ST CLARE MEMORIAL HOSPITAL INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- ST CLARE MEMORIAL HOSPITAL INC (EIN 39-0848401)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-06
- IRS object ID
- 202621269349303237
- Schema version
- 2024v5.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-06T16:58:16+00:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive Suite 2600 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390848401 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Clare Memorial Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCL | BusinessNameControlTxt |
| Phone | 9204330111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Robert Erickson | PersonNm |
| Person Title | Market President & CEO | PersonTitleTxt |
| Signature | 2026-05-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Mallory Fairless | PreparerPersonNm |
| PTIN | P01321579 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Preparation | 2026-05-06 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Robert Erickson | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $42,824,747 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hshs.org/st-clare/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTHCARE MINISTRY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 170 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $11,296,062 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $202,867 | PYContributionsGrantsAmt |
| CY Contributions Grants | $45,751 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,915,274 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $42,160,420 | CYProgramServiceRevenueAmt |
| PY Investment Income | $597,468 | PYInvestmentIncomeAmt |
| CY Investment Income | $324,122 | CYInvestmentIncomeAmt |
| PY Other Revenue | $29,380 | PYOtherRevenueAmt |
| CY Other Revenue | $200,153 | CYOtherRevenueAmt |
| PY Total Revenue | $40,744,989 | PYTotalRevenueAmt |
| CY Total Revenue | $42,730,446 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $48,946 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,156,735 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,429,945 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,236,576 | PYOtherExpensesAmt |
| CY Other Expenses | $29,933,265 | CYOtherExpensesAmt |
| PY Total Expenses | $39,393,311 | PYTotalExpensesAmt |
| CY Total Expenses | $41,412,156 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,351,678 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,318,290 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,122,623 | TotalAssetsBOYAmt |
| Total Assets EOY | $47,115,601 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,814,899 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,908,765 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $13,307,724 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,206,836 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $6,775,428 | ExpenseAmt |
| Revenue | $6,146,986 | RevenueAmt |
| Desc | EMERGENCY SERVICES - St. Clare Memorial Hospital operates an Emergency Department that is staffed 24/7 by medical doctors experienced in all aspects of Emergency Medicine. Staff members are trained in advanced cardiac life support, emergency nursing for pediatrics and trauma nursing. Like all hospital services, emergency care is provided regardless of race, creed, or ability to pay, and financial assistance is available after care is provided for those in need. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,639,650 | ExpenseAmt |
| Revenue | $5,304,102 | RevenueAmt |
| Desc | SURGICAL SERVICES - HSHS St. Clare Memorial Hospital is equipped to handle advanced adult and pediatric procedures with state-of-the art equipment and experienced physicians. There is access to a multidisciplinary care team which includes outstanding registered nurses, certified registered nurse anesthetist (CRNA), physicians, physical and occupational therapists, clinical educators, nutritional services and spiritual advisors. In FY2025, St. Clare Memorial Hospital performed approximately 718 surgical cases and 610 GI procedures. For patients who require a hospital stay, resources are available to make the stay as comfortable as possible. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $5,618,578 | ExpenseAmt |
| Revenue | $5,250,658 | RevenueAmt |
| Desc | INTERNAL MEDICINE - Internal Medicine services at St Clare Hospital Medical center are comprised of general medicine, pulmonary, gastroenterology medical, cardiology medical services and swing bed services. In FY25, a total of 383 patients were admitted to the hospital. The swing bed admissions account for 48% of the overall admissions. In addition, 48% of the overall admissions are admitted through the Emergency department. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $17,232,117 | ExpenseAmt |
| Grant | $48,946 | GrantAmt |
| Revenue | $14,367,450 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES - OTHER PROGRAM SERVICES AT ST. CLARE MEMORIAL HOSPITAL ARE COMPRISED OF MEDICAL SURGICAL, WOUND CARE, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $17,232,117 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $48,946 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $14,367,450 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $36,265,773 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 1079 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 170 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Linda Dace | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6182342120 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3051 Hollis Drive | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62704 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| John L Wagner | |||||||||
| PRESIDENT/CEO (began 8/1/24) | 28.2 | 31.8 | Yes (X) | Yes (X) | $245,425 | $271,058 | $90,824 | ||
| LORI DUFEK | |||||||||
| Vice Chair | 1.5 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL NELESSEN | |||||||||
| Chair | 2.5 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Robert Erickson | |||||||||
| PRESIDENT/CEO (until 7/31/24) | 2.0 | 58.0 | Yes (X) | Yes (X) | $0 | $486,708 | $81,102 | ||
| CARA PETERSON | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Elora Blum | |||||||||
| Board Member (began 11/1/24) | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Ginny O'Harrow | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Kimberly Pytleski | |||||||||
| Board Member (began 11/1/24) | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT CUTLAN MD | |||||||||
| Board Member (until 10/31/24) | 2.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| RON CHRISTENSEN | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Stacee Goedtel Birr DO | |||||||||
| Board Member | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | |||
| Larry Gille | |||||||||
| Secretary | 0.3 | 2.3 | Yes (X) | $0 | $0 | $0 | |||
| Michael Scialdone | |||||||||
| Treasurer / HSHS SVP & CFO | 0.3 | 59.8 | Yes (X) | $0 | $780,312 | $132,635 | |||
| PATRICIA ALLEN | |||||||||
| CFO - CARE DELIVERY (until 4/30/25) | 3.0 | 57.0 | Yes (X) | $0 | $559,236 | $89,922 | |||
| CHERYL BURKEL EMMERS | |||||||||
| CRNA | 60.0 | 0 | $260,325 | $0 | $58,282 | Yes (X) | |||
| Glenn White | |||||||||
| CRNA | 60.0 | 0 | $271,531 | $0 | $35,062 | Yes (X) | |||
| Heidi Marie Cole | |||||||||
| Supervisor - Pharmacy | 60.0 | 0 | $155,279 | $0 | $29,652 | Yes (X) | |||
| Mary Lynn Thompson | |||||||||
| House Supervisor | 60.0 | 0 | $164,736 | $0 | $29,822 | Yes (X) | |||
| Maura May White | |||||||||
| CRNA | 60.0 | 0 | $251,601 | $0 | $43,587 | Yes (X) | |||
| CHRISTOPHER BRABANT | |||||||||
| Former PRESIDENT/CEO | 0.0 | 0.0 | $336,244 | $0 | $33,715 | Yes (X) | |||
| TODD Smart | |||||||||
| Former Treasurer | 0.0 | 0.0 | $0 | $116,976 | $15,590 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,685,141 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,214,290 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $640,193 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 28 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt | Address Line2ContractorAddress/USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|
| Compass One Healthcare | ||||||
| PO Box 102289 | Atlanta | GA | 30368 | Food and nutrition services | $548,725 | |
| Infinity Healthcare Physicians SC | ||||||
| 111 E Wisconsin Ave | Milwaukee | WI | 53202 | PHYSICIAN SERVICES | $401,795 | Ste 2100 |
| Crothall Healthcare | ||||||
| 13028 Collection Center Dr | Chicago | IL | 60693 | Housekeeping Services | $286,468 | |
| Trimedx LLC | ||||||
| PO Box 636129 | Cincinnati | OH | 45263 | Equipment Maintenance Services | $140,119 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $45,751 | GovernmentGrantsAmt |
| Total Contributions | $45,751 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | $23,827,260 | $23,827,260 | |
| PHARMACY REVENUE | 456110 | $18,333,160 | $7,037,098 | $11,296,062 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $42,160,420 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $405,158 | TotalRevenueColumnAmt |
| Exclusion | $405,158 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,580 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $13,265 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$4,685 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,685 | TotalRevenueColumnAmt |
| Exclusion | -$4,685 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $81,036 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$81,036 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$81,036 | TotalRevenueColumnAmt |
| Exclusion | -$81,036 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INSURANCE REFUND | 900099 | $184,927 | $184,927 |
| OTHER OPERATING REVENUE | 900099 | $19,911 | $19,911 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $204,838 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $42,730,446 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,069,196 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $11,296,062 | UnrelatedBusinessRevenueAmt |
| Exclusion | $319,437 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,946 | TotalAmt |
| Program Services | $48,946 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $259,658 | TotalAmt |
| Program Services | $251,360 | ProgramServicesAmt |
| Management And General | $8,298 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,959 | TotalAmt |
| Program Services | $358,135 | ProgramServicesAmt |
| Management And General | $11,824 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,234,561 | TotalAmt |
| Program Services | $7,971,390 | ProgramServicesAmt |
| Management And General | $263,171 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535,961 | TotalAmt |
| Program Services | $518,832 | ProgramServicesAmt |
| Management And General | $17,129 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,323,498 | TotalAmt |
| Program Services | $1,281,200 | ProgramServicesAmt |
| Management And General | $42,298 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $706,308 | TotalAmt |
| Program Services | $683,735 | ProgramServicesAmt |
| Management And General | $22,573 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,730 | TotalAmt |
| Management And General | $38,730 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,112,077 | TotalAmt |
| Program Services | $6,983,856 | ProgramServicesAmt |
| Management And General | $128,221 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295 | TotalAmt |
| Management And General | $295 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,357 | TotalAmt |
| Program Services | $68,360 | ProgramServicesAmt |
| Management And General | $9,997 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,711 | TotalAmt |
| Program Services | $112,539 | ProgramServicesAmt |
| Management And General | $3,172 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,219,053 | TotalAmt |
| Program Services | $1,198,653 | ProgramServicesAmt |
| Management And General | $20,400 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,154 | TotalAmt |
| Program Services | $35,476 | ProgramServicesAmt |
| Management And General | $3,678 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,697 | TotalAmt |
| Program Services | $54,225 | ProgramServicesAmt |
| Management And General | $2,472 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,140,633 | TotalAmt |
| Program Services | $724,664 | ProgramServicesAmt |
| Management And General | $415,969 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,819 | TotalAmt |
| Program Services | $40,384 | ProgramServicesAmt |
| Management And General | $103,435 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $12,970,249 | $12,970,247 | $2 |
| Shared Services | $6,449,450 | $2,431,665 | $4,017,785 |
| Non-Medical Supplies | $268,180 | $260,968 | $7,212 |
| Equipment Rental | $222,259 | $222,259 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,601 | TotalAmt |
| Program Services | $48,879 | ProgramServicesAmt |
| Management And General | $29,722 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,412,156 | TotalAmt |
| Program Services | $36,265,773 | ProgramServicesAmt |
| Management And General | $5,146,383 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $159,974 | BOYAmt |
| EOY | $329,444 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,905 | BOYAmt |
| EOY | $2,333 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,735,304 | BOYAmt |
| EOY | $7,351,775 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,255,204 | BOYAmt |
| EOY | $1,283,540 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,343 | BOYAmt |
| EOY | $294,875 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $29,349,418 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,427,909 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,584,639 | BOYAmt |
| EOY | $8,921,509 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,613,881 | BOYAmt |
| EOY | $28,443,321 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $671,373 | BOYAmt |
| EOY | $488,804 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,122,623 | BOYAmt |
| EOY | $47,115,601 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,084,024 | BOYAmt |
| EOY | $31,145,146 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $666,670 | BOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $64,205 | BOYAmt |
| EOY | $763,619 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,814,899 | BOYAmt |
| EOY | $31,908,765 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,307,724 | BOYAmt |
| EOY | $15,206,836 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,307,724 | BOYAmt |
| EOY | $15,206,836 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,122,623 | BOYAmt |
| EOY | $47,115,601 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,318,290 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $713,574 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$132,752 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $428,317 | OtherCostOrOtherBasisAmt |
| Book Value | $428,317 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,060,542 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,049,355 | DepreciationAmt |
| Book Value | $6,011,187 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,860,559 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,378,554 | DepreciationAmt |
| Book Value | $2,482,005 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,921,509 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal Income Taxes | |
| DUE TO MEDICARE | $237,908 |
| Retirement Obligation - Asbestos | $21,227 |
| OPERATING LEASE | $504,484 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $763,619 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Other Revenue | $0 | OtherRevenueAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $0 | TotalRevenuePerForm990Amt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $0 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $0 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $0 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely Kiara, Inc. will not realize most of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2025 and 2024 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2025 and 2024, HSHS does not have any liabilities for unrecognized tax benefits. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $131,244 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $131,244 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00317 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,637,773 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,906,126 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,731,647 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09011 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,541,093 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $855,953 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $685,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01654 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $9,310,110 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,762,079 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,548,031 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10982 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,100 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $40,100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00097 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $471,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $471,180 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01138 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,946 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,946 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00118 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $560,226 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $560,226 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01353 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $9,870,336 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,762,079 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,108,257 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12335 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $0 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,105,291 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $20,316,688 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,211,397 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 855 S MAIN STREET | AddressLine1Txt |
| City | OCONTO FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54154 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.hshs.org/st-clare/ | WebsiteAddressTxt |
| State License | 1012 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CLARE MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 23 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.hshs.org/getmedia/34867d09-f1ad-4e73-b9d5-13d59d87a974/About-Us-FY24-CHNA.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 24 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.hshs.org/getmedia/627ec125-24dd-462f-981d-bd3b2393cd07/Implementation-Plan_SCO_2025-2027 | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.hshs.org/patients/billing/financial-assistance | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.hshs.org/patients/billing/financial-assistance | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.HSHS.ORG/PATIENTS/BILLING/FINANCIAL-ASSISTANCE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. HSHS St. Clare Memorial Hospital conducted its FY2024 Community Health Needs Assessment (CHNA) for Oconto County during FY2024 (July 1, 2023 through June 30, 2024) in partnership with Healthy Oconto County. Upon completion, the hospital developed a set of implementation strategies and adopted an implementation plan to address priority community health needs. After assessing the population of Oconto County, the following health priorities were identified: 1. Alcohol and Other Drug Use 2. Mental Health & Healthy Activity 3. Transportation From this list, HSHS prioritized the following: 1. Alcohol and Other Drug Use 2. Mental Health 3. Transportation While we are not including Healthy Activity in our top CHNA priorities this cycle, we will continue to partner with workgroups and initiatives developed to address this priority area. Input from persons representing the broad interests of the community was obtained through multiple methods as part of the Healthy Oconto County community health assessment process, including a community health survey (with 691 responses), key informant interviews, stakeholder meetings, and community engagement activities. These efforts incorporated both qualitative and quantitative data and included input from a broad cross-section of community members and organizations, including those representing medically underserved, low-income, and minority populations. Community stakeholders reviewed data, provided input on community health needs, identified community assets and gaps, and participated in prioritization of significant health needs. Governmental public health expertise was included through participation of Oconto County Public Health and the Wisconsin Department of Health Services. No written comments were received regarding the prior FY2021 CHNA or the related implementation strategy. |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. *Bellin Health *Bellin Health Oconto Hospital *Oconto County Public Health *Notrhlakes Community Clinic *CESA 8 *HSHS St. Clare Memorial Hospital *Tri-County United Way *Oconto County Health and Human Services *Oconto County Veterans Services *Oconto County Non-Profit Child Care *Unit Recovery Services UW-Extension *Encompass Childcare *Rainbow House Wisconsin Department of Health services *Oconto Unified School District Greater Green Bay Community Foundation Emergency Medical Services *Aging and Disability Resource Center * Denotes groups representing medically underserved, low-income and minority populations |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. The CHNA was conducted in collaboration with the following organization: Healthy Oconto County Healthy Oconto County is a multi-sector coalition that includes public health agencies, health care providers, and community organizations. Members of this coalition partnered with the hospital in the planning, data collection, analysis, and prioritization of community health needs. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS St. Clare Memorial Hospital. Fiscal year ending June 30, 2025 was the first year of implementation of the 2025 CHIP Plan. Information provided below relates to the activities that occurred during the first year of this CHNA cycle addressing the health needs identified in the 2025 CHNA. Community Health Needs Prioritization As detailed in the FY25 CHNA Report, HSHS St. Clare Memorial Hospital, in collaboration with Healthy Oconto County (HOC) community partners, identified the top three health priorities in Oconto County: - Mental Health & Wellbeing - Alcohol and Other Drug Abuse (AODA) - Transportation Mental Health Implementation Strategies: Current Situation as identified in FY2024 CHNA Report; Mental Health and well-being consistently arose as the most prominent community health priority in Oconto County during CHNA discussions. The primary goal of the Oconto County Mental Health Work Group is to promote optimal mental health for Oconto County. During 2025, the group focused on mental wellbeing with an emphasis on youth and men. During the year the group hosted a Men's event which included a guest speaker who discussed his own struggle with mental health. The event gathered 126 men. In addition, Monthly gatherings called D.U.D.E.S & T.A.C.O.S. (Trailblazing Adventure of Connection, Outreach and Support) took place which provided an opportunity for guest speakers and general discussion in a safe and non-judgmental environment. Healthy Nutrition and Physical Implementation Strategies: Current Situation as identified in FY24 CHNA Report; Nutrition and Physical Activity consistently arose as a significant opportunity to improve health behavior and therefore as a health priority in Oconto County during CHNA discussions. Healthy nutrition and physical activity frequently accompanied discussions around Chronic Disease Prevention and Management, as well as Mental Health. Outcomes: - Colleagues at HSHS St Clare Memorial Hospital continued to support the Kingdom Come Food Pantry, by collecting food donations at the hospital and delivering to the food pantry. - The Healthy Oconto County nutrition and physical activity committee continued planning and financial support for the Oconto County Farmers Market, including the Produce for Pantries campaign which donated healthy produce from the farmer's market to the food pantry. - HSHS St. Clare Memorial Hospital supports a Community Garden on the grounds of the hospital which has strong community support. HSHS Community Benefits provided funding to build a pavilion on the grounds of the Garden. This pavilion is utilized for educational events and community presentations relating to growing and preparing healthy food . In addition, the half of the garden that is worked by community volunteers grew, harvested, and donated more than 20,000 pounds of produce to Kingdom Come Food Pantry over the last three years. Plans to expand the program are underway for 2026. Alcohol and Other Drug Abuse (AODA) Implementation Strategies: Current situation as identified in CHNA: Alcohol and Other Drug Abuse frequently emerged as a major concern on the Community Health Surveys and in stakeholder discussions. This issue often was linked closely to mental health. Reasons commonly cited for the problem included ease of availability, lack of access to treatment, cost of treatment, and lack of understanding of the impact of drug use on overall health. - During FY 2025, St. Clare Memorial Hospital participated in the Bi-annual Drug Take Back Day in April and October. The hospital will continue to lead this event for the coming year. - St. Clare Memorial Hospital continued it's support for the Unity Recovery Center with volunteer hours assisting with extending hours of operation. - The staff also assisted in creating and distributing a survey to the community to determine attitudes toward substance use in the community. The transportation workgroup was formed to address lack of transportation in the rural community. With the closure of the ADRC in the county, there was no avenue for seniors and others not able to drive to attend to basic needs and medical care. Through the course of the year, the workgroup determined that the county could partner with the Menominee Tribal transportation group to provide consistent transit in the county. The program has been very successful and ridership continues to grow each month. The CHNA identified several significant community health needs; however, not all were selected as priorities for the FY2025-FY2027 implementation cycle. The Hospital focused on needs determined to have the greatest impact based on community input, health disparities, feasibility, and available resources. Other identified needs were not addressed directly due to limited resources or alignment considerations but will continue to be monitored for future planning cycles. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - St. Clare Memorial Hospital. Presumptive eligibility under the Financial Assistance Program may be granted if evidence of a patient's inability to pay for medically necessary services is provided by the patient or through other sources available to HSHS. Once determined, due to the inherent nature of the presumptive circumstances, the only discount that can be granted is a 100% write-off of the account balance. Presumptive eligibility may be determined based on individual circumstances that may include: ALL HOSPITALS (HSHS) AND MEDICAL GROUP: i. Homelessness ii. Deceased with no estate iii. Mental incapacitation with no one to act on patient's behalf iv. Medicaid eligibility, but not on date of service or for non-covered services v. Incarceration in a penal institution vi. Enrollment in the following assistance programs for low-income individuals: - Temporary Assistance for Needy Families (TANF) - Illinois Housing Development Authority's Rental Housing Support Program - Wisconsin Department of Health Services Housing Assistance Program URBAN HOSPITALS - Additional Mandated Categories: Enrollment in one or more of the following programs with criteria at or below 200% of the current Federal Poverty Guidelines: i. Participation in Women, Infants and Children programs (WIC) ii. Supplemental Nutrition Assistance Program (SNAP) eligibility iii. Low Income Home Energy Assistance Program (LIHEAP) iv. Wisconsin Home Energy Assistance Program (WHEAP) v. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria vi. Receipt of grant assistance for medical services HSHS may use external programs to verification patients' ability to pay (e.g., Search America). If a patient is determined to be unable to pay for their medically necessary services via these external programs, the accounts will be adjusted off to charity. See "Presumptive Eligibility" (above). Patients who were determined to be eligible for the Financial Assistance Program retain eligibility for a period of up to six (6) months from the date of approval. At the end of six (6) months, the patient is responsible for reapplying for eligibility under the Financial Assistance Program. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HSHS St Clare Memorial Hospital Prevea Lena Health Center | ||||
| 200 SOUTH ROSERA STREET | LENA | WI | 54139 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Mountain Health Center | ||||
| 14353 HWY 32/64 | MOUNTAIN | WI | 54149 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Gillett Health Center | ||||
| 340 NORTH GREEN BAY AVE | GILLETT | WI | 54124 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Suring Health Center | ||||
| 913 E MAIN STREET | SURING | WI | 54174 | CLINIC |
| HSHS St Clare Memorial Hospital Prevea Oconto Falls Health Center | ||||
| 835 S Main St | Oconto Falls | WI | 54154 | Clinic |
| Prevea Oconto Falls Health Center - Medical Services Building | ||||
| 853 S Main St | Oconto Falls | WI | 54154 | Clinic |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 7g Subsidized Health Services | NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC ARE INCLUDED ON LINE 7G. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET 2 WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET 3 TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH PROGRAM, AND DONATIONS ARE STATED AT ACTUAL COST (WHEN APPLICABLE). THE COST OF THESE ITEMS ARE TRACKED THROUGH THE GENERAL LEDGER PROCESS AND THROUGH OTHER ACCOUNTING SOFTWARE. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | FOR FINANCIAL STATEMENT PURPOSES, HOSPITAL SISTERS HEALTH SYSTEM HAS ADOPTED ACCOUNTING STANDARDS UPDATE NO. 2014-09 (TOPIC 606). IMPLICIT PRICE CONCESSIONS INCLUDES BAD DEBTS. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15 AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The text of the footnote to the organization's financial statements that describes bad debt expense can be found on pages 16-19 in the HSHS Consolidated Audit Report. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | The 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 leadership continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. The IRS does not classify this shortfall in Medicare payments as Community Benefit. However, we believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for financial assistance or other means-tested government programs. Further, by absorbing this shortfall and providing care below cost to these individuals, the Hospital is relieving the burden of the government. Accordingly, this shortfall restricts the Hospital's ability to make funds available to provide for financial assistance and other Community Benefit. The hospital's Medicare shortfall at cost for FY25 was $6.2 million. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | Every 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 provide adequate documentation. If the patient qualified 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 qualified 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 payer 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. The Hospital will make reasonable efforts to determine whether a patient is eligible under the Financial Assistance Policy before engaging in any extraordinary collection action. Once a patient is determined to be eligible for financial assistance, HSHS will not pursue extraordinary collection actions and will take all reasonably available measures to reverse any extraordinary collection action taken to obtain payment for care covered under the Financial Assistance Policy. Any remaining balance will be handled in accordance with the Financial Assistance Policy and standard billing procedures. Certain collection safeguards apply to all patients, while additional protections apply specifically to patients known to qualify for financial assistance. |
| Schedule H, Part V, Section B, Line 16a FAP website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16a URL: https://www.hshs.org/patients/billing/financial-assistance; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16b URL: https://www.hshs.org/patients/billing/financial-assistance; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16c URL: HTTPS://WWW.HSHS.ORG/PATIENTS/BILLING/FINANCIAL-ASSISTANCE; |
| Schedule H, Part VI, Line 2 Needs assessment | As indicated in Part V, Section C, ST. CLARE MEMORIAL HOSPITAL conducted a Community Health Needs Assessment in FY2024 (July 1, 2023 through June 30, 2024). In addition to the triennial CHNA process, the hospital continuously reviews updated local and state data, Illinois Comp Data, patient surveys and feedback, and local needs assessments conducted by community groups. Additionally, the hospital receives input from public health officials, community groups and community boards on an ongoing basis. The information received and reviewed is used to inform ongoing strategic initiatives developed to meet CHNA health priorities; as well as new areas of need that are going unmet. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | Patients may learn of Financial Assistance Policy (FAP) resources on-line. Materials are presented in English and Spanish, with translation services available in more than 25 languages. Information regarding the Financial Assistance Policy, including a plain language summary, application for financial assistance, and contact information, is available on the hospital's website and may also be requested by patients. Information regarding the availability of financial assistance is also made available to patients during the registration and discharge processes. Financial counselors discuss patients' financial circumstances to help determine eligibility for financial assistance under the hospital's Financial Assistance Policy and for applicable federal, state, or local government programs. The care management team also works with patients to confirm eligibility for financial assistance and applicable government programs and provides resources accordingly. Patients may also receive information regarding financial assistance through billing communications and through discussions with hospital staff, who are available to assist patients with the financial assistance application process and accessing available assistance programs. |
| Schedule H, Part VI, Line 4 Community information | For purposes of the CHNA, the community served is defined as Oconto County, Wisconsin. HSHS St. Clare Memorial Hospital (SCO) is a critical access hospital located in Oconto Falls, Wisconsin. Oconto Falls is located approximately 30 miles north of Green Bay in the northeast portion of the state and has a population of 2,989. The city is in the central portion of Oconto County. Oconto County is primarily a rural county. The county totals 1,149 square miles and is bordered by Bay of Green Bay to the east, Marinette and Forest counties to the north, Shawano County to the west, and Brown County to the South. Oconto County Community profile. Oconto County has an estimated population of 40,037 (July 1, 2024, U.S. Census Bureau). Oconto County, Wisconsin has 1,149 square miles of land area. The city of Oconto is the County seat and is located on the Bay of Green Bay. Oconto Falls, WI is in the central portion of Oconto County. The remainder of the county consists of small villages and rural residential settings. In 2019 in Oconto County 19% urban & 81% rural. Many rural residents face barriers related to access to housing, transportation, and foods that are safe, healthy, and affordable. These barriers can impact all residents, thought they are particularly problematic for those already struggling financially. In regard to race, 95.7% of Oconto County residents report being Non-Hispanic White; 0.5% Non-Hispanic Black; 1.7% American Indian and Alaska Native alone; 2.3% report Hispanic; 99.4% of the residents in Oconto County, WI are U.S. citizens. The median household income of Oconto County is $73,611 (2022). 7% of residents in Oconto County live in poverty. The majority of jobs in the area are service providing. Several small or medium sized manufacturing firms, service industry, agriculture, and agriculture-related business are located in Oconto County and provide most of the employment opportunities. As of December 2023, 5,791 Oconto County residents are covered by Medicaid/BadgerCare Plus. Per the 2021 County Health Rankings, 7% of Oconto County's adult population and 5% of the child population are uninsured. Of the 72 counties in Wisconsin, Oconto County ranks 48th in overall health outcomes and 29th in overall health factors. (Per the 2022 County Health Rankings) Oconto County has been designated a dental, mental health, and primary care HPSA (health professional shortage area) and the City of Oconto Falls is an MUA (medically underserved area) for Primary Care per HRSA. There are two non-profit, general medical and surgical hospitals servicing the county. There are several outpatient clinics affiliated with the health systems which operate the two hospitals (HSHS/Prevea and Bellin Health). In addition, there is a federally qualified healthcare center, NorthLakes Community Clinic. |
| Schedule H, Part VI, Line 5 Promotion of community health | As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS St. Clare Memorial Hospital (SCO) is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1921, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Oconto Falls and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Clare Memorial Hospital is responding to community need. At every Board of Directors meeting, a written or oral report on community benefit activities was provided. An educational session for the Board is also held to better understand the recent Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP). HSHS SCO has a Patient Family Engagement Council that meets quarterly and provides patient and community feedback on services offered at HSHS St. Clare Memorial Hospital. Consistent with its exempt purpose, HSHS St. Clare Memorial Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Clare Memorial Hospital reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Clare Memorial Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by HSHS St. Clare Memorial Hospital and they often relieve a burden that would otherwise be carried by government. HSHS St. Clare Memorial Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2025, HSHS St. Clare Memorial Hospital provided $5,108,257 in Community Benefit, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. |
| Schedule H, Part VI, Line 6 Affiliated health care system | HEADQUARTERED IN SPRINGFIELD, ILLINOIS, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) IS A HIGHLY INTEGRATED, MULTI-INSTITUTIONAL HEALTH CARE SYSTEM COMPRISED OF 13 HOSPITALS AND MORE THAN 200 PHYSICIAN PRACTICE SITES IN ILLINOIS AND WISCONSIN. HSHS IS SPONSORED BY HOSPITAL SISTERS MINISTRIES (HSM), WHICH IS A PUBLIC JURIDIC PERSON OF THE ROMAN CATHOLIC CHURCH. HSHS CONTINUES THE HEALTH CARE MINISTRIES BEGUN BY ITS FOUNDERS, THE HOSPITAL SISTERS OF ST. FRANCIS, MORE THAN 150 YEARS AGO, IN RURAL AND MIDSIZED COMMUNITIES THROUGHOUT ILLINOIS AND WISCONSIN. HSHS PROVIDES COMPASSIONATE, HOLISTIC, HIGH QUALITY, AND COST-EFFECTIVE HEALTH CARE THROUGH ITS ACUTE CARE HOSPITALS, PHYSICIAN PRACTICES, HOME HEALTH PROGRAMS, PALLIATIVE AND HOSPICE PROGRAMS, AND COMMUNITY OUTREACH SERVICES. IN ADDITION, HSHS AFFILIATED HOSPITALS INCLUDE CRITICAL ACCESS FACILITIES THAT OFFER ESSENTIAL HEALTH SERVICES THAT OTHERWISE WOULD NOT BE AVAILABLE IN MANY COMMUNITIES. OUR MISSION CALLS US TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE, AND WE EXTEND OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY BEYOND THE WALLS OF OUR HOSPITALS BY PROVIDING COMMUNITY HEALTH IMPROVEMENT SERVICES WITH SPECIAL EMPHASIS ON THE POOR AND VULNERABLE. IN ADDITION TO PROVIDING COMMUNITY HEALTH IMPROVEMENT SERVICES TO THE BROADER COMMUNITY, HSHS CARES FOR EVERYONE WHO COMES TO ITS FACILITIES, REGARDLESS OF THEIR ABILITY TO PAY. IN TANDEM WITH A VARIETY OF CROSS SECTOR COMMUNITY PARTNERS, HSHS'S COMMUNITY BENEFIT INITIATIVES ARE STRATEGICALLY PLANNED AND PROFESSIONALLY IMPLEMENTED TO IMPROVE ACCESS TO HEALTH CARE SERVICES; ENHANCE THE HEALTH OF THE COMMUNITY; ADVANCE MEDICAL OR GENERAL HEALTH CARE KNOWLEDGE; AND RELIEVE OR REDUCE THE BURDEN OF GOVERNMENT TO IMPROVE HEALTH. IN FY2025, HSHS COLLECTIVELY PROVIDED $211.9 MILLION IN COMMUNITY BENEFIT (8.39% OF TOTAL HOSPITAL EXPENSES). OF THE TOTAL COMMUNITY BENEFIT PROVIDED, HSHS PROVIDED $4.4 MILLION FOR FINANCIAL ASSISTANCE (AKA CHARITY CARE) AND $119.2 MILLION FOR UNREIMBURSED CARE PROVIDED AS PART OF THE MEDICAID PROGRAM. IN ADDITION, HSHS HOSPITALS COMMITTED SIGNIFICANT RESOURCES TO TREAT MEDICARE PATIENTS. THE COST OF PROVIDING SERVICES TO PRIMARILY ELDERLY BENEFICIARIES OF THE MEDICARE PROGRAM - IN EXCESS OF GOVERNMENTAL AND MANAGED CARE CONTRACT PAYMENTS - WAS $294.9 MILLION. HSHS HOSPITALS ALSO RECORDED $90.8 MILLION IN UNCOLLECTIBLE ACCOUNTS. WHILE HSHS DOES NOT COUNT THE LATTER TWO AMOUNTS AS COMMUNITY BENEFIT, THEY NONETHELESS REFLECT OUR COMMITMENT TO SERVING ALL PERSONS IN NEED OF CARE. IN ADDITION TO THE DOLLARS INVESTED IN OUR COMMUNITY BENEFIT PROGRAMS, HSHS CONTINUES TO REINVEST ANY SURPLUS REVENUE FROM OPERATIONS AND INVESTMENTS INTO NEW MEDICAL TECHNOLOGY, FACILITY INFRASTRUCTURE AND HEALTH CARE SERVICES IN OUR COMMUNITIES. BY DOING SO, WE ENSURE OUR ABILITY TO MEET THE ONGOING DEMAND FOR HIGH QUALITY, EFFICIENT AND EASILY ACCESSIBLE HEALTH CARE. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Unity Hospice | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2366 Pak Ridge Circle | AddressLine1Txt |
| City | De Pere | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54115 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 391750729 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Non Cash Assistance | $45,500 | NonCashAssistanceAmt |
| Valuation Method Used | FMV | ValuationMethodUsedDesc |
| Non Cash Assistance | 13 Hospital beds | NonCashAssistanceDesc |
| Purpose Of Grant | Caring for patients in residence | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION USES A COMMUNITY HEALTH SCORING MATRIX TO ASSESS SPONSORSHIP REQUESTS FROM 501(C)(3) ORGANIZATIONS, ENSURING ALIGNMENT WITH ETHICAL AND RELIGIOUS DIRECTIVES AND THE HSHS MISSION. PROGRAMS ARE EVALUATED BASED ON FACTORS LIKE HEALTH RELEVANCE, COLLECTIVE IMPACT, SUPPORT FOR VULNERABLE POPULATIONS, AND ALIGNMENT WITH CHNA AND COMMUNITY BENEFIT PRIORITIES. BUDGET CONSIDERATIONS ALSO FACTOR INTO SCORING, WITH PREFERENCE GIVEN TO BUDGETED EXPENSES. FUNDING DECISIONS - APPROVAL, DISCUSSION, OR DECLINATION - ARE BASED ON TOTAL SCORES, ENSURING RESOURCES ARE DIRECTED TOWARD INITIATIVES WITH MEANINGFUL COMMUNITY IMPACT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John L Wagner | ||||||||||||||
| PRESIDENT/CEO (began 8/1/24) | $154,991 | $267,026 | $0 | $3,065 | $90,434 | $967 | $0 | $59,986 | $14,233 | $16,605 | $259,658 | $347,649 | $0 | $0 |
| Robert Erickson | ||||||||||||||
| PRESIDENT/CEO (until 7/31/24) | $0 | $440,186 | $0 | $5,000 | $0 | $41,522 | $0 | $61,830 | $0 | $19,272 | $0 | $567,810 | $0 | $0 |
| CHRISTOPHER BRABANT | ||||||||||||||
| Former PRESIDENT/CEO | $110,028 | $0 | $2,023 | $0 | $224,193 | $0 | $2,365 | $0 | $31,350 | $0 | $369,959 | $0 | $69,246 | $0 |
| TODD Smart | ||||||||||||||
| Former Treasurer | $0 | $106,706 | $0 | $9,754 | $0 | $516 | $0 | $0 | $0 | $15,590 | $0 | $132,566 | $0 | $0 |
| PATRICIA ALLEN | ||||||||||||||
| CFO - CARE DELIVERY (until 4/30/25) | $0 | $531,646 | $0 | $4,240 | $0 | $23,350 | $0 | $63,815 | $0 | $26,107 | $0 | $649,158 | $0 | $21,130 |
| Michael Scialdone | ||||||||||||||
| Treasurer / HSHS SVP & CFO | $0 | $727,132 | $0 | $5,000 | $0 | $48,180 | $0 | $112,411 | $0 | $20,224 | $0 | $912,947 | $0 | $0 |
| CHERYL BURKEL EMMERS | ||||||||||||||
| CRNA | $247,990 | $0 | $7,410 | $0 | $4,925 | $0 | $24,244 | $0 | $34,038 | $0 | $318,607 | $0 | $0 | $0 |
| Heidi Marie Cole | ||||||||||||||
| Supervisor - Pharmacy | $151,341 | $0 | $905 | $0 | $3,033 | $0 | $9,460 | $0 | $20,192 | $0 | $184,931 | $0 | $0 | $0 |
| Mary Lynn Thompson | ||||||||||||||
| House Supervisor | $161,320 | $0 | $1,089 | $0 | $2,327 | $0 | $8,518 | $0 | $21,304 | $0 | $194,558 | $0 | $0 | $0 |
| Glenn White | ||||||||||||||
| CRNA | $260,781 | $0 | $6,000 | $0 | $4,750 | $0 | $13,892 | $0 | $21,170 | $0 | $306,593 | $0 | $0 | $0 |
| Maura May White | ||||||||||||||
| CRNA | $244,116 | $0 | $7,410 | $0 | $75 | $0 | $15,677 | $0 | $27,910 | $0 | $295,188 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 1a Tax indemnification and gross-up payments | DURING THE YEAR, THE FOLLOWING INTERESTED PERSONS RECEIVED A TAX GROSS-UP PAYMENT. THE RELATED AMOUNTS WERE TREATED AS TAXABLE COMPENSATION TO THE RECIPIENT. John Wagner |
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | ORGANIZATION: ST. CLARE MEMORIAL HOSPITAL, INC. EIN: 39-0848401 INTERESTED PERSON: CHRISTOPHER BRABANT AMOUNT: 140,922 TERMS: COMPENSATION PAID AS A RESULT OF A SEVERANCE |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2024. THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). PATRICIA ALLEN - $43,115 MICHAEL SCIALDONE - $87,924 JOHN WAGNER - $42,736 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2024. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. PATRICIA ALLEN - $21,130 CHRISTOPHER BRABANT - $69,246 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a-4c Description of program services | (Expenses $ 17,232,117 including grants of $ 48,946)(Revenue $ 14,367,450) OTHER PROGRAM SERVICES - OTHER PROGRAM SERVICES AT ST. CLARE MEMORIAL HOSPITAL ARE COMPRISED OF MEDICAL SURGICAL, WOUND CARE, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. |
| Form 990, Part IV, Line 10 Endowment Funds | The organization maintains net assets with donor restrictions and without donor restrictions on its balance sheet. Such funds are held by Hospital Sisters of St. Francis Foundation, Inc., a related tax-exempt organization. While these funds are held to further one or more exempt purposes of the filing organization, they are not maintained exclusively for the filing organization. The board of directors of Hospital Sisters of St. Francis Foundation, Inc. maintains ownership and ultimately authority and discretion over the use of these funds. Based on the above, the related amounts have not been reported as endowment funds on Part V of Schedule D. |
| Form 990, Part V, Line 1a Number in Box 3 Form 1096 | THE FORM 1096, ANNUAL SUMMARY & TRANSMITTAL OF U.S. INFORMATION RETURN IS FILED BY THE ORGANIZATION'S PARENT, HOSPITAL SISTERS HEALTH SYSTEM (HSHS) ON THE ORGANIZATION'S BEHALF TO TRANSMIT TO THE IRS FORMS 1099, 1098, 5498 AND W-2G. THE ORGANIZATION IS UNABLE TO DETERMINE THE NUMBER OF FORMS 1099, 1098, 5498 AND W-2G FILED BY HSHS ON THEIR BEHALF. AS THE PARENT ORGANIZATION, HSHS ENSURES THAT THE FILING ORGANIZATION COMPLIES WITH ALL INFORMATION RETURN REPORTING REQUIREMENTS AND BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND REPORTABLE GAMING WINNINGS TO PRIZE WINNERS, AS APPLICABLE. ACCORDINGLY, THE NUMBER REPORTED ON FORM 990, PART V, LINE 1A REFLECTS THE NUMBER REPORTED IN BOX 3, OF FORM 1096 FOR HSHS, THE PARENT ORGANIZATION. |
| Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES |
| Form 990, Part VI, Line 16b JOINT VENTURES | HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ALL HSHS HOSPITALS TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD THE ORGANIZATION'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | PER ARTICLE 5.5 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH AND MAY IN ITS DISCRETION EXERCISE THE FULL POWERS, DUTIES, RESPONSIBILITIES, AND AUTHORITY OF THE BOARD EXCEPT WHERE PROHIBITED BY LAW AND SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BYLAWS OR THE BOARD OF DIRECTORS. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF FOUR TO SIX MEMBERS, INCLUDING THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE PRESIDENT AND OTHER MEMBERS SELECTED FROM AMONG THE DIRECTORS BY THE BOARD. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE CORPORATE MEMBER OF ST. CLARE MEMORIAL HOSPITAL (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. CLARE MEMORIAL HOSPITAL (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 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 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 DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (H) 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; (I) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) 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; (O) APPROVE MATERIAL ACTIONS WITH RESPECT TO EMPLOYEE RETIREMENT PLANS SPONSORED BY THE CORPORATION OR ANY AFFILIATE; AND (P) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF THE MEMBER. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP 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. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE 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, AND 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 ANSWER 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. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE 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 HSHS EXECUTIVES. SULLIVAN COTTER, 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 HSHS EXECUTIVES. SULLIVAN COTTER 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. 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. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 19 Required documents available to the public | BOARD-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. |
| Form 990, Part IX, Line 11g Other Fees | Purchased Services - Outside - Total Expense: 6573174, Program Service Expense: 6456293, Management and General Expenses: 116881, Fundraising Expenses: ; Contract Labor - Total Expense: 475601, Program Service Expense: 464261, Management and General Expenses: 11340, Fundraising Expenses: ; Professional Fees - Total Expense: 63302, Program Service Expense: 63302, Management and General Expenses: 0, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | THE ORGANIZATION'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED INVESTMENT FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. 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 FORCERTAIN 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. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in Net Periodic Pension Costs - net of service costs - -2105; Tranfers between affiliates - -130647; Total - -132752; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HOSPITAL SISTERS HEALTH SYSTEM | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371058692 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | NA | false | |
| HOSPITAL SISTERS HEALTHCARE-WEST INC | |||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3) | Type I | HSSI | Yes (true) | |
| HOSPITAL SISTERS MISSION OUTREACH CORPORATION | |||||||||||
| 4849 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 352271729 | RECYCLING MEDICAL SUPPLIES | IL | 501(c)(3) | HSHS | Yes (true) | ||
| HOSPITAL SISTERS OF ST FRANCIS FOUNDATION INC | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371186514 | HEALTHCARE | IL | 501(c)(3) | 7 | HSHS | Yes (true) | |
| HOSPITAL SISTERS SERVICES INC | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSHS | Yes (true) | |
| HSHS GOOD SHEPHERD HOSPITAL INC | |||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 370512290 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| HSHS HOLY FAMILY HOSPITAL INC | |||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 370792770 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| HSHS MEDICAL GROUP INC | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 263956318 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSSI | Yes (true) | |
| HSHS WISCONSIN MEDICAL GROUP INC | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 264515959 | HEALTHCARE | WI | 501(c)(3) | Type III-FI | HSSI | Yes (true) | |
| ORANGE CROSS AMBULANCE INC | |||||||||||
| 919 ASHLAND AVENUE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3) | 10 | ST NICHOLAS | Yes (true) | |
| PRAIRIE CARDIOVASCULAR CONSULTANTS LTD | |||||||||||
| 3051 HOLLIS DRIVE | SPRINGFIELD | IL | 62704 | 371071858 | HEALTHCARE | IL | 501(c)(3) | 10 | HSSI | Yes (true) | |
| PRAIRIE EDUCATION & RESEARCH COOPERATIVE | |||||||||||
| 800 EAST CARPENTER STREET 62 | SPRINGFIELD | IL | 62769 | 371157915 | HEALTHCARE | IL | 501(c)(3) | 4 | HSSI | Yes (true) | |
| SACRED HEART HOSPITAL OF HOSPITAL SISTERS OF THIRD ORDER OF ST FRANCIS | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 390807060 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST ANTHONY'S MEMORIAL HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER O | |||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | F ST FRANCIS |
| ST ELIZABETH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FR | |||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 370663567 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | ANCIS |
| ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS | |||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST JOHN'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS | |||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 12866 TROXLER AVENUE | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 390810545 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 9515 HOLY CROSS LANE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC - HOSPITAL SISTERS | |||||||||||
| 1762 SHAWANO AVENUE | GREEN BAY | WI | 54303 | 390818682 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | |
| ST MARY'S HOSPITAL DECATUR OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST | |||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) | FRANCIS |
| ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANC | |||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | IS |
| ST VINCENT HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCI | |||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 51301 | 390817529 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) | S |
| UNITY LIMITED PARTNERSHIP | |||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3) | 10 | HSSI | Yes (true) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | UBI Code VUBICodeVAmt | OwnershipOwnershipPct | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPRINGFIELD URGENT CARE REAL ESTATE LLC | |||||||||||||
| PO BOX 19456 | SPRINGFIELD | IL | 62794 | 030413258 | RENTAL REAL ESTATE | IL | LASANTE INC | N/A | $0 | 0.83 | |||
| REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC | |||||||||||||
| 9001 LIBERTY PARKWAY | BIRMINGHAM | AL | 35242 | 871489748 | MEDICAL | DE | SACRED HEART HOSPITAL | Related | $0 | 0.5 | $0 | $0 | false |
| HOSPITAL SISTERS SURGERY CENTER O'FALLON llc | |||||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 341446171 | MEDICAL | IL | ST ELIZABETH'S HOSPITAL | N/A | $0 | 0.51 | |||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIARA LLC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163401 | HEALTHCARE | IL | HSHS | C Corporation | $12,978,117 | $19,279,759 | 1 | Yes (true) | |||||
| LASANTE WISCONSIN INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 391572196 | HEALTHCARE | IL | KIARA LLC | C Corporation | Yes (true) | ||||||||
| LASANTE INC | |||||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163400 | HEALTHCARE | IL | KIARA LLC | C Corporation | Yes (true) | ||||||||
| RENAISSANCE QUALITY INSURANCE LTD | |||||||||||||||||
| 980669953 | INSURANCE | HSSI | C Corporation | $0 | $227,389,871 | 1 | Yes (true) | PO BOX 1159 | GRAND CAYMAN | CJ | KY11102 | CJ | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (true) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES | ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION. |
| Schedule R, Part VII Related Organizations | Due to the increasingly complex organization structure of Hospital Sisters Health System and Affiliates, the filing organization has elected to report all tax-exempt organizations, partnerships, and corporations within Hospital Sisters Health System as related, regardless of ownership interest or "control" as defined by the instructions to Schedule R. The intent of this reporting is to promote transparency and increase consistency across the numerous Form 990 submissions by Hospital Sisters Health System and Affiliates. |