ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD (EIN 39-0808480)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-04
- IRS object ID
- 201801249349301615
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-04T18:01:35-05:00 | 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 | 390808480 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Nicholas Hospital of the Hospital Sisters of the Third Order of St Franc | BusinessNameLine1Txt |
| Business Name Line2 | is | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STNI | BusinessNameControlTxt |
| Phone | 9204598300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SUPERIOR AVENUE | AddressLine1Txt |
| City | Sheboygan | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 530811948 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Therese Pandl | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2018-04-11 | 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
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | St Nicholas Hospital | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDREW J BAGNALL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SUPERIOR AVENUE | AddressLine1Txt |
| City | Sheboygan | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 530811948 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $119,391,767 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STNICHOLASHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1890 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO CARRY FORWARD THE HEALING MINISTRY OF THE HOSPITAL SISTERS OF ST. FRANCIS AS PART OF THE HEALTH MINISTRY OF THE ROMAN CATHOLIC CHURCH. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 585 | TotalEmployeeCnt |
| Total Volunteers | 168 | TotalVolunteersCnt |
| Total Gross UBI | $231,877 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$488,866 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $200,603 | PYContributionsGrantsAmt |
| CY Contributions Grants | $25,575 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $83,101,540 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $112,328,494 | CYProgramServiceRevenueAmt |
| PY Investment Income | $522,231 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,896,108 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,088,567 | PYOtherRevenueAmt |
| CY Other Revenue | $1,299,080 | CYOtherRevenueAmt |
| PY Total Revenue | $84,912,941 | PYTotalRevenueAmt |
| CY Total Revenue | $115,549,257 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $29,690,088 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $29,730,759 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $446,085 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $48,599,846 | PYOtherExpensesAmt |
| CY Other Expenses | $80,220,991 | CYOtherExpensesAmt |
| PY Total Expenses | $78,289,934 | PYTotalExpensesAmt |
| CY Total Expenses | $109,951,750 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,623,007 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,597,507 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $129,056,785 | TotalAssetsBOYAmt |
| Total Assets EOY | $129,642,300 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $44,954,154 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $36,085,553 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $84,102,631 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $93,556,747 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. THE HOSPITAL'S CORE VALUES OF RESPECT, CARE COMPETENCE AND JOY ARE LIVED BY ALL WHO SERVE HERE, AND FELT BY ALL WHO RECEIVE HEALTHCARE SERVICES AT ST. NICHOLAS HOSPITAL. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $9,237,220 | ExpenseAmt |
| Revenue | $21,075,032 | RevenueAmt |
| Desc | SURGICAL SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,195,756 | ExpenseAmt |
| Revenue | $14,722,380 | RevenueAmt |
| Desc | RADIOLOGY SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,274,454 | ExpenseAmt |
| Revenue | $9,392,868 | RevenueAmt |
| Desc | EMERGENCY SERVICES - SEE SCHEDULE O | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $63,222,514 | ExpenseAmt |
| Revenue | $66,906,337 | RevenueAmt |
| Desc | OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMEN AND INFANT SERVICES, HOME HEALTH AND HOSPICE CARE, CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, FOOT CLINICS AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $63,222,514 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $66,906,337 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $77,929,944 | 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 | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 585 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | 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 (22 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 |
|---|---|---|---|---|---|---|---|---|
| ANDREW J BAGNALL | ||||||||
| PRESIDENT | 60.0 | 0.0 | Yes (X) | Yes (X) | $0 | $446,637 | $131,373 | |
| DAVID VAN DE WATER JD | ||||||||
| CHAIRPERSON | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TIMOTHY KELLNER | ||||||||
| Vice Chairperson (Part Year) | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MICHAEL LANSER EDD | ||||||||
| VICE CHAIRPERSON (Part Year) | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SR BERNADINE GUTOWSKI OSF | ||||||||
| SECRETARY (Part Year) | 1.0 | 4.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN WENIG | ||||||||
| Secretary (Part Year) | 1.0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK S BETTAG MD | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| John Brotz | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| STUART W BROTZ | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| CARL CLAERBOUT | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| SR MARYBETH CULNAN OSF | ||||||||
| BOARD MEMBER | 1.0 | 9.3 | Yes (X) | $0 | $0 | $0 | ||
| SR MAUREEN FAGAN OSF | ||||||||
| BOARD MEMBER | 1.0 | 2.0 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM TRAGER MD | ||||||||
| BOARD MEMBER | 1.0 | 0 | Yes (X) | $0 | $0 | $0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.3 | 59.4 | Yes (X) | $0 | $359,960 | $312,526 | ||
| MARY MARTIN | ||||||||
| CHIEF NURSING OFFICER | 40.0 | 0 | Yes (X) | $162,085 | $0 | $56,928 | ||
| THERESE B PANDL | ||||||||
| DIVISION CHIEF EXECUTIVE OFFICER | 12.0 | 48.0 | Yes (X) | $0 | $901,796 | $239,493 | ||
| GREG SIMIA | ||||||||
| DIVISION CFO | 10.0 | 30.0 | Yes (X) | $0 | $403,057 | $112,569 | ||
| ANDREA M ANGOTTI | ||||||||
| PHARMACIST | 40.0 | 0 | $143,405 | $0 | $106,896 | Yes (X) | ||
| MELISSA PALECEK | ||||||||
| PHARMACY MANAGER | 40.0 | 0 | $141,495 | $0 | $43,164 | Yes (X) | ||
| CEANNE SIMMELINK | ||||||||
| PHARMACIST | 40.0 | 0 | $119,533 | $0 | $36,174 | Yes (X) | ||
| JOHN WINTER | ||||||||
| SURGICAL SERVICES DIRECTOR | 40.0 | 0 | $112,597 | $0 | $50,346 | Yes (X) | ||
| Tayna Konitzer | ||||||||
| Divisional Director | 40.0 | 0 | $104,900 | $0 | $51,344 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $784,015 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,111,450 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,140,813 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ST VINCENT HOSPITAL | |||||
| 835 S VAN BUREN STREET | GREEN BAY | WI | 54301 | SHARED SERVICES | $7,125,968 |
| PREVEA HEALTH | |||||
| PO BOX 19070 | GREEN BAY | WI | 543079070 | SHARED LABOR & SERVICES | $5,333,341 |
| TOTAL MSP LLC | |||||
| 10 E COLLEGE AVE SUITE 300 | APPLETON | WI | 54911 | CONTRACT LABOR | $737,774 |
| SODEXO INC | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD & HOUSEKEEPING | $639,285 |
| ST MARY'S HOSPITAL MEDICAL CENTER | |||||
| 1726 SHAWANO AVE | GREEN BAY | WI | 54303 | SHARED SERVICES | $414,466 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $25,575 | RelatedOrganizationsAmt |
| Total Contributions | $25,575 | 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 | $112,096,617 | $112,096,617 | |
| LABORATORY OUTREACH REVENUE | 621500 | $231,877 | $231,877 |
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 | $112,328,494 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $371,533 | TotalRevenueColumnAmt |
| Exclusion | $371,533 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,192,426 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $599,019 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $593,407 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $593,407 | TotalRevenueColumnAmt |
| Exclusion | $593,407 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,568,634 | SecuritiesAmt |
| Other | $3,199,432 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,243,491 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,568,634 | SecuritiesAmt |
| Other | -$44,059 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,524,575 | TotalRevenueColumnAmt |
| Exclusion | $1,524,575 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| OTHER OPERATING REVENUE | 900099 | $646,920 | $646,920 |
| Gift Shop and Auxiliary Revenue | $58,753 | $58,753 |
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 | $705,673 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,549,257 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $112,096,617 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $231,877 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,195,188 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,954,188 | TotalAmt |
| Program Services | $16,067,932 | ProgramServicesAmt |
| Management And General | $6,886,256 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $385,327 | TotalAmt |
| Program Services | $269,729 | ProgramServicesAmt |
| Management And General | $115,598 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,851,532 | TotalAmt |
| Program Services | $3,396,072 | ProgramServicesAmt |
| Management And General | $1,455,460 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,539,712 | TotalAmt |
| Program Services | $1,077,798 | ProgramServicesAmt |
| Management And General | $461,914 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,189 | TotalAmt |
| Program Services | $1,532 | ProgramServicesAmt |
| Management And General | $657 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,085 | TotalAmt |
| Fundraising | $446,085 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,619,997 | TotalAmt |
| Program Services | $34,033,998 | ProgramServicesAmt |
| Management And General | $14,585,999 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,890 | TotalAmt |
| Program Services | $50,323 | ProgramServicesAmt |
| Management And General | $21,567 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,916,476 | TotalAmt |
| Program Services | $1,341,533 | ProgramServicesAmt |
| Management And General | $574,943 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,819 | TotalAmt |
| Program Services | $139,173 | ProgramServicesAmt |
| Management And General | $59,646 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $378,659 | TotalAmt |
| Program Services | $265,061 | ProgramServicesAmt |
| Management And General | $113,598 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,144 | TotalAmt |
| Program Services | $85,501 | ProgramServicesAmt |
| Management And General | $36,643 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,137,569 | TotalAmt |
| Program Services | $3,596,298 | ProgramServicesAmt |
| Management And General | $1,541,271 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,772 | TotalAmt |
| Program Services | $260,240 | ProgramServicesAmt |
| Management And General | $111,532 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $13,476,312 | $9,433,418 | $4,042,894 |
| BAD DEBT | $2,111,225 | $2,111,225 | |
| MEDICAID ASSESSMENT TAX | $2,142,037 | $2,142,037 | |
| EQUIPMENT RENTAL & MAINTENANCE | $2,520,818 | $1,764,573 | $756,245 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,704,999 | TotalAmt |
| Program Services | $1,893,501 | ProgramServicesAmt |
| Management And General | $811,498 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,951,750 | TotalAmt |
| Program Services | $77,929,944 | ProgramServicesAmt |
| Management And General | $31,575,721 | ManagementAndGeneralAmt |
| Fundraising | $446,085 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,450 | BOYAmt |
| EOY | $1,450 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,495,715 | BOYAmt |
| EOY | $4,938,760 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,065,716 | BOYAmt |
| EOY | $12,643,355 | 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 | $1,916,210 | BOYAmt |
| EOY | $1,867,460 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $528,065 | BOYAmt |
| EOY | $302,266 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $125,889,868 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $73,774,201 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,813,690 | BOYAmt |
| EOY | $52,115,667 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,753,586 | BOYAmt |
| EOY | $55,937,558 | 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 | $813,731 | BOYAmt |
| EOY | $946,702 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $668,622 | BOYAmt |
| EOY | $889,082 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,056,785 | BOYAmt |
| EOY | $129,642,300 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,246,766 | BOYAmt |
| EOY | $8,580,664 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,133 | BOYAmt |
| EOY | $146,420 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,002,470 | BOYAmt |
| EOY | $17,126,375 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,675,785 | BOYAmt |
| EOY | $10,232,094 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,954,154 | BOYAmt |
| EOY | $36,085,553 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,885,916 | BOYAmt |
| EOY | $84,083,686 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,520,450 | BOYAmt |
| EOY | $7,776,796 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,696,265 | BOYAmt |
| EOY | $1,696,265 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,102,631 | BOYAmt |
| EOY | $93,556,747 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,056,785 | BOYAmt |
| EOY | $129,642,300 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,597,507 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,524,480 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $2,332,129 | 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 | $7,659 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,659 | 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. NICHOLAS HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR THE HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. |
| Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY | ST. NICHOLAS HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR THE HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,715,010 | OtherCostOrOtherBasisAmt |
| Book Value | $1,715,010 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,966,199 | OtherCostOrOtherBasisAmt |
| Depreciation | $20,902,454 | DepreciationAmt |
| Book Value | $20,063,745 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,281,630 | OtherCostOrOtherBasisAmt |
| Depreciation | $376,397 | DepreciationAmt |
| Book Value | $1,905,233 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $39,785,883 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,786,163 | DepreciationAmt |
| Book Value | $11,999,720 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,141,146 | OtherCostOrOtherBasisAmt |
| Depreciation | $24,709,187 | DepreciationAmt |
| Book Value | $16,431,959 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $52,115,667 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| UNAMORTIZED BOND PREMIUM & ISSUE COSTS NET | $772,474 |
| OTHER LONG TERM LIABILITIES | $335,209 |
| ACCRUED PENSION | $9,124,411 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,232,094 | 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 | false | ExpensesExceedBudgetInd |
| 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) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 2090 | PersonsServedCnt |
| Total Community Benefit Expns | $3,538,561 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,119,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,418,839 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0129 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 7976 | PersonsServedCnt |
| Total Community Benefit Expns | $14,444,908 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,605,166 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,839,742 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0804 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 332 | PersonsServedCnt |
| Total Community Benefit Expns | $467,565 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $305,130 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $162,435 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0015 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 10398 | PersonsServedCnt |
| Total Community Benefit Expns | $18,451,034 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,030,018 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,421,016 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0948 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 23 | ActivitiesOrProgramsCnt |
| Persons Served | 3592 | PersonsServedCnt |
| Total Community Benefit Expns | $156,779 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $156,779 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0014 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 8 | PersonsServedCnt |
| Total Community Benefit Expns | $14,871 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,871 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | 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) |
|---|---|---|
| Activities Or Programs | 11 | ActivitiesOrProgramsCnt |
| Persons Served | 8530 | PersonsServedCnt |
| Total Community Benefit Expns | $127,667 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $127,667 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0012 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 36 | ActivitiesOrProgramsCnt |
| Persons Served | 12130 | PersonsServedCnt |
| Total Community Benefit Expns | $299,317 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $299,317 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0027 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 39 | ActivitiesOrProgramsCnt |
| Persons Served | 22528 | PersonsServedCnt |
| Total Community Benefit Expns | $18,750,351 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,030,018 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,720,333 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0975 | 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) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $4,757 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,757 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,651 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,651 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $6,408 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,408 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0001 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,537,072 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $160,159 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,692,745 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $50,000,173 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$19,307,428 | 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 NICHOLAS HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3100 SUPERIOR AVE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 530811948 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.stnicholashospital.org | WebsiteAddressTxt |
| State License | 37 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST NICHOLAS HOSPITAL | 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 | https://www.stnicholashospital.org/Hospital-Information/About/Community-Health-Needs | 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 | https://www.stnicholashospital.org/Hospital-Information/About/Community-Health-Needs | 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 (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - HSHS St. Nicholas Hospital. In addition to qualitative and quantitative data sources, the hospital took into account 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. These people attended the Community Health Improvement Call to Action in October 2014. Melissa Argall, Lutheran Social Services, Licensed Counselor Brooke Artabasy, Aurora Sheboygan Memorial Medical Center, Health Promotions Coordinator Kate Baer, Mental Health America, Executive Director Jerry Baker, Aurora Sheboygan Clinic, Clinic Administrator Jean Beinemann*, Sheboygan County Division of Public Health, Supervisor Amy Betke*, Sheboygan County Division of Public Health, Public Health Nurse Kristin Blanchard#, Lakeshore Community Health Center, CEO Kelly Boeldt, Prevea Health & Wellness Account Executive Terri Boxrucker*, Sheboygan County Division of Public Health Sheboygan County Division of Public Health Paula Burkart, Community Member Mike Burns, YMCA, Vice President - Programs Chuck Butler, Sheboygan Fire Department Deputy Chief Liz Campion*, Sheboygan County Division of Public Health, Public Health Nurse Sherry Carstens, Lakeland College, Director of Health Center Denise Cesar#, Salvation Army Case Manager Elizabeth Clarke, Aurora Health Care, Community Benefits Coordinator Diane Cline, Manitou Girl Scouts, COO Abby Dahmer, Salvation Army, Emergency Lodge Case Manager Tanya Damrow, Serenity Hospice Care, Director of Volunteer & Bereavement Services Nathan Dehne, Lakeland College, Vice President for Student Development Dale Deterding, Sheboygan County ADRC, Aging Unit Director Barb Dodge, HHS Committee and LTC Dean Health and Human Services Jon Doll#, United Way, Executive Director Kim Ecclestone, Aurora - Vince Lombardi Cancer Clinic , Cancer Nurse Navigator Tom Eggebrecht, Health and Human Services, Director Kristine Feggestad, UW-Sheboygan, Licensed Professional Counselor Connie Frank, Rehabilitation Center of Sheboygan, RN Medical Services Anne Gamoke, Plymouth School District, Director of Pupil Services Martha Gedemer, Comfort Keepers, Office Manager/Human Resources Tom Gessler, Community Member Terese Gessler, Community Member Patti Glaser-Martin, Hospital Sisters Health System/Prevea Health, Sr. Manager, Internal Communication and Community Dave Graebner, Aurora Sheboygan Memorial Medical Center, CEO Starr Grossman*, Sheboygan County Division of Public Health, Public Health Nurse Melissa Grube#, Lakeshore Community Health Center, Patient Access Manager Donna Habeck, Prevea Health, MD Lori Hamilton, Sheboygan Area School District, School Nurse Amber Harrigan, Random Lake School District, Elementary Counselor Mike Heidt, Aurora Sheboygan Memorial Medical Center, Director of Rehabilitation and Growth and Market Development at Aurora Health Dale Hippensteel, Community Member Terri Hosterman, Aurora Sheboygan Memorial Medical Center Andrew Hoyer-Booth, WPHCA, Program Coordinator Michael Huck#, Lakeshore CAP, Executive Director David Hughes#, Lakeshore Community Health Center, CFO Jane Jensen, UW-Extension, Family Living Educator Cary Knier, Lakeland College, Director of Counseling Services Lori Knitt, Aurora Sheboygan Memorial Medical Center, CNO Barb Kolar*, Sheboygan County Division of Public Health, Public Health Nurse Ashley Krause#, Lakeshore Community Health Center, Outreach and Enrollment Specialist, Certified Application Counselor Barb Kultgen, Sheboygan County Division of Social Services, Social Worker Diane Liebenthal#, Sheboygan County Division of Public Health, Supervisor Kevin Lukes, Prevea Health, Service Line Marketing Manager Shannon Madden , Love, Inc., Clearinghouse Coordinator Jean McMurray, Aurora Sheboygan Memorial Medical Center, Market Manager Meridith Mueller, Aurora Health Care, Community Benefit Analyst Carol Myers, Family Resource Center, Literacy Council Data and Development Coordinator David Neave#, Salvation Army, Social Services Director Char Neitzel-Goostree, Sheboygan Housing Authority, Housing Counselor Mary Ann Neuses, Community Member Jill Niemczyk, NEWAHEC, Program Manager Denice Nugent, YMCA, Senior Physical Director Robert O'Hara, Boys and Girls Club, Executive Director Sara O'Hara#, United Way, Community Impact Director Joyce Osieczanek, Aurora Sheboygan Clinic, Clinical Immunization Assistant/Sheboygan County Immune Co-Chair Pam Ott, Aurora Sheboygan Memorial Medical Center, Vice President - Finance Roger Otten, Health and Human Services Board, County Supervisor Mary Paluchniak, HSHS St. Nicholas Hospital, Facilitator - Outreach Adam Payne, Sheboygan County, County Administrator Jean Pittner*, Sheboygan County Division of Public Health, Dietician Kathy Pluskat, Child Support, Supervisor Todd Priebe, Sheboygan County, Sheboygan County Sheriff Jean Puls, Sheboygan Leadership Academy, Community Outreach & Service Learning Coordinator Karlyn Raddatz*, Sheboygan County Division of Public Health, County Health Officer Lynsey Ray, WPHCA, Facilitator MaryAdele Revoy, Family Resource Center, Coordinator of Resources and Development Paula Rojas#, Partners for Community Development, Outreach Coordinator Michael Romas, City of Sheboygan Fire Chief Ann Salzmann, Aurora Sheboygan Memorial Medical Center, Case Manager Sherri Samuels-Fuerst, Sargento Foods, Director - Compensation and Benefits Pam Sandee#, Salvation Army, Clinic Coordinator Martin Schaller, NEWAHEC, Executive Director Elizabeth Scheelk, State of WI - NE Region Public Health Educator Denise Schemenauer, Manitou Girl Scouts CEO Deb Schmidt*, Sheboygan County Division of Public Health, Public Health Nurse Jennifer Schmidt, Lakeshore Community Health Center, Community Outreach and Enrollment Specialist Michele Schmitt, Lakeshore Community Health Center, Clinical Administrator Vicky Schneider*, Sheboygan County Division of Public Health, Public Health Nurse Jan Scholke, Prevea Health Smoke Free Program Heidi Selberg, Hospital Sisters Health System, VP Advocacy and Community Benefit Annette Selk, Sheboygan County Division of Public Health, Public Health Nurse Shawna Silberzahn, Community Member Britne Stanke, Sheboygan Falls School District, Middle School Counselor Bobbi Stauber*, Sheboygan County Division of Public Health, Public Health Aide Susan Steinhardt, Sunny Ridge, RN Sue Thiel*, Sheboygan County Division of Public Health, Public Health Nurse Tammy Thill, Lutheran Social Services Social Worker Lindsay Thomack, Partners for Community Development, Healthcare Program Manager Virginia Thomas, Community Member Luann Travis, Family Resource Center, Executive Director Patrick Uselding, Sheboygan Falls School District, Middle School Counselor Mike Vandersteen, City of Sheboygan, Mayor Cindy VanderWeele*, Sheboygan County Division of Public Health, Public Health Nurse Jim Veeser, Sheboygan Police Department , Sargent Emily Vetting, Sheboygan County Planning & Conservation, Associate Planner Darcy Vollrath, Sheboygan ADRC Brett Voskuil, Aurora Sheboygan Memorial Medical Center, Physical Therapy Assistant Lindsay Wagner, Concordia University, BSN Completion Student Katie Warden, UW-Green Bay Ruth Weigel, Rehabilitation Center of Sheboygan, Day Services Coordinator Donna Wendlandt, YMCA, President Wendy Williams, Aurora Health Care, Director of Quality and Medical Staff Jean Wodach*, Sheboygan County Division of Public Health, Clerical Support Staff Ann Wondergem#, United Way Director of Operation & Program Management *Public Health Representative and #Representative of minority, undeserved or low income populations/chronic disease populations |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - St. Vincent Hospital. AURORA SHEBOYGAN MEDICAL CENTER |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - HSHS St. Nicholas Hospital. HSHS St. Nicholas Hospital partnered with several community organizations, including Healthy Sheboygan County 2020, Lakeshore Community Health Center, Sheboygan County Division of Public Health, United Way of Sheboygan County, and University of Wisconsin-Extension - Sheboygan County to complete the Community Health Needs Assessment. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - HSHS ST. NICHOLAS HOSPITAL. Identification and Prioritization of Needs: The following health needs were identified based on burden, scope, severity, or urgency of the health need; the health disparities associated with the health needs; the importance the community places on addressing the health need; and other community assets and resources that could be leveraged through strategic collaboration in the hospital's service area to address the health need. Based on the CHNA planning and development process described, the following community health needs were identified: 1.Mental Health 2.Alcohol, Tobacco and Other Drug Abuse (ATODA) 3.Physical Activity and Nutrition 4.Oral Health (Continued from FY2012 CHNA) In October 2014, a community health improvement call to action, including approximately 110 community leaders with representation from business, non-profit agencies, health care, education, public health and safety and elected officials, was convened. The objective of the event was to obtain community input to identify and prioritize health issues that the hospital is best positioned to address in partnership with other organizations in the community. The event included a presentation by Karlyn Raddatz, RN, Sheboygan County Health Officer with a review of Health People 2020 and Healthiest Wisconsin 2020's 12 health focus areas and objectives to present a framework for identifying the health priorities. Jean Beinemann, RN, Program Supervisor from the Sheboygan County Division of Public Health updated the group on the key accomplishments of the Health Sheboygan County 2020 Coalition since 2011. The event included data review, subgroup discussion in addition to a group process to determine the communities' health priorities. The review of the data included information gained from the telephonic community health survey, secondary data sources and key interviews. The large group was divided into small subgroups (6-8 members) to discuss the following questions: -What is your vision for the health of Sheboygan County in 2014? -For each of the priorities- what systemic change will help us achieve these? -For each of the priorities - what systemic change will help us achieve these? -What factors within the local, national environment may restrict our ability to achieve our aspirations in 2014? -How will you measure whether Sheboygan County will be successful at achieving this vision? -A large group report out session was led by the facilitator to determine priorities based on the small group discussions. After group prioritization, each participant was asked to vote for their top three issues. To accomplish this each participant was given three dots with instructions that they could vote for three different priorities or could place all three of their dots on one priority. The top three priorities identified included: *Mental health *ATODA *Physical activity and nutrition In addition to these priorities, the focus areas listed below were identified as being an integral component of each of the priorities: *Education/prevention *Access to services *Coordination/continuity of care services *Health literacy *Integration of well county initiatives Implementation plan development as part of the engagement process with key stakeholders, attention has been given to natural partnerships and collaborations that will be used to operationalize the implementation plan. The implementation plan is considered a "living document" - a set of strategies that can be adapted to the lessons learned while implementing community benefit programs and services relevant to the priority needs. The broader set of community needs will continue to be monitored for consideration as future focus areas. |
| Schedule H, Part V, Section B, Line 11 Facility , 2 | Facility , 2 - ST. NICHOLAS HOSPITAL (CONTINUED). IMPLEMENTATION PLAN ST. NICHOLAS HOSPITAL WILL PARTNER WITH COMMUNITY WIDE ACTION TEAMS TO DEVELOP, IMPLEMENT, MONITOR AND EVALUATE BOTH NEW AND ONGOING INITIATIVES THAT ADDRESS THE IDENTIFIED PRIORITY COMMUNITY HEALTH NEEDS. THE SET OF IMPLEMENTATION STRATEGIES AND INTERVENTIONS ARE CONTAINED IN THE IMPLEMENTATION PLAN, WHICH WAS APPROVED AND ADOPTED BY AN AUTHORIZED BODY OF THE HOSPITAL. THE IMPLEMENTATION STRATEGIES AND INTERVENTIONS WILL INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING INITIATIVES IN EACH OF THE FIVE HEALTH NEEDS CATEGORIES. 1. MENTAL HEALTH - HSHS ST. NICHOLAS HOSPITAL IS INVOLVED IN THE DEVELOPMENT, IMPLEMENTATION AND/OR CONTINUATION OF THE FOLLOWING EFFORTS TO IMPROVE ACCESS TO CARE. A. SUPPORT THE ACTIVITIES OF THE COMMUNITY ACTION PLANNING TEAMS, WHICH HAVE THEIR OWN THREE YEAR PLAN WITH GOALS AND OUTCOME MEASURES B. DEVELOP STRATEGIES TO ENSURE HEALTH LITERACY IS A COMPONENT OF ALL THE PROGRAMMING AND ACTIVITIES. 2. ATODA - HSHS ST. NICHOLAS HOSPITAL IS ENGAGED IN THE DEVELOPMENT, IMPLEMENTATION AND/CONTINUATION OF THE FOLLOWING EFFORTS TO IMPROVE ATODA SERVICES. A. SUPPORT THE ACTIVITIES OF THE COMMUNITY ACTION PLANNING TEAMS, WHICH HAVE THEIR OWN THREE YEAR PLAN WITH GOALS AND OUTCOME MEASURES B. DEVELOP STRATEGIES TO ENSURE HEALTH LITERACY IS A COMPONENT OF ALL THE PROGRAMMING AND ACTIVITIES. 3. PHYSICAL ACTIVITY AND NUTRITION - HSHS ST. NICHOLAS HOSPITAL IS SUPPORTIVE OF THE DEVELOPMENT, IMPLEMENTATION AND/OR CONTINUATION OF THE FOLLOWING EFFORTS TO ADDRESS OBESITY. A. SUPPORT THE ACTIVITIES OF THE COMMUNITY ACTION PLANNING TEAMS, WHICH HAVE THEIR OWN THREE YEAR PLAN WITH GOALS AND OUTCOME MEASURES. (WORK PLANS WILL BE ATTACHED TO THIS REPORT UPON COMPLETION). B. DEVELOP STRATEGIES TO ENSURE HEALTH LITERACY IS A COMPONENT OF ALL THE PROGRAMMING AND ACTIVITIES. 4. IDENTIFY AND IMPLEMENT PROGRAMS TO PROVIDE APPROPRIATE CARE TO POOR AND NEEDY. A. DEVELOP STRATEGIES TO REDUCE EMERGENCY DEPARTMENT VISITS BY MEDICAID PATIENTS AND PROVIDE THEM WITH CARE IN SETTING APPROPRIATE TO THEIR NEEDS. B. PROVIDE ASSISTANCE TO COMMUNITY MEMBERS TO ENROLL IN INSURANCE PRODUCTS THROUGH THE MARKETPLACE OR TO ENROLL IN BADGERCARE, AS APPROPRIATE FOR THEIR SITUATION. C. WORK WITH PUBLIC HEALTH AND OUR COMMUNITY PARTNERS TO IDENTIFY AND IMPLEMENT AT LEAST ONE NEW EVIDENCE BASED COMMUNITY PROGRAM THAT ADDRESSES ONE OF THE IDENTIFIED HEALTH PRIORITIES. IN ADDITION, THOUGH NOT IDENTIFIED AS ONE OF THE TOP FOCUS AREAS, ORAL HEALTH CONTINUES TO BE A MAJOR CONCERN WITHIN OUR COMMUNITY. ORAL HEALTH WAS THE TOP FOCUS AREA IN OUR PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT. IN RESPONSE TO THIS NEED, IN JANUARY, 2012 THE LAKESHORE COMMUNITY HEALTH CENTER OPENED FOR DENTAL SERVICES ONE DAY A WEEK. CURRENTLY THE CLINIC CONTINUES TO GROW AND HAS BECOME A FEDERALLY QUALIFIED HEALTH CENTER. IN 2014 THEY SERVED NEARLY 3000 PEOPLE. ACCESS TO DENTAL CARE 5. HSHS ST. NICHOLAS HOSPITAL IS INVOLVED IN THE IMPLEMENTATION AND /OR CONTINUATION OF THE FOLLOWING EFFORTS TO IMPROVE ACCESS TO DENTAL CARE. A. SUPPORT THE ACTIVITIES OF THE DENTAL ACCESS COMMITTEE. B. SUPPORT THE ACTIVITIES OF THE LAKESHORE COMMUNITY HEALTH CENTER. C. DEVELOP STRATEGIES TO REDUCE ED VISITS FOR DENTAL CONDITIONS D. CONTINUE TO SUPPORT AND EXPLORE ADDITIONAL STRATEGIES TO PROVIDE EDUCATIONAL MATERIALS AND COMMUNITY RESOURCES FOR PROVIDERS TO SHARE WITH THEIR PATIENTS. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - St. Nicholas 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. Nicholas 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 | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part VI, Line 6 DESCRIPTION OF AFFILIATED GROUP (Continued 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 (Continued 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 VI, Line 5 Promotion of community health (continued) | In one case, a client completed the assessment with a score indicating a need for SBIRT. The patient and the SBIRT case manager put together a plan to decrease the patient's alcohol consumption. At the patient's six-month follow-up, they were reassessed and showed a significant decrease in their score. In addition, their liver enzymes and blood pressure were both lower, which is motivating the patient to continue with the plan. On another positive note, four of six clients who were rescreened after six months had decreased their scores dramatically. Though two patients did not lower their scores, they were enrolled in an AODA Intensive Outpatient Program with the help of the SBIRT case manager. Nutrition: Summer Lunch Program and Double Your Bucks (DYB) Summer Lunch Program: Hospital staff assists a local non-profit at a Sheboygan school to promote nutrition in the community. Nourish is a not-for-profit group that partners with the Sheboygan Area School District each summer to feature and promote local, fresh produce once a week during Summer Lunch at six sites serving elementary school children. HSHS St. Nicholas provides two Ambassadors for the Pigeon River site to deliver high fives, stickers and overall encouragement. Studies have shown that children will try new foods when encouraged. Double Your Bucks (DYB): Adequate food and nutrition was identified as one of the major health needs facing our community. The community wide food and nutrition action planning group has been actively working with local farmers' markets to encourage customers using EBT (electronic benefit transfer, formerly known as food stamps) to purchase fruits and vegetables. They worked to enable vendors to accept EBT, and using funds from HSHS St. Nicholas Hospital trialed a "double your bucks" initiative during the 2016 Farmer's Market to double the purchasing power of EBT when used for fruits and vegetables up to a maximum of $10 during two market days per month. The trial showed that DYB increased purchases of fruits and vegetables by those receiving EBT benefits. Statistics showed the average number of DYB EBT transactions per day was 17.4 as compared to non-DYB EBT transactions per day which were 2.57. The increase of transactions when the DYB was available to recipients was one of the reasons behind the plan to increase the number of days during the market for the 2017 Farmer's Market season. A participant survey showed that main reason for participating in the Farmer's Market was to take part in the community - more than 90% of the respondents indicated that this was important or very important. In addition, more than 94% of respondents stated coming to the Farmer's Market to purchase fresh food was very important. Other Community Benefit Activities and Programs HSHS St. Nicholas Hospital provides a range of community benefit that flows from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by HSHS St. Nicholas Hospital, and they often relieve a burden that would otherwise be carried by government. HSHS St. Nicholas' active participation with the Regional Enrollment Network continues through a partnership with several local social service agencies, health care professionals and insurance professionals to ensure community members have opportunities to obtain insurance through the Marketplace. As part of this initiative, HSHS St. Nicholas Hospital contracts with The Resolute Group to provide on-site services for community members. Another example of community benefit at HSHS St. Nicholas Hospital is the Share of Northeast Wisconsin, which provides support to families who experience loss of life during pregnancy. This program serves the entire community, at no cost to participants, whether their loss occurred at HSHS St. Nicholas Hospital or another facility. Activities include: monthly support meetings, annual memorial and burial services and written grief education materials in addition to memory mementos for the parents. Professionals at the hospital assisted almost 1,000 people to apply for the appropriate assistance, such as Social Security or Medical Assistance when they came to the hospital in a time of medical need. HSHS St. Nicholas Hospital actively participates in "Healthy Sheboygan County 2020", a collaborative group of local community organizations focused on improving the lives of people in our county. Sheboygan County Activity & Nutrition (SCAN) receives support through the hospital's participation in the Well County Initiative and local health fairs. HSHS St. Nicholas Hospital is an active co-sponsor of the Lakeshore Community Health Center developed to address the need to increase access to health care for the uninsured and underinsured in Sheboygan County. In addition to financial support, the Hospital has dedicated staff to assist with the important community benefit effort by serving on the Program/Quality Improvement Committee Community Benefit at HSHS St. Nicholas Hospital also includes multiple programs aimed at health promotion: -Support groups (free) for cancer and brain injury. -Free use of hospital conference and meeting rooms for area not-for-profit organizations -Free bike helmet fittings and helmets at cost, open to the public -In-kind services for Sheboygan County Interfaith, United Way, Safe Harbor Domestic Abuse Shelter, and schools reach thousands in need within the greater Sheboygan County area -Food drives for area food pantries, candy collection for troops overseas, school supply and clothing drives for area schools -Host and staff the Sheboygan site for the community-wide Medication Take Back events which are held at five county locations two times per year. At the October 2016 collection, more than 350 pounds were collected from five locations with nearly 200 pounds being collected at HSHS St. Nicholas Hospital. In April 2017, collections from five locations totaled more than 600 pounds with more than 360 pounds collected at HSHS St. Nicholas Hospital. -Hospital colleagues serve on the Mental Health America of Sheboygan County Board -Provide a no cost way for community members to properly dispose of their contaminated sharps by placing a drop box inside the Emergency Department entrance where sharps can be disposed of 24/7. -Sponsor a Health Literacy Summit in the community. |
| 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 | The community building activities that we have tracked and reported in our community benefit report are a minor portion of our total community benefit efforts. They consist primarily of actively participating in and supporting the work of community groups to advance community awareness about health issues. Activities included: attending the Wisconsin Hospital Association's Advocacy Day where staff and other local health care organizations met with our legislators to discuss healthcare legislation. Funding support for the biennial Health Literacy Summit whose focus this session was on how improved health literacy can help individuals become more engaged with their health and health care. On a local level, hospital staff provides active participation on community boards including Orange Cross Ambulance. Other collaborative efforts to support the health of a specific population include our work on the Refugee Resettlement Committee to help to coordinate and enhance services among agencies for new refugees within our community. Staff members provide insight as members of the newly formed Sheboygan County Child Death Review Committee whose goal is to improve child health, safety and protection. In addition, we are supporting the work within our community to increase access to food and better nutrition by implementing the Plant A Seed Program. With this program, hospital staff is encouraged to plant an extra row or two in their garden or purchase fresh produce a farmers' market and donate to our campaign. The donations are given to the Sheboygan County Food Bank which supplies 11 food pantries within our community. |
| 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. Nicholas Hospital reports bad debt in accordance with Healthcare Financial Management Association Statement 15, as modified by and consistent with Generally Accepted Accounting Principles (GAAP). |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | HSHS St. Nicholas Hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 21 of the HSHS Consolidated Audit Report. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | HSHS St. Nicholas Hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. While this shortfall in Medicare payments is not classified as community benefit by the IRS, we nonetheless believe it is an important contribution made by the hospital to the health and well-being of the community. If the Medicare program did not exist, many Medicare patients would be eligible for charity care or other means-tested government programs. Further, by absorbing this payment shortfall and providing care below cost to these individuals, HSHS St. Nicholas Hospital is relieving the burdens of the government. Accordingly, this shortfall restricts St. Nicholas Hospital's ability to make funds available to provide for charity care and other community benefits. The hospital Medicare shortfall at cost for FY2017 was $19.3 million. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. |
| Schedule H, Part V, Section B, Line 16a FAP website | - ST. NICHOLAS HOSPITAL: Line 16a URL: http://www.hshs.org/FAP; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - ST. NICHOLAS HOSPITAL: Line 16b URL: http://www.hshs.org/FAP; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - ST. NICHOLAS HOSPITAL: 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. Nicholas Hospital's community care brochure and application are available in both English and Spanish on our website. In addition, community care brochures 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. 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. Every patient statement has a brief notice about the availability of applying for financial assistance and it is available to those who qualify. 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 community care and lists the internet address where the policy can be obtained. A system called Search America is utilized after failed attempts made by the hospital and our law firm to make contact or work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a presumptive determination as to whether the patient meets charity guidelines to grant charity care or continue collection efforts. |
| Schedule H, Part VI, Line 4 Community information | Sheboygan County is primarily an urban county, one of 72 counties, and is located in eastern Wisconsin. The population of approximately 115,000 is primarily Caucasian (88%). Five percent of the population is Hispanic, and another 5% is Asian. The percent of people age 65 and over exceeds state and national levels. Per the Wisconsin Department of Health Services, 10.8% of residents are below the federal poverty level. More than 14,000 residents are covered by Medicaid/Badger Care Plus. Per the Wisconsin Department of Health Services Division of Public Health, 6% of Sheboygan County's population is uninsured. Per the US Census Bureau, the income per capita is $27,034 and the median household income is $53,713. Sheboygan County contains a HPSA (health professional shortage area) for Medical, Dental, and Behavioral Health as well as a MUA (medically underserved area), per HRSA. HSHS St. Nicholas Hospital does not exclude Medically Underserved Areas (MUAs), low income or minority populations from its service area. There are two non-profit, general medical and surgical hospitals serving Sheboygan County. Within the report area, 18% of adults 18 and older report having poor or fair health in response to the question "Would you say that in general your health is excellent, very good, good, fair or poor?" The state rate is 15%. This indicator is relevant because it is a measure of general poor health status. |
| Schedule H, Part VI, Line 5 Promotion of community health | As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS St. Nicholas Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded more than 125 years ago to bring a healing presence and improve the health of our community, especially for those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Sheboygan County and surrounding areas. The hospital is governed by a Board of Directors, at least a majority of whom reside in the hospital's primary service area and who are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Nicholas Hospital is responding to community need. In FY2015 for example, the Board reviewed the Community Health Needs Assessment and approved an Implementation Plan for addressing selected health focus areas. Additionally, our hospital Advisory Council, Friends of St. Nicholas Foundation and the Partners of St. Nicholas Hospital, whose volunteer members assist in many areas of the Hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Consistent with its exempt purpose, HSHS St. Nicholas Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Nicholas Hospital reinvests surplus funds to support the mission of the organization and health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. HSHS St. Nicholas Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefit. In FY2017, HSHS St. Nicholas Hospital provided more than $10.7 million in Community Benefit services, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in FY2017, HSHS St. Nicholas Hospital provided $160k (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than $19 million (at cost) in excess of Medicare payment for health care services. HSHS St. Nicholas Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives would not exist without the leadership role played by HSHS St. Nicholas Hospital and they often relieve a burden that would otherwise be carried by government. The hospital's FY2015 Community Health Needs Assessment (CHNA) surfaced the following health focus areas to be addressed by the hospital in collaboration with the other hospital, clinics and community organizations: Oral Health -Actively participate on refocused Sheboygan County Oral Health Partnership. Efforts are directed at consensus building including identification and development of metrics to measure oral health efforts within our community. Led efforts to develop a document to be used to standardize antibiotic/pain treatment for dental patients. Participated at the Committee's resource booth promoting oral health education at the farmer's market health education day. -The Hospital has been active in supporting the establishment of a community clinic. In FY2017, HSHS St. Nicholas continued to support the Lakeshore Community Health Center by funding the purchase of dental equipment for the expansion of their school dental program from one to four school districts. Continue to actively participating on the Program/QI Committee. From July 2016 through June 2017 the clinic served more than 2,800 clients during 7,411 visits. -Coordinate the four HSHS Eastern Wisconsin Division Hospitals' participation in the Oral Health Partnership Committee's Operation Gratitude Project to collect Halloween candy for the troops. The hospitals contributed more than 350 pounds of candy toward the total of more than 1,300 pounds collected in our community. In addition, more than 20 pounds of dental hygiene supplies were donated. Physical Activity and Nutrition -Continued support of the "double your bucks" program at the Sheboygan Farmer's Market to enable EBT recipients to double the amount of fresh fruits and vegetables they can purchase. This program was expanded to allow recipients to access this opportunity every market day which occurs twice weekly instead of only two times per month. -Sponsored an intern with the Farmer's Market to assist with promoting healthy eating in our community. -Supported the efforts of the Early Learning Center to increase the physical activity of the Head Start students in their 50 Million Strong Program to foster participation and promote a team concept. -Actively participate in the Summer Lunch program to provide nutrition education. Mental Health -Actively participate as a board member of Mental Health of America: serve on the Personnel and Finance Committee; took assignments for the Suicide Awareness Walk. SNS was a sponsor for the Walk. -As a member of the Healthy Sheboygan County 2020 Stigma Committee assisted with planning of the 3rd Annual Mental Health/AODA Resource Fair; SNS was a primary sponsor. -Four colleagues (one hospital and three Prevea Health) were trained as Question Persuade and Refer (QPR) Trainers, an evidence based suicide prevention curriculum, as part of the HSC 2020 Stigma Committee's initiative to provide community wide education. -Provide funding for the expansion of the Mental Health America's Mindfulness in School program to help children learn positive ways. Scholarly research finds that mindfulness practice decreases stress and anxiety, increases attention, improves interpersonal relationships, strengthens compassion, and confers a host of other benefits. ATODA (Alcohol, Tobacco and Other Drug Abuse) -Funded a case manager position at Lakeshore Community Health Center to implement and manage SBIRT (Screening, Brief, Intervention and Referral to Treatment). With this Case Manager managing SBIRT, the current Case Mangers will have additional time to dedicate to other priorities including nutrition and activity. -HSC 2020 Heroin Committee: Co-captain on the Harm Reduction Pillar, which is exploring a number of opportunities with community partners. -Actively participate on the HSC 2020 SBIRT Committee which is working to implement SBIRT community wide and exploring opportunities for implementing within both medical and school settings. As a member of this committee assisted with planning of the SBIRT presentation by Dr. Richard Brown. Three examples of the impact these efforts had on our community include: ATODA In FY2017, HSHS St. Nicholas Hospital provided its second and final payment in support of funding a case manager to provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) services at Lakeshore Community Health Care (LCHC) in Sheboygan. First year funding by HSHS St. Nicholas Hospital was used to create the position, and going forward the position will be wholly funded by the clinic. SBIRT services are 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. The CHNA was completed through a partnership between HSHS St. Nicholas Hospital and other community organizations including the Sheboygan County Public Health Department. In that assessment, drug and alcohol abuse ranked as one of the top areas of concern in Sheboygan County. 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 health care costs and decrease the severity of drug and alcohol abuse. A position like this will have a lasting impact on our community. In the first nine months, the SBIRT case manager performed 35 SBIRT assessments, 24 reoccurring follow-up appointments (Brief Intervention), and 12 referrals for specialized treatment. |
| Schedule H, Part VI, Line 6 Affiliated health care system | HSHS St. Nicholas 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 (10 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDREW J BAGNALL | ||||||||||||||
| PRESIDENT | $0 | $278,906 | $0 | $38,172 | $0 | $129,559 | $0 | $102,711 | $0 | $28,662 | $0 | $578,010 | $0 | $91,981 |
| 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 |
| MARY MARTIN | ||||||||||||||
| CHIEF NURSING OFFICER | $153,863 | $0 | $8,072 | $0 | $150 | $0 | $32,139 | $0 | $24,789 | $0 | $219,013 | $0 | $0 | $0 |
| THERESE B PANDL | ||||||||||||||
| DIVISION 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 |
| GREG SIMIA | ||||||||||||||
| DIVISION CFO | $0 | $370,894 | $0 | $31,383 | $0 | $780 | $0 | $85,174 | $0 | $27,395 | $0 | $515,626 | $0 | $0 |
| ANDREA M ANGOTTI | ||||||||||||||
| PHARMACIST | $141,439 | $0 | $1,186 | $0 | $780 | $0 | $98,890 | $0 | $8,006 | $0 | $250,301 | $0 | $0 | $0 |
| MELISSA PALECEK | ||||||||||||||
| PHARMACY MANAGER | $141,331 | $0 | $0 | $0 | $164 | $0 | $42,264 | $0 | $900 | $0 | $184,659 | $0 | $0 | $0 |
| CEANNE SIMMELINK | ||||||||||||||
| PHARMACIST | $118,607 | $0 | $0 | $0 | $926 | $0 | $10,442 | $0 | $25,732 | $0 | $155,707 | $0 | $0 | $0 |
| JOHN WINTER | ||||||||||||||
| SURGICAL SERVICES DIRECTOR | $111,623 | $0 | $0 | $0 | $974 | $0 | $23,407 | $0 | $26,939 | $0 | $162,943 | $0 | $0 | $0 |
| Tayna Konitzer | ||||||||||||||
| Divisional Director | $104,900 | $0 | $0 | $0 | $0 | $0 | $34,651 | $0 | $16,693 | $0 | $156,244 | $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 ORGANIZATIONS HIGHEST COMPENSATED INDIVIDUALS RECEIVED A GIFT CERTIFICATE. 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 DOCUMENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED AND TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2016 THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). Andrew Bagnall - $34,149 Ann Carr -- $31,564 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. Andrew Bagnall - $91,981 Ann Carr -- $31,485 Therese Pandl -- $96,536 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (19 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a SURGICAL SERVICES | ST. NICHOLAS HOSPITAL SURGICAL SERVICES ARE COMPRISED OF CENTRAL PROCESSING, ANESTHESIA, SURGERY AND RECOVERY. THIS INCLUDES TEN OPERATING ROOM SUITES. SEVEN OF THE SURGICAL SUITES ARE LOCATED IN THE HOSPITAL AND THREE ARE LOCATED AT THE ST. NICHOLAS SHEBOYGAN SURGERY CENTER, WHICH WAS ACQUIRED 01/01/2014. SERVICES ARE AVAILABLE 24/7 AND INCLUDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. IN FY2017 THERE WERE NEARLY 5,300 SURGICAL PROCEDURES PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, UROLOGY, TRAUMA AND GYNECOLOGY. ANESTHESIA AND CENTRAL PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. |
| Form 990, Part III, Line 4b RADIOLOGY SERVICES | ST. NICHOLAS HOSPITAL IMAGING SERVICES PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. OVERALL, THE DEPARTMENT PERFORMS MORE THAN 30,000 INPATIENT AND OUTPATIENT EXAMS AND PROCEDURES ANNUALLY. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN RADIOLOGY, COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE, POSITRON EMISSION TOMOGRAPHY (PET), AND ULTRASOUND. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES, AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE-ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. |
| Form 990, Part III, Line 4c EMERGENCY SERVICES | ST. NICHOLAS HOSPITAL OPERATES A LEVEL IV TRAUMA CENTER/EMERGENCY DEPARTMENT THAT IS OPEN 24/7 AND STAFFED BY BOARD-CERTIFIED EMERGENCY MEDICINE PHYSICIAN SPECIALISTS. STAFF MEMBERS ARE TRAINED IN ADVANCED CARDIAC LIFE SUPPORT, EMERGENCY NURSING FOR PEDIATRICS AND TRAUMA NURSING. IN FY2017 THERE WERE OVER 14,000 VISITS TO THE EMERGENCY CENTER. LIKE ALL HOSPITAL SERVICES, EMERGENCY CARE IS PROVIDED REGARDLESS OF RACE, CREED, OR ABILITY TO PAY, AND FINANCIAL ASSISTANCE IS AVAILABLE AFTER CARE IS PROVIDED FOR THOSE IN NEED. |
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 63,222,514 including grants of $)(Revenue $ 66,906,337) OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMEN AND INFANT SERVICES, HOME HEALTH AND HOSPICE CARE, CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, FOOT CLINICS AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. |
| Form 990, Part IV, Line 24a TAX EXEMPT BONDS | ST. NICHOLAS HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"). AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HSSI FORM 990. |
| Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. |
| Form 990, Part VI, Line 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. NICHOLAS 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. NICHOLAS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. NICHOLAS HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | JOHN BROTZ & STUART W. BROTZ - Family relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE SENIOR GOVERNING BODY OF ST. NICHOLAS 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. NICHOLAS 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 CONTROLLLING 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 AMNED 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 AFFLILIATE; (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, EXCHNAGE, 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 THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRAEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORAITON OR ANY AFFILIATE; AND (N) 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. THE CURRENT CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY WAS EFFECTIVE JANUARY 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATION'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 AS 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 TO PROMPTLY DISCLOSE SUCH 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, WHICH ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTERESTS EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO, A PROPOSED CONTRACT, TRANSITION, 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, TRANSACTIONS, RELATIONSHIP, ARRANGEMENTS, OR ACTIVITY IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, THE COMMITTEE 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, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS THE CONTRACT, TRANSACTION, RELATIONSHIP, 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 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 | 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 | CONTRACT LABOR - Total Expense: 671817, Program Service Expense: 470272, Management and General Expenses: 201545, Fundraising Expenses: ; PROFESSIONAL FEES - Total Expense: 1454576, Program Service Expense: 1018203, Management and General Expenses: 436373, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 40000550, Program Service Expense: 28000385, Management and General Expenses: 12000165, Fundraising Expenses: ; Shared Services Fee - Total Expense: 6493054, Program Service Expense: 4545138, Management and General Expenses: 1947916, Fundraising Expenses: ; |
| Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT | ST. NICHOLAS 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 THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, AND EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | TRANSFER TO AFFILIATES - -393653; CHANGE IN PENSION - 2040515; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - 203625; CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS - 662681; SWAP PAYMENTS - -181039; |
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 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) |
| ST CLARE MEMORIAL HOSPITAL | ||||||||||
| 855 S MAIN STREET | OCONTO FALLS | WI | 54154 | 390848401 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | Yes (true) |
| HSHS HOLY FAMILY HOSPITAL | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 370792770 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | Yes (true) |
| UTLAUT MEMORIAL FOUNDATION | ||||||||||
| 200 HEALTHCARE DRIVE | GREENVILLE | IL | 62246 | 371140166 | FUNDRAISING | IL | 501(c)(3) | Type II | HSSI | Yes (true) |
| 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 | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| 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 |