2017-11-14T13:20:51-06:00 2016-12-31 391173131 SCHENCK SC 100 MARITIME DRIVE SUITE 2B MANITOWOC WI 54220 990 2016-01-01 390806395 HOLY FAMILY MEMORIAL INC HOLY 9203202011 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 MARK HERZOG PRESIDENT / CEO 9203203470 2017-11-09 1 LACEY SILBERNAGEL P01245590 9206845500 74.142.163.66 2017-11-09 15:23:21 CS P 9475B8F64D5A719E781C043AAC9DC26B2B2E8E16 A1E3CE75D951098F5CF37418E507036188929F4F 2016 2021-01-29 14:40:06Z MARK HERZOG 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 133071196 0 X WWW.HFMHEALTH.ORG X 1899 WI HEALTH CARE SERVICESHOLY FAMILY MEMORIAL (HFM) IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC, HOME CARE AND HOSPICE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT. 18 13 1243 307 21691 -20084 617349 137664 128414355 129294093 5065322 3217820 133626 56377 134230652 132705954 51491 49029 0 0 76975899 76516477 0 0 132029 51627055 49499713 128654445 126065219 5576207 6640735 172821455 190102873 56848948 66217533 115972507 123885340 X HOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. 0 0 105629321 49029 132486714 HOLY FAMILY MEMORIAL IS AN INTEGRATED NETWORK PROVIDING HEALTH CARE SERVICES INTENDED TO BENEFIT THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE PRIMARY AND SPECIALTY CLINIC CARE, PREVENTIVE CARE SUCH AS HEALTH SCREENINGS, VACCINATION CLINICS AND HEALTH EDUCATION CLASSES, 24/7 EMERGENCY CARE, WALK-IN, INPATIENT ACUTE CARE, OUTPATIENT CARE, HOME CARE AND HOSPICE, HOME MEDICAL EQUIPMENT, PRESCRIPTIONS, OCCUPATIONAL HEALTH SERVICES, AND MEDICALLY BASED FITNESS AND WELLNESS. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. (CONTINUED ON SCHEDULE O)THESE PARTNERSHIPS INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS, AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY. HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HFM UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES, AND CONSIDERS SITUATIONS WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HFM DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $22,468,000 FOR THE YEAR ENDED DECEMBER 31, 2016. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $244,000. MORE INFORMATION IS AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH IS LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG. 105629321 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 115 0 1 1243 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X 18 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 WI X X BRETT NORELL CFO 9203203486 2300 WESTERN AVENUE MANITOWOC WI 542211450 X MICHELLE L BIRSCHBACH DIRECTOR 2.00 X 0 0 0 DEREK R BOWN DC DIRECTOR 40.00 X 138173 0 30699 DONALD R BRISCH CHAIR 2.00 X X 0 0 0 MATTHEW L CAMPBELL MD DIRECTOR 40.00 X 301491 0 32968 WILLIAM R CASEY DIRECTOR 2.00 X 0 0 0 LAURIE CRAWFORD DIRECTOR, FORMER SECRETARY 2.00 X X 0 0 0 JEFFREY S DUNN VICE CHAIR 2.00 X X 0 0 0 SISTER LORITA M GAFFNEY DIRECTOR 2.00 X 0 0 0 SISTER MARLITA HENSELER DIRECTOR 2.00 X 0 0 0 MARK P HERZOG DIRECTOR, PRESIDENT, CEO 40.00 X X 645669 0 127503 ERICK M KAHLENBERG DIRECTOR 2.00 X 0 0 0 MARILYN KAUFMANN PHD RN DIRECTOR 2.00 X 0 0 0 DENISE A KITZEROW TREASURER 2.00 X X 0 0 0 WILLIAM C LEACH JR DO DIRECTOR 40.00 X 379223 0 30681 DANIEL B MCGINTY DIRECTOR 2.00 X 0 0 0 JANE L PFEFFER DIRECTOR 2.00 X 0 0 0 SISTER ELAINE TURBA DIRECTOR 2.00 X 0 0 0 SISTER JAN VILLEMURE DIRECTOR 2.00 X 0 0 0 SISTER LAURA WOLF DIRECTOR 2.00 X 0 0 0 XA XIONG MD DIRECTOR 40.00 X 183507 0 33655 KATHLEEN A ZUCCHI SECRETARY 2.00 X 0 0 0 JANE CURRAN-MEULI EXECUTIVE VP, COO 40.00 X 257480 0 71210 STEVEN D DRIGGERS MD EXECUTIVE VP, CMO 40.00 X 388116 0 65697 LAURA FIELDING VP ORG ENGAGEMENT, CAO 40.00 X 126979 0 10138 MARY MAURER VP COMMUNITY ENGAGEMENT, CIO 40.00 X 270854 0 45982 BRETT NORELL VP FINANCE, CFO 40.00 X 231702 0 59636 DEAN POLLNOW MD EXECUTIVE VP, CMO 40.00 X 142932 0 25095 JEREMY R ANCLAM MD PHYSICIAN PROVIDER 40.00 X 614637 0 22731 KIRK DIMITRIS MD PHYSICIAN PROVIDER 40.00 X 1366336 0 27805 RYAN M DOPIRAK MD PHYSICIAN PROVIDER 40.00 X 1113429 0 27868 DAVID MIKOLYZK MD PHYSICIAN PROVIDER 40.00 X 839230 0 25878 THOMAS SYLVESTER MD PHYSICIAN PROVIDER 40.00 X 647923 0 8340 WILLIAM D HAMPTON DO FORMER DIRECTOR 40.00 X 372924 0 25030 8020605 0 670916 70 1 1 0 CARETECH SOLUTIONS 901 WILSHIRE DRIVE STE 250 TROY MI 48084 IT SERVICES 2023784 COMPLETERX LTD 3100 S GESSNER STE 640 HOUSTON TX 77063 PHARMACY SERVICES 1327890 SODEXO CTM INCMSC - 410672 PO BOX 415000 NASHVILLE TN 372415000 BIO-MED SERVICES 996243 NTT DATA INC PO BOX 4201 BOSTON MA 02211 IMPLEMENTATION SERVICES 475000 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUM PROVIDER STAFFING 421211 23 49671 87993 137664 INTEGRATED HEALTH CARE 900099 116912671 116912671 LAB 621500 11317051 11290078 26973 PHARMACY 446110 1064371 1064371 129294093 3219594 3219594 144661 158779 -14118 -14118 -14118 43108 44882 -1774 -1774 -1774 103229 49671 27452 75777 75777 167528 134129 33399 33399 INVESTMENT HFHS & DME 900003 -38681 -38681 -38681 132705954 132486714 21691 59885 49029 49029 3872749 1230134 2642615 58966259 51867989 7015949 82321 1373577 1208970 162519 2088 8669766 7874651 771002 24113 3634126 3150529 478339 5258 410851 72753 338098 111013 111013 142786 142786 2088020 2088020 353056 25175 327881 509451 379148 125950 4353 4470744 2448452 2019164 3128 2365967 1469958 894135 1874 313171 173725 139160 286 272737 172697 100040 1903544 1183171 718862 1511 4295407 3541726 752068 1613 907302 650038 256761 503 SUPPLIES 19291827 19071649 220025 153 PURCHASED SERVICES 5030366 2734423 2294347 1596 WISCONSIN PROVIDER ASSE 2749377 2749377 MAINTENANCE 2675150 2628791 46359 1608944 858916 746796 3232 126065219 105629321 20303869 132029 X 8447100 14483066 5025140 4871286 26325 18358 15505623 17916992 300000 300000 2424879 2364803 6060564 5845509 195918875 120088475 68609273 75830400 58555081 63721785 4420610 3302262 3376683 1264649 70177 183763 172821455 190102873 12769002 14492087 43786 39006 44035960 51686240 200 200 56848948 66217533 X 113405938 121073605 546491 565001 2020078 2246734 115972507 123885340 172821455 190102873 X 6640735 1026933 245165 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 943 0 1 10601 11544 0 PART II-B, LINE 1: EXPLANATION: PART II-B, LINES 1B & 1G: HOLY FAMILY MEMORIAL SENT A REPRESENTATIVE TO WASHINGTON, D.C. IN 2016, IN PART, TO DISCUSS LEGISLATIVE MATTERS WITH FEDERAL LEGISLATORS. HOLY FAMILY MEMORIAL ALSO SENT TWO HFM STAFF AND ONE HFM BOARD MEMBER TO THE WISCONSIN STATE CAPITAL (WHA ADVOCACY DAY) TO DISCUSS HEALTH RELATED LEGISLATIVE ISSUES ON VARIOUS HEALTH CARE TOPICS WITH STATE LEGISLATORS. EXPLANATION: PART II-B, LINE 1I, OTHER ACTIVITIES: HOLY FAMILY MEMORIAL BELONGS TO THE WISCONSIN HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, WHICH USE A PERCENTAGE OF DUES FOR LOBBYING PURPOSES. 0 0 2566566 314437 105388 174659 2811732 2530941 382393 -19926 326842 2566566 2276763 428510 61207 235539 2530941 1915567 374287 179201 192292 2276763 1637918 514026 236377 1915567 0.86000 0.10000 0.04000 0 1 1 5434579 5434579 121290892 62717323 58573569 5247537 5019789 227748 61963355 51329340 10634015 1982512 1022023 960489 75830400 SECURITY DEPOSIT 200 200 133732887 1026933 1026933 132705954 0 132705954 126065219 0 126065219 0 126065219 PART V, LINE 4: HOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT, MAJOR BUILDING IMPROVEMENTS, PROGRAM DEVELOPMENT, AND OPERATIONS. SAMARITAN DAY 77400 26191 51209 5214 16546 SIP SAVOR 50296 20730 29566 3574 1 25204 2750 22454 2118 152900 49671 103229 5214 22238 27452 75777 1 1 1 X 1 X 1 1 0 1 1 673 243587 243587 0.00190 32482 12891427 3794470 9096957 0.07220 33155 13135014 3794470 9340544 0.07410 11196 197137 197137 0.00160 466 177228 177228 0.00140 290 111307 111307 0.00090 11952 485672 485672 0.00390 45107 13620686 3794470 9826216 0.07800 3200 34522 34522 0.00030 228 228 0.00000 68 3582 3582 0.00000 1216 1216 0.00000 796 7018 7018 0.00010 4064 46566 46566 0.00040 1 1196987 252564 47957565 60554075 -12596510 X 1 1 1 1 HOLY FAMILY MEMORIAL INC 2300 WESTERN AVE PO BOX 1450 MANITOWOC WI 542211450 WWW.HFMHEALTH.ORG X X X HOLY FAMILY MEMORIAL INC 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.HFMHEALTH.ORG X SEE PART V PAGE 8 X 1 14 1 SEE PART V PAGE 8 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X WWW.HFMHEALTH.ORG/COMMUNITY-CARE X WWW.HFMHEALTH.ORG/UPLOAD/DOCS/PATIENTS%20AND%20VISITORS/COMMCAREWEB.PDF X HTTPS://WWW.HFMHEALTH.ORG/UPLOAD/DOCS/PLAIN-LANGUAGE-SUMMARY-UPDATED-.PDF X X X X X X 1 X 0 X 1 0 0 HOLY FAMILY MEMORIAL, INC PART V, SECTION B, LINE 5: ADHERING TO THE TAKE ACTION CYCLE FROM COUNTYHEALTHRANKINGS.ORG, HOLY FAMILY MEMORIAL PARTNERED WITH COMMUNITY LEADERS AND OTHER ORGANIZATIONS TO COLLABORATIVELY PLAN, ASSESS, AND ANALYZE COMMUNITY HEALTH NEEDS. THE PARTNERSHIP GROUP AGREED TO POOL THEIR PERSONNEL RESOURCES AND SHARE THE COSTS OF SURVEY ANALYSIS AND RESULTS TO ACCOMPLISH A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT FOR MANITOWOC COUNTY.THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM CONDUCTED 30 PERSONAL ONE ON ONE INPUT SESSIONS WITH THE PUBLIC HEALTH OFFICER AND PUBLIC HEALTH MANAGER FROM THE MANITOWOC COUNTY HEALTH DEPARTMENT, AS WELL AS THE DIRECTOR OF NORTHEAST WISCONSIN AREA HEALTH AND EDUCATION CENTER, AND THE EXECUTIVE DIRECTOR OF THE UNITED WAY - MANITOWOC COUNTY. ALSO INVOLVED WERE 26 OTHER BUSINESS, COMMUNITY, LEGISLATIVE, AND SOCIAL SERVICE LEADERS, INCLUDING LEADERS FROM THE HMONG AND HISPANIC COMMUNITIES. WE CONDUCTED A COMMUNITY HEALTH TELEPHONE SURVEY WITH 419 RESPONSES FROM COMMUNITY MEMBERS AND A YOUTH RISK BEHAVIOR SURVEY TAKEN BY 1,826 LOCAL HIGH SCHOOL STUDENTS. HOLY FAMILY MEMORIAL, INC PART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH AURORA MEDICAL CENTER - MANITOWOC COUNTY. HOLY FAMILY MEMORIAL, INC PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED COLLABORATIVELY WITH COMMUNITY LEADERS FROM MANITOWOC COUNTY COMING FROM: HOLY FAMILY MEMORIAL, AURORA MEDICAL CENTER - MANITOWOC COUNTY, MANITOWOC COUNTY PUBLIC HEALTH DEPARTMENT, UNITED WAY MANITOWOC COUNTY, LAKESHORE COMMUNITY ACTION PROGRAM, AND LAKESHORE COMMUNITY HEALTH. HOLY FAMILY MEMORIAL, INC PART V, SECTION B, LINE 11: HFM IDENTIFIED THREE SIGNIFICANT NEEDS IN THE CHNA AND HAS CREATED TEAMS WITH AN ASSIGNED LEADER AND OTHER MULTI-DISCIPLINARY PERSONNEL TO OWN, LEAD, AND MONITOR PROGRESS ON THE THREE MAIN GOALS. THE GOALS ARE: 1) IMPROVE SUBSTANCE ABUSE CARE AND SERVICES FOR OUR COMMUNITY; 2) IMPROVE MENTAL HEALTH CARE ACCESS AND SERVICES AT HOLY FAMILY MEMORIAL; AND 3) BE AN ORGANIZATIONAL ROLE MODEL AND COMMUNITY CHAMPION TO IMPROVE NUTRITION AND EXERCISE OPPORTUNITIES. ACTIVITIES AND PROGRESS ARE MONITORED ON A QUARTERLY BASIS. OTHER HEALTH NEEDS WHICH SURFACED IN THE CHNA ARE BEING ADDRESSED BY PARTNERSHIPS WITH OTHER COMMUNITY GROUPS SUCH AS HEALTHIEST MANITOWOC COUNTY AND OTHERS. IDENTIFIED NEEDS INCLUDE: 1) CHRONIC DISEASE MANAGEMENT; 2) TOBACCO CONTROL; 3) SOCIO-ECONOMIC IMPROVEMENTS; 4) INJURY AND FALLS PREVENTION; AND 5) INVESTING EARLY- PARENTAL TRAINING AND HEALTHY BABIES . COMMUNITY COALITIONS AS WELL AS HFM STAFF AND LEADERS ARE WORKING HARD ON COMMUNITY HEALTH ISSUES. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. WE ARE ACTIVELY WORKING TOWARDS HEALTHY SOLUTIONS TO IDENTIFIED HEALTH NEEDS. HOLY FAMILY MEMORIAL, INC PART V, SECTION B, LINE 20E: PAYMENT GUIDELINES AND THE FINANCIAL ASSISTANCE POLICY ARE POSTED IN PATIENT ROOMS AND LOBBIES, ADMISSION AND REGISTRATION AREAS, AND ARE GIVEN TO ALL SURGERY PATIENTS. IN ADDITION, INFORMATION IS PUBLISHED ON THE BACK OFALL PATIENT STATEMENTS. SCHEDULE H, PART V SECTION B, LINE 22D HOLY FAMILY MEMORIAL USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. SCHEDULE H, PART V SECTION B, LINE 7B HEALTHIESTMC.ORG;CO.MANITOWOC.WI.US/DEPARTMENTS/D-H/HEALTH-DEPT/ SCHEDULE H, PART V SECTION B, LINE 10A HFMHEALTH.ORG;HEALTHIESTMC.ORG;CO.MANITOWOC.WI.US/DEPARTMENTS/D-H/HEALTH-DEPT/ 2 1 - HOLY FAMILY HEALTH SERVICES INC 3310 CALUMET AVENUE MANITOWOC WI 54220 RETAIL PHARMACY 2 - NORTH END HOME MEDICAL SERVICES LLC 3310 CALUMET AVENUE MANITOWOC WI 54220 DURABLE MEDICAL EQUIPMENT PART I, LINE 6A: HOLY FAMILY MEMORIAL (HFM) PREPARED A COMMUNITY BENEFIT REPORT FOR THE CURRENT YEAR AND MADE IT AVAILABLE TO LOCAL CHURCH, POLITICAL, AND BUSINESS LEADERS, AS WELL AS OTHERS IN THE COMMUNITY IN EARLY SPRING 2016. IT WAS ALSO POSTED ON OUR WEBSITE. PART I, LINE 7: COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HFM'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CAN NOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATES THAT ITS PREFERENTIAL TAX STATUS IS DESERVED. SCHEDULE H, PART I, LINE 7, COLUMN F THE PERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL EXPENSES REPORTED ON FORM 990 FOR HFM. PART II, COMMUNITY BUILDING ACTIVITIES: HFM LEADS AND PARTICIPATES IN NUMEROUS INITIATIVES ALL AIMED AT IMPROVING THE OVERALL HEALTH OF THE COMMUNITY. WE BELIEVE THERE ARE FOUR MAJOR AREAS THAT CONTRIBUTE TO TRUE COMMUNITY HEALTH. HFM DEDICATES RESOURCES TO ENHANCE THE OVERALL VIBRANCY OF OUR COMMUNITY, MAKING IT AN OVERALL IMPROVED COMMUNITY IN WHICH TO LIVE, LEARN, WORK, AND PLAY. INITIATIVES INCLUDE: 1) HEALTH BEHAVIORS - PROVIDING SMOKING CESSATION CLASSES, COMMUNITY EXERCISE CHALLENGES, A MEDICALLY BASED WELLNESS CENTER, AND PROVIDING FRUIT AND VEGETABLE COUPONS TO ENCOURAGE HEALTHY EATING; 2) SOCIAL AND ECONOMIC FACTORS - PROVIDING LEADERSHIP ON LOCAL ECONOMIC DEVELOPMENT, CHAMBER OF COMMERCE, UNITED WAY, AND STABLE WAGES AND BENEFITS TO OUR EMPLOYEES SINCE HFM IS THE LARGEST EMPLOYER IN THE COUNTY; 3) HOLISTIC HEALTH CARE SERVICES - PROVIDING THE RIGHT CARE IN THE RIGHT SETTING TO ACHIEVE THE RIGHT OUTCOMES AND TO ENCOURAGE PREVENTIVE CARE; 4) ENVIRONMENTAL FACTORS - REDUCING ENERGY USAGE, PROMOTING AN ACTIVE RECYCLING PROGRAM, AND BEAUTIFICATION OF GROUNDS. PART III, LINE 2: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING HFM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 3: ANY PERSON APPROVED FOR COMMUNITY CARE UNDER HFM'S COMMUNITY CARE PROGRAM HAS UP TO 10 MONTHS (FROM THE FIRST STATEMENT) TO PAY THE REMAINING BALANCE IN FULL. IF THERE IS A BALANCE AT THE END OF THE 10 MONTHS, THE PATIENT WILL RECEIVE A FINAL NOTICE. IF THE BALANCE IS NOT PAID WITHIN 30 DAYS, THE BALANCE WILL BE SENT TO BAD DEBT COLLECTIONS. A HINDSIGHT ANALYSIS IS USED TO ESTIMATE THE PERCENT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER HFM'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: AUDIT STATEMENT NOTE 2, SIGNIFICANT ACCOUNTING POLICIES HAS A SECTION LABELED "ACCOUNTS RECEIVABLE" THAT DESCRIBES BAD DEBT AND ITS EVALUATION. PART III, LINE 8: HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH 50.7% OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HFM RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES. THE COST METHODOLOGY USED TO DETERMINE THE ALLOWABLE COSTS OF CARE WAS THE COST TO CHARGE RATIO. PART III, LINE 9B: PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, CT SCAN, AND EMERGENCY SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, THE ELIGIBILITY SPECIALIST WILL HELP THEM COMPLETE THE APPLICATION PROCESS, AND FOLLOW UP ON THEIR APPLICATION THROUGH TO APPROVAL OR DISAPPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON HOW TO APPLY FOR THOSE PROGRAMS. THE ELIGIBILITY SPECIALIST WILL ALSO PROVIDE SUCH ASSISTANCE. PART VI, LINE 2: HFM UTILIZES VARIOUS PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF MANITOWOC COUNTY. AS PART OF OUR STRATEGIC PLANNING PROCESS, WE OBTAIN INPUT FROM HUNDREDS OF PEOPLE REGARDING THEIR OPINIONS AND PERCEPTIONS OF THE GREATEST HEALTH CARE NEEDS. THIS DATA IS COLLECTED AND CONSIDERED AS WE EVALUATE ANNUAL TACTICS TO ADDRESS OUR STRATEGIES. ON A TRI-ANNUAL BASIS, HFM IS A KEY PARTICIPANT IN A VERY BROAD CHNA WHICH INCLUDES PRIMARY INPUT FROM THE COMMUNITY MEMBERS, LEADERS AND THOUGHT LEADERS IN ADDITION TO SECONDARY DATA FROM THE URBAN INSTITUTE FOR POPULATION HEALTH AND COUNTY HEALTH RANKINGS AND ROADMAPS. HFM CONDUCTS REGULAR FACE TO FACE AND GROUP SESSIONS WITH AREA EMPLOYERS TO ASCERTAIN HEALTH NEEDS WITHIN INDUSTRY AND BUSINESS. HFM REGULARLY ANALYZES AND REVIEWS DIRECT CUSTOMER INPUT FROM INPATIENT, OUTPATIENT AND RETAIL SURVEYS TO DETERMINE UNMET NEEDS. HFM HOSTS A PATIENT AND FAMILY ADVISORY COUNCIL WHICH MEETS REGULARLY AND PROVIDES INPUT ON CURRENT SERVICES, IDEAS FOR NEW SERVICES, AND HAS OPEN DIALOGUE AND INPUT ON MEMBERS IDEAS FOR COMMUNITY HEALTH NEEDS. HFM ANNUALLY EVALUATES AND ANALYZES THE COUNTY RANKING AND ROADMAP INFORMATION WHICH RATES OUR COUNTY ON MANY DIFFERENT HEALTH FACTORS. THIS INFORMATION IS UTILIZED TO DETERMINE POTENTIAL PROJECTS AND NEW HEALTH SERVICES. HFM CONDUCTS A COMMUNITY-WIDE RESEARCH STUDY TRI-ANNUALLY TO OBTAIN INPUT FROM COMMUNITY MEMBERS ON SATISFACTION WITH CURRENT SERVICES AS WELL AS IDENTIFICATION OF THE GREATEST HEALTH NEEDS OF OUR COUNTY. PART VI, LINE 3: INFORMATION ON ELIGIBILITY FOR ASSISTANCE IS AVAILABLE FROM HFM'S WEBSITE, BROCHURES, ADMISSIONS STAFF, COLLECTION CORRESPONDENTS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, AND CT SCANS. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST COMMUNICATES TO SELF PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM IN COMPLETING THE APPLICATION AND FOLLOW UP ON THE APPLICATION THROUGH APPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE FOR APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR OR ELIGIBILITY SPECIALIST IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL ASSIST THOSE PATIENTS TO APPLY FOR THOSE PROGRAMS. PART VI, LINE 4: HOLY FAMILY MEMORIAL SERVES MANITOWOC COUNTY, A COUNTY LOCATED IN NORTHEAST WISCONSIN ALONG BEAUTIFUL LAKE MICHIGAN, WITH A POPULATION OF APPROXIMATELY 80,000 AS OF 2016. OF THESE, ROUGHLY 34% ARE 25 OR UNDER, 47% ARE 26-60, AND 19% ARE OVER AGE 60. 50.2% OF THE POPULATION IS MALE WHILE 49.8% IS FEMALE. ROUGHLY 93% IDENTIFY AS WHITE, 3% ASIAN, 1+% EACH OF NATIVE AMERICAN, OTHER RACE, AND TWO OR MORE RACES. ROUGHLY 51% HAVE HOUSEHOLD INCOME $50,000 OR BELOW PER YEAR, 20% HAVE FROM $50,000 TO $75,000; 14% HAVE FROM $75,000 TO $100,000, AND 15% HAVE OVER $100,000. APPROXIMATELY 70% DO NOT HAVE A COLLEGE DEGREE, 10% HAVE AN ASSOCIATES DEGREE, 14% HAVE A BACHELORS DEGREE, AND 6% HOLD A GRADUATE, PROFESSIONAL, OR DOCTORATE DEGREE. THE PREDOMINANT INDUSTRY IN MANITOWOC COUNTY IS MANUFACTURING, COMPRISING ROUGHLY 30% OF OCCUPATIONS FOR INDIVIDUALS OVER AGE 16. HEALTH CARE AND SALES/OFFICE ARE ALSO PROMINENT, MAKING UP ROUGHLY 14% AND 12%, RESPECTIVELY. SMALLER SECTORS MAKING UP APPROXIMATELY 4-6% EACH INCLUDE FOOD SERVICE, AGRICULTURE, CONSTRUCTION, EDUCATION, FINANCE, TRANSPORTATION, AND OTHER. PART VI, LINE 5: HOLY FAMILY MEMORIAL PROMOTES THE HEALTH OF THE COMMUNITY BY ENGAGING COMMUNITY MEMBERS INTO THE INPUT AND DECISION MAKING PROCESS. HFM'S BOARD OF DIRECTORS IS COMPRISED OF 100% LOCAL PEOPLE WHO HAVE A VESTED INTEREST IN ASSURING THAT HFM DOES ITS PART IN CREATING A HEALTHIER COMMUNITY. OUR MEDICAL AND DENTAL STAFF IS OPEN TO ANY PROVIDER WHO MEETS ESTABLISHED CRITERIA AND COMMITS TO PROVIDE CARE FOR ALL WHO SEEK HELP. HFM HOSTS VARIOUS COMMUNITY GROUPS IN OUR FACILITIES AND PROVIDES THEM WITH MEETING SPACE AND RELATED MEETING SUPPLIES. HFM REGULARLY PARTICIPATES IN THE LOCAL FARMERS MARKET AND A HOST OF COMMUNITY SPONSORED HEALTH AND WELLNESS EVENTS, PROVIDING COMPLIMENTARY SCREENS, AND INFORMATION ON HOW TO ACHIEVE BETTER HEALTH. PART VI, LINE 6: THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR OVER 350 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH, AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES -- WISCONSIN, NEBRASKA, AND OHIO -- AND HAS EXISTED FOR OVER 125 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR IN THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGH THE PROVISION OF QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF GOD IN OUR COMMUNITIES. PART VI, LINE 7, REPORTS FILED WITH STATES WI,NE,OH 1 SCHOLARSHIPS 10 12500 ACTUAL TUITION COSTS SCHOLARSHIPS - EDUCATION 8 23800 ACTUAL TUITION COSTS SCHEDULE I, PART III: HOLY FAMILY MEMORIAL'S SCHOLARSHIP PROGRAM IS DESIGNED AS A RECRUITMENT TOOL FOR EMPLOYMENT OF CANDIDATES IN SPECIFIED POSITIONS CONSIDERED DIFFICULT TO FILL. THE SCHOLARSHIP PROGRAM ASSISTS STUDENTS IN THEIR PURSUIT OF A HEALTHCARE RELATED DEGREE. AREAS OF STUDY INCLUDE NURSING, PHARMACY, PHYSICAL THERAPY, AND OTHERS. IN RETURN FOR THE SCHOLARSHIP, AN EMPLOYMENT SERVICE COMMITMENT IS MADE. IN ORDER TO BE ELIGIBLE, STUDENTS MUST: 1)BE ACCEPTED INTO AN ACCREDITED PROGRAM; 2)BE ATTENDING SCHOOL AS A FULL OR PART TIME STUDENT AND REMAIN IN THAT STATUS; 3)HAVE AND MAINTAIN A 3.0 CUMULATIVE GRADE POINT AVERAGE (GPA). SCHOLARSHIPS ARE AWARDED ON THE BASIS OF GPA, VERIFIED WITH AN OFFICIAL TRANSCRIPT OF GRADES, COMPLETION OF AN EMPLOYMENT APPLICATION, AND PERSONAL INTERVIEW. THE SCHOLARSHIP IS USED FOR TUITION COST. THE SCHOLARSHIPS ARE DISBURSED EACH SEMESTER AND ARE PAID DIRECTLY TO THE SCHOOL THE STUDENT ATTENDS. APPLICANTS WHO ARE AWARDED THE SCHOLARSHIP MUST MAKE A SIX MONTH COMMITMENT TO WORK AT HOLY FAMILY MEMORIAL FOR EACH SEMESTER THE SCHOLARSHIP IS AWARDED. THE SCHOLARSHIP RECIPIENT MUST REPAY THE FULL AMOUNT OF THE SCHOLARSHIP IF HE/SHE: 1)DROPS OUT OF SCHOOL; 2)FAILS TO MAINTAIN AT LEAST A 3.0 CUMULATIVE GPA; 3)DOES NOT ACCEPT EMPLOYMENT AT HOLY FAMILY MEMORIAL; 4)DOES NOT COMPLETE THE FULL LENGTH OF EMPLOYMENT COMMITMENT; OR 5)DOES NOT OBTAIN WISCONSIN LICENSURE, AS REQUIRED. X 1 1 X X X X 0 0 0 0 0 1 0 1 0 DEREK R BOWN DC DIRECTOR 113151 0 24492 0 530 0 4381 0 27325 0 169879 0 0 0 MATTHEW L CAMPBELL MD DIRECTOR 295393 0 5558 0 540 0 7950 0 26595 0 336036 0 0 0 MARK P HERZOG DIRECTOR, PRESIDENT, CEO 515495 0 97585 0 32589 0 100535 0 28545 0 774749 0 0 0 WILLIAM C LEACH JR DO DIRECTOR 365991 0 0 0 13232 0 7950 0 24308 0 411481 0 0 0 XA XIONG MD DIRECTOR 170929 0 12020 0 558 0 5788 0 29312 0 218607 0 0 0 JANE CURRAN-MEULI EXECUTIVE VP, COO 245685 0 5231 0 6564 0 47179 0 25608 0 330267 0 0 0 STEVEN D DRIGGERS MD EXECUTIVE VP, CMO 322210 0 61274 0 4632 0 64224 0 3050 0 455390 0 0 0 MARY MAURER VP COMMUNITY ENGAGEMENT, CIO 223556 0 41472 0 5826 0 44422 0 2902 0 318178 0 0 0 BRETT NORELL VP FINANCE, CFO 225115 0 5100 0 1487 0 38518 0 22656 0 292876 0 0 0 DEAN POLLNOW MD EXECUTIVE VP, CMO 105960 0 36542 0 430 0 19831 0 6841 0 169604 0 0 0 JEREMY R ANCLAM MD PHYSICIAN PROVIDER 407185 0 199701 0 7751 0 0 0 22731 0 637368 0 0 0 KIRK DIMITRIS MD PHYSICIAN PROVIDER 690621 0 661768 0 13947 0 0 0 27805 0 1394141 0 0 0 RYAN M DOPIRAK MD PHYSICIAN PROVIDER 752474 0 333492 0 27463 0 0 0 27868 0 1141297 0 0 0 DAVID MIKOLYZK MD PHYSICIAN PROVIDER 690807 0 141206 0 7217 0 0 0 25878 0 865108 0 0 0 THOMAS SYLVESTER MD PHYSICIAN PROVIDER 601078 0 40536 0 6309 0 0 0 8340 0 656263 0 0 0 WILLIAM D HAMPTON DO FORMER DIRECTOR 355914 0 16470 0 540 0 0 0 25030 0 397954 0 0 0 PART I, LINE 1A THE FILING ORGANIZATION PROVIDED CIVIC PAY FOR FIVE OFFICERS (CEO, COO, CMO, CIO, AND CFO) TOTALING $11,500. THIS BENEFIT WAS TREATED AS TAXABLE INCOME. PART I, LINE 6 DURING THE CURRENT YEAR, A BONUS APPRECIATION PROGRAM WAS APPROVED BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD OF DIRECTORS. THE BONUS WAS PAID OUT TO EMPLOYEES, INCLUDING OFFICERS, FOR FINANCIAL ACCOMPLISHMENTS THAT WERE MET BY THE ORGANIZATION. PART I, LINE 7 A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION OF PERSONALLY RENDERED SERVICES. A WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 97710V2S6 2007-04-26 45170000 SEE SCHEDULE K, PART VI 0 0 0 B WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 2014-12-19 7830000 SEE SCHEDULE K, PART VI 0 0 0 C WISCONSIN HEALTH AND EDUCATION FACILITIES 391337855 2016-10-19 10000000 SEE SCHEDULE K, PART VI 0 0 0 A 10248600 45170000 3555000 485000 4990000 2009 1 1 1 1 B 627200 7830000 18000 2006 1 0 1 1 C 250000 10000000 39050 9960950 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATION FACILITIES DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2017 PART I, ROW B, COLUMN F: THE PURPOSE OF THE 2014 BOND ISSUE WAS TO REFUND SERIES 2003B, ISSUED ON 09/09/2003. PART I, ROW A, COLUMN F: THE PURPOSE OF THE 2007 BOND ISSUE WAS TO 1) ACQUIRE, CONSTRUCT, RENOVATE, REMODEL, AND EQUIP CERTAIN HOSPITAL AND OTHER HEALTHCARE FACILITIES AS IDENTIFIED IN A NOTICE OF PUBLIC HEARING PUBLISHED IN CONNECTION WITH THE ISSUANCE OF THE BONDS, INCLUDING THE ACQUISITION OF TELEMETRY MONITORS AND AN MRI SYSTEM; 2) REFUND ALL THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE (WHEFA) BONDS, SERIES 1995; 3) ADVANCE REFUND ALL OF THE WHEFA BONDS, SERIES 1998A; AND 4) ADVANCE REFUND A PORTION OF THE WHEFA BONDS, SERIES 2003A. PART I, ROW C, COLUMN F: THE PURPOSE OF THE 2016 BOND ISSUE WAS TO 1) REPLACE THE ELECTRONIC HEALTH RECORD SYSTEM, INCLUDING THE ACQUISITION OF HARDWARE AND SOFTWARE; AND 2)FINANCE ELIGIBLE FINANCING-RELATED EXPENSES. NORTH END HOME MEDICAL SERVICE LLC HFM DIRECTORS SERVE BOTH ORGANIZATIONS -103784 INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED 0 HOLY FAMILY HEALTH SERVICES HFM DIRECTORS SERVE BOTH ORGANIZATIONS 95972 INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED 0 LINDSAY FROELICH DAUGHTER OF CHAIR, DONALD BRISCH 40437 EMPLOYMENT BY ORGANIZATION 0 KATHARINE CASEY DAUGHTER OF DIRECTOR, WILLIAM CASEY 39101 EMPLOYMENT BY ORGANIZATION 0 SUSAN BOWN SPOUSE OF DIRECTOR, DEREK BOWN 49161 EMPLOYMENT BY ORGANIZATION 0 LISA SCHUELER SISTER OF OFFICER, LAURA FIELDING 33181 EMPLOYMENT BY ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 6 HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM. FORM 990, PART VI, SECTION A, LINE 7A HOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM. FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PROVIDERS. FORM 990, PART VI, SECTION A, LINE 7B SOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE BUDGET, MORTGAGE, PHILOSOPHY, MISSION AND VISION, LEASE OR SALE OF REAL ESTATE MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDIT MUST BE APPROVED BY THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE CHAIR OF THE GOVERNING BOARD REVIEWS FORM 990 PRIOR TO ITS FILING. AN OVERVIEW OF FORM 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, AND CONFLICT OF INTEREST IS PRESENTED TO THE BOARD OR BOARD COMMITTEE. THE COMPENSATION AND EVALUATION SUB-COMMITTEE REVIEWS FORM 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES OF FORM 990 ARE AVAILABLE TO ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, GOVERNING BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND SIGN THE CERTIFICATION ON WHICH THEY DISCLOSE ANY CONFLICTS. AT EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION AND VOTING. ALL PHYSICIANS, LEADERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. CONFLICT OF INTEREST IS MONITORED THROUGH HFM'S COMPLIANCE DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15 LINES 15 A & B - HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES IS GOVERNED BY THE COMPENSATION AND EVALUATION SUB-COMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, AND CHIEF INNOVATION OFFICER. SENIOR LEADER SALARY DATA IS EVALUATED ANNUALLY BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM. TOTAL COMPENSATION FOR SENIOR LEADERS (SALARY, BENEFITS, AND INCENTIVE) IS EVALUATED EVERY THREE YEARS BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM (LAST DONE IN OCTOBER 2014). ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS AND MARKET COMPETITIVENESS. THE POLICY REFLECTS HFM'S MISSION AND VALUES AND THE LOCAL COMMUNITY EXPERIENCE BY EMPHASIZING REWARDS BASED ON WELL-ROUNDED ACCOMPLISHMENTS IN THE AREAS OF MISSION AND RELATIONSHIPS, KEY STRATEGIES, AND OPERATIONS, INCLUDING FINANCE. FORM 990, PART VI, SECTION C, LINE 19 HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION IS PUBLICLY AVAILABLE FROM THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE. IN ADDITION, HFM SUBMITS ITS FINANCIAL INFORMATION TO THE STATE OF WISCONSIN ANNUALLY. FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE OBTAINED FROM THE GUIDESTAR WEBSITE. FORM 990, PART VII, SECTION A, PART 1A LINES 1 THROUGH 5: HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS INCLUDES FIVE EMPLOYED PROVIDERS. THE COMPENSATION REPORTED FOR THESE DIRECTORS IS FOR THEIR SERVICES AS A PROVIDER. FORM 990, PART XI, LINE 9: RESTRICTED CONTRIBUTIONS NET OF ASSETS RELEASED 245,165. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE FISCAL YEAR. NORTH END HOME MED SCS LLC 3310 CALUMET AVENUE MANITOWOC WI 54220 391868808 MEDICAL EQUIPMENT WI -127034 HFM INC FRANCISCAN SISTERS OF CHRISTIAN CHARITY 1415 SOUTH RAPIDS ROAD MANITOWOC WI 54220 391530622 HOLDING CO. WI 501(C)(3) LINE 1 N/A 0 ST PAUL ELDER SERVICES INC 316 EAST 14TH STREET KAUKAUNA WI 54130 391029149 ELDER CARE WI 501(C)(3) LINE 1 N/A 0 GOOD SAMARITAN MEDICAL CENTER 800 FOREST AVENUE ZANESVILLE OH 43701 314379479 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 FRANCISCAN CARE SERVICES INC 430 N MONITOR ST WEST POINT NE 68788 470486026 HEALTHCARE NE 501(C)(3) LINE 3 N/A 0 SILVER LAKE COLLEGE OF THE HOLY FAMILY INC 2406 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390980974 HIGHER EDUCATION WI 501(C)(3) LINE 2 N/A 0 FSCC HOLY FAMILY CONVENT 2409 SOUTH ALVERNO ROAD MANITOWOC WI 54220 390808523 RELIGIOUS WI 501(C)(3) LINE 1 N/A 0 HOLY FAMILY HEALTH SERVICES 3310 CALUMET AVENUE MANITOWOC WI 54220 391572253 PHARMACY WI HFM INC C 88353 1346651 1.00000 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 HOLY FAMILY HEALTH SERVICES B 500000 TRANSFER FUNDS NORTH END HOME MEDICAL SERVICES LLC B 1573356 TRANSFER REMAINING NET ASSETS FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT J 56100 ACTUAL REVENUE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES P 98936 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES P 743640 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC P 1182800 ACTUAL EXPENSE FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS P 9943757 ACTUAL EXPENSE HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSSUPPLIES Q 981004 ACTUAL REVENUE