2013-05-15T18:25:47-05:00 2012-06-30 861065772 DELOITTE TAX LLP 555 E WELLS SUITE 1400 MILWAUKEE WI 53202 990 2011-07-01 390806315 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE COLU 4143262230 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 MARK TAYLOR 4143262230 2013-05-15 1 P00966076 4142713000 2011 2016-02-24 21:20:13Z MARK TAYLOR 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 476465848 0 0928 X COLUMBIA-STMARYS.ORG X 1859 WI FULL-SERVICE HOSPITAL WITH MEDICAL, SURGICAL, ADVANCED CLINICAL AND OTHER COMMUNITY SERVICES. 14 12 2878 393 3434662 -3992985 1419275 1069589 480834242 462713797 1563302 270 10115718 12682192 493932537 476465848 0 0 0 0 227704214 220138233 0 0 0 296036320 261096590 523740534 481234823 -29807997 -4768975 681031989 619741975 454426496 394946704 226605493 224795271 X COLUMBIA 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. 0 0 400754964 470926641 CSM-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. 400754964 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 220 0 1 2878 1 1 1 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X RHONDA ANDERSON 4143262230 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 X PATRICIA DOLHUN MD 1.00 X 0 0 0 GEORGE H HOFF 1.00 X 0 0 0 MICHELLE S NETTLES 1.00 X 0 0 0 KEVIN GONIU MD 5.00 X 0 591105 121065 MARK R TAYLOR 30.00 X X 0 813840 43715 MASON G ROSS 1.00 X 0 0 0 MICHAEL GREBE 1.00 X 0 0 0 R BRUCE MCDONALD 1.00 X 0 0 0 RANDALL PERRY 1.00 X 0 0 0 ROBERT LYON MD 1.00 X 0 0 0 ROBERT J VENABLE 1.00 X 0 0 0 SISTER THERESA SULLIVAN DC 1.00 X 0 0 0 TINA CHANG 1.00 X 0 0 0 CHRISTINE NUERNBERG 1.00 X 0 0 0 LEO P BRIDEAU 30.00 X 0 1009984 37627 RHONDA ANDERSON 20.00 X 0 411076 61167 AMY MARQUARDT 20.00 X 0 387965 4622 CHERYL HILL 20.00 X 0 286781 82120 DAVID H SHAPIRO MD 40.00 X 0 330924 69464 GERRI LIETZ-STAFFILENO 5.00 X 0 312700 103919 KAROL MARCIANO 30.00 X 0 368483 8876 MARY PAUL 20.00 X 0 676110 44176 SUE SANICOLA 20.00 X 0 223728 55026 WILLIAM HART 30.00 X 352024 0 39629 DEBORAH FRIBERG 30.00 X 489990 0 40004 BRUCE MCCARTHY 20.00 X 0 534936 40420 CONSTANCE J BRADLEY 30.00 X 218742 0 40191 DAVID OLSON 5.00 X 0 321166 18694 ROBERT B ROTH MD 40.00 X 1698224 0 123923 ROBERT L HUXLEY MD 40.00 X 1510656 0 130101 DAVID W GRAMBOW MD 40.00 X 1308607 0 108898 SANJAY S DESHPANDE MD 40.00 X 1727773 0 93609 ANDREW J FEIRING MD 40.00 X 1405942 0 101936 8711958 6268798 1369182 241 0 1 0 CG SCHMIDT-BARTON MALOW 26500 AMERICAN DRIVE SOUTHFIELD MI 48034 PROJECT MGMT 13422641 C G SCHMIDT INC 11777 W LAKE PARK DRIVE MILWAUKEE WI 53224 PROJECT MANAGEMENT 10752997 METROPOLITAN ANESTHESIOLOGY 4225 N DOWNER AVE SHOREWOOD WI 53211 ANESTHESIOLOGY SERVICES 9820798 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 RESIDENT & INTERN PROGRAM 2920734 ACCENTURE LLP 100 E WISCONSIN AVE MILWAUKEE WI 53202 EHR PROJECT MANAGEMENT 2539953 66 544106 525483 1069589 NET PATIENT SERVICES 621990 454307610 454307610 RETAIL PHARMACY REVENU 446110 4762987 3195769 1567218 DIAGNOSTIC LAB REVENUE 621500 1566930 1566930 FOOD & NUTRITION 722210 1034956 1034956 RENTAL INCOME 531120 740800 740800 300514 300514 462713797 270 0 270 270 270 EXPENSE TRANSFERS 900099 7283142 7283142 SALES TO OUTSIDE ORGS 900099 2153039 2153039 TEACH\CONSULT\HONORARI 900099 1074794 1074794 2171217 2171217 12682192 476465848 470926641 3434662 1034956 1538117 1538117 168873102 164028413 4844689 13399397 12896920 502477 23889360 22993509 895851 12438257 11971822 466435 1162672 1162672 898 898 32778880 32778880 1012 1012 1073396 1019726 53670 373634 373634 16697436 16697436 166570 166570 7519 7519 27169203 27169203 1603608 1603608 OVERHEAD ALLOCATION 72177722 72177722 PATIENT CARE SUPPLIES 51608047 51608047 BAD DEBT EXPENSE 26243100 26243100 HOSPITAL TAX ASSESSMENT 13157341 13157341 16875552 16875552 481234823 400754964 80479859 0 7025474 915083 25218862 346914 67039777 64673361 142526 55125 6015646 6171158 7873310 6272856 758329989 227097811 543108901 531232178 14760205 394527 9847288 9680773 681031989 619741975 39083856 23399757 415342640 371546947 454426496 394946704 X 226605493 224795271 226605493 224795271 681031989 619741975 X -4768975 2958753 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23470 23470 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. 16151785 16151785 455232520 91906822 363325698 4405762 2170457 2235305 281929270 132476993 149452277 610652 543539 67113 531232178 PAYABLE TO AFFILIATES 245312181 PENSION/DEFERRED COMPENSATION 9599530 PAYABLE TO THIRD PARTIES 3210073 INTERCOMPANY DEBT TO ASCENSION HEALTH ALLIANCE 111450875 OTHER LONG TERM LIABILITIES 1974288 371546947 PART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE. 1 1 X 1 X 1 X 1 1 0 1 1 8191877 8191877 0.01800 97695929 80533224 17162705 0.03770 105887806 80533224 25354582 0.05570 4598904 1114440 3484464 0.00770 15100770 4919033 10181737 0.02240 593301 593301 0.00130 20292975 6033473 14259502 0.03140 126180781 86566697 39614084 0.08710 8379 8379 0.00000 529458 529458 0.00120 37024 37024 0.00010 224070 224070 0.00050 798931 798931 0.00180 0 13777628 275553 436271262 455387914 -19116652 X 1 1 1 2 COLUMBIA ST MARYS HOSPITAL MILWAUKEE

2323 N LAKE DRIVE MILWAUKEE WI 53211

X X X COLUMBIA ST MARY'S HOSPITAL MILWAUKEE 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X X X 1 X 1 X X 1 X 0 0 34 AIRPORT MEDICAL CLINIC

4848 S 6TH STREET MILWAUKEE WI 53221

CLINIC BABBITZ BURNSTEIN & NASH

2350 N LAKE DRIVE SUITE 201 MILWAUKEE WI 53221

CLINIC BAY VIEW FAMILY HEALTH CENTER

3056 S KINNICKINNIC AVE MILWAUKEE WI 53207

CLINIC CSMCP PULMONOLOGY

2311 N PROSPECT AVE MILWAUKEE WI 53211

CLINIC CARDIAC RHYTHM SPECIALISTS

2350 N LAKE DRIVE SUITE 206 MILWAUKEE WI 53211

CLINIC CARDIAC & VASCULAR INTER SPECIALISTS

2350 N LAKE DRIVE SUITE 303 MILWAUKEE WI 53211

CLINIC CATHEDRAL SQUARE URGENT CARE CENTER

734 N JACKSON ST MILWAUKEE WI 53202

CLINIC COLUMBIA WEST CLINIC

10950 W CAPITOL DRIVE WAUWATOSA WI 53222

CLINIC ENT ASSOCIATES

2350 N LAKE DRIVE SUITE 406 MILWAUKEE WI 53211

CLINIC FAMILY HEALTH CENTER

1121 E NORTH AVE MILWAUKEE WI 53212

CLINIC PMC NEUROLOGY

2311 N PROSPECT AVE MILWAUKEE WI 53211

CLINIC GATEWAY MEDICAL CENTER

801 S 70TH ST WEST ALLIS WI 53214

CLINIC GLENDALE GREEN BAY CLINIC

9233 N GREEN BAY ROAD BROWN DEER WI 53209

CLINIC GLENDALE PORT WASHINGTON CLINIC

6900 N PORT WASHINGTON ROAD GLENDALE WI 53217

CLINIC CSM GYN ONCOLOGY

2350 N LAKE DRUVE SUITE 501 MILWAUKEE WI 53211

CLINIC MEDICAL ONCOLOGY

2350 N LAKE DRIVE SUITE 100 MILWAUKEE WI 53211

CLINIC NORTHSHORE MEDICAL CLINIC

7080 N PORT WASHINGTON ROAD GLENDALE WI 53217

CLINIC OBGYN RESIDENCY CLINIC

2320 N LAKE DRIVE MILWAUKEE WI 53211

CLINIC PERINATAL ASSESSMENT CENTER

2323 N LAKE DRIVE MILWAUKEE WI 53211

CLINIC PROSPECT MEDICAL COMMONS

2311 N PROSPECT AVE MILWAUKEE WI 53211

CLINIC RADIATION ONCOLOGY

2350 N LAKE DRIVE SUITE G01 MILWAUKEE WI 53211

CLINIC RIVER GLEN MEDICAL CLINIC

375 W RIVERWOODS PKWY GLENDALE WI 53212

CLINIC RIVER WOODS URGENT CARE

375 W RIVERWOODS PKWY GLENDALE WI 53212

CLINIC SHOREWOOD FAMILY PHYSICIANS

1901 E CAPITOL DRIVE SHOREWOOD WI 53211

CLINIC WEST ALLIS MEDICAL CLINIC

2323 S 102ND ST WEST ALLIS WI 53227

CLINIC WESTGATE MEDICAL GROUP

2727 N MAYFAIR ROAD WAUWATOSA WI 53222

CLINIC PLASTIC SURGERY

2350 N LAKE DRIVE SUITE 501 MILWAUKEE WI 53211

CLINIC WISCONSIN CARDIOVASCULAR GROUP

2350 N LAKE DRIVE SUITE 400 MILWAUKEE WI 53211

CLINIC CSM CANCER CENTER

2350 N LAKE DRIVE SUITE 100 MILWAUKEE WI 53211

CLINIC NORTH SHORE CARDIOLOGY EAST

2350 N LAKE DRIVE SUITE 400 MILWAUKEE WI 53211

CLINIC CARDIAC RHYTHM SPECIALISTS - MAYFAIR

2727 N MAYFAIR ROAD WAUWATOSA WI 53222

CLINIC CENTER FOR PAIN MANAGEMENT

2323 N LAKE DRIVE MILWAUKEE WI 53211

CLINIC MMA CATHEDRAL SQUARE

788 N JEFFERSON ST MILWAUKEE WI 53202

CLINIC MMA WAUKESHA

22370 W BLUEMOUND ROAD WAUKESHA WI 53186

CLINIC 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. COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE 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. 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. X X X X X 1 1 0 0 0 0 0 1 0 KEVIN GONIU MD 0 530364 0 41000 0 19741 0 66148 0 54917 0 712170 0 0 MARK R TAYLOR 0 482149 0 217343 0 114348 0 18446 0 25269 0 857555 0 0 LEO P BRIDEAU 0 388367 0 436894 0 184723 0 13475 0 24152 0 1047611 0 0 RHONDA ANDERSON 0 377857 0 11698 0 21521 0 48250 0 12917 0 472243 0 0 AMY MARQUARDT 0 99244 0 88808 0 199913 0 2079 0 2543 0 392587 0 0 CHERYL HILL 0 242867 0 8613 0 35301 0 63865 0 18255 0 368901 0 0 DAVID H SHAPIRO MD 0 279606 0 18413 0 32905 0 64682 0 4782 0 400388 0 0 GERRI LIETZ-STAFFILENO 0 220696 0 28354 0 63650 0 83685 0 20234 0 416619 0 0 KAROL MARCIANO 0 94745 0 57192 0 216546 0 2095 0 6781 0 377359 0 0 MARY PAUL 0 374334 0 207246 0 94530 0 33791 0 10385 0 720286 0 0 SUE SANICOLA 0 175160 0 0 0 48568 0 31132 0 23894 0 278754 0 0 WILLIAM HART 291124 0 10122 0 50778 0 24066 0 15563 0 391653 0 0 0 DEBORAH FRIBERG 459908 0 7706 0 22376 0 12250 0 27754 0 529994 0 0 0 BRUCE MCCARTHY 0 527284 0 3282 0 4370 0 9846 0 30574 0 575356 0 0 CONSTANCE J BRADLEY 200299 0 0 0 18443 0 29139 0 11052 0 258933 0 0 0 DAVID OLSON 0 298770 0 4848 0 17548 0 2825 0 15869 0 339860 0 0 ROBERT B ROTH MD 1620322 0 56500 0 21402 0 32036 0 91887 0 1822147 0 0 0 ROBERT L HUXLEY MD 1487632 0 15500 0 7524 0 37846 0 92255 0 1640757 0 0 0 DAVID W GRAMBOW MD 1252963 0 36522 0 19122 0 25493 0 83405 0 1417505 0 0 0 SANJAY S DESHPANDE MD 1433698 0 276854 0 17221 0 12250 0 81359 0 1821382 0 0 0 ANDREW J FEIRING MD 751514 0 631331 0 23097 0 37275 0 64661 0 1507878 0 0 0 PART I, LINES 4A-B SEVERANCE 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 7 BOARD 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. DAVID SHAPIRO MD KEY EMPLOYEE 146870 SPOUSE IS ALSO EMPLOYED BY CSM SYSTEM. ALL COMPENSATION IS DETERMINED IN ACCORDANCE WITH PAYROLL POLICY GUIDELINES. 0 FORM 990, PART VI, SECTION A, LINE 6 CSM-M HAS A SINGLE CORPORATE MEMBER, CSM. FORM 990, PART VI, SECTION A, LINE 7A CSM-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 7B ALL 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 11 MANAGEMENT, 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 12C CSM 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 15 15A. 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 19 THE 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. FORM 990, PART XII, LINE 2C NO CHANGES SINCE PRIOR YEAR COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD MILWAUKEE WI 53212 390807063 HOSPITAL WI 501(C)(3) 3 N/A 0 SACRED HEART REHABILITATION INSTITUTE 4425 NORTH PORT WASHINGTON ROAD MILWAUKEE WI 53212 390902199 REHAB FACILITY WI 501(C)(3) 3 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 COLUMBIA COLLEGE OF NURSING 4425 NORTH PORT WASHINGTON ROAD MILWAUKEE WI 53212 391596986 COLLEGE WI 501(C)(3) 2 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 SETON CHILDREN'S SCHOOL 4425 NORTH PORT WASHINGTON ROAD MILWAUKEE WI 53212 391391245 SCHOOL WI 501(C)(3) 9 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 1 ASCENSION HEALTH 4600 EDMUNDSON ROAD ST LOUIS MO 63136 311662309 HEALTH SYSTEM MO 501(C)(3) 11 N/A 0 HORIZON HOME CARE & HOSPICE INC 8949 N DEERBROOK TRL MILWAUKEE WI 53223 391171298 HOME CARE/HOSPICE WI 501(C)(3) 3 N/A 0 COLUMBIA ST MARY'S INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391834639 HEALTH SYSTEM WI 501(C)(3) 11 N/A 0 COLUMBIA HEALTH SYSTEM 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(C)(3) 11 N/A 0 COLUMBIA ST MARY'S FOUNDATION INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391494981 FOUNDATION WI 501(C)(3) 7 N/A 0 ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC 575 RIVERWOODS PKWY GLENDALE WI 53212 392015655 HEALTHCARE WI N/A SLEEP SERVICES OF WISCONSIN 111 E KILBOURN AVE SUITE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI N/A CSM STRATEGIC ALLIANCE 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391871856 HEALTH CARE WI N/A C MADISON MEDICAL AFFILIATES INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391855720 HEALTH CARE WI COLUMBIA ST MARY'S HOSPITAL INC C 1.00000 PROSPECT MEDICAL COMMONS CONDO ASSOCIATION 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 208042108 CONDO ASSOCIATION WI N/A C 0 0 1 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 ORTHOPAEDIC HOSPITAL OF WISCONSIN K 601028 SACRED HEART REHABILITATION INSTITUTE K 1588642 ASCENSION HEALTH E 111450875 COLUMBIA ST MARY'S INC L 72236976 COLUMBIA ST MARY'S INC O 131702000 COLUMBIA ST MARY'S FOUNDATION INC C 3357833 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC O 245312181 SACRED HEART REHABILITATION INSTITUTE P 15667707