2023-04-28T18:34:10+00:00 2022-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2021-07-01 370792770 HSHS Holy Family Hospital HSHS 6186641230 200 HEALTH CARE DRIVE GREENVILLE IL 62246 Corey Hastings Interim Division CFO 2023-04-28 true Patricia Allen 999009999 Mallory Fairless P01321579 3128997000 2021 2023-04-26 12:10:37Z Kelly Sager 200 HEALTH CARE DRIVE GREENVILLE IL 62246 23116620 false 0928 X HSHSHOLYFAMILY.ORG X 1956 IL TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. 7 6 166 7 0 0 10084204 823612 19663056 20862477 220821 153935 865778 1276596 30833859 23116620 0 445000 0 8012918 8563085 0 0 17506214 18724529 25519132 27732614 5314727 -4615994 23020129 21003440 42882056 46346208 -19861927 -25342768 TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 24775859 445000 20862477 HSHS Holy Family Hospital (FKA GREENVILLE REGIONAL HOSPITAL) IS A FULL-SERVICE, ACUTE CARE FACILITY OFFERING 28 LICENSED BEDS, A 24-HOUR EMERGENCY DEPARTMENT, SURGERY DEPARTMENT, REHABILITATION DEPARTMENT, SLEEP DISORDERS CENTER, AND OUTPATIENT SPECIALTY CLINICS. DIAGNOSTIC SERVICES INCLUDE A LABORATORY, CARDIOPULMONARY DEPARTMENT, AND IMAGING SERVICES DEPARTMENT. THE HOSPITAL IS CERTIFIED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). IN ADDITION TO PROVIDING INPATIENT ACUTE CARE, HSHS Holy Family Hospital OFFERS "SWING BEDS". MEDICARE PATIENTS QUALIFYING FOR TRANSITIONAL CARE CAN RECEIVE TREATMENT AT GREENVILLE REGIONAL THROUGH THE "SWING BED" PROGRAM. BOND COUNTY EMERGENCY MEDICAL SERVICES IS BASED AT AND OPERATED BY THE COUNTY. THE SERVICE PROVIDES ADVANCED CARDIAC LIFE SUPPORT (ACLS) AND THE ORGANIZATION HAS ALSO ACHIEVED "RESOURCE HOSPITAL" STATUS. THE HOSPITAL EMERGENCY DEPARTMENT IS STAFFED 24-HOURS PER DAY BY A PHYSICIAN. FOUR MAJOR TRAUMA SUITES, THREE EXAMINATION ROOMS, A TRIAGE ROOM, AND AN IV THERAPY ROOM ARE LOCATED WITHIN THE DEPARTMENT. WHEN NEEDED, HELICOPTER AMBULANCE SERVICE IS AVAILABLE. PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPY ARE OFFERED ON BOTH AN INPATIENT AND OUTPATIENT BASIS. THE HOSPITAL OUTPATIENT SPECIALTY CLINIC OFFERS 13 MEDICAL SPECIALTIES AND CONTAINS 13 EXAMINATION ROOMS. FOUR CLINICS CAN BE IN OPERATION SIMULTANEOUSLY. THE HOSPITAL MAY HOST AS MANY AS 100 CLINICS IN JUST 27 WORKING DAYS. THE HOSPITAL'S LABORATORY CAN PERFORM A WIDE ARRAY OF BLOOD, TISSUE, AND FLUID TESTING. THE IMAGING SERVICES DEPARTMENT OFFERS IN-HOUSE X-RAY, CAT SCAN, MRI, ULTRASOUND, NUCLEAR SCAN, BONE DENSITY, AND 3-D DIGITAL MAMMOGRAPHY TECHNOLOGY. MOBILE PET SCANS ARE ALSO AVAILABLE. THE HOSPITAL HAS THE CAPABILITY OF TRANSMITTING IMAGES TO ON-CALL RADIOLOGISTS FOR SCANS PERFORMED AFTER NORMAL BUSINESS HOURS. THE ORGANIZATION ALSO OWNS AND OPERATES A MEDICAL OFFICE BUILDING ON THE HOSPITAL GROUNDS WHICH IS A CERTIFIED RURAL HEALTH CLINIC. THE CLINIC IS UTILIZED BY PRIMARY CARE AND SPECIALTY PHYSICIANS, AS WELL AS MID-LEVEL PRACTITIONERS. THE ORGANIZATION ALSO OWNS AND OPERATES EMERALD POINTE, AN INDEPENDENT, SENIOR LIVING DEVELOPMENT LOCATED ON THE HOSPITAL CAMPUS. THE DEVELOPMENT CONSISTS OF A 15-UNIT APARTMENT BUILDING, FIVE DUPLEX STRUCTURES, AND A SINGLE UNIT PROVIDING 11 RESIDENCES. 24775859 true false false true false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false true true false false false true X 1058 0 true 166 true false false false false false false false false false false false false X 7 6 false false false false true true true true true false false true true true true true true true true true true X Adam Feriozzi 6186512600 200 HEALTH CARE DRIVE GREENVILLE IL 622461156 BART CALDIERARO 2021 Vice Chair & 2022 CHAIR 1.0 1.0 X X 0 0 0 Crystal Grove 2022 Vice Chair 1.0 1.0 X X 0 0 0 EVERT J KUIPER Division CEO - Illinois (until Jan 2022) 1.2 58.8 X X 0 1325482 225887 JERRY GAFFNER 2021 CHAIR (until Oct 2021) 1.0 3.0 X X 0 0 0 KELLY M SAGER President & CEO 59.0 1.0 X X 0 328332 185648 Suzanne Davis 2021 & 2022 Secretary 1.0 1.0 X X 0 0 0 EUGENE DUNKLEY BOARD MEMBER 1.0 1.0 X 0 0 0 Pam Doll Board member 1.0 1.0 X 0 0 0 PETER KUNG Board Member (until 10/31/21) / HSHS Sr VP & Chief Strategy Officer 1.0 59.0 X 0 535544 83417 Sr Marybeth Culnan OSF Board Member 1.0 3.0 X 0 0 0 Corey J Hastings Interim Division CFO (until 4/15/22) 6.0 54.0 X 0 211880 75146 DAVID NOSACKA DIVISION CFO - ILLINOIS (until 7/27/21) 6.0 54.0 X 0 512300 76172 TODD Smart Treasurer 0.3 59.8 X 0 230248 29959 Ashley White Director Of Clinical Services 40.0 0 X 118109 0 15041 Carla Nusbaum Facilitator, Laboratory 40.0 0 X 109794 0 15390 GABRIEL GIGLIOTTI Anesthesiologist 43.0 0 X 164943 0 3966 KATLYN OBERMARK Pharmacist 40.0 0 X 137188 0 46577 STEVEN DONNAN CRNA 43.0 0 X 131310 0 5310 ANN M CARR Former Treasurer 0.0 1.0 X 0 263877 2041 MARK ENNEN Former DIRECTOR OF FINANCE 0.0 40.0 X 0 145486 18860 661344 3553149 783414 6 true true false Vituity 2100 POWELL STREET SUITE 400 EMERYVILLE CA 94608 ED/Hospitalist Physician Services 1605024 ApexNetwork Physical Therapy 15 Apex Dr Highland IL 62249 Staffing/Management 1415693 G&G Anesthesia 2023 Vadalabene Drive Suite 350 Maryville IL 62062 Management Services 281536 COMPASS ONE PO Box 102289 Atlanta GA 30368 Food Services 270633 Computer Programs and Systems PO Box 850309 Mobile AL 36685 IT Services 204621 19 2965 820647 823612 NET PATIENT REVENUES 621990 20862477 20862477 0 0 0 0 20862477 -43906 -43906 0 0 0 0 197841 197841 Other Revenue 900099 1276596 1276596 0 0 0 0 1276596 23116620 20862477 0 1430531 X 445000 445000 6420305 6018945 401360 133170 124847 8323 2009610 1884009 125601 7621 7621 29644 29644 10839825 10565366 274459 0 71468 3193 68275 146584 136238 10346 519104 473397 45707 1648644 1565342 83302 24448 14779 9669 4118 2048 2070 55222 927 54295 767494 595392 172102 345636 345636 Supplies 1904162 1866625 37537 Medicaid Tax Assessment 1225749 1225749 minor equipment 157374 152127 5247 Dues 61146 11334 49812 916290 916290 0 0 27732614 24775859 2956755 0 359027 1594051 0 3543498 2234687 0 0 0 0 393713 253643 92322 149550 16084002 3212862 14016109 12871140 1663625 1801929 0 0 2951835 2098440 23020129 21003440 4127497 5700612 3529884 907736 3982538 922858 0 0 30351598 37990372 890539 824630 42882056 46346208 X -21155586 -26552340 1293659 1209572 -19861927 -25342768 23020129 21003440 X -4615994 -197841 -667006 X false true X true true true X false false false false false false false false true 26156 26156 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY HSHS HOLY FAMILY HOSPITAL (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HOSPITAL ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 26.47% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.00% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 44.00% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 23.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. 1539949 1539949 13109897 2553195 10556702 980257 567127 413130 453899 92540 361359 12871140 2098440 2098440 ASSET RETIREMENT OBLIGATION 492637 Accrued Benefit Liability -11586 Operating Lease 343579 824630 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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. The net operating loss carryforwards result in a deferred tax asset of $3,548 and $3,650 at June 30, 2022 and 2021, respectively. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of 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 the majority 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, 2022 and 2021 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, 2022 and 2021, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 270756 270756 0.0098 4498073 2467235 2030838 0.0732 199937 199937 0.0072 0 0 4968766 2467235 2501531 0.0902 6038 6038 0.0002 213019 213019 0.0077 573499 573499 0.0207 0 0.0 4419 4419 0.0002 0 0 796975 0 796975 0.0287 0 0 5765741 2467235 3298506 0.1189 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 0 0 5247069 6235197 -988128 X true true 1 1 HSHS Holy Family Hospital 200 HEALTHCARE DRIVE GREENVILLE IL 62246 www.hshsholyfamily.org HF113990 X X X HSHS Holy Family Hospital 1 false false true X X X X X X X X X 20 true false true true X https://www.hshs.org/HSHSFamily/media/Holy-Family/About%20us/CHNA_report_HFG_2021_FINAL.PDF X true 21 true https://www.hshs.org/HSHSFamily/media/Holy-Family/About%20us/Implementation-Plan_HFG_2021.pdf false true X 200.0 600.0 X X X X X X true true X X X true X http://www.hshs.org/FAP X http://www.hshs.org/FAP X http://www.hshs.org/FAP X X X X X X true X false X X X X true X false false 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 Holy Family Hospital. Holy Family Hospital undertook an eight-month planning and implementation effort to develop the CHNA, identify and prioritize community health needs for its service area and formulate an implementation plan to guide ongoing population health initiatives with like-missioned partners and collaborators. These planning and development activities included the following internal and external steps: 1. Identified the CHNA core group comprised of Holy Family Hospital and Bond County Health Department. 2. Convened a community advisory committee to solicit input and help narrow identified priorities. 3. Conducted a community survey to get input from community members around the priorities identified. 4. Convened an internal advisory committee respective to each organization to force rank the final priorities and select the FY2022-FY2024 CHNA priorities. External Holy Family Hospital worked with core group partners to leverage existing relationships and provide diverse input for a comprehensive review and analysis of community health needs in Bond County. Representation on the community advisory council (CAC) was sought from health and social service organizations that: 1. Serve low-income populations 2. Serve at-risk populations 3. Serve minority members of the community 4. Represent the general community The following community stakeholders were invited to serve on the CAC: * HSHS Holy Family Hospital* * Bond County Health Department* * Bond County Senior Center* * Greenville College * FAYCO Enterprises* * Greenville Family Medicine* * Bond County Sheriff's Department * First Christian Church * Greenville Economic Development * Bond County Community School District Unit #2 * Lemuel Rhodes Cancer Foundation * Bond County Emergency Telephone System Board * Denotes groups representing the under resourced in our community including low-income seniors, children living in poverty and families who struggle with shelter and food. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS Holy Family Hospital. Yes, the hospital conducted its FY2018 CHNA with HSHS Holy Family Hospital and: * Bond County Health Department* * Bond County Senior Center* * Greenville College * FAYCO Enterprises* * Greenville Family Medicine* * Bond County Sheriff's Department * First Christian Church * Greenville Economic Development * Bond County Community School District Unit #2 * Lemuel Rhodes Cancer Foundation * Bond County Emergency Telephone System Board Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS Holy Family Hospital. In FY2021, HSHS Holy Family Hospital conducted a CHNA. The hospital partnered with other agencies and reviewed primary and secondary data. Then the internal work group gathered and based on the data and the prioritization process, the following priority community health needs were selected: 1. Access to Mental Health and Behavioral Health Services 2. Chronic Conditions 3. Workforce Development FY2022 Highlights and Outcomes: A partnership with Gateway Foundation launched in FY2022 to identify, connect, screen and develop a treatment plan for persons presenting in the ED with substance use disorder. This initiative employs an engagement specialist who works with the provider to identify referral and linkages to address the patients addiction. The recovery coach helps the patient transition back in the community when exiting residential treatment. Holy Family Hospital along with three others in southern Illinois engaged in an 18-month planning process to identify solutions to crisis screening gaps in the emergency department. In FY2023, the plan will be presented to strategy and finance teams with the goal of deploying in January 2023. As part of this plan, HFG will have 365-day psychiatric coverage in the emergency department. HFG has used the better part of FY2022 to vet and operationalize the use of a determinants of health screening tool for every patient entering the hospital. The goal is to expand this to Primary care physician settings as well. This tool will allow us to make referrals to social service agencies in direct response to our patient's social needs. HSHS launched a DEI committee in FY2022. HFG participates in the Workforce Subcommittee to explore internal and external gaps in workforce readiness, obtainment, and success. Additionally, transportation continues to be a FY2022 focus specifically to assist individuals in accessing medical, dental and other personal appointments. As an outcome of the prioritization process, the following community health needs were also identified but will not be addressed directly by the hospital for reasons indicated: * Affordable Housing: While not a direct priority issue, affordable housing challenges and barriers will be explored within the strategic plan of workforce barriers. * Child Care: While not a direct priority issue, childcare availability will be explored within the strategic plan of workforce barriers. * Human Trafficking: This is an ever-growing issue in all communities across Illinois and the nation. HSHS Holy Family Hospital will be represented on the Illinois Human Trafficking Task Force by the HSHS Illinois division. While not a direct priority area, HSHS and Holy Family Hospital will continue to raise awareness in HSHS facilities and the community on identification and response to human trafficking. * Maternal Health and Child Health: Holy Family is not focusing on this need as part of the CHNA. We continue to offer some services and collaborate with those agencies that assist this population. * Nutrition and Healthy Eating (Access and Knowledge): While not a direct priority issue, nutrition and healthy eating will be addressed within chronic disease education and prevention strategies. * Oral Health: Bond County Health Department identified oral health as one of their IPLAN priorities. Holy Family Hospital will work closely with the health department to raise awareness and provide patient referrals for dental services. * Transportation: Less than 12% of respondents identified transportation as a barrier or challenge. Additionally, HSHS and Holy Family Hospital recently supported a rural transportation grant application to increases transportation for medical appointments across counties. HSHS and Holy Family Hospital will continue to identify and partner with regional strategies to address transportation issues. * Violence Prevention: Overall violence for the community is very low. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - HSHS Holy Family Hospital. Presumptive eligibility is presumed under certain circumstances for uninsured patients based on their enrollment in other means-tested programs or other sources of information, not provided directly by the patient. Once determined, presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 6c. Wisconsin Department of Health Services Housing Assistance Program 7. Participation in Women, Infants and Children programs (WIC); 8. Supplemental Nutrition Assistance Program (SNAP) eligibility; 9. Low Income Home Energy Assistance Program (LIHEAP); 10. Wisconsin Home Energy Assistance Program (WHEAP); 11. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 12. Receipt of grant assistance for medical services 4 EMERALD POINTE 105 HONEY LOCUST LANE GREENVILLE IL 62246 INDEPENDENT LIVING FACILITY CONVENIENT CARE 1345 S ROUTE 127 GREENVILLE IL 62246 WALK IN CLINIC STAFFED BY A NURSE PRACTITIONER HSHS HOLY FAMILY HEALTH CENTER - MOB A 101 HEALTHCARE DRIVE GREENVILLE IL 62246 FAMILY PRACTICE PHYSICIAN CLINIC HSHS HOLY FAMILY HEALTH CENTER - MOB C 201 HEALTHCARE DRIVE GREENVILLE IL 62246 FAMILY PRACTICE PHYSICIAN CLINIC 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 16-17 in the HSHS Consolidated Audit Report. 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 it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. Schedule H, Part V, Section B, Line 16a FAP website - HSHS Holy Family Hospital: Line 16a URL: http://www.hshs.org/FAP; Schedule H, Part V, Section B, Line 16b FAP Application website - HSHS Holy Family Hospital: Line 16b URL: http://www.hshs.org/FAP; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - HSHS Holy Family Hospital: Line 16c URL: http://www.hshs.org/FAP; Schedule H, Part VI, Line 2 Needs assessment Holy Family Hospital is a member of the Intra-Agency group that meets quarterly. The Bond County Health Department has served as host for this meeting that includes representatives from social service agencies, local schools, churches, and other organizations working to meet the health and social needs of the county. During their meetings, the group discusses current activities and identifies any community needs. Meetings of the hospital's Patient Family Advisory Committee are held quarterly. Members are provided updates on the hospital's services and how the hospital is meeting the community's health needs. During the meeting, members are also provided an opportunity to provide feedback about any concerns heard from other community residents. In addition, hospital colleagues represent the hospital at various community group meetings, which provides a way to learn of any emerging needs and to offer support. Feedback is also obtained through ongoing patient surveys to patients receiving care on the inpatient unit, emergency department, surgical services and outpatient areas. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The Registration Department provides brochures to patients upon registration regarding the Financial Assistance Program available to them at the Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. To better serve our patient population, the Hospital offers information on our financial assistance program in Spanish. This includes the Financial Assistance Policy, Brochure and Application, which allows the hospital to serve populations in its county and the surrounding area for whom Spanish is their primary language. Patients are also provided a Fair Billing Act notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the Internet address where the policy can be obtained. A third-party vendor also assists individuals in determining their eligibility for state health plans or insurance on the open health insurance marketplace. They can also assist with the application process. Schedule H, Part VI, Line 4 Community information Holy Family Hospital's main service area is comprised of approximately 383 square miles in Bond County, Illinois, with a county population of approximately 16,800 residents. The hospital is in Greenville, which is the largest town in the service area, and is the location of the county's governance. With a population density of 46 people per square mile, the county is mostly rural and consists of eight smaller villages and communities comprising the service area and includes Donnellson, Keyesport, Mulberry Grove, Panama, Pierron, Pocahontas, Smithboro, and Sorento. Holy Family Hospital is the sole hospital provider in the county and does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. Based on the U.S. Census Bureau's information, the population of the entire county has declined by 5%. The median age is 39 years of age with 16% of the population over the age of 65 compared to 13.5% over the age of 65 in the state of Illinois. A higher percentage of residents in Bond County are disabled than compared to the state rate (15.23% vs. 10.73% respectively). Holy Family Hospital is one of the largest employers in Bond County. The current unemployment rate for the county is 3.9%. Median household income is $57,289 which is slightly lower than the median household income for Illinois at $65,886. Persons living below the federal poverty level is 16.5% of the population. Per the most recent US Census information, 6% of Bond County residents under the age of 65 years are without health insurance. The percentage of the population that is food insecure in Bond County (10.35%) is nearly even with the state rate (10.1%). Bond County is in an area designed as a shortage area for primary care health professionals (HPSA). This designation is made by the U.S. Department of Health & Human Services. The designation is also in place for mental health professionals. 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), Holy Family Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1960, 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 Bond County 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 Holy Family Hospital is responding to community need. In addition, Holy Family Hospital receives community support and guidance through an Advisory Council and HSHS Holy Family Foundation Leadership Council. Both Councils meet quarterly and provide feedback from the community on additional services or improvements needed. Holy Family Hospital is blessed with a strong volunteer program. Volunteers are active in hospital departments and donate many more hours throughout the year to hospital-sponsored community programs. Consistent with its exempt purpose, Holy Family 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, Holy Family 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. Holy Family Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2022, Holy Family Hospital provided more than $3.3 million 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. Holy Family 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 Holy Family Hospital and they often relieve a burden that would otherwise be carried by government. 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 15 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 140 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. The COVID-19 pandemic caused an unprecedented disruption in healthcare services across the United States. HSHS responded with services that benefited our communities, including free telehealth screenings, free testing, and coordination with other healthcare providers in the communities we serve to best ensure access to needed care. In FY2022, HSHS collectively provided $218.9 million in Community Benefit (8.3% of total hospital expenses). Of the total Community Benefit provided, HSHS spent $11.6 million provided for Financial Assistance (aka Charity Care) and $146.1 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 $23.2 million. HSHS hospitals also recorded $68.7 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 IL true HOSPITAL SISTERS OF ST FRANCIS FOUNDATION INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 501(c)(3) 445000 Foundation Support 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. In accordance with HSHS Human Resources Policies, the organization ensures grants are used for their intended purposes through various procedures as set forth by the policy for Education Assistance. Such procedures, as outlined by the policy, include, but are not limited to detailed eligibility requirements, specifications regarding eligible educational courses, limitations on annual allowances and eligible hours, requirements to achieve certain passing grades for eligible courses and reimbursement made only upon completion of such eligible courses. X X X X X false true false false false false false false false EVERT J KUIPER Division CEO - Illinois (until Jan 2022) 0 869727 0 223426 0 232329 0 199698 0 26189 0 1551369 0 142807 KELLY M SAGER President & CEO 0 253276 0 54982 0 20074 0 165390 0 20258 0 513980 0 0 PETER KUNG Board Member (until 10/31/21) / HSHS Sr VP & Chief Strategy Officer 0 352111 0 58573 0 124860 0 65576 0 17841 0 618961 0 0 MARK ENNEN Former DIRECTOR OF FINANCE 0 141220 0 1000 0 3266 0 7715 0 11145 0 164346 0 0 ANN M CARR Former Treasurer 0 49007 0 24145 0 190725 0 0 0 2041 0 265918 0 140277 DAVID NOSACKA DIVISION CFO - ILLINOIS (until 7/27/21) 0 264563 0 38318 0 209419 0 59477 0 16695 0 588472 0 92408 TODD Smart Treasurer 0 155999 0 0 0 74249 0 20716 0 9243 0 260207 0 0 Corey J Hastings Interim Division CFO (until 4/15/22) 0 198503 0 1000 0 12377 0 49079 0 26067 0 287026 0 0 GABRIEL GIGLIOTTI Anesthesiologist 105041 0 0 0 59902 0 3299 0 667 0 168909 0 0 0 KATLYN OBERMARK Pharmacist 132851 0 1000 0 3337 0 19448 0 27129 0 183765 0 0 0 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 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 2021 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Evert Kuiper -- $134,507 Peter Kung -- $49,907 Kelly Sager -- $31,485 Todd Smart -- $12,608 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2021 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr --$140,277 Evert Kuiper -- $142,807 David Nosacka -- $92,408 Form 990, Part IV, Line 24a Tax Exempt Bonds HSHS HOLY FAMILY GREENVILLE HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO. SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. 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 REPORTED IN BOX 3 OF FORM 1096 THE FORM 1096, ANNUAL SUMMARY AND 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. HOWEVER, 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. Form 990, Part VI, Line 13 Whistle Blower 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, INCLUDING HSHS HOLY FAMILY HOSPITAL. 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 HSHS Holy Family Hospital (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) 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 HSHS Holy Family 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 THE MEMBER; (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; AND (O) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. 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, (the top management official, other officers and key employees). INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES (derived from a full market review conducted every other year) TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. 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. The process for reviewing compensation by the compensation committee is completed each fiscal year 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 Professional Services - Total Expense: 10839825, Program Service Expense: 10565366, Management and General Expenses: 274459, Fundraising Expenses: ; Form 990, Part X, Line 11 POOLED INVESTMENT FUND 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 FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES AND ALL INVESTMENTS IN DEBT SECURITIES ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME and 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 NET TRANSFERS BETWEEN AFFILIATE - -812305; CHANGE IN TEMPORARY ASSETS - -84088; Pension expense-Mark to Market Adjustment - 162907; Pension expense-Other - 66480; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -187394 554439 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 625612 14756411 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL 231342 1299915 KCIN HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false HOSPITAL SISTERS OF ST FRANCIS FOUNDATION 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 7 HSHS true HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I HSSI true SACRED HEART HOSPITAL 990 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 HSSI true ST ELIZABETH'S HOSPITAL ONE ST ELIZABETHS BLVD OFALLON IL 62269 370663567 HEALTHCARE IL 501(c)(3) 3 HSSI true ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL MEDICAL CENTER 1762 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 HSSI true ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 51301 390817529 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 HSSI true ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 HSSI true HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS true HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 263956318 HEALTHCARE IL 501(c)(3) Type III-FI HSSI true HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 264515959 HEALTHCARE WI 501(c)(3) Type III-FI HSSI true ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 10 ST NICHOLAS true UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true PRAIRIE EDUCATION & RESEARCH COOPERATIVE 317 NORTH 5TH STREET SPRINGFIELD IL 62701 371157915 HEALTHCARE IL 501(c)(3) 4 HSSI true ST CLARE MEMORIAL HOSPITAL 855 S MAIN STREET OCONTO FALLS WI 54154 390848401 HEALTHCARE WI 501(c)(3) 3 HSSI true UTLAUT MEMORIAL FOUNDATION 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HSSI true HSHS GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371778753 TRUST IL 501(a) HSSI true SOUTHERN ILLINOIS CARDIOVASCULAR FACILITY INC ONE ST ELIZABETHS BLVD OFALLON IL 62269 371276333 HEALTHCARE IL 501(c)(3) 3 ST ELIZABETH'S HOSPITAL false HOSPITAL SISTERS MISSION OUTREACH CORPORATION 4849 LAVERNA ROAD SPRINGFIELD IL 62707 352271729 RECYCLING MEDICAL SUPPLIES IL 501(c)(3) HSHS true PRAIRIE CARDIOVASCULAR CONSULTANTS LTD 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371071858 HEALTHCARE IL 501(c)(3) 10 HSSI true CARPENTER STREET HOTEL LLC 525 NORTH SIXTH STREET SPRINGFIELD IL 62702 364128127 HOTEL IL LASANTE INC N/A 0 SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD IL 627949456 030413258 RENTAL REAL ESTATE IL LASANTE INC N/A 0 PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261479945 MEDICAL IL HSHS Related -6963 19229 false true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL ST ELIZABETH'S Related -108805 1568301 false false 0.5 REHABILITATION HOSPITAL OF WESTERN WISCONSIN LLC 900 W Clairemont Avenue Eau Claire WI 54701 871489748 Medical DE HSHS Related 0 0.5 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation -151955 18269653 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA INC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation -25530 26059531 0.5 true PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY WI 54304 391839349 HEALTHCARE WI PHSI C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 INSURANCE CJ HSSI C Corporation 0 159241050 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false true true false true false false false false false true false true true true true true true true 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 organizations 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.