2017-05-11T08:56:32-05:00 2016-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2015-07-01 390816845 UNITED HOSPITAL SYSTEM INC UNIT 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 THOMAS J KELLEY VP & CFO 2625778113 2017-05-08 1 TERRI REXRODE CPA MST P00096513 9206620016 2017-05-08 2015 2021-01-29 14:40:06Z THOMAS J KELLEY 6308 8TH AVENUE KENOSHA WI 531435082 421835354 0 X WWW.UNITEDHOSPITALSYSTEM.ORG X 1910 WI UNITED HOSPITAL SYSTEM, INC. IS COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL-BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. WE STRIVE TO RECRUIT AND RETAIN THE BEST PHYSICIANS AND STAFF AND PURCHASE THE BEST DIAGNOSTIC AND CURATIVE MEDICAL EQUIPMENT THAT OUR FINANCIAL RESOURCES WILL PERMIT. WE ALSO STRIVE TO BE ACCESSIBLE TO ALL MEMBERS OF OUR COMMUNITY WITH EMERGENT AND URGENT HEALTHCARE NEEDS, IRRESPECTIVE OF THEIR ABILITY TO PAY. THIS IS OUR COMMITTMENT TO THE QUALITY, ACCESSIBILITY AND AFFORDABILITY FUNDAMENTALS AFFECTING THE DELIVERY OF HEALTHCARE. 14 10 2624 97 195246 0 91950 232988 315781773 324436848 3528454 1340154 546691 -71125 319948868 325938865 4625 7050 0 0 152544694 161389439 0 0 0 136901441 140200932 289450760 301597421 30498108 24341444 385840916 392516348 98836292 134378118 287004624 258138230 X UNITED HOSPITAL SYSTEM, INC. IS A COMPREHENSIVE REGIONAL HEALTHCARE SYSTEM THAT HAS SERVED SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS COMMUNITIES FOR MORE THAN 100 YEARS. UNITED HOSPITAL SYSTEM PROVIDES SERVICES PRIMARILY THROUGH THE KENOSHA MEDICAL CENTER CAMPUS AND THE ST. CATHERINE'S MEDICAL CENTER CAMPUS AND SEVERAL OTHER CLINIC LOCATIONS.WE, AT UNITED, ARE COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. 0 0 248109897 7050 324241602 ACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO ITS COMMUNITY. 248109897 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 82 0 2624 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 WI X JENS EMERSON 2625778113 6308 8TH AVENUE KENOSHA WI 531435082 THOMAS AMBRO MD DIRECTOR/PHYSICIAN - START 1/1/16 2.00 X 426276 0 45211 TODD BATTLE DIRECTOR 2.00 X 0 0 0 A JAMES CICCHINI DIRECTOR 2.00 X 0 0 0 JAMES CONCANNON MD DIRECTOR - THRU 1/1/16 2.00 X 0 0 0 EDWARD C EMMA DIRECTOR 2.00 X X 0 0 0 MARIO GARRETTO MD PHYSICIAN/DIRECTOR - START 1/1/16 2.00 X 725156 0 95154 DON E KAELBER DIRECTOR 2.00 X 0 0 0 RAYMOND KNIGHT MD DIRECTOR/PHYSICIAN - THRU 1/1/16 40.00 X 393915 0 45154 ROBERT LEE JR DIRECTOR 2.00 X X 0 0 0 THOMAS P MAHONEY DIRECTOR 2.00 X 0 0 0 HAROLD W MAYER DIRECTOR 2.00 X X 0 0 0 LAWRENCE REIF MD DIRECTOR - THRU 1/1/16 2.00 X 0 0 0 DAVID R RILEY DIRECTOR 2.00 X 0 0 0 GARY ZAID MD DIRECTOR - START 1/1/16 2.00 X 0 0 0 DR F GREGORY CAMPBELL CHAIRMAN 2.00 X X 0 0 0 ROBERT A CORNOG VICE-CHAIRMAN/SECRETARY/TREASURER 2.00 X X 0 0 0 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 45.00 X X 1215706 0 148512 THOMAS KELLEY ASST TREASURER/VP-CFO 45.00 X 422672 0 68043 LINDA WOHLGEMUTH ASST SECRETARY/VP-COO-SCMC 45.00 X 522977 0 55704 SUSAN VENTURA SVP/COO-KMCC 45.00 X 526271 0 55704 KATHERINE ABBO MD PHYSICIAN 40.00 X 619356 0 29294 KEVIN FULLIN MD PHYSICIAN 40.00 X 617608 0 41632 ASHWANI SETHI MD PHYSICIAN 40.00 X 775043 0 45330 NEIL SHEPLER MD PHYSICIAN 40.00 X 3471534 0 43899 W HARLEY SOBIN MD DIRECTOR/PHYSICIAN - THRU 1/1/16 40.00 X 777934 0 43252 10494448 0 716889 165 0 1 0 RILEY CONSTRUCTION 5301 99TH AVENUE KENOSHA WI 53144 BUILDING 7186913 ALLSCRIPTS HEALTHCARE LLC 24630 NETWORK PLACE CHICAGO IL 60673 IS SERVICES 2323050 INFINITY HEALTHCARE PHYSICIAN SC 111 E WISCONSIN AVENUE SUITE 2100 MILWAUKEE WI 53202 MEDICAL 1550833 AEROTEK COMMERCIAL STAFFING PO BOX 198531 ATLANTA GA 30384 ENVIRONMENTAL SERVICES STAFFING 1431979 STATE COLLECTION SERVICES 2509 S STOUGHTON ROAD MADISON WI 53716 BUSINESS OFFICE SERVICES 1028340 38 73981 159007 232988 NET PATIENT SERVICE REVENUE 623000 317759725 317759725 OTHER OPERATING REVENUE 623990 6312586 6117340 195246 MEDICAL OFFICE RENTAL 900099 364537 364537 324436848 2154994 2154994 94926010 44150 95764065 20935 -838055 23215 -814840 -814840 40364 73981 111489 -71125 -71125 325938865 324241602 195246 1269029 7050 7050 4306886 3573307 733579 122030876 101245723 20785153 8406260 6974447 1431813 19076577 5742179 13334398 7568840 6285050 1283790 106707 106707 87300 87300 19324625 12072849 7251776 575945 134705 441240 62962095 60380329 2581766 7202649 7202649 5832919 5699836 133083 724719 239432 485287 15977474 14379727 1597747 1112120 515080 597040 BAD DEBTS 9938003 9938003 STATE HOSPITAL ASSESSME 7652708 7652708 REPAIRS 2707653 1858023 849630 SMALL EQUIPMENT 1836186 1634059 202127 4159829 2574741 1585088 301597421 248109897 53487524 0 88917336 103673409 46241038 55620666 3346838 3390814 4039420 3869886 313018554 222082145 80881153 90936409 130999965 128245220 31415166 6779944 385840916 392516348 27914875 32541323 70921417 101836795 98836292 134378118 X 284954447 255969420 532841 652743 1517336 1516067 287004624 258138230 385840916 392516348 X 24341444 -2081350 -51126488 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2050490 125683 7363 2168810 2037824 17291 4625 2050490 2030556 19058 11790 2037824 2039142 489 9075 2030556 2012126 38761 11745 2039142 0.00000 0.69900 0.30100 0 0 6124397 6124397 139245352 94434591 44810761 164016215 125399094 38617121 3632590 2248460 1384130 90936409 FIXED INCOME FUNDS 31351442 F EQUITY MUTUAL FUNDS 7385159 F EQUITY SECURITIES 25105790 F CORPORATE BONDS 31983747 F ETFS 10834035 F INTERNATIONAL EQUITIES 12796805 F US GOVERNMENT & AGENCY OBLIGATIONS 8788242 F 128245220 DEFERRED COMPENSATION 12150116 PENSION LIABILITY 86468804 A/P TO THIRD-PARTY REIMBURSEMENT PROGRAMS 3217875 101836795 272721595 -2081350 -51133538 -53214888 325936483 2382 2382 325938865 301595039 0 301595039 2382 2382 301597421 PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE RESTRICTED FOR EDUCATION SCHOLARSHIP GRANTS AND VARIOUS HEALTH CARE PROGRAMS. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE FOR HOSPITAL DEVELOPMENT. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE -42,428,478. REVENUE SHARING WITH AFFILIATE -8,698,010. SCHOLARSHIPS INCLUDED IN INCOME -7,050. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING INCOME 2,382. PART XII, LINE 4B - OTHER ADJUSTMENTS: EMPLOYEE GIFTS 2,382. GOLF OUTING 100345 73981 26364 12814 39220 9879 7549 HEART BALL 14000 14000 1400 31983 8644 114345 73981 40364 14214 71203 9879 16193 111489 -71125 1 1 X 1 X 1 X 1 1 1 0 1 1 3810614 3810614 0.01310 55390280 22407399 32982881 0.11310 59200894 22407399 36793495 0.12620 5240 54499 378115 378115 0.00130 1 9 1479 1479 0.00000 36 550 304946 304946 0.00100 5277 55058 684540 684540 0.00230 5277 55058 59885434 22407399 37478035 0.12850 0 0 12958 0 12958 0.00000 4 623 89640 0 89640 0.00030 5 100 3979 0 3979 0.00000 5 0 1257 0 1257 0.00000 14 723 107834 107834 0.00030 1 3388859 0 49300513 68626115 -19325602 X 1 1 2 1 KENOSHA MEDICAL CENTER CAMPUS 6308 8TH AVENUE KENOSHA WI 53143 WWW.UNITEDHOSPITALSYSTEM.ORG 22 X X X 2 SAINT CATHERINE'S MEDICAL CENTER CAMPUS 9555 76TH STREET PLEASANT PRAIRIE WI 53158 WWW.UNITEDHOSPITALSYSTEM.ORG 305 X X X KENOSHA MEDICAL CENTER CAMPUS 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X HTTP://WWW.UHSI.ORG/ABOUT/COMMUNITY-BENEFITS/ X 1 13 1 HTTP://WWW.UHSI.ORG/ABOUT/COMMUNITY-BENEFITS/ 0 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X X X X X 1 X 0 X X X X 1 X 0 0 SAINT CATHERINE'S MEDICAL CENTER CAMPUS 2 0 0 1 X X X X X X X X X 13 1 1 1 1 X HTTP://WWW.UHSI.ORG/ABOUT/COMMUNITY-BENEFITS/ X 1 13 1 HTTP://WWW.UHSI.ORG/ABOUT/COMMUNITY-BENEFITS/ 0 0 1 X 100.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X HTTP://WWW.UNITEDHOSPITALSYSTEM.ORG/ X X X X X 1 X 0 X X X X 1 X 0 0 KENOSHA MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, 32 PERSONS WHO REPRESENT THE COMMUNITY SERVED BY UNITED HOSPITAL SYSTEM PROVIDED VALUABLE FEEDBACK REGARDING THEIR VIEWS OF THE HEALTHCARE CHALLENGES FACING OUR COMMUNITY. THIRTY-TWO PEOPLE PARTICIPATED REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY INCLUDING LOW-INCOME, RACIAL AND ETHNIC MINORITIES, THE ELDERLY, YOUTH, VETERANS, FAITH COMMUNITIES, INDIVIDUALS WITH DISABILITIES, RURUAL COMMUNITIES, SURVIVORS OF DOMESTIC AND SEXUAL VIOLENCE, AND THOSE LIVING WITH MENTAL ILLNESS AND SUBSTANCE ABUSE. THE INFORMATION/FEEDBACK PROVIDED BY THESE PERSONS WHO REPRESENT THE COMMUNITY SERVED BY UNITED HOSPITAL SYSTEM WAS INCORPORATED INTO THE COMMUNITY HEALTH NEEDS ASSESSMENT, IDENTIFICATION, PRIORITIZATION AND IMPLEMENTATION PLANNING SUMMARY. KEY INFORMANTS RANKED UP TO FIVE PUBLIC HEALTH ISSUES AND PROVIDED EXISTING STRATEGIES TO ADDRESS THESE ISSUES, ALONG WITH BARRIERS/CHALLENGES TO ADDRESSING THESE ISSUES AND ADDITIONAL STRATEGIES NEEDED. SAINT CATHERINE'S MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, 32 PERSONS WHO REPRESENT THE COMMUNITY SERVED BY UNITED HOSPITAL SYSTEM PROVIDED VALUABLE FEEDBACK REGARDING THEIR VIEWS OF THE HEALTHCARE CHALLENGES FACING OUR COMMUNITY. THIRTY-TWO PEOPLE PARTICIPATED REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY INCLUDING LOW-INCOME, RACIAL AND ETHNIC MINORITIES, THE ELDERLY, YOUTH, VETERANS, FAITH COMMUNITIES, INDIVIDUALS WITH DISABILITIES, RURUAL COMMUNITIES, SURVIVORS OF DOMESTIC AND SEXUAL VIOLENCE, AND THOSE LIVING WITH MENTAL ILLNESS AND SUBSTANCE ABUSE. THE INFORMATION/FEEDBACK PROVIDED BY THESE PERSONS WHO REPRESENT THE COMMUNITY SERVED BY UNITED HOSPITAL SYSTEM WAS INCORPORATED INTO THE COMMUNITY HEALTH NEEDS ASSESSMENT, IDENTIFICATION, PRIORITIZATION AND IMPLEMENTATION PLANNING SUMMARY. KEY INFORMANTS RANKED UP TO FIVE PUBLIC HEALTH ISSUES AND PROVIDED EXISTING STRATEGIES TO ADDRESS THESE ISSUES, ALONG WITH BARRIERS/CHALLENGES TO ADDRESSING THESE ISSUES AND ADDITIONAL STRATEGIES NEEDED. KENOSHA MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED DURING THE FISCAL YEAR ENDED 2014. AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, A THREE (3) YEAR ACTION PLAN WAS DEVELOPED IN AN EFFORT TO ADDRESS THE NEEDS IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNITED HOSPITAL SYSTEM IS ACTIVELY WORKING ON THE ACTION ITEMS ESTABLISHED FOR YEAR THREE. SAINT CATHERINE'S MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED DURING THE 2014 TAX YEAR. AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, A THREE (3) YEAR ACTION PLAN WAS DEVELOPED IN AN EFFORT TO ADDRESS THE NEEDS IDENTIFIED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNITED HOSPITAL SYSTEM IS ACTIVELY WORKING ON THE ACTION ITEMS ESTABLISHED FOR YEAR TWO. KENOSHA MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 22D: CHARGES FOR MEDICAL CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE CHARGED AT LESS THAN THEGROSS CHARGE FOR SUCH SERVICES. THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. UNITED DETERMINES THE AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (1) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEEFORSERVE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF COPAYS, COINSURANCE OR DEDUCTIBLES BY (2) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. THE CALCULATION OF THE AGB PERCENTAGE SHALL COMPLY WITH THE "LOOKBACK METHOD" DESCRIBED IN TREASURY REGULATION SECTION 1501B(B)(3). SAINT CATHERINE'S MEDICAL CENTER CAMPUS PART V, SECTION B, LINE 22D: CHARGES FOR MEDICAL CARE PROVIDED TO INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE CHARGED AT LESS THAN THEGROSS CHARGE FOR SUCH SERVICES. THESE LIMITATIONS ON CHARGES FOR MEDICAL SERVICES SHALL NOT APPLY IF AN INDIVIDUAL HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE APPLICATION AS OF THE TIME THE CHARGES ARE BILLED TO SUCH INDIVIDUAL; PROVIDED, HOWEVER, THAT ADJUSTMENTS WILL BE MADE IF AMOUNTS ARE CHARGED IN EXCESS OF THESE LIMITATIONS AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE. UNITED DETERMINES THE AGB BY MULTIPLYING THE GROSS CHARGES FOR THE APPLICABLE MEDICAL CARE BY THE AGB PERCENTAGE, WHICH IS DETERMINED ANNUALLY BY DIVIDING (1) THE SUM OF THE AMOUNTS FOR ALL OF ITS CLAIMS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE THAT HAVE BEEN ALLOWED DURING THE AGB PERIOD BY MEDICARE FEEFORSERVE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF COPAYS, COINSURANCE OR DEDUCTIBLES BY (2) THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. THE CALCULATION OF THE AGB PERCENTAGE SHALL COMPLY WITH THE "LOOKBACK METHOD" DESCRIBED IN TREASURY REGULATION SECTION 1501B(B)(3). 7 1 - PADDOCK LAKE FAMILY MEDICINE CLINIC 7322 236TH AVENUE SALEM WI 53168 OUTPATIENT PHYSICIAN CLINIC 2 - THE GURNEE CLINIC 1790 NATIONS DRIVE SUITE 106 GURNEE IL 60031 OUTPATIENT PHYSICIAN CLINIC 3 - LAKEVIEW RECPLEX 9900 TERWALL TERRACE PLEASANT PRAIRIE WI 53158 REHABILITATION CLINIC 4 - NORTH CENTRAL CLINIC 6127 GREEN BAY ROAD SUITE 200 KENOSHA WI 53142 OUTPATIENT PHYSICIAN CLINIC 5 - SCMCC-MMB 9697 ST CATHERINES DRIVE PLEASANT PRAIRIE WI 53158 OUTPATIENT PHYSICIAN CLINIC 6 - RCW ADMINISTRATIVE BUILDING 5000 68TH AVE KENOSHA WI 53144 ADMINISTRATIVE BUILDING 7 - SOMERS NORTHSIDE CLINIC 3400 MARKET LANE KENOSHA WI 53144 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: THE COST METHOD USED TO CALCULATE THE COST OF THE COMMUNITY BENEFIT PROGRAMS WAS THE COST-TO-CHARGE RATIO. WORKSHEET 2 WAS USED TO CALCULTE THE RATIO OF PATIENT CARE COST TO CHARGES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $9,938,003. PART II, COMMUNITY BUILDING ACTIVITIES: MANY STAFF MEMBERS ARE UTILIZED TO PROMOTE THE HEALTH OF THE COMMUNITY AND THE GENERAL WELL-BEING OF THE COMMUNITY WE SERVE. THROUGH OUR EMERGENCY PREPAREDNESS COMMITTEE, STAFF ARE ALWAYS PLANNING AND PREPARING TO BE READY TO MEET THE NEEDS OF THE COMMUNITY AS EVENTS OCCUR. ADDITIONALLY, A VARIETY OF STAFF WORK WITH LOCAL SCHOOLS AND OTHER ORGANIZATIONS TO GIVE TALKS PROMOTING HEALTH AND CAREERS IN HEALTHCARE. A NUMBER OF STAFF MEMBERS ARE INVOLVED IN MENTORING PROGRAMS WITHIN THE LOCAL SCHOOLS. RECOGNIZING THE IMPORTANCE OF SUSTAINING AND GROWING OUR ECONOMY, WE PARTICIPATE IN OUR LOCAL BUSINESS ALLIANCE. PART III, LINE 2: THE ORGANIZATIONS UTILIZED THE HMFA #15 METHODOLOGY FOR DETERMINING BAD DEBT EXPENSE. PART III, LINE 3: SINCE THE ORGANIZATION UTILIZES HMFA #15, THERE IS NO PORTION OF THE BAD DEBT THAT WOULD BE CONSIDERED CHARITY CARE. PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION EXPERIENCE AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. WORKSHEET A IN THE INSTRUCTIONS WAS USED TO DETERMINE THE COSTING METHODOLOGY. PART III, LINE 8: SCHEDULE H PART III SECTION B LINE 6 REPORTS "ALLOWABLE COSTS OF CARE" AS TAKEN FROM THE MOST RECENTLY FILED MEDICARE COST REPORT AVAILABLE AT THE TIME THE COMMUNITY BENEFIT REPORT IS PUBLISHED. THE MEDICARE COST REPORT CALCULATES ITS ALLOWABLE TOTAL COSTS BASED ON APPLICABLE MEDICARE REGULATIONS. MEDICARE AND MEDICAID COST IS DETERMINED USING INDIVIDUAL COST CENTER COST-TO-CHARGE RATIOS. THIS COST TO CHARGE RATIO IS DETERMINED USING ALL PAYER COST AND ALL PAYER CHARGES. THE COST TO CHARGE RATIO IS APPLIED TO THE ACTUAL MEDICARE AND MEDICAID CHARGES TO DETERMINE THE MEDICARE AND MEDICAID COST. THIS ORGANIZATION HAS ADOPTED THE COST AND CHARGE PRACTICES AS RECOMMENDED BY THE CATHOLIC HEALTH ASSOCIATION AND THE WISCONSIN, IOWA, OR ILLINOIS HOSPITAL ASSOCIATION AS APPLICABLE, AND THEREFORE, DOES NOT COUNT ANY MEDICARE SHORTFALL NUMBERS IN ITS ANNUAL REPORTING OF COMMUNITY BENEFIT AMOUNTS. PART III, LINE 9B: OUR COLLECTION PROCESS IS THE SAME FOR ALL PATIENTS. IF A PATIENT EXPRESSES A NEED FOR FINANCIAL ASSISTANCE WE OFFER THE COMMUNITY CARE APPLICATION. WE BILL ALL INSURANCES. PATIENT DOES NOT RECEIVE A COPY OF THE BILL UNTIL IT IS THEIR BALANCE. OUR EXTENDED BUSINESS OFFICE SENDS THREE STATEMENTS AND OUR REQUIRED FINAL REQUEST STATEMENT. FROM THIS POINT THE OUTSTANDING BALANCE IS HANDLED BY THE COLLECTION AGENCY. THE ACCOUNT DOES STAY ACTIVE ON OUR FINANCIAL SYSTEM FOR ONE YEAR. AT THAT TIME THE OUTSTANDING BALANCE IS MOVED OVER TO A BAD DEBT STATUS. PART VI, LINE 2: IN AN EFFORT TO UNDERSTAND AND ASSIST IN ADDRESSING THE NEEDS OF THE COMMUNITY WE SERVE, UNITED HOSPITAL SYSTEM HAS INVOLVEMENT IN A VARIETY OF COMMUNITY COMMITTEES. UNITED HOSPITAL SYSTEM HAS MULTIPLE STAFF, MANAGEMENT AND ADMINISTRATIVE LEVEL EMPLOYEES PARTICIPATE IN COMMITTEES THAT ARE SET UP TO ASSESS AND ADDRESS NEEDS IN THE COMMUNITY SUCH AS A HEALTHY LIFESTYLE COMMITTEE, MENTAL HEALTH COMMITTEE, INJURY PREVENTION COMMITTEE, SUICIDE PREVENTION COMMITTEE, INFANT MORTALITY COMMITTEE. THROUGH OUR PARTICIPATION IN COMMUNITY COMMITTEES WE GAIN AN UNDERSTANDING ABOUT THE NEEDS OF THE COMMUNITY AS WELL AS THE OPPORTUNITY TO WORK TOGETHER TO ADDRESS THE NEEDS. PART VI, LINE 3: WHEN STATEMENTS ARE SENT FROM OUR EXTENDED BUSINESS OFFICE, THERE IS A PHONE NUMBER FOR THE PATIENT TO CALL FOR ASSISTANCE WITH THEIR BALANCES. PATIENTS CALL AND THEY WORK WITH THEM TO SET UP PAYMENT ARRANGEMENTS. IF THEY EXPRESS ANY CONCERNS FOR FINANCIAL NEEDS THEY OFFER TO SEND THEM A COMMUNITY CARE APPLICATION. PART VI, LINE 4: KENOSHA COUNTY IS A FAST GROWING LAKESHORE COUMMUNITY IN SOUTHEASTERN WISCONSIN. LOCATED BETWEEN CHICAGO AND MILWAUKEE, KENOSHA COUNTY BOASTS A DIVERSE ECONOMY. KENOSHA IS THE FOURTH LARGEST CITY IN THE STATE OF WISCONSIN WITH 99,218 RESIDENTS REPORTED IN THE 2010 CENSUS. KENOSHA IS NOW THE EIGHTH LARGEST COUNTY IN WISCONSIN IN TERMS OF POPULATION WITH 166,426 RESIDENTS. UNITED HOSPITAL SYSTEM SERVES PEOPLE IN SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS THROUGH ITS TWO HOSPITAL CAMPUSES, ST CATHERINE'S MEDICAL CENTER AND KENOSHA MEDICAL CENTER. AURORA MEDICAL CENTER ALSO HAS A HOSPITAL CAMPUS IN KENOSHA. PART VI, LINE 5: UNITED HOSPITAL SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF OUR PATIENTS AND NEIGHBORS. WE OFFER A VARIETY OF COMMUNITY OUTREACH PROGRAMS TO HELP THE GENERAL PUBLIC MAINTAIN GOOD HEALTH. THESE INCLUDE FREE COMMUNITY EDUCATION SEMINARS, HEALTH SCREENINGS, AND VARIOUS SUPPORT GROUPS. PART VI, LINE 7, REPORTS FILED WITH STATES WI 1 SCHOLARSHIPS 7 7050 PART I, LINE 2: THE MANAGER OF COMMUNITY RELATIONS EVALUATES APPLICANTS IN ACCORDANCE WITH SCHOLARSHIP PROGRAM REQUIREMENTS. RECIPIENTS ARE THEN MONITORED TO ENSURE COMPLIANCE REQUIREMENTS ARE MET, SUCH AS GPA. TRADITIONAL ACCOUNTING RECORDS ARE MAINTAINED FOR ANY DISBURSEMENTS. X X 0 1 0 0 0 0 0 0 0 THOMAS AMBRO MD DIRECTOR/PHYSICIAN - START 1/1/16 425724 0 0 0 552 0 23612 0 21599 0 471487 0 0 0 MARIO GARRETTO MD PHYSICIAN/DIRECTOR - START 1/1/16 539548 0 184084 0 1524 0 73612 0 21542 0 820310 0 0 0 RAYMOND KNIGHT MD DIRECTOR/PHYSICIAN - THRU 1/1/16 388971 0 0 0 4944 0 23612 0 21542 0 439069 0 0 0 RICHARD O SCHMIDT JR PRESIDENT/CEO/DIRECTOR 830002 0 366106 0 19598 0 123612 0 24900 0 1364218 0 0 0 THOMAS KELLEY ASST TREASURER/VP-CFO 364467 0 57719 0 486 0 48612 0 19431 0 490715 0 0 0 LINDA WOHLGEMUTH ASST SECRETARY/VP-COO-SCMC 433571 0 85842 0 3564 0 48612 0 7092 0 578681 0 0 0 SUSAN VENTURA SVP/COO-KMCC 433571 0 85842 0 6858 0 48612 0 7092 0 581975 0 0 0 KATHERINE ABBO MD PHYSICIAN 619356 0 0 0 0 0 23612 0 5682 0 648650 0 0 0 KEVIN FULLIN MD PHYSICIAN 617608 0 0 0 0 0 23612 0 18020 0 659240 0 0 0 ASHWANI SETHI MD PHYSICIAN 467182 0 306829 0 1032 0 23612 0 21718 0 820373 0 0 0 NEIL SHEPLER MD PHYSICIAN 268634 0 3201868 0 1032 0 23612 0 20287 0 3515433 0 0 0 W HARLEY SOBIN MD DIRECTOR/PHYSICIAN - THRU 1/1/16 277663 0 498687 0 1584 0 23612 0 19640 0 821186 0 0 0 ROBERT LEE DIRECTOR 326617 SERVICES PROVIDED BY LEE PLUMBING MECHANICAL CONTRACTOR, INC. ROBERT LEE OWNS LEE PLUMBING MECHANICAL CONTRACTOR, INC. 0 DAVID RILEY DIRECTOR 2873502 SERVICES PROVIDED BY RILEY CONSTRUCTION COMPANY, INC. DAVID RILEY OWNS RILEY CONSTRUCTION COMPANY, INC. 0 ROBERT LEE DIRECTOR 549271 SERVICES PROVIDED BY LEE ELECTRICAL, INC. ROBERT LEE OWNS LEE ELECTRICAL, INC. 0 DAVID RILEY DIRECTOR 569271 SERVICES PROVIDED BY RILEY PURCHASING, LLC. DAVID RILEY OWNS RILEY PURCHASING, LLC. 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE ORGANIZATION'S CFO AND CONTROLLER PRIOR TO FILING. A COPY OF THE 990 IS PROVIDED TO THE GOVERNING BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C UNITED HOSPITAL SYSTEM'S WRITTEN CONFLICT OF INTEREST POLICY FOR THE BOARD IS REVIEWED ANNUALLY BY EACH BOARD MEMBER, AND ANY POTENTIAL CONFLICTS OF INTEREST ARE DISCLOSED AT THAT TIME. THE WRITTEN CONFLICT OF INTEREST POLICY FOR EMPLOYEES IS REVIEWED DURING ORIENTATION AND PERIODICALLY AT ORGANIZATION MEETINGS, AND IS INCORPORATED INTO THE PERFORMANCE STANDARDS OF THEIR ANNUAL EVALUATIONS. IF A CONFLICT ARISES, DEPENDING UPON THE NATURE OF THE FINANCIAL INTEREST AND WORK DONE BY THE BOARD, SEVERAL ACTIONS MAY BE CONSIDERED: THE BOARD MEMBER WITH A FINANCIAL INTEREST WOULD NEED TO VOLUNTARILY EXCUSE HIM OR HERSELF FROM THE DELIBERATIONS OR VOTING ON SUCH A MATTER; OR, IF NECESSARY, THE BOARD WOULD DETERMINE THAT THE SUBJECT'S FINANCIAL INTEREST WAS AN ACTUAL CONFLICT OF INTEREST, IN WHICH CASE THE BOARD MEMBER WOULD BE INFORMED BY THE BOARD CHAIRPERSON THAT HE OR SHE WOULD NOT BE ALLOWED TO VOTE IN ANY SUCH MATTERS DUE TO THIS REAL OR PERCEIVED CONFLICT OF INTEREST. MINUTES OF THE BOARD MEETING WOULD DOCUMENT THIS DECISION PROCESS, AND REFLECT WHATEVER ACTION(S) ARE ULTIMATELY TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE PRESIDENT, CEO AND GENERAL COUNSEL AND THE COMPENSATION FOR THE VICE PRESIDENTS REPORTING DIRECTLY TO THE PRESIDENT, CEO AND GENERAL COUNSEL ARE DETERMINED BY THE BOARD EXECUTIVE COMMITTEE WHICH SERVES AS THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE CONTRACTS WITH THE HEALTHCARE COMPENSATION FIRM NAMED THE GROVES GROUP, LLC, AND HAS UTILIZED THE PRESIDENT OF THE GROVES GROUP, LLC AS THE COMPENSATION CONSULTANT SINCE 2005. THE COMPENSATION CONSULTANT UTILIZES A METHODOLOGY THAT EVALUATES INTERNAL AND EXTERNAL EQUITY AFTER EVALUATING THE RESPONSIBILITIES OF EACH POSITION AND MAKES A RECOMMENDATION TO THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE HAS FOLLOWED THE DETAILED RECOMMENDATIONS OF THE COMPENSATION CONSULTANT ANNUALLY SINCE 2005 AND THE COMPENSATION CONSULTANT HAS BEEN RETAINED THROUGH 2016. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION OBLIGATION -42,428,478. REVENUE SHARING WITH AFFILIATE -8,698,010. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SAINT CATHERINE'S HOSPITAL INC 6308 8TH AVENUE KENOSHA WI 53143 390855075 HEALTHCARE WI 501(C)(3) LINE 11B, II N/A 1 UHS INC 6308 8TH AVENUE KENOSHA WI 53143 391956749 HEALTHCARE WI 501(C)(3) LINE 11A N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 SAINT CATHERINE'S HOSPITAL INC K FMV