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ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ST JOSEPHS HOSPITAL BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDE (EIN 37-1208459)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-13
IRS object ID
201411339349305016
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)
Timestamp2014-05-13T15:51:54-05:00Timestamp
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)
EIN371208459EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST JOSEPH'S HOSPITAL - HOSPITALBusinessNameLine1
Business Name Line2SISTERS - THIRD ORDER OF ST FRANCISBusinessNameLine2
FieldValueIRS element (for citing)
In Care Of Name% JOHN JEFFRIESInCareOfName
Name ControlSTJONameControl
Phone6185264511Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line19515 HOLY CROSS LANE PO BOX 99AddressLine1
Address Line2SuiteAddressLine2
CityBREESECity
StateILState
ZIP Code622300099ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJohn JeffriesName
TitleCFOTitle
Phone6185264511Phone
Date Signed2014-05-13DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
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 PersonMARK KLOSTERMANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line19515 HOLY CROSS LANEAddressLine1
CityBREESECity
StateILState
ZIP Code622300099ZIPCode
FieldValueIRS element (for citing)
Gross Receipts54104238GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.stjoebreese.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1987YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO MINISTER TO THOSE IN NEED AS EXEMPLIFIED BY THE GOSPEL OF CHRIST.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees420TotalNbrEmployees
Total Nbr Volunteers521TotalNbrVolunteers
Total Gross UBI106352TotalGrossUBI
Net Unrelated Business Txbl Income-26817NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year82828ContributionsGrantsPriorYear
Contributions Grants Current Year1528546ContributionsGrantsCurrentYear
Program Service Revenue Prior Year49961505ProgramServiceRevenuePriorYear
Program Service Revenue CY48669951ProgramServiceRevenueCY
Investment Income Prior Year4096112InvestmentIncomePriorYear
Investment Income Current Year3133299InvestmentIncomeCurrentYear
Other Revenue Prior Year90912OtherRevenuePriorYear
Other Revenue Current Year-11539OtherRevenueCurrentYear
Total Revenue Prior Year54231357TotalRevenuePriorYear
Total Revenue Current Year53320257TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22198546SalariesEtcPriorYear
Salaries Etc Current Year23512194SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year22512303OtherExpensePriorYear
Other Expenses Current Year19813373OtherExpensesCurrentYear
Total Expenses Prior Year44710849TotalExpensesPriorYear
Total Expenses Current Year43325567TotalExpensesCurrentYear
Revenues Less Expenses Prior Year9520508RevenuesLessExpensesPriorYear
Revenues Less Expenses CY9994690RevenuesLessExpensesCY
Total Assets BOY114057880TotalAssetsBOY
Total Assets EOY124227050TotalAssetsEOY
Total Liabilities BOY28770236TotalLiabilitiesBOY
Total Liabilities EOY25052375TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY85287644NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY99174675NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO MINISTER TO THOSE IN NEED AS EXEMPLIFIED BY THE GOSPEL OF CHRIST.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense35959344Expense
Revenue49031178Revenue
DescriptionSEE SCHEDULE O - PROGRAM SERVICE ACCOMPLISHMENTSDescription
Total Program Service Expense35959344TotalProgramServiceExpense
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 With109662NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees420NumberOfEmployees
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 Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
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
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHN JEFFRIESNamePerson
Telephone Number6185265312TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line19515 HOLY CROSS LANEAddressLine1
CityBREESECity
StateILState
ZIP Code622300099ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Jonathan Osborn MD
Secretary1.039.0XX028271530153
Mark Klosterman
President40.00.0XX028080760518
Carson Hempen
Director1.00.0X000
Elaine Behrmann
Director1.00.0X000
Erin Gagen MD
Director1.00.0X000
Janice Wiegmann PhD
Director1.00.0X000
Paul Strieker
Vice-Chair Person1.00.0XX000
John Hudspeth
Chairperson1.00.0XX000
Sr Marybeth Culnan OSF
Director1.059.0X000
George Kruse
Director1.00.0X000
Sr Kenneth Wildt OSF
Director1.00.0X000
Johnny Watkins
Division CFO8.451.6X027432945867
Ann M Carr
Treasurer0.2559.75X0272146138031
Mark Reifsteck
Division CEO8.451.6X049572198441
James Burke
Division VP of Legal Services8.451.6X021585838693
John Jeffries
CFO40.00.0X1714035395
William Deters
Pharmacist40.00.0X10603405502
Paulette Evans
CNO40.00.01500501109X
Jene Bieri
Director of Prof. Services40.00.011129800X
Jan Robert
Director of Quality Management40.00.010414506138X
FieldValueIRS element (for citing)
Total Reportable Comp From Org642930TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1821576TotalReportableCompFrmRltdOrgs
Total Other Compensation429847TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
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
MIDWEST EMERGENCY DEPT SERV
320 EAST HIGHWAY 50OFALLONIL62269ER COVERAGE2063810
CLINTON COUNTY ANESTHESIOLOGY
1320 PINEWOODBREESEIL62230ANESTHESIA PHYSICIAN958684
PREMIERCARE INC
13810 CHAMPION FOREST DRHOUSTONTX77069CONSULTING SERVICES184325
QUEST DIAGNOSTICS
12436 COLLECTIONS CENTERCHICAGOIL60693LAB SERVICES175991
COMPETITIVE EDGE SPORTS MEDICINE
14160 JAMESTOWN RDBREESEIL62230SPORTS MED PHYSICIAN104933
FieldValueIRS element (for citing)
Number Of Contractors GT100 K12NumberOfContractorsGT100K
Related Organizations8900RelatedOrganizations
Government Grants1519646GovernmentGrants
Total Contributions1528546TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE9000994856605548566055
MEDICAL OFFICE RENT FROM AFFILIATE (MG)103896103896
FieldValueIRS element (for citing)
Total Program Service Revenue48669951TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1139183TotalRevenueColumn
Exclusion$1,139,183ExclusionAmount

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)
Real297934Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real783981Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-486047Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-486047TotalRevenueColumn
Exclusion-$486,047ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1994116Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1994116Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1994116TotalRevenueColumn
Exclusion$1,994,116ExclusionAmount

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
Unrelated Business Revenue0UnrelatedBusinessRevenue

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenueRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
REVENUE CAFETERIA7223206929$6,929
EXERCISE PROGRAMS900099106352106352
LIFELINE SUBSCRIBERS9000994498344983

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column316244TotalRevenueColumn
Related Or Exempt Function Income316244RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue474508TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column53320257TotalRevenueColumn
Related Or Exempt Function Income49031178RelatedOrExemptFunctionIncome
Unrelated Business Revenue106352UnrelatedBusinessRevenue
Exclusion$2,654,181ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

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)
Total150050Total
Management And General150050ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16766467Total
Program Services14051041ProgramServices
Management And General2715426ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1586992Total
Program Services1317203ProgramServices
Management And General269789ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3912154Total
Program Services3247088ProgramServices
Management And General665066ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1096531Total
Program Services910121ProgramServices
Management And General186410ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2978169Total
Program Services2471880ProgramServices
Management And General506289ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total19479Total
Program Services16168ProgramServices
Management And General3311ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total14719Total
Program Services12217ProgramServices
Management And General2502ManagementAndGeneral

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)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total277320Total
Program Services230176ProgramServices
Management And General47144ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3976865Total
Program Services3300798ProgramServices
Management And General676067ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total964048Total
Program Services800160ProgramServices
Management And General163888ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total92786Total
Program Services77012ProgramServices
Management And General15774ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total135208Total
Program Services112223ProgramServices
Management And General22985ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total2740632Total
Program Services2274725ProgramServices
Management And General465907ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2871405Total
Program Services2383266ProgramServices
Management And General488139ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total367610Total
Program Services305116ProgramServices
Management And General62494ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES20176591674657343002
MAINTENANCE REPAIRS & SERVICES12378251027395210430
BAD DEBT785039651582133457
PROVIDER TAX686808570051116757

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total647801Total
Program Services526465ProgramServices
Management And General121336ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total43325567Total
Program Services35959344ProgramServices
Management And General7366223ManagementAndGeneral
Fundraising0Fundraising
FieldValueIRS element (for citing)
Info In Schedule O Part XXInfoInScheduleOPartX

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3324475BOY
EOY3545768EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7592234BOY
EOY7763958EOY

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)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY613789BOY
EOY627663EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY207495BOY
EOY241328EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis59193512LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec37111212LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23649968BOY
EOY22082300EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY78531675BOY
EOY89799867EOY

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)
BOY138244BOY
EOY166166EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY114057880BOY
EOY124227050EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6116758BOY
EOY6637726EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY10940000BOY
EOY8704307EOY

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)
BOY11713478BOY
EOY9710342EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY28770236BOY
EOY25052375EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY83739672BOY
EOY97529089EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1547972BOY
EOY1645586EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY85287644BOY
EOY99174675EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY114057880BOY
EOY124227050EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses9994690ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3274319ReconciliationUnrealizedInvest
Reconcilation Other Changes618022ReconcilationOtherChanges
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$17,524OtherActivitiesAmount
Total Lobbying Expenditures IIB17524TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDescription of other lobbying activitiesIdentifier
Return ReferenceSchedule C, Part II-B, Question 1iReturnReference
ExplanationST. JOSEPH'S HOSPITAL IS A MEMBER OF THE CATHOLIC HEALTH 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, with PART OF THESE DUES being ATTRIBUTABLE TO LOBBYING FEES. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.Explanation

Schedule D IRS990ScheduleD

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Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

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Other Cost Or Other Basis1454337OtherCostOrOtherBasis
Book Value1454337BookValue

Buildings Buildings

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Book Value10049415BookValue

Leasehold Improvements LeaseholdImprovements

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Depreciation126815Depreciation
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Depreciation26342508Depreciation
Book Value8510213BookValue

Other Land Buildings OtherLandBuildings

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Book Value2031670BookValue
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Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ACCRUED BENEFIT LIABILITY$4,682,443
RETIREMENT OBLIGATION-ASBESTOS$2,501,695
EST. WORK COMP SELF INS. LIAB.$124,521
RATE SWAP AGREEMENTS$2,401,683
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Total Of Amounts9710342TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

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IdentifierADOPTION OF SUBTOPIC ASC 740-10Identifier
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 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, 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

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Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

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Total Community Benefit Expense698047TotalCommunityBenefitExpense
Net Community Benefit Expense698047NetCommunityBenefitExpense
Percent Of Total Expense0.01640PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

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Direct Offsetting Revenue2751258DirectOffsettingRevenue
Net Community Benefit Expense1988783NetCommunityBenefitExpense
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Total Charity Care TotalCharityCare

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Net Community Benefit Expense2686830NetCommunityBenefitExpense
Percent Of Total Expense0.06320PercentOfTotalExpense

Community Health Services CommunityHealthServices

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Net Community Benefit Expense410880NetCommunityBenefitExpense
Percent Of Total Expense0.00970PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

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Cash And In Kind Contributions CashAndInKindContributions

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Net Community Benefit Expense119693NetCommunityBenefitExpense
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Total Other Benefits TotalOtherBenefits

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Net Community Benefit Expense536919NetCommunityBenefitExpense
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Total Community Benefits TotalCommunityBenefits

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Direct Offsetting Revenue2751258DirectOffsettingRevenue
Net Community Benefit Expense3223749NetCommunityBenefitExpense
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Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$785,039BadDebtExpenseAmount
Amount Attributable To78504AmountAttributableTo
Amount Reimbursed By Medicare12361047AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11896788CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall464259MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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Cost To Charge RatioXCostToChargeRatio
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Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
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Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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ZIP Code622300099ZIPCode
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Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

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FPG Free Percent200.FPGFreePercent
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FPG Discount Percent300.FPGDiscountPercent
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Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I - LINE 3CNot applicable as the organization does follow FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals.
PART I - LINE 6ASt. Josephs Hospitals Community Benefit Report can be accessed by contacting Barb Strieker at 9515 Holy Cross Lane, Breese, IL 62230 or by phone: (618) 526-5302. The Community Benefit Report is also available on the hospitals website: http://www.stjoebreese.com/2013annualreport/FLASH/index.html PART I, LINE 7, COLUMN (F) THE PERCENTAGE OF CHARITY CARE AND CERTAIN OTHER BENEFITS AT COST AS A PERCENT OF TOTAL EXPENSES LESS BAD DEBT IS 7.58%. THE AMOUNT OF BAD DEBT REMOVED WHEN CALCULLATING PART I, LINE 7, COLUMN (F) WAS $785,039.
PART I - LINE 7Our calculation of cost is based on the charges for these services times the overall cost-to-charge ratio based on our financial statements to determine the actual cost of these services.CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS
Part IIPrimary care physicians are the foundation for the health care system as they are the patients first point of access to manage their ongoing care. Access to primary care physicians is a concern for many residents in Clinton County, a Health Professional Shortage Area (HPSA), so physician recruitment is a high priority. Three of the nine active primary care physicians in Clinton County are over the age of 65. Due to St. Josephs Hospitals successful recruitment efforts during the year, two primary care physicians and a general surgeon have replaced providers leaving the area. Additional physicians are still needed to improve access to care.
PART III, Line 4THE HOSPITAL STRONGLY BELIEVES THAT ITS CHARITY CARE, AND THE RELATED COMMUNITY BENEFIT OBTAINED FROM SUCH CARE, IS UNDERSTATED BECAUSE OF THOSE PATIENTS THAT POTENTIALLY QUALIFY FOR CHARITY CARE BUT DO NOT WISH TO APPLY FOR IT. IN ADDITION, SOME CARE IS NOT CLASSIFIED AS CHARITY DUE TO MISSING DOCUMENTATION ON PATIENT RESOURCES. THUS, THE HOSPITAL'S BAD DEBT MAY INCLUDE A PORTION THAT COULD BE CLASSIFIED AS CHARITY CARE IF APPLICATION FOR SUCH CARE WAS SOUGHT AND/OR COMPLETED. DURING THE YEAR, THE HOSPITAL IMPLEMENTED PROCESSES TO MORE EFFECTIVELY DETERMINE CHARITY CARE THAT WILL REDUCE A PATIENT'S DOCUMENTATION REQUIREMENTS AND EASE THE PATIENT'S EMOTIONAL BURDEN IN APPLYING. AT TIME OF REGISTRATION, SELF-PAY PATIENTS ARE COMPLETING A DOCUMENTATION FORM THAT IS ASSISTING IN THE DETERMINATION OF WHICH PATIENTS MAY QUALIFY FOR ASSISTANCE. SEARCH AMERICA WAS ALSO IMPLEMENTED, WHICH ACCESSES CREDIT INFORMATION THAT IS USED TO DETERMINE THE PROBABILITY OF A PATIENT BEING ABLE TO PAY FOR HOSPITAL SERVICES. THIS IS IMPROVING ABILITIES TO PROVIDE A MORE ACCURATE REPORTING OF CHARITY CARE SERVICES PROVIDED BY THE HOSPITAL. THE HOSPITAL COMPUTES THE COST OF BAD DEBT BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE TOTAL CHARGES WRITTEN OFF AS BAD DEBT EXPENSE. THE PATIENT CARE COST IS DETERMINED BY ADJUSTING THE TOTAL ANNUAL OPERATING EXPENSE BY THE COST OF NONPATIENT-CARE ACTIVITIES, BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES, AND COMMUNITY BENEFIT EXPENSE. THE ADJUSTED OPERATING COST IS THEN DIVIDED BY THE TOTAL GROSS PATIENT CHARGES TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES.
PART III, Line 8THE COST REPORT USES THE SAME METHODOLOGY OF COST-TO-CHARGE RATIO. HOWEVER, THE SYSTEM USED (COMPUMAX 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 9BSPECIFIC POLICIES ARE WRITTEN FOR UNINSURED PATIENT'S DISCOUNTS AND CHARITY/CHRISTIAN CARE. THE POLICIES OUTLINE ELIGIBILITY CRITERIA AND PROCESSES TO FOLLOW FOR MAKING ADJUSTMENTS TO PATIENT BILLS. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO SCHEDULE H, PART VI, QUESTION 3.
PART V, SECTION B LINE 3DURING THE HEALTH NEEDS ASSESSMENT PROCESS, THERE WERE SEVERAL METHODS THE HOSPITAL UTILIZED TO GAIN INPUT FROM THE COMMUNITY. THE CHIEF NURSING OFFICER IS A MEMBER OF THE CLINTON COUNTY HEALTH ADVISORY COMMITTEE, WHICH COMPLETED A SIGNIFICANT PART OF THE ASSESSMENT THROUGH THEIR IPLAN (A STANDARDIZED PROCESS FOR ILLINOIS PUBLIC HEALTH DEPARTMENTS). OTHER MEMBERS OF THAT COMMITTEE INCLUDE REPRESENTATIVES FROM HEALTH CARE AND SENIOR SERVICES, AS WELL AS LOCAL BUSINESSES AND COMMUNITY MEMBERS. AN OUTSIDE COMPANY, LEEDE RESEARCH, WAS ENGAGED TO COMPLETE TELEPHONE INTERVIEWS WITH RESIDENTS THROUGHOUT THE SERVICE AREA. APPROXIMATELY 300 HOUSEHOLDS WERE CONTACTED IN THE SURVEY WHICH WAS TARGETED TO THE BROAD COMMUNITY AND ALSO INCLUDED RESIDENTS WHO ARE UNINSURED, LOW-INCOME, AND THOSE WITH CHRONIC DISEASE. TO GAIN DEEPER INSIGHT, THREE FOCUS GROUPS WERE ALSO CONDUCTED. PRINCIPALS FROM AREA SCHOOLS, MEMBERS OF THE LOCAL CLERGY, AND REPRESENTATIVES OF THE MINORITY HISPANIC POPULATION WERE INVITED TO PARTICIPATE. THROUGH THESE DISCUSSIONS, MORE DETAILED INFORMATION WAS OBTAINED ON THE NEEDS OF YOUTH, SENIORS, AND SOME OF THE MOST VULNERABLE IN THE HISPANIC COMMUNITY.
Part V, Section B Line 4St. Joseph's Hospital is the sole hospital in the Clinton County area. There were no other hospital facilities included.
Part V, Section B, Line 7The most recent Community Health Needs Assessment was completed in the spring of fiscal year 2012. Priorities identified - diabetes, cancer, and womens health - were considered during the hospitals strategic planning and budgeting process and an Implementation Strategy was developed. In May 2012, the Board of Directors approved the Implementation Strategy, which was initiated during the reporting year. Alcohol abuse and underage drinking were also identified as issues through various sources. However, the hospital did not take the lead on this issue, as education programs are available in the schools and through initiatives sponsored by Drug Abuse Resistance Education (DARE). Local chapters of Alcoholics Anonymous are also available. St. Joseph's Hospital did continue to support "after-prom" events.Further ability to impact the issue and community readiness were rated as low through the prioritization process. With the initiatives of other organizations and the hospital concentrating efforts in areas where it has capabilities, this need was not included in fiscal year 2013 implementation plans. Part V, Section B, Line 20D The hospital determines the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care by using a sliding scale based on federal poverty levels.
Needs AssessmentAs indicated in Part V, Section B, St. Josephs Hospital conducted a Community Health Needs Assessment in FY2012. In previous years, community need was assessed by working with the Clinton County Health Boards Advisory Committee through their development of the IPLAN. Internal statistical data was also utilized including top DRG and primary diagnosis of inpatients.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:As part of the Mission of St. Joseph's Hospital, "to reveal and embody Christ's healing love for all people," the hospital has established several financial assistance programs to help patients and families who are unable to pay for the services they have received from the hospital, including: A. Uninsured Christian Care is for those uninsured individuals whose family income falls below 600% of the Federal Poverty Guidelines (FPG); assistance available on a sliding scale basis. B. Uninsured Discount Program is for those uninsured individuals whose family income is in excess of 600% of the Federal Poverty Guidelines (FPG). C. Traditional Christian Care is for those individuals whose gross income falls below 250% of the Federal Poverty Guidelines (FPG). In mid-June of the reporting period this amount was increased to 300% below FPG. To determine a persons eligibility in a hospital sponsored Financial Assistance Program, the hospital has established a financial eligibility scale. Eligibility requirements are based upon Federal Poverty Guidelines (FPG) published by the Federal Government according to the applicant's family size and family income. In the absence of supporting documentation to verify family size and income level, presumptive eligibility processes have been put in place in order to provide financial assistance to a larger population. St. Josephs Hospital informs patients about financial assistance programs in various ways. Patients who are self-pay receive a Christian Care packet at the time of registration, which explains St. Josephs Christian Care Financial Assistance Program and how to apply. The information is written in English and Spanish for the areas Latino population. Signage is located at each registration desk which directs patients to the Business Office. In the event of a language barrier, an interpreter is provided to assist patients with completing the application. Packets about the Christian Care Financial Assistance Program are also available with registration in St. Josephs Hospital Emergency Room and St. Josephs Priority Care. Inpatients are provided information about the availability of financial assistance by the Social Services Department. Information about financial assistance is also available on the facilitys website.
Community InformationClinton County includes nine small communities ranging in population from 1,000 to 7,500 and rural areas. Based on the U.S. Census Bureaus 2010 information, the population of the entire county has grown by 6.3% over the past 10 years. The median age is 39 years of age with 14.5% of the population over the age of 65 compared to 12.5% over the age of 65 in the state of Illinois. Cultural diversity is increasing with growth seen in the Hispanic population. According to the Bureaus 2010 information, 20% of residents in the community work in the health care and social assistance sector and 17% retail. This is followed by 11% in construction and 10% manufacturing. Several grain and livestock farm operations are also located throughout the rural areas of the county. Current unemployment rate is 6.9%. Median household income has risen to $55,278, which is near the median household income for Illinois of $55,735. Persons living below the poverty level are 7.8% of the population, an increase of 1.4% since the last 2000 census. According to the June 2012 Metropolitan Chicago Healthcare Council, 12.2% of Clinton County residents are uninsured.
Promotion of Community HealthSt. Josephs 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. Josephs Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 110 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 hospitals purpose and tradition, it is organized to promote the health of Clinton County and surrounding areas. The hospital is governed by a Board of Directors, the majority of whom reside in the organizations primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Josephs Hospital is responding to community need. During FY2012, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. In addition, St. Josephs Hospital receives community support and guidance through the Advisory Board and Friends of St. Josephs. Both Boards meet quarterly and provide feedback from the community on additional services or improvements needed. St. Josephs Hospital is blessed with a strong volunteer program. Volunteers are active in many hospital departments on a daily basis and donate many more hours throughout the year to hospital-sponsored community programs. Also consistent with its exempt purpose, St. Josephs Hospital 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. St. Josephs Priority Care office is located in Carlyle, a community approximately 10 miles east of Breese. The walk-in clinic is open 7 a.m. to 7 p.m. each day including weekends, and on holidays, the facility is open 8 a.m. to 5 p.m. During the hours the clinic is open, a physician is available to treat patients. St. Josephs Hospital also maintains medical offices in the outlying communities of Carlyle, Germantown, Trenton, and Greenville, which are utilized by primary care providers. Research was completed this fiscal year on ways to increase access to care in the southwest corner of the county. New Baden, a community located in this area and the second largest town in Clinton County, was identified as having a high need for additional access to medical care. Location of a priority care office in the community will be pursued in the next fiscal year. As a not-for-profit hospital, St. Josephs 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. During the fiscal year, funds were used for the construction of permanent medical building in Carlyle. The majority of the building houses the priority care services, which includes medical imaging services. In addition, residents can obtain outpatient lab services and physical therapy at the location. A primary care physician practice occupies the remaining area of the building. St. Josephs Hospital 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. Most recently, an upgrade was completed with MEDITECH, the facilitys patient electronic health record system. Significant resources are devoted to improve access for patients who cannot afford care, along with other community benefits. In fiscal year 2013, St. Josephs provided over $3 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. Josephs provided $3.2 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance. St. Josephs Hospital provides a range of community benefits that flow from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Josephs Hospital, and they often relieve a burden that would otherwise be carried by government. Several of these programs and activities are designed to respond to our FY2012 Community Health Needs Assessment, which surfaced the following priority needs for attention from the hospital in collaboration with other community organizations: Diabetes In Clinton County, the prevalence of diabetes is higher than state and national numbers. Twelve percent of Clinton County residents report receiving a diagnosis of diabetes. This is almost 50% higher when compared to the most recent numbers available 8.7% in the state of Illinois and 8.3% nationally. Studies have also shown the Hispanic population has a higher risk of developing the disease than some other races. Residents of Hispanic origin are the fastest growing minority in Clinton County increasing from 1.6% to 2.8% between the 2000 and 2010 census. Low Cost/No Cost Screenings: Community residents have an opportunity to obtain a free finger stick measuring blood sugar levels at any of the 10 health fairs offered in Breese or the surrounding communities. A comprehensive blood screening and A1C test are also available at a reduced cost. In addition to the spring and fall Health Fairs, St. Josephs Hospital added an additional opportunity for diabetics to obtain an A1C screening. The screening was held on a Sunday in Damiansville, a community where a significant number of the minority Hispanic population resides. In addition to the A1C screening, free foot screenings were also available. Partnering with the National Kidney Foundation, the KidneyMobile was hosted two times during the fiscal year. Over 200 individuals visited the KidneyMobile and received free testing offered. Participants received a blood draw to check for creatinine and kidney function, blood pressure check, finger stick to measure blood glucose levels, Body Mass Index, waist circumference, and urinalysis. Over 90% of the participants tested abnormal in one or more of the screenings with the high blood pressure being the most prevalent. Follow-up included referral to primary physicians, and for those participants without a primary health care provider, referrals are made to the Southern Illinois Healthcare Foundation. Community Education: Recognizing the need to improve the communitys and individuals knowledge about diabetes, health education was also provided. St. Josephs Hospitals certified diabetes educators partnered with the local school system to offer the American Diabetes Associations Safe at School program. Teachers and staff from area schools were invited to the program which covered diabetes basics, hypoglycemia/hyperglycemia, blood glucose monitoring and insulin. The national Safe at School campaign was implemented to ensure all children with diabetes are medically safe at school and have the same educational opportunities as their classmates. Support groups are also held. In addition to providing those attending an opportunity to ask questions and learn from each other, an educational topic was also covered. Cancer Cancer is the second leading cause of mortality in Clinton County. A goal of the Clinton County Health Departments Health Advisory Board is to increase the number of residents over 50 receiving a colorectal screening by 20%; women over 40 receiving mammograms by 10%; and men over 50 receiving a prostate screening by 20%. St. Josephs Hospital partnered with the Health Department to increase awareness of prevention and screening opportunities. Each week a Health & Wellness column was published in local newspapers. St. Josephs Hospital also offered at-home colorectal screening kits at all ten health fairs. These were available at a cost of $5. Also at the health fairs, information on the effects of smoking and available smoking cessation classes was distributed. American Cancer Societys Look Good, Feel Better program continues to be offered several times during the year in Breese. This is a support program for cancer patients to help them to cope with appearance related side eff
Affiliated Health Care SystemSt. Josephs Hospital in Breese, 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 do, 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. 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 (SCDH) 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 SCDH. 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, losing a total of 2,491 pounds. The Decatur Health Coalition unites St. Marys Hospital in Decatur, Illinois, the American Lung Association, Community Health Improvement Center, Decatur Memorial Hospital, Decatur Community Partnership, Heritage Behavioral Health and Macon County Health Department as p
STATE FILING OF COMMUNITY BENEFIT REPORTIL,990 SCHEDULE H, PART VI

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Jonathan Osborn MD
Secretary028189800081700031056031377100
Mark Klosterman
President0208765042832029210038351023060034221800
Johnny Watkins
Division CFO02422370317020390036688010141032115800
Ann M Carr
Treasurer019345402944004925201211700176860411002018215
Mark Reifsteck
Division CEO0397173066854031694074658030647060102600
James Burke
Division VP of Legal Services0215078000780012171027484025551300
John Jeffries
CFO15306418339005395176798
Paulette Evans
CNO139527105230011091511590

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ANN M. CARRSCHEDULE J, PART I, LINE 4BANN CARR PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $42,817.
MARK KLOSTERMANSCHEDULE J, PART I, LINE 4BMARK KLOSTERMAN PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $27,266.
MARK REIFSTICKSCHEDULE J, PART I, LINE 4BMARK REIFSTICK PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $48,937.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
STATEMENT OF PROGRAM SERVICE ACOMPLISHMENTSFORM 990, PAGE 2, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSST. JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDES QUALITY HEALTHCARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, RELIGION, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS ESSENTIAL TO THE CONTINUED OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS ARE ABLE TO AFFORD REQUIRED MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH THE BEST QUALITY HEALTHCARE SERVICES AND HEALTHCARE EDUCATION. INHERENT IN OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. IN OUR TAX YEAR BEGINNING JULY 1, 2012 AND ENDING JUNE 30, 2013, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 1,433 INPATIENTS UTILIZING 3,483 DAYS OF CARE. IN ADDITION, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 94,486 OUTPATIENTS. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO THE POOR AT NO COST THROUGH OUR CHRISTIAN CARE PROGRAM. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE ILLINOIS MEDICAID PROGRAM, WHICH REIMBURSES THE HOSPITAL AT RATES SUBSTANTIALLY BELOW THE COST OF PROVIDING THE SERVICES. FULFILLING OUR MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO 221 MEDICAID INPATIENTS UTILIZING 451 DAYS OF CARE. THE COST OF PROVIDING SERVICES TO MEDICAID PATIENTS EXCEEDED REIMBURSEMENT UNDER THE STATE OF ILLINOIS MEDICAID PROGRAM BY $1,988,783. THE TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THE POOR IS $2,686,830. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO MEMBERS OF THE BROADER COMMUNITY THROUGH PARTICIPATION IN THE MEDICARE PROGRAM AND THROUGH EDUCATIONAL PROGRAMS AND ACTIVITIES AT A REDUCED PRICE, OR AT NO COST. ST. JOSEPH'S HOSPITAL, BREESE PROVIDED MEDICAL SERVICES TO 599 MEDICARE INPATIENTS UTILIZING 1,616 DAYS OF CARE.
TAX EXEMPT BONDSFORM 990, PART IV, LINE 24ST JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS 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.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODYFORM 990, PART VI, LINE 6 & 7ATHE SENIOR GOVERNING BODY OF ST. JOSEPH'S HOSPITAL BREESE (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. JOSEPH'S HOSPITAL BREESE (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 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 SYSTEM 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 used SINCE JANUARY, 2010 TO establish the practice of managing 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, 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.
POLICIES COMPENSTION 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.
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, PAGE 11, PART X, LINE 11ST. JOSEPH'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 HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, 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 9Change in Pension Fund Status (1,086,165) Transfer from Affiliates 3,000,618 Loss on Early Extinguishment of Debt (100,987) Change in Fair Value of Interest Rate Swaps (1,067,560) Swap Payments (122,248) Decrease in Temp Restricted Net Assets (5,636) ========== TOTAL 618,022

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Springfield Health Partners LLC
4936 Laverna RoadSpringfieldIL62707371365519HealthcareILHSHS MG
Kiara Clinical Integration Network
4936 Laverna RoadSpringfieldIL62707261417684HealthcareILHSSI
Physician Clinical Integration Network
4936 Laverna RoadSpringfieldIL62707371668647HealthcareILKCIN

Form990 Schedule R Part II Form990ScheduleRPartII (24 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
HSHS Self Insurance Trust Fund
4936 LAVERNA ROADSPRINGFIELDIL62707371120626INSURANCEIL501(c)(3)11AHSHSfalse
Hospital Sisters of St Francis FDTN
4936 LAVERNA ROADSPRINGFIELDIL62707371186514HEALTHCAREIL501(c)(3)11AHSHSfalse
HSHS Health Care Trust Fund
4936 LAVERNA ROADSPRINGFIELDIL62707371137724HEALTHCAREIL501(c)(9)N/AHSHSfalse
Hospital Sisters Healthcare West Inc
2661 COUNTY HIGHWAY ICHIPPEWA FALLSWI54729510157933HEALTHCAREIL501(c)(3)11AHSSIfalse
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROADSPRINGFIELDIL62707371163402HEALTHCAREIL501(c)(3)11AHSSIfalse
SACRED HEART HOSPITAL
900 WEST CLAIREMONT AVENUEEAU CLAIREWI54701390807060HEALTHCAREWI501(c)(3)3HSSIfalse
St Anthony's Hospital
503 N MAPLE STREETEFFINGHAMIL62401370661233HEALTHCAREIL501(c)(3)3HSSIfalse
St Elizabeth's Hospital
211 SOUTH THIRD STREETBELLEVILLEIL62220370663567HEALTHCAREIL501(c)(3)3HSSIfalse
St Francis Hospital
1215 FRANCISCAN DRIVELITCHFIELDIL62056370661236HEALTHCAREIL501(c)(3)3HSSIfalse
St John's Hospital
800 EAST CARPENTER STREETSPRINGFIELDIL62769370661238HEALTHCAREIL501(c)(3)3HSSIfalse
St Joseph's Hospital
2661 COUNTY HIGHWAY 1CHIPPEWA FALLSWI54729390810545HEALTHCAREWI501(c)(3)3HSSIfalse
St Joseph's Hospital
1515 MAIN STREETHIGHLANDIL62249370663568HEALTHCAREIL501(c)(3)3HSSIfalse
St Mary's Hospital
1800 E LAKE SHORE DRIVEDECATURIL62521370661244HEALTHCAREIL501(c)(3)3HSSIfalse
St Mary's Hospital
111 SPRING STREETSTREATORIL61364362169181HEALTHCAREIL501(c)(3)3HSSIfalse
St Mary's HOSPITAL Medical Center
1726 SHAWANO AVENUEGREEN BAYWI54303390818682HEALTHCAREWI501(c)(3)3HSSIfalse
St Nicholas Hospital
3100 SUPERIOR AVENUESHEBOYGANWI53081390808480HEALTHCAREWI501(c)(3)3HSSIfalse
St Vincent Hospital
835 S VAN BURENGREEN BAYWI54301390817529HEALTHCAREWI501(c)(3)3HSSIfalse
HSHS MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703263956318HEALTHCAREIL501(c)(3)11aHSSIfalse
HSHS WISCONSIN MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVESPRINGFIELDIL62703264515959HEALTHCAREWI501(c)(3)11AHSSIfalse
Orange Cross Ambulance Inc
919 Ashland AveSheboyganWI53081391860942HealthcareWI501(c)(3)9St Nicholasfalse
Wisconsin Upper Pen Onc Mngmt Services
835 S Van BurenGreen BayWI54301391677100HealthcareWI501(c)(3)3St Vincentfalse
Unity Limited Partnership
2366 Oak Ridge CircleDe PereWI54115391750729HealthcareWI501(c)(3)9HSSIfalse
Kiara Clinical Integration Network
4936 Laverna RoadSPRINGFIELDIL62707HEALTH CAREIL501(c)(3)NONEHSSIfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartner
Memorial and St Elizabeth's Healthcare
4000 North Illinois StreetSwanseaIL62226371312961HealthCareILSt Elizabeth'sRELATEDfalse$0false
Prairie Heart Institute - Carbondale
800 East Carpenter StreetSpringfieldIL62769371321197HealthCareILSt John'sRELATEDfalse$0false
Northeast Wisconsin Radiation Therapy Se
1821 S Webster Avenue STE 300Green BayWI543079047263749065HealthCareWIHSSIRELATEDfalse$0false
Pain Center of Wisconsin
4131 W Loomis Road STE 300GreenfieldWI53221263155343HealthCareWISt VincentRELATEDfalse$0false
Surgery Center of Sheboygan LLC
3141 Saemann AveSheboyganWI53081260822209HealthCareWISt NicholasRELATEDfalse$0false
Prevea Ventures LLC
2710 EXECUTIVE DRGreen BayWI54304203775127HealthCareWIHSSIRELATEDfalse$0false
Carpenter Street Hotel LLC
525 North Sixth StreetspringfieldIL62702364128127hotelILlasante incRELATEDfalse$0false
Springfield Urgent Care Real Estate LLC
PO Box 19456springfieldIL627949456030413258rent. real esILlasante incRELATEDfalse$0false

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrgLegal Domicile Foreign CountryLegalDomicileForeignCountryShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
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 CORPtrueCJ
OJV Inc
4936 Laverna RdSpringfieldIL62707460873384HealthcareILLasanteC Corpfalse00
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
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 OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierTRANSACTIONS WITH RELATED ENTITIESIdentifier
Return ReferenceFORM 990, SCHEDULE R, PART V, LINE 2ReturnReference
ExplanationTHE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.Explanation