STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC (EIN 39-0818682)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201131339349300228
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-13T07:52:41-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 West Nationwide Blvd Ste 500AddressLine1
CityColumbusCity
StateOHState
ZIP Code432152568ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390818682EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S HOSPITAL MEDICAL CENTER OFBusinessNameLine1
Business Name Line2GREEN BAY INC - HOSPITAL SISTERSBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSTMANameControl
Phone9204984200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11726 SHAWANO AVENUEAddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code54303ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTherese PandlName
TitleChief Executive OfficerTitle
Date Signed2011-04-25DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKPMG LLPName
Phone6142492300Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GREEN BAY INC - HOSPITAL SISTERSBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonTHERESE PANDLNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11726 SHAWANO AVENUEAddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code54303ZIPCode
FieldValueIRS element (for citing)
Gross Receipts113740366GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501cXOrganization501c
Web SiteWWW.STMGB.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1900YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionTO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees843TotalNbrEmployees
Total Nbr Volunteers110TotalNbrVolunteers
Total Gross UBI975875TotalGrossUBI
Net Unrelated Business Txbl Income-2713039NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year611563ContributionsGrantsPriorYear
Contributions Grants Current Year81278ContributionsGrantsCurrentYear
Program Service Revenue Prior Year98249843ProgramServiceRevenuePriorYear
Program Service Revenue CY109687964ProgramServiceRevenueCY
Investment Income Prior Year-2289985InvestmentIncomePriorYear
Investment Income Current Year376304InvestmentIncomeCurrentYear
Other Revenue Prior Year3375749OtherRevenuePriorYear
Other Revenue Current Year1253834OtherRevenueCurrentYear
Total Revenue Prior Year99947170TotalRevenuePriorYear
Total Revenue Current Year111399380TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year46732195SalariesEtcPriorYear
Salaries Etc Current Year45023380SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year50470273OtherExpensePriorYear
Other Expenses Current Year58515830OtherExpensesCurrentYear
Total Expenses Prior Year97202468TotalExpensesPriorYear
Total Expenses Current Year103539210TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2744702RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7860170RevenuesLessExpensesCY
Total Assets BOY133292848TotalAssetsBOY
Total Assets EOY150181055TotalAssetsEOY
Total Liabilities BOY59382123TotalLiabilitiesBOY
Total Liabilities EOY75301348TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY73910725NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY74879707NetAssetsOrFundBalancesEOY
Mission DescriptionTO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense12897393Expense
Revenue24423669Revenue
DescriptionSurgical Services at St. Mary's Hospital Medical Center are comprised of Central Processing, Anesthesia, Surgery and Recovery. This includes eight OR Suites, a C-Section Room and two minor treatment rooms, Services are available 24/7 and include both inpatient and outpatient procedures. In fiscal year 2009-2010, 4,924 surgical procedures were performed. Surgical procedures include General, Orthopedic, Urology, Gynecology, Oral - Maxillofacial, and Organ procurement. Anesthesia and Central Processing also provide Hospital-wide services to Inpatient Nursing, Labor and Delivery and the Emergency Department. The Anesthesia department is comprised of eight employed Nurse Anesthetists and five Anesthesiologists.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense6404361Expense
Revenue18229348Revenue
DescriptionThe Imaging services department at St. Mary's Hospital Medical Center provides Inpatient, Outpatient, and Emergency care. Overall, the department performs more than 54,300 inpatient and outpatient exams and procedures annually. Patients have access to the latest technology in Mammograms, Computed Tomography, MRI, Nuclear Medicine, and Ultrasound. Four Interventional Radiologists provide minimally invasive procedures using image guidance. The staff consists of Board Certified radiologists as well as licensed and certified technologists, nurses, and sonographers. The modalities utilize state-of-the-art equipment to afford the radiologists optimal images for interpretation. The department and hospital are accredited by the Joint Commission.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3385646Expense
Revenue7920152Revenue
DescriptionThe Cath Lab offers a complete array of catheterization laboratory procedures and noninvasive cardiovascular diagnostic procedures, doing 913 cardiac catheterizations in FY2010. If needed, a state-of-the-art Cardiovascular operating center (CVOR) is available nearby at our sister facility, St. Vincent Hospital, for cutting-edge open heart procedures by our highly-skilled cardiothoracic surgeons. CVICU suites are also offered there. For those patients who need follow-up, a Cardio-Pulmonary Rehabilitation Program is offered on site at St. Mary's.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp59950731TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev59114795TotalOfOtherProgramServiceRev
Total Program Service Expense82638131TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees843NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProceduretrueWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDONNA HUTCHINSONNamePerson
Telephone Number9204984622TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11726 SHAWANO AVENUEAddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code54303ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SISTER MARYBETH CULNAN OSF
DIRECTOR1.0X000
THERESE PANDL
PRESIDENT/CEO40.0X040850379299X
JUDY NAGEL
CHAIRPERSON1.0X000X
SISTER BERNADINE GUTOWSKI OSF
DIRECTOR1.0X000
BOB BURNS
director1.0X000X
JOHN HAGER
vice chair1.0X000
KENNETH JOHNSON MD
SECRETARY1.0X000X
D J LONG
DIRECTOR1.0X000
ROLF LULLOFF MD
DIRECTOR1.0X000
ANN CARR
TREASURER1.0X0153448117382X
Robert Atwell
Director1.0X000
LAWRENCE J CONNORS
COO40.01895100107684X
Amy J Unrath
DIVISION ADMINISTRATOR40.01856220197840X
Donna A Hutchinson
CFO/ASSISTANT ADMINISTRATOR40.01743190147855X
JOHN DAUL
CRNA40.0186793089373X
MARY ALICE JOHNSON
CRNA40.01817170185837X
CRAIG BABIARZ
CRNA40.0187829023788X
STEPHEN KORDIYAK
CRNA40.0174677064556X
MARTIN SCHWEINER
CRNA40.01755580117409X
JAMES COLLER
PRESIDENT/CEO (RETIRED)40.00485356227298X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1456025TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1047307TotalReportableCompFrmRltdOrgs
Total Other Compensation1358321TotalOtherCompensation
Number Individuals GT100 K26NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ST VINCENT HOSPITAL
835 S VAN BUREN STREETGREEN BAYWI54303SHARED SERVICES7191528
ZIMMER US INC
W165 N5815 RIDGEWOOD DRIVEMENOMONEE FALLSWI53051SURGERY COMPONENTS1989828
HOWARD IMMEL INC
1820 RADISSON STREETGREEN BAYWI54302GENERAL CONTRACTOR12523991
PREVEA CLINIC
PO BOX 19070GREEN BAYWI54307SHARED LABOR2901471
CARDINAL HEALTH
7000 CARDINAL PLACEDUBLINOH43017EQUIPMENT3809076
FieldValueIRS element (for citing)
Number Of Contractors GT100 K77NumberOfContractorsGT100K
Related Organizations81278RelatedOrganizations
Total Contributions81278TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES900099107710742107710742
LABORATORY SERVICES621500679535679535
PREVEA INVESTMENT LOSS90009912976871297687
FieldValueIRS element (for citing)
Total Program Service Revenue109687964TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column219101TotalRevenueColumn
Exclusion$219,101ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real2304996Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2246754Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real58242Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column58242TotalRevenueColumn
Exclusion$58,242ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities164980Securities
Other86455Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other94232Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities164980Securities
Other-7777Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column157203TotalRevenueColumn
Exclusion$157,203ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
OTHER REVENUE900099455082$455,082
NONEMPLOYEE CHILDCARE REVENUE624410740510444170296340
FieldValueIRS element (for citing)
Total Other Revenue1195592TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column111399380TotalRevenueColumn
Related Or Exempt Function Income109452599RelatedOrExemptFunctionIncome
Unrelated Business Revenue975875UnrelatedBusinessRevenue
Exclusion$889,628ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1002830Total
Program Services0ProgramServices
Management And General1002830ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total32038080Total
Program Services30235015ProgramServices
Management And General1803065ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1746089Total
Program Services1597808ProgramServices
Management And General148281ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7913476Total
Program Services7241449ProgramServices
Management And General672027ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2322905Total
Program Services2125640ProgramServices
Management And General197265ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4650996Total
Management And General4650996ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total246966Total
Management And General246966ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5607Total
Program Services5607ProgramServices

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total8781241Total
Program Services7155701ProgramServices
Management And General1625540ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total855882Total
Program Services3080ProgramServices
Management And General852802ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total416646Total
Program Services377619ProgramServices
Management And General39027ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4209969Total
Program Services4111646ProgramServices
Management And General98323ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total34292Total
Program Services9097ProgramServices
Management And General25195ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total116680Total
Program Services53481ProgramServices
Management And General63199ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total441338Total
Management And General441338ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5071884Total
Program Services4577172ProgramServices
Management And General494712ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total518615Total
Program Services95754ProgramServices
Management And General422861ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
BAD DEBT EXPENSE42595524259552
PREVEA INVESTMENT LEASE76942037694203
MEDICAID TAX ASSESSMENT30125743012574
FOOD & CATERING SERVICES73466553453681212
SUPPLIES - MED/SURG/O2/DRUGS1547274715472747

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1991973Total
Program Services1200900ProgramServices
Management And General791073ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total103539210Total
Program Services82638131ProgramServices
Management And General20901079ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4235BOY
EOY4335EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4206210BOY
EOY5940922EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11050371BOY
EOY14377432EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY250000EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY497338BOY
EOY487268EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2525921BOY
EOY2441759EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1293939BOY
EOY606705EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis153152155LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec73866022LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY71096996BOY
EOY79286133EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY34250078BOY
EOY37124405EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4125BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY5440691BOY
EOY7054073EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2922944BOY
EOY2608023EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY133292848BOY
EOY150181055EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY8794675BOY
EOY14180020EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY34874036BOY
EOY34262494EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15713412BOY
EOY26858834EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY59382123BOY
EOY75301348EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY68259569BOY
EOY67698987EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3355398BOY
EOY4884151EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2295758BOY
EOY2296569EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY73910725BOY
EOY74879707EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY133292848BOY
EOY150181055EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$5,607OtherActivitiesAmount
Total Lobbying Expenditures IIB5607TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierDescription of other lobbying activitiesIdentifier
Return Referenceschedule C, Part II-B, Question 1IReturnReference
ExplanationST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION (CHA), THE WISCONSIN HEALTH ASSOCIATION (WHA), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION (AHA). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES AND PART OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis5599402OtherCostOrOtherBasis
Book Value5599402BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis61958798OtherCostOrOtherBasis
Depreciation21911691Depreciation
Book Value40047107BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis627772OtherCostOrOtherBasis
Depreciation2214519Depreciation
Book Value-1586747BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis35661210OtherCostOrOtherBasis
Depreciation49739812Depreciation
Book Value-14078602BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis49304973OtherCostOrOtherBasis
Book Value49304973BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings79286133TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
PROFESSIONAL LIABILITY$20,646
ACCRUED PENSION LIABILITY$24,022,038
ESTIMATED SELF-INSURANCE$54,555
SETTLEMENT VALUE OF CONSTR RETAINAGE$346,562
RETIRE OBLIGATION ABESTOS$211,033
DERIVITIVE INSTRUMENTS$2,204,000
FieldValueIRS element (for citing)
Total Of Amounts26858834TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierASC SUBTOPIC 740-10Identifier
ExplanationON JULY 1, 2007, HSHS ADOPTED ASC SUBTOPIC 740-10,ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS AND REQUIRES INCREASED DISCLOSURES. AT THE DATE OF ADOPTION, AND AS OF JUNE 30, 2010 AND 2009, HSHS DOES NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage225.FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1108PersonsServed
Total Community Benefit Expense1247771TotalCommunityBenefitExpense
Net Community Benefit Expense1247771NetCommunityBenefitExpense
Percent Of Total Expense0.01260PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served20123PersonsServed
Total Community Benefit Expense14032825TotalCommunityBenefitExpense
Direct Offsetting Revenue10968777DirectOffsettingRevenue
Net Community Benefit Expense3064048NetCommunityBenefitExpense
Percent Of Total Expense0.03090PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served468PersonsServed
Total Community Benefit Expense745916TotalCommunityBenefitExpense
Direct Offsetting Revenue608396DirectOffsettingRevenue
Net Community Benefit Expense137520NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served21699PersonsServed
Total Community Benefit Expense16026512TotalCommunityBenefitExpense
Direct Offsetting Revenue11577173DirectOffsettingRevenue
Net Community Benefit Expense4449339NetCommunityBenefitExpense
Percent Of Total Expense0.04490PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs57NumberOfActivitiesOrPrograms
Persons Served11673PersonsServed
Total Community Benefit Expense6330489TotalCommunityBenefitExpense
Direct Offsetting Revenue2897907DirectOffsettingRevenue
Net Community Benefit Expense3432582NetCommunityBenefitExpense
Percent Of Total Expense0.03460PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served5PersonsServed
Total Community Benefit Expense145355TotalCommunityBenefitExpense
Net Community Benefit Expense145355NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs6NumberOfActivitiesOrPrograms
Persons Served1500PersonsServed
Total Community Benefit Expense136895TotalCommunityBenefitExpense
Net Community Benefit Expense136895NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs65NumberOfActivitiesOrPrograms
Persons Served13178PersonsServed
Total Community Benefit Expense6612739TotalCommunityBenefitExpense
Direct Offsetting Revenue2897907DirectOffsettingRevenue
Net Community Benefit Expense3714832NetCommunityBenefitExpense
Percent Of Total Expense0.03750PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs69NumberOfActivitiesOrPrograms
Persons Served34877PersonsServed
Total Community Benefit Expense22639251TotalCommunityBenefitExpense
Direct Offsetting Revenue14475080DirectOffsettingRevenue
Net Community Benefit Expense8164171NetCommunityBenefitExpense
Percent Of Total Expense0.08240PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1PersonsServed
Total Community Building Expense24033TotalCommunityBuildingExpense
Net Community Building Expense24033NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served60PersonsServed
Total Community Building Expense69TotalCommunityBuildingExpense
Net Community Building Expense69NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served61PersonsServed
Total Community Building Expense24102TotalCommunityBuildingExpense
Net Community Building Expense24102NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,768,868BadDebtExpenseAmount
Amount Attributable To609835AmountAttributableTo
Amount Reimbursed By Medicare31256223AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare41762544CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-10506321MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (6 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
PREVEA CLINIC-PHS
HEALTHCARE0.250000.50000
PREVEA HEALTH NETWOR
HEALTHCARE0.250000.50000
PREVEA VENTURES
HEALTHCARE0.250000.50000
PREVEA HLTH SERVICES
HEALTHCARE0.250000.50000
UNITY LTD PARTNERSHP
HEALTHCARE0.10000
NE WI RAD THERAPY
HEALTHCARE0.250000.50000

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST MARY'S HOSPITAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11726 SHAWANO AVENUEAddressLine1
CityGREEN BAYCity
StateWIState
ZIP Code54303ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaNot applicable as the organization does follow fpg to determine eligibility for charity and discounted care to low-income uninsured and underinsured individuals.IncomeBasedCriteria
Annual Community Benefit ExplnYes. The hospital's community benefit report is available to anyone that requests a copy from St. Mary's Hospital 1726 Shawano Ave. Green Bay, WI 54303 by contacting our Strategic Planning Department at 920-498-4200 or by visiting our website at www.stmgb.org and looking under *About SMH* Annual Report*.AnnualCommunityBenefitExpln
Costing Method UsedCharity Care is calculated by determining the total amount from patient billing that is written off to charity care charge codes or allowances. This amount matches the number that is reported on our fiscal year ending 2010 audited financial statements. The total charity care dollar amount is then reduced to cost by applying the Hospital's cost to charge ratio as calculated on IRS schedule H - worksheet 2.CostingMethodUsed
Subsidized Health Services ExplnThe hospital does not have sufficient information at this time to determine if subsidized services exist based on the definition and calculations required by the IRS and is working to provide such information in next year's return.SubsidizedHealthServicesExpln
Percent Of Total Expense ExplnThe percent of charity care and certain other benefits at cost as a percent of total expenses less bad debt is 8.24%.PercentOfTotalExpenseExpln
Bad Debt FootnoteThe hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients that potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity due to missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital. Bad debt expense at cost is $1,768,868. To calculate charity-eligible cost of accounts written off as bad debt expense, census data was used to determine the average household size in the county. This average size was then applied to the Federal Poverty Guidelines to determine what the Federal Poverty Level would be for the average household and that number was multiplied by the percentage of Federal Poverty Guidelines that our organization's policy specifies as the upper threshold for 100% charity care. Census data was then used to determine what percentage of the county's households would qualify under our charity care threshold and that percentage was multiplied by the amount written off to bad debt, which produced the amount of charges written off to bad debt that could be assumed to be charity-eligible. The hospital cost-to-charge ratio was then applied to determine the cost that could have been charity (and hence community benefit) had all paperwork been completed.BadDebtFootnote
Shortfall As Community BenefitThe hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients that are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall of $10,506,321 in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well being of the community. Our mission calls us to serve all patients with the highest possible quality and efficiency, even if we are not paid fully for doing so. Due to the fixed, and often low, incomes of a significant portion of the Medicare population, if the Medicare program did not exist many of these patients would either qualify for Medicaid or charity/community care, both of which are considered to be community benefits. The methodology for calculating Medicare shortfall is as follows. The hospital cost-to-charge ratio is applied to Medicare charges to arrive at the estimated cost of providing care to Medicare patients. Reimbursement from Medicare is then subtracted from the estimated cost to arrive at the shortfall.ShortfallAsCommunityBenefit
Debt Collection PolicyEvery effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payor reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections.DebtCollectionPolicy
Number Of Facility Type ExplnThe hospital does not have any healthcare facilities that are not registered as a health care facility under state law.NumberOfFacilityTypeExpln
Needs AssessmentWe employ a number of methods to assess health care needs: 1) we have a community advisory committee broadly representative of the community. This committee meets regularly to discuss hospital services and advise us on how well we are meeting community needs. As terms expire, committee members assist in identifying new members who can continue to assist us in this way. We make an effort to include members from the neighboring communities we serve, as well as some potentially underserved groups-such as Hmong or Native American leaders. 2) Hospital leadership meets with each committee member individually to learn more about their opinions about community needs. 3) We examine the reasons that self-pay and Medical Assistance patients come to our emergency department for care. 4) Hospital leadership serve on local social service agency boards, such as the N.E.W. Community Clinic (a "free clinic"), and meet with representatives of the Catholic Diocese to discuss community needs. 5) Our Hispanic Health Educator/Cultural Liaisons assist us in identifying needs of special subgroups of patients. During FY2011, St. Mary's leadership assisted with and participated in the Brown County Health Department's Community Health Improvement Process, a community needs assessment that reviews how Brown County compares to the rest of the state on indicators contained in "Healthy Wisconsin 2020". A group widely representative of the community has been convened to review the data and determine the high priority issues for Brown County. St. Mary's will examine the results of this study to determine how best address the high priority needs.NeedsAssessment
Patient Education AssistanceOur hospital posts our charity care policy and application on our website. In addition, charity care applications are available and prominently displayed in our registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. Last but not least, we have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits.PatientEducationAssistance
Community InformationSt. Mary's Hospital is located in Brown County, Wisconsin, an urban county with a population of about 250,000 people. Most of St. Mary's patients come from the west side of Green Bay, but patients also come from the nearby rural areas in Brown, Shawano and Oconto counties. Brown County's population is primarily Caucasian, but there is a notable Native American population, as well as a growing Asian and Hispanic population. Over 50 languages are spoken in Brown County, and we provide interpretation services for all.CommunityInformation
Community Building ActivitiesOur hospital has a long standing commitment to being environmentally sensitive, as part of our Franciscan heritage. There are many examples of how this is demonstrated, one of which is our participation in the Brown County Sharps programs. The hospital serves as a drop-off site for sharps, such as needles used to inject insulin. Community members drop these items and the hospital pays to have them disposed of properly. We support our community's environmental efforts to avoid adding to landfills because we actively contribute to the Hospital Sisters Mission Outreach program, whereby surplus or otherwise unused hospital supplies are collected and distributed to missions in the US and elsewhere. In addition, we participate in the Wisconsin Hospital Emergency Preparedness Plan (WHEPP). The purpose of the Wisconsin Hospital Emergency Plan (WHEPP) is to develop processes to help participating institutions in Wisconsin meet community needs in a collaborative and organized manner during an incident emergency. The State of Wisconsin recognized that a mass casualty incident due to a biological, chemical, radiological or natural disaster can easily overwhelm or damage the ability of local healthcare resources to meet community needs, so developed the Wisconsin Hospital Emergency Preparedness Plan (WHEPP), a mutual aid plan, to address this concern. We have actively participated in the organization and development of this group and led efforts in our region. As leaders in this group, we have helped to initiate the preparedness efforts by WHEPP that assist hospitals in our state to maintain the minimum levels of readiness that are expected by the federal and state governments. Another significant portion of the community building dollars is dedicated to workforce assistance and growth through support of the Green Bay Area Chamber of Commerce Youth Apprenticeship Program (on-the-job training) and Partners in Education, a local program which recognizes exceptional teachers and provides students with a variety of career exploration and experience programs. We support those who are related to the acute health care industry by maintaining regular communication and updating on trends and issues in the industry and fostering collaborative relationships. This is done through regular luncheon meetings with nursing home administrators and clergy, as well as through health care career talks to local students. Our sister hospital, St. Vincent, has been a leader in cancer care for over 50 years; that programming recently expanded to St. Mary's site. As part of this leadership, we have actively supported the efforts of the American Cancer Society (ACS) projects to eliminate cancer, save lives and diminish suffering. A portion of the community building dollars are dedicated to supporting various ACS efforts.CommunityBuildingActivities
Other InformationOur hospital has an open medical staff and a board comprised of community members. Funds over and above what is needed for operations are reinvested in the facility and program services, using generally accepted accounting principles and market assessment to ensure that the funds are being used wisely. Our hospitals were founded over 100 years ago by a group of Catholic sisters whose purpose was to extend Christ's healing love throughout our area. Because of that, we comply with the Ethical and Religious Directives for Health Care issued by the US Council of Catholic Bishops. We also actively offer a variety of no-charge community and health education programs locally to assist community members in learning more about their health condition or possible health issues. St. Mary's Hospital Medical Center provides significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2010, St. Mary's provided over $8 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. During this period, St. Mary's provided $10.5 million (at cost) in excess of Medicare payment for health care services. An example of our community benefit initiatives is the support we provide to patients that pass each year through the doors of the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care prevented a trip to the emergency department. These various efforts to serve the needs of our community result in real benefits for the people of Green Bay.OtherInformation
Affiliated Health Care SystemSt. Mary's Hospital Medical Center is an affiliate of Hospital Sisters Health System. The foundational mission principles of Hospital Sisters Health System (HSHS) embody the belief that every life is a sacred gift and every human being is a unity of body, mind and spirit. Our health care ministry calls on us to foster healing, serve with compassion, and promote wellness for all persons, with special attention to our neighbors who are sick, poor, underserved, and most vulnerable. These principles have made it possible for HSHS to provide high quality, cost-effective and compassionate health care for millions of people in Illinois and Wisconsin. Our health care ministry consists of 13 hospitals and numerous physician partners committed to continuing the healing ministry of Jesus Christ. Beyond functioning as a primary source for health care in the 12 primary communities we serve, HSHS also provides a wide array of Community Benefits that expand residents' access to health care, enhance their overall health status, and further medical education. In the Fiscal Year that ended June 30, 2010, HSHS hospitals provided $152.2 million in Community Benefits (or 8.5% of total expenses), an increase of $28 million from FY 2009. Of this amount, $32.3 million was provided for charity care and $89.2 million was the amount of unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals provided $159.3 million in health care services primarily to the elderly beneficiaries of the Medicare program in excess of governmental and managed care contract payments. HSHS hospitals also recorded $95 million in uncollectible accounts. HSHS is committed to sustaining and strengthening the health of our communities by continually reinvesting any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services. These ongoing enhancements ensure that our hospitals can continue to provide high quality, compassionate care to our patients. During Fiscal Year 2010, HSHS continued to pursue a Care Integration strategy designed to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by the system investments in information technology, this strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. The Care Integration strategy includes, among other efforts, three "Medical Home" pilot projects, the coordination of care for cardiac patients living in rural communities through the use of telemedicine, and development of a "clinical integration network" that will help independent physicians improve quality and the patient experience by benchmarking their care against best practices. HSHS also placed a special emphasis on investing in interoperable health information technologies and robust health information exchanges. We recognize that our investments in information technology will have a positive impact on the quality, safety and efficiency of health care. These investments also ensure that the patient is at the center of a high quality, highly integrated, compassionate health care delivery system. Expanding access to health care At the heart of our health care ministry is the commitment to care for every patient who seeks our help. Because not all patients have health insurance, HSHS hospitals have generous Charity Care program guidelines that cover 100% of hospital charges for individuals and families who earn less than 250% of the federal poverty level. Under these guidelines a family of four without health insurance that has an annual household income of $55,125 or less is eligible for a 100% discount on their hospital bill. HSHS Charity Care programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Hospitals have created a simple two page form for those wishing to apply for Charity Care and assign counselors to visit with inpatients who are uninsured to let them know about our charity care policies and provide assistance filling out applications for financial assistance or enrollment in publicly funded health care programs. The gratitude of the people who have benefitted from our Charity Care program (sometimes referred to as Christian Care) is reflected in some of the thank you letters sent to St. Anthony's Memorial Hospital in Effingham, IL. Comments included: "When I opened your letter today and read that you gave me a 100% Christian Care adjustment, I gasped and started crying. I am so grateful. I count this as an unexpected miracle from God working through people willing to show his love to others." - D.K. The King will reply, "I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me." - Matthew 25:40. "We just want to take a moment to express our deepest gratitude! Your generosity has eased our minds, hearts & pocket book!! Thank you, Thank you, Thank you! God Bless You All! I pray someday I will be able to help someone in such a generous way! You have no idea what a relief this is for us! Thank You seems too simple of words!" - S.L. and C.S. "I want to say at all those who have made it possible to help us pay my hospital bills - Thank You! I don't have words to thank you for all the worry that you have taken away. A thousand "thanks." May God bless you." - L.B. (translated by N.R. and W.R.) "My husband K. and I would like to express our deepest gratitude for your assistance with his medical bill from the hospital. We cannot thank you enough for the help and how this eased a financial burden that we faced. Keeping this gift in mind, we will strive to help others who are in need in whatever way we can to 'Pay it forward.' Thank you and bless you all!" - K.S. and L.S. Our Charity Care programs are only one aspect of our commitment to increasing access to health care services in Illinois and Wisconsin. In many of our communities, HSHS collaborates with Federally Qualified Health Centers (FQHCs) to provide greater access to health care services for low-income residents. For example, St. Elizabeth's Hospital in Belleville, IL hosts a FQHC primary care clinic adjacent to its Emergency Department and St. John's Hospital in Springfield, IL coordinates specialty physician referrals with the local FQHC and provides free health care to its clients. HSHS hospitals work collaboratively in their communities to support the various social services that together make up the fabric of the health care safety net. Sacred Heart Hospital in Eau Claire, WI provides leadership, staff support and laboratory and radiology services for the Chippewa Valley Free Clinic. During FY2010 Sacred Heart's Lab performed 676 tests for patients from the clinic St. Mary's Hospital Medical Center in Green Bay, WI supports a Women's Place, which provides health care services and referrals for men and women in the Latino community. "Because of language barriers, erratic work schedules and the lack of insurance and transportation, many in the Latino community aren't able to access our health system," explains Program Director Carol Ponce. "I feel it is important to overcome those barriers and build bridges for people in the Latino community to access health care and other services that contribute to their well-being. Our programs not only bring health care to the Latino community but joy and connection to other people from Mexico, Honduras, Nicaragua, Peru and Puerto Rico." In rural Illinois, Prairie Heart Institute of Illinois (PHII), a physician group affiliated with HSHS, is bringing a higher level of cardiovascular care to patients in their communities through extensive collaboration with local hospitals and physicians. Through regularly scheduled clinics and sharing of protocols and best practices, rural hospitals across central and southern Illinois can more rapidly and accurately identify heart attack patients and speed treatment to minimize damage to the heart muscle. Meanwhile, access to clinical trials provides opportunities for patients in rural areas to have access to drugs and treatments available only through PHII. "The result of this unique commitment is that regardless of where a patient lives, they will have access to care designed to detect heart disease earlier. We can also offer previously unavailable life-saving techniques and drugs and ensure a return to a quality of life," explains Jim Zito, PHII CEO. The benefits of this type of collaboration are many, including the standardization of quality assurance measures, the sharing of successful patient safety strategies, the addition of clinical research, workforce development and internal benchmarking. Enhancing the health status of the community A spirit of collaboration is pervasive for HSHSAffiliatedHealthCareSystem
Reports Filed With StatesWIReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
First Class Or Charter TravelXFirstClassOrCharterTravel
Travel For CompanionsXTravelForCompanions
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
THERESE PANDL
0284441010000002406207094408712048815900
ANN CARR
0131424000220240104209013649027130600
LAWRENCE J CONNORS
18951000000881800195040297194000
Amy J Unrath
1856220000019686909710383462000
Donna A Hutchinson
1741540001650146841010140322174000
JOHN DAUL
18452200022710746600147130276166000
MARY ALICE JOHNSON
181717000001664010194360367554000
CRAIG BABIARZ
18762900020002285209360211617000
STEPHEN KORDIYAK
17467700000497730147830239233000
MARTIN SCHWEINER
175558000001034420139670292967000
JAMES COLLER
03795190591430466940213744017549071664900

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name Persontherese pandlNamePerson
Purpose Of Loanmortgage extensionPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$250,000OriginalPrincipalAmount
Balance Due250000BalanceDue
DefaultfalseDefault
Approved By BoardtrueApprovedByBoard
Written AgreementtrueWrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due250000TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonPREVEA CLINICNamePerson
FieldValueIRS element (for citing)
RelationshipOFFICERRelationship
Amount Of Transaction2901471AmountOfTransaction
Description Of TransactionPHYSICIAN SERVICESDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER PROGRAM SERVICESFORM 990, PART III, LINE 4DSt. Mary's Hospital Medical is an acute care community hospital. We have an advanced line of health care services, including comprehensive orthopedic, digestive health, cardiac, women's care, emergency and diagnostic care. We were the first all-private room community hospital in Northeast Wisconsin. St. Mary's is an Environmental Leadership Circle award winner (only 30 hospitals nationwide have received this.) for three consecutive years.
TAX EXEMPT BONDSFORM 990, PART IV, LINE 24ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990.
RIGHTS OF MEMBERS TO ELECT GOVERNING BODYFORM 990, PART VI, LINE 6 & 7ATHE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS HEALTH SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT
MEMBER RESERVED POWERSFORM 990, PART VI, LINE 7BResponsibility for the policy and operations of St. Mary's Hospital Medical Center of Green Bay Inc (the "Corporation") is vested in its Board of Directors, except with respect to specific powers reserved in the Corporation's Bylaws to the Corporation's Member, Hospital Sisters Health Services, Inc. ("HSSI") , an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The member of HSSI is Hospital Sisters Health System ("HSHS"), an Illinois not for profit corporation exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code. The members of HSHS are the individual sisters who from time to time are the duly elected Provincial Superior and Provincial Councilors, respectively of the American Province of the Hospital Sisters of St. Francis ("American Province"). The American Province is the United States organization of the Congregation of the Hospital Sisters of the Third Order Regular of St. Francis, a religious institute of the Roman Catholic Church. The governance and operations of the Corporation are subject to HSSI's right to exercise these reserved powers with respect to the Corporation and organizations of which the Corporation is either, directly or indirectly, a controlling member or a controlling shareholder ("Affiliates"). HSSI's right to exercise certain of these reserved powers is, in turn, subject to the approval of HSHS and HSHS' members. The reserved powers include all rights granted to HSSI by law and the right to: (a) Adopt, approve amendments to, or amend any statement of philosophy, mission, mission integration or values or any name, logo, or mark of the Corporation or of any Affiliate; (b) Adopt, approve amendments to, or amend the Articles of Incorporation of the Corporation or of any Affiliate; (c) Adopt, approve amendments to, or amend the Bylaws of the Corporation or of any Affiliate; (d) Appoint and remove the Board of Directors, any one or more of the Directors of the Corporation or of any Affiliate, and the Chairperson and President of the Corporation or of any Affiliate; (e) Approve the recommendation of the Board of Directors to appoint or remove the Board of Directors, any one or more Directors of the Corporation or of any Affiliate, or the Chairperson and President of the Corporation or of any Affiliate. (f) With respect to the Corporation or any Affiliate, approve the purchase, sale, alienation, exchange, lease or encumbrance of any real property of the Corporation or of any Affiliate, which property has a value in excess of limits set from time to time by HSSI; (g) Approve the operating and capital budgets of the Corporation or of any Affiliate, and any deviations by the Corporation or of any Affiliate from such budgets in an amount or percentage specified by HSSI from time to time; (h) Approve the strategic plan and goals of the Corporation or of any Affiliate; (i) Approve the sale of substantially all of the assets of the Corporation or of any Affiliate; (j) Approve the merger or dissolution of the Corporation or of any Affiliate; (k) Adopt or amend the plan for ministry education and governance for the Corporation and its Affiliates; (l) Approve the Corporation's Mission Accountability Reports and those of any Affiliate; (m) Approve the financial policies and procedures of the Corporation or of any Affiliate and approve any deviations from such policies and procedures by the Corporation or any Affiliate; and (n) Adopt policies to implement the Reserved Powers of HSSI.
FORM 990 REVIEW PROCESSFORM 990, PART VI, LINE 11AThe hospital employs KPMG to assist in the overall review and electronic submission of its Form 990. KPMG provides guidance in identifying critical errors in the return submission and feedback on quantitative and qualitative responses. Additionally, the hospital CFO performs a thorough review of the return and reviews it with the hospital CEO and/or senior leaders before presenting it in its entirety to the hospital Board for questioning and review prior to the return's signing and submission to the IRS.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, LINE 12CThe organization is subject to the corporate compliance program and conflict of interest policy ("policy") of Hospital Sisters Health System, an Illinois not for profit corporation exempt from federal taxation under section 501(c)(3) of the internal revenue code. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH the organizaton's CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP OR ACTIVITY CONTEMPLATED, ENTERED INTO OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWERS ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
WHISTLEBLOWER POLICYFORM 990, PART VI, LINE 13PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES.
RECORD RETENTION POLICYFORM 990, PART VI, LINE 14THE HOSPITAL IMPLEMENTED A NEW SYSTEM-WIDE RECORD RETENTION AND DISPOSAL POLICY WHICH HAS AN EFFECTIVE DATE OF JUNE 1, 2010.
COMPENSATION PROCESSFORM 990, PART VI, LINE 15The Compensation Committee (Committee) is comprised of independent members of the Board of Directors. The Committee develops a compensation philosophy for the System and all affiliates. The Committee selects and hires the independent compensation consultant to develop comparability data and advise the Committee during its deliberations regarding all elements of total compensation for all disqualified individuals. Integrated Healthcare Strategies (IHS), the consultants utilized by the Committee, use data from multiple tax-exempt peer group sources to determine salary ranges, incentive opportunity ranges and benefits for the disqualified individuals. IHS then assists the Committee in preparing contemporaneous documentation of all actions. Each Committee meeting is conducted with the intent to create a rebuttable presumption of reasonableness for all elements of executive total compensation for the disqualified individuals. The Chairman makes this declaration and also inquires if there are any conflicts of interest by any attendees. Any conflicts are disclosed and the Committee then acts in a manner to avoid any conflicted individual participating in any manner where a conflict might exist. At the end of the meeting, the Committee prepares contemporaneous minutes that record all actions taken during the meeting.
DISCLOSURE: DOCUMENTS AVAILABLE TO THE PUBLICFORM 990, PART VI, LINE 19Board-approved financial statements are made available to the public upon request. The governing documents and conflict of interest policy are not made available to the general public at this time.
POOLED INVESTMENT ACCOUNTFORM 990, PART X, LINE 11THE HOSPITALS CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM (HSHS). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS (SFAS) NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS.
TRANSACTIONS WITH RELATED ORGANIZATIONSSCHEDULE R, PART V, LINE 2The Transactions reported in Line 1 are between related 501(c)(3) public charities and are not reported in this section.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Springfield Health Partners LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14936 Laverna RoadAddressLine1
CityspringfieldCity
StateILState
ZIP Code62707ZIPCode
FieldValueIRS element (for citing)
EIN371364419EIN
Primary ActivitieshealthcarePrimaryActivities
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1hshs mgBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HOSPITAL SISTERS HEALTH SYSTEM
4936 LAVERNA ROADSPRINGFIELDIL62707371058692HEALTHCAREIL501(c)(3)11ANA
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROADSPRINGFIELDIL62707371163402HEALTHCAREIL501(c)(3)11ANA
HOSPITAL SISTERS OF ST FRANCIS FDTN
4936 LAVERNA ROADSPRINGFIELDIL62707371186514HEALTHCAREIL501(c)(3)11ANA
HSHS HEALTH CARE TRUST FUND
4936 LAVERNA ROADSPRINGFIELDIL62707371137724HEALTHCAREIL501(c)(9)NA
ST ANTHONY'S HOSPITAL
503 N MAPLE STREETEFFINGHAMIL62401370661233HEALTHCAREIL501(c)(3)3NA
ST ELIZABETH'S HOSPITAL
211 SOUTH THIRD STREETBELLEVILLEIL62220370663567HEALTHCAREIL501(c)(3)3NA
ST FRANCIS HOSPITAL
1215 FRANCISCAN DRIVELITCHFIELDIL62056370661236HEALTHCAREIL501(c)(3)3NA
ST JOHN'S HOSPITAL
500 EAST CARPENTER STREETSPRINGFIELDIL62769370661238HEALTHCAREIL501(c)(3)3NA
ST JOSEPH'S HOSPITAL
9515 HOLY CROSS LANEBREESEIL62230371208459HEALTHCAREIL501(c)(3)3NA
ST JOSEPH'S HOSPITAL
1515 MAIN STREETHIGHLANDIL62249370663568HEALTHCAREIL501(c)(3)3NA
ST JOSEPH'S HOSPITAL
2661 COUNTY HIGHWAY 1CHIPPEWA FALLSWI54729390810545HEALTHCAREWI501(c)(3)3NA
ST MARY'S HOSPITAL
1800 E LAKE SHORE DRIVEDECATURIL62521370661244HEALTHCAREIL501(c)(3)3NA
ST MARY'S HOSPITAL
111 SPRING STREETSTREATORIL61364372169181HEALTHCAREIL501(c)(3)3NA
SACRED HEART HOSPITAL
900 WEST CLAIREMONT AVEEAU CLAIREWI54701390807060HEALTHCAREWI501(c)(3)3NA
ST NICHOLAS HOSPITAL
3100 SUPERIOR AVENUESHEBOYGANWI53081390808480HEALTHCAREIL501(c)(3)3NA
ST VINCENT HOSPITAL
835 S VAN BURENGREEN BAYWI54301390817529HEALTHCAREWI501(c)(3)3NA
Hospital Sisters Healthcare West - Inc
2661 COUNTY HIGHWAY ICHIPPEWA FALLSWI54729510157933HEALTHCAREWI501(c)(3)11ANA
HSHS SELF INSURANCE FUND
4936 LAVERNA ROADSPRINGFIELDIL62707371120626INSURANCEIL501(c)(3)11ANA
HSHS Medical Group Inc
4936 Laverna RoadSpringfieldIL62707263956318healthcareIL501(c)(3)11ana
HSHS Wisconsin Medical Group Inc
8040 Excelsior Drive STE 200madisonWI53717264515959healthcareWI501(c)(3)11ana
Orange Cross Ambulance Inc
919 ASHLAND AVENUESHEBOYGANWI53081391860942HEALTHCAREWI501(c)(3)9ST NICHOLAS
WISCONSIN UPPER PENINSULA ONCOLOGY MGMT
835 S VAN BURENGREEN BAYWI54301391677100HEALTHCAREWI501(c)(3)3ST VINCENTS
UNITY LIMITED PARTNERSHIP
2366 OAK RIDGE CIRCLEDE PEREWI54115391750729HEALTHCAREWI501(c)(3)9HSSI

Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
Memorial and St Elizabeth's Healthcare
4000 North Illinois StreetSwanseaIL62226371312961HealthCareILSt Elizabeth'sRELATEDfalsefalse
Health Ventures Of So Illinois LLC
2810 Frank Scott Pkwy W STE 700BellevilleIL62223371334060HealthCareILSt Elizabeth'sRELATEDfalsefalse
Prairie Heart Insutute - Carbondale LLC
800 East Carpenter StreetSpringfieldIL62769371321197HealthCareILSt John'sRELATEDfalsefalse
Northeast Wisconsin Radiation Therapy Se
1821 S Webster Avenue STE 300Green BayWI543079047263749065HealthCareWIHSSIRELATEDfalsefalse
Pain Center of Wisconsin
4131 W Loomis Road STE 300GreenfieldWI53221263155343HealthCareWIHSSIRELATEDfalsefalse
Surgery Center of Sheboygan LLC
3141 Saemann AveNUESheboyganWI53081260822209HealthCareWISt NicholasRELATEDfalsefalse
Prevea Ventures LLC
2710 EXECUTIVE DRGreen BayWI54304203775127HealthCareWIHSSIRELATEDfalsefalse
Kiara Clinical Integration Network LLC
4936 Laverna ROAdSpringfieldIL62707261417684HealthCareILKiara IncRELATEDfalsefalse
Carpenter Street Hotel LLC
525 North Sixth StreetspringfieldIL62702364128127hotelILlasante increlatedfalsefalse
Springfield Urgent Care Real Estate LLC
PO Box 19456springfieldIL627949456030413258rent. real estateILlasante increlatedfalsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
Kiara Inc
4936 Laverna ROAdSpringfieldIL62707371163401HealthCareILHSHSC Corp
LaSante Wisconsin Inc
4936 Laverna ROAdSpringfieldIL62707391572196HealthCareILKiara IncC Corp
LaSante Inc
4936 Laverna ROAdSpringfieldIL62707371163400HealthCareILKiara IncC Corp
Prairie Cardiovascular
619 East Mason STE 4P57SpringfieldIL62701371071858HealthCareILKiara IncC Corp
Prevea Health Services
2710 EXECUTIVE DRIVEGreen BayWI54304391839351HealthCareWIHSSIC Corp
Prevea Clinic Inc
2710 EXECUTIVE DRIVEGreen BayWI54304391839349HealthCareWIHSSIC Corp
Prevea Health Network
2710 EXECUTIVE DRIVEGreen BayWI54304392000537HealthCareWIHSSIC Corp
Prevea Regional Services
2710 EXECUTIVE DRIVEGreen BayWI54304391909993HealthCareWIHSSIC Corp
Renaissance Qual Insurance
980669953INSURANCEHSSIC CORPPO BOX 1159 KY1-1102GRAND CAYMANSCJCJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg