ST CLARE MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: ST CLARE MEMORIAL HOSPITAL INC (EIN 39-0848401)
Tax period: 2016-07-01 to 2017-06-30
Filed: 2018-05-04
IRS object ID: 201801249349301525
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2018-05-04T18:07:04-05:00	ReturnTs
Tax Period End	2017-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	350921680	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CROWE HORWATH LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	225 West Wacker Drive Suite 2600	AddressLine1Txt
City	Chicago	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	606061224	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2016-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	390848401	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	STCL	BusinessNameControlTxt
Phone	9208463444	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 S MAIN STREET	AddressLine1Txt
City	OCONTO FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54154	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	Therese B Pandl	PersonNm
Person Title	PRESIDENT & CHIEF EXECUTIVE OFFICER	PersonTitleTxt
Signature	2018-05-04	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	RACHEL SPURLOCK	PreparerPersonNm
PTIN	P00520729	PTIN
Phone	3128997000	PhoneNum

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	THERESE B PANDL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 S MAIN STREET	AddressLine1Txt
City	OCONTO FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54154	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$33,050,797	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	http://www.stclarememorial.org/	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1929	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY.	ActivityOrMissionDesc
Voting Members Governing Body	10	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	229	TotalEmployeeCnt
Total Volunteers	40	TotalVolunteersCnt
Total Gross UBI	$5,808,504	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$1,856,656	NetUnrelatedBusTxblIncmAmt
CY Contributions Grants	$74,664	CYContributionsGrantsAmt
PY Program Service Revenue	$38,072,046	PYProgramServiceRevenueAmt
CY Program Service Revenue	$32,771,661	CYProgramServiceRevenueAmt
PY Investment Income	$91,854	PYInvestmentIncomeAmt
CY Investment Income	$112,518	CYInvestmentIncomeAmt
PY Other Revenue	$37,434	PYOtherRevenueAmt
CY Other Revenue	$34,144	CYOtherRevenueAmt
PY Total Revenue	$38,201,334	PYTotalRevenueAmt
CY Total Revenue	$32,992,987	CYTotalRevenueAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$16,817,055	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$12,454,692	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$21,508,997	PYOtherExpensesAmt
CY Other Expenses	$25,412,164	CYOtherExpensesAmt
PY Total Expenses	$38,326,052	PYTotalExpensesAmt
CY Total Expenses	$37,866,856	CYTotalExpensesAmt
PY Revenues Less Expenses	-$124,718	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$4,873,869	CYRevenuesLessExpensesAmt
Total Assets BOY	$24,175,085	TotalAssetsBOYAmt
Total Assets EOY	$23,463,861	TotalAssetsEOYAmt
Total Liabilities BOY	$13,976,810	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$17,729,347	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$10,198,275	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$5,734,514	NetAssetsOrFundBalancesEOYAmt
Mission	ST. CLARE MEMORIAL HOSPITAL, INC. OPERATES AN ACUTE CARE HOSPITAL PROVIDING COMPREHENSIVE INPATIENT MEDICAL AND SURGICAL SERVICES AS WELL AS EMERGENCY, PRIMARY CARE PHYSICIAN, AND OUTPATIENT SERVICES. THE HOSPITAL HAS BEEN DESIGNATED AS A CRITICAL ACCESS HOSPITAL UNDER MEDICARE AND MEDICAID REGULATIONS. THIS DESIGNATION, WHICH ENABLES THE HOSPITAL TO RECEIVE REIMBURSEMENT UNDER COST-BASED METHODS, LIMITS THE NUMBER OF STAFFED BEDS THE HOSPITAL MAY OPERATE TO 25.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$26,300,213	ExpenseAmt
Revenue	$26,963,157	RevenueAmt
Desc	ST. CLARE MEMORIAL HOSPITAL SERVES THE GREATER OCONTO COUNTY WITH A FULL-SERVICE HOSPITAL AND FIVE PRIMARY CARE CLINICS LOCATED THROUGHOUT OCONTO COUNTY. THE FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL WITH A LICENSURE OF 25 BEDS AND HAS A 24-HOUR, PHYSICIAN-STAFFED EMERGENCY DEPARTMENT, URGENT CARE, RETAIL PHARMACY, INTENSIVE CARE, INPATIENT AND OUTPATIENT SURGICAL AND DIAGNOSTIC SERVICES, REHABILITATION, WOUND THERAPY AND THE CENTER FOR WOMEN'S CARE. THE ST. CLARE PRIMARY CARE CLINICS ARE LOCATED IN LENA, OCONTO FALLS, GILLETT, SURING AND MOUNTAIN. ST. CLARE MEMORIAL HOSPITAL IS A NON-PROFIT ORGANIZATION DEDICATED TO OUR MISSION TO REVEAL AND EMBODY CHRIST'S HEALING LOVE FOR ALL PEOPLE THROUGH OUR HIGH QUALITY FRANCISCAN HEALTH CARE MINISTRY. ST.CLARE MEMORIAL HOSPITAL EXTENDS THIS MISSION INTO OUR VALUES OF QUALITY, CARE, COMMUNITY, TRUST, AND RESPECT AND PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING THE FISCAL YEAR ENDING JUNE 30, 2017, THE HOSPITAL HAD 510 DISCHARGES; 4,544 VISITS TO THE EMERGENCY ROOM; 789 surgeries AND 18,845 outpatient visits. ST. CLARE MEMORIAL HOSPITAL PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO THEIR AGE, RACE, SEX, OR ABILITY TO PAY FOR SERVICES. DURING FISCAL YEAR 2017, ST. CLARE MEMORIAL HOSPITAL PROVIDED $886,363 IN CHARITY CARE AND $168,702 IN BAD DEBT WRITE OFFS OF PATIENT ACCOUNTS DUE TO THE PATIENTS' INABILITY TO PAY FOR SERVICES THEY RECEIVED. IN ADDITION TO ITS HOSPITAL AND CLINIC SERVICES. ST. CLARE MEMORIAL HOSPITAL PROVIDES THE COMMUNITY MANY OPPORTUNITIES TO RECEIVE FREE AND LOW-COST HEALTH SCREENINGS AND SERVICES. FOR EACH OF THESE OFFERINGS, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL HOSTS COMMUNITY HEALTH INFORMATION SEMINARS ON VARIOUS TOPICS THAT ARE FREE AND OPEN TO THE PUBLIC. THE HOSPITAL ASSUMES THE ENTIRE COSTS FOR THE SPEAKER TO PRESENT THE SEMINAR, PUBLICITY, SUPPLIES, AND THE MEALS. THREE ST. CLARE MEMORIAL HOSPITAL SENIOR SPECIALS DINNER SEMINARS WERE HELD IN 2016. ST. CLARE MEMORIAL HOSPITAL IS PLEASED TO PARTNER, PARTICIPATE AND COLLABORATE WITH MANY COMMUNITY PARTNERS FOR VARIOUS INITIATIVES AND EVENTS. ST. CLARE MEMORIAL HOSPITAL PLANNED AND SPONSORED INCLUDING A COMMUNITY HEALTH INITIATIVE. WE ALSO PRESENTED THE OCONTO COUNTY SAFETY FAIR IN COOPERATION WITH THE OCONTO COUNTY HEALTH DEPARTMENT, OCONTO FALLS FIRE AND POLICE DEPARTMENTS AND THE OCONTO FALLS AMBULANCE SERVICE. ST. CLARE MEMORIAL HOSPITAL OFFERED FREE WORKSHOPS FOR CANCER PATIENTS IN 2015. ST. CLARE MEMORIAL HOSPITAL HOSTS AMERICAN RED CROSS BLOOD DRIVES MULTIPLE TIMES EACH YEAR. ST. CLARE MEMORIAL HOSPITAL IS AN ACTIVE MEMBER IN THE OCONTO FALLS CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN THEIR MAJOR FUND RAISING COMMITTEE AND THE EXECUTIVE COMMITTEE. FOR EACH OF THESE INITIATIVES, ST. CLARE MEMORIAL HOSPITAL PROVIDED PLANNING, PUBLICITY, STAFF, EQUIPMENT, SUPPLIES, AND FACILITIES. ST. CLARE MEMORIAL HOSPITAL SUPPORTS AND PARTICIPATES IN AREA SCHOOL-RELATED ACTIVITIES. IN ADDITION TO PROVIDING COMPREHENSIVE SPORTS PHYSICAL CLINICS IN WHICH THE FEES ARE DONATED BACK TO THE SCHOOLS OF THE PARTICIPATING STUDENTS, ST. CLARE MEMORIAL HOSPITAL PARTICIPATED IN AREA SCHOOL HEALTH FAIRS, CAREER FAIRS, AND EARLY CHILDHOOD SCREENINGS. SCHOOL FIELD TRIP TOURS ARE ROUTINELY HOSTED AT THE HOSPITAL. ST. CLARE MEMORIAL HOSPITAL ALSO DONATED TO THE CONSTRUCTION OF NEW SOFTBALL FIELDS FOR THE OCONTO FALLS SCHOOL DISTRICT.	Desc
Total Program Service Expenses	$26,300,213	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	Yes (true)	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	17	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	229	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	10	GoverningBodyVotingMembersCnt
Independent Voting Member	6	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	Yes (true)	WrittenPolicyOrProcedureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Joanne Horvath	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	9204313211	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	835 S Van Buren St	AddressLine1Txt
City	Green Bay	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54301	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
THERESE B PANDL
PRESIDENT & CHIEF EXECUTIVE OFFICER	6.0	54.0	Yes (X)	Yes (X)	$0	$901,796	$239,493
CHRISTY KAEMPFER
Chair	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
DANIEL BOETTCHER
Vice Chair	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
JAN STRANZ
Secretary	2.0	0	Yes (X)	Yes (X)	$0	$0	$0
DR JAMES CLEMENS
BOARD MEMBER/PHYSICIAN	2.0	40.0	Yes (X)		$0	$575,619	$32,495
DR ROBERT CUTLAN
BOARD MEMBER/PHYSICIAN	2.0	40.0	Yes (X)		$0	$693,241	$32,495
HOWARD ESLIEN
BOARD MEMBER	2.0	0	Yes (X)		$0	$0	$0
SR MaryAnn Falbe OSF
BOARD MEMBER	1.0	0	Yes (X)		$0	$0	$0
GREG JONES
BOARD MEMBER	2.0	0	Yes (X)		$0	$0	$0
PETER MANNIX
BOARD MEMBER	1.0	59.8	Yes (X)		$0	$510,477	$196,555
ANN M CARR
TREASURER	0.3	59.4		Yes (X)	$0	$359,960	$312,526
DANIEL DEGROOT
Ex-Officio Board Member/COO	40.0	0.5		Yes (X)	$258,789	$0	$11,577
GREG SIMIA
Division CFO	5.0	35.0		Yes (X)	$0	$403,057	$112,569
JAMES ARNOLD
PHYSICIAN	40.0	0			$164,663	$0	$33,077	Yes (X)
GRAM COTTON
CRNA	40.0	0			$274,298	$0	$29,522	Yes (X)
JASON KNOX
PHARMACY DIRECTOR	40.0	0			$143,255	$0	$36,913	Yes (X)
DAVID MISKULIN
PHARMACIST	40.0	0			$128,337	$0	$27,711	Yes (X)
JASON MURPHY
CRNA	40.0	0			$187,466	$0	$122,171	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,156,808	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$3,444,150	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,187,104	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	10	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	Yes (true)	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
IEI General Contractors
1725 Midway Rd	DePere	WI	54115	Construction	$780,031
General & Vascular Consult LLC
840 S Madison St	Green Bay	WI	54301	Trauma Services	$733,333
RF Connect LLC
37735 Enterprise Ct Suite 200	Farmington Hills	MI	483313474	Telecommunications	$227,761
Infinity Healthcare SC
111 E Wisconsin Ave	Milwaukee	WI	53202	ER Physician Services	$177,143
NEW Surgical Associates
670 Cormier Rd	Green Bay	WI	54304	Physician Services	$174,344

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	11	CntrctRcvdGreaterThan100KCnt
Related Organizations	$16,165	RelatedOrganizationsAmt
All Other Contributions	$58,499	AllOtherContributionsAmt
Total Contributions	$74,664	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE	900099	$21,065,297	$21,065,297
PHARMACY REVENUE	446110	$11,706,364	$5,897,860	$5,808,504

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$32,771,661	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$34,405	TotalRevenueColumnAmt
Exclusion	$34,405	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$3,987	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$3,987	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,987	TotalRevenueColumnAmt
Exclusion	$3,987	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$87,212	SecuritiesAmt
Other	$48,711	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$57,810	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$87,212	SecuritiesAmt
Other	-$9,099	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$78,113	TotalRevenueColumnAmt
Exclusion	$78,113	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA REVENUE	900099	$30,157	$30,157
		$0		$0

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$30,157	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$32,992,987	TotalRevenueColumnAmt
Related Or Exempt Func Income	$26,963,157	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$5,808,504	UnrelatedBusinessRevenueAmt
Exclusion	$146,662	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$258,789	TotalAmt
Management And General	$258,789	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$9,213,403	TotalAmt
Program Services	$6,630,534	ProgramServicesAmt
Management And General	$2,582,869	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$199,286	TotalAmt
Program Services	$139,500	ProgramServicesAmt
Management And General	$59,786	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$2,155,643	TotalAmt
Program Services	$1,508,950	ProgramServicesAmt
Management And General	$646,693	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$627,571	TotalAmt
Program Services	$439,300	ProgramServicesAmt
Management And General	$188,271	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,850	TotalAmt
Management And General	$1,850	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$30,100	TotalAmt
Management And General	$30,100	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$4,191	TotalAmt
Management And General	$4,191	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$38,227	TotalAmt
Management And General	$38,227	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$12,301,855	TotalAmt
Program Services	$8,611,299	ProgramServicesAmt
Management And General	$3,690,556	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$138,357	TotalAmt
Program Services	$96,850	ProgramServicesAmt
Management And General	$41,507	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,238	TotalAmt
Program Services	$2,267	ProgramServicesAmt
Management And General	$971	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$905,251	TotalAmt
Program Services	$633,676	ProgramServicesAmt
Management And General	$271,575	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$80,437	TotalAmt
Program Services	$56,306	ProgramServicesAmt
Management And General	$24,131	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$90,696	TotalAmt
Program Services	$63,487	ProgramServicesAmt
Management And General	$27,209	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$168,684	TotalAmt
Management And General	$168,684	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,283,119	TotalAmt
Program Services	$898,183	ProgramServicesAmt
Management And General	$384,936	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$115,318	TotalAmt
Program Services	$80,723	ProgramServicesAmt
Management And General	$34,595	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$8,133,103	$5,693,172	$2,439,931
EQUIPMENT RENTAL & MAINTENANCE	$1,611,294	$1,127,906	$483,388
BAD DEBT	$168,702	$168,702
MEDICAID TAX ASSESSMENT	$128,565		$128,565

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$209,177	TotalAmt
Program Services	$149,358	ProgramServicesAmt
Management And General	$59,819	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$37,866,856	TotalAmt
Program Services	$26,300,213	ProgramServicesAmt
Management And General	$11,566,643	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$1,025,003	BOYAmt
EOY	$492,252	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$2,836,104	BOYAmt
EOY	$1,357,766	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,644,278	BOYAmt
EOY	$5,398,183	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,683,388	BOYAmt
EOY	$1,552,069	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$57,891	BOYAmt
EOY	$29,727	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$26,272,681	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$15,676,107	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$10,384,298	BOYAmt
EOY	$10,596,574	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$3,339,522	BOYAmt
EOY	$3,880,080	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$37,303	BOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$167,298	BOYAmt
EOY	$157,210	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$24,175,085	BOYAmt
EOY	$23,463,861	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$5,439,324	BOYAmt
EOY	$9,946,770	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,916,976	BOYAmt
EOY	$7,530,000	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$620,510	BOYAmt
EOY	$252,577	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$13,976,810	BOYAmt
EOY	$17,729,347	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$10,048,142	BOYAmt
EOY	$5,434,520	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$140,133	BOYAmt
EOY	$289,994	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$10,000	BOYAmt
EOY	$10,000	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$10,198,275	BOYAmt
EOY	$5,734,514	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$24,175,085	BOYAmt
EOY	$23,463,861	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$4,873,869	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$144,305	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$265,803	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$4,191	OtherActivitiesAmt
Total Lobbying Expenditures	$4,191	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

ST. CLARE MEMORIAL HOSPITAL, INC. ("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 AND PART OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FOR ITS DUES PAID.

Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$428,316	OtherCostOrOtherBasisAmt
Book Value	$428,316	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$18,997,905	OtherCostOrOtherBasisAmt
Depreciation	$10,997,322	DepreciationAmt
Book Value	$8,000,583	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$86,732	OtherCostOrOtherBasisAmt
Depreciation	$12,354	DepreciationAmt
Book Value	$74,378	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,719,113	OtherCostOrOtherBasisAmt
Depreciation	$4,666,431	DepreciationAmt
Book Value	$2,052,682	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$40,615	OtherCostOrOtherBasisAmt
Book Value	$40,615	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$10,596,574	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDesc	AmtAmt
CAPITAL LEASES	$22,686
DUE TO MEDICARE
ACCRUED BENEFIT LIABILITY	$51,737
RETIREMENT OBLIGATION-ASBESTOS	$130,171
Advance Pain Mgmt	$47,983

Field	Value	IRS element (for citing)
Total Liability	$252,577	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	FormAndLineReferenceDesc
Explanation	HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501 (c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely than not Kiara, Inc. will not realize the majority of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2017 and 2016 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, 2017 and 2016, HSHS does not have any liabilities for unrecognized tax benefits.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

Field	Value	IRS element (for citing)
Other	Yes (X)	OtherInd
Discounted Care Other	600	DiscountedCareOtherPct

Field	Value	IRS element (for citing)
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$481,310	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$481,310	NetCommunityBenefitExpnsAmt
Total Expense	0.0127	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,790,166	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,876,016	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,914,150	NetCommunityBenefitExpnsAmt
Total Expense	0.0770	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$251,959	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$72,773	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$179,186	NetCommunityBenefitExpnsAmt
Total Expense	0.0047	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$6,523,435	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,948,789	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,574,646	NetCommunityBenefitExpnsAmt
Total Expense	0.0944	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Persons Served	800	PersonsServedCnt
Total Community Benefit Expns	$24,668	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$24,668	NetCommunityBenefitExpnsAmt
Total Expense	0.0007	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Persons Served	7	PersonsServedCnt
Total Community Benefit Expns	$11,665	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$11,665	NetCommunityBenefitExpnsAmt
Total Expense	0.0003	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Persons Served	6334	PersonsServedCnt
Total Community Benefit Expns	$55,333	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$55,333	NetCommunityBenefitExpnsAmt
Total Expense	0.0015	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	7141	PersonsServedCnt
Total Community Benefit Expns	$91,666	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$91,666	NetCommunityBenefitExpnsAmt
Total Expense	0.0024	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	7141	PersonsServedCnt
Total Community Benefit Expns	$6,615,101	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,948,789	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,666,312	NetCommunityBenefitExpnsAmt
Total Expense	0.0968	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Persons Served	21	PersonsServedCnt
Total Community Benefit Expns	$1,503	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,503	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.0	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Persons Served	13	PersonsServedCnt
Total Community Benefit Expns	$1,258	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,258	NetCommunityBenefitExpnsAmt
Total Expense	0.0000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	34	PersonsServedCnt
Total Community Benefit Expns	$2,761	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,761	NetCommunityBenefitExpnsAmt
Total Expense	0.0001	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$168,702	BadDebtExpenseAmt
Bad Debt Expense Attributable	$29,787	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$12,053,423	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$20,210,329	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$8,156,906	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	855 SOUTH MAIN STREET	AddressLine1Txt
City	OCONTO FALLS	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	54154	ZIPCd

Field	Value	IRS element (for citing)
Website Address	http://www.stclarememorial.org/	WebsiteAddressTxt
State License	1012	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ST CLARE MEMORIAL HOSPITAL INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	false	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	false	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	14	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (true)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (true)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	http://www.stclarememorial.org/Hospital-Information/About/Community-Health-Needs.aspx	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	14	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (true)	StrategyPostedWebsiteInd
Strategy Website URL	http://www.stclarememorial.org/Hospital-Information/About/Community-Health-Needs.aspx	StrategyWebsiteURLTxt
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.0	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	600.0	FPGFamilyIncmLmtDscntCarePct
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (true)	ExplainedBasisInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	http://www.hshs.org/FAP	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	http://www.hshs.org/FAP	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	http://www.hshs.org/FAP	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	false	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Other Actions Taken	Yes (X)	OtherActionsTakenInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Look Back Medicare Private	Yes (X)	LookBackMedicarePrivateInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - HSHS St. Clare Memorial Hospital. In Fall 2015, the Healthy County Oconto Coalition was reconvened to re-energize the partners who conducted the Community Health Needs Assessment and to review and revise the strategies included in the Healthy Oconto County Community Health Improvement Plan 2014-2018. The meeting was facilitated by HSHS St. Clare Memorial Hospital and Bellin Health, two health systems who are members of the Healthy Oconto County Coalition. As part of the process, the Coalition agreed to focus its efforts on one of the three identified community health need areas: Nutrition and Physical Activity and specifically, the completion of the Oconto Falls Trail System, which was launched in 2014 with a "Run for the Trails 5K/10K" run to benefit the creation of the Oconto Falls Trail System. HSHS St. Clare Memorial partners with community-wide action planning teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address identified priority community health needs. The 2014 to 2018 implementation strategies and interventions included, but were not limited to, the following initiatives: 1. Physical Activity and Nutrition Lead the activities of Healthy Oconto County 2018, a coalition of community partners dedicated to improving the health of Oconto County. Create an Oconto Falls Trail System to increase safe, physical activity in Oconto County. Assist Kingdom Come Food Pantry by coordinating food drives, utilizing sites and courier services for food distribution, and providing educational materials regarding healthy food choices. 2. Mental Health Infrastructure planning to provide tele-psychiatry coverage at HSHS St. Clare Memorial Hospital. Scheduled to go live in early 2018, the program will utilize Genoa, a tele-psychiatry vendor, to operationalize this service in all four HSHS eastern Wisconsin hospitals. Proposal development for Employee Assistance Program (EAP) services for the Oconto Falls School District. Led by the HSHS and Prevea Executive Director for Behavioral Care Services, the proposal was to provide outpatient counseling services to the school district. The program's purpose was to provide School Based Mental Health to improve access and to provide timely access to services and treatment. Furthermore, the program was designed to reduce and prevent suicide and or violence against others among school age children through early identification and intervention. The school district ultimately chose a different provider for the EAP services. Prevea Health and Libertas, a department of HSHS St. Vincent Hospital, a related tax-exempt hospital, and an alcohol and drug addiction treatment center for adolescents and adults, participated in the Annual Oconto County Community Wellness Fair at the Bond Community Center in Oconto on Friday, September 8th, 2017. Prevea Health offers a state-certified outpatient behavioral health clinic in the Medical Services Building on the campus of HSHS St. Clare Memorial Hospital in Oconto Falls. 3. Alcohol and other Drug Abuse In October 2016, a team at HSHS St. Clare Memorial Hospital researched the feasibility of offering Inpatient AODA Detox services at HSHS St. Clare Memorial Hospital. We arranged multiple meetings with other Critical Access Hospitals that offered these services. After careful consideration and evaluation, we decided not to offer AODA Detox services at HSHS St. Clare Memorial Hospital at this time. *Hope Grant: Heroin and Opioid, Prevention and Education -Individuals who are without insurance can receive services, thanks to a grant from the Wisconsin Department of Health Services in 2015, which established an opioid treatment program known as Northeast Wisconsin Opioid Treatment Services. This program is provided through a collaborative effort between Libertas (a department of HSHS St. Vincent Hospital, a related tax-exempt hospital) and Prevea Health to help individuals addicted to opioids. -Northeast Wisconsin Opioid Treatment Services provides services to people living with an opioid addiction in Florence, Marinette, Menominee and Oconto counties. -Libertas, an alcohol and drug addiction treatment center for adolescents and adults, provides heroin and opioid addiction services. -With this service, people with opioid addiction can access abstinence-based treatment or medication-assisted treatment with substance use counseling. Quantitative data for each of the potential health focus areas was assembled from a wide variety of public sources. The quantitative data was then reviewed to help validate the selection of health priorities. Per IRS requirements, the data was reviewed by key community stakeholders who represented 1) the broad interests of the community, and 2) the voice of community members who were medically underserved, minorities, low-income, and/or those persons with chronic illnesses at the community health improvement summit in November 2015. Key community stakeholders included: Aaron Malczewski, Superintendent, Oconto School District; Ann Kresl, Account Executive, Bellin Health Business Health Solutions; Ashley Vanden Elzen, Supervisor, Aging Disability Resource Center-Wolf River Region; Brittany Beyer, Public Health Nurse, Oconto County Public Health; Cara Peterson, General Manager, The Cottages Assisted Living and Memory Care; Carrie Rupert, RN, Team Leader Clinical Services, Bellin Health Oconto Hospital; Charles Heyka, MD, Oconto Bellin Health; Chris Schultz, EMT, Mountain Ambulance; Charlie Anderson, EMT, Mountain Ambulance; Claudia Bartz Citizen Suring, WI USA; Connie Parkovich, Bond Community Center; David Honish Superintendent, Lena Public Schools; David Konop, Citizen, Lena, WI; David Lally, Director - Business Development, HSHS St. Clare Memorial Hospital; Debra Konitzer, Health Officer, Oconto County Public Health; Elisabeth Scheelk, Public Health Educator, WI DHS/Division of Public Health; Elisabeth Schmelzer, Branch Manager, ResCare Home Care; Heidi Selberg, HSHS St Clare Memorial Hospital; Hope Kersten, WIC Director, Oconto County WIC Program; Jane Schneider Guidance Counselor, Oconto Falls Washington Middle School; Jill Cholewa Family Living Agent, UWEX; John Pinkart, Director/WI Food and Nutrition, UW-Extension; Kathy Henne, HSHS St. Clare Memorial Hospital; Kim Keyser, Psychotherapist, Bellin Health Psychiatric Center-Behavioral Health; Kim Pytleski, County Clerk, Oconto County; Kriss Krause, Executive Assistant/Human Resources, Oconto Electric Cooperative; Laura Cormier, VP Operations, Bellin Health Oconto Hospital; Mary Lemmen, County Board HHS Committee; Nuala Nowidki, Prevea Health; Patti Arendt, Team Leader Regional Clinics, Bellin Health Psychiatric Center-Behavioral Health; Patty Belongia, Prevea Health Leadwell; Phil Everhart, CEO/Executive Director, TriCity Area United Way; Rhonda Stuart, Northern Health Centers; Ron Christensen, Woodland Village; Samantha Routheau, Oconto County Economic Development Corporation; Sara Applebee, Community Health Director, Oconto County Public Health; Sara Vaessen, Case Manager, Bellin Health Oconto Hospital; Sarah Ciancio RN, Director of Nursing, Sharpe Care. By hosting the summit and sharing the priorities and implementation plans with the hospital board of directors, the hospital collected input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of, or expertise in public health (local, regional, state and/or tribal). Members of medically underserved, low-income and minority populations served by the hospital or individuals or organizations representing the interests of such populations also provided input. The medically underserved are members of a population who experience health disparities, are at risk of not receiving adequate medical care as a result of being uninsured or underinsured, and/or experiencing barriers to health care due to geographic, language, financial or other barriers.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - HSHS St. Clare Memorial Hospital. Bellin Health of Oconto Hospital.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - HSHS St. Clare Memorial Hospital. A community wide CHNA steering committee was developed to guide the structure of the process to ensure that the requirements of all parties were met. Members of the CHNA Steering Committee represented organizations that have a legal or regulatory requirement to conduct a CHNA. CHNA Steering Committee members included: Debbie Konitzer, Oconto County Public Health; Laura Cormier, Bellin Health; David Lally, HSHS St. Clare Memorial Hospital; Kathy Henne, HSHS St. Clare Memorial Hospital; Heidi Selberg Hospital Sisters Health System; and Beth Scheelk, WI Department of Health Northeast Region.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - HSHS St. Clare Memorial Hospital. In Fall 2015, the Healthy County Oconto Coalition was reconvened to re-energize the partners who conducted the Community Health Needs Assessment and to review and revise the strategies included in the Healthy Oconto County Community Health Improvement Plan 2014-2018. The meeting was facilitated by HSHS St. Clare Memorial Hospital and Bellin Health, two health systems who are members of the Healthy Oconto County Coalition. As part of the process, the Coalition agreed to focus its efforts on one of the three identified community health need areas: Nutrition and Physical Activity and specifically, the completion of the Oconto Falls Trail System which was launched in 2014 with a "Run for the Trails 5K/10K" run to benefit the creation of the Oconto Falls Trail System. HSHS St. Clare Memorial partners with community-wide action planning teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address identified priority community health needs. The 2014 to 2018 implementation strategies and interventions included, but were not limited to, the following initiatives: Physical Activity and Nutrition Lead the activities of Healthy Oconto County 2018, a coalition of community partners dedicated to improving the health of Oconto County. Create an Oconto Falls Trail System to increase safe, physical activity in Oconto County. Assist Kingdom Come Food Pantry by coordinating food drives, utilizing sites and courier services for food distribution, and providing educational materials regarding healthy food choices. Mental Health Infrastructure planning to provide tele-psychiatry coverage at HSHS St. Clare Memorial Hospital. Scheduled to go live in early 2018, the program will utilize Genoa, a tele-psychiatry vendor, to operationalize this service in all four HSHS eastern Wisconsin hospitals. Proposal development for Employee Assistance Program (EAP) services for the Oconto Falls School District. Led by the HSHS and Prevea Executive Director for Behavioral Care Services, the proposal was to provide outpatient counseling services to the school district. The program's purpose was to provide School Based Mental Health to improve access and to provide timely access to services and treatment. Furthermore, the program was designed to reduce and prevent suicide and or violence against others among school age children through early identification and intervention. The school district ultimately chose a different provider for the EAP services. Prevea Health and Libertas, a department of HSHS St. Vincent Hospital, a related tax-exempt hospital, and an alcohol and drug addiction treatment center for adolescents and adults, participated in the Annual Oconto County Community Wellness Fair at the Bond Community Center in Oconto on Friday, September 8th, 2017. Prevea Health offers a state-certified outpatient behavioral health clinic in the Medical Services Building on the campus of HSHS St. Clare Memorial Hospital in Oconto Falls. Alcohol and other Drug Abuse In October 2016, a team at HSHS St. Clare Memorial Hospital researched the feasibility of offering Inpatient AODA Detox services at HSHS St. Clare Memorial Hospital. We arranged multiple meetings with other Critical Access Hospitals that offered these services. After careful consideration and evaluation, we decided not to offer AODA Detox services at HSHS St. Clare Memorial Hospital at this time. *Hope Grant: Heroin and Opioid, Prevention and Education -Individuals who are without insurance can receive services, thanks to a grant from the Wisconsin Department of Health Services in 2015 which established an opioid treatment program known as Northeast Wisconsin Opioid Treatment Services. This program is provided through a collaborative effort between Libertas (a department of HSHS St. Vincent Hospital, a related tax-exempt hospital) and Prevea Health to help individuals addicted to opioids. -Northeast Wisconsin Opioid Treatment Services provides services to people living with an opioid addiction in Florence, Marinette, Menominee and Oconto counties. -Libertas, an alcohol and drug addiction treatment center for adolescents and adults, provides heroin and opioid addiction services. -With this service, people with opioid addiction can access abstinence-based treatment or medication-assisted treatment with substance use counseling.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - St. Clare Memorial 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
Schedule H, Part V, Section B, Line 20 Facility , 1	Facility , 1 - St. Clare Memorial Hospital. HSHS provids a written notice about upcoming ECAs at least 30 days prior to initiating ECAs. This statement is included on a patient billing statement prior to placement with an agency. Additionally, a message about the availability of financial assistance is included on the statement, but it was not a separate summary document.

Field	Value	IRS element (for citing)
Facility	6	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
HSHS St Clare Memorial Hospital Prevea Lena Health Center
200 SOUTH ROSERA STREET	LENA	WI	54139	CLINIC
HSHS St Clare Memorial Hospital Prevea Mountain Health Center
14353 HWY 32/64	MOUNTAIN	WI	54149	CLINIC
HSHS St Clare Memorial Hospital Prevea Gillett Health Center
340 NORTH GREEN BAY AVE	GILLETT	WI	54124	CLINIC
HSHS St Clare Memorial Hospital Prevea Suring Health Center
913 E MAIN STREET	SURING	WI	54174	CLINIC
HSHS St Clare Memorial Hospital Prevea Oconto Falls Health Center
835 SMain St	Oconto Falls	WI	54154	Clinic

Supplemental Information Detail SupplementalInformationDetail (20 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part VI, Line 6 DESCRIPTION OF AFFILIATED GROUP (Cont. A)	HSHS Good Shepherd Hospital in Shelbyville, Illinois increases access to mammograms, diagnostic screenings and breast cancer treatments for women through the hospital's Pink Ribbon Program and Vicky Wagner Breast Cancer Assistance Fund. The Pink Ribbon Program covers the costs of mammograms or diagnostic screenings for women living in rural areas who are under or uninsured. The Vicky Wagner Breast Cancer Assistance Fund assists women living in Shelby County who are receiving treatment for breast cancer with out of pocket expenses such as wigs, transportation to treatment appointments, child care, meals or other expenses that insurance doesn't cover. In southwest Illinois, HSHS St. Joseph's Hospital in Highland provides enhanced offerings for senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive a comprehensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, St. Joseph's Hospital is the lead collaborator in the Highland Area Meals on Wheels Program. In April 1977, the hospital partnered with the now defunct Highland Area Council of Churches to introduce the Meals on Wheels program. Today, St. Joseph's partners with the civic organization Highland Area Meals on Wheels Program to prepare and deliver nutritious meals to the elderly, those who are recuperating from illness or hospital stays, or anyone wishing to participate in the program within a 15-mile radius (cumulative population 20,000+) of the hospital. Annually, approximately 16,896 meals are delivered in eight communities. In addition to programs designed to increase access to care, HSHS makes sure that those who need financial assistance receive it. HSHS's Financial Assistance (Charity Care) policy was modified to offer a 45 percent self-pay discount to all patients who register without insurance. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 55 percent reduction off billed charges if an uninsured patient's family income level is determined to be above 500 percent but equal to our less than 600 percent of the current Federal Poverty Guidelines. HSHS hospitals waive all charges for patients below 200 percent of the Federal Poverty Levels. Counselors are available in our hospitals to explain our financial assistance policy to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Enhance community health As part of our mission to embody Christ's healing love for all people, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. To ensure the health care needs of all are being met, HSHS hospitals also understand we need to listen closely to the residents of the communities we serve. In turn, 13 HSHS hospitals conducted Community Health Needs Assessments (CHNAs) in FY2015. HSHS St. Clare Memorial Hospital in Oconto Falls, Wisconsin, who affiliated with HSHS in September 2015, and HSHS Holy Family Hospital in Greenville, Illinois, who affiliated with HSHS in May 2016, both completed their CHNAs in FY2014. HSHS Good Shepherd Hospital in Shelbyville, Illinois who affiliated with HSHS in January 2017, conducted its most recent CHNA in FY2016. HSHS hospitals are using the information gathered from their most recent CHNAs to develop new, and enhance existing, programs and services that best address the needs of the community. Priority health care needs were identified in the FY2015 CHNAs including access to health care services; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In many cases, the hospitals collaborate with other hospital facilities, local departments of public health and community organizations to address identified needs. In western Wisconsin, HSHS Sacred Heart Hospital in Eau Claire and HSHS St. Joseph's Hospital in Chippewa Falls are taking the lead to educate the public about mental health issues and treatment, the stigma associated with mental health, and the recognition of mental health issues. Under the umbrella of 3D Community Health, the hospitals led suicide prevention activities across multiple sectors in collaboration with the Chippewa Health Improvement Partnership in FY2017. Strategies included community trainings of an evidence-based suicide prevention program, QPR (question, persuade & refer), and a variety of events, activities and displays pertaining to suicide prevention. Efforts are measured by the county suicide rate, inventory of change in community knowledge, stigma and behaviors, as well as participation in the county suicide death review team to monitor for potential trends and respond accordingly. 3D formed a suicide death review team in both Eau Claire and Chippewa Counties. These teams review details of each suicide to look for trends and key pieces of information that may guide efforts in targeting certain geographic areas, certain age or gender, etc. 3D is also focused on increasing community awareness and knowledge of the factors that offer protection from suicidal behaviors and that promote wellness and recovery in collaboration with multiple community partners on an ongoing basis. One strategy is to promote effective programs and practices i.e. adverse childhood experiences (ACEs) that increase protection from suicidal risk and promote connectedness among residents of Chippewa and Eau Claire Counties. At the Children, Health and Family Summit that 3D Community Health coordinated in partnership with the County Department of Human Services in FY2017, 99 of the 190 attendees took a pre-and- post-event survey about ACEs and brain development. There was a 24% increase in the percentage who strongly agreed that exposing infants to stress can actually cause them to develop a smaller brain post-event compared to pre-event survey. HSHS Holy Family Hospital in Greenville, Illinois has sponsored a multi-faceted health fair for decades, one of the largest Health Fairs in the east St. Louis metropolitan area. The event provides many free health tests in addition to five, low-cost comprehensive blood tests. In FY2017, more than 2,000 blood tests were performed as part of the hospital's annual Health Fair. Participants could choose from a comprehensive blood test, prostate specific antigen blood test (PSA), Hemoglobin A1-C, Vitamin D blood test, Colovantage or a combination of the five blood tests. The cost incurred by HSHS Holy Family Hospital for offering these discounted services was $1,431,105. In addition to the services provided on the day of the Health Fair, the hospital also performs the low-cost blood tests at several off-site locations including area schools, businesses, and manufacturers. Through the years, life-threatening and serious medical conditions have been discovered through testing performed in association with the Health Fair. Mary's Garden is a community teaching garden located on the campus of HSHS St. Mary's Hospital in Decatur, Illinois. The goals of the community garden are to improve community health and food accessibility for those in need, teach the younger generation sustainable gardening and offer a comprehensive, place-based approach to community health improvement. In FY2017 Mary's Garden became a living classroom for Eisenhower High School students who use the garden for interactive instruction on health and nutrition, science, mathematics, ecology and agriculture. Mary's Garden also provided opportunities for two apprentices to develop competencies and self-confidence to move into rural and urban farming/gardening leadership roles and launched a community-supported agriculture (CSA) program for colleagues. This created two jobs and is providing a model for turning dilapidated city lots into urban gardens. The hospital has engaged City officials about a job creation program and neighborhood revitalization.
Schedule H, Part VI, Line 6 DESCRIPTION OF AFFILIATED GROUP (Cont. B)	In FY2017, HSHS St. Nicholas Hospital in Sheboygan supported a case manager position to provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) services at Lakeshore Community Health Care (LCHC) in Sheboygan. First year funding by the hospital in FY2016 was used to create the position. In FY2018, the position will be solely funded by LCHC. SBIRT is an evidence-based practice designed to identify, reduce and prevent problematic use, abuse and dependence on drugs and alcohol. The creation of the SBIRT case manager position stems from Healthy Sheboygan County's 2020 Community Health Implementation Plan which was created following the Community Health Needs Assessment in 2014. Studies show that excessive use of alcohol and other drugs contributes to more than 70 diseases and leads to expensive, long-term health problems. Through early intervention, provided by the SBIRT case manager, the plan is to reduce costs and decrease the severity of drug and alcohol abuse. Advance medical knowledge HSHS works to advance medical knowledge by supporting research initiatives and educational opportunities. In FY2017, HSHS hospitals and affiliated physician groups contributed more than $21.5 million toward research and health professions education. Highlights of this commitment include subsidizing medical school residency programs, offering ongoing medical education to physicians and clinicians, and providing job shadowing programs for high school students. In southern Illinois, HSHS St. Joseph's Hospital in Breese, hosted members of the Health Occupations Students of America onsite to learn about job opportunities in health care from health care professionals. St. Joseph's also provided clinical experience for Kaskaskia College students enrolled in nursing, physical therapy and radiology programs. Pharmacy students have also completed their clinical training at St. Joseph's Hospital. In FY2017, the program served more than 200 students. In FY2017, HSHS St. Mary's Hospital Medical Center and HSHS St. Vincent Hospital in Green Bay invested more than $636,000 to provide onsite training and education of nurses and allied health professionals. In addition, the hospitals have been collaborating with the Medical College of Wisconsin to establish a community medical education program in Green Bay and to provide financial support to offset operating costs in FY2017. Also in eastern Wisconsin, HSHS St. Clare Memorial Hospital in Oconto Falls provided training for local paramedics and emergency response personnel through the hospital's EMS liaison program. Mission-driven and strategically implemented Community Benefit is an integral part of Hospital Sisters Health System's Mission. Our commitment to Community Benefit arises from our Catholic identity, Mission and Core Values shared by 14,000 colleagues across Illinois and Wisconsin. Through our work to improve access to health care services, enhance community health, advance medical knowledge, and relieve or reduce the burden of government, we believe we have made a positive difference in the quality of lives of tens of thousands of people in Illinois and Wisconsin in FY2017. As a Catholic health care ministry, HSHS is concerned with the dignity of all persons, the common good, and the stewardship of resources. We advocate for health care for all and work to improve social conditions that lead to improved health and well-being. We engage partners in our communities to improve health and quality of life and to reduce duplication. Working side- by-side with many faith communities, HSHS remains dedicated to our common purpose of compassionate care for all people.
Schedule H, Part I, Line 7 SCHEDULE H, PART 1, COL F	The bad debt expense included on Form 990, Part IX, Line 25, column (A) was subtracted prior to and for the purpose of calculating the percentage in Part I, Line 7, column (f) is $168,702.
Schedule H, Part VI, Line 5 Promotion of Community Health (Part A)	Free skin cancer screenings in collaboration with the Mary Hendrickson Johnson Foundation, American Cancer Society, and HSHS St. Vincent Hospital Regional Cancer Center. Each participant is screened for their skin cancer risk, reviews educational material regarding the detection and prevention of skin cancer, and is examined by a physician or midlevel provider. Depending on the findings, participants may be referred to a provider for follow up. This event is fully staffed by volunteers and includes physicians, midlevel providers, nurses, and other hospital colleagues. More than 60 participants were screened at the annual event in April 2017. Free Family & Friends CPR classes taught by certified CPR instructors from HSHS St. Clare Memorial Hospital. In FY2017, 49 community members participated county wide. Nutritional Education for high school students Assisted 486 patients and community members in completing Advanced Directives
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FY2017 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET 2.
Schedule H, Part II Community Building Activities	HSHS St. Clare Memorial Hospital leads the Oconto Falls Area Trail System project in partnership with the Oconto Falls Area Chamber of Commerce, Oconto Falls Area School District, and Bellin Health of Oconto Hospital. As identified in the CHNA, this project addresses the need for increased physical activity for Oconto county residents through the creation of a safe, accessible trail system. The multiple phases of this project will establish walking trails and sidewalks that connect to existing sidewalks to create walking and running loops throughout the city and along county roads. Annually, HSHS St. Clare Memorial Hospital hosts a day-long EMS Conference for Oconto County EMS providers. Many rural EMS services are challenged with keeping their staff current with pre-hospital care. Oconto County Basic EMT and Advanced EMT providers are often from volunteer services where education is minimal. By providing a yearly conference, spotlighting the latest pre-hospital care, HSHS St. Clare Memorial Hospital increases health care knowledge and competencies for area EMS providers. In FY2017, the EMS conference topics included human trafficking, the latest in Tele-Stroke, EKG review and STEMI recognition and 21 EMS providers were served.
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 that 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 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. HSHS St .Clare Memorial Hospital reports bad debt in accordance with healthcare financial management association statement 15, as modified and consistent with Generally Accepted Accounting Principles.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	HSHS St. Clare 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. Currently, the hospital is implementing processes, procedures and systems to more effectively determine charity care that will reduce a patient's documentation requirements and ease the patient's emotional burden in applying for charity care. This will provide a more accurate reporting of charity care services provided by the hospital.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 21 in the HSHS Consolidated Audit Report.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	The hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital 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. The hospital Medicare shortfall at cost for fiscal year 2017 was $8,156,906.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections.
Schedule H, Part V, Section B, Line 16a FAP website	- ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16a URL: http://www.hshs.org/FAP;
Schedule H, Part V, Section B, Line 16b FAP Application website	- ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16b URL: http://www.hshs.org/FAP;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- ST. CLARE MEMORIAL HOSPITAL, INC.: Line 16c URL: http://www.hshs.org/FAP;
Schedule H, Part VI, Line 2 Needs assessment	As indicated in Part V, Section C, the hospital conducted a Community Health Needs Assessment in FY2015. In addition to conducting a Community Health Needs Assessment (CHNA) triennially per the provisions in the Affordable Care Act, the hospital routinely assesses the health care needs of the communities it serves in a variety of ways, including reviewing the health needs assessments of other health care organizations in our service area as well our local and state health departments and the United Way. We continually review primary data such as hospital and emergency department utilization and patient surveys as well as secondary data from our county and state public health departments, the Centers for Disease Control, County Health Rankings, and the Behavioral Risk FS Survey to name a few. On occasion, we will also collect primary data through telephone and electronic survey instruments. In addition to ongoing primary and secondary data collection and analysis, the hospital regularly assesses the health care needs of the communities it serves through feedback received from its internal assessment team, assessment advisory team, hospital leadership, Strategy department and hospital Board members. As part of the three-year Implementation Plan, the hospital shares its progress toward achieving its short and long term indicators in various community venues such as town hall meetings, community forums, and Chamber of Commerce. Also through volunteer and board service with other local health care, social service agencies, law enforcement task forces, and area schools, hospital colleagues gather ongoing information on the health care needs of the communities it serves.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	HSHS St. Clare Memorial Hospital posts our charity care brochure and application on the hospital's website. In addition, charity care applications are available and prominently displayed in our waiting and registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. We also have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. One-on-one conversations to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's charity care program. The letter provides direct contact information to begin the application process for charity care and lists the internet address where the policy can be obtained. A system called Search America is now being utilized after failed attempts made by the hospital and our law firm to work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity care or continue collection efforts.
Schedule H, Part VI, Line 4 Community information	Oconto County, Wisconsin is a primarily rural county; about 81% of residents live in rural areas. Oconto County is one of 72 Wisconsin counties, and is located in the northeastern part of the state. Oconto County's population is predominantly Caucasian (97%), with a small proportion of people who are Native American or African American (about 1.5%). There is also a Hispanic population of about 1.5% of the population. There are approximately 38,000 residents, of which about 6,100 are covered by Medicaid/Badger Care Plus. About 10.2% of Oconto County Residents live at or below the federal poverty level, (Source: US CENSUS, ACS, 2009-2013). According to the 2015 County Health Rankings, 11% of Oconto County's population is uninsured. Oconto County is considered a primary care health professional shortage area and a mental health professional shortage area, but is not a dental health professional shortage area or a medically underserved area per HRSA. HSHS St. Clare Memorial Hospital is one of two Critical Access Hospitals in Oconto County, the other CAH being Bellin Oconto Hospital.
Schedule H, Part VI, Line 5 Promotion of community health	HSHS St. Clare Memorial Hospital offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), HSHS St. Clare Memorial is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 94 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Oconto County, Wisconsin, and surrounding areas. The hospital is governed by a board of directors, the majority of whom who reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The board ensures that HSHS St. Clare Memorial Hospital is responding to community need. During FY2013 for example, the board reviewed the community health needs assessment and approved an implementation strategy for addressing selected needs. Also consistent with its exempt purpose, HSHS St. Clare Memorial Hospital has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Clare Memorial Hospital reinvests surplus funds into the mission of the organization and health of the community rather than distributing them 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, HSHS St. Clare Memorial Hospital is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. For example, the Epic electronic medical record system enables providers to connect with their patients' medical records from wherever they are and allows emergency physicians access to patient medical records from any facility that has Epic. This reduces duplicate testing, puts critical health information at providers' fingertips, helps better manage chronic conditions, and improves patient safety. HSHS St. Clare Memorial Hospital devotes significant resources to provide access for patients who cannot afford care, along with other community benefits. In FY2017 HSHS St. Clare Memorial Hospital provided over $3.6 million in community benefit services, including charity care 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 FY2017, St. Clare Memorial Hospital PROVIDED $30K (AT COST) IN UNCOMPENSATED CARE TO PATIENTS WHO DID NOT QUALIFY FOR CHARITY CARE OR PUBLIC ASSISTANCE AND MORE THAN MORE THAN $8 MILLION (AT COST) IN EXCESS OF MEDICARE PAYMENT FOR HEALTH CARE SERVICES. In Fall 2015, the Healthy County Oconto Coalition was reconvened to re-energize the partners who conducted the Community Health Needs Assessment and to review and revise the strategies included in the Healthy Oconto County Community Health Improvement Plan 2014-2018. The meeting was facilitated by HSHS St. Clare Memorial Hospital and Bellin Health, two health systems who are members of the Healthy Oconto County Coalition. As part of the process, the Coalition agreed to focus its efforts on one of the three identified community health need areas: Nutrition and Physical Activity and specifically, the completion of the Oconto Falls Trail System which was launched in 2014 with a "Run for the Trails 5K/10K" run to benefit the creation of the Oconto Falls Trail System. HSHS St. Clare Memorial partners with community-wide action planning teams to develop, implement, monitor and evaluate both new and ongoing initiatives that address identified priority community health needs. The 2014 to 2018 implementation strategies and interventions included, but were not limited to, the following initiatives: Physical Activity and Nutrition Lead the activities of Healthy Oconto County 2018, a coalition of community partners dedicated to improving the health of Oconto County Create an Oconto Falls Trail System to increase safe, physical activity in Oconto County Assist Kingdom Come Food Pantry by coordinating food drives, utilizing sites and courier services for food distribution, and providing educational materials regarding healthy food choices. Mental Health Infrastructure planning to provide tele-psychiatry coverage at HSHS St. Clare Memorial Hospital. Scheduled to go live in early 2018, the program will utilize Genoa, a tele-psychiatry vendor, to operationalize this service in all four HSHS eastern Wisconsin hospitals. Proposal development for Employee Assistance Program (EAP) services for the Oconto Falls School District. Led by the HSHS and Prevea Executive Director for Behavioral Care Services, the proposal was to provide outpatient counseling services to the school district. The program's purpose was to provide School Based Mental Health to improve access and to provide timely access to services and treatment. Furthermore, the program was designed to reduce and prevent suicide and or violence against others among school age children through early identification and intervention. The school district ultimately chose a different provider for the EAP services. Prevea Health and Libertas, a department of HSHS St. Vincent Hospital and an alcohol and drug addiction treatment center for adolescents and adults, participated in the Annual Oconto County Community Wellness Fair at the Bond Community Center in Oconto on Friday, September 8th, 2017. Prevea Health offers a state-certified outpatient behavioral health clinic in the Medical Services Building on the campus of HSHS St. Clare Memorial Hospital in Oconto Falls. Alcohol and other Drug Abuse In October 2016, a team at HSHS St. Clare Memorial Hospital researched the feasibility of offering Inpatient AODA Detox services at HSHS St. Clare Memorial Hospital. We arranged multiple meetings with other Critical Access Hospitals that offered these services. After careful consideration and evaluation, we decided not to offer AODA Detox services at HSHS St. Clare Memorial Hospital at this time. Hope Grant: Heroin and Opioid, Prevention and Education -Individuals who are without insurance can receive services, thanks to a grant from the Wisconsin Department of Health Services in 2015 which established an opioid treatment program known as Northeast Wisconsin Opioid Treatment Services. This program is provided through a collaborative effort between Libertas (a department of HSHS St. Vincent Hospital) and Prevea Health to help individuals addicted to opioids. -Northeast Wisconsin Opioid Treatment Services provides services to people living with an opioid addiction in Florence, Marinette, Menominee and Oconto counties. -Libertas, an alcohol and drug addiction treatment center for adolescents and adults, provides heroin and opioid addiction services. -With this service, people with opioid addiction can access abstinence-based treatment or medication-assisted treatment with substance use counseling. The following is a listing of some of the other services HSHS St. Clare Memorial Hospital provided in FY2017: Cash donations, used equipment, and event sponsorships, to organizations and schools; Free support programs including diabetes support group Free quarterly community education classes for seniors that include a free meal Hospital colleagues spoke at health fairs and other community events Training for local EMS personnel through the hospital's EMS liaison program Student intern programs with local colleges and universities Board service on local health organization boards Assistance with insurance and public assistance enrollment Free meeting space for area organizations such as UW Healthy Bones program, Narcotics Anonymous, Breast Cancer Awareness, and Oconto County 4H-UW Extension
Schedule H, Part VI, Line 6 Affiliated health care system	HSHS St. Clare Memorial Hospital is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 15 hospitals, numerous community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The mission of HSHS is "to reveal and embody Christ's healing love for all people through our high-quality Franciscan health care ministry." We live our mission by providing holistic healing to all who seek our care, as well as through Community Benefit. In tandem with others in the communities we serve, our Community Benefit initiatives are strategically increasing access to care, improving the health status of residents, and increasing medical education and knowledge. In FY2017, our hospitals responded to the top needs identified in each of their most recent Community Health Needs Assessments (CHNAs). The information gathered from these assessments was used to develop or enhance Community Benefit programs and services to best address community health needs. Among the priority needs identified in the most recent CHNA process were access to care; alcohol, tobacco, and other drug abuse; chronic disease prevention and management; nutrition/wellness; mental health; and oral health. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. In FY2017, HSHS collectively provided $197.6 million in Community Benefit (9.2% of total hospital expenses). This amount included $26.0 million provided for Financial Assistance (a.k.a. Charity Care) and $128.6 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 $205.9 million. HSHS hospitals also recorded $40.9 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. Improve access to health care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need with a special focus on the poor and vulnerable. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care, at the right time, and in the right setting involve collaborating with others to achieve this goal. Across our two-state System, there are numerous examples of partnerships with departments of public health, other health care facilities and community and social service organizations to enhance access to care for those in need. In FY2017, HSHS and our 15 hospitals dedicated Community Benefit resources to educate uninsured persons about enrollment opportunities in affordable health care coverage and to facilitate the enrollment process. Studies have shown that people without insurance are more likely to postpone care and develop more severe and expensive conditions than their insured counterparts. It is for this reason that the Catholic Church, Catholic health care and HSHS have long promoted "coverage and access for all." HSHS and our 15 hospitals in partnership with local health departments, social service agencies and other health care providers played a vital role in educating eligible people in their service areas, by referring people to Certified Application Counselors and/or in enrolling them in the health insurance exchanges, or by helping them to obtain coverage through Medicaid expansion. In southern Illinois, HSHS St. Elizabeth's Hospital in Belleville is committed to improving access to health care services by assisting eligible patients to enroll in health care plans. In FY2017, more than 3,200 patients were screened and 74% met eligibility criteria and were enrolled in Medicaid. Access to health care is not limited to insurance coverage and access to primary care providers. In FY2017, the hospital assisted patients with access to medications, durable medical equipment, and transportation including more than $5,600 in cab and bus tickets for patients and $14,000 for patients who needed transfer by ambulance. In response to its FY2015 CHNA, HSHS St. John's Hospital in Springfield, Illinois established a community health worker program to increase access to health care and coordination of care for residents of the Enos Park Neighborhood. The hospital also helped establish an Enos Park Neighborhood Advisory Council and Providers Alliance as part of the access collaborative to drive behavior changes and improve health outcomes. In the first three years, the program has realized 93% engagement of 300 clients. Services rendered include basic needs and health care access. Sixteen formally homeless individuals or families were placed in affordable, safe housing. Of the 35 parolees in the program, the recidivism rate was only 18% compared to 60% nationwide. The only reason participating parolees went back to prison was because of lack of a job or housing. One-hundred percent of our clients saw a primary care provider and 84% were connected to a medical home. This program is being replicated in a second location in Sangamon County's eastside where our most vulnerable, low-income and underserved populations exist. Through the support of HSHS St. Mary's Hospital Medical Center and St. Vincent Hospital in Green Bay, the Oral Health Partnership (OHP) continues to expand to communities throughout Brown County, providing dental care to 0 - 19 year olds who are uninsured or underinsured. In FY2017, more than 12,000 general dentistry procedures, including exams, X-rays, cleanings, fillings, and crowns, were completed for youth in Brown County's smaller, less urban communities, and more than 1,300 preventative sealants were applied. OHP serves more than 9,000 kids each year through three fixed-site clinics and the traveling school-based program. In January 2017, OHP's West location was opened in response to data showing an unmet need of medical assistance children in the Ashwaubenon area. This clinic, along with the traveling school-based team, will help OHP and HSHS reach the goal of expanding services to a wider population of Brown County children in need. HSHS St. Francis Hospital in Litchfield, Illinois collaborated with Lewis & Clark Community College and local dental providers to bring the College's mobile dental health unit to the Litchfield area; the unit provides free or low cost dental exams and screenings, x-rays and hygiene services. In addition, three local dental providers also participated by opening their offices and donating time, staff and supplies to provide either a free filling, extraction or hygiene services. Beginning in 2015, the hospital collaborated with Catholic Charities to launch a dental voucher program. Five dentists in Macoupin and Montgomery counties participate in the program, which covers an initial exam and x-rays, one tooth extraction and up to three fillings per year per individual. The percentage of total emergency department visits related to dental issues has decreased from 2.2% in 2011 to .95% in 2016 because of this collaboration. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between HSHS St. Anthony's Memorial Hospital in Effingham and Catholic Charities. In FY2017, St. Anthony's Memorial Hospital helped to underwrite the cost of prescription medications for 246 residents. St. Anthony's Memorial Hospital and Catholic Charities believe no one should be without prescriptions because of the inability to pay.
Schedule H, Part VI, Line 7 State filing of community benefit report	WI

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Form990 Of Other Organizations	Yes (X)	Form990OfOtherOrganizationsInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
THERESE B PANDL
PRESIDENT & CHIEF EXECUTIVE OFFICER	$0	$650,406	$0	$111,977	$0	$139,413	$0	$208,461	$0	$31,032	$0	$1,141,289	$0	$96,536
DR JAMES CLEMENS
BOARD MEMBER/PHYSICIAN	$0	$575,619	$0	$0	$0	$0	$0	$13,056	$0	$19,439	$0	$608,114	$0	$0
DR ROBERT CUTLAN
BOARD MEMBER/PHYSICIAN	$0	$693,241	$0	$0	$0	$0	$0	$13,056	$0	$19,439	$0	$725,736	$0	$0
PETER MANNIX
BOARD MEMBER	$0	$359,675	$0	$79,600	$0	$71,202	$0	$166,667	$0	$29,888	$0	$707,032	$0	$56,767
ANN M CARR
TREASURER	$0	$251,800	$0	$39,616	$0	$68,544	$0	$291,816	$0	$20,710	$0	$672,486	$0	$31,485
DANIEL DEGROOT
Ex-Officio Board Member/COO	$220,096	$0	$38,693	$0	$0	$0	$10,425	$0	$1,152	$0	$270,366	$0	$0	$0
GREG SIMIA
Division CFO	$0	$370,894	$0	$31,383	$0	$780	$0	$85,174	$0	$27,395	$0	$515,626	$0	$0
JAMES ARNOLD
PHYSICIAN	$163,883	$0	$0	$0	$780	$0	$5,771	$0	$27,306	$0	$197,740	$0	$0	$0
GRAM COTTON
CRNA	$265,387	$0	$4,152	$0	$4,759	$0	$0	$0	$29,522	$0	$303,820	$0	$0	$0
JASON KNOX
PHARMACY DIRECTOR	$142,111	$0	$0	$0	$1,144	$0	$8,832	$0	$28,081	$0	$180,168	$0	$0	$0
DAVID MISKULIN
PHARMACIST	$127,557	$0	$0	$0	$780	$0	$7,132	$0	$20,579	$0	$156,048	$0	$0	$0
JASON MURPHY
CRNA	$179,744	$0	$7,152	$0	$570	$0	$101,152	$0	$21,019	$0	$309,637	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 1a Tax indemnification and gross-up payments	ONE OF THE ORGANIZATION'S HIGHEST COMPENSATED EMPLOYEES RECEIVED A GIFT CERTIFICATE DURING THE YEAR. THE RELATED TAX EFFECT WAS DETERMINED AND A GROSS UP PAYMENT WAS MADE.
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 2016 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Ann Carr -- $31,564 Peter Mannix -- $53,907 Therese Pandl -- $94,337 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016 THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. Ann Carr -- $31,485 Peter Mannix -- $56,767 Therese Pandl -- $96,536

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	391337855	BondIssuerEIN
Bond Issued	2013-04-16	BondIssuedDt
Issue Price	$9,053,000	IssuePriceAmt
Purpose	See Part VI	PurposeDesc
Defeased	false	DefeasedInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Pool Financing	false	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$1,141,000	RetiredAmt
Total Proceeds	$9,053,000	TotalProceedsAmt
Issuance Costs From Proceeds	$180,472	IssuanceCostsFromProceedsAmt
Capital Expenditures	$1,681,913	CapitalExpendituresAmt
Other Spent Proceeds	$7,190,615	OtherSpentProceedsAmt
Substantial Completion	2013	SubstantialCompletionYr
Current Refunding	Yes (true)	CurrentRefundingInd
Advance Refunding	false	AdvanceRefundingInd
Final Allocation Made	Yes (true)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (true)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedPropertyInd
Any Lease Arrangements	Yes (true)	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (true)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (true)	EngageBondCounselContractsInd
Any Research Agreements	false	AnyResearchAgreementsInd
Private Bus Use By Others	0.032	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.0	PrivateBusConcerningUBIPct
Total Private Business Use	0.032	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	false	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	Yes (true)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiledInd
Rebate Not Due Yet	Yes (true)	RebateNotDueYetInd
Exception To Rebate	false	ExceptionToRebateInd
No Rebate Due	false	NoRebateDueInd
Variable Rate Issue	false	VariableRateIssueInd
Hedge Identified In Bks And Rec	false	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGICInd
Regulatory Safe Harbor Stsfd	false	RegulatorySafeHarborStsfdInd
Gross Proceeds Invested	false	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (true)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (true)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule K, Part I, Column (f) Description of purpose	FormAndLineReferenceDesc
Explanation	Issuer Name: Wisconsin Health and Educational Facilities Authority Description: REFINANCING OF 2/11/2003 BOND ISSUANCE; CONSTRUCTION, IMPROVEMENT, AND EQUIPPING HOSPITAL FACILITIES.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY	PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES
Form 990, Part VI, Line 16b JOINT VENTURES	HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. VINCENT HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. VINCENT HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. CLARE'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS.
Form 990, Part VI, Line 6 Classes of members or stockholders	THE SENIOR GOVERNING BODY OF ST. CLARE MEMORIAL HOSPITAL (THE CORPORATION) IS THE MEMBER OF THE CORPORATION, WHICH 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. CLARE MEMORIAL HOSPITAL (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 CHAIRPERSON AND 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 HSSI; (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 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 HORWATH TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION, AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS.
Form 990, Part VI, Line 12c Conflict of interest policy	THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH, A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES.
Form 990, Part VI, Line 15a Process to establish compensation of top management official	THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA, AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. 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 FOR THE DISQUALIFIED INDIVIDUALS. 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.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A.
Form 990, Part VI, Line 19 Required documents available to the public	BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME.
Form 990, Part IX, Line 11g Other Fees	PROF FEES-PHYSICIAN - Total Expense: 3090699, Program Service Expense: 2163489, Management and General Expenses: 927210, Fundraising Expenses: ; CONSULTING - Total Expense: 3597, Program Service Expense: 2518, Management and General Expenses: 1079, Fundraising Expenses: ; OUTSIDE SERVICES - Total Expense: 7335887, Program Service Expense: 5135121, Management and General Expenses: 2200766, Fundraising Expenses: ; OTHER - Total Expense: 467801, Program Service Expense: 327461, Management and General Expenses: 140340, Fundraising Expenses: ; Shared service FEe - Total Expense: 1403871, Program Service Expense: 982710, Management and General Expenses: 421161, Fundraising Expenses: ;
Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT	INVESTMENTS IN SECURITIES AND RELATED INVESTMENT INCOME: THE 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 INDIVIDUAL HOSPITAL PARTICIPANTS
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	TRANSFER TO/FROM AFFILIATES - -170607; RECOGNITION OF CHANGE IN PENSION FUNDED STATUS - 359909; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 149065; Change Investment Advanced Pain Mgmt - -72564;

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
KIARA CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	261417684	HEALTHCARE	IL	-$1,762,307	$6,257,513	HSSI
PHYSICIAN CLINICAL INTEGRATION NETWORK LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371668647	HEALTHCARE	IL	-$950,689	$8,580,781	KCIN
HSHS ACO LLC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	320465666	HEALTHCARE & SOCIAL ASSISTANCE	IL	-$515,297	$146,855	KCIN

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (27 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd
HOSPITAL SISTERS HEALTH SYSTEM
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371058692	HEALTHCARE	IL	501(c)(3)	Type III-FI	NA	false
HOSPITAL SISTERS OF ST FRANCIS FOUNDATION
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371186514	HEALTHCARE	IL	501(c)(3)	7	HSHS	Yes (true)
HSHS SELF INSURANCE TRUST
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371120626	INSURANCE	IL	501(c)(3)	Type I	HSHS	Yes (true)
HOSPITAL SISTERS HEALTHCARE WEST INC
2661 COUNTY HIGHWAY 1	CHIPPEWA FALLS	WI	54729	510157933	HEALTHCARE	WI	501(c)(3)	Type I	HSSI	Yes (true)
SACRED HEART HOSPITAL
990 WEST CLAIREMONT AVENUE	EAU CLAIRE	WI	54701	390807060	HEALTHCARE	WI	501(c)(3)	3	HSSI	Yes (true)
ST ANTHONY'S HOSPITAL
503 N MAPLE STREET	EFFINGHAM	IL	62401	370661233	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST ELIZABETH'S HOSPITAL
211 SOUTH THIRD STREET	BELLEVILLE	IL	62220	370663567	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST NICHOLAS HOSPITAL
3100 SUPERIOR AVENUE	SHEBOYGAN	WI	53081	390808480	HEALTHCARE	WI	501(c)(3)	3	HSSI	Yes (true)
ST JOHN'S HOSPITAL
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	370661238	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
9515 HOLY CROSS LANE	BREESE	IL	62230	371208459	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
2661 COUNTY HIGHWAY 1	CHIPPEWA FALLS	WI	54729	390810545	HEALTHCARE	WI	501(c)(3)	3	HSSI	Yes (true)
ST MARY'S HOSPITAL
1800 E LAKE SHORE DRIVE	DECATUR	IL	62521	370661244	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST MARY'S HOSPITAL
111 SPRING STREET	STREATOR	IL	61364	362169181	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST MARY'S MEDICAL CENTER
1762 SHAWANO AVENUE	GREEN BAY	WI	54303	390818682	HEALTHCARE	WI	501(c)(3)	3	HSSI	Yes (true)
ST VINCENT HOSPITAL
835 S VAN BUREN	GREEN BAY	WI	51301	390817529	HEALTHCARE	WI	501(c)(3)	3	HSSI	Yes (true)
ST JOSEPH'S HOSPITAL
12866 TROXLER AVENUE	HIGHLAND	IL	62249	370663568	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
ST FRANCIS HOSPITAL
1215 FRANCISCAN DRIVE	LITCHFIELD	IL	62056	370661236	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
HOSPITAL SISTERS SERVICES INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163402	HEALTHCARE	IL	501(c)(3)	Type III-FI	HSHS	Yes (true)
HSHS MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVE	SPRINGFIELD	IL	62703	263956318	HEALTHCARE	IL	501(c)(3)	Type III-FI	HSSI	Yes (true)
HSHS WISCONSIN MEDICAL GROUP INC
3215 EXECUTIVE PARK DRIVE	SPRINGFIELD	IL	62703	264515959	HEALTHCARE	WI	501(c)(3)	Type III-FI	HSSI	Yes (true)
ORANGE CROSS AMBULANCE INC
919 ASHLAND AVENUE	SHEBOYGAN	WI	53081	391860942	HEALTHCARE	WI	501(c)(3)	10	ST NICHOLAS	Yes (true)
UNITY LIMITED PARTNERSHIP
2366 OAK RIDGE CIRCLE	DE PERE	WI	54115	391750729	HEALTHCARE	WI	501(c)(3)	10	HSSI	Yes (true)
PRAIRIE EDUCATION & RESEARCH COOPERATIVE
317 NORTH 5TH STREET	SPRINGFIELD	IL	62701	371157915	HEALTHCARE	IL	501(c)(3)	4	HSSI	Yes (true)
HSHS HOLY FAMILY HOSPITAL
200 HEALTHCARE DRIVE	GREENVILLE	IL	62246	370792770	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)
UTLAUT MEMORIAL FOUNDATION
200 HEALTHCARE DRIVE	GREENVILLE	IL	62246	371140166	FUNDRAISING	IL	501(c)(3)	Type II	HSSI	Yes (true)
SHELBY MEMORIAL HOSPITAL FOUNDATION INC
200 SOUTH CEDAR STREET	SHELBYVILLE	IL	62565	371294401	FUNDRAISING	IL	501(c)(3)	Type I	HSSI	Yes (true)
HSHS GOOD SHEPHERD HOSPITAL INC
200 SOUTH CEDAR STREET	SHELBYVILLE	IL	62565	370512290	HEALTHCARE	IL	501(c)(3)	3	HSSI	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct	Address Line2USAddress/AddressLine2Txt
MEMORIAL AND ST ELIZABETH'S HEALTHCARE CANCER TREATMENT CENTER
4000 NORTH ILLINOIS STREET	SWANSEA	IL	62226	371312961	HEALTHCARE	IL	ST ELIZABETH'S	Related	$674,729	$4,464,307	false	false	0.5
PRAIRIE HEART INSTITUTE ST JOHN'S
800 EAST CARPENTER STREET	SPRINGFIELD	IL	62769	371321197	HEALTHCARE	IL	HSHS	Related	$0	$8,000	false	false	1
PAIN CENTER OF WISCONSIN
4131 W LOOMIS ROAD	GREENFIELD	WI	53221	263155343	HEALTHCARE	WI	ST VINCENT	Related	$527,290	$608,459	false	false	0.5	SUITE 300
PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC
4131 W LOOMIS ROAD	GREENFIELD	WI	53221	364717036	HEALTHCARE	WI	ST CLARE	Related	$82,878	$213,434	false	false	0.5	SUITE 300
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	62794	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	-$7,119	$10,276	false	Yes (true)	1

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	Province Or StateForeignAddress/ProvinceOrStateNm	CountryForeignAddress/CountryCd	Foreign PostalForeignAddress/ForeignPostalCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd
KIARA INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163401	HEALTHCARE	IL	HSHS	C Corporation	-$32,734,440	$34,421,714	1	Yes (true)
LASANTE WISCONSIN INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	391572196	HEALTHCARE	IL	KIARA INC	C Corporation				Yes (true)
LASANTE INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	371163400	HEALTHCARE	IL	KIARA INC	C Corporation				Yes (true)
PRAIRIE CARDIOVASCULAR
619 EAST MASON SUITE 4P57	SPRINGFIELD	IL	62701	371071858	HEALTHCARE	IL	KIARA INC	C Corporation				Yes (true)
PREVEA HEALTH SERVICES INC
2710 EXECUTIVE DRIVE	GREEN BAY	WI	54304	391839351	HEALTHCARE	WI	HSSI	C Corporation	$260,762	$45,933,122	0.5	Yes (true)
PREVEA CLINIC INC
2710 EXECUTVE DRIVE	GREEN BAY	WI	54304	391839349	HEALTHCARE	WI	PHSI	C Corporation				Yes (true)
RENAISSANCE QUALITY INSURANCE LTD
				980669953	INSURANCE		HSSI	C Corporation	$0	$120,349,324	1	Yes (true)	PO BOX 1159	GRAND CAYMAN	CJ	KY11102	CJ
OJV INC
4936 LAVERNA ROAD	SPRINGFIELD	IL	62707	460873384	HEALTHCARE	IL	LASANTE INC	C Corporation				Yes (true)

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (true)	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (true)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (true)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt