ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC (EIN 39-0818682)
- Tax period
- 2018-07-01 to 2019-06-30
- Filed
- 2020-05-14
- IRS object ID
- 202021359349304417
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-05-14T22:00:11-05:00 | ReturnTs |
| Tax Period End | 2019-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 350921680 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROWE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 West Wacker Drive Suite 2600 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606061224 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390818682 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Mary's Hospital Medical Center of Green Bay Inc - Hospital Sisters | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STMA | BusinessNameControlTxt |
| Phone | 9204984200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATRICIA ALLEN | PersonNm |
| Person Title | DIVISION CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Signature | 2020-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Mallory Fairless | PreparerPersonNm |
| PTIN | P01321579 | PTIN |
| Phone | 3128997000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THERESE PANDL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $133,423,881 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STMGB.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1900 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 729 | TotalEmployeeCnt |
| Total Volunteers | 115 | TotalVolunteersCnt |
| Total Gross UBI | $749,078 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $425,422 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,227,821 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $123,844,068 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $122,881,082 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,958,343 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,499,268 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,857,315 | PYOtherRevenueAmt |
| CY Other Revenue | $2,139,290 | CYOtherRevenueAmt |
| PY Total Revenue | $128,085,148 | PYTotalRevenueAmt |
| CY Total Revenue | $129,747,461 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $43,873,921 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,961,104 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $75,323,874 | PYOtherExpensesAmt |
| CY Other Expenses | $80,770,887 | CYOtherExpensesAmt |
| PY Total Expenses | $119,197,795 | PYTotalExpensesAmt |
| CY Total Expenses | $125,731,991 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,887,353 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,015,470 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $207,008,307 | TotalAssetsBOYAmt |
| Total Assets EOY | $203,049,411 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $50,482,282 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $54,890,130 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $156,526,025 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $148,159,281 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $12,873,876 | ExpenseAmt |
| Revenue | $30,109,467 | RevenueAmt |
| Desc | SURGERY - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,297,408 | ExpenseAmt |
| Revenue | $14,345,344 | RevenueAmt |
| Desc | HEART & VASCULAR CENTER - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,630,796 | ExpenseAmt |
| Revenue | $18,542,946 | RevenueAmt |
| Desc | RADIOLOGY SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $60,463,430 | ExpenseAmt |
| Revenue | $59,674,252 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. IN FY2019 THE HOSPITAL HAD NEARLY 97,400 OUTPATIENT VISITS, 3,800 ADMISSIONS, OVER 12,500 PATIENT DAYS, 344 BIRTHS AND OVER 26,100 EMERGENCY ROOM VISITS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $60,463,430 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $59,674,252 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $84,265,510 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 26 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 729 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | Yes (true) | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dawn Gracyalny | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9204330111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 835 S Van Buren St | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54301 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DANIEL J PLATKOWSKI | ||||||||
| 2018 & 2019 Chair | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BETSY MITCHELL | ||||||||
| 2018 & 2019 Vice Chair | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Brian Charlier | ||||||||
| President/COO | 10.0 | 30.0 | Yes (X) | Yes (X) | $0 | $464,881 | $49,950 | |
| Dennis Langenberg | ||||||||
| 2018 & 2019 SECRETARY | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THERESE B PANDL | ||||||||
| PRES / CEO EASTERN WISCONSIN DIVISION | 24.0 | 36.0 | Yes (X) | Yes (X) | $0 | $924,387 | $174,302 | |
| MANAR ALSHAHROURI MD | ||||||||
| BOARD MEMBER | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| JULES BLANK MD | ||||||||
| BOARD MEMBER | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL W COTTRELL | ||||||||
| BOARD MEMBER/HSHS CFO | 1.0 | 59.0 | Yes (X) | $0 | $828,161 | $189,746 | ||
| SR MAUREEN FAGAN OSF | ||||||||
| Board Member | 1.0 | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| Staci Kring | ||||||||
| BOARD MEMBER | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| MITCH WECKOP | ||||||||
| BOARD MEMBER | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Michael Wickman | ||||||||
| Board Member | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.3 | 59.7 | Yes (X) | $0 | $329,829 | $110,463 | ||
| GREG SIMIA | ||||||||
| DIVISION CFO | 5.0 | 35.0 | Yes (X) | $0 | $456,456 | $89,224 | ||
| PAULA HAFEMANN | ||||||||
| Chief Nursing Officer | 20.0 | 21.0 | Yes (X) | $0 | $330,528 | $88,145 | ||
| JAYNE BLEUEL | ||||||||
| PHARMACIST | 40.0 | 0 | $144,839 | $0 | $69,363 | Yes (X) | ||
| DANIEL DORAN | ||||||||
| DIVISIONAL DIRECTOR-CARDIOVASCULAR | 40.0 | 0 | $172,522 | $0 | $83,639 | Yes (X) | ||
| Scott Stillwell | ||||||||
| Physician | 40.0 | 0 | $205,513 | $0 | $32,968 | Yes (X) | ||
| MELISSA WEIDERT | ||||||||
| PHYSICIAN | 40.0 | 0 | $243,653 | $0 | $12,799 | Yes (X) | ||
| Jarod Husmann | ||||||||
| DIVISIONAL DIRECTOR-REHAB | 40.0 | 0 | $140,536 | $0 | $26,645 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $907,063 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,334,242 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $927,244 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PREVEA | |||||
| PO BOX 19070 | GREEN BAY | WI | 54307 | SHARED LABOR & SERVICES | $3,715,292 |
| COMPASS ONE | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | FOOD & HOUSEKEEPING | $1,147,613 |
| ST VINCENT HOSPITAL | |||||
| 835 S VAN BUREN ST | GREEN BAY | WI | 54303 | SHARED SERVICES | $887,539 |
| GREEN BAY ANESTHESIA ASSOCIATES | |||||
| 225 S EXECUTIVE DR | BROOKFIELD | WI | 53005 | ANESTHESIA | $560,506 |
| IEI GENERAL CONTRACTORS | |||||
| PO BOX 5067 | DE PERE | WI | 54115 | CONTRACTOR | $489,846 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,227,821 | RelatedOrganizationsAmt |
| Total Contributions | $2,227,821 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 621990 | $123,088,671 | $123,088,671 | |
| LABORATORY SERVICES | 621500 | $209,073 | $209,073 | |
| PREVEA INVESTMENT GAIN/LOSS | 900099 | -$416,662 | -$416,662 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $122,881,082 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $578,026 | TotalRevenueColumnAmt |
| Exclusion | $578,026 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,192,426 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,392,320 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$199,894 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$199,894 | TotalRevenueColumnAmt |
| Exclusion | -$199,894 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,981,939 | SecuritiesAmt |
| Other | $223,403 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $284,100 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,981,939 | SecuritiesAmt |
| Other | -$60,697 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,921,242 | TotalRevenueColumnAmt |
| Exclusion | $1,921,242 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $1,164,567 | $1,164,567 | |
| CHILDCARE REVENUE | 624410 | $1,125,760 | $585,755 | $540,005 |
| GIFT SHOP REVENUE | 453220 | $48,857 | $48,857 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,339,184 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $129,747,461 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $122,672,009 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $749,078 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,098,553 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,641,022 | TotalAmt |
| Program Services | $23,338,567 | ProgramServicesAmt |
| Management And General | $11,302,455 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$627,095 | TotalAmt |
| Program Services | -$422,474 | ProgramServicesAmt |
| Management And General | -$204,621 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,845,011 | TotalAmt |
| Program Services | $5,958,884 | ProgramServicesAmt |
| Management And General | $2,886,127 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,102,166 | TotalAmt |
| Program Services | $1,416,229 | ProgramServicesAmt |
| Management And General | $685,937 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $879,871 | TotalAmt |
| Management And General | $879,871 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,241,526 | TotalAmt |
| Program Services | $3,190,777 | ProgramServicesAmt |
| Management And General | $17,050,749 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,203 | TotalAmt |
| Program Services | $63,542 | ProgramServicesAmt |
| Management And General | $13,661 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,223,040 | TotalAmt |
| Program Services | $54,151 | ProgramServicesAmt |
| Management And General | $2,168,889 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,390 | TotalAmt |
| Program Services | $21,286 | ProgramServicesAmt |
| Management And General | $17,104 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,669 | TotalAmt |
| Program Services | $30,226 | ProgramServicesAmt |
| Management And General | $3,443 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,462 | TotalAmt |
| Management And General | $450,462 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,570,341 | TotalAmt |
| Program Services | $1,685,219 | ProgramServicesAmt |
| Management And General | $3,885,122 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,363 | TotalAmt |
| Program Services | $127,363 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES - MED/SURG/O2/DRUGS | $20,773,271 | $20,312,234 | $461,037 |
| PREVEA INVESTMENT AND LEASE | $19,130,523 | $18,608,970 | $521,553 |
| BAD DEBT EXPENSE | $3,944,300 | $3,944,300 | |
| MEDICAID TAX ASSESSMENT | $3,306,060 | $3,306,060 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,974,868 | TotalAmt |
| Program Services | $2,630,176 | ProgramServicesAmt |
| Management And General | $1,344,692 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,731,991 | TotalAmt |
| Program Services | $84,265,510 | ProgramServicesAmt |
| Management And General | $41,466,481 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,877 | BOYAmt |
| EOY | $2,523 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,246,671 | BOYAmt |
| EOY | $2,338,102 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,581,193 | BOYAmt |
| EOY | $15,253,280 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $387,000 | BOYAmt |
| EOY | $371,888 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,704,937 | BOYAmt |
| EOY | $2,447,688 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,559 | BOYAmt |
| EOY | $57,779 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $154,232,860 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $82,935,418 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,153,111 | BOYAmt |
| EOY | $71,297,442 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $108,127,096 | BOYAmt |
| EOY | $100,512,835 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,225,309 | BOYAmt |
| EOY | $7,956,337 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,941,896 | BOYAmt |
| EOY | $2,811,537 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,008,307 | BOYAmt |
| EOY | $203,049,411 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,548,455 | BOYAmt |
| EOY | $12,571,398 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $334,288 | BOYAmt |
| EOY | $333,809 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,985,706 | BOYAmt |
| EOY | $25,422,115 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,613,833 | BOYAmt |
| EOY | $16,562,808 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,482,282 | BOYAmt |
| EOY | $54,890,130 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $149,229,951 | BOYAmt |
| EOY | $143,120,160 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,997,388 | BOYAmt |
| EOY | $2,740,435 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,298,686 | BOYAmt |
| EOY | $2,298,686 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,526,025 | BOYAmt |
| EOY | $148,159,281 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,008,307 | BOYAmt |
| EOY | $203,049,411 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $4,015,470 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$348,755 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$12,033,459 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $10,802 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $10,802 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | FormAndLineReferenceDesc |
| Explanation | ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), AND THE AMERICAN HEALTH 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 22.73% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.52% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 13.60% 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,615,741 | OtherCostOrOtherBasisAmt |
| Book Value | $2,615,741 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $70,147,589 | OtherCostOrOtherBasisAmt |
| Depreciation | $30,732,165 | DepreciationAmt |
| Book Value | $39,415,424 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $467,133 | OtherCostOrOtherBasisAmt |
| Depreciation | $289,727 | DepreciationAmt |
| Book Value | $177,406 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,086,408 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,754,546 | DepreciationAmt |
| Book Value | $10,331,862 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,915,989 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,158,980 | DepreciationAmt |
| Book Value | $18,757,009 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $71,297,442 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PENSION LIABILITY | $16,319,627 |
| RETIREMENT OBLIGATION ASBESTOS | $243,181 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $16,562,808 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501 (c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all 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 than not 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, 2019 and 2018 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, 2019 and 2018, HSHS does not have any liabilities for unrecognized tax benefits. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,927,826 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,895,352 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,032,474 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0167 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,225,212 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,968,225 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,256,987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0842 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,335,700 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $948,160 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $387,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0032 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $27,488,738 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,811,737 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,677,001 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1041 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $245,753 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $245,753 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $128,454 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $128,454 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0011 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,189,429 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,585,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $603,713 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0050 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $66,614 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $66,614 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0005 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $2,630,250 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,585,716 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,044,534 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0086 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $30,118,988 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,397,453 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,721,535 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.1127 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,944,300 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $421,402 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $36,540,217 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $55,160,430 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$18,620,213 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.stmgb.org | WebsiteAddressTxt |
| State License | 18 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.stmgb.org/www-smgb/media/SMGB-PDFs/About/CHNA-SMGB.pdf | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.stmgb.org/www-smgb/media/SMGB-PDFs/About/CHIP-SMGB.pdf | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.hshs.org/FAP | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.hshs.org/FAP | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://www.hshs.org/FAP | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. In FY2018 (July 1, 2017 through June 30, 2018), HSHS St. Mary's Hospital in partnership with the member organizations that comprise Beyond Health - Brown County Public Health, City of De Pere Public Health, Aurora BayCare, Bellin Health, HSHS St. Mary's Hospital Medical Center, and Brown County United Way - conducted the Brown County Community Health Needs Assessment (CHNA) and developed a Community Health Improvement Plan (CHIP) in response to identified priority community health needs. Beyond Health was formed in 2013 to improve the health of Brown County residents by conducting triennial CHNAs and leading community-wide action planning teams. Every three years, the steering committee of Beyond Health brings community stakeholders together to review health data, share knowledge and expertise, identify health priorities, and develop the Community Health Improvement Plan (CHIP). The Beyond Health CHNA and CHIP are grounded in national and state-level regulations. The Affordable Care Act, State of Wisconsin statutes, and Public Health Accreditation Board (PHAB) clearly outline required steps for health care systems and accredited public health agencies to improve upon the health of communities. The Beyond Health steering committee provides the necessary support and oversight to these task forces and ensures that collectively agreed upon goals are prioritized and met during each CHNA/CHIP triennial cycle. In the FY2018 CHNA, the population assessed was Brown County, Wisconsin. Data collected throughout the assessment process was supplemented with qualitative data gathered through a CHNA steering committee with broad community representation, secondary data sources, and the input of key community stakeholders who attended the Community Health Needs Assessment Summit hosted at Lambeau Field in Green Bay in October 2017. Prior to the Summit, the Beyond Health steering committee emailed the community health needs assessment data report to community stakeholders. The report included links to additional data sources for review prior to the Summit. One hundred twenty-three individuals representing more than 50 Brown County community and social service agencies attended the Summit, including - Aging and Disability Resource Center* - Aids Resource Center of Wisconsin (ARCW) - Ashwaubenon Schools - Aurora BayCare Medical Center (ABMC) - Aurora Behavioral Health - Bay Area Community Council - Bellin Health - Bellin Psychiatric Center - Brown County Board - Brown County Board of Health* - Brown County Child and Adolescent Behavioral Health* - Brown County Health & Human Services* - Brown County Public Health* - City of De Pere - Health Department* - City of Green Bay - Mayor - NEW Community Clinic & Brown County Board of Health* - NEW Community Clinic* - United Way - Brown County* - WI DHS Division of Public Health* *Denotes groups representing medically underserved, low-income and minority populations Representatives of Beyond Health and the more than 50 agencies who attended the Summit have extensive knowledge and quantifiable data regarding the needs of their service populations. Actively including these cross-sector organizations in the CHNA process was critical to ensure that the needs of the most vulnerable persons in our communities were being shared and addressed in the CHNA process and development of related implementation strategies. Hospital Sisters Health System and HSHS St. Mary'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. We believe that the CHNA process must be informed by input from the poor and vulnerable populations we seek to serve. |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. Yes, the hospital conducted its CHNA with Bellin Health, Aurora BayCare Medical Center, and our sister hospital, HSHS St. Vincent Hospital. |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. Yes, the hospital conducted its FY2018 CHNA with Brown County Public Health, De Pere Health Department, Brown County United Way, and the Wisconsin Department Division of Public Health. |
| Schedule H, Part V, Section B, Line 7 Facility , 1 | Facility , 1 - HSHS St Mary's Hospital Medical Center. The FY2018 CHNA was shared with hospital leaders including the hospital Board, Community Advisory Committee, medical staff leaders, and all hospital leaders. In addition, Beyond Health held a press conference sharing the results of the study. A link to the news report is here: https://fox11online.com/news/local/brown-countys-new-health-improvement-plan-points-to-three-major-concerns |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS St. Mary's Hospital Medical Center. In FY2018 (July 1, 2017 through June 30, 2018), HSHS St. Mary's Hospital in partnership with the member organizations that comprise Beyond Health - Brown County Public Health, City of De Pere Public Health, Aurora BayCare, Bellin Health, HSHS St. Vincent Hospital Medical Center, and Brown County United Way - conducted the Brown County Community Health Needs Assessment (CHNA). Based on the data and prioritization process, the following community health needs were selected: * Alcohol and Other Drug Abuse (AODA) * Mental health * Physical activity, obesity and nutrition * Oral health was top priority for Brown County FY2015 CHNA. A consensus was reached that ongoing efforts should be sustained. Implementation plan HSHS St. Mary's Hospital's implementation plan is part of a community effort to address three priority health needs. The hospital works collaboratively with a broad range of direct-service organizations, coalitions and government agencies to address these needs. The FY2018 CHIP outlines the actions that HSHS St. Mary's Hospital will take to address the health needs of Brown County, many of which will be implemented collaboratively. Recognizing that no single organization can effect substantial change alone, the CHIP long-term performance indicators will be achieved through the collective impact of many community organizations working together. Alcohol and Other Drug Abuse (AODA) Goal: By 2020, HSHS St. Mary's Hospital, in partnership with the Brown County Health Department and other organizations and the Alcohol and Drug Task Force will create community-wide partnerships with individuals, families and organizations creating cultural change that leads to a measured decrease in binge drinking behavior, drug use and fatalities. Long-term performance indicators * Reduce binge drinking rate from 24 percent to 22 percent by June 30, 2021. * Decrease the percentage of driving deaths with alcohol involvement from 67 to 50 percent by June 30, 2021. * Decrease the number of deaths related to drug misuse from 13 to at least eight by June 30, 2021. * By June 30, 2021, community members seeking support and/or needing to gain access will receive services same day they are sought. AODA Strategy One: Access HSHS St. Mary's Hospital will collaborate with the Mental Health Task Force and other community stakeholders on the following strategies. * Create a community-wide portal for patients and providers to access where AODA services are available. FY2019 Outcomes: As of September 2018, residents can have a conversation with a trained 211 Information & Referral specialist, Monday-Friday between the hours of 8 a.m. to 4 p.m. by texting their zip code to TXT211. 211 connects people with community resources and volunteer opportunities in Brown County. For the last 11 years, people have called 211, or more recently have searched for information on the public website. With the addition of text messaging, 211 increases access to trained 211 Information & Referral specialists and community resources. * Support the expansion of recovery coaching to support those awaiting services. FY2019 Outcomes: HSHS St. Mary's Hospital helped secure a HOPE Grant (Heroin and Opioid, Prevention and Education) to provide resources to patients closer to their homes and thus avoiding a long trip to Brown County. The HOPE Grant is working to add peer support specialists in several regional Counties. Northeast Wisconsin Opioid Treatment Services provides services to people living with an opioid addiction in Florence, Marinette, Menominee and Oconto counties. Services also are available to Wisconsin members of the Menominee Nation. HSHS St. Mary's Hospital will partner with Bellin under the Voices of Recovery grant to expand Recovery Coaches/peer specialist into the ER when patients arrive with Opioid addiction concerns * Collaborate on community stakeholder initiatives that address opioids and identify any crossover to the AODA task force surrounding access to treatment/support. FY2019 Outcomes: HSHS St. Mary's Hospital participated with the Coalition for Change, Brown County Drug Alliance, Substance Use provider meetings. Alcohol and Drug Coalition has participation from multiple agencies that service AODA--and access to treatment and support are reviewed at the team. The Mental Health Task Force is owning the work on access and the AODA group is the supporter. AODA Strategy Two: Policy HSHS St. Mary's Hospital will collaborate with the Mental Health Task Force and other community stakeholders on the following tactics. * Partner with law enforcement and the tavern league to assist in supporting policies that lower the risk of deaths associated with driving while under the influence. FY2019 Outcomes: HSHS St. Mary's Hospital is collaborating with the Brown County Coalition for Change. OWI's in Brown County are the lowest they have been in the past 14 years. Traffic fatalities that are alcohol related are the lowest since 2010. * Advocate for the uniform and effective request of the "Place of last drink" report from tavern owners. FY2019 Outcomes: HSHS St. Mary's Hospital is collaborating with the Brown County Coalition for Change. The Wisconsin Tavern league is participating in the Last Place of Drink study and meeting with any bar owners who show up multiple times on the report. Demonstrated improvement in establishments falling off the list of repeat offenders. Safe rides up 100%. March 2019: Sober server ordinance: Supported the attempt to create a sober server ordinance in Green Bay. We were defeated at the council meeting-as Tavern League had a strong presence. * Identify and communicate a minimum of two best practice approaches that decrease exposure of drugs and alcohol to youth, and support needed policy or practice changes in the community. FY2019 Outcomes: Brown County Drug Alliance is working on this. Alcohol and Drug Coalition for Change has supported multiple write-in campaigns and in person support at the Health and Protection committee to educate on the negative effects of advertising to our youth. * Annually educate legislators and community stakeholders, at a community event, on needed policy change that impacts alcohol and drug misuse FY2019 Outcomes: The Brown County Coalition for Change has held meetings with newly elected Green Bay Mayor Genrich to educate him as to the work of the task force and key areas of opportunity for improvement * Collaborate with the Wisconsin Hospital Association (WHA) to advocate for new and innovative policy and/or legislative changes that support a healthy substance use culture in Brown, Oconto and Sheboygan Counties. FY2019 Outcomes: On May 23rd, 2019, Wisconsin Department of Health Services hosted a listening session on DHS 75 (Behavioral health regulations) at HSHS St. Mary's Hospital which was attended by David Lally, Paula Manley, and Jeff Stumbras and coordinated by Matthew Stanford of Wisconsin Hospital Association. DHS is in the process of developing a comprehensive revision to DHS 75, which includes Wisconsin's rules regarding AODA certification for multiple types of facilities and providers. This is good news as WHA was one of the few voices during the Governor's Opioid Task Force emphasizing the need to prioritize removing outdated, complex, and onerous DHS 75 regulations. AODA Strategy Three: Public Awareness HSHS St. Mary's Hospital will collaborate with the Mental Health Task Force and other community stakeholders on the following tactics. * Support a minimum of two community conversations and public awareness events around alcohol and drug misuse annually. FY2019 Outcomes: HSHS St. Mary's Hospital supported the local Drug Take Back as well as the Recovery Month Celebration at St. James Park in Green Bay and at the Wisconsin Capital in Madison. Introduced the Sober table with the Green Bay Packers. * Create a video in partnership with HWLI (Healthy Wisconsin Learning Initiative) that creates awareness around "access to care" for those struggling with substance misuse. FY2019 Outcomes: Video segments created and used at meetings or as a community voice. * Partner with statewide coalitions to raise awareness and identify key practices that influence culture. Evaluate these practices and implement these in Brown County as appropriate. FY2019 Outcomes: Working within the team and with local officials on the following evidenced based or Best Practices: Sober Server, Place of Last Drink, Compliance Checks * Partner with key stakeholders around their work surrounding opioid abuse and utilize existing educational materials to create awareness in the community. FY2019 Outcomes: The Brown County Coalition members participated in the support of the Community-wide Opioid education at Brown County Aging and Disability Resource Center. |
| Schedule H, Part V, Section B, Line 11 Facility , 2 | Facility , 2 - HSHS St. Mary's Hospital Green Bay. FY2019 Outcomes: The Brown County Coalition members participated in the support of the Community-wide Opioid education at Brown County Aging and Disability Resource Center. * Participate in a minimum of two field trips each year that bring task force members out into the community to engage with key stakeholders that are impacted by drug and alcohol addiction and misuse. FY2019 Outcomes: The Brown County Coalition for Change attended the Green Bay Wednesday night farmers market to identify access to "alternatives to alcohol" * Create a process for sustaining the notification letter that goes out to local establishments and organizations that are hosting events. This letter will outline best practices for safe serving. Also establish the process to send a "thank you" to those organizations that follow the best practice standards. FY2019 Outcomes: This continues to be part of the Brown County Coalition for Change work --recognizing and sending letters to organizations and events that do a good job following evidenced based principles and educating those that do not. Mental Health Goal: Brown County will improve access to mental health services, information, and education for all populations in the county by creating a common platform that consumers, mental health providers, partner agencies, and stakeholders can access. Long-term performance indicators By July 2021, the average number of poor mental health days per 30 days, as reported by county residents, will decrease from 3.4 to 3.2. Mental Health Strategy One: Screening tool assessment and best practice identification HSHS St. Mary's Hospital will work collaboratively with the Brown County Health Department and Mental Health task force to: - Assist in completing an inventory of current behavioral health screening tools used across settings. FY2019 Outcomes: The Mental Health task force continues to work on this and are investigating what tools are being used in community agencies, schools, and health care systems. - Assist in completing an inventory of current suicide risk screening tools used across settings (consider collaboration with the Brown County Coalition for Suicide Prevention on this activity). FY2019 Outcomes: The Mental Health task force has identified the Columbia suicide risk screening tool as a best practice to be used across community settings. - Identify best practice behavioral health screening tools and develop recommendations for tools used in various community settings. FY2019 Outcomes: The Mental Health task force continues to work on a set of recommendations that can be shared with community agencies. - Identify best practice suicide risk screening tools and develop recommendations for tools used in various community settings. FY2019 Outcomes: The Mental Health task force continues to work on identifying best practice suicide risk screening tools. Mental Health Strategy Two: "No wrong door" access platform for mental health treatment and providers HSHS St. Mary's Hospital will work collaboratively with the Brown County Health Department and Mental Health Task Force to: - Implement Trilogy - network of care in collaboration with NEW Connections FY2019 Outcomes: Triology was implemented. Network of care in collaboration with NEW Connections for Mental Wellness. Connections for Mental Wellness is a community-wide collective impact initiative in Brown County, Wisconsin that brings together and facilitates diverse groups of stakeholders (i.e. non-profits, government, education organizations, employers, health systems, etc.) to help address community needs and issues related to mental wellness and mental health care. We focus on issues that cannot be solved by one organization alone. With the core values of innovation, collaboration, compassion, inclusion and equity, Connections envisions a community that values and embraces the need for mentally healthy children, adults and families. - Work with primary care providers to identify education needs and strengthen primary care as the entry point to "Right Care, Right Person, Right Time" mental health treatment. FY2019 Outcomes: NEW Connections for Mental Wellness is working with primary care providers to strengthen primary care as the entry point to mental health treatment. Mental Health Strategy Three: Develop a network of peer support, increasing availability of immediate resources to community HSHS St. Mary's Hospital will work collaboratively with the Brown County Health Department and Mental Health task force to: - Complete an inventory of current mental health peer support resources available in the community. FY2019 Outcomes: The Mental Health task force completed this with the addition of the software platform Trilogy. - Identify educational/training programs available to those interested in providing peer support in the community (e.g. QPR, Mental Health First Aid, etc). FY2019 Outcomes: The Mental Health task force completed this work. - Develop a peer support network, implement services and provide resource contacts to community organizations and agencies. FY2019 Outcomes: The Mental Health task force completed this work and found that the groups were not interested in this network. Physical activity, obesity and nutrition Goal: Increase number of individuals with healthy weight Long-term performance indicators: By 2021, increase number of individuals with a healthy weight by three percent, as evidenced by an increase in the number of community members with a BMI under 30. (Baseline measure: 72 percent at healthy weight, based on County Health Rankings 2017- 2013 data). Physical activity, obesity and nutrition Strategy One: Food as medicine HSHS St. Mary's Hospital will work collaboratively with the Beyond Health Food and Nutrition Task Force & the Brown County Health Department to improve equitable access to healthy food, and increase the proportion of Brown County residents who consume the recommended number of servings of fruits and vegetables by at least two percent (short term) and four percent (long term) by: - Establish relationships with various community groups and offering assistance to facilitate change or maintenance for programs that focus on consumption of healthy foods FY2019 Outcomes: Work plan is still in progress. At each group meeting, discuss issues that need support related to for healthy food availability. Decide if actionable. - Monitoring healthy food donations at Scouting for Foods drive FY2019 Outcomes: Maintain promotion of healthy donations for food drives by posting four times on social media throughout 2019 (May, June, August, October) - Maintaining and promoting Food Drive 5 toolkit FY2019 Outcomes: Edited "Food Drive 5" with expiration date recommendations. Please click on link to learn more about Food Drive 5: https://www.greenbaypressgazette.com/story/life/2014/10/10/food-drive-five-encourages-healthier-donations/17045553/ Organizers of an effort to distribute healthy food at local food pantries are focusing on two goals: Fill pantry shelves with nutritional options and encourage shoppers to make healthier choices for their own cupboards. The goal of Beyond Health - a collaboration of the Brown County and De Pere health departments, Bellin Health, Aurora Health Care, St. Mary's and St. Mary's Hospitals, Brown County United Way, and state Division of Public Health is to educate people on making healthier choices. - Monitoring and encouraging food pantry infrastructure that promotes healthy food choices FY2019 Outcomes: Supported Green Bay Garden Blitz by spreading the word about garden boxes. The Green Bay Garden Blitz empowers residents to grow food and be part of a sustainable urban agricultural system. We provide a comprehensive approach to urban agriculture by selling and installing raised bed gardens at a low cost and by providing education and mentorship for gardeners. The garden boxes are installed over the course of one weekend by our team of volunteers. In addition to their garden boxes, new gardeners have a variety of educational opportunities, including our mentor program, which matches experienced gardeners with new growers since 2014, Blitz volunteers have built 547 gardens in our community. - Institute a platform of healthy snacks in the school system by eliminating candy, high fat snacks and soda from vending machines and cafeterias FY2019 Outcomes: Work plan is still in progress. At each group meeting, discuss issues that need support related to school-based healthy food programs - Tracking the ratio of eligibility for EBT program to those who use the Double Your Bucks program at the farmer's market |
| Schedule H, Part V, Section B, Line 11 Facility , 3 | Facility , 3 - HSHS St. Mary's Hospital Green Bay. FY2019 Outcomes: HSHS St. Mary's Hospital directly supports the Double your Bucks program. Electronic Benefits Transfer (EBT) is an electronic system that allows FoodShare recipients authorization to transfer their government benefits from a Federal account to a retailer account to pay for food. To create a healthy, equitable food environment where all residents have access to fresh fruits and vegetables at Farmers' Markets, Wello has worked with local partners to develop the sustainable infrastructure necessary to accept FoodShare benefits through the use of an EBT machine at local markets in the Greater Green Bay Area. In addition to Farmers' Markets accepting EBT, we have also been able to offer an incentive program called Double Your Bucks (DYB) due to the generous support of Hospital Sisters Health System. DYB provides families who use EBT with the means to purchase more locally grown fruits and vegetables by doubling the first $10 of their EBT dollars. - Ben's Wish program that assists local communities in fighting food insecurity issues through food drive collection, weekend backpack program and educational activities. FY2019 Outcomes: HSHS St. Mary's Hospital directly supports this community initiative. Ben's Wish provides food assistance with the help of community volunteers. Our program is involved with three primary efforts. o Food Drive Collections to support local food pantries. There are many more food pantries than people generally know about. These pantries are the year-round first line of defense helping families to fight Food Insecurity. o Weekend Backpack program Children are the future. We view their success as the success of every community. On weekends, children may be required to fend for themselves. We supply nutritional food packs to needy children during the school year so they can return to school ready to study. o Educational Activities Children have compelling stories. Through art, essays, and digital media, students have shared their view of poverty and hunger issues around us. Local media, museums and galleries can share these stories. Educating the local community of these far-reaching issues is a primary activity to finding solutions. Physical activity, obesity and nutrition Strategy Two: Movement as medicine. HSHS St. Mary's Hospital will work collaboratively with the Beyond Health Food and Nutrition Task Force & the Brown County Health Department to decrease physical inactivity (short-term by two percent, long-term by four percent) through empowering community members to use active means of transport/movement by partnering with the Greater Green Bay Active Community Alliance. Encourage Brown County residents to utilize community resources (e.g. walking/biking trails, fitness centers, etc.) and facilitate campaign(s) that promote(s) healthy lifestyles through safe and affordable modes of physical activity (as measured by a decrease in physical inactivity) by structuring the work around the three Es (engineering, education, enforcement). Together, we will accomplish this by: - Partnering with the Greater Green Bay Active Community Alliance to create a more active and connected community. FY2019 Outcomes: Spread the information to contacts and social media about Frogger events on May 28, July 23, September 3. Wello teamed up with local municipal law enforcement for the first of three Regional Crosswalk Education and Enforcement events, better known as "Frogger," happening throughout Greater Green Bay in 2019. Our season kicked off on May 28th with "Frogger" operations held in eleven locations across Allouez, Bellevue, Denmark, De Pere, Green Bay, Howard and Suamico. These operations are named after the popular video game. - Developing an educational strategy using the three Es in partnership with the Greater Green Bay Active Community Alliance. FY2019 Outcomes: Connected with various community groups to get community voice in Wikimaps for safe walking and biking in GB for safe routes to schools. - Monitoring utilization trends of active design and infrastructure to identify gaps and opportunities to improve. FY2019 Outcomes: Continued to support injury prevention efforts related to pedestrian safety and bike helmet distribution and education. Strategy Three: Culture change HSHS St. Mary's Hospital will work collaboratively with the Brown County Health Department to link LIFE study data, CHIP and The GROW Project together to collaborate on community initiatives. Together we will create a community driven by multi-sectored partnerships supportive of cultural well-being that improves the health of Brown County by: - Testing a community education platform supporting the connection between nutrition, movement and health status. FY2019 Outcomes: Standardize and implement best practice prevention strategies for Diabetes and Cardiovascular Disease with kick off meeting which will lead into an evaluation of current practices. - Engaging and empowering the growth and development of relationships between agencies in the food-related and well-being sectors. FY2019 Outcomes: Collaborating with Wello on several projects. Established a three-year commitment to help support the Farm to School initiative to educate students on the value of fresh garden-grown food and how to do it. - Adopting Healthful Hospital Food American Medical Association Resolution 406 FY2019 Outcomes: All three hospital systems in Brown County have adopted AMA Resolution 406 (Resolution 406: HEALTHFUL HOSPITAL FOODS a call on US hospitals to improve the health of patients, staff, and visitors by (1) providing a variety of healthful food, including plant-based meals and meals that are low in fat, sodium, and added sugars, (2) eliminating processed meats from menus, and (3) providing and promoting healthful beverages. Oral health (sustaining strategies) 1. Promote and improve oral health and assure access to effective and adequate oral health services for the benefit of all Brown County citizens; 2. Reduce the number of oral health related emergency department visits; and 3. Improve the oral health services available for Medicaid and uninsured patients. Long-term performance indicators: HSHS St. Mary's Hospital, partnering closely with the Oral Health Coalition for Brown County, will continue to work with the underserved dental population in Brown County who need dental care. This will ensure this population receives the dental services they need. Strategy One: Outreach Referral Process- HSHS St. Mary's Hospital will work with the Oral Health Partnership and NEW Clinic to increase awareness of medical staff about options for dental treatment for children and adults. Demonstrate via pre and post surveys a 15% increase in medical provider awareness of dental resources. Reduce the number of Green Bay Hospitals' Emergency Departments Visits for Dental Diagnoses by 8% from 2017 to 2019. - Attend meetings at the hospitals with the ER Physicians, OBGYN, and Pediatricians and hand out the Oral Health brochures and RX pads every six months. Track data from RX referrals. FY2019 Outcomes: Referral forms and procedure setup via multiple meetings and contacts with HSHS and Prevea providers regarding OHP, NEW, and NWTC clinics, 5/26/19 urgent care/emergency department meeting at Prevea with roughly 40 doctors and nurses in attendance, 6/7/19 family medicine at Prevea with roughly 40 doctors and nurses in attendance, 7/9/19 emergency department at HSHS St. Mary's with roughly 30 doctors and nurses in attendance. Repeating presentations scheduled for 2019 and 2020, forms shared on routine basis with physicians, OB/Gyns, and Pediatrician offices, forms shared and utilized, referrals for dental taking place. Future progress will involve training new providers and reminding existing providers of referrals and info - A member of the oral health team will monitor dental access for disabled patients who need to be seen in hospital under sedation. FY2019 Outcomes: Wisconsin legislation LRB 1947 is related to allowing Dental Therapists in Wisconsin that might better help people with disabilities, other legislation is considering raising dental reimbursement rates for people with disabilities under sedation, Children's Hospital of Wisconsin is leading an effort to train more dental providers to work with people with disabilities. Strategy Two: Marquette Student Externship HSHS St. Mary's Hospital will work with the Oral Health Partnership and NEW Clinic as they host Marquette dental student in Brown County to attract more Marquette dental professionals to Brown County. - Visit Tri County to see how program works for their clinic. FY2019 Outcomes: Planned to receive 2 students 4 days a week at OHP in fall 2019, - Outflow to Marquette School of Dentistry FY2019 Outcomes: Marquette had to delay until spring or fall 2020 - Involve local dentist's through the BDK (Brown, Door & Kewaunee) /mentorship |
| Schedule H, Part V, Section B, Line 11 Facility , 4 | Facility , 4 - HSHS St. Mary's Hospital Green Bay. FY2019 Outcomes: Two volunteer BDK dentists assisted OHP patients and learned about OHP workflow for future mentorship, future trainings for other dentists upcoming. Strategy Three: Healthy Smiles for Mom and Baby HSHS St. Mary's Hospital will work with the Oral Health Partnership and NEW Clinic Children and Pregnant women in Brown County have more favorable overall health, and lower caries (tooth decay) rates. By June 2021, increase the % of pregnant women in WIC who utilize dental services at NEW Clinic from 23% to 33%. By June 2021, increase the % of Children age 1-5 years in WIC who utilize dental services at OHP from 25% to 35%. Explore option if an oral health intake question can be added to the OB/GYN health histories in EPIC. FY2019 Outcomes: Oral Health Coalition of Brown County working with group in Madison that successfully added EPIC question to entire hospital group, no solid plans to add question and work with EPIC/HSHS yet. Strategy Four: Legislative Pursuits Increase medical, dental, and legislative cooperation via health professional meetings and legislative lobbying efforts Identify ideas how Oral Health would like to present the oral health coalition to legislative members by June 30, 2021 FY2019 Outcomes: Two health professional meetings were held - one with Mary Otto, a national speaker on pediatric dental care and prevention on 4/30/19 with 100 people in attendance, event scheduled with Dr. Brian Novy for 10/28/19 with dentists, doctors, and other health providers - (2 CME credits provided). Oral Health Coalition of Brown County scheduled future legislative meetings, to be held in 2020 Community Health Needs that are not being addressed Environmental health: Being a provider of health care services through inpatient and outpatient services, the hospital does not have the expertise or resources to take the lead on addressing this priority in the region. However, in our role as an employer, HSHS St. Mary's Hospital is involved in many initiatives that contribute to helping our community members as their health is impacted due to environmental health (e.g. Double Your Bucks program helps community members receive healthy food from a local farmers market; recycling efforts lead to less waste and reduces our carbon footprint; Mission Outreach programs help recycle medical equipment and make it available to those who are in need, but do not have a means of obtaining such equipment). Creating a culture of safety: Being a provider of health care services through inpatient and outpatient services, the hospital does not have the resources to address the various factors that affect safety in the region. HSHS St. Mary's Hospital does lead daily huddles that examine our culture of safety and addresses safety issues immediately by 1) establishing action plans to address safety, 2) fostering an environment where safety issues are transparent and openly discussed, and 3) having colleagues complete a culture of safety evaluation annually. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - St. Mary's Hospital Medical Center. Presumptive Eligibility provides indivuals 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 the date of service or for non-covered services. 5. Incarceration in a penal institution 6. Enrollment in one of the following assistance programs for low-income individuals. 6a. Temporary assistance for needy families (TANF) 6b. Illinois Housing Development Authority Rental Housing Support Program. 7. Wisconsin Department of Health Services Housing Assistance Program. 8. Participation in Women, Infants and Children Program (WIC 9. Supplemental Nutrition Assistance Program (SNAP) 10. Illinois Free Lunch and Breakfast Program 11. Wisconsin Free Lunch Program. 12. Low Income Home Energy Assistance Program (LIHEAP). 13. Wisconsin Home Energy Assistance Program (WHEAP) 14. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria 15. Receipt of grant assistance for medical services. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation | 3944300 |
| 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 FY2019 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 | Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors who do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria up to 400% of the federal poverty level will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for Doubtful Accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations. The Hospital reports bad debt in accordance with Generally Accepted Accounting Principles (GAAP). |
| 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 in the HSHS Consolidated Audit Report. Please also reference Footnote 2Q on page 14 for an explanation of how the financials account for bad debt. |
| 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 management 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. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Mary's Hospital is relieving the burden of the government. Accordingly, this shortfall restricts HSHS St. Mary's Hospital's ability to make funds available to provide charity care and other community benefit. The hospital computes the unpaid costs of providing care to Medicare patients by comparing the cost of the services to the reimbursement received from Medicare during the year. The cost of Medicare services is calculated by applying the ratio of patient care cost to charges to the annual Medicare charges. The patient care cost is determined by reducing the total annual operating expense by bad debt expenses, Medicaid provider taxes and community benefit expense. The difference between the reimbursement received and the calculated cost of the services is reported as the Medicare shortfall. The hospital's Medicare shortfall at cost for FY2019 was $18.6 million. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government 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. MARY'S HOSPITAL MEDICAL CENTER: Line 16a URL: http://www.hshs.org/FAP; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16b URL: http://www.hshs.org/FAP; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. MARY'S HOSPITAL MEDICAL CENTER: Line 16c URL: http://www.hshs.org/FAP; |
| Schedule H, Part VI, Line 2 Needs assessment | HSHS St. Mary's Hospital is continually assessing the health care needs of the community through several avenues. The Hospital Advisory Committee 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. Feedback is also solicited through patient surveys and the Patient Family Engagement Council. The hospital maintains a close relationship with our public health department who also is a good resource regarding the health of our community. HSHS St. Mary's Hospital leaders serve on many local boards and organizations that have direct link or connection to serving Brown County. Through these roles, direct feedback is given on current needs in the community. The organizations include Catholic Charities, Habitat for Humanity, St John's Homeless Shelter, NEW Community Clinic and WELLO (wellness). |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | HSHS St. Mary's Hospital posts the financial assistance brochure and application on the hospital website. In addition, financial assistance applications are available and prominently displayed in waiting and registration areas. Financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our financial assistance program. We also have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. 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 either in person or over the phone 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 financial assistance and lists the internet address where the policy and an application can be obtained. A system called Search America is utilized after failed attempts made by the hospital and our law firm to make contact or work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a presumptive determination as to whether the patient meets charity guidelines to grant charity care or continue collection efforts. |
| Schedule H, Part VI, Line 4 Community information | Brown County, Wisconsin is a primarily urban county, one of 72 Wisconsin counties, located in the northeastern part of the state. HSHS St. Mary's Hospital serves a population of more than 940,000 in 13 counties which spans 9,700 square miles. Brown County is home to a population of 263,378 people of which 96.3% are citizens. The ethnic composition of the population of Brown County is composed of 218,606 Caucasian residents (80.2%), 24,487 Hispanic residents (9.0%), 8,878 Asian residents (3.3%), 8,691 Native American residents (3.3%), and 6,058 Two+ residents (2.3%). In addition to English, the most common languages spoken in Brown County are Spanish (16,298 speakers), Asian and Pacific Islander languages (5,229 speakers), and Other Indo-European languages (3,138 speakers). Compared to other Wisconsin counties, Brown County has a relatively high number of Hmong (3,965 speakers), Other Native North American (377 speakers), and Laotian (260 speakers). Of Brown County's 260,000 residents, approximately 37,000 are covered by Medicaid/BadgerCare. Per the 2019 County Health Rankings, 7% of Brown County's population is uninsured. Approximately 9.7% of Brown County residents live at or below the federal poverty level. (Source: County Health Rankings). Brown County has a median age of 37.6 and a median household income of $56,775. Between 2016 and 2017 the population of Brown County, WI grew from 259,586 to 262,052, a 0.95% increase and its median household income grew from $57,783 to $60,793, a 5.21% increase. A total of 24.1% of the hospital's and community's patients are uninsured or Medicaid recipients (5.8 % uninsured and 18.3 % Medicaid). Of the 72 counties in Wisconsin, Brown County ranks * 31st in overall health outcomes * 58th in health behaviors (tobacco use, diet and exercise, alcohol and drug use) The biggest opportunity for improvement is in excessive drinking and alcohol-impaired driving deaths * 32nd in social economic factors (education, employment, children in poverty, income inequality and community safety Brown County has been designated a dental, mental health, and primary care HPSA (health professional shortage area) and the metro area is an MUA (medically underserved area) per HRSA. HSHS St. Mary's Hospital does not exclude MUAs, low income or minority populations from its service area. There are three not-for-profit general medical surgical hospitals and one for-profit general medical surgical hospital serving Brown County and the surrounding area. In addition, there is one not-for-profit psychiatric hospital, one for-profit psychiatric hospital and one county operated psychiatric hospital in the area. Since most of the population resides in the Green Bay metro area, plans and services focus on this area. |
| 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. Mary's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1888, 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 Brown County, Wisconsin and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Mary's Hospital is responding to community need. In FY2019, for example, the Board dedicated its May 2018 educational session to better understand the recent Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP). The Board of Directors also receives an update on the Community Benefit work at each meeting. Consistent with its exempt purpose, HSHS St. Mary'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. Mary'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. HSHS St. Mary's Hospital also conducts medical research through the Cancer Research Institute and serves as a site for health professionals education. Examples of the reinvestment of HSHS St. Mary's Hospital's surplus funds includes: Welcome Baby, a county-wide screening program that helps to prevent child abuse and neglect in the community by addressing gaps in knowledge and resources. All resident families giving birth in Brown County are screened for risk factors, including financial hardships, education level of the parents, and the disability status of the mother. Based on the screening, the family may be connected to community-based resources. Between January and September of 2019, 655 parents received a Welcome Baby visit at HSHS St. Vincent Hospital and HSHS St. Mary's Hospital Medical Center. Of those 655 parents, 171 were identified as being "at-risk." HSHS St. Mary's Hospital updated the Cath Labs with the latest diagnostic and interventional equipment ($2.24 million) and upgraded the pharmacy to meet all the USP737 standards ($533,601). HSHS St. Mary's Hospital recognizes the critical role dental care plays in overall health and has partnered with the Oral Health Partnership (OHP) for years to provide this public health service. Through the support of HSHS-Eastern Wisconsin Division, the OHP continues to expand to communities throughout Brown County, providing dental care for infants to 19 years, who are uninsured and underinsured. HSHS St. Mary's Hospital actively supported the work of Ben's Wish to help feed low-income students in Brown County by serving as a contributing sponsor to their annual fundraiser/dinner. In addition, the hospital contributed supplies and furniture worth more than $29,860 to the HSHS System's Mission Outreach program. The donations included carts, nebulizers, chairs, IV poles and more items that would otherwise have been thrown away. Items not able to be used by missions in Third World countries are contributed to other agencies such as St. Mary's de Paul, House of Hope, Habitat for Humanity, and the Curative Workshop. In addition, this Annually, HSHS St. Mary's Hospital contributes to the Altrusa House in Green Bay, a non-profit organization that offers a "home away from home" to those who have a loved one in the hospital and need a place to stay. Guests of the Altrusa House generally live greater than 50 miles from Green Bay, are in financial need or require an extended stay in Green Bay due to medical treatment. The 12-bed facility is located just two blocks from St. Mary's Hospital. HSHS St. Mary's Hospital also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2019, HSHS St. Mary's Hospital provided more than $13.7 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 FY2019, HSHS St. Mary's Hospital provided $421,000 (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and nearly $19 million (at cost) in excess of Medicare payment for health care services. HSHS St. Mary'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. Mary'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 16 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. In FY2019, HSHS collectively provided $211.7 million in Community Benefit (9.2% of total hospital expenses). This amount included $27.7 million provided for Financial Assistance (a.k.a. Charity Care) and $142.3 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 $279.9 million. HSHS hospitals also recorded $41.1 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Brian Charlier | ||||||||||||||
| President/COO | $0 | $439,618 | $0 | $23,973 | $0 | $1,290 | $0 | $24,500 | $0 | $25,450 | $0 | $514,831 | $0 | $0 |
| THERESE B PANDL | ||||||||||||||
| PRES / CEO EASTERN WISCONSIN DIVISION | $0 | $702,210 | $0 | $46,929 | $0 | $175,248 | $0 | $144,623 | $0 | $29,679 | $0 | $1,098,689 | $0 | $139,297 |
| MICHAEL W COTTRELL | ||||||||||||||
| BOARD MEMBER/HSHS CFO | $0 | $657,185 | $0 | $15,342 | $0 | $155,634 | $0 | $158,581 | $0 | $31,165 | $0 | $1,017,907 | $0 | $127,730 |
| ANN M CARR | ||||||||||||||
| TREASURER | $0 | $268,272 | $0 | $4,360 | $0 | $57,197 | $0 | $89,873 | $0 | $20,590 | $0 | $440,292 | $0 | $28,431 |
| GREG SIMIA | ||||||||||||||
| DIVISION CFO | $0 | $415,076 | $0 | $0 | $0 | $41,380 | $0 | $60,580 | $0 | $28,644 | $0 | $545,680 | $0 | $0 |
| PAULA HAFEMANN | ||||||||||||||
| Chief Nursing Officer | $0 | $294,736 | $0 | $16,512 | $0 | $19,280 | $0 | $69,430 | $0 | $18,715 | $0 | $418,673 | $0 | $0 |
| JAYNE BLEUEL | ||||||||||||||
| PHARMACIST | $143,312 | $0 | $1,527 | $0 | $0 | $0 | $46,045 | $0 | $23,318 | $0 | $214,202 | $0 | $0 | $0 |
| DANIEL DORAN | ||||||||||||||
| DIVISIONAL DIRECTOR-CARDIOVASCULAR | $172,132 | $0 | $0 | $0 | $390 | $0 | $63,819 | $0 | $19,820 | $0 | $256,161 | $0 | $0 | $0 |
| Scott Stillwell | ||||||||||||||
| Physician | $205,513 | $0 | $0 | $0 | $0 | $0 | $5,304 | $0 | $27,664 | $0 | $238,481 | $0 | $0 | $0 |
| MELISSA WEIDERT | ||||||||||||||
| PHYSICIAN | $243,158 | $0 | $0 | $0 | $495 | $0 | $6,286 | $0 | $6,513 | $0 | $256,452 | $0 | $0 | $0 |
| Jarod Husmann | ||||||||||||||
| DIVISIONAL DIRECTOR-REHAB | $140,068 | $0 | $0 | $0 | $468 | $0 | $10,724 | $0 | $15,921 | $0 | $167,181 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 DOCUMENTS 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 2018; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ANN M. CARR -- $29,653 MICHAEL W. COTTRELL -- $84,073 THERESE B. PANDL -- $89,819 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANN M. CARR -- $28,430 MICHAEL W. COTTRELL -- $127,730 THERESE B. PANDL -- $139,297 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (20 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a PROGRAM SERVICE REVENUE - SURGERY | SURGICAL SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER ARE COMPRISED OF CENTRAL PROCESSING, ANESTHESIA, SURGERY AND PRE/POST OP SURGERY. THIS INCLUDES EIGHT OPERATING ROOM SUITES, A C-SECTION ROOM AND TWO MINOR TREATMENT ROOMS. SERVICES ARE AVAILABLE 24/7 AND INCLUDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. IN FY2019, NEARLY 5,700 SURGICAL PROCEDURES WERE PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, UROLOGY, GYNECOLOGY, ORAL - MAXILLOFACIAL, ORGAN PROCUREMENT, DENTAL, ENT, OPHTHALMOLOGY, PODIATRY AND PLASTICS. ANESTHESIA AND CENTRAL PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. |
| Form 990, Part III, Line 4c PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES | THE IMAGING SERVICES DEPARTMENT AT ST. MARY'S HOSPITAL MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. OVERALL, THE DEPARTMENT PERFORMED NEARLY 8,300 INPATIENT AND NEARLY 31,300 OUTPATIENT EXAMS AND PROCEDURES DURING FY19. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN DIGITAL MAMMOGRAPHY, COMPUTED TOMOGRAPHY, MRI, NUCLEAR MEDICINE, AND ULTRASOUND. THE DEPARTMENT USES A STATE OF THE ART MRI WIDE BORE SCANNER. FIVE INTERVENTIONAL RADIOLOGISTS PROVIDE MINIMALLY INVASIVE PROCEDURES USING IMAGE GUIDANCE. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. |
| Form 990, Part III, Line 4b PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER | CARDIOLOGY SERVICES OFFERS A COMPLETE ARRAY OF CATHETERIZATION LABORATORY PROCEDURES, NONINVASIVE CARDIOVASCULAR DIAGNOSTIC PROCEDURES AND ELECTROPHYSIOLOGY PROCEDURES. THERE WERE OVER 5,000 INPATIENT AND 11,500 OUTPATIENT CARDIAC PROCEDURES IN FY2019. IF NEEDED, A STATE-OF-THE-ART CARDIOVASCULAR OPERATING CENTER (CVOR) IS AVAILABLE NEARBY AT OUR SISTER FACILITY, ST. VINCENT HOSPITAL, FOR CUTTING-EDGE OPEN HEART PROCEDURES BY OUR HIGHLY-SKILLED CARDIOTHORACIC SURGEONS. CVICU SUITES ARE ALSO OFFERED THERE. FOR THOSE PATIENTS WHO NEED FOLLOW-UP, A CARDIO-PULMONARY REHABILITATION PROGRAM IS OFFERED ON SITE AT ST. MARY'S. |
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 60,463,430 including grants of $)(Revenue $ 59,674,252) OTHER PROGRAM SERVICES AT ST. MARY'S HOSPITAL MEDICAL CENTER IS COMPRISED OF FAMILY BIRTHING CENTER, INTENSIVE CARE, EMERGENCY, CENTER FOR DIGESTIVE HEALTH, PHARMACY, LABORATORY, RESPIRATORY THERAPY, REHABILITATION AND OTHER SERVICES. IN FY2019 THE HOSPITAL HAD NEARLY 97,400 OUTPATIENT VISITS, 3,800 ADMISSIONS, OVER 12,500 PATIENT DAYS, 344 BIRTHS AND OVER 26,100 EMERGENCY ROOM VISITS. |
| Form 990, Part IV, Line 24a TAX EXEMPT BONDS | ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. |
| Form 990, Part IV, Line 10 Endowment Funds | The organization maintains temporarily and permanently restricted net assets 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 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. MARY'S MEDICAL CENTER. 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. NICHOLAS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD THE ORGANIZATION'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | PER ARTICLE 6.2 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE WITHIN ITS AUTHORITY THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION AS WELL AS OVERSEE THE FINANCIAL CONDITION OF THE CORPORATION. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE PRESIDENT, THE VICE PRESIDENT, THE SECRETARY, AND THE TREASURER. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SOLE CORPORATE MEMBER OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (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 2.1 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC. (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS 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 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 THE MEMBER; (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 THE MEMBER FROM TIME TO TIME; (I) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (O) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF THE MEMBER. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL HSHS EXECUTIVES, (the top management official, other officers and key employees). INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES (derived from a full market review conducted every other year) TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. The process for reviewing compensation by the compensation committee is completed each fiscal year. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. |
| Form 990, Part VI, Line 19 Required documents available to the public | BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. |
| Form 990, Part IX, Line 11g Other Fees | PROFESSIONAL FEES - Total Expense: 3936092, Program Service Expense: 1732421, Management and General Expenses: 2203671, Fundraising Expenses: 0; ISC FEES - Total Expense: 9453215, Program Service Expense: 0, Management and General Expenses: 9453215, Fundraising Expenses: 0; CONTRACT LABOR - Total Expense: 149834, Program Service Expense: 149834, Management and General Expenses: 0, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 5345928, Program Service Expense: 1308522, Management and General Expenses: 4037406, Fundraising Expenses: ; SHARED SERVICES - Total Expense: 1356457, Program Service Expense: , Management and General Expenses: 1356457, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | THE HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | CHANGE IN PENSION - -8801664; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - -2256955; CHANGE IN FAIR VALUE INTEREST RATE SWAPS - -974840; |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261417684 | HEALTHCARE | IL | -$1,945,270 | $3,230,896 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371668647 | HEALTHCARE | IL | $563,783 | $11,970,191 | KCIN |
| HSHS ACO LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 320465666 | HEALTHCARE & SOCIAL ASSISTANCE | IL | -$381,285 | $458,242 | KCIN |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Yes (true) |
| HOSPITAL SISTERS HEALTHCARE WEST INC | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3) | Type I | HSSI | Yes (true) |
| SACRED HEART HOSPITAL | ||||||||||
| 990 WEST CLAIREMONT AVENUE | EAU CLAIRE | WI | 54701 | 390807060 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST ANTHONY'S HOSPITAL | ||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST ELIZABETH'S HOSPITAL | ||||||||||
| ONE ST ELIZABETHS BLVD | OFALLON | IL | 62269 | 370663567 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST NICHOLAS HOSPITAL | ||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOHN'S HOSPITAL | ||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 9515 HOLY CROSS LANE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 390810545 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST MARY'S HOSPITAL | ||||||||||
| 111 SPRING STREET | STREATOR | IL | 61364 | 362169181 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST VINCENT HOSPITAL | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 51301 | 390817529 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 12866 TROXLER AVENUE | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| ST FRANCIS HOSPITAL | ||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| HOSPITAL SISTERS SERVICES INC | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSHS | Yes (true) |
| HSHS MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 263956318 | HEALTHCARE | IL | 501(c)(3) | Type III-FI | HSSI | Yes (true) |
| HSHS WISCONSIN MEDICAL GROUP INC | ||||||||||
| 3215 EXECUTIVE PARK DRIVE | SPRINGFIELD | IL | 62703 | 264515959 | HEALTHCARE | WI | 501(c)(3) | Type III-FI | HSSI | Yes (true) |
| ORANGE CROSS AMBULANCE INC | ||||||||||
| 919 ASHLAND AVENUE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3) | 10 | ST NICHOLAS | Yes (true) |
| UNITY LIMITED PARTNERSHIP | ||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3) | 10 | HSSI | Yes (true) |
| PRAIRIE EDUCATION & RESEARCH COOPERATIVE | ||||||||||
| 317 NORTH 5TH STREET | SPRINGFIELD | IL | 62701 | 371157915 | HEALTHCARE | IL | 501(c)(3) | 4 | HSSI | Yes (true) |
| ST CLARE MEMORIAL HOSPITAL | ||||||||||
| 855 S MAIN STREET | OCONTO FALLS | WI | 54154 | 390848401 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| HSHS HOLY FAMILY HOSPITAL | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 370792770 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| UTLAUT MEMORIAL FOUNDATION | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 371140166 | FUNDRAISING | IL | 501(c)(3) | Type II | HSSI | Yes (true) |
| HSHS GOOD SHEPHERD HOSPITAL INC | ||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 370512290 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST | ||||||||||
| 200 SOUTH CEDAR STREET | SHELBYVILLE | IL | 62565 | 371778753 | TRUST | IL | 501(a) | GSS | Yes (true) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | Address Line2USAddress/AddressLine2Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAIN CENTER OF WISCONSIN | ||||||||||||||
| 4131 W LOOMIS ROAD | SUITE 300 | GREENFIELD | WI | 53221 | 263155343 | HEALTHCARE | WI | ST VINCENT | Related | $742,948 | $556,009 | 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 | $26,375 | $142,266 | 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 | -$6,697 | $9,753 | false | Yes (true) | 1 | |
| SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP | ||||||||||||||
| 4000 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 823633320 | REAL ESTATE | IL | ST ELIZABETH'S | Related | $337,078 | $1,174,120 | false | false | 0.5 | |
| PRAIRIE HEART INSTITUTE ST JOHN'S | ||||||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 371321197 | HEALTHCARE | IL | HSHS | Related | $0 | $0 | false | false | 1 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Foreign PostalForeignAddress/ForeignPostalCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KIARA INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163401 | HEALTHCARE | IL | HSHS | C Corporation | 1 | Yes (true) | |||||
| LASANTE WISCONSIN INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 391572196 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| LASANTE INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163400 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| PRAIRIE CARDIOVASCULAR | |||||||||||||||
| 619 EAST MASON SUITE 4P57 | SPRINGFIELD | IL | 62701 | 371071858 | HEALTHCARE | IL | KIARA INC | C Corporation | Yes (true) | ||||||
| PREVEA HEALTH SERVICES INC | |||||||||||||||
| 2710 EXECUTIVE DRIVE | GREEN BAY | WI | 54304 | 391839351 | HEALTHCARE | WI | HSSI | C Corporation | 0.5 | Yes (true) | |||||
| PREVEA CLINIC INC | |||||||||||||||
| 2710 EXECUTVE DRIVE | GREEN BAY | WI | 54304 | 391839349 | HEALTHCARE | WI | PHSI | C Corporation | Yes (true) | ||||||
| RENAISSANCE QUALITY INSURANCE LTD | |||||||||||||||
| 980669953 | SELF-INSURANCE | HSSI | C Corporation | 1 | Yes (true) | PO BOX 1159 | GRAND CAYMAN | CJ | KY11102 | CJ | |||||
| OJV INC | |||||||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 460873384 | HEALTHCARE | IL | LASANTE INC | C Corporation | Yes (true) | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ORGANIZATIONS | 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. |