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FROEDTERT SOUTH INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FROEDTERT SOUTH INC (EIN 39-0816845)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201331359349307963
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-15T15:47:32-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390758449EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WIPFLI LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line110000 INNOVATION DRIVE SUITE 250AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code532264837ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390816845EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNITED HOSPITAL SYSTEM INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlUNITNameControl
Phone2625778113Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line16308 8TH AVENUEAddressLine1
CityKENOSHACity
StateWIState
ZIP Code53143ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTHOMAS J KELLEYName
TitleVP & CFOTitle
Phone2625778113Phone
Date Signed2013-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAY ADKISSON CPAName
PTINP01360892PTIN
Phone4144319300Phone
Date Prepared2013-05-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTHOMAS J KELLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line16308 8TH AVENUEAddressLine1
CityKENOSHACity
StateWIState
ZIP Code53143ZIPCode
FieldValueIRS element (for citing)
Gross Receipts331067628GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.UNITEDHOSPITALSYSTEM.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1910YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionUNITED HOSPITAL SYSTEM, INC. IS COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL-BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING. WE STRIVE TO RECRUIT AND RETAIN THE BEST PHYSICIANS AND STAFF AND PURCHASE THE BEST DIAGNOSTIC AND CURATIVE MEDICAL EQUIPMENT THAT OUR FINANCIAL RESOURCES WILL PERMIT. WE ALSO STRIVE TO BE ACCESSIBLE TO ALL MEMBERS OF OUR COMMUNITY WITH EMERGENT AND URGENT HEALTHCARE NEEDS, IRRESPECTIVE OF THEIR ABILITY TO PAY. THIS IS OUR COMMITTMENT TO THE QUALITY, ACCESSIBILITY AND AFFORDABILITY FUNDAMENTALS AFFECTING THE DELIVERY OF HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees2509TotalNbrEmployees
Total Nbr Volunteers151TotalNbrVolunteers
Total Gross UBI234491TotalGrossUBI
Net Unrelated Business Txbl Income-16528NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year39070ContributionsGrantsPriorYear
Contributions Grants Current Year100831ContributionsGrantsCurrentYear
Program Service Revenue Prior Year284810928ProgramServiceRevenuePriorYear
Program Service Revenue CY303624543ProgramServiceRevenueCY
Investment Income Prior Year2566994InvestmentIncomePriorYear
Investment Income Current Year1028282InvestmentIncomeCurrentYear
Other Revenue Prior Year710808OtherRevenuePriorYear
Other Revenue Current Year628391OtherRevenueCurrentYear
Total Revenue Prior Year288127800TotalRevenuePriorYear
Total Revenue Current Year305382047TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year9395GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY11745GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year142050026SalariesEtcPriorYear
Salaries Etc Current Year144860983SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year124744225OtherExpensePriorYear
Other Expenses Current Year132539069OtherExpensesCurrentYear
Total Expenses Prior Year266803646TotalExpensesPriorYear
Total Expenses Current Year277411797TotalExpensesCurrentYear
Revenues Less Expenses Prior Year21324154RevenuesLessExpensesPriorYear
Revenues Less Expenses CY27970250RevenuesLessExpensesCY
Total Assets BOY311712686TotalAssetsBOY
Total Assets EOY323780841TotalAssetsEOY
Total Liabilities BOY80483668TotalLiabilitiesBOY
Total Liabilities EOY118963026TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY231229018NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY204817815NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionUNITED HOSPITAL SYSTEM, INC. IS A COMPREHENSIVE REGIONAL HEALTHCARE SYSTEM THAT HAS SERVED SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS COMMUNITIES FOR MORE THAN 100 YEARS. UNITED HOSPITAL SYSTEM PROVIDES SERVICES PRIMARILY THROUGH THE KENOSHA MEDICAL CENTER CAMPUS AND THE ST. CATHERINE'S MEDICAL CENTER CAMPUS AND SEVERAL OTHER CLINIC LOCATIONS. WE, AT UNITED, ARE COMMITTED TO LIVING OUT THE HEALING MINISTRIES OF THE JUDEO-CHRISTIAN FAITHS BY PROVIDING EXCEPTIONAL AND COMPASSIONATE HEALTHCARE SERVICES THAT PROMOTES THE DIGNITY AND WELL BEING OF THE PEOPLE WE SERVE. THIS IS OUR MISSION AND OUR REASON FOR BEING.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense233699858Expense
Grants11745Grants
Revenue304031583Revenue
DescriptionACUTE CARE HOSPITAL THAT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO ITS COMMUNITY.Description
Total Program Service Expense233699858TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109668NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2509NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2625778113TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16308 8TH AVENUEAddressLine1
CityKENOSHACity
StateWIState
ZIP Code53143ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JAMES ARNESON
CHAIRMAN2.00XX000
DR F GREGORY CAMPBELL
VICE-CHAIRMAN2.00XX000
ROBERT A CORNOG
SECRETARY/TREASURER/DIRECTOR2.00XX000
RICHARD O SCHMIDT JR
PRESIDENT/CEO/DIRECTOR45.00XX10336430155434
EDWARD C EMMA
DIRECTOR2.00X000
HAROLD W MAYER
DIRECTOR2.00X000
A JAMES CICCHINI
DIRECTOR2.00X000
JAMES CONCANNON MD
DIRECTOR2.00X000
DON E KAELBER
DIRECTOR2.00X000
RAYMOND KNIGHT MD
DIRECTOR/PHYSICIAN2.00X738397051038
ROBERT LEE JR
DIRECTOR2.00X000
JOSEPH F MADRIGRANO SR
DIRECTOR2.00X000
LAWRENCE REIF MD
DIRECTOR2.00X000
W HARLEY SOBIN MD
DIRECTOR/PHYSICIAN2.00X978181051675
LINDA WOHLGEMUTH
ASST SECRETARY/VP-COO-SCMCC45.00X421317063429
CHARLES TALBERT - THRU JUN 2011
ASST TREASURER/VP-CFO45.00X179352033434
THOMAS KELLEY - BEGIN JUL 2011
ASST TREASURER/VP-CFO45.00X225939073594
SUSAN VENTURA
SVP/COO-KMCC45.00422309063429X
ASHWANI SETHI MD
PHYSICIAN40.00977629052054X
MARIO GARRETTO MD
PHYSICIAN40.00929846052543X
KATHERINE ABBO MD
PHYSICIAN40.00600254037787X
RAMANUJA MANDA MD
PHYSICIAN40.00597722051572X
WENDEL FRIEDL MD
PHYSICIAN40.00937850052566X
FieldValueIRS element (for citing)
Total Reportable Comp From Org8042439TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation738555TotalOtherCompensation
Number Individuals GT100 K111NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ECLIPSYS CORP
PO BOX 8538 133PHILADELPHIAPA19171IS SERVICES2518604
H M P OF KENOSHA COUNTY LTD
PO BOX 645037CINCINNATIOH45264MEDICAL1565263
QUEST DIAGNOSTICS
3924 COLLECTION CENTER DRCHICAGOIL60693MEDICAL1262753
ALL SAINTS
PO BOX 14759MILWAUKEEWI53214MEDICAL748414
WHEATON FRANCISCAN HEALTHCARE
PO BOX 14759MILWAUKEEWI53214MEDICAL668174
FieldValueIRS element (for citing)
Number Of Contractors GT100 K29NumberOfContractorsGT100K
Fundraising Events23265FundraisingEvents
All Other Contributions77566AllOtherContributions
Total Contributions100831TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE RE623000298212244298212244
OTHER OPERATING REVENU62399054122995177808234491
FieldValueIRS element (for citing)
Total Program Service Revenue303624543TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1273276TotalRevenueColumn
Exclusion$1,273,276ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real641531Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real641531Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column641531TotalRevenueColumn
Related Or Exempt Function Income641531RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities25230607Securities
Other155000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities25428202Securities
Other202399Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-197595Securities
Other-47399Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-244994TotalRevenueColumn
Exclusion-$244,994ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events41840GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events23265CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses54980FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-13140TotalRevenueColumn
Exclusion-$13,140ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column305382047TotalRevenueColumn
Related Or Exempt Function Income304031583RelatedOrExemptFunctionIncome
Unrelated Business Revenue234491UnrelatedBusinessRevenue
Exclusion$1,015,142ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total11745Total
Program Services11745ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4491171Total
Program Services3562053ProgramServices
Management And General929118ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total110330756Total
Program Services92842390ProgramServices
Management And General17488366ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6510943Total
Program Services5478903ProgramServices
Management And General1032040ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total16437005Total
Program Services6574782ProgramServices
Management And General9862223ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total7091108Total
Program Services5922587ProgramServices
Management And General1168521ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total13904719Total
Program Services8695588ProgramServices
Management And General5209131ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total343946Total
Program Services152945ProgramServices
Management And General191001ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total52995205Total
Program Services50434173ProgramServices
Management And General2561032ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4669454Total
Program Services4669454ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6224494Total
Program Services6105086ProgramServices
Management And General119408ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total567694Total
Program Services154874ProgramServices
Management And General412820ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1192513Total
Program Services1073262ProgramServices
Management And General119251ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total15725243Total
Program Services14152719ProgramServices
Management And General1572524ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1027164Total
Program Services440126ProgramServices
Management And General587038ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS2030968620309686
STATE HOSPITAL ASSESSME79668797966879
REPAIRS20989091480562618347
GROCERIES17105832362221474361

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total3802580Total
Program Services3435822ProgramServices
Management And General366758ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total277411797Total
Program Services233699858ProgramServices
Management And General43711939ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY20231914BOY
EOY47819261EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY34535648BOY
EOY36239122EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY3582164BOY
EOY4213110EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3612675BOY
EOY4212357EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis250122998LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec163970349LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY89867452BOY
EOY86152649EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY90616034BOY
EOY81786222EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY69266799BOY
EOY63358120EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY311712686BOY
EOY323780841EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY28597704BOY
EOY28493220EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY23675025BOY
EOY16378570EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY28210939BOY
EOY74091236EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY80483668BOY
EOY118963026EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY229216892BOY
EOY202778673EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY495243BOY
EOY520158EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1516883BOY
EOY1518984EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY231229018BOY
EOY204817815EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY311712686BOY
EOY323780841EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses27970250ReconcilationRevenueExpenses
Reconcilation Other Changes-54381453ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2012126BeginningOfYearBalance
Investment Earnings Or Losses38761InvestmentEarningsOrLosses
Other Expenditures11745OtherExpenditures
End Of Year Balance2039142EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1998034BeginningOfYearBalance
Investment Earnings Or Losses23485InvestmentEarningsOrLosses
Other Expenditures9395OtherExpenditures
End Of Year Balance2012124EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1973518BeginningOfYearBalance
Investment Earnings Or Losses46211InvestmentEarningsOrLosses
Other Expenditures21695OtherExpenditures
End Of Year Balance1998034EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1955842BeginningOfYearBalance
Investment Earnings Or Losses33529InvestmentEarningsOrLosses
Other Expenditures15853OtherExpenditures
End Of Year Balance1973518EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.74000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.26000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5519546OtherCostOrOtherBasis
Book Value5519546BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis114805242OtherCostOrOtherBasis
Depreciation77447615Depreciation
Book Value37357627BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis123948289OtherCostOrOtherBasis
Depreciation84920154Depreciation
Book Value39028135BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5849921OtherCostOrOtherBasis
Depreciation1602580Depreciation
Book Value4247341BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings86152649TotalOfBookValueLandBuildings

Other Securities OtherSecurities (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
CASH EQUIVLENTS8980022C
CERTIFICATE OF DEPOSIT15000000C
FIXED INCOME FUNDS19858253C
EQUITY MUTUAL FUNDS29789964C
EQUITY SECURITIES8157983C
FieldValueIRS element (for citing)
Total Of Book Value Securities81786222TotalOfBookValueSecurities

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionDUE FROM AFFILIATEDescription
Book Value63358120BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets63358120TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$8,067,658
PENSION LIABILITY$66,023,578
FieldValueIRS element (for citing)
Total Of Amounts74091236TotalOfAmounts
Total Revenue305382047TotalRevenue
Total Expenses277411797TotalExpenses
Excess Or Deficit For Year27970250ExcessOrDeficitForYear
Net Unrealized GL On Investments-906169NetUnrealizedGLOnInvestments
Other-$53,475,284OtherAmount
Total Adjustments-54381453TotalAdjustments
Excess Or Deficit Per FS-26411203ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt259560202TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-906169NetUnrealizedGainsInvestments
Other Revenues-44915676OtherRevenues
Revenue Not Rptd F990-45821845RevenueNotRptdF990
Revenue Subtotal305382047RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990305382047TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt279655242TotExpensesEtcAuditedFinclStmt
Other Expenses Included2398466OtherExpensesIncluded
Expenses Not Rptd F9902398466ExpensesNotRptdF990
Expenses Subtotal277256776ExpensesSubtotal
Other Expenses Not Included155021OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt155021ExpensesNotRptdOnFinStmt
Total Expenses Per Form990277411797TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:TEMPORARILY RESTRICTED NET ASSETS ARE RESTRICTED FOR EDUCATION SCHOLARSHIP GRANTS AND VARIOUS HEALTH CARE PROGRAMS. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE FOR HOSPITAL DEVELOPMENT.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE CORPORATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THAT TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE CORPORATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS IN 2011 AND 2010. TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2008 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN MINIMUM PENSION OBLIGATION -44,964,082. REVENUE SHARING WITH AFFILIATE -8,654,478. MACRS DEPRECIATION ADJUSTMENT 143,276. TOTAL TO SCHEDULE D, PART XI, LINE 8: -53,475,284.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN PENSION OBLIGATION OTHER THAN PENSION EXPENSE -44,964,082. REVENUE SHARING WITH AFFILIATE -8,654,478. SCHOLARSHIPS INCLUDED IN INCOME -11,745. RELATED ORGANIZATION REVENUE 8,671,360. FUNDRAISING EVENT EXPENSES 43,269.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RELATED ORGANIZATION EXPENSES 2,355,197. FUNDRAISING EVENT EXPENSES 43,269.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:SCHOLARSHIPS INCLUDED IN INCOME 11,745. MACRS DEPRECIATION ADJUSTMENT 143,276.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF OUTINGNameOfEvent1
Gross Receipts Event165105GrossReceiptsEvent1
Charitable Contributions Event123265CharitableContributionsEvent1
Gross Revenue Event141840GrossRevenueEvent1
Cash Prizes Event11100CashPrizesEvent1
Non Cash Prizes Event18333NonCashPrizesEvent1
Food And Beverage Event132080FoodAndBeverageEvent1
Other Direct Expenses Event113467OtherDirectExpensesEvent1
Gross Receipts Total65105GrossReceiptsTotal
Charitable Contributions Total23265CharitableContributionsTotal
Gross Revenue Total Events41840GrossRevenueTotalEvents
Cash Prizes Total Events1100CashPrizesTotalEvents
Non Cash Prizes Total Events8333NonCashPrizesTotalEvents
Food And Beverage Total Events32080FoodAndBeverageTotalEvents
Other Direct Expenses Total Events13467OtherDirectExpensesTotalEvents
Direct Expense Summary Events54980DirectExpenseSummaryEvents
Net Income Summary-13140NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3421669TotalCommunityBenefitExpense
Net Community Benefit Expense3421669NetCommunityBenefitExpense
Percent Of Total Expense0.01330PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense42738413TotalCommunityBenefitExpense
Direct Offsetting Revenue25037152DirectOffsettingRevenue
Net Community Benefit Expense17701261NetCommunityBenefitExpense
Percent Of Total Expense0.06880PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense46160082TotalCommunityBenefitExpense
Direct Offsetting Revenue25037152DirectOffsettingRevenue
Net Community Benefit Expense21122930NetCommunityBenefitExpense
Percent Of Total Expense0.08210PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs554NumberOfActivitiesOrPrograms
Persons Served62481PersonsServed
Total Community Benefit Expense108319TotalCommunityBenefitExpense
Net Community Benefit Expense108319NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served78PersonsServed
Total Community Benefit Expense660688TotalCommunityBenefitExpense
Net Community Benefit Expense660688NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs26NumberOfActivitiesOrPrograms
Persons Served547PersonsServed
Total Community Benefit Expense242132TotalCommunityBenefitExpense
Net Community Benefit Expense242132NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs580NumberOfActivitiesOrPrograms
Persons Served63106PersonsServed
Total Community Benefit Expense1011139TotalCommunityBenefitExpense
Net Community Benefit Expense1011139NetCommunityBenefitExpense
Percent Of Total Expense0.00390PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs580NumberOfActivitiesOrPrograms
Persons Served63106PersonsServed
Total Community Benefit Expense47171221TotalCommunityBenefitExpense
Direct Offsetting Revenue25037152DirectOffsettingRevenue
Net Community Benefit Expense22134069NetCommunityBenefitExpense
Percent Of Total Expense0.08600PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1971TotalCommunityBuildingExpense
Net Community Building Expense1971NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Persons Served37PersonsServed
Total Community Building Expense144518TotalCommunityBuildingExpense
Net Community Building Expense144518NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Persons Served150PersonsServed
Total Community Building Expense1314TotalCommunityBuildingExpense
Net Community Building Expense1314NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs11NumberOfActivitiesOrPrograms
Persons Served187PersonsServed
Total Community Building Expense147803TotalCommunityBuildingExpense
Net Community Building Expense147803NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$7,128,699BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare46926231AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare62961424CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-16035193MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24Hours
KENOSHA MEDICAL CENTER CAMPUS
16308 8TH AVENUEKENOSHAWI53143XXX
SAINT CATHERINE'S MEDICAL CENTER CAMPUS
29555 76TH STREETPLEASANT PRAIRIEWI53158XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumberCHNA ConductedCHNAConductedEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelAsset LevelAssetLevelMedical IndigencyMedicalIndigencyInsurance StatusInsuranceStatusUninsured DiscountUninsuredDiscountExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresAvailable On RequestAvailableOnRequestActions On NonpaymentActionsOnNonpaymentPermit Report To Credit AgencyPermitReportToCreditAgencyCollection ActivitiesCollectionActivitiesReport To Credit AgencyReportToCreditAgencyNotified All PatientsNotifiedAllPatientsDocumented DeterminationDocumentedDeterminationNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyUsed Other MethodUsedOtherMethodAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
KENOSHA MEDICAL CENTER CAMPUS
1011200.0000000000001200.0000000000001XXXXX11X1X1XXX1X00
SAINT CATHERINE'S MEDICAL CENTER CAMPUS
2011200.0000000000001200.0000000000001XXXXX11X1X1XXX1X00

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities8NumberOfOtherFacilities

Other Facilities OtherFacilities (8 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
KENOSHA NORTHSIDE CLINIC
3601 30TH AVENUE SUITE 205KENOSHAWI53143OUTPATIENT PHYSICIAN CLINIC
PADDOCK LAKE FAMILY MEDICINE CLINIC
7322 236TH AVENUEPADDOCK LAKEWI53168OUTPATIENT PHYSICIAN CLINIC
THE GURNEE CLINIC
1790 NATIONS DRIVE SUITE 106GURNEEIL60031OUTPATIENT PHYSICIAN CLINIC
LAKEVIEW RECPLEX
9900 TERWALL TERRACEPLEASANT PRAIRIEWI53158REHABILITATION CLINIC
VERNON ELEMENTARY SCHOOL - POOL AREA
8518 22ND AVENUEKENOSHAWI53143REHABILITATION CLINIC
NORTH CENTRAL CLINIC
6127 GREEN BAY ROAD SUITE 200KENOSHAWI53142OUTPATIENT PHYSICIAN CLINIC
SCMCC-MMB
9697 ST CATHERINES DRIVEPLESANT PRAIRIEWI53158OUTPATIENT PHYSICIAN CLINIC
RCW ADMINISTRATIVE BUILDING
5000 68TH AVEKENOSHAWI53144ADMINISTRATIVE BUILDING

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifier
PART I, LINE 7: THE COST METHOD USED TO CALCULATE THE COST OF THE COMMUNITY BENEFIT PROGRAMS WAS THE COST-TO-CHARGE RATIO. WORKSHEET 2 WAS USED TO CALCULTE THE RATIO OF PATIENT CARE COST TO CHARGES.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 20309686.
PART II: MANY STAFF MEMBERS ARE UTILIZED TO PROMOTE THE HEALTH OF THE COMMUNITY AND THE GENERAL WELL-BEING OF THE COMMUNITY WE SERVE. THROUGH OUR EMERGENCY PREPAREDNESS COMMITTEE, STAFF ARE ALWAYS PLANNING AND PREPARING TO BE READY TO MEET THE NEEDS OF THE COMMUNITY AS EVENTS OCCUR. ADDITIONALLY, A VARIETY OF STAFF WORK WITH LOCAL SCHOOLS AND OTHER ORGANIZATIONS TO GIVE TALKS PROMOTING HEALTH AND CAREERS IN HEALTHCARE. A NUMBER OF STAFF MEMBERS ARE INVOLVED IN MENTORING PROGRAMS WITHIN THE LOCAL SCHOOLS. RECOGNIZING THE IMPORTANCE OF SUSTAINING AND GROWING OUR ECONOMY, WE PARTICIPATE IN OUR LOCAL BUSINESS ALLIANCE.
PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION EXPERIENCE AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. WORKSHEET A IN THE INSTRUCTIONS WAS USED TO DETERMINE THE COSTING METHODOLOGY.
PART III, LINE 8: SCHEDULE H PART III SECTION B LINE 6 REPORTS "ALLOWABLE COSTS OF CARE" AS TAKEN FROM THE MOST RECENTLY FILED MEDICARE COST REPORT AVAILABLE AT THE TIME THE COMMUNITY BENEFIT REPORT IS PUBLISHED. THE MEDICARE COST REPORT CALCULATES ITS ALLOWABLE TOTAL COSTS BASED ON APPLICABLE MEDICARE REGULATIONS. MEDICARE AND MEDICAID COST IS DETERMINED USING INDIVIDUAL COST CENTER COST-TO-CHARGE RATIOS. THIS COST TO CHARGE RATIO IS DETERMINED USING ALL PAYER COST AND ALL PAYER CHARGES. THE COST TO CHARGE RATIO IS APPLIED TO THE ACTUAL MEDICARE AND MEDICAID CHARGES TO DETERMINE THE MEDICARE AND MEDICAID COST. THIS ORGANIZATION HAS ADOPTED THE COST AND CHARGE PRACTICES AS RECOMMENDED BY THE CATHOLIC HEALTH ASSOCIATION AND THE WISCONSIN, IOWA, OR ILLINOIS HOSPITAL ASSOCIATION AS APPLICABLE, AND THEREFORE, DOES NOT COUNT ANY MEDICARE SHORTFALL NUMBERS IN ITS ANNUAL REPORTING OF COMMUNITY BENEFIT AMOUNTS.
PART III, LINE 9B: OUR COLLECTION PROCESS IS THE SAME FOR ALL PATIENTS, REGARDLESS IF THEY QUALIFY FOR FINANCIAL ASSISTANCE. WE BILL ALL INSURANCES. PATIENT DOES NOT RECEIVE A COPY OF THE BILL UNTIL IT IS THEIR BALANCE. WE SEND THREE STATEMENTS FROM OUR FINANCIAL SYSTEM. WE HAVE AN OUTSIDE COLLECTION AGENCY SEND OUT OUR REQUIRED FINAL REQUEST LETTERS. FROM THIS POINT THE OUTSTANDING BALANCE IS HANDLED BY THE COLLECTION AGENCY. THE ACCOUNT DOES STAY ACTIVE ON OUR FINANCIAL SYSTEM FOR ONE YEAR. AT THAT TIME THE OUTSTANDING BALANCE IS MOVED OVER TO A BAD DEBT STATUS.
PART V, SECTION B, LINE 19D: SELF-PAY PATIENTS ARE OFFERED A FLAT DISCOUNT AND A PROMPT PAY DISCOUNT OFF BILLED SERVICES. MEANS TEST IS APPLIED TO DETERMINE IF ADDITIONAL DISCOUNTING IS POSSIBLE. PAYMENT AMOUNT IS DETERMINED BASED UPON 2012 HSS POVERTY GUIDELINES.KENOSHA MEDICAL CENTER CAMPUS
PART V, SECTION B, LINE 19D: SELF-PAY PATIENTS ARE OFFERED A FLAT DISCOUNT AND A PROMPT PAY DISCOUNT OFF BILLED SERVICES. MEANS TEST IS APPLIED TO DETERMINE IF ADDITIONAL DISCOUNTING IS POSSIBLE. PAYMENT AMOUNT IS DETERMINED BASED UPON 2012 HSS POVERTY GUIDELINES.SAINT CATHERINE'S MEDICAL CENTER CAMPUS
PART VI, LINE 2: IN AN EFFORT TO UNDERSTAND AND ASSIST IN ADDRESSING THE NEEDS OF THE COMMUNITY WE SERVE, UNITED HOSPITAL SYSTEM HAS INVOLVEMENT IN A VARIETY OF COMMUNITY COMMITTEES. UNITED HOSPITAL SYSTEM HAS MULTIPLE STAFF, MANAGEMENT AND ADMINISTRATIVE LEVEL EMPLOYEES PARTICIPATE IN COMMITTEES THAT ARE SET UP TO ASSESS AND ADDRESS NEEDS IN THE COMMUNITY SUCH AS A HEALTHY LIFESTYLE COMMITTEE, MENTAL HEALTH COMMITTEE, INJURY PREVENTION COMMITTEE, SUICIDE PREVENTION COMMITTEE, INFANT MORTALITY COMMITTEE. THROUGH OUR PARTICIPATION IN COMMUNITY COMMITTEES WE GAIN AN UNDERSTANDING ABOUT THE NEEDS OF THE COMMUNITY AS WELL AS THE OPPORTUNITY TO WORK TOGETHER TO ADDRESS THE NEEDS.
PART VI, LINE 3: WHEN STATEMENTS ARE SENT FROM OUR FINANCIAL SYSTEM, THERE IS A PHONE NUMBER FOR THE PATIENT TO CALL FOR ASSISTANCE WITH THEIR BALANCES. PATIENTS CALL AND WE WORK WITH THEM TO SET UP PAYMENT ARRANGEMENTS. IF THEY EXPRESS ANY CONCERNS FOR FINANCIAL NEEDS WE OFFER TO SEND THEM A COMMUNITY CARE APPLICATION.
PART VI, LINE 4: KENOSHA COUNTY IS A FAST GROWING LAKESHORE COUMMUNITY IN SOUTHEASTERN WISCONSIN. LOCATED BETWEEN CHICAGO AND MILWAUKEE, KENOSHA COUNTY BOASTS A DIVERSE ECONOMY. KENOSHA IS THE FOURTH LARGEST CITY IN THE STATE OF WISCONSIN WITH 99,218 RESIDENTS REPORTED IN THE 2010 CENSUS. KENOSHA IS NOW THE EIGHTH LARGEST COUNTY IN WISCONSIN IN TERMS OF POPULATION WITH 166,426 RESIDENTS. UNITED HOSPITAL SYSTEM SERVES PEOPLE IN SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS THROUGH ITS TWO HOSPITAL CAMPUSES, ST CATHERINE'S MEDICAL CENTER AND KENOSHA MEDICAL CENTER. AURORA MEDICAL CENTER ALSO HAS A HOSPITAL CAMPUS IN KENOSHA.
PART VI, LINE 5: UNITED HOSPITAL SYSTEM IS COMMITTED TO IMPROVING THE HEALTH OF OUR PATIENTS AND NEIGHBORS. WE OFFER A VARIETY OF COMMUNITY OUTREACH PROGRAMS TO HELP THE GENERAL PUBLIC MAINTAIN GOOD HEALTH. THESE INCLUDE FREE COMMUNITY EDUCATION SEMINARS, HEALTH SCREENINGS, AND VARIOUS SUPPORT GROUPS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIP FINANCIAL ASSISTANCE TO INDIVIDUALSTypeOfGrant
Number Of Recipients11NumberOfRecipients
Amount Of Cash Grant11745AmountOfCashGrant

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RICHARD O SCHMIDT JR
7076680312948013027013087002456401189077000
RAYMOND KNIGHT MD
3736040003647930308700201680789435000
W HARLEY SOBIN MD
25925707178920103203087002080501029856000
LINDA WOHLGEMUTH
34972006927502322055870075590484746000
CHARLES TALBERT - THRU JUN 2011
156852022500000225980108360212786000
THOMAS KELLEY - BEGIN JUL 2011
19560503000003340534260201680299533000
SUSAN VENTURA
34947006927503564055870075590485738000
ASHWANI SETHI MD
4446200532457055203087002118401029683000
MARIO GARRETTO MD
5191010409161015840308700216730982389000
KATHERINE ABBO MD
5986700001584030870069170638041000
RAMANUJA MANDA MD
59613800015840308700207020649294000
WENDEL FRIEDL MD
24273302887506662420308700216960990416000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonROBERT LEENamePerson
FieldValueIRS element (for citing)
RelationshipDIRECTOR OF ORGANIZATIONRelationship
Amount Of Transaction307090AmountOfTransaction
Description Of TransactionSERVICES PROVIDED BY LEE PLUMBINGDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVIEWED BY THE ORGANIZATION'S CFO AND CONTROLLER PRIOR TO FILING. A COPY OF THE 990 IS PROVIDED TO THE GOVERNING BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CUNITED HOSPITAL SYSTEM'S WRITTEN CONFLICT OF INTEREST POLICY FOR THE BOARD IS REVIEWED ANNUALLY BY EACH BOARD MEMBER, AND ANY POTENTIAL CONFLICTS OF INTEREST ARE DISCLOSED AT THAT TIME. THE WRITTEN CONFLICT OF INTEREST POLICY FOR EMPLOYEES IS REVIEWED DURING ORIENTATION AND PERIODICALLY AT ORGANIZATION MEETINGS, AND IS INCORPORATED INTO THE PERFORMANCE STANDARDS OF THEIR ANNUAL EVALUATIONS.
FORM 990, PART VI, SECTION B, LINE 15THE COMPENSATION FOR THE PRESIDENT, CEO AND GENERAL COUNSEL AND THE COMPENSATION FOR THE VICE PRESIDENTS REPORTING DIRECTLY TO THE PRESIDENT, CEO AND GENERAL COUNSEL ARE DETERMINED BY THE BOARD EXECUTIVE COMMITTEE WHICH SERVES AS THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE CONTRACTS WITH THE HEALTHCARE COMPENSATION FIRM NAMED THE GROVES GROUP, LLC, AND HAS UTILIZED THE PRESIDENT OF THE GROVES GROUP, LLC AS THE COMPENSATION CONSULTANT SINCE 2005. THE COMPENSATION CONSULTANT UTILIZES A METHODOLOGY THAT EVALUATES INTERNAL AND EXTERNAL EQUITY AFTER EVALUATING THE RESPONSIBILITIES OF EACH POSITION AND MAKES A RECOMMENDATION TO THE BOARD COMPENSATION COMMITTEE. THE BOARD COMPENSATION COMMITTEE HAS FOLLOWED THE DETAILED RECOMMENDATIONS OF THE COMPENSATION CONSULTANT ANNUALLY SINCE 2005 AND THE COMPENSATION CONSULTANT HAS BEEN RETAINED THROUGH 2015.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -906,169. CHANGE IN MINIMUM PENSION OBLIGATION -44,964,082. REVENUE SHARING WITH AFFILIATE -8,654,478. MACRS DEPRECIATION ADJUSTMENT 143,276. TOTAL TO FORM 990, PART XI, LINE 5: -54,381,453.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
ST CATHERINE'S HOSPITAL INC
6308 8TH AVENUEKENOSHAWI53143390855075HEALTHCAREWI501(C)(3)LINE 11B, II0
UHS INC
6308 8TH AVENUEKENOSHAWI53143391956749HEALTHCAREWI501(C)(3)LINE 90
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg