STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

COLUMBIA ST MARYS HOSPITAL MILWAUKEE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COLUMBIA ST MARYS HOSPITAL MILWAUKEE INC (EIN 39-0806315)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201331359349309183
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)
Timestamp2013-05-15T18:25:47-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELOITTE TAX LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1555 E WELLS SUITE 1400AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390806315EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA ST MARY'S HOSPITAL MILWAUKEEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone4143262230Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14425 N PORT WASHINGTON ROADAddressLine1
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARK TAYLORName
TitlePRESIDENT/CEOTitle
Phone4143262230Phone
Date Signed2013-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
PTINP00966076PTIN
Phone4142713000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARK TAYLORNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14425 N PORT WASHINGTON ROADAddressLine1
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Gross Receipts476465848GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteCOLUMBIA-STMARYS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1859YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionFULL-SERVICE HOSPITAL WITH MEDICAL, SURGICAL, ADVANCED CLINICAL AND OTHER COMMUNITY SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees2878TotalNbrEmployees
Total Nbr Volunteers393TotalNbrVolunteers
Total Gross UBI3434662TotalGrossUBI
Net Unrelated Business Txbl Income-3992985NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1419275ContributionsGrantsPriorYear
Contributions Grants Current Year1069589ContributionsGrantsCurrentYear
Program Service Revenue Prior Year480834242ProgramServiceRevenuePriorYear
Program Service Revenue CY462713797ProgramServiceRevenueCY
Investment Income Prior Year1563302InvestmentIncomePriorYear
Investment Income Current Year270InvestmentIncomeCurrentYear
Other Revenue Prior Year10115718OtherRevenuePriorYear
Other Revenue Current Year12682192OtherRevenueCurrentYear
Total Revenue Prior Year493932537TotalRevenuePriorYear
Total Revenue Current Year476465848TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year227704214SalariesEtcPriorYear
Salaries Etc Current Year220138233SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year296036320OtherExpensePriorYear
Other Expenses Current Year261096590OtherExpensesCurrentYear
Total Expenses Prior Year523740534TotalExpensesPriorYear
Total Expenses Current Year481234823TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-29807997RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-4768975RevenuesLessExpensesCY
Total Assets BOY681031989TotalAssetsBOY
Total Assets EOY619741975TotalAssetsEOY
Total Liabilities BOY454426496TotalLiabilitiesBOY
Total Liabilities EOY394946704TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY226605493NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY224795271NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCOLUMBIA ST. MARY'S HOSPITAL MILWAUKEE ("CSM-M") IS PART OF COLUMBIA ST. MARY'S INC. ("CSM"), A HEALTHCARE PROVIDER FOUNDED IN RESPONSE TO IDENTIFIED COMMUNITY NEEDS, WHICH IS SPONSORED BY ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM, AND COLUMBIA HEALTH SYSTEM, A NON-SECTARIAN COMMUNITY HEALTH SYSTEM. CSM-M'S GOVERNING BODY HAS ADOPTED THE MISSION OF CSM. CSM EXISTS TO MAKE A POSITIVE DIFFERENCE IN THE HEALTH STATUS AND LIVES OF INDIVIDUALS AND OUR COMMUNITY, WITH SPECIAL CONCERN FOR THOSE WHO ARE VULNERABLE. CSM AND ITS AFFILIATES ARE COMMITTED TO PROVIDING HIGH-QUALITY, ACCESSIBLE, VALUES-DRIVEN PROGRAMS AND SERVICES WITH EQUAL ATTENTION TO THE PHYSICIAL, SPIRITUAL, AND EMOTIONAL DIMENSIONS OF HEALTH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense400754964Expense
Revenue470926641Revenue
DescriptionCSM-M OPERATES A FULL-SERVICE 336-BED HOSPITAL, WHICH OFFERS A COMPLETE RANGE OF MEDICAL, SURGICAL AND ADVANCED CLINICAL SPECIALITIES. CSM-M OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. DURING FISCAL 2012, CSM-M'S HOSPITAL AND CLINICS PROVIDED CARE TO 272,841 PATIENTS. CSM-M'S ESTIMATED UNREIMBURSED COSTS OF SERVICES TO THE ELDERLY, UNINSURED, AND UNDERINSURED TOTALED $93,832,922. CSM-M ALSO SPONSORS A NUMBER OF PROGRAMS DESIGNED TO IMPROVE THE HEALTH CARE IN ITS COMMUNITY. REFER TO THE COMMUNITY BENEFIT INFORMATION IN SCHEDULE H FOR DISCUSSION OF HOW CSM-M MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE.Description
Total Program Service Expense400754964TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
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 Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
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 Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096220NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees2878NumberOfEmployees
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 Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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 Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RHONDA ANDERSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4143262230TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14425 N PORT WASHINGTON ROADAddressLine1
CityGLENDALECity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (33 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PATRICIA DOLHUN MD
BOARD MEMBER1.00X000
GEORGE H HOFF
VICE CHAIR1.00X000
MICHELLE S NETTLES
BOARD MEMBER1.00X000
KEVIN GONIU MD
BOARD MEMBER AND CSM PHYSI5.00X0591105121065
MARK R TAYLOR
PRESIDENT/CEO START 02/1130.00X081384043715X
MASON G ROSS
BOARD MEMBER1.00X000
MICHAEL GREBE
BOARD MEMBER1.00X000
R BRUCE MCDONALD
CHAIR1.00X000
RANDALL PERRY
SECRETARY/TREASURER1.00X000
ROBERT LYON MD
BOARD MEMBER1.00X000
ROBERT J VENABLE
VICE CHAIR1.00X000
SISTER THERESA SULLIVAN DC
BOARD MEMBER1.00X000
TINA CHANG
BOARD MEMBER1.00X000
CHRISTINE NUERNBERG
BOARD MEMBER1.00X000
LEO P BRIDEAU
PRESIDENT/CEO END 02/1130.000100998437627X
RHONDA ANDERSON
EXEC VP FINANCE/CFO20.00041107661167X
AMY MARQUARDT
VP LEGAL SERVICES END 05/1120.0003879654622X
CHERYL HILL
VP HUMAN RESOURCES20.00028678182120X
DAVID H SHAPIRO MD
CHIEF MEDICAL OFFICER40.00033092469464X
GERRI LIETZ-STAFFILENO
VP HOSP OPERATIONS5.000312700103919X
KAROL MARCIANO
EXEC VP BUS DEV END 05/1130.0003684838876X
MARY PAUL
VP/CIO20.00067611044176X
SUE SANICOLA
VP CSM COMM PHYSICIANS20.00022372855026X
WILLIAM HART
VP/COO30.00352024039629X
DEBORAH FRIBERG
EXEC VP/PRES CSM HOSP END 06/1230.00489990040004X
BRUCE MCCARTHY
EXEC VP/PRESIDENT CSM PHYS20.00053493640420X
CONSTANCE J BRADLEY
VP PATIENT SERVICES30.00218742040191X
DAVID OLSON
EXEC VP/PRES CSM HOSP END 06/125.00032116618694X
ROBERT B ROTH MD
PHYSICIAN40.0016982240123923X
ROBERT L HUXLEY MD
PHYSICIAN40.0015106560130101X
DAVID W GRAMBOW MD
PHYSICIAN40.0013086070108898X
SANJAY S DESHPANDE MD
PHYSICIAN40.001727773093609X
ANDREW J FEIRING MD
PHYSICIAN40.0014059420101936X
FieldValueIRS element (for citing)
Total Reportable Comp From Org8711958TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6268798TotalReportableCompFrmRltdOrgs
Total Other Compensation1369182TotalOtherCompensation
Number Individuals GT100 K241NumberIndividualsGT100K
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
CG SCHMIDT-BARTON MALOW
26500 AMERICAN DRIVESOUTHFIELDMI48034PROJECT MGMT13422641
C G SCHMIDT INC
11777 W LAKE PARK DRIVEMILWAUKEEWI53224PROJECT MANAGEMENT10752997
METROPOLITAN ANESTHESIOLOGY
4225 N DOWNER AVESHOREWOODWI53211ANESTHESIOLOGY SERVICES9820798
MEDICAL COLLEGE OF WISCONSIN
8701 WATERTOWN PLANK ROADMILWAUKEEWI53226RESIDENT & INTERN PROGRAM2920734
ACCENTURE LLP
100 E WISCONSIN AVEMILWAUKEEWI53202EHR PROJECT MANAGEMENT2539953
FieldValueIRS element (for citing)
Number Of Contractors GT100 K66NumberOfContractorsGT100K
Related Organizations544106RelatedOrganizations
All Other Contributions525483AllOtherContributions
Total Contributions1069589TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
NET PATIENT SERVICES621990454307610454307610
RETAIL PHARMACY REVENU446110476298731957691567218
DIAGNOSTIC LAB REVENUE62150015669301566930
FOOD & NUTRITION7222101034956$1,034,956
RENTAL INCOME531120740800740800

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column300514TotalRevenueColumn
Unrelated Business Revenue300514UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue462713797TotalProgramServiceRevenue

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities270Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities270Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column270TotalRevenueColumn
Related Or Exempt Function Income270RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EXPENSE TRANSFERS90009972831427283142
SALES TO OUTSIDE ORGS90009921530392153039
TEACH\CONSULT\HONORARI90009910747941074794

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2171217TotalRevenueColumn
Related Or Exempt Function Income2171217RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue12682192TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column476465848TotalRevenueColumn
Related Or Exempt Function Income470926641RelatedOrExemptFunctionIncome
Unrelated Business Revenue3434662UnrelatedBusinessRevenue
Exclusion$1,034,956ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1538117Total
Management And General1538117ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total168873102Total
Program Services164028413ProgramServices
Management And General4844689ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total13399397Total
Program Services12896920ProgramServices
Management And General502477ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total23889360Total
Program Services22993509ProgramServices
Management And General895851ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total12438257Total
Program Services11971822ProgramServices
Management And General466435ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1162672Total
Program Services1162672ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total898Total
Management And General898ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total32778880Total
Program Services32778880ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1012Total
Program Services1012ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1073396Total
Program Services1019726ProgramServices
Management And General53670ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total373634Total
Program Services373634ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total16697436Total
Program Services16697436ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total166570Total
Program Services166570ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7519Total
Program Services7519ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total27169203Total
Program Services27169203ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1603608Total
Program Services1603608ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
OVERHEAD ALLOCATION7217772272177722
PATIENT CARE SUPPLIES5160804751608047
BAD DEBT EXPENSE2624310026243100
HOSPITAL TAX ASSESSMENT1315734113157341

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total16875552Total
Program Services16875552ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total481234823Total
Program Services400754964ProgramServices
Management And General80479859ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7025474BOY
EOY915083EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY25218862BOY
EOY346914EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY67039777BOY
EOY64673361EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY142526BOY
EOY55125EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY6015646BOY
EOY6171158EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY7873310BOY
EOY6272856EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis758329989LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec227097811LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY543108901BOY
EOY531232178EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY14760205BOY
EOY394527EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY9847288BOY
EOY9680773EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY681031989BOY
EOY619741975EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY39083856BOY
EOY23399757EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY415342640BOY
EOY371546947EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY454426496BOY
EOY394946704EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY226605493BOY
EOY224795271EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY226605493BOY
EOY224795271EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY681031989BOY
EOY619741975EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-4768975ReconcilationRevenueExpenses
Reconcilation Other Changes2958753ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$23,470OtherActivitiesAmount
Total Lobbying Expenditures IIB23470TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationLOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis16151785OtherCostOrOtherBasis
Book Value16151785BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis455232520OtherCostOrOtherBasis
Depreciation91906822Depreciation
Book Value363325698BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4405762OtherCostOrOtherBasis
Depreciation2170457Depreciation
Book Value2235305BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis281929270OtherCostOrOtherBasis
Depreciation132476993Depreciation
Book Value149452277BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis610652OtherCostOrOtherBasis
Depreciation543539Depreciation
Book Value67113BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings531232178TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
PAYABLE TO AFFILIATES$245,312,181
PENSION/DEFERRED COMPENSATION$9,599,530
PAYABLE TO THIRD PARTIES$3,210,073
INTERCOMPANY DEBT TO ASCENSION HEALTH ALLIANCE$111,450,875
OTHER LONG TERM LIABILITIES$1,974,288
FieldValueIRS element (for citing)
Total Of Amounts371546947TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationPART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE.Explanation

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
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense8191877TotalCommunityBenefitExpense
Net Community Benefit Expense8191877NetCommunityBenefitExpense
Percent Of Total Expense0.01800PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense97695929TotalCommunityBenefitExpense
Direct Offsetting Revenue80533224DirectOffsettingRevenue
Net Community Benefit Expense17162705NetCommunityBenefitExpense
Percent Of Total Expense0.03770PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense105887806TotalCommunityBenefitExpense
Direct Offsetting Revenue80533224DirectOffsettingRevenue
Net Community Benefit Expense25354582NetCommunityBenefitExpense
Percent Of Total Expense0.05570PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense4598904TotalCommunityBenefitExpense
Direct Offsetting Revenue1114440DirectOffsettingRevenue
Net Community Benefit Expense3484464NetCommunityBenefitExpense
Percent Of Total Expense0.00770PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense15100770TotalCommunityBenefitExpense
Direct Offsetting Revenue4919033DirectOffsettingRevenue
Net Community Benefit Expense10181737NetCommunityBenefitExpense
Percent Of Total Expense0.02240PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense593301TotalCommunityBenefitExpense
Net Community Benefit Expense593301NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense20292975TotalCommunityBenefitExpense
Direct Offsetting Revenue6033473DirectOffsettingRevenue
Net Community Benefit Expense14259502NetCommunityBenefitExpense
Percent Of Total Expense0.03140PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense126180781TotalCommunityBenefitExpense
Direct Offsetting Revenue86566697DirectOffsettingRevenue
Net Community Benefit Expense39614084NetCommunityBenefitExpense
Percent Of Total Expense0.08710PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense8379TotalCommunityBuildingExpense
Net Community Building Expense8379NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense529458TotalCommunityBuildingExpense
Net Community Building Expense529458NetCommunityBuildingExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense37024TotalCommunityBuildingExpense
Net Community Building Expense37024NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense224070TotalCommunityBuildingExpense
Net Community Building Expense224070NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense798931TotalCommunityBuildingExpense
Net Community Building Expense798931NetCommunityBuildingExpense
Percent Of Total Expense0.00180PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$13,777,628BadDebtExpenseAmount
Amount Attributable To275553AmountAttributableTo
Amount Reimbursed By Medicare436271262AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare455387914CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-19116652MedicareSurplusOrShortfall

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 Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number2FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA ST MARYS HOSPITAL MILWAUKEEBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12323 N LAKE DRIVEAddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53211ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA ST MARY'S HOSPITAL MILWAUKEEBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
Notified All PatientsXNotifiedAllPatients
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities34NumberOfOtherFacilities

Other Facilities OtherFacilities (34 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
AIRPORT MEDICAL CLINIC
4848 S 6TH STREETMILWAUKEEWI53221CLINIC
BABBITZ BURNSTEIN & NASH
2350 N LAKE DRIVE SUITE 201MILWAUKEEWI53221CLINIC
BAY VIEW FAMILY HEALTH CENTER
3056 S KINNICKINNIC AVEMILWAUKEEWI53207CLINIC
CSMCP PULMONOLOGY
2311 N PROSPECT AVEMILWAUKEEWI53211CLINIC
CARDIAC RHYTHM SPECIALISTS
2350 N LAKE DRIVE SUITE 206MILWAUKEEWI53211CLINIC
CARDIAC & VASCULAR INTER SPECIALISTS
2350 N LAKE DRIVE SUITE 303MILWAUKEEWI53211CLINIC
CATHEDRAL SQUARE URGENT CARE CENTER
734 N JACKSON STMILWAUKEEWI53202CLINIC
COLUMBIA WEST CLINIC
10950 W CAPITOL DRIVEWAUWATOSAWI53222CLINIC
ENT ASSOCIATES
2350 N LAKE DRIVE SUITE 406MILWAUKEEWI53211CLINIC
FAMILY HEALTH CENTER
1121 E NORTH AVEMILWAUKEEWI53212CLINIC
PMC NEUROLOGY
2311 N PROSPECT AVEMILWAUKEEWI53211CLINIC
GATEWAY MEDICAL CENTER
801 S 70TH STWEST ALLISWI53214CLINIC
GLENDALE GREEN BAY CLINIC
9233 N GREEN BAY ROADBROWN DEERWI53209CLINIC
GLENDALE PORT WASHINGTON CLINIC
6900 N PORT WASHINGTON ROADGLENDALEWI53217CLINIC
CSM GYN ONCOLOGY
2350 N LAKE DRUVE SUITE 501MILWAUKEEWI53211CLINIC
MEDICAL ONCOLOGY
2350 N LAKE DRIVE SUITE 100MILWAUKEEWI53211CLINIC
NORTHSHORE MEDICAL CLINIC
7080 N PORT WASHINGTON ROADGLENDALEWI53217CLINIC
OBGYN RESIDENCY CLINIC
2320 N LAKE DRIVEMILWAUKEEWI53211CLINIC
PERINATAL ASSESSMENT CENTER
2323 N LAKE DRIVEMILWAUKEEWI53211CLINIC
PROSPECT MEDICAL COMMONS
2311 N PROSPECT AVEMILWAUKEEWI53211CLINIC
RADIATION ONCOLOGY
2350 N LAKE DRIVE SUITE G01MILWAUKEEWI53211CLINIC
RIVER GLEN MEDICAL CLINIC
375 W RIVERWOODS PKWYGLENDALEWI53212CLINIC
RIVER WOODS URGENT CARE
375 W RIVERWOODS PKWYGLENDALEWI53212CLINIC
SHOREWOOD FAMILY PHYSICIANS
1901 E CAPITOL DRIVESHOREWOODWI53211CLINIC
WEST ALLIS MEDICAL CLINIC
2323 S 102ND STWEST ALLISWI53227CLINIC
WESTGATE MEDICAL GROUP
2727 N MAYFAIR ROADWAUWATOSAWI53222CLINIC
PLASTIC SURGERY
2350 N LAKE DRIVE SUITE 501MILWAUKEEWI53211CLINIC
WISCONSIN CARDIOVASCULAR GROUP
2350 N LAKE DRIVE SUITE 400MILWAUKEEWI53211CLINIC
CSM CANCER CENTER
2350 N LAKE DRIVE SUITE 100MILWAUKEEWI53211CLINIC
NORTH SHORE CARDIOLOGY EAST
2350 N LAKE DRIVE SUITE 400MILWAUKEEWI53211CLINIC
CARDIAC RHYTHM SPECIALISTS - MAYFAIR
2727 N MAYFAIR ROADWAUWATOSAWI53222CLINIC
CENTER FOR PAIN MANAGEMENT
2323 N LAKE DRIVEMILWAUKEEWI53211CLINIC
MMA CATHEDRAL SQUARE
788 N JEFFERSON STMILWAUKEEWI53202CLINIC
MMA WAUKESHA
22370 W BLUEMOUND ROADWAUKESHAWI53186CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifier
PART I, LINE 6A: CSM HOSPITAL MILWAUKEE PREPARES AND FILES AN ANNUAL COMMUNITY BENEFIT PLAN REPORT WITH THE WISCONSIN HOSPITAL ASSOCIATION ("WHA"). THE INFORMATION ON THIS REPORT INCLUDES INFORMATION ONLY FOR CSM MILWAUKEE AND NOT ANY OF ITS AFFILIATED HOSPITALS.
PART I, LINE 7: THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR CERTAIN CATEGORIES IN THE TABLE, THIS WAS A COST ACCOUNTING SYSTEM; IN OTHER CATEGORIES, A SPECIFIC COST-TO-CHARGE RATIO WAS APPLIED. PART I, LINE 7: THE TOTAL AMOUNT OF CHARITY CARE AND OTHER COMMUNITY BENEFITS IN PART I, LINE 7 IS DIFFERENT FROM THE COMMUNITY BENEFIT AS REPORTED IN THE ANNUAL COMMUNITY BENEFIT REPORT BY THE AMOUNT OF COMMUNITY BUILDING ACTIVITIES REPORTED ON PART II OF SCHEDULE H. THE IRS DOES NOT CONSIDER COMMUNITY BUILDING ACTIVITIES TO BE COMMUNITY BENEFIT; HOWEVER, THESE COSTS ARE INCLUDED IN THE TOTAL COMMUNITY BENEFIT AMOUNT AS REPORTED IN THE ANNUAL COMMUNITY BENEFIT REPORT.PART I, LINE 7G: THE ORGANIZATION EMPLOYS ITS PHYSICIANS AT ITS HOSPITALS AND PHYSICIAN CLINICS, SO THE ASSOCIATED COSTS AND CHARGES RELATING TO THOSE PHYSICIAN SERVICES ARE INCLUDED IN ALL RELEVANT CATEGORIES IN PART I.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN (F) IS $26,243,100.
PART II: OTHER COMMUNITY PROGRAMS AND SERVICES ARE DELIVERED ON A PROACTIVE BASIS FROM THE COMMUNITY BENEFIT PLAN GOALS. HIGHLIGHTS OF PLAN GOALS INCLUDE WORK TO IMPROVE INFANT MORTALITY; PROGRAMS AT SETON DENTAL CLINIC TO SUPPORT ORAL HEALTH ACCESS, PARTICULARLY FOR CHILDREN; IMPROVEMENT IN ACCESS TO PRIMARY AND SECONDARY CARE; IMPROVED EDUCATION AND ACCESS REGARDING CANCER SCREENING AND COLLABORATION WITH THE MILWAUKEE HEALTH CARE PARTNERSHIP. INFANT MORTALITY, PARTICULARLY AMONG THE AFRICAN AMERICAN COMMUNITY IN MILWAUKEE, IS A PARTICULAR HEALTH ISSUE NEEDING IMPROVEMENT. CSM HAS BEEN AN IMPORTANT COLLABORATOR IN CITY AND STATE EFFORTS TO IMPROVE BIRTH OUTCOMES AND REDUCE INFANT MORTALITY RATES IN MILWAUKEE. CSM HAS SUPPORTED THE LIFECOURSE INITIATIVE FOR HEALTHY FAMILIES AS A COMMUNITY/ACADEMIC PARTNERSHIP FOR INITIATION OF A FIVE YEAR FUNDED PLAN FOR MORTALITY IMPROVEMENT. A PARTICULAR CSM FOCUS HAS BEEN THAT OF SAFE SLEEP INITIATIVES TO ASSURE THAT INFANTS HAVE A SAFE PLACE TO SLEEP BY PROVIDING PACK AND PLAY CRIBS FOR MOTHERS WITHOUT A DEDICATED INFANT SLEEP SPACE. ADDITIONALLY, PARENTS ARE EDUCATED ABOUT THE IMPORTANCE OF AN INFANT SLEEPING ON HIS BACK THROUGH A "BACK TO SLEEP" CAMPAIGN OF INFANT APPAREL WITH THAT MESSAGE IMPRINTED. PRENATAL EDUCATION IS DELIVERED IN A COMMUNITY SETTING THROUGH CSMS BLANKET OF LOVE PROGRAM. LACK OF ACCESS TO ORAL HEALTH CARE HAS ALSO BEEN IDENTIFIED IN THE NEEDS ASSESSMENT. CSM MILWAUKEE SPONSORED THE SMART SMILES PROGRAM OF SCHOOL-BASED ORAL HEALTH CARE TO SERVE 4,000 CHILDREN IN FISCAL 2012. DENTIST ASSESSMENT, ORAL HYGIENE CARE, DENTAL SEALANTS AND FLUORIDE TREATMENTS ARE PROVIDED IN MORE THAN 30 SCHOOLS TO MEET THESE NEEDS. THE ST. ELIZABETH ANN SETON DENTAL CLINIC SERVES AS THE URGENT DENTAL CARE PROVIDER FOR UNINSURED PEOPLE IN MILWAUKEE, BOTH CHILDREN AND ADULTS. ACCESS TO PRIMARY CARE HAS BEEN IMPROVED IN MILWAUKEE THROUGH THE WORK OF ST. BENS CLINIC FOR THE HOMELESS AND THE COMMUNITY CHRONIC DISEASE MANAGEMENT (CCDM) CLINIC TO TREAT HYPERTENSION AND DIABETES THROUGH CHURCH PARTNERSHIPS. ADDITIONALLY CSM SPONSORS MEDICAL RESIDENCY PROGRAMS THROUGH CSM FAMILY HEALTH CENTER AND THE CSM OB/GYN CLINIC. THE COLUMBIA COLLEGE OF NURSING SPONSORS EL CENTRO DE SALUD TO PROVIDE HEALTH EDUCATION, SCREENING AND SERVICE THROUGH A PRIMARY EDUCATION SYSTEM IN AN IMPOVERISHED AREA OF MILWAUKEE. CSM CO-SPONSORSHIP OF THE SATURDAY FREE CLINIC WITH THE MEDICAL COLLEGE OF WISCONSIN ALSO DELIVERS HEALTH SCREENING AND BASIC HEALTH CARE TO UNINSURED PEOPLE. SPECIALTY CARE ACCESS HAS BEEN IMPROVED THROUGH THE WORK OF THE MILWAUKEE HEALTH CARE PARTNERSHIP, (MHCP) A COLLABORATION OF MILWAUKEES FIVE HEALTH SYSTEMS AND FOUR FEDERALLY QUALIFIED HEALTH CENTERS. ONE PROGRAM TARGETS UNINSURED PEOPLE FROM THE FQHCS AND FROM AREA FREE CLINICS FOR ACCESS TO SPECIALTY CARE. THE SPECIALTY ACCESS FOR UNINSURED PROGRAM (SAUP) PAIRS HOSPITALS WITH FQHCS AND FREE CLINICS TO DELIVER SPECIALTY CARE FOR PRIMARY CARE PATIENTS. ADDITIONALLY, THE MHCP COLLABORATES WITH STATE AND COUNTY RESOURCES TO PLAN FOR IMPROVEMENT IN BEHAVIORAL HEALTH DELIVERY IN MILWAUKEE COUNTY. THIS ADVISORY WORK CONTINUES THROUGH PARTICIPATION BY CSM VICE-PRESIDENTS AND DIRECTORS. A HIGHLIGHT OF CANCER SCREENING IS THE USE OF A MOBILE MAMMOGRAPHY DIGITAL COACH TO DELIVER BREAST SCREENING WITHIN COMMUNITY SETTINGS. THIS IS PARTICULARLY IMPORTANT FOR PARTNERSHIP WITH CENTRAL CITY CHURCHES TO IDENTIFY WOMEN WHO OTHERWISE WOULD NOT ACCESS TRADITIONAL HOSPITAL BASED SCREENING. OFTEN CHURCH PARTNERSHIPS SUPPORT CSM'S WORK IN THE COMMUNITY. CSM PARISH NURSES WORK WITH MORE THAN 40 CHURCHES OF THE NORTHWEST CHURCH OF GOD IN CHRIST (COGIC) JURISDICTION UNDER A LOCAL BISHOP TO DELIVER HEALTH EDUCATION AND SCREENING THROUGH COMMUNITY HEALTH WORKERS AND CHURCH HEALTH LIAISONS THROUGH A PROGRAM CALLED THE COGIC COVENANT. PARTNERSHIP IS A KEY ELEMENT IN COMMUNITY BENEFIT ACTIVITIES OF CSM. A PARTICULARLY STRONG PARTNER THESE ACTIVITIES HAS BEEN THE MEDICAL COLLEGE OF WISCONSIN IN SPONSORSHIP OF PROGRAMS: CSM COLLABORATES WITH THE MEDICAL COLLEGE OF WISCONSIN IN SPONSORING THE FOLLOWING:- THE FAMILY HEALTH CENTER, A RESIDENCY-BASED FAMILY MEDICINE CLINIC THAT PROVIDES PRIMARY CARE TO MORE THAN 9,000 INDIVIDUALS IN THE COMMUNITY.- THE OB/GYN CLINIC, A RESIDENCY-BASED PROGRAM THAT SERVES OVER 150 PATIENTS, 250 OB APPOINTMENTS PER MONTH, AND 325 DELIVERIES PER YEAR.- THE CHRONIC DISEASE MANAGEMENT CLINIC, WHICH SCREENS AND MANAGES HYPERTENSION, DIABETES, OBESITY, AND SMOKING FOR LOW INCOME ADULTS THROUGH A CLINIC BASED IN A FOOD PANTRY. - THE SATURDAY CLINIC FOR THE UNINSURED, WHICH USES MEDICAL STUDENTS AND VOLUNTEER PHYSICIANS TO SERVE HUNDREDS OF UNINSURED PATIENTS EACH YEAR.ALL OF THESE SERVICES ARE REPORTED AS PART OF THE COMMUNITY BENEFIT EXPENSES IN SECTION H. ADDITIONALLY CSM PARTICIPATES IN COMMUNITY BUILDING ACTIVITIES THROUGH PROGRAMS SUCH AS INROADS, WHICH IS AN OPPORTUNITY FOR CULTURALLY DIVERSE COLLEGE STUDENTS TO SERVE AN INTERNSHIP OVER SUMMER BREAK TO FAMILIARIZE THEMSELVES WITH THE CHALLENGES AND OPPORTUNITIES IN HEALTH CARE AND GAIN REAL WORLD EXPERIENCE. INROADS IS REFLECTED IN THE COMMUNITY BUILDING SECTION OF THE REPORT.
PART III, LINE 4: THE ORGANIZATION IS A PART OF THE COLUMBIA ST. MARY'S, INC. CONSOLIDATED AUDIT AND FURTHER INCLUDED AS PART OF THE ASCENSION HEALTH CONSOLIDATED AUDITED FINANCIALS. THE FOOTNOTE THAT REFERENCES BAD DEBT EXPENSE IN THE FISCAL 2012 CONSOLIDATED AUDITED FINANCIALS IS AS FOLLOWS: "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING ECONOMIC CONDITIONS, HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NO COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE ORGANIZATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE ORGANIZATION. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE ORGANIZATION'S POLICIES."
PART III, LINE 8: ASCENSION HEALTH AND RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT.
PART III, LINE 9B: THE ORGANIZATION HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY.
PART V, SECTION B, LINE 9: ALL PATIENTS WITH INCOME LESS THAN 200% OF THE FEDERAL POVERTY LEVEL WILL BE ELIGIBLE FOR 100% CHARITY CARE WRITE-OFF OF THE CHARGES FOR SERVICES THAT HAVE BEEN PROVIDED. ELIGIBILITY MAY BE DETERMINED AT ANY POINT IN THE REVENUE CYCLE. FINANCIAL COUNSELORS PROVIDE ASSISTANCE TO THE PATIENTS TO DETERMINE IF THEY ARE ELIGIBLE FOR MEDICAID OR OTHER PUBLIC ASSISTANCE IN ORDER TO QUALIFY FOR CHARITY CARE. CREDIT REPORTS OR OTHER SIMILAR REPORTS MAY BE RUN TO VERIFY INFORMATION PROVIDED.COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE
PART V, SECTION B, LINE 10: PATIENTS WITH INCOMES ABOVE 300% OF THE POVERTY LEVEL MAY BE ELIGIBLE FOR SOME LEVEL OF DISCOUNT BASED ON A SUBSTANTIVE ASSESSMENT OF THEIR ABILITY TO PAY. THE ASSESSMENT CONSIDERS TOTAL INCOME AND DOLLAR AMOUNT OF PATIENT RESPONSIBILITY ON A SLIDING SCALE. A MEANS TEST IS PERFORMED THAT CONSIDERS INCOME, TOTAL MEDICAL BILL OBLIGATIONS, MORTGAGE PAYMENTS, UTILITY PAYMENTS, NUMBER OF FAMILY MEMBERS, AND ANY DISABILITY CONSIDERATIONS. PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, BUT ARE IN NEED OF FINANCIAL ASSISTANCE, WILL BE OFFERED APPROPRIATE EXTENDED PAYMENT TERMS OR OTHER PAYMENT OPTIONS THAT TAKE INTO ACCOUNT THE PATIENT'S FINANCIAL STATUS.COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE
PART V, SECTION B, LINE 19D: ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE A MINIMUM DISCOUNT OF 40% OFF GROSS CHARGES FOR SERVICES PROVIDED TO THEM.COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE
PART VI, LINE 2: THE COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE COMMUNITY BENEFIT PROCESS IS COORDINATED THROUGH THE WORK OF THE MILWAUKEE COMMUNITY BENEFIT COMMITTEE (MCBC). THE MCBC IS GUIDED BY THE MISSION STATEMENT OF CSM AND A COMMUNITY BENEFIT PHILOSOPHY STATEMENT. THE COMMITTEE IS COMPRISED OF ADMINISTRATIVE LEADERSHIP, MANAGERS, AND STAFF INVOLVED IN DIRECT SERVICE TO VULNERABLE PEOPLE. TWO REPRESENTATIVES OF THE CSM PATIENT FAMILY ADVISORY COMMITTEE PARTICIPATE IN THE MCBC.THE MCBC ROLES INCLUDE THE FOLLOWING: - DEVELOP COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO DETERMINE MILWAUKEE COUNTY NEEDS- REVIEW CHNA AND CREATE COMMUNITY BENEFIT PLAN TO ADDRESS NEEDS- INCORPORATE COMMUNITY BENEFIT PLAN GOALS IN THE CSM INTEGRATED STRATEGIC, OPERATIONAL AND FINANCIAL PLAN (ISOFP) FOR BOARD LEVEL APPROVAL AND SUBMISSION TO ASCENSION HEALTH SYSTEM - DEVELOP A STRATEGY TO MEASURE AND INCREASE THE IMPACT OF COMMUNITY BENEFIT PLAN ELEMENTSTHE NEEDS ASSESSMENT IN FY 12 INVOLVED THE GATHERING OF SECONDARY INFORMATION ABOUT MILWAUKEE COUNTY FROM VARIED PUBLIC SOURCES INCLUDING STATE DATA, MILWAUKEE COUNTY DATA AND CITY OF MILWAUKEE DATA. THE MOST REMARKABLE NEEDS FOR THE SERVICE AREA INCLUDED ADDRESSING INFANT MORTALITY ISSUES, IMPROVING ACCESS TO ORAL HEALTH CARE, PARTICULARLY FOR CHILDREN, IMPROVING ACCESS TO PRIMARY AND SPECIALTY CARE, AND IMPROVING HEALTH DISPARITIES, PARTICULARLY REGARDING CANCER SCREENING.
PART VI, LINE 3: CSM HOSPITAL MILWAUKEE ATTEMPTS TO IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY OR DISCOUNTED CARE AS OUTLINED IN THE CHARITY CARE POLICY DURING THE PRE-REGISTRATION, REGISTRATION, ADMISSIONS AND DISCHARGE PROCESSES. A COPY OF THE CHARITY CARE POLICY IS POSTED IN THE EMERGENCY ROOM, AND A SUMMARY OF THE POLICY IS PROVIDED TO PATIENTS WITH ADMISSION AND DISCHARGE PAPERWORK. CSM HOSPITAL MILWAUKEE HAS TRAINED FINANCIAL COUNSELORS AVAILABLE TO DISCUSS PAYMENT OPTIONS TO THE PATIENTS. UPON MAKING AN APPOINTMENT, THE FINANCIAL COUNSELORS WILL MEET WITH THE PATIENT TO DETERMINE WHAT OTHER FINANCIAL ASSISTANCE PROGRAMS FOR WHICH THE PATIENT MAY QUALIFY.
PART VI, LINE 4: CSM HOSPITAL MILWAUKEE SERVES A PRIMARY SERVICE AREA OF EASTERN MILWAUKEE COUNTY, FROM THE NEAR SOUTH SIDE OF MILWAUKEE NORTH THROUGH OZAUKEE COUNTY. CSM HOSPITAL MILWAUKEE IS LOCATED IN AN URBAN COMMUNITY WITHIN MILWAUKEE COUNTY. THE POPULATION OF MILWAUKEE COUNTY IS APPROXIMATELY 953,000, WITH OVER 20% OF THE HOUSEHOLDS LIVING AT OR BELOW FEDERAL POVERTY GUIDELINES. THE MEDIAN INCOME IS APPROXIMATELY $43,000, OVER 46% OF THE POPULATION IS A MINORITY, AND APPROXIMATELY 16% OF THE POPULATION SPEAK A LANGUAGE OTHER THAN ENGLISH. THE SERVICE AREA IS VARIED, WITH SOME SECTORS HAVING HIGH INCOMES AND MANY HEALTH RESOURCES WHILE OTHER HIGH ADMISSION ZIP CODES ARE LOCATED IN THE IMPOVERISHED CENTRAL CITY AND IN MEDICALLY UNDERSERVED AREAS. SEVERAL HIGH ADMITTING ZIP CODES FOR CSM HAVE A HIGH PROPORTION OF AFRICAN AMERICAN PEOPLE AND TWO HIGH ADMITTING ZIP CODES HAVE HIGH PROPORTIONS OF PEOPLE OF HISPANIC BACKGROUND. ADDRESSING THE HEALTH DISPARITY ISSUES OF THESE POPULATIONS IS AN IMPORTANT PART OF THE COMMUNITY BENEFIT SERVICE OF CSM HOSPITAL MILWAUKEE. IN FISCAL 2012, CSM HOSPITAL MILWAUKEE SERVED 272,841 PATIENTS AND PROVIDED $8,191,877 IN TRADITIONAL CHARITY CARE (AT COST), $17,162,705 IN UNPAID COSTS OF PUBLIC PROGRAMS, $8,060,156 IN UNINSURED DISCOUNTS AND $15,058,432 IN OTHER COMMUNITY PROGRAMS AND SERVICES, WHICH ARE REPORTED ON PART I, LINE 7J AND PART II. DISCOUNTS FOR THE UNINSURED AND UNDERINSURED ARE NOT INCLUDED IN PARTS I OR II OF SCHEDULE H.
PART VI, LINE 6: CSM HOSPITAL MILWAUKEE IS PART OF THE CSM HEALTH SYSTEM, WHICH CONTRIBUTES TO THE POSITIVE HEALTH STATUS OF THE COMMUNITIES IT SERVES. CSM IS AN ORGANIZATION COMPRISED OF THREE HOSPITALS, 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, SETON CHILDREN'S SCHOOL (CLOSED IN JUNE 2012), A PARTNERSHIP WITH THE ORTHOPAEDIC HOSPITAL OF WISCONSIN, AND FOUR URGENT CARE CENTERS. CSM PROVIDES CARE FOR INDIVIDUALS AND FAMILIES THROUGHOUT MILWAUKEE, OZAUKEE, WASHINGTON, AND SHEBOYGAN COUNTIES - WITH MORE THAN 160 YEARS OF SERVICE TO INDIVIDUALS AND FAMILIES IN THESE COMMUNITIES.AS A MEMBER OF ASCENSION HEALTH, THE NATION'S LARGEST CATHOLIC HEALTHCARE SYSTEM, CSM CONTINUES TO BUILD AND STRENGTHEN SUSTAINABLE COLLABORATIVE EFFORTS THAT BENEFIT THE HEALTH OF INDIVIDUALS, FAMILIES, AND SOCIETY AS A WHOLE. THE GOAL OF CSM IS TO PERPETUATE THE HEALTH MISSION OF THE CHURCH. CSM FURTHERS THIS GOAL THROUGH DELIVERY OF PATIENT SERVICES, CARE TO THE ELDERLY AND INDIGENT, PATIENT EDUCATION AND HEALTH AWARENESS PROGRAMS FOR THE COMMUNITY, AND MEDICAL RESEARCH. OUR CONCERN FOR ALL HUMAN LIFE AND DIGNITY OF EACH PERSON LEADS THE ORGANIZATION TO PROVIDE MEDICAL SERVICES TO ALL PEOPLE IN THE COMMUNITY WITHOUT REGARD TO THE PATIENT'S RACE, CREED, NATIONAL ORIGIN, ECONOMIC STATUS, OR ABILITY TO PAY.CSM EMPLOYS A COMMUNITY BENEFIT PHILOSOPHY IN PROGRAM PLANNING AND IMPLEMENTATION. CSM PROVIDES FOR THE HEALTH OF THE COMMUNITY THROUGH FINANCIAL SUPPORT PROVIDED TO PATIENTS BY FINANCIAL DISCOUNTS AND CONTRACTS, BY DEVELOPING CLINICS AND SERVICES FOR SPECIFIC VULNERABLE GROUPS, BY SPONSORING COMMUNITY EDUCATION AND TRAINING AND BY COLLABORATING WITH GOVERNMENT PROGRAMS.DURING FISCAL 2012, THE CSM SYSTEM PROVIDED $57,420,370 IN COMMUNITY HEALTH BENEFIT SERVICES, INCLUDING SUBSIDIZED HEALTH CARE, PROFESSIONAL EDUCATION, FINANCIAL CONTRIBUTIONS AND COMMUNITY BUILDING ACTIVITIES.IN ADDITION, THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF LOCAL COMMUNITY LEADERS AND PHYSICIANS, THE MAJORITY OF WHOM RESIDE WITHIN THE COMMUNITIES CSM SERVES AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY; HOWEVER, THE CLINICS WITHIN THE ORGANIZATION ARE SERVED BY PHYSICIANS AFFILIATED WITH CSM.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
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 Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (21 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
KEVIN GONIU MD
0530364041000019741066148054917071217000
MARK R TAYLOR
048214902173430114348018446025269085755500
LEO P BRIDEAU
0388367043689401847230134750241520104761100
RHONDA ANDERSON
0377857011698021521048250012917047224300
AMY MARQUARDT
09924408880801999130207902543039258700
CHERYL HILL
024286708613035301063865018255036890100
DAVID H SHAPIRO MD
027960601841303290506468204782040038800
GERRI LIETZ-STAFFILENO
0220696028354063650083685020234041661900
KAROL MARCIANO
09474505719202165460209506781037735900
MARY PAUL
03743340207246094530033791010385072028600
SUE SANICOLA
017516000048568031132023894027875400
WILLIAM HART
2911240101220507780240660155630391653000
DEBORAH FRIBERG
459908077060223760122500277540529994000
BRUCE MCCARTHY
0527284032820437009846030574057535600
CONSTANCE J BRADLEY
200299000184430291390110520258933000
DAVID OLSON
02987700484801754802825015869033986000
ROBERT B ROTH MD
162032205650002140203203609188701822147000
ROBERT L HUXLEY MD
14876320155000752403784609225501640757000
DAVID W GRAMBOW MD
125296303652201912202549308340501417505000
SANJAY S DESHPANDE MD
1433698027685401722101225008135901821382000
ANDREW J FEIRING MD
751514063133102309703727506466101507878000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINES 4A-BSEVERANCE AMOUNTS PAID IN FY12 INCLUDE: AMY MARQUARDT $172,749 KAROL MARCIANO $167,578 ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. THE FILING ORGANIZATION, CSMM, DID NOT CONTRIBUTE TO THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FOR ANY OF THE EXECUTIVES THIS FISCAL YEAR.
PART I, LINE 7BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY SERVE, BASED ON ESTABLISHED GUIDELINES. OFFICERS AND KEY EMPLOYEES PARTICIPATE IN A MANAGEMENT INCENTIVE PLAN, WHEREBY CERTAIN FINANCIAL TRIGGERS OF THE CSM SYSTEM AS APPROVED BY THE BOARD MUST BE MET BEFORE ANY ELIGIBLE EMPLOYEE MAY RECEIVE PAYMENT OF THE INCENTIVE. ONCE THE TRIGGER IS MET, THE INCENTIVE IS MEASURED BASED ON VARIOUS ESTABLISHED GOALS, INCLUDING OPERATING MARGIN, PATIENT SATISFACTION, QUALITY, AND PRODUCTIVITY.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonDAVID SHAPIRO MDNamePerson
FieldValueIRS element (for citing)
RelationshipKEY EMPLOYEERelationship
Amount Of Transaction146870AmountOfTransaction
Description Of TransactionSPOUSE IS ALSO EMPLOYED BY CSM SYSTEM. ALL COMPENSATION IS DETERMINED IN ACCORDANCE WITH PAYROLL POLICY GUIDELINES.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 6CSM-M HAS A SINGLE CORPORATE MEMBER, CSM.
FORM 990, PART VI, SECTION A, LINE 7ACSM-M HAS A SOLE MEMBER, HAS A SINGLE CORPORATE MEMBER, CSM, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSM-M.
FORM 990, PART VI, SECTION A, LINE 7BALL DECISIONS THAT HAVE A MATERIAL IMPACT TO CSM-M'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, CSM.
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT, INCLUDING CERTAIN KEY EMPLOYEES, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE BOARD, OR A DESIGNATED COMMITTEE, TO REVIEW AND ANSWER ANY QUESTIONS. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS.
FORM 990, PART VI, SECTION B, LINE 12CCSM HAS A WRITTEN CONFLICT OF INTEREST POLICY. THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX EXEMPT PURPOSE.
FORM 990, PART VI, SECTION B, LINE 1515A. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE AUDIT COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO OTHER HOSPITALS IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. THE CEO WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. 15B. IN DETERMINING COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION, THE PROCESS INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE AUDIT COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATIONS, THE OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION WERE COMPARED TO OTHER HOSPITALS' EMPLOYEES IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. CSM DOES PUBLISH AN ANNUAL REPORT AND FACT SHEETS ON THE EXTERNAL WEBSITE, WHICH IS AVAILABLE FOR PUBLIC VIEWING.
FORM 990, PART VII, COLUMN (A)BOARD MEMBERS WHO ARE ALSO CSM PHYSICIANS ARE COMPENSATED BY CSM FOR SERVICES PERFORMED AS CSM PHYSICIANS AND EMPLOYEES, NOT FOR THEIR SERVICES AS BOARD MEMBERS.
FORM 990, PART VII, COLUMN (B)THE KEY EMPLOYEES AND OFFICERS LISTED ON FORM 990, PART VII, PROVIDE SERVICES TO THIS ORGANIZATION AS WELL AS OTHER RELATED CSM ORGANIZATIONS. THE HOURS REPORTED IN COLUMN (B) REPRESENT THE ESTIMATED PERCENTAGE OF TIME THESE INDIVIDUALS DEVOTE TO THE REPORTING ORGANIZATION BASED ON AN AVERAGE WEEK. THE TOTAL AVERAGE HOURS PER WEEK THESE INDIVIDUALS SPEND ON ALL CSM ORGANIZATIONS, INCLUDING THIS ORGANIZATION, EXCEED 40 HOURS.
FORM 990, PART XI, LINE 5:TRANSFERS FROM FOUNDATION - CAPITAL PURCHASE 2,807,344. GRANTS FOR CAPITAL EXPENDITURE 186,960. FAS 158 PENSION ADJUSTMENT -27,887. OTHER ADJUSTMENT -7,664. TOTAL TO FORM 990, PART XI, LINE 5: 2,958,753.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CNO CHANGES SINCE PRIOR YEAR

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC
4425 NORTH PORT WASHINGTON ROADMILWAUKEEWI53212390807063HOSPITALWI501(C)(3)3N/A0
SACRED HEART REHABILITATION INSTITUTE
4425 NORTH PORT WASHINGTON ROADMILWAUKEEWI53212390902199REHAB FACILITYWI501(C)(3)31COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC
COLUMBIA COLLEGE OF NURSING
4425 NORTH PORT WASHINGTON ROADMILWAUKEEWI53212391596986COLLEGEWI501(C)(3)21COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC
SETON CHILDREN'S SCHOOL
4425 NORTH PORT WASHINGTON ROADMILWAUKEEWI53212391391245SCHOOLWI501(C)(3)91COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC
ASCENSION HEALTH
4600 EDMUNDSON ROADST LOUISMO63136311662309HEALTH SYSTEMMO501(C)(3)11N/A0
HORIZON HOME CARE & HOSPICE INC
8949 N DEERBROOK TRLMILWAUKEEWI53223391171298HOME CARE/HOSPICEWI501(C)(3)3N/A0
COLUMBIA ST MARY'S INC
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391834639HEALTH SYSTEMWI501(C)(3)11N/A0
COLUMBIA HEALTH SYSTEM
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391494977HEALTH SYSTEMWI501(C)(3)11N/A0
COLUMBIA ST MARY'S FOUNDATION INC
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391494981FOUNDATIONWI501(C)(3)7N/A0

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC
575 RIVERWOODS PKWYGLENDALEWI53212392015655HEALTHCAREWIN/A
SLEEP SERVICES OF WISCONSIN
111 E KILBOURN AVE SUITE 1300MILWAUKEEWI53202273148310SLEEP SERVICESWIN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Percentage OwnershipPercentageOwnership
CSM STRATEGIC ALLIANCE
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391871856HEALTH CAREWIN/AC
MADISON MEDICAL AFFILIATES INC
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391855720HEALTH CAREWICCOLUMBIA ST MARY'S HOSPITAL INC1.00000
PROSPECT MEDICAL COMMONS CONDO ASSOCIATION
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212208042108CONDO ASSOCIATIONWIN/AC
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 Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ORTHOPAEDIC HOSPITAL OF WISCONSIN
K601028
SACRED HEART REHABILITATION INSTITUTE
K1588642
ASCENSION HEALTH
E111450875
COLUMBIA ST MARY'S INC
L72236976
COLUMBIA ST MARY'S INC
O131702000
COLUMBIA ST MARY'S FOUNDATION INC
C3357833
COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC
O245312181
SACRED HEART REHABILITATION INSTITUTE
P15667707