL EMMERS CRNA 40.0 0 X 234095 0 54654 JASON KNOX PHARMACY DIRECTOR 40.0 0 X 152368 0 28540 DAVID MISKULIN PHARMACIST 40.0 0 X 137057 0 27164 1284704 2314267 922802 9 false true false Infinity Healthcare 111 E Wisconsin Ave Milwaukee WI 53202 Physician Services 1172360 General & Vascular Consult LLC 840 S Madison St Green Bay WI 54301 Physician Services 800000 IEI General Contrators 1725 Midway Rd De Pere WI 54115 Construction 621979 NEW Surgical Associates 670 Cormier Rd Green Bay WI 54304 Physician Services 218843 Medical Outsourcing 1735 DeKalb Ave Sycamore IL 60178 Nuclear Medicine 111315 5 108800 108800 NET PATIENT SERVICE REVENUE 900099 20945312 20945312 PHARMACY REVENUE 446110 10232039 5062863 5169176 OTHER 900099 325523 325523 0 0 0 0 31502874 22243 22243 5419 5419 0 5419 5419 17262 2705 17262 -2705 14557 14557 CAFETERIA REVENUE 900099 8897 8897 0 0 0 0 8897 31662790 26333698 5169176 51116 X 240747 240747 7519258 5422495 2096763 260538 185883 74655 1615232 1136664 478568 576712 403698 173014 31523 31523 4946 4946 12794 12794 11962614 8373829 3588785 0 156044 156044 212428 148700 63728 91441 64009 27432 811962 568373 243589 89031 62322 26709 78796 55157 23639 201996 141397 60599 1536164 1075315 460849 88046 61632 26414 MEDICAL SUPPLIES 7387098 5170969 2216129 EQUIPMENT RENTAL & MAINTENANCE 1265538 885877 379661 BAD DEBT 563456 563456 MEDICAID TAX ASSESSMENT 80568 80568 203689 142584 61105 0 34990621 24618404 10372217 0 492252 755706 1357766 781618 5398183 5883633 0 0 0 1552069 1377969 29727 30570 27367250 15709023 10596574 11658227 3880080 1293916 0 0 157210 0 23463861 21781639 9946770 12225088 7530000 6990878 0 252577 300648 17729347 19516614 X 5434520 1920334 289994 334691 10000 10000 5734514 2265025 23463861 21781639 X -3327831 54804 -196462 X false true X true false X false false false false false false false false true 4946 4946 false 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 22.98% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 14.30% 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 22.98% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 14.30% 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. 428316 428316 18302986 10671777 7631209 86732 21619 65113 8282858 5015627 3267231 266358 0 266358 11658227 CAPITAL LEASES 17105 DUE TO MEDICARE ACCRUED BENEFIT LIABILITY 58889 RETIREMENT OBLIGATION-ASBESTOS 127694 Advance Pain Mgmt 96960 300648 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2018 and 2017 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, 2018 and 2017, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 384019 384019 0.0112 4892496 2551597 2340899 0.0680 252769 114233 138536 0.0040 0 0 5529284 2665830 2863454 0.0832 18806 0 18806 0.0005 27920 0 27920 0.0008 0 0.0 0 0.0 20144 0 20144 0.0006 0 0 66870 0 66870 0.0019 0 0 5596154 2665830 2930324 0.0851 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 533 533 0.0000 0 0.0 1739 1739 0.0001 302 0 302 0.0000 0 0 2574 0 2574 0.0001 true 563456 96600 12239354 18091793 -5852439 X true true 1 1 ST CLARE MEMORIAL HOSPITAL INC 855 SOUTH MAIN STREET OCONTO FALLS WI 54154 http://www.stclarememorial.org/ 1012 X X X X ST CLARE MEMORIAL HOSPITAL INC 1 false false true X X X X X X X X X 17 true true true true X https://www.stclarememorial.org/www-sco/media/SCO-PDFs/About/CHNA-SCO.pdf X true 17 true https://www.stclarememorial.org/www-sco/media/SCO-PDFs/About/CHIP-SCO.pdf false true X 200.0 600.0 X X X X X X true true X X X true X http://www.hshs.org/fap X http://www.hshs.org/fap X http://www.hshs.org/fap X X X X X X true X false X X X X true X false false 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 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 - 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. Bellin Health Oconto Hospital. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Clare Memorial Hospital. Oconto County Department of Public Health Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Clare Memorial Hospital. The organization's most recently conducted CHNA was completed for the fiscal year ended 6/30/18. The related implementation strategy that was adopted is for the period July 1, 2018 through June 30, 2021. The information below pertains to the 3rd year cycle of the implementation strategy from the CHNA conducted in the fiscal year 2015. 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 HSHS St. Clare Memorial Hospital is involved in the implementation and/or continuation of the following efforts to increase access to physical activity opportunities and access to healthy food. Oconto Falls Area Trail System: Additional phases of the Oconto Falls Area Trail System continue to be developed. St. Clare Memorial Hospital, along with other community organizations, financially supported the addition of an 1,145- foot walking trail on the campus of the Oconto Falls School District. This 8-foot-wide trail which provides a safe walking path where there were no sidewalks previously was completed in October, 2017. Additionally, marketing tools such as brochures and posters have been developed to educate the public about the trail system and generate support and donations from community members and businesses. HSHS St. Clare Memorial Hospital is a sponsor for Run for the Trails, an annual run where proceeds are used to maintain the Oconto Falls Area Trail System. Pickle Ball Courts: Pickle Ball is a popular pastime in the community and provides a way to improve people's health by increasing physical activity. HSHS St. Clare Hospital financially supported the efforts to resurface, seal, and paint lines on three Pickle Ball Courts, and paid for an equipment box which was built by the Oconto Falls High School metalwork students. Community Health/Safety Fair: This annual event provides education on various topics regarding health and physical activity. Forty vendors attended this year's event and more than 350 community members participated. A food drive was conducted promoting our Donate a Healthy Plate initiative. More than 200 non-perishable food items were donated to Kingdom Come Food Pantry. Produce to Pantries: This initiative supports fresh produce options at the county food pantries. HSHS St. Clare Hospital has participated in this program in the past. This year the Physical Activity and Nutrition workgroup invited faith based organizations as well as Oconto county businesses with more than 50 employees to participate. Letters explaining the initiative as well as area food pantry contact information were mailed the first week in May. Employers were encouraged to support this program within their business. Included in the mailing was a Donate a Healthy Plate flyer with recommendations for healthy non-perishable food donations for businesses that conduct food drives. Produce to Pantries is scheduled through the middle of October. Members of the Physical Activity and Nutrition workgroup will contact pantries to determine community participation and total pounds of produce donated. Donate a Healthy Plate Toolkit: 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 it. The toolkits have been 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. Alcohol and Other Drug Abuse (AODA) In the fall of 2017 the AODA Workgroup in Oconto county was awarded a grant through the Advancing a Healthier Wisconsin Endowment. The grant money was used to hire a consultant to support the development and initial infrastructure and action planning for the workgroup. The funding invested will move the workgroup from problem identification and prioritization to action planning. The 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 a 6 month period 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. In June 2018, the workgroup identified three strategies for change: * Increase Access to Treatment * Decrease Access to AOD * Create a Culture of Health Action teams were identified for each strategy. Achievable objectives and action steps have been outlined. The lead for each action team will organize their team and begin meeting in September 2018. HSHS St Clare Memorial Hospital participates on the Increase Access to Treatment team. Mental Health 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 two Behavioral Care therapists at the Medical Office Building on the campus of HSHS St. Clare Memorial Hospital. These therapists provide services including couple and family counseling, work and career issues, anxiety, depression and mood disorders, bereavement, life stressors, self-injury, and crisis interventions. One of these therapists also provides services at the Prevea Health Oconto Clinic one day a week. Twenty-eight patients a week are seen between the therapists. Oconto County Health and Human Services has four Clinical Therapists. One of the therapists and the Public Health Educator are on the newly formed Mental Health Team in the Oconto School District. The goal of that team is to provide training and resources to the staff of the district. Health & Human Services has one trained QPR instructor and HSHS St. Clare Memorial Hospital has committed to providing an additional instructor for the county. Needs Not Being Addressed and Why In the FY2018 CHNA process, access to care was identified as a health priority but is not being addressed by the hospital due to a lack of county-wide resources to establish a formal work group to address access to care. However, access is a component of all of the hospital's identified health priorities including access to physical activity and nutrition resources, access to AODA treatment services, and access to mental health education, resources and treatment services. 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 6 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 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 $563,456. Schedule H, Part VI SECTION 501(R) INFORMATION IN JANUARY 2015, THE ORGANIZATION ENGAGED A LAW FIRM TO REVIEW AND REVISE ITS FINANCIAL ASSISTANCE POLICY TO MEET THE REQUIREMENTS OF TREASURY REGULATIONS ISSUED UNDER SECTION 501(R). THE HOSPITAL BEGAN TO FOLLOW THAT REVISED POLICY DURING 2015, HOWEVER IT WAS NOT FORMALLY APPROVED UNTIL OCTOBER 2017.TO ENSURE FULL COMPLIANCE WITH SECTION 501(R) AND THE TREASURY REGULATIONS ISSUED THEREUNDER, IN NOVEMBER 2017 THE ORGANIZATION ENGAGED AN OUTSIDE CONSULTANT TO REVIEW ALL APPLICABLE POLICIES AND PRACTICES AND CONTINUES TO MONITOR COMPLIANCE WITH 501(R) ON A REGULAR BASIS. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 563456 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 FY2018 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 HSHS St. Clare Memorial Hospital leads the Oconto Falls Area Trail System project in partnership with the Oconto Falls Area Chamber of Commerce and the Oconto Falls Area School District. As identified in the CHNA, this project addresses the need for increased physical activity for Oconto county residents through the creation of a safe, accessible trail system. A colleague from the hospital also is actively involved in the AODA Workgroup. To support the need for economic development a Director from HSHS St. Clare Memorial Hospital serves as the Vice President of the Oconto County Economic Development Corp. HSHS St Clare Memorial Hospital supports leadership development and training for community members by providing financial support to the Leadership Oconto County (LOC) program. The goal of the program is to build a pool of citizens with broad knowledge of the ideas, issues and concerns faced by our local communities. It is hoped that as the participants become aware of the challenges and existing resources, they will take leadership roles to help to meet those challenges. A HSHS St. Clare Memorial Hospital colleague serves as the Chair of the steering team for the LOC program. In addition, the hospital supports workforce development within the county by participating in the Oconto County Business & Education Alliance Program. In May 2018, HSHS St. Clare Memorial Hospital hosted the annual day-long EMS Conference for Oconto County EMS providers. Many rural EMS services are challenged with keeping their staff current with pre-hospital care. Twenty-seven Oconto and Marinette County Basic EMT and Advanced EMT providers attended this year's conference. By providing a yearly conference, spotlighting the latest pre-hospital care, HSHS St. Clare Memorial Hospital increases health care knowledge and competencies for area EMS providers. The hospital supports community wellness activities by sponsoring such activities as the Conquer Suring Hill 5k/10k Run, the Run for the Trails 5k/10k in Oconto Falls, and the Nicolet Run/Walk in Lakewood, WI. In addition, a HSHS St. Clare Memorial Hospital colleague serves as the EWD Division lead for advocacy and works with local legislators on health and wellness initiatives. HSHS St. Clare Memorial Hospital in partnership with Bellin Health Oconto Hospital and Oconto County Health & Human Services comprise the Healthy Oconto County Steering Committee. This committee oversees the activities of the Physical Activity & Nutrition Workgroup as well as the AODA Workgroup. The hospital provides meeting space for various workgroups and organizations throughout the county, including the Physical Activity & Nutrition Workgroup, Oconto Falls Area Trail System Organization, the Northeastern Wisconsin Technical College Leadership Team, Narcotics Anonymous, UW Healthy Bones Program, Breast Cancer Awareness, and Oconto County 4H-UW Extension. HSHS St. Clare Memorial Hospital also offers a variety of free community outreach events to enhance the health of the community including Family & Friends CPR classes; diabetes support group; community education classes for seniors that include a free meal; educational talks at health fairs and other community events; student intern programs with local colleges and universities; and free cancer screenings in collaboration with the Mary Hendrickson Johnson Foundation, American Cancer Society, and HSHS St. Vincent Hospital Regional Cancer Center. Community building activities included attending the Wisconsin Hospital Association Advocacy Day where staff and other local health care organizations met with our legislators to discuss health care legislation. 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). WHILE THE HOSPITAL FEELS THEIR BAD DEBT EXPENSE INCLUDES AMOUNTS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE HOSPITAL IS UNABLE TO ESTIMATE THIS AMOUNT. 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 20 in the HSHS Consolidated Audit Report. 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 2018 was $5,852,439. 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. In addition, a HSHS St. Clare Memorial Hospital colleague serves on the Board of Directors of the Northern Health Centers (FQHC) in the northern most area of our county. 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. There is also signage in these areas to high light the availability for assistance for patients that need it. 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 2,820. Oconto County is a primarily rural county, and 81% of its 37,553 residents live in rural areas. Though northeastern Wisconsin is less diverse than the nation (97% white/Caucasian), there are a few unique minority populations residing in the hospitals service area, including Hispanic (1.5%) and Native American or African American (1.5%). HSHS St. Clare Memorial Hospital's service area mean household income in $52,765, which is approximately $1100 lower than the national average. In Oconto County, the percentage of children living below the federal poverty level is 13.9% which is slightly higher than the national benchmark. Forty-three 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, (Source: US CENSUS, ACS, 2017). Per the 2015 County Health Rankings, 11% 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 6.8%. Uninsured individuals generally receive much less care, either preventive or for acute and chronic conditions, than insured individuals. Within Oconto County more than 6,100 residents 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 4,160 residents, which is far above the state ratio of 1:1055. 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 who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that St. Clare Memorial Hospital is responding to community need. In FY2018, for example, a written report on community benefit activities was provided at every Board of Directors meeting. In May of 2018 a presentation was made to the Board on the recent Community Health Needs Assessment and the identified health needs that will be addressed in FY2019, FY2020 and FY2021. Consistent with its exempt purpose, St. Clare Memorial Hospital (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, St. Clare Memorial (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. In FY2018, SCO remodeled four pre-op procedure rooms to enhance the patient experience; expanded two service lines including urology and ENT to provide high quality health care close to home; purchased a new 64-slice Siemens CT scanner to increase image quality and resolution, decrease radiation dose, and improve safety for patients; added a clinical rotation for sonography students in addition to clinical rotations for radiology students; and remodeled the inpatient environment. In FY2019, SCO will purchase a new flat panel C-arm for surgical cases and interventional radiology cases. This new technology will offer cleaner and sharper images, aiding in surgical cases that involve orthopedics, urology, vascular surgery and general surgery. A larger quality image will also drastically improve the visualization of wires and catheters used to insert PICC lines and ports during interventional radiology procedures. This equipment will be the first of its kind in the EWD and will be a huge asset to both the radiology department and surgery department. HSHS St. Clare Memorial Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2018, the hospital provided more than $2.9 million in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in FY2018, St. Clare Memorial Hospital provided <$X.X>million (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than $5.9 million (at cost) in excess of Medicare payment for health care services. HSHS St. Clare Memorial Hospital 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, which often relieve a burden that would otherwise be carried by the government, would not exist without the leadership role played by HSHS St. Clare Memorial Hospital. 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 15 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 FY2018, HSHS collectively provided $198.4 million in Community Benefit (9.1% of total hospital expenses). This amount included $25.7 million provided for Financial Assistance (a.k.a. Charity Care) and $133.7 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 $221.5 million. HSHS hospitals also recorded $45.9 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 X true true X X X X X false true false false false false false false false THERESE B PANDL PRES / CEO EASTERN WISCONSIN DIVISION 0 673649 0 0 0 153540 0 164052 0 32637 0 1023878 0 121553 PAULA HAFEMANN CHIEF NURSING OFFICER & Interim COO (April to June 2018) 0 277154 0 0 0 18780 0 108472 0 19178 0 423584 0 0 PETER MANNIX BOARD MEMBER 0 371902 0 0 0 92819 0 118610 0 36250 0 619581 0 85653 GREG SIMIA DIVISION CFO 0 389050 0 0 0 18862 0 58646 0 28404 0 494962 0 0 DANIEL DEGROOT Ex-Officio Board Member/COO 226782 0 0 0 382 0 5009 0 8574 0 240747 0 0 0 ANN M CARR TREASURER 0 260012 0 0 0 58499 0 98998 0 21199 0 438708 0 31564 GRAM COTTON CRNA 268822 0 5852 0 780 0 7026 0 32661 0 315141 0 0 0 JASON MURPHY CRNA 252423 0 5363 0 780 0 42072 0 30656 0 331294 0 0 0 CHERYL BURKEL EMMERS CRNA 226050 0 7355 0 690 0 31001 0 23653 0 288749 0 0 0 JASON KNOX PHARMACY DIRECTOR 134813 0 0 0 17555 0 2578 0 25962 0 180908 0 0 0 DAVID MISKULIN PHARMACIST 136277 0 0 0 780 0 2363 0 24801 0 164221 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments ONE OF THE ORGANIZATION'S OFFICERS RECEIVED A GIFT CERTIFICATE DURING THE YEAR. THE RELATED TAX EFFECT WAS DETERMINED AND A GROSS UP PAYMENT WAS MADE. 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 DOCUENTS 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 2017 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $28,431 Therese Pandl -- $83,706 Peter Mannix -- $45,832 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2017 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $31,564 Therese Pandl -- $121,553 Peter Mannix -- $85,653 A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2013-04-16 9053000 See Part VI false false false A 1735737 0 9053000 0 0 0 180472 0 0 1681913 7190615 0 2013 true false true true A false true true true false 0.032 0.0 0.032 false false true A false true false true false false false false false true A true Schedule K, Part I, Column (f) Description of purpose Issuer Name: Wisconsin Health and Educational Facilities Authority Description: REFINANCING OF 2/11/2003 BOND ISSUANCE; CONSTRUCTION, IMPROVEMENT, AND EQUIPPING HOSPITAL FACILITIES. Schedule K, Part IV, Line 2c Date of Rebate Calculation The rebate computation was performed on June 22, 2018. Schedule K, Part IV, Line 2c COLUMN A Issuer name: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY The calculation for computing no rebate due was performed on 06/22/2018 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 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 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 8b Documentation of meetings held by committees of governing body THERE WAS NO ACTIVE COMMITTEE WITH BROAD AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY DURING THE TAX YEAR. 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-PHYSICIAN - Total Expense: 2948612, Program Service Expense: 2064028, Management and General Expenses: 884584, Fundraising Expenses: ; OUTSIDE SERVICES - Total Expense: 8995606, Program Service Expense: 6296924, Management and General Expenses: 2698682, Fundraising Expenses: ; Contract Labor - Total Expense: 18396, Program Service Expense: 12877, Management and General Expenses: 5519, 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 TRANSFER TO/FROM AFFILIATES - -147515; RECOGNITION OF CHANGE IN PENSION FUNDED STATUS - -95944; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 46997; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -1385886 3938708 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 149935 8833307 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL -538042 88228 KCIN 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 true HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I HSSI true SACRED HEART HOSPITAL 990 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 HSSI true ST ELIZABETH'S HOSPITAL ONE ST ELIZABETHS BLVD OFALLON IL 62269 370663567 HEALTHCARE IL 501(c)(3) 3 HSSI true ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S MEDICAL CENTER 1762 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 HSSI true ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 51301 390817529 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 HSSI true ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 HSSI true HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS true HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 263956318 HEALTHCARE IL 501(c)(3) Type III-FI HSSI true HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 264515959 HEALTHCARE WI 501(c)(3) Type III-FI HSSI true ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 10 ST NICHOLAS true UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true PRAIRIE EDUCATION & RESEARCH COOPERATIVE 317 NORTH 5TH STREET SPRINGFIELD IL 62701 371157915 HEALTHCARE IL 501(c)(3) 4 HSSI true HSHS HOLY FAMILY HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 370792770 HEALTHCARE IL 501(c)(3) 3 HSSI true UTLAUT MEMORIAL FOUNDATION 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HFG true HSHS GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371778753 TRUST IL 501(a) GSS true MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 371312961 HEALTHCARE IL ST ELIZABETH'S Related 187165 0 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 PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 263155343 HEALTHCARE WI ST VINCENT Related 240126 4769500 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 -48977 202533 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 -6440 20163 false true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL ST ELIZABETH'S Related 0 2467223 false false 0.5 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation -32771486 29755341 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA INC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA INC C Corporation true PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD IL 62701 371071858 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation 82898 44874417 0.5 true PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY WI 54304 391839349 HEALTHCARE WI PHSI C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 INSURANCE CJ HSSI C Corporation 0 116763493 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false true false true false false false true true false true true true true true true true false 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.