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ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST FRANCIS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST F (EIN 37-0661236)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-12
IRS object ID
201401329349303040
Schema version
2012v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-12T14:24:18-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 West Nationwide Blvd Ste 500AddressLine1
CityColumbusCity
StateOHState
ZIP Code432152568ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370661236EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST FRANCIS HOSPITAL SISTERS OF THE THIRDBusinessNameLine1
Business Name Line2ORDER OF ST FRANCISBusinessNameLine2
FieldValueIRS element (for citing)
In Care Of Name% DIANE LINDSAYInCareOfName
Name ControlSTFRNameControl
Phone2173242191Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11215 FRANCISCAN DRIVEAddressLine1
Address Line2SuiteAddressLine2
CityLITCHFIELDCity
StateILState
ZIP Code62056ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDaniel PerrymanName
TitleCEOTitle
Phone2173248368Phone
Date Signed2014-04-08DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKPMG LLPName
Phone6142492300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDaniel PerrymanNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11215 Franciscan DriveAddressLine1
CityLitchfieldCity
StateILState
ZIP Code62056ZIPCode
FieldValueIRS element (for citing)
Gross Receipts36004436GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.STFRANCIS-LITCHFIELD.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1955YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTo reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees268TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI7025TotalGrossUBI
Net Unrelated Business Txbl Income-148NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year244704ContributionsGrantsPriorYear
Contributions Grants Current Year685508ContributionsGrantsCurrentYear
Program Service Revenue Prior Year34835905ProgramServiceRevenuePriorYear
Program Service Revenue CY33943159ProgramServiceRevenueCY
Investment Income Prior Year1293848InvestmentIncomePriorYear
Investment Income Current Year868352InvestmentIncomeCurrentYear
Other Revenue Prior Year428586OtherRevenuePriorYear
Other Revenue Current Year400629OtherRevenueCurrentYear
Total Revenue Prior Year36803043TotalRevenuePriorYear
Total Revenue Current Year35897648TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year14576655SalariesEtcPriorYear
Salaries Etc Current Year15084192SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year17262733OtherExpensePriorYear
Other Expenses Current Year17244938OtherExpensesCurrentYear
Total Expenses Prior Year31841388TotalExpensesPriorYear
Total Expenses Current Year32331130TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4961655RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3566518RevenuesLessExpensesCY
Total Assets BOY51547183TotalAssetsBOY
Total Assets EOY51365438TotalAssetsEOY
Total Liabilities BOY29211326TotalLiabilitiesBOY
Total Liabilities EOY22298101TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY22335857NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY29067337NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense18814459Expense
Revenue28097768Revenue
DescriptionSEE SCHEDULE O - OUTPATIENT ACUTE CAREDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4244380Expense
Revenue4954513Revenue
DescriptionSEE SCHEDULE O - INPATIENT MEDICAL/SURGICALDescription

Activity3 Activity3

FieldValueIRS element (for citing)
Expense698362Expense
Revenue890878Revenue
DescriptionSEE SCHEDULE O - MATERNITY/GYNECOLOGY SERVICESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp23110TotalOfOtherProgramServiceExp
Total Program Service Expense23780311TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109644NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees268NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDIANE LINDSAYNamePerson
Telephone Number2173248510TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11215 FRANCISCAN DRIVEAddressLine1
CityLITCHFIELDCity
StateILState
ZIP Code62056ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedReportable Comp From OrganizationReportableCompFromOrganizationHighest Compensated EmployeeHighestCompensatedEmployee
CHRIS POIROT MD
BOARD MEMBER1.0X
Dona McGraw
Board Member1.0X
DANIEL PERRYMAN
BOARD PRESIDENT/HOSPITAL CEO50.0XX39735560422
LONNIE BATHURST
Chairperson1.0XX
SISTER MARGUERITE COOK OSF
BOARD MEMBER1.0X
Tom Franzen
VICE CHAIRPERSON1.0XX
JOHN FASSERO
Secretary1.0XX
ROGER WUJEK MD
BOARD MEMBER1.0X
Sister Janice Schneider OSF
Board Member1.0X
Peter Mannix
Board Member1.0X3546539286559.0
Mike Fleming
Board Member1.0X
TIM REENTZ
BOARD MEMBER1.0X000
Robert Ritz
Divisional President/CEO11.25X69572611540048.75
Larry J Ragel
Divisional CFO3.75X3128995842456.25
ANN M CARR
TREASURER0.25X27214613803159.75
CAROL JACO
COO/CNO50.0X40251177169
DIANE LINDSAY
CFO50.0X61182173732
Kathryn Knobloch
DIRECTOR OF ANCILLARY SERVICES45.024848108893X
JILL MOUTRIA
PHARMACIST40.09808128318X
Christine Yates
Pharmacist40.016480119170X
FieldValueIRS element (for citing)
Total Reportable Comp From Org707282TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2032779TotalReportableCompFrmRltdOrgs
Total Other Compensation617711TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WALSH CONSTRUCTION CO
301 N 8TH STREET SUITE 1B201ASPRINGFIELDIL62701CONST CONTRACTOR8876352
ILLINOIS EMERGENCY PHYSICIANS
PO BOX 793TRAVERSE CITYMI49685CRNA SERVICES1715293
HENSON ROBIN
PO box 13137SPRINGFIELDIL62791CONST CONTRACTOR655655
AMSOL ANESTHETISTS OF LITCHFIELD LL
PO BOX 6633HIGH POINTNC27262CRNA SERVICES591497
Sodexo Inc
4880 PAYSPHERE CIRCLECHICAGOIL60674DIETARY FOOD SVC396881
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
Government Grants675669GovernmentGrants
All Other Contributions9839AllOtherContributions
Total Contributions685508TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE9000993393613433936134
LAB62150070257025
FieldValueIRS element (for citing)
Total Program Service Revenue33943159TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column321822TotalRevenueColumn
Exclusion$321,822ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real90657Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real106788Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-16131Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-16131TotalRevenueColumn
Exclusion-$16,131ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities546530Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities546530Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column546530TotalRevenueColumn
Exclusion$546,530ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
OTHER RELATED SERVICES900099100798$100,798
REGIONAL REFERRAL RECEIPTS900099103578$103,578
SPECIALTY PHYSICIAN PMTS FOR STAFF900099212229$212,229

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column155TotalRevenueColumn
Exclusion$155ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue416760TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column35897648TotalRevenueColumn
Related Or Exempt Function Income33936134RelatedOrExemptFunctionIncome
Unrelated Business Revenue7025UnrelatedBusinessRevenue
Exclusion$1,268,981ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2000Total
Program Services2000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total359888Total
Program Services181916ProgramServices
Management And General177972ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10352705Total
Program Services7462514ProgramServices
Management And General2890191ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1226453Total
Program Services874950ProgramServices
Management And General351503ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2420378Total
Program Services1726694ProgramServices
Management And General693684ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total724768Total
Program Services517048ProgramServices
Management And General207720ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13705Total
Management And General13705ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total78063Total
Management And General78063ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1181894Total
Program Services631172ProgramServices
Management And General550722ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total44217Total
Management And General44217ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total102301Total
Program Services50243ProgramServices
Management And General52058ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1216830Total
Program Services912622ProgramServices
Management And General304208ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total21916Total
Program Services7421ProgramServices
Management And General14495ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total52034Total
Program Services9045ProgramServices
Management And General42989ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total10670Total
Program Services10670ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1383693Total
Program Services749210ProgramServices
Management And General634483ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total640661Total
Program Services448463ProgramServices
Management And General192198ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES25490652425422123643
PROVISION FOR BAD DEBT25692542569254
MAINTENANCE AND REPAIRS965025677738287287
MISCELLANEOUS EXPENSES641561045239291891681

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total32331130Total
Program Services23780311ProgramServices
Management And General8550819ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Info In Schedule O Part XXInfoInScheduleOPartX

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3911728BOY
EOY2382170EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY44BOY
EOY44EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2642145BOY
EOY2002705EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY250899BOY
EOY63683EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY370729BOY
EOY387459EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY273811BOY
EOY297521EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis51843970LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec29301642LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY13643517BOY
EOY22542328EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY30217177BOY
EOY23535908EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY237133BOY
EOY153620EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY51547183BOY
EOY51365438EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4295916BOY
EOY3993438EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY12167BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY12367385BOY
EOY10185695EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12535858BOY
EOY8118968EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY29211326BOY
EOY22298101EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY19697069BOY
EOY26065767EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2015400BOY
EOY2378182EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY623388BOY
EOY623388EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY22335857BOY
EOY29067337EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY51547183BOY
EOY51365438EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3566518ReconcilationRevenueExpenses
Reconciliation Unrealized Invest958522ReconciliationUnrealizedInvest
Reconcilation Other Changes2206440ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$8,169OtherActivitiesAmount
Total Lobbying Expenditures IIB8169TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF OTHER LOBBYING ACTIVITIESIdentifier
Return ReferencePART II-B, LINE 1IReturnReference
ExplanationTHE HOSPITAL PAYS MEMBERSHIP DUES TO DIFFERENT ASSOCIATIONS AND A PERCENTAGE OF THOSE DUES ARE DEDICATED TO LOBBY EXPENSES. THE ASSOCIATIONS ST FRANCIS PAYS ARE AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 23.98% LOBBY EXPENSE, CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.00% LOBBY EXPENSE, ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 34.00% LOBBY EXPENSE AND NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 10.00% LOBBY EXPENSE. THE TOTAL AMOUNT OF YEARLY DUES IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBY EXPENSE TO CALCULATE THE LOBBY EXPENDITURES PAID.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis99383OtherCostOrOtherBasis
Book Value99383BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis31341181OtherCostOrOtherBasis
Depreciation14805802Depreciation
Book Value16535379BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis17935634OtherCostOrOtherBasis
Depreciation14495840Depreciation
Book Value3439794BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2467772OtherCostOrOtherBasis
Book Value2467772BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings22542328TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ACCRUED BENEFIT LIABILITY$6,117,226
SETTLEMENT VALUE OF INTEREST$534,917
RETIRE OBLIGATION - ASBESTOS$867,723
WORKERS' COMP TRUST LIABILITY$599,102
FieldValueIRS element (for citing)
Total Of Amounts8118968TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierExplanation for adoption of ASC Subtopic 740-10Identifier
Return ReferenceASC Subtopic 740-10ReturnReference
ExplanationHSHS HAS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FORM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AS OF JUNE 30, 2013 AND 2012, HSHS DOES NOT HAVE AN ASSET OR LIABILITY FOR UNRECOGNIZED TAX BENEFITS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served437PersonsServed
Total Community Benefit Expense909475TotalCommunityBenefitExpense
Net Community Benefit Expense909475NetCommunityBenefitExpense
Percent Of Total Expense0.03060PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6831939TotalCommunityBenefitExpense
Direct Offsetting Revenue5917372DirectOffsettingRevenue
Net Community Benefit Expense914567NetCommunityBenefitExpense
Percent Of Total Expense0.03060PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served437PersonsServed
Total Community Benefit Expense7741414TotalCommunityBenefitExpense
Direct Offsetting Revenue5917372DirectOffsettingRevenue
Net Community Benefit Expense1824042NetCommunityBenefitExpense
Percent Of Total Expense0.06120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served700PersonsServed
Total Community Benefit Expense113451TotalCommunityBenefitExpense
Net Community Benefit Expense113451NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served16510PersonsServed
Total Community Benefit Expense154190TotalCommunityBenefitExpense
Direct Offsetting Revenue9716DirectOffsettingRevenue
Net Community Benefit Expense144474NetCommunityBenefitExpense
Percent Of Total Expense0.00490PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served17210PersonsServed
Total Community Benefit Expense267641TotalCommunityBenefitExpense
Direct Offsetting Revenue9716DirectOffsettingRevenue
Net Community Benefit Expense257925NetCommunityBenefitExpense
Percent Of Total Expense0.00870PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served17647PersonsServed
Total Community Benefit Expense8009055TotalCommunityBenefitExpense
Direct Offsetting Revenue5927088DirectOffsettingRevenue
Net Community Benefit Expense2081967NetCommunityBenefitExpense
Percent Of Total Expense0.06990PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served43PersonsServed
Total Community Building Expense1338TotalCommunityBuildingExpense
Net Community Building Expense1338NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served43PersonsServed
Total Community Building Expense1338TotalCommunityBuildingExpense
Net Community Building Expense1338NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,569,254BadDebtExpenseAmount
Amount Attributable To76968AmountAttributableTo
Amount Reimbursed By Medicare13406299AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare13288611CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall117688MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1St Francis Hospital of the HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11215 Franciscan DriveAddressLine1
CityLitchfieldCity
StateILState
ZIP Code62056ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1STFRANCIS HOSPITAL OF THE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent125.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent200.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE 3CNot applicable. The organization follows FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals.
PART I, LINE 6ASt. Francis Hospitals community benefit report is available on the hospitals website: http://www.stfrancis-litchfield.org/sfl/annual-report.aspx
PART I, LINE 7, COLUMN (F)The percent of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 6.99%. The amount of bad debt expense removed when calculating the percentages in part i, line 7, column (f) was $2,569,254.
PART I, LINE 7Charity care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2013 audited financial statements. The total charity care dollar amount is then reduced to cost by applying the hospitals cost to charge ratio as calculated on IRS Schedule H worksheet 2.
PART IISt. Francis Hospital partners with the Montgomery County Health Department, Hillsboro Area Hospital, and the University of Illinois Extension Service to provide locally grown fresh produce to families who participate in the WIC program of the county health department. Free bags of produce are provided along with information about food handling, storage, and preparation, as well as recipes and cooking suggestions. Produce programs are provided in the summer and fall in order to offer a variety of vegetables. St. Francis Hospital also participates on the Health Services Advisory Board for the Macoupin County Head Start Program. This board reviews the health programs in place for the Head Start Preschool Program and provides guidance for program development.
PART III, LINE 4Bad debt expense of HSHS is described on pages 18 and 19 of the audited financial statements, a copy of which is attached to this return.
Part III, Line 8By changing methodology to Cost Report, the hospital no longer reports a shortfall.
Part III, Line 9bIf an account that has been sent to a collection agency is determined by the agency to be uncollectible, attempts by the agency to collect payment on the account will cease and the account will be returned to the hospital. The hospital will then consider the account to be uncollectible.
Part V, Line 3Yes. Sixty seven percent of respondents to the telephone survey were of ages 18-54 and almost sixty percent were married. Forty four percent of those responded that they had children living at home, with fifty percent of those children between the ages of 11-16. The majority of respondents were Caucasian with only three percent of other races represented. More than ninety six percent of the population for both counties is Caucasian. The education level of respondents varied with thirty percent achieving high school or equivalent, thirty seven percent having some college or technical school education, and twenty one percent having graduated from college. Only nine percent of the surveyed population held an advanced or professional degree. Approximately forty percent of respondents reported an annual income of $35,000 or less and forty two percent reported an annual income of $35,000-$75,000. Nineteen percent reported annual income of greater than $75,000. Sixty four percent of telephone survey respondents were female and thirty six percent male. In order to provide representation of all aspects of our community, a cross section of community members were identified by the St. Francis Hospital Internal Needs Assessment Team and were invited to participate in the assessment process. Representatives from law enforcement, education, public health, religious organizations, the medical and dental fields, service organizations, as well as state senator and state representative offices received a personal phone call and email invitation to assist with the needs assessment process. Letters of invitation were also mailed. Representatives from these fields as well as the hospital and a hospital board member convened to form the Community Advisory Committee. Community Advisory Committee Members 1. St Francis Hospital Internal Needs Assessment Team: Chief Executive Officer Hospital Board Member Community Outreach Facilitator Administrative Director of Ancillary Services Director of Financial Services Marketing Coordinator Director of Development 2. Local and county law enforcement: Litchfield Chief of Police-120 E, Ryder, Litchfield, IL 3. Director Montgomery County Health Department- Rt. 185 Hillsboro IL 4. Director Macoupin County Health Department-805 N. Broad St. Carlinville, IL 5. State Representative Wayne Rosenthal - 324A N. State St., Litchfield, IL 6. State Senator Sam McCann - 220 N. Broad St., Carlinville, IL. 7. Minister of First Baptist Church, 608 N. Van Buren, Litchfield, IL 8. St. Francis Hospital Auxiliary, Litchfield, IL. 9. Student Council Representative from Litchfield High School, Litchfield, IL The following persons were also invited to participate but were unable to attend: . Macoupin Co. Sheriff . Litchfield High School Guidance Counselor . Hearts United Service Organization Director . Holy Family Church, 410 S. State St. Litchfield, IL . Minister and physician, local representative . Local dental provider The directors of both county health departments, Macoupin County Health Department and Montgomery County Health Department, are very aware of the needs of the uninsured and low income or minority populations as these are the target populations that they serve. Both county health department directors were fully engaged with the needs assessment process and provided valuable insight into the primary and chronic disease needs of the uninsured and low income populations. Part V, Line 4 Yes. Hillsboro Area Hospital also partnered with St. Francis Hospital and Leede Research for the primary telephone survey portion of the Community Health Needs Assessment. Part V, Line 5c St. Francis Hospital's Community Health Needs Assessment is currently available on the hospital website or upon request: http://www.stfrancis-litchfield.org/sfl/needs-assessment.aspx
Part V, Line 7The top health care needs identified in our community included: Elevated Blood Pressure, Elevated Cholesterol, Dental Care, Diabetes, Tobacco Use, Mental Health, Alcohol Use, Health Screenings and Teen Substance Abuse. As a health care provider, St. Francis Hospital elected to focus on the following areas because we have experience caring for patients with diabetes and elevated blood pressure as well as providing medical care related to dental health and teen substance abuse. 1. Diabetes 2. Teen Substance Abuse 3. Dental Care 4. Elevated Blood Pressure St. Francis Hospital did not take the lead on the following issues as they were addressed by organizations in the community with support from the hospital: Alcohol Use, Tobacco Use, Mental Health, Elevated Cholesterol, and Health Screenings. St. Francis Hospital referred persons to agencies which have existing programs in place. Alcohol Use Montgomery County Health Department, Macoupin County Health Department and the Continuing Recovery Center in Irving, IL provide services for persons with alcohol abuse needs. Tobacco Use Montgomery County Health Department and Macoupin County Health Department provide services for tobacco cessation. Montgomery County Health Department also provides classes to sixth and seventh graders in all four county school districts regarding tobacco use, alcohol, and drugs. St. Francis Hospital also refers persons to the Illinois Quit Line. Mental Health Montgomery County Health Department, Macoupin County Health Department and the Behavioral Health Department at St. Johns Hospital in Springfield, IL, a sister hospital, provide services for persons with mental health needs. Elevated Cholesterol A variety of free cholesterol screenings are currently available through both county health departments and St. Francis Hospital at health fairs and programs throughout the year. Health Screenings A variety of free health screenings are currently available through both county health departments and St. Francis Hospital at health fairs and programs throughout the year.
Needs AssessmentAs indicated in Part V, Section B, we conducted a Community Health Needs Assessment in FY2012. In 2009 a Community Health Needs Assessment was conducted for St. Francis Hospital by the Illinois Institute of Rural Affairs through Western Illinois University. Sources of data included the 2000 Census and subsequent updates and estimates from the U.S. Census Bureau, the Illinois Behavioral Risk Factor Surveillance System (IBRFSS), official websites of the City of Litchfield and Macoupin and Montgomery Counties health departments, and a statewide report on poverty in Illinois. In addition, primary data was collected through telephone interviews with 71 physicians, dentists, other healthcare providers, and social service agency employees. Focus groups were also conducted with 40 area residents. The hospitals awareness of health care needs in our community continues through phone calls, inquiries, and requests received by the Community Outreach Facilitator from the community for health related services. A community health fair was provided in 2013 in response to these types of requests. Evaluations of community outreach programs also provide a mechanism for feedback from the community regarding health care and health related education needs.
Patient Education of Eligibility for AssistancePatients are notified of the organizations charity care policy and other available financial assistance through signage in the registration areas, text on the billing statements, hospital web site, and information from the registrars and other hospital personnel. The hospital employs a Financial Counselor who is responsible for educating patients about potential eligibility for assistance under federal, state, or local government programs or under the hospitals charity care policy or uninsured patient discount policy. The Financial Counselor contacts uninsured patients to determine eligibility for Medicaid or other government assistance programs. Eligibility is verified using internet-based products and through contact with government resources. If it is determined that a patient may be eligible for assistance, the Financial Counselor will assist the patient with applications for the appropriate program. If the patient is not eligible for a government assistance program or if the program does not cover the patients needs, the counselor will provide an application for the hospitals Christian Care program and assist with the completion of the application. All uninsured patients are eligible for an uninsured patient discount, in accordance with the Illinois Hospital Uninsured Patient Discount Act. The Financial Counselor ensures that the discounts under the Act are applied appropriately.
Community InformationMore than 92% of the inpatients treated at St. Francis Hospital reside in Montgomery and Macoupin Counties. Fifty-six percent of the inpatients live in Montgomery County and 36% live in neighboring Macoupin County. Both of the counties are located in central Illinois, between the cities of Springfield, Illinois and St. Louis, Missouri. Combined population is 77,535 and the median household income is less than $45,000 per year. The percentage of people living below the poverty level averages 12.0% in Macoupin County and 14.0% in Montgomery County and the current unemployment rate is 8.9% and 11.1%, respectively. Persons eligible for Medicare account for 46% of the patient revenue generated at the hospital and Medicaid-eligible patients generate 23%. Likewise, 26% of the revenue is derived from patients who have managed care/commercial insurance coverage. The remaining 5% of the patient revenue comes from patients with no insurance. Most of the Medicaid revenue originates in the Maternity unit. Over 65.4% of the Maternity unit revenue came from treating patients eligible for Medicaid. Provision of maternity services is financially detrimental to the hospital, since the hospital is a Critical Access Hospital (CAH) and is reimbursed by Medicare based on the Medicare-eligible costs incurred. Maintaining a maternity unit limits the number of Medicare patients that can be admitted to the hospital, as a CAH is allowed only 25 inpatients at a time, including maternity patients. Also, the maternity unit absorbs hospital overhead costs that would otherwise be eligible for Medicare cost-based reimbursement. In FY 2013, over $1,266,520 of the hospital's total operating cost was allocated to maternity services and was excluded from the computation of Medicare reimbursement. But since St. Francis is the only hospital offering maternity services between Springfield and Maryville, IL, maternity services continue to be provided as a service to the community.
Promotion of Community HealthSt. Francis Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Francis is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 135 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Litchfield and surrounding areas. The hospital is governed by a Board of Directors, the majority of whom reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Francis is responding to community need. During FY 2013, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. Also consistent with its exempt purpose, St. Francis has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Francis reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Francis is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. St. Francis also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2013, St. Francis provided over $2.08 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, during this period, St. Francis provided $910,000 (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance. St. Francis Hospital provides a variety of community benefit that flow from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Francis, and they often relieve a burden that would otherwise be carried by government. Several of these programs and activities are designed to respond to our FY2012 Community Health Needs Assessment, which surfaced the following priority needs for attention from the hospital in collaboration with other community organizations: Diabetes The Community Outreach Coordinator of St. Francis Hospital serves the community by participating on the Macoupin County Diabetes Coalition which provides diabetes education programs for the community. As a part of this coalition, Diabetes Self-Management Program courses are provided twice per year. These courses are facilitated by the Community Outreach Facilitator of St. Francis Hospital and a lay instructor. This evidence-based course, which was developed by Stanford University, consists of six weekly classes which meet for three hours. St. Francis Hospital is part of a regional approach to diabetes education with courses being provided in Montgomery, Macoupin, Jersey, and Bond counties throughout central Illinois. All facilitators are working together as part of a regional approach to provide diabetic education to these four counties, which is coordinated by Macoupin County Health Department. A diabetes class reunion was also held in May 2012. The hospital also partners with the Illinois Kidney Mobile and the Montgomery County Health Department to provide free screenings for diabetes and renal disease. This free service provides a large mobile van full of diabetic and renal disease education displays in addition to a health screening process. The health screenings consist of free urinalysis, blood glucose testing, hemoglobin A1C testing if appropriate, height, weight, body mass index, and additional chemistry testing for those meeting specific criteria. Once all screenings are completed a nurse practitioner reviews results with each individual and referrals for care are arranged if needed. A team of four individuals with the Kidney Mobile are assisted by staff from the Montgomery County Health Department and St. Francis Hospital, which sponsor this free day of screening and education. Many individuals who normally would not be able to afford these tests have been able to obtain much needed testing and screening through this program. In 2012 St. Francis Hospital also partnered with Carlinville Area Hospital and the Macoupin County Health Department to bring the Kidney Mobile to the Carlinville area. Dental Care Dental care was identified as an area of need through the Community Health Needs Assessment. As a result, St. Francis Hospital has coordinated free or low cost dental services for the uninsured in our community since 2011. The hospital partnered with the dental hygiene program at Lewis and Clark Community College to bring their mobile dental van to the Litchfield area. This pilot program provided free or low cost dental exams and cleanings to the uninsured in the spring of 2012 and continued in 2013. In addition, three local dental providers also participated by donating time, staff, and supplies, to provide either a free filling, extraction or hygiene services. This portion of the program was expanded in 2012 to the Hillsboro area and partnerships were established with Hillsboro Area Hospital and a dental provider in Hillsboro. Sixty four individuals benefitted from these community dental opportunities in FY13. Hypertension Free blood pressure checks are provided at the St. Clare Food Pantry as well as education and counseling regarding healthy food choices. A focus on providing low sodium food choices is a new initiative for the Food Pantry. Community Health Fairs and Free Screenings In response to multiple requests received from the community, St. Francis Hospital partnered with several local social service agencies and the Montgomery County Health Department to provide a community health fair in 2012. Laboratory tests to check for infection, anemia, electrolyte levels, diabetes, cholesterol levels and thyroid and kidney function were available at greatly reduced rates. In addition a variety of other free health screenings were provided including balance, flexibility, and hand grip, bone density testing, oral cancer screenings, and pulmonary health screenings. St. Francis Hospital partnered with Macoupin County Health Department to provide the oral cancer screenings and Montgomery County Health Department to provide the bone density screenings. A variety of informational displays also provided health related information regarding cholesterol levels, heart health, blood pressure, and colon cancer. The following community service agencies also provided displays and information: Hearts United, Pregnancy Resource Center, and the Elizabeth Ann Seton group.
Affiliated Health Care SystemSt. Francis Hospital in Litchfield, Illinois is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The Mission of HSHS is "to reveal and embody Christs 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 FY2013, 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 $185.6 million in Community Benefit (or 10.2% of total hospital expenses) in FY2013. Included in this amount was $45.9 million provided for Financial Assistance (i.e. Charity Care) and $104.2 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 $152.3 million. HSHS hospitals also recorded $107.1 million in uncollectible accounts. 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 FY2013, 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. From 2006 to 2009, the United States saw a 16% increase in individuals seeking dental care at hospital emergency rooms. With the support of St. Marys Hospital Medical Center and St. Vincent Hospital in Green Bay, Wisconsin, the NEW Dental Clinic on the campus of Northeast Wisconsin Technical College expanded in FY2013 and was able to accommodate up to 6,000 visits. The clinic provides dental services to low-income and uninsured persons including the homeless in Brown County. St. Francis Hospital in Litchfield, Illinois partnered with Lewis & Clark Community College to bring their mobile health unit to the Litchfield area; the unit provides dental exams and screenings, x-rays and dental hygiene to those in need. In western Wisconsin, St. Josephs Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,672 patient visits, an 11% increase from the prior year. With more than 166 individuals volunteering, the clinic provided more than 6,751 hours (including 753 provider hours and 675 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthonys Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthonys helped underwrite the cost of prescription medications for more than 280 residents. 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, in collaboration with the Illinois Department of Insurance, St. Josephs Hospital participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Financial Assistance (i.e. Charity Care) program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our financial assistance policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our Mission to embody Christs 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. Among the many priority needs identified from the CHNAs include 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 partnership with the Sangamon County Health Department (SCHD) and local farmers, St. Johns Hospital in Springfield, Illinois took a lead role in bringing a Farmers Market to the east side of Springfield. The East Side Farmers Market 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." WIC Cooking Classes are also offered in tandem with the East Side Farmers Market to teach participants how to prepare fresh produce. The Farmers Market and cooking classes are hosted at the SCHD. St. Marys Hospital in Streator, Illinois teamed up with the Streator YMCA to offer a 12 week weight loss program Healthy You to motivate 282 participants (nearly double the participants from last year) 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. A total of 191 participants completed the program,
STATE FILING OF COMMUNITY BENEFIT REPORTILLINOIS

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
DANIEL PERRYMAN
BOARD PRESIDENT/HOSPITAL CEO2651975786474294445801841946035467458
Peter Mannix
Board Member294468450591512665554282044484110
Robert Ritz
Divisional President/CEO5588151065863032586678404178228210
Larry J Ragel
Divisional CFO256392565073953519792372226
ANN M CARR
TREASURER19345429440492521211701768641100218215
CAROL JACO
COO/CNO15699720172318848367217420
DIANE LINDSAY
CFO153673200594764013542234914

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
SCHEDULE J, PART I, LINE 1ACOUNTRY CLUB DUES WERE PROVIDED FOR ROBERT RITZ. THIS BENEFIT WAS TREATED AS TAXABLE COMPENSATION. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SCHEDULE J, PART I, LINE 1A TAX GROSS-UPS WERE PAID BY HSHS TO ANN CARR FOR $11 DURING THE YEAR. THE FAIR VALUE OF THIS WAS INCLUDED IN HER ANNUAL REPORTED INCOME. ROBERT RITZ SCHEDULE J, PART I, LINE 4B ROBERT RITZ PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $68,574.
ANN M. CARRANN M. CARR PARTCIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $42,817.SCHEDULE J, PART I, LINE 4B
PETER MANNIXPETER MANNIX PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $34,875.SCHEDULE J, PART I, LINE 4B
DANIEL PERRYMANDANIEL PERRYMAN PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $100,154.SCHEDULE J, PART I, LINE 4B

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROGRAM SERVICES REVENUE - ACCOMPLISHMENTS990 PART III LINE 4AThe community benefit contribution of St. Francis Hospital includes programs and activities that improve access to health care and improve health in our communities. In order to portray the full breadth of our contribution, our community benefit information is described below: SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: During the fiscal year ended June 30, 2013 St. Francis Hospital operated as a Critical Access Hospital. The hospital provided 4,924 adult, pediatric, and skilled nursing days of care and accommodated 46,804 outpatient visits during the fiscal year. Quality medical services were provided to all patients regardless of race, creed, sex, national origin, handicap, age or financial status. Although reimbursement for services rendered is critical to the operation and stability of the Hospital, it is recognized that not all individuals possess the ability to purchase essential medical services. St. Francis Hospital's mission is to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry. To accomplish the mission, the hospital provides care to the poor, elderly, and the needy of the community through various programs and services. These activities include wellness programs, community education, community support activities, and programs specifically designed for the elderly, handicapped and medically underserved. Benefits for the poor include services provided to persons who cannot afford health care because of inadequate resources and who are uninsured or underinsured. These benefits are provided in the form of charity care for those who cannot afford to pay through the hospital's uninsured discount program and through public programs such as Medicaid. St. Francis provides charity care through its Christian Care program. The Christian Care program is designed to ensure that the resources used to assist patients are provided for those who are unable to pay for their medical care. Financial assistance is determined by comparing the applicant's gross family income to the most recent Federal Poverty Guidelines. In order to qualify for assistance applicants must complete an application form, provide documentation of current family income, documentation of medical expenses and available assets, and provide evidence of investigation of all other means of assistance. Applications are reviewed by the Hospital's Christian Care Committee and selection for assistance is determined by the Hospital's available funds and the eligibility of the applicant. All uninsured patients are allowed a discount of at least 10% from the charges billed for the patients' hospital services. In accordance with the State of Illinois Public Act 095-0965, St. Francis provides uninsured patients the ability to apply for further discounts. Under the Hospital Uninsured Patient Discount Act, uninsured patients may be eligible for discounts ensuring that they pay no more than 135% of the cost of the services provided. Benefits for the broader community include services provided to needy populations that may not qualify as poor but need special services and support. St. Francis provides these benefits through the provision of unbilled services for community members. Non-billed community services include the cost of health education and community health clinics and screenings. Specific services provided by St. Francis include: * Assistance with community blood drives, kidney mobile, dental care, and Fresh Fruit Program * Employee speakers at health fairs, schools, and other community organizations * Nutritional management consulting services and educational materials * Educational seminars for the general public on senior fitness programs, breast cancer awareness, diabetes, cardiac rehabilitation, congestive heart failure, elder abuse, stroke, and drug prevention * Screenings for colorectal cancer, hypertension, cholesterol, and obesity * Donation of medical supplies and used equipment to missions in underdeveloped countries * Donation of cash and supplies to local agencies * Educational sessions for healthcare providers on blood borne pathogens, stress management, and CPR * St. Clare Food Pantry to provide food for needy families QUANTIFIABLE COMMUNITY BENEFIT: The financial information in this report was prepared in accordance with the Catholic Health Associations (CHA) community benefit reporting guidelines. These guidelines recommend the following: * Report charity care at cost, not charges * Do not include bad debt, contractual allowances, and prompt pay discounts as part of charity care expense * Do not count a Medicare shortfall as a community benefit * Report the net expense for community services, i.e. the total community benefit expense minus any associated revenue from patients, payers, and external sources The CHA reporting guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access and awareness to health care and improve community health. The hospital also committed significant resources to serving the Medicaid population. The cost of providing services to pregnant women and their newborns was $1,266,520 for the year ended June 30, 2013. St. Francis Hospital is the only hospital between Springfield and Maryville that offers Maternity Services. The State of Illinois (the State) renewed an assessment program to assist in financing of its Medicaid program in December of 2006 for the State's fiscal years ended June 30, 2006, 2007, 2008, 2009, 2010, 2011, 2012 and 2013. The program was approved in 2008 and has been renewed each year since. Pursuant to this program, hospitals within the State are required to remit payment to the State of Illinois Medicaid program under an assessment formula approved by the Centers for Medicare and Medicaid Services (CMS). The assessment program also provides hospitals within the State with additional Medicaid reimbursement based on funding formulas, also approved by CMS. The net effect of the 2013 assessment and reimbursement included in the Hospital's 2013 statement of operations is $2.1 million.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODYFORM 990, PART VI, LINE 6 & 7ATHE SENIOR GOVERNING BODY OF ST. FRANCIS 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. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT.
MEMBER RESERVED POWERSFORM 990, PART VI, LINE 7BResponsibility for the policy and operations of St. Francis 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 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; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate, and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI.
REVIEW PROCESSFORM 990, PART VI, LINE 11BThe hospital employs KPMG to assist in the overall preparation, review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission, and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, LINE 12CThe organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, and ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION, OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICYFORM 990, PART VI, LINE 13PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
RECORD RETENTION AND DESTRUCTION POLICYFORM 990, PART VI, LINE 14THE HOSPITAL IS CURRENTLY FOLLOWING THE SYSTEM-WIDE RECORD RETENTION AND DESTRUCTION POLICY.
COMPENSATION PROCESSFORM 990, PART VI, LINE 15The Compensation Committee (Committee) is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges, and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting. Joint Ventures Form 990 Part VI, Line 16B HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. FRANCIS HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. FRANCIS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. FRANCIS HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS.
DOCUMENTS AVAILABLE TO THE PUBLICFORM 990, PART VI, LINE 19BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
POOLED INVESTMENT ACCOUNTFORM 990, PART X, LINE 11St. Francis Hospital's cash reserves are invested in a pooled investment account. Participation in the pooled fund is limited to the 501(C)(3) Hospitals and related health services organizations sponsored by the Hospital Sisters Health System. The pooled account consists of cash, and equity and debt securities that are publicly traded. In accordance with the provisions of SFAS No. 124 "Accounting for certain investments held by Not-For-Profit Organizations," investments in equity securities with readily determinable values, and all investments in debt securities, are reported at fair value on the Balance Sheet. Income, realized and unrealized gains and losses are pooled and allocated to the participants. Individual components of assets and revenue are not identified to the participants.
OTHER CHANGES IN NET ASSETSFORM 990, Part XI, Line 9Reversal of changes in pension funded status 3,599,173 Increase in temporarily restricted net assets 198,003 Transfer from affiliates (2,368,152) Loss on early extinguishment of debt (51,170) Swap payments (81,861) Change in fair value of interest rate swaps 910,447 ----------- Total 2,206,440 ===========

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Springfield Health Partners LLC
4936 Laverna RoadspringfieldIL62707371364419healthcareIL0hshs mg
Kiara Clinical Integration Network LLC
4936 Laverna RdspringfieldIL62707261417684healthcareIL0HSSI
Physician Clinical Integration Network
4936 Laverna RoadSpringfieldIL62707371668647HealthcareIL0KCIN

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Hospital Sisters Health System
4936 laverna RoadSPRINGFIELDIL62707371058692HEALTHCAREIL501(c)(3)11aNAfalse
Hospital Sisters Services Inc
4936 laverna RoadSPRINGFIELDIL62707371163402HEALTHCAREIL501(c)(3)11aNAfalse
Hospital Sisters of St Francis Fdtn
4936 laverna RoadSPRINGFIELDIL62707371186514HEALTHCAREIL501(c)(3)11aNAfalse
HSHS Self Insurance Trust Fund
4936 laverna RoadSPRINGFIELDIL62707371120626INSURANCEIL501(c)(3)11aNAfalse
HSHS Health Care Plan Trust Fund
4936 laverna RoadSPRINGFIELDIL62707371137724HEALTHCAREIL501(c)(9)N/ANAfalse
Hospital Sisters Healthcare West Inc
2661 COUNTY HIGHWAY ICHIPPEWA FALLSWI54729510157933HEALTHCAREWI501(c)(3)11aNAfalse
Sacred Heart Hospital
900 WEST CLAIREMONT AVENUEEAU CLAIREWI54701390807060HEALTHCAREWI501(c)(3)3NAfalse
St Anthony's Hospital
503 N MAPLE STREETEFFINGHAMIL62401370661233HEALTHCAREIL501(c)(3)3NAfalse
St Elizabeth's Hospital
211 SOUTH THIRD STREETBELLEVILLEIL62220370663567HEALTHCAREIL501(c)(3)3NAfalse
St Nicholas Hospital
3100 SUPERIOR AVENUESHEBOYGANWI53081390808480HEALTHCAREWI501(c)(3)3NAfalse
St John's Hospital
800 EAST CARPENTER STREETSPRINGFIELDIL62769370661238HEALTHCAREIL501(c)(3)3NAfalse
St Joseph's Hospital
9515 Holy Cross Lane PO Box 99BREESEIL62230371208459HEALTHCAREIL501(c)(3)3NAfalse
St Joseph's Hospital
2661 COUNTY HIGHWAY 1CHIPPEWA FALLSWI54729390810545HEALTHCAREWI501(c)(3)3NAfalse
St Mary's Hospital
1800 E LAKE SHORE DRIVEDECATURIL62521370661244HEALTHCAREIL501(c)(3)3NAfalse
St Mary's Hospital
111 SPRING STREETSTREATORIL61364362169181HEALTHCAREIL501(c)(3)3NAfalse
St Mary's Medical Center
1726 SHAWANO AVENUEGREEN BAYWI54303390818682HEALTHCAREWI501(c)(3)3NAfalse
St Vincent Hospital
835 S VAN BURENGREEN BAYWI54301390817529HEALTHCAREWI501(c)(3)3NAfalse
St Joseph's Hospital
1515 MAIN STREETHIGHLANDIL62249370663568HEALTHCAREIL501(c)(3)3NAfalse
HSHS MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703263956318HEALTHCAREIL501(c)(3)11aNAfalse
HSHS WISCONSIN MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703264515959HEALTHCAREWI501(c)(3)11ANAfalse
Orange Cross Ambulance Inc
919 Ashland AveSheboyganWI53081391860942HealthcareWI501(c)(3)9St Nicholasfalse
Wisconsin Upper Pen Ocn Mngmt Services
835 S Van BurenGreen BayWI54301391677100healthcareWI501(c)(3)3St Vincentfalse
Unity Limited Partnership
2366 Oak Ridge CircleDe PereWI54115391750729HealthcareWI501(c)(3)11AHSSIfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
Memorial and St Elizabeth's Healthcare
4000 North Illinois StreetSwanseaIL62226371312961HealthCareILSt Elizabeth'sRELATEDfalse$0
Prairie Heart Institute - CarbondaleLLC
800 East Carpenter StreetSpringfieldIL62769371321197HealthCareILSt John'sRELATEDfalse$0
Northeast Wisconsin Radiation Therapy Se
1821 S Webster Avenue STE 300Green BayWI543079047263749065HealthCareWIHSSIRELATEDfalse$0
Pain Center of Wisconsin
4131 W Loomis Road STE 300GreenfieldWI53221263155343HealthCareWISt VincentRELATEDfalse$0
Surgery Center of Sheboygan LLC
3141 Saemann AveSheboyganWI53081260822209HealthCareWISt NicholasRELATEDfalse$0
Prevea Ventures LLC
2710 EXECUTIVE DRGreen BayWI54304203775127HealthCareWIHSSIRELATEDfalse$0
CARPENTER STREET HOTEL LLC 36-
HOTELILLASANTE INCRELATEDfalse$0
SPRINGFIELD URGENT CARE REAL ESTATE
RENT. REAL ESILLASANTE INCRELATEDfalse$0
PRAIRIE HEART INSTITUTE MANAGEMENT LLC
4936 Laverna RoadSpringfieldIL62707261417684MedicalILHSHSRelatedfalse00

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrgAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
Kiara Inc
4936 Laverna RdSpringfieldIL62707371163401HealthCareILHSHSC Corpfalse
LaSante Wisconsin Inc
4936 Laverna RdSpringfieldIL62707391572196HealthCareILKiara IncC Corpfalse
LaSante Inc
4936 Laverna RdSpringfieldIL62707371163400HealthCareILKiara IncC Corpfalse
Prairie Cardiovascular
619 East Mason STE 4P57SpringfieldIL62701371071858HealthCareILKiara IncC Corpfalse
Prevea Health Services
2710 EXECUTIVE DRGreen BayWI54304391839351HealthCareWIHSSIC Corpfalse
Prevea Clinic Inc
2710 EXECUTIVE DRGreen BayWI54304391839349HealthCareWIHSSIC Corpfalse
Prevea Health Network
2710 EXECUTIVE DRGreen BayWI54304392000537HealthCareWIHSSIC Corpfalse
Renaissance Quality Insurance
980669953insuranceHSSIc corpfalsePO Box 1159Grand CaymansCJKY1-1102CJ
OJV Inc
4936 Laverna RdSpringfieldIL62707460873384HealthcareILLaSanteC Corpfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ENTITIESIdentifier
Return ReferenceSCHEDULE R, PART V, LINE 2ReturnReference
ExplanationANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) ORAGNIZATIONS AND DO NOT REQUIRE REPORTING ON THIS SECTION.Explanation