ST CLARE MEMORIAL HOSPITAL INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: ST CLARE MEMORIAL HOSPITAL INC (EIN 39-0848401)
Tax period: 2013-10-01 to 2014-09-30
Filed: 2015-08-14
IRS object ID: 201532269349301743
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 K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-08-14T17:00:08-05:00	ReturnTs
Tax Period End	2014-09-30	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	2013-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390848401	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Business Name Control	STCL	BusinessNameControlTxt
Phone	9208463444	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 S MAIN STREET	AddressLine1
City	OCONTO FALLS	City
State	WI	State
ZIP Code	54154	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MICHELE MILLER-CAMPBELL	PersonNm
Person Title	CFO	PersonTitleTxt
Signature	2015-08-14	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	2016-04-25 22:37:26Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

Field	Value	IRS element (for citing)
Business Name Line1	DANIEL DEGROOT	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 S MAIN STREET	AddressLine1
City	OCONTO FALLS	City
State	WI	State
ZIP Code	54154	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$33,995,169	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	HTTP://WWW.STCLAREMEMORIAL.ORG/	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1929	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	TO PROVIDE HIGH QUALITY HEALTHCARE, CLOSE TO HOME.	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	431	TotalEmployeeCnt
Total Volunteers	46	TotalVolunteersCnt
Total Gross UBI	$2,979,396	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$582,635	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$121,002	PYContributionsGrantsAmt
CY Contributions Grants	$28,814	CYContributionsGrantsAmt
PY Program Service Revenue	$35,112,308	PYProgramServiceRevenueAmt
CY Program Service Revenue	$33,698,250	CYProgramServiceRevenueAmt
PY Investment Income	$195,466	PYInvestmentIncomeAmt
CY Investment Income	$96,126	CYInvestmentIncomeAmt
PY Other Revenue	-$53,722	PYOtherRevenueAmt
CY Other Revenue	-$81,988	CYOtherRevenueAmt
PY Total Revenue	$35,375,054	PYTotalRevenueAmt
CY Total Revenue	$33,741,202	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$18,653,248	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$18,439,801	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$18,095,469	PYOtherExpensesAmt
CY Other Expenses	$19,784,918	CYOtherExpensesAmt
PY Total Expenses	$36,748,717	PYTotalExpensesAmt
CY Total Expenses	$38,224,719	CYTotalExpensesAmt
PY Revenues Less Expenses	-$1,373,663	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$4,483,517	CYRevenuesLessExpensesAmt
Total Assets BOY	$29,636,760	TotalAssetsBOYAmt
Total Assets EOY	$24,850,414	TotalAssetsEOYAmt
Total Liabilities BOY	$13,578,443	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$13,016,391	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$16,058,317	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$11,834,023	NetAssetsOrFundBalancesEOYAmt
Mission	ST. CLARE MEMORIAL HOSPITAL, INC. OPERATES AN ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE INPATIENT MEDICAL AND SURGICAL SERVICES AS WELL AS EMERGENCY, PRIMARY CARE PHYSICIAN, AND OUTPATIENT SERVICES. THE HOSPITAL HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL UNDER MEDICARE AND MEDICAID REGULATIONS. THIS DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$31,064,100	ExpenseAmt
Revenue	$30,718,854	RevenueAmt
Desc	ST. CLARE MEMORIAL HOSPITAL IS AN INDEPENDENT HEALTHCARE SYSTEM SERVING GREATER OCONTO COUNTY WITH A FULL-SERVICE HOSPITAL AND SIX PRIMARY CARE CLINICS LOCATED THROUGHOUT OCONTO COUNTY. THE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH A LICENSURE OF 25 BEDS AND HAS A 24-HOUR, PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, URGENT CARE, RETAIL PHARMACY, INTENSIVE CARE, INPATIENT AND OUTPATIENT SURGICAL AND DIAGNOSTIC SERVICES, REHABILITATION, ONCOLOGY OUTPATIENT CLINIC AND THE CENTER FOR WOMEN'S CARE. THE ST. CLARE PRIMARY CARE CLINICS ARE LOCATED IN LENA, OCONTO FALLS, OCONTO, GILLETT, SURING AND MOUNTAIN. ST. CLARE MEMORIAL HOSPITAL IS A NON-PROFIT ORGANIZATION DEDICATED TO OUR MISSION TO PROVIDE HIGH QUALITY HEALTH CARE CLOSE TO HOME. ST.CLARE MEMORIAL HOSPITAL EXTENDS THIS MISSION INTO OUR VALUES OF QUALITY, CARE, COMMUNITY, TRUST, AND RESPECT AND PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTHCARE SERVICES. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2014, THE HOSPITAL HAD 702 DISCHARGES; 4,900 VISITS TO THE EMERGENCY ROOM; 1,958 SURGICAL CASES (INCLUDING AMBULATORY); AND 30,728 VISITS TO OUR HOSPITAL-BASED CLINICS. ST. CLARE MEMORIAL HOSPITAL PROVIDES HEALTHCARE SERVICES TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO THEIR AGE, RACE, SEX, OR ABILITY TO PAY FOR SERVICES. DURING FISCAL YEAR 2014, ST. CLARE MEMORIAL HOSPITAL PROVIDED $1,396,510 IN CHARITY CARE AND $1,998,004 IN BAD DEBT WRITE OFFS OF PATIENT ACCOUNTS DUE TO THE PATIENTS' INABILITY TO PAY FOR SERVICES THEY RECEIVED. IN ADDITION TO ITS HOSPITAL AND CLINIC SERVICES. ST. CLARE MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE FREE AND LOW-COST HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE OFFERINGS, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. THE HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, PUBLICITY, SUPPLIES, AND THE MEALS. FOUR ST. CLARE MEMORIAL HOSPITAL SENIOR SPECIALS DINNER SEMINARS WERE HELD IN 2014. ST. CLARE MEMORIAL HOSPITAL IS PLEASED TO PARTNER, PARTICIPATE AND COLLABORATE WITH MANY COMMUNITY PARTNERS FOR VARIOUS INITIATIVES AND EVENTS. ST. CLARE MEMORIAL HOSPITAL PLANNED AND SPONSORED INCLUDING A COMMUNITY HEALTH INITIATIVE. WE ALSO PRESENTED THE OCONTO COUNTY SAFETY FAIR IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. ST. CLARE MEMORIAL HOSPITAL OFFERED FREE WORKSHOPS FOR CANCER PATIENTS IN 2014. ST. CLARE MEMORIAL HOSPITAL HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. ST. CLARE MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR MAJOR FUNDRAISING COMMITTEE AND THE EXECUTIVE COMMITTEE. FOR EACH OF THESE INITIATIVES, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. IN ADDITION TO PROVIDING COMPREHENSIVE SPORTS PHYSICAL CLINICS IN WHICH THE FEES ARE DONATED BACK TO THE SCHOOLS OF THE PARTICIPATING STUDENTS, ST. CLARE MEMORIAL HOSPITAL PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE ROUTINELY HOSTED AT THE HOSPITAL. ST. CLARE MEMORIAL HOSPITAL ALSO DONATED TO THE CONSTRUCTION OF NEW SOFTBALL FIELDS FOR THE OCONTO FALLS SCHOOL DISTRICT.	Desc
Total Program Service Expenses	$31,064,100	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	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	false	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	Yes (true)	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	27	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	431	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	9	GoverningBodyVotingMembersCnt
Independent Voting Member	6	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (true)	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	false	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	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MICHELE MILLER-CAMPBELL	BusinessNameLine1

Field	Value	IRS element (for citing)
Phone	9208463444	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 SOUTH MAIN STREET	AddressLine1
City	OCONTO FALLS	City
State	WI	State
ZIP Code	54154	ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (17 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
CHRISTY KAEMPFER
BOARD PRESIDENT	2.00	0	Yes (X)	Yes (X)	$0	$0	$0
JAMES VANDORNICK
BOARD VICE PRESIDENT	2.00	0	Yes (X)	Yes (X)	$0	$0	$0
JAN STRANZ
BOARD SECRETARY/ TREASURER	2.00	0	Yes (X)	Yes (X)	$0	$0	$0
ASHOK RAI
BOARD MEMBER/ HSHS REP	2.00	40.00	Yes (X)		$0	$707,079	$49,685
DANIEL BOETTCHER
BOARD MEMBER	2.00	0	Yes (X)		$0	$0	$0
GENADI MALTINSKI
BOARD MEMBER/ PRESIDENT ELECT	42.00	0	Yes (X)		$232,120	$0	$0
HOWARD ESLIEN
BOARD MEMBER	2.00	0	Yes (X)		$0	$0	$0
ISAIAS CUPINO
BOARD MEMBER/ CHIEF OF STAFF	42.00	0	Yes (X)		$499,439	$0	$42,807
THOMAS R BAYER
BOARD MEMBER/ HSHS REP	2.00	40.00	Yes (X)		$0	$219,321	$141,685
DANIEL DEGROOT
Ex-Officio Board Member/CEO	40.00	0.50		Yes (X)	$182,005	$0	$7,280
KAY BARANCZYK
CNO	40.00	0		Yes (X)	$108,513	$0	$16,009
MICHELE MILLER-CAMPELL
CFO	40.00	0.50		Yes (X)	$119,056	$0	$23,721
DR LUZ BALMADRID
PHYSICIAN	40.00	0			$258,965	$0	$26,482	Yes (X)
HENRY LOOMANS MD
Physician	40.00	0			$242,516	$0	$28,627	Yes (X)
JAMES SPLIT MD
Physician	40.00	0			$378,854	$0	$35,686	Yes (X)
KEITH ELKINS
PHYSICIAN	40.00	0			$417,703	$0	$39,218	Yes (X)
R SCOTT LIEBL
PHYSICIAN	40.00	0			$443,914	$0	$37,950	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$2,883,085	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$926,400	TotReportableCompRltdOrgAmt
Total Other Compensation	$449,150	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	18	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
WIPFLI LLP
PO BOX 3160	MILWAUKEE	WI	53201	ACCOUNTING AND CONSULTING SERVICES	$1,185,239
ST VINCENT HOSPITAL
PO BOX 13508	GREEN BAY	WI	543073508	VARIOUS HOSPITAL SERVICES	$973,681
RODAC LLC
1365 NORTH RD STE F	GREEN BAY	WI	54313	CONSTRUCTION	$309,000
ST MARY'S MEDICAL CENTER
1726 SHAWANO AVE	GREEN BAY	WI	54303	VARIOUS HOSPITAL SERVICES	$283,395
GENALDI MALTINSKI MD
W121 LAKE SANDIA	KRAKOW	WI	54137	CONTRACT PHYSICIAN	$232,120

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Government Grants	$8,364	GovernmentGrantsAmt
All Other Contributions	$20,450	AllOtherContributionsAmt
Total Contributions	$28,814	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	$22,983,410	$22,983,410
PHARMACY REVENUE	446110	$9,313,584	$6,334,188	$2,979,396
OTHER REVENUE	900099	$1,401,256	$1,401,256
		$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	$33,698,250	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$107,041	TotalRevenueColumnAmt
Exclusion	$107,041	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	$114,012	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$243,052	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$129,040	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$129,040	TotalRevenueColumnAmt
Exclusion	-$129,040	ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$10,915	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$0	SecuritiesAmt
Other	-$10,915	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$10,915	TotalRevenueColumnAmt
Exclusion	-$10,915	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
CAFETERIA REVENUE	900099	$45,047	$45,047
GIFT SHOP REVENUE	452000	$2,005	$2,005
		$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	$47,052	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$33,741,202	TotalRevenueColumnAmt
Related Or Exempt Func Income	$30,718,854	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$2,979,396	UnrelatedBusinessRevenueAmt
Exclusion	$14,138	ExclusionAmt

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	$532,737	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$532,737	ManagementAndGeneralAmt

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	$13,929,560	TotalAmt
Program Services	$11,207,582	ProgramServicesAmt
Management And General	$2,721,978	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$267,885	TotalAmt
Program Services	$205,467	ProgramServicesAmt
Management And General	$62,418	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,863,992	TotalAmt
Program Services	$2,275,729	ProgramServicesAmt
Management And General	$588,263	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$845,627	TotalAmt
Program Services	$614,722	ProgramServicesAmt
Management And General	$230,905	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

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

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$177,275	TotalAmt
Management And General	$177,275	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$96,065	TotalAmt
Management And General	$96,065	ManagementAndGeneralAmt

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	$3,220,420	TotalAmt
Program Services	$2,459,428	ProgramServicesAmt
Management And General	$760,992	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$183,477	TotalAmt
Management And General	$183,477	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,167,514	TotalAmt
Program Services	$644,560	ProgramServicesAmt
Management And General	$522,954	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$810,626	TotalAmt
Program Services	$810,626	ProgramServicesAmt

Royalties RoyaltiesGrp

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

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,953,266	TotalAmt
Program Services	$1,361,391	ProgramServicesAmt
Management And General	$591,875	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$324,534	TotalAmt
Program Services	$241,533	ProgramServicesAmt
Management And General	$83,001	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	$0	TotalAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$249,436	TotalAmt
Management And General	$249,436	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

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

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$2,605,494	TotalAmt
Program Services	$2,428,316	ProgramServicesAmt
Management And General	$177,178	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$277,167	TotalAmt
Program Services	$142,634	ProgramServicesAmt
Management And General	$134,533	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE	$1,998,004	$1,998,004
MEDICAL SUPPLIES	$5,856,948	$5,839,212	$17,736
REPAIRS AND MAINTENANCE	$864,692	$834,896	$29,796

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt
Program Services	$0	ProgramServicesAmt
Management And General	$0	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$38,224,719	TotalAmt
Program Services	$31,064,100	ProgramServicesAmt
Management And General	$7,160,619	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	$646,671	BOYAmt
EOY	$480,658	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$2,596,340	BOYAmt
EOY	$2,103,198	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,764,825	BOYAmt
EOY	$3,043,969	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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$702,324	BOYAmt
EOY	$857,700	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,624,707	BOYAmt
EOY	$1,942,096	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$557,823	BOYAmt
EOY	$129,861	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$22,032,927	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$12,799,486	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$11,010,491	BOYAmt
EOY	$9,233,441	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$6,262,027	BOYAmt
EOY	$6,709,537	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$124,074	BOYAmt
EOY	$0	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

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

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,347,478	BOYAmt
EOY	$349,954	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$29,636,760	BOYAmt
EOY	$24,850,414	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$3,827,290	BOYAmt
EOY	$4,419,408	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$8,910,000	BOYAmt
EOY	$8,556,000	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	$841,153	BOYAmt
EOY	$40,983	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,578,443	BOYAmt
EOY	$13,016,391	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$15,934,243	BOYAmt
EOY	$11,834,023	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$124,074	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$16,058,317	BOYAmt
EOY	$11,834,023	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$29,636,760	BOYAmt
EOY	$24,850,414	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$4,483,517	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$186,284	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$72,939	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	false	FSAuditedInd
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	$6,405	OtherActivitiesAmt
Total Lobbying Expenditures	$6,405	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	THE HOSPITAL IS A MEMBER OF THE AMERICAN HEALTH ASSOCIATION ("AHA") AND WISCONSIN HOSPITAL ASSOCIATION ("WHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, PART OF WHICH ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID, AS FOLLOWS: AHA - $4,422 WHA - $1,983	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$423,937	OtherCostOrOtherBasisAmt
Book Value	$423,937	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$13,739,306	OtherCostOrOtherBasisAmt
Depreciation	$7,566,037	DepreciationAmt
Book Value	$6,173,269	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$7,533,043	OtherCostOrOtherBasisAmt
Depreciation	$5,211,620	DepreciationAmt
Book Value	$2,321,423	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$336,641	OtherCostOrOtherBasisAmt
Depreciation	$21,829	DepreciationAmt
Book Value	$314,812	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$9,233,441	TotalBookValueLandBuildingsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	CAPITAL LEASES	Desc
Amt	$40,983	Amt

Field	Value	IRS element (for citing)
Total Liability	$40,983	TotalLiabilityAmt

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)
Total Community Benefit Expns	$731,790	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$731,790	NetCommunityBenefitExpnsAmt
Total Expense	0.02020	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,078,821	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,953,985	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,124,836	NetCommunityBenefitExpnsAmt
Total Expense	0.05870	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$188,562	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$25,892	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$162,670	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$4,999,173	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,979,877	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,019,296	NetCommunityBenefitExpnsAmt
Total Expense	0.08340	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$13,166	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$13,166	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

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

Subsidized Health Services SubsidizedHealthServicesGrp

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

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$13,166	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$13,166	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	10	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$5,012,339	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,979,877	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,032,462	NetCommunityBenefitExpnsAmt
Total Expense	0.08380	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)
Total Community Benefit Expns	$30,677	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$30,677	NetCommunityBenefitExpnsAmt
Total Expense	0.00080	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)
Net Community Benefit Expns	$0	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)
Persons Served	10	PersonsServedCnt
Total Community Benefit Expns	$63,498	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$63,498	NetCommunityBenefitExpnsAmt
Total Expense	0.00160	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	0	ActivitiesOrProgramsCnt
Persons Served	10	PersonsServedCnt
Total Community Benefit Expns	$94,175	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$94,175	NetCommunityBenefitExpnsAmt
Total Expense	0.00240	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$1,998,004	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$7,804,407	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$7,695,657	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$108,750	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
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 SOUTH MAIN STREET	AddressLine1
City	OCONTO FALLS	City
State	WI	State
ZIP Code	54154	ZIPCode

Field	Value	IRS element (for citing)
Website Address	HTTP://WWW.STCLAREMEMORIAL.ORG/	WebsiteAddressTxt
State License	1012	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	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
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
CHNA Conducted	12	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	http://www.stclarememorial.org/documents/CHIPPReport2013FINAL.pdf	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	http://www.improvingwihealth.org/implementation.php?organization=L50&priority=8	OtherWebsiteURLTxt
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	Yes (true)	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
Medicaid Medicare	Yes (X)	MedicaidMedicareInd
State Regulation	Yes (X)	StateRegulationInd
Residency	Yes (X)	ResidencyInd
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
Medicare Rates	Yes (X)	MedicareRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment	(1) - ST. CLARE MEMORIAL HOSPITAL: DEVELOPMENT OF THE PLAN INCLUDED REVIEWING, DISCUSSING AND ANALYZING OCONTO COUNTY SPECIFIC HEALTH DATA FROM STATE DATABASES, PARTICIPANT EXPERTISE AND A SPECIFIC OCONTO COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN PUBLIC OPINION SURVEY WAS INITIATED AND MADE AVAILABLE THROUGHOUT THE COUNTY BY THE PARTICIPANTS. OVER 600 SURVEY'S WERE COMPLETED AND A SUMMARY OF THE DATA USED AS PART OF THE PLAN DEVELOPMENT. THE FOLLOWING COMMUNITY PARTNERS CONTRIBUTED THEIR TIME AND EXPERTISE TO THE NEEDS ASSESSMENT AND IMPROVEMENT PLAN (* DENOTES PLAN LEADS): ALI CARLSON, OCONTO COUNTY DEPT OF H&HS AMANDA ANDERSON, NEWCAP APRIL KONITZER, NWTC BECKY WOLF, COMMUNITY MEMBER BERNIE FAITH, OCONTO POLICE DEPARTMENT CAROL JEAN LUEBECK, OCONTO COUNTY PUBLIC HEALTH CAROL KOPP, OCONTO COUNTY SHERIFF'S DEPARTMENT DAVID LALLY, ST. CLARE MEMORIAL HOSPITAL DAVID HONISH, LENA PUBLIC SCHOOLS DEBRA KONITZER, OCONTO COUNTY PUBLIC HEALTH* DR. KEITH ELKINS, PUBLIC HEALTH MEDICAL ADVISOR ELAINE KLUTH, BELLIN HEALTH OCONTO HOSPITAL HOPE KERSTEN, OCONTO COUNTY WIC PROGRAM IRENE DRAKE, CITY OF GILLETT JAN STRANZ, ST. CLARE MEMORIAL HOSPITAL JANE SCHNEIDER, OCONTO FALLS SCHOOL DISTRICT JOEY SIEBER, OCONTO GOSPEL CHURCH JOHN PINKART, UW-EXTENSION JULIE YONKER, GILLETT AMBULANCE SERVICE KIM WOLFMEYER, AGING & DISABILITY RESOURCE CENTER LAURA CORMIER, BELLIN HEALTH OCONTO HOSPITAL* LISA SBONIK, BELLIN HEALTH OCONTO HOSPITAL LYNN STYMIEST, OCONTO COUNTY PUBLIC HEALTH MARY LEMMEN, COUNTY BOARD, H&HS BOARD NANCY WILLIQUETTE, ST. CLARE MEMORIAL HOSPITAL* RHONDA STUART, NORTHERN HEALTH CENTERS ROSE O'HARA, TRICITY AREA UNITED WAY SARA APPLEBEE, OCONTO COUNTY PUBLIC HEALTH A COALITION OF AGENCIES AND INDIVIDUALS IN OCONTO COUNTY WORKED TOGETHER OVER NINE MONTHS TO ASSESS COMMUNITY HEALTH DATA, STRENGTHS, RESOURCES, AND OPPORTUNITIES FOR IMPROVEMENT. DATA WAS REVIEWED FROM THE STATE HEALTH PLAN, HEALTHY WISCONSIN 2020, WWW.DHS.WISCONSIN.GOV/HW2020, COALITION AGENCIES, UW POPULATION HEALTH COUNTY HEALTH RANKINGS WWW.COUNTYHEALTHRANKINGS.ORG, AND AN OCONTO COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN PUBLIC OPINION SURVEY. THE RESULTS OF THE PUBLIC OPINION SURVEY CAN BE FOUND AT WWW.HEALTHYOCONTOCOUNTY.INFO.;
Schedule H, Part V Sec B, Line 4, Other Hospital Facilities included in Needs Assessment	(1) - ST. CLARE MEMORIAL HOSPITAL: BELLIN HEALTH OCONTO HOSPITAL ;
Schedule H, Part V Sec B, Line 5a, Hospital Facility's Website (list URL)	(1) - ST. CLARE MEMORIAL HOSPITAL, INC.: HTTP://WWW.STCLAREMEMORIAL.ORG/DOCUMENTS/CHIPPREPORT2013FINAL.PDF;
Schedule H, Part V Sec B, Line 5b, Other Website (list URL)	(1) - ST. CLARE MEMORIAL HOSPITAL, INC.: HTTP://WWW.IMPROVINGWIHEALTH.ORG/IMPLEMENTATION.PHP?ORGANIZATION=L50&PRIORITY=8;
Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy	(1) - ST. CLARE MEMORIAL 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 POSTREGISTRATION 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 ADDITION, 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.;

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	FacilityFacilityTxt
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA LENA HEALTH CENTER
200 SOUTH ROSERA STREET	LENA	WI	54139	CLINIC
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA MOUNTAIN HEALTH CENTER
14353 HWY 32/64	MOUNTAIN	WI	54149	CLINIC
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA GILLETT HEALTH CENTER
340 NORTH GREEN BAY AVE	GILLETT	WI	54124	CLINIC
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA OCONTO HEALTH CENTER
103 FIRST STREET	OCONTO	WI	54153	CLINIC
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA SURING HEALTH CENTER
913 E MAIN STREET	SURING	WI	54174	CLINIC
HSHS ST CLARE MEMORIAL HOSPITAL PREVEA OCONTO FALLS HEALTH CENTER
835 SMain St	OCONTO FALLS	WI	54154	CLINIC

Supplemental Information Detail SupplementalInformationDetail (17 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 6a, Community benefit report prepared by related organization	WISCONSIN HOSPITAL ASSOCIATION
Schedule H, Part I, Line 7, Costing Methodology used to calculate financial assistance	THE HOSPITAL UTILIZES THE IRS WORKSHEET TWO: RATIO OF PATIENT CARE COST TO CHARGES. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COST REPORT IS BASED ON THE HOSPITAL'S EXPENSING OF COSTS TO THE APPROPRIATE COST CENTER THROUGH THE HOSPITAL'S INTERNAL COMPUTER SYSTEM.
Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation	1,998,004
Schedule H, Part II, Community Building Activities	THE HOSPITAL PROVIDES EDUCATION TO THE COMMUNITY MEMBERS ABOUT VARIOUS HEALTH ISSUES AT THE HEALTH FAIRS DONE THROUGHOUT THE COUNTY SUCH AS SKIN CANCER SCREENING, HEART FAIR, ETC. TO KEEP THE COMMUNITY AWARE OF HEALTH ISSUES AND HELP THEM BE PROACTIVE IN SEEKING TREATMENT FOR HEALTHCARE CONCERNS.
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. CLARE MEMORIAL 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	ON SEPTEMBER 1, 2014, HOSPITAL SISTERS SERVICES, INC. (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. (SCO). 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. AS A RESULT OF THIS AFFILIATION AND THE DIFFERING FISCAL YEARS OF SCO AND HSSI AND ITS SUBSIDIARIES, SCO DID NOT OBTAIN AN AUDIT OF ITS FINANCIAL STATEMENTS FOR THE PERIOD COVERED BY THIS FORM 990 (OCTOBER 1, 2013 - SEPTEMBER 30, 2014).
Schedule H, Part III, Line 8, Community benefit & methodology for determining medicare costs	THE MEDICARE PROGRAM DOES NOT COVER ALL SERVICES PROVIDED TO THEIR PARTICIPANTS AND THE HOSPITAL IS NOT ALLOWED TO COLLECT FROM THE PARTICIPANTS FOR SOME SERVICES BASED ON THE HOSPITAL'S AGREEMENT WITH THE PROGRAM. THEREFORE, NOT ALL EXPENSES ARE COVERED BY MEDICARE REVENUE. IN ADDITION, MEDICARE DOES NOT ALLOW ALL BUSINESS COSTS OF THE HOSPITAL TO BE INCLUDED IN THE COST REPORT, SO THERE MAY BE ADDITIONAL UNCOVERED COSTS.
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.	THE ORGANIZATION DEVELOPED A COUNTY WIDE INDIVIDUAL PUBLIC OPINION SURVEY, WHICH GENERATED 600 RESPONSES. THE RESPONSES WERE GATHERED FROM A VARIETY OF SOURCES, WHICH INCLUDED BUT WERE NOT LIMITED TO SCHOOLS, LAW ENFORCEMENT, HEALTHCARE PROVIDERS, CHURCHES, COUNTY AGENCIES, THE UNITED WAY, PUBLIC OFFICIALS, AND PUBLIC HEALTH DEPARTMENTS. THE VARIETY OF ORGANIZATIONS THAT RESPONDED ALLOWED THE ORGANIZATION TO APPROPRIATELY ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY.
Schedule H, Part VI, Line 3, Patient education of eligibility for assistance.	OUR HOSPITAL POSTS INFORMATION ABOUT OUR CHARITY CARE POLICY AND APPLICATION ON OUR WEBSITE. IN ADDITION, CHARITY CARE APPLICATIONS ARE AVAILABLE AND PROMINENTLY DISPLAYED IN OUR WAITING AND REGISTRATION AREAS. OUR FINANCIAL COUNSELORS ARE AVAILABLE TO MEET WITH PATIENTS ON SITE BEFORE OR AT THE TIME OF SERVICE TO ASSIST THEM IN IDENTIFYING WHETHER THEY ARE ELIGIBLE FOR GOVERNMENT AID OR FINANCIAL ASSISTANCE, AND TO ASSIST THEM IN APPLYING FOR PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. AFTER PATIENTS RECEIVE SERVICE, OUR CUSTOMER SERVICE REPRESENTATIVES ARE ALSO TRAINED TO ASSIST THEM TO APPLY FOR VARIOUS GOVERNMENT PROGRAMS OR FOR OUR CHARITY CARE PROGRAM. OUR COLLECTORS ARE TRAINED TO PROVIDE THIS ASSISTANCE AS WELL. LAST BUT NOT LEAST, WE HAVE CONTRACTED WITH AN OUTSIDE FIRM TO DO ACTIVE OUTREACH WITH PATIENTS WHO MAY NEED ADDITIONAL ASSISTANCE OR ADVOCACY TO APPLY FOR BENEFITS, APPEAL DENIALS, OR WHO NEED TRANSPORTATION TO GOVERNMENT AGENCIES TO APPLY FOR BENEFITS. ONE-ON-ONE CONVERSATIONS TO EDUCATE PATIENTS ABOUT FINANCIAL ASSISTANCE OFTEN STEM FROM PATIENTS RECEIVING A STATEMENT OR A PRE-COLLECTION LETTER. AT THAT POINT, THE CUSTOMER SERVICE REPRESENTATIVE OR CASHIER, OR OTHER QUALIFIED STAFF, WILL INFORM/EDUCATE THE CALLER ABOUT FINANCIAL ASSISTANCE OPTIONS. THE FIRST PRE-COLLECTION LETTER REMINDS THE PATIENT THEIR ACCOUNT IS IN DELINQUENT STATUS. IT ALSO INFORMS THEM THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE THROUGH THE ORGANIZATION'S CHARITY CARE PROGRAM. THE LETTER PROVIDES DIRECT CONTACT INFORMATION TO BEGIN THE APPLICATION PROCESS FOR CHARITY CARE AND LISTS THE INTERNET ADDRESS WHERE THE POLICY CAN BE OBTAINED.
Schedule H, Part VI, Line 4, Community information.	ST. CLARE MEMORIAL HOSPITAL SERVES GREATER OCONTO COUNTY. OCONTO COUNTY, WISCONSIN IS A LARGE, RURAL COUNTY WHICH INCLUDES MEDICALLY UNDERSERVED AREAS AND POPULATIONS AND WHICH CONSISTENTLY FACES ECONOMIC DEVELOPMENT CHALLENGES. RURAL: THE U.S. CENSUS BUREAU ESTIMATED THE 2014 OCONTO COUNTY POPULATION AT 37,417 PERSONS AND THE COUNTY ITSELF HAD 37.5 PERSONS PER SQUARE MILE. UNDERSERVED: OCONTO COUNTY CONTAINS MEDICALLY UNDERSERVED AREAS AS WELL AS PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS AS DESIGNATED BY THE U.S. DEPT. OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION. NINETEEN MEDICALLY UNDERSERVED AREAS ARE DESIGNATED WITHIN OCONTO COUNTY ACCORDING TO HRSA. THE ONLY OTHER HOSPITAL IN THE ST. CLARE MEMORIAL HOSPITAL SERVICE AREA IS A 4-BED HOSPITAL LOCATED IN OCONTO, THE COUNTY'S LARGEST CITY. OTHER HOSPITALS THAT SERVE THE OCONTO COUNTY COMMUNITY INCLUDING THE NEAREST TERTIARY CARE HOSPITALS ARE LOCATED THIRTY MILES SOUTH IN GREEN BAY. IN A COMMUNITY NEEDS ASSESSMENT SURVEY OF THE ST. CLARE MEMORIAL HOSPITAL SERVICE AREA CONDUCTED IN AUGUST 2007 BY THE LEEDE RESEARCH GROUP, THE LARGEST BARRIERS TO HEALTHCARE CITED BY COMMUNITY MEMBERS ARE FINANCIAL CONSTRAINTS, A LACK OF AFFORDABLE MEDICAL INSURANCE COVERAGE, AND GEOGRAPHICAL/TRANSPORTATION CONSTRAINTS THAT NEGATIVELY IMPACT ACCESS TO MEDICAL FACILITIES. OF THOSE SURVEYED, 30.1% INDICATED THAT LOCATION WAS THEIR PRIMARY CONSIDERATION WHEN SELECTING A DOCTOR AND/OR CLINIC. ACCORDING TO THE WISCONSIN DEPARTMENT OF HEALTH SERVICES 2012 PUBLIC HEALTH PROFILE STATEWIDE AND FOR OCONTO COUNTY: [OCONTO COUNTY / STATEWIDE] TOTAL POPULATION: 37,730 / 5,715,330 - AGES 0-17: 21.0% / 23.0% - AGES 65+: 16.5% / 14.4% POVERTY ESTIMATE (ALL AGES): 9.1% / 13.2% POVERTY ESTIMATE (AGES 0-17): 14.1% / 18.3% MEDIAN HOUSEHOLD INCOME: $52,156 / $51,063 UNEMPLOYMENT RATE: 7.9% / 6.9% 5-YEAR AVERAGE UNEMPLOYMENT RATE: 8.7% / 7.2% TOTAL HOSPITALIZATIONS: 3,345 / 622,221 - ALCOHOL & DRUG RELATED: 1.3% / 2.4% - PNEUMONIA & INFLUENZA RELATED: 2.2% / 2.6% - PSYCHIATRIC RELATED: 5.8% / 6.0% - CORONARY HEART DISEASE: 3.6% / 3.1% - PREVENTABLE* HOSPITALIZATIONS: 12.8% / 12.0% (*HOSPITALIZATIONS FOR CONDITIONS WHERE TIMELY AND EFFECTIVE AMBULATORY CARE CAN REDUCE LIKELIHOOD OF HOSPITALIZATION) ST. CLARE MEMORIAL HOSPITAL IS PROUD OF ITS COMMITMENT TO PROVIDE SERVICE TO ANY PERSON SEEKING MEDICAL CARE, REGARDLESS OF ABILITY TO PAY. THIS MAKES ST. CLARE MEMORIAL HOSPITAL A VERY SPECIAL PLACE IN TODAY'S HEALTHCARE MARKET. IN ADDITION, THE ST. CLARE FAMILY OF HEALTHCARE PROVIDERS HAS A LONG HISTORY OF WORKING COOPERATIVELY WITH LOCAL, STATE AND FEDERAL HEALTHCARE AGENCIES, EDUCATORS, INDUSTRY, AND THE GENERAL PUBLIC TO DEVELOP AND DELIVER EFFECTIVE HEALTHCARE SERVICES TO THE RURAL NORTHEAST WISCONSIN POPULATION. ST. CLARE MEMORIAL HOSPITAL IS DISTINGUISHED BY ITS RELIABLE AND CONSISTENT LEVEL OF SUPERIOR SERVICE AND COMMITMENT TO CONTINUOUS IMPROVEMENT OF ITS PATIENT CARE SERVICES. ST. CLARE MEMORIAL HOSPITAL MEDICAL STAFF MEMBERS ARE COMMITTED PARTNERS IN ENHANCING ORGANIZATIONAL PERFORMANCE AND CONTINUALLY WORKING TO IMPROVE PATIENT CARE.
Schedule H, Part VI, Line 5, Promotion of community health	THE ST. CLARE MEMORIAL HOSPITAL BOARD OF DIRECTORS CONSIST OF DEDICATED MEMBERS OF THE COMMUNITY WHO PROVIDE EXCEPTIONAL LEADERSHIP, INSIGHT AND POSITIVE DIRECTION IN THE ORGANIZATIONAL MISSION TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY LOCALLY. A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. MEMBERS ARE STAKEHOLDERS IN THE COMMUNITIES SERVED BY ST. CLARE MEMORIAL HOSPITAL WHO PROVIDE DIRECTION AND SUPERVISION TO THE ORGANIZATION. A SIGNIFICANT PORTION OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF ST. CLARE MEMORIAL HOSPITAL, NOR FAMILY MEMBERS THEREOF. AS A NON-PROFIT HEALTHCARE SYSTEM ST. CLARE MEMORIAL HOSPITAL INVESTS IN ITS SERVICES/PROGRAMS AND FACILITY/EQUIPMENT UPGRADES AND REINVESTS ANY PROFITS TO UPDATE OR ENHANCE THE HEALTHCARE SERVICE. ST. CLARE MEMORIAL HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, EXTENDING PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR MEDICAL AND SURGICAL SERVICES PROVIDED AT THESE FACILITIES. IN ADDITION TO ITS REGULAR HOSPITAL AND CLINIC SERVICES, THE HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE LOW-COST AND FREE HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE FREE AND LOW-COST SERVICE OFFERINGS, COMMUNITY MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL PROVIDES ITS COMMUNITY ROOM LARGE CONFERENCE ROOM AS WELL AS ITS OTHER MEETING AREAS FREE-OF-CHARGE TO COMMUNITY GROUPS. SOME OF THE MANY LOCAL GROUPS THAT MEET AT ST. CLARE MEMORIAL HOSPITAL INCLUDE 4H CLOVER, RELAY FOR LIFE, OVEREATERS ANONYMOUS, CEMETERY ASSOCIATION, WEIGHT WATCHERS, QUILTING GROUPS, THE COUNTY FAIR BOARD, THE COUNTY FAIREST OF THE FAIR COMMITTEE, UW EXTENSION, BREAST CANCER SUPPORT GROUP, AND THE OCONTO FALLS LIONESS CLUB. EXCESS FUNDS OF THE ORGANIZATION ARE BEING USED TO UPDATE THE TECHNOLOGY USED IN THE FACILITY TO PROVIDE UP TO DATE PATIENT CARE TO COMMUNITY MEMBERS AND TO ENHANCE THE SERVICES PROVIDED TO THE COMMUNITY. ST. CLARE MEMORIAL HOSPITAL HAS LONG BEEN A CORNERSTONE OF THE GREATER OCONTO COUNTY COMMUNITY AND PROVIDES AN ESSENTIAL SERVICE TO OCONTO COUNTY RESIDENTS. THE HOSPITAL IS PROUD OF ITS MISSION TO PROVIDE HIGH QUALITY HEALTH CARE CLOSE TO HOME, AND ALWAYS STRIVES TO STRENGTHEN ITS COMMUNITY PARTNERSHIPS TO PROMOTE HEALTH AND WELLNESS.
Schedule H, Part VI, Line 6, Affiliated health care system	AS OF SEPTEMBER 1, 2014, ST. CLARE MEMORIAL HOSPITAL IS AN AFFILIATE OF HOSPITAL SISTERS HEALTH SYSTEM (HSHS), A HEALTH CARE MINISTRY THAT INCLUDES 13 OTHER HOSPITALS, NUMEROUS COMMUNITY-BASED HEALTH CENTERS AND CLINICS, AND HUNDREDS OF PHYSICIAN PARTNERS ACROSS ILLINOIS AND WISCONSIN. THE AFFILIATION ALLOWS ST. CLARE TO EXPAND HEALTH CARE RESOURCES AVAILABLE TO THE GREATER OCONTO COUNTY COMMUNITY. 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."
SCHEDULE H, PART VI, LINE 6, AFFILIATED HEALTH CARE SYSTEM (CONTINUED)	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 Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	false	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
THOMAS R BAYER
BOARD MEMBER/ HSHS REP	$0	$213,205	$0	$4,961	$0	$1,155	$0	$116,971	$0	$24,714	$0	$361,006	$0	$0
ASHOK RAI
BOARD MEMBER/ HSHS REP	$0	$610,019	$0	$96,700	$0	$360	$0	$27,871	$0	$21,814	$0	$756,764	$0	$0
ISAIAS CUPINO
BOARD MEMBER/ CHIEF OF STAFF	$482,709	$0	$0	$0	$16,730	$0	$19,998	$0	$22,809	$0	$542,246	$0	$0	$0
GENADI MALTINSKI
BOARD MEMBER/ PRESIDENT ELECT	$232,120	$0	$0	$0	$0	$0	$0	$0	$0	$0	$232,120	$0	$0	$0
DANIEL DEGROOT
EX-OFFICIO BOARD MEMBER/CEO	$181,775	$0	$0	$0	$230	$0	$7,280	$0	$0	$0	$189,285	$0	$0	$0
KEITH ELKINS
PHYSICIAN	$417,553	$0	$0	$0	$150	$0	$16,708	$0	$22,510	$0	$456,921	$0	$0	$0
R SCOTT LIEBL
PHYSICIAN	$425,144	$0	$0	$0	$18,770	$0	$17,757	$0	$20,193	$0	$481,864	$0	$0	$0
DR LUZ BALMADRID
PHYSICIAN	$240,805	$0	$0	$0	$18,160	$0	$10,359	$0	$16,123	$0	$285,447	$0	$0	$0
JAMES SPLIT MD
PHYSICIAN	$373,125	$0	$0	$0	$5,729	$0	$15,154	$0	$20,532	$0	$414,540	$0	$0	$0
HENRY LOOMANS MD
PHYSICIAN	$242,054	$0	$0	$0	$462	$0	$9,701	$0	$18,926	$0	$271,143	$0	$0	$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	BusinessNameLine1

Field	Value	IRS element (for citing)
Bond Issuer EIN	391337855	BondIssuerEIN
Bond Issued	2013-04-16	BondIssuedDt
Issue Price	$9,053,000	IssuePriceAmt
Purpose	REFINANCING OF 2/11/2003 BOND ISSUANCE; CONSTRUCTION, IMPROVEMENT, AND EQUIPPING HOSPITAL FACILITIES	PurposeDesc
Defeased	false	DefeasedInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Pool Financing	false	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$143,000	RetiredAmt
Bond Defeased	$0	BondDefeasedAmt
Total Proceeds	$9,053,000	TotalProceedsAmt
In Reserve Fund	$0	InReserveFundAmt
Capitalized Interest	$0	CapitalizedInterestAmt
Refunding Escrow	$0	RefundingEscrowAmt
Issuance Costs From Proceeds	$180,472	IssuanceCostsFromProceedsAmt
Credit Enhancement	$0	CreditEnhancementAmt
Working Capital Expenditures	$0	WorkingCapitalExpendituresAmt
Capital Expenditures	$1,681,913	CapitalExpendituresAmt
Other Spent Proceeds	$7,190,615	OtherSpentProceedsAmt
Unspent	$0	UnspentAmt
Substantial Completion	2013	SubstantialCompletionYr
Current Refunding	Yes (true)	CurrentRefundingInd
Advance Refunding	false	AdvanceRefundingInd
Final Allocation Made	Yes (true)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (true)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedPropertyInd
Any Lease Arrangements	false	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	false	MgmtContractBondFincdPropInd
Any Research Agreements	false	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	false	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (true)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiledInd
Rebate Not Due Yet	Yes (true)	RebateNotDueYetInd
Exception To Rebate	false	ExceptionToRebateInd
No Rebate Due	false	NoRebateDueInd
Variable Rate Issue	false	VariableRateIssueInd
Hedge Identified In Bks And Rec	false	HedgeIdentifiedInBksAndRecInd
Term Of Hedge	0.0	TermOfHedgePct
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGICInd
Term Of GIC	0.0	TermOfGICPct
Gross Proceeds Invested	false	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (true)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (true)	ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART IV, LINE 20B, AUDITED FINANCIAL STATEMENTS	ON SEPTEMBER 1, 2014, HOSPITAL SISTERS SERVICES, INC. (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. (SCO). 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. AS A RESULT OF THIS AFFILIATION AND THE DIFFERING FISCAL YEARS OF SCO AND HSSI AND ITS SUBSIDIARIES, SCO DID NOT OBTAIN AN AUDIT OF ITS FINANCIAL STATEMENTS FOR THE PERIOD COVERED BY THIS FORM 990 (OCTOBER 1, 2013 - SEPTEMBER 30, 2014). THEREFORE A COPY OF THE HOSPITAL'S INTERNAL FINANCIAL STATEMENTS HAVE BEEN ATTACHED TO THE FORM 990.
Form 990, Part VI, Sec A, Line 4, Significant changes to organizational documents	THE ORGANIZATION'S BYLAWS WERE AMENDED SUCH THAT IT WILL NOW PROMOTE AND SUPPORT, DIRECTLY OR INDIRECTLY, BY DONATION, LOAN OR OTHERWISE, THE INTERESTS AND PURPOSES OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCES, A RELIGIOUS INSTITUTE WITHIN THE ROMAN CATHOLIC CHURCH. HOSPITAL SISTERS SERVICES, INC., AN ILLINOIS NOT-FOR-PROFIT CORPORATION, WAS NAMED THE ORGANIZATION'S SOLE MEMBER WITH SPECIFIED RESERVED POWERS AS DESCRIBED IN THE NARRATIVES FOR FORM 990, PART VI, LINES 6, 7A, AND 7B.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders	THE SENIOR GOVERNING BODY OF ST. CLARE MEMORIAL HOSPITAL (THE CORPORATION) IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.
Form 990, Part VI, 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. CLARE MEMORIAL HOSPITAL (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO, FROM TIME TO TIME, ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY, OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (I) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (O) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body	AS THE FILING DATE OF THE FORM 990 IS GOING TO FALL BEFORE THE NEXT BOARD MEETING, THE FORM WILL BE PRESENTED TO THE BOARD AT THE MOST RECENT BOARD MEETING FOLLOWING THE DATE OF FILING. THE FORM 990 IS REVIEWED BY MANAGEMENT PRIOR TO FILING.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy	A CONFLICT OF INTEREST DISCLOSURE STATEMENT IS DISTRIBUTED TO BOARD MEMBERS AND OFFICERS FOR REVIEW AND SIGNATURE EACH YEAR. THIS PROCESS IS COMPLETED ANNUALLY IN JANUARY. UPON DISCLOSURE OF ANY CONFLICTS, THE BOARD MEMBER OR THE OFFICER MAKING SUCH DISCLOSURE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE FINANCIAL INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE CHAIRMAN OF THE BOARD WILL IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD/COMMITTEE WILL DETERMINE WHETHER ST. CLARE MEMORIAL HOSPITAL CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE, THE BOARD OR CEO SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN ST. CLARE MEMORIAL HOSPITAL'S BEST INTEREST, IS FOR ST. CLARE MEMORIAL HOSPITAL'S OWN BENEFIT, AND IS FAIR AND REASONABLE TO ST. CLARE MEMORIAL HOSPTIAL AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION.
Form 990, Part VI, Sec B, Line 15a, Process to establish compensation of top management official	MGMA SURVEY DATA REVIEW AND A POSITION REVIEW PROCESS IS PERFORMED BY THE BOARD OF DIRECTORS, AN INDEPENDENT PARTY, AT THEIR MONTHLY MEETING FOR THEIR FINAL APPROVAL. DECISIONS MADE AT THE BOARD OF DIRECTORS MEETINGS ARE DOCUMENTED.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees	MGMA SURVEY DATA REVIEW AND A POSITION REVIEW PROCESS IS PERFORMED BY CEO AND PRESENTED TO THE BOARD OF DIRECTORS, AN INDEPENDENT PARTY, AT THEIR MONTHLY MEETING FOR THEIR FINAL APPROVAL. DECISIONS MADE AT THE BOARD OF DIRECTORS MEETINGS ARE DOCUMENTED.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public	THE ORGANIZATION CURRENTLY DOES NOT MAKE ITS GOVERNING DOCUMENTS AND CONFLICT ON INTEREST POLICY AVAILABLE TO THE PUBLIC.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances	TRANSFER OF ASSETS FROM COMMUNITY HEALTHCARE FOUNDATION UPON DISSOLUTION - 72939;

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 (27 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 NICHOLAS HOSPITAL
3100 SUPERIOR AVENUE	SHEBOYGAN	WI	53081	390808480	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes (true)
ST JOHN'S HOSPITAL
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	370661238	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
9515 HOLY CROSS LANE	BREESE	IL	62230	371208459	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
2661 COUNTY HIGHWAY 1	CHIPPEWA FALLS	WI	54729	390810545	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes (true)
ST MARY'S HOSPITAL
1800 E LAKE SHORE DRIVE	DECATUR	IL	62521	370661244	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
ST MARY'S HOSPITAL
111 SPRING STREET	STREATOR	IL	61364	362169181	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
ST MARY'S MEDICAL CENTER
1762 SHAWANO AVENUE	GREEN BAY	WI	54303	390818682	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes (true)
ST VINCENT HOSPITAL
835 S VAN BUREN	GREEN BAY	WI	51301	390817529	HEALTHCARE	WI	501(C)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
12866 TROXLER AVENUE	HIGHLAND	IL	62249	370663568	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
ST FRANCIS HOSPITAL
1215 FRANCISCAN DRIVE	LITCHFIELD	IL	62056	370661236	HEALTHCARE	IL	501(C)(3)	3	HSSI	Yes (true)
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163402	HEALTHCARE	IL	501(C)(3)	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 HEALTHCARE FOUNDATION
855 SOUTH MAIN STREET	OCONTO FALLS	WI	54154	391700944	FUNDRAISING (DISSOLVED 8/25/14)	WI	501(C)(3)	7	ST CLARE	Yes (true)
CMH HOUSING INC
855 SOUTH MAIN STREET	OCONTO FALLS	WI	54154	391586706	ELDERLY AND HANDICAPPED HOUSING	WI	501(C)(3)	9	ST CLARE	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	false	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	false	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	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	false	TransferToOtherOrgInd
Transfer From Other Org	Yes (true)	TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART II, RELATED ORGANIZATIONS

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.