ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD (EIN 39-0808480)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-12
- IRS object ID
- 201641339349306219
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-05-12T19:05:21-05:00 | 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 | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390808480 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Nicholas Hospital of the Hospital Sisters of the Third Order of St Franc | BusinessNameLine1Txt |
| Business Name Line2 | is | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STNI | BusinessNameControlTxt |
| Phone | 9204598300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SUPERIOR AVENUE | AddressLine1Txt |
| City | Sheboygan | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 530811948 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREW J BAGNALL | PersonNm |
| Person Title | President and CEO | PersonTitleTxt |
| Signature | 2016-04-21 | 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 | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Nicholas Hospital | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDREW J BAGNALL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SUPERIOR AVENUE | AddressLine1Txt |
| City | Sheboygan | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 530811948 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $81,483,154 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STNICHOLASHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1890 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO CARRY FORWARD THE HEALING MINISTRY OF THE HOSPITAL SISTERS OF ST. FRANCIS AS PART OF THE HEALTH MINISTRY OF THE ROMAN CATHOLIC CHURCH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 587 | TotalEmployeeCnt |
| Total Volunteers | 116 | TotalVolunteersCnt |
| Total Gross UBI | $71,497 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$306,356 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $621,712 | PYContributionsGrantsAmt |
| CY Contributions Grants | $69,586 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $72,617,651 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $77,572,205 | CYProgramServiceRevenueAmt |
| PY Investment Income | $2,298,789 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,392,386 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,367,686 | PYOtherRevenueAmt |
| CY Other Revenue | $1,708,530 | CYOtherRevenueAmt |
| PY Total Revenue | $78,905,838 | PYTotalRevenueAmt |
| CY Total Revenue | $80,742,707 | 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 | $27,789,809 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,919,848 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $46,514,450 | PYOtherExpensesAmt |
| CY Other Expenses | $44,492,803 | CYOtherExpensesAmt |
| PY Total Expenses | $74,304,259 | PYTotalExpensesAmt |
| CY Total Expenses | $73,412,651 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,601,579 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,330,056 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $120,330,298 | TotalAssetsBOYAmt |
| Total Assets EOY | $124,367,846 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $36,648,057 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $37,785,340 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $83,682,241 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $86,582,506 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. THE HOSPITAL'S CORE VALUES OF RESPECT, CARE COMPETENCE AND JOY ARE LIVED BY ALL WHO SERVE HERE, AND FELT BY ALL WHO RECEIVE HEALTHCARE SERVICES AT ST. NICHOLAS HOSPITAL. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,022,334 | ExpenseAmt |
| Revenue | $16,671,030 | RevenueAmt |
| Desc | SURGICAL SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,138,361 | ExpenseAmt |
| Revenue | $12,130,721 | RevenueAmt |
| Desc | DIAGNOSTIC IMAGING - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,235,766 | ExpenseAmt |
| Revenue | $7,748,439 | RevenueAmt |
| Desc | EMERGENCY SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $38,038,091 | ExpenseAmt |
| Revenue | $40,950,518 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMENS' AND INFANT SERVICES, HOMES HEALTH AND HOSPICE CARE CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS FOOT CLINICS, AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $38,038,091 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $40,950,518 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $52,434,552 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | false | TaxExemptBondsInd |
| 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 | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 587 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
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 (20 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 |
|---|---|---|---|---|---|---|---|---|
| ANDREW J BAGNALL | ||||||||
| PRESIDENT & CEO | 40.00 | 0.00 | Yes (X) | Yes (X) | $0 | $344,140 | $87,494 | |
| DAVID VAN DE WATER JD | ||||||||
| CHAIRPERSON | 1.00 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL LANSER EDD | ||||||||
| VICE CHAIRPERSON | 1.00 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SR BERNADINE GUTOWSKI OSF | ||||||||
| SECRETARY | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SR MARYBETH CULNAN OSF | ||||||||
| BOARD MEMBER | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | ||
| STUART W BROTZ | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| TIMOTHY KELLNER | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| CARL CLAERBOUT | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| CHRISTOPHER LARSON MD | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM TRAGER MD | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| S MARK BETTAG MD | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| JOHN WENIG | ||||||||
| BOARD MEMBER | 1.00 | 0 | Yes (X) | $0 | $0 | $0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.25 | 59.25 | Yes (X) | $0 | $335,735 | $228,208 | ||
| THERESE B PANDL | ||||||||
| DIVISIONAL CEO | 15.00 | 45.00 | Yes (X) | $0 | $791,486 | $179,082 | ||
| GREG SIMIA | ||||||||
| DIVISION CFO | 10.00 | 30.00 | Yes (X) | $0 | $414,983 | $77,244 | ||
| ANDREA M ANGOTTI | ||||||||
| PHARMACIST | 40.00 | 0 | $137,099 | $0 | $71,374 | Yes (X) | ||
| MELISSA PALECEK | ||||||||
| PHARMACY MANAGER | 40.00 | 0 | $128,707 | $0 | $13,789 | Yes (X) | ||
| SUSAN M WHEELER | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0 | $142,429 | $0 | $46,082 | Yes (X) | ||
| MARY MARTIN | ||||||||
| CHIEF NURSING OFFICER | 40.00 | 0 | $121,504 | $0 | $19,095 | Yes (X) | ||
| SHALON EDSON | ||||||||
| CLINICAL DIRECTOR | 40.00 | 0 | $104,129 | $0 | $10,947 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $633,868 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,886,344 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $733,315 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ST VINCENT HOSPITAL | |||||
| 835 S VAN BUREN STREET | GREEN BAY | WI | 54301 | SHARED SERVICES | $6,521,671 |
| DIVERSIFIED CLINICAL SERVICES | |||||
| PO BOX 551187 | JACKSONVILLE | FL | 32255 | CLINICAL | $743,100 |
| SODEXO INC | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD & HOUSEKEEPING | $652,614 |
| ST MARY'S HOSPITAL MEDICAL CENTER | |||||
| 1726 SHAWANO AVE | GREEN BAY | WI | 54303 | SHARED SERVICES | $581,952 |
| ANESTHESIOLOGY ASSOCIATES LTD | |||||
| 3100 SUPERIOR AVE | SHEBOYGAN | WI | 53081 | CONTRACTED SERVICES | $383,450 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $69,586 | RelatedOrganizationsAmt |
| Total Contributions | $69,586 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 900099 | $77,500,708 | $77,500,708 | |
| LABORATORY OUTREACH REVENUE | 621500 | $71,497 | $0 | $71,497 |
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 | $77,572,205 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $203,958 | TotalRevenueColumnAmt |
| Exclusion | $203,958 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,113,416 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $740,447 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $372,969 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $372,969 | TotalRevenueColumnAmt |
| Exclusion | $372,969 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,184,628 | SecuritiesAmt |
| Other | $3,800 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,184,628 | SecuritiesAmt |
| Other | $3,800 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,188,428 | TotalRevenueColumnAmt |
| Exclusion | $1,188,428 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $1,359,366 | $1,359,366 |
| LOSS ON EARLY EXTINGUISHMENT OF DEBT | 900099 | -$23,805 | -$23,805 |
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 | $1,335,561 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $80,742,707 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77,500,708 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $71,497 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,100,916 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,681,676 | TotalAmt |
| Program Services | $15,177,173 | ProgramServicesAmt |
| Management And General | $6,504,503 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,395,976 | TotalAmt |
| Program Services | $977,183 | ProgramServicesAmt |
| Management And General | $418,793 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,361,568 | TotalAmt |
| Program Services | $3,053,098 | ProgramServicesAmt |
| Management And General | $1,308,470 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,480,628 | TotalAmt |
| Program Services | $1,036,440 | ProgramServicesAmt |
| Management And General | $444,188 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,881,364 | TotalAmt |
| Program Services | $4,116,955 | ProgramServicesAmt |
| Management And General | $1,764,409 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,238 | TotalAmt |
| Program Services | $44,267 | ProgramServicesAmt |
| Management And General | $18,971 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,733,726 | TotalAmt |
| Program Services | $11,713,609 | ProgramServicesAmt |
| Management And General | $5,020,117 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,291 | TotalAmt |
| Program Services | $54,804 | ProgramServicesAmt |
| Management And General | $23,487 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,996 | TotalAmt |
| Program Services | $133,697 | ProgramServicesAmt |
| Management And General | $57,299 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,653 | TotalAmt |
| Program Services | $36,857 | ProgramServicesAmt |
| Management And General | $15,796 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,218 | TotalAmt |
| Program Services | $147,153 | ProgramServicesAmt |
| Management And General | $63,065 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,851,873 | TotalAmt |
| Program Services | $2,696,311 | ProgramServicesAmt |
| Management And General | $1,155,562 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,640 | TotalAmt |
| Program Services | $174,048 | ProgramServicesAmt |
| Management And General | $74,592 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $10,308,446 | $7,215,912 | $3,092,534 |
| BAD DEBT | $1,505,354 | $1,505,354 | |
| MEDICAID ASSESSMENT TAX | $1,980,299 | $1,980,299 | |
| EQUIPMENT RENTAL & MAINTENANCE | $1,842,776 | $1,289,943 | $552,833 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,544,929 | TotalAmt |
| Program Services | $1,081,449 | ProgramServicesAmt |
| Management And General | $463,480 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,412,651 | TotalAmt |
| Program Services | $52,434,552 | ProgramServicesAmt |
| Management And General | $20,978,099 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,450 | BOYAmt |
| EOY | $1,450 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,340,461 | BOYAmt |
| EOY | $8,625,034 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,982,434 | BOYAmt |
| EOY | $13,297,399 | 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 |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,521,326 | BOYAmt |
| EOY | $1,864,223 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,417 | BOYAmt |
| EOY | $273,611 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $118,851,772 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $73,118,236 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,273,322 | BOYAmt |
| EOY | $45,733,536 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,920,087 | BOYAmt |
| EOY | $52,840,490 | 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 | $890,638 | BOYAmt |
| EOY | $793,312 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,244,163 | BOYAmt |
| EOY | $938,791 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,330,298 | BOYAmt |
| EOY | $124,367,846 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,726,410 | BOYAmt |
| EOY | $8,408,141 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,833 | BOYAmt |
| EOY | $155,118 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,768,347 | BOYAmt |
| EOY | $18,819,915 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,964,467 | BOYAmt |
| EOY | $10,402,166 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,648,057 | BOYAmt |
| EOY | $37,785,340 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,988,187 | BOYAmt |
| EOY | $78,507,866 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,007,889 | BOYAmt |
| EOY | $6,378,475 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,686,165 | BOYAmt |
| EOY | $1,696,165 | EOYAmt |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,682,241 | BOYAmt |
| EOY | $86,582,506 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $120,330,298 | BOYAmt |
| EOY | $124,367,846 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,330,056 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$739,433 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,690,358 | 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $7,563 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,563 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | ST. NICHOLAS HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR THE HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE OT LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,715,010 | OtherCostOrOtherBasisAmt |
| Book Value | $1,715,010 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,872,654 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,998,249 | DepreciationAmt |
| Book Value | $17,874,405 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $741,079 | OtherCostOrOtherBasisAmt |
| Depreciation | $110,782 | DepreciationAmt |
| Book Value | $630,297 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,837,153 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,732,198 | DepreciationAmt |
| Book Value | $12,104,955 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,685,876 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,277,007 | DepreciationAmt |
| Book Value | $13,408,869 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $45,733,536 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE | $1,159,249 |
| OTHER LONG TERM LIABILITIES | $337,083 |
| ACCRUED PENSION | $8,905,834 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,402,166 | 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 and the Foundation are Illinois not for profit organizations as described in Section 501(c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely than not that Kiara, Inc. will not realize the majority of the benefits of these deductible differences. The deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2015 and 2014 have been fully reserved in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2015 and 2014, HSHS does not have any liabilities for unrecognized tax benefits. | 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 | 600 | 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) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 1485 | PersonsServedCnt |
| Total Community Benefit Expns | $2,805,273 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,815,052 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $990,221 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0138 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 9482 | PersonsServedCnt |
| Total Community Benefit Expns | $14,255,766 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,041,570 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,214,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1142 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 377 | PersonsServedCnt |
| Total Community Benefit Expns | $571,632 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $386,777 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $184,855 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0026 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 11344 | PersonsServedCnt |
| Total Community Benefit Expns | $17,632,671 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,243,399 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,389,272 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1306 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 34 | ActivitiesOrProgramsCnt |
| Persons Served | 5271 | PersonsServedCnt |
| Total Community Benefit Expns | $185,831 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $400 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $185,431 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0026 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $68,777 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,777 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 115 | PersonsServedCnt |
| Total Community Benefit Expns | $8,808 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $860 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,948 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 34800 | PersonsServedCnt |
| Total Community Benefit Expns | $45,471 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $45,471 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0006 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 41 | ActivitiesOrProgramsCnt |
| Persons Served | 40186 | PersonsServedCnt |
| Total Community Benefit Expns | $308,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,260 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $307,627 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0043 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 44 | ActivitiesOrProgramsCnt |
| Persons Served | 51530 | PersonsServedCnt |
| Total Community Benefit Expns | $17,941,558 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,244,659 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,696,899 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1349 | 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) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $3,650 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,650 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | 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) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,174 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,174 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,191 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,191 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | 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 | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $10,015 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,015 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,505,354 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $161,463 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $29,153,230 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $47,042,323 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$17,889,093 | 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 | ORANGE CROSS AMBULANCE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | AMBULANCE SERVICES | 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 NICHOLAS HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.stnicholashospital.org | WebsiteAddressTxt |
| State License | 37 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| 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 NICHOLAS HOSPITAL | 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 | 14 | 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 | https://www.stnicholashospital.org/Hospital-Information/About/Community-Health-Needs.aspx | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.stnicholashospital.org/Hospital-Information/About/Community-Health-Needs.aspx | 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 | https://www.stnicholashospital.org/Patient-Guest/HSHS-EWD-Patient-Financial-Services.aspx | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.stnicholashospital.org/Patient-Guest/HSHS-EWD-Patient-Financial-Services.aspx | 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 (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - St. Nicholas Hospital. In addition to qualitative and quantitative data sources, 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. Community Health Improvement Call to Action October 2, 2014 Attendee List - Melissa Argall, Lutheran Social Services, Licensed Counselor - Brooke Artabasy, Aurora Sheboygan Memorial Medical Center, Health Promotions Coordinator - Kate Baer, Mental Health America, Executive Director - Jerry Baker, Aurora Sheboygan Clinic, Clinic Administrator - Jean Beinemann*, Sheboygan County Division of Public Health, Supervisor - Amy Betke*, Sheboygan County Division of Public Health, Public Health Nurse - Kristin Blanchard#, Lakeshore Community Health Center, CEO - Kelly Boeldt, Prevea Health & Wellness Account Executive - Terri Boxrucker*, Sheboygan County Division of Public Health, Sheboygan County Division of Public Health - Paula Burkart, Community Member, Community Member - Mike Burns, YMCA, Vice President - Programs - Chuck Butler, Sheboygan Fire Department Deputy Chief - Liz Campion*, Sheboygan County Division of Public Health, Public Health Nurse - Sherry Carstens, Lakeland College, Director of Health Center - Denise Cesar#, Salvation Army, Case Manager - Elizabeth Clarke, Aurora Health Care, Community Benefits Coordinator - Diane Cline, Manitou Girl Scouts, COO - Abby Dahmer#, Salvation Army Emergency Lodge Case Manager - Tanya Damrow, Serenity Hospice Care, Director of Volunteer & Bereavement Services - Nathan Dehne, Lakeland College, Vice President for Student Development - Dale Deterding, Sheboygan County ADRC, Aging Unit Director - Barb Dodge, HHS Committee and LTC, Dean Health and Human Services - Jon Doll# , United Way, Executive Director - Kim Ecclestone, Aurora - Vince Lombardi Cancer Clinic, Cancer Nurse Navigator - Tom Eggebrecht, Health and Human Services, Director - Kristine Feggestad, UW-Sheboygan, Licensed Professional Counselor - Connie Frank, Rehabilitation Center of Sheboygan, RN Medical Services - Anne Gamoke, Plymouth School District, Director of Pupil Services - Martha Gedemer, Comfort Keepers, Office Manager/Human Resources - Tom Gessler, Community Member - Terese Gessler, Community Member - Patti Glaser-Martin, Hospital Sisters Health System/Prevea, Sr. Manager, Internal Communication and Community - Dave Graebner, Aurora Sheboygan Memorial Medical Center, CEO - Starr Grossman*, Sheboygan County Division of Public Health, Public Health Nurse - Melissa Grube#, Lakeshore Community Health Center ,Patient Access Manager - Donna Habeck, Prevea, MD - Lori Hamilton, Sheboygan Area School District, School Nurse - Amber Harrigan, Random Lake School District, Elementary Counselor - Mike Heidt, Aurora Sheboygan Memorial Medical Center, Director of Rehabilitation and Growth and Market Development at Aurora Health Care - Dale Hippensteel, Community Member - Terri Hosterman, Aurora Sheboygan Memorial Medical Center - Andrew Hoyer-Booth, WPHCA, Program Coordinator - Michael Huck#, Lakeshore CAP, Executive Director - David Hughes#, Lakeshore Community Health Center CFO - Jane Jensen, UW-Extension, Family Living Educator - Cary Knier, Lakeland College, Director of Counseling Services - Lori Knitt, Aurora Sheboygan Memorial Medical Center, CNO - Barb Kolar*, Sheboygan County Division of Public Health, Public Health Nurse - Ashley Krause#, Lakeshore Community Health Center, Outreach and Enrollment Specialist, Certified Application Counselor - Barb Kultgen*, Sheboygan County Division of Social Services, Social Worker - Diane Liebenthal*, Sheboygan County Division of Public Health, Supervisor - Kevin Lukes, Prevea Service Line Marketing Manager - Shannon Madden , Love, Inc., Clearinghouse Coordinator - Jean McMurray , Aurora Sheboygan Memorial Medical Center, Market Manager - Meridith Mueller, Aurora Health Care, Community Benefit Analyst - Carol Myers, Family Resource Center, Literacy Council Data and Development Coordinator - David Neave#, Salvation Army, Social Services Director - Char Neitzel-Goostree#, Sheboygan Housing Authority, Housing Counselor - Mary Ann Neuses, Community Member - Jill Niemczyk, NEWAHEC, Program Manager - Denice Nugent, YMCA, Senior Physical Director - Robert O'Hara, Boys and Girls Club, Executive Director - Sara O'Hara#, United Way, Community Impact Director - Joyce Osieczanek, Aurora Sheboygan Clinic, Clinical Immunization Assistant/Sheboygan County Immune Co-Chair - Pam Ott , Aurora Sheboygan Memorial Medical Center, Vice President - Finance - Roger Otten, Health and Human Services Board, County Supervisor - Mary Paluchniak, HSHS St. Nicholas Hospital, Facilitator - Outreach - Adam Payne, Sheboygan County, County Administrator - Jean Pittner*, Sheboygan County Division of Public Health, Dietician - Kathy Pluskat, Child Support, Supervisor - Todd Priebe, Sheboygan County, Sheboygan County Sheriff - Jean Puls , Sheboygan Leadership Academy, Community Outreach & Service Learning Coordinator - Karlyn Raddatz*, Sheboygan County Division of Public Health, County Health Officer - Lynsey Ray, WPHCA, Facilitator - MaryAdele Revoy, Family Resource Center, Coordinator of Resources and Development - Paula Rojas#, Partners for Community Development Outreach Coordinator - Michael Romas, City of Sheboygan, Fire Chief - Ann Salzmann, Aurora Sheboygan Memorial Medical Center, Case Manager - Sherri Samuels-Fuerst, Sargento Foods, Director - Compensation and Benefits - Pam Sandee#, Salvation Army, Clinic Coordinator - Martin Schaller, NEWAHEC, Executive Director - Elizabeth Scheelk, State of WI - NE Region , Public Health Educator - Denise Schemenauer, Manitou Girl Scouts, CEO - Deb Schmidt*, Sheboygan County Division of Public Health, Public Health Nurse - Jennifer Schmidt, Lakeshore Community Health Center, Community Outreach and Enrollment Specialist - Michele Schmitt, Lakeshore Community Health Center, Clinical Administator - Vicky Schneider*, Sheboygan County Division of Public Health, Public Health Nurse - Jan Scholke, Prevea, Smoke Free Program - Heidi Selberg, Hospital Sisters Health System, VP Advocacy and Community Benefit - Annette Selk, Sheboygan County Division of Public Health, Public Health Nurse - Shawna Silberzahn, Community Member - Britne Stanke, Sheboygan Falls School District, Middle School Counselor - Bobbi Stauber*, Sheboygan County Division of Public Health, Public Health Aide - Susan Steinhardt, Sunny Ridge, RN - Sue Thiel*, Sheboygan County Division of Public Health, Public Health Nurse - Tammy Thill, Lutheran Social Services, Social Work - Lindsay Thomack, Partners for Community Development, Healthcare Program Manager - Virginia Thomas, Community Member - Luann Travis, Family Resource Center, Executive Director - Patrick Uselding, Sheboygan Falls School District, Middle School Counselor - Mike Vandersteen, City of Sheboygan, Mayor - Cindy VanderWeele* ,Sheboygan County Division of Public Health, Public Health Nurse - Jim Veeser, Sheboygan Police Department Sgt. -Emily Vetting, Sheboygan County Planning & Conservation, Associate Planner - Darcy Vollrath, Sheboygan ADRC - Brett Voskuil, Aurora Sheboygan Memorial Medical Center, Physical Therapy Assistant - Lindsay Wagner, Concordia University, BSN Completion Student - Katie Warden, UW-Green Bay - Ruth Weigel, Rehabilitation Center of Sheboygan, Day Services Coordinator - Donna Wendlandt, YMCA, President - Wendy Williams, Aurora Health Care, Director of Quality and Medical Staff - Jean Wodach*, Sheboygan County Division of Public Health, Clerical Support Staff - Ann Wondergem#, United Way, Director of Operation & Program Management *Public Health Representative #Representative of minority, underserved or low income populations/chronic disease populations |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - St. Nicholas Hospital. Aurora Sheboygan Medical Center |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - St. Nicholas Hospital. HSHS St. Nicholas partnered with a number of community organizations, including Healthy Sheboygan County 2020, Lakeshore Community Health Center, Sheboygan County Division of Public Health, United Way of Sheboygan County, and University of Wisconsin-Extension - Sheboygan County, to complete the community health needs assessment. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - St. Nicholas Hospital. Identification and Prioritization of Needs: The following health needs were identified based on burden, scope, severity and urgency of the health need; the health disparities associated with the health need; the importance the community places on addressing the health need; the community assets and resources that could be leveraged through strategic collaboration in the hospital's service area to address the health need; secondary data sources; local expertise and input. * Mental Health * Alcohol, Tobacco and Other Drug Abuse (ATODA) * Physical Activity and Nutrition * Oral Health (continued from FY2012 CHNA) The process used to determine the priorities is below. In October 2014, a Community Health Improvement Call to Action including approximately 110 community leaders with representation from business, non-profit agencies, healthcare, education, public health and safety and elected officials was convened. The objective of the event was to obtain community input to identify and prioritize health issues that the hospital is best positioned to address in partnership with other organizations in the community. This event included a presentation by Karlyn Raddatz, RN, Sheboygan County Health Officer with a review of Healthy People 2020 and Healthiest Wisconsin 2020's 12 Health Focus Areas and Objectives to present a framework for identifying the health priorities. Jean Beinemann, RN, Program Supervisor from the Sheboygan County Division of Public Health updated the group on the Key Accomplishments of the Healthy Sheboygan County 2020 Coalition since 2011. The event included: data review, subgroup discussion in addition to a nominal group process to determine the communities' health priorities. * The review of the data included information gained from the telephonic community health survey, secondary data sources and key interviews. * The large group was divided into small subgroups (6-8 members) to discuss the following questions: - What is your vision for the Health of Sheboygan County in 2014? - For each of the priorities - what systemic change will help us achieve these? - What factors within the local, state, national environment may restrict our ability to achieve our aspirations in 2014? - How will you measure whether Sheboygan County will be successful at achieving this vision? * A large group report out session was led by the facilitator to determine priorities based on the small group discussions. After this group prioritization each participant was asked to vote for their top three issues. To accomplish this each participant was given three dots with instructions that they could vote for three different priorities or could place all three of their dots on one priority. The top three priorities identified included: * Mental Health * ATODA * Physical Activity and Nutrition In addition to these priorities the focus areas listed below were identified as being an integral component of each of the priorities. * Education/Prevention * Access to Services * Coordination/Continuity of care services * Health Literacy * Integration of Well County Initiatives Implementation Plan Development: 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. |
| Schedule H, Part V, Section B, Line 11 Facility , 2 | Facility , 2 - St. Nicholas Hospital (continued). Implementation Plan St. Nicholas Hospital will partner with community wide action teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address the identified priority community health needs. The set of implementation strategies and interventions are contained in the Implementation Plan which was approved and adopted by an authorized body of the hospital. The implementation strategies and interventions will include, but are not limited to, the following initiatives in each of the five health needs categories. 1. Mental Health - HSHS St. Nicholas Hospital is involved in the development, implementation and/or continuation of the following efforts to improve access to care. a. Support the activities of the community action planning teams, which have their own three year plan with goals and outcome measures (work plans will be attached to this report upon completion). b. Develop strategies to ensure Health literacy is a component of all the programming and activities. 2. ATODA - HSHS St. Nicholas Hospital is engaged in the development, implementation and/continuation of the following efforts to improve ATODA services. a. Support the activities of the community action planning teams, which have their own three year plan with goals and outcome measures (work plans will be attached to this report upon completion). b. Develop strategies to ensure Health literacy is a component of all the programming and activities. 3. Physical Activity and Nutrition - HSHS St. Nicholas Hospital is supportive of the development, implementation and/or continuation of the following efforts to address obesity. a. Support the activities of the community action planning teams, which have their own three year plan with goals and outcome measures. (work plans will be attached to this report upon completion). b. Develop strategies to ensure Health literacy is a component of all the programming and activities. 4. Identify and implement programs to provide appropriate care to poor and needy. a. Develop strategies to reduce ED visits by Medicaid patients and provide them with care in setting appropriate to their needs. b. Provide assistance to community members to enroll in insurance products through the marketplace or to enroll in BadgerCare, as appropriate for their situation. c. 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. In addition, though not identified as one of the top focus areas, oral health continues to be a major concern within our community. Oral health was the top focus area in our previous Community Health Needs Assessment. In response to this need, in January, 2012 the Lakeshore Community Health Center opened for dental services one day a week. Currently the clinic continues to grow and has become a Federally Qualified Health Center. In 2014 they served nearly 3000 people. Access to Dental Care 5. HSHS St. Nicholas Hospital is involved in the implementation and /or continuation of the following efforts to improve access to dental care. a. Support the activities of the Dental Access Committee. b. Support the activities of the Lakeshore Community Health Center. c. Develop strategies to reduce ED visits for dental conditions d. Continue to support and explore additional strategies to provide educational materials and community resources for providers to share with their patients. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (19 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 VI, Line 5 Promotion of community health (continued) | Responding to Community Need HSH St. Nicholas Hospital provides a range of community benefits that flow from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Nicholas, and they often relieve a burden that would otherwise be carried by government. HSHS St. Nicholas' active participation with the Regional Enrollment Network continues with partnership with a number of local social service agencies, health care professional and insurance professional to ensure community members have opportunities to obtain insurance thru the Marketplace. As part of this initiative HSHS St. Nicholas Hospital contracts with The Resolute Group to provide on-site services for community members. The hospital hosted a community education session on the Federal Health Marketplace in addition to providing staff to participate in a community enrollment fair. Another example of community benefit at St. Nicholas is the Hope After Loss Organization (HALOTM), which provides support to families who experience loss of life during pregnancy. This program serves the entire community, at no cost to participants, whether their loss occurred at St. Nicholas Hospital or another facility. More than 100 participants attended HALO programs. Community Benefit at St. Nicholas also includes multiple programs aimed at health promotion. St. Nicholas Hospital actively participates in "Healthy Sheboygan County 2020", a collaborative group of local community organizations focused on improving the lives of people in our county. Hospital staff co-chairs the Health Literacy Committee. Sheboygan County Activity & Nutrition (SCAN) receives support through the hospital's participation in the Employee Health & Fitness Day and local health fairs. * St. Nicholas Hospital is an active co-sponsor of the Lakeshore Community Health Center developed to address the need to increase access to health care for the uninsured and underinsured in Sheboygan County. In addition to financial support, the Hospital has dedicated staff to assist with the important community benefit effort by serving on the Program/Quality Improvement Committee. * Support groups (free) for cancer, brain injury, and grief support. * Free use of hospital conference and meeting rooms for area not-for-profit organizations. * Professionals at the hospital assisted more than 1,500 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. * Free bike helmet fittings and helmets at cost, open to the public. * More than 220 individuals attended foot clinics for the elderly and individuals with diabetes. The clinics assist with care that can be difficult due to degenerative health conditions as well as provide regular specialized care for diabetics. * Diagnostic imaging services for Salvation Army Free Clinic patients * Financial support and in-kind services for Sheboygan County Interfaith Organization, Family Resource Center, Safe Harbor Domestic Abuse Shelter, and schools reaches thousands in need within the greater Sheboygan County area. * Food drives for area food pantries; school supply and clothing drives for area schools. * Offer community blood drives with the Red Cross twice yearly. The annual Good Friday Blood Drive has been ongoing for more than 30 years, encouraging members from the Catholic Community to donate after Good Friday Mass. We collected 24 pints during our most recent drive. * Collected one truckload of home medical supplies for the annual Community Medical Collection to support Hospital Sisters Mission Outreach, a medical surplus recovery organization focused on meeting the health care needs of individuals in developing countries. Collection included wheelchairs, walker, canes, bandages, ace wraps, and other home medical supplies. This was done in conjunction with the Community Wide Medication Take Back Event. We hosted the Sheboygan site which was one of three county locations. The total amount of medication collected that day from all three locations totaled almost 400 pounds with 194 pounds being collected at HSHS St. Nicholas Hospital. * Staff from our organization participates on the Mental Health America of Sheboygan County Board. * Worked with community partners to sponsor a Mental Health and Alcohol and Other Drug Abuse Resource Fair. More than 140 participants attended this event. In addition, we provided sponsorship for Sculpture and Blues, a mental health awareness event which was attended by more than 300 people. * Provides a no cost way for community members to properly dispose of their contaminated sharps. There is a Drop Box located inside the Emergency Entrance where sharps containers can be brought 24 hours a day, 7 days a week. |
| Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation | 1505354 |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | To determine the actual cost of these services, the hospital uses a cost-to-charge ratio based on our audited financial statements to calculate the amounts reported on Lines 7a through 7i. |
| Schedule H, Part II Community Building Activities | THE COMMUNITY BUILDING ACTIVITIES THAT WE HAVE TRACKED AND REPORTED IN OUR COMMUNITY BENEFIT REPORT ARE A MINOR PORTION OF OUR TOTAL COMMUNITY BENEFIT EFFORTS. THEY INCLUDE PROVIDING HOUSES WITH FINANCIAL SUPPORT AND IN-KIIND SERVICES FOR SHEBOYGAN COUNTY INTERFAITH ORGANIZATION AND THEIR BRIDGEWAY HOUSE, WHICH PROVIDES TEMPORARY HOUSING FOR HOMELESS WOMEN AND CHILDREN AND FAMILIES TRANSITIONING OUT OF DOMESTIC ABUSE SITUATIONS. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors that do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for Doubtful Accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations. St. Nicholas Hospital reports bad debt in accordance with Healthcare Financial Management Association Statement 15, as modified by and consistent with Generally Accepted Accounting Principles (GAAP). |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | The hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 20 of the HSHS Consolidated Audit Report. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Nicholas Hospital is relieving the burdens of the government. Accordingly, this shortfall restricts St. Nicholas Hospital's ability to make funds available to provide for charity care and other community benefits. The hospital Medicare shortfall at cost for fiscal year 2015 was $17,889,093. |
| 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. NICHOLAS HOSPITAL: Line 16b URL: https://www.stnicholashospital.org/Patient-Guest/HSHS-EWD-Patient-Financial-Services.aspx; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. NICHOLAS HOSPITAL: Line 16c URL: https://www.stnicholashospital.org/Patient-Guest/HSHS-EWD-Patient-Financial-Services.aspx; |
| Schedule H, Part VI, Line 2 Needs assessment | As indicated in Part V, Section C, HSHS St. Nicholas Hospital conducted a Community Health Needs Assessment in FY2015 (July 1, 2014 through June 30, 2015). In previous years, we assessed community need by a number of methods to assess health care needs. For example, in FY2012 we conducted a collaborative, multistage process that included HSHS St. Nicholas and Sheboygan County Health Division of Public Health, and community partners. Two complementary community engagement sessions occurred; one sponsored by HSHS St. Nicholas and one sponsored by Sheboygan County Health Division of Public Health. In both of the sessions, participants developed priorities for community-wide action based. We also have a community advisory committee that is representative of the community that the hospital serves. The committee meets regularly to discuss hospital services and the ability of the hospital to meet community health care needs. Agendas are purposely organized to include time for feedback from members on what they are hearing in the community. In addition, hospital colleagues represent the hospital on a variety of community groups. Through this representation, the hospital becomes aware of emerging needs and as a result is able to offer or support screening and education programs that address these 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. Nicholas Hospital led a collaborative approach to conduct its CHNA and adopt an Implementation Plan in FY2015 (July 1, 2014 through June 30, 2015), a process we undertake every three years. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | The Registration Department provides brochures to patients upon registration regarding the Payment Assistance Program available to them at HSHS St. Nicholas Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. HSHS St. Nicholas Hospital translates forms into other primary languages spoken by its patient population. The organization has a representative on site to assist patients who may be eligible for BadgerCare (Medicaid) assistance through the Wisconsin Department of Health Services. They work with patients to determine if they may be eligible, and if so, assist in pulling together the necessary application for submission. 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 | Sheboygan County is primarily an urban county, one of 72 counties, and is located in eastern Wisconsin. The population of approximately 115,000 is primarily Caucasian (88%). Five percent of the population is Hispanic, and another 5% is Asian. The percent of people age 65 and over exceeds state and national levels. According to the Wisconsin Department of Health Services, 10.8% of residents are below the federal poverty level. More than 14,000 residents are covered by Medicaid/Badger Care Plus. According to the Wisconsin Department of Health Services Division of Public Health, 6% of Sheboygan County's population is uninsured. The hospital does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. Within the report area 18% of adults 18 and older report having poor or fair health in response to the question "Would you say that in general your health is excellent, very good, good, fair or poor?" -- higher than the state rate of only 15%. This indicator is relevant because it is a measure of general poor health status. Sheboygan County contains a primary care and a mental health HPSA (health professional shortage area). There are two not for profit, general medical and surgical hospitals serving Sheboygan County. |
| Schedule H, Part VI, Line 5 Promotion of community health | As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), St. Nicholas Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded more than 125 years ago to bring a healing presence and improve the health of our community, especially for those persons who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Sheboygan County and surrounding areas. The hospital is governed by a Board of Directors, at least a majority of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Nicholas Hospital is responding to community need. In FY2015, for example, the Board reviewed the Community Health Needs Assessment and approved an Implementation Plan for addressing selected health focus areas. In addition our hospital Advisory Council, Friends of St. Nicholas Foundation and the Partners of St. Nicholas Hospital, whose volunteer members assist in many areas of the hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, HSHS St Nicholas Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Nicholas Hospital reinvests surplus funds to support the mission of the organization and health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Nicholas Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2015, HSHS St. Nicholas Hospital provided more than $9,706,914 million in Community Benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in fiscal year 2015, HSHS St. Nicholas Hospital provided more than $17,889,093 million (at cost) in excess of Medicare payment for health care services. HSHS St. Nicholas Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives would not exist without the leadership role played by HSHS St. Nicholas Hospital and they often relieve a burden that would otherwise be carried by government. The majority of the Community Benefit programs and activities provided in FY2015 are in response to the hospital's FY2012 Community Health Needs Assessment (CHNA). The FY2012 CHNA surfaced the following health focus areas to be addressed by the hospital in collaboration with other hospitals and community organizations: * Oral Health The hospital has been active in supporting the establishment of a community clinic. In FY2015, St. Nicholas continued to support the Lakeshore Community Health Center, with a particular focus on the identified oral health need within our community, including financial support to purchase additional dental equipment to expand the clinic's services as well as actively participating on the Program/QI Committee. A significant portion of the dental equipment which was funded is being used to for the the expansion of the dental services provided within the Sheboygan Area School District to allow for restorative care to be provided to students. In addition, St. Nicholas also participates on oral health projects through its membership in the Sheboygan County Dental Access Committee, including Give Kids a Smile day. From July 2014 thru June 2015, the dental clinic has served more than 5,000 people. * Health Literacy Hospital staff co-chairs the Healthy Sheboygan County 2020 Health Literacy Committee, comprised of community hospitals, health care providers, Department of Public Health, University of Wisconsin - Extension, social services agencies and the Literacy Counsel. The Health Literacy Committee launched their community awareness campaign OK2Ask which was supported by funds from HSHS St. Nicholas Hospital. These funds were utilized as part of the media campaign including bus advertising. As part of this effort St. Nicholas Hospital staff was a co-presenter at the Wisconsin Health Literacy Summit sharing the health literacy initiative within Sheboygan County. In addition, outreach about this campaign was shared with a presentation at the Ministerial Association, article in the local newspaper and an interview on the local radio. * Adequate, appropriate and safe food and nutrition In partnership with Prevea Health, St. Nicholas Hospital provided nutritional education to the community at the Farmers Market. In addition, the hospital provided the public with the opportunity to "Ask the Nurse" and receive educational materials at the Farmers Market as well as healthy food samples and showcasing recipes utilizing local produce. |
| Schedule H, Part VI, Line 6 Affiliated health care system | St. Nicholas Hospital in Sheboygan 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 (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDREW J BAGNALL | ||||||||||||||
| PRESIDENT & CEO | $0 | $252,541 | $0 | $55,437 | $0 | $36,162 | $0 | $60,534 | $0 | $26,960 | $0 | $431,634 | $0 | $0 |
| ANN M CARR | ||||||||||||||
| TREASURER | $0 | $238,965 | $0 | $34,985 | $0 | $61,785 | $0 | $207,994 | $0 | $20,214 | $0 | $563,943 | $0 | $28,503 |
| THERESE B PANDL | ||||||||||||||
| DIVISIONAL CEO | $0 | $624,051 | $0 | $146,556 | $0 | $20,879 | $0 | $148,433 | $0 | $30,649 | $0 | $970,568 | $0 | $0 |
| GREG SIMIA | ||||||||||||||
| DIVISION CFO | $0 | $414,983 | $0 | $0 | $0 | $0 | $0 | $50,389 | $0 | $26,855 | $0 | $492,227 | $0 | $0 |
| ANDREA M ANGOTTI | ||||||||||||||
| PHARMACIST | $137,099 | $0 | $0 | $0 | $0 | $0 | $49,537 | $0 | $21,837 | $0 | $208,473 | $0 | $0 | $0 |
| SUSAN M WHEELER | ||||||||||||||
| DIRECTOR OF PHARMACY | $142,429 | $0 | $0 | $0 | $0 | $0 | $26,916 | $0 | $19,166 | $0 | $188,511 | $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). Ann Carr -- $29,789 Therese Pandl -- $77,769 Andrew Bagnall -- $33,257 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2014; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANN CARR -- $28,503 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a SURGICAL SERVICES | ST. NICHOLAS HOSPITAL SURGICAL SERVICES ARE COMPRISED OF CENTRAL PROCESSING, ANESTHESIA, SURGERY AND RECOVERY. THIS INCLUDES TEN OR SUITES. SEVEN OF THE SURGICAL SUITES ARE LOCATED IN THE HOSPITAL AND THREE ARE LOCATED AT THE ST. NICHOLAS SHEBOYGAN SURGERY CENTER, WHICH WAS ACQUIRED 01/01/2014. SERVICES ARE AVAILABLE 24/7 AND INCLUDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. IN FISCAL YEAR 2014-2015 THERE WERE 5,551 SURGICAL PROCEDURES PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, UROLOGY, TRAUMA AND GYNECOLOGY. ANESTHESIA AND CENTRAL PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. |
| Form 990, Part III, Line 4b RADIOLOGY SERVICES | ST. NICHOLAS HOSPITAL IMAGING SERVICES PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. OVERALL, THE DEPARTMENT PERFORMS MORE THAN 30,000 INPATIENT AND OUTPATIENT EXAMS AND PROCEDURES ANNUALLY. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN RADIOLOGY, COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE, POSITRON EMISSION TOMOGRAPHY (PET), AND ULTRASOUND. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. |
| Form 990, Part III, Line 4c EMERGENCY SERVICES | ST. NICHOLAS HOSPITAL OPERATES A LEVEL III TRAUMA CENTER/EMERGENCY DEPARTMENT THAT IS OPEN 24/7 AND STAFFED BY BOARD-CERTIFIED EMERGENCY MEDICINE PHYSICIAN SPECIALISTS. STAFF MEMBERS ARE CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT, AND TRAUMA. IN FISCAL YEAR 2014-2015 THERE WERE 14,090 VISITS TO THE EMERGENCY CENTER. LIKE ALL HOSPITAL SERVICES, EMERGENCY CARE IS PROVIDED REGARDLESS OF RACE, CREED, OR ABILITY TO PAY, AND FINANCIAL ASSISTANCE IS AVAILABLE AFTER CARE IS PROVIDED FOR THOSE IN NEED. |
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 38,038,091 including grants of $)(Revenue $ 40,950,518) OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMENS' AND INFANT SERVICES, HOMES HEALTH AND HOSPICE CARE CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS FOOT CLINICS, AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. |
| Form 990, Part IV, Line 24a TAX EXEMPT BONDS | ST. NICHOLAS HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"). AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HSSI FORM 990. |
| Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. |
| Form 990, Part VI, Line 16b JOINT VENTURES | HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. NICHOLAS HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. NICHOLAS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. NICHOLAS HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SENIOR GOVERNING BODY OF ST. NICHOLAS 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. NICHOLAS 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 MEMBER 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 CONTROLLLING 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 AMNED 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 AFFLILIATE; (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, EXCHNAGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRAEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORAITON OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE HOSPITAL EMPLOYS CROWE HORWATH TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE 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. THE CURRENT CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY WAS EFFECTIVE JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATION'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 AS 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 TO PROMPTLY DISCLOSE SUCH 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, WHICH ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTERESTS EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSITION, 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, TRANSACTIONS, RELATIONSHIP, ARRANGEMENTS, OR ACTIVITY IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, THE COMMITTEE 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, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS THE CONTRACT, TRANSACTION, RELATIONSHIP, 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 THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 19 Required documents available to the public | BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. |
| Form 990, Part IX, Line 11g Other Fees | CONTRACT LABOR - Total Expense: 668324, Program Service Expense: 467827, Management and General Expenses: 200497, Fundraising Expenses: ; PROFESSIONAL FEES - Total Expense: 1148500, Program Service Expense: 803950, Management and General Expenses: 344550, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 14916902, Program Service Expense: 10441832, Management and General Expenses: 4475070, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | ST. NICHOLAS HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, AND EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | TRANSFER TO AFFILIATES - -668857; CHANGE IN PENSION - -3119056; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 635397; CHANGE IN PERMANENTLY RESTRICTED NET ASSETS - 10000; CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS - -209175; SWAP PAYMENTS - -166810; CHANGE IN HEALTH CARE TRUST - -171857; |
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 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) |
| ST CLARE MEMORIAL HOSPITAL | ||||||||||
| 855 S MAIN STREET | OCONTO FALLS | WI | 54154 | 390848401 | HEALTHCARE | WI | 501(c)(3 | 3 | 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 | Yes (true) | 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 | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | 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 | Yes (true) | 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 |