2016-05-12T19:05:47-05:00 2015-06-30 350921680 CROWE HORWATH LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2014-07-01 390817529 St Vincent Hospital of the Hospital Sisters of the Third Order of St Franci s STVI 9204330111 835 S VAN BUREN Green Bay WI 543013256 Therese Pandl Division CEO 2016-04-20 true John V Woodhull P01305268 3128997000 2014 2016-08-17 19:52:53Z THERESE PANDL 835 S VAN BUREN Green Bay WI 543013256 480906979 false 0928 X WWW.STVINCENTHOSPITAL.ORG X 1888 WI ST. VINCENT HOSPITAL'S MISSION IS TO CARRY OUT THE HEALING MINISTRY OF THE CATHOLIC CHURCH BY PROVIDING HIGH-QUALITY HOSPITAL SERVICES TO THE PEOPLE OF GREEN BAY, NORTHEAST WISCONSIN, AND NEARBY UPPER MICHIGAN. 11 8 2153 510 3254157 -2101059 3189818 2748448 441123634 466340831 20425128 9838948 2568927 1456999 467307507 480385226 0 0 0 0 107361758 111528742 0 0 0 320387734 339847308 427749492 451376050 39558015 29009176 643669402 665045139 169117581 191184935 474551821 473860204 ST. VINCENT HOSPITAL'S MISSION IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 24614939 46860718 SURGICAL SERVICES - SEE SCHEDULE O "PROGRAM SERVICE ACCOMPLISHMENTS" 11822582 29996776 HEART AND VASCULAR CENTER - SEE SCHEDULE O "PROGRAM SERVICE ACCOMPLISHMENTS" 10222391 44423342 RADIOLOGY SERVICES - SEE SCHEDULE O "PROGRAM SERVICE ACCOMPLISHMENTS" 340788477 342251422 ST VINCENT HOSPITAL PROVIDES A WIDE ARRAY OF SERVICES. BESIDES THE PROGRAMS LISTED ABOVE, WE HAVE A REGIONAL CANCER CENTER THAT INCLUDES PEDS HEMATOLOGY/ONCOLOGY, GYN ONCOLOGY, A CANCER RESEARCH INSTITUTE AND RADIATION ONCOLOGY ON SITE AS WELL AS IN TWO SATELLITE OFFICES IN MARINETTE, WI AND STURGEON BAY, WI. WE ALSO HAVE ORTHOPEDIC SERVICES THAT INCLUDES JOINT CARE, PHYSICAL THERAPY & OCCUPATIONAL THERAPY. OUR WOMEN'S SERVICES DEPARTMENT PROVIDES LABOR & DELIVERY SERVICES, OB CLINIC, NURSE EDUCATORS AND LACTATION SPECIALIST. WE PROVIDE NEONATAL, PEDIATRIC AND GENERAL ICU AS WELL AS INTERMEDIATE CARE UNITS. WE HAVE A 24 HOUR EMERGENCY DEPARTMENT/TRAUMA CENTER WITH SANE NURSES AVAILABLE. OUR PHARMACY IS ALSO OPEN 24 HOURS TO MEET PATIENT NEEDS. OUR PULMONARY FUNCTIONS AREA INCLUDES A BRONCHIAL LAB, RESPIRATORY CARE AND A SLEEP CENTER. WE PROVIDE DIALYSIS FOR BOTH INPATIENT AND OUTPATIENTS. OUR HOME HEALTH CARE DEPARTMENT PROVIDES CARE FOR PATIENTS THAT NO LONGER REQUIRE HOSPITALIZATION BUT WHO CONTINUE CARE IN SOME WAY. WE PROVIDE A WOUND CARE CENTER THAT INCLUDES HYPERBARIC TREATMENTS. WE ALSO HAVE PROGRAMS TO INCREASE PATIENT CARE AND SATISFACTION SUCH AS CASE MANAGEMENT, PALLIATIVE CARE, INFECTION PREVENTION, SPIRITUAL SERVICES, CONTINUOUS PROCESS IMPROVEMENT AND RISK MANAGEMENT. 340788477 342251422 387448389 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 true false false false true false false false false true true false false false true 130 0 true 2153 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 GREEN BAY WI 54301 THERESE B PANDL PRESIDENT 20.00 40.00 X X 0 791486 179082 DJ LONG JR CHAIRPERSON 1.00 1.00 X X 0 0 0 JUDY NAGEL VICE CHAIR 1.00 1.00 X X 0 0 0 JOHN HAGER SECRETARY 1.00 1.00 X X 0 0 0 KENNETH JOHNSON MD CHIEF MEDICAL OFFICER 26.00 0 X X 403984 0 64478 FRANK L MIKELL DIRECTOR 1.00 55.00 X 0 753537 129167 SR BERNADINE GUTOWSKI OSF DIRECTOR 1.00 2.00 X 0 0 0 ROBERT BURNS DIRECTOR 1.00 1.00 X 0 0 0 DANIEL J PLATKOWSKI DIRECTOR 1.00 1.00 X 0 0 0 BETSY MITCHELL DIRECTOR 1.00 1.00 X 0 0 0 JULES BLANK MD DIRECTOR 1.00 1.00 X 0 0 0 KENNETH HUJET MD DIRECTOR 1.00 1.00 X 0 0 0 ANN M CARR TREASURER 0.25 59.75 X 0 335735 228208 LAWRENCE J CONNORS COO 20.00 20.00 X 0 328017 144229 GREG SIMIA DIVISION CFO 20.00 20.00 X 414983 0 77244 PAULA HAFEMAN CNO 40.00 0 X 276406 0 190063 KELLY GIGOT VP FINANCE 40.00 0 X 200887 0 125147 CHRISTINE JENSEMA CHIEF PEOPLE OFFICER 50.00 0 X 237545 0 164962 THOMAS R BAYER SR VP - REGIONAL DEVELOPMENT 40.00 0 X 237781 0 121628 CURTIS WATSON ANESTHESIA MANAGER 40.00 0 X 239160 0 134084 JOHN NOLDIN CRNA 40.00 0 X 225073 0 107368 JOHN KLINKHAMMER CRNA 40.00 0 X 215517 0 57327 SARAH LULLOFF PHYSICIAN 40.00 0 X 218532 0 51181 MOHAMOUD GAILDON PHYSICIST 40.00 0 X 206557 0 64955 2876425 2208775 1839123 76 false true false CARDINAL HEALTH - PHARMACY 2901 ENLOE STREET HUDSON WI 54016 PHARMACY SERVICES 4946721 SODEXO INC & AFFILIATES 4880 PAYSHERE CIR CHICAGO IL 60674 FOOD SERVICE 1878048 GENERAL & VASCULAR CONSULT LLC 720 S VAN BUREN ST SUITE 101 GREEN BAY WI 54301 TRAUMA SERVICES 800000 JH FINDORFF & SON INC 300 S BEDFORD ST MADISON WI 53703 CONSTRUCTION 682637 RESOLUTE 2704 NE INDEPENDENCE AVE LEES SUMMIT MO 64064 REIMBURSEMENT/COLLECTION 615869 51 X 1078191 1653005 17252 2748448 Patient Service Revenue 900099 460207501 460207501 Other Operating Revenue 900099 3979458 3324757 654701 Reference Lab 621500 2153872 2153872 0 0 0 0 466340831 1698403 1698403 664405 436 190040 474365 436 474801 436 474365 8225712 246546 331713 8225712 -85167 8140545 8140545 Laundry Services 812300 209883 209883 Catering 722320 33965 33965 Printing 323100 512465 378554 133911 225885 0 32629 193256 982198 480385226 463532258 3254157 10850363 X 1728680 1728680 81553087 70473538 11079549 7607302 6437346 1169956 13481632 11408239 2073393 7158041 6057178 1100863 697779 697779 23565 23565 200961524 171631453 29330071 0 2546705 2546501 204 2301174 1149120 1152054 1934113 1162381 771732 13183965 11258129 1925836 275884 191575 84309 2361235 2105730 255505 995994 995994 17257045 13061086 4195959 1837996 1138417 699579 Medical Supplies 65342132 64739655 602477 Equipment Rental & Maintenance 13927935 13587521 340414 Bad Debt 5349870 5349870 10850392 5150650 5699742 0 451376050 387448389 63927661 0 10908049 9493543 17803420 14537169 72004114 82237002 4575 4125 0 0 5438013 5425822 5468339 6015843 2171240 2747411 365996415 221558429 137499828 144437986 358882285 364396508 0 33059089 29619056 5618798 430450 511876 643669402 665045139 49428822 56204986 75892817 74016272 0 43795942 60963677 169117581 191184935 X 466269368 465986503 5173335 5021837 3109118 2851864 474551821 473860204 643669402 665045139 X 29009176 -7012057 -22688736 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 23565 23565 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. VINCENT HOSPITAL (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), 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. 12344168 12344168 154807672 89191114 65616558 2578581 1946270 632311 194403371 130421045 63982326 1862623 1862623 144437986 DUE TO MEDICARE 210786 CAP LEASE PAY-PREVEA 4835691 ACCRUED BENEFIT LIABILITY 55236675 RETIREMENT OBLIGATION - ASBESTOS 680525 60963677 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. 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 that Kiara, Inc. will not realize the majority of the benefits of these deductible differences. The deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2015 and 2014 have been fully reserved 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 that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2015 and 2014, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 0 0 3751381 0 3751381 0.0084 0 0 62931940 29377960 33553980 0.0752 0 0 2416165 956803 1459362 0.0033 0 0 69099486 30334763 38764723 0.0869 0 204235 1270243 300 1269943 0.0028 0 1809 324679 0 324679 0.0007 0 964 175916 0 175916 0.0004 0 0 0 0 0 0.0 0 0 55809 0 55809 0.0001 0 207008 1826647 300 1826347 0.0041 0 207008 70926133 30335063 40591070 0.0910 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 5349870 1727604 120068905 193189297 -73120392 X true true UNITY LIMITED PARTNERSHIP HEALTHCARE 0.45 0.0 0.0 NE WI RADIATION THERAPY SERVICES LLC Healthcare - dissolved 6/1/15 0.25 0.0 0.0 PAIN CENTER OF WI LLC HEALTHCARE 0.5 0.0 0.0 PREVEA HEALTH SERVICES INC HEALTHCARE 0.25 0.0 0.0 COMMUNITY MEMORIAL HOSPITAL Healthcare 0.168 0.0 0.0 PREVEA CLINIC INC HEALTHCARE 0.25 0.0 0.0 1 1 ST VINCENT HOSPITAL http://www.stvincenthospital.org/ 19 X X X ST VINCENT HOSPITAL 1 false false true X X X X X X X X X 14 true true true true X http://stvincenthospital.org/Scripts/pageview.asp?id=418 X true 14 true http://stvincenthospital.org/Scripts/pageview.asp?id=418 false false true X 2.0 6.0 X X X X true true X X X X true X http://stvincenthospital.org/Scripts/pageview.asp?id=68 X http://stvincenthospital.org/Scripts/pageview.asp?id=68 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 - ST. VINCENT HOSPITAL. Data profiles of the health focus areas outlined in Healthy Wisconsin 2020 were developed, drawing specifically on Brown County data with state and national comparisons as available. This quantitative data was reviewed to help validate the selection of health priorities. In alignment with IRS Treasury Notice 2011-52,2 data reviewed 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 a community health improvement project summit in November 2014, where they reviewed the quantitative data and provided their observations, and then through a priority setting exercise identified the top health focus areas for the next three years. - 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, Live54218 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 - Patti Smeester, Brown County Health Department - Rose Smits, Community Volunteer, 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 - ST. VINCENT HOSPITAL. Bellin Health and Aurora BayCare Hospital, as well as our sister hospital, HSHS St Mary's Hospital Medical Center. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - St. Vincent Hospital. Members of the community health improvement steering committee included the Brown County Health Department, City of De Pere Health Department, Wisconsin State Department of Public Health, United Way of Brown County, and the three local health systems-Bellin Health, Aurora Bay Care, HSHS St. Vincent Hospital, and HSHS St. Mary's Hospital Medical Center. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Vincent Hospital. HSHS St. Vincent 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. HSHS St. Vincent 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. Vincent 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. 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 Vincent 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 e vidence-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 0 Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH (CONTINUED) In FY2015, St. Vincent spent more than $300,000 to provide onsite training and education of nursing and allied health professionals within its facilities. We have also been collaborating with Medical College of Wisconsin to establish a community medical education program in Green Bay, and have provided financial support to offset operating costs this fiscal year, and have budgeted to do the same in the future. St. Vincent Hospital provided $513,121 in family support services. Professionals at the hospital assisted in excess of 3200 people by screening and applying for the appropriate assistance, such as SSDI or Medical Assistance when they came to the hospital in a time of medical need. This included providing certified application counselors to assist patients in understanding and using the new insurance marketplace. When patients can't get to St. Vincent Hospital, or get to their doctor appointments from the hospital, St. Vincent finds a way to help. In the past year, the hospital paid for more than $7086 in uncompensated ambulance and other vehicle rides for patients, either to or from the hospital or to help them get to their doctor appointments elsewhere. The following is a listing of some of the other services St. Vincent Hospital provided in FY2015: * Cash donations, used equipment, furnishings and printing services to local churches, organizations and schools; * Free support programs including cancer survivor and grief care; * Eagle III - transportation for critically ill and injured patients; provided over 4 FTE's and more than $96,000 in financial assistance to Eagle III for patients they served who were unable to pay their bill; * EnCare program - Emergency Room nurses give presentations at area schools and organizations and provide training on the dangers of drinking and driving; * "Every 15 Minutes" program, an in-depth program about the dangers and consequences of drinking and driving provided to teens around homecoming and prom times. * Hospital colleagues spoke at health fairs, schools, technical colleges, and a wide variety of organizations; * Training for county health nurses, local paramedics and home health agencies; * Student intern programs with local colleges and universities; * Hospital colleagues serve on local health organization boards and donate their time and expertise during and after business hours; * Free translator service to those patients who do not speak English; * Laundry service for the local Altrusa House free of charge. * St. Vincent Hospital along with St. Mary's Hospital and Bellin Health supports Unity Hospice, a provider of appropriate and compassionate care for the terminally ill. * St. Vincent, along with St. Mary's Hospital, held a community medical equipment drive to collect home medical equipment for Hospital Sisters Mission Outreach, a medical supply recovery organization and conducted an oral hygiene drive to collect toothbrushes, toothpaste and floss to provide to needy emergency department patients. Schedule H, Part VI, Line 6 DESCRIPTION OF AFFILIATED GROUP (CONTINUED A) Enhance community health As part of our mission to embody Christ's healing love, 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. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, 13 of our hospitals completed Community Health Needs Assessments (CHNAs) in FY2015 and in FY2012. HSHS St. Clare Memorial Hospital in Oconto Falls, Wisconsin, who affiliated with HSHS in September 2015, completed their CHNA in FY2014. The information gathered from these assessments is being used to develop new, and enhance existing, programs and services that best address the needs of the community. Several priority needs were identified in the FY2015 CHNAs including mental health; chronic disease prevention and management; alcohol, tobacco and other drug abuse; nutrition/wellness; access to care; oral health; and domestic abuse. 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 are providing community education sessions on QPR (Question, Persuade and Refer), an evidence-based suicide prevention program. In addition, the hospitals hosted sessions to train community members to become Certified QPR Trainers. In southern Illinois, HSHS St Elizabeth's Hospital in Belleville also identified suicide as a priority community health need. In response, the hospital in cooperation with the local county mental board offered QPR to educate the community about how to identify and talk to someone who may be considering suicide. In addition, St Elizabeth's mental health counselors provided free evaluations to assess for services or referred individuals to other local agencies for assistance. They also provided telephone assistance to individuals with mental health questions. In FY2015, the counselors screened more than 300 clients and fielded more than 1,000 calls. HSHS St. Vincent Hospital in Green Bay developed the Sexual Assault Nurse Examiner (SANE) program comprised of 11 nurses and a medical director to provide care for anyone who has been sexually assaulted. Begun in 1992, St. Vincent's SANE program is the regional site for such care, one where all the hospitals in Green Bay and the surrounding communities send sexual assault victims. St. Vincent's SANE nurses have been properly trained to conduct the medical examination, collect evidence, treat injury and provide courtroom testimony. In FY2015, SANE served more than 185 individuals at a vulnerable and devastating time of their lives. HSHS St. Mary's Hospital in Streator, Illinois teamed up with the Streator YMCA to offer a 12-week weight loss program - Healthy You - to motivate more than 284 participants. The program included aerobics classes, cooking classes, and a maintenance program to encourage participants to weigh in monthly. Surveys were collected at registration to quantify progress for repeat participants - 14 percent returned with a further weight loss and 9 percent within 5 pounds of their 2014 weight. In FY2015, Healthy You participants collectively lost 2,982 pounds. In FY2015, HSHS St. Mary's Hospital in Decatur, Illinois partnered with Macon County Care Coordination (MCCC) comprised of the Macon County Health Board, Community Health Improvement Center, Decatur Memorial Hospital, Heritage Behavioral Health Center, and Macon County Health Department to provide a team approach to health care and behavioral health services for Medicaid recipients with chronic health conditions. In FY2015, a nurse practitioner was hired to lead the program and recruit physicians. Three teams consisting of a Registered Nurse, Care Navigator and Care Coordinator were hired to provide services. St. Mary's is in the final stages of the development of an interface with the Electronic Medical Record, and is working on fully integrating MCCC services into their Emergency Department and exploring possibilities of integrating MCCC within the HSHS Medical Group to provide care coordination for Medicaid recipients with chronic health conditions. According to the National Assessment of Adult Literacy, only 12 percent of adults have "proficient" health literacy, i.e. nine out of 10 adults lack the skills needed to manage their health. Health literacy was identified in the CHNA completed by HSHS St. Nicholas Hospital in Sheboygan and the Department of Public Health in FY2012. In FY2014, the Healthy Sheboygan County 2020 Health Literacy Committee hosted five focus groups (Hispanic, Hmong, low-income, senior citizens and young adults) and an Executive Briefing for health care leaders to share the results of the community survey and focus groups. In FY2015, with the support of St. Nicholas Hospital, a health literacy community awareness campaign was launched - Okay2Ask - to encourage people to build strong relationships with their health care providers and pharmacists. Schedule H, Part VI, Line 6 DESCRIPTION OF AFFILIATED GROUP (CONTINUED B) Advance medical knowledge HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In FY2015, HSHS hospitals and affiliated physician groups contributed more than $19 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 FY2015, 73 students were served by the program. In FY2015, HSHS St. Mary's Hospital Medical Center and HSHS St. Vincent Hospital in Green Bay invested more than $450,000 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 FY2015. 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. In response to its FY2012 CHNA, HSHS St. John's Hospital in Springfield, Illinois convened a team of health care providers in FY2015 to identify the practice gaps around metabolic syndrome in children and adults and to research best practices and evidence-based protocols to reduce the progression of metabolic syndrome. The team developed and implemented a three-part multidisciplinary discussion on preventing childhood obesity entitled "Childhood Obesity in Central Illinois: Weighing in on the Problem," which was offered during grand rounds. In addition, the team hosted a Continuing Medical Education program for the community entitled "Restoring Healthy Families and Communities in an Obesongenic Environment: A Tool Kit for Health Care Professionals." 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 FY2015. 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 I, Line 7g Subsidized Health Services THE HOSPITAL USES LYON SOFTWARE (CBISA) TO DETERMINE SUBSIDIZED SERVICES. PHYSICIAN CLINICS WERE NOT INCLUDED IN THE SUBSIDIZED HEALTH SERVICES. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 5349870 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 2015 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 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. St. Vincent 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 20 of 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, St. Vincent Hospital is relieving the burden of the government. Accordingly, this shortfall restricts St. Vincent 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 2015 was $ 73,120,392. 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 16b FAP Application website - ST VINCENT HOSPITAL: Line 16b URL: http://stvincenthospital.org/Scripts/pageview.asp?id=68; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST VINCENT HOSPITAL: Line 16c URL: http://stvincenthospital.org/Scripts/pageview.asp?id=68; Schedule H, Part VI, Line 2 Needs assessment As indicated in Part V, Section C, St. Vincent 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 Vincent 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 accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a 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 250,000 residents, of which about 33,000 are covered by Medicaid/Badger Care Plus. About 11% of Brown County Residents live at or below the federal poverty level, (Sources: Applied Population Lab, WI DHS). According to the 2015 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 under construction. 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 St. Vincent Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Vincent 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 people 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, the majority of whom who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Vincent is responding to community need. During both FY2012 and 2015, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. In addition our hospital Advisory Council, Friends of St. Vincent Foundation, Cancer Research Institute Board, and the St. Vincent Auxiliary, whose members assist in many areas of the hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, St. Vincent has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Vincent reinvests surplus funds into the mission of the organization and health of the community rather than distributing them 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. For example, St. Vincent is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. For example, the Epic electronic medical record system enables providers to connect with their patients' medical records from wherever they are and allows emergency physicians access to patient medical records from any facility that has Epic. This reduces duplicate testing, puts critical health information at providers' fingertips, helps better manage chronic conditions, and improves patient safety. A Heart Failure Clinic has been established to assist heart failure patients to maintain good health and stay out of the hospital by incorporating diet, exercise and other wellness information into the long-term care plan. This growing program has shown success in reducing readmissions, which is also helpful for those with limited financial resources. St. Vincent Hospital devotes significant resources to provide access for patients who cannot afford care, along with other community benefits. In Fiscal Year 2015, St. Vincent provided over $40.5 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, during this period, St. Vincent covered the unreimbursed cost for Medicare services, totaling an additional $73 million (at cost). Responding to Community Need An example of our community benefit initiatives is the support we also provide to patients of the NEW Community Clinic. St. Vincent covers the cost of a nurse employed by the NEW Community Clinic to assist the volunteer physicians who see patients with acute needs at their Bodart Street location. We also supply the clinic with free and discounted laboratory and radiology services. More than 70% of patients indicate the clinic's care prevented a trip to the Emergency Department. St. Vincent Hospital, along with sister hospital St. Mary's Hospital Medical Center, provided funds to purchase the equipment to enable the local oral surgeons to provide care (on a volunteer basis) at the NEW Community Clinic dental program-the site that we assisted in setting up in 2013. An ongoing donation assists NEW Clinic to pay for specialized dental assistants to enable the oral surgeons to see as many patients as possible during their volunteer time. Many disabled people have now been able to receive this specialized care-patients who had no other option for services. St. Vincent Hospital developed the Sexual Assault Nurse Examiner (SANE) program to provide care and assistance for anyone who has been sexually assaulted; 11 nurses and a medical director comprise the SANE program at St. Vincent Hospital. SANE operates in a specially designed room in the Emergency Center, one that is available around the clock to the victims of sexual assault, male or female, infant to elderly. The SANE staff greets them all with gentle words and compassionate medical care. The program, which began in 1992, is the regional site for such care, one where all the hospitals in Green Bay and the surrounding communities send sexual assault victims because only our SANE nurses have been properly trained to conduct the detailed medical examination, collect evidence, repair injury and later provide courtroom testimony that will be a key factor in getting convictions of the perpetrators of these crimes. Special tools, such as a picture book, have been developed to assist with examination and evidence gathering with some of our most tender victims-children. SANE reached more than 185 patients this last year at a most vulnerable and devastating time of their lives and truly demonstrates the compassion and mission that is St. Vincent Hospital. SANE works closely with the police force and investigators in the area. Schedule H, Part VI, Line 6 Affiliated health care system HSHS St. Vincent Hospital in Green Bay is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 14 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. Working collaboratively with others in the communities we serve, our Community Benefit initiatives are strategically and successfully expanding access to care, improving the health status of residents, and increasing medical education and knowledge. In FY2015, our hospitals responded to needs identified in each of their most recent Community Health Needs Assessments (CHNAs) completed in FY2012. 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 many priority needs identified in our CHNAs were chronic disease prevention and management, obesity, adequate food and nutrition, mental health, and access to health care services. 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. System-wide, HSHS collectively provided $195.3 million in Community Benefit (9.9% of total hospital expenses) in FY2015. This amount included $25.2 million provided for Financial Assistance (i.e. Charity Care) and $132.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to care for 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 $183.7 million. HSHS hospitals also recorded $61.5 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to 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. As the U.S. health care delivery model continues to evolve, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care across the continuum to meet the needs of each patient. During FY2015, HSHS made significant progress with this strategy as we implemented additional interoperable health information technologies and strengthened our alignment with physicians. 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 often involve partnering with others to achieve this goal. Across our two-state System, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. In FY2015, HSHS and our 14 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 coverage are more likely than their insured counterparts to postpone care and to develop more severe and expensive conditions. 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 14 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. Of the eight states with the highest concentration of uninsured, Illinois was among 25 states that adopted Medicaid expansion under the Affordable Care Act. HSHS St. Mary's Hospital Medical Center in Green Bay supports the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured, and also provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients indicate the care they received at the clinic prevented a trip to the emergency department. This year St. Mary's Hospital, along with sister hospital HSHS St. Vincent Hospital in Green Bay, provided more than $100,000 to support acute care clinic operations at their Northeast Wisconsin Technical College location, as well as funds to support operating costs associated with the oral surgeon's services at the dental clinic. HSHS St. Francis Hospital in Litchfield, Illinois partnered 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. The percentage of total emergency department visits related to dental issues has decreased from 2.2 percent in 2011 to 1.27 percent in 2014 as a result of these collaborative efforts to provide the right care in the right setting. 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 FY2015, St. Anthony's helped underwrite the cost of prescription medications for 312 residents. St. Anthony's and Catholic Charities believe that no one should be without prescription medications because of the inability to pay. 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. All charges are waived 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. Schedule H, Part VI, Line 7 State filing of community benefit report WI X X X X X X false true false false false false false false false THERESE B PANDL PRESIDENT 0 624051 0 146556 0 20879 0 148433 0 30649 0 970568 0 0 KENNETH JOHNSON MD CHIEF MEDICAL OFFICER 403984 0 0 0 0 0 36704 0 27774 0 468462 0 64478 0 FRANK L MIKELL DIRECTOR 0 364732 0 0 0 388805 0 107196 0 21971 0 882704 0 160956 ANN M CARR TREASURER 0 238965 0 34985 0 61785 0 207994 0 20214 0 563943 0 28503 LAWRENCE J CONNORS COO 0 286379 0 36445 0 5193 0 119843 0 24386 0 472246 0 0 GREG SIMIA DIVISION CFO 414983 0 0 0 0 0 50389 0 26855 0 492227 0 0 0 PAULA HAFEMAN CNO 266794 0 9612 0 0 0 172656 0 17407 0 466469 0 0 0 KELLY GIGOT VP FINANCE 200887 0 0 0 0 0 104808 0 20339 0 326034 0 0 0 CHRISTINE JENSEMA CHIEF PEOPLE OFFICER 237545 0 0 0 0 0 137977 0 26985 0 402507 0 0 0 THOMAS R BAYER SR VP - REGIONAL DEVELOPMENT 237781 0 0 0 0 0 95687 0 25941 0 359409 0 0 0 CURTIS WATSON ANESTHESIA MANAGER 239160 0 0 0 0 0 109175 0 24909 0 373244 0 0 0 JOHN NOLDIN CRNA 225073 0 0 0 0 0 91750 0 15618 0 332441 0 0 0 JOHN KLINKHAMMER CRNA 215517 0 0 0 0 0 47373 0 9954 0 272844 0 0 0 SARAH LULLOFF PHYSICIAN 218532 0 0 0 0 0 27725 0 23456 0 269713 0 0 0 MOHAMOUD GAILDON PHYSICIST 202608 0 3949 0 0 0 38302 0 26653 0 271512 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 2014; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $29,789 Therese Pandl -- $77,769 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2014; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $28,503 Frank Mikell -- $185,779 THERESE PANDL DIR/OFFICER STOCK PURCHASE X 4125 4125 false true true 4125 PREVEA CLINIC INC OFFICER (SEE PART V) 1188529 LEASED FACILITIES/EQUIP false Schedule L, Part II LOAN TO/FROM INTERESTED PERSONS ALL TRANSACTIONS WITH INTERESTED PERSONS ARE COMPLIANT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE REVIEWED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. Schedule L, Part IV BUSINESS TRANSACTIONS WITH INTERESTED PERSONS THERESE PANDL, PRESIDENT OF SVGB, IS A BOARD MEMBER OF PREVEA CLINIC. ALL TRANSACTIONS WITH INTERESTED PERSONS ARE COMPLIANT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE REVIEWED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS - SURGERY ST. VINCENT HOSPITAL SURGICAL SERVICES SURGICAL SERVICES IS COMPRISED OF PRE-OPERATIVE SERVICES (PREADMISSION TESTING/AM ADMIT/SHORT STAY), 16 FUNCTIONAL OR SUITES AND 2 OPEN HEART OR SUITES, CENTRAL PROCESSING/DISTRIBUTION, ANESTHESIA, AND RECOVERY. THE 24/7 OPERATIONS ARE CONDUCTED ON 4TH AND 5TH FLOOR WITH THE DIRECT REPORT OF 178 EMPLOYEES. IN FY2015, 9,275 SURGICAL PROCEDURES WERE PERFORMED AND PATIENTS CARED FOR BOTH ON AN INPATIENT AND OUTPATIENT BASIS. THE SURGICAL PROCEDURES PERFORMED ARE GENERAL, ORTHOPEDIC, NEUROSURGERY, UROLOGY, GYNECOLOGY, OPHTHALMOLOGY, ORAL - MAXILLOFACIAL, TRAUMA, CARDIAC SURGERY, AND ORGAN PROCUREMENT. SURGICAL SERVICES COLLABORATES AND PROVIDES SERVICES IN THE HEART CENTER, CANCER CENTER, WOMEN'S AND CHILDREN, ORTHOPEDIC CENTER, TRAUMA CENTER. ANESTHESIA AND CENTRAL PROCESSING/DISTRIBUTION ALSO PROVIDES HOSPITAL WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. THE ANESTHESIA DEPARTMENT IS COMPRISED OF 24 EMPLOYED NURSE ANESTHETISTS AND 14 CONTRACTED ANESTHESIOLOGISTS. Form 990, Part III, Line 4c PROGRAM SERVICE ACCOMPLISHMENTS - RADIOLOGY ST. VINCENT HOSPITAL IMAGING SERVICES THE IMAGING SERVICES DEPARTMENT AT ST. VINCENT HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY AND TRAUMA CARE. OVERALL, THE DEPARTMENT PERFORMS MORE 100,000 EXAMS AND PROCEDURES ANNUALLY. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN COMPUTED TOMOGRAPHY, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. FIVE INTERVENTIONAL RADIOLOGISTS PROVIDE MINIMALLY INVASIVE PROCEDURES USING IMAGE GUIDANCE. THROUGH THE DEPARTMENT'S FIXED SITE PET/CT, PATIENTS HAVE GREATER ACCESS TO A TECHNOLOGY WHICH PROVIDES UNIQUE IMAGES FOR EARLY DIAGNOSIS. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. ADDITIONALLY, MANY OF THE MODALITIES MAINTAIN SEPARATE ACCREDITATION TO ENSURE QUALITY IN THE WORK PERFORMED. Form 990, Part III, Line 4b PROGRAM SERVICE ACCOMPLISHMENTS - HEART & VASCULAR CENTER ST. VINCENT HEART AND VASCULAR CENTER THE CATH LAB OFFERS A COMPLETE ARRAY OF CATHETERIZATION LABORATORY PROCEDURES AND NONINVASIVE CARDIOVASCULAR DIAGNOSTIC PROCEDURES DOING 1,854 CARDIAC CATHETERIZATIONS IN FY2015. JUST STEPS AWAY, THE STATE-OF-THE-ART CARDIOVASCULAR OPERATING CENTER (CVOR) IS AVAILABLE FOR CUTTING-EDGE OPEN HEART PROCEDURES BY OUR HIGHLY-SKILLED CARDIOTHORACIC SURGEONS WHERE 191 OPEN HEART SURGERIES WERE PERFORMED THIS YEAR. IN THE SAME COMPLEX, CARDIO VASCULAR ICU SUITES ARE OUTFITTED WITH UP-TO-THE-MINUTE MONITORING DEVICES THAT ALLOW STAFF AND PHYSICIANS TO KEEP CAREFUL WATCH OVER THEIR PATIENTS WHILE DELIVERING HANDS-ON CARE IMMEDIATELY AFTER PROCEDURES. FOR THOSE PATIENTS WHO NEED FOLLOW-UP, A CARDIO-PULMONARY REHABILITATION PROGRAM IS OFFERED. Form 990, Part III, Line 4d Description of other program services (Expenses $ 340,788,477 including grants of $)(Revenue $ 342,251,422) ST VINCENT HOSPITAL PROVIDES A WIDE ARRAY OF SERVICES. BESIDES THE PROGRAMS LISTED ABOVE, WE HAVE A REGIONAL CANCER CENTER THAT INCLUDES PEDS HEMATOLOGY/ONCOLOGY, GYN ONCOLOGY, A CANCER RESEARCH INSTITUTE AND RADIATION ONCOLOGY ON SITE AS WELL AS IN TWO SATELLITE OFFICES IN MARINETTE, WI AND STURGEON BAY, WI. WE ALSO HAVE ORTHOPEDIC SERVICES THAT INCLUDES JOINT CARE, PHYSICAL THERAPY & OCCUPATIONAL THERAPY. OUR WOMEN'S SERVICES DEPARTMENT PROVIDES LABOR & DELIVERY SERVICES, OB CLINIC, NURSE EDUCATORS AND LACTATION SPECIALIST. WE PROVIDE NEONATAL, PEDIATRIC AND GENERAL ICU AS WELL AS INTERMEDIATE CARE UNITS. WE HAVE A 24 HOUR EMERGENCY DEPARTMENT/TRAUMA CENTER WITH SANE NURSES AVAILABLE. OUR PHARMACY IS ALSO OPEN 24 HOURS TO MEET PATIENT NEEDS. OUR PULMONARY FUNCTIONS AREA INCLUDES A BRONCHIAL LAB, RESPIRATORY CARE AND A SLEEP CENTER. WE PROVIDE DIALYSIS FOR BOTH INPATIENT AND OUTPATIENTS. OUR HOME HEALTH CARE DEPARTMENT PROVIDES CARE FOR PATIENTS THAT NO LONGER REQUIRE HOSPITALIZATION BUT WHO CONTINUE CARE IN SOME WAY. WE PROVIDE A WOUND CARE CENTER THAT INCLUDES HYPERBARIC TREATMENTS. WE ALSO HAVE PROGRAMS TO INCREASE PATIENT CARE AND SATISFACTION SUCH AS CASE MANAGEMENT, PALLIATIVE CARE, INFECTION PREVENTION, SPIRITUAL SERVICES, CONTINUOUS PROCESS IMPROVEMENT AND RISK MANAGEMENT. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST. VINCENT HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"). AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HSSI FORM 990. Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 16b JOINT VENTURES HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. VINCENT HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. VINCENT HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. VINCENT HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. Form 990, Part VI, Line 6 Classes of members or stockholders THE SENIOR GOVERNING BODY OF ST. VINCENT HOSPITAL (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 VINCENT HOSPITAL (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 PREPARATION, 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. THE FOLLOWING DESCRIPTIONS PRESENT ST. VINCENT'S PROCESS FOR DETERMINATION OF COMPENSATION FOR VARIOUS INDIVIDUALS: OFFICER: PROCESS IS DONE AT THE HSHS SYSTEM OFFICE WITH INPUT FROM THE PRESIDENT AND CEO OF THE EASTERN WISCONSIN DIVISION. KEY EMPLOYEE: IF THE POSITION IS FOR A SENIOR LEADERSHIP MEMBER, THE PROCESS IS DONE AT THE HSHS SYSTEM OFFICE WITH INPUT FROM THE PRESIDENT AND CEO OF THE EASTERN WISCONSIN DIVISION. IF THE POSITION IS A DIRECTOR POSITION AT ST. VINCENT HOSPITAL, ON AN ANNUAL BASIS AN OUTSIDE ORGANIZATION, CURRENTLY INTEGRATED HEALTHCARE STRATEGIES ("IHS"), COMPILES MARKET DATA FOR EACH POSITION AND PROVIDES RECOMMENDATIONS FOR THE SALARY RANGE FOR THESE POSITIONS. THE MANAGER OF PEOPLE SERVICES PROVIDES A RECOMMENDATION FOR ADJUSTMENT BASED UPON THE RECOMMENDED RANGE INFORMATION FROM IHS. THE WAGE AND SALARY COMMITTEE AT ST. VINCENT HOSPITAL, WHICH CONSISTS OF THE SENIOR LEADERSHIP TEAM AND MANAGER OF PEOPLE SERVICES, REVIEWS THE SALARY RANGE AND ADJUSTMENT RECOMMENDATIONS; DOCUMENTATION IS KEPT REGARDING ANY DEVIATIONS FROM THE RECOMMENDATIONS. HIGHEST PAID: ON AN ANNUAL BASIS SALARY RANGE RECOMMENDATIONS ARE MADE UTILIZING MARKET DATA THAT IS EXTRACTED FROM SALARY SURVEYS AND AGED TO ALIGN WITH THE COMPENSATION PROGRAM PHILOSOPHY. THE RECOMMENDATIONS FOR SALARY RANGE AND INDIVIDUAL PAY ADJUSTMENTS BY POSITION ARE THEN REVIEWED AND DISCUSSED DURING A MEETING OF THE WAGE AND SALARY COMMITTEE, WHICH CONSISTS OF THE SENIOR LEADERSHIP TEAM AND MANAGER OF PEOPLE SERVICES. DOCUMENTATION IS KEPT REGARDING APPROVAL AND/OR DEVIATIONS FROM THE RECOMMENDATIONS. 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 VIII, Line 11d Other Miscellaneous Revenue PHYSICIAN FEES/DUES - Total Revenue: 32629, Related or Exempt Function Revenue: , Unrelated Business Revenue: 32629, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; - Total Revenue: 193256, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 193256; Form 990, Part IX, Line 11g Other Fees Professional Fees - Physicians - Total Expense: 8390165, Program Service Expense: 8279563, Management and General Expenses: 110602, Fundraising Expenses: ; Medical Group Allocation - Total Expense: 21061390, Program Service Expense: 21061390, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 22542688, Program Service Expense: 3750, Management and General Expenses: 22538938, Fundraising Expenses: ; Outside Services - Total Expense: XXX-XX-XXXX, Program Service Expense: XXX-XX-XXXX, Management and General Expenses: 6680531, Fundraising Expenses: ; Other - Total Expense: -2946661, Program Service Expense: -2946661, Management and General Expenses: , Fundraising Expenses: ; Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT INVESTMENTS IN SECURITIES AND RELATED INVESTMENT INCOME: THE HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS" INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE 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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