2019-05-14T18:34:17-05:00 2018-06-30 990 2017-07-01 391834639 Columbia St Mary's Inc COLU 3147338000 400 West River Woods Parkway Glendale WI 53212 Tonya Mershon Tax Officer 2019-05-14 2017 2020-01-14 16:20:31Z Bernard Sherry Sr VP 400 West River Woods Parkway Glendale WI 53212 313426731 false X N/A X 2001 WI TO IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN THE COMMUNITIES WE SERVE. 11 10 1733 10 64000 15425 330533 242541 205817467 308377277 -66525 -354155 425159 4702134 206506634 312967797 644384 470000 0 0 57357346 128679638 0 0 0 150346169 202438415 208347899 331588053 -1841265 -18620256 214869341 252025717 493501387 889323512 -278632046 -637297795 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 217887045 470000 309643599 COLUMBIA ST. MARY'S, INC. EXISTS AS THE PARENT CORPORATION IN THE COLUMBIA ST. MARY'S SYSTEM, WHICH IS COMPRISED OF THREE HOSPITALS, (COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE INC, COLUMBIA ST. MARY'S HOSPITAL OZAUKEE INC, AND SACRED HEART REHABILITATION INSTITUTE INC.), 61 COMMUNITY CLINICS, THE COLUMBIA COLLEGE OF NURSING, A PARTNERSHIP WITH THE ORTHOPAEDIC HOSPITAL OF WISCONSIN, A PARTNERSHIP WITH THE SLEEP WELLNESS INSTITUTE, AND FIVE URGENT CARE CENTERS. 217887045 true true false true false false false false false true false true true true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 206 0 true 1733 true true true false false false false false true false false false X 11 10 false false false false true true true true true false false false true true true true true false true false X Sara OBrien 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 WILLIAM C WERNER CHAIR 1.0 2.0 X X 0 0 0 ROBERT J VENABLE VICE CHAIR 1.0 2.0 X X 0 0 0 RANDALL PERRY SECRETARY 1.0 2.0 X X 0 0 0 KURT D VELDHUIZEN CPA TREASURER 1.0 2.0 X X 0 0 0 BERNARD J SHERRY EX-OFFICIO - SR VP ASCENSION WI 0.0 50.0 X X 0 2088531 45582 SISTER M THERESE GOTTSCHALK BOARD MEMBER 1.0 4.0 X 0 0 0 JOHN BYKOWSKI BOARD MEMBER 1.0 3.0 X 0 0 0 JOHN SPLUDE BOARD MEMBER 1.0 2.0 X 0 0 0 PATRICIA DOLHUN MD BOARD MEMBER 1.0 2.0 X 0 0 0 TRACY JOHNSON BOARD MEMBER 1.0 2.0 X 0 0 0 SISTER ANDREA LEE BOARD MEMBER 1.0 2.0 X 0 0 0 JONATHAN SOHN CFO - ASCENSION, WI 2.0 48.0 X 903904 0 48367 TRAVIS D ANDERSEN REGIONAL PRESIDENT - ASCENSION WI 5.0 45.0 X 1367565 0 44454 Tracy A Rogers CHIEF OPERATING OFFICER - ASCENSION WI 14.0 36.0 X 1696876 0 51047 DEBRA STANDRIDGE REGIONAL PRESIDENT - ASCENSION WI 5.0 45.0 X 825914 0 36007 BRUCE D MCCARTHY MD PRESIDENT-CLINICAL AMG - ASCENSION WI 25.0 25.0 X 727375 0 9730 SARAH HERZOG CHIEF LEGAL OFFICER - ASCENSION WI 5.0 45.0 X 0 678124 43604 DOUGLAS REDING MD CHIEF MEDICAL OFFICER - ASCENSION WI 10.0 40.0 X 647638 0 40758 VINCENT GALLUCCI Chief Marketing Officer - Ascension WI 10.0 40.0 X 187107 360404 19891 CELIA SHAUGHNESSY VP-HUMAN RESOURCES - WI, MI MARKET 5.0 45.0 X 0 511669 31898 LISA S BENSON MD CHIEF QUALITY OFFICER - ASCENSION WI 10.0 40.0 X 510066 0 20485 RICHARD J SHIMP MD CHIEF MEDICAL OFFICER 5.0 45.0 X 480534 0 42615 THOMAS W ZOCH VP-CARE MANAGEMENT CLINICAL 50.0 0 X 479629 0 46706 JOAN M BACHLEITNER CHIEF STRATEGY OFFICER - ASCENSION WI 15.0 35.0 X 446988 0 44242 TIMOTHY J DOWD MD CHIEF CLINICAL OFFICER - ASCENSION WI 40.0 0 X 441460 0 12923 TOM E VEESER CHIEF NURSING OFFICER - ASCENSION WI 19.0 31.0 X 439962 0 40307 TIMOTHY J MASEK VP-FINANCE, AMG WI 5.0 45.0 X 426799 0 37698 THERESE M ROCOLE CHIEF MISSION INTEGRATION OFFICER - ASCENSION WI 20.0 30.0 X 425644 0 19594 WILLIAM D HART CHIEF ADMIN OFFICER - ASCENSION WI 50.0 0.0 X 410069 0 20854 SUZANNE SANICOLA REGIONAL VP OPS-PRIMARY MEDICAL GROUP 10.0 40.0 X 0 373266 45536 TIMOTHY L BELEC WI MARKET INFOMRATION OFFICER 10.0 40.0 X 0 369674 17272 KEVIN JOHN KLUESNER CHIEF ADMIN OFFICER - AW SOUTH 15.0 35.0 X 139624 199326 44158 KELLY ELKINS PRESIDENT COLUMBIA ST MARY'S 12.0 38.3 X 307600 0 20717 LORI J DARR VP-FINANCE WISCONSIN 35.0 15.0 X 402935 0 46724 JULIE E SWIDERSKI VP-MARKET SERVICE LINES 50.0 0.0 X 408685 0 36440 VANESSA L FREITAG CHIEF ADMIN OFFICER - AW SOUTH 50.0 0.0 X 397928 0 46762 MARY B MCDONALD ADMIN COO - AMG WI 5.0 45.0 X 387315 0 44884 RICHARD P THIEDE MD PHYSICIAN 50.0 0 X 320751 0 34812 GERRI G LIETZ-STAFFILENO FORMER KEY EMPLOYEE (END 6/2017) 50.0 0.0 X 271033 0 9776 CLARISSA L COX FORMER KEY EMPLOYEE (END 6/2017) 50.0 0.0 X 172450 0 0 LYNN SCHUSTER FORMER KEY EMPLOYEE (END 6/30/2017) 0.0 50.0 X 163493 113694 39461 TIMOTHY JAMES WALDOCH FORMER OFFICER (END 12/2016) 0.0 0.0 X 257352 0 40746 13646696 4694688 1084050 165 true true false MEDSPEED LLC 655 W GRAND AVE SUITE 320 ELMHURST IL 601261043 COURIER SERVICES 2095838 HOUSER AND COMPANY LLC 60 N WESTERN AVE LAKE FOREST IL 600452130 HEALTHCARE MANAGEMENT CONSULTING 1827416 ACCENTURE LLP 161 N CLARK STREET CHICAGO IL 606013206 CONSULTING SERVICES 1696494 INTEGRATED HEALTH NETWORK OF WISCONSIN 19601 W BLUEMOUND ROAD SUITE 200 BROOKFIELD WI 53045 HEALTHCARE MANAGEMENT CONSULTING 1232059 BG STAFFING LLC 14900 LANDMARK BLVD SUITE 300 DALLAS TX 75254 STAFFING SERVICES 1096431 21 X 0 0 0 39598 11445 191498 242541 MANAGEMENT FEES 561000 291448995 291384995 64000 INCOME FROM JOINT VENTURES 622110 15803000 15803000 NET PATIENT REVENUE 621990 829615 829615 SERVICES TO AFFILIATES 900099 156719 156719 CONTRACTED SERVICES REVENUE 900099 120392 120392 18556 18556 0 0 308377277 19773 19773 0 0 0 0 319493 0 0 319493 0 319493 319493 0 85005 458934 0 -373929 -373928 -373928 0 0 0 0 0 0 0 0 RESEARCH REVENUE 900099 1266322 1266322 LAUNDRY SERVICES 812300 479603 479603 MEDICAL STAFF DUES 561499 189500 189500 2447216 0 0 2447216 4382641 312967797 309579599 64000 3081657 470000 470000 11427212 1714082 9713130 76634626 65139432 11495194 34243442 29106926 5136516 6374358 5418204 956154 190513 152410 38103 101435 101435 -249787 -249787 45621 45621 610 610 4780699 4546050 234649 0 2834006 425101 2408905 6482690 3241345 3241345 2842980 1705788 1137192 9904846 9880084 24762 913429 365372 548057 394532 157813 236719 57066120 54212814 2853306 19162653 18204520 958133 10269365 10218018 51347 MANAGEMENT FEE TO AFFILIATE 63557469 63557469 PURCHASED SERVICES 5681458 5397385 284073 OTHER NON MEDICAL SUPPLIES 2987676 2898046 89630 CONTRACT LABOR 2634052 921918 1712134 12838048 3711737 9126311 0 331588053 217887045 113701008 0 2010513 584 0 1099855 292751 267000 257215 -145476 0 0 0 0 0 0 52151 2990131 1669772 3214386 65342831 40962503 25499906 24380328 0 0 0 30850434 31998297 27013753 34982905 127222846 153237707 214869341 252025717 24912469 15053362 0 0 21548 10000 0 0 0 0 0 0 0 0 0 0 468567370 874260150 493501387 889323512 X -294295458 -653309579 11139233 11487605 4524179 4524179 -278632046 -637297795 214869341 252025717 X -18620256 -340045493 X false true X true false X X X 4 COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 390806315 3 true 0 0 COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 390807063 3 true 0 0 SACRED HEART REHABILITATION INSTITUTE INC 390902199 3 true 0 0 3 0 0 false false false false false false false false false false false false false false false true Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name The Corporation is organized and at all times shall be operated exclusively for the benefit of, to perform the functions of, and to carry out the purposes of Ascension Sponsor and such other of its subsidiary organizations that qualify under Section 501(c)(3) and under Section 509(a)(1) or Section 509(a)(2) of the Internal Revenue Code. Columbia St. Mary's Inc. is the sole corporate member of all of its supported organizations. false true false false false false true 43661 false true 45621 89282 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ASCENSION WISCONSIN WAS PART OF A CONTROLLED GROUP OF HEALTHCARE ORGANIZATIONS RELATED THROUGH A COMMON PARENT ORGANIZATION. CERTAIN ENTITIES WITHIN THIS CONTROLLED GROUP ENGAGED IN LIMITED LOBBYING ACTIVITIES THAT BENEFITED EACH ORGANIZATION COLLECTIVELY. FOR CALENDAR YEAR 2017, TWO INDIVIDUALS WERE EMPLOYED WHOSE RESPONSIBILITIES INCLUDED OVERSIGHT AND MANAGEMENT OF LOBBYING ACTIVITIES FOR THESE ORGANIZATIONS - THE VICE PRESIDENT AND CHIEF ADVOCACY OFFICER AND THE DIRECTOR OF GOVERNMENT RELATIONS AND ADVOCACY. THE VICE PRESIDENT PROVIDED STRATEGIC OVERSIGHT FOR THE DEPARTMENT AND PARTICIPATED IN VISITS WITH KEY ELECTED OFFICIALS WHEN APPROPRIATE. THE DIRECTOR PROVIDED ON-THE-GROUND SUPPORT, SERVED AS THE FIRST POINT OF CONTACT FOR ELECTED OFFICIALS, AND EXECUTED ON LEGISLATIVE LOBBYING ACTIVITIES THAT SUPPORTED THE STRATEGIC INTERESTS OF THE ORGANIZATION. WE ESTIMATE THESE LOBBYING ACTIVITIES APPROXIMATED 50% OF TOTAL ANNUAL SALARY FOR THE DIRECTOR AND 25% FOR THE VICE PRESIDENT. A BENEFITS FACTOR OF 25% WAS ADDED, AND THE TOTAL WAS ALLOCATED AMONGST THE ORGANIZATIONS THAT RECEIVED THE BENEFIT OF THESE SERVICES. THE LOBBYING ACTIVITIES INCLUDED ADVOCACY EFFORTS RELATED TO PUBLIC POLICY PROPOSALS SUCH AS: CHANGES TO MEDICARE AND MEDICAID FUNDING; FEDERAL OR STATE LEGISLATION THAT MAY IMPACT THE ORGANIZATIONS IN WISCONSIN; PARTICIPATING IN AND COORDINATING VISITS WITH ELECTED OFFICIALS AT ALL LEVELS OF GOVERNMENT (LOCAL, STATE AND FEDERAL); MOBILIZING GRASSROOTS EFFORTS ON BEHALF OF THE ORGANIZATION ON ISSUES OF IMPORTANCE; COORDINATING ADVOCACY ACTIVITIES IN CONJUNCTION WITH RELEVANT TRADE ASSOCIATIONS; AND PROVIDING INTERNAL AWARENESS ON SPECIFIC STATE-RELATED LEGISLATIVE ISSUES WHEN THE NEED ARISES. FINALLY, ANY TRADE ASSOCIATION DUES CONTAINING A PERCENTAGE PORTION ALLOCABLE TO LOBBYING ACTIVITIES, HAS BEEN IDENTIFIED, AND INCLUDED WHERE APPROPRIATE. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ASCENSION WISCONSIN WAS PART OF A CONTROLLED GROUP OF HEALTHCARE ORGANIZATIONS RELATED THROUGH A COMMON PARENT ORGANIZATION. CERTAIN ENTITIES WITHIN THIS CONTROLLED GROUP ENGAGED IN LIMITED LOBBYING ACTIVITIES THAT BENEFITED EACH ORGANIZATION COLLECTIVELY. FOR CALENDAR YEAR 2017, TWO INDIVIDUALS WERE EMPLOYED WHOSE RESPONSIBILITIES INCLUDED OVERSIGHT AND MANAGEMENT OF LOBBYING ACTIVITIES FOR THESE ORGANIZATIONS - THE VICE PRESIDENT AND CHIEF ADVOCACY OFFICER AND THE DIRECTOR OF GOVERNMENT RELATIONS AND ADVOCACY. THE VICE PRESIDENT PROVIDED STRATEGIC OVERSIGHT FOR THE DEPARTMENT AND PARTICIPATED IN VISITS WITH KEY ELECTED OFFICIALS WHEN APPROPRIATE. THE DIRECTOR PROVIDED ON-THE-GROUND SUPPORT, SERVED AS THE FIRST POINT OF CONTACT FOR ELECTED OFFICIALS, AND EXECUTED ON LEGISLATIVE LOBBYING ACTIVITIES THAT SUPPORTED THE STRATEGIC INTERESTS OF THE ORGANIZATION. WE ESTIMATE THESE LOBBYING ACTIVITIES APPROXIMATED 50% OF TOTAL ANNUAL SALARY FOR THE DIRECTOR AND 25% FOR THE VICE PRESIDENT. A BENEFITS FACTOR OF 25% WAS ADDED, AND THE TOTAL WAS ALLOCATED AMONGST THE ORGANIZATIONS THAT RECEIVED THE BENEFIT OF THESE SERVICES. THE LOBBYING ACTIVITIES INCLUDED ADVOCACY EFFORTS RELATED TO PUBLIC POLICY PROPOSALS SUCH AS: CHANGES TO MEDICARE AND MEDICAID FUNDING; FEDERAL OR STATE LEGISLATION THAT MAY IMPACT THE ORGANIZATIONS IN WISCONSIN; PARTICIPATING IN AND COORDINATING VISITS WITH ELECTED OFFICIALS AT ALL LEVELS OF GOVERNMENT (LOCAL, STATE AND FEDERAL); MOBILIZING GRASSROOTS EFFORTS ON BEHALF OF THE ORGANIZATION ON ISSUES OF IMPORTANCE; COORDINATING ADVOCACY ACTIVITIES IN CONJUNCTION WITH RELEVANT TRADE ASSOCIATIONS; AND PROVIDING INTERNAL AWARENESS ON SPECIFIC STATE-RELATED LEGISLATIVE ISSUES WHEN THE NEED ARISES. FINALLY, ANY TRADE ASSOCIATION DUES CONTAINING A PERCENTAGE PORTION ALLOCABLE TO LOBBYING ACTIVITIES, HAS BEEN IDENTIFIED, AND INCLUDED WHERE APPROPRIATE. 764011 764011 18283451 15622675 2660776 437522 318905 118617 35429117 25020923 10408194 10428730 0 10428730 24380328 Investment in Unconsolidated Entities 31998297 C 31998297 DEFERRED COMPENSATION/RETIREMENT/PENSION ASSET 63549 DUE FROM AFFILIATES 130856345 OTHER RECEIVABLES 6264286 MISCELLANEOUS ASSETS 41744 INTEREST IN NET ASSETS OF COLUMBIA ST. MARY'S FOUNDATION 16011783 153237707 0 DEBT WITH ASCENSION HEALTH ALLIANCE 300234151 AT RISK LIABILITY DEFERRED COMPENSATION LIABILITY 302392 LIABILITY FROM DISCONTINUED OPERATIONS 4757777 DUE TO AFFILIATES 566944574 LEASE LIABILITY 1702541 OTHER MISCELLANEOUS LIABILITIES 316844 PENSION LIABILITY SAVINGS PLAN LIABILITY ACCRUED TAX LIABILITY 1871 874260150 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 61000 0 61000 0.0002 5976901 893145 5083756 0.0145 0 0.0 0 0 6037901 893145 5144756 0.0146 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 0 0 6037901 893145 5144756 0.0146 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 false 121017 9168 7288021 20153555 -12865534 X true true ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC ORTHOPEDIC SURGERIES 0.5 0.5 1 1 ORTHOPAEDIC HOSPITAL OF WISCONSIN 475 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 WWW.OHOW.COM 1006 X SPECIALTY ORTHOPEDIC HOSPITAL ORTHOPAEDIC HOSPITAL OF WISCONSIN 1 false false true X X X X X X X X X 15 true true false true X https://healthcare.ascension.org/Locations/Wisconsin/WIMIL/Glendale-Orthopaedic-Hospital-of-Wisconsi X X true 15 true https://healthcare.ascension.org/Locations/Wisconsin/WIMIL/Glendale-Orthopaedic-Hospital-of-Wisconsi false true X 250.0 400.0 X X X X true true X X X true X http://www.ohow.com/financial-assistance.html 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; OPPORTUNITIES FOR PARTNERSHIP; 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 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. 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. 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 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. AURORA HEALTH CARE CHILDREN'S HOSPITAL OF WISCONSIN FROEDTERT HOSPITAL WHEATON FRANCISCAN HEALTH CARE. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. 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 2018 (TAX YEAR 2017), THE HOSPITAL IMPLEMENTED THE FOLLOWING PLAN TO ADDRESS THE PRIORITY NEEDS: VIOLENCE AND INJURY -- PROVIDED EDUCATION IN THE COMMUNITY TO REDUCE FALLS AND INJURY CHRONIC DISEASE -- INCREASED HEALTHY OPTIONS AVAILABLE AT COMMUNITY DIABETIC FRIENDLY FOOD PANTRY 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. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - ORTHOPAEDIC HOSPITAL OF WISCONSIN. 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 IS AVAILABLE ON OUR WEBSITE AT HTTP://WWW.OHOW.COM/FINANCIAL-ASSISTANCE.HTML, AND HAS BEEN TRANSLATED INTO 7 LANGUAGES: ENGLISH, SPANISH, HMONG, LAOTIAN, ARABIC, RUSSIAN, AND SERBIAN/CROATIAN. 0 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 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 $458,399 AT CHARGES, ($121,017 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 - ORTHOPAEDIC HOSPITAL OF WISCONSIN: Line 16a URL: http://www.ohow.com/financial-assistance.html; Schedule H, Part VI, Line 2 Needs assessment IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B, ORTHOPAEDIC HOSPITAL OF WISCONIN 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. ORTHOPAEDIC HOSPITAL OF WISCONIN 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: HTTP://WWW.OHOW.COM/FINANCIAL-ASSISTANCE.HTML - 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 UNITED WAY OF GREATER MILWAUKEE 225 W VINE STREET MILWAUKEE WI 53212 390806190 501(C)(3) 420000 OPERATING SUPPORT CONCORDIA UNIVERSITY WISCONSIN FOUNDATION 12800 NORTH LAKE SHORE DRIVE MEQUON WI 53097 396077337 501(C)(3) 50000 OPERATING SUPPORT 2 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. CONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 400 W RIVER WOODS PARKWAY, GLENDALE, WI 53212. true true false false false false false false false BERNARD J SHERRY EX-OFFICIO - SR VP ASCENSION WI 0 839075 0 950848 0 298608 0 17550 0 28032 0 2134113 0 0 TIMOTHY JAMES WALDOCH FORMER OFFICER (END 12/2016) 209647 0 46613 0 1092 0 12417 0 28329 0 298098 0 0 0 JONATHAN SOHN CFO - ASCENSION, WI 505898 0 270732 0 127274 0 14885 0 33482 0 952271 0 0 0 GERRI G LIETZ-STAFFILENO FORMER KEY EMPLOYEE (END 6/2017) 26969 0 0 0 244064 0 2195 0 7581 0 280809 0 0 0 CLARISSA L COX FORMER KEY EMPLOYEE (END 6/2017) 0 0 0 0 172450 0 0 0 0 0 172450 0 0 0 LYNN SCHUSTER FORMER KEY EMPLOYEE (END 6/30/2017) 137814 68147 0 44909 25679 638 9231 5810 17733 6687 190457 126191 0 0 TRAVIS D ANDERSEN REGIONAL PRESIDENT - ASCENSION WI 563166 0 701999 0 102400 0 13500 0 30954 0 1412019 0 0 0 Tracy A Rogers CHIEF OPERATING OFFICER - ASCENSION WI 641898 0 611054 0 443924 0 16200 0 34847 0 1747923 0 0 0 DEBRA STANDRIDGE REGIONAL PRESIDENT - ASCENSION WI 493219 0 207295 0 125400 0 9931 0 26076 0 861921 0 0 0 BRUCE D MCCARTHY MD PRESIDENT-CLINICAL AMG - ASCENSION WI 69797 0 0 0 657578 0 3152 0 6578 0 737105 0 0 0 SARAH HERZOG CHIEF LEGAL OFFICER - ASCENSION WI 0 412615 0 210783 0 54726 0 16200 0 27404 0 721728 0 0 DOUGLAS REDING MD CHIEF MEDICAL OFFICER - ASCENSION WI 523885 0 115749 0 8004 0 13500 0 27258 0 688396 0 0 0 VINCENT GALLUCCI Chief Marketing Officer - Ascension WI 174611 148035 0 196044 12496 16325 3350 4750 4539 7252 194996 372406 0 0 CELIA SHAUGHNESSY VP-HUMAN RESOURCES - WI, MI MARKET 0 299105 0 178963 0 33601 0 8100 0 23798 0 543567 0 0 LISA S BENSON MD CHIEF QUALITY OFFICER - ASCENSION WI 419726 0 87358 0 2982 0 13500 0 6985 0 530551 0 0 0 RICHARD J SHIMP MD CHIEF MEDICAL OFFICER 364550 0 82203 0 33781 0 13500 0 29115 0 523149 0 0 0 THOMAS W ZOCH VP-CARE MANAGEMENT CLINICAL 384536 0 87358 0 7735 0 16200 0 30506 0 526335 0 0 0 JOAN M BACHLEITNER CHIEF STRATEGY OFFICER - ASCENSION WI 349093 0 68508 0 29387 0 10800 0 33442 0 491230 0 0 0 TIMOTHY J DOWD MD CHIEF CLINICAL OFFICER - ASCENSION WI 121973 0 0 0 319487 0 2310 0 10613 0 454383 0 0 0 TOM E VEESER CHIEF NURSING OFFICER - ASCENSION WI 340537 0 76438 0 22987 0 12663 0 27644 0 480269 0 0 0 TIMOTHY J MASEK VP-FINANCE, AMG WI 323543 0 72287 0 30969 0 16200 0 21498 0 464497 0 0 0 THERESE M ROCOLE CHIEF MISSION INTEGRATION OFFICER - ASCENSION WI 214600 0 122011 0 89033 0 16837 0 2757 0 445238 0 0 0 WILLIAM D HART CHIEF ADMIN OFFICER - ASCENSION WI 306049 0 66840 0 37180 0 17550 0 3304 0 430923 0 0 0 SUZANNE SANICOLA REGIONAL VP OPS-PRIMARY MEDICAL GROUP 0 268274 0 63859 0 41133 0 17325 0 28211 0 418802 0 0 TIMOTHY L BELEC WI MARKET INFOMRATION OFFICER 0 264076 0 103833 0 1765 0 9450 0 7822 0 386946 0 0 KEVIN JOHN KLUESNER CHIEF ADMIN OFFICER - AW SOUTH 128644 128603 0 58967 10980 11756 4050 12050 14015 14043 157689 225419 0 0 KELLY ELKINS PRESIDENT COLUMBIA ST MARY'S 282409 0 0 0 25191 0 4696 0 16021 0 328317 0 0 0 LORI J DARR VP-FINANCE WISCONSIN 282993 0 63992 0 55950 0 14850 0 31874 0 449659 0 0 0 JULIE E SWIDERSKI VP-MARKET SERVICE LINES 158989 0 65523 0 184173 0 12794 0 23646 0 445125 0 0 0 VANESSA L FREITAG CHIEF ADMIN OFFICER - AW SOUTH 257743 0 58967 0 81218 0 16200 0 30562 0 444690 0 0 0 MARY B MCDONALD ADMIN COO - AMG WI 331431 0 40000 0 15884 0 16200 0 28684 0 432199 0 0 0 RICHARD P THIEDE MD PHYSICIAN 245675 0 68661 0 6415 0 13280 0 21532 0 355563 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, 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 OF 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: Bruce D McCarthy, MD - $541,659 Timothy J Dowd, MD - $260,000 Gerri G Lietz-Staffileno - $234,140 Clarissa L Cox - $171,040 Julie E Swiderski - $138,462 Therese M Rocole - $51,924 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. No payments were made to listed persons in Part VII under the non-qualified retirement plan during the year. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S 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 TOP MANAGEMENT OFFICIAL 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 6 Classes of members or stockholders COLUMBIA ST. MARY'S, INC. HAS TWO CORPORATE MEMBERS, ASCENSION HEALTH AND COLUMBIA HEALTH SYSTEM. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body ONE OF COLUMBIA ST. MARY'S, INC. (CSM) CORPORATE MEMBERS, ASCENSION HEALTH, HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF CSM. 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, INC. FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ONE OF ITS CORPORATE MEMBERS, ASCENSION HEALTH. COLUMBIA HEALTH SYSTEM HAS THE AUTHORITY TO APPROVE ANY CHANGES TO THE GOVERNING DOCUMENTS WHICH WOULD AFFECT ITS INTEREST OR RIGHTS IN CSM, THE MISSION AND VISION STATEMENTS OF CSM, AND ANY MAJOR CORPORATE STRUCTURAL TRANSACTIONS OF CSM. 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 15b Process to establish compensation of other employees IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS 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 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VII, Section A Related Entities The organization utilizes an affiliate as the common pay agent. Employees reported in Part VII may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting. Form 990, Part VIII, Line 2f Other Program Service Revenue Interest Income from Affiliates - Total Revenue: 18556, Related or Exempt Function Revenue: 18556, 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: 1916, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1916; OTHER MISCELLANEOUS REVENUE - Total Revenue: 1400173, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1400173; NON-PROGRAM REVENUE - Total Revenue: 1045127, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1045127; Form 990, Part XI, Line 9 Other changes in net assets or fund balances FAS 158 PENSION LIABILITY ADJUSTEMENT - -67195; TRANSFERS WITH ALPHA FUND - -340006654; EQUITY TRANSFER TO COLUMBIA HEALTH SYSTEM - -320016; CHANGE IN INTEREST OF NET ASSETS OF COLUMBIA ST MARY'S FOUNDATION - 348372; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS THE ACTIVITY OF COLUMBIA ST. MARY'S, INC. IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF COLUMBIA ST. MARY'S, 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, INC. Form 990, Part XII, Line 2c AUDIT COMMITTEE COLUMBIA ST. MARY'S, 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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