2021-05-13T11:43:24-05:00 2020-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2019-07-01 371208459 St Joseph's Hospital - Hospital Sisters - Third Order of St Francis STJO 6185264511 9515 HOLY CROSS LANE PO BOX 99 Breese IL 622300099 David Nosacka Division CFO 2021-05-13 true Mallory Fairless P01321579 3128997000 2019 2022-09-23 18:48:47Z Chris Klay 9515 HOLY CROSS LANE PO BOX 99 Breese IL 622300099 62735755 false 0928 X WWW.STJOEBREESE.COM X 1987 IL OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. 12 10 391 370 255805 0 91222 4692046 58586895 51384958 3543841 5955954 367640 261059 62589598 62294017 0 0 20666654 20637220 0 0 33795991 38378547 54462645 59015767 8126953 3278250 180877074 185714320 35756558 45181732 145120516 140532588 OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. false false 44008267 51347492 SEE SCHEDULE O - PROGRAM SERVICE ACCOMPLISHMENTS 44008267 true true false true false false false false false true false false false 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 1081 0 true 391 true true true false false false false false false false false false false false X 12 10 false false false false true true true true true false false true true true true true true true true true true X JOHN JEFFRIES 6185265312 9515 HOLY CROSS LANE BREESE IL 62230 CHRIS KLAY PRESIDENT & CEO 60.0 0 X X 0 242744 145686 GEORGE KRUSE 2019 & 2020 Chair 1.0 0 X X 0 0 0 Richelle Rennegarbe PHD 2019 & 2020 Secretary 1.0 0 X X 0 0 0 TOM BROECKLING 2019 & 2020 Vice Chair 1.0 0 X X 0 0 0 ANN Doll-Pollard MD BOARD MEMBER 1.0 0 X 0 0 0 DAVID BEACH BOARD MEMBER 1.0 59.0 X 0 455018 98642 Dennis Litteken BOARD MEMBER 1.0 0 X 0 0 0 John Fridley BOARD MEMBER 0.0 0 X 0 0 0 JULIE MASCHHOFF BOARD MEMBER 1.0 0 X 0 0 0 SISTER ANNA PHIRI OSF BOARD MEMBER 2.0 2.0 X 0 0 0 SISTER MARGUERITE COOK OSF BOARD MEMBER 1.0 2.0 X 0 0 0 Tom Freker BOARD MEMBER 1.0 0 X 0 0 0 ANN M CARR TREASURER 0.3 59.3 X 0 336583 297864 DAVID NOSACKA DIVISION CFO - ILLINOIS 6.0 54.0 X 0 379369 108460 EVERT J KUIPER Division CEO - Illinois 0.5 59.5 X 0 1058881 202146 JACQUELYNNE N HOLST DIVISION ASSOCIATE GENERAL COUNSEL 7.8 29.0 X 0 212804 105920 MARGARET A LUNA DIVISION CPO 4.2 29.0 X 0 267698 261486 ZACHARY YODER CNO 40.0 0 X 104869 0 10427 Barbara Eilers Nurse Supervisor 40.0 0 X 107774 0 110658 EILEEN HAGEN Nurse Supervisor 40.0 0 X 113804 0 93272 JENNIFER BLACK APRN 40.0 0 X 107515 0 459 JOHN JEFFRIES DIRECTOR OF FINANCE 40.0 0 X 198340 0 99565 Serra Morton Director of Women & Infants 40.0 0 X 114289 0 8271 AMY M BALLANCE Former Interim CEO/ VP BUSINESS DEVELOPMENT SOUTHERN IL DIVISION 7.8 29.0 X 0 255483 193748 JAMES DOVER Former CEO SOUTHERN IL DIVISION 0.0 X 0 348355 16894 746591 3556936 1753499 6 true true false POETTKER CONSTRUCTION CO 3215 EXECUTIVE PARK DR SPRINGFIELD IL 627034514 CONSTRUCTION 1254463 CEP AMERICA 2100 Powell St Emeryville CA 94608 ED Coverage 942892 CEP AMERICAL ILLINOIS HOSPITALISTS 2100 POWELL ST SUITE 400 EMERYVILLE CA 94608 HOSPITALIST COVERAGE 857141 BERNER SCHOBER ASSOCIATES INC 310 PINE ST GREEN BAY WI 543015136 ARCHITECTURE 479151 Compass One Healthcare PO Box 102289 Atlanta GA 30368 Food Services 392330 15 74141 4617905 4692046 Net Patient Service Revenue 621990 51076077 51076077 Medical Office Rent from Affiliate 900099 195299 195299 Other department revenue 900099 113582 113582 0 0 0 0 51384958 1752524 1752524 245559 441738 -196179 0 -196179 -196179 4203430 4203430 0 4203430 4203430 Exercise Programs 713940 318121 62316 255805 Cafeteria 722310 42720 42720 96397 96397 0 0 457238 62294017 51347492 255805 5998674 X 115296 115296 13574659 12223946 1350713 988077 882254 105823 4987265 2993445 1993820 971923 867830 104093 11953 11953 56465 56465 3054766 3054766 21241620 15124083 6117537 0 94198 245 93953 323321 292927 30394 1969076 1969076 1420856 1365702 55154 89546 51989 37557 9301 8685 616 339875 0 339875 2341025 1037062 1303963 586418 498925 87493 Medical Supplies 4575338 4574661 677 Medicaid Assessment 1796854 1796854 Equipment Rental 204579 202391 2188 Licenses and taxes 124078 79954 44124 139278 38238 101040 0 59015767 44008267 15007500 0 624213 4388798 11861747 8009742 0 0 0 0 644072 848807 136511 113345 81329363 51811935 28053850 29517428 139556681 142498880 0 0 0 337320 180877074 185714320 7926040 16118483 16125968 15704707 0 0 11704550 13358542 35756558 45181732 X 143604769 139072972 1515747 1459616 145120516 140532588 180877074 185714320 X 3278250 -3017147 -4849031 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 16993 16993 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 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 23.32% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.55% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 37.00% LOBBYING EXPENSE 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. 1704211 1704211 49600905 30187420 19413485 267301 267301 0 25443794 20257526 5186268 4313152 1099688 3213464 29517428 RETIREMENT OBLIGATION-ASBESTOS 2969163 ACCRUED BENEFIT LIABILITY 3989383 Derivative Instruments 6062842 Right of Use - Operating Lease Liability 337154 13358542 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 $83,066 and $70,000 at June 30, 2020 and 2019, 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, 2020 and 2019 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, 2020 and 2019, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 721940 721940 0.0122 6787902 4551477 2236425 0.0379 0 0.0 0 0 7509842 4551477 2958365 0.0501 227130 227130 0.0038 4181 4181 0.0001 9034754 6720355 2314399 0.0392 0 0.0 42808 42808 0.0007 0 0 9308873 6720355 2588518 0.0439 0 0 16818715 11271832 5546883 0.0940 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 11601476 21365360 -9763884 X true true 1 1 ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 622300099 WWW.STJOEBREESE.COM 0002527 X X X ST JOSEPH'S HOSPITAL 1 false false true X X X X X X X X X 17 true false true true X https://www.hshs.org/HSHSFamily/media/St.Joseph-s-Breese/About%20us/FY2018-SJB-CHNA-Report.pdf X true 17 true https://www.hshs.org/HSHSFamily/media/St.Joseph-s-Breese/About%20us/FY2018-SJB-Implementation-Plan.p 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 St. Joseph's Hospital Breese. HSHS St. Joseph's Hospital, Breese completed its FY 2018 community health needs assessment (CHNA) in June 2018. In addition to reviewing available secondary data, St. Joseph's Hospital conducted engagement sessions to gain input from those representing the broader community and vulnerable populations. Three focus group meetings were held, and attendees included individuals who work in city government, education, health care, senior services, social service agencies and public health. To gain community input for the FY2018 CHNA, a variety of stakeholders were asked to participate in the engagement sessions. Engagement session participants were identified in coordination with the University of Illinois Survey Research Office (UIS SRO). Organizations and institutions represented included the following: * Breese District 12 Elementary School* * Catholic Charities* * City of Breese * City of New Baden * Clinton County Coroner's Office * Clinton County Health Department* * Community Link, serving the developmentally disabled* * Community Physicians * Community Resource Center - Centralia* * Countryside Manor Nursing Home - Aviston * Hoyleton Youth and Family Services * * HSHS Home Care Southern IL * Kaskaskia College, an area community college * SAFE* (Sexual Assault and Family Emergencies Center) * South Central Transit, public transportation provider * Trenton Village Retirement * University of Illinois Extension * Wesclin CUSD #3* * YMCA *Denotes group representing medically underserved, low-income, and/or minority populations. In addition, St. Joseph's Hospital, Breese is one of the leading members of the Clinton County Health Improvement Coalition. Organized in 2014, the adopted purpose of the Coalition is to "collaborate with community partners to advance the health and quality of life for the residents of Clinton County through the assessment of needs and development of education and preventative initiatives". The Coalition consists of 20 not-for-profit organizations and social service agencies. Coalition Steering Committee members were first presented the community health needs assessment for review; the group of seven reviewed the primary and secondary data gathered during the assessment. Following discussion, the group supported the identified priorities and recommended the information for the full Coalition membership to review. With nine members present at the May 2018 meeting, Clinton County Health Improvement Coalition members validated the findings and priority community health needs. Prior to presentation to the hospital's Board of Directors, the Community Health Needs Assessment (CHNA) was shared with the hospital's internal Community Benefit team, which includes administration, finance, nursing, social services, and strategic planning leadership. Following their input, the CHNA and Implementation Plan was presented at a meeting of the St. Joseph's Hospital's Board of Directors, which also includes members of the hospital's Senior Leadership Team as well as HSHS Southern Illinois Division executive leadership. Funding for implementation was approved in the upcoming fiscal year's budget. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. Yes, the hospital conducted its FY2018 CHNA with Breese District 12 Elementary School, Catholic Charities, City of Breese, City of New Baden, Clinton County Coroner's Office, Clinton County Health Department, Community Link, Community Physicians, Community Resource Center - Centralia, Countryside Manor Nursing Home - Aviston, Hoyleton Youth and Family Services, HSHS Home Care Southern IL, Kaskaskia College, SAFE (Sexual Assault and Family Emergencies Center), South Central Transit (public transportation provider), Trenton Village Retirement, University of Illinois Extension, Wesclin CUSD #3, and the YMCA. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. In addition to the organizations on the Clinton County Health Improvement Coalition, the CHNA was presented during a meeting of the Carlyle Rotary Club and distributed in a news release to area newspapers. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. As part of the identification and prioritization of health needs, the internal Community Benefit team considered the estimated feasibility and effectiveness of possible interventions by the hospital to impact health priorities. Prioritization was based on scope, severity, and burden; health disparities associated with the need; the importance the community places on addressing the health need; the hospital and community assets and resources available to address the health need; and local expertise and input. Based on the CHNA planning and development process described, the following priority community health needs were identified: 1. Access to Care 2. Obesity 3. Mental Health 4. Alcohol, Tobacco, and Other Drug Use. Implementation Strategies established to address these needs through specific initiatives included: Access to Care Goal: Increase access to care for Breese area community members, with a focus on low-income and elderly populations. FY2020 Outcomes Clinton County is in an area designated as a shortage area for primary care health professionals (HPSA). Additional points of access to medical care were subsidized for those in need through walk-in clinics and rural health clinics located in the small surrounding communities of Carlyle, Germantown, New Baden and Trenton. Operations are financially subsidized by St. Joseph's Hospital, Breese (SJB). Many residents do not have a reliable means of transportation. In turn, transportation to and from medical appointments can be difficult. In partnership with the Healthcare Foundation, a new van was obtained to provide residents with reliable transportation to medical, dental, and other personal appointments. Travelling within a 20-mile radius of the hospital, the new van service transported approximately 2,000 individuals in FY2020. The National Kidney Foundation of Illinois brought their Kidney Mobile to the community and offered three free health exams and screenings for hypertension, diabetes, and kidney disease. 145 individuals were provided free screenings. Support groups provide individuals affected by illness, their family members and caregivers an opportunity to learn more about their illness. This support system can be crucial to their maintenance of health and well-being. Support groups for grief, cancer, diabetes and breastfeeding were provided for more than 150 individuals. Obesity Goal: Make nutrition and healthy living education and programs available for all members of the community. FY2020 Outcomes The services of the SJB dietitian were made available to other organizations free of charge for education about nutrition and healthy eating. The dietitian participated in local health and safety fairs offered through the local schools. Nutrition information was also presented at the Breese Farmer's Market. The dietitian provided education for more than 400 students and community members. Exercise programs through the YMCA's partnership with the hospital also continue at the hospital's on-site exercise facility. In addition to the financial support of the YMCA, three hospitals colleagues are on the YMCA's Board including the hospital's president and chief executive officer. The YMCA has brought several programs to the community that would not otherwise be available: * Livestrong, an exercise class for cancer survivors. * Exercise for Parkinson's, a class designed for persons diagnosed with Parkinson's. * The Clinton County YMCA offers youth basketball, flag football and volleyball leagues for children ages 4 years to 8th grade. Practices and games take place at locations throughout Clinton County including schools and community facilities. * The Clinton County YMCA offers a summer day camp located at a local park. * An after-school program for students who attend Aviston Elementary School is offered every day that school is in session. Students are given time to complete their homework, physical activity in the gym or outside, snacks, and time for arts and craft. With the YMCA's presence in the community, county municipalities have sought out the YMCA's expertise with youth programs. The YMCA now manages one community's local pool and manages the summer youth league sports program for another community. HSHS St. Joseph's Hospital, Breese (SJB) gained international recognition as a Designated Baby-Friendly Hospital by Baby-Friendly USA. Baby-Friendly USA, Inc. is the U.S. authority for the implementation of the Baby-Friendly Hospital Initiative, which is a global program sponsored by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). The Baby-Friendly initiative encourages and recognizes hospitals and birthing centers that offer an optimal level of care for breastfeeding mothers and their babies. SJB also provides free breastfeeding classes and breastfeeding support groups to all mothers in the community - participation is not contingent on delivery at SJB. Participants are provided support from hospital colleagues specially trained in this area. HSHS St. Joseph's Hospital Breese continues to be a leading member of the Clinton County Health Improvement Coalition (CCHIC). The Coalition began in 2014 and is comprised of over 25 members including local organizations, social service agencies and individuals using their skills to improve the health of county residents. With March recognized by the Academy of Nutrition and Dietetics as National Nutrition Month, the CCHIC promoted ways to improve health through nutrition. An activity led by Coalition members included a food drive for county food pantries and the Snack Pack Program with suggestions made for healthy options. Daily tips on healthy cooking ideas and simple ways to improve healthy eating were also posted on the group's Facebook page and participating organizations throughout the county were encouraged to promote events and programs to their organization's clients and employees. Mental Health and Substance Use: In FY2020 discussions began with Gateway Foundation to place an engagement counselor onsite to work with patients presenting with substance use disorder. Discussions will continue into FY2021 with a hopeful plan to launch in FY2021. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Joseph's 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. 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 St. Joseph's Hospital operates 6 rural health clinics located in Breese, Trenton, Germantown, New Baden and Carlyle. All of the rural health clinics are located in rural and underserved areas. The loss on these clinics is included in the subsidized health services cost. 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 FY2020 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 The hospital 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 19 OF 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 2020 was $9,763,884. 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 St. Joseph's Hospital is a leading member of the Clinton County Health Improvement Coalition. The Coalition consists of 30 individuals representing 20 agencies. Their meetings are held quarterly and the Steering Committee for the group also meets an additional four times during the year. During the meetings held, members provide an update on activities of their organization and the needs of those they serve. This provides the hospital with an ongoing assessment of the health needs in the community. In addition to representatives from public health, attendees include representatives of a local minority population. Meetings of the hospital's Patient Family Advisory Committee, Community Engagement Council, and HSHS St. Joseph's Hospital Foundation are held each quarter. 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. Members of the Board of Directors and Foundation Leadership Council are asked for input throughout the year. 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. Community members attending the eight local health fairs held throughout the year are also asked to complete a survey. The survey asks for their input about needs in the community. Individuals are also asked to identify what they consider to be the highest priority need. 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 St. Joseph's Hospital's service area is comprised of approximately 503 square miles with a population of approximately 37,760 residents and a population density of 75 people per square mile. The service area consists of the following cities and rural communities: Albers, Aviston, Bartelso, Beckemeyer, Breese, Carlyle, Centralia, Damiansville, Germantown, Hoffman, Huey, Keyesport, New Baden, and Trenton. St. Joseph's 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 held about the same over the past six years. The median age is 39 years of age with 15.7% of the population over the age of 65 compared to 13.5% over the age of 65 in the state of Illinois. Cultural diversity is increasing with slight growth seen in the Hispanic population. A higher proportion of the Clinton County population (11.8%) is disabled than the state (10.73%). Current unemployment rate is 4.5% (source - County Health Rankings 2018). Median household income has risen to $63,929, which is slightly above the median household income for Illinois at $59,588. Persons living below the federal poverty level are 8.87% of the population, an increase of 1%. The proportion of residents who are food insecure in Clinton County (9.4%) is lower than the state (12.9%), though the percent of the food insecure population ineligible for assistance (45%) is higher than the state rate of 32%. The percent of households receiving SNAP benefits in Clinton County (7.14%) is lower than the state rate (13.06%). Just over eleven percent of children in Clinton County live in poverty, while 38% are eligible for the free lunch program. Per the most recent US Census information, 4.5% of Clinton County residents under the age of 65 years old are without health insurance. Of those insured under 65 years of age, 28% are covered by public insurance. Clinton 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. Rural populations can be disadvantaged regarding access to fresh and health food as well as physical activity locations leading to obesity and chronic health conditions. Nearly 30% of men in Clinton County were obese, notably higher than the state rate. The rate in women, 28.6%, was slightly below the state rate of 30.5%. A smaller proportion of adults in Clinton County consume five or more fruits and vegetables a day (12.8%) than the state (22.6%). The proportion of adults who report getting exercise (73.7%) is slightly lower than the state rate (75.2%). Just under two out of three of Clinton County residents (60%) had access to exercise opportunities, compared to 89% of residents statewide. The prevalence of high cholesterol in Clinton County (40.6%) has increased by nearly 8% since the 2007-2009 series of surveys, and is now higher than the state rate (36%). More Medicare beneficiaries in Clinton County have high cholesterol (47.36%) than the state rate for Medicare beneficiaries (46.19%), while for hypertension, both the county and state rate for Medicare beneficiaries is 56.4%. In general, Clinton County (9.76%) has a similar prevalence of diabetes to the state (9.71%), though the rate for Clinton County is increasing at a higher pace. Specific programs to raise awareness about obesity and healthy living will benefit the population with a focus on improving overall health. In addition, an individual's physical environment can contribute to or deter healthy behavior. The percentage of Clinton County residents who report heavy drinking is 16%, compared to a state rate of 9.9%. The percentage of Clinton County residents who report binge drinking is 31%, compared to 22.4% for the state. Over a third (36%) of Clinton County eighth graders had used alcohol, cigarettes, inhalants or marijuana in the past year, compared to the state rate of 27%. Secondary data in the CHNA indicated there is a much higher density of bars and drinking establishments in Clinton County (74.1 per 100,000) than the state density (20.6 per 100,000). The rate of establishments that provide accommodations or food service in Clinton County is 224.1 per 100,000; this compares to 201.75 per 100,000 in the state. There are 134.97 video gaming establishments per 100,000 in Clinton County compared to 69.51 per 100,000 for the state of Illinois. The smoking rate in Clinton County is 17.79%, higher than the state rate of 13.68%. Both men (18.7%) and women (16.92%) of Clinton County smoke at a higher rate than the state rate for males and females (14.89% and 12.52% respectively). The rate of infants born to mothers who smoke was 227.4 per 100,000 compared to the statewide rate of 89.9 per 100,000. 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), St. Joseph's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1897, 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 Breese 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 St. Joseph's Hospital is responding to community need. In FY2020, for example, reports are provided to Board members throughout the year to update them on community health initiatives as well as an annual report. This provides them an opportunity to give input and directional guidance. In addition, St. Joseph's Hospital receives community support and guidance through the Patient Family Advisory Council, Community Engagement Council, and HSHS St. Joseph's Foundation Leadership Council. The Family Advisory Council and Community Engagement Council meeting quarterly, while the Foundation Leadership Council meetings every other month. These groups provide feedback from the community on additional services or improvements needed, as well as helps the hospital understand the community's perception of those services and identify potentials opportunities for improvement. St. Joseph's Hospital is blessed with a strong volunteer program. Volunteers are active in many hospital departments daily and donate many more hours throughout the year to hospital-sponsored community programs. 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, 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. St. Joseph's Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2020, St. Joseph's Hospital provided more than $5.5 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, St. Joseph's Hospital provided $14,758 in in-kind public health management for the COVID-19 Pandemic. 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 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 FY2020, HSHS collectively provided $244.0 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 $26.9 million provided for Financial Assistance (aka Charity Care) and $173.3 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 $183.9 million. HSHS hospitals also recorded $26.4 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 X true true X X X X X false true false false false false false false false AMY M BALLANCE Former Interim CEO/ VP BUSINESS DEVELOPMENT SOUTHERN IL DIVISION 0 253229 0 1694 0 560 0 162774 0 30974 0 449231 0 0 CHRIS KLAY PRESIDENT & CEO 0 238171 0 1156 0 3417 0 117558 0 28128 0 388430 0 0 DAVID BEACH BOARD MEMBER 0 409564 0 9645 0 35809 0 68303 0 30339 0 553660 0 0 JAMES DOVER Former CEO SOUTHERN IL DIVISION 0 291320 0 12427 0 44608 0 0 0 16894 0 365249 0 0 ANN M CARR TREASURER 0 272481 0 4651 0 59451 0 272885 0 24979 0 634447 0 29653 JACQUELYNNE N HOLST DIVISION ASSOCIATE GENERAL COUNSEL 0 210944 0 1415 0 445 0 73599 0 32321 0 318725 0 0 EVERT J KUIPER Division CEO - Illinois 0 781769 0 16120 0 260992 0 171807 0 30339 0 1261027 0 221504 MARGARET A LUNA DIVISION CPO 0 265507 0 1831 0 360 0 241395 0 20091 0 529185 0 0 DAVID NOSACKA DIVISION CFO - ILLINOIS 0 371352 0 3681 0 4336 0 78171 0 30289 0 487829 0 0 Barbara Eilers Nurse Supervisor 107324 0 450 0 0 0 98275 0 12383 0 218432 0 0 0 EILEEN HAGEN Nurse Supervisor 113304 0 500 0 0 0 92291 0 981 0 207076 0 0 0 JOHN JEFFRIES DIRECTOR OF FINANCE 168807 0 23375 0 6158 0 76797 0 22768 0 297905 0 0 0 Schedule J, Part I, Line 1a Tax indemnification and gross-up payments A TAX GROSS-UP WAS PAID TO VARIOUS INDIVIDUALS DURING THE YEAR IN THE AMOUNT OF $50 OR LESS. THE FAIR VALUE WAS INCLUDED IN THEIR ANNUAL TAXABLE INCOME. 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 2019 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). DAVID BEACH -- $53,586 ANN CARR -- $30,435 Chris Klay -- $24,384 Evert Kuiper -- $89,431 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2019 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $29,653 Evert Kuiper -- $221,504 Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS ST. JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDES QUALITY HEALTH CARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, RELIGION, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS ESSENTIAL TO THE CONTINUED OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS ARE ABLE TO AFFORD REQUIRED MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH THE BEST QUALITY HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. INHERENT IN OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. IN OUR TAX YEAR BEGINNING JULY 1, 2019 AND ENDING JUNE 30, 2020, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 1,356 INPATIENTS UTILIZING 3,855 DAYS OF CARE. IN ADDITION, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 71,807 OUTPATIENTS. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO THE POOR AT NO COST THROUGH OUR CHRISTIAN CARE PROGRAM. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE ILLINOIS MEDICAID PROGRAM, WHICH REIMBURSES THE HOSPITAL AT RATES SUBSTANTIALLY BELOW THE COST OF PROVIDING THE SERVICES. FULFILLING OUR MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO 345 MEDICAID INPATIENTS UTILIZING 795 DAYS OF CARE. THE COST OF PROVIDING SERVICES TO MEDICAID PATIENTS EXCEEDED REIMBURSEMENT UNDER THE STATE OF ILLINOIS MEDICAID PROGRAM BY $2,236,425. THE TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THE POOR IS $2,958,365. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO MEMBERS OF THE BROADER COMMUNITY THROUGH PARTICIPATION IN THE MEDICARE PROGRAM AND THROUGH EDUCATIONAL PROGRAMS AND ACTIVITIES AT A REDUCED PRICE, OR AT NO COST. ST. JOSEPH'S HOSPITAL, BREESE PROVIDED MEDICAL SERVICES TO 539 MEDICARE INPATIENTS UTILIZING 1,905 DAYS OF CARE. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS 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 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 WHISTLEBLOWER POLICY PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 1a COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF GOVERNING BODY 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 THREE 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 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. JOHN'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 SACRED HEART HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD SACRED HEART HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF ST. JOSEPH'S HOSPITAL BREESE (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 BREESE (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 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 SYSTEM 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 USED SINCE JANUARY, 2010 TO ESTABLISH THE PRACTICE OF MANAGING CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS, AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO 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 VIII, Line 11d Other Miscellaneous Revenue Miscellaneous - Total Revenue: 96397, Related or Exempt Function Revenue: 96397, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Other Professional Services - Total Expense: 9550864, Program Service Expense: 3710767, Management and General Expenses: 5840097, Fundraising Expenses: ; Purchased Services - Total Expense: 11690756, Program Service Expense: 11413316, Management and General Expenses: 277440, Fundraising Expenses: ; 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 HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, 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 fair value of interest rate swap - -1969346; Changes to Temporarily Restricted Net Assets - -56155; Changes to Permanently Restricted Net Assets - 25; Transfer to/from affiliates - -3256329; Pension-related changes other than net periodic pension costs - 432774; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -1065421 2091139 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 706293 10243449 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL -458206 453719 KCIN 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 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 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 HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 263155343 HEALTHCARE WI ST VINCENT Related -12402 266872 false false 0.5 PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 364717036 HEALTHCARE WI ST CLARE Related -70585 97862 false false 0.5 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 -6697 17910 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 282559 1572355 false false 0.5 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation -43228090 38923072 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 PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD IL 62701 371071858 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation -3206 44317532 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 148104719 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false true false false false false true true true false true true true true true true true true 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.