COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC (EIN 39-0807063)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201231379349300248
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T13:40:12-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 555 EAST WELLS ST SUITE 1400 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 53202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807063 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COLU | NameControl |
| Phone | 4143262230 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N PORT WASHINGTON ROAD | AddressLine1 |
| City | GLENDALE | City |
| State | WI | State |
| ZIP Code | 53212 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RHONDA ANDERSON | Name |
| Title | EXECUTIVE VP FINANCE / CFO | Title |
| Phone | 4143262217 | Phone |
| Date Signed | 2012-05-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4142713000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARK TAYLOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N PORT WASHINGTON ROAD | AddressLine1 |
| City | GLENDALE | City |
| State | WI | State |
| ZIP Code | 53212 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 198275211 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | COLUMBIA-STMARYS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | FULL-SERVICE HOSPITAL PROVIDING MEDICAL, SURGICAL, ADVANCED CLINICAL, AND OTHER COMMUNITY SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1309 | TotalNbrEmployees |
| Total Nbr Volunteers | 177 | TotalNbrVolunteers |
| Total Gross UBI | 535281 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -90352 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 49042 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 54200 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 214333682 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 195308082 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 50712 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1626193 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2912929 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 216059629 | TotalRevenuePriorYear |
| Total Revenue Current Year | 198275211 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 25750 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 26523 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 75823758 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 74736823 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 111092784 | OtherExpensePriorYear |
| Other Expenses Current Year | 103903551 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 186942292 | TotalExpensesPriorYear |
| Total Expenses Current Year | 178666897 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 29117337 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 19608314 | RevenuesLessExpensesCY |
| Total Assets BOY | 328067320 | TotalAssetsBOY |
| Total Assets EOY | 337928255 | TotalAssetsEOY |
| Total Liabilities BOY | 71479682 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 60872547 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 256587638 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 277055708 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | COLUMBIA ST. MARY'S HOSPITAL OZAUKEE INC ("CSMO") 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. CSMO'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 Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 136802439 | Expense |
| Grants | 26523 | Grants |
| Revenue | 197108167 | Revenue |
| Description | CSMO OPERATES A FULL-SERVICE 152-BED HOSPITAL, WHICH OFFERS A COMPLETE RANGE OF MEDICAL, SURGICAL, AND ADVANCED CLINICAL SPECIALITIES. CSMO OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. DURING FISCAL 2011, CSMO PROVIDED CARE TO 4,801 INPATIENTS AND 78,030 OUTPATIENTS. CSMO'S ESTIMATED UNREIMBURSED COSTS OF SERVICES TO THE ELDERLY, UNINSURED, AND UNDERINSURED TOTALED $42,222,116. CSMO 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 CSMO MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE. | Description |
| Total Program Service Expense | 136802439 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 98 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1309 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RHONDA ANDERSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4143262230 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N PORT WASHINGTON ROAD | AddressLine1 |
| City | GLENDALE | City |
| State | WI | State |
| ZIP Code | 53212 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (35 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| DAVID HOOGERLAND MD | |||||||||
| BOARD MEMBER AND CSM PHYSI | 1.00 | X | 0 | 537518 | 47468 | ||||
| GEORGE H HOFF | |||||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | ||||
| PATRICIA J DOLHUN MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| KEVIN GONIU MD | |||||||||
| BOARD MEMBER AND CSM PHYSI | 40.00 | X | 581431 | 0 | 55819 | ||||
| LEO P BRIDEAU | |||||||||
| PRESIDENT/CEO 07/10-02/11 | 15.00 | X | 0 | 1836612 | 78942 | X | |||
| MARK TAYLOR | |||||||||
| PRESIDENT/CEO 02/11-06/11 | 15.00 | X | 0 | 0 | 0 | X | |||
| MASON G ROSS | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| MICHELLE S NETTLES | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| MICHAEL GREBE | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| R BRUCE MCDONALD | |||||||||
| CHAIR | 1.00 | X | 0 | 0 | 0 | ||||
| RANDALL PERRY | |||||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | ||||
| ROBERT LYON MD | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| ROBERT VENABLE | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| SISTER THERESA SULLIVAN DC | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| TINA CHANG | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| CHRISTINE NUERNBERG | |||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||||
| RHONDA ANDERSON | |||||||||
| PRESIDENT / CFO | 15.00 | 0 | 467315 | 44961 | X | ||||
| AMY MARQUARDT | |||||||||
| VP LEGAL SERVICES | 15.00 | 0 | 333816 | 36621 | X | ||||
| CHERYL HILL | |||||||||
| VP HUMAN RESOURCES | 15.00 | 0 | 313013 | 35052 | X | ||||
| DAVID H SHAPIRO MD | |||||||||
| CHIEF MEDICAL OFFICER | 15.00 | 0 | 386542 | 19935 | X | ||||
| GERRI LIETZ-STAFFILENO | |||||||||
| VP HOSP OPERATIONS | 35.00 | 312928 | 0 | 30724 | X | ||||
| KAROL MARCIANO | |||||||||
| EXEC VP BUSINESS DEVELOPME | 10.00 | 0 | 361072 | 26841 | X | ||||
| MARY PAUL | |||||||||
| VP/CIO | 15.00 | 0 | 661504 | 49057 | X | ||||
| SUE SANICOLA | |||||||||
| VP PHYSICIAN DIVISION | 10.00 | 0 | 231123 | 34778 | X | ||||
| WILLIAM HART | |||||||||
| VP/COO | 10.00 | 0 | 356106 | 20055 | X | ||||
| DEBORAH FRIBERG | |||||||||
| PRESIDENT HOSPITAL DIVISION | 10.00 | 0 | 634473 | 41593 | X | ||||
| BRUCE MCCARTHY MD | |||||||||
| PRESIDENT PHYSICIAN DIVISION | 10.00 | 0 | 386167 | 29766 | X | ||||
| CONSTANCE J BRADLEY | |||||||||
| VP HOSPITAL OPERATIONS | 1.00 | 0 | 248016 | 22826 | X | ||||
| DAVID OLSON | |||||||||
| PRESIDENT CSMO HOSPITAL | 35.00 | 514194 | 0 | 39710 | X | ||||
| DEBORAH A CORTLANDT MD | |||||||||
| PHYSICIAN | 40.00 | 398479 | 0 | 17586 | X | ||||
| ROBERT M HORTH MD | |||||||||
| PHYSICIAN | 40.00 | 390147 | 0 | 24048 | X | ||||
| DAVID G MEULER MD | |||||||||
| PHYSICIAN | 40.00 | 367664 | 0 | 46926 | X | ||||
| DIRK STEINERT MD | |||||||||
| PHYSICIAN | 40.00 | 369036 | 0 | 39044 | X | ||||
| DANIEL HAGERMAN MD | |||||||||
| PHYSICIAN | 40.00 | 348842 | 0 | 40394 | X | ||||
| CHARLES J DREHER | |||||||||
| FORMER CFO / PROJECT MNGR | 1.00 | 0 | 154720 | 27198 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3282721 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6907997 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 809344 | TotalOtherCompensation |
| Number Individuals GT100 K | 66 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FW MADISON MEDICAL ASSOC SC | |||||
| 788 N JEFFERSON ST | MILWAUKEE | WI | 53202 | MEDICAL SERVICES | 4207999 |
| METROPOLITAN ANESTHESIOLOGISTS | |||||
| 4225 N DOWNER AVE | SHOREWOOD | WI | 53211 | ANESTHESIOLOGY SERVICES | 910999 |
| CARDINAL HEALTH | |||||
| 6464 CANOGA AVENUE | WOODLAND HILLS | CA | 91367 | NUCLEAR PHARMACY SERVICES | 431723 |
| ROGERS MEMORIAL HOSPITAL | |||||
| 34700 VALLEY ROAD | OCONOMOWOC | WI | 53066 | MEDICAL SERVICES | 369765 |
| IMPERIAL LAUNDRY SYSTEMS | |||||
| 1236 13TH ST | RACINE | WI | 53403 | LAUNDRY SERVICES | 334332 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 25 | NumberOfContractorsGT100K |
| Related Organizations | 53950 | RelatedOrganizations |
| All Other Contributions | 250 | AllOtherContributions |
| Total Contributions | 54200 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| NET PATIENT SERVICES | 621990 | 192460844 | 192460844 | ||
| RETAIL PHARMACY REVENU | 446110 | 1785513 | 1250232 | 535281 | |
| RENTAL INCOME | 531120 | 603589 | 603589 | ||
| FOOD & NUTRITION | 722210 | 458136 | $458,136 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 195308082 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| EXPENSE TRANSFERS | 1260430 | 1260430 |
| FROM AFFILIATE | 822520 | 822520 |
| TEACH/CONSULT/HONORARI | 416418 | 416418 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 413561 | TotalRevenueColumn |
| Related Or Exempt Function Income | 294134 | RelatedOrExemptFunctionIncome |
| Exclusion | $119,427 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2912929 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 198275211 | TotalRevenueColumn |
| Related Or Exempt Function Income | 197108167 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 535281 | UnrelatedBusinessRevenue |
| Exclusion | $577,563 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26523 | Total |
| Program Services | 26523 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 906649 | Total |
| Management And General | 906649 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58189728 | Total |
| Program Services | 55523575 | ProgramServices |
| Management And General | 2666153 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3264314 | Total |
| Program Services | 3104363 | ProgramServices |
| Management And General | 159951 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10040568 | Total |
| Program Services | 9548580 | ProgramServices |
| Management And General | 491988 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2335564 | Total |
| Program Services | 2221121 | ProgramServices |
| Management And General | 114443 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 355832 | Total |
| Program Services | 338040 | ProgramServices |
| Management And General | 17792 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10103919 | Total |
| Program Services | 10103919 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3398 | Total |
| Program Services | 3398 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1580728 | Total |
| Program Services | 1580728 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5042909 | Total |
| Program Services | 5042909 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51669 | Total |
| Program Services | 51669 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65584 | Total |
| Program Services | 65584 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1961086 | Total |
| Program Services | 1961086 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7406443 | Total |
| Program Services | 7406443 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 473343 | Total |
| Program Services | 473343 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| CSM MANAGEMENT FEES | 32763875 | 32763875 | |
| PATIENT CARE SUPPLIES | 24053169 | 24053169 | |
| BAD DEBT EXPENSES | 8439000 | 8439000 | |
| HOSPITAL ASSESSMENT TAX | 6791415 | 6791415 | |
| EXP TRANSFER PHYS BILLI | 4743607 | 4743607 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67574 | Total |
| Program Services | 67574 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178666897 | Total |
| Program Services | 136802439 | ProgramServices |
| Management And General | 41864458 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2350766 | BOY |
| EOY | 1962752 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1817987 | BOY |
| EOY | 4439852 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30021456 | BOY |
| EOY | 22304304 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2646633 | BOY |
| EOY | 3113441 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 865340 | BOY |
| EOY | 521988 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 189301307 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 80866592 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 113435687 | BOY |
| EOY | 108434715 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23750 | BOY |
| EOY | 60056 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 176905701 | BOY |
| EOY | 197091147 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 328067320 | BOY |
| EOY | 337928255 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12390398 | BOY |
| EOY | 10948295 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59089284 | BOY |
| EOY | 49924252 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71479682 | BOY |
| EOY | 60872547 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 256587638 | BOY |
| EOY | 277055708 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 256587638 | BOY |
| EOY | 277055708 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 328067320 | BOY |
| EOY | 337928255 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 19608314 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 859756 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $14,243 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 14243 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | LOBBYING 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1753743 | OtherCostOrOtherBasis |
| Book Value | 1753743 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 105662538 | OtherCostOrOtherBasis |
| Depreciation | 23544874 | Depreciation |
| Book Value | 82117664 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1195330 | OtherCostOrOtherBasis |
| Depreciation | 429280 | Depreciation |
| Book Value | 766050 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 74782949 | OtherCostOrOtherBasis |
| Depreciation | 53292744 | Depreciation |
| Book Value | 21490205 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5906747 | OtherCostOrOtherBasis |
| Depreciation | 3599694 | Depreciation |
| Book Value | 2307053 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 108434715 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM AFFILIATES | Description |
| Book Value | 197091147 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 197091147 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INTERCOMPANY DEBT TO ASCENSION HEALTH | $49,304,970 |
| MISC NONCURRENT LIABILITIES | $619,282 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 49924252 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | PART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2584028 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2584028 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01520 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17414617 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11960554 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5454063 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03200 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19998645 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11960554 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8038091 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04720 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 128712 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5487 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 123225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 396865 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 396865 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 529577 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5487 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 524090 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20528222 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11966041 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8562181 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05020 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 695 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 695 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Environmental Improvements EnvironmentalImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7622 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 7622 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 0 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8317 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8317 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,547,661 | BadDebtExpenseAmount |
| Amount Attributable To | 210975 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 243868158 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 267077611 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -23209453 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13111 N PORT WASHINGTON ROAD | AddressLine1 |
| City | MEQUON | City |
| State | WI | State |
| ZIP Code | 53097 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 31 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (31 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType | Address Line2Address/AddressLine2 |
|---|---|---|---|---|---|
| MARSHO FAMILY MEDICAL GROUP | |||||
| 1703 N TAYLOR DR | SHEBOYGAN | WI | 53081 | CLINIC | |
| MARSHO FAMILY MEDICAL GROUP | |||||
| 515 E MILL ST | PLYMOUTH | WI | 53073 | CLINIC | |
| CEDAR MILLS MEDICAL GROUP | |||||
| N143 W6515 PIONEER RD | CEDARBURG | WI | 53012 | CLINIC | |
| CEDARBURG MEDICAL CLINIC | |||||
| N28 W5901 W LINCOLN BLVD | CEDARBURG | WI | 53012 | CLINIC | |
| FAMILY PRACTICE ASSOCIATES OF CEDARBRUG | |||||
| W62 N179 WASHINGTON AVE | CEDARBURG | WI | 53012 | CLINIC | |
| GERMANTOWN CLINIC | |||||
| N112 W15415 MEQUON RD | GERMANTOWN | WI | 53022 | CLINIC | |
| MADISON MEDICAL AFFILIATES - GERMANTOWN | |||||
| N112 W15415 MEQUON RD | GERMANTOWN | WI | 53022 | CLINIC | |
| GRAFTON (DR HONG) | |||||
| 1990 WISCONSIN AVE | GRAFTON | WI | 53024 | CLINIC | |
| GRAFTON MEDICAL CENTER | |||||
| 2061 CHEYENNE CT | GRAFTON | WI | 53024 | CLINIC | |
| CARDIAC RHYTHM SPECIALISTS - OZAUKEE | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 122 |
| NEUROLOGY | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | G06 |
| CANCER CENTER - OZAUKEE ONCOLOGYHEMATOL | |||||
| 13133 N PORT WASHINGTON RD | MEQUON | WI | 53097 | CLINIC | |
| RADIATION ONCOLOGY | |||||
| 13133 N PORT WASHINGTON RD | MEQUON | WI | 53097 | CLINIC | |
| ENT ASSOCIATES - OZAUKEE | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 226 |
| HIGHLAND FAMILY HEALTH CENTER | |||||
| 12800 N PORT WASHINGTON RD | MEQUON | WI | 53097 | CLINIC | |
| MADISON MEDICAL AFFILIATES - MEQUON | |||||
| 13133 N PORT WASHINGTON RD | MEQUON | WI | 53097 | CLINIC | |
| MEADOWVIEW OBSTETRICS & GYNECOLOGY | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 118 |
| MEQUON PODIATRY | |||||
| 11203 N BUNTROCK AVE SUITE 103 | MEQUON | WI | 53092 | CLINIC | |
| NORTH SHORE CARDIOLOGY - MEQUON | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 122 |
| WISCONSIN CARDIOVASCULAR GROUP - MEQUON | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 202 |
| CARDIAC RHYTHM SPECIALISTS - OSHKOSH | |||||
| 2700 W 9TH AVE | OSHKOSH | WI | 54904 | CLINIC | |
| PORT WASHINGTON FAMILY MEDICAL CLINIC | |||||
| 1317 W GRAND AVE | PORT WASHINGTON | WI | 53074 | CLINIC | |
| GENESIS CHIROPRACTIC CLINIC | |||||
| 830 E GREEN BAY AVE SUITE 103 | SAUKVILLE | WI | 53080 | CLINIC | |
| GREENLANE FAMILY PRACTICE | |||||
| 830 E GREEN BAY AVE | SAUKVILLE | WI | 53080 | CLINIC | |
| CARDIAC RHYTHM SPECIALISTS - SHEBOYGAN | |||||
| 1414 N TAYLOR DR | SHEBOYGAN | WI | 53081 | CLINIC | |
| COULIS CARDIOLOGY | |||||
| 1414 N TAYLOR DR | SHEBOYGAN | WI | 53081 | CLINIC | |
| GRAFTON (DR SHEWCZYK) | |||||
| 1990 WISCONSIN AVE | GRAFTON | WI | 53024 | CLINIC | |
| CSM HOSPITAL OZAUKEE SUITE 206 | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 206 |
| MADISON MEDICAL AFFILIATES - OZAUKEE G16 | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | G16 |
| MADISON MEDICAL AFFILIATES - OZAUKEE G18 | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | G18 |
| MADISON MEDICAL AFFILIATES - SURGERY | |||||
| 13133 N PORT WASHINGTON RD SUITE | MEQUON | WI | 53097 | CLINIC | 224 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 6A: CSM HOSPITAL OZAUKEE 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 HOSPITAL OZAUKEE 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 HOSPITAL 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): PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25, COL(A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN PART 1, LINE 7, COL(F) IS $8,439,000. |
| PART II: SUPPORT OF NON-PROFIT HEALTH AND CULTURAL PROGRAMS IS SIGNIFICANT TO CSM HOSPITAL OZAUKEE. AS A SIGNIFICANT EMPLOYER AND A SIGNIFICANT ECONOMIC RESOURCE IN THE COUNTY, THE OZAUKEE CAMPUS SUPPORTS NON-PROFIT PROGRAMS IN THEIR PROVISION OF IMPORTANT COMMUNITY SERVICES AND CULTURAL ACTIVITIES. DURING FISCAL YEAR 2011, CSM HOSPITAL OZAUKEE CONTINUED TO SUPPORT THE SCHOOL TO WORK PROGRAM, A YOUTH PROGRAM WHICH PROVIDES WORKFORCE DEVELOPMENT IN COLLABORATION WITH LOCAL HIGH SCHOOLS. CSM HOSPITAL OZAUKEE OFFERS STUDENTS INTERESTED IN HEALTH PROFESSIONS LOCAL HEALTH WORKFORCE INTERNSHIPS. STUDENTS SPEND TIME WORKING WITH PROFESSIONALS TO UNDERSTAND THE VALUES AND ROLES OF DIFFERENT PROFESSIONS. THIS PROGRAM IS SUPPORTED BY THE VOLUNTEER DEPARTMENT OF CSM AND THE CSM PROFESSIONALS WITHIN THE INTERNSHIP SETTINGS. |
| 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 2011 CONSOLIDATED AUDIT 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 NOT 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." CSM HOSPITAL OZAUKEE'S SHARE OF BAD DEBT EXPENSE IN 2011 WAS $8,439,000 AT CHARGES ($3,547,661 AT COST). |
| 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 VI, LINE 8: CSM HOSPITAL OZAUKEE FILES A COMMUNITY BENEFIT REPORT WITH THE WHA IN WISCONSIN WHICH INCLUDES DATA ONLY FOR CSM HOSPITAL OZAUKEE. THE AFFILIATE HOSPITALS OF CSM, INCLUDING CSM HOSPITAL MILWAUKEE, INC., AND SACRED HEART REHABILITATION INSTITUTE, INC ALSO FILE SEPARATE COMMUNITY BENEFIT REPORTS WITH WHA. |
| COLUMBIA ST. MARY'S, INC. AND ITS AFFILIATED HOSPITALS SPONSORS ENVIRONMENTAL INITIATIVES AS PART OF THE NATIONAL PRACTICE GREENHEALTH ENVIRONMENTAL PROGRAM. A CSM GREEN TEAM MEETS MONTHLY TO DEVELOP AND ACCOMPLISH GOALS ACROSS THE INSTITUTIONS. THE TEAM SERVES THE CSM HOSPITALS AND REPORTS THE FOLLOWING ACHIEVEMENTS IN THE PAST YEAR UNDER THE THEMES OF REDUCE, REUSE, AND RECYCLE.REDUCE:AS A HEALTH SYSTEM, CSM WAS AN AWARD RECIPIENT OF THE 2011 PRACTICE GREENHEALTH ENVIRONMENTAL EXCELLENCE AWARD-PARTNER FOR CHANGE WITH DISTINCTION. THIS AWARD DESIGNATION REQUIRES A RECYCLING RATE THROUGH ALL WASTE STREAMS OF GREATER THAN 25%.IN EARLY 2011, CSM HOSPITAL OZAUKEE EARNED AN ENERGY STAR DESIGNATION FROM THE EPA FOR USING 35% LESS ENERGY THAN THE AVERAGE HOSPITAL.REUSE:CSM'S REPROCESSING PRACTICE WITH STERILMED DIVERTED 24,355 UNITS FROM LANDFILLS OR 14,306 POUNDS.RECYCLE:SINGLE SOURCE RECYCLING: 377 TONS RECYCLABLES-EACH TON SAVES 24 GALLONS OF GAS, 4100 KWH OF ELECTRICITY, AND 7,000 GALLONS OF WATER.ADDITIONALLY, CSM HOSPITAL MILWAUKEE, AN AFFILIATED HOSPITAL, IMPLEMENTED A DESIGN OF THE PATIENT CARE TOWER WITH A TOTAL OF 18,800 SQUARE FEET OF GREEN ROOF. THE ROOF REMOVES THE EQUIVALENT OF 282 PASSENGER CARS OF GREENHOUSE GASES ANNUALLY, HOLDS ROUGHLY 25,000 GALLONS OF RAINWATER OUT OF THE SEWAGE SYSTEM, AND REDUCES INDOOR SOUND BY AS MUCH AS 40 DECIBELS LEADING TO A QUIETER PATIENT EXPERIENCE. |
| PART VI, LINE 2: THE HEALTH NEEDS OF THE COMMUNITIES WHICH CSM HOSPITAL OZAUKEE SERVE ARE ASSESSED THROUGH THE WORK OF THE CSM COMMUNITY BENEFIT COMMITTEE ("CBC"). THE CBC IS GUIDED BY THE MISSION STATEMENT OF CSM, AND IS COMPRISED OF ADMINISTRATIVE LEVEL LEADERSHIP, MANAGERS, AND STAFF INVOLVED IN DIRECT SERVICE TO VULNERABLE PEOPLE. ADDITIONALLY, CBC INCLUDES A REPRESENTATIVE OF THE PATIENT FAMILY ADVISORY COMMITTEE OF CSM AS A STRUCTURED METHOD FOR RECEIVING COMMUNITY INPUT. THE CBC ROLES INCLUDE THE FOLLOWING:- DEVELOP COMMUNITY ASSESSMENT TO DETERMINE NEEDS OVER A TWO YEAR PERIOD TO ADDRESS THROUGH CSM RESOURCES.- CREATE A COMMUNITY BENEFIT PLAN TO DRIVE CSM ACTIVITIES OVER SEVERAL YEARS.- REVIEW AND PROVIDE INPUT TO COMMUNITY BENEFIT REPORTS TO ASCENSION HEALTH, WHA AND CHA.- DEVELOP ANNUAL COMMUNITY BENEFIT GOALS TO INCLUDE WITHIN CSM INTEGRATED, STRATEGIC, OPERATIONAL AND FINANCIAL PLAN.- PROVIDE INPUT TO AND ADVOCATE FOR CSM ORGANIZATIONAL POLICIES FOCUSED ON VULNERABLE POPULATIONS (E.G. OUTREACH SCREENING GUIDELINES, TRANSPORTATION, COLLECTION POLICIES).- DEVELOP AND IMPLEMENT COMMUNICATION STRATEGIES TO INFORM MULTIPLE COMMUNITIES ABOUT COMMUNITY BENEFIT ACHIEVEMENTS.- DEVELOP A STRATEGY TO MEASURE AND INCREASE THE IMPACT OF COMMUNITY BENEFIT PROGRAMS.IN FISCAL 2011, THE CBC PREPARED A NEEDS ASSESSMENT WHICH ADDRESSES THE COMMUNITY IN WHICH THE HOSPITAL SERVES TO GUIDE THE CSMO PLANNING. THE ASSESSMENT WAS DEVELOPED BY GATHERING KEY PUBLIC HEALTH AND DISEASE SPECIFIC ASSESSMENTS FOR THE COMMUNITY AND SYNTHESIZING THE ASSESSMENTS INTO ONE DOCUMENT FROM PUBLIC SOURCES SUCH AS HRSA COMMUNITY HEALTH STATUS REPORT FOR OZAUKEE COUNTY, THE OZAUKEE HEALTH INITIATIVE 2002-2007, CHILDREN'S HEALTH IN WISCONSIN (CENTER FOR HEALTH STATISTICS), START SMART MILWAUKEE STATE OF MILWAUKEE'S CHILDREN HEALTH REPORT, HEALTHIEST WISCONSIN 2010, CITY OF MILWAUKEE HEALTH DEPT. REPORT, CITY OF MILWAUKEE COMMUNITY HEALTH SURVEY, HRSA COMMUNITY HEALTH STATUS REPORT FOR MILWAUKEE COUNTY , WISCONSIN DHFS FAMILY HEALTH SURVEY, WISCONSIN DHFS HEALTH INSURANCE COVERAGE REPORT, RIVERWEST HEALTH INITIATIVES SURVEY REPORT, MILWAUKEE'S COMMITMENT TO ACTION: REPORT FROM THE 2003 URBAN HEALTH FORUM, MILWAUKEE PUBLIC HEALTH REPORT BY ALDERMANIC DISTRICT, WISCONSIN COUNTY HEALTH RANKINGS 2006 AND WISCONSIN NUTRITION AND PHYSICAL ACTIVITY STATE PLAN. SEVERAL OF THESE SURVEYS INCLUDE DIRECT CITIZEN INPUT REGARDING THE STATE OF THEIR HEALTH.THE NEEDS ASSESSMENT WAS DISCUSSED IN DETAIL BY THE CBC TO GAIN THE INSIGHT OF THOSE AT CSMO INVOLVED IN ALL AREAS OF HEALTH AND COMMUNITY HEALTH. THE PLAN THAT WAS SUBSEQUENTLY DEVELOPED FOCUSED ON CARE FOR VULNERABLE PEOPLE CONSISTENT WITH THE CSM MISSION STATEMENT. |
| PART VI, LINE 3: CSM HOSPITAL OZAUKEE 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 OZAUKEE 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 OZAUKEE SERVES THE HEALTHCARE NEEDS OF THOSE LIVING IN THE OZAUKEE, SHEBOYGAN, AND WASHINGTON COMMUNITIES. CSM OZAUKEE SERVED A POPULATION OF OVER 330,000, WITH MEDIAN INCOME IN EACH COUNTY RANGING FROM $51,000 TO $75,000, AND POVERTY LEVELS RANGING BETWEEN 4.5% AND 8.4%. IN FISCAL 2011, CSM HOSPITAL OZAUKEE SERVED 82,831 PATIENTS AND PROVIDED $2,584,028 IN TRADITIONAL CHARITY CARE, $5,454,063 IN UNPAID COSTS OF PUBLIC PROGRAMS, $1,727,074 IN UNINSURED DISCOUNTS AND $532,407 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 OZAUKEE PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY WITHIN OZAUKEE COUNTY. THE HUIRAS FAMILY OZAUKEE COMMUNITY HEALTH CENTER IS A LONG-STANDING FREE CLINIC IN OZAUKEE COUNTY. ALTHOUGH OZAUKEE COUNTY HAS A HIGH AVERAGE INCOME RATE, MANY PEOPLE LIVE IN POVERTY THROUGHOUT THE COUNTY. THE COUNTY EXPERIENCED A NUMBER OF CORPORATE LAYOFFS DURING THE YEAR, INCREASING THE NUMBER OF UNINSURED. THE CLINIC USED PAID STAFF AND VOLUNTEER PHYSICIANS TO PROVIDE PRIMARY CARE TO THOSE IN NEED. THE CLINIC SERVES AN AVERAGE OF 700 PATIENTS IN A YEAR. A PARTICULAR BENEFIT OF THE CLINIC IS THE PATIENT PRESCRIPTION ASSISTANCE PROGRAM TO FACILITATE PROVISION OF ONGOING MEDICATIONS TO PATIENTS.SUPPORT OF MEDICAL EDUCATION IS PARTICULARLY IMPORTANT IN OZAUKEE. THE OZAUKEE CAMPUS PARTICIPATED IN NURSING AND ANCILLARY PROFESSIONAL STUDENT TRAINING. A SIGNIFICANT PART OF MEDICAL EDUCATION WAS ALSO THAT OF PARAMEDIC TRAINING, WHICH WAS AN IMPORTANT COLLABORATION OFFERED TO PROFESSIONALS WHO PARTNER WITH THE EMERGENCY DEPARTMENT FOR PATIENT CARE.OZAUKEE SPONSORED A VARIETY OF SUPPORT AND EDUCATION PROGRAMS AVAILABLE TO COMMUNITY MEMBERS, WITH PARTICULAR FOCUS ON CANCER, ORTHOPEDIC, AND CANCER SCREENING AND ONGOING SUPPORT.CSM HOSPITAL OZAUKEE WAS DESIGNATED A LEVEL III TRAUMA CENTER DURING FISCAL 2011, GREATLY IMPROVING THE ACCESS TO EMERGENCY TRAUMA CARE FOR OZAUKEE COUNTRY RESIDENTS AND SAVING VALUABLE TIME THAT CAN MEAN THE DIFFERENCE BETWEEN LIFE AND DEATH. |
| PART VI, LINE 7: CSM HOSPITAL OZAUKEE 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, 65 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, SETON CHILDREN'S SCHOOL, 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 2011, THE CSM SYSTEM PROVIDED $71,858,714 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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MEQUON | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 N CEDARBURG RD | AddressLine1 |
| City | MEQUON | City |
| State | WI | State |
| ZIP Code | 53092 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Of Cash Grant | 26523 | AmountOfCashGrant |
| Purpose Of Grant | DONATION FOR FIRE EQUIPMENT FOR THE CITY | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Housing Allowance Or Residence | X | HousingAllowanceOrResidence |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (22 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID HOOGERLAND MD | |||||||||||||
| 0 | 414900 | 0 | 101000 | 0 | 21618 | 0 | 4900 | 0 | 42568 | 0 | 584986 | 0 | 0 |
| KEVIN GONIU MD | |||||||||||||
| 522609 | 0 | 40000 | 0 | 18822 | 0 | 4900 | 0 | 50919 | 0 | 637250 | 0 | 0 | 0 |
| LEO P BRIDEAU | |||||||||||||
| 0 | 804390 | 0 | 857565 | 0 | 174657 | 0 | 4900 | 0 | 74042 | 0 | 1915554 | 0 | 0 |
| RHONDA ANDERSON | |||||||||||||
| 0 | 353962 | 0 | 109478 | 0 | 3875 | 0 | 3323 | 0 | 41638 | 0 | 512276 | 0 | 0 |
| AMY MARQUARDT | |||||||||||||
| 0 | 234247 | 0 | 74208 | 0 | 25361 | 0 | 19951 | 0 | 16670 | 0 | 370437 | 0 | 0 |
| CHERYL HILL | |||||||||||||
| 0 | 228137 | 0 | 61396 | 0 | 23480 | 0 | 4834 | 0 | 30218 | 0 | 348065 | 0 | 0 |
| DAVID H SHAPIRO MD | |||||||||||||
| 0 | 288246 | 0 | 53235 | 0 | 45061 | 0 | 4900 | 0 | 15035 | 0 | 406477 | 0 | 0 |
| GERRI LIETZ-STAFFILENO | |||||||||||||
| 216241 | 0 | 58443 | 0 | 38244 | 0 | 2141 | 0 | 28583 | 0 | 343652 | 0 | 0 | 0 |
| KAROL MARCIANO | |||||||||||||
| 0 | 246422 | 0 | 81198 | 0 | 33452 | 0 | 4900 | 0 | 21941 | 0 | 387913 | 0 | 0 |
| MARY PAUL | |||||||||||||
| 0 | 364297 | 0 | 220605 | 0 | 76602 | 0 | 33625 | 0 | 15432 | 0 | 710561 | 0 | 0 |
| SUE SANICOLA | |||||||||||||
| 0 | 165577 | 0 | 45781 | 0 | 19765 | 0 | 3825 | 0 | 30953 | 0 | 265901 | 0 | 0 |
| WILLIAM HART | |||||||||||||
| 0 | 280195 | 0 | 72496 | 0 | 3415 | 0 | 0 | 0 | 20055 | 0 | 376161 | 0 | 0 |
| DEBORAH FRIBERG | |||||||||||||
| 0 | 432541 | 0 | 115466 | 0 | 86466 | 0 | 361 | 0 | 41232 | 0 | 676066 | 0 | 0 |
| BRUCE MCCARTHY MD | |||||||||||||
| 0 | 344948 | 0 | 0 | 0 | 41219 | 0 | 0 | 0 | 29766 | 0 | 415933 | 0 | 0 |
| CONSTANCE J BRADLEY | |||||||||||||
| 0 | 196027 | 0 | 48703 | 0 | 3286 | 0 | 4740 | 0 | 18086 | 0 | 270842 | 0 | 0 |
| DAVID OLSON | |||||||||||||
| 348362 | 0 | 58277 | 0 | 107555 | 0 | 0 | 0 | 39710 | 0 | 553904 | 0 | 0 | 0 |
| DEBORAH A CORTLANDT MD | |||||||||||||
| 173064 | 0 | 0 | 0 | 225415 | 0 | 0 | 0 | 17586 | 0 | 416065 | 0 | 0 | 0 |
| ROBERT M HORTH MD | |||||||||||||
| 298044 | 0 | 30884 | 0 | 61219 | 0 | 0 | 0 | 24048 | 0 | 414195 | 0 | 0 | 0 |
| DAVID G MEULER MD | |||||||||||||
| 362316 | 0 | 5000 | 0 | 348 | 0 | 4900 | 0 | 42026 | 0 | 414590 | 0 | 0 | 0 |
| DIRK STEINERT MD | |||||||||||||
| 312000 | 0 | 57036 | 0 | 0 | 0 | 0 | 0 | 39044 | 0 | 408080 | 0 | 0 | 0 |
| DANIEL HAGERMAN MD | |||||||||||||
| 326685 | 0 | 5000 | 0 | 17157 | 0 | 16500 | 0 | 23894 | 0 | 389236 | 0 | 0 | 0 |
| CHARLES J DREHER | |||||||||||||
| 0 | 126732 | 0 | 10696 | 0 | 17292 | 0 | 3214 | 0 | 23984 | 0 | 181918 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | TAX INDEMNIFICATION PAYMENTS ARE MADE ON THE PERSONAL USE OF EMPLOYER-PROVIDED CELL PHONES. THIS POLICY EXISTS FOR ALL EMPLOYEES ISSUED EMPLOYER-PROVIDED CELL PHONES. GROSS UP PAYMENTS TO COVER TAXES FOR NON-QUALIFIED RELOCATION EXPENSES FOR EXECUTIVES WERE PAID IN FY11. | |
| PART I, LINES 4A-B | PART I, LINE 4B: 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 (CSMO) DID NOT CONTRIBUTE TO THIS PLAN DURING THIS YEAR. PART 1, LINE 4A: DEBORAH A CORTLANDT, MD, A HIGHEST PAID EMPLOYEE, HAD A SEVERANCE PAYMENT OF $225,000 INCLUDED IN HER COMPENSATION. | |
| 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. | |
| PART III | CSM, A RELATED ORGANIZATION OF CSMO, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | KEVIN GONUI MD | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER/CSM PHYSICIAN | Relationship |
| Amount Of Transaction | 13283 | AmountOfTransaction |
| Description Of Transaction | SPOUSE IS ALSO EMPLOYED BY CSMO. ALL COMPENSATION IS DETERMINED IN ACCORDANCE WITH PAYROLL POLICY GUIDELINES. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CSMO HAS A SINGLE CORPORATE MEMBER, CSM. | |
| FORM 990, PART VI, SECTION A, LINE 7A | CSMO HAS A SINGLE MEMBER, CSM, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSMO. | |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO CSMO'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 OFFICERS, 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. | |
| CSMO 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 12C | |
| 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 COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS 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 COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS 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 B, LINE 15 | |
| THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| EMPLOYEE HOURS | 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 VII, COL (B) |
| CHANGES IN NET ASSETS OR FUND BALANCES: | OTHER ADJUSTMENTS 685,380. TRANSFERS FROM FOUNDATION FOR CAPITAL PURCHASES 174,376. TOTAL TO FORM 990, PART XI, LINE 5: 859,756. | FORM 990, PART XI, LINE 5: |
| NO CHANGES SINCE THE PRIOR YEAR | FORM 990, PART XII, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| COLUMBIA ST MARY'S HOSPITAL MILWAUKEE | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 390806315 | 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 | N/A | 0 |
| COLUMBIA COLLEGE OF NURSING | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 391596986 | COLLEGE | WI | 501(C)(3) | 2 | N/A | 0 |
| SETON CHILDREN'S SCHOOL | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 391391245 | SCHOOL | WI | 501(C)(3) | 9 | N/A | 0 |
| ASCENSION HEALTH | ||||||||||
| 4600 EDMUNDSON ROAD | ST LOUIS | MO | 63136 | 311662309 | HEALTH SYSTEM | MI | 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 |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC | |||||||
| 575 RIVERWOODS PKWY | GLENDALE | WI | 53212 | 392015655 | HEALTHCARE | WI | N/A |
| SLEEP SERVICES OF WISCONSIN | |||||||
| 111 E KILBOURN AVE STE 1300 | MILWAUKEE | WI | 53202 | 273148310 | SLEEP SERVICES | WI | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| CSM STRATEGIC ALLIANCE | ||||||||
| 4425 NORTH PORT WASHINGTON RD | GLENDALE | WI | 53212 | 391871856 | HEALTHCARE | WI | N/A | C |
| MADISON MEDICAL AFFILIATES | ||||||||
| 4425 NORTH PORT WASHINGTON RD | GLENDALE | WI | 53212 | 391855720 | HEALTHCARE | WI | N/A | C |
| PROSPECT MEDICAL COMMONS | ||||||||
| 4425 NORTH PORT WASHINGTON RD | GLENDALE | WI | 53212 | 208042108 | CONDO ASSOCIATION | WI | N/A | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| ASCENSION HEALTH | |
| E | 49304970 |
| COLUMBIA ST MARY'S INC | |
| L | 30771839 |
| COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC | |
| L | 1992036 |
| COLUMBIA ST MARY'S INC | |
| O | 82761000 |