2022-05-05T15:32:44-05:00 2021-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2020-07-01 390810545 St Joseph's Hospital of the Hospital Sisters of the Third Order of St Franc is STJO 7157231811 2661 COUNTY HIGHWAY I Chippewa Falls WI 54729 PATRICIA ALLEN DIVISION CHIEF FINANCIAL OFFICER 2022-05-05 true PATRICIA ALLEN 999009999 MALLORY FAIRLESS P01321579 3128997000 2020 2022-09-23 18:48:47Z Patricia Allen 2661 COUNTY HIGHWAY I Chippewa Falls WI 54729 68302495 false 0928 X WWW.STJOESCHIPFALLS.COM X 1885 WI ST. JOSEPH'S MISSION IS TO DELIVER COMPASSIONATE HEALTH CARE TO PEOPLE IN NEED AND TO BE THE PREFERRED CHOICE FOR HEALTH CARE IN THE CHIPPEWA VALLEY. 10 6 377 87 100387 0 1283795 19418975 51227419 43695034 4460376 4493623 472462 72294 57444052 67679926 0 0 0 30361257 22604519 0 0 29362524 27531792 59723781 50136311 -2279729 17543615 145611794 162358469 48435239 30333346 97176555 132025123 X THE MISSION OF ST. JOSEPH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S PEOPLE IN NEED. REFLECTING OUR HIGH REGARD FOR ONE ANOTHER AS INSPIRED BY OUR FRANCISCAN TRADITION, ST. JOSEPH'S GOAL IS TO BE THE PREFERRED CHOICE FOR HEALTH CARE IN THE CHIPPEWA VALLEY. false false 3995699 5796962 EMERGENCY ROOM SERVICES- St. Joseph's Hospital operates an Emergency Department that is staffed 24/7 by doctors and Advanced Practice Providers experienced in Emergency Medicine. It is the only one of its kind in the area, providing emergency and trauma services. 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. 3359281 4749985 DRUG/ALCOHOL ABUSE SERVICES The treatment center focuses on the development of new skills, learning the process of recovery and maintaining abstinence, all in a confidential setting. Customized approaches are offered in the Adult recovery program. In the Adolescent program, each patient is assigned a physician, a licensed substance abuse counselor and 24 hour nursing support. The compassionate team of therapists helps individuals and families in Eau Claire, Chippewa Falls and the surrounding communities move through life's struggles to a point of healing and wholeness. The center seeks to provide the best possible care to clients and foster a safe, chemical and tobacco free environment for healing. 2090650 7281649 RADIOLOGY SERVICES - The Imaging Services Department at St. Joseph Hospital provides Inpatient, Outpatient, and Emergency care. Patients have access to the high-quality technology in Digital Mammography, Computed Tomography, MRI, and Ultrasound. The department uses a new state of the art wide bore CT scanner as well as new flat panel intra-operative x-ray equipment. Our highly trained Radiologists provide minimally invasive procedures using image guidance. The staff consists of Board Certified radiologists as well as licensed and certified technologists and sonographers. The modalities utilize state-of-the-art equipment to afford the radiologists optimal images for interpretation and diagnosis of injuries and illnesses. St. Joseph's CT, MRI, and Ultrasound are ACR accredited and Mammography is MQSA certified. 29140755 0 25766051 OTHER PROGRAM SERVICES OTHER PROGRAM SERVICES AT ST. JOSEPH HOSPITAL ARE COMPRISED OF MEDICAL SURGICAL, WOUND CARE, SURGERY, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. 29140755 25766051 38586385 true true 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 false false true false false false false false false false false false false false false true true false false false true X 982 0 true 377 true true true false false false false false false false false false false false X 10 6 false false false false true true true true true false false true true true true true true true true true true X PATRICIA ALLEN 7157176121 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 547291498 ANDREW J BAGNALL PRESIDENT & Division CEO - Wisconsin 8.0 52.0 X X 0 950320 237374 GERALD JACOBSON 2020 & 2021 Secretary 1.0 1.0 X X 0 0 0 JAMES E DOCKSEY 2020 & 2021 Vice Chair 1.0 1.0 X X 0 0 0 Jeff Halloin 2020 & 2021 Chair 1.0 1.0 X X 0 0 0 JOHN WAGNER CEO/PRESIDENT - SJCF 58.0 2.0 X X 0 242691 53115 Andy Barth Board Member/ SHEC President 2021 1.0 59.0 X 0 0 0 GREG HEILER MD BOARD MEMBER 1.0 1.0 X 0 0 0 Patti Darley BOARD MEMBER 1.0 1.0 X 0 0 0 PETER KUNG BOARD MEMBER / Sr VP & Chief Strategy Officer 1.0 59.0 X 0 61223 8666 SR BERNADINE GUTOWSKI OSF BOARD MEMBER 1.0 2.0 X 0 0 0 ANN M CARR TREASURER (until 3/9/21) 0.3 59.7 X 0 331281 304701 PATRICIA ALLEN DIVISION CFO - WISCONSIN 9.0 51.0 X 0 494395 33034 Beth Stokka MANAGER - PHARMACY 40.0 0 X 168560 0 161143 DEBRA ANN LAUER Director Home Health/Hospice 40.0 0 X 163777 0 210731 Peter Pokrzywinski Pharmacist 40.0 0 X 160512 0 145718 RHONDA ADLER PHARMACIST 40.0 0 X 178594 0 123162 SARA JORGENSON PHARMACIST 40.0 0 X 178808 0 145491 850251 2079910 1423135 29 false true false INFINITY HEALTHCARE PHYSICIANS SC 11 E WISCONSIN AVE STE 2100 MILWAUKEE WI 53202 PHYSICIAN COVERAGE 2814772 ANESTHESIA MANAGEMENT SOLUTIONS 28 N PALAFOX STREET PENSACOLA FL 32502 ANESTHESIA SERVICES 1135875 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 45263 PROFESSIONAL SERVICES 695513 COMPASS ONE HEALTHCARE PO BOX 102289 ATLANTA GA 30368 MANAGEMENT AND FOOD SERVICES 494231 MMPF II CHIPPEWA FALLS SPE LLC 668 NORTH CENTRAL EXPRESSWAY SUITE 300 DALLAS TX 75206 BUILDING RENT 399028 17 48479 19370496 19418975 PATIENT SERVICE REVENUE 621990 43594647 43594647 Reference Lab 541380 100387 100387 0 0 0 0 43695034 1086914 1086914 539674 622569 -82895 0 -82895 -82895 3406709 3406709 0 3406709 3406709 OTHER OPERATING REVENUE 900099 147674 147674 GIFT SHOP REVENUE 453220 7515 7515 0 0 0 0 155189 67679926 43594647 100387 4565917 16565978 13898023 2667955 1692732 1420033 272699 3177479 2665587 511892 1168330 980112 188218 2241883 2241883 3946064 3482448 463616 0 707 207 500 3607652 3459753 147899 58584 58584 1070312 1059711 10601 158657 158268 389 1434 1159 275 111672 111672 2018073 1972864 45209 160644 75819 84825 PURCHASED SERVICES 12236557 7554492 4682065 EQUIPMENT RENTAL 849766 849766 MEDICAL ASSESSMENT 845816 845816 223971 103743 120228 0 50136311 38586385 11549926 0 2310562 78866 6417931 5833780 0 0 0 0 428639 394547 281771 211903 71964934 49242058 24076505 22722876 111744520 117855521 0 0 351866 15260976 145611794 162358469 13597060 12746447 14805440 13528210 0 0 6486 0 20026253 4058689 48435239 30333346 X 90670790 132025123 6505765 97176555 132025123 145611794 162358469 X 17543615 11653929 5651024 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 7540 7540 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY St. Joseph's Hospital (The Hospital) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), 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 25.56% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.66% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 11.30% 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. 383686 383686 21065678 10803771 10261907 25170835 21463659 3707176 25344735 16974628 8370107 22722876 Due from Affiliates 15260976 15260976 RATE SWAP AGREEMENTS MINIMUM PENSION LIABILITY ACCRUED BENEFIT LIABIITY 1359321 DERIVATIVE INSTRUMENTS 2699368 4058689 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 $3,650 and $83,066 at June 30, 2021 and 2020, 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, 2021 and 2020 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, 2021 and 2020, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X true true true false true true 299482 0 299482 0.0060 9765167 6154841 3610326 0.0720 3555518 2410503 1145015 0.0228 0 0 13620167 8565344 5054823 0.1008 160 188051 0 188051 0.0038 0 0 0 0 0 0.0 7149716 5698711 1451005 0.0289 0 0 0 0 0 0.0 40692 0 40692 0.0008 0 160 7378459 5698711 1679748 0.0335 0 160 20998626 14264055 6734571 0.1343 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 623619 15971424 21938644 -5967220 X true true 1 1 ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY I CHIPPEWA FALLS WI 54729 http://www.stjoeschipfalls.com/ 15 X X X ST JOSEPH'S HOSPITAL 1 false false true X X X X X X X X X 20 true true true true X https://www.hshs.org/HSHSFamily/media/St.Josephs-Chippewa-Falls/SJCF_FY2021-CHNA.pdf X https://www.co.chippewa.wi.us/government/public-health/health-data X X true 21 true https://www.hshs.org/HSHSFamily/media/St.Josephs-Chippewa-Falls/About%20us/FY2021-CHNA-Implementatio false true X 200.0 400.0 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 St. Joseph's Hospital, Chippewa Falls. Provisions in the Affordable Care Act (ACA) require charitable hospitals to conduct a Community Health Needs Assessment (CHNA) and adopt implementation strategies to meet the needs identified. The CHNA is a systematic process involving the identification and prioritization of community health needs, as well as the identification of community assets and resources potentially available to help address those needs. This process involves the solicitation and consideration of input received from persons who represent the broad interests of the community, including individuals or organizations serving or representing the interests of medically underserved, low-income, and minority populations in the community. The resulting CHNA report is used to develop implementation strategies for improving the health status of the community at large and/or specific populations within the community. Triennially, HSHS St. Joseph's Hospital conducts such an assessment and adopts an implementation plan by an authorized body of the hospital, making those reports widely available to the public via the hospital website and other means. For purposes of this process, HSHS St. Joseph's Hospital defines the community it serves as Chippewa County, Wisconsin. Hospital Sisters Health System and HSHS St. Joseph's Hospital are committed to promoting and defending human dignity, caring for persons living in poverty and other vulnerable persons, promoting the common good, and stewarding resources wisely. Consequently, we strongly believe that the assessment process must be informed by input from the poor and vulnerable populations we seek to serve. During FY2021, HSHS St. Joseph's Hospital conducted the CHNA for Chippewa County (WI) in conjunction with HSHS Sacred Heart Hospital, Marshfield Clinic Health System, Mayo Clinic Health System, the Chippewa County Department of Public Health, Eau Claire City-County Health Department, United Way of the Greater Chippewa Valley, and Chippewa Health Improvement Partnership (a local health coalition). The CHNA partners in turn worked together to gather input from a broad range of sources, ranging from hospital systems and educational institutions to government and service agencies to community groups, as well as from area residents. These efforts included, but were not limited to, outreach to and through the Aging and Disability Resource Center, Community Table, Eau Claire Area Hmong Mutual Assistance Association, Chippewa County Jail, El Centro, Feed My People Food Bank, and Joining Our Neighbors Advancing Hope (JONAH), as well as churches, schools, municipalities, and other organizations. All of these organizations serve the under-resourced in our community - such as low-income seniors, children living in poverty, families who struggle with shelter and food insecurity, justice-involved individuals, and other vulnerable populations - and possess extensive knowledge regarding the needs of those they serve. Actively including these organizations in the CHNA process was critical to ensure consideration of diverse needs in the both the assessment itself and the development of related implementation strategies. The FY2021 CHNA process involved several key components. These included a Community Health Survey (distributed via SurveyMonkey and paper copies), online Community Conversations with area residents and stakeholders, and a virtual discussion with members of Chippewa Health Improvement Partnership. The feedback collected through these means, in combination with secondary data comparisons of local and national health indicators, were used to identify community health needs and priorities. The hospital subsequently used this data to develop a community health implementation plan incorporating health improvement strategies. The health priorities identified in the CHNA report were formally approved by the HSHS St. Joseph's Hospital Board of Directors on May 20, 2021. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital, Chippewa Falls. The FY2021 CHNA was conducted with sister-hospital HSHS Sacred Hospital, Eau Claire, WI, and Mayo Clinic Health System and Marshfield Clinic Health System, also of Eau Claire, WI. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital, Chippewa Falls. HSHS St. Joseph's Hospital also conducted the FY2021 CHNA in conjunction with the Chippewa County Department of Public Health, Eau City-County Health Department, United Way of the Greater Chippewa Valley, and Chippewa Health Improvement Partnership. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital, Chippewa Falls. Hard copies of the CHNA are available free of charge through the hospital's Community Health Department, as well as through the community health coalition, Chippewa Health Improvement Partnership. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital, Chippewa Falls. Fiscal year ending June 30, 2021 was the final year of the Implementation Strategy adopted in tax year 2017 for the CHNA that was conducted in 2017. Information provided below relates to the activities that occurred during the third year of this CHNA cycle addressing the health needs identified in the 2017 CHNA. Based on the FY2018 CHNA planning and development process, the following top three community health needs were identified and have been the primary focus areas for HSHS St. Joseph's Hospital's (SJCF) community benefit in FY2021: 1) Mental Health 2) Substance Abuse 3) High-Risk Alcohol Consumption Mental Health HSHS St. Joseph's Hospital in Chippewa Falls (SJCF) led the implementation and/or continuation of multiple efforts to improve the mental health and emotional wellbeing of residents of the area that the hospital serves. The SJCF Community Benefit Implementation Plan includes several evidence-based strategies to positively impact mental health, which was the top identified need for both Chippewa and Eau Claire counties. These strategies were selected with the understanding that behavioral health and mental illness are affected by a multitude of factors at the intrapersonal, interpersonal, community, and societal levels, with no single factor explaining or addressing the prevention, care and treatment, or rehabilitation of mental illness. Goal: In partnership with the Chippewa County Public Health Department and other organizations, HSHS St. Joseph's Hospital will continue existing efforts, while enhancing others, to educate/create awareness of mental health and increase access to mental health services in the community, including services offered by the hospital. St. Joseph's Hospital will also continue to host and support the substance abuse initiatives of the Eau Claire County Healthy Communities Coalition and Chippewa Health Improvement Partnership (CHIP). Strategy 1: Mental Health Awareness and Education HSHS St. Joseph's Hospital will develop, promote, and/or participate in a minimum of five mental health awareness events, activities, and/or educational sessions annually to raise awareness of mental health issues. FY2021 Outcomes Activity in this area was limited during the fiscal year due to COVID-19 restrictions and furloughs. SJCF, in conjunction with sister hospital Sacred Heart in Eau Claire (SHEC) and Prevea Health, did present a virtual event in March called "Navigating Mental Health Challenges During COVID-19," which was viewed by approximately 130 people. Via social media, HSHS St. Joseph's and CHIP shared educational messages related to mental health and promoted registration in Question, Persuade, Refer (QPR) suicide prevention training (more information on these trainings is detailed below). SJCF Community Health sponsors and leads CHIP, a community health coalition involving dozens of local stakeholders. While this coalition previously formed an Infant Mental Health Action Team, this group was not active during FY2021. Strategy 2: Promote Resilience for Chippewa Valley Youth SJCF will continue to promote resilience and other protective factors in youth through active participation in the Mental Health Matters grant project from Advancing a Healthier Wisconsin Endowment-Medical College of Wisconsin. The hospital's Community Health Department will also assist the area school district in coordinating a Teen Mental Health Summit. FY2021 Outcomes As noted above, many planned activities during the fiscal year were curtailed due to COVID-19 safety concerns and workload constraints. While the SJCF Outreach Facilitator continued to participate in Mental Health Matters, activity during this time period was limited to planning and development of virtual workshops promoting awareness of the effect of trauma and adverse childhood experiences (ACEs) on brain development and ways to build resiliency. SJCF worked with the Chippewa Falls Area Unified School District during FY2020 to hold a Teen Summit but was not able to repeat this activity in FY2021. Strategy 3: Increase Community Access to Mental and Behavioral Health Services The hospital's Behavioral Health Services will continue to provide frontline care to address patients' mental and behavioral health needs by offering outpatient psychiatric consultations by a psychiatrist at Prevea Health, provide detox, in-patient and out-patient behavioral health services, as well as residential alcohol and other drug treatment at L.E. Phillips Libertas Treatment Center located on the campus of HSHS St. Joseph's Hospital in Chippewa Falls, Wisconsin. Goals for the hospital's Behavioral Health Services include: embed Behavioral Health into primary clinics (placement of a mental health/substance abuse clinician within clinic settings); open a 12 bed Inpatient Behavioral Health adolescent unit in St. Joseph's Hospital; expand reach of outpatient behavioral health counseling services by utilizing telehealth equipment; continue support of mental health services provided by L.E. Phillips Libertas Treatment Center to the patients of the Open Door Clinic; and implement school-based counseling in at least two schools. FY2021 Outcomes In addition to providing detox and other substance use treatment services at L.E. Phillips Libertas Treatment Center adjacent to the hospital, HSHS, in conjunction with Prevea, achieved the following: * Embedded Behavioral Care into the new Prevea Health Center in nearby Menomonie (Dunn County). * Secured $15 million in state grant funding to help create a dedicated 18-bed adolescent psychiatric unit at SJCF, as well as expand adult psychiatric beds at SHEC. * Continued to provide outpatient behavioral health - including school-based mental health - services via telehealth. o These included 577 school-based mental health visits to 19 school districts. This represents expansion of services to 16 additional districts - including Bloomer, Cornell, and Stanley-Boyd in Chippewa County - during the fiscal year. Of these, 150 visits were funded through the HSHS Sacred Heart/St. Joseph's foundation for students in the Chippewa Falls and Eau Claire school districts. o In total, 2,291 telehealth appointments were provided for counseling and medication management. In conjunction with CHIP, SJCF also promoted "Check In Chippewa" a volunteer calling service initiated by Chippewa County to combat isolation during the pandemic. Strategy 4: Promote and Support Suicide Prevention Efforts Chippewa County's suicide crude death rate (2016-WISH) is 14 per 100,000 population compared to 15 for State (2016-American Foundation for Suicide Prevention) and 13.5 in the United States (2016-American Foundation for Suicide Prevention). The Healthy People 2020 target for the United States is 10.2. In partnership with the Chippewa County Public Health Department and other organizations, HSHS St. Joseph's Hospital will provide/promote local QPR and Mental Health First Aid training as a means of suicide prevention. FY2021 Outcomes SJCF led suicide prevention activities across multiple sectors and settings in collaboration with multiple community partners. During FY2021, these efforts primarily centered around the delivery of QPR "gatekeeper" training to equip anyone to help save a life from suicide. Per the surgeon general's national strategy for suicide prevention, a gatekeeper is someone in a position to recognize a crisis and the warning signs that someone may be contemplating suicide. During the fiscal year, the SJCF/SHEC Outreach Facilitator provided nine gatekeeper trainings to 288 individuals, including 80 youth. Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - HSHS St. Joseph's Hospital, Chippewa Falls. Substance Abuse According to the national Office of Disease Prevention and Health Promotion, substance abuse has a major impact on individuals, families, and communities resulting in teenage pregnancy, HIV/AIDS, other STDs, domestic violence, child abuse and neglect, motor vehicle crashes, physical fights, escalation of crime, homicide, and suicide. Goal: In partnership with the Chippewa County Department of Public Health and other organizations, HSHS St. Joseph's Hospital will educate/create awareness of substance abuse issues and increase awareness of and access to substance abuse services in the community, including services offered by the hospital and affiliates. Strategy 1: Increase Community Access to Substance Abuse Services HSHS St. Joseph's Hospital will enhance community access to substance abuse services. Behavioral Health hospital colleagues will participate in a state-wide project of expanding access to treatment around opioid addiction. SJCF will have developed/implemented a Medication Assisted Treatment (MAT) Program for opioid addiction for WWD HSHS/Prevea - Behavioral Health program. FY2021 Outcomes HSHS St. Joseph's Hospital/L.E. Phillips Libertas Center and Prevea Health leaders and colleagues worked together on a Health Services & Resources Administration (HRSA) Rural Opioid Response Program (RCORP) planning grant around prevention, treatment, and recovery, specifically addressing opioids and alcohol. This included an assessment of MAT availability in the grant counties (Chippewa, Barron, Rusk, and Washburn). SJCF continued to provide MAT at its L.E. Phillips Libertas Center. Clinic partner Prevea Health also continued to provide MAT during this time. Strategy 2: Substance Abuse Awareness and Education HSHS St. Joseph's Hospital will develop, coordinate, promote, and/or participate in a minimum of four Substance Abuse awareness, education events, and/or activities to raise awareness and educate about substance abuse issues. FY2021 Outcomes As noted earlier, many community benefit activities were curtailed during this fiscal year due to COVID-19. Nonetheless, the SJCF/SHEC Outreach Facilitator provided staff support to the CHIP Voices in Prevention (VIP) Action Team, which focused its efforts on youth, alcohol, and tobacco/vaping products through a Drug-Free Communities grant and Wisconsin Wins, a tobacco prevention program. The HRSA RCORP grant team assessed community needs around opioid and alcohol misuse prevention, treatment, and recovery. The SJCF/SHEC Outreach Facilitator continued to serve as a liaison to Chippewa County's "Take a Stand Against Meth" campaign as well. SJCF, in conjunction with CHIP, developed social media posts around substance use and recovery. Strategy 3: Reduce the Stigma Associated with Addiction HSHS St. Joseph's Hospital will develop, coordinate, promote, and/or participate in Substance Abuse awareness, education events, and/or activities to reduce the stigma associated with addiction. FY2021 Outcomes Community benefit activities in this area were curtailed during the fiscal year due to COVID-19. As referenced above, participation in local coalition activities continued during this time, as did creation of social media posts, and RCORP grant planning. High-Risk Alcohol Consumption The misuse and abuse of alcohol, over-the-counter medications, illicit drugs, and tobacco affect the health and well-being of millions of Americans (SAMHSA 2018). SAMHSA's National Survey on Drug Use and Health (NSDUH) - 2014 (PDF | 3.4 MB) reports that in 2014 there were 139.7 million current alcohol users aged 12 or older, with 23% classified as binge drinkers and 6.2% as heavy drinkers. About 17 million of these, or 6.4%, met criteria for an alcohol use disorder in the past year. Excessive alcohol use, including underage drinking and binge drinking (drinking 5 or more drinks on a single occasion for men or 4 or more drinks on an occasion for women), can increase a person's risk of developing serious health problems, including brain and liver damage, heart disease, hypertension, and fetal damage in pregnant women. According to the Centers for Disease Control and Prevention (CDC), alcohol use causes 88,000 deaths a year. 47% of the driving deaths in Chippewa County are associated with alcohol involvement (Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2016). Goal: In partnership with the Chippewa County Department of Public Health and other organizations, HSHS St. Joseph's Hospital will educate and/or create awareness of issues related to alcohol misuse and create awareness of and access to Alcohol and Other Drug Abuse services in the community, including services offered by the hospital and affiliates. St. Joseph's Hospital will also continue to host and support the substance abuse initiatives of the Chippewa County healthy communities' coalition, Chippewa Health Improvement Partnership (CHIP). Strategy 1: Non-Alcoholic Events/Activities The hospital will support and/or fund area events and activities which are alcohol-free to curb underage drinking and increase number of alcohol-free events in the community. FY2021 Outcomes SJCF activities in this area were limited during the fiscal year due to COVID-19. Strategy 2: Alcohol Misuse Community Awareness and Education The hospital will coordinate/host/actively participate in a minimum of five events/activities where education related to high-risk drinking is provided. FY2021 Outcomes SJCF is an active member of the CHIP Voices in Prevention (VIP) Action Team, with a strong focus on preventing underage drinking, with the hospital's Outreach Facilitator providing staff support to the group. SJCF, in conjunction with CHIP, also addressed this issue through social media posts. Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - HSHS St. Joseph's Hospital, Chippewa Falls. Other CHNA Identified Needs Chronic Disease Prevention SJCF is always concerned with the prevention and management of chronic disease and continues to incorporate this focus area into community awareness and education events/activities. Toward this end, the SJCF Outreach Facilitator provided staff support to the CHIP Chronic Disease Prevention Action Team, which among other activities, helped plan and promote the Chippewa Valley Summer Activity Passport program, which encouraged family engagement in local recreational opportunities. Obesity/Healthy Nutrition See above (Chronic Disease Prevention). SJCF also offered free garden plots once again to community members whose limited resources otherwise restrict their access to fresh produce and rented plots to individuals and organizations willing to donate the harvest to local food pantries. More than 3,500 pounds of food were harvested during the 2021 growing season. Physical Activity See above (Chronic Disease Prevention). Healthy Growth and Development To promote healthy pregnancy and infant care, HSHS St. Joseph's Hospital, in conjunction with sister hospital Sacred Heart, instituted the Maternity onto Motherhood (MOM) program, which provides free consultation and individualized support to any family expecting a child. In addition, SJCH/SHEC participate in the Substance-free Pregnancy and Recovery Coalition (SPaRC), which seeks to improve outcomes for mothers, children, and families when a woman has a history of substance use. SJCF/SHEC also contributed $10,000 to the River Source Family Center, which provides parenting support to local families. Injury and Violence The community has a well-established, well- respected community sexual assault and domestic violence agency that provides leadership in this area of community health. SJCF donated $1,000 to Bolton Refuge House in FY2021. As an outcome of the prioritization process, the following community health needs were also identified to a lesser degree. Reproductive/Sexual Health While the Chippewa County Department of Public Health and other community agencies take the lead in this area, SJCF/SHEC did institute the MOM program and participate in SPaRC meetings. Environmental/Occupational Health The Chippewa County Department of Public Health leads activities that support environmental/occupational health due to that agency's expertise in this area. Tobacco Use and Exposure SJCF is a smoke-free campus and advocates for smoking cessation through a variety of means, including participation in CHIP's VIP Action Team. Communicable Disease Prevention and Control While HSHS St. Joseph's Hospital participated in prevention, education, and treatment efforts around COVID-19, the Chippewa County Department of Public Health took the lead on communicable disease in the community. Oral Health The Chippewa County Department of Public Health leads activities for oral disease prevention, while Marshfield Clinic Chippewa Falls Dental Center provides dental care to the community regardless of payment ability. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Joseph's Hospital (SJCF). 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. Illinois Free Lunch and Breakfast Program; 10. Wisconsin Free Lunch Program; 11. Low Income Home Energy Assistance Program (LIHEAP); 12. Wisconsin Home Energy Assistance Program (WHEAP); 13. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 14. Receipt of grant assistance for medical services 0 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 CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FY2021 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET 2. 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 3 Bad Debt Expense Methodology St. Joseph's Hospital of the Hospital Sisters of the Third Order of St. Francis strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. 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 page 17 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 fiscal year 2021 was $5,967,220. 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 - ST JOSEPH'S HOSPITAL: Line 16a URL: http://www.hshs.org/fap; Schedule H, Part V, Section B, Line 16b FAP Application website - ST JOSEPH'S HOSPITAL: Line 16b URL: http://www.hshs.org/fap; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST JOSEPH'S HOSPITAL: Line 16c URL: http://www.hshs.org/fap; Schedule H, Part VI, Line 2 Needs assessment HSHS St. Joseph's Hospital continually assesses the health care needs of the community through several means. - The hospital's Patient & Family Advisory Council (PFAC) meets regularly to discuss hospital services and the ability of the hospital to meet community health care needs. Agendas are purposely organized to include time for feedback from members on what they are hearing in the community. The Community Health Needs Assessment & Community Health Implementation Plans are presented to the PFAC and discussed. - The HSHS Community Health Department assumes a lead role in working with community organizations to identify and address local health needs. For instance, the department's outreach facilitator coordinated and provided staff support to the Chippewa Health Improvement Partnership and its various action teams, Mental Health Matters, Stand Against Meth, Hope Village (initiative to address homelessness), and other community initiatives during FY21. - HSHS St. Joseph's Hospital also contracts for a clinical coordinator for the Open Door Clinic (free clinic in Chippewa Falls for individuals without health insurance). - In addition, HSHS St. Joseph's Hospital leaders and colleagues represent the hospital on a variety of local boards and organizations, providing additional opportunities to reach and serve the medically underserved, low income, and minority populations within Eau Claire County. This involvement includes but is not limited to United Way of the Greater Chippewa Valley, Sojourner House, Family Support Center, Take a Stand Against Meth, and Feed My People Food Bank. Through this representation, the hospital becomes aware of emerging needs and can offer assistance or support to address these needs. - Finally, the hospital maintains a close working relationship with the Chippewa County Department of Public Health, which captures much of the data and work done locally around community health. 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 HSHS St. Joseph's Hospital (SJCF) is an acute care community hospital located in Chippewa Falls, Wisconsin. Chippewa Falls is approximately 90 miles east of the twin cities and 100 miles north of LaCrosse, WI. Chippewa Falls has a population of 14,035 (2017) and is the county seat of Chippewa County which has a population of 63,813 (54 percent urban, 46 percent rural) in 2017. The average income of this population is $52,657, and approximately 11.5% are living below federal poverty guidelines. Chippewa County is HSHS St. Joseph's Hospital's primary service area. Its secondary service area includes surrounding counties: portions of Barron, Clark, Dunn, Rusk and Taylor counties. Chippewa County is the largest of the six counties. Five out of six service area counties are considered rural by the U.S. Department of Agriculture. Evidence continues to suggest that rural settings in the U.S. exhibit pronounced needs in the areas of health, education, and economic security. Approximately, 46% of the residents in the county are living in a rural location compared to the state rate of 29.8%. Rural populations suffer from health inequities regarding access to food and physical activity locations. Rural residents have less access to fresh and healthy food, as convenience stores and fast food restaurants are often more common in villages than grocery stores. 19% of the residents do not have adequate access to locations for physical activity. Improper access can deter county residents from pursuing healthy behaviors, such as exercising outdoors. Chippewa County has 17% (6,740 residents) who lack adequate access to food within the community, which is higher than the state rate. Low-income residents who do not live close (rural areas are defined as less than ten miles from a grocery store; non-rural, less than one mile) to a grocery store in the county is 3,154 residents, which is similar to the state rate. The percentage of children in the county who attend a public school and are eligible for free or reduced price lunch has continued to increase- currently 42% of children are eligible. It is important to be mindful of the rural distinction to better address these disparities by focusing programs and services appropriately to these communities. Chippewa County has eight public and private school districts, Chippewa Valley Technical College campus, and Lakeland College. Economic drivers in the county include production agriculture, computer information systems, and seasonal tourism focused on outdoor recreation. Three hospitals serve Chippewa County: HSHS St. Joseph's Hospital in Chippewa Falls, Mayo Clinic Health System-Chippewa Valley in Bloomer, and Our Lady of Victory Medical Center in Stanley. The service area population is aging, much like the rest of the nation. The largest segment of growth from 2000 to 2010 occurred in the 18 to 64 year-old age category with a growth rate of 16.9 percent followed by a 10.3 percent growth rate in the 65+ year old age category. The number of 0 to 18 years olds is declining. Combined population growth for these six counties was approximately 6.6 percent between 2000 and 2010. Along with the aging population come increased health care costs with chronic disease. Studies indicate that the health of the aging population can be maintained and chronic diseases can be reduced by promoting healthy behaviors and expanding preventive health services. The service area's racial profile is primarily white (93.7 percent), higher than the state (86.2 percent) and nation (72.4 percent). The largest minority population in the service area is Hispanic or Latino (1.7 percent), with other races making up the remaining 3 percent of the population. Several unique minority populations are found in Western Wisconsin, Including the Amish, Mennonites and Hmong. Wisconsin has the fourth largest Amish population in the nation. Several communities of Amish are located throughout Chippewa and the surrounding counties with significant settlements in Barron, Buffalo and Clark counties. Determining an accurate number of Amish and Mennonites living in the state is not easy as the census bureau and other statistical agencies do not have data on religious affiliation. Chippewa County is federally- designated as a medically underserved area even though there are two acute-care hospitals that offer tertiary level services including cardiovascular surgery, neurosurgery, oncology and trauma level II in nearby Eau Claire: HSHS Sacred Heart Hospital (SHEC) and Mayo Clinic Health System - Eau Claire, in addition to Oakleaf Surgical Hospital and Marshfield Medical Center-Eau Claire. HSHS and Mayo Health System have extensive penetration in Eau Claire and surrounding counties. Likewise, the Oakleaf Medical Network and Marshfield Clinic offer services at several sites throughout Chippewa and Eau Claire counties. Residents located on the periphery of SJCF's service area have access to equivalent and even greater levels of acute care. To the west, the twin cities market boasts several large community hospitals with trauma level 1 and an academic medical center. A comprehensive health care network, including two hospitals, a large multi-specialty group practice, and a regional community clinic, exists to the south in La Crosse. To the east, Ministry Health Care, St. Joseph's Hospital, Marshfield and the Marshfield Clinic physician group provide both acute care and primary care services. Uninsured or underinsured residents suffer from health disparities regarding access to care. 10% of adults and 4% of children in the county do not have insurance. In the last year, 25% of residents did not get the recommended dental or medical care, which is higher than the Wisconsin rate. An area of high concern is the lack of health care providers who accept Badgercare, the healthcare coverage program for low-income Wisconsin residents. 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. Joseph's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1885 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 Chippewa County and surrounding areas. The hospital is governed by a Board of Directors, most of who 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 St. Joseph's Hospital is responding to community need. There are also other bodies that assist St. Joseph's Hospital's connection with the community, such as the hospital Advisory Council, Patient and Family Advisory Council, The Foundation of HSHS St. Joseph's Hospital, and Volunteer Partners Board. Consistent with its exempt purpose, St. Joseph's 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. Joseph's 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. For example, SJCF continues to partner with Prevea Health, a multi-specialty health care organization based in Green Bay, Wisconsin that has been a part of the Western Wisconsin region since 2015. Prevea Health works extensively with SJCF and sister hospital HSHS Sacred Heart Hospital in Eau Claire. In partnership with SJCF, Prevea opened clinics in Menomonie, Chippewa Falls, Altoona and Ladysmith in FY19. Prevea President and CEO and Chief Medical Officer and Vice President of Clinical Operations - Western Wisconsin worked closely with HSHS Wisconsin to serve the common good of communities during the pandemic through consistent educational messaging, testing sites, processing COVID lab tests, etc. A need was identified to have more advanced care planning discussions with patients and families. Part of the care planning discussion involves provision of care in the most appropriate setting. As a result, SJCF/SHEC Spiritual Care team partnered with Prevea to hold advance care planning session discussions, complete advance directives, enter advance directives into the medical record so physicians and staff can follow patient's wishes when patients become incapacitated. By working together, we can be sure we are providing the most appropriate care that aligns with the patient's wishes in the setting that is most conducive. HSHS St. Joseph's Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2020, HSHS St. Joseph's Hospital provided more than 6.4 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. Additionally, in FY2020, HSHS St. Joseph's Hospital provided 1.5 (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than 8.8 million (at cost) in excess of Medicare payment for health care services. HSHS St. Joseph's 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. Joseph's 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 FY2021, HSHS collectively provided $201.4 million in Community Benefit (10.0% of total hospital expenses) including more than $1 million in response to the pandemic. Of the total Community Benefit provided, HSHS spent $15.5 million provided for Financial Assistance (aka Charity Care) and $142.8 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 $295.2 million. HSHS hospitals also recorded $62.9 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 X true true X X X X X false true false false false false false false false ANDREW J BAGNALL PRESIDENT & Division CEO - Wisconsin 0 570321 0 0 0 379999 0 200598 0 36776 0 1187694 0 89926 JOHN WAGNER CEO/PRESIDENT - SJCF 0 242131 0 0 0 560 0 24694 0 28421 0 295806 0 0 ANN M CARR TREASURER (until 3/9/21) 0 270217 0 0 0 61064 0 278644 0 26057 0 635982 0 30435 PATRICIA ALLEN DIVISION CFO - WISCONSIN 0 367658 0 3549 0 123188 0 8753 0 24281 0 527429 0 3528 DEBRA ANN LAUER Director Home Health/Hospice 163192 0 0 0 585 0 188835 0 21896 0 374508 0 0 0 Beth Stokka MANAGER - PHARMACY 164863 0 3322 0 375 0 130670 0 30473 0 329703 0 0 0 SARA JORGENSON PHARMACIST 128990 0 49413 0 405 0 132486 0 13005 0 324299 0 0 0 Peter Pokrzywinski Pharmacist 155718 0 4794 0 0 0 121944 0 23774 0 306230 0 0 0 RHONDA ADLER PHARMACIST 132939 0 45421 0 234 0 110937 0 12225 0 301756 0 0 0 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. Ronda Adler 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 2020 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Andy Bagnall -- $73,211 Ann Carr -- $29,873 John Wagner -- $24,694 Peter Kung -- $6,240 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2020 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Andy Bagnall -- $89,926 Ann Carr -- $30,435 Patricia Allen -- $3,528 Form 990, Part III, Line 4d Description of other program services (Expenses $ 29,140,755 including grants of $ 0)(Revenue $ 25,766,051) OTHER PROGRAM SERVICES OTHER PROGRAM SERVICES AT ST. JOSEPH HOSPITAL ARE COMPRISED OF MEDICAL SURGICAL, WOUND CARE, SURGERY, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST JOSEPHS HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. 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 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, INCLUDING ST. JOSEPH'S 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 ST. JOSEPH'S HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. JOSEPH'S HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. Form 990, Part VI, Line 1a GOVERNING BODY DELEGATED BROAD AUTHORITY TO AN EXECUTIVE 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 FIVE 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. JOSEPH'S HOSPITAL CHIPPEWA FALLS (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, CHAIRPERSON OF THE BOARD AND PRESIDENT. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. JOSEPH'S HOSPITAL CHIPPEWA FALLS (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 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 ANNUAL 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 PREPARATION, 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 X, Line 11 POOLED INVESTMENT ACCOUNT ST. JOSEPH'S HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED 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, AND EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE 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 PARTICIPANTS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in Temporarily Restricted Net Assets - -3513515; Change in Permanently Restricted Net Assets - -2992251; Transfer to Affiliates - -248983; CHANGE IN NET PERIODIC PENSION COSTS - NET OF SERVICE COSTS - 10548778; CHANGE IN FAIR VALUE OF THE INTEREST RATE SWAPS - 1856995; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -1302922 744772 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 1689514 11919402 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL 418615 675112 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 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 HSHS HOLY FAMILY HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 370792770 HEALTHCARE IL 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 0 SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD IL 627949456 030413258 RENTAL REAL ESTATE IL LASANTE INC N/A 0 0 PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261479945 MEDICAL IL HSHS Related -6718 11192 false 0 true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL ST ELIZABETH'S Related 6286 1740006 false 0 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 1028635 20896784 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 -86336 26085061 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 170845551 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false true true false false false false false true true false true true true true true false false 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 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.