2017-05-13T10:04:27-05:00 2016-06-30 990 2015-07-01 391834639 Columbia St Mary's Inc COLU 4143262230 4425 North Port Washington Road 301 Glendale WI 53212 Timothy Waldoch Interim CFO 2017-05-13 2015 2021-01-29 14:40:06Z Travis Andersen 4425 North Port Washington Road Glendale WI 53212 146712372 false 0928 X columbia-stmarys.org X 2001 WI HEALTH CARE SYSTEM DEDICATED TO MAKING A POSITIVE DIFFERENCE IN INDIVIDUALS AND OUR COMMUNITY. 12 10 449 14 64000 4333 154090 541763 160826536 144265947 3947187 631720 3497620 1272942 168425433 146712372 539910 650500 0 41764640 26844327 0 0 82329525 99632399 124634075 127127226 43791358 19585146 227069734 220506061 168989384 198401807 58080350 22104254 COLUMBIA ST. MARY'S, INC. ("CSM") IS A HEALTH CARE PROVIDER FOUNDED IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, WHICH IS SPONSORED BY ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM, AND COLUMBIA HEALTH SYSTEM, A NON-SECTARIAN COMMUNITY HEALTH SYSTEM. CSM EXISTS TO MAKE A POSITIVE DIFFERENCE IN THE HEALTH STATUS AND LIVES OF INDIVIDUALS AND OUR COMMUNITY, WITH SPECIAL CONCERN FOR THOSE WHO ARE VULNERABLE. CSM AND ITS AFFILIATES ARE COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE, VALUES-DRIVEN PROGRAMS AND SERVICES WITH EQUAL ATTENTION TO THE PHYSICAL, SPIRITUAL, AND EMOTIONAL DIMENSIONS OF HEALTH. false false 88754153 650500 145474889 CSM, INC EXISTS AS THE PARENT CORPORATION IN THE CSM SYSTEM, WHICH IS COMPRISED OF THREE HOSPITALS, (COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE INC, COLUMBIA ST. MARY'S HOSPITAL OZAUKEE INC, AND SACRED HEART REHABILITATION INSTITUTE INC.), 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, A PARTNERSHIP WITH THE ORTHOPAEDIC HOSPITAL OF WISCONSIN, A PARTNERSHIP WITH THE SLEEP WELLNESS INSTITUTE, AND FIVE URGENT CARE CENTERS. DURING FISCAL 2016, CSM'S HEALTH SYSTEM (SACRED HEART REHABILITATION, COLUMBIA ST. MARY'S MILWAUKEE, COLUMBIA ST. MARY'S OZAUKEE) PROVIDED CARE TO 125,309 PATIENTS. THE ESTIMATED UNREIMBURSED COST OF SERVICES PROVIDED TO THE ELDERLY, UNINSURED AND UNDERINSURED TOTALED $171,237,636. REFER TO THE COMMUNITY BENEFIT INFORMATION IN SCHEDULE H FOR DISCUSSION OF HOW CSM MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE. 88754153 true true false false false false false false false false true false true true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 99 0 true 449 true true true false false false false false false false false false X 12 10 false false false false true true true true true false false true true true true true true false true false X Timothy Waldoch 4143262230 4425 N Port Washington Rd Ste 301 Glendale WI 53212 TRAVIS D ANDERSEN PRESIDENT/CEO 10.0 36.0 X X 1068528 0 61462 TINA CHANG BOARD MEMBER 0.2 0.8 X 0 0 0 PATRICIA J DOLHUN MD BOARD MEMBER 0.2 0.8 X 0 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 0.2 45.4 X 0 540814 189305 MICHAEL GREBE BOARD MEMBER 0.2 0.8 X 0 0 0 GEORGE H HOFF CHAIR 0.2 0.8 X 0 0 0 ROBERT LYON MD BOARD MEMBER 0.2 0.8 X 0 0 0 R BRUCE MCDONALD BOARD MEMBER 0.2 0.8 X 0 0 0 CHRISTINE NUERNBERG BOARD MEMBER 0.2 0.8 X 0 0 0 RANDALL PERRY SECRETARY/TREASURER 0.2 0.8 X 0 0 0 STEPHEN ROBBINS MD BOARD MEMBER 0.2 0.8 X 0 0 0 ROBERT J VENABLE VICE CHAIR 0.2 0.8 X 0 0 0 TIMOTHY WALDOCH INTERIM CFO 10.0 36.0 X 273038 0 65995 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 10.0 35.0 X 237460 0 25297 WILLIAM HART VP/COO 5.0 45.0 X 356332 0 38138 KEVIN KLUESNER VP CLINICAL SERVICES 5.0 45.0 X 269517 0 65711 GERRI LIETZ-STAFFILENO VP/CNO 5.0 45.3 X 299518 0 77515 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 5.0 45.0 X 761964 0 116261 MICHAEL SANDERL VP MISSION INTEGRATION & ADVOC 10.0 35.0 X 252916 0 66494 SUZANNE SANICOLA VP PHYSICIAN SVCS 5.0 35.0 X 247248 0 76596 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION (END 08/31/15) 5.0 35.0 X 741627 0 49902 JO ANN HANKWITZ INTERIM CHRO 10.0 35.0 X 148146 0 48658 RICHARD SHIMP MD CHIEF MEDICAL OFFICER 5.0 35.0 X 422475 0 59695 JEFFREY SQUIER PAYOR RELATIONS & STRATEGY OFFICER 40.0 0 X 264017 0 55377 JEAN VOIGHT CHIEF FIN ADVSR-PHYSICIAN DIV 40.0 0 X 234087 0 56174 ROBYN ARNOLD GENERAL COUNSEL 40.0 0 X 177244 0 35071 DAVID MANNES CONTROLLER 40.0 0 X 183611 0 80653 MARK REPENSHEK DIR MISSION INTEGRATION 10.0 0 X 202491 0 52396 6140217 540814 1220700 33 true true false Healthcare Services 401 N Michigan Avenue Suite 2700 Chicago IL 60611 Revenue Cycle Management 24817515 Integraged Health Network of Wisconsin 19601 W Bluemound Rd Suite 200 Brookfield WI 53045 ACO Member Fees 1193919 Accenture LLP 111 E Kilbourn Ave Suite 1200 Milwaukee WI 53202 Consulting 906623 MedSpeed LLC 11260 W Lincoln Ave West Allis WI 53227 Courier Services 836835 Leidos Health Holdings LLC 705 E Main St Westfield IN 46074 Consulting 443419 23 X 467440 73829 494 541763 Service Fee 541610 129768064 129768064 Joint Venture Income 622110 13958000 13958000 Medical Staff Dues 561499 205621 205621 Program revenue 900099 1600 1600 Management Fee Income 541610 64000 64000 268662 268662 0 0 144265947 631720 631720 52507 52507 0 52507 52507 0 0 Other Operating Revenue 561499 1220435 1220435 0 0 0 0 1220435 146712372 145474889 64000 631720 X 650500 650500 5294691 283792 5010899 17027083 14296240 2730843 -3129481 -3129481 5893164 1145301 4747863 1758870 1086176 672694 95428 76326 19102 792281 75948 716333 3343289 528876 2814413 57221199 54169486 3051713 0 3473829 476384 2997445 1993649 1011242 982407 618544 362074 256470 3898072 3889359 8713 257687 102691 154996 78276 31857 46419 9662252 9662252 8314615 8238190 76425 774462 770912 3550 Community Benefit Expense 1236070 31292 1204778 Restructuring Costs 1659488 0 1659488 Other Operating 635546 222557 412989 Patient Care Supplies 650198 629113 21085 4927514 675837 4251677 0 127127226 88754153 38373073 0 3116320 2108757 20623073 2781118 11683995 8704915 0 0 52151 52151 2973633 664991 42456302 31515859 7722462 10940443 0 43528626 40116027 30254997 25379281 107114477 129758378 227069734 220506061 12831802 8338075 157438200 155480213 -1280618 34583519 168989384 198401807 X 39375674 6430960 13577079 10447723 5127597 5225571 58080350 22104254 227069734 220506061 X 19585146 -55561242 X false true X true false X X X 4 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 390806315 3 true 0 0 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 390807063 3 true 0 0 SACRED HEART REHABILITATION INSTITUTE INC 390902199 3 true 0 0 COLUMBIA COLLEGE OF NURSING INC 391596986 2 true 0 0 4 0 0 true false false false false false false false false false false false false false false true Schedule A, Part I, Line 11 SCH A, PART I, LINE 11 COLUMBIA ST. MARY'S, INC. SUPPORTS THE PROVISION OF HEALTHCARE SERVICES AT THE CORPORATIONS TO WHICH IT IS A MEMBER BY THE PROVISION OF CENTRALIZED ADMINISTRATIVE SUPPORT, INCLUDING BILLING AND COLLECTIONS, IT, MANAGED CARE CONTRACTING, FINANCIAL SERVICES, BUSINESS DEVELOPMENT, MEDICAL LIBRARY, CME, PROPERTY MANAGEMENT, ADMINISTRATIVE COSTS FOR CLINICAL INSTITUTES (INCLUDING ONCOLOGY, CARDIOLOGY, BARIATRICS, PEDIATRICS, STROKE AND NEUROSCIENCES), RESEARCH (INCLUDING ONCOLOGY, NEUROSCIENCES, AND GENERAL RESEARCH), MARKETING, LOGISTICS, EXTERNAL AFFAIRS, PUBLIC RELATIONS, AND CONSTRUCTION. COSTS OF CERTAIN OF THESE DEPARTMENTS ARE CHARGED TO THE MEMBERS THROUGH A MANAGEMENT FEE. TRANSACTIONS WITH EACH MEMBER ARE DELINEATED ON SCHEDULE R. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 764011 764011 15781763 13137876 2643887 479900 425206 54694 23887565 17862141 6025424 1543063 90636 1452427 10940443 Investment in Unconsolidated Entities 24442733 C Investments in CSM Foundation - Perm Rest 5225571 C Investments in CSM Foundation - Temp Rest 10447723 C 40116027 Deferred Compensation 146542 Pension Prefunding Interest in Investments held by Ascension Health Alliance 128171101 A/R Intercomp between HMS 1403133 Other Current Assets 37602 129758378 A/P Intercompany between HMS Accrued Pension 3522296 Deferred Compensation 146542 Misc Noncurrent Liabilities 2767975 Misc Current Liabilities 2630630 Pension Liability 25516076 34583519 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE AND ITS MEMBER ORGANIZATION ("THE SYSTEM") WHICH INCLUDE THE ACTIVITY OF COLUMBIA ST. MARY'S INC.: THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX PROVISIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2016. true true X true X true X true true false true true 45914 0 45914 0.0004 5792556 651508 5141048 0.0404 0 0 0 0.0 0 0 5838470 651508 5186962 0.0408 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 5838470 651508 5186962 0.0408 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0 0 0.0 false 135634 2713 5487466 16067287 -10579821 X true true ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC ORTHOPEDIC SURGERIES 0.5 0.5 1 1 ORTHOPAEDIC HOSPITAL OF WISCONSIN 475 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 WWW.OHOW.COM 1006 X Specialty Orthopedic Hospital ORTHOPAEDIC HOSPITAL OF WISCONSIN 1 false false true X X X X X X X X X 15 true true true true X HTTP://WWW.OHOW.COM/ X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH101109 X true 15 true http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC102829 false false true X 200.0 300.0 X X X true true X X X true X http://www.ohow.com/financial-assistance.html X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin. THE HOSPITAL FACILITY TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH. THE COLLABORATION INCLUDED PARTICIPATION BY THE MILWAUKEE COUNTY HEALTH DEPARTMENT AND REPRESENTATIVES FROM HEALTH DEPARTMENTS IN MILWAUKEE COUNTY. THE CHNA TEAM DEVELOPED A MULTI-LEVEL ASSESSMENT PROCESS. THE FIRST LEVEL CONSISTED OF A SURVEY OF COUNTY RESIDENTS REGARDING THEIR HEALTH STATUS, HEALTH ACCESS AND THE PERCEPTION OF COMMUNITY NEEDS. WORKING TOGETHER, SURVEY QUESTIONS WERE DEVELOPED AND APPROVED. A CONSULTANT WAS CONTRACTED TO PERFORM THE SURVEY USING TECHNIQUES THAT THE CONSULTANT HAD USED IN SIMILAR SURVEYS OVER TEN YEARS. THE SURVEY WAS CONDUCTED OVER THE TELEPHONE TO CELL PHONE OWNERS AND "LAND LINE" TELEPHONE OWNERS. MORE THAN 1,900 PEOPLE WERE INTERVIEWED. THE SECOND LEVEL OF DATA GATHERING WAS PERFORMED BY THE CENTER FOR URBAN POPULATION HEALTH (CUPH) AS SECONDARY DATA GATHERING ABOUT COMMUNITY NEEDS BASED ON PUBLIC HEALTH AND OTHER PUBLICLY AVAILABLE INFORMATION. THE THIRD LEVEL OF DATA WAS GATHERED THROUGH A KEY STAKEHOLDER INTERVIEW PROCESS. THE MHCP MEMBERS HAD AGREED UPON THOSE DIVERSE PEOPLE WHO REPRESENTED KEY ASPECTS OF THE COMMUNITY. A SURVEY TOOL WAS DEVELOPED BY THE GROUP AND INTERVIEWS WERE SCHEDULED BY MHCP MEMBERS AND BY PUBLIC HEALTH STUDENTS WORKING WITH THE CITY OF MILWAUKEE HEALTH DEPARTMENT. IN ALL, 35 INDIVIDUAL INTERVIEWS AND FIVE GROUP INTERVIEWS WERE CONDUCTED BY TEAM MEMBERS. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin. DESCRIPTION: THE OTHER HOSPITAL FACILITIES WITH WHICH THE REPORTING HOSPITAL FACILITY CONDUCTED ITS CHNA, INCLUDE AURORA HEALTH CARE, CHILDREN'S HOSPITAL OF WISCONSIN, FROEDTERT HEALTH AND WHEATON FRANCISCAN HEALTHCARE. THESE FIVE HOSPITAL SYSTEMS HAVE DEVELOPED THE MILWAUKEE HEALTH CARE PARTNERSHIP (MHCP) TO COLLABORATE EFFORTS TO IMPROVE UNDERSTANDING OF HEALTH CARE NEEDS IN MILWAUKEE AND TO IMPROVE ACCESS TO HEALTH CARE. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin. THE CHNA WAS CONDUCTED WITH CENTER FOR URBAN POPULATION HEALTH Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin. The Milwaukee CHNA identified 10 key issues: infant mortality, oral health access, substance abuse, cancer disparity, mental health, injury and violence, chronic disease, overweight/obesity, health literacy, and sexual health. GIVEN THE SPECIALTY NATURE OF OHOW, MANY OF THE IDENTIFIED COMMUNITY NEEDS HAD NO RELEVANCE TO OHOW RESOURCES. Primary areas of focus in this CHNA for OHOW include injury/violence and chronic disease. Injury and Violence plan: A program of Home Assessment will be designed to help patients and caregivers develop plans to avoid falls and decrease risks. Physical therapists and occupational therapists will conduct the assessments and advise patients and caregivers. This will be part of an Orthopaedic Hospital of Wisconsin approach. The goal will be to develop and implement a pilot program of home assessment in partnership with the North Shore Health Department and North Shore Paramedics. Chronic Disease plan: CSM, as a partner in community service with OHOW, has a history of work to manage diabetes through church partnership and food pantry partnership and therefore developed a diabetes-friendly food pantry model as well as the Ebenezer Health Resource Center, both at the same location. These will be supported through the Orthopaedic Hospital of Wisconsin Community Health Improvement Plan, given the history of support for health programs at Ebenezer. The goal will be to create a diabetes-friendly food pantry at Ebenezer food pantry by working with partners such as Feeding America, Hunger Task Force, dietary instructors, CSM Foundation and other funders, and the Ebenezer Health Resource Center staff. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin. ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE A MINIMUM DISCOUNT OF 44% OFF GROSS CHARGES FOR SERVICES PROVIDED TO THEM. 0 Schedule H, Part VI, Line 7 Community Benefit Report CSM does not file a community benefit report since it does not have any patient care revenue. However, CSM's three hospital organizations, Columbia St. Mary's Hospital, Milwaukee, Inc., Columbia St. Mary's Hospital Ozaukee, Inc. and Sacred Heart Rehabilitation Institute, Inc. each file community benefit reports with the Wisconsin Hospital Association. Schedule H, Part I, Line 7g Subsidized Health Services THE ORGANIZATION HAS NOT INCLUDED COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC AS PART OF SUBSIDIZED HEALTH SERVICES. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR CERTAIN CATEGORIES IN THE TABLE, THIS WAS A COST ACCOUNTING SYSTEM; IN OTHER CATEGORIES, A SPECIFIC COST-TO-CHANGE RATION WAS APPLIED. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad debt is calculated from the audited financial statements using an average cost to charge ration. The same ratio is used to calculate all of the expenses at cost within Schedule H. Schedule H, Part III, Line 3 Bad Debt Expense Methodology OHOW and CSM have a very robust financial assistance program; however, when comparing OHOW's percentage of charity care to its total expenses against the poverty levels in the greater Milwaukee community that OHOW serves, OHOW and CSM estimates that approximately 2% of its total bad debt expense relates to patients who might otherwise qualify for financial assistance under its policies but choose not to apply. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote OHOW, which files financial statements separate from CSM, includes the following footnote related to accounts receivables: "The majority of the Hospital's accounts receivables are due from third party payors under reimbursement agreements and from patients for services provided. Accounts receivable are due upon receipt of invoice. Receivables are stated net of any allowance for contractual discounts and uncollectible accounts by considering the number of days past due, collection history, and the general economy and industry as a whole. Contractual adjustments are based on expected payment rates in accordance with third-party payor agreements. The Hospital writes off accounts receivable when they are determined to be uncollectible. Payments subsequently received are credited to the allowance for doubtful accounts." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs OHOW follows the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance OHOW has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Schedule H, Part V, Section B, Line 16a FAP website - ORTHOPAEDIC HOSPITAL OF WISCONSIN: Line 16a URL: http://www.ohow.com/financial-assistance.html; Schedule H, Part VI, Line 2 Needs assessment Columbia St. Mary's, Inc. serves the Milwaukee and Ozaukee communities through a Community Benefit Process overseen by the Milwaukee Community Benefit Committee and the Ozaukee Community Benefit Committee. The process of understanding community needs through a Community Health Needs Assessment and interpreted through the work of Community Benefit Committees to lead to a Community Benefit Plan for Milwaukee and Ozaukee communities is consistent across the organization. Although the Community Benefit Plan occurs primarily in the Milwaukee, Ozaukee and Sacred Heart Rehabilitation Institute settings, the work is also supported by departments behind the scenes across CSM, including accounting, human resources, purchasing, legal counsel and other administrative functions. Programs such as the Orthopaedic Hospital of Wisconsin have also contributed to support of Community Benefit programming. Community Benefit Committees at CSM have consistent roles to support the Community Benefit functions. The roles include the following: - Develop Community Health Needs Assessment (CHNA) to determine community needs - Review CHNA and create Community Benefit Plan to address needs - Incorporate Community Benefit Plan goals in the CSM Integrated Strategic, Operational and Financial Plan (ISOFP) for Board level approval and submission to Ascension Health System - Develop a strategy to measure and increase the impact of Community Benefit Plan elements The Community Health Needs Assessments are specific to the demographics and health issues to the community. The Needs Assessments completed in 2015 involved the gathering of secondary information about the communities from varied public sources including state data, and county data. The most remarkable needs for the service were addressed through Community Benefit Plans for each community. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance CSM attempts to identify patients who may be eligible for charity or discounted care as outlined in the charity care policy during the pre-registration, registration, admissions and discharge processes. A copy of the charity care policy is posted in the emergency room, and a summary of the policy is provided to patients with admission and discharge paperwork. CSM has trained financial counselors available to discuss payment options to the patients. Upon making an appointment, the financial counselors will meet with the patient to determine what other financial assistance programs the patient may qualify for. Schedule H, Part VI, Line 4 Community information CSM primarily serves the Milwaukee and Ozaukee counties in southeastern Wisconsin. OHOW is located in an urban community within Milwaukee County. The population of Milwaukee County is approximately 953,000, with over 20% of the households living at or below federal poverty guidelines. The median income is approximately $43,000, over 46% of the population is a minority, and approximately 16% of the population speak a language other than English. Discounts for the uninsured and underinsured are not included in Parts I or II of Schedule H. Schedule H, Part VI, Line 5 Promotion of community health A hallmark of CSM, Inc. is the ability to proactively meet health needs through preventive programs and programs to allow access to primary and specialty care. The programs are most often delivered through partnership with other non-profit organizations in health and social services. Each hospital has access improvement programs including: St. Ben's Clinic for the Homeless, Seton Dental Clinic, Community Chronic Disease Management Clinic, Huiras Family Community Health Center, and the CSM Family Health Center. A particularly strong partner in these activities has been the Medical College of Wisconsin in sponsorship of programs: - The Family Health Center, a residency-based Family Medicine clinic that provides primary care to more than 9,000 individuals in the community. - The Chronic Disease Management Clinic, which screens and manages hypertension, diabetes, obesity, and smoking for low income adults through a clinic based in a food pantry. In turn, CSM across the hospital settings hosts residents for their training growth and development. All of these services are reported as part of the Community Benefit expenses in Section H of the appropriate hospital report. Schedule H, Part VI, Line 6 Affiliated health care system The CSM health system focuses on contributing to the positive health status of the communities it serves. CSM is an organization comprised of three hospitals, 61 community clinics, The Columbia College of Nursing, a partnership with the Orthopaedic Hospital of Wisconsin, a partnership with Sleep Services of Wisconsin, and five Urgent Care Centers. CSM provides care for individuals and families throughout Milwaukee, Ozaukee, Washington, and Sheboygan counties - with more than 160 years of service to individuals and families in these communities. OHOW itself is a specialty hospital which performs more than 5,000 surgical procedures each year and offers the complete range of orthopedic services, including joint replacements and spine procedures, rehabilitation, diagnostic testing and pain management services. As a member of Ascension Health, the nation's largest Catholic healthcare system, CSM continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of CSM is to perpetuate the health mission of the church. CSM furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. CSM employs a Community Benefit Philosophy in program planning and implementation. CSM provides for the health of the community through financial support provided to patients by financial discounts and contracts, by developing clinics and services for specific vulnerable groups, by sponsoring community education and training and by collaborating with government programs. During fiscal 2016, the CSM system provided $86,306,151 in community health benefit services, including traditional charity care, discounts to the uninsured, and other unpaid public programs, including subsidized health care, professional education, financial contributions and community building activities. In addition, the organization's governing body is comprised of local community leaders and physicians, the majority of whom reside within the communities CSM serves and are neither employees nor contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community; however, the clinics within the organization are served by physicians affiliated with CSM. true United Way of Greater Milwaukee 225 W Vine Street Milwaukee WI 53212 390806190 501(c)(3) 625000 FEDERALLY QUALIFIED HEALTH CENTERS FUNDING Bread of Healing Clinic 1821 N 16TH ST Milwaukee WI 53205 810669867 15000 Contribution for labor expense MILWAUKEE AREA WORKFORCE INVESTMENT BOARD 2342 N 27TH ST Milwaukee WI 53210 391636835 50000 Center for Healthcare Careers of Southeast WI Collaboration 3 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212. true true false false false false false true false TRAVIS D ANDERSEN PRESIDENT/CEO 563273 0 433518 0 71737 0 25800 0 35662 0 1129991 0 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 0 536211 0 500 0 4103 0 150050 0 39255 0 730118 0 0 TIMOTHY WALDOCH INTERIM CFO 225973 0 46540 0 524 0 31276 0 34719 0 339033 0 0 0 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 189874 0 33533 0 14054 0 20221 0 5076 0 262757 0 0 0 WILLIAM HART VP/COO 300173 0 52953 0 3206 0 31950 0 6188 0 394469 0 0 0 KEVIN KLUESNER VP CLINICAL SERVICES 223639 0 41285 0 4593 0 31950 0 33761 0 335228 0 0 0 GERRI LIETZ-STAFFILENO VP/CNO 238684 0 43671 0 17163 0 48399 0 29115 0 377033 0 0 0 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 557979 0 125883 0 78102 0 74375 0 41886 0 878225 0 0 0 MICHAEL SANDERL VP MISSION INTEGRATION & ADVOC 206127 0 34541 0 12249 0 39914 0 26580 0 319409 0 0 0 SUZANNE SANICOLA VP PHYSICIAN SVCS 207588 0 37435 0 2225 0 48418 0 28177 0 323844 0 0 0 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION (END 08/31/15) 343147 0 104852 0 293627 0 30006 0 19895 0 791528 0 0 0 JO ANN HANKWITZ INTERIM CHRO 121866 0 25630 0 649 0 26265 0 22393 0 196804 0 0 0 RICHARD SHIMP MD CHIEF MEDICAL OFFICER 357632 0 62276 0 2567 0 25650 0 34045 0 482170 0 0 0 JEFFREY SQUIER PAYOR RELATIONS & STRATEGY OFFICER 222806 0 40706 0 506 0 24381 0 30996 0 319394 0 0 0 JEAN VOIGHT CHIEF FIN ADVSR-PHYSICIAN DIV 197468 0 36184 0 434 0 26705 0 29468 0 290260 0 0 0 ROBYN ARNOLD GENERAL COUNSEL 150137 0 27006 0 101 0 22544 0 12527 0 212315 0 0 0 DAVID MANNES CONTROLLER 171066 0 12393 0 153 0 41282 0 39371 0 264264 0 0 0 MARK REPENSHEK DIR MISSION INTEGRATION 164451 0 36928 0 1112 0 19744 0 32653 0 254887 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment SEVERANCE PAYMENTS: Allan Spooner: $401,932.08 Michael Sanderl: $146,520.40 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. NO DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WERE MADE IN THE CURRENT YEAR. Schedule J, Part I, Line 7 Non-fixed payments BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY SERVED, BASED ON ESTABLISHED GUIDELINES. OFFICERS AND KEY EMPLOYEES PARTICIPATE IN A MANAGEMENT INCENTIVE PLACE, WHEREBY CERTAIN FINANCIAL TRIGGERS OF THE CSM SYSTEM AS APPROVED BY THE BOARD MUST BE MET BEFORE ANY ELIGIBLE EMPLOYEE MAY RECEIVE PAYMENT OF THE INCENTIVE. ONCE THE TRIGGER IS MET, THE INCENTIVE IS MEASURED BASED ON VARIOUS ESTABLISHED GOALS, INCLUDING OPERATING MARGIN, PATIENT SATISFACTION, QUALITY AND PRODUCTIVITY. Form 990, Part VI, Line 6 Classes of members or stockholders CSM HAS TWO CORPORATE MEMBERS: ASCENSION HEALTH AND COLUMBIA HEALTH SYSTEM. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ONE OF CSM'S CORPORATE MEMBERS, ASCENSION HEALTH, HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSM. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ASCENSION HEALTH HAS DESIGNED A SYSTEM AUTHORITY MATRIX WHICH ASSIGNS AUTHORITY FOR KEY DECISIONS THAT ARE NECESSARY IN THE OPERATION OF THE SYSTEM. SPECIFIC AREAS THAT ARE IDENTIFIED IN THE AUTHORITY MATRIX ARE: NEW ORGANIZATIONS & MAJOR TRANSACTIONS; GOVERNING DOCUMENTS; APPOINTMENTS/REMOVALS; EVALUATION; DEBT LIMITS; STRATEGIC & FINANCIAL PLANS; ASSETS; SYSTEM POLICIES & PROCEDURES. THESE AREAS ARE SUBJECT TO CERTAIN LEVELS OF APPROVAL BY ASCENSION PER THE SYSTEM AUTHORITY MATRIX. COLUMBIA HEALTH SYSTEM HAS THE AUTHORITY TO APPROVE ANY CHANGES TO THE GOVERNING DOCUMENTS WHICH WOULD AFFECT ITS INTEREST OR RIGHTS IN CSM, THE MISSION AND VISION STATEMENTS OF CSM, AND ANY MAJOR CORPORATE STRUCTURAL TRANSACTIONS OF CSM Form 990, Part VI, Line 11b Review of form 990 by governing body MANAGEMENT, INCLUDING CERTAIN OFFICERS, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE BOARD, OR A DESIGNATED COMMITTEE, TO REVIEW AND ANSWER ANY QUESTIONS. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy CSM HAS A WRITTEN CONFLICT OF INTEREST POLICY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX EXEMPT PURPOSE. Form 990, Part VI, Line 15b Process to establish compensation of other employees IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS INT HE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HER COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATIONS, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO THE OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue Contract Services - Total Revenue: 46891, Related or Exempt Function Revenue: 46891, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Research Sponsor - Total Revenue: 221771, Related or Exempt Function Revenue: 221771, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Courier Costs - Total Expense: 874667, Program Service Expense: 836835, Management and General Expenses: 37832, Fundraising Expenses: ; Contract Labor - Total Expense: 184226, Program Service Expense: 6755, Management and General Expenses: 177471, Fundraising Expenses: ; Professional Fees - Total Expense: 1558713, Program Service Expense: 334447, Management and General Expenses: 1224266, Fundraising Expenses: ; Billing - Total Expense: 919535, Program Service Expense: 903603, Management and General Expenses: 15932, Fundraising Expenses: ; Environmental Service - Total Expense: 11822, Program Service Expense: 11822, Management and General Expenses: , Fundraising Expenses: ; Information Systems - Total Expense: 34569727, Program Service Expense: 33115883, Management and General Expenses: 1453844, Fundraising Expenses: ; Medical - Total Expense: 108255, Program Service Expense: 105926, Management and General Expenses: 2329, Fundraising Expenses: ; Physician Contracted Services - Total Expense: 13603, Program Service Expense: 12157, Management and General Expenses: 1446, Fundraising Expenses: ; Other - Total Expense: 2511702, Program Service Expense: 2377672, Management and General Expenses: 134030, Fundraising Expenses: ; Repairs and Maintenance - Total Expense: 16468949, Program Service Expense: 16464386, Management and General Expenses: 4563, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Intercompany payable/receivable adjustment - -55561242; COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390806315 HOSPITAL WI 501(c)(3 3 COLUMBIA ST MARY'S INC true COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390807063 HOSPITAL WI 501(c)(3 3 COLUMBIA ST MARY'S INC true SACRED HEART REHABILITATION INSTITUTE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390902199 REHAB FACILITY WI 501(c)(3 3 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC true COLUMBIA COLLEGE OF NURSING INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391596986 COLLEGE WI 501(c)(3 2 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC true ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE true HORIZON HOME CARE & HOSPICE INC 8949 N DEERBROOK TRL MILWAUKEE WI 53223 391171298 HOME CARE/HOSPICE WI 501(c)(3 3 NA false COLUMBIA HEALTH SYSTEM 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(c)(3 Type I NA false COLUMBIA ST MARY'S FOUNDATION INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494981 FOUNDATION WI 501(c)(3 7 NA false ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC 575 RIVERWOODS PKWY GLENDALE WI 53212 392015655 HEALTH CARE WI COLUMBIA ST MARY'S INC Related 13045228 26125423 false true SLEEP SERVICES OF WISCONSIN LLC 111 E KILBOURN AVE STE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI COLUMBIA ST MARY'S INC Related -30436 755724 false true CSM STRATEGIC ALLIANCE 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391871856 HEALTHCARE WI COLUMBIA ST MARY'S INC C Corporation 0 80000 0.5 false MADISON MEDICAL AFFILIATES INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391855720 HEALTHCARE WI COLUMBIA ST MARY'S HOSPITAL C Corporation -13561846 8603605 1 true PROSPECT MEDICAL COMMONS CONDO ASSOCIATION 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 208042108 CONDO ASSOC WI COLUMBIA ST MARY'S INC C Corporation 0 411926 0.7 true false false true false true false false false false true false true true false true false false true false Ascension Health E 155480213 BOOK Columbia St Mary's Foundation Inc C 267440 FMV Columbia St Mary's Hospital Milwaukee Inc L 85645776 BOOK Columbia St Mary's Hospital Ozaukee Inc L 25533276 BOOK Sacred Heart Rehabilitation Institute Inc L 2709168 BOOK Columbia College of Nursing Inc L 743520 BOOK Madison Medical Affiliates Inc L 1375551 BOOK Ascension Health L 71229931 BOOK Orthopaedic Hospital of Wisconsin LLC O 12563880 BOOK Madison Medical Affiliates R 11500000 BOOK Columbia Health System R 320016 BOOK Orthopaedic Hospital of Wisconsin LLC L 488369 FMV Ascension Health C 200000 FMV