2012-05-15T13:40:12-05:00 2011-06-30 DELOITTE TAX LLP 555 EAST WELLS ST SUITE 1400 MILWAUKEE WI 53202 990 2010-07-01 390807063 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC COLU 4143262230 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 RHONDA ANDERSON 4143262217 2012-05-15 1 4142713000 2010 2016-02-24 21:20:13Z MARK TAYLOR 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 198275211 0 0928 X COLUMBIA-STMARYS.ORG X 1955 WI FULL-SERVICE HOSPITAL PROVIDING MEDICAL, SURGICAL, ADVANCED CLINICAL, AND OTHER COMMUNITY SERVICES 15 12 1309 177 535281 -90352 49042 54200 214333682 195308082 50712 0 1626193 2912929 216059629 198275211 25750 26523 0 0 75823758 74736823 0 0 0 111092784 103903551 186942292 178666897 29117337 19608314 328067320 337928255 71479682 60872547 256587638 277055708 X 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. 0 0 136802439 26523 197108167 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. 136802439 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 98 0 1 1309 1 1 1 0 0 0 0 0 0 0 0 0 X 15 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 DAVID HOOGERLAND MD 1.00 X 0 537518 47468 GEORGE H HOFF 1.00 X 0 0 0 PATRICIA J DOLHUN MD 1.00 X 0 0 0 KEVIN GONIU MD 40.00 X 581431 0 55819 LEO P BRIDEAU 15.00 X X 0 1836612 78942 MARK TAYLOR 15.00 X X 0 0 0 MASON G ROSS 1.00 X 0 0 0 MICHELLE S NETTLES 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 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 RHONDA ANDERSON 15.00 X 0 467315 44961 AMY MARQUARDT 15.00 X 0 333816 36621 CHERYL HILL 15.00 X 0 313013 35052 DAVID H SHAPIRO MD 15.00 X 0 386542 19935 GERRI LIETZ-STAFFILENO 35.00 X 312928 0 30724 KAROL MARCIANO 10.00 X 0 361072 26841 MARY PAUL 15.00 X 0 661504 49057 SUE SANICOLA 10.00 X 0 231123 34778 WILLIAM HART 10.00 X 0 356106 20055 DEBORAH FRIBERG 10.00 X 0 634473 41593 BRUCE MCCARTHY MD 10.00 X 0 386167 29766 CONSTANCE J BRADLEY 1.00 X 0 248016 22826 DAVID OLSON 35.00 X 514194 0 39710 DEBORAH A CORTLANDT MD 40.00 X 398479 0 17586 ROBERT M HORTH MD 40.00 X 390147 0 24048 DAVID G MEULER MD 40.00 X 367664 0 46926 DIRK STEINERT MD 40.00 X 369036 0 39044 DANIEL HAGERMAN MD 40.00 X 348842 0 40394 CHARLES J DREHER 1.00 X 0 154720 27198 3282721 6907997 809344 66 1 1 0 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 25 53950 250 54200 NET PATIENT SERVICES 621990 192460844 192460844 RETAIL PHARMACY REVENU 446110 1785513 1250232 535281 RENTAL INCOME 531120 603589 603589 FOOD & NUTRITION 722210 458136 458136 195308082 EXPENSE TRANSFERS 1260430 1260430 FROM AFFILIATE 822520 822520 TEACH/CONSULT/HONORARI 416418 416418 413561 294134 119427 2912929 198275211 197108167 535281 577563 26523 26523 906649 906649 58189728 55523575 2666153 3264314 3104363 159951 10040568 9548580 491988 2335564 2221121 114443 355832 338040 17792 10103919 10103919 3398 3398 1580728 1580728 5042909 5042909 51669 51669 65584 65584 1961086 1961086 7406443 7406443 473343 473343 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 67574 67574 178666897 136802439 41864458 0 2350766 1962752 1817987 4439852 30021456 22304304 2646633 3113441 865340 521988 189301307 80866592 113435687 108434715 23750 60056 176905701 197091147 328067320 337928255 12390398 10948295 59089284 49924252 71479682 60872547 X 256587638 277055708 256587638 277055708 328067320 337928255 X 19608314 859756 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 14243 14243 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. 1753743 1753743 105662538 23544874 82117664 1195330 429280 766050 74782949 53292744 21490205 5906747 3599694 2307053 108434715 DUE FROM AFFILIATES 197091147 197091147 INTERCOMPANY DEBT TO ASCENSION HEALTH 49304970 MISC NONCURRENT LIABILITIES 619282 49924252 PART X: ASC 740 FOOTNOTE REGARDING UNCERTAIN TAX POSITIONS IN AUDITED FINANCIALS: NOT APPLICABLE 1 1 1 X 1 X 1 1 1 0 1 1 2584028 0 2584028 0.01520 17414617 11960554 5454063 0.03200 0 0 19998645 11960554 8038091 0.04720 128712 5487 123225 0.00070 396865 0 396865 0.00230 0 0 0 0 4000 0 4000 0.00000 529577 5487 524090 0.00300 20528222 11966041 8562181 0.05020 0 0 0 0 695 0 695 0.00000 0 0 0 0 0 0 0 0 7622 0 7622 0.00000 0 0 8317 8317 0 3547661 210975 243868158 267077611 -23209453 X 1 1 1 1 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC

13111 N PORT WASHINGTON ROAD MEQUON WI 53097

X X X NA 1 31 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 122 MEQUON WI 53097

CLINIC NEUROLOGY

13133 N PORT WASHINGTON RD SUITE G06 MEQUON WI 53097

CLINIC 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 226 MEQUON WI 53097

CLINIC 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 118 MEQUON WI 53097

CLINIC MEQUON PODIATRY

11203 N BUNTROCK AVE SUITE 103 MEQUON WI 53092

CLINIC NORTH SHORE CARDIOLOGY - MEQUON

13133 N PORT WASHINGTON RD SUITE 122 MEQUON WI 53097

CLINIC WISCONSIN CARDIOVASCULAR GROUP - MEQUON

13133 N PORT WASHINGTON RD SUITE 202 MEQUON WI 53097

CLINIC 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 206 MEQUON WI 53097

CLINIC MADISON MEDICAL AFFILIATES - OZAUKEE G16

13133 N PORT WASHINGTON RD SUITE G16 MEQUON WI 53097

CLINIC MADISON MEDICAL AFFILIATES - OZAUKEE G18

13133 N PORT WASHINGTON RD SUITE G18 MEQUON WI 53097

CLINIC MADISON MEDICAL AFFILIATES - SURGERY

13133 N PORT WASHINGTON RD SUITE 224 MEQUON WI 53097

CLINIC 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. 1 CITY OF MEQUON 1133 N CEDARBURG RD MEQUON WI 53092 26523 DONATION FOR FIRE EQUIPMENT FOR THE CITY 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. X X 1 1 1 1 0 0 0 0 0 1 0 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 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. SUPPLEMENTAL INFORMATION 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 KEVIN GONUI MD BOARD MEMBER/CSM PHYSICIAN 13283 SPOUSE IS ALSO EMPLOYED BY CSMO. ALL COMPENSATION IS DETERMINED IN ACCORDANCE WITH PAYROLL POLICY GUIDELINES. 0 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. FORM 990, PART VI, SECTION B, LINE 12C 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 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 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 C, LINE 19 THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. EMPLOYEE HOURS FORM 990, PART VII, COL (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: 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 XII, LINE 2C NO CHANGES SINCE THE PRIOR YEAR 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 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 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 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 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