2014-05-12T14:10:51-05:00 2013-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2012-07-01 370661244 ST MARY'S HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS % REBECCA COLKER STMA 2174642966 1800 E LAKE SHORE DRIVE Suite DECATUR IL 62521 REBECCA COLKER 2174642966 2014-05-11 true KPMG LLP 6142492300 2012 2015-11-30 17:44:51Z Daniel Perryman 1800 E LAKE SHORE DRIVE DECATUR IL 62521 145682248 false 0928 X WWW.STMARYSDECATUR.COM X 1878 IL To participate in the health care ministry of the church and provide a family-centered approach in meeting the community's health care needs regardless of ability to pay. 12 9 1400 361 68097 8923897 80762 138284968 137908679 617634 191592 1219232 6692211 149045731 144873244 0 0 0 0 57551408 58555339 0 0 0 81667446 84836503 139218854 143391842 9826877 1481402 136158575 143368741 84818413 81311630 51340162 62057111 X The mission of St. Mary's Hospital is to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry. false false 91333065 137908679 SEE SCHEDULE O - Statement of Program Service Accomplishments 91333065 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false true false false false false true true false false false true 118 0 true 1400 true true true false false false false false false false false false X 12 9 false false false false true true true true true false false true true true true true true true true false true IL X REBECCA COLKER 2174642970 1800 E LAKE SHORE DRIVE DECATUR IL 62521 X REV JOSEPH MOLLOY 1.0 X 0 0 0 SR HELEN PLUMMER OSF 1.0 X 0 0 0 KEVIN KAST 60.0 X X 0 585194 114028 JOHN SKEFFINGTON 1.0 X X 0 0 0 KEVIN BREHENY 1.0 X X 0 0 0 JON ROBINSON 1.0 X X 0 0 0 MARK CHEVIRON 1.0 X 0 0 0 PAT DAWSON 1.0 X 0 0 0 BOB WIESEMANN 1.0 X X 0 0 0 CLAUDIA MADDING 1.0 X 0 0 0 ALAN FRIGY MD 1.0 X 0 0 0 MIKE COTTRELL 1.0 59.0 X 0 620195 120098 THERESA J RUTHERFORD 60.0 X 216840 0 38475 ANN M CARR 0.25 59.75 X 0 272146 138031 REBECCA COLKER 60.0 X 281970 0 44141 MARIA GRANZOTTI 20.0 20.0 X 333057 0 25574 MARY HARTMAN 40.0 X 243976 0 43411 SHEILA HOLLINDEN 40.0 X 204342 0 86084 BETH MCCOY 40.0 X 210283 0 19304 ROBERTA MCBRIDE 40.0 X 217161 0 -4951 SARAH STAMBAUGH 40.0 X 204569 0 26731 1912198 1477535 650926 31 false true false sodexo 488 paysphere circle DECATUR IL 60674 cafeteria management 1867653 WALSH CONSTRUCTION 929 WEST ADAMS CHICAGO IL 60607 CONTRACTOR 1804620 Central IL Emergency Physicians PO Box 793 TRAVERSE CITY MI 496850793 Emergency Dept Mgmt 1131555 CENTRAL IL ASSOCIATES 1800 E LAKE SHORE DR DECATUR IL 62521 ANESTHESIA PHY SERV 1089634 REHAB CARE 7733 FORSYTH BOULEVARD ST LOUIS MO 63105 CONTRACTOR 919092 16 80762 80762 NET PROGRAM SERVICE REVENUE 900099 137908679 137908679 137908679 136022 136022 0 0 1057714 452220 605494 0 605494 605494 208252 204102 356784 208252 -152682 55570 55570 0 0 0 REFERENCE LAB 621500 38016 38016 PHYSICIAN ANSWERING SERVICES 621500 30081 30081 OTHER REVENUE 900099 6018620 6018620 6086717 144873244 137908679 68097 6815706 0 0 0 0 853447 0 853447 0 0 41317473 37628386 3689087 4432649 4432649 8899420 8841907 57513 3052350 3052350 734544 368361 366183 520430 575 519855 0 62453 62453 0 17375 17375 25271754 14709684 10562070 478808 478808 272566 4532 268034 54475 54475 0 1938011 1891696 46315 0 0 232810 145334 87476 0 8752497 8752497 8043613 82452 7961161 2132884 156759 1976125 SUPPLIES 18970892 18562303 408589 BAD DEBT EXPENSE 10770090 10770090 MEDICAID TAX ASSESSMENT 3817932 3817932 OTHER 2120085 1453515 666570 645284 2562 642722 143391842 91333065 52058777 0 X 1461109 4394511 0 0 0 0 24231183 23587110 0 0 0 0 0 0 3180631 3136557 1089972 711565 217055665 118513029 97423371 98542636 8461915 10536380 0 0 0 2240654 0 0 310394 219328 136158575 143368741 30968876 27582173 0 0 97809 97001 0 0 0 0 0 0 0 0 0 0 53751728 53632456 84818413 81311630 X 45135891 55076341 5003264 5779767 1201007 1201003 51340162 62057111 136158575 143368741 X 1481402 350101 8885446 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 62453 62453 false DESCRIPTION OF OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II B, QUESTION 1I ST. MARY'S HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH, ILL ASSOCIATION ("CHA"), THE ILLINOIS HEALTH ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES. A PART OF THESE DUES IS ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. $29,453 of THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE HOSPITAL PAID $33,000 DURING THE YEAR TO JULIE CURRY, A PROFESSIONAL LOBBYIST THROUGH ITS LEGAL COUNSEL. 3295160 3295160 89829360 31986489 57842871 42089075 26155679 15933396 78161517 60370861 17790656 3680553 3680553 98542636 0 ACCRUED BENEFIT LIABILITY 17862240 ABSETOS LONG TERM DEBT 32293077 RETIRE OBLIGATION - ASBESTOS 1708772 ESTIMATED SELF INSURANCE LIAB 1768367 53632456 X ASC SUBTOPIC 740-10 HSHS 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, the Obligated Group 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 from 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, the Obligated Group does not have a liability for unrecognized tax benefits. true true true X true X true true true false true true 1 8234 4914169 4914169 0.03710 1 8814270 8814270 0.06650 1 2141 308562 270075 38487 0.00020 3 10375 14037001 270075 13766926 0.10380 60 646532 411 646122 0.00490 5 155171 12750 142421 0.00110 6743 49883460 47849124 2034336 0.01530 24 209244 209244 0.00160 89 6743 50894407 47862285 3032123 0.02290 92 17118 64931408 48132360 16799049 0.12670 3 56784 56784 0.00040 3 56784 56784 0.00040 true 10770090 18370 48231833 45557313 2674520 X true true 1 1 ST MARY'S HOSPITAL

1700 E LAKE SHORE DR DECATUR IL 62521

X X X ST MARY'S HOSPITAL true X X X X X X X X X X 12 true false true X X X X X X X X false false true true 150. true 300. true X X X X X X X true true X X X true false true X false false PART I, LINE 3C The organization does follow FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. PART I, LINE 6A The hospitals community benefit report can be accessed at www.stmarysdecatur.com. 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 12.67%. The amount of bad debt expense removed when calculating the percentages in Part I, Line 7, Column (F) was 10,770,090. PART I, LINE 7 Costing methodology for amounts reported in table: The common method for estimating the true economic cost of medical services is to adjust the charges through the use of cost-to-charge ratios. Cost-to-charge ratios convert charges for medical services to their true economic costs. Applying cost-to-charge ratios to medical service charges produces average estimates of true costs. The cost-to-charge ratio represents total hospital operating costs divided by total gross billed charges. The exception to the costing methodology described in the preceding paragraph is for the amount for subsidized services on line 7g, for which a costing information system was utilized. More accurate allocations of direct costs are available through the use of that system, and were applied for the subsidized health services. a. For FY2013, total charity care written off was $16,799,049 as reported on the income statement. The net community benefit cost, after applying the cost-to-charge ratio, was $4,914,169. b. For FY2013, estimated cost of Medicaid was $22,402,821. The net community benefit cost, after applying the cost-to-charge ratio, was $8,814,270. c. The estimated cost is calculated using the cost-to-charge ratio. Actual cost can be traced directly to (or identified with) a specific cost center or cost object such as a department, process, or product. The following other benefits are calculated from the income statement. For FY2013, unreimbursed cost from other means tested government programs realized revenue of $270,075 and expenses $308,562. The net community benefit expense was $38,487. d. Total of line 7a through 7c. e. For FY2013, community health improvement services and benefit operations realized revenue of $410 and expenses $646,532. The net community benefit expense was $646,122. f. For FY2013, health professions education realized revenues of $12,750 and expense of $155,171. The net community benefit expense was $142,421. g. For FY2013 subsidized health service costs attributed to $2,034,336. Subsidized services contribution is calculated by taking total charges less deductions and operating costs. h. For FY2013, there were no research costs attributed to community benefit. i. For FY2013, cash and in-kind contributions realized expenses of $209,244. Actual cash contributions of $195,304 are included and consist of charitable contributions made to organizations in the community. j. Total of lines 7e through 7i. k. Total of lines 7d and 7j. Decatur Health Coalition: St. Mary's Hospital partners with local providers to promote the Learn More Breathe Better campaign, in coordination with the National Heart, Lung and Blood Institute (NHLBI), to educate the community about COPD and other breathing issues, and to promote behaviors that improve health. The Decatur Health Coalition is made up of representatives from American Lung Association, Community Health Improvement Center, Decatur Memorial Hospital, Decatur Community Partnership, Heritage Behavioral Health, Macon County Health Department and St. Marys Hospital and its creation was a result of our organization reaching out to the community as part of our COPD Project. The COPD Project is St. Marys pursuit of better quality of life for people living with COPD. This would be done primarily through education for both the health providers and the community and through coordination of care across the continuum for better patient outcomes. The Decatur Health Coalition is responsible for organizing two major community health events each year that provides free community health education and screenings, such as genetic COPD, blood pressure, BMI, oxygen saturation, cholesterol and sleep apnea. Due to the large manufacturing industry in Macon County and the poor air quality that results from the toxic agents released, breathing issues are prevalent in our community. Research also shows a correlation between a high percentage of blue collar workers and a high rate of occurrence for COPD. St. Marys has researched admissions data related to COPD and has increased education to promote improved health of community members with breathing issues. This model for COPD core measures was shared at national best-practice seminars in order to benefit other communities as well. Obesity Coalition: St. Mary's staff participates on the local Obesity Prevention Coalition to help raise awareness and take action in lowering the number of Illinoisans that are considered obese. Local partners on the Macon County Obesity Prevention Coalition include Decatur Day Care, Macon County Health Department, Decatur Public School System #61, Decatur Memorial Hospital, Decatur Community Partnership, Community Health Improvement Center, and many others. The Obesity Prevention Coalition began in 2008 through a grant from the American Academy of Pediatrics to focus on the issue of childhood obesity in Macon County. Since its inception, the group has grown in members, scope and area. The mission of the OPC is to provide a collaborative county-wide network to promote healthy nutrition and physical activity, awareness through education and advocacy to prevent obesity and obesity-related conditions. Obesity has reached epidemic proportions in Illinois 33% of adults in Macon County and 20% of adults in the state. This is considerably higher than the national average of 14%. Given that obesity and overweight are primary determinants of cardiovascular diseases, cancer, respiratory diseases, and diabetes already leading causes of death in Illinois the implications of this epidemic for the health of our state are staggering. Eisenhower High School HUB Initiative: Eisenhower High School is located adjacent to the St. Mary's Hospital Campus. The majority of students attending the school are low-income, minority students. The school received a HUB Grant to assist not only in renovating the school, but to help build a strong neighborhood hub. St. Mary's colleagues have contributed expertise and resources by providing various health and behavioral workshop topics, such as anger management, drug use and conflict resolution. The goal of this initiative is to improve the neighborhood community by providing safe and fun evening activities, offer events that promote family involvement, and offer education on healthy habits and career choices for the children and families who live there. Lake Shore Connection: The Lake Shore Connection program is focused on individuals age 55 and over. The organization also offers participants free quarterly health screenings, discounts on monthly lunch and learn programs, and other resources to assist participants in staying productive, healthy and independent. PART II Please see promotion of community health narrative in this Part VI PART III, LINE 4 Bad 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 8 The cost report uses the same methodology of cost-to-charge ratio. However, the system used (Compu-Max Micro System) to calculate the costs will include or exclude various expenses. The common method for estimating the true economic cost of medical services is to adjust the charges through the use of cost-to-charge ratios. Cost-to-charge ratios convert charges for medical services to their true economic costs. Applying cost-to-charge ratios to medical service charges produces average estimates of true costs. The cost-to-charge ratio represents total hospital operating costs divided by total gross billed charges. PART III, LINE 9(B) The organization has a policy on account resolution that outlines the procedures to be followed in collecting balances on outstanding patient bills. Besides addressing the procedures and follow-up for accounts covered by insurance or governmental programs, the policy discusses situations where the patient may be eligible for financial assistance through our charity care program. If a patient is deemed eligible, reference is made to the organizations charity care policy. Even with the best intentions, patients cannot always meet their responsibility to pay for the care they receive. For a number of reasons, from the loss of a job to temporary hardships, this leaves the organization to cover the unpaid balance or even the entire bill, an expense for the organization referred to as bad debt. In the fiscal year ended June 30, 2013, bad debt expense less recoveries was $10,770,090 million with no outside source of funding to help compensate for the expense. The cost, after applying the cost to charge ratio, was $3,695,039 million. This is a growing problem. Bad debt accounted for 7.51% of our total costs in the fiscal year ended June 30, 2013 and constituted a significant community benefit. PART V The organization does not have any healthcare facilities that are not registered as a healthcare facility under State law. Part V, Section B, Line 1 During fiscal year 2012, St. Marys Hospital conducted a health needs assessment of the facilitys service area. Macon County makes up the majority of the St. Marys Hospital primary service area, with surrounding counties comprising much of the secondary and tertiary areas. St. Marys Hospital, which is affiliated with Hospital Sisters Health Systems, is one of two acute care hospitals serving this area. St. Marys Hospital first participated with the Macon County Health Department and other community health providers as part of the Community Health Committee for completion of the Illinois Project for Local Assessment of Needs (IPLAN). St. Marys Hospital then supplemented the IPLAN data with primary data from 400 telephone surveys, conducted by Leede Research, to the primary service area. Part V, Section B, LINE 3 Assessing the health needs of the community began with the collaboration of health professionals on the Community Health Committee, which was organized by the Macon County Health Department. This committee of 19 members was led by Brandi Binkley, Director of Health Promotion. In addition to 8 representatives from St. Mary's Hospital, members of this committee include representatives from United Way, Decatur Memorial Hospital, Macon County Mental Health Board, Decatur Housing Authority, Decatur Community Partnership, Community Health Improvement Center, Dove Retired Senior Volunteer Program, American Cancer Society, and a Parish Nurse. These community partners bring special knowledge and expertise in the areas of public health, underserved, low-income and minority populations, and chronic disease. The Community Health Plan (IPLAN) for Macon County was created as a result of this group's research. To supplement the work of the Community Health Committee, St. Mary's Hospital sought additional primary data. In November 2011, along with other hospitals in the Hospital Sisters Health System, St. Mary's Hospital contracted with Leede Research to conduct telephone interviews in each local service area. The study consisted of 400 completed telephone interviews utilizing a questionnaire designed by Leede in cooperation with hospital leadership. A proportionate stratified sample was used to provide equal input from all geographic areas. Weighting by age and income was used to more accurately represent the actual population in the area. The goal was to give the survey an accurate representation of the actual service area. Analysis showed that results from Leede survey process aligned with IPLAN data. Since the data was mutually supportive with similar findings, St. Mary's chose to utilize the primary data set for our prioritization process and implementation planning. The facility's parent organization, Hospital Systems Health Systems, has formed a Community Benefit Planning Team that has developed guidelines for consistency in community health needs assessments, implementation planning and guidelines for reporting community benefit. St. Mary's Hospital formed an internal Community Benefit Team consisting of hospital colleagues. The purpose of this group is to provide input, monitor the progress of our community benefit initiative and implementation plan, as well as assist in identifying additional opportunities for addressing the needs of the community. Since December 2009, the St. Mary's Strategic Planning Committee, comprised of hospital leadership, local physicians, community leaders and local Board Members, has been instrumental in examining the St. Mary's Ministry from every vantage point. They provide valuable input on an ongoing basis on the community's healthcare needs. The hospital's Strategic Plan is built from the work of this group, and is updated yearly based on the identified service gaps and needs of our community. Members of our community-based Strategic Planning Committee, hospital volunteers, and our Community Benefit Team were asked to participate in the prioritization process for identified health needs from the Community Health Needs Assessment. In addition, St. Mary's participation in Grow Decatur, a community-based group working toward building a healthier community, lends further perspective into the needs of the community and presents further opportunities for service collaboration among local businesses and service providers. St. Mary's Hospital Representative worked with the group to analyze and prioritize the data gleaned from the group's community assessment and will continue to participate in the improvement process. Input is continuously obtained from the patients we serve through patient satisfaction surveys. Input provided through some of these surveys was taken into consideration in the development of the hospital's master facility plan, which resulted in the major Emergency Room capital project. Part V, Section B, Line 5C The Community Health Needs Assessment was made available on the hospital website at www.stmarysdecatur.com and was distributed to and reviewed by our community-based boards. Part V, Section B, LINE 7 While the issue of affordable housing was identified in the Community Health Needs Assessment, St. Marys Hospital is not directly involved in addressing that issue, as this is outside our area of focus or expertise. The Decatur Housing Authority, Energy Assistance Foundation, and Community Investment Corporation of Decatur are all offices in Macon County that offer housing assistance. Part V, Line 12h Yes, the Financial Assistance Policy contains a detailed description of the Purpose, Definitions and Guidelines for financial assistance. Part V, Line 14g Yes, section I of the Financial Assistance Policy describes the Communication of the Financial Assistance Program to Patients in detail. Part V, Section B, Line 20D The hospital automatically gives a 25% uninsured discount to all of its uninsured patients. The hospital also reviews the patient's accounts to ensure they are not charged more than 25% of their annual gross income. Once the charges for a self-pay balance exceed 25% of the patient's annual gross income, the remaining balance is adjusted off to Christian Care. Needs Assessment As indicated in Part V, Section B, we conducted a Community Health Needs Assessment in our FY2012. In previous years, we assessed community need through involvement on the boards of other community health providers, such as Macon County Health Department, Community Health Improvement Center, and Macon County Mental Health Board. Input from St. Marys Hospitals community-based Board of Directors and Advisory Committee, as well as patient admission data has provided, and continues to provide, valuable information regarding the health needs of our service area. The community needs assessment is available online at https://www.stmarysdecatur.com/about/community.aspx Patient Education for eligibility for assistance The Registration Department provides brochures to patients upon registration regarding the payment assistance programs available to them at St. Marys Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. Contact numbers for several agencies are listed in the brochure, as well as information about how to read and understand the bill. Information on payment assistance, billing procedures and explanations of Medicare forms are available on the organizations website. The organization has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. They work with patients to determine if they may be eligible, and if so, assist in pulling together the necessary application for submission. Patients are also provided a Fair Billing Act Notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patients financial responsibility if their insurance plan is out of network. One on one conversation to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's Charity Care program. The letter provides direct contact information to begin the application process for Charity Care. A system called Search America is now being utilized after failed attempts made by the hospital and by our law firm to work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity or continue collection efforts. Community Information Community Served The population of Macon County is 110,122, based on the United States Census Bureau's Annual Estimate of Population from April 2010 to July 2012. This shows a .6% decline in population, as compared to the population from the 2010 Census reported at 110,768. The county median household income is $44,415, with 43,604 households. 85% of households are urban and 15% rural The income for 13.9% of the population falls below poverty level. In the 2011-2012 school year, 48.3% of children qualified for free or reduced-price lunches. Results from the hospitals CHNA showed that 14.1% of the 400 respondents were not covered by health insurance. 56.7% had coverage provided by employers, which is slightly lower than national averages. Unemployment Rate in Macon County was recorded at 11.60 % in July of 2012, according to the United States Federal Reserve The racial makeup of the county in 2011 was 78.1% White, 16.9% African American, with other races comprising the remaining 5%. 30.5% of the Macon County population is age 55 or older. Macon County's adult obesity rate, at 33%, greatly exceeds the Illinois rate of 20%, and the national rate of 14%. Macon County has 580 square miles in land area and a population density of 190.8 per square mile. The town of Decatur, which is where St. Mary's Hospital is located, is the county seat and also the largest city in Macon County. St. Mary's Hospital is one of 2 acute care hospitals serving this area. While our primary service area is not designated as a medically underserved area by the federal government, it is a mental health professional shortage area. Promotion of Community Health St. Mary's 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. Mary's 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 Macon County and surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who 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. Mary's Hospital is responding to community need. During 2012, 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. Mary's 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/day to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Mary's 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. Mary's 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. Mary's also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2013, St. Mary's provided over $17 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. The range of benefits provided by St. Mary's flows from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Mary's, 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: Access to Services Mental Health Services: St. Mary's Hospital has partnered with the Macon County Mental Health Board, Community Health Improvement Center, Decatur Memorial Hospital, Heritage Behavioral Health Center, Macon County Health Department and SIU School of Medicine to create My Health Care Coordination (MHCC), in response to a state request for innovative programs to improve the health care to Medicaid residents. Through this program, care coordination teams will coordinate the health services, including transportation to appointments, for members receiving Aid to the Aged, Blind and Disable (AABD) Medicaid benefits, at no cost to the individual. The goals of this program are: - To coordinate care across continuum by identifying and spanning gaps in care - Identifying and addressing barriers to care - Assisting individuals in self-management in their chronic conditions through increasing knowledge of their condition and incorporating self-management activities into the daily living habits - By increasing attendance at primary provider appointments, reduce Emergency Room visits and hospitalizations. Any funds that are received from the program are reinvested to provide additional patient care. These funds may be requested from othe AFFILIATED HEALTH CARE SYSTEM St. Mary's Hospital in Decatur, 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 Christ's healing love for all people through our high quality Franciscan health care ministry." We live our Mission by providing holistic healing to all who seek our care, as well as through Community Benefit. Working collaboratively with others in the communities we serve, our Community Benefit initiatives are strategically and successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. In 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. Mary's 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. Joseph's 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. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's 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. Joseph's 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 Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. 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. John's Hospital in Springfield, Illinois took a lead role in bringing a Farmers Market to the east side of Springfield. The East Side Farmers Market 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. Mary's 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 STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL, X X X X X X X false true false false false false false false false KEVIN KAST 0 378897 0 55273 0 151024 0 90300 0 24621 0 700115 0 112204 MIKE COTTRELL 0 492349 0 91403 0 36443 0 92874 0 28117 0 741186 0 0 THERESA J RUTHERFORD 199276 0 17564 0 0 0 24541 0 14833 0 256214 0 0 0 ANN M CARR 0 193454 0 29440 0 49252 0 121170 0 17686 0 411002 0 18215 REBECCA COLKER 252162 0 29808 0 0 0 29791 0 15253 0 327014 0 0 0 MARY HARTMAN 241584 0 2392 0 0 0 27917 0 16340 0 288233 0 0 0 SHEILA HOLLINDEN 202284 0 2058 0 0 0 78574 0 8356 0 291272 0 0 0 BETH MCCOY 208128 0 2155 0 0 0 -4585 0 24697 0 230395 0 0 0 ROBERTA MCBRIDE 214985 0 2176 0 0 0 -18885 0 14780 0 213056 0 0 0 SARAH STAMBAUGH 202307 0 2116 0 146 0 6292 0 21285 0 232146 0 0 0 MARIA GRANZOTTI 323957 0 9100 0 0 0 18245 0 8214 0 359516 0 0 0 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. ANN M. CARR SCHEDULE J, PART I, LINE 4B ANN M. CARR PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $42,817. MIKE COTTRELL SCHEDULE J, PART I, LINE 4B MIKE COTTRELL PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $10,061. KEVIN KAST SCHEDULE J, PART I, LINE 4B KEVIN KAST PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $138,408. DEFINED BENEFIT PLAN SCHEDULE J, PART II THE ACTUARY COMPUTES THE DEFINED BENEFIT AMOUNT FOR ALL OF THE DISCLOSURES. THE REDUCTION DIRECTLY RELATES TO THE IMPROVEMENT IN THE DISCOUNT RATE. Bolen Robinson Ellis Board Member 448736 legal services false KMB SC Board Member 106167 Lab services false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS FORM 990 SCHEDULE L, PART IV BOARD MEMBER, JON ROBINSON, IS A 50% PARTNER IN THE BOLEN, ROBINSON LAW FIRM. THE FIRM PROVIDES LEGAL SERVICES TO THE ORGANIZATION AND ALL SERVICES WERE CONSIDERED TO BE ARMS-LENGTH TRANSACTIONS. FORM 990 SCHEDULE L, PART IV BOARD MEMBER, ALAN FRIGY, MD, IS A 33.3% PARTNER IN KMB, S.C. WHICH PROVIDES LAB SERVICES TO THE ORGANIZATION. ALL TRANSACTIONS ARE CONSIDERED TO BE AT ARMS-LENGTH. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ST. MARY'S HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF ST. MARY'S HOSPITAL, IT IS RECONGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE NECESSARY MEDICAL SERVICES. INHERENT TO OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE COMMUNITY EDUCATION PROGRAMS, WELLNESS PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FISCAL YEAR 2013, ST. MARY'S HOSPITAL PROVIDED 44,005 ADULT AND PEDIATRIC DAYS OF CARE AND 160,934 OUTPATIENT REGISTRATIONS DURING THE SAME TIME PERIOD. ST. MARY'S HOSPITAL PROVIDES BOTH BENEFITS TO THE POOR AND TO THE BROADER COMMUNITY. BENEFITS TO THE POOR ARE PROVIDED ON THE FORM OF TRADITIONAL CHARITY CARE FOR THOSE WHO CANNOT AFFORD TO PAY, UNPAID COSTS Of PUBLIC PROGRAMS SUCH AS MEDICAID AND GENERAL RELIEF, NONBILLED SERVICES FOR THE POOR AND MANY IN-KIND DONATIONS. THE TOTAL VALUES OF THESE UNREIMBURSED BENEFITS FOR THE POOR WERE $16,870,386 IN FISCAL YEAR 2013. ST. MARY'S HOSPITAL PROVIDES NUMEROUS BENEFITS TO THE BROADER COMMUNITY. THIS IS CARRIED OUT THROUGH OUR PARTICIPATION IN THE MEDICARE PROGRAM, PROVIDING MANY PROGRAMS AND SERVICES FREE OR AT A REDUCED PRICE, AND PROVIDING SERVICES THAT BENEFIT THE COMMUNITY BUT HAVE A NEGATIVE MARGIN TOTALED $14,581,359 DURING FISCAL YEAR 2013. ALL OTHER NONBILLED SERVICES PROVIDED TO THE COMMUNITY AND SERVICES PROVIDED AT LOW OR NEGATIVE MARGINS TOTALED $1,107,611 FOR THE YEAR ENDED 6/30/2013. BELOW ARE SPECIFIC EXAMPLES OF SERVICES INCLUDED IN THE ABOVE FIGURES: THROUGH THE OPERATION OF ITS PRENATAL CLINIC, THE HOSPITAL PROVIDES BOTH PRE AND POST NATAL CARE TO THE POOR. THE HOSPITAL ROUTINELY DONATES FOOD TO LOCAL FOOD PANTRIES. OBSOLETE EQUIPMENT IS ALSO OCCASIONALLY DONATED TO LOCAL AGENCIES. PROVIDE TRAINING TO THE LOCAL PARAMEDICS, FIRST RESPONDER GROUPS, AND FIRE DEPARTMENTS. IN ADDITIONAL, AREA ORGANIZATIONS RECEIVE CPR TRAINING THROUGH THE HOSPITAL'S EMS DEPARTMENT. the HOSPITAL PARTICIPATES IN THE SECONDARY TRANSITIONAL EXPERIENCE PROGRAM BY PROVIDING EMPLOYMENT OPPORTUNITIES TO HANDICAPPED STUDENTS. PASTORAL CARE AND SOCIAL SERVICE DEPARTMENTS PROVIDE ASSISTANCE FOR PATIENT AND FAMILY NEEDS. PROVIDED LIFELINE VOICE COMMUNICATORS TO ELDERLY PATIENTS WITH SPECIAL NEEDS. EMPLOYEES SERVE AS SPEAKERS AT HEALTH FAIRS, SCHOOLS, AND A VARIETY OF AREA ORGANIZATIONS. ASSIST THE UNITED WAY CAMPAIGN BY HAVING STAFF MEMBERS ORGANIZE THE HOSPITAL'S ANNUAL FUND DRIVE. PROVIDE A VARIETY OF HEALTH SCREENINGS TO THE PUBLIC IN DIFFERENT LOCATIONS THROUGHOUT THE COMMUNITY. TAX EXEMPT BONDS FORM 990, PART IV, QUESTION 24 St. Mary's Decatur HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. Delegation of management Form 990, Part VI, Line 3 St. Mary's Hospital outsources management of the Rehab department to better facilitate the health needs of its patients. In doing so, St. Mary's hospital is able to focus its efforts in other areas, improving the already exceptional quality provided in those areas. RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990, PART VI, LINES 6 & 7A THE SENIOR GOVERNING BODY OF ST. Mary's 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 POWERS FORM 990, PART VI, LINE 7B Responsibility for the policy and operations of St. Mary's 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. FORM 990 REVIEW PROCESS FORM 990, PART VI, LINE 11B The hospital employs KPMG to assist in the overall 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 POLICY FORM 990, PART VI, LINE 12C The organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. 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 POLICY FORM 990, PART VI, LINE 13 Provisions within the Corporate Compliance Program and Conflict of Interest Policy provide protections for whistleblower type activities. COMPENSATION PROCESS FORM 990, PART VI, LINE 15 The Compensation Committee ("Committee") is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges, and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting. 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. MARY'S 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. MARY'S HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. MARY'S HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time. POOLED INVESTMENT ACCOUNT FORM 990, PART X, LINE 11 St. Mary's 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 assets Form 990, Part XI, Line 9 transfer to affiliates (4,926,341) change in pension funded status 10,720,468 change in fair value of interest rate swaps 3,408,823 swap payments (420,160) loss on early extinguishment of debt (368,210) change in temorarily restricted assets 470,866 ------------- total 8,885,446 ============= Springfield Health Partners LLC 4936 Laverna Road springfield IL 62707 371364419 healthcare IL 0 0 hshs mg Kiara Clinical Integration Network LLC 4936 Laverna Rd springfield IL 62707 261417684 healthcare IL 0 0 HSSI PHYSICIAN CLINICAL INTERGRATION NETWORK 4936 LAVERNA RD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 0 0 KCIN HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(C)(3) 11A HSHS false Hospital Sisters Services Inc 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(C)(3) 11A NA false HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(C)(3) 11A HSHS false HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(C)(3) 11A HSHS false HSHS HEALTH CARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(C)(9) N/A HSHS false Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(C)(3) 11A HSSI false SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(C)(3) 3 HSSI false ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(C)(3) 3 HSSI false ST ELIZABETH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE IL 62220 370663567 HEALTHCARE IL 501(C)(3) 3 HSSI false ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(C)(3) 3 HSSI false ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(C)(3) 3 HSSI false ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(C)(3) 3 HSSI false ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(C)(3) 3 HSSI false ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(C)(3) 3 HSSI false ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(C)(3) 3 HSSI false ST MARY'S MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(C)(3) 3 HSSI false ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 501(C)(3) 3 HSSI false ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(C)(3) 3 HSSI false HSHS MEDICAL GROUP INC 3215 Executive Park Drive Springfield IL 62703 263956318 HEALTHCARE IL 501(C)(3) 11A HSSI false HSHS WISCONSIN MEDICAL GROUP INC 3215 Executive Park Drive Springfield IL 62703 264515959 HEALTHCARE WI 501(C)(3) 11A HSSI false Orange Cross Ambulance inc 919 Ashland Ave Sheboygan WI 53081 391860942 Healthcare WI 501(C)(3) 9 St Nicholas false Wisconsin Upper Peninsula Onc Mngmt Svcs 835 S Van Buren Green Bay WI 54301 391677100 Healthcare WI 501(C)(3) 3 St Vincent false Unity Limited Partnership 2366 Oak Ridge Circle De Pere WI 54115 391750729 Healthcare WI 501(C)(3) 9 HSSI false Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea IL 62226 371312961 HealthCare IL St Elizabeth's NONE 0 0 false 0 false Prairie Heart Institute - Carbondale 800 East Carpenter Street Springfield IL 62769 371321197 HealthCare IL St John's NONE 0 0 false 0 false Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay WI 543079047 263749065 HealthCare WI HSSI NONE 0 0 false 0 false Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield WI 53221 263155343 HealthCare WI St Vincent NONE 0 0 false 0 false Surgery Center of Sheboygan LLC 3141 Saemann Ave Sheboygan WI 53081 260822209 HealthCare WI St Nicholas NONE 0 0 false 0 false Prevea Ventures LLC 2710 EXECUTIVE DR Green Bay WI 54304 203775127 HealthCare WI HSSI NONE 0 0 false 0 false CARPENTER STREET HOTEL LLC 36- HOTEL IL LASANTE INC NONE 0 0 false 0 false SPRINGFIELD URGENT CARE REAL E RENT. REAL ES IL LASANTE INC NONE 0 0 false 0 false Prairie Heart Institute Management LLC 4936 Laverna Road Springfield IL 62707 261417684 Medical IL HSHS Related 0 0 false 0 false Kiara Inc 4936 Laverna Rd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp 0 0 LaSante Wisconsin Inc 4936 Laverna Rd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp 0 0 LaSante Inc 4936 Laverna Rd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp 0 0 Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp 0 0 Prevea Health Services 2710 EXECUTIVE DR Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp 0 0 Prevea Clinic Inc 2710 EXECUTIVE DR Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp 0 0 Prevea Health Network 2710 EXECUTIVE DR Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp 0 0 Renaissance Quality Insurance PO Box 1159 Grand Caymans CJ KY1-1102 980669953 Insurance CJ HSSI c corp 0 0 false OJV INC 4936 LAVERNA RD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C CORP 0 0 false false false false false true false false false true false true false false true true true true true transactions with related organizations schedule r, part v, line 2 The transactions reported on line 1 and not specifically identified on line 2 are between related 501(c)(3) public charities. accordingly they are not reported in this section.