ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD (EIN 39-0808480)
Tax period: 2013-07-01 to 2014-06-30
Filed: 2015-05-13
IRS object ID: 201531339349302778
Schema version: 2013v4.0
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	2015-05-13T12:03:58-05:00	ReturnTs
Tax Period End	2014-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CROWE HORWATH LLP	BusinessNameLine1

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	225 WEST WACKER DRIVE	AddressLine1
Address Line2	SUITE 2600	AddressLine2
City	CHICAGO	City
State	IL	State
ZIP Code	606061224	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2013-07-01	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	BusinessNameLine1
Business Name Line2	IS	BusinessNameLine2

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	AddressLine1
City	Sheboygan	City
State	WI	State
ZIP Code	530811948	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ANDREW J BAGNALL	PersonNm
Person Title	PRESIDENT AND CEO	PersonTitleTxt
Signature	2015-04-20	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	2013	TaxYr
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	ST NICHOLAS HOSPITAL	BusinessNameLine1

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

Field	Value	IRS element (for citing)
Business Name Line1	ANDREW J BAGNALL	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3100 SUPERIOR AVENUE	AddressLine1
City	Sheboygan	City
State	WI	State
ZIP Code	530811948	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$79,724,444	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	553	TotalEmployeeCnt
Total Volunteers	150	TotalVolunteersCnt
Total Gross UBI	$80,537	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$293,724	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$901,063	PYContributionsGrantsAmt
CY Contributions Grants	$621,712	CYContributionsGrantsAmt
PY Program Service Revenue	$69,491,523	PYProgramServiceRevenueAmt
CY Program Service Revenue	$72,617,651	CYProgramServiceRevenueAmt
PY Investment Income	$1,374,588	PYInvestmentIncomeAmt
CY Investment Income	$2,298,789	CYInvestmentIncomeAmt
PY Other Revenue	$1,159,622	PYOtherRevenueAmt
CY Other Revenue	$3,367,686	CYOtherRevenueAmt
PY Total Revenue	$72,926,796	PYTotalRevenueAmt
CY Total Revenue	$78,905,838	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	$27,339,375	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$27,789,809	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$40,823,984	PYOtherExpensesAmt
CY Other Expenses	$46,514,450	CYOtherExpensesAmt
PY Total Expenses	$68,163,359	PYTotalExpensesAmt
CY Total Expenses	$74,304,259	CYTotalExpensesAmt
PY Revenues Less Expenses	$4,763,437	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$4,601,579	CYRevenuesLessExpensesAmt
Total Assets BOY	$114,585,253	TotalAssetsBOYAmt
Total Assets EOY	$120,330,298	TotalAssetsEOYAmt
Total Liabilities BOY	$37,693,078	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$36,648,057	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$76,892,175	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$83,682,241	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
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	$8,518,483	ExpenseAmt
Revenue	$16,154,405	RevenueAmt
Desc	SURGICAL SERVICES - SEE SCHEDULE O - COMMUNITY BENEFIT REPORT	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$3,142,740	ExpenseAmt
Revenue	$11,982,461	RevenueAmt
Desc	DIAGNOSTIC IMAGING - SEE SCHEDULE O - COMMUNITY BENEFIT REPORT	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$1,912,384	ExpenseAmt
Revenue	$7,652,284	RevenueAmt
Desc	EMERGENCY SERVICES - SEE SCHEDULE O - COMMUNITY BENEFIT REPORT	Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

Field	Value	IRS element (for citing)
Expense	$39,549,754	ExpenseAmt
Revenue	$36,747,964	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	$39,549,754	TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue	$36,747,964	TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses	$53,123,361	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
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
Transaction With Control Ent	false	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	37	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	553	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	GREG SIMIA	BusinessNameLine1

Field	Value	IRS element (for citing)
Phone	9204598300	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3100 SUPERIOR AVENUE	AddressLine1
City	SHEBOYGAN	City
State	WI	State
ZIP Code	530811940	ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (19 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	$306,092	$82,688
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
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
PETER F BEMIS
BOARD MEMBER	1.00	0	Yes (X)		$0	$0	$0
S MARK BETTAG MD
BOARD MEMBER	1.00	0	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
WILLIAM TRAGER MD
BOARD MEMBER	1.00	0	Yes (X)		$0	$0	$0
ANN M CARR
TREASURER	0.25	61.75		Yes (X)	$0	$318,955	$255,068
DEBRA FRENN
CHIEF NURSING OFFICER	40.00	0		Yes (X)	$145,562	$0	$3,097
GREG SIMIA
DIVISION CFO	10.00	40.00		Yes (X)	$0	$384,802	$71,163
THERESE B PANDL
DIVISIONAL CEO	15.00	40.00		Yes (X)	$0	$735,498	$166,424
ANDREA M ANGOTTI
PHARMACIST	40.00	0			$132,290	$0	$69,433	Yes (X)
MELISSA PALECEK
PHARMACIST	40.00	0			$121,931	$0	$14,464	Yes (X)
SUSAN M WHEELER
DIRECTOR OF PHARMACY	40.00	0			$136,582	$0	$52,572	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$536,365	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$1,745,347	TotReportableCompRltdOrgAmt
Total Other Compensation	$714,909	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	4	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/AddressLine1	CityContractorAddress/USAddress/City	StateContractorAddress/USAddress/State	ZIP CodeContractorAddress/USAddress/ZIPCode	ServicesServicesDesc	CompensationCompensationAmt
ST VINCENT HOSPITAL
835 S VAN BUREN	GREEN BAY	WI	543013256	PHYSICIAN SERVICES	$7,020,453
IEI GENERAL CONTRACTORS
PO BOX 5067	DE PERE	WI	54115	CONTRACTOR	$982,917
SODEXO INC
4880 PAYSPHERE CIRCLE	CHICAGO	IL	60674	SERVICE	$626,131
DIVERSIFIED CLINICAL SERVICES
PO BOX 551187	JACKSONVILLE	FL	32255	SERVICE	$601,215
ANESTHESIOLOGY ASSOCIATES LTD
3100 SUPERIOR AVE	SHEBOYGAN	WI	53081	SERVICE	$397,832

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	21	CntrctRcvdGreaterThan100KCnt
Related Organizations	$621,712	RelatedOrganizationsAmt
Noncash Contributions	$11,235	NoncashContributionsAmt
Total Contributions	$621,712	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE	900099	$72,537,114	$72,537,114
LABORATORY OUTREACH REVENUE	621500	$80,537		$80,537
		$0
		$0
		$0

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	$72,617,651	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$277,011	TotalRevenueColumnAmt
Exclusion	$277,011	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,542,671	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$743,616	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$799,055	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$799,055	TotalRevenueColumnAmt
Exclusion	$799,055	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$2,096,768	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$74,990	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$2,096,768	SecuritiesAmt
Other	-$74,990	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,021,778	TotalRevenueColumnAmt
Exclusion	$2,021,778	ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt
OTHER OPERATING REVENUE	900099	$2,568,631	$2,568,631
		$0
		$0

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	$2,568,631	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$78,905,838	TotalRevenueColumnAmt
Related Or Exempt Func Income	$72,537,114	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$80,537	UnrelatedBusinessRevenueAmt
Exclusion	$5,666,475	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$20,863,819	TotalAmt
Program Services	$14,604,673	ProgramServicesAmt
Management And General	$6,259,146	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,252,287	TotalAmt
Program Services	$876,601	ProgramServicesAmt
Management And General	$375,686	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$4,264,563	TotalAmt
Program Services	$2,985,194	ProgramServicesAmt
Management And General	$1,279,369	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$1,409,140	TotalAmt
Program Services	$986,398	ProgramServicesAmt
Management And General	$422,742	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$5,647,473	TotalAmt
Program Services	$3,953,231	ProgramServicesAmt
Management And General	$1,694,242	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$146,003	TotalAmt
Program Services	$102,202	ProgramServicesAmt
Management And General	$43,801	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$14,240,032	TotalAmt
Program Services	$9,968,022	ProgramServicesAmt
Management And General	$4,272,010	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$110,907	TotalAmt
Program Services	$77,635	ProgramServicesAmt
Management And General	$33,272	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,108,168	TotalAmt
Program Services	$775,718	ProgramServicesAmt
Management And General	$332,450	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$175,292	TotalAmt
Program Services	$122,704	ProgramServicesAmt
Management And General	$52,588	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$55,346	TotalAmt
Program Services	$38,742	ProgramServicesAmt
Management And General	$16,604	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$200,691	TotalAmt
Program Services	$140,484	ProgramServicesAmt
Management And General	$60,207	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$7,501,783	TotalAmt
Program Services	$5,251,248	ProgramServicesAmt
Management And General	$2,250,535	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$241,566	TotalAmt
Program Services	$169,096	ProgramServicesAmt
Management And General	$72,470	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$10,777,601	$7,544,321	$3,233,280
BAD DEBT	$1,760,138	$1,760,138
MEDICAID ASSESSMENT TAX	$1,941,128	$1,941,128
EQUIPMENT RENTAL & MAINTENANCE	$1,809,946	$1,266,962	$542,984

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$798,376	TotalAmt
Program Services	$558,864	ProgramServicesAmt
Management And General	$239,512	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$74,304,259	TotalAmt
Program Services	$53,123,361	ProgramServicesAmt
Management And General	$21,180,898	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Joint Costs TotalJointCostsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,170	BOYAmt
EOY	$1,450	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$6,210,195	BOYAmt
EOY	$8,340,461	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$10,220,219	BOYAmt
EOY	$11,982,434	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
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,610,598	BOYAmt
EOY	$1,521,326	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$139,578	BOYAmt
EOY	$156,417	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$116,763,869	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$68,490,547	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$48,684,272	BOYAmt
EOY	$48,273,322	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$45,321,470	BOYAmt
EOY	$47,920,087	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,258,971	BOYAmt
EOY	$890,638	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,138,780	BOYAmt
EOY	$1,244,163	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$114,585,253	BOYAmt
EOY	$120,330,298	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$7,543,347	BOYAmt
EOY	$9,726,410	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$283,968	BOYAmt
EOY	$188,833	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$16,172,628	BOYAmt
EOY	$15,768,347	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,693,135	BOYAmt
EOY	$10,964,467	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$37,693,078	BOYAmt
EOY	$36,648,057	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$69,448,329	BOYAmt
EOY	$75,988,187	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$5,792,781	BOYAmt
EOY	$6,007,889	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,651,065	BOYAmt
EOY	$1,686,165	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$76,892,175	BOYAmt
EOY	$83,682,241	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$114,585,253	BOYAmt
EOY	$120,330,298	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$4,601,579	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$2,080,288	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$108,199	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
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$8,555	OtherActivitiesAmt
Total Lobbying Expenditures	$8,555	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, Description of the activities reported on Lines 1a through 1i	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	$36,962,379	OtherCostOrOtherBasisAmt
Depreciation	$18,068,695	DepreciationAmt
Book Value	$18,893,684	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$629,688	OtherCostOrOtherBasisAmt
Depreciation	$56,049	DepreciationAmt
Book Value	$573,639	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$41,376,649	OtherCostOrOtherBasisAmt
Depreciation	$28,133,432	DepreciationAmt
Book Value	$13,243,217	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$36,080,143	OtherCostOrOtherBasisAmt
Depreciation	$22,232,371	DepreciationAmt
Book Value	$13,847,772	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$48,273,322	TotalBookValueLandBuildingsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
CAPITAL LEASE	$4,856,798
OTHER LONG TERM LIABILITIES	$320,891
ACCRUED PENSION	$5,786,778

Field	Value	IRS element (for citing)
Total Liability	$10,964,467	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, 2014 AND 2013 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, 2014 AND 2013, 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
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	1790	PersonsServedCnt
Total Community Benefit Expns	$3,965,079	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,986,560	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,978,519	NetCommunityBenefitExpnsAmt
Total Expense	0.02730	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	7665	PersonsServedCnt
Total Community Benefit Expns	$11,367,702	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,946,447	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,421,255	NetCommunityBenefitExpnsAmt
Total Expense	0.07470	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	536	PersonsServedCnt
Total Community Benefit Expns	$714,304	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$517,885	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$196,419	NetCommunityBenefitExpnsAmt
Total Expense	0.00270	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Persons Served	9991	PersonsServedCnt
Total Community Benefit Expns	$16,047,085	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,450,892	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,596,193	NetCommunityBenefitExpnsAmt
Total Expense	0.10470	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	36	ActivitiesOrProgramsCnt
Persons Served	4658	PersonsServedCnt
Total Community Benefit Expns	$217,557	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,120	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$216,437	NetCommunityBenefitExpnsAmt
Total Expense	0.00300	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	66	PersonsServedCnt
Total Community Benefit Expns	$18,863	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$18,863	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	114	PersonsServedCnt
Total Community Benefit Expns	$5,518	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,518	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	9	ActivitiesOrProgramsCnt
Persons Served	29140	PersonsServedCnt
Total Community Benefit Expns	$89,776	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$182	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$89,594	NetCommunityBenefitExpnsAmt
Total Expense	0.00120	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	47	ActivitiesOrProgramsCnt
Persons Served	33978	PersonsServedCnt
Total Community Benefit Expns	$331,714	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,302	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$330,412	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	50	ActivitiesOrProgramsCnt
Persons Served	43969	PersonsServedCnt
Total Community Benefit Expns	$16,378,799	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$8,452,194	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,926,605	NetCommunityBenefitExpnsAmt
Total Expense	0.10920	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	125	PersonsServedCnt
Total Community Benefit Expns	$6,868	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,868	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$294	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$294	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Persons Served	125	PersonsServedCnt
Total Community Benefit Expns	$7,162	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,162	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,760,138	BadDebtExpenseAmt
Bad Debt Expense Attributable	$237,593	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$23,375,858	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$35,365,591	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$11,989,733	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	BusinessNameLine1

Field	Value	IRS element (for citing)
Primary Activities	AMBULANCE SERVICES	PrimaryActivitiesTxt
Org Profit Or Ownership	0.5	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0	OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership	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	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3100 SUPERIOR AVE	AddressLine1
City	SHEBOYGAN	City
State	WI	State
ZIP Code	530811948	ZIPCode

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	BusinessNameLine1

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
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	11	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	www.stnicholashospital.org	OwnWebsiteURLTxt
Rpt Available Upon Request	Yes (X)	RptAvailableUponRequestInd
Adopt Implementation Strategy	Yes (X)	AdoptImplementationStrategyInd
Exec Implementation Strategy	Yes (X)	ExecImplementationStrategyInd
Develop Community Wide Plan	Yes (X)	DevelopCommunityWidePlanInd
Exec Community Wide Plan	Yes (X)	ExecCommunityWidePlanInd
Include Operational Plan	Yes (X)	IncludeOperationalPlanInd
Adopt Budget	Yes (X)	AdoptBudgetInd
Prioritize Health Needs	Yes (X)	PrioritizeHealthNeedsInd
Prioritize Services	Yes (X)	PrioritizeServicesInd
All Needs Addressed	false	AllNeedsAddressedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Used Deter Elig Free Care	Yes (true)	FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care	200	FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt Care	Yes (true)	FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care	600	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (true)	ExplainedBasisInd
Income Level	Yes (X)	IncomeLevelInd
Asset Level	Yes (X)	AssetLevelInd
Medical Indigency	Yes (X)	MedicalIndigencyInd
Insurance Status	Yes (X)	InsuranceStatusInd
Uninsured Discount	Yes (X)	UninsuredDiscountInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
Available On Request	Yes (X)	AvailableOnRequestInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Collection Activities	false	CollectionActivitiesInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Average Negotiated Rates	Yes (X)	AverageNegotiatedRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment	(1) - ST. NICHOLAS HOSPITAL: THE HOSPITAL'S CHNA INVOLVED PEOPLE BROADLY REPRESENTATIVE OF THE COMMUNITY. HOW THE CHNA WAS CONDUCTED THE CHNA WAS A COLLABORATIVE, MULTISTAGE PROCESS THAT INCLUDED ST. NICHOLAS HOSPITAL, THE SHEBOYGAN COUNTY HEALTH DIVISION OF PUBLIC HEALTH, AND COMMUNITY PARTNERS. TWO COMPLEMENTARY COMMUNITY ENGAGEMENT SESSIONS OCCURRED: - A COMMUNITY HEALTH NEEDS FORUM SPONSORED BY ST. NICHOLAS HOSPITAL. AS DESCRIBED IN THE COMPANION BROCHURE ALSO POSTED ON OUR WEBSITE, THIS FORUM INCLUDED PRESENTATIONS AND ENGAGEMENT BY A GROUP BROADLY REPRESENTATIVE OF THE COMMUNITY. - THE COMMUNITY HEALTH IMPROVEMENT CALL TO ACTION EVENT SPONSORED BY THE SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH AND HEALTHY SHEBOYGAN COUNTY 2020 (HSC 2020). HSC 2020 IS A COALITION OF COMMUNITY AND HEALTH-RELATED ORGANIZATIONS. THIS EVENT ALSO ENTAILED BROAD COMMUNITY PARTICIPATION, INCLUDING REPRESENTATION FROM ST. NICHOLAS HOSPITAL. IN BOTH OF THE ABOVE SESSIONS, PARTICIPANTS DEVELOPED PRIORITIES FOR COMMUNITY-WIDE ACTION BASED ON THE 2009 COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY THE SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH - INCLUDING UPDATED DATA FROM THE 2010 CENSUS AND MORE CURRENT PUBLICLY REPORTED PUBLIC HEALTH STATISTICS. THIS HEALTH ASSESSMENT UTILIZED THE HEALTH FOCUS FRAMEWORK OF HEALTHIEST WISCONSIN 2020 TO GATHER SHEBOYGAN COUNTY DATA AND KEY FINDINGS. MAJOR NEEDS AND HOW PRIORITIES WERE ESTABLISHED AT THE MAY 2011 ST. NICHOLAS HOSPITAL COMMUNITY HEALTH NEEDS FORUM, APPROXIMATELY 70 COMMUNITY LEADERS PARTICIPATED IN THE EVENT WITH REPRESENTATION FROM BUSINESS, NON-PROFIT AGENCIES, HEALTHCARE, EDUCATION, PUBLIC HEALTH AND SAFETY AND ELECTED OFFICIALS. THE OBJECTIVE OF THE FORUM 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 JEAN BEINEMANN, RN, PROGRAM SUPERVISOR FROM THE SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH ON THE 2009 SHEBOYGAN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. HER PRESENTATION ALSO INCLUDED UPDATED DATA FROM THE 2010 CENSUS AND MORE CURRENT PUBLICLY REPORTED PUBLIC HEALTH STATISTICS. THE LARGER GROUP WAS BROKEN DOWN INTO NINE SUBGROUPS TO RATE AND RANK THE HEALTH NEEDS USING TWO DOCUMENTS DEVELOPED FOR THIS PROCESS TO ASSESS THE NEEDS AGAINST THREE CRITERIA: (A) MAGNITUDE OF PROBLEM; (B) SERIOUSNESS OF THE CONSEQUENCES; AND (C) FEASIBILITY OF CORRECTING. THESE DOCUMENTS INCLUDED A PROBLEM IMPORTANCE WORKSHEET FOR EACH OF THE IDENTIFIED 12 KEY FOCUS AREAS IDENTIFIED IN THE SHEBOYGAN COUNTY HEALTH NEEDS ASSESSMENT AND A PROBLEM PRIORITIZATION WORKSHEET TO RANK THE PROBLEMS IDENTIFIED IN THE PROBLEM IMPORTANCE WORKSHEET. A SIMILAR PROCESS WAS USED AT THE JUNE 2011 CALL TO ACTION EVENT SPONSORED BY THE HEALTH DEPARTMENT AND HSC 2020. THIS EVENT INCLUDED ABOUT 60 REPRESENTATIVES FROM GOVERNMENT, NOT-FOR-PROFIT, HEALTHCARE, EDUCATION, PUBLIC SAFETY AND BUSINESS. THE GROUP REVIEWED HEALTH DATA IN RELATION TO THE HEALTHY PEOPLE 2020 AND HEALTHIEST WISCONSIN 2020 FRAMEWORK. THEY DISCUSSED HEALTH NEEDS IN SMALL GROUPS, AND THEN ESTABLISHED PRIORITIES USING THE DOT METHOD WHEREBY EACH PARTICIPANT CAN ATTRIBUTE AN ALLOCATED NUMBER OF VOTES TO THE NEEDS THAT THEY DEEM MOST IMPORTANT. THE TWO PRIORITY-SETTING FORUMS HAD SLIGHTLY DIFFERENT BUT COMPLEMENTARY PURPOSES. RESULTS FROM THE CALL TO ACTION EVENT FED INTO THE SHEBOYGAN COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN. THIS PLAN INCLUDES EXTENSIVE INVOLVEMENT FROM ST. NICHOLAS HOSPITAL STAFF WHO SERVE ON SEVERAL IMPLEMENTING COMMITTEES. THE ST. NICHOLAS FORUM ALSO SOUGHT COMMUNITY INPUT TO SET PRIORITIES, BUT WITH A FOCUS ON NEEDS THAT THE HOSPITAL IS BEST POSITIONED TO HELP ADDRESS AND TO SUPPORT DEVELOPMENT OF THIS IMPLEMENTATION STRATEGY. THE ST. NICHOLAS HOSPITAL FORUM IDENTIFIED FIVE PRIORITY ISSUES: 1. ORAL HEALTH 2. PHYSICAL ACTIVITY 3. ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION (TIE) 4. UNHEALTHY DRUG AND ALCOHOL USE (TIE) 5. TOBACCO USE AND EXPOSURE. IN ADDITION (THOUGH NOT FORMALLY IDENTIFIED AS A SEPARATE PRIORITY) EACH ISSUE INCLUDES HEALTH LITERACY AS A COMPONENT. 1. ORAL/DENTAL HEALTH ISSUES 2. MENTAL HEALTH ISSUES 3. IMPROVEMENT OF HEALTH LITERACY 4. AODA AND TOBACCO USE ISSUES 5. OBESITY THE NEXT STEP FOR ST. NICHOLAS HOSPITAL WAS TO IDENTIFY COMMONALITY BETWEEN THE IDENTIFIED ISSUES WHICH EMERGED AS A RESULT OF THE COMMUNITY ENGAGEMENT SESSIONS. THE PRIORITIES IDENTIFIED AT BOTH OF THE COMMUNITY ENGAGEMENT SESSIONS SHARED MANY COMMONALITIES. ORAL HEALTH EMERGED AS THE TOP ISSUE AT BOTH SESSIONS. ANOTHER SET OF THE PRIORITIES COULD BE GROUPED TOGETHER: PHYSICAL ACTIVITY, ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION, AND OBESITY. AODA, INCLUDING TOBACCO, WAS ALSO HIGHLIGHTED AS A TOP CONCERN. WHILE MENTAL HEALTH WAS NOT IDENTIFIED AS ONE OF THE TOP FIVE PRIORITIES AT THE ST. NICHOLAS HOSPITAL FORUM, IT WAS IDENTIFIED AS THE SIXTH PRIORITY. HEALTH CARE FACILITIES AND RESOURCES WITHIN THE COMMUNITY THERE ARE TWO ACUTE CARE HOSPITALS IN SHEBOYGAN COUNTY-ST. NICHOLAS HOSPITAL AND AURORA SHEBOYGAN MEDICAL CENTER; BOTH PROVIDE INPATIENT, OUTPATIENT AND EMERGENCY CARE. OTHER FACILITIES AND RESOURCES INCLUDE AURORA SHEBOYGAN MEMORIAL MENTAL HEALTH AND AODA TREATMENT PROGRAMS. IN 2012, A COMMUNITY HEALTH CLINIC AND A COMMUNITY DENTAL CLINIC WERE STARTED TO SERVE THE HEALTH CARE NEEDS OF LOW INCOME PEOPLE. SHEBOYGAN COUNTY, COMMUNITY HEALTH NEEDS FORUM SPONSORED BY ST. NICHOLAS HOSPITAL, MAY 6, 2011 ATTENDEE LIST - ANN WONDERGEM, SHEBOYGAN & PLYMOUTH AREA UNITED WAY # - DR. CLIFFORD MARTIN, PREVEA SHEBOYGAN WOMEN'S CARE - BEVERLY RANDALL, MENTAL HEALTH AMERICA # - MARTY FOLAN, ST. NICHOLAS HOSPITAL - KATY PRUITT, SAFE HARBOR # - DR. AL HARDERSEN, UW-SHEBOYGAN - TANYA SMITH, ST. NICHOLAS HOSPITAL - STEVE STAUBER, FRIENDS OF ST. NICHOLAS HOSPITAL - HEIDI SELBERG, HSHS DIVISION-EASTERN WISCONSIN - JEAN BEINEMANN, SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - SUE WHEELER, ST. NICHOLAS HOSPITAL - ALY FLASKRUD, WILLOWDALE NURSING AND REHABILITATION CENTER - BRIAN CHARLIER, PREVEA HEALTH - ANDY BAGNALL, ST. NICHOLAS HOSPITAL - DR. DONALD GORE, SHEBOYGAN ORTHOPAEDIC ASSOCIATES - SHERRI SAMUELS-FUERST, SARGENTO FOODS, INC. - CHRIS JENSEMA, HSHS DIVISION-EASTERN WISCONSIN - JUDY HALVERSON, PARTNERS OF ST. NICHOLAS HOSPITAL - MARY SCHUELLER, HSHS DIVISION-EASTERN WISCONSIN - ANNETTE SELK, PUBLIC HEALTH NURSE, SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - JOSEPH LEIBHAM, WISCONSIN STATE SENATE - JEANETTE MILLER, PARTNERS OF ST. NICHOLAS HOSPITAL - NANCY JUSKY, SHEBOYGAN & PLYMOUTH AREA UNITED WAY # - EVE KOVACS, PARTNERS OF ST. NICHOLAS HOSPITAL - MARY JO TITTL, FAMILY RESOURCE CENTER # - BETH MILLIN, ST. NICHOLAS HOSPITAL - JILL NIEMCZYK, NORTHEASTERN WISCONSIN AREA HEALTH EDUCATION CENTER - MARK RADTKE, WIND MILL SLATWALL PRODUCTS - JODY MOESCH EBELING, PUBLIC HEALTH NURSE, SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - DALE HIPPENSTEEL, HEALTH OFFICER, SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - KRISTIN BLANCHARD, SHEBOYGAN COUNTY INTERFAITH ORGANIZATION # - SUSIE RUNAAS, ST. NICHOLAS HOSPITAL - AMY BETKE, PUBLIC HEALTH NURSE, SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - CARRIE BENDER, ROCKLINE INDUSTRIES - STEVE NEISIUS, ROCKLINE INDUSTRIES - JEAN MCMURRAY, AURORA HEALTH CARE - WENDY ELGIN, BRIDGEPOINT HEALTH # - JAN MULHERN, ST. NICHOLAS HOSPITAL - MICHELLE NIEMI-PRANGE, SHEBOYGAN PROGRESSIVE CARE CENTER - DAWN KIND, PRAIRIE STATES ENTERPRISES - MARY PALUCHNIAK, ST. NICHOLAS HOSPITAL - CYNTHIA BERTSCH, ST. NICHOLAS HOSPITAL - XUE YANG, ST. NICHOLAS HOSPITAL - KAITLIN SWANSON, HSHS DIVISION-EASTERN WISCONSIN - VIRGINIA THOMAS, SHEBOYGAN AREA COMMUNITY CLINICS, INC. # - ALEJANDRA KLEMME, CATHOLIC CHARITIES # - PHIL DUKET, FAMILY RESOURCE CENTER # - CHASONG YANG, HMONG MUTUAL ASSISTANCE ASSOCIATION # - DR. DAVID WYATT SEAL, MEDICAL COLLEGE OF WISCONSIN - RYAN PERKINS, ST. NICHOLAS HOSPITAL - JENNY PERNAT, ST. NICHOLAS HOSPITAL - MARLENE MIELKE, REGIONAL REPRESENTATIVE FOR U.S. SENATOR HERBERT KOHL - TERRI BOXRUCKER, PUBLIC HEALTH NURSE,SHEBOYGAN COUNTY DIVISION OF PUBLIC HEALTH * - CONNIE BITTER, FRIENDS OF ST. NICHOLAS HOSPITAL AND BEMIS MANUFACTURING - MIKE KLEIN, BEMIS MANUFACTURING - ROBERT WEBER, D.D.S. - DR. GREGORY GROSE, PREVEA SHEBOYGAN UROLOGY - JESSICA MUCHOWSKI, WILLOWDALE NURSING AND REHABILITATION CENTER - CINDY MUSIAL, THE GATHERING PLACE # - NICHOL FIDLIN, PREVEA HEALTH - MEL BLANKE, SHEBOYGAN AREA COMMUNITY CLINICS, INC. # - JOHN KOEHLER, SHEBOYGAN AREA SCHOOL DISTRICT - JOANN WIELAND, SHEBOYGAN & PLYMOUTH AREA UNITED WAY # - JOHN WENIG, FRIENDS OF ST. NICHOLAS HOSPITAL - LORRAINE PASHLEY, ST. NICHOLAS HOSPITAL - THOMAS EGGEBRECHT, SHEBOYGAN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT # - CHECK BUTLER, SHEBOYGAN CITY FIRE DEPARTMENT * PUBLIC HEALTH REPRESENTATIVE # REPRESENTATIVE OF MINORITY, UNDERSERVED OR LOW INCOME POPULATIONS/CHRONIC DISEASE POPULATIONS;
Schedule H, Part V Sec B, Line 4, Other Hospital Facilities included in Needs Assessment	(1) - ST. NICHOLAS HOSPITAL: INVOLVED IN THE COMMUNITY WIDE CHNA COMMITTEE WERE: BELLIN HEALTH, AURORA SHEBOYGAN, ST. MARY'S HOSPITAL MEDICAL CENTER, ST. NICHOLAS HOSPITAL, ST. VINCENT HOSPITAL, BROWN COUNTY PUBLIC HEALTH, CITY OF DE PERE PUBLIC HEALTH AND UNITED WAY.;
Schedule H, Part V Sec B, Line 7, Needs not addressed in Needs Assessment	(1) - ST. NICHOLAS HOSPITAL: ST. NICHOLAS HOSPITAL'S BOARD OF DIRECTORS APPROVED AN IMPLEMENTATION STRATEGY BASED ON THE CHNA IN FY2012. BASED ON THE CHNA, THE FOLLOWING PRIORITY NEEDS FOR THE COMMUNITY WERE IDENTIFIED IN FY2013 AND FY2014: ORAL HEALTH; PHYSICAL ACTIVITY, ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION, AND OBESITY; AND ALCOHOL AND OTHER DRUG USE (AODA) INCLUDING TOBACCO. ORAL HEALTH THE HOSPITAL HAS BEEN ACTIVE IN SUPPORTING THE ESTABLISHMENT OF A COMMUNITY CLINIC THROUGH BOARD SERVICE AND ASSISTANCE WITH GRANT APPLICATIONS. IN FY2014, 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. IN ADDITION, ST. NICHOLAS ALSO PARTICIPATES ON ORAL HEALTH PROJECTS THROUGH ITS MEMBERSHIP IN THE SHEBOYGAN COUNTY DENTAL ACCESS COMMITTEE, INCLUDING: OPERATION GRATITUDE (COLLECTING HALLOWEEN CANDY FOR THE TROOPS) AND GIVE KIDS A SMILE DAY. FROM JULY 2013 THRU JUNE 2014, THE DENTAL CLINIC HAS SERVED MORE THAN 3000 PEOPLE. A FLUORIDE VARNISH PROGRAM FOR WIC PARTICIPANTS WAS IDENTIFIED AS A WAY TO ADDRESS ORAL HEALTH IN THE COMMUNITY. PLANS FOR DEVELOPING THIS PROGRAM WERE PUT ON HOLD BY THE SHEBOYGAN HEALTH DEPARTMENT BECAUSE A SIGNIFICANT PUBLIC HEALTH ISSUE AROSE RELATED TO COMMUNICABLE DISEASE EXPOSURE. THE HEALTH DEPARTMENT, WHICH WAS IN THE LEAD ROLE FOR THE FLUORIDE VARNISH PROGRAM, DIVERTED ITS RESOURCES TO THIS MORE URGENT NEED. DENTAL CARE FOR CHILDREN WILL BE HANDLED BY LAKESHORE COMMUNITY HEALTH CENTER TO THE EXTENT RESOURCES ARE AVAILABLE. HEALTH LITERACY HEALTH LITERACY IS A MAJOR CONCERN IN OUR COUNTRY. ONLY 12 PERCENT OF ADULTS HAVE "PROFICIENT" HEALTH LITERACY, ACCORDING TO THE NATIONAL ASSESSMENT OF ADULT LITERACY. IN OTHER WORDS, NINE OUT OF 10 ADULTS MAY LACK THE SKILLS NEEDED TO MANAGE THEIR HEALTH AND PREVENT DISEASES. IN RESPONSE TO ITS CHNA, THE 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 COMPLETED FIVE FOCUS GROUPS (HISPANIC, HMONG, LOW INCOME, SENIORS, AND YOUNG ADULTS) AND HOSTED AN EXECUTIVE BRIEF FOR HEALTHCARE PROVIDERS TO SHARE RESULTS OF THE COMMUNITY SURVEY AND FOCUS GROUPS. A COMMUNITY AWARENESS MEDIA CAMPAIGN IS BEING DEVELOPED AND ST. NICHOLAS HOSPITAL HAS PROVIDED FINANCIAL SUPPORT FOR A COMMUNITY AWARENESS MEDIA CAMPAIGN. AS A MEMBER OF THE HSC HEALTH LITERACY COMMITTEE, ST. NICHOLAS HOSPITAL STAFF WAS A PANELIST AT THE HEALTH SISTER HOSPITAL SYSTEM'S SPIRITUALITY CONFERENCE ON HEALTH LITERACY. ADEQUATE FOOD AND NUTRITION IN PARTNERSHIP WITH PREVEA HEALTH, ST. NICHOLAS HOSPITAL CONTINUES TO PROVIDE NUTRITIONAL EDUCATION TO THE COMMUNITY AT THE FARMERS MARKET. IN ADDITION, THE HOSPITAL PROVIDED THE PUBLIC WITH THE OPPORTUNITY TO "ASK THE DIETICIAN" AND RECEIVE EDUCATIONAL MATERIALS AT THE FARMERS MARKET AS WELL AS HEALTHY FOOD SAMPLES AND SHOWCASING RECIPES UTILIZING LOCAL PRODUCE. ;
Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy	(1) - ST. NICHOLAS HOSPITAL: COMMUNICATION/NOTIFICATION ABOUT FINANCIAL ASSISTANCE AVAILABILITY FROM HSHS, INCLUDES THE FOLLOWING: A. FINANCIAL ASSISTANCE APPLICATIONS. THE FINANCIAL ASSISTANCE APPLICATION IS PROVIDED TO PATIENTS UPON REQUEST AND THROUGHOUT THE REGISTRATION AND POST-REGISTRATION PROCESS. THIS APPLICATION COMPLIES WITH CURRENT ILLINOIS AND WISCONSIN STATUTES AND ANY APPLICABLE FEDERAL STATUTES. B. POSTERS. THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM IS ADVERTISED ON POSTER-SIZED SIGNAGE LOCATED IN ADMISSIONS, OUTPATIENT, WAITING ROOM AREAS. A TOLL-FREE PHONE NUMBER IS INCLUDED. C. BROCHURES. BROCHURES OUTLINING THE FINANCIAL ASSISTANCE PROGRAM, APPLICATION PROCESS AND TOLL-FREE PHONE NUMBER ARE AVAILABLE AT ALL PATIENT REGISTRATION DESKS AND IN ALL WAITING AREAS. D. INTERNET. THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM AND ILLINOIS UNINSURED DISCOUNT ACT OF 2009 ARE POSTED ON THE HSHS INTERNET HOME PAGE. E. PATIENT STATEMENTS. EACH BILL, INVOICE OR OTHER SUMMARY OF CHARGES TO AN UNINSURED PATIENT INCLUDES WITH IT, OR ON IT, A PROMINENT STATEMENT THAT AN UNINSURED PATIENT WHO MEETS CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR AN UNINSURED DISCOUNT AND INFORMATION REGARDING HOW AN UNINSURED PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HSHS FINANCIAL ASSISTANCE PROGRAM. IN ADDITIO, REFERRAL OF PATIENTS MAY BE MADE BY ANY MEMBER OF THE HSHS STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAIN'S, AND RELIGIOUS SPONSORS. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS.;

Supplemental Information Detail SupplementalInformationDetail (18 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3C, FACTORS OTHER THAN FPG	NOT APPLICABLE. THE ORGANIZATION DOES FOLLOW FPG TO DETERMINE ELIGIBILITY FOR PROVIDING CHARITY AND DISCOUNTED CARE TO LOW-INCOME UNINSURED AND UNDERINSURED INDIVIDUALS.
SCHEDULE H, PART I, LINE 6A, COMMUNITY BENEFIT REPORT	THE HOSPITAL'S COMMUNITY BENEFIT REPORT CAN BE ACCESSED AT WWW.STNICHOLASHOSPITAL.ORG.
Schedule H, Part I, Line 7, Costing Methodology used to calculate financial assistance	CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FISCAL YEAR ENDING 2014 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H-WORKSHEET J.
Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation	1,760,138
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 POTION OF OUR TOTAL COMMUNITY BENEFIT EFFORTS. THEY INCLUDE PROVIDING HOUSES WITH FINANCIAL SUPPORT AND IN-KIND 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. THAT 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. EACH MATRIX IN USE HAS BEEN UPDATED WITHIN THE PAST YEAR. 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. THE HOSPITAL COMPUTES THE COST OF BAD DEBT BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE TOTAL CHARGES WRITTEN OFF AS BAD DEBT EXPENSE. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY NON-PATIENT CARE EXPENSES, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFIT EXPENSE. THE ADJUSTED OPERATING COST IS THEN DIVIDED BY THE TOTAL GROSS PATIENT CHARGES TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES.
Schedule H, Part III, Line 4, Bad debt expense - financial statement footnote	THE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE CAN BE FOUND ON PAGE 19 IN THE HSHS CONSOLIDATED AUDIT REPORT.
Schedule H, Part III, Line 8, Community benefit & methodology for determining medicare costs	THE HOSPITAL CONTINUALLY STRIVES TO PROVIDE EXCELLENT PATIENT CARE IN THE MOST COST EFFECTIVE FASHION. NONETHELESS, THE MEDICARE PROGRAM, IN MANY CASES, DOES NOT PROVIDE PAYMENT THAT COVERS THE FULL COST OF THE CARE PROVIDED. SINCE IT IS THE MISSION OF THE HOSPITAL TO RESPOND TO COMMUNITY NEED, HOSPITAL MANAGEMENT CONTINUALLY ADVOCATES FOR IMPROVED MEDICARE PAYMENT SO THAT THE COST OF QUALITY CARE TO THOSE PATIENTS THAT 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. OUR MISSION CALLS US TO SERVE ALL PATIENTS WITH THE HIGHEST POSSIBLE QUALITY AND EFFICIENCY, EVEN IF WE ARE NOT PAID FULLY FOR DOING SO. IF THE MEDICARE PROGRAM DID NOT EXIST, MANY MEDICARE PATIENTS WOULD BE ELIGIBLE FOR CHARITY CARE OR OTHER MEANS-TESTED GOVERNMENT PROGRAMS. FURTHER, BY ABSORBING THIS PAYMENT SHORTFALL AND PROVIDING CARE BELOW COST TO THESE INDIVIDUALS, ST NICHOLAS HOSPITAL IS RELIEVING THE BURDEN OF THE GOVERNMENT. THE HOSPITAL COMPUTES THE UNPAID COSTS OF PROVIDING CARE TO MEDICARE PATIENTS BY COMPARING THE COST OF THE SERVICES TO THE REIMBURSEMENT RECEIVED FROM MEDICARE DURING THE YEAR. THE COST OF MEDICARE SERVICES IS CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE ANNUAL MEDICARE CHARGES. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFIT EXPENSE. THE DIFFERENCE BETWEEN THE REIMBURSEMENT RECEIVED AND THE CALCULATED COST OF THE SERVICES IS REPORTED AS THE MEDICARE SHORTFALL. THE HOSPITAL MEDICARE SHORTFALL AT COST FOR FY2014 IS $11,989,733.
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 VI, Line 2, Needs assessment.	AS INDICATED IN PART V, SECTION B, ST. NICHOLAS HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN OUR FY2012 (JULY 1, 2011 THROUGH JUNE 30, 2012). IN PREVIOUS YEARS, WE ASSESSED COMMUNITY NEED BY A NUMBER OF METHODS TO ASSESS HEALTH CARE NEEDS. FOR EXAMPLE, WE 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, ST. NICHOLAS HOSPITAL WILL LEAD A COLLABORATIVE APPROACH TO CONDUCT ITS CHNA AND ADOPT AN IMPLEMENTATION PLAN IN OUR 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.	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE REGISTRATION DEPARTMENT PROVIDES BROCHURES TO PATIENTS UPON REGISTRATION REGARDING THE PAYMENT ASSISTANCE PROGRAM AVAILABLE TO THEM AT ST. NICHOLAS HOSPITAL. THE BROCHURES ARE ALSO SUPPLIED IN WAITING AND ANCILLARY AREAS FOR EASY ACCESS BY THE PATIENT. 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, 9% OF RESIDENTS ARE BELOW THE FEDERAL POVERTY LEVEL. MORE THAN 18,000 RESIDENTS ARE COVERED BY MEDICAID/BADGER CARE PLUS. ACCORDING TO THE WISCONSIN DEPARTMENT OF HEALTH SERVICES DIVISION OF PUBLIC HEALTH, 5% OF SHEBOYGAN COUNTY'S POPULATION IS UNINSURED. 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	ST. NICHOLAS HOSPITAL OFFERS HOPE TO OUR COMMUNITY IN THE TRADITION OF THE HOSPITAL SISTERS OF ST. FRANCIS. AS A HEALING MINISTRY OF THE CATHOLIC CHURCH AND AN AFFILIATE OF THE HOSPITAL SISTERS HEALTH SYSTEM (HSHS), ST. NICHOLAS HOSPITAL IS COMMITTED TO DELIVERING HIGH QUALITY, COMPASSIONATE, AND COST-EFFECTIVE HEALTH CARE SERVICES TO ALL. THE HOSPITAL WAS FOUNDED MORE THAN 120 YEARS AGO TO BRING A HEALING PRESENCE AND IMPROVE THE HEALTH OF OUR COMMUNITY, ESPECIALLY FOR PEOPLE WHO ARE SICK, POOR, AND DISADVANTAGED. BECAUSE OF THE HOSPITAL'S PURPOSE AND TRADITION, IT IS ORGANIZED TO PROMOTE THE HEALTH OF SHEBOYGAN COUNTY, WISCONSIN AND SURROUNDING AREAS. THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS, A MAJORITY OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE HOSPITAL (NOR FAMILY MEMBERS THEREOF). THE BOARD ENSURES THAT ST. NICHOLAS HOSPITAL IS RESPONDING TO COMMUNITY NEED. DURING FY2012, FOR EXAMPLE, THE BOARD REVIEWED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND APPROVED AN IMPLEMENTATION STRATEGY FOR ADDRESSING SELECTED NEEDS. IN ADDITION OUR HOSPITAL ADVISORY COUNCIL, FRIENDS OF ST. 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, ST. NICHOLAS HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. IN ADDITION, THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN 24 HOURS TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. AS A NOT-FOR-PROFIT HOSPITAL, ST. NICHOLAS REINVESTS SURPLUS FUNDS INTO THE MISSION OF THE ORGANIZATION AND HEALTH OF THE COMMUNITY RATHER THAN DISTRIBUTING THEM AS PROFITS TO SHAREHOLDERS OR INDIVIDUALS. FUNDS NOT COMMITTED TO ONGOING OPERATIONS ARE GENERALLY USED TO UPGRADE FACILITIES, SECURE NEW TECHNOLOGIES, IMPROVE PATIENT CARE, AND SUPPORT INITIATIVES AND CONDUCT MEDICAL EDUCATION AND RESEARCH DESIGNED TO PROMOTE HEALTH AND ENSURE ACCESS FOR ALL. FOR EXAMPLE, ST. NICHOLAS IS CURRENTLY WORKING WITH ITS PARENT ORGANIZATION, HOSPITAL SISTERS HEALTH SYSTEM, TO CONTINUOUSLY ENHANCE QUALITY AND IMPROVE COORDINATION OF CARE BOTH INSIDE THE HOSPITAL AND WITH A GROWING NUMBER OF PHYSICIAN PARTNERS. SUPPORTED BY INVESTMENTS IN INFORMATION TECHNOLOGY, OUR "CARE INTEGRATION" STRATEGY IS DESIGNED TO BETTER COORDINATE CARE, IMPROVE HEALTH OUTCOMES, CREATE NEW EFFICIENCIES, AND HELP ENSURE PATIENTS (ESPECIALLY THOSE WITH CHRONIC CONDITIONS) GET WELL AND STAY WELL. FOR INSTANCE, THE EPIC ELECTRONIC MEDICAL RECORD SYSTEM ENABLES PROVIDERS TO CONNECT WITH THEIR PATIENTS' MEDICAL RECORDS FROM WHEREVER THEY ARE AND ALLOWS EMERGENCY PHYSICIANS ACCESS TO PATIENT MEDICAL RECORDS FROM ANY FACILITY THAT HAS EPIC. THIS REDUCES DUPLICATE TESTING, PUTS CRITICAL HEALTH INFORMATION AT PROVIDERS' FINGERTIPS, HELPS BETTER MANAGE CHRONIC CONDITIONS, AND IMPROVES PATIENT SAFETY. ST. NICHOLAS HOSPITAL ALSO DEVOTES SIGNIFICANT RESOURCES TO ACCESS FOR PATIENTS WHO CANNOT AFFORD CARE, ALONG WITH OTHER COMMUNITY BENEFITS. IN FY2014, ST. NICHOLAS PROVIDED OVER $7,933,767 MILLION IN COMMUNITY BENEFIT SERVICES, INCLUDING CHARITY CARE AT COST, UNPAID COSTS OF MEDICAID AND OTHER PUBLIC PROGRAMS, AND A RANGE OF DIVERSE PROGRAMS DESIGNED TO ENHANCE ACCESS AND IMPROVE COMMUNITY HEALTH. ADDITIONALLY, DURING THIS PERIOD, ST. NICHOLAS PROVIDED $1,978,519 (AT COST) IN UNCOMPENSATED CARE TO PATIENTS THAT DID NOT QUALIFY FOR CHARITY CARE OR PUBLIC ASSISTANCE AND MORE THAN $18 MILLION (AT COST) IN EXCESS OF MEDICARE PAYMENT FOR HEALTH CARE SERVICES IN EXCESS OF MEDICARE PAYMENT FOR HEALTH CARE SERVICES. ST. NICHOLAS HOSPITAL PROVIDES A RANGE OF COMMUNITY BENEFITS THAT FLOWS 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 HOSPITAL AND THEY OFTEN RELIEVE A BURDEN THAT WOULD OTHERWISE BE CARRIED BY GOVERNMENT. SEVERAL OF THESE PROGRAMS AND ACTIVITIES ARE DESIGNED TO RESPOND TO OUR FY2012 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH SURFACED THE FOLLOWING PRIORITY NEEDS FOR ATTENTION FROM THE HOSPITAL IN COLLABORATION WITH OTHER COMMUNITY ORGANIZATIONS: ORAL HEALTH THE HOSPITAL HAS BEEN ACTIVE IN SUPPORTING THE ESTABLISHMENT OF A COMMUNITY CLINIC. IN FY2014, 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. IN ADDITION, ST. NICHOLAS ALSO PARTICIPATES ON ORAL HEALTH PROJECTS THROUGH ITS MEMBERSHIP IN THE SHEBOYGAN COUNTY DENTAL ACCESS COMMITTEE, INCLUDING: OPERATION GRATITUDE (COLLECTING HALLOWEEN CANDY FOR THE TROOPS) AND GIVE KIDS A SMILE DAY. FROM JULY 2013 THRU JUNE 2014, THE DENTAL CLINIC HAS SERVED MORE THAN 3,000 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 COMPLETED FIVE FOCUS GROUPS (HISPANIC, HMONG, LOW INCOME, SENIORS, AND YOUNG ADULTS) AND HOSTED AN EXECUTIVE BRIEFING FOR HEALTHCARE LEADERS TO SHARE RESULTS OF THE COMMUNITY SURVEY AND FOCUS GROUPS. A COMMUNITY AWARENESS CAMPAIGN IS BEING DEVELOPED AND ST. NICHOLAS HOSPITAL HAS PROVIDED FINANCIAL SUPPORT. AS PART OF THIS EFFORT ST. NICHOLAS HOSPITAL STAFF WAS A PANELIST AT THE HEALTH SISTER HOSPITAL SYSTEM'S SPIRITUALITY CONFERENCE ON HEALTH LITERACY. ADEQUATE, APPROPRIATE AND SAFE FOOD AND NUTRITION IN PARTNERSHIP WITH PREVEA HEALTH, ST. NICHOLAS HOSPITAL CONTINUES TO PROVIDE NUTRITIONAL EDUCATION TO THE COMMUNITY AT THE FARMERS MARKET. IN ADDITION, THE HOSPITAL PROVIDED THE PUBLIC WITH THE OPPORTUNITY TO "ASK THE DIETICIAN" AND RECEIVE EDUCATIONAL MATERIALS AT THE FARMERS MARKET AS WELL AS HEALTHY FOOD SAMPLES AND SHOWCASING RECIPES UTILIZING LOCAL PRODUCE. PURCHASED REUSABLE SHOPPING BAGS AND INSULATED LUNCH BAGS FOR PARTICIPANTS. ENROLLMENT OUTREACH AND ASSISTANCE IN FY2014, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) AND OUR 13 LOCAL SYSTEMS INVESTED A CONSIDERABLE AMOUNT OF COMMUNITY BENEFIT RESOURCES IN ORDER TO EDUCATE THE UNINSURED ABOUT HISTORIC NEW OPPORTUNITIES TO ENROLL IN AFFORDABLE HEALTH INSURANCE COVERAGE AND TO FACILITATE THE ENROLLMENT PROCESS. BETWEEN OCTOBER 1, 2013 AND MARCH 31, 2014, STATE-BASED INSURANCE EXCHANGES BEGAN A SIX-MONTH OPEN ENROLLMENT PERIOD THAT GAVE MILLIONS OF AMERICANS ACCESS TO HEALTH INSURANCE COVERAGE. ST. NICHOLAS HOSPITAL PLAYED A VITAL ROLE IN EDUCATING ELIGIBLE PEOPLE IN THEIR LOCAL COMMUNITIES, REFERRING THEM TO CERTIFIED APPLICATION COUNSELORS AND/OR ENROLLING THEM IN THE HEALTH INSURANCE EXCHANGES OR IN SECURING COVERAGE THROUGH MEDICAID EXPANSION. ST. NICHOLAS HOSPITAL'S ENROLLMENT OUTREACH AND ASSISTANCE INCLUDED PRINTED MATERIALS; LUNCH AND LEARNS; LEADERSHIP HUDDLES, ONSITE CACS; COMMUNITY EDUCATIONAL PROGRAMS; PARTICIIPATION IN THE REGIONAL ENROLLMENT NETWORK; AND THE DIVISIONAL CEO SERVED ON THE WISCONSIN HEALTH ASSOCIATION ENROLLMENT TASK FORCE.
SCHEDULE H, PART VI, LINE 5, PROMOTION OF COMMUNITY HEALTH (CONTINUED)	RESPONDING TO COMMUNITY NEED 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. ST. NICHOLAS' ACTIVE PARTICIPATION WITH THE HMONG COMMUNITY CONTINUES WITH THE ADDITION OF A PARTNERSHIP WITH A LOCAL CATHOLIC CHURCH TO PROVIDE SCREENINGS AND EDUCATION IN A LOCATION WHICH IS NONTHREATENING TO MEMBERS OF THIS POPULATION. IN DOING SO, THE HOSPITAL HAS REACHED OUT TO THIS COMMUNITY AND BEEN ABLE TO IDENTIFY CRITICAL HEALTH CONDITIONS AND ENCOURAGE AND PROMOTE ONGOING PROACTIVE HEALTH CARE RATHER THAN REACTIVE CARE. 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, FAMILY HEALTH & FITNESS DAY AND LOCAL HEALTH FAIRS. * ST. NICHOLAS HOSPITAL IS AN ACTIVE CO-SPONSOR OF THE LAKESHORE COMMUNITY HEALTH CENTER BEING 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. * FREE SCREENINGS AND HEALTH EDUCATION FOR THE HMONG MUTUAL ASSISTANCE ASSOCIATION. * SUPPORT GROUPS (FREE) FOR CANCER, BRAIN INJURY, GRIEF AND TEEN SUPPORT. * FREE USE OF HOSPITAL CONFERENCE AND MEETING ROOMS FOR AREA NOT-FOR-PROFIT ORGANIZATIONS. * PROFESSIONALS AT THE HOSPITAL ASSISTED MORE THAN 1,700 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 1,400 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, BIG BROTHERS/BIG SISTERS, AND AREA CHURCHES AND SCHOOLS REACHES THOUSANDS IN NEED WITHIN THE GREATER SHEBOYGAN COUNTY AREA. * FOOD DRIVES FOR AREA FOOD PANTRIES; CANDY COLLECTION FOR TROOPS OVERSEAS, 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, DRAWING MEMBERS FROM THE CATHOLIC COMMUNITY TO DONATE BLOOD AFTER GOOD FRIDAY MASS. WE COLLECT AN AVERAGE OF 25 PINTS A 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, BODY BAGS, ACE WRAPS, AND OTHER HOME MEDICAL SUPPLIES. * ALSO IN RESPONSE TO THE COMMUNITY NEED FOR "ADEQUATE AND APPROPRIATE NUTRITION", PARTICIPATED IN THE FARMERS MARKET BY PROVIDING NUTRITIONAL INFORMATION AND "ASK A DIETITIAN" AND PROVIDED REUSABLE GROCERY BAGS.
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 13 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 FURTHERING MEDICAL EDUCATION AND KNOWLEDGE. IN FY2014, OUR 13 HOSPITALS RESPONDED TO NEEDS IDENTIFIED IN EACH OF THEIR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNAS) COMPLETED IN FY2012. THE INFORMATION GATHERED FROM THESE ASSESSMENTS WAS USED TO DEVELOP NEW AND ENHANCE EXISTING COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT BEST ADDRESSED COMMUNITY NEEDS. INCLUDED 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. ACROSS HSHS, WE COLLECTIVELY PROVIDED $174.0 MILLION IN COMMUNITY BENEFIT (OR 9.3% OF TOTAL HOSPITAL EXPENSES) IN FY2014. INCLUDED IN THIS AMOUNT WAS $39.9 MILLION PROVIDED FOR FINANCIAL ASSISTANCE (I.E. CHARITY CARE) AND $95.8 MILLION FOR UNREIMBURSED CARE PROVIDED UNDER 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 $175.2 MILLION. HSHS HOSPITALS ALSO RECORDED $94.2 MILLION IN UNCOLLECTIBLE ACCOUNTS. WHILE THE LATTER TWO AMOUNTS ARE NOT COUNTED 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 ALSO 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 WE ARE ABLE TO MEET THE ONGOING DEMAND FOR HIGH QUALITY, EFFICIENT AND EASILY ACCESSIBLE HEALTH CARE. RECOGNIZING THAT THE HEALTH CARE DELIVERY MODEL IN THE UNITED STATES IS EVOLVING, HSHS REMAINS FOCUSED ON IMPLEMENTING OUR CARE INTEGRATION STRATEGY. CARE INTEGRATION COORDINATES THE DELIVERY OF CARE AROUND THE NEEDS OF EACH PATIENT. DURING FY2014, WE MADE SIGNIFICANT PROGRESS WITH THIS STRATEGY AS WE FURTHER IMPLEMENTED INTEROPERABLE HEALTH INFORMATION TECHNOLOGIES, EXPANDED THE NUMBER OF MEDICAL HOMES, AND STRENGTHENED OUR ALIGNMENT WITH PHYSICIANS. GREATER ACCESS TO CARE AS A FRANCISCAN HEALTH CARE MINISTRY, HSHS IS DEEPLY COMMITTED TO SERVING THOSE WHO ARE MOST IN NEED. 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 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 FY2014, HSHS AND OUR 13 HOSPITALS INVESTED A CONSIDERABLE AMOUNT OF COMMUNITY BENEFIT RESOURCES TO EDUCATE THE UNINSURED ABOUT HISTORIC NEW OPPORTUNITIES TO ENROLL IN AFFORDABLE HEALTH CARE COVERAGE AND TO FACILITATE THE ENROLLMENT 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 13 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, IN 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 MOVED TOWARD MEDICAID EXPANSION UNDER THE AFFORDABLE CARE ACT. WITH THE SUPPORT OF ST. MARY'S HOSPITAL MEDICAL CENTER AND ST. VINCENT HOSPITAL IN GREEN BAY, WISCONSIN, THE NEW COMMUNITY CLINIC DENTAL PROGRAM ON THE CAMPUS OF NORTHEAST WISCONSIN (NEW) TECHNICAL COLLEGE WAS ABLE TO PURCHASE EQUIPMENT TO ENABLE LOCAL ORAL SURGEONS TO PROVIDE CARE (ON A VOLUNTEER BASIS) AT THE CLINIC - THE SITE THAT ST. MARY'S AND ST. VINCENT HOSPITALS HELPED TO ESTABLISH IN 2013. ANNUALLY, THE CLINIC PROVIDES DENTAL SERVICES TO APPROXIMATELY 6,000 LOW-INCOME AND UNINSURED PERSONS INCLUDING THE HOMELESS IN BROWN COUNTY. 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 EXAMS AND SCREENINGS, X-RAYS AND HYGIENE TO THOSE IN NEED. IN WESTERN WISCONSIN, A PARTNERSHIP BETWEEN ST. JOSEPH'S HOSPITAL IN CHIPPEWA FALLS, THE CHIPPEWA HEALTH IMPROVEMENT PARTNERSHIP (CHIP), LE PHILLIPS-LIBERTAS TREATMENT CENTER AND THE OPEN DOOR CLINIC (A FREE CLINIC SUPPORTED BY ST. JOSEPH'S HOSPITAL AND CHIP) WAS DEVELOPED IN FY2014 TO PROVIDE FREE BEHAVIORAL HEALTH SERVICES TO ELIGIBLE PATIENTS OF THE OPEN DOOR CLINIC. THIS INITIATIVE IS IN DIRECT RESPONSE TO THE IDENTIFIED NEED TO PROVIDE BETTER ACCESS TO MENTAL HEALTH SERVICES FOR THOSE WITHOUT INSURANCE COVERAGE. IN FY2014, 105 REFERRALS WERE MADE FROM THE OPEN DOOR CLINIC TO LE PHILLIPS-LIBERTAS TREATMENT CENTER. IN TOTAL, 950 VISITS WERE PROVIDED TO REFERRED PATIENTS INCLUDING INITIAL INTAKE AND FOLLOW UP THERAPY SESSIONS - MENTAL HEALTH SERVICES THAT WOULD NOT HAVE BEEN RECEIVED HAD THE PROGRAM NOT BEEN DEVELOPED AND IMPLEMENTED. IN SOUTHEAST ILLINOIS, AREA RESIDENTS CAN GET HELP FILLING A PRESCRIPTION THROUGH THE LONG-TERM COLLABORATION BETWEEN ST. ANTHONY'S MEMORIAL HOSPITAL IN EFFINGHAM AND CATHOLIC CHARITIES. IN FY2014, ST. ANTHONY'S HELPED UNDERWRITE THE COST OF PRESCRIPTION MEDICATIONS FOR 311 RESIDENTS, A 10% INCREASE OVER FY2013. ST. ANTHONY'S AND CATHOLIC CHARITIES BELIEVE THAT NO ONE SHOULD BE WITHOUT PRESCRIBED MEDICATIONS BECAUSE OF INABILITY TO PAY. IN SOUTHWEST ILLINOIS, 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 AN INTENSIVE 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% 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% REDUCTION OFF BILLED CHARGES IF AN UNINSURED PATIENT'S FAMILY INCOME LEVEL IS DETERMINED TO BE ABOVE 500% BUT EQUAL TO OUR LESS THAN 600% OF THE CURRENT FEDERAL POVERTY GUIDELINES. ALL CHARGES ARE WAIVED FOR PATIENTS BELOW 200% 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 6, AFFILIATED HEALTH CARE SYSTEM (CONTINUED)	BETTER 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, EACH OF OUR 13 HOSPITALS COMPLETED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) DURING FY2012. THE INFORMATION GATHERED FROM THESE ASSESSMENTS IS BEING USED TO HELP US DEVELOP NEW, AND ENHANCE EXISTING, PROGRAMS AND SERVICES THAT BEST ADDRESS THE NEEDS OF THE COMMUNITY. SEVERAL PRIORITY NEEDS WERE IDENTIFIED IN THE CHNAS INCLUDING METABOLIC AND CARDIOVASCULAR DISEASE MANAGEMENT, ADEQUATE FOOD AND NUTRITION, AND MENTAL HEALTH. 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 COMMUNITY ORGANIZATIONS TO ADDRESS IDENTIFIED NEEDS. IN PARTNERSHIP WITH THE SANGAMON COUNTY HEALTH DEPARTMENT AND LOCAL FARMERS, ST. JOHN'S HOSPITAL IN SPRINGFIELD, ILLINOIS TOOK A LEAD ROLE IN BRINGING A FARMERS MARKET TO THE EAST SIDE OF SPRINGFIELD. THE EAST SIDE FARMERS MARKET (ESFM) ADDRESSES THREE COMMUNITY NEEDS: CHILDHOOD OBESITY, CHILDHOOD POVERTY (26% OF CHILDREN IN SANGAMON COUNTY LIVE IN POVERTY VS. 18% IN THE STATE) AND PROVIDING FRESH PRODUCE TO PERSONS LIVING IN A KNOWN "FOOD DESERT." OVER THE LAST THREE SUMMERS (JUNE - OCTOBER), ESFM HAS SERVED 3,074 FAMILIES. WIC CLIENTS, SENIOR CITIZENS AND DISABLED PERSONS HAVE ESPECIALLY BENEFITTED DUE TO ESFM BEING OFFERED ON THE SAME DAY AS WIC EDUCATION CLASSES, AND THE CLOSE PROXIMITY OF PARKING TO VENDORS. IN ADDITION, THE FARMERS CREATED A "DRIVE THROUGH" TO MAKE SHOPPING EASIER FOR SENIORS AND DISABLED PERSONS. 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 300 PARTICIPANTS, 80% OF WHOM WERE RETURNING PARTICIPANTS FROM FY2013, TO LOSE WEIGHT AND MAINTAIN A HEALTHY LIFESTYLE. 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 - 53% STATED THEY WERE ABLE TO MAINTAIN THEIR WEIGHT LOSS AND 74% WERE ABLE TO CONTINUE TO LOSE WEIGHT. IN FY2014, HEALTHY YOU PARTICIPANTS COLLECTIVELY LOST 2,853 POUNDS OR 4.42% OF TOTAL BODY WEIGHT. IN FY2014, ST. MARY'S HOSPITAL IN DECATUR, ILLINOIS PARTNERED WITH LOCAL PROVIDERS TO PROMOTE THE LEARN MORE, BREATHE BETTER CAMPAIGN IN COORDINATION WITH THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE TO EDUCATE THE COMMUNITY ABOUT COPD AND OTHER BREATHING ISSUES AND TO PROMOTE BEHAVIORS THAT IMPROVE HEALTH. BREATHING ISSUES ARE PREVALENT IN THE DECATUR AREA DUE TO THE CONCENTRATION OF MANUFACTURING AND POOR AIR QUALITY. ST. MARY'S HAS RESEARCHED AND COMPILED ADMISSIONS DATA RELATED TO COPD AND HAS INCREASED PATIENT, PROVIDER AND COMMUNITY EDUCATION TO BETTER COORDINATE CARE ACROSS THE CONTINUUM FOR BETTER PATIENT OUTCOMES. IN ADDITION, ST. MARY'S HOSPITAL'S MODEL FOR COPD CORE MEASURES HAS BEEN SHARED AT NATIONAL BEST PRACTICES SEMINARS TO BENEFIT OTHER COMMUNITIES. ACCORDING TO THE NATIONAL ASSESSMENT OF ADULT LITERACY, ONLY 12% 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 ST. NICHOLAS HOSPITAL IN SHEBOYGAN AND THE DEPARTMENT OF PUBLIC HEALTH IN FY2012. IN TURN, ST. NICHOLAS HOSPITAL SPONSORED A SYMPOSIUM FOR HEALTH CARE PROVIDERS AND SOCIAL SERVICES ORGANIZATIONS AND A COMMUNITY-WIDE CME FOR ALL SHEBOYGAN PHYSICIANS AS WELL AS STAFF TRAINING AS FIRST STEPS IN ADDRESSING THE HEALTH LITERACY NEEDS OF THE SHEBOYGAN COMMUNITY IN FY2013. 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. WITH THE SUPPORT OF ST. NICHOLAS HOSPITAL, A HEALTH LITERACY COMMUNITY AWARENESS CAMPAIGN IS BEING DEVELOPED. SACRED HEART HOSPITAL IN EAU CLAIRE, WISCONSIN ADDRESSED THE NEED FOR MENTAL AND BEHAVIORAL HEALTH SERVICES THROUGH THE HEALING PLACE. FREE GRIEF AND HOLISTIC SUPPORT SERVICES SUCH AS ONE ON ONE COUNSELING, WORKSHOPS AND PRESENTATIONS ARE PROVIDED FOR INDIVIDUALS AND FAMILIES DEALING WITH LOSS AND MAJOR LIFE TRANSITIONS DUE TO MILITARY SERVICE, ILLNESS, DEATH, DIVORCE, ETC. EXPANDED MEDICAL KNOWLEDGE HSHS WORKS TO ADVANCE MEDICAL KNOWLEDGE BY SUPPORTING RESEARCH INITIATIVES AND EDUCATIONAL OPPORTUNITIES. IN FY2014, HSHS HOSPITALS AND AFFILIATED PHYSICIAN GROUPS CONTRIBUTED MORE THAN $18.5 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. ANOTHER EXAMPLE OF THIS COMMITMENT INCLUDES ST. JOHN'S COLLEGE OF NURSING IN SPRINGFIELD, ILLINOIS, WHICH OFFERS THE LAST TWO YEARS OF THE BACCALAUREATE DEGREE IN NURSING, AS WELL AS CONTINUING EDUCATION PROGRAMS FOR NURSES AND HEALTH PROFESSIONALS. ST. JOHN'S COLLEGE HAS BEEN CITED AS THE OLDEST CATHOLIC HOSPITAL-BASED SCHOOL OF NURSING IN THE UNITED STATES. FOUNDED IN 1886, THE COLLEGE HAS REMAINED DEDICATED THROUGHOUT ITS RICH HISTORY TO THE EDUCATION OF PROFESSIONAL NURSES WHOSE PRACTICE EXEMPLIFIES EXCELLENCE IN AN INTEGRATED HEALTH CARE SYSTEM. THE COLLEGE IS ALSO HELPING TO ADDRESS THE SHORTAGE OF PRIMARY CARE PROFESSIONALS IN DOWNSTATE ILLINOIS. ST. ELIZABETH'S HOSPITAL IN BELLEVILLE, ILLINOIS PROVIDED CLINICAL EDUCATION IN NURSING, RADIOLOGY, SURGERY, RESPIRATORY, DIETARY, PHYSICAL AND OCCUPATIONAL THERAPY, PHARMACY AND BEHAVIORAL HEALTH TO 637 AREA COMMUNITY COLLEGE AND UNIVERSITY STUDENTS. THIS MENTORING IS VALUED AT MORE THAN $440,000. IN ADDITION, TO ADDRESS A SHORTAGE OF PRIMARY CARE FAMILY PRACTICE DOCTORS IN ST. CLAIR COUNTY, ST. ELIZABETH'S SUBSIDIZED THE ST. LOUIS UNIVERSITY FAMILY MEDICINE RESIDENCY PROGRAM, A UNIQUE MERGER OF A COMMUNITY-BASED SETTING, AN ACADEMIC CENTER AND A MILITARY-BASED RESIDENCY. CLINICAL EDUCATION SITES INCLUDED ST. ELIZABETH'S HOSPITAL, CARDINAL GLENNON CHILDREN'S HOSPITAL, AREA PHYSICIANS' OFFICES AND SCOTT AIR FORCE BASE OUTPATIENT CLINICS. ALSO IN SOUTHERN ILLINOIS, 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 HOSPITAL WAS RECENTLY RECOGNIZED BY THE ILLINOIS PRINCIPALS ASSOCIATION - KASKASKIA REGION FOR SPONSORING THE PROGRAM FOR MORE THAN 30 YEARS. ST. JOSEPH'S HOSPITAL ALSO PROVIDES CLINICAL EXPERIENCE FOR KASKASKIA COLLEGE STUDENTS ENROLLED IN THE NURSING, PHYSICAL THERAPY AND RADIOLOGY PROGRAMS. PHARMACY STUDENTS HAVE ALSO COMPLETED THEIR CLINICAL TRAINING AT ST. JOSEPH'S HOSPITAL. HIGHER LEVEL OF CARE HSHS COMMUNITY BENEFIT INITIATIVES ARE A VITAL PART OF OUR OVERALL MISSION. WE BELIEVE THAT THROUGH OUR WORK TO CREATE GREATER ACCESS TO CARE, BETTER COMMUNITY HEALTH, AND EXPANDED MEDICAL KNOWLEDGE, WE MADE A POSITIVE DIFFERENCE IN THE LIVES OF TENS OF THOUSANDS OF PEOPLE IN ILLINOIS AND WISCONSIN IN FY2014. HOSPITAL SISTERS HEALTH SYSTEM'S COMMITMENT TO COMMUNITY BENEFIT STEMS FROM THE FRANCISCAN AND CATHOLIC VALUES SHARED BY OUR 14,000 COLLEAGUES ACROSS WISCONSIN AND ILLINOIS. CATHOLIC HEALTH CARE IS COMMITTED TO PROMOTING AND DEFENDING HUMAN DIGNITY, CARING FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE POPULATIONS, AND PROMOTING THE COMMON GOOD. WE REMAIN DEDICATED TO CONTINUOUSLY IMPROVE COMMUNITY HEALTH THROUGH OUR STRATEGIC, WELL-DEFINED COMMUNITY BENEFIT INITIATIVES SO THAT WE CAN HELP MORE PEOPLE LIVE HEALTHIER LIVES.
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	Yes (true)	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	$230,210	$0	$42,966	$0	$32,916	$0	$57,058	$0	$25,630	$0	$388,780	$0	$0
ANN M CARR
TREASURER	$0	$223,926	$0	$38,138	$0	$56,891	$0	$236,713	$0	$18,355	$0	$574,023	$0	$24,602
THERESE B PANDL
DIVISIONAL CEO	$0	$592,471	$0	$122,797	$0	$20,230	$0	$138,315	$0	$28,109	$0	$901,922	$0	$0
GREG SIMIA
DIVISION CFO	$0	$347,648	$0	$36,374	$0	$780	$0	$45,644	$0	$25,519	$0	$455,965	$0	$0
ANDREA M ANGOTTI
PHARMACIST	$131,510	$0	$0	$0	$780	$0	$48,452	$0	$20,981	$0	$201,723	$0	$0	$0
SUSAN M WHEELER
DIRECTOR OF PHARMACY	$135,552	$0	$250	$0	$780	$0	$33,473	$0	$19,099	$0	$189,154	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 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 4a, Severance or change-of-control payment	PER THE TERMS OF DEBRA FRENN'S TERMINATION AGREEMENT, SHE WAS TO RECEIVE SEVERANCE PAYMENTS BEGINNING THE FIRST PAY PERIOD AFTER HER TERMINATION DATE OF MAY 14, 2013 THROUGH THE PAY PERIOD ENDING NOVEMBER 23, 2013. DURING CALENDAR YEAR 2013, DEBRA FRENN RECEIVED SEVERANCE PAYMENTS TOTALING $75,000.
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 2013; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ANN M. CARR -- $28,503 THERESE PANDL -- $72,113 ANDREW BAGNALL -- $29,575 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2013; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANN M. CARR -- $24,602

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (17 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 2013-2014, 3,983 SURGICAL PROCEDURES WERE 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 2013-2014 THERE WERE 13,395 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 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, Sec A, 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, Sec A, 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, Sec A, 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, Sec B, 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, Sec B, 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 13, WHISTLEBLOWER POLICY	PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
Form 990, Part VI, Sec B, 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, Sec B, Line 15b, Process to establish compensation of other employees	PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A.
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, Sec C, 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 Expenses	CONTRACT LABOR - TOTAL EXPENSE: 576064, PROGRAM SERVICE EXPENSE: 403245, MANAGEMENT AND GENERAL EXPENSES: 172819, FUNDRAISING EXPENSES: ; PROFESSIONAL FEES - TOTAL EXPENSE: 934989, PROGRAM SERVICE EXPENSE: 654492, MANAGEMENT AND GENERAL EXPENSES: 280497, FUNDRAISING EXPENSES: ; PURCHASED SERVICES - TOTAL EXPENSE: 12728979, PROGRAM SERVICE EXPENSE: 8910285, MANAGEMENT AND GENERAL EXPENSES: 3818694, 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 - -1021708; CHANGE IN PENSION - 1193164; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 24057; CHANGE IN PERMANENTLY RESTRICTED NET ASSETS - 35100; CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS - 37920; SWAP PAYMENTS - -160334;

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1
SPRINGFIELD HEALTH PARTNERS LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371364419	HEALTHCARE (DISSOLVED 03/22/13)	IL	$0	$0	HSHS MG
KIARA CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	261417684	HEALTHCARE	IL	-$3,651,339	$7,292,316	HSSI
PHYSICIAN CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371668647	HEALTHCARE	IL	-$779,271	$1,233,121	KCIN

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrganizationControlledOrganizationInd
HOSPITAL SISTERS HEALTH SYSTEM
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371058692	HEALTHCARE	IL	501(C)(3)	11 - Type III - FI	NA	false
HOSPITAL SISTERS OF ST FRANCIS FDTN
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371186514	HEALTHCARE	IL	501(C)(3)	9	HSHS	Yes (true)
HSHS HEALTHCARE PLAN TRUST FUND
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371137724	HEALTHCARE	IL	501(C)(9)	N/A	HSHS	Yes (true)
HSHS SELF INSURANCE TRUST
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371120626	INSURANCE	IL	501(C)(3)	11 - Type I	HSHS	Yes (true)
HOSPITAL SISTERS HEALTHCARE WEST INC
2661 COUNTY HIGHWAY 1	CHIPPEWA FALLS	WI	54729	510157933	HEALTHCARE	WI	501(C)(3)	11 - 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)	11 - Type III - FI	HSHS	Yes (true)
HSHS MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVE	SPRINGFIELD	IL	62703	263956318	HEALTHCARE	IL	501(C)(3)	11 - Type III - FI	HSSI	Yes (true)
HSHS WISCONSIN MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVE	SPRINGFIELD	IL	62703	264515959	HEALTHCARE	WI	501(C)(3)	11 - 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 MGMT
835 S VAN BUREN	GREEN BAY	WI	54301	391677100	HEALTHCARE	WI	501(C)(3)	3	ST VINCENT	Yes (true)
UNITY LIMITED PARTNERSHIP
2366 OAK RIDGE CIRCLE	DE PERE	WI	54115	391750729	HEALTHCARE	WI	501(C)(3)	9	HSSI	Yes (true)
PRAIRIE EDUCATION & RESEARCH COOPERATIVE
317 NORTH 5TH STREET	SPRINGFIELD	IL	62701	371157915	HEALTHCARE	IL	501(C)(3)	4	HSSI	Yes (true)
COMMUNITY MEMORIAL HOSPITAL
855 S MAIN STREET	OCONTO FALLS	WI	54154	390848401	HEALTHCARE	WI	501(C)(3)	3	HSSI (SEE PART VII)	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	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	$599,299	$4,931,271	false	false	0
PRAIRIE HEART INSTITUTE ST JOHN'S
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	371321197	HEALTHCARE	IL	HSHS	RELATED	-$1,018	$47,055	false	false	0
NORTHEAST WISCONSIN RADIATION THERAPY SERVICES LLC
1726 SHAWANO AVE	GREEN BAY	WI	543079047	263749065	HEALTHCARE	WI	SMGB	RELATED	$147,184	$514,563	false	Yes (true)	0
PAIN CENTER OF WISCONSIN
4131 W LOOMIS ROAD SUITE 300	GREENFIELD	WI	53221	263155343	HEALTHCARE	WI	ST VINCENT	RELATED	$1,752,500	$1,353,813	false	false	0
SURGERY CENTER OF SHEBOYGAN LLC
3141 SAEMANN AVENUE	SHEBOYGAN	WI	53081	260822209	HEALTHCARE	WI	ST NICHOLAS (SOLD 1114)	RELATED	$155,892	$0	false	false	0
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	-$7,553	$9,078	false	Yes (true)	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1	Province Or StateForeignAddress/ProvinceOrState	CountryForeignAddress/Country	Postal CodeForeignAddress/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
KIARA INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163401	HEALTHCARE	IL	HSHS	C CORPORATION	-$23,279,067	$45,045,072	0	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	$2,912,268	$45,322,060	0	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	$100,258,139	0	Yes (true)	PO BOX 1159	GRAND CAYMAN	CJ	KY1-1102	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	-$3,136	$20,601	0	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	Yes (true)	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	Yes (true)	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 (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART II, COLUMN (F), DIRECT CONTROLLING ENTITY (CMH)

ON SEPTEMBER 1, 2014, HSSI BECAME THE SOLE CORPORATE MEMBER OF COMMUNITY MEMORIAL HOSPITAL (CMH) IN OCONTO FALLS, WISCONSIN. EFFECTIVE ON THE ACQUISITION DATE, CMH BECAME A CATHOLIC ENTITY AND THE HOSPITAL NAME WAS CHANGED TO ST. CLARE MEMORIAL HOSPITAL, INC. PREVIOUS TO THE ACQUISITION, TWO HSSI AFFILIATES HELD A COMBINED 24% MINORITY INTEREST IN CMH. REVISED GOVERNING DOCUMENTS ARE CONSISTENT WITH HSHS POLICIES APPLICABLE TO AFFILIATES. HSSI WILL RETAIN CERTAIN RESERVE POWERS OVER ST. CLARE MEMORIAL HOSPITAL, INC. CONSISTENT WITH OTHER HSSI SUBSIDIARIES.

PART V, LINE 2, TRANSACTIONS WITH RELATED ENTITIES

THE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501 (C) (3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.