2019-05-14T18:32:50-05:00 2018-06-30 990 2017-07-01 390806315 Columbia St Mary's Hospital Milwaukee Inc COLU 3147338000 400 W River Woods Pkway Glendale WI 53212 Tonya Mershon Tax Officer 2019-05-14 2017 2019-02-21 02:37:17Z Travis Andersen MD Regional President AW 400 W River Woods Pkway Glendale WI 53212 507151514 false 0928 X SEE SCHEDULE O X 1959 WI To improve the health and well-being of all people in the communities we serve. 9 5 3056 325 3459996 -99521 1034455 1346218 455361188 503209602 114914 83886 3567907 2486510 460078464 507126216 151654 0 0 0 215135286 237086649 0 0 0 278862635 273415792 494149575 510502441 -34071111 -3376225 661739923 635605537 155615888 142000019 506124035 493605518 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 329911628 0 503232238 Columbia St. Mary's Hospital Milwaukee, Inc. is a 288-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, Columbia St. Mary's Hospital Milwaukee, Inc. treated 12,157 adults and children for a total of 63,855 patient days of service. The hospital also provided services for 611,207 outpatient visits, which included 4,332 outpatient surgeries and 65,368 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 329911628 true true false true false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 208 0 true 3056 true true true false false false false false true false false false X 9 5 false false false false true true true true true false false false true true true true true false false false X Sara OBrien 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 TINA CHANG CHAIR 1.0 2.0 X X 0 0 0 ROBERT VANHIMBERGEN VICE CHAIR 1.0 3.0 X X 0 0 0 CHRISTINE NUERNBERG SECRETARY/TREASURER 1.0 2.0 X X 0 0 0 ROBERT D LYON MD DIRECTOR/ADMIN MD-STAFF OFFICER 1.0 3.0 X 0 60050 0 LYNNE BRIGGS DIRECTOR 1.0 2.0 X 0 0 0 KEVIN J GONJU MD DIRECTOR/PHYSICIAN 17.0 33.0 X 0 586766 52820 STEPHEN E ROBBINS MD DIRECTOR/ADMIN MD-STAFF OFFICER 1.0 2.0 X 0 9167 0 WENDELL WILLIS DIRECTOR 1.0 2.0 X 0 0 0 TRAVIS D ANDERSEN DIRECTOR/REGIONAL PRESIDENT AW 9.0 41.0 X 0 1367565 44454 KELLY ELKINS PRESIDENT COLUMBIA ST MARY'S 13.0 37.3 X 0 307600 20717 JONATHAN SOHN CFO - ASCENSION, WI 2.0 48.0 X 0 903904 48367 SUZANNE SANICOLA REGIONAL VP OPS-PRIMARY MEDICAL GROUP 10.0 40.0 X 373266 0 45536 RICHARD J SHIMP MD CHIEF MEDICAL OFFICER 15.0 35.0 X 0 480534 42615 SHARON D BAUGHMAN REGIONAL CNO, NORTH 17.0 33.0 X 0 316915 49524 SANJAY S DESHPANDE MD PHYSICIAN 50.0 0 X 1618795 0 58856 ANTHONY J LINN MD PHYSICIAN 50.0 0 X 1389725 0 49565 CRAIG A SCHULZ MD PHYSICIAN 50.0 0 X 1169330 0 53426 EMAD S BOTROS MD PHYSICIAN 50.0 0 X 1101148 0 55967 RICHARD A PIRCON MD PHYSICIAN 50.0 0 X 1095084 0 46939 KEVIN JOHN KLUESNER FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 338950 44158 BRUCE D MCCARTHY MD FORMER KEY EMPLOYEE (END 1/2017) 0.0 50.0 X 0 727375 9730 WILLIAM D HART FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 410069 20854 GERRI G LIETZ-STAFFILENO FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 271033 9776 CLARISSA L COX FORMER KEY EMPLOYEE (END 6/2017) 0.0 50.0 X 0 172450 0 TIMOTHY JAMES WALDOCH FORMER OFFICER (END 12/2016) 0.0 0.0 X 0 257352 40746 6747348 6209730 694050 271 true true false METROPOLITAN ANESTHESIOLOGISTS SC 225 S EXECUTIVE DRIVE BROOKFIELD WI 43005 PHYSICIAN SERVICES 12954757 WISCONSIN RADIOLOGY SPECIALISTS SC PO BOX 44370 MADISON WI 53744 RADIOLOGY SERVICES 1392711 ARUP LABORATORIES 500 S CHIPETA WAY SALT LAKE CITY UT 841081221 LABORATORY SERVICES 1250277 READYMED LLC 5715 STATE ROAD 83 HARTLAND WI 53029 HEALTHCARE STAFFING 1153087 NORTH SHORE PATHOLOGISTS SC 2323 N LAKE DRIVE MILWAUKEEE WI 53211 LABORATORY SERVICES 1026395 25 X 0 0 0 0 202713 1143505 1346218 NET PATIENT SERVICE REVENUE 621990 467903454 467903454 SERVICES TO AFFILIATES 900099 23625106 23625106 PHARMACY REVENUE 446110 18823935 18585768 238167 LAB SERVICES 621500 3373151 455972 2917179 CONTRACTED SERVICES REVENUE 900099 1586299 1586299 -12102343 -12406993 304650 0 503209602 78222 78222 0 0 0 0 745531 0 0 745531 0 745531 745531 0 30962 25298 0 5664 5664 5664 0 0 0 0 0 0 0 0 CAFETERIA/VENDING REVENUE 722514 1071594 1071594 MEDICAL RECORDS FEES 900099 30459 30459 EDUCATION REVENUE 611430 22636 22636 616290 0 0 616290 1740979 507126216 499772242 3459996 2547760 418802 370221 48581 192140054 168760361 23379693 32549087 28588599 3960488 11978706 10521263 1457443 19569 14844 4725 350 350 13519 13519 19168 19168 16319193 17696738 -1377545 0 221950 21392 200558 779096 709911 69185 238049 221144 16905 15185953 8437201 6748752 579314 321929 257385 213466 176426 37040 27185399 7243676 19941723 7848 1400 6448 MEDICAL SUPPLIES 68561967 68575648 -13681 PURCHASED SERVICES 49110222 11450138 37660084 CORPORATE ALLOCATIONS 48228036 48228036 MANAGEMENT FEES TO AFFILIATE 33670152 33670152 13062541 6800737 6261804 0 510502441 329911628 180590813 0 563602 10495 0 655351 27881 1248 58988767 56565568 0 0 0 0 0 443572 6354818 5701169 4924137 4718928 799936481 349206753 463674547 450729728 0 0 0 0 141624 76982 127064547 116702496 661739923 635605537 37524809 36676968 0 0 0 0 0 0 0 0 0 0 0 0 0 0 118091079 105323051 155615888 142000019 X 506124035 493605518 0 0 0 0 506124035 493605518 661739923 635605537 X -3376225 -9142292 X false true X true false X false false false false false false false false true 19168 19168 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 11856580 11856580 631334812 225767114 405567698 4793587 3687432 1106155 138651087 116614755 22036332 13300415 3137452 10162963 450729728 Asset Retir Oblig Asset Bldgs 22257 Deferred Compensation Asset DUE FROM AFFILIATES 109088518 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 4774764 OTHER RECEIVABLES 2816957 116702496 0 DUE TO AFFILIATES 95534900 Pension/Deferred Compensation ESTIMATED 3RD PARTY PAYOR SETTLEMENT 4217869 ACCRUED TAX LIABILITY 1081236 ASSET RETIREMENT LIABILITY 956006 DISCONTINUED OPERATIONS LIABILITIES 143651 LEASE LIABILITIES 573534 OTHER MISCELLANEOUS LIABILITIES 286900 RECOVERY TAIL LIABILITY 1514551 VALUATION ALLOWANCE 1014404 105323051 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX PROVISIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018. true true X true X 250 true X true true true false true true 6406699 514260 5892439 0.0115 119394999 68696850 50698149 0.0993 0 0.0 0 0 125801698 69211110 56590588 0.1109 5252339 1686931 3565408 0.0070 8546328 0 8546328 0.0167 529336 139493 389843 0.0008 0 0 0 0.0 232512 0 232512 0.0005 0 0 14560515 1826424 12734091 0.0249 0 0 140362213 71037534 69324679 0.1358 0 0.0 0 0.0 6831 6831 0.0000 0 0.0 0 0.0 0 0.0 0 0.0 62077 62077 0.0001 0 0.0 0 0 68908 0 68908 0.0001 false 6318742 160093 119281674 130788497 -11506823 X true true 1 1 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE 2301 N LAKE DRIVE MILWAUKEE WI 53211 https://healthcare.ascension.org/Locations/Wisconsin/WIMIL/Milwaukee-Ascension-Columbia-St-Marys-Hos 53 X X X COLUMBIA ST MARY'S HOSPITAL MILWAUKEE 1 false false true X X X X X X X X X 15 true true true true X https://healthcare.ascension.org/Locations/Wisconsin/WIMIL/Milwaukee-Ascension-Columbia-St-Marys-Hos X X true 15 true https://healthcare.ascension.org/Locations/Wisconsin/WIMIL/Milwaukee-Ascension-Columbia-St-Marys-Hos false true X 250.0 400.0 X X X X true true X X X true X https://healthcare.ascension.org/Financial-Assistance/wisconsin X https://healthcare.ascension.org/Financial-Assistance/wisconsin X https://healthcare.ascension.org/Financial-Assistance/wisconsin X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E TO BETTER TARGET COMMUNITY RESOURCES ON THE SERVICE AREA'S MOST PRESSING HEALTH NEEDS, THE HOSPITAL PARTICIPATED IN A GROUP DISCUSSION WITH ORGANIZATIONAL DECISION MAKERS AND COMMUNITY LEADERS TO PRIORITIZE THE SIGNIFICANT COMMUNITY HEALTH NEEDS WHILE CONSIDERING SEVERAL CRITERIA: ALIGNMENT WITH ASCENSION HEALTH STRATEGIES OF HEALTHCARE THAT LEAVES NO ONE BEHIND; CARE FOR THE POOR AND VULNERABLE; OPPORTUNITIES FOR PARTNERSHIP; AVAILABILITY OF EXISTING PROGRAMS AND RESOURCES; ADDRESSING DISPARITIES OF SUBGROUPS; AVAILABILITY OF EVIDENCE-BASED PRACTICES; AND COMMUNITY INPUT. THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AS IDENTIFIED THROUGH THE CHNA. SEE SCHEDULE H, PART V, LINE 7 FOR THE LINK TO THE CHNA AND SCHEDULE H, PART V, LINE 11 FOR HOW THOSE NEEDS ARE BEING ADDRESSED. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. THE CHNA WAS CONDUCTED TO INCLUDE THREE LEVELS OF INFORMATION: A COMMUNITY TELEPHONE SURVEY OF RESIDENTS TO GATHER THEIR INPUT ON COMMUNITY HEALTH NEEDS; A SECONDARY DATA REPORT COMMISSIONED FROM A CONSULTANT PROFICIENT IN GATHERING AND INTERPRETING OF DATA FROM PUBLIC HEALTH DEPARTMENTS, STATE ORGANIZATIONS AND NON-PROFIT ORGANIZATIONS WORKING IN THE FIELD OF HEALTH; AND INTERVIEWS WITH KEY STAKEHOLDERS IN THE FIELD OF HEALTH. A LIST OF THE ORGANIZATIONS THAT PROVIDE INPUT ARE LISTED BELOW. T DENOTES THIS ORGANIZATION REPRESENTS LOW-INCOME POPULATIONS. TT DENOTES THIS ORGANIZATION REPRESENTS MEDICALLY UNDERSERVED POPULATIONS. TTT DENOTES THIS ORGANIZATION REPRESENTS MINORITY POPULATIONS. * AIDS RESOURCE CENTER OF WISCONSIN T,TT, * APOSTLE PRESBYTERIAN CHURCH T,TT, * BLACK HEALTH COALITION OF WISCONSIN, INC. T,TT,TTT * BOYS & GIRLS CLUB T,TT, * CENTER FOR VETERANS ISSUES T,TT, * CENTRO HISPANO T,TT,TTT * CHILDREN'S HOSPITAL OF WISCONSIN T,TT, * CHILDREN'S HEALTH ALLIANCE OF WISCONSIN/ MILWAUKEE COUNTY ORAL HEALTH TASK FORCE T,TT, * CITY OF MILWAUKEE HEALTH DEPARTMENT T,TT, * CITY OF WEST ALLIS T,TT, * COMMUNITY ADVOCATES T,TT, * CORE/EL CENTO T,TT,TTT * CUDAHY HEALTH DEPARTMENT T,TT, * FRANKLIN HEALTH DEPARTMENT T,TT, * GERALD E. IGNACE INDIAN HEALTH CENTER T,TT,TTT * GREENFIELD HEALTH DEPARTMENT T,TT, * HMONG AMERICAN WOMEN'S ASSOCIATION T,TT,TTT * IMPACT PLANNING COUNCIL T,TT, * MEDICAL COLLEGE OF WISCONSIN INSTITUTE FOR HEALTH AND SOCIETY T,TT, * MENTAL HEALTH AMERICA OF WISCONSIN T,TT, * MILWAUKEE CENTER FOR INDEPENDENCE T,TT,TTT * MILWAUKEE COUNTY BEHAVIORAL HEALTH DIVISION * MILWAUKEE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES T,TT, * MILWAUKEE COUNTY DEPARTMENT ON AGING T,TT, * MILWAUKEE POLICE DEPARTMENT T,TT, * MILWAUKEE PUBLIC SCHOOLS T,TT, * MP3 HEALTH GROUP; T,TT, * NEXT DOOR FOUNDATION T,TT, * NORTH SHORE HEALTH DEPARTMENT T,TT, * OAK CREEK HEALTH DEPARTMENT T,TT, * SOUTH MILWAUKEE HEALTH DEPARTMENT T,TT, * TRI-CITY NATIONAL BANK T, * UNITED WAY OF GREATER MILWAUKEE AND WAUKESHA COUNTY T,TT, * UW-MILWAUKEE JOSEPH J. ZILBER SCHOOL OF PUBLIC HEALTH (2012-2015) T,TT, * WAUWATOSA HEALTH DEPARTMENT T,TT, * WEST ALLIS & WEST MILWAUKEE HEALTH DEPARTMENT T,TT, * WEST ALLIS FIRE DEPARTMENT T,TT, * WEST ALLIS FIRE DEPARTMENT T,TT, * WEST ALLIS/WEST MILWAUKEE CHAMBER OF COMMERCE T,TT, * WEST ALLIS/WEST MILWAUKEE SCHOOL DISTRICT T,TT, * YMCA OF METRO MILWAUKEE T,TT, * YWCA SOUTHEAST WISCONSIN T,TT, Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. AURORA HEALTH CARE CHILDREN'S HOSPITAL OF WISCONSIN FROEDTERT HOSPITAL WHEATON FRANCISCAN HEALTH CARE. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. A LIST OF THE ORGANIZATIONS THAT PROVIDE INPUT ARE LISTED BELOW. MILWAUKEE HEALTH CARE PARTNERSHIP WHICH INCLUDES THE FOLLOWING PARTNERS: * AURORA HEALTH CARE * CHILDREN'S HOSPITAL OF WISCONSIN * FROEDTERT HEALTH * PROGRESSIVE COMMUNITY HEALTH CENTERS * MILWAUKEE HEALTH SERVICE, INC. * SIXTEENTH STREET COMMUNITY HEALTH CENTERS * MEDICAL COLLEGE OF WISCONSIN * CITY OF MILWAUKEE HEALTH DEPARTMENT * MILWAUKEE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES * WISCONSIN DEPARTMENT OF HEALTH SERVICES * THE MEDICAL SOCIETY OF MILWAUKEE COUNTY * THE MILWAUKEE FREE CLINIC COMMUNITY COLLABORATIVE * WISCONSIN STATEWIDE HEALTH INFORMATION NETWORK (WISHIN) * WHEATON FRANCISCAN HEALTHCARE * WISCONSIN HOSPITAL ASSOCIATION * WISCONSIN PRIMARY HEALTH CARE ASSOCIATION. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. SEVERAL REPORTS APPLICABLE TO OUR WISCONSIN HOSPITAL FACILITIES ARE AVAILABLE AT THE MILWAUKEE HEALTH CARE PARTNERSHIP'S (MHCP) WEBSITE AT HTTP://MKEHCP.ORG/PUBLICATIONS. MHCP IS A PUBLIC / PRIVATE CONSORTIUM DEDICATED TO IMPROVING HEALTH CARE COVERAGE, ACCESS, AND CARE COORDINATION FOR UNDERSERVED POPULATIONS IN MILWAUKEE COUNTY, WITH THE GOALS OF IMPROVING HEALTH OUTCOMES, ELIMINATING DISPARITIES, AND REDUCING THE TOTAL COST OF CARE. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. USING THE CHNA COMPLETED IN JUNE 2016, THE HOSPITAL DEVELOPED, ADOPTED, AND WORKED ON EXECUTING A THREE-YEAR IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. IN FISCAL YEAR 2017 (TAX YEAR 2016), THE HOSPITAL IMPLEMENTED THE FOLLOWING PLAN TO ADDRESS THE PRIORITY NEEDS: SUBSTANCE ABUSE -- IMPROVED HEALTH SCREENING AND EDUCATION TO CLIENTS AT SUBSTANCE ABUSE TREATMENT CENTER FOR WOMEN ORAL HEALTH -- IMPROVED ORAL HEALTH SCREENING AND EDUCATION TO DIABETIC PATIENTS -- EXPANDED DENTAL HEALTH SERVICES INTO PRIMARY CARE AND OB CLINICS -- PROVIDED ORAL HEALTH SERVICES IN SCHOOLS -- EXPANDED DENTAL HEALTH SERVICES INTO PRIMARY CARE AND OB CLINICS BREAST CANCER -- PROVIDED MAMMOGRAPHY SCREENINGS IN THE COMMUNITY INFANT MORTALITY -- PROVIDED PRENATAL EDUCATION AND CASE MANAGEMENT -- PROVIDED EDUCATION TO PREGNANT WOMEN THROUGH COLLABORATIVE RELATIONSHIP WITH CHURCHES OBESITY PREVENTION -- INCREASED ACCESS TO HEALTHY FOODS -- INCREASED ACCESS TO HEALTHY FOODS THROUGH VEGETABLE PRESCRIPTION PROGRAM ---------------------------------------------------------------------------------------------------------------------------- EXPLANATION ON NEEDS IDENTIFIED IN CHNA THAT ARE NOT BEING ADDRESSED: SEXUAL HEALTH THIS IS AN AREA IN WHICH CSM WILL NOT PARTICIPATE DIRECTLY. UNITED WAY OF GREATER MILWAUKEE AND WAUKESHA COUNTY HAS LED A TASK FORCE TO REDUCE TEEN PREGNANCY AND SIGNIFICANTLY REDUCED PREGNANCY RATES. CSM HAS NOT PARTICIPATED IN THIS ACTIVITY AND THIS COLLABORATION. OUR RESOURCES ARE WELL USED IN OTHER AREAS OF COMMUNITY LEADERSHIP. INJURY AND VIOLENCE BECAUSE OF THE STRATEGY TO FOCUS ON FALL ASSESSMENT AND INJURIES THIS NEED WILL BE ADDRESSED IN THE SACRED HEART REHABILITATION INSTITUTE COMMUNITY HEALTH IMPROVEMENT PLAN. CHRONIC DISEASE BECAUSE OF THE FOCUS ON DIABETES FRIENDLY FOOD PANTRY AND SACRED HEART REHABILITATION INSTITUTE'S HISTORY OF SUPPORT OF THE EBENEZER FOOD PANTRY AS WELL AS THE ROLE OF DIABETES IN CHRONIC DISEASES RELATED TO REHABILITATION, THIS NEED WILL BE ADDRESSED IN THE SACRED HEART REHABILITATION INSTITUTE COMMUNITY HEALTH IMPROVEMENT PLAN. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.. THE FILING ORGANIZATION TAKES SEVERAL PROACTIVE APPROACHES TO MAKE PATIENTS AWARE OF OUR FINANCIAL ASSISTANCE POLICY. IN ADDITION TO OUR POLICY BEING POSTED ON OUR WEBSITE AND AVAILABLE TO ANYONE WHO REQUESTS ONE, THERE IS ABUNDANT SIGNAGE THROUGHOUT OUR FACILITY EXPLAINING OUR FINANCIAL ASSISTANCE POLICY AND HOW TO OBTAIN THE ACTUAL POLICY, IF DESIRED. NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE DISPLAYED IN HIGHLY VISIBLE LOCATIONS WHERE THERE IS A SIGNIFICANT VOLUME OF INPATIENT OR OUTPATIENT TRAFFIC SUCH AS IN INPATIENT AND OUTPATIENT ADMITTING AND REGISTRATION AREAS, PHYSICIAN OFFICES, AND EMERGENCY DEPARTMENTS. BROCHURES DESCRIBING THE POLICY ARE AVAILABLE IN THE SAME LOCATIONS, AND THE POLICY IS DISCUSSED AT THE TIME OF REGISTRATION OR PRE-REGISTRATION, ADMISSION, DISCHARGE, AND WITH BILLING FOR THOSE IDENTIFIED WITH A NEED. PATIENTS WHO CALL AND EXPRESS A FINANCIAL HARDSHIP WITH PAYING THEIR BILL WILL BE ASSISTED BY A CUSTOMER SERVICE REPRESENTATIVE, WHO WILL ASSIST THE PATIENT IN SETTING UP AN APPOINTMENT TO MEET WITH A FINANCIAL ADVOCATE WHO WILL GO OVER THE FINANCIAL ASSISTANCE POLICY IN DETAIL, GET THE FINANCIAL ASSISTANCE APPLICATION PROCESS STARTED, AND EDUCATE THE PATIENT REGARDING ANY QUESTIONS THEY MAY HAVE. LASTLY, OUR PATIENT STATEMENTS ALSO INCLUDE NOTIFICATIONS ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE AND A PHONE NUMBER TO CALL FOR MORE INFORMATION. ADDITIONALLY, OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL ASSISTANCE APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE ON OUR WEBSITE, HTTP://WWW.COLUMBIA-STMARYS.ORG/OTH/PAGE.ASP?PAGEID=OTH000609. THE FINANCIAL ASSISTANCE POLICY, APPLICATION, PLAIN LANGUAGE SUMMARY, AND PROVIDER LISTING HAS BEEN TRANSLATED INTO 7 LANGUAGES: ENGLISH, SPANISH, HMONG, LAOTIAN, ARABIC, RUSSIAN, AND SERBIAN/CROATIAN. 27 Prospect Medical Commons 2311 N Prospect Ave Milwaukee WI 53211 Clinic Van Dyke Cancer Center - Milwaukee 2350 N Lake Drive Suite 100 Milwaukee WI 53211 Clinic River Woods Outpatient Center 375 W Riverwoods PKWY Glendale WI 53212 Outpatient Center Gateway Medical Center 801 S 70th st West Allis WI 53214 Clinic Glendale Green Bay Clinic 9233 N Green Bay Road Brown Deer WI 53209 Clinic CSM Cardiovascular Specialists - WTMC 2350 N Lake Drive Suite 400 Milwaukee WI 53211 Clinic CSM Cardiovascular Specialists - Electrophysiology - WTMC 2350 N Lake Drive Suite 206 Milwaukee WI 53211 Clinic CSM Cardiovascular Specialists - Electrophysiology - West Allis 801 S 70th st West Allis WI 53214 Clinic CSM Cardiovascular Specialists - Electrophysiology - Bay View 3056 S Kinnickinnic Ave Suite 302 Milwaukee WI 53207 Clinic West Allis Medical Clinic 2323 S 102ND St West Allis WI 53227 Clinic Airport Medical Clinic 4848 S 6th Street Milwaukee WI 53221 Clinic Columbia West Clinic 10950 W Capitol Drive Wauwatosa WI 53222 Clinic Glendale Port Washington Clinic 6900 N Port Washington Road Glendale WI 53217 Clinic Bay View Family Health Center 3056 S Kinnickinnic Ave Milwaukee WI 53207 Clinic Westgate Medical Group 2727 N Mayfair Road Wauwatosa WI 53222 Clinic River Woods Urgent Care 375 W Riverwoods PKWY Glendale WI 53212 Clinic Shorewood Family Physicians 1901 E Capitol Drive Shorewood WI 53211 Clinic Cathedral Square Express Care Center 734 N Jackson St Milwaukee WI 53202 Clinic Family Health Center 1121 E North Ave Milwaukee WI 53212 Clinic ENT Associates 2350 N Lake Drive Suite 406 Milwaukee WI 53211 Clinic Center For Pain Management 3056 S Kinnickinnic Ave Milwaukee WI 53207 Clinic CSM Urogynocology 2350 N Lake Drive Suite 504 Milwaukee WI 53211 Clinic CSM Cardiovascular Specialists - Bay View 3056 S Kinnickinnic Ave Suite 300 Milwaukee WI 53207 Clinic CSM Behavioral Medicine Clinic 2323 N Lake Drive Milwaukee WI 53211 Clinic St Elizabeth Ann Seton Dental Clinic 1730 S 13th Street Milwaukee WI 53204 Clinic Perinatal Assessment Center 2323 N Lake Drive Milwaukee WI 53211 Clinic St Ben's Clinic 1027 N 9th Street Milwaukee WI 53233 Clinic Schedule H, Part I, Line 7g Subsidized Health Services COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. DID NOT INCLUDE ANY SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO PHYSICIAN CLINICS. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COST OF PROVIDING CHARITY CARE, MEANS-TESTED GOVERNMENT PROGRAMS, AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE, A COST-TO-CHARGE RATIO WAS CALCULATED AND APPLIED. Schedule H, Part II Community Building Activities ASCENSION COLUMBIA ST. MARY'S MILWAUKEE HOSPITAL PROVIDES JOB SHADOWING EXPERIENCES FOR MILWAUKEE COUNTY HIGH SCHOOL STUDENTS. STUDENTS ARE PLACED IN VARIOUS DEPARTMENTS WORKING WITH A CSM STAFF AND ARE ASSIGNED A MENTOR. THE PROGRAM IS DESIGNED TO TEACH CHILDREN WITH PHYSICAL, EMOTIONAL AND COGNITIVE DISABILITIES JOB TRAINING/ READINESS SKILLS ALONG WITH ACCEPTABLE WORK BEHAVIORS. ACCORDING TO THE COUNTY HEALTH RANKINGS, EMPLOYMENT PROVIDES INCOME AND, OFTEN, BENEFITS THAT CAN SUPPORT HEALTHY LIFESTYLE CHOICES. UNEMPLOYMENT AND UNDER EMPLOYMENT LIMIT THESE CHOICES, AND NEGATIVELY AFFECT BOTH QUALITY OF LIFE AND HEALTH OVERALL. FUTURE COMMUNITY LEADERS WHO ARE KNOWLEDGEABLE ABOUT BOTH THE ASSET AND CHALLENGES OUR COMMUNITY HAS WILL HELP US TO POSITIVELY ADDRESS THE HEALTH ISSUES OF THE FUTURE. ASCENSION COLUMBIA ST. MARY'S MILWAUKEE HAS A COLLABORATION WITH THE INROADS PROGRAM TO PROVIDE CULTURALLY DIVERSE COLLEGE STUDENTS AN OPPORTUNITY TO EXPERIENCE THE HEALTHCARE WORKPLACE AND LEARN VALUABLE LEADERSHIP SKILLS DURING THEIR INTERNSHIP. ASCENSION COLUMBIA ST. MARY'S MILWAUKEE ALSO COORDINATES A THANKSGIVING FOOD DISTRIBUTION PROGRAM. RESIDENTS OF MILWAUKEE COUNTY LIVING IN POVERTY CAN RECEIVE FOOD AND OTHER BASIC NESSES SITES TO ASSIST WITH REDUCING FOOD INSECURITY. FOOD INSECURITY HAS BEEN SHOWN TO BE LINKED TO INCREASED RISK OF CHRONIC DISEASES, PARTICULARLY AMONG LOW INCOME POPULATIONS. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE CORPORATION FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITHIN COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY ASCENSION HEALTH. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE CORPORATION'S POLICIES. AFTER APPLYING THE COST-TO-CHARGE RATIO, THE SHARE OF THE BAD DEBT EXPENSE IN FISCAL YEAR 2018 WAS $19,485,314 AT CHARGES, ($6,318,742 AT COST). Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote THE ORGANIZATION IS PART OF THE ASCENSION HEALTH ALLIANCE'S CONSOLIDATED AUDIT IN WHICH THE FOOTNOTE THAT DISCUSSES THE BAD DEBT EXPENSE IS LOCATED ON PAGE 21. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A COST TO CHARGE RATIO IS APPLIED TO THE ORGANIZATION'S MEDICARE EXPENSE TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT. ASCENSION HEALTH AND ITS RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE ORGANIZATION FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. Schedule H, Part V, Section B, Line 16a FAP website - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE: Line 16a URL: https://healthcare.ascension.org/Financial-Assistance/wisconsin; Schedule H, Part V, Section B, Line 16b FAP Application website - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE: Line 16b URL: https://healthcare.ascension.org/Financial-Assistance/wisconsin; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE: Line 16c URL: https://healthcare.ascension.org/Financial-Assistance/wisconsin; Schedule H, Part VI, Line 2 Needs assessment IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, COLUMBIA SAINT MARY'S HOSPITAL, MILWAUKEE USES BOTH HOSPITAL DATA AND RELIABLE, THIRD PARTY REPORTS, INCLUDING DATA FROM GOVERNMENT SOURCES, TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY IT SERVES. THESE REPORTS PROVIDE INFORMATION ABOUT KEY HEALTH, SOCIOECONOMIC, AND DEMOGRAPHIC INDICATORS THAT POINT TO AREAS OF NEED. COLUMBIA SAINT MARY'S HOSPITAL, MILWAUKEE UTILIZES THIS INFORMATION TO DETERMINE DEVELOP PROGRAMS AND SERVICES TO BE PROVIDED FOR THE COMMUNITY. THESE NEEDS AND INITIATIVES ARE PRESENTED TO SENIOR LEADERSHIP AND BOARD MEMBERS TO ENSURE THE FINDINGS ARE CONSIDERED IN DEVELOPING THE ORGANIZATION'S STRATEGY, POLICY DEVELOPMENT, AND INTERNAL FINANCIAL AND OPERATIONAL DECISIONS. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance THE FILING ORGANIZATION IS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL (OR HEALTH SYSTEM), IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, OUR FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES AND IS PROVIDED FOR THOSE WHO EARN UP TO 400% OF THE FEDERAL POVERTY LEVEL. THE FOLLOWING DOCUMENTS ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AT: HTTPS://WWW.MYWHEATON.ORG/ABOUT-WHEATON/BILLING-INFORMATION/#POLICY - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY THE ORGANIZATION ALSO MAKES PAPER COPIES OF THE FOLLOWING DOCUMENTS AVAILABLE UPON REQUEST: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE, AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. THE ORGANIZATION INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION CAN BE OBTAINED. SIGNAGE DISPLAYED IN THE EMERGENCY ROOM AND ADMISSION AREA ALSO INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY. Schedule H, Part VI, Line 4 Community information PLEASE SEE DETAILED INFORMATION PROVIDED AT SCHEDULE H PART V SECTION B LINES 1-12 AND PART VI LINE 5. Schedule H, Part VI, Line 5 Promotion of community health THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING DIVERSE ASPECTS AND INTERESTS OF THE COMMUNITY. MANY MEMBERS OF the GOVERNING BODY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA; WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. SURPLUS FUNDS ARE PROVIDED TO FUND IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH THROUGH DONATIONS FROM SUPPORTING ORGANIZATIONS. PLEASE ALSO SEE PART III FOR COMMUNITY ACTIVITIES UNDERTAKEN BY THIS ORGANIZATION, AS WELL AS A COMPILATION OF REGIONAL CHARITY CARE INFORMATION. Schedule H, Part VI, Line 6 Affiliated health care system THE FILING ORGANIZATION IS AN AFFILIATE OF COLUMBIA ST. MARY'S, INC. AND ASCENSION HEALTH. THE HOSPITAL'S AFFILIATES ARE LARGE MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT MINISTRIES INCLUDING HOSPITAL AND NON-HOSPITAL MINISTRIES (PHYSICIAN GROUP PRACTICES, HOSPITAL ORGANIZATIONS, RESEARCH, HOME HEALTH, DURABLE MEDICAL EQUIPMENT AND SENIOR FACILITIES). THESE MINISTRIES WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF SERVING AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION AND RESEARCH. THE ORGANIZATIONS WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVEL. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ORGANIZATIONS/ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING HEALTHCARE SERVICES IN THE SOUTHEAST WISCONSIN AREA, REGARDLESS OF THE PERSON'S ABILITY TO PAY, BECAUSE IT IS OUR MISSION TO IMPROVE THE LIVES OF THOSE IN THE COMMUNITIES WE SERVE. true true false false false false false false false KEVIN J GONJU MD DIRECTOR/PHYSICIAN 0 578242 0 1000 0 7524 0 17550 0 35270 0 639586 0 0 TRAVIS D ANDERSEN DIRECTOR/REGIONAL PRESIDENT AW 0 563166 0 701999 0 102400 0 13500 0 30954 0 1412019 0 0 TIMOTHY JAMES WALDOCH FORMER OFFICER (END 12/2016) 0 209647 0 46613 0 1092 0 12417 0 28329 0 298098 0 0 KELLY ELKINS PRESIDENT COLUMBIA ST MARY'S 0 282409 0 0 0 25191 0 4696 0 16021 0 328317 0 0 JONATHAN SOHN CFO - ASCENSION, WI 0 505898 0 270732 0 127274 0 14885 0 33482 0 952271 0 0 KEVIN JOHN KLUESNER FORMER KEY EMPLOYEE (END 6/2017) 0 257247 0 58967 0 22736 0 16100 0 28058 0 383108 0 0 BRUCE D MCCARTHY MD FORMER KEY EMPLOYEE (END 1/2017) 0 69797 0 0 0 657578 0 3152 0 6578 0 737105 0 0 WILLIAM D HART FORMER KEY EMPLOYEE (END 6/2017) 0 306049 0 66840 0 37180 0 17550 0 3304 0 430923 0 0 GERRI G LIETZ-STAFFILENO FORMER KEY EMPLOYEE (END 6/2017) 0 26969 0 0 0 244064 0 2195 0 7581 0 280809 0 0 CLARISSA L COX FORMER KEY EMPLOYEE (END 6/2017) 0 0 0 0 0 172450 0 0 0 0 0 172450 0 0 SUZANNE SANICOLA REGIONAL VP OPS-PRIMARY MEDICAL GROUP 268274 0 63859 0 41133 0 17325 0 28211 0 418802 0 0 0 RICHARD J SHIMP MD CHIEF MEDICAL OFFICER 0 364550 0 82203 0 33781 0 13500 0 29115 0 523149 0 0 SHARON D BAUGHMAN REGIONAL CNO, NORTH 0 249824 0 56892 0 10199 0 15702 0 33822 0 366439 0 0 SANJAY S DESHPANDE MD PHYSICIAN 1540309 0 73584 0 4902 0 14850 0 44006 0 1677651 0 0 0 ANTHONY J LINN MD PHYSICIAN 863258 0 33000 0 493467 0 17550 0 32015 0 1439290 0 478989 0 CRAIG A SCHULZ MD PHYSICIAN 1163432 0 1184 0 4714 0 16200 0 37226 0 1222756 0 0 0 EMAD S BOTROS MD PHYSICIAN 1095246 0 1000 0 4902 0 14850 0 41117 0 1157115 0 0 0 RICHARD A PIRCON MD PHYSICIAN 1086460 0 1000 0 7624 0 16200 0 30739 0 1142023 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ascension Health, a related organization of Columbia St. Mary's Hospital Milwaukee Inc. uses the following to establish the compensation of the organization's President: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual(s) received severance payments from the organization or a related organization during calendar year 2017 : Clarissa Cox - $171,040 Gerri G Lietz-Staffileno - $234,140 Bruce D McCarthy - $541,659 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payment from the supplemental nonqualified retirement plan in the amount as noted during calendar year 2017 : Anthony Linn - $478,989 Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE PRESIDENT WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED BY COLUMBIA ST. MARY'S INC., A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S HOSPITAL OF MILWAUKEE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders Columbia St. Mary's Hospital Milwaukee, Inc. has a single corporate member, Columbia St. Mary's, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Columbia St. Mary's Hospital Milwaukee, Inc. (CSM-M) has a single corporate member, Columbia St. Mary's, Inc. who has the ability to elect members to the governing body of Columbia St. Mary's Hospital Milwaukee, Inc. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to Columbia St. Mary's Hospital Milwaukee, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Columbia St. Mary's, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public The Organization will provide any documents open to public inspection upon request. Form 990, Part VIII, Line 2f Other Program Service Revenue INCOME FROM JOINT VENTURES - Total Revenue: -13541643, Related or Exempt Function Revenue: -13541643, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; MANAGEMENT FEES - Total Revenue: 609944, Related or Exempt Function Revenue: 305294, Unrelated Business Revenue: 304650, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; CONSULTING FEES - Total Revenue: 11349, Related or Exempt Function Revenue: 11349, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; PROGRAM REVENUE - Total Revenue: 818007, Related or Exempt Function Revenue: 818007, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue ESCHEATMENT REVENUE - Total Revenue: 1001, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1001; PARKING REVENUE - Total Revenue: 4290, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 4290; MISCELLANEOUS REVENUE - Total Revenue: 610999, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 610999; Form 990, Part XI, Line 9 Other changes in net assets or fund balances TRANSFERS WITH ALPHA FUND - -9186815; TRANSFER WITH AFFILIATE - 44523; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS THE ACTIVITY OF COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. IS COMPLETED. THEREFORE, THE ATTACHED AUDITED FINANCIAL STATEMENTS ARE OF ASCENSION HEALTH ALLIANCE AND AFFILIATES, WHICH INCLUDE THE ACTIVITY OF COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC. Form 990, Part XII, Line 2c AUDIT COMMITTEE COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE, INC.IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. THE FINANCE AND AUDIT COMMITTEE OF ASCENSION HEALTH ALLIANCE'S BOARD ASSUMES RESPONSIBILITY FOR THE CONSOLIDATED ORGANIZATION AS A WHOLE. 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