ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD (EIN 39-0808480)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-14
IRS object ID: 201331349349305088
Schema version: 2011v1.5
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-14T15:11:16-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KPMG LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	191 West Nationwide Blvd Ste 500	AddressLine1
City	Columbus	City
State	OH	State
ZIP Code	432152568	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	390808480	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	St Nicholas Hospital of the Hospital	BusinessNameLine1
Business Name Line2	Sisters of the Third Order of St Francis	BusinessNameLine2

Field	Value	IRS element (for citing)
In Care Of Name	% GREG SIMIA	InCareOfName
Name Control	STNI	NameControl
Phone	9204598300	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	3100 Superior Avenue	AddressLine1
City	Sheboygan	City
State	WI	State
ZIP Code	530811948	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Andrew Bagnall	Name
Title	President and CEO	Title
Date Signed	2013-05-08	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	6142492300	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Andrew J Bagnall	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	3100 Superior Avenue	AddressLine1
City	Sheboygan	City
State	WI	State
ZIP Code	530811948	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	65412358	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	www.stnicholashospital.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1890	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	TO CARRY FORWARD THE HEALING MINISTRY OF THE HOSPITAL SISTERS OF ST. FRANCIS AS PART OF THE HEALTH MINISTRY OF THE ROMAN CATHOLIC CHURCH.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	552	TotalNbrEmployees
Total Nbr Volunteers	145	TotalNbrVolunteers
Total Gross UBI	129179	TotalGrossUBI
Net Unrelated Business Txbl Income	-48573	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	195887	ContributionsGrantsPriorYear
Contributions Grants Current Year	321523	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	65663911	ProgramServiceRevenuePriorYear
Program Service Revenue CY	60601783	ProgramServiceRevenueCY
Investment Income Prior Year	2611371	InvestmentIncomePriorYear
Investment Income Current Year	2400003	InvestmentIncomeCurrentYear
Other Revenue Prior Year	1100314	OtherRevenuePriorYear
Other Revenue Current Year	1254926	OtherRevenueCurrentYear
Total Revenue Prior Year	69571483	TotalRevenuePriorYear
Total Revenue Current Year	64578235	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	27745134	SalariesEtcPriorYear
Salaries Etc Current Year	26181320	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	46455254	OtherExpensePriorYear
Other Expenses Current Year	39744596	OtherExpensesCurrentYear
Total Expenses Prior Year	74200388	TotalExpensesPriorYear
Total Expenses Current Year	65925916	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-4628905	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-1347681	RevenuesLessExpensesCY
Total Assets BOY	107469074	TotalAssetsBOY
Total Assets EOY	108806524	TotalAssetsEOY
Total Liabilities BOY	32008096	TotalLiabilitiesBOY
Total Liabilities EOY	43413417	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	75460978	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	65393107	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. the hospital's CORE VALUES OF RESPECT, CARE, COMPETENCE AND JOY ARE LIVED BY ALL WHO serve HERE, AND FELT BY ALL WHO receive healthcare SERVICES at st. nicholas hospital	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	5146154	Expense
Revenue	8239933	Revenue
Description	surgical services - See Schedule O - Community Benefit Report	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	3260541	Expense
Revenue	11107338	Revenue
Description	diagnostic imaging - See Schedule O - Community Benefit Report	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	1539306	Expense
Revenue	6694524	Revenue
Description	emergency services - See Schedule O - Community Benefit Report	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	38939885	TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev	34559988	TotalOfOtherProgramServiceRev
Total Program Service Expense	48885886	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	true	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	true	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	true	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	45	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	552	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	true	InvestmentInJointVenture
Written Policy Or Procedure	true	WrittenPolicyOrProcedure
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	GREG SIMIA	NamePerson
Telephone Number	9204598300	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	3100 SUPERIOR AVENUE	AddressLine1
City	SHEBOYGAN	City
State	WI	State
ZIP Code	530811948	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
SR MARYBETH CULNAN OSF
BOARD MEMBER	1.0	X	0	0	0
ANDREW J BAGNALL
PRESIDENT & CEO	40.0	X	0	216973	78509	X
STUART W BROTZ
BOARD MEMBER	1.0	X	0	0	0
TIMOTHY KELLNER
BOARD MEMBER	1.0	X	0	0	0
DAVID VAN DE WATER JD LLM
CHAIRPERSON	1.0	X	0	0	0	X
WILLIAM L TRAGER MD
BOARD MEMBER	1.0	X	0	0	0
SR BERNADINE GUTOWSKI OSF
SECRETARY	1.0	X	0	0	0
S MARK BETTAG MD
BOARD MEMBER	1.0	X	0	0	0
MICHAEL A LANSER EDD
VICE CHAIRPERSON	1.0	X	0	0	0	X
CHRISTOPHER L LARSON MD
BOARD MEMBER	1.0	X	0	0	0
PETER F BEMIS
BOARD MEMBER	1.0	X	0	0	0
ANN m CARR
TREASURER	0.25		0	225813	215561	X
THERESE PANDL
DIVISIONAL CEO	15.0		0	575727	192393	X
GREG SIMIA
DIVISION CFO	15.0		0	216664	12283	X
BARBARA HOCKING
COO/CNO	40.0		203134	0	7002	X
ANDREA M ANGOTTI
PHARMACIST	40.0		126441	0	17308		X
SUSAN M WHEELER
DIRECTOR OF PHARMACY	40.0		129265	0	19060		X
DOUG PETRY
DIAGNOSTIC IMAGING TECH	40.0		103812	0	15550		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	562652	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1235177	TotalReportableCompFrmRltdOrgs
Total Other Compensation	557666	TotalOtherCompensation
Number Individuals GT100 K	4	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Prevea health services
2710 EXECUTIVE DRIVE	GREEN BAY	WI	54304	physician services	9357400
St vincent hospital
835 S VAN BUREN	GREEN BAY	WI	543013256	physician services	7581994
St mary's hospital medical center
1726 SHAWANO AVENUE	GREEN BAY	WI	54303	physician services	480348
DIVERSIFIED CLINICAL SERVICES
5220 BELFORT ROAD SUITE 200	JACKSONVILLE	FL	32256	WOUND CENTER	467396
Infinity healthcare inc
111 E WISCONSIN AVENUE SUITE 2000	MILWAUKEE	WI	53202	ER AND HYPERBARIC	397832

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	5	NumberOfContractorsGT100K
Related Organizations	321523	RelatedOrganizations
Total Contributions	321523	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE	900099	59726004	59726004
LABORATORY OUTREACH REVENUE	621500	129179		129179
OTHER OPERATING REVENUES	900099	746600	746600

Field	Value	IRS element (for citing)
Total Program Service Revenue	60601783	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	804138	TotalRevenueColumn
Exclusion	$804,138	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	2048442	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	793516	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	1254926	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1254926	TotalRevenueColumn
Exclusion	$1,254,926	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1616472	Securities
Other	20000	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	40607	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	1616472	Securities
Other	-20607	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	1595865	TotalRevenueColumn
Exclusion	$1,595,865	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Unrelated Business Revenue	0	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Other Revenue	0	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	64578235	TotalRevenueColumn
Related Or Exempt Function Income	60472604	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	129179	UnrelatedBusinessRevenue
Exclusion	$3,654,929	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	210893	Total

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	19806536	Total
Program Services	12884796	ProgramServices
Management And General	6921740	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	1057934	Total
Program Services	688220	ProgramServices
Management And General	369714	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	3860584	Total
Program Services	2511435	ProgramServices
Management And General	1349149	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1245373	Total
Program Services	810156	ProgramServices
Management And General	435217	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	4004280	Total
Program Services	2604914	ProgramServices
Management And General	1399366	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	311534	Total
Program Services	202663	ProgramServices
Management And General	108871	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	14437245	Total
Program Services	11241597	ProgramServices
Management And General	3195648	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	0	Total

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	119415	Total
Program Services	84824	ProgramServices
Management And General	34591	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	0	Total

Travel Travel

Field	Value	IRS element (for citing)
Total	133827	Total
Program Services	115685	ProgramServices
Management And General	18142	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	26931	Total
Program Services	10728	ProgramServices
Management And General	16203	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	289163	Total
Program Services	188110	ProgramServices
Management And General	101053	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	3877502	Total
Program Services	2092541	ProgramServices
Management And General	1784961	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	236870	Total
Program Services	154092	ProgramServices
Management And General	82778	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
SUPPLIES	8654599	8541138	113461
BAD DEBT	2230789	2230789
MEDICAID TAX	2087901	2087901
EQUIPMENT RENTAL & MAINTENANCE	1843746	1466487	377259

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1490794	Total
Program Services	969810	ProgramServices
Management And General	520984	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	65925916	Total
Program Services	48885886	ProgramServices
Management And General	16829137	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	2674232	BOY
EOY	5662992	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	10857930	BOY
EOY	9269068	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1629830	BOY
EOY	1560659	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	303739	BOY
EOY	232193	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	115736473	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	66598554	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	44365270	BOY
EOY	49137919	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	44211814	BOY
EOY	40116535	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	1252082	BOY
EOY	1237191	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	2174177	BOY
EOY	1589967	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	107469074	BOY
EOY	108806524	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	5332843	BOY
EOY	6108031	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	266636	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	16755524	BOY
EOY	16333920	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	9919729	BOY
EOY	20704830	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	32008096	BOY
EOY	43413417	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	67628899	BOY
EOY	57687975	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	6201864	BOY
EOY	6064167	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1630215	BOY
EOY	1640965	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	75460978	BOY
EOY	65393107	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	107469074	BOY
EOY	108806524	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-1347681	ReconcilationRevenueExpenses
Reconcilation Other Changes	-8720190	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$7,546	OtherActivitiesAmount
Total Lobbying Expenditures IIB	7546	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Description of other lobbying activities	Identifier
Return Reference	Schedule C, part II B, QUestion 1I	ReturnReference
Explanation	ST.NICHOLAS HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE wisconsin HEALTH ASSOCIATION ("WHA"), 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 PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Current Year Minus3 Years		CurrentYearMinus3Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1407040	OtherCostOrOtherBasis
Book Value	1407040	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	68881658	OtherCostOrOtherBasis
Depreciation	35816589	Depreciation
Book Value	33065069	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	283176	OtherCostOrOtherBasis
Depreciation	13179	Depreciation
Book Value	269997	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	42704819	OtherCostOrOtherBasis
Depreciation	28900951	Depreciation
Book Value	13803868	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2459780	OtherCostOrOtherBasis
Depreciation	1867835	Depreciation
Book Value	591945	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	49137919	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescription	AmountAmount
ACCRUED BENEFIT LIABILITIES	$13,099,380
CAPITAL LEASE	$5,063,994
INTEREST RATE SWAP SETTLEMENT	$1,987,015
ESTIMATED SELF-INSURANCE LIAB	$265,300
OTHER LONG TERM LIABILITIES	$289,141

Field	Value	IRS element (for citing)
Total Of Amounts	20704830	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	ASC SUBTOPIC 740-10	Identifier
Return Reference	SCHEDULE D, PART X, LINE 2	ReturnReference
Explanation	HSHS has adopted ASC Subtopic 740-10, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109. ASC Subtopic 740-10 addresses the determination of how tax benefits claimed or expected to be claimed on a tax return should be recorded in the consolidated financial statements. Under ASC Subtopic 740-10, the Obligated Group must recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from such a position are measured based on the largest benefit that has a greater than 50% likelihood of being realized upon ultimate settlement. ASC Subtopic 740-10 also provides guidance on derecognition, classification, interest and penalties on income taxes, and accounting in interim periods, and requires increased disclosures. As of June 30, 2012 and 2011, the Obligated Group does not have a liability for unrecognized tax benefits.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
FPG Reference Free Care	true	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	225.	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1346287	TotalCommunityBenefitExpense
Net Community Benefit Expense	1346287	NetCommunityBenefitExpense
Percent Of Total Expense	0.02120	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	1978	PersonsServed
Total Community Benefit Expense	10574440	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5577561	DirectOffsettingRevenue
Net Community Benefit Expense	4996879	NetCommunityBenefitExpense
Percent Of Total Expense	0.07870	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	1978	PersonsServed
Total Community Benefit Expense	11920727	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5577561	DirectOffsettingRevenue
Net Community Benefit Expense	6343166	NetCommunityBenefitExpense
Percent Of Total Expense	0.09990	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	6067	PersonsServed
Total Community Benefit Expense	239926	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7379	DirectOffsettingRevenue
Net Community Benefit Expense	232547	NetCommunityBenefitExpense
Percent Of Total Expense	0.00370	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Persons Served	105	PersonsServed
Total Community Benefit Expense	590906	TotalCommunityBenefitExpense
Direct Offsetting Revenue	379931	DirectOffsettingRevenue
Net Community Benefit Expense	210975	NetCommunityBenefitExpense
Percent Of Total Expense	0.00330	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Persons Served	6172	PersonsServed
Total Community Benefit Expense	830832	TotalCommunityBenefitExpense
Direct Offsetting Revenue	387310	DirectOffsettingRevenue
Net Community Benefit Expense	443522	NetCommunityBenefitExpense
Percent Of Total Expense	0.00700	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Persons Served	8150	PersonsServed
Total Community Benefit Expense	12751559	TotalCommunityBenefitExpense
Direct Offsetting Revenue	5964871	DirectOffsettingRevenue
Net Community Benefit Expense	6786688	NetCommunityBenefitExpense
Percent Of Total Expense	0.10690	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Persons Served	60	PersonsServed
Total Community Building Expense	1246	TotalCommunityBuildingExpense
Net Community Building Expense	1246	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Persons Served	222	PersonsServed
Total Community Building Expense	3355	TotalCommunityBuildingExpense
Net Community Building Expense	3355	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Persons Served	282	PersonsServed
Total Community Building Expense	4601	TotalCommunityBuildingExpense
Net Community Building Expense	4601	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$2,230,789	BadDebtExpenseAmount
Amount Reimbursed By Medicare	20146711	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	31497127	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-11350416	MedicareSurplusOrShortfall
Costing Methodology Used		CostingMethodologyUsed
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivity	Organization Profit Or OwnershipOrganizationProfitOrOwnership	Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership	Physicans Profit Or OwnershipPhysicansProfitOrOwnership
orange cross
ambulance services	0.50000	0.00000	0.00000
sheboygan surg cntr
outpatient surgery center	0.50000	0.00000	0.50000

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	St Nicholas Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	St Nicholas Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	true	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Needs Assessment Conducted	11	NeedsAssessmentConducted
Take Into Account	true	TakeIntoAccount
Other Facilities	true	OtherFacilities
CHNA Widely Available	true	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Adopt Implement Strategy	X	AdoptImplementStrategy
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	false	AllNeedsAddressed
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	225.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	300.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Attached To Invoices	X	AttachedToInvoices
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
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	The Hospital's community benefit report can be accessed at www.stnicholashospital.org.
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 10.69%. THE AMOUNT OF BAD DEBT REMOVED WHEN CALCULATING PART I, LINE 7, COLUMN (F) WAS 2,230,789.
PART I, LINE 7	Charity care is reported on St. Nicholas Hospital's fiscal year 2012 audited financial statements. Charity care is processed through patient billing and identified through the use of charity care billing codes. The total charity care dollar amount is then reduced to cost by applying the Hospital's cost to charge ratio as calculated on IRS Schedule H-Worksheet J.
Part II	The community building activities are identified and reported in St. Nicholas Hospital's community benefit reports. The activities consist primarily of participating in and supporting the work of community groups to advance community awareness about health issues.
Part III, Line 4	The Hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because some patients who potentially qualify for charity care do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the Hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the Hospital is implementing processes, procedures, and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the Hospital in the future. The Hospital computes the cost of bad debt by multiplying the ratio of patient care cost to charges to the total charges written off as bad debt expense. The patient care cost is determined by reducing the total Hospital annual operating expenses by bad debt expenses, Medicaid provider taxes, and community benefit expense. This adjusted patient care 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 Hospital continually strives to provide excellent patient care in the most cost effective manner. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since the mission of the Hospital is to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, it is an important contribution made by the Hospital to the health and well being of the community. St. Nicholas Hospital's mission is to serve all patients with the highest possible quality and efficiency, regardless of financial reimbursement. The Hospital computes the unpaid costs of providing care to Medicare patients by comparing the cost of the services to the reimbursement received from Medicare during the year. The cost of Medicare services is calculated by applying the ratio of patient care cost to charges to the annual Medicare charges. The patient care cost is determined by reducing the total annual operating expense by bad debt expenses, Medicaid provider taxes, and community benefit expense. The difference between the reimbursement received and the calculated cost of the services is reported as the Medicare shortfall. While the Medicare shortfall is not recognized as a community benefit, St. Nicholas Hospital reports this information within the Community Benefit footnote of the audited financial statements.
Part III, Line 9b	Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the Hospital's efforts to be reimbursed will the account be sent to collections. For additional information, see response to question VI, 3.
Part V-B, Line 3	The community needs assessment was a collaborative, multi-stage process which included St. Nicholas Hospital, the Sheboygan County Health Division of Public Health, and community partners. Two complementary community engagement sessions occurred: * A Community Health Needs Forum sponsored by St. Nicholas Hospital. As described in the companion brochure which is also posted on the Hospital's website, this Forum included presentations and engagement by a group broadly representative of the community. * The Community Health Improvement Call to Action event sponsored by the Sheboygan County Division of Public Health and Healthy Sheboygan County 2020 (HSC 2020). HSC 2020 is a coalition of community and health-related organizations. This event also entailed broad community participation, including representation from St. Nicholas Hospital. In both of the above sessions, participants developed priorities for community-wide action based on the 2009 Community Health Needs Assessment conducted by the Sheboygan County Division of Public Health, updated data from the 2010 census, and more current publicly reported public health statistics. This Health Assessment utilized the health focus framework of Healthiest Wisconsin 2020 to gather Sheboygan County data and key findings. Major Needs and How Priorities Were Established At the May 2011 St. Nicholas Hospital Community Health Needs Forum, approximately 70 community leaders participated in the event with representation from business, non-profit agencies, healthcare, education, public health and safety, and elected officials. The objective of the Forum was to obtain community input to identify and prioritize health issues that the Hospital is best positioned to address in partnership with other organizations in the community. This event included a presentation by Jean Beinemann, RN, Program Supervisor from the Sheboygan County Division of Public Health on the 2009 Sheboygan County Community Health Needs Assessment, updated data from the 2010 census, and more current publicly reported public health statistics. The larger group was broken down into nine subgroups to rate and rank the health needs using two documents developed for this process to assess the needs against three criteria: (a) magnitude of problem; (b) seriousness of the consequences; and (c) feasibility of correcting. These documents included a Problem Importance Worksheet for each of the identified 12 key focus areas identified in the Sheboygan County Health Needs Assessment, and a Problem Prioritization Worksheet to rank the problems identified in the Problem Importance Worksheet. A similar process was used at the June 2011 Call to Action event sponsored by the Health Department and HSC 2020. This event included about 60 representatives from government, not-for-profit, healthcare, education, public safety, and business. The group reviewed health data in relation to the Healthy People 2020 and Healthiest Wisconsin 2020 framework. They discussed health needs in small groups. Priorities were established using the "dot method", whereby each participant can attribute an allocated number of votes to the needs that they identify as most important. The two priority-setting forums had slightly different but complementary purposes. Results from the Call to Action event were incorporated into the Sheboygan County Community Health Improvement Plan. This plan includes extensive involvement from St. Nicholas Hospital staff members, who serve on several implementing committees. The St. Nicholas Hospital forum also sought community input to set priorities, but with a focus on needs that the Hospital is best positioned to help address and to help support the development of the implementation strategy. The St. Nicholas Hospital forum identified five priority health issues: 1. Oral health. 2. Physical activity. 3. Adequate, appropriate, and safe food and nutrition (tie). 4. Unhealthy drug and alcohol use (tie). 5. Tobacco use and exposure. In addition (though not formally identified as a separate priority), each issue includes health literacy as a component. The Sheboygan County/HSC 2020 event also identified five top priorities: 1. Oral/dental health issues. 2. Mental health issues. 3. Improvement of health literacy. 4. AODA and tobacco use issues. 5. Obesity. The next step for St. Nicholas Hospital was to identify commonality between the identified issues which emerged as a result of the community engagement sessions. The priorities identified at both of the community engagement sessions shared many commonalities. Oral Health emerged as the top health issue at both sessions. Some of the priorities could be grouped together, including: physical activity; adequate, appropriate and safe food and nutrition; and obesity. AODA, including tobacco use, was also highlighted as a top community concern. Mental health was not identified as one of the top five priorities at the St. Nicholas Hospital forum, but it was identified as the sixth community health priority. Health Care Facilities and Resources within the Community There are two acute care hospitals in Sheboygan County-St. Nicholas Hospital and Aurora Sheboygan Medical Center. Both provide inpatient, outpatient, and emergency care. In addition, Aurora Sheboygan Memorial provides mental health and AODA treatment programs. In 2012, a community health clinic and a community dental clinic were started to serve the health care needs of low income individuals within the community. Sheboygan County Community Health Needs Forum Sponsored by St. Nicholas Hospital May 6, 2011 Attendee List * Ann Wondergem, Sheboygan & Plymouth Area United Way ** * Dr. Clifford Martin, Prevea Sheboygan Women's Care * Beverly Randall, Mental Health America ** * Marty Folan, St. Nicholas Hospital * Katy Pruitt, Safe Harbor ** * Dr. Al Hardersen, UW-Sheboygan * Tanya Smith, St. Nicholas Hospital * Steve Stauber, Friends of St. Nicholas Hospital * Heidi Selberg, HSHS Division-Eastern Wisconsin * Jean Beinemann, Sheboygan County Division of Public Health * * Sue Wheeler, St. Nicholas Hospital * Aly Flaskrud, Willowdale Nursing and Rehabilitation Center * Brian Charlier, Prevea Health * Andy Bagnall, St. Nicholas Hospital * Dr. Donald Gore, Sheboygan Orthopaedic Associates * Sherri Samuels-Fuerst, Sargento Foods, Inc. * Chris Jensema, HSHS Division-Eastern Wisconsin * Judy Halverson, Partners of St. Nicholas Hospital * Mary Schueller, HSHS Division-Eastern Wisconsin * Annette Selk, Public Health Nurse, Sheboygan County Division of Public Health * * Joseph Leibham, Wisconsin State Senate * Jeanette Miller, Partners of St. Nicholas Hospital * Nancy Jusky, Sheboygan & Plymouth Area United Way ** * Eve Kovacs, Partners of St. Nicholas Hospital * Mary Jo Tittl, Family Resource Center ** * Beth Millin, St. Nicholas Hospital * Jill Niemczyk, Northeastern Wisconsin Area Health Education Center * Mark Radtke, Wind Mill Slatwall Products * Jody Moesch Ebeling, Public Health Nurse, Sheboygan County Division of Public Health * * Dale Hippensteel, Health Officer, Sheboygan County Division of Public Health * * Kristin Blanchard, Sheboygan County Interfaith Organization ** * Susie Runaas, St. Nicholas Hospital * Amy Betke, Public Health Nurse, Sheboygan County Division of Public Health * * Carrie Bender, Rockline Industries * Steve Neisius, Rockline Industries * Jean McMurray, Aurora Health Care * Wendy Elgin, BridgePoint Health ** * Jan Mulhern, St. Nicholas Hospital * Michelle Niemi-Prange, Sheboygan Progressive Care Center * Dawn Kind, Prairie States Enterprises * Mary Paluchniak, St. Nicholas Hospital * Cynthia Bertsch, St. Nicholas Hospital * Xue Yang, St. Nicholas Hospital * Kaitlin Swanson, HSHS Division-Eastern Wisconsin * Virginia Thomas, Sheboygan Area Community Clinics, Inc. ** * Alejandra Klemme, Catholic Charities ** * Phil Duket, Family Resource Center ** * Chasong Yang, Hmong Mutual Assistance Association ** * Dr. David Wyatt Seal, Medical College of Wisconsin * Ryan Perkins, St. Nicholas Hospital * Jenny Pernat, St. Nicholas Hospital * Marlene Mielke, Regional Representative for U.S. Senator Herbert Kohl * Terri Boxrucker, Public Health Nurse,Sheboygan County Division of Public Health * * Connie Bitter, Friends of St. Nicholas Hospital and Bemis Manufacturing * Mike Klein, Bemis Manufacturing * Robert Weber, D.D.S. * Dr. Gregory Grose, Prevea Sheboygan Urology * Jessica Muchowski, Willowdale Nursing and Rehabilitation Center * Cindy Musial, The Gathering Place ** * Nichol Fidlin, Prevea Health * Mel Blanke, Sheboygan Area Community Clinics, Inc. ** * John Koehler, Sheboygan Area School District * Joann Wieland, Sheboygan & Plymouth Area United Way ** * John Wenig, Friends of St. Nicholas Hospital * Lorraine Pashley, St. Nicholas Hospital * Thomas Eggebrecht, Sheboygan County Health and Human Services Department ** * Check Butler, Sheboygan City Fire Department * Public health representative ** Representative of minority, underserve
Needs Assessment	The Community Health Needs and associated implementation strategy will be used to guide the Hospital's efforts in FY2013. For prior years, the Hospital employed a number of methods to assess health care needs. For example, the Hospital has a community advisory committee that is representative of the community that the Hospital serves. The committee meets regularly to discuss hospital services and the ability of the Hospital to meet community health care needs. Agendas are purposely organized to include time for feedback from members on what they are hearing in the community. In addition, Hospital colleagues represent the Hospital on a wide variety of community groups. Through this representation, the Hospital becomes aware of emerging needs, and as a result, is able to offer or support screening and education programs that addresses these needs. St. Nicholas Hospital's Community Needs Assessment is published on its website. The link is http://www.stnicholashospital.org/communityHealthNeeds.html.
Patient Education of Eligibility for Assistance	St. Nicholas Hospital posts its charity care policy and application on its website. In addition, charity care applications are available and prominently displayed in waiting rooms and registration areas. The Hospital's financial counselors are available to meet with patients on site before or at the time of service to assist in identifying whether or not they are eligible for government aid or financial assistance. The financial counselors assist patients in applying for programs for which they may be eligible. After patients receive their health care service(s), the Hospital's customer service representatives are also trained to assist patients in applying for various government programs or for the Hospital's charity care program. In addition, the Hospital's collectors are trained to provide this assistance as well. Lastly, the Hospital has contracted with an outside organization to perform active outreach with patients, who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits.
Community Information	Sheboygan County is primarily an urban county. Sheboygan County is one of 72 Wisconsin counties, and is located in eastern Wisconsin. The population of approximately 115,000 is primarily Caucasian. However, there are an estimated 5,600 Hispanic residents (over 200% increase since 1990) and nearly 5,000 Asian residents (over 100% increase since 1990). The percent of people age 65 and over exceeds state and national levels. According to the Wisconsin Department of Health Services, 5% of residents are below the federal poverty level, and another 9% have incomes of less than 200% of the federal poverty level. About 3% of the population receives Medicaid assistance. Other notable findings on community needs include: * There are no dental providers in Sheboygan County that accept new patients if their source of payment is Medicaid. * 66% of the Sheboygan County adults are overweight or obese. * 33% of Sheboygan County adults have hypertension. * 22% of Sheboygan County adults have diabetes, which includes 2,460 undiagnosed adults. * Estimated 19% of Sheboygan County individuals over age 20 and older are pre-diabetic.
Promotion of Community Health	St. Nicholas Hospital offers hope to the 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. Nicholas Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 120 years ago to bring a healing presence to the community and to improve the health of the community, especially for people who are sick, poor, and disadvantaged. Because of the Hospital's purpose and tradition, it is organized to promote the health of Sheboygan County, Wisconsin, and surrounding areas. The Hospital is governed by a Board of Directors, of which the majority is comprised of persons who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board insures that St. Nicholas Hospital is responding to community need. During the last fiscal year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. In addition, the Hospital Advisory Council, Friends of St. Nicholas Foundation, and the Partners of St. Nicholas Hospital (whose volunteer members assist in many areas of the Hospital) provide the Hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, St. Nicholas 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. As a not-for-profit hospital, St. Nicholas Hospital 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 insure access for all. For example, St. Nicholas 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 insure that patients (especially those with chronic conditions) get well and stay well. For example, the new Epic electronic medical record system enables providers to connect with their patients' medical record from wherever they are, as well as, allows emergency physicians access to patient medical records from any facility that has implemented Epic. This reduces duplicate testing, puts critical health information at providers' fingertips, helps better manage chronic conditions, and improves patient safety. A Heart Failure Clinic has been established to assist heart failure patients with maintaining good health and staying out of the hospital by incorporating diet, exercise and other wellness information into the long-term care plan. This growing program has shown success in reducing readmissions, which is especially helpful for those with limited financial resources. St. Nicholas Hospital provides significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, St. Nicholas provided $6.8 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. During this period, St. Nicholas provided $15.3 million (at cost) in excess of Medicare payments for health care services. Responding to Community Need The range of benefits provided by St. Nicholas Hospital flows from its mission and long-standing commitment to the community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Nicholas Hospital, and these programs often relieve a burden that would otherwise be carried by the government. St. Nicholas Hospital's active participation with the local Hmong and Hispanic organizations has brought screenings and education to locations and venues, which are nonthreatening to members of those populations. In doing so, the Hospital has reached out to more than 350 members of these communities. The Hospital has been able to identify critical health conditions, and to encourage and promote ongoing proactive health care. Another example of community benefit at St. Nicholas Hospital is the Hope After Loss Organization (HALOTM), which provides support to families that experience loss of life during pregnancy. This program serves the entire community, at no cost to participants, whether their loss occurred at St. Nicholas Hospital or another facility. Over 100 individuals attended HALO support programs. Community benefits at St. Nicholas Hospital also include multiple programs aimed at health promotion. * St. Nicholas Hospital actively participates in "Healthy Sheboygan County 2020". This collaborative group is made up local health care organizations. The group's primary focus is to improve the lives of people in Sheboygan County. St. Nicholas Hospital staff members help the AODA Committee with a County-wide Medication Drop Off, as well as educational presentations. * The Sheboygan County Activity & Nutrition (SCAN) receives assistance through the Hospital's participation in the Employee Health & Fitness Day, Family Health & Fitness Day, and local health fairs. * St. Nicholas Hospital is a supporting co-sponsor of the Community Clinic being developed to address the need to increase access to health care for the un- and underinsured in Sheboygan County. In addition to the financial support, St. Nicholas Hospital has dedicated staff to assist with this important community benefit effort. * Free monthly screenings and health education for the Hmong Mutual Assistance Association. * Support groups free of charge for heart, renal, and stroke patients, as well as grief counseling for adults and children. * Free monthly blood pressure screenings at dozens of locations throughout the county. * Free use of hospital conference and meeting rooms for area not-for-profit organizations. * Provide a house with financial support and in-kind services for Sheboygan County Interfaith Organization and their Bridgeway House, which provides temporary housing for homeless women and children and families transitioning out of domestic abuse situations. * More than 100 families took advantage of child care seat safety checks by certified technicians open to the public free of charge. The checks include education on the need for regular use of safety seats, and the importance of proper installation and of child restraints. * Free bike helmet fittings and bike helmets at cost. The helmet fittings are open to the public. More than 200 helmets were provided through Emergency Department walk in sessions, and over 300 helmets were provided through bike rodeos and other special events. * More than 900 individuals attended foot clinics for the elderly and individuals with diabetes. The clinics assist with care that can be difficult primarily related to degenerative health conditions, as well as, provide regular specialized care for diabetics. * Breast cancer screenings, at cost, for the underserved, including special services and translation for women from the local Hispanic community. * Financial support and in-kind services for Sheboygan County Interfaith Organization, Family Resource Center, Safe Harbor Domestic Abuse Shelter, Big Brothers/Big Sisters, and area churches and schools, which reaches thousands in need within the greater Sheboygan County area; * Food drives for local food pantries. * School supply and clothing drives for area schools.
Affiliated Health Care System	St. Nicholas Hospital of the Hospital 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 more than 2,000 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 healing those who seek our care, as well as through our Community Benefit initiatives. Working collaboratively with others in the 12 communities we serve, our Community Benefit efforts are successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. Across HSHS, we collectively provided $174.2 million in Community Benefits (or 9.7% of total hospital expenses) in FY2012. Included in this amount was $43.1 million provided for Charity Care and $97.9 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 $168.4 million. HSHS hospitals also recorded $106.6 million in uncollectible accounts. Beyond 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 U.S. 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 FY2012, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for the individual. Our efforts to ensure residents in the communities we serve receive the right care at the right time often involve partnering with others to achieve this goal. Across our two-state system, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. In western Wisconsin, St. Joseph's Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,216 patient visits, a 25% increase from the prior year. With more than 150 individuals volunteering, the clinic provided over 6,500 hours (including 700 physician hours and 1,500 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 northeastern Wisconsin, St. Vincent Hospital in Green Bay supports patient care for the uninsured at the NEW Community Clinic by paying a nurse's salary and offering free and discounted laboratory and radiology services. More than 70% of patients who use the clinic report the care they received helped keep them out of the Emergency Department. St. Nicholas Hospital in Sheboygan proactively reaches out to local Hmong and Hispanic organizations to ensure these populations can participate in free screenings and health education programs. Through this ongoing outreach initiative, St. Nicholas engaged more than 350 people last year, and in many cases was able to identify critical health conditions early and provide appropriate follow-up care. A Woman's Place at St. Mary's Hospital Medical Center in Green Bay reaches out to Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services. Last year A Woman's Place touched the lives of more than 7,000 women through health screenings, educational events, classes and its resource center. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's helped underwrite the cost of prescription medications for more than 430 residents. In southwest Illinois, St. Joseph's Hospital in Highland recognized many rural residents did not have a reliable means of transportation and partnered with generous individuals in the community to offer a free transportation service. The "Friends' Van," fully supported by the Friends of St. Joseph's Hospital, provides free rides to medical, dental and other personal appointments within a 20-mile radius of Highland. In FY2012, the Friends Van transported 2,050 individuals for a total of 12,561 miles. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Charity Care program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Charity Care 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 charity care policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our mission to embody Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. To address metabolic disease management, St. Francis Hospital in Litchfield, Illinois, partners with Montgomery County Health Department to provide screening for diabetes and renal disease. St. Francis Hospital teams up with Macoupin County Health Department to provide Diabetes Self-Management classes. St. Joseph's Hospital in Breese, Illinois coordinates several community education seminars and health fairs on cardiovascular disease and healthy eating each year. Over 3,000 residents participated in these health events last year. Recognizing the importance of proper food and nutrition to overall health, St. John's Hospital in Springfield initiated the Destination Dinner program which teaches families how to cook healthy, from-scratch meals, and eat together as a family. Families meet quarterly to learn new cooking skills. They also learn how to prepare a meal for a family of four on a budget of $8.00. In addition to raising awareness about how to eat healthy on a limited budget, the program brings families together around the dinner table, which research shows promotes healthy relationships, increased academic performance and decreased risk for substance abuse and risky sexual behavior. Sacred Heart Hospital in Eau Claire, Wisconsin addressed the need for access to mental health services for children and adolescents by opening an outpatient behavioral health clinic. Sacred Heart has also adopted screening tools for behavioral and mental health risk factors for use at affiliated clinics. The goal is to better identify mental health issues and provide earlier intervention. Sacred Heart Hospital is also working with the Chippewa Valley Free Clinic (CVFC) to develop expanded provider coverage for CVFC patients who require mental health servi
STATE FILING OF COMMUNITY BENEFIT REPORT	WI,	990 SCHEDULE H, PART VI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	true	WrittenPolicyReTAndEExpenses
Substantiation Required	true	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Form990 Of Other Organizations	X	Form990OfOtherOrganizations
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ANDREW J BAGNALL
0	205068	0	0	0	11905	0	54984	0	24649	0	296606	0	16031
ANN m CARR
0	180382	0	0	0	45431	0	197622	0	18652	0	442087	0	15440
THERESE PANDL
0	559242	0	0	0	16485	0	169750	0	27306	0	772783	0	58540
GREG SIMIA
0	166664	0	50000	0	0	0	0	0	12664	0	229328	0	0
BARBARA HOCKING
203134	0	0	0	0	0	0	0	7759	0	210893	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Social Club Dues	Schedule J, Part I, Line 1a	St. Nicholas paid social club dues on Andrew Bagnall's behalf during the year. The fair market value was included in his reportable compensation for the year.
therese pandl	schedule j, part i, line 4b	Therese pandl participated in a SERP plan during the year in the amount of $114,915.
ann m. carr	schedule j, part i, line 4b	ann m. carr participated in a SERP plan during the year in the amount of $33,655.
andrew bagnall	schedule j, part i, line 4b	andrew bagnall participated in a SERP plan during the year in the amount of $37,044.

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoan	Loan From OrganizationLoanFromOrganization	Original PrincipalOriginalPrincipalAmount	Balance DueBalanceDue	DefaultDefault	Approved By BoardApprovedByBoard	Written AgreementWrittenAgreement
THERESE PANDL
mortgage extension	X	$250,000	274484	false	true	true
THERESE PANDL
stock purchase	X	$4,125	4125	false	true	true

Field	Value	IRS element (for citing)
Total Balance Due	278609	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	Barbara Hocking	NamePerson

Field	Value	IRS element (for citing)
Relationship	Temporary Placement	Relationship
Amount Of Transaction	186879	AmountOfTransaction
Description Of Transaction	Director of Surgery placement	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Loans to/from interested persons	Schedule L, Part II	All loans involving interested persons are compliant with the organization's conflict of interest policy. any transactions requiring board approval are reviewed by an independent board prior to being approved.
business transactions involving interested persons	schedule l, part iv	All business transactions involving interested persons are compliant with the organization's conflict of interest policy. any transactions requiring board approval are reviewed by an independent board prior to being approved.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (16 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Organization's Mission	FORM 990 PART III, LINE 1	ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. The hospital's CORE VALUES OF RESPECT, CARE, COMPETENCE AND JOY ARE LIVED BY ALL WHO serve HERE, AND FELT BY ALL WHO receive healthcare services at St. nicholas Hospital. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990 PART III, LINE 4A THE COMMUNITY BENEFIT CONTRIBUTION OF ST. NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS INCLUDES PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN the community the hospital serves. IN ORDER TO PORTRAY THE FULL BREADTH OF this CONTRIBUTION, the hospital's COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: SECTION 1: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT MISSION, HOW THE MISSION IS TRANSLATED INTO A PROACTIVE APPROACH DESIGNED TO MEET COMMUNITY HEALTH NEEDS, HOW THE HOSPITAL MEETS TAX-EXEMPT REQUIREMENTS, AND A DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT HIGHLIGHT THE HOSPITAL'S IMPACT ON COMMUNITY HEALTH. SECTION 2: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT CONTRIBUTION IN FINANCIAL TERMS PRESENTING THE level OF CHARITY CARE, THE UNPAID SHORTFALL FROM GOVERNMENT HEALTH CARE FOR THE INDIGENT, AND THE NET EXPENSE OF COMMUNITY BENEFIT SERVICES. SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT 1. ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT A. DESCRIBE HOSPITAL'S MISSION AND PRIMARY EXEMPT PURPOSE. (IF APPLICABLE, IDENTIFY HOSPITAL'S STATUS AS A CRITICAL ACCESS HOSPITAL, SOLE COMMUNITY HOSPITAL, DISPROPORTIONATE SHARE HOSPITAL, OR RELATED STATUS.) THE MISSION OF ST. NICHOLAS HOSPITAL IS TO CARRY FORWARD THE HEALING MINISTRY OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS AS PART OF THE HEALTH MINISTRY OF THE ROMAN CATHOLIC CHURCH. ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. the hospital's CORE VALUES OF RESPECT, CARE, COMPETENCE, AND JOY ARE LIVED BY ALL WHO serve HERE, AND FELT BY ALL WHO receive healthcare services at St. nicholas hospital. B. SUMMARIZE HOSPITAL'S APPROACH TO PROVIDING COMMUNITY BENEFIT. THIS SUMMARY INCLUDEs THE FOLLOWING INFORMATION: GEOGRAPHIC AREA AND TARGET POPULATIONS. ST. NICHOLAS HOSPITAL'S SERVICE AREA INCLUDES SHEBOYGAN COUNTY AND PARTS OF OZAUKEE, FOND DU LAC, MANITOWOC, AND CALUMET COUNTIES WITH A TOTAL POPULATION OF APPROXIMATELY 140,000. MUCH OF THIS AREA IS RURAL AND CONSISTS OF SMALL FAMILY FARMS. IMMIGRANT COMMUNITIES HAVE expanded SUBSTANTIALLY IN RECENT YEARS, PARTICULARLY HISPANICS FROM MEXICO AND LATIN AMERICA, HMONGS FROM SOUTHEAST ASIA, AND EASTERN EUROPEANS. IT IS ESTIMATED THAT OVER 10% OF THE United States POPULATION IS UNINSURED. IN ADDITION TO MEDICAID, WISCONSIN HAS BADGERCARE, which WAS INTRODUCED IN 1999. THE NEW BADGERCARE PLUS PROGRAM REACHED MAXIMUM ENROLLMENT LEVELS THREE MONTHS AFTER ITS inception. THE STATE WAS FORCED TO CAP ENROLLMENT FOR CHILDLESS ADULTS IN ITS BADGERCARE PLUS CORE PROGRAM AFTER 33,000 ADULTS HAD ENROLLED IN THE FIRST FEW MONTHS OF THE PROGRAM. MAJOR TRENDS, NEEDS, AND PROBLEMS IN THE COMMUNITY; AS NOTED ABOVE, JOB LOSSES including THE LOSS OF INSURANCE and expansion of IMMIGRANT COMMUNITIES IN RECENT YEARS have created new issues and needs in the community. LANGUAGE AND CULTURAL BARRIERS CAN HAMPER COMMUNICATIONS. NUTRITION AND LIFESTYLE CHOICES HAVE LED TO RISING RATES OF DIABETES, CARDIOVASCULAR DISEASE, OBESITY, and other health issues AMONG ALL POPULATIONS. MAJOR STRATEGIES TO ADDRESS IDENTIFIED NEEDS AND PROBLEMS; UTILIZING DATA COLLECTED BY THE STATE OF WISCONSIN, THE COUNTY DEPARTMENT OF PUBLIC HEALTH, THE NORTHEASTERN WISCONSIN AREA HEALTH EDUCATION CENTER, AND OTHER AREA HEALTHCARE PROVIDERS, ST. NICHOLAS HOSPITAL MONITORS CHANGES IN POPULATION, DISEASE INDICATORS, ETC., AND DEVELOPS A BROAD RANGE OF PROGRAMS TO ADDRESS UNMET HEALTHCARE NEEDS. THE MAJORITY OF THESE PROGRAMS ARE PROVIDED FREE OF CHARGE OR AT/BELOW COST. COMMUNITY ORGANIZATIONS COLLABORATING WITH THE HOSPITAL TO IMPROVE COMMUNITY HEALTH, EXPAND ACCESS TO HEALTH CARE, OR IN OTHER WAYS BENEFIT THE COMMUNITY; ST. NICHOLAS HOSPITAL WAS A FOUNDING MEMBER OF "HEALTHY SHEBOYGAN COUNTY 2020" ("HSC 2020"), A COLLABORATIVE EFFORT TO IMPROVE THE LIVES OF PEOPLE IN sheboygan COUNTY. PARTNERS IN THIS EFFORT INCLUDE THE PUBLIC HEALTH DEPARTMENT, AURORA HEALTH CARE, THE MENTAL HEALTH ASSOCIATION, FAMILY RESOURCE CENTER, SALVATION ARMY, AND PRAIRIE STATES ENTERPRISES. OUTREACH PROGRAMS ARE CURRENTLY FOCUSED ON OBESITY/INACTIVITY, ALCOHOL AND OTHER DRUG ABUSE PREVENTION, AND MENTAL HEALTH ISSUES, PARTICULARLY SUICIDE PREVENTION. HSC 2020 IS CURRENTLY IN A LONG-RANGE PLANNING PROCESS (FUNDED BY A GRANT FROM THE LOCAL UNITED WAY agency) which is focusing on THE NEED TO INCREASE ACCESS TO HEALTHCARE FOR THE UN- AND UNDERINSURED IN sheboygan COUNTY. st. nicholas HOSPITAL HAS DEDICATED STAFF TO ASSIST with THE COMMUNITY BENEFIT EFFORT. THE HOSPITAL'S COMMUNITY EDUCATION AND OUTREACH DEPARTMENTS ARE STAFFED BY NURSES, SCREENERS, AND EDUCATORS, WHO ARE TRAINED AND DEDICATED TO BRINGING HEALTH EDUCATION AND SERVICES TO THE COMMUNITY, PARTICULARLY FOR THE POOR AND ETHNIC MINORITIES. AN INTERPRETER SERVICE IS AVAILABLE TO ASSIST WITH LANGUAGE BARRIERS FOR ANY POPULATION. C. DESCRIBE THE HOSPITAL'S FINANCIAL ASSISTANCE POLICIES OR PROGRAMS (E.G. CHARITY CARE, DISCOUNTING) FOR LOW-INCOME PERSONS AND HOW those policies and programs ARE COMMUNICATED TO THE PUBLIC. AS A CATHOLIC ORGANIZATION, ST. NICHOLAS HOSPITAL IS RESPECTFUL OF THE DIGNITY OF EVERY PERSON, AND PROVIDES SERVICES IN A COURTEOUS MANNER REGARDLESS OF FINANCIAL STATUS. WE OFFER FINANCIAL ASSISTANCE TO THOSE PATIENTS IN NEED. however, GUIDELINES HAVE BEEN ESTABLISHED TO ENSURE THAT THE HOSPITAL'S LIMITED RESOURCES ARE USED TO TREAT PATIENTS WHO ARE TRULY UNABLE TO PAY AND ARE NOT CONSUMED BY THOSE UNWILLING TO PAY OR WHO HAVE ALTERNATE PAY SOURCES. PATIENT ACCOUNT SPECIALISTS HELP PEOPLE EXPLORE OPTIONS FOR FINANCIAL ASSISTANCE AND THEN, if necessary, OFFER st. nicholas hospital's CHARITY CARE PROGRAM. UPON APPLICATION, AND IF THE GUIDELINES ARE MET, THE HOSPITAL WILL PROVIDE Charity care OF 25% - 100%, BASED ON THE MINIMUM ANNUAL INCOME GUIDELINES ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND SOCIAL SERVICES. DISCOUNTS ARE ALSO AVAILABLE FOR PATIENTS WHO MAY BE UN- OR UNDERINSURED, BUT WHO FALL OUTSIDE THE CHARITY CARE PROGRAM GUIDELINES. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE AT ADMITTING/REGISTRATION, THE CASHIER OFFICE, AND EMERGENCY DEPARTMENT.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED	FORM 990 PART III, LINE 4A	2. ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTION INDICATE WHETHER THE HOSPITAL: OPERATES AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; ST. NICHOLAS HOSPITAL OPERATES A LEVEL III TRAUMA CENTER/EMERGENCY DEPARTMENT THAT IS OPEN 24/7 AND STAFFED BY board-CERTIFIED EMERGENCY MEDICINE PHYSICIAN SPECIALISTS. STAFF MEMBERS ARE CERTIFIED IN ADVANCED CARDIAC LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT, AND TRAUMA. LIKE ALL HOSPITAL SERVICES, EMERGENCY CARE IS PROVIDED REGARDLESS OF RACE, CREED, OR ABILITY TO PAY, AND FINANCIAL ASSISTANCE IS AVAILABLE AFTER CARE IS PROVIDED FOR THOSE IN NEED. HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA; st. nicholas hospital's MEDICAL STAFF IS OPEN TO ALL AREA PHYSICIANS who ARE PROPERLY CREDENTIALED. HAS A GOVERNING BODY IN WHICH INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY COMPRISE A MAJORITY; ST. NICHOLAS HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF HOSPITAL SISTERS HEALTH SYSTEM EXECUTIVES AS WELL AS REPRESENTATIVES FROM the surrounding GEOGRAPHIC AREA. st. nicholas hospital's ADVISORY COUNCIL IS COMPRISED OF 19 MEN AND WOMEN REPRESENTING A BROAD RANGE OF AREA BUSINESS AND PHYSICIAN INTERESTS AS WELL AS LOCAL FAITH COMMUNITIES AND SOCIAL SERVICE AGENCIES. ENGAGES IN MEDICAL OR SCIENTIFIC RESEARCH PROGRAMS; THE HOSPITAL HAS CONDUCTED SOME LIMITED MEDICAL/SCIENTIFIC RESEARCH PROGRAMS, I.E. DRUG TRIALS, ONLY UNDER CAREFUL MEDICAL STAFF/ INSTITUTIONAL REVIEW BOARD SUPERVISION. ENGAGES IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS; ST. NICHOLAS HOSPITAL PROVIDES EDUCATIONAL TRAINING AND SUPERVISED HANDS-ON EXPERIENCE FOR INTERNS AND EXTERNS FROM AREA COLLEGES AND TECHNICAL COLLEGEs. PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS; ST. NICHOLAS HOSPITAL PARTICIPATES IN MEDICAID, MEDICARE, CHAMPUS, tricare, AND OTHER GOVERNMENT-SPONSORED HEALTHCARE PROGRAMS. 3. DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS A. DESCRIBE AND HIGHLIGHT ONE OR MORE PROGRAMS THAT HAVE CLEARLY MET AN IDENTIFIED COMMUNITY HEALTH NEED. FREE MONTHLY SCREENINGS AND HEALTH EDUCATION FOR THE HMONG MUTUAL ASSISTANCE ASSOCIATION AND THE HISPANIC CONGREGATION AT ST. CLEMENT PARISH, INCLUDING CULTURALLY APPROPRIATE NUTRITION EDUCATION; PROVIDING TWO HOUSES, INCLUDING UTILITIES, FREE OF CHARGE TO THE SHEBOYGAN SAFE HARBOR AGENCY FOR USE AS DOMESTIC ABUSE SHELTERS; PROVIDING ATHLETIC TRAINERS TO THE SHEBOYGAN AREA SCHOOL DISTRICT FOR LOCAL HIGH SCHOOL SPORTING EVENTS; PROVIDING free of charge SUPPORT GROUPS FOR HEART, RENAL, AND STROKE PATIENTS, AS WELL AS GRIEF support groups FOR ADULTS AND CHILDREN; FREE MONTHLY BLOOD PRESSURE SCREENINGS AT DOZENS OF LOCATIONS THROUGHOUT THE COUNTY; FREE USE OF HOSPITAL CONFERENCE AND MEETING ROOMS FOR AREA NOT-FOR-PROFIT ORGANIZATIONS; PROVIDING THREE HOMES WITH FINANCIAL SUPPORT AND IN-KIND SERVICES FOR the SHEBOYGAN COUNTY INTERFAITH ORGANIZATION ("SCIO") AND BRIDGEWAY AND BEYOND. this program PROVIDES TEMPORARY HOUSING FOR HOMELESS WOMEN AND CHILDREN, AND FAMILIES TRANSITIONING OUT OF DOMESTIC ABUSE SITUATIONS; CHILD CAR SEAT SAFETY CHECKS BY CERTIFIED TECHNICIANS OPEN TO THE PUBLIC FREE OF CHARGE; FREE PRENATAL CARE PROGRAM FOR THE POOR; FREE BIKE HELMET FITTINGS AND HELMETS are available for purchase AT COST. OPEN TO THE PUBLIC BREAST CANCER SCREENINGS AT COST FOR THE UNDERSERVED, INCLUDING SPECIAL SERVICES AND TRANSLATION FOR WOMEN OF THE LOCAL HISPANIC COMMUNITY; FREE ADVANCE DIRECTIVE EDUCATION IN LOCAL CHURCHES AND OTHER VENUES TO ASSIST THE PUBLIC WITH END-OF-LIFE PLANNING; PARTNER WITH THE PUBLIC HEALTH DEPARTMENT TO OFFER FREE CHILDBIRTH EDUCATION IN SPANISH; PROVIDING FINANCIAL SUPPORT AND IN-KIND SERVICES FOR SCIO, FAMILY RESOURCE CENTER, SAFE HARBOR DOMESTIC ABUSE SHELTER, BIG BROTHERS/BIG SISTERS, AND AREA CHURCHES AND SCHOOLS; PROVIDE SAFE SHARPS DISPOSAL FREE OF CHARGE TO THE PUBLIC; ANNUAL ASSESSMENT BY THE STATE OF WISCONSIN TO FUND WISCONSINCARE THAT SERVES THE UNINSURED; FOOD DRIVES FOR AREA FOOD PANTRIES; SCHOOL SUPPLY AND CLOTHING DRIVES FOR AREA SCHOOLS; SENDING THE HEALTHEXPRESS vehicle INTO THE COMMUNITY THROUGHOUT THE YEAR TO PROVIDE FREE SCREENINGS AND HEALTH EDUCATION; 4. LINKS TO ADDITIONAL COMMUNITY BENEFIT INFORMATION A. PLEASE VISIT st. nicholas hospital's WEBSITE (WWW.STNICHOLASHOSPITAL.ORG) FOR ADDITIONAL INFORMATION ABOUT OUR HOSPITAL PROVIDED SERVICES AND OUR 2011 COMMUNITY BENEFIT REPORT: SECTION 2 - QUANTIFIABLE COMMUNITY BENEFIT THIS SECTION INCLUDES A LIST OF THE TYPES OF PROGRAMS AND SERVICES THAT COULD BE INCLUDED AS COMMUNITY BENEFIT ACTIVITIES. SEE WWW.CHAUSA.ORG/COMMUNITYBENEFIT/COUNTING FOR MORE DETAILS ABOUT THESE PROGRAMS AND SERVICES. THE FINANCIAL INFORMATION IN THIS REPORT WAS PREPARED IN ACCORDANCE WITH THE CATHOLIC HEALTH ASSOCIATION'S ("CHA") COMMUNITY BENEFIT REPORTING GUIDELINES. st. nicholas hospital's REPORT FOLLOWS THESE ("CHA") RECOMMENDATIONS: - REPORT CHARITY CARE AT COST, NOT CHARGES. - DOes NOT INCLUDE BAD DEBT, CONTRACTUAL ALLOWANCES, AND QUICK PAY DISCOUNTS AS PART OF CHARITY CARE EXPENSE. - DO NOT COUNT MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. - REPORT THE NET EXPENSE FOR COMMUNITY BENEFIT SERVICES, I.E., THE TOTAL COMMUNITY BENEFIT EXPENSE MINUS ANY ASSOCIATED REVENUE FROM PATIENTS, PAYERS, AND OTHER EXTERNAL SOURCES. THE CHA REPORTING GUIDELINES REFLECT A CONSERVATIVE APPROACH TO REPORTING QUANTIFIABLE COMMUNITY BENEFIT. THE GOAL OF THE REPORTING GUIDELINES IS TO PRODUCE COMMUNITY BENEFIT FINANCIAL REPORTS THAT REFLECT TRUE COSTS AND THAT DESCRIBE COMMUNITY BENEFIT ACTIVITIES THAT INCREASE ACCESS TO HEALTH CARE AND IMPROVE COMMUNITY HEALTH. FOR FISCAL YEAR ENDED JUNE 30, 2012, 1) CHARITY CARE - AT COST DO NOT INCLUDE BAD DEBT. $ 1,346,287 2) GOVERNMENT SPONSORED HEALTH CARE - NET EXPENSE $ 4,996,879 UNPAID COST OF PUBLIC INDIGENT CARE PROGRAMS (INCLUDES MEDICAID, SCHIP, OTHER SAFETY NET PROGRAMS; DOES NOT INCLUDE MEDICARE SHORTFALL) 3) COMMUNITY BENEFIT PROGRAMS - NET EXPENSE $ 443,522 SPECIFIC EXPENSES MAY BE ITEMIZED AS APPROPRIATE. TOTAL QUANTIFIABLE COMMUNITY BENEFIT $ 6,786,688 OTHER EXAMPLES OF COMMUNITY BENEFIT PROGRAM NET EXPENSES OTHER PROGRAM SERVICES FORM 990, PART IV, LINE 4D ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING WOMENS' AND INFANT SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. st. nicholas hospital PROVIDEs AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, foot clinics, AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY.
Tax Exempt Bonds	Form 990 Part IV, Question 4	St. Nicholas Hospital HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"). AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HSSI FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODY	FORM 990 PART VI, LINES 6 & 7A	THE SENIOR GOVERNING BODY OF ST. NICHOLAS HOSPITAL (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT.
MEMBER RESERVED POWERS	FORM 990 PART VI, LINE 7B	Responsibility for the policy and operations of St. Nicholas Hospital (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Services, Inc. ("HSSI"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who, from time to time, are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values, or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease, or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate, and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI.
FORM 990 REVIEW PROCESS	FORM 990 PART VI, LINE 11B	The hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission, and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS.
CONFLICT OF INTEREST POLICY	FORM 990 PART VI, LINE 12C	The organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. the current CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY was effective JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, and ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS, AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED to PROMPTLY DISCLOSE such 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, which 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 IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, the committee HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION, OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY, AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICY	FORM 990 PART VI, LINE 13	Provisions within the Corporate Compliance Program and Conflict of Interest Policy provide protections for whistleblower type activities.
COMPENSATION PROCESS	FORM 990 PART VI, LINE 15	The Compensation Committee ("Committee") is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies ("IHS"), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges, and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting. Joint Ventures FORM 990 PART VI, LINE 16B Hospital Sisters Health System adopted a Joint Venture Compliance Program policy effective on January 1, 2012 for all system hospitals, including St. Nicholas Hospital. The overall purpose of the policy is to provide practical guidelines for ethical business conduct, to achieve compliance, and to detect and prevent violations of applicable laws. The policy requires St. Nicholas Hospital, and all HSHS hospitals, to evaluate their participation in joint venture arrangements, including under applicable federal tax laws, and to safeguard St. Nicholas hospitals tax exempt status with respect to any joint venture arrangements.
DOCUMENTS AVAILABLE TO THE PUBLIC	FORM 990 PART VI, LINE 19	Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time.
POOLED INVESTMENT ACCOUNT	FORM 990 PART X, LINE 11	St. Nicholas Hospital's cash reserves are invested in a pooled investment account. Participation in the pooled fund is limited to the 501(C)(3) Hospitals and related health services organizations sponsored by the Hospital Sisters Health System. The pooled account consists of cash, and equity and debt securities that are publicly traded. In accordance with the provisions of SFAS No. 124 "Accounting for certain investments held by Not-For-Profit Organizations," investments in equity securities with readily determinable values, and all investments in debt securities, are reported at fair value on the Balance Sheet. Income, realized and unrealized gains and losses are pooled and allocated to the participants. Individual components of assets and revenue are not identified to the participants.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 5	unrealized losses from investments (1,454,036) change in fair value of interest rate swaps (1,104,687) unrealized losses on investments at foundation (570,455) increase in temporarily restricted net assets 332,687 increase in permanently restricted net assets 10,750 contributions reported on foundation (321,523) transfer to related organization (716,000) pension changes other than net periodic cost (5,107,819) ----------- (8,931,083) ===========
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:SR. MARYBETH CULNAN, OSF TITLE:BOARD MEMBER HOURS:59
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ANN m. CARR TITLE:TREASURER HOURS:60
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:THERESE PANDL TITLE:DIVISIONAL CEO HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:GREG SIMIA TITLE:DIVISION CFO HOURS:45

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Total IncomeTotalIncome	EOY AssetsEOYAssets	Business Name Line1DirectControllingEntityName/BusinessNameLine1
KIARA CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	261417684	HEALTHCARE	IL	0	0	HSSI
PHYSICIAN CLINICAL INTEGRATION NETWORK L
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371668647	HEALTHCARE	IL	0	0	KCIN
SPRINGFIELD HEALTH PARTNERS LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371364419	HEALTHCARE	IL	0	0	HSHS MG

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
HOSPITAL SISTERS OF ST FRANCIS FDTN
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371186514	HEALTHCARE	IL	501(C)(3)	11A	NA	false
HOSPITAL SISTERS HEALTH SYSTEM
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371058692	HEALTHCARE	IL	501(C)(3)	11A	NA	false
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163402	HEALTHCARE	IL	501(C)(3)	11A	NA	false
HSHS HEALTH CARE PLAN TRUST FUND
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371137724	HEALTHCARE	IL	501(C)(9)	N/A	NA	false
HOSPITAL SISTERS HEALTHCARE - WEST INC
2661 COUNTY HIGHWAY I	CHIPPEWA FALLS	WI	54729	510157933	HEALTHCARE	WI	501(C)(3)	11A	NA	false
SACRED HEART HOSPITAL
900 WEST CLAIREMONT AVENUE	EAU CLAIRE	WI	54701	390807060	HEALTHCARE	WI	501(C)(3)	3	NA	false
ST NICHOLAS HOSPITAL
3100 SUPERIOR AVENUE	SHEBOYGAN	WI	53081	390808480	HEALTHCARE	WI	501(C)(3)	3	NA	false
ST ELIZABETH'S HOSPITAL
211 SOUTH THIRD STREET	BELLEVILLE	IL	62220	370663567	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST JOHN'S HOSPITAL
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	370661238	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST FRANCIS HOSPITAL
1215 FRANCISCAN DRIVE	LITCHFIELD	IL	62056	370661236	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST JOSEPH'S HOSPITAL
9515 HOLY CROSS LANE	BREESE	IL	62230	371208459	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST JOSEPH'S HOSPITAL
1515 MAIN STREET	HIGHLAND	IL	62249	370663568	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST JOSEPH'S HOSPITAL
2661 COUNTY HIGHWAY 1	CHIPPEWA FALLS	WI	54729	390810545	HEALTHCARE	WI	501(C)(3)	3	NA	false
ST MARY'S HOSPITAL
1800 E LAKE SHORE DRIVE	DECATUR	IL	62521	362169181	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST MARY'S HOSPITAL
111 SPRING STREET	STREATOR	IL	61364	362169181	HEALTHCARE	IL	501(C)(3)	3	NA	false
ST VINCENT HOSPITAL
835 S VAN BUREN	GREEN BAY	WI	54301	390817529	HEALTHCARE	WI	501(C)(3)	3	NA	false
ST MARY'S HOSPITAL MEDICAL CENTER
1726 SHAWANO AVENUE	GREEN BAY	WI	54303	390818682	HEALTHCARE	WI	501(C)(3)	3	NA	false
HSHS MEDICAL GROUP INC
3215 Executive Park Drive	SPRINGFIELD	IL	62703	263956318	HEALTHCARE	IL	501(C)(3)	11A	NA	false
HSHS WISCONSIN MEDICAL GROUP INC
3215 Executive Park Drive	Springfield	IL	62703	264515959	HEALTHCARE	WI	501(C)(3)	11A	NA	false
HSHS SELF INSURANCE TRUST FUND
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371120626	INSURANCE	IL	501(C)(3)	11A	NA	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

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	Code VCodeVAmount	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership
MEMORIAL AND ST ELIZABETH'S HEALTHCARE
4000 NORTH ILLINOIS STREET	SWANSEA	IL	62226	371312961	HEALTHCARE	IL	ST ELIZABETH'S	RELATED	0	0	false	$0	false	0.00000
PRAIRIE HEART INSUTUTE - CARBONDALE LLC
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	371321197	HEALTHCARE	IL	ST JOHN'S	RELATED	0	0	false	$0	false	0.00000
NORTHEAST WISCONSIN RADIATION THERAPY SE
1821 S WEBSTER AVENUE STE 300	GREEN BAY	WI	543079047	263749065	HEALTHCARE	WI	HSSI	RELATED	0	0	false	$0	false	0.00000
PAIN CENTER OF WISCONSIN
4131 W LOOMIS ROAD STE 300	GREENFIELD	WI	53221	263155343	HEALTHCARE	WI	ST VINCENT	RELATED	0	0	false	$0	false	0.00000
SURGERY CENTER OF SHEBOYGAN LLC
3141 SAEMANN AVE	SHEBOYGAN	WI	53081	260822209	HEALTHCARE	WI	ST NICHOLAS	RELATED	0	0	false	$0	false	0.00000
PREVEA VENTURES LLC
2710 EXECUTIVE DR	GREEN BAY	WI	54304	203775127	HEALTHCARE	WI	HSSI	RELATED	0	0	false	$0	false	0.00000
CARPENTER STREET HOTEL LLC
525 NORTH SIXTH STREET	SPRINGFIELD	IL	62702	364128127	HOTEL	IL	LASANTE INC	RELATED	0	0	false	$0	false	0.00000
SPRINGFIELD URGENT CARE REAL ESTATE LLC
PO BOX 19456	SPRINGFIELD	IL	627949456	030413258	RENT. REAL ES	IL	LASANTE INC	RELATED	0	0	false	$0	false	0.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
KIARA INC
4936 LAVERNA RD	SPRINGFIELD	IL	62707	371163401	HEALTHCARE	IL	HSHS	C CORP	0	0	0.00000
LASANTE WISCONSIN INC
4936 LAVERNA RD	SPRINGFIELD	IL	62707	391572196	HEALTHCARE	IL	KIARA INC	C CORP	0	0	0.00000
LASANTE INC
4936 LAVERNA RD	SPRINGFIELD	IL	62707	371163400	HEALTHCARE	IL	KIARA INC	C CORP	0	0	0.00000
PRAIRIE CARDIOVASCULAR
619 EAST MASON STE 4P57	SPRINGFIELD	IL	62701	371071858	HEALTHCARE	IL	KIARA INC	C CORP	0	0	0.00000
PREVEA HEALTH SERVICES
2710 EXECUTIVE DR	GREEN BAY	WI	54304	391839351	HEALTHCARE	WI	HSSI	C CORP	0	0	0.00000
PREVEA CLINIC INC
2710 EXECUTIVE DR	GREEN BAY	WI	54304	391839349	HEALTHCARE	WI	HSSI	C CORP	0	0	0.00000
PREVEA HEALTH NETWORK
2710 EXECUTIVE DR	GREEN BAY	WI	54304	392000537	HEALTHCARE	WI	HSSI	C CORP	0	0	0.00000
RENAISSANCE QUALITY INSURANCE
				980669953	INSURANCE		hssi	c corp	0	0	0.00000	PO BOX 1159	grand caymans	CJ	KY1-1102	CJ

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	true	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	true	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	true	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	TRANSACTIONS WITH RELATED ENTITIES	Identifier
Return Reference	FORM 990 SCHEDULE R, PART V LINE 2	ReturnReference
Explanation	The Transactions reported in Question 1 are between related 501(c)(3) public charities and are not reported in this section.	Explanation