2016-05-16T16:53:29-05:00 2015-06-30 861065772 Deloitte Tax LLP 555 East Wells Street Suite 1400 Milwaukee WI 53202 990 2014-07-01 390816818 St Elizabeth Hospital Inc STEL 9207382000 1506 South Oneida Street Appleton WI 549151397 Brian Regan Interim CFO 2016-05-16 true Rachel Becker P00966076 4142713000 2014 2016-08-17 19:52:53Z Monica Hilt 1506 South Oneida Street Appleton WI 549151397 201247042 false 0928 X www.affinityhealth.org X 1899 WI To further the healing ministry of Jesus by improving the health and well-being of all people. 16 9 1359 356 201867 -8657 1469503 1196319 184284906 195612809 235141 142556 4584388 2968979 190573938 199920663 613381 70000 0 0 78437985 85704460 0 0 0 74601315 76994919 153652681 162769379 36921257 37151284 195528987 232239054 126076497 126799006 69452490 105440048 The mission of St. Elizabeth Hospital, Inc. is to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor. false false 126839417 70000 195962950 ST. ELIZABETH HOSPITAL, INC. PROVIDES INPATIENT, OUTPATIENT, EMERGENCY ROOM, AND ANCILLARY SERVICES REGARDLESS OF AN INDIVIDUAL'S ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES EDUCATIONAL PROGRAMS AND SERVICES ON HEALTH CARE ISSUES TO THE COMMUNITY IT SERVES. SEE SCHEDULE H FOR FURTHER DETAILS. 126839417 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 84 0 true 1359 true true true false false false false false false false false false X 16 9 true false false false true true true true true false false true true true true true true false false false WI X Craig Aittama 7153465161 5700 Lands End Way 2nd Floor Stevens Point WI 54482 WILLIAM J CALHOUN HOSPITAL PRES-STE APP (END 9/14) 10.00 45.30 X X 0 431695 14940 MONICA ANN HILT PRESIDENT STE HOSPITAL (START 1/15) 17.00 27.90 X X 0 572461 19954 STEPHEN C MORTON CHAIRMAN 0.30 1.20 X X 0 0 0 DANIEL NEUFELDER SR. VP HOSP OPS/VICE CHAIR 10.00 53.30 X X 0 1071649 17365 KATHRYN SIEMAN TREASURER 0.30 1.20 X X 0 0 0 WAYNE TREMBLY SECRETARY 0.30 1.20 X X 0 0 0 LANE EARNS BOARD MEMBER 0.30 1.20 X 0 0 0 MARK W FAUSTICH MD BOARD MEMBER 0.30 40.80 X 0 465056 3699 MARY HARP-JIRSCHELE BOARD MEMBER 0.30 1.20 X 0 0 0 FREDERICK KLEIN MD BOARD MEMBER 0.30 1.20 X 0 0 0 JOSEPH MCCORMICK MD BOARD MEMBER 0.30 1.20 X 0 456058 21532 KEVIN RAFLOFSKY BOARD MEMBER 0.30 1.10 X 0 0 0 JAY SAUTER BOARD MEMBER (END 9/14) 0.30 0.40 X 0 0 0 STACEY SENSOR DO BOARD MEMBER 0.30 41.10 X 0 526309 23275 SUDEEP SODHI MD BOARD MEMBER 0.30 40.80 X 0 829590 21095 BARBARA J STRAND MD BOARD MEMBER 0.30 40.80 X 0 369312 7343 MONICA VOMASTIC BOARD MEMBER 0.30 1.20 X 0 0 0 MARLIN GREENFIELD BOARD MEMBER (START 10/14) 0.30 1.20 X 0 0 0 TRAVIS ANDERSON HOSPITAL PRES-STE-APP (END 8/2014) 25.60 1.90 X 0 344821 13716 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO 1.00 54.60 X 0 2134343 18803 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO 1.00 53.80 X 0 1021840 19803 LAWRENCE DONATELLE VICE PRESIDENT OF MEDICAL AFFAIRS 40.00 0 X 0 376131 17613 MARK KEHRBERG MD CHIEF MEDICAL OFFICER 10.00 30.60 X 0 487342 16019 JENNIE REBECCA GAURKEE PHARMACY DIRECTOR 40.00 0 X 176334 0 19377 BRIAN G HUMPHREY SENIOR ULTRASOUND TECHNOLOGIST 40.00 0 X 153658 0 7655 DEBRA LASTOFKA PHARMACIST 35.00 0 X 180691 0 15783 NANETTE KRIZENESKY REGISTERED NURSE LEAD-ICU 36.00 0 X 170532 0 18729 ERIC LOBB MEDICAL PHYSICIST 40.00 0 X 149291 0 7925 JEFF BADGER FORMER OFFICER 0.00 0.00 X 0 659840 13832 830507 9746446 298458 42 true true false THE BOLDT COMPANY 2525 N ROEMER RD PO BOX 419 APPLETON WI 54912 CONSTRUCTION SERVICES 34133061 BOLDT PROCUREMENT LLC 2525 N ROEMER RD PO BOX 419 APPLETON WI 54912 CONSTRUCTION SERVICES 14677748 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MRI/CT SERVICES 1155662 HAMEL GREEN & ABRAHAMSON INC 333 EAST ERIE STREET MILWAUKEE WI 53202 CONSULTING & DESIGN SERVICES 1066995 GUNDERSON INC 41 MAIN ST MENASHA WI 549523198 DRY CLEANING SERVICES 574704 25 X 1157882 38437 1196319 Net Patient Revenue 622110 195118517 195118517 Misc. Hospital Revenue 622000 1309865 1309865 Outpatient Lab Revenue 621500 197017 197017 Genetic Services 900099 4850 4850 Equity Int. in Catalpa 621500 -1127508 -1127508 110068 110068 0 0 195612809 98664 98664 2702282 1326379 1375903 0 1375903 1375903 43892 0 43892 43892 43892 EHR Incentive Payment 900099 333004 333004 Cafeteria Income 722210 1041068 1041068 Other Non-Op. Revenue 900099 219004 219004 0 0 0 0 1593076 199920663 195962950 201867 2559527 70000 70000 66621247 54576510 12044737 2115577 1734773 380804 12920335 9896379 3023956 4047301 3318787 728514 3767919 865900 2902019 0 26477175 25793703 683472 2440 2440 4215230 3411173 804057 459471 115209 344262 1191 1191 2662041 2662041 9714939 8787339 927600 445139 437411 7728 Purchased Services 13182398 6877786 6304612 Pharmaceuticals 7347092 7327616 19476 Food 808217 723457 84760 Dues 246682 23864 222818 7664985 213838 7451147 0 162769379 126839417 35929962 0 3280970 14415110 660107 660107 27070582 28358025 0 0 0 3145705 3226965 169831 206896 196581597 16611618 153657110 179969979 0 0 7544682 5401972 195528987 232239054 36770693 41090959 0 79236726 78839410 10069078 6868637 126076497 126799006 X 68434029 105239709 1018461 200339 69452490 105440048 195528987 232239054 X 37151284 -212666 -951060 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 9356 9356 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Elizabeth Hospital, Inc. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 4137024 4137024 139636153 7416558 132219595 2256064 155168 2100896 48871007 8977996 39893011 1681349 61896 1619453 179969979 Pension Liability 5446130 Due to third party payors 262899 457(b) Plan 639608 Unspecified revenue 520000 Deferred tax liability 6868637 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote From the consolidated audited financial statements of Ministry Health Care, Inc. which include the activity of St. Elizabeth Hospital, Inc.: The Health Ministry accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position or expected to be taken in a tax returns. true true X true X true X true true true false true true 698208 698208 0.0043 1501393 1501393 0.0092 7537 7537 0.0000 0 0 2207138 0 2207138 0.0136 12 2267 663473 1702 661771 0.0041 3 2 1383808 162575 1221233 0.0075 3 15 5418514 4151226 1267288 0.0078 0 0.0 7 0 473252 0 473252 0.0029 25 2284 7939047 4315503 3623544 0.0223 25 2284 10146185 4315503 5830682 0.0358 0 0.0 0 0.0 1 15 349 0 349 0.0000 0 0.0 2 17 158 0 158 0.0000 3 0 30722 0 30722 0.0002 2 78 1499 0 1499 0.0000 3 64 3396 0 3396 0.0000 0 0.0 11 174 36124 0 36124 0.0002 false 8605839 0 75202005 71275595 3926410 X true true 1 1 St Elizabeth Hospital Inc 1506 South Oneida Street Appleton WI 54915 www.affinityhealth.org 88 X X X X St Elizabeth Hospital Inc 1 false false true X X X X X X X X X 12 true true true true X http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013-STE-CHNA_FINA X true 12 true http://www.affinityhealth.org/Affinity-Files/Community-Health-Needs-Assessments/FY2013_STE_Implement false false true X 2.0 3.0 X X X X X true true X X X true X http://ministryhealth.org/Ministry_Health_Care/Financial_Assistance_Program_RC08.pdf X http://ministryhealth.org/Ministry_Health_Care/MHC_FinancialAid_Application_REV4.pdf X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St. Elizabeth Hospital, Inc.. St. Elizabeth Hospital, Inc. participated in the assessment processes that gathered input from both private and public Outagamie, Calumet, and Winnebago County organization members including: medical staff, nurses and administrators, clinic personnel, public health nurses and educators, behavioral health staff and leaders, health insurance-health management staff, elementary, high school, and post high school educators, nurses and administrators, police and emergency personnel, child, women's family, and senior social services, as well as community members interested in the health needs assessment process. Several Affinity representatives participated as a member of the Fox Valley L.I.F.E. Study and/or Fox Valley Regional Community Health Coalition throughout the assessment process. Ernesto Gonzalez, CASA Hispana, was consulted about the Latino community health needs. As part of the Fox Cities L.I.F.E. Study, Kristene Stacker, Fox Cities Community Health Clinic, was consulted about the medically under-served community health needs. Outagamie County Public Health Experts include: - Mary Dorn, Public Health Manager of Outagamie County, Department of Health and Human Services, Division of Public Health BSN and Master's in Public Health (MPH). Fifteen years of public health experience in tribal and local health department settings focusing on population based health. - Sue Kamien, Health Officer/Maternal Child Health Supervisor of Outagamie County Health and Human Services. More than 30 years of public health experience with a focus on nutrition, maternal and child health. - Ellen Koski, Community Health Educator of Outagamie County, Department of Health and Human Services, Division of Public Health, Master's in Public Health (MPH). Nine years of academic and community programming through the University of Minnesota School of Public Health. - City of Appleton Health Experts include: Kurt Eggebrecht, Public Health Officer, Appleton Health Department, Master's in Education (M.Ed). Thirteen years of experience as City of Appleton Health Officer conducting and overseeing community health needs assessments; has more than 34 years health promotion/disease prevention experience. City of Menasha Health Experts, include: - Sue Nett, Public Health Director, City of Menasha Health Department BSN and Master in Public Administration. About 28 years of experience as City of Menasha Public Health Director overseeing the health of the community with 10 years of experience conducting and overseeing community needs assessments (as part of the Fox Cities L.I.F.E. Study). Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. Elizabeth Hospital, Inc.. The CHNA was conducted with Calumet Medical Center, Mercy Medical Center, Thedacare, and Aurora Health. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - St. Elizabeth Hospital, Inc.. The CHNA was conducted with the Health Departments of Appleton, Neenah, Menasha, Calumet County, Outagamie County and Winnebago County. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Elizabeth Hospital Inc. Using the CHNA conducted in 2012, the hospital developed, adopted, and worked on executing a 2014-2016 Implementation Strategy to address priority community health needs. In 2014, the hospital implemented the following plan to address the priority needs: 1. Access to healthcare: Continue to support services that improve community residents' and patients' access to health care. Provide funding to community clinics. Expand health services to Spanish speaking farming population. 2. Mental Health: Decrease rate of suicide in the Fox Valley - Create QPR Portal to promote QPR training and resources - Expand QPR trainings to Spanish speaking population in the area. - Create a community-wide suicide prevention collaboration 3. Obesity: Reduce obesity in Fox Valley residents. - Organize a kick-off event for Weight of the Fox Valley action teams. - Expand Weight of the Fox Valley's web and social media presence. - Establish a process to share BMI information between Weight of the Fox Valley partners. Three other broad health categories were identified by the Community Health Needs Assessment process. While individual segments within our system are addressing specific health needs within these broad categories (i.e. COPD, hypertension, palliative care, etc.), the following will not be a priority of St. Elizabeth Hospital: Chronic Disease Management- already being addressed by others in the community and system (with the exception of obesity, which is a priority need for St. Elizabeth Hospital) ; Sexual Activity, Pregnancy and Parenting - already being addressed by others in the community; Preventive Care Services - already being addressed by others in the community. 0 Schedule H, Part I, Line 3c Other Factors other than FPG It is the policy of St. Elizabeth Hospital, Inc. to provide medically necessary health care services to people in the communities it serves, regardless of their ability to pay. Affinity Care financial assistance is granted based upon the patient's inability to pay and to individuals who are uninsured, underinsured or medically indigent. Affinity Care works in collaboration with other financial (both public and private) assistance programs. This is to ensure holistic wellness of patients by facilitating knowledge of abailable services and programs for health while practicing good stewardship of funds. Key criteria utilized to determine eligibility for Affinity Care financial assistance includes family size, federal poverty income guidelines and available assets. The available asset test includes consideration of the amount of equity in a home, automobiles, and savings accounts which are considered part of total allowable income when assessing against the federal poverty income guidelines. Schedule H, Part I, Line 6a Community benefit report prepared by related organization ST. ELIZABETH HOSPITAL, INC. IS INCLUDED IN THE ANNUAL COMMUNITY BENEFIT REPORT WHICH IS PUBLISHED BY MINISTRY HEALTH CARE, INC. (EIN: 39-1490371) AND AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.MINISTRYHEALTH.ORG. THIS REPORT INCLUDES ALL OF THE RELATED ENTITIES WITHIN THE MINISTRY HEALTH CARE NETWORK OF HOSPITALS, CLINICS AND OTHER HEALTH-RELATED ORGANIZATIONS. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance Amounts calculated in Part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with Worksheet 2, Ratio of Patient Care Cost to Charges. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount. Schedule H, Part II Community Building Activities Community-building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include, cash, in-kind donations, and expenditures for the development of a variety of community health programs and partnerships. Some examples include: Rebuilding Together in which managers from St. Elizabeth Hospital went out to help low-income elderly members of the community with remodeling projects to improve safety or condition of their homes. Another example is the Health Career Experience Day in which professionals from St. Elizabeth Hospital, Inc. highlighted a variety of healthcare careers and talk about their professions (i.e. nursing, surgery, laboratory, and radiology). Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Accounts are written off to bad debt after all internal collection efforts have been exhausted. Attempts to resolve these outstanding balances can include, but are not limited to statements being sent, phone calls and letters being sent. Account follow up protocol is based on personal pay balance size owed. Schedule H, Part III, Line 3 Bad Debt Expense Methodology St. Elizabeth Hospital, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote From the consolidated audited financial statements of Ministry Health Care, Inc. (which includes the activity of St. Elizabeth Hospital, Inc.): The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies. The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. The Health Ministry has not experienced material changes in write-off trends and has not materially changed its charity care policy in the current year. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance St. Elizabeth Hospital, Inc. has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts. Schedule H, Part V, Section B, Line 16a FAP website - St. Elizabeth Hospital, Inc.: Line 16a URL: http://ministryhealth.org/Ministry_Health_Care/Financial_Assistance_Program_RC08.pdf; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Elizabeth Hospital, Inc.: Line 16b URL: http://ministryhealth.org/Ministry_Health_Care/MHC_FinancialAid_Application_REV4.pdf; Schedule H, Part VI, Line 2 Needs assessment St. Elizabeth Hospital, Inc. performs community health needs assessments as needed. Planning workgroups consisting of community partners are formed to define the community and its health needs through review of United Way Life Study results, Healthy People Initiatives, census documents, and local government health and welfare agencies. Considering other community resources/assets, data collection methods are used to identify particular problems or subgroups and areas known to have high poverty rates and to be underserved. The data is analyzed and priorities are set based on trending information which may target a specific need. When a need is identified, the Hospital develops a plan to implement a program either through community collaboration or individually. Outcomes from the programs are measured and considered insubsequent community health needs assessments. The leadership at Affinity takes their commitment to the health and well-bring of the community it serves very seriously. In fact, it is core to the Organization's mission, "to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor." Senior leaders and management are also highly encouraged to provide direct service to the poor in their communities. St. Elizabeth and the leadership also subscribe to publications like the Advisory Board to compare national trends to local trends to ensure the hospital is resourcing areas to meet patient needs. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Elizabeth Hospital, Inc. goes to great lengths in order to inform and educate patients/persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs and under the organizations Affinity Care Policy. The Affinity Care Policy and application is posted on the Organization's website. Admissions and other key areas contain summary information of the Affinity Care Policy. As part of the intake/discharge process, patients are provided with a copy of the policy and other information for financial assistance. If during the course of the patient registration process, care encounter, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to the organizations Affinity Care Program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Affinity Care financial assistance can be initiated by any member of the Hospital's workforce, including medical staff members, who become aware of the patients potential need for Affinity Care financial assistance. The Affinity Care brochure was also translated into dialects prevalent in the community in order to reach out to those that may speak another language (Spanish and Hmong). Patient registration staff and financial counselors are provided with guidelines to follow when interacting with patients. As part of the Affinity Care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs. Schedule H, Part VI, Line 4 Community information While there is growing agreement in the United States about what constitutes a non-profit hospitals "community benefit," this is a work in progress. St. Elizabeth Hospital, Inc. provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. St. Elizabeth Hospital, Inc., like most community hospitals, was created and is maintained in order to provide care locally, care that without our hospital, may not be available locally. Certain specialized services available include: I/P adult behavioral health services, I/P adolescent behavioral health services and neonatal intensive care services. The City of Appleton is located in Outagamie, Calumet, and Winnebago counties. According to the 2008-2012 American Community Survey 5-Year Estimates, there were 72,575 people living in Appleton, consisting of 28,428 households and 18,074 families. The population density of Appleton was 2,984.9 people per square mile. The population consisted of 86.0% White, 4.7% Hispanic, 1.6% African American, 0.5% Native American, 5.3% Asian, and 1.9% Other. Of the 28,428 households in Appleton, 32.8% of those had children under the age of 18, living at home. The 28,428 households are categorized as 49% married couples living together, 4.1% had a male head of household with no wife present, 10.5% had a female head of household with no husband present, and 47% were non-families. 29.6% of the households consisted of individuals and 10.1% had someone 65 and older living alone. The age population is widely spread. 28.9% were under 18, 6.5% were 19-24, 26.8% were 25-44, 26.3% were 45-64, and 11.5% were 65+. The median income for a household was $52,605 and the median income for a family was $66,781. The per capita income for the city was $27,106. The largest industry in Appleton is educational, health and social services (21.5%). Manufacturing (20.4%) and retail trade (11.4%) are the next largest industries in Appleton. Roughly 8% of families and 10.5% of the population were below the poverty line. That includes 13.5% of those under 18 years old and 7.4% of those 65 and older. The unadjusted seasonal unemployment rate for Outagamie, Calumet, and Winnebago Counties was 4.0%, 3.7%, and 4.3%, respectively, compared to a state unemployment rate of 5.1% and a national unemployment rate of 7.9%. Schedule H, Part VI, Line 5 Promotion of community health The Organization strives to further its exempt purposes by the following: (1) The Organization's governing board consists primarily of persons who reside within the primary service area who are not employees of the Organization. (2) As mentioned, the Organization provides several services which are not otherwise available being in a rural setting. (3) Based on the Organization's mission, emergency rooms are made available to all patients regardless of the ability to pay. (4) The Organization also participates in the education and training of healthcare professionals through internship programs. Certain specialized services available include: dental services to primarily the indigent, fertility clinic services and WIC home visits to new mothers and infants. Schedule H, Part VI, Line 6 Affiliated health care system MINISTRY HEALTH CARE, INC. (MINISTRY OR THE HEALTH MINISTRY) IS A MEMBER OF ASCENSION HEALTH. IN DECEMBER 2011, ASCENSION HEALTH ALLIANCE, DOING BUSINESS AS ASCENSION, BECAME THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTH CARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. IN ADDITION TO SERVING AS THE SOLE CORPORATE MEMBER OF ASCENSION HEALTH, ASCENSION SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS OTHER SUBSIDIARIES. ASCENSION, ITS SUBSIDIARIES, AND THE HEALTH MINISTRIES ARE REFERRED TO COLLECTIVELY FROM TIME TO TIME HEREAFTER AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE, THE CONGREGATION OF ST. JOSEPH, THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET, THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE, AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI-US/CARIBBEAN PROVINCE. THE HEALTH MINISTRY IS A WISCONSIN NON-STOCK, TAX-EXEMPT CORPORATION THAT MANAGES, PROMOTES, AND SUPPORTS HEALTH CARE AND RELATED MINISTRIES IN WISCONSIN AND MINNESOTA. THE HEALTH MINISTRY PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF WISCONSIN AND MINNESOTA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE HEALTH MINISTRY IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF THE HEALTH MINISTRY ARE RELATED TO PROVIDING HEALTH CARE SERVICES. EFFECTIVE NOVEMBER 1, 2014, THE HEALTH MINISTRY SOLD 50% OF ITS OWNERSHIP IN NETWORK HEALTH, INC. TO AN UNRELATED HEALTH SYSTEM (SEE NOTE 3). ON FEBRUARY 1, 2015, THE HEALTH MINISTRY TRANSFERRED ITS OWNERSHIP IN MINISTRY HOME CARE, INC. TO ASCENSION HEALTH. THE CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING AFFILIATES LOCATED PRIMARILY IN WISCONSIN, IN WHICH MINISTRY HAS A CONTROLLING INTEREST AND/OR IS THE SOLE SPONSOR. AFFINITY HEALTH SYSTEM, INC. (AFFINITY): CALUMET MEDICAL CENTER, INC. (CMC): AFFINITY MEDICAL GROUP (AMG) TWIN MED, LLC MERCY MEDICAL CENTER, INC. MERCY HEALTH FOUNDATION ST. ELIZABETH HOSPITAL CATALPA HEALTH: ST. ELIZABETH FOUNDATION AGAPE COMMUNITY CENTER OF MILWAUKEE, INC. DOOR COUNTY MEMORIAL HOSPITAL (DOOR COUNTY) GOOD SAMARITAN HEALTH CENTER OF MERRILL GOOD SAMARITAN HEALTH CENTER FOUNDATION HOWARD YOUNG HEALTH CARE, INC. (HOWARD YOUNG): DR. KATE NEWCOMB CONVALESCENT CENTER HOWARD YOUNG MEDICAL CENTER, INC. DR. HOWARD YOUNG FOUNDATION EAGLE RIVER MEMORIAL HOSPITAL, INC. MINISTRY MEDICAL GROUP, INC. MINISTRY HOLDINGS, INC. (THROUGH NOVEMBER 1, 2014): NETWORK HEALTH (NH) (THROUGH NOVEMBER 1, 2014) NETWORK HEALTH INSURANCE CORPORATION (NHIC) (THRU NOVEMBER 1, 2014) OUR LADY OF VICTORY HOSPITAL SACRED HEART HOSPITAL-ST. MARY'S HOSPITAL, INC. ST. CLARE'S HOSPITAL OF WESTON, INC. FOUNDATION OF ST. CLARE'S HOSPITAL OF WESTON, INC. ST. ELIZABETH'S HOSPITAL OF WABASHA, INC. ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. FOUNDATION OF ST. JOSEPH'S HOSPITAL OF MARSHFIELD, INC. ST. MICHAEL'S HOSPITAL OF STEVENS POINT, INC. ST. MICHAEL'S FOUNDATION OF STEVENS POINT, INC. THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE THAT SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND TO OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND FOR COMMUNITY BENEFIT PROGRAMS: 1. TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. 2. UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS. 3. COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND THE OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. 4. COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY OR IN THE COST OF OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OF OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA AND IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF TOTAL OPERATING EXPENSES TO BILLED CHARGES FOR PATIENT CARE. THE AMOUNT OF TRADITIONAL CHARITY CARE PROVIDED, DETERMINED ON THE BASIS OF COST, WAS APPROXIMATELY $12,600 AND $18,400 FOR THE YEARS ENDED JUNE 30, 2015 AND 2014, RESPECTIVELY. THE AMOUNT OF UNPAID COST OF PUBLIC PROGRAMS, COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND FOR OTHER VULNERABLE PERSONS, AND COST OF COMMUNITY BENEFIT PROGRAMS ARE REPORTED IN THE ACCOMPANYING SUPPLEMENTARY INFORMATION. true PARTNERSHIP COMMUNITY HEALTH CENTER INC 5337 GRANDE MARKET DRIVE APPLETON WI 54913 202090446 SECTION 501(C)(3) 70000 Provide medical care for the uninsured in our community. 1 0 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds Each year St. Elizabeth Hospital provides a grant based on an integration agreement. The integration agreement substantiates the amount and the recipient of the grant. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Each year St. Elizabeth Hospital provides a grant based on an integration agreement. The integration agreement substantiates the amount and the recipient of the grant. false true false false false false false false false WILLIAM J CALHOUN HOSPITAL PRES-STE APP (END 9/14) 0 287898 0 120923 0 22874 0 0 0 14940 0 446636 0 0 MONICA ANN HILT PRESIDENT STE HOSPITAL (START 1/15) 0 331953 0 118639 0 121869 0 0 0 19954 0 592415 0 0 DANIEL NEUFELDER SR. VP HOSP OPS/VICE CHAIR 0 791344 0 259379 0 20926 0 0 0 17365 0 1089014 0 0 MARK W FAUSTICH MD BOARD MEMBER 0 440913 0 0 0 24143 0 0 0 3699 0 468754 0 0 JOSEPH MCCORMICK MD BOARD MEMBER 0 424443 0 1000 0 30615 0 0 0 21532 0 477590 0 0 STACEY SENSOR DO BOARD MEMBER 0 526309 0 0 0 0 0 0 0 23275 0 549584 0 0 SUDEEP SODHI MD BOARD MEMBER 0 817681 0 0 0 11909 0 0 0 21095 0 850685 0 0 BARBARA J STRAND MD BOARD MEMBER 0 258827 0 84720 0 25765 0 0 0 7343 0 376654 0 0 JEFF BADGER FORMER OFFICER 0 264031 0 374899 0 20910 0 0 0 13832 0 673672 0 0 TRAVIS ANDERSON HOSPITAL PRES-STE-APP (END 8/2014) 0 176807 0 136945 0 31068 0 0 0 13716 0 358537 0 0 NICHOLAS DESIEN MINISTRY HEALTH CARE CEO 0 1009502 0 1079643 0 45198 0 0 0 18803 0 2153146 0 0 JEFFREY FRANCIS MINISTRY HEALTH CARE CAFO 0 438327 0 141768 0 441745 0 0 0 19803 0 1041644 0 0 LAWRENCE DONATELLE VICE PRESIDENT OF MEDICAL AFFAIRS 0 279755 0 70341 0 26035 0 0 0 17613 0 393744 0 0 MARK KEHRBERG MD CHIEF MEDICAL OFFICER 0 113129 0 344147 0 30066 0 0 0 16019 0 503361 0 0 JENNIE REBECCA GAURKEE PHARMACY DIRECTOR 161138 0 2800 0 12396 0 0 0 19377 0 195711 0 0 0 BRIAN G HUMPHREY SENIOR ULTRASOUND TECHNOLOGIST 137815 0 0 0 15843 0 0 0 7655 0 161313 0 0 0 DEBRA LASTOFKA PHARMACIST 151395 0 8000 0 21296 0 0 0 15783 0 196474 0 0 0 NANETTE KRIZENESKY REGISTERED NURSE LEAD-ICU 149593 0 3538 0 17402 0 0 0 18729 0 189261 0 0 0 ERIC LOBB MEDICAL PHYSICIST 132449 0 0 0 16842 0 0 0 7925 0 157216 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ministry Health Care, Inc., a related organization of St. Elizabeth Hospital, Inc., uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan THESE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FOLLOWING INDIVIDUALS RECEIVED PAYOUT FROM MINISTRY HEALTH CARE'S NON-QUALIFIED RETIREMENT PLAN IN THE AMOUNT AS NOTED: JEFF FRANCIS - $260,079 MONICA HILT - $52,618 Form 990, Part VI, Line 2 FAMILY/BUSINESS RELATIONSHIPS MANY OF THE PERSONS LISTED ON PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT BY MINISTRY HEALTHCARE, INC. RELATED ENTITIES. Form 990, Part VI, Line 15 COMPENSATION OF OFFICERS IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF ST. ELIZABETH HOSPITAL, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS, PERFORMED BY MINISTRY HEALTH CARE, INC., A RELATED ORGANIZATION OF ST. ELIZABETH HOSPITAL, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. Form 990, Part VI, Line 6 Classes of members or stockholders St. Elizabeth Hospital, Inc. has two corporate members, Ministry Healthcare, Inc. and Affinity Health System. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body St. Elizabeth Hospital, Inc. has two corporate members, Ministry Healthcare, Inc. and Affinity Health System, who have the ability to elect members to the governing body of St. Elizabeth Hospital Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to St. Elizabeth Hospital, Inc. financial information or corporation as a whole are subject to approval by its two corporate members, Ministry Healthcare, Inc. and Affinity Health System. Form 990, Part VI, Line 11b Review of form 990 by governing body Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions. Form 990, Part VI, Line 12c Conflict of interest policy The Organization regularly and consistently monitors and enforces compliance with the Conflict of Interest Policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the Conflict of Interest Policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public The Ministry web page is available to the public for inspection with a good deal of information regarding whom Ministry Health Care is and the entities included along with our mission. The Articles of Incorporation, Bylaws, Conflicts of Interest Policy, and financial statements are not included on any web page. However, if an inquiry is made for any documents, they are shared as appropriate. Form 990, Part VII, Section B, Line 1 Independent Contractors The payments reported on Form 990, Part VII, Section B for The Boldt Company and Boldt Procurement represent amounts for both services and materials. These amounts cannot be separated. Form 990, Part VIII, Line 2f Other Program Service Revenue 340 B Pharmacy - Total Revenue: 110068, Related or Exempt Function Revenue: 110068, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FASB 136 ENTRIES - -818122; CATALPA ELIMINATING - -132938; ASCENSION HEALTH ALLIANCE PO BOX 45998 STLOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I N/A false ASCENSION HEALTH PO BOX 45998 STLOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false MINISTRY HEALTH CARE INC 10925 W LAKE PARK DR STE 100 MILWAUKEE WI 53224 391490371 PARENT CORPORATION WI 501(c)(3 Type II ASCENSION HEALTH false AFFINITY HEALTH SYSTEM 1570 MIDWAY PLACE MENASHA WI 54952 391568866 SUPPORT RELATED HEALTHCARE ORGANZIATIONS IL 501(c)(3 3 MINISTRY HEALTH CARE INC false AGAPE COMMUNITY CENTER OF MILWAUKEE INC 6100 NORTH 42ND STREET MILWAUKEE WI 53209 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