2016-05-19T16:00:23-05:00 2015-06-30 861065772 Deloitte Tax LLP 555 E Wells St Suite 1400 Milwaukee WI 53202 990 2014-07-01 391834639 Columbia St Mary's Inc COLU 4143262230 4425 North Port Washington Road Glendale WI 53212 Timothy Waldoch Interim CFO 2016-05-19 true Rachel J Becker P00966076 4142713000 2014 2016-08-17 19:52:53Z Travis Andersen 4425 North Port Washington Road Glendale WI 53212 168425433 false 0928 X columbia-stmarys.org X 2001 WI HEALTH CARE SYSTEM DEDICATED TO MAKING A POSITIVE DIFFERENCE IN INDIVIDUALS AND OUR COMMUNITY. 13 11 540 12 64000 4333 364187 154090 141309835 160826536 4596687 3947187 4937485 3497620 151208194 168425433 428000 539910 0 0 18951026 41764640 0 0 0 87298238 82329525 106677264 124634075 44530930 43791358 235812966 227069734 186671608 168989384 49141358 58080350 COLUMBIA ST. MARY'S, INC. ("CSM") IS A HEALTH CARE PROVIDER FOUNDED IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, WHICH IS SPONSORED BY ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM, AND COLUMBIA HEALTH SYSTEM, A NON-SECTARIAN COMMUNITY HEALTH SYSTEM. CSM EXISTS TO MAKE A POSITIVE DIFFERENCE IN THE HEALTH STATUS AND LIVES OF INDIVIDUALS AND OUR COMMUNITY, WITH SPECIAL CONCERN FOR THOSE WHO ARE VULNERABLE. CSM AND ITS AFFILIATES ARE COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE, VALUES-DRIVEN PROGRAMS AND SERVICES WITH EQUAL ATTENTION TO THE PHYSICAL, SPIRITUAL, AND EMOTIONAL DIMENSIONS OF HEALTH. false false 66602947 539910 164272618 CSM, INC EXISTS AS THE PARENT CORPORATION IN THE CSM SYSTEM, WHICH IS COMPRISED OF THREE HOSPITALS, (COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE INC, COLUMBIA ST. MARY'S HOSPITAL OZAUKEE INC, AND SACRED HEART REHABILITATION INSTITUTE INC.), 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, A PARTNERSHIP WITH THE ORTHOPEDIC HOSPITAL OF WISCONSIN, A PARTNERSHIP WITH THE SLEEP WELLNESS INSTITUTE, AND FIVE URGENT CARE CENTERS. DURING FISCAL 2015, CSM'S HEALTH SYSTEM (SACRED HEART REHABILITATION, COLUMBIA ST. MARY'S MILWAUKEE, COLUMBIA ST. MARY'S OZAUKEE) PROVIDED CARE TO 140,215 PATIENTS. THE ESTIMATED UNREIMBURSED COST OF SERVICES PROVIDED TO THE ELDERLY, UNINSURED AND UNDERINSURED TOTALED $153,589,389. REFER TO THE COMMUNITY BENEFIT INFORMATION IN SCHEDULE H FOR DISCUSSION OF HOW CSM MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE. 66602947 true true false false false false false false false false true false true true false true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 107 0 true 540 true true true false false false false false false false false false X 13 11 true false false false true true true true true false false true true true true true true false true false X Timothy Waldoch 4143262230 4425 N Port Washington Rd Ste 301 Glendale WI 53212 TRAVIS ANDERSEN CSM PRESIDENT/CEO (Start Date 8/4/14) 1.00 61.00 X X 300693 0 7878 TINA CHANG BOARD MEMBER 0.20 0.80 X 0 0 0 PATRICIA J DOLHUN MD BOARD MEMBER 0.20 0.80 X 0 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 0.20 40.80 X 0 510213 43418 MICHAEL GREBE BOARD MEMBER 0.20 0.80 X 0 0 0 GEORGE H HOFF CHAIR 0.20 0.80 X 0 0 0 ROBERT LYON MD BOARD MEMBER 0.20 0.80 X 0 0 0 R BRUCE MCDONALD BOARD MEMBER 0.20 0.80 X 0 0 0 CHRISTINE NUERNBERG BOARD MEMBER 0.20 0.80 X 0 0 0 RANDALL PERRY SECRETARY/TREASURER 0.20 0.80 X 0 0 0 STEPHEN ROBBINS MD BOARD MEMBER 0.20 0.80 X 0 0 0 SISTER THERESA SULLIVAN DC BOARD MEMBER 0.20 0.80 X 0 0 0 ROBERT J VENABLE VICE CHAIR 0.20 0.80 X 0 0 0 RHONDA ANDERSON CSM PRESIDENT/CFO (End Date 10/11/14) 1.00 49.00 X 607445 127497 42333 TIMOTHY WALDOCH INTERIM CFO 5.00 46.00 X 213345 0 37363 CHERYL HILL VP HUMAN RESOURCES (End 8/26/14) 5.00 48.00 X 308377 0 19917 GERRI LIETZ-STAFFILENO VP HOSP OPERATIONS 5.00 45.30 X 378557 0 29218 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 5.00 45.00 X 1034205 0 45369 SUZANNE SANICOLA VP CSM COMM PHYSICIANS 5.00 45.00 X 313443 0 32866 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION 5.00 45.00 X 680455 0 27407 KEVIN KLUESNER VP CLINICAL SERVICES 40.00 0.00 X 238771 0 36360 WILLIAM HART VP/COO 5.00 45.00 X 451606 0 13625 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 40.00 0.00 X 269288 0 10694 MICHAEL SANDERL VP MISSION INTEGRATION & ADVOC 40.00 0.00 X 295372 0 28897 JEFFREY SQUIER PAYOR RELATIONS & STRATEGY OFFICER 40.00 0.00 X 250627 0 34453 JOY TAPPER EXECUTIVE DIRECTOR MHCP 40.00 0.00 X 250992 0 3359 JEAN VOIGHT CHIEF FIN ADVSR-PHYSICIAN DEV 40.00 0.00 X 221415 0 32671 MARK TAYLOR Former PRESIDENT / CEO (END 6/30/14) 0.00 0.00 X 1332208 0 14876 7146799 637710 460704 15 true true false Accretive Health 401 N Michigan Ave Suite 2700 Chicago IL 60611 Revenue Cycle Management 44022964 Hall Render Killian Heath & Lyman 111 E Kilbourn Ave Suite 1300 Milwaukee WI 53202 Legal Services 1893746 Accenture LLP 111 E Kilbourn Ave Suite 1200 Milwaukee WI 53202 Consulting 1836552 Integrated Health Network of Wisconsin 19601 W Bluemound Rd Suite 200 Brookfield WI 53045 Membership fee to be included in the ACO 1478919 Medspeed LLC 11260 W Lincoln Ave West Allis WI 53227 Courier Services 911116 24 X 151590 2500 154090 Service Fee 541610 146653581 146653581 Joint Venture Income 622110 13511040 13511040 Medical Staff Dues 561499 187900 187900 Program revenue 107133 107133 Management Fee Income 541610 64000 64000 302882 302882 0 0 160826536 3934725 3934725 59825 59825 0 59825 59825 12462 0 12462 12462 12462 Other Operating Revenue 561499 3437795 3437795 0 0 0 0 3437795 168425433 164272618 64000 3934725 539910 539910 3941591 3941591 21916744 9835377 12081367 15906305 784543 15121762 62697 62697 599249 599249 418111 97022 321089 2360775 632853 1727922 0 4424164 191267 4232897 200465 28852 171613 1325512 1325512 4572392 3967798 604594 188713 46326 142387 119687 71439 48248 9871931 9871931 6770686 6507785 262901 Repairs & Maintenance 408738 322300 86438 Purchased Services 45613321 40347432 5265889 Patient Care Supplies 551082 205760 345322 Minor Equipment 326280 287653 38627 4515722 1348421 3167301 0 124634075 66602947 58031128 0 2097433 3116320 17388157 20623073 10008698 11683995 0 0 52151 52151 2793220 2973633 38296018 30573556 5035796 7722462 0 42873188 43528626 31296567 30254997 124267756 107114477 235812966 227069734 11789287 12831802 157438200 174882321 -1280618 186671608 168989384 X 32044715 39375674 11969046 13577079 5127597 5127597 49141358 58080350 235812966 227069734 X 43791358 0 0 0 0 -34852366 X false true X true false X X X 4 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 390806315 3 true 0 0 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 390807063 3 true 0 0 SACRED HEART REHABILITATION INSTITUTE INC 390902199 3 true 0 0 COLUMBIA COLLEGE OF NURSING INC 391596986 2 true 0 0 4 0 0 true false false false false false false false false false false false false false false true Schedule A, Part I, Line 11 SCH A, PART I, LINE 11 COLUMBIA ST. MARY'S INC. SUPPORTS THE PROVISION OF HEALTHCARE SERVICES AT THE CORPORATIONS TO WHICH IT IS A MEMBER BY THE PROVISION OF CENTRALIZED ADMINISTRATIVE SUPPORT, INCLUDING BILLING AND COLLECTIONS, IT, MANAGED CARE CONTRACTING, FINANCIAL SERVICES, BUSINESS DEVELOPMENT, MEDICAL LIBRARY, CME, PROPERTY MANAGEMENT, ADMINISTRATIVE COSTS FOR CLINICAL INSTITUTES (INCLUDING ONCOLOGY, CARDIOLOGY, BARIATRICS, PEDIATRICS, STROKE AND NEUROSCIENCES), RESEARCH (INCLUDING ONCOLOGY, NEUROSCIENCES AND GENERAL RESEARCH), MARKETING, LOGISTICS, EXTERNAL AFFAIRS, PUBLIC RELATIONS, AND CONSTRUCTION. COSTS OF CERTAIN OF THESE DEPARTMENTS ARE CHARGED TO THE MEMBERS THROUGH A MANAGEMENT FEE. TRANSACTIONS WITH EACH MEMBER ARE DELINEATED ON SCHEDULE R. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 764011 764011 14468714 13010616 1458098 479900 418599 61301 19121314 16765516 2355798 3462079 378825 3083254 7722462 Investment in Unconsolidated Entities 24823950 C Investments in CSM Foundation - Perm Rest 5127597 C Investments in CSM Foundation - Temp Rest 13577079 C 43528626 Deferred Compensation 236315 Pension Prefunding 39881702 Interest in Investments held by Ascension Health Alliance 62985228 A/R Intercomp between HMS 4011232 107114477 A/P Intercompany between HMS -13647089 Accrued Pension 6415842 Deferred Compensation 1711683 Misc Noncurrent Liabilities 2190442 Misc Current Liabilities 2048504 -1280618 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE AND ITS MEMBER ORGANIZATION ("THE SYSTEM") WHICH INCLUDE THE ACTIVITY OF COLUMBIA ST. MARY'S INC.: THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX PROVISIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2015. true true X true X true X true true false true true 57500 0 57500 0.0003 4565289 588116 3977173 0.0190 0 0 0 0.0 0 0 4622789 588116 4034673 0.0193 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 4622789 588116 4034673 0.0193 0 0.0 0 0.0 34775 34775 0.0002 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 34775 0 34775 0.0002 false 161901 6305 5813787 14881052 -9067265 X true true ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC ORTHOPEDIC SURGERIES 0.5 0.5 1 1 ORTHOPAEDIC HOSPITAL OF WISCONSIN WWW.OHOW.COM 1006 X Specialty Orthopedic Hospital ORTHOPAEDIC HOSPITAL OF WISCONSIN 1 false false true X X X X X X X X X 12 true true true true X http://www.ohow.com/ X http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100356 X true 12 true http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100626 false false true X 2.0 3.0 X X X X true true X X X true X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000946 X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. The hospital facility took into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health. The collaboration included participation by the Milwaukee County Health Department and representatives from health departments in Milwaukee County. The CHNA team developed a multi-level assessment process. The first level consisted of a survey of county residents regarding their health status, health access and the perception of community needs. Working together, survey questions were developed and approved. A consultant was contracted to perform the survey using techniques that the consultant had used in similar surveys over ten years. The survey was conducted over the telephone to cell phone owners and "land line" telephone owners. More than 1,900 people were interviewed. The second level of data gathering was performed by the Center for Urban Population Health (CUPH) as secondary data gathering about community needs based on public health and other publicly available information. The third level of data was gathered through a key stakeholder interview process. The MHCP members had agreed upon those diverse people who represented key aspects of the community. A survey tool was developed by the group and interviews were scheduled by MHCP members and by public health students working with the City of Milwaukee Health Department. In all, 35 individual interviews and five group interviews were conducted by team members. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. The other hospital facilities with which the reporting hospital facility conducted its CHNA, include Aurora Health Care, Children's Hospital of Wisconsin, Froedtert Health and Wheaton Franciscan Healthcare. These five hospital systems have developed the Milwaukee Health Care Partnership (MHCP) to collaborate efforts to improve understanding of health care needs in Milwaukee and to improve access to health care. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Columbia St. Mary's Inc.. The CHNA was conducted with Center for Urban Population Health Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Orthopaedic Hospital of Wisconsin, LLC. The Milwaukee CHNA identified seven key issues: Infant Mortality, Children's Dental Needs, Breast Cancer, Access to Care in general, Access to Care regarding medical specialists and Inappropriate Use of Emergency Departments. Given the specialty nature of OHOW, many of the identified community needs had no relevance to OHOW resources. A primary area of focus in the Milwaukee CHNA, however, was access to specialist care and OHOW does have resources to apply in this area. As part of its community benefit plan, OHOW has focused on increasing the value of government shortfall through Medical Assistance and BadgerCare, and Supports Granville interfaith, a community free clinic, through coordinated volunteer support on a periodic basis. In addition, OHOW and CSM are collaborating in Orthopedic coverage through the Specialty Access for Uninsured Program (SAUP) pilot program of the Milwaukee Health Care Partnership, with St. Ben's Clinic and Sixteenth Street Community Health Center as CSM's referring clinic. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. All patients eligible for financial assistance receive a minimum discount of 44% off gross charges for services provided to them. 0 Schedule H, Part VI, Line 7 Community Benefit Report CSM does not file a community benefit report since it does not have any patient care revenue. However, CSM's three hospital organizations, Columbia St. Mary's Hospital, Milwaukee, Inc., Columbia St. Mary's Hospital Ozaukee, Inc. and Sacred Heart Rehabilitation Institute, Inc. each file community benefit reports with the Wisconsin Hospital Association. Schedule H, Part I, Line 7g Subsidized Health Services The organization has not included costs attributable to a physician clinic as part of subsidized health services. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For certain categories in the table, this was a cost accounting system; in other categories, a specific cost-to-change ration was applied. Schedule H, Part II Community Building Activities During 2014, OHOW made a number of contributions to organizations that encourage youth fitness and overall health education. Beginning in 2014, OHOW also sponsored and organized a 5K Run/2 Mile walk to benefit the Glendale Police Department. Further, in order to accomplish the collaborative work in the community and to oversee access clinics and outreach programs, CSM has a Community Services Department which oversees the CSM Community Benefit Process. CSM, Inc. participates in Community Building activities through programs such as INROADS, which is an opportunity for culturally diverse college students to serve an internship over summer break to familiarize themselves with the challenges and opportunities in health care and gain real world experience. INROADS is reflected in the Community Building section of the report. CSM is a founding member of the Milwaukee Health Care Partnership (MHCP), which is a collaboration between the five Milwaukee health systems and Federally Qualified Health Centers to improve access to health care in the community. The partnership has worked with County health officials to improve behavioral access and Partnership funding supports mental health respite beds in the community. CSM's CEO and VP of Mission Services each spend significant time in MHCP collaborative work. Access to health education and screening in many areas of the city is best accomplished through church collaboration. CSM employs nurses to work in collaboration with churches and community organizations to offer health education, health screening, and care management support to parishioners and community members in a variety of outreach programs affiliated with churches. CSM developed the beginning stages of a collaboration with 44 Church of God in Christ churches in Milwaukee to accomplish better health awareness and improve screening rates. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Bad debt is calculated from the audited financial statements using an average cost to charge ration. The same ratio is used to calculate all of the expenses at cost within Schedule H. Schedule H, Part III, Line 3 Bad Debt Expense Methodology OHOW and CSM have a very robust financial assistance program; however, when comparing OHOW's percentage of charity care to its total expenses against the poverty levels in the greater Milwaukee community that OHOW serves, OHOW and CSM estimates that approximately 2% of its total bad debt expense relates to patients who might otherwise qualify for financial assistance under its policies but choose not to apply. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote OHOW, which files financial statements separate from CSM, includes the following footnote related to accounts receivables: "The majority of the Hospital's accounts receivables are due from third party payors under reimbursement agreements and from patients for services provided. Accounts receivable are due upon receipt of invoice. Receivables are stated net of any allowance for contractual discounts and uncollectible accounts by considering the number of days past due, collection history, and the general economy and industry as a whole. Contractual adjustments are based on expected payment rates in accordance with third-party payor agreements. The Hospital writes off accounts receivable when they are determined to be uncollectible. Payments subsequently received are credited to the allowance for doubtful accounts." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs OHOW follows the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance OHOW has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Schedule H, Part V, Section B, Line 16a FAP website - ORTHOPAEDIC HOSPITAL OF WISCONSIN: Line 16a URL: http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000946; Schedule H, Part VI, Line 2 Needs assessment Columbia St. Mary's, Inc. serves the Milwaukee and Ozaukee communities through a Community Benefit Process overseen by the Milwaukee Community Benefit Committee and the Ozaukee Community Benefit Committee. The process of understanding community needs through a Community Health Needs Assessment and interpreted through the work of Community Benefit Committees to lead to a Community Benefit Plan for Milwaukee and Ozaukee communities is consistent across the organization. Although the Community Benefit Plan occurs primarily in the Milwaukee, Ozaukee and Sacred Heart Rehabilitation Institute settings, the work is also supported by departments behind the scenes across CSM, including accounting, human resources, purchasing, legal counsel and other administrative functions. Programs such as the Orthopaedic Hospital of Wisconsin have also contributed to support of Community Benefit programming. Community Benefit Committees at CSM have consistent roles to support the Community Benefit functions. The roles include the following: - Develop Community Health Needs Assessment (CHNA) to determine community needs - Review CHNA and create Community Benefit Plan to address needs - Incorporate Community Benefit Plan goals in the CSM Integrated Strategic, Operational and Financial Plan (ISOFP) for Board level approval and submission to Ascension Health System - Develop a strategy to measure and increase the impact of Community Benefit Plan elements The Community Health Needs Assessments are specific to the demographics and health issues to the community. The Needs Assessments completed in FY13 involved the gathering of secondary information about the communities from varied public sources including state data, and county data. The most remarkable needs for the service were addressed through Community Benefit Plans for each community. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance CSM attempts to identify patients who may be eligible for charity or discounted care as outlined in the charity care policy during the pre-registration, registration, admissions and discharge processes. A copy of the charity care policy is posted in the emergency room, and a summary of the policy is provided to patients with admission and discharge paperwork. CSM has trained financial counselors available to discuss payment options to the patients. Upon making an appointment, the financial counselors will meet with the patient to determine what other financial assistance programs the patient may qualify for. Schedule H, Part VI, Line 4 Community information CSM primarily serves the Milwaukee and Ozaukee counties in southeastern Wisconsin. OHOW is located in an urban community within Milwaukee County. The population of Milwaukee County is approximately 953,000, with over 20% of the households living at or below federal poverty guidelines. The median income is approximately $43,000, over 46% of the population is a minority, and approximately 16% of the population speak a language other than English. Discounts for the uninsured and underinsured are not included in Parts I or II of Schedule H. Schedule H, Part VI, Line 5 Promotion of community health A hallmark of CSM, Inc. is the ability to proactively meet health needs through preventive programs and programs to allow access to primary and specialty care. The programs are most often delivered through partnership with other non-profit organizations in health and social services. Each hospital has access improvement programs including: St. Ben's Clinic for the Homeless, Seton Dental Clinic, Community Chronic Disease Management Clinic, Huiras Family Community Health Center, El Centro de Salude Clinic sponsored by the Columbia College of Nursing, the CSM OB/Clinic and the CSM Family Health Center. A particularly strong partner in these activities has been the Medical College of Wisconsin in sponsorship of programs: - The Family Health Center, a residency-based Family Medicine clinic that provides primary care to more than 9,000 individuals in the community. - The OB/GYN Clinic, a residency-based program that serves over 150 patients, 250 OB appointments per month, and 325 deliveries per year. - The Chronic Disease Management Clinic, which screens and manages hypertension, diabetes, obesity, and smoking for low income adults through a clinic based in a food pantry. In turn, CSM across the hospital settings hosts residents for their training growth and development. All of these services are reported as part of the Community Benefit expenses in Section H of the appropriate hospital report. Schedule H, Part VI, Line 6 Affiliated health care system The CSM health system focuses on contributing to the positive health status of the communities it serves. CSM is an organization comprised of three hospitals, 61 community clinics, The Columbia College of Nursing, a partnership with the Orthopaedic Hospital of Wisconsin, a partnership with Sleep Services of Wisconsin, and four Urgent Care Centers. CSM provides care for individuals and families throughout Milwaukee, Ozaukee, Washington, and Sheboygan counties - with more than 160 years of service to individuals and families in these communities. OHOW itself is a specialty hospital which performs more than 5,000 surgical procedures each year and offers the complete range of orthopaedic services, including joint replacements and spine procedures, rehabilitation, diagnostic testing and pain management services. As a member of Ascension Health, the nation's largest Catholic healthcare system, CSM continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of CSM is to perpetuate the health mission of the church. CSM furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. CSM employs a Community Benefit Philosophy in program planning and implementation. CSM provides for the health of the community through financial support provided to patients by financial discounts and contracts, by developing clinics and services for specific vulnerable groups, by sponsoring community education and training and by collaborating with government programs. During fiscal 2015, the CSM system provided $61,669,246 in unreimbursed services, including $6,718,041 in traditional charity care, $6,185,433 in discounts to the uninsured, $13,866,992 in community benefit programs, and $34,898,780 in other unpaid public programs, including subsidized health care, professional education, financial contributions and community building activities. In addition, the organization's governing body is comprised of local community leaders and physicians, the majority of whom reside within the communities CSM serves and are neither employees nor contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community; however, the clinics within the organization are served by physicians affiliated with CSM. true United Way of Greater Milwaukee 225 W Vine Street Milwaukee WI 53212 390806190 501(c)(3) 400000 Federally Qualified Health Centers Funding Concordia University 12800 N Lake Shore Drive Mequon WI 53097 390833608 501(c)(3) 50000 For School of Pharmacy Public Policy Forum Inc Researching 633 W Wisconsin Avenue Milwaukee WI 53203 390210400 501(c)(3) 10000 Public Policy Forum Research Contribution 3 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212. X true true true true false false false false false true false TRAVIS ANDERSEN CSM PRESIDENT/CEO (Start Date 8/4/14) 224785 0 75000 0 908 0 0 0 7878 0 308571 0 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 0 388456 0 0 0 121757 0 7800 0 35618 0 553631 0 0 MARK TAYLOR Former PRESIDENT / CEO (END 6/30/14) 347993 0 934720 0 49495 0 7800 0 7076 0 1347084 0 0 0 RHONDA ANDERSON CSM PRESIDENT/CFO (End Date 10/11/14) 329663 114936 217783 0 59999 12561 7800 25667 7113 1753 622358 154917 0 0 TIMOTHY WALDOCH INTERIM CFO 194618 0 18446 0 281 0 6337 0 31026 0 250708 0 0 0 CHERYL HILL VP HUMAN RESOURCES (End 8/26/14) 186822 0 105600 0 15955 0 5742 0 14175 0 328294 0 0 0 GERRI LIETZ-STAFFILENO VP HOSP OPERATIONS 230943 0 123237 0 24377 0 7501 0 21717 0 407775 0 0 0 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 698420 0 306588 0 29197 0 7800 0 37569 0 1079574 0 0 0 SUZANNE SANICOLA VP CSM COMM PHYSICIANS 187055 0 106686 0 19702 0 6558 0 26308 0 346309 0 0 0 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION 478474 0 180971 0 21010 0 7800 0 19607 0 707862 0 0 0 KEVIN KLUESNER VP CLINICAL SERVICES 215606 0 18779 0 4386 0 7313 0 29047 0 275131 0 0 0 WILLIAM HART VP/COO 297519 0 150910 0 3177 0 7800 0 5825 0 465231 0 0 0 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 191778 0 73944 0 3566 0 6268 0 4426 0 279982 0 0 0 MICHAEL SANDERL VP MISSION INTEGRATION & ADVOC 188537 0 103656 0 3179 0 5974 0 22923 0 324269 0 0 0 JEFFREY SQUIER PAYOR RELATIONS & STRATEGY OFFICER 221074 0 29231 0 322 0 6847 0 27606 0 285080 0 0 0 JOY TAPPER EXECUTIVE DIRECTOR MHCP 249007 0 0 0 1985 0 0 0 3359 0 254351 0 0 0 JEAN VOIGHT CHIEF FIN ADVSR-PHYSICIAN DEV 195009 0 25984 0 422 0 6866 0 25805 0 254086 0 0 0 Schedule J, Part I, Line 1a Housing allowance or residence for personal use PAYMENTS WERE MADE TO NEW PRESIDENT HOSPITAL DIVISION TO ASSIST WITH MOVING EXPENSES AND THE SALE OF HIS HOME IN CALENDAR YEAR 2013. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE Schedule J, Part I, Line 4a Severance or change-of-control payment SEVERANCE PAYMENTS: DEBORAH FRIBERT: $232,993 CONSTANCE J. BRADLEY: $118,575 DAVID H. SHAPIRO, MD: $156,925 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE ORGANIZATION THAT PAID THE SALARIES OF THE INDIVIDUALS LISTED IN SCHEDULE H, PART II PAID OUT OF THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN IN THE AMOUNTS AS NOTED: MARK R. TAYLOR: $107,104 GERRI G. LIETZ-STAFFILENO: $5,366 CHERY L. HILL: $6,093 CONSTANCE J. BRADLEY: $2,391 DAVID H. SHAPIRO, MD: $3,623 Schedule J, Part I, Line 7 Non-fixed payments BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY SERVED, BASED ON ESTABLISHED GUIDELINES. OFFICERS AND KEY EMPLOYEES PARTICIPATE IN A MANAGEMENT INCENTIVE PLACE, WHEREBY CERTAIN FINANCIAL TRIGGERS OF THE CSM SYSTEM AS APPROVED BY THE BOARD MUST BE MET BEFORE ANY ELIGIBLE EMPLOYEE MAY RECEIVE PAYMENT OF THE INCENTIVE. ONCE THE TRIGGER IS MET, THE INCENTIVE IS MEASURED BASED ON VARIOUS ESTABLISHED GOALS, INCLUDING OPERATING MARGIN, PATIENT SATISFACTION, QUALITY AND PRODUCTIVITY. Form 990, Part VI, Line 2 Family/business relationships amongst interested persons MANY OF THE PERSONS LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTURE OF EMPLOYMENT FOR COLUMBIA ST. MARY'S INC. RELATED ENTITIES. - Form 990, Part VI, Line 6 Classes of members or stockholders CSM HAS TWO CORPORATE MEMBERS: ASCENSION HEALTH AND COLUMBIA HEALTH SYSTEM. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ONE OF CSM'S CORPORATE MEMBERS, ASCENSION HEALTH, HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSM. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ASCENSION HEALTH HAS DESIGNED A SYSTEM AUTHORITY MATRIX WHICH ASSIGNS AUTHORITY FOR KEY DECISIONS THAT ARE NECESSARY IN THE OPERATION OF THE SYSTEM. SPECIFIC AREAS THAT ARE IDENTIFIED IN THE AUTHORITY MATRIX ARE: NEW ORGANIZATIONS & MAJOR TRANSACTIONS; GOVERNING DOCUMENTS; APPOINTMENTS/REMOVALS; EVALUATION; DEBT LIMITS; STRATEGIC & FINANCIAL PLANS; ASSETS; SYSTEM POLICIES & PROCEDURES. THESE AREAS ARE SUBJECT TO CERTAIN LEVELS OF APPROVAL BY ASCENSION PER THE SYSTEM AUTHORITY MATRIX. COLUMBIA HEALTH SYSTEM HAS THE AUTHORITY TO APPROVE ANY CHANGES TO THE GOVERNING DOCUMENTS WHICH WOULD AFFECT ITS INTEREST OR RIGHTS IN CSM, THE MISSION AND VISION STATEMENTS OF CSM, AND ANY MAJOR CORPORATE STRUCTURAL TRANSACTIONS OF CSM Form 990, Part VI, Line 11b Review of form 990 by governing body MANAGEMENT, INCLUDING CERTAIN OFFICERS, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE BOARD, OR A DESIGNATED COMMITTEE, TO REVIEW AND ANSWER ANY QUESTIONS. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy CSM HAS A WRITTEN CONFLICT OF INTEREST POLICY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX EXEMPT PURPOSE. Form 990, Part VI, Line 15b Process to establish compensation of other employees IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS INT HE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HER COMPENSATION WAS DECIDED. IN DETERMINING COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATIONS, THE OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO THE OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VIII, Line 2f Other Program Service Revenue Contract Service Revenue - Total Revenue: 31405, Related or Exempt Function Revenue: 31405, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Community Service Revenue - Total Revenue: 500, Related or Exempt Function Revenue: 500, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Medical Record Fees - Total Revenue: 42, Related or Exempt Function Revenue: 42, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Research Sponsor Revenue - Total Revenue: 268435, Related or Exempt Function Revenue: 268435, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Community Education Program Revenue - Total Revenue: 2500, Related or Exempt Function Revenue: 2500, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Intercompany payable/receivable adjustment - -34852366; COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390806315 HOSPITAL WI 501(c)(3 3 COLUMBIA ST MARY'S INC true COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390807063 HOSPITAL WI 501(c)(3 3 COLUMBIA ST MARY'S INC true SACRED HEART REHABILITATION INSTITUTE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390902199 REHAB FACILITY WI 501(c)(3 3 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC true COLUMBIA COLLEGE OF NURSING INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391596986 COLLEGE WI 501(c)(3 2 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC true ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE true HORIZON HOME CARE & HOSPICE INC 8949 N DEERBROOK TRL MILWAUKEE WI 53223 391171298 HOME CARE/HOSPICE WI 501(c)(3 3 NA false COLUMBIA HEALTH SYSTEM 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(c)(3 Type I NA false COLUMBIA ST MARY'S FOUNDATION INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494981 FOUNDATION WI 501(c)(3 7 NA false ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC 575 RIVERWOODS PKWY GLENDALE WI 53212 392015655 HEALTH CARE WI COLUMBIA ST MARY'S INC Related 12940070 24976796 false true 0.5 SLEEP SERVICES OF WISCONSIN LLC 111 E KILBOURN AVE STE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI COLUMBIA ST MARY'S INC Related 52646 836074 false true 0.5 CSM STRATEGIC ALLIANCE 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391871856 HEALTHCARE WI COLUMBIA ST MARY'S INC C Corporation 0 424000 0.5 false MADISON MEDICAL AFFILIATES INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391855720 HEALTHCARE WI COLUMBIA ST MARY'S HOSPITAL C Corporation -13858929 6109173 1 true PROSPECT MEDICAL COMMONS CONDO ASSOCIATION 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 208042108 CONDO ASSOC WI COLUMBIA ST MARY'S INC C Corporation 0 134042 0.7 true false false true false true false false false false true true true true false true false false true false Ascension Health E 157438200 Book Ascension Health M 45695173 Book Ascension Health K 76473 FMV Columbia St Mary's Foundation Inc C 151590 FMV Columbia St Mary's Milwaukee Inc M 55768 Book Orthopaedic Hospital of Wisconsin LLC O 12173980 Book Columbia St Mary's Hospital Milwaukee Inc M 55768 Book Orthopaedic Hospital of Wisconsin LLC L 680653 Book Columbia St Mary's Hospital Milwaukee Inc L 65887891 Book Columbia St Mary's Hospital Ozaukee Inc L 22277280 Book Sacred Heart Rehabilitation Institute Inc L 1685315 Book Columbia College of Nursing Inc L 743524 Book Madison Medical Affiliates Inc R 7850000 Book