2019-05-14T08:30:18-05:00 2018-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2017-07-01 371208459 St Joseph's Hospital - Hospital Sisters - Third Order of St Francis STJO 6185264511 9515 HOLY CROSS LANE PO BOX 99 Breese IL 622300099 Chris Klay PRESIDENT AND CEO 2019-05-14 true RACHEL SPURLOCK P00520729 3128997000 2017 2019-02-21 02:37:17Z Chris Klay 9515 HOLY CROSS LANE PO BOX 99 Breese IL 622300099 60962070 false 0928 X WWW.STJOEBREESE.COM X 1987 IL OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. 12 10 458 400 296890 -42645 19089 551486 59896265 55884518 4687945 3181464 720464 806720 65323763 60424188 0 0 23087395 20908861 0 0 30942146 30830725 54029541 51739586 11294222 8684602 168009457 176869199 37148311 33303913 130861146 143565286 OUR MISSION OF ST. JOSEPH'S HOSPITAL IS TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY false false 42799777 56394348 SEE SCHEDULE O - PROGRAM SERVICE ACCOMPLISHMENTS 42799777 true true false true false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false true true false false false true 48 0 true 458 true true true false false false false false true false false false X 12 10 false false false false true true true true true false false true true true true true true true true false X JOHN JEFFRIES 6185265312 9515 HOLY CROSS LANE BREESE IL 62230 PAULETTE EVANS President and CEO (Partial Year) 60.0 0 X X 0 228339 104866 AMY M BALLANCE Interim CEO (partial year) 7.8 29.0 X X 0 227863 69692 CHRIS KLAY PRESIDENT 60.0 0 X X 0 78175 15927 JOHN HUDSPETH 2017 & 2018 Chair 1.0 0 X X 0 0 0 GEORGE KRUSE 2017 & 2018 VICE CHAIR 1.0 0 X X 0 0 0 TOM BROECKLING 2017 & 2018 SECRETARY 1.0 0 X X 0 0 0 DAVID BEACH BOARD MEMBER 1.0 59.0 X 0 380886 53273 SR MARYBETH CULNAN OSF BOARD MEMBER/HSHS Sister 1.0 10.0 X 0 0 0 SISTER MARGUERITE COOK OSF BOARD MEMBER 1.0 3.0 X 0 0 0 John Fridley BOARD MEMBER 0.0 0 X 0 0 0 ERIN GAGEN MD BOARD MEMBER 1.0 0 X 0 0 0 Dennis Litteken BOARD MEMBER 1.0 0 X 0 0 0 JULIE MASCHHOFF BOARD MEMBER 1.0 0 X 0 0 0 Richelle Rennegarbe PHD Board Member 1.0 0 X 0 0 0 JAMES DOVER CEO SOUTHERN IL DIVISION 7.8 52.2 X 0 786328 119860 DAVID NOSACKA DIVISION CFO 8.0 52.0 X 0 340763 54052 ANN M CARR TREASURER 0.3 59.7 X 0 318511 120197 HELEN ESSENPREIS CNO 40.0 0 X 137748 0 67366 MARGARET A LUNA DIVISION CPO 4.2 29.0 X 0 235644 94198 JACQUELYNNE N HOLST DIVISION ASSOCIATE GENERAL COUNSEL 7.8 29.0 X 0 185912 43182 JOHN JEFFRIES DIRECTOR OF FINANCE 40.0 0 X 184486 0 50754 JOEL A TUCKER DIRECTOR OF PHARMACY 40.0 0 X 149233 0 38467 JENE BIERI DIRECTOR OF PROF. SERVICES 40.0 0 X 140030 0 70075 Barbara Eilers Nurse Supervisor 40.0 0 X 113871 0 17650 EILEEN HAGEN Nurse Supervisor 40.0 0 X 107495 0 1820 832863 2782421 921379 9 false true false INFINITY MEDS 111 E Wisconsin Ave Suite 2100 Milwaukee WI 53202 ER Coverage 973884 PRAIRIE ANESTHESIA ASSOCIATES 12482 Alswell Ln St Louis MO 63128 Anesthesia Services 896207 Sodexo Inc & Affiliates PO Box 360170 Pittsburgh AL 152516170 EVS & Food Services 433209 Comprehensive Anesthesia 19 Willow Creek Dr Highland IL 62249 Anesthesia Services 275573 Jannx Medical Systems 12166 Old Big Bend Rd Kirkwood MO 63122 consulting services 222849 9 529326 22160 551486 Net Patient Service Revenue 900099 55808286 55808286 Medical Office Rent from Affiliate 900099 76232 76232 0 0 0 0 55884518 409825 409825 333269 537882 -204613 0 -204613 -204613 2771639 2771639 0 2771639 2771639 Miscellaneous 900099 631105 631105 Exercise Programs 713940 380228 83338 296890 0 0 0 0 1011333 60424188 56394348 296890 3181464 205114 0 205114 0 15507654 12999818 2507836 374883 314258 60625 3754494 3147332 607162 1066716 894211 172505 48180 40389 7791 49834 41775 8059 478056 478056 1999685 1676304 323381 0 115328 96678 18650 5100422 4275602 824820 1021993 856720 165273 78991 66217 12774 355141 297709 57432 11951220 10018517 1932703 2085780 1748476 337304 521313 437008 84305 PROVIDER TAX 1380495 1157247 223248 MAINTENANCE REPAIRS & SERVICES 1304986 1093949 211037 BAD DEBT 26255 22009 4246 PURCHASED SERVICES 3822764 3204562 618202 490282 410996 79286 0 51739586 42799777 8939809 0 3143579 3040670 12298516 9309246 0 0 0 600631 691072 110644 83963 74248181 47241411 22113686 27006770 129699033 136737478 0 0 43368 0 168009457 176869199 6151447 8022582 16974708 16536607 0 14022156 8744724 37148311 33303913 X 129013611 141959755 1847535 1595376 0 10155 130861146 143565286 168009457 176869199 X 8684602 2468685 1550853 X false true X true true true X false false false false false false false false true 16895 16895 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. JOSEPH'S HOSPITAL, (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HOSPITAL ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 22.98% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.93% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 38.00% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 15.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. JOSEPH'S HOSPITAL, (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE ILLINOIS HOSPITAL ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 22.98% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.93% LOBBYING EXPENSE - ILLINOIS HOSPITAL ASSOCIATION ("IHA") AT 38.00% LOBBYING EXPENSE - NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE AT 15.00% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. 1634241 1634241 34236608 23754720 10481888 24378316 20516326 3861990 13999016 2970365 11028651 27006770 RETIREMENT OBLIGATION-ASBESTOS 2897934 ACCRUED BENEFIT LIABILITY 3252590 Derivative Instruments 2594200 8744724 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501 (c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. 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, 2018 and 2017 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, 2018 and 2017, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X 600 true true false true true 944743 944743 0.0183 6681390 4250074 2431316 0.0470 0 0.0 0 0 7626133 4250074 3376059 0.0653 83228 83228 0.0016 0 0.0 8731558 7314209 1417349 0.0274 0 0.0 0 0.0 0 0 8814786 7314209 1500577 0.0290 0 0 16440919 11564283 4876636 0.0943 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 26256 2626 9796172 17911376 -8115204 X true true 1 1 ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 622300099 WWW.STJOEBREESE.COM 0002527 X X X ST JOSEPH'S HOSPITAL 1 false false true X X X X X X X X X 17 true false true true X https://www.stjoebreese.com/www-sjb/media/SJB-PDF-Documents/FY2018-SJB-CHNA-Report.pdf X true 17 true https://www.stjoebreese.com/www-sjb/media/SJB-PDF-Documents/FY2018-SJB-Implementation-Plan.pdf false true X 200.0 600.0 X X X X X X true true X X X true X http://www.hshs.org/fap X http://www.hshs.org/fap X http://www.hshs.org/fap X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Yes, the significant health needs are a prioritized description of the significant health needs of the community and identified through the CHNA process. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. HSHS St. Joseph's Hospital, Breese, completed their FY2018 Community Health Needs Assessment (CHNA) in June 2018. In addition to reviewing available secondary data, St. Joseph's Hospital conducted engagement sessions to gain input from those representing the broader community and vulnerable populations. Three focus group meetings were held and attendees included individuals who work in city government, the education system, medical field, senior services, social service agencies and public health. To gain community input for the FY2018 CHNA, a variety of stakeholders were asked to participate in the engagement sessions. Engagement session participants were identified in coordination with the University of Illinois Survey Research Office. Organizations and institutions represented included the following: * Breese District 12 Elementary School* * Catholic Charities* * City of Breese * City of New Baden * Clinton County Coroner's Office * Clinton County Health Department* * Community Link, serving the developmentally disabled* * Community Physicians * Community Resource Center - Centralia* * Countryside Manor Nursing Home - Aviston * Hoyleton Youth and Family Services * * HSHS Home Care Southern IL * Kaskaskia College, an area community college * SAFE (Sexual Assault and Family Emergencies Center)* * South Central Transit, public transportation provider * Trenton Village Retirement * University of Illinois Extension * Wesclin CUSD #3* * YMCA *Denotes group representing medically underserved, low-income, and/or minority populations. In addition, St. Joseph's Hospital in Breese is one of the leading members of the Clinton County Health Improvement Coalition. Organized in 2014, the adopted purpose of the coalition is to "collaborate with community partners to advance the health and quality of life for the residents of Clinton County through the assessment of needs and development of education and preventative initiatives". The coalition consists of 20 not-for-profit organizations and social service agencies. Steering committee members of the coalition were first presented the community health needs assessment for their review. The group of seven reviewed the primary and secondary data gathered during the assessment. Following discussion of these findings, the group consensus supported the identified priorities and recommended the information for the full Coalition membership to review. With nine members present at the May 2018 meeting, Clinton County Health Improvement Coalition members validated the findings and priority health needs. Prior to presentation to the hospital's board of directors, the Community Health Needs Assessment (CHNA) was shared with the hospital's internal community benefit team, which includes administration, finance, nursing, social services, and strategic planning leadership. Following their input, the CHNA and Implementation Plan was presented at a meeting of the St. Joseph's Hospital Board of Directors, which also includes members of the hospital's senior leadership team as well as HSHS Southern Illinois Division executive leadership. Funding for implementation was approved in the upcoming fiscal year's budget. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. Yes, the hospital conducted its FY2018 CHNA with Breese District 12 Elementary School, Catholic Charities, City of Breese, City of New Baden, Clinton County Coroner's Office, Clinton County Health Department, Community Link, Community Physicians, Community Resource Center - Centralia, Countryside Manor Nursing Home - Aviston, Hoyleton Youth and Family Services, HSHS Home Care Southern IL, Kaskaskia College, SAFE (Sexual Assault and Family Emergencies Center), South Central Transit (public transportation provider), Trenton Village Retirement, University of Illinois Extension, Wesclin CUSD #3, and the YMCA. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. In addition to the organizations on the Clinton County Health Improvement Coalition, the CHNA was presented during a meeting of the Carlyle Rotary Club and distributed in a news release to area newspapers. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS St. Joseph's Hospital Breese. The organization's most recently conducted CHNA was completed for the fiscal year ended 6/30/18. The related implementation strategy that was adopted is for the period July 1, 2018 through June 30, 2021. The information below pertains to the 3rd year cycle of the implementation strategy from the CHNA conducted in the fiscal year 2015. As part of the identification and prioritization of health needs, the internal community benefit team considered the estimated feasibility and effectiveness of possible interventions by the hospital to impact health priorities. Prioritization was based on scope, severity, and burden; health disparities associated with the need; the importance the community places on addressing the health need; the hospital and community assets and resources available to address the health need; and local expertise and input. Based on the CHNA planning and development process described, the following priority community health needs were identified access to care, chronic disease and mental health. Objectives established to address these needs through specific initiatives included: 1. Access to Medical Care (Affordability & Transportation) a. Additional points of access to medical care were subsidized for those in need through walk-in clinics and rural health clinics located in the small surrounding communities of Carlyle, Germantown, New Baden and Trenton. Operations are financially subsidized by St. Joseph's Hospital. The number of visits for physicians and mid-level providers working the outlying clinics totaled 54,508. b. Resources were dedicated to improve the minority Hispanic population's access to care through an interpreter/navigator program assisting in 3,700 encounters with individuals during the fiscal year. c. The need for non-emergency medical transportation was further researched and organizations identified for possible collaboration. This included partnership with the Healthcare Foundation that made possible the start-up of a patient van transportation service that will begin serving Clinton County in the upcoming fiscal year. 2. Mental Health - (The programs with NAMI were held in FY2017). The hospital continues to have a representative on the Mental Health Coalition of the Clinton County Health Department. The health department is the main lead for expanding outpatient mental health services. a goal in the health department's current IPlan includes the establishment of an outpatient mental health clinic. The health department is working through approvals for a new building to be built in the upcoming fiscal year that will have space dedicated to outpatient mental health. St. Joseph's Hospital will continue to be involved and prepared to assist with available resources as appropriate. 3. Chronic Disease Management (Cancer, Cardiovascular Health, & Diabetes) a. Heart Disease/Cerebrovascular Disease: Information about healthy food choices was presented at the local Farmer's Market. b. Cancer i. Support for women with cancer was provided by helping them cope with appearance related side effects of cancer through the American Cancer Society's "Look Good, Feel Better" program with 14 individuals attending during the year. St. Joseph's Hospital also continued to operate the American Cancer Society's regional wig closet. Space was dedicated to maintain wigs, scarves, and hats for the program and served 27 women from Clinton and surrounding counties. c. Diabetes i. Information and support was provided to individuals with diabetes helping them with self-management. Education was provided at six Diabetes Support Group meetings held during the year with an average of 20 people attending each group meeting. Topics covered included healthy choices at the restaurant, ways to avoid added sugars, and managing diabetes in an emergency. ii. The services of the dietician were made available to other organizations free of charge for education about nutrition and healthy eating. The dietitian participated in local health and safety fairs offered through the local schools. iii. Kidney Mobile: The National Kidney Foundation of Illinois brought their KidneyMobile to the community offering free health exams and screenings for hypertension, diabetes, and kidney disease. Eighty individuals received the free screenings available. As an outcome of the prioritization process, the following community health needs were also identified and were not addressed directly by the hospital for the reasons indicated: * Addictions (alcohol, smoking drugs, gaming, & food) - Through the prioritization process, this community health need was rated low specifically in the hospital's ability to impact the issue and the community's readiness. There also continues to be other external resources available. The local school systems provide students education about making healthy choices, and Hoyleton Ministries has organized the Communities that Care Coalition to specifically target teen drug and alcohol abuse. Chapters of Alcohol Anonymous are also available. * Dental care - Based on the number of providers compared to Clinton County's population, additional providers of dental care are needed. Few of the current providers accept the public insurance provided to the disadvantaged and low-income populations. With other health needs prioritized higher, dental care will not be a focus area for the hospital. A dental clinic is operated through the health department in an adjacent county and available to Clinton County residents as appointment times permit. The hospital will be supportive as resources allow should the Clinton County Health Department adopt this as a focus area in their upcoming needs assessment and implementation strategy. * Prevention of illness & disease (health, exercise, & nutrition) - St. Joseph's Hospital will continue to offer health education and nutrition information pertaining to chronic disease prevention and management. Exercise programs through the YMCA's partnership with the hospital will also continue at the hospital's on-site exercise facility. The Clinton County Health Improvement Coalition has identified prevention of illness & disease as their focus. As an organizing member of the coalition, the hospital will be involved and supportive of the coalition's lead on health and wellness initiatives. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Joseph's Hospital. Presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 7. Wisconsin Department of Health Services Housing Assistance Program 8. Participation in Women, Infants and Children programs (WIC); 9. Supplemental Nutrition Assistance Program (SNAP) eligibility; 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 0 Schedule H, Part VI SECTION 501(R) INFORMATION IN JANUARY 2015, THE ORGANIZATION ENGAGED A LAW FIRM TO REVIEW AND REVISE ITS FINANCIAL ASSISTANCE POLICY TO MEET THE REQUIREMENTS OF TREASURY REGULATIONS ISSUED UNDER SECTION 501(R). THE HOSPITAL BEGAN TO FOLLOW THAT REVISED POLICY DURING 2015, HOWEVER IT WAS NOT FORMALLY APPROVED UNTIL OCTOBER 2017.TO ENSURE FULL COMPLIANCE WITH SECTION 501(R) AND THE TREASURY REGULATIONS ISSUED THEREUNDER, IN NOVEMBER 2017 THE ORGANIZATION ENGAGED AN OUTSIDE CONSULTANT TO REVIEW ALL APPLICABLE POLICIES AND PRACTICES AND CONTINUES TO MONITOR COMPLIANCE WITH 501(R) ON A REGULAR BASIS. Schedule H, Part I, Line 7g Subsidized Health Services St. Joseph's Hospital did include losses on their Rural Health Clinics in the Subsidized health services line. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance To determine the actual cost of these services, the hospital uses a cost-to-charge ratio (derived from IRS worksheet 2) based on our audited financial statements to calculate the amounts reported on Lines 7a through 7i. Schedule H, Part II Community Building Activities St. Joseph's Hospital partnered with Central Community High School for the school's annual college and career success program. The hospital provided the space for their annual program. Central High School teachers and counselors provided students information about college and employment opportunities. A meal was served to the group by the hospital's food services department at no cost. Community Building activities included attending the Illinois Hospital Association Advocacy Day where staff and other local health care organizations met with our legislators to discuss health care legislation. 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 600% 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 HSHS St. Joseph's 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 pages 21 of the HSHS Consolidated Audit Report. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs HSHS St. Joseph's 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, St. Joseph's Hospital, Breese is relieving the burdens of the government. Accordingly, this shortfall restricts St. Joseph's Hospital's ability to make funds available to provide for charity care and other community benefits. The hospital Medicare shortfall at cost for fiscal year 2018 was $8,115,204. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Every effort is made prior to, during and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and provide adequate documentation. If the patient qualified for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualified for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. Schedule H, Part V, Section B, Line 16a FAP website - ST. JOSEPH'S HOSPITAL: Line 16a URL: http://www.hshs.org/fap; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. JOSEPH'S HOSPITAL: Line 16b URL: http://www.hshs.org/fap; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. JOSEPH'S HOSPITAL: Line 16c URL: http://www.hshs.org/fap; Schedule H, Part VI, Line 2 Needs assessment St. Joseph's Hospital is a leading member of the Clinton County Health Improvement Coalition. The coalition consists of 30 individuals representing 20 agencies. Their meetings are held quarterly and the steering committee for the group also meets an additional four times during the year. During the meetings held, members provide an update on activities of their organization and the needs of those they serve. This provides the hospital with an ongoing assessment of the health needs in the community. In addition to representatives from public health, attendees include representatives of a local minority population. Meetings of the hospital's patient family advisory committee and HSHS St. Joseph's Hospital Foundation are held each quarter. Members are provided updates on the hospital's services and how the hospital is meeting the community's health needs. During the meeting, members are also provided an opportunity to provide feedback about any concerns heard from other community residents. In addition, hospital colleagues represent the hospital at various community group meetings, which provides a way to learn of any emerging needs and to offer support. Feedback is also obtained through ongoing patient surveys to patients receiving care on the inpatient unit, emergency department, surgical services and outpatient areas. In addition, community members attending the eight local health fairs held throughout the year are also asked to complete a survey. The survey asks for their input about needs in the community. Individuals are also asked to identify what they consider to be the highest priority need. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The Registration Department provides a packet to all self-pay patients at the time of registration. This packet contains a brochure identifying financial assistance opportunities offered to our patients as well as a financial assistance application. The brochures are also supplied in other ancillary waiting areas for easy access by the patient. We also offer an online business office portal that provides information on how to read and understand billing information. The site is located at HSHS.patientsimple.com. Each statement that a patient receives contains information about our financial assistance program and a phone number for assistance with applying. Any patient visiting the onsite financial counselor as well as contacting us via phone is given information about payment options including financial assistance. Even after an account is sent to a collection agency and/or anytime in the process they believe a patient may be eligible for financial assistance, the account is returned to the hospital for evaluation. HSHS St. Joseph's makes their financial assistance application and standard response letters available in English as well as Spanish. Patients are also provided a Fair Billing Act notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. Schedule H, Part VI, Line 4 Community information St. Joseph's Hospital's service area is comprised of approximately 503 square miles with a population of approximately 37,760 residents and a population density of 75 people per square mile. The service area consists of the following cities and rural communities: Albers, Aviston, Bartelso, Beckemeyer, Breese, Carlyle, Centralia, Damiansville, Germantown, Hoffman, Huey, Keyesport, New Baden and Trenton. St. Joseph's is the sole hospital provider in the county and does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. Based on the U.S. Census Bureau's information, the population of the entire county has held about the same over the past six years. The median age is 39 years of age with 15.7% of the population over the age of 65 compared to 13.5% over the age of 65 in the state of Illinois. Cultural diversity is increasing with slight growth seen in the Hispanic population. A higher proportion of the Clinton County population (11.8%) is disabled than the state (10.73%). Current unemployment rate is 4.5% (source - County Health Rankings 2018). Median household income has risen to $63,929, which is slightly above the median household income for Illinois at $59,588. Persons living below the federal poverty level are 8.87% of the population, an increase of 1%. The proportion of residents who are food insecure in Clinton County (9.4%) is lower than the state (12.9%), though the percent of the food insecure population ineligible for assistance (45%) is higher than the state rate of 32%. The percent of households receiving SNAP benefits in Clinton County (7.14%) is lower than the state rate (13.06%). Just over 11% of children in Clinton County live in poverty, while 38% are eligible for the free lunch program. Per the most recent US Census information, 4.5% of Clinton County residents under the age of 65 years old are without health insurance. Of those insured under 65 years of age, 28% are covered by public insurance. Clinton County is in an area designed as a shortage area for primary care health professionals (HPSA). This designation is made by the U.S. Department of Health & Human Services. The designation is also in place for mental health professionals. Rural populations can be disadvantaged regarding access to fresh and health food as well as physical activity locations leading to obesity and chronic health conditions. Nearly 30% of men in Clinton County were obese, notably higher than the state rate. The rate in women, 28.6%, was slightly below the state rate of 30.5%. A smaller proportion of adults in Clinton County consume five or more fruits and vegetables a day (12.8%) than the state (22.6%). The proportion of adults who report getting exercise (73.7%) is slightly lower than the state rate (75.2%). Just under two out of three of Clinton County residents (60%) had access to exercise opportunities, compared to 89% of residents statewide. The prevalence of high cholesterol in Clinton County (40.6%) has increased by nearly 8% since the 2007-2009 series of surveys, and is now higher than the state rate (36%). More Medicare beneficiaries in Clinton County have high cholesterol (47.36%) than the state rate for Medicare beneficiaries (46.19%), while for hypertension, both the county and state rate for Medicare beneficiaries is 56.4%. In general, Clinton County (9.76%) has a similar prevalence of diabetes to the state (9.71%), though the rate for Clinton County is increasing at a higher pace. Specific programs to raise awareness about obesity and healthy living will benefit the population with a focus on improving overall health. In addition, an individual's physical environment can contribute to or deter healthy behavior. The percentage of Clinton County residents who report heavy drinking is 16%, compared to a state rate of 9.9%. The percentage of Clinton County residents who report binge drinking is 31%, compared to 22.4% for the state. Over a third (36%) of Clinton County eighth graders had used alcohol, cigarettes, inhalants or marijuana in the past year, compared to the state rate of 27%. Secondary data in the CHNA indicated there is a much higher density of bars and drinking establishments in Clinton County (74.1 per 100,000) than the state density (20.6 per 100,000). The rate of establishments that provide accommodations or food service in Clinton County is 224.1 per 100,000; this compares to 201.75 per 100,000 in the state. There are 134.97 video gaming establishments per 100,000 in Clinton County compared to 69.51 per 100,000 for the state of Illinois. The smoking rate in Clinton County is 17.79%, higher than the state rate of 13.68%. Both men (18.7%) and women (16.92%) of Clinton County smoke at a higher rate than the state rate for males and females (14.89% and 12.52% respectively). The rate of infants born to mothers who smoke was 227.4 per 100,000 compared to the statewide rate of 89.9 per 100,000. Schedule H, Part VI, Line 5 Promotion of community health As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), St. Joseph's Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1897, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Clinton County and surrounding areas. The hospital is governed by a board of directors, most of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The board ensures that St. Joseph's Hospital is responding to community need. In FY2018, for example, reports are provided to board members throughout the year to update them on community health initiatives as well as an annual report. This provides them an opportunity to give input and directional guidance. In addition, St. Joseph's Hospital receives community support and guidance through the patient family advisory council and the foundation leadership council. Both councils meet quarterly and provide feedback from the community on additional services or improvements needed. St. Joseph's Hospital is blessed with a strong volunteer program. Volunteers are active in many hospital departments daily and donate many more hours throughout the year to hospital-sponsored community programs. Consistent with its exempt purpose, St. Joseph's Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Joseph's Hospital reinvests surplus funds to support the mission of the organization and promote the health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, the hospital reinvested surplus funds in FY2018 to build a new outpatient surgery addition. The new 13,880 square-foot outpatient surgery center was designed to increase efficiency and patient privacy and includes 17 ambulatory surgery prep/recovery rooms, four infusion rooms, and a new ambulance garage. The building also has a new discharge exit with an overhang and a circle drive, so patients will not need to travel through the hospital after having surgery. A significant refurbishment was also completed in the emergency department and a new portable digital medical imaging unit was purchased. St. Joseph's Hospital, Breese, also devotes significant resources to access for patients who cannot afford care, along with other Community Benefits. In FY2018, St. Joseph's Hospital, Breese provided more than $4.9 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 FY2018, St. Joseph's Hospital provided $944,743 (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than $8.1 million (at cost) in excess of Medicare payment for health care services. St. Joseph's Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by St. Joseph's Hospital and they often relieve a burden that would otherwise be carried by government. Schedule H, Part VI, Line 6 Affiliated health care system Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 15 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. In FY2018, HSHS collectively provided $198.4 million in Community Benefit (9.1% of total hospital expenses). This amount included $25.7 million provided for Financial Assistance (a.k.a. Charity Care) and $133.7 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 $221.5 million. HSHS hospitals also recorded $45.9 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. Schedule H, Part VI, Line 7 State filing of community benefit report IL X X X X X false true false false false false false false false PAULETTE EVANS President and CEO (Partial Year) 0 163343 0 0 0 64996 0 101102 0 3764 0 333205 0 30254 AMY M BALLANCE Interim CEO (partial year) 0 217385 0 9698 0 780 0 47593 0 22099 0 297555 0 0 DAVID BEACH BOARD MEMBER 0 348181 0 0 0 32705 0 52121 0 1152 0 434159 0 0 JAMES DOVER CEO SOUTHERN IL DIVISION 0 567456 0 0 0 218872 0 81543 0 38317 0 906188 0 0 DAVID NOSACKA DIVISION CFO 0 335717 0 0 0 5046 0 30103 0 23949 0 394815 0 0 ANN M CARR TREASURER 0 260012 0 0 0 58499 0 98998 0 21199 0 438708 0 31564 HELEN ESSENPREIS CNO 137748 0 0 0 0 0 48070 0 19296 0 205114 0 0 0 MARGARET A LUNA DIVISION CPO 0 235254 0 0 0 390 0 77207 0 16991 0 329842 0 0 JACQUELYNNE N HOLST DIVISION ASSOCIATE GENERAL COUNSEL 0 185345 0 0 0 567 0 21306 0 21876 0 229094 0 0 JOHN JEFFRIES DIRECTOR OF FINANCE 153396 0 16089 0 15001 0 22047 0 28707 0 235240 0 0 0 JOEL A TUCKER DIRECTOR OF PHARMACY 149233 0 0 0 0 0 8652 0 29815 0 187700 0 0 0 JENE BIERI DIRECTOR OF PROF. SERVICES 140030 0 0 0 0 0 51002 0 19073 0 210105 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2017 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $28,431 David Beach -- $44,889 James Dover -- $75,077 Chris Klay -- $6,774 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2017 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $31,564 Paulette Evans -- $30,254 Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS ST. JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS PROVIDES QUALITY HEALTH CARE SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, RELIGION, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS ESSENTIAL TO THE CONTINUED OPERATION AND STABILITY OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS ARE ABLE TO AFFORD REQUIRED MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH THE BEST QUALITY HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. INHERENT IN OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. IN OUR TAX YEAR BEGINNING JULY 1, 2017 AND ENDING JUNE 30, 2018, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 1,226 INPATIENTS UTILIZING 3,509 DAYS OF CARE. IN ADDITION, ST. JOSEPH'S HOSPITAL, BREESE PROVIDED SERVICES TO 92,482 OUTPATIENTS. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO THE POOR AT NO COST THROUGH OUR CHRISTIAN CARE PROGRAM. IN ADDITION, THE HOSPITAL PARTICIPATES IN THE ILLINOIS MEDICAID PROGRAM, WHICH REIMBURSES THE HOSPITAL AT RATES SUBSTANTIALLY BELOW THE COST OF PROVIDING THE SERVICES. FULFILLING OUR MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO 257 MEDICAID INPATIENTS UTILIZING 656 DAYS OF CARE. THE COST OF PROVIDING SERVICES TO MEDICAID PATIENTS EXCEEDED REIMBURSEMENT UNDER THE STATE OF ILLINOIS MEDICAID PROGRAM BY $2,431,316. THE TOTAL UNREIMBURSED VALUE OF PROVIDING CARE TO THE POOR IS $3,376,059. ST. JOSEPH'S HOSPITAL, BREESE PROVIDES QUALITY MEDICAL CARE TO MEMBERS OF THE BROADER COMMUNITY THROUGH PARTICIPATION IN THE MEDICARE PROGRAM AND THROUGH EDUCATIONAL PROGRAMS AND ACTIVITIES AT A REDUCED PRICE, OR AT NO COST. ST. JOSEPH'S HOSPITAL, BREESE PROVIDED MEDICAL SERVICES TO 499 MEDICARE INPATIENTS UTILIZING 1,678 DAYS OF CARE. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST JOSEPH'S HOSPITAL, BREESE OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 1a COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF GOVERNING BODY PER ARTICLE 5.5 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH AND MAY IN ITS DISCRETION EXERCISE THE FULL POWERS, DUTIES, RESPONSIBILITIES, AND AUTHORITY OF THE BOARD EXCEPT WHERE PROHIBITED BY LAW AND SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BYLAWS OR THE BOARD OF DIRECTORS. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF THREE TO SIX MEMBERS, INCLUDING THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE PRESIDENT AND OTHER MEMBERS SELECTED FROM AMONG THE DIRECTORS BY THE BOARD. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF ST. JOSEPH'S HOSPITAL BREESE (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD AND PRESIDENT. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. JOSEPH'S HOSPITAL BREESE (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE DEBT INCURRED BY THE CORPORATION OR ANY AFFILIATE IN AN AMOUNT IN EXCESS OF LIMITS SET FROM TIME TO TIME BY THE MEMBER. (H) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (I)APPROVE THE STRATEGIC PLAN AND ANNUAL GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (K) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (L) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (M) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (N) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (O) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. Form 990, Part VI, Line 11b Review of form 990 by governing body THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND SYSTEM CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN USED SINCE JANUARY, 2010 TO ESTABLISH THE PRACTICE OF MANAGING CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS, AND MEDICAL DEVICES, ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE, AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL HSHS EXECUTIVES, (the top management official, other officers and key employees). INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES (derived from a full market review conducted every other year) TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. The process for reviewing compensation by the compensation committee is completed each fiscal year. Form 990, Part VI, Line 15b Process to establish compensation of other employees PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT ST. JOSEPH'S HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Change in fair value of interest rate swap - 803169; Swap Payments - -351879; Changes to Temporarily Restricted Net Assets - -252459; Changes to Permanently Restricted Net Assets - 10155; Transfer to/from affiliates - -1145791; Pension-related changes other than net periodic pension costs - 2487658; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -1385886 3938708 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 149935 8833307 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL -538042 88228 KCIN HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false HOSPITAL SISTERS OF ST FRANCIS FOUNDATION 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 7 HSHS true HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I HSSI true SACRED HEART HOSPITAL 990 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 HSSI true ST ELIZABETH'S HOSPITAL ONE ST ELIZABETHS BLVD OFALLON IL 62269 370663567 HEALTHCARE IL 501(c)(3) 3 HSSI true ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S MEDICAL CENTER 1762 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 HSSI true ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 51301 390817529 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 HSSI true ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 HSSI true HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS true HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 263956318 HEALTHCARE IL 501(c)(3) Type III-FI HSSI true HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 264515959 HEALTHCARE WI 501(c)(3) Type III-FI HSSI true ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 10 ST NICHOLAS true UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true PRAIRIE EDUCATION & RESEARCH COOPERATIVE 317 NORTH 5TH STREET SPRINGFIELD IL 62701 371157915 HEALTHCARE IL 501(c)(3) 4 HSSI true ST CLARE MEMORIAL HOSPITAL 855 S MAIN STREET OCONTO FALLS WI 54154 390848401 HEALTHCARE WI 501(c)(3) 3 HSSI true HSHS HOLY FAMILY HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 370792770 HEALTHCARE IL 501(c)(3) 3 HSSI true UTLAUT MEMORIAL FOUNDATION 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HFG true HSHS GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371778753 TRUST IL 501(a) GSS true MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 371312961 HEALTHCARE IL ST ELIZABETH'S Related 187165 0 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 PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 263155343 HEALTHCARE WI ST VINCENT Related 240126 4769500 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 -48977 202533 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 -6440 20163 false true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL ST ELIZABETH'S Related 0 2467223 false false 0.5 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation -32771486 29755341 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA INC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA INC C Corporation true PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD IL 62701 371071858 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation 82898 44874417 0.5 true PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY WI 54304 391839349 HEALTHCARE WI PHSI C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 INSURANCE CJ HSSI C Corporation 0 116763493 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false true false false false false true true true false true true true true true true true true Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION. FOR ALL ORGANIZATIONS REPORTED AS 512(B)(13) CONTROLLED IN SCHEDULE R, PART II, PLEASE SEE SCHEDULE A, PART IV FOR THE ONLY TRANSACTIONS BETWEEN THESE ORGANIZATIONS. HOSPITAL SISTERS HEALTH SYSTEM (HSHS) CHARGES A MANAGEMENT FEE TO THE RELATED ORGANIZATIONS FOR SERVICES RENDERED IN FULFILLING THE MISSION OF HSHS.