2014-05-13T15:51:54-05:00 2013-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2012-07-01 371208459 ST JOSEPH'S HOSPITAL - HOSPITAL SISTERS - THIRD ORDER OF ST FRANCIS % JOHN JEFFRIES STJO 6185264511 9515 HOLY CROSS LANE PO BOX 99 Suite BREESE IL 622300099 John Jeffries 6185264511 2014-05-13 true 6142492300 2012 2015-11-30 17:44:51Z MARK KLOSTERMAN 9515 HOLY CROSS LANE BREESE IL 622300099 54104238 false 0928 X www.stjoebreese.com X 1987 IL OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO MINISTER TO THOSE IN NEED AS EXEMPLIFIED BY THE GOSPEL OF CHRIST. 11 9 420 521 106352 -26817 82828 1528546 49961505 48669951 4096112 3133299 90912 -11539 54231357 53320257 0 0 0 0 22198546 23512194 0 0 0 22512303 19813373 44710849 43325567 9520508 9994690 114057880 124227050 28770236 25052375 85287644 99174675 X OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO MINISTER TO THOSE IN NEED AS EXEMPLIFIED BY THE GOSPEL OF CHRIST. false false 35959344 49031178 SEE SCHEDULE O - PROGRAM SERVICE ACCOMPLISHMENTS 35959344 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 false false false false false true true false false false true 62 0 true 420 true true true false false false false false false false false false X 11 9 false false false false true true true true true false false true true true true true true true true false X JOHN JEFFRIES 6185265312 9515 HOLY CROSS LANE BREESE IL 622300099 Jonathan Osborn MD 1.0 39.0 X X 0 282715 30153 Mark Klosterman 40.0 0.0 X X 0 280807 60518 Carson Hempen 1.0 0.0 X 0 0 0 Elaine Behrmann 1.0 0.0 X 0 0 0 Erin Gagen MD 1.0 0.0 X 0 0 0 Janice Wiegmann PhD 1.0 0.0 X 0 0 0 Paul Strieker 1.0 0.0 X X 0 0 0 John Hudspeth 1.0 0.0 X X 0 0 0 Sr Marybeth Culnan OSF 1.0 59.0 X 0 0 0 George Kruse 1.0 0.0 X 0 0 0 Sr Kenneth Wildt OSF 1.0 0.0 X 0 0 0 Johnny Watkins 8.4 51.6 X 0 274329 45867 Ann M Carr 0.25 59.75 X 0 272146 138031 Mark Reifsteck 8.4 51.6 X 0 495721 98441 James Burke 8.4 51.6 X 0 215858 38693 John Jeffries 40.0 0.0 X 171403 5395 William Deters 40.0 0.0 X 106034 0 5502 Paulette Evans 40.0 0.0 X 150050 1109 Jene Bieri 40.0 0.0 X 111298 0 0 Jan Robert 40.0 0.0 X 104145 0 6138 642930 1821576 429847 10 false true false MIDWEST EMERGENCY DEPT SERV 320 EAST HIGHWAY 50 OFALLON IL 62269 ER COVERAGE 2063810 CLINTON COUNTY ANESTHESIOLOGY 1320 PINEWOOD BREESE IL 62230 ANESTHESIA PHYSICIAN 958684 PREMIERCARE INC 13810 CHAMPION FOREST DR HOUSTON TX 77069 CONSULTING SERVICES 184325 QUEST DIAGNOSTICS 12436 COLLECTIONS CENTER CHICAGO IL 60693 LAB SERVICES 175991 COMPETITIVE EDGE SPORTS MEDICINE 14160 JAMESTOWN RD BREESE IL 62230 SPORTS MED PHYSICIAN 104933 12 8900 1519646 1528546 NET PATIENT SERVICE REVENUE 900099 48566055 48566055 MEDICAL OFFICE RENT FROM AFFILIATE (MG) 103896 103896 48669951 1139183 1139183 0 0 297934 783981 -486047 0 -486047 -486047 1994116 1994116 1994116 1994116 0 0 0 0 REVENUE CAFETERIA 722320 6929 6929 EXERCISE PROGRAMS 900099 106352 106352 LIFELINE SUBSCRIBERS 900099 44983 44983 316244 316244 474508 53320257 49031178 106352 2654181 0 0 0 0 150050 150050 0 16766467 14051041 2715426 1586992 1317203 269789 3912154 3247088 665066 1096531 910121 186410 2978169 2471880 506289 19479 16168 3311 14719 12217 2502 0 0 0 0 277320 230176 47144 3976865 3300798 676067 0 0 964048 800160 163888 0 0 92786 77012 15774 135208 112223 22985 2740632 2274725 465907 2871405 2383266 488139 367610 305116 62494 PURCHASED SERVICES 2017659 1674657 343002 MAINTENANCE REPAIRS & SERVICES 1237825 1027395 210430 BAD DEBT 785039 651582 133457 PROVIDER TAX 686808 570051 116757 647801 526465 121336 43325567 35959344 7366223 0 X 3324475 3545768 0 0 0 0 7592234 7763958 0 0 0 0 0 0 613789 627663 207495 241328 59193512 37111212 23649968 22082300 78531675 89799867 0 0 0 0 0 0 138244 166166 114057880 124227050 6116758 6637726 0 0 0 0 10940000 8704307 0 0 0 0 0 0 0 0 11713478 9710342 28770236 25052375 X 83739672 97529089 1547972 1645586 0 0 85287644 99174675 114057880 124227050 X 9994690 3274319 618022 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 17524 17524 false false Description of other lobbying activities Schedule C, Part II-B, Question 1i ST. 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. 1454337 1454337 18233552 8184137 10049415 163480 126815 36665 34852721 26342508 8510213 4489422 2457752 2031670 22082300 0 ACCRUED BENEFIT LIABILITY 4682443 RETIREMENT OBLIGATION-ASBESTOS 2501695 EST. WORK COMP SELF INS. LIAB. 124521 RATE SWAP AGREEMENTS 2401683 9710342 X ADOPTION OF SUBTOPIC ASC 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, 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. true true true X true X true true false true true 698047 698047 0.01640 4470041 2751258 1988783 0.04680 5168088 2751258 2686830 0.06320 410880 410880 0.00970 6346 6346 0.00010 119693 119693 0.00280 536919 536919 0.01260 5705007 2751258 3223749 0.07580 true 785039 78504 12361047 11896788 464259 X true true 1 1 St Joseph's Hospital

9515 Holy Cross Lane Breese IL 622300099

X X X ST JOSEPH'S HOSPITAL 1 true X X X X X X X X X 12 true false true X X X X X X X X X false false true true 200. true 300. true X X X X X true true X X X X X true false true X false false PART I - LINE 3C Not 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 6A St. 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 7 CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS Our 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. Part II Primary 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 4 THE 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 8 THE 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 9B SPECIFIC 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 3 DURING 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 4 St. Joseph's Hospital is the sole hospital in the Clinton County area. There were no other hospital facilities included. Part V, Section B, Line 7 The 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 Assessment As 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 Information Clinton 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 Health St. 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 System St. 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 REPORT 990 SCHEDULE H, PART VI IL, X X X X X X false true false false false false false false false Jonathan Osborn MD 0 281898 0 0 0 817 0 0 0 31056 0 313771 0 0 Mark Klosterman 0 208765 0 42832 0 29210 0 38351 0 23060 0 342218 0 0 Johnny Watkins 0 242237 0 31702 0 390 0 36688 0 10141 0 321158 0 0 Ann M Carr 0 193454 0 29440 0 49252 0 121170 0 17686 0 411002 0 18215 Mark Reifsteck 0 397173 0 66854 0 31694 0 74658 0 30647 0 601026 0 0 James Burke 0 215078 0 0 0 780 0 12171 0 27484 0 255513 0 0 John Jeffries 153064 18339 0 0 5395 176798 Paulette Evans 139527 10523 0 0 1109 151159 0 ANN M. CARR SCHEDULE J, PART I, LINE 4B ANN CARR PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $42,817. MARK KLOSTERMAN SCHEDULE J, PART I, LINE 4B MARK KLOSTERMAN PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $27,266. MARK REIFSTICK SCHEDULE J, PART I, LINE 4B MARK REIFSTICK PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $48,937. STATEMENT OF PROGRAM SERVICE ACOMPLISHMENTS FORM 990, PAGE 2, PART III, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ST. 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 BONDS FORM 990, PART IV, LINE 24 ST 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 BODY FORM 990, PART VI, LINE 6 & 7A THE 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 POWERS FORM 990, PART VI, LINE 7B RESPONSIBILITY 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 PROCESS FORM 990, PART VI, LINE 11B THE 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 POLICY FORM 990, PART VI, LINE 12C THE 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 POLICY FORM 990, PART VI, LINE 13 PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. POLICIES COMPENSTION 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. 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, PAGE 11, PART X, LINE 11 ST. 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 Assets Form 990, Part XI, Line 9 Change 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 Springfield Health Partners LLC 4936 Laverna Road Springfield IL 62707 371365519 Healthcare IL HSHS MG Kiara Clinical Integration Network 4936 Laverna Road Springfield IL 62707 261417684 Healthcare IL HSSI Physician Clinical Integration Network 4936 Laverna Road Springfield IL 62707 371668647 Healthcare IL KCIN Hospital Sisters Health System 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) 11A NA false HSHS Self Insurance Trust Fund 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(c)(3) 11A HSHS false Hospital Sisters of St Francis FDTN 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 11A HSHS false HSHS Health Care 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 I CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE IL 501(c)(3) 11A HSSI false HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 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 Francis Hospital 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 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 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 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 St Mary's Hospital 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 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 HOSPITAL Medical Center 1726 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 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 Vincent Hospital 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 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 Pen Onc Mngmt Services 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 Kiara Clinical Integration Network 4936 Laverna Road SPRINGFIELD IL 62707 HEALTH CARE IL 501(c)(3) NONE HSSI false Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea IL 62226 371312961 HealthCare IL St Elizabeth's RELATED false 0 false Prairie Heart Institute - Carbondale 800 East Carpenter Street Springfield IL 62769 371321197 HealthCare IL St John's RELATED false 0 false Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay WI 543079047 263749065 HealthCare WI HSSI RELATED false 0 false Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield WI 53221 263155343 HealthCare WI St Vincent RELATED false 0 false Surgery Center of Sheboygan LLC 3141 Saemann Ave Sheboygan WI 53081 260822209 HealthCare WI St Nicholas RELATED false 0 false Prevea Ventures LLC 2710 EXECUTIVE DR Green Bay WI 54304 203775127 HealthCare WI HSSI RELATED false 0 false Carpenter Street Hotel LLC 525 North Sixth Street springfield IL 62702 364128127 hotel IL lasante inc RELATED false 0 false Springfield Urgent Care Real Estate LLC PO Box 19456 springfield IL 627949456 030413258 rent. real es IL lasante inc RELATED false 0 false Kiara Inc 4936 Laverna Rd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp false LaSante Wisconsin Inc 4936 Laverna Rd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp false LaSante Inc 4936 Laverna Rd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp false Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp false Prevea Health Services 2710 EXECUTIVE DR Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp false Prevea Clinic Inc 2710 EXECUTIVE DR Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp false Prevea Health Network 2710 EXECUTIVE DR Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp false RENAISSANCE QUALITY INSURANCE 980669953 INSURANCE CJ HSSI C CORP true OJV Inc 4936 Laverna Rd Springfield IL 62707 460873384 Healthcare IL Lasante C Corp 0 0 false true false false false false false false false false false false false false false true false false false false TRANSACTIONS WITH RELATED ENTITIES FORM 990, SCHEDULE R, PART V, LINE 2 THE TRANSACTIONS REPORTED IN QUESTION 1 ARE BETWEEN RELATED 501(C)(3) PUBLIC CHARITIES AND ARE NOT REPORTED IN THIS SECTION.