ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC (EIN 39-0818682)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-04
- IRS object ID
- 201841249349301574
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-04T18:03:54-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | 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 HORWATH 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 | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390818682 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Mary's Hospital Medical Center of Green Bay Inc - Hospital Sisters | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STMA | BusinessNameControlTxt |
| Phone | 9204984200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THERESE PANDL | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Signature | 2018-04-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RACHEL SPURLOCK | PreparerPersonNm |
| PTIN | P00520729 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THERESE PANDL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $137,168,884 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STMGB.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1900 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 818 | TotalEmployeeCnt |
| Total Volunteers | 93 | TotalVolunteersCnt |
| Total Gross UBI | $834,642 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$1,126,066 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $184,300 | PYContributionsGrantsAmt |
| CY Contributions Grants | $300,625 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $125,549,707 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $128,004,644 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,440,582 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,252,153 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,666,797 | PYOtherRevenueAmt |
| CY Other Revenue | $1,993,371 | CYOtherRevenueAmt |
| PY Total Revenue | $128,841,386 | PYTotalRevenueAmt |
| CY Total Revenue | $133,550,793 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $48,408,981 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $48,186,540 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $73,685,366 | PYOtherExpensesAmt |
| CY Other Expenses | $73,879,901 | CYOtherExpensesAmt |
| PY Total Expenses | $122,094,347 | PYTotalExpensesAmt |
| CY Total Expenses | $122,066,441 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,747,039 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,484,352 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $194,660,407 | TotalAssetsBOYAmt |
| Total Assets EOY | $202,590,785 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $68,444,806 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $58,094,870 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $126,215,601 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $144,495,915 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,024,112 | ExpenseAmt |
| Revenue | $30,684,090 | RevenueAmt |
| Desc | SURGERY - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $7,616,003 | ExpenseAmt |
| Revenue | $16,300,118 | RevenueAmt |
| Desc | HEART & VASCULAR CENTER - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,350,757 | ExpenseAmt |
| Revenue | $19,562,427 | RevenueAmt |
| Desc | RADIOLOGY SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $62,710,768 | ExpenseAmt |
| Revenue | $61,145,122 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY AND OTHER SERVICES. IN FY2017 THE HOSPITAL HAD NEARLY 102,000 OUTPATIENT VISITS, OVER 4,400 ADMISSIONS, OVER 12,400 PATIENT DAYS, NEARLY 600 BIRTHS AND OVER 30,400 EMERGENCY ROOM VISITS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $62,710,768 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $61,145,122 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $90,701,640 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| 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 | Yes (true) | 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 | 32 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 818 | 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 | false | 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | Joanne Horvath | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204313211 | 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 (23 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 |
|---|---|---|---|---|---|---|---|---|
| THERESE B PANDL | ||||||||
| PRESIDENT/Divisional CEO | 24.0 | 36.0 | Yes (X) | Yes (X) | $0 | $901,796 | $239,493 | |
| DJ LONG JR | ||||||||
| CHAIR PERSON | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BETSY MITCHELL | ||||||||
| Vice Chair | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL J PLATKOWSKI | ||||||||
| 2016 VICE CHAIR | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN HAGER | ||||||||
| SECRETARY | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JUDY NAGEL | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JULES BLANK MD | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT BURNS | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL W COTTRELL | ||||||||
| DIRECTOR | 1.0 | 59.1 | Yes (X) | $0 | $877,154 | $229,172 | ||
| SR MAUREEN FAGAN OSF | ||||||||
| Board Member | 1.0 | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| SR BERNADINE GUTOWSKI OSF | ||||||||
| DIRECTOR | 1.0 | 4.0 | Yes (X) | $0 | $0 | $0 | ||
| KENNETH HUJET MD | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Staci Kring | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Dennis Langenberg | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Michael Wickman | ||||||||
| Board Member | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.3 | 59.4 | Yes (X) | $0 | $359,960 | $312,526 | ||
| LAWRENCE J CONNORS | ||||||||
| COO | 20.0 | 20.0 | Yes (X) | $357,777 | $0 | $262,047 | ||
| GREG SIMIA | ||||||||
| DIVISION CFO | 5.0 | 35.0 | Yes (X) | $0 | $403,057 | $112,569 | ||
| JAMIE BABBITTS | ||||||||
| EXECUTIVE DIRECTOR | 20.0 | 0 | $158,060 | $0 | $160,431 | Yes (X) | ||
| JAYNE BLEUEL | ||||||||
| PHARMACIST | 40.0 | 0 | $140,851 | $0 | $130,172 | Yes (X) | ||
| GREGORY LAEHN | ||||||||
| PHARMACIST | 40.0 | 0 | $157,117 | $0 | $138,513 | Yes (X) | ||
| DANIEL DORAN | ||||||||
| PHARMACIST | 40.0 | 0 | $146,694 | $0 | $109,503 | Yes (X) | ||
| Scott Stillwell | ||||||||
| Physician | 40.0 | 0 | $204,148 | $0 | $35,417 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,164,647 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,541,967 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,729,843 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | 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 |
|---|---|---|---|---|---|
| ST VINCENT HOSPITAL | |||||
| 835 S VAN BUREN STREET | GREEN BAY | WI | 54303 | SHARED SERVICES | $17,990,219 |
| PREVEA CLINIC | |||||
| PO BOX 19070 | GREEN BAY | WI | 54307 | SHARED LABOR & SERVICES | $3,631,373 |
| SODEXO INC | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD & HOUSEKEEPING SERVICES | $830,915 |
| IEI GENERAL CONTRACTORS | |||||
| PO BOX 5067 | DE PERE | WI | 54115 | CONTRACTOR | $408,395 |
| AMERICAN RED CROSS | |||||
| PO BOX 73013 | CHICAGO | IL | 606737013 | BLOOD BANK | $340,408 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $300,625 | RelatedOrganizationsAmt |
| Total Contributions | $300,625 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 900099 | $128,055,016 | $128,055,016 | |
| LABORATORY SERVICES | 621500 | $312,887 | $312,887 | |
| PREVEA INVESTMENT GAIN/LOSS | 900099 | -$363,259 | -$363,259 |
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 | $128,004,644 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $514,568 | TotalRevenueColumnAmt |
| Exclusion | $514,568 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,353,039 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,464,740 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$111,701 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$111,701 | TotalRevenueColumnAmt |
| Exclusion | -$111,701 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,774,483 | SecuritiesAmt |
| Other | $116,453 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $153,351 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,774,483 | SecuritiesAmt |
| Other | -$36,898 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,737,585 | TotalRevenueColumnAmt |
| Exclusion | $2,737,585 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $1,073,644 | $1,073,644 | |
| CHILDCARE REVENUE | 624410 | $1,031,428 | $509,673 | $521,755 |
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 | $2,105,072 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $133,550,793 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $127,691,757 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $834,642 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,723,769 | 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 | $619,824 | TotalAmt |
| Management And General | $619,824 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,726,609 | TotalAmt |
| Program Services | $25,442,503 | ProgramServicesAmt |
| Management And General | $10,284,106 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $532,477 | TotalAmt |
| Program Services | $372,734 | ProgramServicesAmt |
| Management And General | $159,743 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,120,433 | TotalAmt |
| Program Services | $6,384,303 | ProgramServicesAmt |
| Management And General | $2,736,130 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,187,197 | TotalAmt |
| Program Services | $1,531,038 | ProgramServicesAmt |
| Management And General | $656,159 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $884 | TotalAmt |
| Program Services | $619 | ProgramServicesAmt |
| Management And General | $265 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $839,735 | TotalAmt |
| Management And General | $839,735 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,280,310 | TotalAmt |
| Program Services | $14,896,218 | ProgramServicesAmt |
| Management And General | $6,384,092 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,393 | TotalAmt |
| Program Services | $103,175 | ProgramServicesAmt |
| Management And General | $44,218 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,514,231 | TotalAmt |
| Program Services | $1,059,962 | ProgramServicesAmt |
| Management And General | $454,269 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,726 | TotalAmt |
| Program Services | $45,308 | ProgramServicesAmt |
| Management And General | $19,418 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,290 | TotalAmt |
| Program Services | $33,103 | ProgramServicesAmt |
| Management And General | $14,187 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $487,599 | TotalAmt |
| Program Services | $341,319 | ProgramServicesAmt |
| Management And General | $146,280 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,851,918 | TotalAmt |
| Program Services | $3,396,343 | ProgramServicesAmt |
| Management And General | $1,455,575 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,103 | TotalAmt |
| Program Services | $254,172 | ProgramServicesAmt |
| Management And General | $108,931 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES - MED/SURG/O2/DRUGS | $21,015,246 | $14,710,672 | $6,304,574 |
| PREVEA INVESTMENT AND LEASE | $13,768,822 | $13,768,822 | |
| BAD DEBT EXPENSE | $2,341,799 | $2,341,799 | |
| MEDICAID TAX ASSESSMENT | $3,365,866 | $3,365,866 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,790,979 | TotalAmt |
| Program Services | $2,653,684 | ProgramServicesAmt |
| Management And General | $1,137,295 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,066,441 | TotalAmt |
| Program Services | $90,701,640 | ProgramServicesAmt |
| Management And General | $31,364,801 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,077 | BOYAmt |
| EOY | $2,877 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$691,720 | BOYAmt |
| EOY | $4,131,389 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,294,848 | BOYAmt |
| EOY | $13,145,852 | 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 |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415,371 | BOYAmt |
| EOY | $401,455 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,452,311 | BOYAmt |
| EOY | $2,523,794 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $306,776 | BOYAmt |
| EOY | $124,990 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $148,947,144 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $74,917,865 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,566,376 | BOYAmt |
| EOY | $74,029,279 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,077,513 | BOYAmt |
| EOY | $98,446,984 | 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 | $9,044,174 | BOYAmt |
| EOY | $8,470,834 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,191,681 | BOYAmt |
| EOY | $1,313,331 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,660,407 | BOYAmt |
| EOY | $202,590,785 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,231,038 | BOYAmt |
| EOY | $9,250,609 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,629 | BOYAmt |
| EOY | $426,027 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,132,572 | BOYAmt |
| EOY | $28,653,863 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,918,567 | BOYAmt |
| EOY | $19,764,371 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,444,806 | BOYAmt |
| EOY | $58,094,870 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,298,786 | BOYAmt |
| EOY | $136,998,583 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,618,245 | BOYAmt |
| EOY | $5,198,762 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,298,570 | BOYAmt |
| EOY | $2,298,570 | EOYAmt |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $126,215,601 | BOYAmt |
| EOY | $144,495,915 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $194,660,407 | BOYAmt |
| EOY | $202,590,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $11,484,352 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,995,467 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $3,800,495 | 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 | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | $9,816 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $9,816 | 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. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH 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. |
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH 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. |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,276,732 | OtherCostOrOtherBasisAmt |
| Book Value | $2,276,732 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,141,046 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,738,811 | DepreciationAmt |
| Book Value | $43,402,235 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $628,607 | OtherCostOrOtherBasisAmt |
| Depreciation | $374,986 | DepreciationAmt |
| Book Value | $253,621 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,026,778 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,971,535 | DepreciationAmt |
| Book Value | $8,055,243 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,873,981 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,832,533 | DepreciationAmt |
| Book Value | $20,041,448 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $74,029,279 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION LIABILITY | $19,534,519 |
| RETIREMENT OBLIGATION ASBESTOS | $229,852 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $19,764,371 | 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, 2017 and 2016 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, 2017 and 2016, 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 |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 600 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 3302 | PersonsServedCnt |
| Total Community Benefit Expns | $5,751,386 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,492,532 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,258,854 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0185 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 19173 | PersonsServedCnt |
| Total Community Benefit Expns | $21,072,264 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,805,848 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,266,416 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0841 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 456 | PersonsServedCnt |
| Total Community Benefit Expns | $1,298,434 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $893,096 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $405,338 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0033 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 22931 | PersonsServedCnt |
| Total Community Benefit Expns | $28,122,084 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,191,476 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,930,608 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1059 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 44 | ActivitiesOrProgramsCnt |
| Persons Served | 2980 | PersonsServedCnt |
| Total Community Benefit Expns | $362,787 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,820 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $358,967 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0029 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 10 | ActivitiesOrProgramsCnt |
| Persons Served | 101 | PersonsServedCnt |
| Total Community Benefit Expns | $296,293 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $296,293 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0024 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,813,628 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,288,827 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,524,801 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0125 | 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) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $93,723 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $93,723 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0008 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 63 | ActivitiesOrProgramsCnt |
| Persons Served | 3081 | PersonsServedCnt |
| Total Community Benefit Expns | $4,566,431 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,292,647 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,273,784 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0186 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 66 | ActivitiesOrProgramsCnt |
| Persons Served | 26012 | PersonsServedCnt |
| Total Community Benefit Expns | $32,688,515 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,484,123 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,204,392 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1246 | 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) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | 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) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | 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 | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,341,799 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $249,144 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $34,022,214 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $51,204,297 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$17,182,083 | 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 MARY'S HOSPITAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.stmgb.org | WebsiteAddressTxt |
| State License | 18 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| 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 MARY'S HOSPITAL MEDICAL CENTER | 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 | 14 | 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.stmgb.org/Hospital-Information/About/Community-Health-Needs | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.stmgb.org/Hospital-Information/About/Community-Health-Needs | 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 | 600.0 | 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 | https://www.stmgb.org/Patients-Guests/Patient-Financial-Services | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.stmgb.org/Patients-Guests/Patient-Financial-Services | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.stmgb.org/Patients-Guests/Patient-Financial-Services | 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 |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| 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 5 Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. Quantitative data for each of the potential health focus areas was assembled from a wide variety of public sources. The quantitative data was then reviewed to help validate the selection of health priorities. In alignment with IRS Treasury Notice 2011-52,2 data was reviewed by individuals who represented 1) the broad interests of the community, and 2) the voice of community members who were medically underserved, minorities, low-income, and/or those persons with chronic illnesses. These people attended the community health improvement project summit in November 2014. Scott Anderson, Northeast Wisconsin Technical College, Associate Dean, Allied Health Sciences Deborah Armbruster, Brown County Health Department, MCH Nurse Manager Sandy Atkins, Greater Green Bay YMCA, Director of Center Operations Sharla Baenen, Bellin Psychiatric Center, President Donna Boehm, HSHS St. Vincent Hospital, Director, Regional Cancer Services Erin Bongers, De Pere Health Department, Public Health Nurse Jamie Campbell, N.E.W. Community Clinic - WIC, Project Nutritionist, RD Tina Cazzola, Brown County Community Treatment Center, Substance Abuse Counselor In Training Barbara Coniff, Libertas, Director Laura Cormier, Bellin Health Oconto Hospital, Vice President Operations Kathie DeMuth, Bellin College, Assistant Professor Mike Donovan, City of De Pere Board of Health Chair/Council President Elaine Doxtator, HSHS St. Mary's Hospital Medical Center, Director Emergency Dept/Nursing Resource Grant Dvorak, Greater Green Bay Chamber Health Educator John Dye, Live 54218, Chairman, Executive Committee Christopher Elfner, Bellin Health, Team Leader Howard Endow, Brown County United Way, Community Impact Manager Thomas Erdman, University of Wisconsin Green Bay, Academic Curator Richter Museum of Natural History Patricia Finder-Stone, De Pere Board of Health/LWVGGB/BACC, Volunteer/BOD Judy Friederichs, Brown County Health Department, Director Caroline Glander, HSHS St. Vincent Hospital, RN-Patient Navigator (Cancer Center) Patti Glaser-Martin, Hospital Sisters Health System/Prevea Health, Sr. Manager, Internal Communication and Community Rob Gollman, Brown County Health Department, Environmental and Laboratory Division Manager Meredith Hansen, Aging & Disability Resource Center, Resource Specialist Adam Hardy, Achieve Brown County, Executive Director Margie Hempel, Unified School District of De Pere, Health Services Coordinator Kimberly Hess, Center for Childhood Safety Executive Director Laura Hieb, Bellin Health Sarah Himmelheber, University of Wisconsin-Green Bay Sarah Inman, Brown County United Way, VP of Community Investment & Strategic Impact Amy Jerdee, Aurora Baycare Medical Center, Vice President of Clinical Operations Elizabeth Kostichka, ElizK Insurance, Independent Insurance Agent Bonnie Kuhr, N.E.W. Community Clinic CEO Celia LaTour, Catholic Charities Greg Maass, Brown County United Way , Pres/CEO Steve McCarthy, N.E.W. Curative Rehabilitation, President and CEO Mary Miceli-Wink, Brown County Human Services, AODA Counselor Seth Moore, N.E.W. Community Clinic - Outreach Healthcare, Nurse Practitioner / Program Coordinator Melinda Morella, Live54218 , Assistant Director Mary Paluchniak, HSHS St. Nicholas Hospital, Facilitator - Outreach Angela Raleigh, Prevea Health, Marketing Associate John Rocheleau, Bellin Health, System V.P. Business Support and I.T. Stacy Ross, Brown County Health Department Dawn Schaefer, West De Pere School District, School Nurse Elizabeth Scheelk, State of Wisconsin - Division of Public Health, Public Health Educator Christine Schneider, Schneider National, Health and Wellness Manager Heidi Selberg, Hospital Sisters Health System, VP Advocacy and Community Benefit Patti Smeester, Brown County Health Department Rose Smits, Community Volunteer Jill Sobieck, Brown County United Way, Community Partnership for Children Coordinator Carrie Stempski, Brown County Oral Health Partnership Executive Director Troy Streckenbach, Brown County Brown County Executive Kaitlin Swanson, HSHS St. Vincent and St. Mary's Hospitals, Director of Planning & Strategic Support Dan Teaters, BC Planning & Land Services Dept./Green Bay MPO, Transportation Planner/GIS Catherine Therrien, N.E.W. Community Clinic, N.E.W. Dental Clinic Coordinator Ashley VandenBoomen, Brown County United Way, Research and Initiatives Manager Jen Van Den Elzen, Live54218, Director Christine Vandenhouten, University of Wisconsin Green Bay, Associate Professor Janelle Walton Aging & Disability Resource Center of Brown County, Disability Benefit Specialist Jody Wilmet, Bellin Health VP Bob Woessner, Bob, Inc. CEO Chrystal Woller, De Pere Health Department, Director Chua Xiong, Brown County Health Department, Nurse Manager Leanne Zhu, University of Wisconsin - Green Bay, Assistant Professor in Nutritional Sciences By holding the summit and sharing the priorities and implementation plans with the hospital community advisory committee, the hospital took into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health (local, regional, state and/or tribal). Members of medically underserved, low-income and minority populations served by the hospital or individuals or organizations representing the interests of such populations also provided input. The medically underserved are members of a population who experience health disparities, are at risk of not receiving adequate medical care as a result of being uninsured or underinsured, and/or experiencing barriers to health care due to geographic, language, financial or other barriers. |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. Yes, we conducted the CHNA with Bellin Health and Aurora BayCare Medical Center, as well as with our sister hospital HSHS St. Vincent Hospital. |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. A community wide CHNA steering committee was developed to guide the structure of the process to ensure that the requirements of all parties were met. Members of the CHNA Steering Committee represented organizations that have a legal or regulatory requirement to conduct a CHNA. The CHNA Steering Committee members included: Judy Friedrichs, Brown County Public Health Chrystal Woller, City of DePere Public Health Heidi Selberg, Hospital Sisters Health System John Rocheleau, Bellin Health Jodi Wilmet, Bellin Health Laura Heib, Bellin Health Mark Huber, Aurora Health Howard Endow, United Way Christopher Colletta, WI Department of Health Northeast Region |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. HSHS St. Mary's Hospital will partner 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: 1. Oral Health -HSHS St. Mary's Hospital is involved in the implementation and/or continuation of the following efforts to improve access to care: a. Lead the activities of the community Oral Health Task Force, which has its own three year plan with goals and outcome measures (work plan will be attached to this report upon completion). b. Support Public Health's efforts to retain fluoridation in public health water supplies via testimony when requested 2. Mental Health, AODA, Physical Activity and Nutrition - HSHS St. Mary's Hospital is engaged in the development, implementation and/or continuation of the following efforts to improve services: a. Support the activities of the community action planning teams, which have their own three year plan with goals and outcome measures (work plans will be attached to this report upon completion). b. Work with Public Health and our community partners to identify and implement at least one new evidence-based community program that addresses one of the identified health priorities. 3. Identify and implement programs to provide appropriate care to poor and needy. a. Develop strategies to reduce ED visits for dental conditions b. Develop strategies to reduce ED visits by Medicaid patients and provide them with care in settings appropriate to their needs. c. Provide assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare, as appropriate for their situation. HSHS ST. MARY'S HOSPITAL WAS A KEY PART OF A COLLABORATIVE APPROACH IN CONDUCTING ITS CHNA AND ADOPTING AN IMPLEMENTATION PLAN IN FY2015 (JULY 1, 2014 THROUGH JUNE 30, 2015) IN PARTNERSHIP WITH REPRESENTATIVES FROM THE COMMUNITY. UPON COMPLETION OF THE CHNA, THE HOSPITAL DEVELOPED A SET OF IMPLEMENTATION STRATEGIES AND ADOPTED AN IMPLEMENTATION PLAN TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. THE POPULATION ASSESSED WAS BROWN COUNTY, WISCONSIN. DATA COLLECTED THROUGHOUT THE ASSESSMENT PROCESS WAS SUPPLEMENTED WITH THE RESULTS OF A BEHAVIORAL RISK FACTOR COMMUNITY SURVEY AND THE OPINIONS OF COMMUNITY LEADERS OBTAINED VIA A COMMUNITY HEALTH NEEDS ASSESSMENT "SUMMIT" HELD IN NOVEMBER, 2014. THE FOLLOWING HEALTH NEEDS WERE IDENTIFIED BASED ON THE PERCEIVED MAGNITUDE AND SERIOUSNESS OF THE PROBLEM AND THE FEASIBILITY OF ADDRESSING IT, AS DETERMINED AT A HEALTH NEEDS SUMMIT ATTENDED BY A GROUP BROADLY REPRESENTATIVE OF THE COMMUNITY: ALCOHOL AND OTHER DRUG ABUSE, MENTAL HEALTH, PHYSICAL ACTIVITY AND NUTRITION, AND ORAL HEALTH. THESE NEEDS WERE IDENTIFIED BY USING THE WISCONSIN DEPARTMENT OF PUBLIC HEALTH'S CHIP INFRASTRUCTURE IMPROVEMENT PROJECT'S RECOMMENDED LIST OF HEALTH FOCUS AREAS, IDENTIFYING EXISTING DATA THAT OUTLINES THE MAGNITUDE AND SERIOUSNESS OF THE HEALTH FOCUS AREAS, AND THEN CONVENING A HEALTH SUMMIT WITH ATTENDANCE BROADLY REPRESENTATIVE OF THE COMMUNITY TO SELECT THE HEALTH FOCUS AREA FOR INTENSIVE FOCUS OVER THE NEXT THREE YEARS. AS PART OF THE ENGAGEMENT PROCESS WITH KEY STAKEHOLDERS, ATTENTION HAS BEEN GIVEN TO NATURAL PARTNERSHIPS AND COLLABORATIONS THAT WILL BE USED TO OPERATIONALIZE THE IMPLEMENTATION PLAN. THE IMPLEMENTATION PLAN IS CONSIDERED A "LIVING DOCUMENT" - A SET OF STRATEGIES THAT CAN BE ADAPTED TO THE LESSONS LEARNED WHILE IMPLEMENTING COMMUNITY BENEFIT PROGRAMS AND SERVICES RELEVANT TO THE PRIORITY NEEDS. THE BROADER SET OF COMMUNITY HEALTH NEEDS WILL CONTINUE TO BE MONITORED FOR CONSIDERATION AS FUTURE FOCUS AREAS. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - St. Mary's Hospital Medical Center. Presumptive Eligibility provides indivuals 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 the date of service or for non-covered services. 5. Incarceration in a penal institution 6. Enrollment in one of the following assistance programs for low-income individuals. 6a. Temporary assistance for needy families (TANF) 6b. Illinois Housing Development Authority Rental Housing Support Program. 7. Wisconsin Department of Health Services Housing Assistance Program. 8. Participation in Women, Infants and Children Program (WIC 9. Supplemental Nutrition Assistance Program (SNAP) 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. |
| Schedule H, Part V, Section B, Line 20 Facility , 1 | Facility , 1 - St. Mary's Hospital Medical Center. HSHS provides a written notice about upcoming ECAs at least 30 days prior to initiating ECAs. This statement is placed on a patient billing statement prior to placement with an agency. Additionally, a message about the availability of financial assistance is included on the statement, but it was not a separate summary document. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part VI, Line 6 Description of Affiliated Group (Continued A) | HSHS Good Shepherd Hospital in Shelbyville, Illinois increases access to mammograms, diagnostic screenings and breast cancer treatments for women through the hospital's Pink Ribbon Program and Vicky Wagner Breast Cancer Assistance Fund. The Pink Ribbon Program covers the costs of mammograms or diagnostic screenings for women living in rural areas who are under or uninsured. The Vicky Wagner Breast Cancer Assistance Fund assists women living in Shelby County who are receiving treatment for breast cancer with out of pocket expenses such as wigs, transportation to treatment appointments, child care, meals or other expenses that insurance doesn't cover. In southwest Illinois, HSHS St. Joseph's Hospital in Highland provides enhanced offerings for senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive a comprehensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, St. Joseph's Hospital is the lead collaborator in the Highland Area Meals on Wheels Program. In April 1977, the hospital partnered with the now defunct Highland Area Council of Churches to introduce the Meals on Wheels program. Today, St. Joseph's partners with the civic organization Highland Area Meals on Wheels Program to prepare and deliver nutritious meals to the elderly, those who are recuperating from illness or hospital stays, or anyone wishing to participate in the program within a 15-mile radius (cumulative population 20,000+) of the hospital. Annually, approximately 16,896 meals are delivered in eight communities. In addition to programs designed to increase access to care, HSHS makes sure that those who need financial assistance receive it. HSHS's Financial Assistance (Charity Care) policy was modified to offer a 45 percent self-pay discount to all patients who register without insurance. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 55 percent reduction off billed charges if an uninsured patient's family income level is determined to be above 500 percent but equal to our less than 600 percent of the current Federal Poverty Guidelines. HSHS hospitals waive all charges for patients below 200 percent of the Federal Poverty Levels. Counselors are available in our hospitals to explain our financial assistance policy to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Enhance community health As part of our mission to embody Christ's healing love for all people, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. To ensure the health care needs of all are being met, HSHS hospitals also understand we need to listen closely to the residents of the communities we serve. In turn, 13 HSHS hospitals conducted Community Health Needs Assessments (CHNAs) in FY2015. HSHS St. Clare Memorial Hospital in Oconto Falls, Wisconsin, who affiliated with HSHS in September 2015, and HSHS Holy Family Hospital in Greenville, Illinois, who affiliated with HSHS in May 2016, both completed their CHNAs in FY2014. HSHS Good Shepherd Hospital in Shelbyville, Illinois who affiliated with HSHS in January 2017, conducted its most recent CHNA in FY2016. HSHS hospitals are using the information gathered from their most recent CHNAs to develop new, and enhance existing, programs and services that best address the needs of the community. Priority health care needs were identified in the FY2015 CHNAs including access to health care services; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In many cases, the hospitals collaborate with other hospital facilities, local departments of public health and community organizations to address identified needs. In western Wisconsin, HSHS Sacred Heart Hospital in Eau Claire and HSHS St. Joseph's Hospital in Chippewa Falls are taking the lead to educate the public about mental health issues and treatment, the stigma associated with mental health, and the recognition of mental health issues. Under the umbrella of 3D Community Health, the hospitals led suicide prevention activities across multiple sectors in collaboration with the Chippewa Health Improvement Partnership in FY2017. Strategies included community trainings of an evidence-based suicide prevention program, QPR (question, persuade & refer), and a variety of events, activities and displays pertaining to suicide prevention. Efforts are measured by the county suicide rate, inventory of change in community knowledge, stigma and behaviors, as well as participation in the county suicide death review team to monitor for potential trends and respond accordingly. 3D formed a suicide death review team in both Eau Claire and Chippewa Counties. These teams review details of each suicide to look for trends and key pieces of information that may guide efforts in targeting certain geographic areas, certain age or gender, etc. 3D is also focused on increasing community awareness and knowledge of the factors that offer protection from suicidal behaviors and that promote wellness and recovery in collaboration with multiple community partners on an ongoing basis. One strategy is to promote effective programs and practices i.e. adverse childhood experiences (ACEs) that increase protection from suicidal risk and promote connectedness among residents of Chippewa and Eau Claire Counties. At the Children, Health and Family Summit that 3D Community Health coordinated in partnership with the County Department of Human Services in FY2017, 99 of the 190 attendees took a pre-and- post-event survey about ACEs and brain development. There was a 24% increase in the percentage who strongly agreed that exposing infants to stress can actually cause them to develop a smaller brain post-event compared to pre-event survey. HSHS Holy Family Hospital in Greenville, Illinois has sponsored a multi-faceted health fair for decades, one of the largest Health Fairs in the east St. Louis metropolitan area. The event provides many free health tests in addition to five, low-cost comprehensive blood tests. In FY2017, more than 2,000 blood tests were performed as part of the hospital's annual Health Fair. Participants could choose from a comprehensive blood test, prostate specific antigen blood test (PSA), Hemoglobin A1-C, Vitamin D blood test, Colovantage or a combination of the five blood tests. The cost incurred by HSHS Holy Family Hospital for offering these discounted services was $1,431,105. In addition to the services provided on the day of the Health Fair, the hospital also performs the low-cost blood tests at several off-site locations including area schools, businesses, and manufacturers. Through the years, life-threatening and serious medical conditions have been discovered through testing performed in association with the Health Fair. Mary's Garden is a community teaching garden located on the campus of HSHS St. Mary's Hospital in Decatur, Illinois. The goals of the community garden are to improve community health and food accessibility for those in need, teach the younger generation sustainable gardening and offer a comprehensive, place-based approach to community health improvement. In FY2017 Mary's Garden became a living classroom for Eisenhower High School students who use the garden for interactive instruction on health and nutrition, science, mathematics, ecology and agriculture. Mary's Garden also provided opportunities for two apprentices to develop competencies and self-confidence to move into rural and urban farming/gardening leadership roles and launched a community-supported agriculture (CSA) program for colleagues. This created two jobs and is providing a model for turning dilapidated city lots into urban gardens. The hospital has engaged City officials about a job creation program and neighborhood revitalization. |
| Schedule H, Part VI, Line 6 Description of Affiliated Group (Continued B) | In FY2017, HSHS St. Nicholas Hospital in Sheboygan supported a case manager position to provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) services at Lakeshore Community Health Care (LCHC) in Sheboygan. First year funding by the hospital in FY2016 was used to create the position. In FY2018, the position will be solely funded by LCHC. SBIRT is an evidence-based practice designed to identify, reduce and prevent problematic use, abuse and dependence on drugs and alcohol. The creation of the SBIRT case manager position stems from Healthy Sheboygan County's 2020 Community Health Implementation Plan which was created following the Community Health Needs Assessment in 2014. Studies show that excessive use of alcohol and other drugs contributes to more than 70 diseases and leads to expensive, long-term health problems. Through early intervention, provided by the SBIRT case manager, the plan is to reduce costs and decrease the severity of drug and alcohol abuse. Advance medical knowledge HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In FY2017, HSHS hospitals and affiliated physician groups contributed more than $21.5 million toward research and health professions education. Highlights of this commitment include subsidizing medical school residency programs, offering ongoing medical education to physicians and clinicians, and providing job shadowing programs for high school students. In southern Illinois, HSHS St. Joseph's Hospital in Breese, hosted members of the Health Occupations Students of America onsite to learn about job opportunities in health care from health care professionals. St. Joseph's also provided clinical experience for Kaskaskia College students enrolled in nursing, physical therapy and radiology programs. Pharmacy students have also completed their clinical training at St. Joseph's Hospital. In FY2017, the program served more than 200 students. In FY2017, HSHS St. Mary's Hospital Medical Center and HSHS St. Vincent Hospital in Green Bay invested more than $636,000 to provide onsite training and education of nurses and allied health professionals. In addition, the hospitals have been collaborating with the Medical College of Wisconsin to establish a community medical education program in Green Bay and to provide financial support to offset operating costs in FY2017. Also in eastern Wisconsin, HSHS St. Clare Memorial Hospital in Oconto Falls provided training for local paramedics and emergency response personnel through the hospital's EMS liaison program. Mission-driven and strategically implemented Community Benefit is an integral part of Hospital Sisters Health System's Mission. Our commitment to Community Benefit arises from our Catholic identity, Mission and Core Values shared by 14,000 colleagues across Illinois and Wisconsin. Through our work to improve access to health care services, enhance community health, advance medical knowledge, and relieve or reduce the burden of government, we believe we have made a positive difference in the quality of lives of tens of thousands of people in Illinois and Wisconsin in FY2017. As a Catholic health care ministry, HSHS is concerned with the dignity of all persons, the common good, and the stewardship of resources. We advocate for health care for all and work to improve social conditions that lead to improved health and well-being. We engage partners in our communities to improve health and quality of life and to reduce duplication. Working side- by-side with many faith communities, HSHS remains dedicated to our common purpose of compassionate care for all people. |
| Schedule H, Part VI, Line 5 Promotion of Community Health (Continued A) | Double your bucks: Adequate food and nutrition was identified as one of the major health needs facing our community. The community wide food and nutrition action planning group has been actively working with local farmers' market to encourage customers using EBT (Electronic benefit transfer, formerly known as food stamps) to purchase fruits and vegetables. They worked to enable vendors to accept EBT, and using a planning grant from a local foundation, trialed a "double your bucks" initiative to double the purchasing power of EBT when used for fruits and vegetables up to a maximum of $10. A trial of this program showed that that the programs increased purchases of fruits and vegetables by those receiving EBT benefits. HSHS St. Vincent and St. Mary's Hospitals have stepped forward to provided funding so that the "double your bucks" program could continue. Without this agreement, the trial program would have been discontinued despite demonstrated success. Here are some of the outcomes from the 2015 season: 95% of participants say that because of the program they eat more fruits and vegetables; 84% say they purchase fewer high fat low nutrition snacks, and 94% say they now purchase more fruits and vegetables year-round. To have this program have an even greater impact, a condition of our support has been that the patient focused literature developed by the oral health group be distributed to participants with toothbrushes. Participants are delighted by this extra added bonus. Other community benefit activities: * Provided free and discounted laboratory and radiology services to NEW Community Clinic, an FQHC. More than 70 percent of patients indicated the clinic's care prevented a trip to the emergency department. * Provided more than $100,000 to support acute care clinic operations NEW Community Clinic's Northeast Wisconsin Technical College location, as well as funds to help support operating costs associated with the oral surgeon's services at the dental clinic. * Assisted in excess of 2,900 people by screening and applying for the appropriate assistance, such as SSDI or medical assistance, including providing certified application counselors to assist patients in understanding and using the new health insurance marketplace. * Spent over $296,000 to provide onsite training and education of nursing and allied health students within its facilities. * Collaborated with Medical College of Wisconsin to offer a community medical education program in Green Bay, and have provided financial support to offset operating costs and staff to assist in training physicians. * Through A Woman's Place, provided health and wellness education, health screenings, resources and referral services, facilitated by a Hispanic health outreach facilitator. * A Woman's Place served nearly 1,200 women through its resource center and consumer lending library; screenings for cardiovascular disease, osteoporosis and reproductive cancer; and educational events and classes on a variety of health topics. * Hospital employees provide information at educational and public forums. Many underserved and uninsured of our community attend these events. * A loan closet located at A Woman's Place provides wigs, scarves, turbans, hats and breast prostheses for women living with the side effects of cancer treatments. * Additionally, the Look Good, Feel Better Program offers information and guidance to cancer patients looking to enhance their appearance. This gives patients a sense of control over physical changes they may experience. * HSHS St. Mary's donated more than $21,000 in diagnostic services supplies to the missions. * HSHS St. Mary's Hospital in partnership with HSHS St. Vincent Hospital and Bellin Health, supports Unity Hospice, a provider of appropriate and compassionate care for the terminally ill. |
| 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 FY2017 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 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 that 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 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. HSHS St. Mary's Hospital reports bad debt in accordance with healthcare financial management association statement 15, as modified and consistent with Generally Accepted Accounting Principles (GAAP). |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | The 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 21 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. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Mary's Hospital is relieving the burden of the government. Accordingly, this shortfall restricts HSHS St. Mary's Hospital's ability to make funds available to provide charity care and other community benefit. The hospital computes the unpaid costs of providing care to Medicare patients by comparing the cost of the services to the reimbursement received from Medicare during the year. The cost of Medicare services is calculated by applying the ratio of patient care cost to charges to the annual Medicare charges. The patient care cost is determined by reducing the total annual operating expense by bad debt expenses, Medicaid provider taxes and community benefit expense. The difference between the reimbursement received and the calculated cost of the services is reported as the Medicare shortfall. The hospital's Medicare shortfall at cost for FY2017 was nearly $17.2 million. |
| 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. |
| Schedule H, Part V, Section B, Line 16a FAP website | - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16a URL: https://www.stmgb.org/Patients-Guests/Patient-Financial-Services; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16b URL: https://www.stmgb.org/Patients-Guests/Patient-Financial-Services; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16c URL: https://www.stmgb.org/Patients-Guests/Patient-Financial-Services; |
| Schedule H, Part VI, Line 2 Needs assessment | As indicated in Part V, Section C, the hospital conducted a Community Health Needs Assessment in FY2015. In addition to conducting a Community Health Needs Assessment (CHNA) triennially per the provisions in the Affordable Care Act, the hospital routinely assesses the health care needs of the communities it serves in a variety of ways, including reviewing the health needs assessments of other health care organizations in our service area as well our local and state health departments and the United Way. We continually review primary data such as hospital and emergency department utilization and patient surveys as well as secondary data from our county and state public health departments, the Centers for Disease Control, County Health Rankings, and the Behavioral Risk FS Survey to name a few. On occasion, we will also collect primary data through telephone and electronic survey instruments. In addition to ongoing primary and secondary data collection and analysis, the hospital regularly assesses the health care needs of the communities it serves through feedback received from its internal assessment team, assessment advisory team, hospital leadership, Strategy department and hospital Board members. As part of the three-year Implementation Plan, the hospital shares its progress toward achieving its short and long term indicators in various community venues such as town hall meetings, community forums, and Chamber of Commerce. Also through volunteer and board service with other local health care, social service agencies, law enforcement task forces, and area schools, hospital colleagues gather ongoing information on the health care needs of the communities it serves. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | Our hospital posts our charity care brochure and application on our website. In addition, charity care applications are available and prominently displayed in our waiting and registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. We also have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate either in person or over the phone about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the internet address where the policy and an application can be obtained. A system called Search America is utilized after failed attempts made by the hospital and our law firm to make contact or work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a presumptive determination as to whether the patient meets charity guidelines to grant charity care or continue collection efforts. |
| Schedule H, Part VI, Line 4 Community information | Brown County, Wisconsin is a primarily urban county, one of 72 Wisconsin counties, and is located in the northeastern part of the state. Brown County's population is predominantly Caucasian (82%), with a small proportion of people who are Native American) (3%) or Black (3%). There is a sizeable Hispanic population, with almost 9% of the population. (Source: census.gov). There are approximately 260,000 residents, of which nearly 34,000 are covered by Medicaid/BadgerCare. Per the 2017 County Health Rankings, 9% of Brown County's population is uninsured and the median household income in Brown County is $56,000. About 11% of Brown County residents live at or below the federal poverty level. (Source: County Health Rankings). Brown County contains a dental care HPSA (health professional shortage area) and the metro area is a MUA (medically underserved area), per HRSA. HSHS St. Mary's Hospital does not exclude MUAs, low income or minority populations from its service area. There are three not-for-profit general medical surgical hospitals and one for-profit general medical surgical hospital serving brown county and the surrounding area. In addition, there is one not-for-profit psychiatric hospital, one for-profit psychiatric hospital and one county operated psychiatric hospital in the area. Since most of the population resides in the Green Bay metro area, plans and services focus on this area. |
| Schedule H, Part VI, Line 5 Promotion of community health | HSHS St Mary's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded more than 125 years ago to bring a healing presence and improve the health of our community, especially for those persons who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Brown County, Wisconsin and surrounding areas. The hospital is governed by a Board of Directors, at least a majority 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 HSHS St Mary's Hospital is responding to community need. During both FY2012 and 2015, for example, the board reviewed the community health needs assessment and approved an implementation strategy for addressing selected needs. Our hospital advisory council and the Friends of St. Mary's Foundation, provide the hospital with additional connections to and insights into the larger community and its health care needs. Consistent with its exempt purpose, HSHS St. Mary's Hospital 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 St. Mary's Hospital reinvests surplus funds to support the mission of the organization and 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. HSHS St. Mary's Hospital also serves as a site for health professionals education HSHS St. Mary's Hospital devotes significant resources to access for patients who cannot afford care, along with other community benefits. In FY2017, HSHS St. Mary's Hospital provided $15.2 million in Community Benefit services, including charity care 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 FY2017, HSHS St. Mary's Hospital provided over $17 million (at cost) in excess of Medicare payment for health care services. HSHS St. Mary's Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives would not exist without the leadership role played by HSHS St. Mary's Hospital and they often relieve a burden that would otherwise be carried by government. Since HSHS St. Mary's Hospital and HSHS St. Vincent Hospital are in the same market, only a few miles apart, they jointly conduct the CHNA along with community partners, and work together on their CHNA implementation strategies. Indeed, the cost of most proactive community benefit is shared by HSHS St. Mary's Hospital (1/3) and HSHS St. Vincent Hospital (2/3). Here are examples of strategies implemented during FY2017: 1. Oral Health a. Continued to lead the activities of the community Oral Health Task Force, which has its own three-year plan with goals and outcome measures. Extensive summary of this work is available. Prevention, intervention, and policy modification strategies are included in the committee's action plan. b. Helped to expand services at NEW Community Clinic dental clinic by i. Supporting the effort to gain a HRSA grant for expansion through subsidizing the rent guarantee necessary and assisting with the design cost for the center ii. Supporting the efforts of the oral surgeons to provide their services free of charge at NEW Clinic by subsidizing the cost of a staff person to gain the necessary medical clearances and consent forms for patients-many of whom are elderly and/or disabled and need consent from guardians c. Helped to expand the services to children in other school districts by paying for a dental hygienist employed by the Brown County Oral Health Partnership to offer services in the Ashwaubenon school district. d. Served on the boards for NEW Community Clinic and Oral Health Partnership, playing significant roles in their governance (e.g., Vice President on NEW Clinic board; search committee member for OHP and lead the announcement process for the new executive director) 2. Mental Health, AODA, Physical Activity and Nutrition a. Actively participate in the development of the Greater Green Bay Mental Health Connection, which is a collaboration of agencies and organizations designed to reform the mental health delivery system in our community. Lead the strategic planning process, wrote portions of the grant application that resulted in a major seven-year grant from Medical College of Wisconsin, and serve on the steering committee. b. Worked with Prevea Health to implement the TIPS program, a program for non-violent opioid abusers that provides treatment and deferred/dismissed prosecution upon successful completion of the treatment process. Actions include subsidizing scholarships for a residential treatment program and arranging to have the first dose of Vivitrol donated. c. Started the "Plant a row" program in the division since "food and nutrition" is a health focus area in all our markets. d. Supported the "double your bucks" program at farmers' markets in Green Bay, DePere and Oneida to enable EBT recipients to buy double the amount of fresh fruits and vegetables. e. Supported the Boy Scout "Scouting for Food" food drive. This food drive is using the materials developed by the local food and nutrition group that provides guidelines and suggestions for donors that encourages them to contribute healthy foods. 3. Identify and implement programs to provide appropriate care to poor and needy. a. Provided assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare through certified application counselors and educational sessions. b. Through an agreement with Brown County, subsidized the cost of an income maintenance worker to assist with immediate enrollment in BadgerCare. Assistance). Here are two examples of the impact these efforts have had on our community: Oral Health Partnership: The Oral Health Partnership has made tremendous inroads in the Green Bay schools to address these issues, but has not had the capacity to reach out to other local school districts-there are nine in Brown County. Based on their assessment of where the greatest need resides and using a donation from HSHS St. Vincent and HSHS St. Mary's, OHP was able to begin services to the Ashwaubenon school district. OHP shared the following story: Due to our opportunity to expand our school based services to Ashwaubenon, a young middle school student was able to receive much needed dental services. Her only access to dental care has been provided through OHP. During her school appointment for an exam, sealants and a cleaning, six teeth were identified with decay. One of these molars was deeply decayed down to the gum line and the infection had spread through the roof of the mouth. This situation is especially dangerous in that the infection can spread to other parts of the body, including the brain. This patient received chair-side oral hygiene education and then through case management was appointed for follow up treatment at the Howe Resource Center Dental Clinic. The mother of this patient was unaware of the severity of her child's dental disease and our clinical staff was able to relay the importance of receiving oral care and education to aid in prevention of further disease and maintenance of oral health. The school nurse writes, I am so appreciative of the relationship that the Brown County Oral Health Partnership has forged with our district. Through this alliance 79 students received oral health care that otherwise would have been difficult to obtain. Some of these students were identified with significant dental issues, including dental caries and abscesses. What a relief to know that these students can now receive the proper dental care, which in turn helps them to be healthy and ready to learn. I am hoping we can continue this partnership in the future! |
| Schedule H, Part VI, Line 6 Affiliated health care system | HSHS St. Mary's Hospital Medical Center is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 15 hospitals, numerous community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The mission of HSHS is "to reveal and embody Christ's healing love for all people through our high-quality Franciscan health care ministry." We live our mission by providing holistic healing to all who seek our care, as well as through Community Benefit. In tandem with others in the communities we serve, our Community Benefit initiatives are strategically increasing access to care, improving the health status of residents, and increasing medical education and knowledge. In FY2017, our hospitals responded to the top needs identified in each of their most recent Community Health Needs Assessments (CHNAs). The information gathered from these assessments was used to develop or enhance Community Benefit programs and services to best address community health needs. Among the priority needs identified in the most recent CHNA process were access to care; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. In FY2017, HSHS collectively provided $197.6 million in Community Benefit (9.2% of total hospital expenses). This amount included $26.0 million provided for Financial Assistance (a.k.a. Charity Care) and $128.6 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 $205.9 million. HSHS hospitals also recorded $40.9 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. Improve access to health care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need with a special focus on the poor and vulnerable. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care, at the right time, and in the right setting involve collaborating with others to achieve this goal. Across our two-state System, there are numerous examples of partnerships with departments of public health, other health care facilities and community and social service organizations to enhance access to care for those in need. In FY2017, HSHS and our 15 hospitals dedicated Community Benefit resources to educate uninsured persons about enrollment opportunities in affordable health care coverage and to facilitate the enrollment process. Studies have shown that people without insurance are more likely to postpone care and develop more severe and expensive conditions than their insured counterparts. It is for this reason that the Catholic Church, Catholic health care and HSHS have long promoted "coverage and access for all." HSHS and our 15 hospitals in partnership with local health departments, social service agencies and other health care providers played a vital role in educating eligible people in their service areas, by referring people to Certified Application Counselors and/or in enrolling them in the health insurance exchanges, or by helping them to obtain coverage through Medicaid expansion. In southern Illinois, HSHS St. Elizabeth's Hospital in Belleville is committed to improving access to health care services by assisting eligible patients to enroll in health care plans. In FY2017, more than 3,200 patients were screened and 74% met eligibility criteria and were enrolled in Medicaid. Access to health care is not limited to insurance coverage and access to primary care providers. In FY2017, the hospital assisted patients with access to medications, durable medical equipment, and transportation including more than $5,600 in cab and bus tickets for patients and $14,000 for patients who needed transfer by ambulance. In response to its FY2015 CHNA, HSHS St. John's Hospital in Springfield, Illinois established a community health worker program to increase access to health care and coordination of care for residents of the Enos Park Neighborhood. The hospital also helped establish an Enos Park Neighborhood Advisory Council and Providers Alliance as part of the access collaborative to drive behavior changes and improve health outcomes. In the first three years, the program has realized 93% engagement of 300 clients. Services rendered include basic needs and health care access. Sixteen formally homeless individuals or families were placed in affordable, safe housing. Of the 35 parolees in the program, the recidivism rate was only 18% compared to 60% nationwide. The only reason participating parolees went back to prison was because of lack of a job or housing. One-hundred percent of our clients saw a primary care provider and 84% were connected to a medical home. This program is being replicated in a second location in Sangamon County's eastside where our most vulnerable, low-income and underserved populations exist. Through the support of HSHS St. Mary's Hospital Medical Center and St. Vincent Hospital in Green Bay, the Oral Health Partnership (OHP) continues to expand to communities throughout Brown County, providing dental care to 0 - 19 year olds who are uninsured or underinsured. In FY2017, more than 12,000 general dentistry procedures, including exams, X-rays, cleanings, fillings, and crowns, were completed for youth in Brown County's smaller, less urban communities, and more than 1,300 preventative sealants were applied. OHP serves more than 9,000 kids each year through three fixed-site clinics and the traveling school-based program. In January 2017, OHP's West location was opened in response to data showing an unmet need of medical assistance children in the Ashwaubenon area. This clinic, along with the traveling school-based team, will help OHP and HSHS reach the goal of expanding services to a wider population of Brown County children in need. HSHS St. Francis Hospital in Litchfield, Illinois collaborated with Lewis & Clark Community College and local dental providers to bring the College's mobile dental health unit to the Litchfield area; the unit provides free or low cost dental exams and screenings, x-rays and hygiene services. In addition, three local dental providers also participated by opening their offices and donating time, staff and supplies to provide either a free filling, extraction or hygiene services. Beginning in 2015, the hospital collaborated with Catholic Charities to launch a dental voucher program. Five dentists in Macoupin and Montgomery counties participate in the program, which covers an initial exam and x-rays, one tooth extraction and up to three fillings per year per individual. The percentage of total emergency department visits related to dental issues has decreased from 2.2% in 2011 to .95% in 2016 because of this collaboration. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between HSHS St. Anthony's Memorial Hospital in Effingham and Catholic Charities. In FY2017, St. Anthony's Memorial Hospital helped to underwrite the cost of prescription medications for 246 residents. St. Anthony's Memorial Hospital and Catholic Charities believe no one should be without prescriptions because of the inability to pay. |
| 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 (10 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 | ||||||||||||||
| PRESIDENT/Divisional CEO | $0 | $650,406 | $0 | $111,977 | $0 | $139,413 | $0 | $208,461 | $0 | $31,032 | $0 | $1,141,289 | $0 | $96,536 |
| MICHAEL W COTTRELL | ||||||||||||||
| DIRECTOR | $0 | $617,558 | $0 | $139,028 | $0 | $120,568 | $0 | $199,280 | $0 | $29,892 | $0 | $1,106,326 | $0 | $83,663 |
| ANN M CARR | ||||||||||||||
| TREASURER | $0 | $251,800 | $0 | $39,616 | $0 | $68,544 | $0 | $291,816 | $0 | $20,710 | $0 | $672,486 | $0 | $31,485 |
| LAWRENCE J CONNORS | ||||||||||||||
| COO | $313,818 | $0 | $25,142 | $0 | $18,817 | $0 | $236,871 | $0 | $25,176 | $0 | $619,824 | $0 | $0 | $0 |
| GREG SIMIA | ||||||||||||||
| DIVISION CFO | $0 | $370,894 | $0 | $31,383 | $0 | $780 | $0 | $85,174 | $0 | $27,395 | $0 | $515,626 | $0 | $0 |
| JAMIE BABBITTS | ||||||||||||||
| EXECUTIVE DIRECTOR | $157,280 | $0 | $0 | $0 | $780 | $0 | $132,878 | $0 | $27,553 | $0 | $318,491 | $0 | $0 | $0 |
| JAYNE BLEUEL | ||||||||||||||
| PHARMACIST | $135,030 | $0 | $4,630 | $0 | $1,191 | $0 | $123,401 | $0 | $6,771 | $0 | $271,023 | $0 | $0 | $0 |
| GREGORY LAEHN | ||||||||||||||
| PHARMACIST | $151,987 | $0 | $4,740 | $0 | $390 | $0 | $129,213 | $0 | $9,300 | $0 | $295,630 | $0 | $0 | $0 |
| DANIEL DORAN | ||||||||||||||
| PHARMACIST | $145,914 | $0 | $0 | $0 | $780 | $0 | $89,622 | $0 | $19,881 | $0 | $256,197 | $0 | $0 | $0 |
| Scott Stillwell | ||||||||||||||
| Physician | $203,368 | $0 | $0 | $0 | $780 | $0 | $7,068 | $0 | $28,349 | $0 | $239,565 | $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 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 2016 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $31,564 Michael Cottrell -- $94,085 Therese Pandl -- $94,337 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $31,485 Michael Cottrell -- $83,663 Therese Pandl -- $96,536 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PREVEA CLINIC INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SVGB OFFICER IS PREVEA CLINIC BOARD MEMBER (SEE PART V) | RelationshipDescriptionTxt |
| Transaction | $3,631,373 | TransactionAmt |
| Transaction | PHYSICIAN SERVICES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part IV BUSINESS TRANSACTIONS WITH INTERESTED PERSONS | FormAndLineReferenceDesc |
| Explanation | THERESE PANDL, PRESIDENT OF SVGB, IS A BOARD MEMBER OF PREVEA CLINIC. ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE REVENUE - SURGERY | SURGICAL SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER ARE COMPRISED OF CENTRAL PROCESSING, ANESTHESIA, SURGERY AND RECOVERY. THIS INCLUDES EIGHT OPERATING ROOM SUITES, A C-SECTION ROOM AND TWO MINOR TREATMENT ROOMS. SERVICES ARE AVAILABLE 24/7 AND INCLUDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. IN FY2017, NEARLY 6,700 SURGICAL PROCEDURES WERE PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, UROLOGY, GYNECOLOGY, ORAL - MAXILLOFACIAL, AND ORGAN PROCUREMENT. ANESTHESIA AND CENTRAL PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. |
| Form 990, Part III, Line 4c PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES | THE IMAGING SERVICES DEPARTMENT AT ST. MARY'S HOSPITAL MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. OVERALL, THE DEPARTMENT PERFORMED NEARLY 54,700 INPATIENT AND OUTPATIENT EXAMS AND PROCEDURES DURING FY17. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN DIGITAL MAMMOGRAPHY, COMPUTED TOMOGRAPHY, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. FIVE INTERVENTIONAL RADIOLOGISTS PROVIDE MINIMALLY INVASIVE PROCEDURES USING IMAGE GUIDANCE. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. THE DEPARTMENT USES A STATE OF THE ART MRI WIDE BORE SCANNER. |
| Form 990, Part III, Line 4b PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER | CARDIOLOGY SERVICES OFFERS A COMPLETE ARRAY OF CATHETERIZATION LABORATORY PROCEDURES AND NONINVASIVE CARDIOVASCULAR DIAGNOSTIC PROCEDURES, DOING OVER 3,900 CARDIAC PROCEDURES IN FY2017. IF NEEDED, A STATE-OF-THE-ART CARDIOVASCULAR OPERATING CENTER (CVOR) IS AVAILABLE NEARBY AT OUR SISTER FACILITY, ST. VINCENT HOSPITAL, FOR CUTTING-EDGE OPEN HEART PROCEDURES BY OUR HIGHLY-SKILLED CARDIOTHORACIC SURGEONS. CVICU SUITES ARE ALSO OFFERED THERE. FOR THOSE PATIENTS WHO NEED FOLLOW-UP, A CARDIO-PULMONARY REHABILITATION PROGRAM IS OFFERED ON SITE AT ST. MARY'S. ELECTROPHYSIOLOGY HAS BEEN AVAILABLE AT ST. MARY'S HOSPITAL SINCE FY13. |
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 62,710,768 including grants of $)(Revenue $ 61,145,122) OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY AND OTHER SERVICES. IN FY2017 THE HOSPITAL HAD NEARLY 102,000 OUTPATIENT VISITS, OVER 4,400 ADMISSIONS, OVER 12,400 PATIENT DAYS, NEARLY 600 BIRTHS AND OVER 30,400 EMERGENCY ROOM VISITS. |
| Form 990, Part IV, Line 24a TAX EXEMPT BONDS | ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, 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. MARY'S MEDICAL CENTER. 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 ST. NICHOLAS HOSPITAL, AND 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 SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH 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, CHAIRPERSON OF THE BOARD, AND PRESIDENT. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC. (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 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; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) 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 (N) 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 HORWATH TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE HORWATH 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 DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. 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 FOR THE DISQUALIFIED INDIVIDUALS. 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. |
| 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 | PROFESSIONAL FEES - Total Expense: 3201878, Program Service Expense: 2241315, Management and General Expenses: 960563, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 8062864, Program Service Expense: 5644005, Management and General Expenses: 2418859, Fundraising Expenses: ; SHARED SERVICES FEE - Total Expense: 10015568, Program Service Expense: 7010898, Management and General Expenses: 3004670, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | THE HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. 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 FOR CERTAIN 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 AFFILIATES - -651136; CHANGE IN PENSION - 3459912; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 471364; CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS - 843109; SWAP PAYMENTS - -322754; |
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 | -$1,762,307 | $6,257,513 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371668647 | HEALTHCARE | IL | -$950,689 | $8,580,781 | KCIN |
| HSHS ACO LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 320465666 | HEALTHCARE & SOCIAL ASSISTANCE | IL | -$515,297 | $146,855 | KCIN |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (27 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) |
| HSHS SELF INSURANCE TRUST | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371120626 | INSURANCE | IL | 501(c)(3) | Type I | 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 | ||||||||||
| 211 SOUTH THIRD STREET | BELLEVILLE | IL | 62220 | 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 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) |
| ST CLARE MEMORIAL HOSPITAL | ||||||||||
| 855 S MAIN STREET | OCONTO FALLS | WI | 54154 | 390848401 | HEALTHCARE | WI | 501(c)(3) | 3 | 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) |
| SHELBY MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 371294401 | FUNDRAISING | IL | 501(c)(3) | Type I | 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) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | 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 | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER | ||||||||||||||
| 4000 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 371312961 | HEALTHCARE | IL | ST ELIZABETH'S | Related | $674,729 | $4,464,307 | false | false | 0.5 | |
| PRAIRIE HEART INSTITUTE ST JOHN'S | ||||||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 371321197 | HEALTHCARE | IL | HSHS | Related | $0 | $8,000 | false | false | 1 | |
| PAIN CENTER OF WISCONSIN | ||||||||||||||
| 4131 W LOOMIS ROAD | GREENFIELD | WI | 53221 | 263155343 | HEALTHCARE | WI | ST VINCENT | Related | $527,290 | $608,459 | false | false | 0.5 | SUITE 300 |
| PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC | ||||||||||||||
| 4131 W LOOMIS ROAD | GREENFIELD | WI | 53221 | 364717036 | HEALTHCARE | WI | ST CLARE | Related | $82,878 | $213,434 | false | false | 0.5 | SUITE 300 |
| 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 | 62794 | 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 | -$7,119 | $10,276 | false | Yes (true) | 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 | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | 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 | -$32,734,440 | $34,421,714 | 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 | $260,762 | $45,933,122 | 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 | INSURANCE | HSSI | C Corporation | $0 | $120,349,324 | 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 | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | 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 | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ORGANIZATIONS | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |