2017-05-12T07:03:51-05:00 2016-06-30 350921680 CROWE HORWATH LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2015-07-01 390818682 St Mary's Hospital Medical Center of Green Bay Inc - Hospital Sisters STMA 9204984200 1726 SHAWANO AVENUE Green Bay WI 54303 THERESE PANDL CHIEF EXECUTIVE OFFICER 2017-05-11 true John V Woodhull P01305268 3128997000 2015 2021-01-29 14:40:06Z THERESE PANDL 1726 SHAWANO AVENUE Green Bay WI 54303 133258264 false 0928 X WWW.STMGB.ORG X 1900 WI TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. 11 8 798 100 753400 -1114503 567879 184300 122800388 125549707 680925 1440582 2709122 1666797 126758314 128841386 0 0 0 0 47899833 48408981 0 0 0 69721517 73685366 117621350 122094347 9136964 6747039 198257345 194660407 60605804 68444806 137651541 126215601 X TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. false false 14543601 27234553 SURGERY - SEE SCHEDULE O 7621255 17434369 HEART & VASCULAR CENTER - SEE SCHEDULE O 5621700 19680744 RADIOLOGY SERVICES - SEE SCHEDULE O 63384678 60891274 ST. MARY'S HOSPITAL MEDICAL CENTER OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY AND OTHER SERVICES. IN FY2016 THE HOSPITAL HAD OVER 103,600 OUTPATIENT VISITS, NEARLY 4,400 ADMISSIONS, OVER 13,100 PATIENT DAYS, OVER 550 BIRTHS AND OVER 31,100 EMERGENCY ROOM VISITS. 63384678 60891274 91171234 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false true false false false false true true false false false true 42 0 true 798 true true true false false false false false false false false false X 11 8 false false false false true true true true true false false true true true true true true true true true true X Joanne Horvath 9204313211 835 S Van Buren St GREEN BAY WI 54301 JOHN HAGER SECRETARY 1.0 1.0 X X 0 0 0 DJ LONG JR CHAIR PERSON 1.0 1.0 X X 0 0 0 JUDY NAGEL 2015 VICE CHAIR 1.0 1.0 X X 0 0 0 THERESE B PANDL PRESIDENT/Divisional CEO 20.0 40.0 X X 0 1047858 231464 DANIEL J PLATKOWSKI 2016 VICE CHAIR 1.0 1.0 X X 0 0 0 JULES BLANK MD DIRECTOR 1.0 1.0 X 0 0 0 ROBERT BURNS DIRECTOR 1.0 1.0 X 0 0 0 MICHAEL W COTTRELL DIRECTOR 1.0 64.0 X 0 959964 215686 SR BERNADINE GUTOWSKI OSF DIRECTOR 1.0 2.0 X 0 0 0 KENNETH HUJET MD DIRECTOR 1.0 1.0 X 0 0 0 BETSY MITCHELL DIRECTOR 1.0 1.0 X 0 0 0 ANN M CARR TREASURER 0.3 59.8 X 0 354305 222661 LAWRENCE J CONNORS COO 20.0 20.0 X 361521 0 157276 GREG SIMIA DIVISION CFO 5.0 35.0 X 0 803634 165408 JAMIE BABBITTS EXECUTIVE DIRECTOR 20.0 0 X 150244 0 87412 THOMAS BERG PHARMACIST 40.0 0 X 149094 0 54530 JAYNE BLEUEL PHARMACIST 40.0 0 X 146829 0 98062 GREGORY LAEHN PHARMACIST 40.0 0 X 154726 0 81356 KAREN WENZEL PHARMACIST 40.0 0 X 155448 0 54363 1117862 3165761 1368218 14 false true false ST VINCENT HOSPITAL 835 S VAN BUREN STREET GREEN BAY WI 54303 SHARED SERVICES 18951990 PREVEA CLINIC PO BOX 19070 GREEN BAY WI 54307 SHARED LABOR & SERVICES 4208865 SODEXO INC 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 FOOD & HOUSEKEEPING SERVICES 945867 IEI GENERAL CONTRACTORS PO BOX 5067 DE PERE WI 54115 CONTRACTOR 853144 SUPERIOR HEALTH LINENS 2150 MAPLE DRIVE PLOVER WI 54467 LAUNDRY & LINEN 393314 12 184300 184300 PATIENT SERVICES 900099 125236057 125236057 LABORATORY SERVICES 621500 308767 308767 PREVEA INVESTMENT GAIN/LOSS 900099 4883 4883 0 0 0 0 125549707 276561 276561 3459869 3588147 -128278 0 -128278 -128278 1187704 805048 828731 1187704 -23683 1164021 1164021 OTHER OPERATING REVENUE 900099 815253 815253 CHILDCARE REVENUE 624410 979822 444633 535189 0 0 0 0 1795075 128841386 125240940 753400 2662746 0 0 0 0 0 0 0 0 0 0 0 0 518797 0 518797 0 35981804 25550421 10431383 0 1033390 723373 310017 0 8710598 6097419 2613179 0 2164392 1515074 649318 0 10080564 7056395 3024169 0 22077 15454 6623 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11468433 8027903 3440530 0 0 0 0 0 139402 97581 41821 0 0 0 0 0 0 0 0 1521669 1065168 456501 0 59527 41669 17858 0 0 0 0 0 107469 75228 32241 0 142963 100074 42889 0 0 0 0 0 5164903 3615432 1549471 0 372793 260955 111838 0 SUPPLIES - MED/SURG/O2/DRUGS 21394987 14976491 6418496 0 PREVEA INVESTMENT AND LEASE 13055115 13055115 0 0 BAD DEBT EXPENSE 2369206 2369206 0 0 MEDICAID TAX ASSESSMENT 3592984 3592984 0 0 4193274 2935292 1257982 0 122094347 91171234 30923113 0 2007 3077 2729510 -691720 0 0 13504993 13294848 0 0 0 428540 415371 2618333 2452311 145008 306776 165223043 85656667 82654211 79566376 85026970 89077513 0 9234116 9044174 0 0 1913657 1191681 198257345 194660407 9808638 9231038 0 0 0 162629 31555884 30132572 0 0 0 0 0 0 0 19241282 28918567 60605804 68444806 X 130840623 119298786 4512348 4618245 2298570 2298570 0 0 0 0 0 0 137651541 126215601 198257345 194660407 X 6747039 -3356232 -14826747 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10842 10842 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. 0 2276732 2276732 0 74053586 29907069 44146517 0 682229 385974 296255 0 35321405 24557655 10763750 0 52889091 30805969 22083122 79566376 ACCRUED PENSION LIABILITY 28686671 RETIREMENT OBLIGATION ASBESTOS 231896 28918567 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code} and are exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset- and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets-and-liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely than not Kiara, Inc. will not realize the majority of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2016 and 2015 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2016 and 2015, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 1 2182 4990577 2927710 2062867 0.0172 1 19979 21605284 10941622 10663662 0.0891 1 620 1003456 683642 319814 0.0027 3 22781 27599317 14552974 13046343 0.1090 54 6619 316602 10375 306227 0.0026 10 13 311157 0 311157 0.0026 1 3463205 2375092 1088113 0.0091 0 0 0 0.0 8 166734 0 166734 0.0014 73 6632 4257698 2385467 1872231 0.0156 76 29413 31857015 16938441 14918574 0.1246 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 2000 0 2000 0.0000 0 0.0 0 0.0 1 0 2000 0 2000 0.0000 true 2369206 258306 34113598 50940612 -16827014 X true true PREVEA CLINIC INC HEALTHCARE 0.25 PREVEA HEALTH SERVICES HEALTHCARE 0.25 UNITY LIMITED PARTNERSHIP HEALTHCARE 0.1 1 1 ST MARY'S HOSPITAL MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY WI 54303 www.stmgb.org 18 X X X ST MARY'S HOSPITAL MEDICAL CENTER 1 false false true X X X X X X X X X 14 true true true true X www.stvincenthospital.org/Hospital-Information X true 14 true www.stvincenthospital.org/Hospital-Information/About/Community-Health-Needs.aspx false false true X 200.0 600.0 X X X X true true X X X X true X http://www.stmgb.org/Patients-Guests/Patient-Financial-Services X http://www.stmgb.org/Patients-Guests/Patient-Financial-Services X http://www.stmgb.org/Patients-Guests/Patient-Financial-Services X 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 - HSHS St. Mary's Hospital Medical Center. Quantitative data for each of the potential health focus areas was assembled from a wide variety of public sources. The quantitative data was then reviewed to help validate the selection of health priorities. In alignment with IRS Treasury Notice 2011-52,2 data was reviewed by individuals who represented 1) the broad interests of the community, and 2) the voice of community members who were medically underserved, minorities, low-income, and/or those persons with chronic illnesses. These people attended the community health improvement project summit in November 2014. Scott Anderson, Northeast Wisconsin Technical College, Associate Dean, Allied Health Sciences Deborah Armbruster, Brown County Health Department, MCH Nurse Manager Sandy Atkins, Greater Green Bay YMCA, Director of Center Operations Sharla Baenen, Bellin Psychiatric Center, President Donna Boehm, St. Vincent Hospital, Director, Regional Cancer Services Erin Bongers, De Pere Health Department, Public Health Nurse Jamie Campbell, N.E.W. Community Clinic - WIC, Project Nutritionist, RD Tina Cazzola, Brown County Community Treatment Center, Substance Abuse Counselor In Training Barbara Coniff, Libertas, Director Laura Cormier, Bellin Health Oconto Hospital, Vice President Operations Kathie DeMuth, Bellin College, Assistant Professor Mike Donovan, City of De Pere Board of Health Chair/Council President Elaine Doxtator, HSHS St. Mary's Hospital Medical Center, Director Emergency Dept/Nursing Resource Grant Dvorak, Greater Green Bay Chamber Health Educator John Dye, Live 54218, Chairman, Executive Committee Christopher Elfner, Bellin Health, Team Leader Howard Endow, Brown County United Way, Community Impact Manager Thomas Erdman, University of Wisconsin Green Bay, Academic Curator Richter Museum of Natural History Patricia Finder-Stone, De Pere Board of Health/LWVGGB/BACC, Volunteer/BOD Judy Friederichs, Brown County Health Department, Director Caroline Glander, St. Vincent Hospital, RN-Patient Navigator (Cancer Center) Patti Glaser-Martin, Hospital Sisters Health System/Prevea Health, Sr. Manager, Internal Communication and Community Rob Gollman, Brown County Health Department, Environmental and Laboratory Division Manager Meredith Hansen, Aging & Disability Resource Center, Resource Specialist Adam Hardy, Achieve Brown County, Executive Director Margie Hempel, Unified School District of De Pere, Health Services Coordinator Kimberly Hess, Center for Childhood Safety Executive Director Laura Hieb, Bellin Health Sarah Himmelheber, University of Wisconsin-Green Bay Sarah Inman, Brown County United Way, VP of Community Investment & Strategic Impact Amy Jerdee, Aurora Baycare Medical Center, Vice President of Clinical Operations Elizabeth Kostichka, ElizK Insurance, Independent Insurance Agent Bonnie Kuhr, N.E.W. Community Clinic CEO Celia LaTour, Catholic Charities Greg Maass, Brown County United Way , Pres/CEO Steve McCarthy, N.E.W. Curative Rehabilitation, President and CEO Mary Miceli-Wink, Brown County Human Services, AODA Counselor Seth Moore, N.E.W. Community Clinic - Outreach Healthcare, Nurse Practitioner / Program Coordinator Melinda Morella, Live54218 , Assistant Director Mary Paluchniak, St. Nicholas Hospital, Facilitator - Outreach Angela Raleigh, Prevea Health, Marketing Associate John Rocheleau, Bellin Health, System V.P. Business Support and I.T. Stacy Ross, Brown County Health Department Dawn Schaefer, West De Pere School District, School Nurse Elizabeth Scheelk, State of Wisconsin - Division of Public Health, Public Health Educator Christine Schneider, Schneider National, Health and Wellness Manager Heidi Selberg, Hospital Sisters Health System, VP Advocacy and Community Benefit Patti Smeester, Brown County Health Department Rose Smits, Community Volunteer Jill Sobieck, Brown County United Way, Community Partnership for Children Coordinator Carrie Stempski, Brown County Oral Health Partnership Executive Director Troy Streckenbach, Brown County Brown County Executive Kaitlin Swanson, St. Vincent and St. Mary's Hospitals, Director of Planning & Strategic Support Dan Teaters, BC Planning & Land Services Dept./Green Bay MPO, Transportation Planner/GIS Catherine Therrien, N.E.W. Community Clinic, N.E.W. Dental Clinic Coordinator Ashley VandenBoomen, Brown County United Way, Research and Initiatives Manager Jen Van Den Elzen, Live54218, Director Christine Vandenhouten, University of Wisconsin Green Bay, Associate Professor Janelle Walton Aging & Disability Resource Center of Brown County, Disability Benefit Specialist Jody Wilmet, Bellin Health VP Bob Woessner, Bob, Inc. CEO Chrystal Woller, De Pere Health Department, Director Chua Xiong, Brown County Health Department, Nurse Manager Leanne Zhu, University of Wisconsin - Green Bay, Assistant Professor in Nutritional Sciences By holding the summit and by sharing the priorities and implementation plans with the hospital community advisory committee, the hospital took into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health (local, regional, state and/or tribal). Members of medically underserved, low-income and minority populations served by the hospital or individuals or organizations representing the interests of such populations also provided input. The medically underserved are members of a population who experience health disparities, are at risk of not receiving adequate medical care as a result of being uninsured or underinsured, and/or experiencing barriers to health care due to geographic, language, financial or other barriers. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - HSHS St. Mary's Hospital Medical Center. Yes, we conducted the CHNA with Bellin Health and with Aurora BayCare Medical Center, as well as with our sister hospital HSHS St. Vincent Hospital. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Mary's Hospital Medical Center. A community wide CHNA steering committee was developed to guide the structure of the process to ensure that the requirements of all parties were met. Members of the CHNA Steering Committee represented organizations that have a legal or regulatory requirement to conduct a CHNA. The CHNA Steering Committee members included: Judy Friedrichs, Brown County Public Health Chrystal Woller, City of DePere Public Health Heidi Selberg, Hospital Sisters Health System John Rocheleau, Bellin Health Jodi Wilmet, Bellin Health Laura Heib, Bellin Health Mark Huber, Aurora Health Howard Endow , United Way Christopher Colletta, WI Department of Health Northeast Region Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Mary's Hospital Medical Center. HSHS St. Mary's Hospital will partner with the community wide action planning teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address the identified priority community health needs. The implementation strategies and interventions will include, but are not limited to, the following initiatives categories. 1. Oral Health -HSHS St. Mary's Hospital is involved in the implementation and/or continuation of the following efforts to improve access to care. a. Lead the activities of the community Oral Health Task Force, which has its own three year plan with goals and outcome measures (work plan will be attached to this report upon completion). b. Support Public Health's efforts to retain fluoridation in public health water supplies via testimony when requested 2. Mental Health, AODA, Physical Activity and Nutrition - St. Mary's Hospital is engaged in the development, implementation and/or continuation of the following efforts to improve services. a. Support the activities of the community action planning teams, which have their own three year plan with goals and outcome measures (work plans will be attached to this report upon completion). b. Work with Public Health and our community partners to identify and implement at least one new evidence-based community program that addresses one of the identified health priorities. 3. Identify and implement programs to provide appropriate care to poor and needy. a. Develop strategies to reduce ED visits for dental conditions b. Develop strategies to reduce ED visits by Medicaid patients and provide them with care in settings appropriate to their needs. c. Provide assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare, as appropriate for their situation. HSHS ST. MARY'S HOSPITAL WAS A KEY PART OF A COLLABORATIVE APPROACH IN CONDUCTING ITS CHNA AND ADOPTING AN IMPLEMENTATION PLAN IN FY2015 (JULY 1, 2014 THROUGH JUNE 30, 2015) IN PARTNERSHIP WITH REPRESENTATIVES FROM THE COMMUNITY. UPON COMPLETION OF THE CHNA, THE HOSPITAL DEVELOPED A SET OF IMPLEMENTATION STRATEGIES AND ADOPTED AN IMPLEMENTATION PLAN TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. THE POPULATION ASSESSED WAS BROWN COUNTY, WISCONSIN. DATA COLLECTED THROUGHOUT THE ASSESSMENT PROCESS WAS SUPPLEMENTED WITH THE RESULTS OF A BEHAVIORAL RISK FACTOR COMMUNITY SURVEY AND THE OPINIONS OF COMMUNITY LEADERS OBTAINED VIA A COMMUNITY HEALTH NEEDS ASSESSMENT "SUMMIT" HELD IN NOVEMBER, 2014. THE FOLLOWING HEALTH NEEDS WERE IDENTIFIED BASED ON THE PERCEIVED MAGNITUDE AND SERIOUSNESS OF THE PROBLEM AND THE FEASIBILITY OF ADDRESSING IT, AS DETERMINED AT A HEALTH NEEDS SUMMIT ATTENDED BY A GROUP BROADLY REPRESENTATIVE OF THE COMMUNITY: ALCOHOL AND OTHER DRUG ABUSE, MENTAL HEALTH, PHYSICAL ACTIVITY AND NUTRITION, AND ORAL HEALTH. THESE NEEDS WERE IDENTIFIED BY USING THE WISCONSIN DEPARTMENT OF PUBLIC HEALTH'S CHIP INFRASTRUCTURE IMPROVEMENT PROJECT'S RECOMMENDED LIST OF HEALTH FOCUS AREAS, IDENTIFYING EXISTING DATA THAT OUTLINES THE MAGNITUDE AND SERIOUSNESS OF THE HEALTH FOCUS AREAS, AND THEN CONVENING A HEALTH SUMMIT WITH ATTENDANCE BROADLY REPRESENTATIVE OF THE COMMUNITY TO SELECT THE HEALTH FOCUS AREA FOR INTENSIVE FOCUS OVER THE NEXT THREE YEARS. AS PART OF THE ENGAGEMENT PROCESS WITH KEY STAKEHOLDERS, ATTENTION HAS BEEN GIVEN TO NATURAL PARTNERSHIPS AND COLLABORATIONS THAT WILL BE USED TO OPERATIONALIZE THE IMPLEMENTATION PLAN. THE IMPLEMENTATION PLAN IS CONSIDERED A "LIVING DOCUMENT" - A SET OF STRATEGIES THAT CAN BE ADAPTED TO THE LESSONS LEARNED WHILE IMPLEMENTING COMMUNITY BENEFIT PROGRAMS AND SERVICES RELEVANT TO THE PRIORITY NEEDS. THE BROADER SET OF COMMUNITY HEALTH NEEDS WILL CONTINUE TO BE MONITORED FOR CONSIDERATION AS FUTURE FOCUS AREAS. 0 Schedule H, Part VI, Line 6 Description of Affiliated Group (Continued A) In southwest Illinois, HSHS St. Joseph's Hospital in Highland enhanced their offerings to their senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive a comprehensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, St. Joseph's Hospital in collaboration with the Illinois Department of Insurance participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs designed to increase access to care, HSHS makes sure that those who need financial assistance receive it. HSHS's Financial Assistance (Charity Care) policy was modified effective January 1, 2014 to offer a 25 percent self-pay discount to all patients who register without insurance. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 55 percent reduction off billed charges if an uninsured patient's family income level is determined to be above 500 percent but equal to our less than 600 percent of the current Federal Poverty Guidelines. HSHS hospitals waive all charges for patients below 200 percent of the Federal Poverty Levels. Counselors are available in our hospitals to explain our financial assistance policy to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Enhance community health As part of our mission to embody Christ's healing love for all people, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. To ensure the health care needs of all are being met, HSHS hospitals also understand we need to listen closely to the residents of the communities we serve. In turn, 13 of our 15 hospitals completed Community Health Needs Assessments (CHNAs) in FY2015. HSHS St. Clare Memorial Hospital in Oconto Falls, Wisconsin, who affiliated with HSHS in September 2015, and HSHS Holy Family Hospital in Greenville, Illinois, who affiliated with HSHS in May 2016, both completed their CHNAs in FY2014. HSHS hospitals are using the information gathered from their most recent CHNAs to develop new, and enhance existing, programs and services that best address the needs of the community. Several priority areas were identified in the FY2015 CHNAs including access to health care services; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In many cases, the hospitals collaborate with other hospital facilities, local departments of public health and community organizations to address identified needs. In western Wisconsin, HSHS Sacred Heart Hospital in Eau Claire and HSHS St. Joseph's Hospital in Chippewa Falls are taking the lead on programming to educate the public about mental health issues and treatment, the stigma associated with mental health, and the recognition of mental health issues. To combat the rising rate of suicides in the area, both hospitals under the umbrella of 3D Community Health are providing community education on QPR (Question, Persuade and Refer), an evidence-based suicide prevention program. In FY2016, 3D Community Health provided 37 adult QPR programs for 1,046 persons and 44 youth QPR programs for 1,161 high school students. In addition, 3D Community Health hosted a community forum to discuss the CHNA results and introduce QPR to 192 community members. HSHS St. Vincent Hospital in Green Bay collaborated with Prevea Health to implement the TIPS program, a program for non-violent opioid abusers that provides treatment and deferred/dismissed prosecution upon successful completion of the treatment program. St. Vincent Hospital also subsidized scholarships for a residential treatment program and arranged to have the first dose of Vivitrol donated; Vivitrol prevents relapse to opioid dependence after opioid detox by attaching to opioid receptors and blocking feelings of pain relief and wellbeing. HSHS St. Mary's Hospital in Decatur, Illinois joined the Macon County Mental Health Board to collaborate on existing programs and to provide resources to meet identified gaps. While other communities are cutting back on mental health services, St. Mary's Hospital remains committed to providing a full spectrum of behavioral health services for adolescents, adults and senior. For example, the hospital collaborates with the Decatur Public School District to provide school teachers for two hours per day for children in the adolescent behavioral health unit. The partnership limits the amount of schoolwork missed during hospitalization. The hospital also has substance abuse counselors who provide educational programs on alcohol and other drug abuse in county schools for students and faculty. HSHS St. Nicholas Hospital in Sheboygan identified nutrition and physical activity as a priority health need in its FY2015 CHNA. In response, St. Nicholas Hospital coordinated and supported the development of the "Double Your Bucks" program at the Sheboygan Farmers Market in FY2016 to enable EBT recipients to double the amount of fresh fruits and vegetables they can purchase. The hospital is also a sponsor of the Sheboygan Farmers Market to promote healthy eating in the community. Additionally, St. Nicholas subsidized the cost of additional bike helmets at the Early Learning Center to increase the physical activity levels of Head Start students and purchased culinary equipment for South High School nutrition and fitness classes to increase opportunities for students to learn how to prepare healthy food. HSHS St. Mary's Hospital in Streator, Illinois collaborated with two local schools to establish community gardens on each of their campuses to address childhood obesity in addition to the community garden on the hospital campus. Students, their families, and hospital colleagues planted, tended and harvested the gardens. Math and science teachers incorporated the gardens into their curricula. Neither school offered Home Economics classes, so St. Mary's Hospital provided the produce and colleagues to offer cooking demonstrations in the classrooms to encourage students to prepare fresh fruit and vegetables snacks. The three gardens produced more than 1,713 pounds of produce in three years, which was donated to the local food pantry, Salvation Army, students and local churches providing healthy food to the poor and vulnerable. Advance medical knowledge HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In FY2016, HSHS hospitals and affiliated physician groups contributed more than $19.1 million toward research and education. Highlights of this commitment include subsidizing medical school residency programs, offering ongoing medical education to physicians and clinicians, and providing job shadowing programs for high school students. In southern Illinois, HSHS St. Joseph's Hospital in Breese, hosted members of the Health Occupations Students of America onsite to learn about job opportunities in health care from health care professionals. St. Joseph's also provided clinical experience for Kaskaskia College students enrolled in nursing, physical therapy and radiology programs. Pharmacy students have also completed their clinical training at St. Joseph's Hospital. In FY2016, the program served more than 100 students. In FY2016, HSHS St. Mary's Hospital Medical Center and HSHS St. Vincent Hospital in Green Bay invested more than $311,000 to provide onsite training and education of nurses and allied health professionals. In addition, the hospitals have been collaborating with the Medical College of Wisconsin to establish a community medical education program in Green Bay and to provide financial support to offset operating costs in FY2016. Also in eastern Wisconsin, HSHS St. Clare Memorial Hospital in Oconto Falls provided training for local paramedics and emergency response personnel through the hospital's EMS liaison program. Schedule H, Part VI, Line 6 Description of Affiliated Group (Continued B) Mission-driven and strategically implemented Community Benefit is an integral part of Hospital Sisters Health System's Mission. Our commitment to Community Benefit arises from our Catholic identity, Mission and Core Values shared by 14,000 colleagues across Illinois and Wisconsin. Through our work to improve access to health care services, enhance community health, advance medical knowledge, and relieve or reduce the burden of government, we believe we have made a positive difference in the quality of lives of tens of thousands of people in Illinois and Wisconsin in FY2016. As a Catholic health care ministry, HSHS is concerned with the dignity of all persons, the common good, and the stewardship of resources. We advocate for health care for all and work to improve social conditions that lead to improved health and well-being. We engage partners in our communities to improve health and quality of life and to reduce duplication. Working side by side with many faith communities, HSHS remains dedicated to our common purpose of compassionate care for all people. Schedule H, Part VI, Line 5 Promotion of Community Health (Continued A) Double your bucks: Adequate food and nutrition was identified as one of the major health needs facing our community. The community wide food and nutrition action planning group has been actively working with local farmers market to encourage customers using EBT (Electronic benefit transfer, formerly known as food stamps) to purchase fruits and vegetables. They worked to enable vendors to accept EBT, and, using a planning grant from a local foundation, trialed a "double your bucks" initiative to double the purchasing power of EBT when used for fruits and vegetables up to a maximum of $10. A trial of this program showed that that the programs increased purchases of fruits and vegetables by those receiving EBT benefits. HSHS St. Vincent and St Mary's has stepped forward to provided funding so that the "double your bucks" program could continue. Without this agreement, the trial program would have been discontinued despite demonstrated success. Here are some of the outcomes from the 2015 season: 95% of participants say that as a result of the program they eat more fruits and vegetables; 84% say they purchase fewer high fat low nutrition snacks, and 94% say they now purchase more fruits and vegetables year round. And, to have this program have even greater impact, a condition of our support has been that the patient focused literature developed by the oral health group be distributed to participants along with toothbrushes. Reports are the participants are delighted by this extra added bonus! Other community benefit activities: * Provided free and discounted laboratory and radiology services to NEW Community Clinic, an FQHC. More than 70 percent of patients indicate the clinic's care prevented a trip to the emergency department. * Provided more than $100,000 to support acute care clinic operations NEW Community Clinic's Northeast Wisconsin Technical College location, as well as funds to help support operating costs associated with the oral surgeon's services at the dental clinic. * Assisted in excess of 2800 people by screening and applying for the appropriate assistance, such as SSDI or medical assistance, including providing certified application counselors to assist patients in understanding and using the new health insurance marketplace. * Spent over $311,000 to provide onsite training and education of nursing and allied health professionals within its facilities. * Collaborate with Medical College of Wisconsin in offering a community medical education program in Green Bay, and have provided financial support to offset operating costs and staff to assist in training physicians. * Through A Woman's Place, provide health and wellness education, health screenings, resources and referral services, facilitated by a Hispanic health outreach facilitator. * A Woman's Place served nearly 4800 women through its resource center and consumer lending library; screenings for cardiovascular disease, osteoporosis and reproductive cancer; and educational events and classes on a variety of health topics. * Hospital employees provide information at educational and public forums. Many underserved and uninsured of our community attend these events. * A loan closet located at A Woman's Place provides wigs, scarves, turbans, hats and breast prostheses for women living with the side effects of cancer treatments. * Additionally, the Look Good, Feel Better Program offers information and guidance to cancer patients looking to enhance their appearance. This gives patients a sense of control over physical changes they may experience. * St. Mary's Hospital donated more than $44,000 in diagnostic services supplies to the missions. * St. Mary's Hospital, along with St. Vincent Hospital and Bellin Health, supports Unity Hospice, a provider of appropriate and compassionate care for the terminally ill. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 2369206 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Charity care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2016 audited financial statements. The total charity care dollar amount is then reduced to cost by applying the hospital's cost to charge ratio as calculated on IRS Schedule H-Worksheet J. Schedule H, Part II Community Building Activities THE COMMUNITY BUILDING ACTIVITIES THAT WE HAVE TRACKED AND REPORTED IN OUR COMMUNITY BENEFIT REPORT ARE A MINOR PORTION OF OUR TOTAL COMMUNITY BENEFIT EFFORTS. THEY CONSIST PRIMARILY OF ACTIVELY PARTICIPATING IN AND SUPPORTING THE WORK OF COMMUNITY GROUPS TO ADVANCE COMMUNITY AWARENESS ABOUT HEALTH ISSUES SUCH AS LEADING THE ORAL HEALTH COMMUNITY TASK FORCE AND SERVING ON THE NEW COMMUNITY CLINIC BOARD. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors that do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for doubtful accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations. HSHS St. Mary's Hospital reports bad debt in accordance with healthcare financial management association statement 15, as modified and consistent with Generally Accepted Accounting Principles (GAAP). Schedule H, Part III, Line 3 Bad Debt Expense Methodology The hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 21 in the HSHS Consolidated Audit Report. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Mary's Hospital is relieving the burden of the government. Accordingly, this shortfall restricts HSHS St. Mary's Hospital's ability to make funds available to provide charity care and other community benefit. The hospital computes the unpaid costs of providing care to Medicare patients by comparing the cost of the services to the reimbursement received from Medicare during the year. The cost of Medicare services is calculated by applying the ratio of patient care cost to charges to the annual Medicare charges. The patient care cost is determined by reducing the total annual operating expense by bad debt expenses, Medicaid provider taxes and community benefit expense. The difference between the reimbursement received and the calculated cost of the services is reported as the Medicare shortfall. The hospital's Medicare shortfall at cost for fiscal year 2016 was nearly $16,827,014. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. Schedule H, Part V, Section B, Line 16a FAP website - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16a URL: http://www.stmgb.org/Patients-Guests/Patient-Financial-Services; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16b URL: http://www.stmgb.org/Patients-Guests/Patient-Financial-Services; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16c URL: http://www.stmgb.org/Patients-Guests/Patient-Financial-Services; Schedule H, Part VI, Line 2 Needs assessment As indicated in Part V, Section C, HSHS St. Mary's Hospital conducted a community health needs assessment in FY2015 (July 1, 2014 through June 30, 2015). The previous community health needs assessment was completed in fiscal year 2012, using a community-wide collaborative process similar to the one used in FY2015. Prior to that, the hospital used a variety of means to assess community needs. These included forming a community advisory committee broadly representative of the community, having executive leaders serve on the boards of community agencies, visiting with agencies serving the poor and needy to learn what their needs are, and reviewing the health care needs of the Medicaid and uninsured patients who visited our emergency departments. Provisions in the Affordable Care Act require charitable hospitals to conduct a CHNA and adopt implementation strategies to meet the needs identified. To comply with these requirements, St. Mary's Hospital led a collaborative approach to conduct its CHNA and adopt an implementation plan in FY2015 (July 1, 2014 through June 30, 2015), a process we undertake every three years. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Our hospital posts our charity care brochure and application on our website. In addition, charity care applications are available and prominently displayed in our waiting and registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. We also have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre- collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the internet address where the policy can be obtained. A system called Search America is now being utilized after failed attempts made by the hospital and our law firm to work out payment arrangements. That system reviews credit and other publicly available financial information to discern the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity care or continue collection efforts. Schedule H, Part VI, Line 4 Community information Brown County, Wisconsin is a primarily urban county, one of 72 Wisconsin counties, and is located in the northeastern part of the state. Brown County's population is predominantly Caucasian (86%), with a small proportion of people who are Native American) or Black (about 2%). There is a sizeable Hispanic population, just over 7% of the population. There are approximately 260,000 residents, of which nearly 34,000 are covered by Medicaid/BadgerCare . About 12% of Brown County residents live at or below the federal poverty level (sources: County Health Rankings). According to the 2016 County Health Rankings, 11% of Brown County's population is uninsured. Brown County contains a dental care HPSA (health professional shortage area) and the metro area is a MUA (medically underserved area), per HRSA. There are three not-for-profit general medical surgical hospitals and one for-profit general medical surgical hospital serving brown county and the surrounding area. In addition, there is one not-for-profit psychiatric hospital and one county operated psychiatric hospital operating, and one for-profit psychiatric hospital scheduled to open summer of 2016. Since most of the population resides in the Green Bay metro area, plans and services focus on this area. Schedule H, Part VI, Line 5 Promotion of community health HSHS St. Mary's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded more than 125 years ago to bring a healing presence and improve the health of our community, especially for those persons who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Brown County, Wisconsin and surrounding areas. The hospital is governed by a Board of Directors, at least a majority of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St Mary's Hospital is responding to community need. During FY2012 and FY2015, for example, the board reviewed the community health needs assessment and approved an implementation strategy for addressing selected needs. Our hospital advisory council and the Friends of St. St. Mary's Foundation, provide the hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, HSHS St. Mary's Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Mary's Hospital reinvests surplus funds to support the mission of the organization and health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Mary's Hospital also serves as a site for health professions education HSHS St. Mary's Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In FY 2016, HSHS St. Mary's Hospital provided nearly $15 million in Community Benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in FY2016, HSHS St. Mary's Hospital provided nearly $17 million (at cost) in excess of Medicare payment for health care services. HSHS St. Mary's Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives would not exist without the leadership role played by HSHS St. Mary's Hospital and they often relieve a burden that would otherwise be carried by government. Since HSHS St. Vincent Hospital and HSHS St Mary's Hospital are in the same market, only a few miles apart, they jointly conduct the CHNA along with community partners. They work together on their CHNA implementation strategy. Indeed, the cost of most proactive community benefit projects are shared two thirds by St. Vincent and one third by St. Mary's. Following are the top identified health needs and examples of related implementation strategies in FY2016: 1. Oral Health a. Continued to lead the activities of the community Oral Health Task Force, which has its own three year plan with goals and outcome measures. Extensive summary of this work is available. Prevention, intervention, and policy modification strategies are included in the committee's action plan. b. Helped to expand services at NEW Community Clinic dental clinic by i. Supporting the effort to gain a HRSA grant for expansion through subsidizing the rent guarantee necessary and assisting with the design cost for the center ii. Supporting the efforts of the oral surgeons to provide their services free of charge at NEW Clinic by subsidizing the cost of a staff person to gain the necessary medical clearances and consent forms for patients-many of whom are elderly and/or disabled and need consent from guardians c. Helped to expand oral health services to children in other school districts by paying for a dental hygienist employed by the Brown County Oral Health Partnership to offer services in the Ashwaubenon school district. d. Served on the boards for NEW Community Clinic and Oral Health Partnership, playing significant roles in their governance (e.g., Vice President on NEW Clinic board; search committee member for OHP and lead the announcement process for the new executive director) 2. Mental Health, AODA, Physical Activity and Nutrition a. Actively participated in the development of the Greater Green Bay Mental Health Connection, which is a collaboration of agencies and organizations designed to reform the mental health delivery system in our community. Led the strategic planning process, wrote portions of the grant application that resulted in a major seven year grant from Medical College of Wisconsin, and served on the steering committee. b. Partnered with Prevea Health to implement the TIPS program, a program for non-violent opioid abusers that provides treatment and deferred/dismissed prosecution upon successful completion of the treatment process. Actions included subsidizing scholarships for a residential treatment program and arranging to have the first dose of Vivitrol donated. c. Started the "Plant a Row" program to address "food and nutrition," a health focus area in all of our markets. d. Supported the "double your bucks" program at farmers markets in Green Bay, DePere and Oneida to enable EBT recipients to by double the amount of fresh fruits and vegetables. e. Supported the Boy Scout "Scouting for Food" food drive. This food drive is using the materials developed by the local food and nutrition group that provides guidelines and suggestions for donors that encourages them to contribute healthy foods. 3. Identify and implement programs to provide appropriate care to poor and needy. a. Provided assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare with the assistance of certified application counselors and educational sessions. b. Through an agreement with Brown County, subsidized the cost of an income maintenance worker to assist with immediate enrollment in BadgerCare. Assistance). The following are two examples of the impact these efforts have had on our community: Oral Health Partnership: The Oral Health Partnership has made tremendous inroads in the Green Bay schools to address these issues, but has not had the capacity to reach out to other local school districts-there are 9 in Brown County. Based on their assessment of where the greatest need resides and using a donation from HSHS St Vincent and HSHS St Mary's, OHP was able to begin services to the Ashwaubenon school district. OHP shared the following story: "Due to our opportunity to expand our school based services to Ashwaubenon, a young middle school student was able to receive much needed dental services. Her only access to dental care has been provided through OHP. During her school appointment for an exam, sealants and a cleaning 6 teeth were identified with decay. One of these molars was deeply decayed down to the gum line and the infection had spread through the roof of the mouth. This situation is especially dangerous in that the infection can spread to other parts of the body, including the brain. This patient received chair-side oral hygiene education and then through case management was appointed for follow up treatment at the Howe Resource Center Dental Clinic. The mother of this patient was unaware of the severity of her child's dental disease and our clinical staff was able to relay the importance of receiving oral care and education to aid in prevention of further disease and maintenance of oral health." The school nurse writes, "I am so appreciative of the relationship that the Brown County Oral Health Partnership has forged with our district. Through this alliance 79 students received oral health care that otherwise would have been difficult to obtain. Some of these students were identified with significant dental issues, including dental caries and abscesses. What a relief to know that these students can now receive the proper dental care, which in turn helps them to be healthy and ready to learn. I am hoping we can continue this partnership in the future!" Schedule H, Part VI, Line 6 Affiliated health care system HSHS St. Mary's Hospital Medical Center in Green Bay is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 15 hospitals, numerous community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The mission of HSHS is "to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry." We live our mission by providing holistic healing to all who seek our care, as well as through Community Benefit. In tandem with others in the communities we serve, our Community Benefit initiatives are strategically increasing access to care, improving the health status of residents, and increasing medical education and knowledge. In FY2016, our hospitals responded to the top needs identified in each of their most recent Community Health Needs Assessments (CHNAs). The information gathered from these assessments was used to develop or enhance Community Benefit programs and services to best address community health needs. Among the priority needs identified in the most recent CHNA process were access to care; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. In FY2016, HSHS collectively provided $203.8 million in Community Benefit (10.0% of total hospital expenses). This amount included $28.1 million provided for Financial Assistance (i.e. Charity Care) and $134.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $221.3 million. HSHS hospitals also recorded $31.4 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. Improve access to health services As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need with a special focus on the poor and vulnerable. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care, at the right time, and in the right setting involve collaborating with others to achieve this goal. Across our two-state System, there are numerous examples of partnerships with departments of public health, other health care facilities and community and social service organizations to enhance access to care for those in need. In FY2016, HSHS and our 15 hospitals invested Community Benefit resources to educate the uninsured about new enrollment opportunities in affordable health care coverage and to facilitate the process. Studies have shown that people without insurance are more likely to postpone care and develop more severe and expensive conditions than their insured counterparts. It is for this reason that the Catholic Church, Catholic health care and HSHS have long promoted "coverage and access for all." HSHS and our 15 hospitals in partnership with local health departments, social service agencies and other health care providers played a vital role in educating eligible people in their local communities, by referring people to Certified Application Counselors and/or in enrolling them in the health insurance exchanges, or in securing coverage through Medicaid expansion. In southern Illinois, HSHS St. Elizabeth's Hospital in Belleville identified an education gap among newly insured patients. Although these patients now had health insurance, they did not know how to use insurance nor did they understand the many benefits that come with different plans. To bridge the gap, St. Elizabeth's Hospital hosted quarterly resource fairs in collaboration with other social service agencies in the community to not only educate the public about their health insurance benefits but also about other resources in the community that can improve their overall health and quality of life. More than 100 persons participated in the resource fairs and each received a healthy snack or hygiene kit. In response to its FY2015 CHNA, HSHS St. John's Hospital in Springfield, Illinois established a community health worker program to increase access to health care and coordination of care for residents of the Enos Park Neighborhood. The hospital also helped establish an Enos Park Neighborhood Advisory Council and Providers Alliance as part of the access collaborative to drive behavior changes and improve health outcomes. In the first year of the program, 103 clients were 100% engaged. Services provided included basic needs (70%) and health care access (30%). The access collaborative also placed 12 homeless individuals or families in affordable, safe housing in Enos Park. Of the 27 parolees we worked with, we realized an 18% recidivism rate compared to the national rate of 60% due to lack of housing or employment. One hundred percent of our clients visited a primary care provider and 84% connected to a medical home. Due to the program's initial success, it is being replicated in Sangamon County's eastside where our most poor and vulnerable populations live. HSHS St. Mary's Hospital Medical Center in Green Bay led the activities of the community Oral Health Task Force, which focuses on prevention, intervention and policy modification strategies to improve oral health in Brown County. In FY2016, St. Mary's Hospital helped to expand the services at NEW Community Clinic dental clinic by supporting their efforts to secure a HRSA grant for expansion by subsidizing the rent guarantee necessary and by assisting with the design cost for the center. The hospital also subsidized the cost of a staff person to obtain the necessary medical clearances and consent forms for patients, many of whom are elderly and/or disabled and need consent from guardians - thus supporting the oral surgeons who are providing their services free of charge. St. Mary's Hospital expanded oral health services for children by covering the costs of a dental hygienist employed by the Brown County Oral Health Partnership to offer oral health services in the Ashwaubenon school district. Through this new alliance, 79 students received oral health care that otherwise would have been difficult to obtain, including care for dental caries and abscesses. HSHS St. Francis Hospital in Litchfield, Illinois collaborated with Lewis & Clark Community College and local dental providers to bring the College's mobile dental health unit to the Litchfield area; the unit provides free or low cost dental exams and screenings, x-rays and hygiene services. In addition, three local dental providers also participated by opening their offices and donating time, staff and supplies to provide either a free filling, extraction or hygiene services. Beginning in 2015, the hospital collaborated with Catholic Charities to launch a dental voucher program. Five dentists in Macoupin and Montgomery counties participate in the program, which covers an initial exam and x-rays, one tooth extraction and up to three fillings per year per individual. The percentage of total emergency department visits related to dental issues decreased from 2.2 percent in 2011 to 1.27 percent in 2014 because of this collaboration. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between HSHS St. Anthony's Memorial Hospital in Effingham and Catholic Charities. In FY2016, St. Anthony's Memorial Hospital helped to underwrite the cost of prescription medications for 518 residents. St. Anthony's Memorial Hospital and Catholic Charities believe no one should be without prescriptions because of the inability to pay. Schedule H, Part VI, Line 7 State filing of community benefit report WI X X X X X false true false false false false false false false THERESE B PANDL PRESIDENT/Divisional CEO 0 663621 0 145946 0 238291 0 200088 0 31376 0 1279322 0 217428 MICHAEL W COTTRELL DIRECTOR 0 608295 0 125031 0 226638 0 185294 0 30392 0 1175650 0 189961 ANN M CARR TREASURER 0 253980 0 36527 0 63798 0 201780 0 20881 0 576966 0 29789 LAWRENCE J CONNORS COO 302422 0 40127 0 18972 0 136198 0 21078 0 518797 0 0 0 GREG SIMIA DIVISION CFO 0 760565 0 41509 0 1560 0 112100 0 53308 0 969042 0 0 JAMIE BABBITTS EXECUTIVE DIRECTOR 149464 0 0 0 780 0 59974 0 27438 0 237656 0 0 0 THOMAS BERG PHARMACIST 144787 0 4307 0 0 0 53312 0 1218 0 203624 0 0 0 JAYNE BLEUEL PHARMACIST 138929 0 4323 0 3577 0 81607 0 16455 0 244891 0 0 0 GREGORY LAEHN PHARMACIST 149764 0 4572 0 390 0 72174 0 9182 0 236082 0 0 0 KAREN WENZEL PHARMACIST 148106 0 4615 0 2727 0 52067 0 2296 0 209811 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2015; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $31,485 Michael Cottrell --$76,064 Therese Pandl -- $81,687 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2015; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $29,789 Michael Cottrell -- $189,961 Theresa Pandl -- $217,428 PREVEA CLINIC INC SVGB OFFICER IS PREVEA CLINIC BOARD MEMBER (SEE PART V) 4208865 PHYSICIAN SERVICES false Schedule L, Part IV BUSINESS TRANSACTIONS WITH INTERESTED PERSONS THERESE PANDL, PRESIDENT OF SVGB, IS A BOARD MEMBER OF PREVEA CLINIC. ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. Form 990, Part III, Line 4a PROGRAM SERVICE REVENUE - SURGERY ST. MARY'S HOSPITAL MEDICAL CENTER SURGICAL SERVICES: SURGICAL SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER ARE COMPRISED OF CENTRAL PROCESSING, ANESTHESIA, SURGERY AND RECOVERY. THIS INCLUDES EIGHT OR SUITES, A C-SECTION ROOM AND TWO MINOR TREATMENT ROOMS. SERVICES ARE AVAILABLE 24/7 AND INCLUDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. IN FY2016, NEARLY 6,100 SURGICAL PROCEDURES WERE PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, UROLOGY, GYNECOLOGY, ORAL - MAXILLOFACIAL, AND ORGAN PROCUREMENT. ANESTHESIA AND CENTRAL PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. Form 990, Part III, Line 4c PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES ST. MARY'S HOSPITAL MEDICAL CENTER IMAGING SERVICES: THE IMAGING SERVICES DEPARTMENT AT ST. MARY'S HOSPITAL MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. OVERALL, THE DEPARTMENT PERFORMED NEARLY 54,700 INPATIENT AND OUTPATIENT EXAMS AND PROCEDURES DURING FY16. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN DIGITAL MAMMOGRAPHY, COMPUTED TOMOGRAPHY, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. FOUR INTERVENTIONAL RADIOLOGISTS PROVIDE MINIMALLY INVASIVE PROCEDURES USING IMAGE GUIDANCE. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. THE DEPARTMENT USES A STATE OF THE ART MRI WIDE BORE SCANNER. Form 990, Part III, Line 4b PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER ST. MARY'S HOSPITAL MEDICAL CENTER CATH LAB: THE CATH LAB OFFERS A COMPLETE ARRAY OF CATHETERIZATION LABORATORY PROCEDURES AND NONINVASIVE CARDIOVASCULAR DIAGNOSTIC PROCEDURES, DOING NEARLY 2,000 CARDIAC CATHETERIZATIONS IN FY2016. IF NEEDED, A STATE-OF-THE-ART CARDIOVASCULAR OPERATING CENTER (CVOR) IS AVAILABLE NEARBY AT OUR SISTER FACILITY, ST. VINCENT HOSPITAL, FOR CUTTING-EDGE OPEN HEART PROCEDURES BY OUR HIGHLY-SKILLED CARDIOTHORACIC SURGEONS. CVICU SUITES ARE ALSO OFFERED THERE. FOR THOSE PATIENTS WHO NEED FOLLOW-UP, A CARDIO-PULMONARY REHABILITATION PROGRAM IS OFFERED ON SITE AT ST. MARY'S. ELECTROPHYSIOLOGY HAS BEEN AVAILABLE AT ST. MARY'S HOSPITAL SINCE FY13. Form 990, Part III, Line 4d Description of other program services (Expenses $ 63,384,678 including grants of $)(Revenue $ 60,891,274) ST. MARY'S HOSPITAL MEDICAL CENTER OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY AND OTHER SERVICES. IN FY2016 THE HOSPITAL HAD OVER 103,600 OUTPATIENT VISITS, NEARLY 4,400 ADMISSIONS, OVER 13,100 PATIENT DAYS, OVER 550 BIRTHS AND OVER 31,100 EMERGENCY ROOM VISITS. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 6 Classes of members or stockholders THE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC. (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO, FROM TIME TO TIME, ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. Form 990, Part VI, Line 11b Review of form 990 by governing body THE HOSPITAL EMPLOYS CROWE HORWATH TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE HORWATH PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION, AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. Form 990, Part VI, Line 15b Process to establish compensation of other employees PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT THE HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. 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