ST CLARE MEMORIAL HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- ST CLARE MEMORIAL HOSPITAL INC (EIN 39-0848401)
- Tax period
- 2014-10-01 to 2015-06-30
- Filed
- 2016-05-13
- IRS object ID
- 201611349349305881
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-13T14:57:08-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE HORWATH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive | AddressLine1Txt |
| Address Line2 | Suite 2600 | AddressLine2Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390848401 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCL | BusinessNameControlTxt |
| Phone | 9208463444 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Therese B Pandl | PersonNm |
| Person Title | PRESIDENT & CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Signature | 2016-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN V WOODHULL | PreparerPersonNm |
| PTIN | P01305268 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DANIEL DEGROOT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $27,037,682 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://www.stclarememorial.org/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 365 | TotalEmployeeCnt |
| Total Volunteers | 45 | TotalVolunteersCnt |
| Total Gross UBI | $3,509,728 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$848,313 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $28,814 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,698,250 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,933,294 | CYProgramServiceRevenueAmt |
| PY Investment Income | $96,126 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,519 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$81,988 | PYOtherRevenueAmt |
| CY Other Revenue | -$28,626 | CYOtherRevenueAmt |
| PY Total Revenue | $33,741,202 | PYTotalRevenueAmt |
| CY Total Revenue | $26,909,187 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,439,801 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $14,881,020 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,784,918 | PYOtherExpensesAmt |
| CY Other Expenses | $12,795,178 | CYOtherExpensesAmt |
| PY Total Expenses | $38,224,719 | PYTotalExpensesAmt |
| CY Total Expenses | $27,676,198 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,483,517 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$767,011 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,850,414 | TotalAssetsBOYAmt |
| Total Assets EOY | $26,671,948 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,016,391 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,581,622 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,834,023 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $11,090,326 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ST. CLARE MEMORIAL HOSPITAL, INC. OPERATES AN ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE INPATIENT MEDICAL AND SURGICAL SERVICES AS WELL AS EMERGENCY, PRIMARY CARE PHYSICIAN, AND OUTPATIENT SERVICES. THE HOSPITAL HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL UNDER MEDICARE AND MEDICAID REGULATIONS. THIS DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $23,708,523 | ExpenseAmt |
| Revenue | $23,423,566 | RevenueAmt |
| Desc | ST. CLARE MEMORIAL HOSPITAL SERVES THE GREATER OCONTO COUNTY WITH A FULL-SERVICE HOSPITAL AND FIVE PRIMARY CARE CLINICS LOCATED THROUGHOUT OCONTO COUNTY. THE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH A LICENSURE OF 25 BEDS AND HAS A 24-HOUR, PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, URGENT CARE, RETAIL PHARMACY, INTENSIVE CARE, INPATIENT AND OUTPATIENT SURGICAL AND DIAGNOSTIC SERVICES, REHABILITATION, WOUND THERAPY AND THE CENTER FOR WOMEN'S CARE. THE ST. CLARE PRIMARY CARE CLINICS ARE LOCATED IN LENA, OCONTO FALLS, GILLETT, SURING AND MOUNTAIN. ST. CLARE MEMORIAL HOSPITAL IS A NON-PROFIT ORGANIZATION DEDICATED TO OUR MISSION TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. ST.CLARE MEMORIAL HOSPITAL EXTENDS THIS MISSION INTO OUR VALUES OF QUALITY, CARE, COMMUNITY, TRUST, AND RESPECT AND PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING THE FISCAL YEAR ENDING JUNE 30, 2015, THE HOSPITAL HAD 505 DISCHARGES; 3,643 VISITS TO THE EMERGENCY ROOM; 1,476 SURGICAL CASES (INCLUDING AMBULATORY); AND 14,107 VISITS TO OUR HOSPITAL-BASED CLINICS. ST. CLARE MEMORIAL HOSPITAL PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO THEIR AGE, RACE, SEX, OR ABILITY TO PAY FOR SERVICES. DURING FISCAL YEAR 2015, ST. CLARE MEMORIAL HOSPITAL PROVIDED $515,077 IN CHARITY CARE AND $319,687 IN BAD DEBT WRITE OFFS OF PATIENT ACCOUNTS DUE TO THE PATIENTS' INABILITY TO PAY FOR SERVICES THEY RECEIVED. IN ADDITION TO ITS HOSPITAL AND CLINIC SERVICES. ST. CLARE MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE FREE AND LOW-COST HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE OFFERINGS, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. THE HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, PUBLICITY, SUPPLIES, AND THE MEALS. THREE ST. CLARE MEMORIAL HOSPITAL SENIOR SPECIALS DINNER SEMINARS WERE HELD IN 2015. ST. CLARE MEMORIAL HOSPITAL IS PLEASED TO PARTNER, PARTICIPATE AND COLLABORATE WITH MANY COMMUNITY PARTNERS FOR VARIOUS INITIATIVES AND EVENTS. ST. CLARE MEMORIAL HOSPITAL PLANNED AND SPONSORED INCLUDING A COMMUNITY HEALTH INITIATIVE. WE ALSO PRESENTED THE OCONTO COUNTY SAFETY FAIR IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. ST. CLARE MEMORIAL HOSPITAL OFFERED FREE WORKSHOPS FOR CANCER PATIENTS IN 2015. ST. CLARE MEMORIAL HOSPITAL HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. ST. CLARE MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR MAJOR FUND RAISING COMMITTEE AND THE EXECUTIVE COMMITTEE. FOR EACH OF THESE INITIATIVES, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. IN ADDITION TO PROVIDING COMPREHENSIVE SPORTS PHYSICAL CLINICS IN WHICH THE FEES ARE DONATED BACK TO THE SCHOOLS OF THE PARTICIPATING STUDENTS, ST. CLARE MEMORIAL HOSPITAL PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE ROUTINELY HOSTED AT THE HOSPITAL. ST. CLARE MEMORIAL HOSPITAL ALSO DONATED TO THE CONSTRUCTION OF NEW SOFTBALL FIELDS FOR THE OCONTO FALLS SCHOOL DISTRICT. | Desc |
| Total Program Service Expenses | $23,708,523 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 35 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 365 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Joanne Horvath | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204313211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 835 S Van Buren St | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| THERESE B PANDL | ||||||||
| PRESIDENT & CHIEF EXECUTIVE OFFICER | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $791,486 | $179,082 | |
| CHRISTY KAEMPFER | ||||||||
| BOARD PRESIDENT | 2.00 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAN STRANZ | ||||||||
| BOARD SECRETARY/ TREASURER | 2.00 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL BOETTCHER | ||||||||
| BOARD MEMBER | 2.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| HOWARD ESLIEN | ||||||||
| BOARD MEMBER | 2.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| DR JAMES CLEMENS | ||||||||
| BOARD MEMBER/PHYSICIAN | 2.00 | 40.00 | Yes (X) | $0 | $599,438 | $46,829 | ||
| DR ROBERT CUTLAN | ||||||||
| BOARD MEMBER/PHYSICIAN | 2.00 | 40.00 | Yes (X) | $0 | $704,990 | $47,710 | ||
| GREG SIMIA | ||||||||
| Division CFO | 5.00 | 35.00 | Yes (X) | $0 | $414,983 | $77,244 | ||
| DANIEL DEGROOT | ||||||||
| Ex-Officio Board Member/CEO | 40.00 | 0.50 | Yes (X) | $200,099 | $0 | $8,654 | ||
| Kay Baranczyk | ||||||||
| CNO | 40.00 | 0 | Yes (X) | $113,104 | $0 | $13,983 | ||
| KEITH ELKINS | ||||||||
| PHYSICIAN | 40.00 | 0 | $265,928 | $0 | $23,658 | Yes (X) | ||
| R SCOTT LIEBL | ||||||||
| PHYSICIAN | 40.00 | 0 | $408,534 | $0 | $21,617 | Yes (X) | ||
| DR ISAIAS CUPINO JR | ||||||||
| PHYSICIAN | 40.00 | 0 | $497,147 | $0 | $22,955 | Yes (X) | ||
| DR IRIS PERIZ-MARQUARDT | ||||||||
| PHYSICIAN | 40.00 | 0 | $284,008 | $0 | $21,592 | Yes (X) | ||
| DR LUZ BALMADRID | ||||||||
| PHYSICIAN | 40.00 | 0 | $342,835 | $0 | $20,423 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,111,655 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,510,897 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $483,747 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (true) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WIPFLI LLP | |||||
| PO BOX 3160 | MILWAUKEE | WI | 53201 | ACCOUNTING AND CONSULTING SERVICES | $502,461 |
| ST VINCENT HOSPITAL | |||||
| PO BOX 13508 | GREEN BAY | WI | 543073508 | VARIOUS HOSPITAL SERVICES | $332,633 |
| ST MARY'S MEDICAL CENTER | |||||
| 1726 SHAWANO AVE | GREEN BAY | WI | 54303 | VARIOUS HOSPITAL SERVICES | $304,498 |
| CLINICAL PATH CONSULTING LLC | |||||
| 190 N MILWAUKEE STREET | MILWAUKEE | WI | 53202 | VARIOUS HOSPITAL AND CONSULTING SERVICES | $138,475 |
| PREVEA HEALTH | |||||
| PO BOX 19070 | GREEN BAY | WI | 54307 | VARIOUS HOSPITAL SERVICES | $119,966 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 900099 | $17,963,217 | $17,963,217 | |
| PHARMACY REVENUE | 446110 | $8,043,442 | $4,533,714 | $3,509,728 |
| OTHER REVENUE | 900099 | $926,635 | $926,635 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,933,294 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,523 | TotalRevenueColumnAmt |
| Exclusion | $2,523 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $70,145 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,495 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$58,350 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$58,350 | TotalRevenueColumnAmt |
| Exclusion | -$58,350 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,996 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $1,996 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,996 | TotalRevenueColumnAmt |
| Exclusion | $1,996 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $29,724 | TotalRevenueColumnAmt |
| Exclusion | $29,724 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $29,724 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,909,187 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,423,566 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $3,509,728 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$24,107 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,947 | TotalAmt |
| Management And General | $300,947 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,230,181 | TotalAmt |
| Program Services | $9,562,007 | ProgramServicesAmt |
| Management And General | $1,668,174 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $313,867 | TotalAmt |
| Program Services | $260,196 | ProgramServicesAmt |
| Management And General | $53,671 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,599,357 | TotalAmt |
| Program Services | $2,154,867 | ProgramServicesAmt |
| Management And General | $444,490 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,668 | TotalAmt |
| Program Services | $361,999 | ProgramServicesAmt |
| Management And General | $74,669 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $301,133 | TotalAmt |
| Program Services | $301,133 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,869 | TotalAmt |
| Management And General | $23,869 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,393 | TotalAmt |
| Management And General | $27,393 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,471,961 | TotalAmt |
| Program Services | $1,124,137 | ProgramServicesAmt |
| Management And General | $347,824 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,591 | TotalAmt |
| Management And General | $117,591 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $758,733 | TotalAmt |
| Program Services | $533,998 | ProgramServicesAmt |
| Management And General | $224,735 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $581,995 | TotalAmt |
| Program Services | $581,995 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,149,720 | TotalAmt |
| Program Services | $988,606 | ProgramServicesAmt |
| Management And General | $161,114 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,903 | TotalAmt |
| Program Services | $14,600 | ProgramServicesAmt |
| Management And General | $26,303 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,477 | TotalAmt |
| Program Services | $173,477 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,232,573 | TotalAmt |
| Program Services | $1,215,125 | ProgramServicesAmt |
| Management And General | $17,448 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,377 | TotalAmt |
| Program Services | $30,247 | ProgramServicesAmt |
| Management And General | $75,130 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $319,687 | $319,687 | |
| Medical Supplies | $5,616,044 | $5,599,196 | $16,848 |
| Repairs and Maintenance | $874,722 | $487,253 | $387,469 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,676,198 | TotalAmt |
| Program Services | $23,708,523 | ProgramServicesAmt |
| Management And General | $3,967,675 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,658 | BOYAmt |
| EOY | $928,065 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,103,198 | BOYAmt |
| EOY | $3,524,305 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,043,969 | BOYAmt |
| EOY | $4,047,677 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $857,700 | BOYAmt |
| EOY | $195,259 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,942,096 | BOYAmt |
| EOY | $1,919,233 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,861 | BOYAmt |
| EOY | $56,671 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,086,363 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,270,846 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,233,441 | BOYAmt |
| EOY | $8,815,517 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,709,537 | BOYAmt |
| EOY | $6,814,388 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $349,954 | BOYAmt |
| EOY | $370,833 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,850,414 | BOYAmt |
| EOY | $26,671,948 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,419,408 | BOYAmt |
| EOY | $7,228,383 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,556,000 | BOYAmt |
| EOY | $8,312,989 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,983 | BOYAmt |
| EOY | $40,250 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,016,391 | BOYAmt |
| EOY | $15,581,622 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,834,023 | BOYAmt |
| EOY | $11,040,921 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $35,058 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $14,347 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,834,023 | BOYAmt |
| EOY | $11,090,326 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,850,414 | BOYAmt |
| EOY | $26,671,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$767,011 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $111,731 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$88,417 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | Yes (true) | RalliesDemonstrationsInd |
| Rallies Demonstrations | $6,375 | RalliesDemonstrationsAmt |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $6,375 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $428,317 | OtherCostOrOtherBasisAmt |
| Book Value | $428,317 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,302,697 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,463,760 | DepreciationAmt |
| Book Value | $5,838,937 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,886,755 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,778,964 | DepreciationAmt |
| Book Value | $2,107,791 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $468,594 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,122 | DepreciationAmt |
| Book Value | $440,472 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,815,517 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASES | Desc |
| Amt | $40,250 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $40,250 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | HSHS is an 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. 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 0 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $257,946 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $257,946 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0094 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,078,821 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,953,985 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,124,836 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0777 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $188,562 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,892 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $162,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0059 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,525,329 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,979,877 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,545,452 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0930 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,166 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0005 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $13,166 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0005 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,538,495 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,979,877 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,558,618 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0935 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $94,175 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $94,175 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0034 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $94,175 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $94,175 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0034 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $319,687 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $55,748 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,878,143 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,477,925 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,599,782 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pain Centers of Wisconsin - Oconto Falls | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Pain management | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.5 | OrgProfitOrOwnershipPct |
| Ofcr Etc Profit Or Ownership | 0.0 | OfcrEtcProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.0 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 SOUTH MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.stclarememorial.org/ | WebsiteAddressTxt |
| State License | 1012 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.stclarememorial.org/about.html | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 12 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.stclarememorial.org/about.html | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 2.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 6.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.stclarememorial.org/billing/PayorInformation.html | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.stclarememorial.org/billing/PayorInformation.html | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - ST. CLARE MEMORIAL HOSPITAL. A collaborative community health needs assessment process was conducted in FY2013. Data profiles of the health focus areas outlined in Healthy Oconto County 2018 were developed, drawing specifically on Oconto 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. Data was reviewed from the State Health Plan, Healthy Wisconsin 2020, www.dhs.wisconsin.gov/hw2020, coalition agencies, UW Population Health County Health Rankings www.countyhealthrankings.org, and an Oconto County Community Health Improvement Plan Public Opinion Survey. The results of the Public Opinion Survey can be found on our website at www.healthyocontocounty.info. Ali Carlson , Oconto County Dept of H&HS Amanda Anderson, NEWCAP April Konitzer, NWTC Becky Wolf, Community Member Bernie Faith, Oconto Police Department Carol Jean Luebeck, Oconto County Public Health Carol Kopp, Oconto County Sheriff's Department David Lally, Community Memorial Hospital David Honish, Lena Public Schools Debra Konitzer, Oconto County Public Health* Dr. Keith Elkins, Public Health Medical Advisor Elaine Kluth, Bellin Health Oconto Hospital Hope Kersten, Oconto County WIC Program Irene Drake, City of Gillett Jan Stranz, Community Memorial Hospital Jane Schneider, Oconto Falls School District Joey Sieber, Oconto Gospel Church John Pinkart, UW-Extension Julie Yonker, Gillett Ambulance Service Kim Wolfmeyer, Aging & Disability Resource Center Laura Cormier, Bellin Health Oconto Hospital* Lisa Sbonik, Bellin Health Oconto Hospital Lynn Stymiest, Oconto County Public Health Mary Lemmen, County Board Nancy Williquette, Community Memorial Hospital* Rhonda Stuart, Northern Health Centers Rose O'Hara, TriCity Area United Way Sara Applebee, Oconto County Public Health By engaging the community through the Oconto County Community Health Improvement Plan Public Opinion Survey and by sharing the priorities and implementation plans with the community we serve, 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. CLARE MEMORIAL HOSPITAL. Bellin Health Oconto Hospital |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - St. Clare Memorial Hospital. Oconto County Public Health |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - St. Clare Memorial Hospital. HSHS St. Clare Memorial Hospital is one of three organizations instrumental in the Healthy Oconto County 2018 initiative. This started as a Community Health Needs Assessment and is a joint effort sponsored by HSHS St. Clare Memorial Hospital, (formerly known as: Community Memorial Hospital), Bellin Health Oconto Hospital (BHOH), and Oconto County Public Health. The needs assessment identified the following three health priorities and focus areas for improvement for the county: Alcohol and Other Drugs, Nutrition and Physical Activity & Mental Health. 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 hospital role consists of participating in the leadership team guiding all three focus areas as well as implementing action plans for the Nutrition and Physical Activity focus area. The population assessed was Oconto County, Wisconsin. Data collected throughout the assessment process was supplemented with the Community Health Improvement Plan Public Opinion Survey and by sharing the priorities and implementation plans with the community we serve. 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. Clare Memorial 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 initiative categories. 1. Alcohol and Other Drugs - HSHS St Clare Memorial Hospital is involved in the implementation and/or continuation of the following efforts to improve access to care. a. Support the activities of the community Alcohol and Other Drugs Task Force, which have their own three year plan with goals and outcome measures. 2. Nutrition and Physical Activity - HSHS St Clare Memorial Hospital is engaged in the development, implementation and/or continuation of the following efforts to improve services. a. Lead the activities of the community Nutrition and Physical Activity Task Force, which has its own three year plan with goals and outcome measures. 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. This is the one area in which we have made some significant progress. 3. Mental Health - HSHS St Clare Memorial Hospital is engaged in the development, implementation and/or continuation of the following efforts to improve services. a. Support the activities of the community Mental Health Task Force, which have their own three year plan with goals and outcome measures. Our community group which has collaborated on this has determined that we need to bring more focus to our CHNA and implementation strategies to match the resources available in our very rural county. Therefore, we will be updating the CHNA during FY2016, through reviewing the most current data available, engaging our community stake holders, and identifying those areas that need the most focus. This will then serve as our CHNA for the next few years per IRS regulations. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HSHS St Clare Memorial Hospital Prevea Lena Health Center | ||||
| 200 SOUTH ROSERA STREET | LENA | WI | 54139 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Mountain Health Center | ||||
| 14353 HWY 32/64 | MOUNTAIN | WI | 54149 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Gillett Health Center | ||||
| 340 NORTH GREEN BAY AVE | GILLETT | WI | 54124 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Oconto Health Center | ||||
| 103 FIRST STREET | OCONTO | WI | 54153 | CLINIC (CLOSED DURING FY15) |
| HSHS St Clare Memorial Hospital Prevea Suring Health Center | ||||
| 913 E MAIN STREET | SURING | WI | 54174 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Oconto Falls Health Center | ||||
| 835 SMain St | Oconto Falls | WI | 54154 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 7 Bad Debt Expense excluded from financial assistance calculation | 319687 |
| 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 2014 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 activities reported relate to an annual health fair that the hospitals holds for the community. It consists of many different aspects related to safety and general wellness of the community. |
| 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 Clare Memorial 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. The hospital computes the cost of bad debt by applying the ratio of patient care cost to charges to the total charges written off as bad debt expense. The patient care cost is determined by reducing the total annual operating expense by non-patient care expenses, Medicaid provider taxes and community benefit expense. The adjusted operating cost is then divided by the total gross patient charges to calculate the ratio of patient care cost to charges. |
| 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 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. The hospital Medicare shortfall at cost for fiscal year 2015 was $4,599,782. |
| 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. CLARE MEMORIAL HOSPITAL, INC.: Line 16b URL: http://www.stclarememorial.org/billing/PayorInformation.html; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16c URL: http://www.stclarememorial.org/billing/PayorInformation.html; |
| Schedule H, Part VI, Line 2 Needs assessment | As indicated in Part V, Section C, HSHS St. Clare Memorial Hospital conducted a Community Health Needs Assessment in FY2013. The previous Community Health Needs Assessment was completed in Fiscal Year 2010, using a community-wide collaborative process similar to the one used in fiscal year 2013. Prior to that, the hospital used a variety of means to assess community needs. 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, HSHS St Clare Memorial Hospital led a collaborative approach to conduct its CHNA and adopt an Implementation Plan in FY2013, a process we are repeating in 2016 and then again in 2018 to become consistent with the other hospitals in the system which which we became affiliated in fiscal year 2014 (See Schedule H, Part VI, line 6) |
| 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. Last but not least, we 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 | Oconto County, Wisconsin is a primarily rural county; about 81% of residents live in rural areas. Oconto County is one of 72 Wisconsin counties, and is located in the northeastern part of the state. Oconto County's population is predominantly Caucasian (97%), with a small proportion of people who are Native American or African American (about 1.5%). There is also a Hispanic population of about 1.5% of the population. There are approximately 38,000 residents, of which about 6,100 are covered by Medicaid/Badger Care Plus. About 10.2% of Oconto County Residents live at or below the federal poverty level, (Source: US CENSUS, ACS, 2009-2013). According to the 2015 County Health Rankings, 11% of Oconto County's population is uninsured. Oconto County is considered a primary care health professional shortage area, a mental health professional shortage area, but is not a dental health professional shortage area or a medically underserved area per HRSA. HSHS St. Clare Memorial Hospital is one of two Critical Access Hospitals (CAH) in Oconto County, the other CAH being Bellin Oconto Hospital. |
| Schedule H, Part VI, Line 5 Promotion of community health | HSHS St. Clare Memorial 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), HSHS St. Clare Memorial is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 93 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 Oconto 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 HSHS St. Clare Memorial Hospital is responding to community need. During FY2013 for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. Also consistent with its exempt purpose, HSHS St. Clare Memorial Hospital 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, HSHS St. Clare Memorial Hospital 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, HSHS St. Clare Memorial Hospital 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. HSHS St. Clare Memorial Hospital devotes significant resources to provide access for patients who cannot afford care, along with other community benefits. In Fiscal Year 2015, HSHS St. Clare Memorial Hospital provided over $3.1 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. The following is a listing of some of the other services HSHS St. Clare Memorial Hospital provided in FY2015: * Cash donations, used equipment, and event sponsorships, to organizations and schools; * Free support programs including diabetes support group. * Free Quarterly Community education classes (Senior Specials that provided a free meal and pertinent health topics for our senior population. * Hospital colleagues spoke at health fairs & other community events as well as providing logo items for prizes for the various functions; * Training for local paramedics and emergency response personal through our EMS liaison program. * 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 * Professionals at the hospital assisted people to apply for the appropriate assistance, such as Social Security or Medical Assistance when they came to the hospital in a time of medical need. |
| Schedule H, Part VI, Line 6 Affiliated health care system | St. Clare Memorial Hospital in Oconto Falls 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 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THERESE B PANDL | ||||||||||||||
| PRESIDENT & CHIEF EXECUTIVE OFFICER | $0 | $624,051 | $0 | $146,556 | $0 | $20,879 | $0 | $148,433 | $0 | $30,649 | $0 | $970,568 | $0 | $0 |
| DR JAMES CLEMENS | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $0 | $598,761 | $0 | $0 | $0 | $677 | $0 | $28,392 | $0 | $18,437 | $0 | $646,267 | $0 | $0 |
| DR ROBERT CUTLAN | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $0 | $704,696 | $0 | $0 | $0 | $294 | $0 | $28,392 | $0 | $19,318 | $0 | $752,700 | $0 | $0 |
| GREG SIMIA | ||||||||||||||
| Division CFO | $0 | $414,983 | $0 | $0 | $0 | $0 | $0 | $50,389 | $0 | $26,855 | $0 | $492,227 | $0 | $0 |
| DANIEL DEGROOT | ||||||||||||||
| Ex-Officio Board Member/CEO | $199,583 | $0 | $0 | $0 | $516 | $0 | $5,762 | $0 | $2,892 | $0 | $208,753 | $0 | $0 | $0 |
| KEITH ELKINS | ||||||||||||||
| PHYSICIAN | $239,307 | $0 | $5,250 | $0 | $21,371 | $0 | $7,650 | $0 | $16,008 | $0 | $289,586 | $0 | $0 | $0 |
| R SCOTT LIEBL | ||||||||||||||
| PHYSICIAN | $370,968 | $0 | $1,500 | $0 | $36,066 | $0 | $7,650 | $0 | $13,967 | $0 | $430,151 | $0 | $0 | $0 |
| DR ISAIAS CUPINO JR | ||||||||||||||
| PHYSICIAN | $448,770 | $0 | $4,000 | $0 | $44,377 | $0 | $7,650 | $0 | $15,305 | $0 | $520,102 | $0 | $0 | $0 |
| DR IRIS PERIZ-MARQUARDT | ||||||||||||||
| PHYSICIAN | $278,783 | $0 | $4,000 | $0 | $1,225 | $0 | $6,138 | $0 | $15,454 | $0 | $305,600 | $0 | $0 | $0 |
| DR LUZ BALMADRID | ||||||||||||||
| PHYSICIAN | $319,473 | $0 | $4,000 | $0 | $19,362 | $0 | $6,518 | $0 | $13,905 | $0 | $363,258 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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). Therese Pandl -- $77,769 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2013-04-16 | BondIssuedDt |
| Issue Price | $9,053,000 | IssuePriceAmt |
| Purpose | See Part VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $446,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $9,053,000 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $180,472 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $1,681,913 | CapitalExpendituresAmt |
| Other Spent Proceeds | $7,190,615 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | Yes (true) | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.032 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.0 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.032 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule K, Part I, Column (f) Description of purpose | FormAndLineReferenceDesc |
| Explanation | Issuer Name: Wisconsin Health and Educational Facilities Authority Description: REFINANCING OF 2/11/2003 BOND ISSUANCE; CONSTRUCTION, IMPROVEMENT, AND EQUIPPING HOSPITAL FACILITIES. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SENIOR GOVERNING BODY OF ST. CLARE MEMORIAL 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. CLARE MEMORIAL 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 DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) 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; (I) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) 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 (O) 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 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 XI, Line 9 Other changes in net assets or fund balances | Unrestricted Fund Balance - Change Pension status - -48514; Unrestricted Fund Balance - Transfers HCTF - -39903; |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261417684 | HEALTHCARE | IL | -$2,181,245 | $7,140,533 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371668647 | HEALTHCARE | IL | -$487,125 | $5,630,644 | KCIN |
| HSHS ACO LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62749 | 320465666 | HEALTHCARE | IL | $0 | $0 | KCIN |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HOSPITAL SISTERS HEALTH SYSTEM | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371058692 | HEALTHCARE | IL | 501(c)(3 | Type III-FI | NA | false |
| HOSPITAL SISTERS OF ST FRANCIS FOUNDATION | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371186514 | HEALTHCARE | IL | 501(c)(3 | 7 | HSHS | Yes (true) |
| HSHS HEALTHCARE PLAN TRUST FUND | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371137724 | HEALTHCARE | IL | 501(c)(9 | HSHS | Yes (true) | |
| HSHS SELF INSURANCE TRUST | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371120626 | INSURANCE | IL | 501(c)(3 | Type I | HSHS | Yes (true) |
| HOSPITAL SISTERS HEALTHCARE WEST INC | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3 | Type III-FI | HSSI | Yes (true) |
| SACRED HEART HOSPITAL | ||||||||||
| 990 WEST CLAIREMONT AVENUE | EAU CLAIRE | WI | 54701 | 390807060 | HEALTHCARE | WI | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST ANTHONY'S HOSPITAL | ||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST ELIZABETH'S HOSPITAL | ||||||||||
| 211 SOUTH THIRD STREET | BELLEVILLE | IL | 62220 | 370663567 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST NICHOLAS HOSPITAL | ||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST JOHN'S HOSPITAL | ||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 9515 HOLY CROSS LANE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 390810545 | HEALTHCARE | WI | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 111 SPRING STREET | STREATOR | IL | 61364 | 362169181 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST MARY'S MEDICAL CENTER | ||||||||||
| 1762 SHAWANO AVENUE | GREEN BAY | WI | 54303 | 390818682 | HEALTHCARE | WI | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST VINCENT HOSPITAL | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 51301 | 390817529 | HEALTHCARE | WI | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 12866 TROXLER AVENUE | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| ST FRANCIS HOSPITAL | ||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3 | 3 | HSSI | Yes (true) |
| HOSPITAL SISTERS SERVICES INC | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3 | Type III-FI | HSHS | Yes (true) |
| HSHS MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 263956318 | HEALTHCARE | IL | 501(c)(3 | Type III-FI | HSSI | Yes (true) |
| HSHS WISCONSIN MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 264515959 | HEALTHCARE | WI | 501(c)(3 | Type III-FI | HSSI | Yes (true) |
| ORANGE CROSS AMBULANCE INC | ||||||||||
| 919 ASHLAND AVENUE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3 | 9 | ST NICHOLAS | Yes (true) |
| WISCONSIN UPPER PENINSULA ONCOLOGY MANAGEMENT | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 54301 | 391677100 | HEALTHCARE | WI | 501(c)(3 | 3 | ST VINCENT | Yes (true) |
| UNITY LIMITED PARTNERSHIP | ||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3 | 9 | HSSI | Yes (true) |
| PRAIRIE EDUCATION & RESEARCH COOPERATIVE | ||||||||||
| 317 NORTH 5TH STREET | SPRINGFIELD | IL | 62701 | 371157915 | HEALTHCARE | IL | 501(c)(3 | 4 | HSSI | Yes (true) |
| COMMUNITY HEALTHCARE FOUNDATION | ||||||||||
| 855 SOUTH MAIN STREET | OCONTO FALLS | WI | 54154 | 391700944 | FUNDRAISING (DISSOLVED 8/25/14) | WI | 501(c)(3 | 7 | ST CLARE | Yes (true) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER | |||||||||||||
| 4000 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 371312961 | HEALTHCARE | IL | ST ELIZABETH'S | Related | $1,009,386 | $4,940,657 | false | false | 0.005 |
| PRAIRIE HEART INSTITUTE ST JOHN'S | |||||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 371321197 | HEALTHCARE | IL | HSHS | Related | -$874 | $46,181 | false | false | 0.01 |
| NORTHEAST WISCONSIN RADIATION THERAPY SERVICES LLC | |||||||||||||
| 1726 SHAWANO AVE | GREEN BAY | WI | 543079047 | 263749065 | HEALTHCARE (Disolved 6/1/15) | WI | SMGB | Related | $0 | $0 | false | Yes (true) | 0.005 |
| PAIN CENTER OF WISCONSIN | |||||||||||||
| 4131 W LOOMIS ROAD SUITE 300 | GREENFIELD | WI | 53221 | 263155343 | HEALTHCARE | WI | ST VINCENT | Related | $1,121,849 | $1,119,039 | false | false | 0.005 |
| PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC | |||||||||||||
| 4131 W LOOMIS ROAD SUITE 300 | GREENFIELD | WI | 53221 | 364717036 | HEALTHCARE | WI | ST CLARE | Related | -$68,999 | $194,065 | false | false | 0.005 |
| CARPENTER STREET HOTEL LLC | |||||||||||||
| 525 NORTH SIXTH STREET | SPRINGFIELD | IL | 62702 | 364128127 | HOTEL | IL | LASANTE INC | N/A | |||||
| SPRINGFIELD URGENT CARE REAL ESTATE LLC | |||||||||||||
| PO BOX 19456 | SPRINGFIELD | IL | 727949456 | 030413258 | RENTAL REAL ESTATE | IL | LASANTE INC | N/A | |||||
| PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC | |||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261479945 | MEDICAL | IL | HSHS | Related | -$7,920 | $21,158 | false | Yes (true) | 0.01 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIARA INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163401 | HEALTHCARE | IL | HSHS | C Corporation | -$27,121,195 | $46,374,438 | 0.01 | Yes (true) | |||||
| LASANTE WISCONSIN INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 391572196 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||||
| LASANTE INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163400 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||||
| PRAIRIE CARDIOVASCULAR | |||||||||||||||||
| 619 EAST MASON SUITE 4P57 | SPRINGFIELD | IL | 62701 | 371071858 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||||
| PREVEA HEALTH SERVICES INC | |||||||||||||||||
| 2710 EXECUTIVE DRIVE | GREEN BAY | WI | 54304 | 391839351 | HEALTHCARE | WI | HSSI | C Corporation | $315,933 | $46,398,032 | 0.005 | Yes (true) | |||||
| PREVEA CLINIC INC | |||||||||||||||||
| 2710 EXECUTVE DRIVE | GREEN BAY | WI | 54304 | 391839349 | HEALTHCARE | WI | PHSI | C Corporation | Yes (true) | ||||||||
| RENAISSANCE QUALITY INSURANCE LTD | |||||||||||||||||
| 980669953 | INSURANCE | HSSI | C Corporation | $0 | $103,291,372 | 0.01 | Yes (true) | PO BOX 1159 | GRAND CAYMAN | CJ | KY11102 | CJ | |||||
| OJV INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 460873384 | HEALTHCARE | IL | LASANTE INC | C Corporation | Yes (true) | ||||||||
| STREATORLAND QUALITY CARE PHO LLC | |||||||||||||||||
| 111 SPRING STREET | STREATOR | IL | 61364 | 364105007 | HEALTHCARE | IL | ST MARY'S STREATOR | C Corporation | -$3,116 | $17,486 | 0.005 | Yes (true) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES | FormAndLineReferenceDesc |
| Explanation | THE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION. | ExplanationTxt |