2018-05-14T20:03:20-05:00 2017-06-30 990 2016-07-01 390902199 Sacred Heart Rehabilitation Institute Inc SACR 3147338000 400 West River Woods Parkway Glendale WI 53212 Tonya Mershon Tax Officer 2017-09-27 2016 2021-01-29 14:40:06Z X Bernard Sherry Sr VP 400 West River Woods Parkway Glendale WI 53212 13751378 false 0928 X www.columbia-stmarys.org/SHRI X 1955 WI Provider of rehabilitation services, focusing on the needs of persons physically disabled. 9 8 116 9 0 0 125287 16929 11435441 13730388 0 -3073 13136 4003 11573864 13748247 0 0 0 5624972 6362717 0 0 0 5687043 5304692 11312015 11667409 261849 2080838 12620590 5545339 10323970 1564139 2296620 3981200 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 8193133 0 13730388 Sacred Heart Rehabilitation Institute is a comprehensive provider of rehabilitation services with 31 licensed beds, solely dedicated to meeting the needs of persons with physical disabilities. Patient care teams treat the whole patient, striving to meet not only the physical needs, but also addressing emotional, social, psychological and spiritual aspects of change and the adjustment for patient and family. 8193133 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 9 0 true 116 true false false false false false false false false false false X 9 8 false false false false true true true true true false false false true true true true true false false false X David Mannes Controller 4144654589 400 W River Woods Pkwy Glendale WI 53212 WILLIAM C WERNER CHAIR (START 9/2016) 0.2 1.9 X X 0 0 101 ROBERT J VENABLE VICE CHAIR 0.2 1.9 X X 0 0 101 RANDALL PERRY SECRETARY 0.2 1.9 X X 0 0 101 KURT D VELDHUIZEN CPA TREASURER (START 9/2016) 0.2 1.9 X X 0 0 101 BERNARD J SHERRY SR VP - ASCENSION WI (START 9/2016) 7.0 44.0 X X 0 1559311 45520 SISTER M THERESE GOTTSCHALK DIRECTOR (START 9/2016) 0.2 7.6 X 0 0 0 JOHN BYKOWSKI DIRECTOR (START 9/2016) 0.3 2.5 X 0 0 101 JOHN SPLUDE DIRECTOR (START 9/2016) 0.2 1.9 X 0 0 101 PATRICIA DOLHUN MD DIRECTOR 0.2 1.9 X 0 0 101 JONATHAN SOHN CFO - ASCENSION, WI 7.0 39.0 X 0 707247 95164 TIMOTHY WALDOCH INTERIM CFO (END 12/2016) 5.0 41.0 X 0 252913 18219 KEVIN KLUESNER VP CLINICAL SERVICES 9.0 58.0 X 0 261820 40319 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 5.0 40.0 X 0 246644 14379 WILLIAM HART VP/Chief Operating Officer 5.0 45.0 X 0 335740 21829 GERRI LIETZ-STAFFILENO VP/Chief Nursing Officer 5.0 45.3 X 0 283666 37124 BRUCE MCCARTHY MD PRESIDENT PHYSICIAN DIVISION (END 1/2017) 5.0 45.0 X 0 703503 38015 SUZANNE SANICOLA VP PHYSICIAN SVCS 5.0 35.0 X 0 234696 41525 RICHARD SHIMP MD CHIEF MEDICAL OFFICER 5.0 35.0 X 0 432536 41640 TRAVIS D ANDERSEN REGIONAL PRESIDENT - SOUTH MARKET 1.0 43.0 X 0 1214959 43221 ELIZABETH DAVIS MD Physiatrist 40.0 0 X 233914 0 43321 CHERYL A MICHLER Dir SHRI IP Operations 40.0 0 X 106156 0 21746 GERALD J NORA MD Physician 40.0 0 X 123968 0 11040 MICHAEL SANDERL FORMER KEY EMPLOYEE (END 12/2015) 0.0 0.0 X 0 159745 11943 ALLAN SPOONER FORMER KEY EMPLOYEE (END 8/2015) 0.0 0.0 X 0 357603 10586 MARK TAYLOR FORMER OFFICER (END 6/2014) 0.0 0.0 X 0 409715 0 464038 7160098 536299 3 true true false PRICEWATERHOUSE COOPERS LLP 1 N WACKER DRIVE CHICAGO IL 60606 ADVISORY SERVICES 120301 1 16896 33 16929 NET PATIENT REVENUE 622310 13730388 13730388 0 0 0 0 13730388 58 58 0 0 3131 0 -3131 -3131 -3131 Miscellaneous Revenue 900099 4003 4003 0 0 0 0 4003 13748247 13730388 0 930 5030257 4792779 237478 974104 928117 45987 358356 341438 16918 1080 1080 356666 60369 296297 0 17791 12135 5656 76803 750 76053 36394 36394 21819 20237 1582 3193 3193 35438 35085 353 585 585 CORPORATE OVERHEAD 3857956 1458006 2399950 PROVIDER TAX 324437 324437 MEDICAL SUPPLIES 283884 283884 CONTRACT LABOR 65983 65983 222663 154763 67900 0 11667409 8193133 3474276 0 309 3257 2284057 3731139 0 0 0 4642 3575 7730 7585 668991 445014 173788 223977 0 0 10150064 1575806 12620590 5545339 369154 628772 0 9954816 935367 10323970 1564139 X 2296620 3981200 2296620 3981200 12620590 5545339 X 2080838 -396258 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1080 1080 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. SACRED HEART REHABILITATION INSTITUTE, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. SACRED HEART REHABILITATION INSTITUTE, INC. DOES NOT PARTICIPATE IN OR INTERVENE IN (INCLUDING THE PUBLISHING OR DISTRIBUTING OR STATEMENTS) ANY POLITICAL CAMPAIGN ON BEHALF OF (OR IN OPPOSITION TO) ANY CANDIDATE FOR PUBLIC OFFICE. 195259 106588 88671 421186 338426 82760 52546 52546 223977 Due From Affiliates 1571168 Other Receivables 4638 1575806 Due to Affiliates 901045 Estimated Settlement to Third-Party Payor 34285 Other Liability 37 935367 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The System accounts for uncertainty in income tax position by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2017. true true X true X 250 true X true true true false true true 38772 38772 0.0033 3813249 3948421 0 0.0 0 0.0 0 0 3852021 3948421 38772 0.0033 206470 206470 0.0177 65688 65688 0.0056 373500 9915 363585 0.0312 1251 1251 0.0001 7030 7030 0.0006 0 0 653939 9915 644024 0.0552 0 0 4505960 3958336 682796 0.0585 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 230703 13982 11633109 14114839 -2481730 X true true 1 1 Sacred Heart Rehabilitation Institute 2301 North Lake Drive Milwaukee WI 53211 http://www.columbia-stmarys.org/SHRI 165 X X Rehabilitation Center Sacred Heart Rehabilitation Institute 1 false false true X X X X X X X X X 15 true true false true X http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC103014 X X true 15 true http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC103014 false true X 250.0 400.0 X X X X X true true X X X true X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609 X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609 X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609 X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Sacred Heart Rehabilitation Institute, Inc.. The CHNA was conducted to include three levels of information: a community telephone survey of residents to gather their input on community health needs; a secondary data report commissioned from a consultant proficient in gathering and interpreting of data from public health departments, state organizations and non-profit organizations working in the field of health; and interviews with key stakeholders in the field of health.T Denotes this organization represents low-income populations. TT Denotes this organization represents medically underserved populations. TTT Denotes this organization represents minority populations. * AIDS Resource Center of Wisconsin T,TT, * Apostle Presbyterian Church T,TT, * Black Health Coalition of Wisconsin, Inc. T,TT,TTT * Boys & Girls Club T,TT, * Center for Veterans Issues T,TT, * Centro Hispano T,TT,TTT * Children's Hospital of Wisconsin T,TT, * Children's Health Alliance of Wisconsin/ Milwaukee County Oral Health Task Force T,TT, * City of Milwaukee Health Department T,TT, * City of West Allis T,TT, * Community Advocates T,TT, * CORE/El Cento T,TT,TTT * Cudahy Health Department T,TT, * Franklin Health Department T,TT, * Gerald E. Ignace Indian Health Center T,TT,TTT * Greenfield Health Department T,TT, * Hmong American Women's Association T,TT,TTT * IMPACT Planning Council T,TT, * Medical College of Wisconsin Institute for Health and Society T,TT, * Mental Health America of Wisconsin T,TT, * Milwaukee Center for Independence T,TT,TTT * Milwaukee County Behavioral Health Division * Milwaukee County Department of Health & Human Services T,TT, * Milwaukee County Department on Aging T,TT, * Milwaukee Police Department T,TT, * Milwaukee Public Schools T,TT, * MP3 Health Group; T,TT, * Next Door Foundation T,TT, * North Shore Health Department T,TT, * Oak Creek Health Department T,TT, * South Milwaukee Health Department T,TT, * Tri-City National Bank T, * United Way of Greater Milwaukee and Waukesha County T,TT, * UW-Milwaukee Joseph J. Zilber School of Public Health (2012-2015) T,TT, * Wauwatosa Health Department T,TT, * West Allis & West Milwaukee Health Department T,TT, * West Allis Fire Department T,TT, * West Allis Fire Department T,TT, * West Allis/West Milwaukee Chamber of Commerce T,TT, * West Allis/West Milwaukee School District T,TT, * YMCA of Metro Milwaukee T,TT, * YWCA Southeast Wisconsin T,TT, Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Sacred Heart Rehabilitation Institute, Inc.. Aurora Health Care, Children's Hospital of Wisconsin, Froedtert Hospital, and Wheaton Franciscan Health Care. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Sacred Heart Rehabilitation Institute, Inc.. Several reports applicable to our Wisconsin Hospital Facilities are available at the Milwaukee Health Care Partnership's (MHCP) website at http://mkehcp.org/publications. MHCP is a public / private consortium dedicated to improving health care coverage, access, and care coordination for underserved populations in Milwaukee County, with the goals of improving health outcomes, eliminating disparities, and reducing the total cost of care. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Sacred Heart Rehabilitation Institute, Inc.. Using the CHNA completed in June 2016, the hospital developed, adopted, and worked on executing a three-year Implementation Strategy to address priority community health needs. In Fiscal Year 2017 (Tax Year 2016), the hospital implemented the following plan to address the priority needs: Violence and Injury -- Reduce Falls and Injury -- Developed a risk assessment to be shared with community partners -- Offered fall prevention education at community resource center -- Provided preventative strategies to reduce falls to community Chronic Disease -- Support Diabetic Friendly Food Pantry -- Offered nutrition education to pantry participants. -- Increased the number of healthy food options at the pantry. -- Expanded food panty offerings and services" SEXUAL HEALTH This is an area in which CSM will not participate directly. United Way of Greater Milwaukee and Waukesha County has led a task force to reduce teen pregnancy and significantly reduced pregnancy rates. CSM has not participated in this activity and this collaboration. Our resources are well used in other areas of community leadership. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - Sacred Heart Rehabilitation Institute, Inc.. The filing organization takes several proactive approaches to make patients aware of our financial assistance policy. In addition to our policy being posted on our website and available to anyone who requests one, there is abundant signage throughout our facility explaining our financial assistance policy and how to obtain the actual policy, if desired. Notices regarding the availability of financial assistance are displayed in highly visible locations where there is a significant volume of inpatient or outpatient traffic such as in inpatient and outpatient admitting and registration areas, physician offices, and emergency departments. Brochures describing the policy are available in the same locations, and the policy is discussed at the time of registration or pre-registration, admission, discharge, and with billing for those identified with a need. Patients who call and express a financial hardship with paying their bill will be assisted by a customer service representative, who will assist the patient in setting up an appointment to meet with a financial advocate who will go over the financial assistance policy in detail, get the financial assistance application process started, and educate the patient regarding any questions they may have. Lastly, our patient statements also include notifications about the availability of financial assistance and a phone number to call for more information. Additionally, our Financial Assistance Policy, Financial Assistance Application, and Plain Language Summary are available on our website, https://www.columbia-stmarys.org/oth/page.asp?pageid=oth000609. All three documents have been translated into 7 languages: English, Spanish, Hmong, Laotian, Arabic, Russian, and Serbian/Croatian. 0 Schedule H, Part V, Section B, Line 17 Billing and Collection Policy During tax year 2017, the organization learned via verbal comments of IRS agents at public events that the IRS intends that the "readily obtainable" standard in the 501(r) regulations for the AGB calculation and billing and collection policy is only met if those items are posted to the organization's web site. The organization had interpreted that web posting standard to be a safe harbor after consulting with external counsel and tax advisors, and timely took other steps to make the information readily obtainable. Consequently, the organization does not believe its decision to not post these documents to its web site rises to the level of a failure, nor does it believe the circumstances were either willful or egregious, having otherwise timely taken the steps necessary to attain and continue to maintain compliance with the other requirements related to the billing and collection policy and the AGB, as part of its policies and procedures for ensuring compliance with all aspects of 501(r). However, the organization is making this voluntary disclosure in order to communicate to the IRS the changes it is undertaking in response to the recent IRS informal guidance on this specific point concerning the "readily obtainable" standard, and the fact that the organization has started the work necessary to post its AGB information and billing and collection policy to its web site and will complete those additional postings as soon as reasonably possible. The other web postings required under 501(r) (i.e., those related to the community health needs assessment and the financial assistance policy) were timely completed and continue to remain in place as required. The organization believes its safeguards worked as intended in this case (i.e., the organization has regular communications with a number of external law firms and tax consultants and the timely attention to the recent guidance was supported by the framework of regular access to subject matter experts). These changes are in the process of being incorporated into corporate policies and procedures that apply to the organization. Schedule H, Part I, Line 7g Subsidized Health Services The filing organization has not included any PHYSICIAN CLINIC COSTS IN SUBSIDIZED HEALTH SERVICES. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2017 was $699,100 at charges, ($230,703 at cost). Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense begins on page 19. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The filing organization FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED, THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED. Schedule H, Part V, Section B, Line 16a FAP website - Sacred Heart Rehabilitation Institute: Line 16a URL: http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609; Schedule H, Part V, Section B, Line 16b FAP Application website - Sacred Heart Rehabilitation Institute: Line 16b URL: http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - Sacred Heart Rehabilitation Institute: Line 16c URL: http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000609; Schedule H, Part VI, Line 2 Needs assessment In addition to the CHNA reported in Part V, Section B, Sacred Heart Hospital uses both hospital data and reliable, third party reports, including data from government sources, to assess the health needs of the community it serves. These reports provide information about key health, socioeconomic, and demographic indicators that point to areas of need. Sacred Heart Hospital utilizes this information to determine develop programs and services to be provided for the community. These needs and initiatives are presented to senior leadership and board members to ensure the findings are considered in developing the organization's strategy, policy development, and internal financial and operational decisions. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The filing organization iS COMMITTED TO DELIVERING EFFECTIVE, SAFE, PERSON-CENTRIC, HEALTH CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS A NONPROFIT HOSPITAL (OR HEALTH SYSTEM), IT IS OUR MISSION AND PRIVILEGE TO PLAY THIS IMPORTANT ROLE IN OUR COMMUNITY. STAFF SCREEN UNINSURED PATIENTS AND IF FOUND POTENTIALLY ELIGIBLE FOR A GOVERNMENT FUNDING SOURCE, PROVIDE ASSISTANCE AND/OR RESOURCES TO THE PATIENT AND THEIR FAMILY. IF A PATIENT IS NOT ELIGIBLE FOR A PAYMENT SOURCE, our FINANCIAL ASSISTANCE POLICY COVERS PATIENTS WHO LACK THE FINANCIAL RESOURCES TO PAY FOR ALL OR PART OF THEIR BILLS. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED UPON THE ANNUAL FEDERAL POVERTY GUIDELINES and is provided for tHOSE WHO EARN UP TO 400% OF THE FEDERAL POVERTY LEVEL. The following documents are widELY PUBLICIZEd on the organization's website at: https://www.mywheaton.org/about-wheaton/billing-information/#policy - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY The organization also MAKES PAPER COPIES OF the following DOCUMENTS AVAILABLE UPON REQUEST: - FINANCIAL ASSISTANCE POLICY - FINANCIAL ASSISTANCE APPLICATION - FINANCIAL ASSISTANCE POLICY SUMMARY - LIST OF PROVIDERS COVERED BY THE FINANCIAL ASSISTANCE POLICY - AMOUNT GENERALLY BILLED CALCULATION PAPER COPIES ARE MADE READILY AVAILABLE AS PART OF THE INTAKE, DISCHARGE, AND CUSTOMER SERVICE PROCESSES. UPON REQUEST, PAPER COPIES CAN ALSO BE OBTAINED BY MAIL. The organization INFORMS ITS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY VIA A NOTICE ON PATIENT BILLING STATEMENTS, INCLUDING THE PHONE NUMBER AND WEB ADDRESS WHERE MORE INFORMATION CAN BE OBTAINED. Signage displayed in the emergency room and admission area also INFORMS PATIENTS OF THE FINANCIAL ASSISTANCE POLICY. Schedule H, Part VI, Line 4 Community information Please see detailed information provided at Schedule H Part V Section B Lines 1-12 and Part VI Line 5. Schedule H, Part VI, Line 5 Promotion of community health The organization's GOVERNING BODY IS COMPRISED OF PERSONS REPRESENTING DIVERSE ASPECTS AND INTERESTS OF THE COMMUNITY. MANY MEMBERS OF the GOVERNING BODY RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA; WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. SURPLUS FUNDS are provided TO FUND IMPROVEMENTS IN PATIENT CARE, MEDICAL EDUCATION, and RESEARCH through DONATIONS from supporting organizations. Please also see Part III for community activities undertaken by this organization, as well as a compilation of regional charity care information. Schedule H, Part VI, Line 6 Affiliated health care system The filing organization IS AN AFFILIATE OF Columbia St. Mary's, and ASCENSION HEALTH. The hospital's aFFILIATES ARE LARGE MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT MINISTRIES INCLUDING HOSPITAL AND NON-HOSPITAL MINISTRIES (PHYSICIAN GROUP PRACTICES, HOSPITAL ORGANIZATIONS, RESEARCH, HOME HEALTH, DURABLE MEDICAL EQUIPMENT AND SENIOR FACILITIES). THESE MINISTRIES WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF SERVING AS A HEALING PRESENCE WITH SPECIAL CONCERN FOR OUR NEIGHBORS ESPECIALLY THOSE WHO ARE poor or VULNERABLE. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION AND RESEARCH. THE ORGANIZATIONS WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, STATE AND NATIONAL LEVEL. ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ORGANIZATIONS/ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. The organization PROMOTES THE HEALTH OF THE COMMUNITY BY providing healthcare services in the Southeast Wisconsin area, regardless of the person's ability to pay, because it is our mission to improve the lives of those in the communities we serve. true true false false false false false true false BERNARD J SHERRY SR VP - ASCENSION WI (START 9/2016) 0 745387 0 575928 0 237996 0 17226 0 28294 0 1604831 0 0 MARK TAYLOR FORMER OFFICER (END 6/2014) 0 0 0 0 0 409715 0 0 0 0 0 409715 0 360637 JONATHAN SOHN CFO - ASCENSION, WI 0 487399 0 206003 0 13845 0 67575 0 27589 0 802411 0 0 TIMOTHY WALDOCH INTERIM CFO (END 12/2016) 0 231469 0 20233 0 1211 0 12290 0 5929 0 271132 0 0 MICHAEL SANDERL FORMER KEY EMPLOYEE (END 12/2015) 0 0 0 0 0 159745 0 0 0 11943 0 171688 0 0 ALLAN SPOONER FORMER KEY EMPLOYEE (END 8/2015) 0 0 0 0 0 357603 0 0 0 10586 0 368189 0 0 KEVIN KLUESNER VP CLINICAL SERVICES 0 232817 0 20208 0 8795 0 13238 0 27081 0 302139 0 0 CLARISSA COX VP QUALITY & CLINICAL INTEGRATION 0 188127 0 16334 0 42183 0 11086 0 3293 0 261023 0 0 WILLIAM HART VP/Chief Operating Officer 0 303200 0 25293 0 7247 0 15900 0 5929 0 357569 0 0 GERRI LIETZ-STAFFILENO VP/Chief Nursing Officer 0 243022 0 20963 0 19681 0 17041 0 20083 0 320790 0 0 BRUCE MCCARTHY MD PRESIDENT PHYSICIAN DIVISION (END 1/2017) 0 548057 0 60724 0 94722 0 14575 0 23440 0 741518 0 0 SUZANNE SANICOLA VP PHYSICIAN SVCS 0 211973 0 18060 0 4663 0 14674 0 26851 0 276221 0 0 RICHARD SHIMP MD CHIEF MEDICAL OFFICER 0 364753 0 56107 0 11676 0 13250 0 28390 0 474176 0 0 TRAVIS D ANDERSEN REGIONAL PRESIDENT - SOUTH MARKET 0 564396 0 517513 0 133050 0 13250 0 29971 0 1258180 0 0 ELIZABETH DAVIS MD Physiatrist 229537 0 0 0 4377 0 13881 0 29440 0 277235 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF SACRED HEART REHABILITATION INSTITUTE, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual(s) received severance payments from the organization or a related organization during calendar year 2016 : Allan Spooner - $344,725 Michael Sanderl - $159,745 Clarissa Cox - $26,606 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payment from the supplemental nonqualified retirement plan in the amount as noted during calendar year 2016 : Jonathan Sohn - $9,620 Mark Taylor - $360,637 Schedule J, Part I, Line 7 Non-fixed payments BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO ARE EMPLOYED BY THE CSM ORGANIZATIONS AND ARE MEDICAL DOCTORS ARE ELIGIBLE TO RECEIVE A PERCENTAGE OF THE REVENUE GENERATED FROM PATIENTS THEY SERVE, BASED ON ESTABLISHED GUIDELINES. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF SACRED HEART REHABILITATION INSTITUTE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE PRESIDENT WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. Form 990, Part VI, Line 14 PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED BY COLUMBIA ST. MARY'S INC, A RELATED ORGANIZATION OF SACRED HEART REHABILITATION INSTITUTE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED BY COLUMBIA ST. MARY'S INC., A RELATED ORGANIZATION OF SACRED HEART REHABILITATION INSTITUTE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders SACRED HEART REHABILITATION INSTITUTE, INC. has a sole member, Columbia St. Mary's, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body SACRED HEART REHABILITATION INSTITUTE, INC. has a sole member, Columbia St. Mary's, Inc. who has the ability to elect members to the governing body. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to SACRED HEART REHABILITATION INSTITUTE, INC. Financial information or corporation as a whole are subject to approval by its sole corporate member, Columbia St. Mary's, Inc. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public The organization will provide any documents open to public inspection upon request. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers with Alpha Fund - -396258; Form 990, Part XII, Line 2b AUDITED FINANCIAL STATEMENTS The activity of SACRED HEART REHABILITATION INSTITUTE, INC. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of SACRED HEART REHABILITATION INSTITUTE, INC. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of SACRED HEART REHABILITATION INSTITUTE, INC. Form 990, Part XII, Line 2c AUDIT COMMITTEE SACRED HEART REHABILITATION INSTITUTE, INC. is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH MO 501(c)(3) Type I NA false ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH MO 501(c)(3) Type I ASCENSION HEALTH ALLIANCE false COLUMBIA ST MARY'S INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391834639 PARENT CORPORATION WI 501(c)(3) Type I ASCENSION HEALTH false MINISTRY HEALTH CARE INC 10925 W LAKE PARK DR STE 100 MILWAUKEE WI 53224 391490371 PARENT CORPORATION WI 501(c)(3) Type II ASCENSION HEALTH false WHEATON FRANCISCAN HEALTHCARE - SOUTHEAST WISCONSIN INC 400 WEST RIVER WOODS PARKWAY GLENDALE WI 53212 391568865 PARENT CORPORATION IL 501(c)(3) Type III-FI ASCENSION HEALTH false COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390806315 HOSPITAL WI 501(c)(3) 3 COLUMBIA ST MARY'S INC true COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 390807063 HOSPITAL WI 501(c)(3) 3 COLUMBIA ST MARY'S INC true AFFINITY HEALTH SYSTEM 1570 MIDWAY PLACE MENASHA WI 54952 391568866 HEALTH SYSTEM IL 501(c)(3) Type II MINISTRY HEALTH CARE INC true AGAPE COMMUNITY CENTER OF MILWAUKEE INC 6100 NORTH 42ND STREET MILWAUKEE WI 53209 391461846 COMMUNITY CENTER WI 501(c)(3) 7 MINISTRY HEALTH CARE INC true ASCENSION EAGLE RIVER MEMORIAL HOSPITAL INC FKA EAGLE RIVER MEMORIAL HOSPIT AL INC 201 HOSPITAL ROAD EAGLE RIVER WI 54521 390985690 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION GOOD SAMARITAN HOSPITAL INC FKA GOOD SAMARITAN HEALTH CENTER OF M ERRILL WI INC 601 SOUTH CENTER AVENUE MERRILL WI 54452 390808503 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION OUR LADY OF VICTORY HOSPITAL INC FKA OUR LADY OF VICTORY HOSPITAL INC 1120 PINE STREET STANLEY WI 54768 390807065 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION SACRED HEART-STMARY'S HOSPITALS INC FKA SACRED HEART-SAINT MARY'S HOSPITALS INC PO BOX 347 STEVENS POINT WI 54481 391390638 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION ST CLARE'S HOSPITAL INC FKA SAINT CLARE'S HOSPITAL OF WESTON INC 3400 MINISTRY PARKWAY WESTON WI 54476 721531917 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION ST MICHAEL'S HOSPITAL INC FKA SAINT MICHAEL'S HOSPITAL OF STEVENS POINT INC 900 ILLINOIS AVENUE STEVENS POINT WI 54481 390808443 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true HOWARD YOUNG HEALTH CARE INC 240 MAPLE STREET WOODRUFF WI 54568 391499115 HOME OFFICE WI 501(c)(3) Type II MINISTRY HEALTH CARE INC true MERCY MEDICAL CENTER OF OSHKOSH INC 500 S OAKWOOD ROAD OSHKOSH WI 54904 390806268 HOSPITAL WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true MINISTRY MEDICAL GROUP INC 824 ILLINOIS AVENUE STEVENS POINT WI 54481 391965593 MEDICAL GROUP WI 501(c)(3) Type III-FI MINISTRY HEALTH CARE INC true SAINT ELIZABETH'S HOSPITAL OF WABASHA INC 1200 GRANT BLVD WEST WABASHA MN 55981 410693877 MEDICAL GROUP MN 501(c)(3) 3 MINISTRY HEALTH CARE INC true SAINT JOSEPH'S HOSPITAL OF MARSHFIELD INC 611 SAINT JOSEPH AVENUE MARSHFIELD WI 54449 391847631 MEDICAL GROUP WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ST ELIZABETH HOSPITAL INC 1506 S ONEIDA STREET APPLETON WI 54915 390816818 MEDICAL GROUP WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true THE HOWARD YOUNG MEDICAL CENTER INC 240 MAPLE STREET WOODRUFF WI 54568 390873606 MEDICAL GROUP WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true DOOR COUNTY MEMORIAL HOSPITAL INC 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 390806324 MEDICAL GROUP WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true ASCENSION CALUMET HOSPITAL INC FKA CALUMET MEDICAL CENTER INC 614 MEMORIAL DRIVE CHILTON WI 53014 390905385 MEDICAL GROUP WI 501(c)(3) 3 MINISTRY HEALTH CARE INC true WHEATON FRANCISCAN HEALTHCARE - 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