FURP.ORG / PUBLIC DATA EXPLORER

HOLY FAMILY MEMORIAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
HOLY FAMILY MEMORIAL INC (EIN 39-0806395)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-08
IRS object ID
201833129349303113
Schema version
2017v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-08T16:15:45-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN391173131PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SCHENCK SCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1100 MARITIME DRIVE SUITE 2BAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390806395EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOLYBusinessNameControlTxt
Phone9203202011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBRETT NORELLPersonNm
Person TitlePRESIDENT / CEOPersonTitleTxt
Phone9203203470PhoneNum
Signature2018-11-05SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonLACEY SILBERNAGELPreparerPersonNm
PTINP01245590PTIN
Phone9206845500PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address74.142.163.66IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-05IPDt
IP Tm09:03:08IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdB602D594AFD2B0B327E07A06F36CA6A7E42546D0AtSubmissionCreationDeviceId
At Submission Filing Device Id201AC506A6DA8D9D4516FED2DD8E9342B88F33A9AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBRETT NORELLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$126,061,506GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HFMHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1899FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionHEALTH CARE SERVICESHOLY FAMILY MEMORIAL (HFM) IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC, HOME CARE AND HOSPICE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT.ActivityOrMissionDesc
Voting Members Governing Body17VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee1261TotalEmployeeCnt
Total Volunteers294TotalVolunteersCnt
Total Gross UBI$155,328TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$137,664PYContributionsGrantsAmt
CY Contributions Grants$133,019CYContributionsGrantsAmt
PY Program Service Revenue$129,294,093PYProgramServiceRevenueAmt
CY Program Service Revenue$121,959,906CYProgramServiceRevenueAmt
PY Investment Income$3,217,820PYInvestmentIncomeAmt
CY Investment Income$3,366,794CYInvestmentIncomeAmt
PY Other Revenue$56,377PYOtherRevenueAmt
CY Other Revenue$232,023CYOtherRevenueAmt
PY Total Revenue$132,705,954PYTotalRevenueAmt
CY Total Revenue$125,691,742CYTotalRevenueAmt
PY Grants And Similar Paid$49,029PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$50,988CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$76,516,477PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$75,741,043CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$94,057CYTotalFundraisingExpenseAmt
PY Other Expenses$49,499,713PYOtherExpensesAmt
CY Other Expenses$53,527,296CYOtherExpensesAmt
PY Total Expenses$126,065,219PYTotalExpensesAmt
CY Total Expenses$129,319,327CYTotalExpensesAmt
PY Revenues Less Expenses$6,640,735PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$3,627,585CYRevenuesLessExpensesAmt
Total Assets BOY$190,102,873TotalAssetsBOYAmt
Total Assets EOY$197,622,136TotalAssetsEOYAmt
Total Liabilities BOY$66,217,533TotalLiabilitiesBOYAmt
Total Liabilities EOY$70,835,599TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$123,885,340NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$126,786,537NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$108,775,416ExpenseAmt
Grant$50,988GrantAmt
Revenue$125,000,285RevenueAmt
DescHOLY FAMILY MEMORIAL IS AN INTEGRATED NETWORK PROVIDING HEALTH CARE SERVICES INTENDED TO BENEFIT THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE PRIMARY AND SPECIALTY CLINIC CARE, PREVENTIVE CARE SUCH AS HEALTH SCREENINGS, VACCINATION CLINICS AND HEALTH EDUCATION CLASSES, 24/7 EMERGENCY CARE, WALK-IN, INPATIENT ACUTE CARE, OUTPATIENT CARE, HOME CARE AND HOSPICE, PRESCRIPTIONS, OCCUPATIONAL HEALTH SERVICES, AND MEDICALLY BASED FITNESS AND WELLNESS. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. (CONTINUED ON SCHEDULE O)THESE PARTNERSHIPS INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS, AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY. HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HFM UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES, AND CONSIDERS SITUATIONS WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HFM DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $27,238,000 FOR THE YEAR ENDED DECEMBER 31, 2017. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $431,000. MORE INFORMATION IS AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH IS LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG.Desc
Total Program Service Expenses$108,775,416TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document88IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1261EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
DAF Excess Business Holdings0DAFExcessBusinessHoldingsInd
Taxable Distributions0TaxableDistributionsInd
Distribution To Donor0DistributionToDonorInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members17GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TROY DAY INTERIM CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9203203449PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (32 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MICHELLE L BIRSCHBACH
DIRECTOR2.00Yes (X)$0$0$0
DEREK R BOWN DC
DIRECTOR40.00Yes (X)$133,224$0$26,382
DONALD R BRISCH
CHAIR2.00Yes (X)$0$0$0Yes (X)
MATTHEW L CAMPBELL MD
DIRECTOR40.00Yes (X)$298,552$0$25,082
WILLIAM R CASEY
DIRECTOR2.00Yes (X)$0$0$0
JEFFREY S DUNN
CHAIR2.00Yes (X)$0$0$0Yes (X)
SISTER LORITA M GAFFNEY
DIRECTOR2.00Yes (X)$0$0$0
SISTER MARLITA HENSELER
DIRECTOR2.00Yes (X)$0$0$0
MARK P HERZOG
DIRECTOR, PRESIDENT, CEO40.00Yes (X)$736,754$0$27,032Yes (X)
ERICK M KAHLENBERG
DIRECTOR2.00Yes (X)$0$0$0
MARILYNN KAUFMANN PHD RN
VICE CHAIR2.00Yes (X)$0$0$0Yes (X)
DENISE A KITZEROW
TREASURER2.00Yes (X)$0$0$0Yes (X)
WILLIAM C LEACH JR DO
DIRECTOR40.00Yes (X)$346,225$0$25,394
DANIEL B MCGINTY
DIRECTOR2.00Yes (X)$0$0$0
SISTER ELAINE TURBA
DIRECTOR2.00Yes (X)$0$0$0
SISTER JAN VILLEMURE
DIRECTOR2.00Yes (X)$0$0$0
KATHLEEN A ZUCCHI
SECRETARY2.00Yes (X)$0$0$0Yes (X)
ANNETTE M KAMINSKY APNP
DIRECTOR40.00Yes (X)$140,627$0$8,360
COLLEEN A TIMM PHD
DIRECTOR2.00Yes (X)$0$0$0
JANE CURRAN-MEULI
EXECUTIVE VP, COO40.00$328,392$0$24,198Yes (X)
STEVEN D DRIGGERS MD
EXECUTIVE VP, CMO40.00$136,315$0$0Yes (X)
LAURA FIELDING
VP ORG ENGAGEMENT, CAO40.00$163,090$0$3,684Yes (X)
MARY MAURER
VP COMMUNITY ENGAGEMENT, CIO40.00$226,945$0$1,560Yes (X)
BRETT NORELL
VP FINANCE, CFO40.00$278,840$0$19,417Yes (X)
DEAN POLLNOW MD
EXECUTIVE VP, CMO40.00$382,655$0$21,119Yes (X)
JEREMY R ANCLAM MD
PHYSICIAN PROVIDER40.00$940,006$0$22,794Yes (X)
KIRK DIMITRIS MD
PHYSICIAN PROVIDER40.00$1,326,849$0$27,869Yes (X)
RYAN M DOPIRAK MD
PHYSICIAN PROVIDER40.00$1,056,396$0$27,948Yes (X)
DAVID MIKOLYZK MD
PHYSICIAN PROVIDER40.00$771,945$0$27,885Yes (X)
THOMAS SYLVESTER MD
PHYSICIAN PROVIDER40.00$728,158$0$8,360Yes (X)
XA XIONG MD
FORMER DIRECTOR40.00$45,759$0$4,843Yes (X)
WILLIAM D HAMPTON DO
FORMER DIRECTOR40.00$330,166$0$29,394Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$8,370,898TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$331,321TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K88IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CARETECH SOLUTIONS
901 WILSHIRE DRIVE STE 250TROYMI48084IT SERVICES$2,775,214
COMPLETERX LTD
3100 S GESSNER STE 640HOUSTONTX77063PHARMACY SERVICES$1,323,188
INFOR (US) INC
13560 MORRIS ROAD STE 4100ALPHARETTAGA30004IMPLEMENTATION SERVICE$1,195,125
SODEXO CTM INCMSC - 410672
PO BOX 415000NASHVILLETN372415000BIO-MED SERVICES$946,507
PREVEA
2710 EXECUTIVE DRIVE PO BOX 19070GREEN BAYWI54307PROVIDER FEE SERVICES$429,046
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K22CntrctRcvdGreaterThan100KCnt
Fundraising$66,129FundraisingAmt
All Other Contributions$66,890AllOtherContributionsAmt
Total Contributions$133,019TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
INTEGRATED HEALTH CARE900099$95,796,858$95,796,858
LAB621500$20,839,430$20,789,361$50,069
PHARMACY446110$5,323,618$5,323,618
FieldValueIRS element (for citing)
Total Program Service Revenue$121,959,906TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,090,448TotalRevenueColumnAmt
Related Or Exempt Func Income$3,090,448RelatedOrExemptFuncIncomeAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$161,200RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$129,436RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$31,764RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,764TotalRevenueColumnAmt
Exclusion$31,764ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$389,266OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$112,920OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$276,346OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$276,346TotalRevenueColumnAmt
Exclusion$276,346ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$117,171FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$66,129ContriRptFundraisingEventAmt
Fundraising Direct Expenses$22,171FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$95,000TotalRevenueColumnAmt
Exclusion$95,000ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$146,703GrossSalesOfInventoryAmt
Cost Of Goods Sold$105,237CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,466TotalRevenueColumnAmt
Unrelated Business Revenue$41,466UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescINVESTMENT HFHSDesc
Business900003BusinessCd
Total Revenue Column$63,793TotalRevenueColumnAmt
Unrelated Business Revenue$63,793UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Other Revenue Total$63,793OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$125,691,742TotalRevenueColumnAmt
Related Or Exempt Func Income$125,000,285RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$155,328UnrelatedBusinessRevenueAmt
Exclusion$403,110ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$50,988TotalAmt
Program Services$50,988ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$3,984,536TotalAmt
Program Services$1,125,148ProgramServicesAmt
Management And General$2,859,388ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$57,966,363TotalAmt
Program Services$51,476,483ProgramServicesAmt
Management And General$6,421,487ManagementAndGeneralAmt
Fundraising$68,393FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,068,426TotalAmt
Program Services$930,375ProgramServicesAmt
Management And General$137,378ManagementAndGeneralAmt
Fundraising$673FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$9,061,840TotalAmt
Program Services$8,149,906ProgramServicesAmt
Management And General$897,981ManagementAndGeneralAmt
Fundraising$13,953FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,659,878TotalAmt
Program Services$3,180,263ProgramServicesAmt
Management And General$475,038ManagementAndGeneralAmt
Fundraising$4,577FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$574,121TotalAmt
Program Services$120,969ProgramServicesAmt
Management And General$453,152ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$251,008TotalAmt
Management And General$251,008ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$84,490TotalAmt
Management And General$84,490ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,486,945TotalAmt
Program Services$2,486,616ProgramServicesAmt
Management And General$329ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$372,639TotalAmt
Program Services$16,637ProgramServicesAmt
Management And General$356,002ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$518,323TotalAmt
Program Services$430,858ProgramServicesAmt
Management And General$87,169ManagementAndGeneralAmt
Fundraising$296FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,010,389TotalAmt
Program Services$3,955,766ProgramServicesAmt
Management And General$54,623ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,175,147TotalAmt
Program Services$2,139,304ProgramServicesAmt
Management And General$35,843ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$300,188TotalAmt
Program Services$165,403ProgramServicesAmt
Management And General$134,547ManagementAndGeneralAmt
Fundraising$238FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$262,516TotalAmt
Program Services$187,783ProgramServicesAmt
Management And General$72,478ManagementAndGeneralAmt
Fundraising$2,255FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,885,668TotalAmt
Program Services$1,854,596ProgramServicesAmt
Management And General$31,072ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,484,354TotalAmt
Program Services$4,101,217ProgramServicesAmt
Management And General$1,382,664ManagementAndGeneralAmt
Fundraising$473FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$624,042TotalAmt
Program Services$584,298ProgramServicesAmt
Management And General$39,744ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SUPPLIES$19,381,942$19,173,228$208,188$526
PURCHASED SERVICES$8,521,343$2,921,628$5,600,288-$573
WISCONSIN PROVIDER ASSE$2,610,439$2,610,439
MAINTENANCE$2,516,416$2,450,332$66,084

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,467,326TotalAmt
Program Services$663,179ProgramServicesAmt
Management And General$800,901ManagementAndGeneralAmt
Fundraising$3,246FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$129,319,327TotalAmt
Program Services$108,775,416ProgramServicesAmt
Management And General$20,449,854ManagementAndGeneralAmt
Fundraising$94,057FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$14,483,066BOYAmt
EOY$4,801,203EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,871,286BOYAmt
EOY$5,521,082EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$18,358BOYAmt
EOY$26,595EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$17,916,992BOYAmt
EOY$29,098,610EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$300,000BOYAmt
EOY$300,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,364,803BOYAmt
EOY$2,075,404EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$5,845,509BOYAmt
EOY$6,905,859EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$204,413,847LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$122,453,202LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$75,830,400BOYAmt
EOY$81,960,645EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$63,721,785BOYAmt
EOY$63,119,302EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$3,302,262BOYAmt
EOY$2,221,805EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$1,264,649BOYAmt
EOY$1,328,442EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$183,763BOYAmt
EOY$263,189EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$190,102,873BOYAmt
EOY$197,622,136EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$14,492,087BOYAmt
EOY$18,687,821EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$39,006BOYAmt
EOY$35,793EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$51,686,240BOYAmt
EOY$52,111,035EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$200BOYAmt
EOY$950EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$66,217,533BOYAmt
EOY$70,835,599EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$121,073,605BOYAmt
EOY$123,625,688EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$565,001BOYAmt
EOY$632,744EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,246,734BOYAmt
EOY$2,528,105EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$123,885,340BOYAmt
EOY$126,786,537EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$190,102,873BOYAmt
EOY$197,622,136EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$3,627,585ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$6,101,120NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$427,662OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$1,016DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$12,874OtherActivitiesAmt
Total Lobbying Expenditures$13,890TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationEXPLANATION: PART II-B, LINES 1B & 1G: HOLY FAMILY MEMORIAL SENT A REPRESENTATIVE TO WASHINGTON, D.C. IN 2017 TO PARTICIPATE IN AHA'S HEALTH REFORM ADVISORY GROUP. HOLY FAMILY MEMORIAL ALSO SENT TWO HFM STAFF AND ONE HFM BOARD MEMBER TO THE WISCONSIN STATE CAPITAL (WHA ADVOCACY DAY) TO DISCUSS HEALTH RELATED LEGISLATIVE ISSUES ON VARIOUS HEALTH CARE TOPICS WITH STATE LEGISLATORS. EXPLANATION: PART II-B, LINE 1I, OTHER ACTIVITIES: HOLY FAMILY MEMORIAL BELONGS TO THE WISCONSIN HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, WHICH USE A PERCENTAGE OF DUES FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab0InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,811,732BeginningYearBalanceAmt
Contributions$350,741ContributionsAmt
Investment Earnings Or Losses$242,832InvestmentEarningsOrLossesAmt
Other Expenditures$244,459OtherExpendituresAmt
End Year Balance$3,160,846EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,566,566BeginningYearBalanceAmt
Contributions$314,437ContributionsAmt
Investment Earnings Or Losses$105,388InvestmentEarningsOrLossesAmt
Other Expenditures$174,659OtherExpendituresAmt
End Year Balance$2,811,732EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,530,941BeginningYearBalanceAmt
Contributions$382,393ContributionsAmt
Investment Earnings Or Losses-$19,926InvestmentEarningsOrLossesAmt
Other Expenditures$326,842OtherExpendituresAmt
End Year Balance$2,566,566EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,276,763BeginningYearBalanceAmt
Contributions$428,510ContributionsAmt
Investment Earnings Or Losses$61,207InvestmentEarningsOrLossesAmt
Other Expenditures$235,539OtherExpendituresAmt
End Year Balance$2,530,941EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915,567BeginningYearBalanceAmt
Contributions$374,287ContributionsAmt
Investment Earnings Or Losses$179,201InvestmentEarningsOrLossesAmt
Other Expenditures$192,292OtherExpendituresAmt
End Year Balance$2,276,763EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.87000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.10000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.03000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,465,349OtherCostOrOtherBasisAmt
Book Value$5,465,349BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$113,718,812OtherCostOrOtherBasisAmt
Depreciation$65,861,975DepreciationAmt
Book Value$47,856,837BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,734,481OtherCostOrOtherBasisAmt
Depreciation$2,663,804DepreciationAmt
Book Value$70,677BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$80,844,431OtherCostOrOtherBasisAmt
Depreciation$53,072,539DepreciationAmt
Book Value$27,771,892BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,650,774OtherCostOrOtherBasisAmt
Depreciation$854,884DepreciationAmt
Book Value$795,890BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$81,960,645TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescSECURITY DEPOSITDesc
Amt$950Amt
FieldValueIRS element (for citing)
Total Liability$950TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$131,871,409TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$6,101,120NetUnrealizedGainsInvstAmt
Other Revenue$78,547OtherRevenueAmt
Revenue Not Reported$6,179,667RevenueNotReportedAmt
Revenue Subtotal$125,691,742RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$125,691,742TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$129,319,327TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$129,319,327ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$129,319,327TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:HOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT, MAJOR BUILDING IMPROVEMENTS, PROGRAM DEVELOPMENT, AND OPERATIONS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:GAIN ON EXTINGUISHMENT OF DEBT 78,547.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1SAMARITAN DAYEvent1Nm
Gross Receipts Event1$82,068GrossReceiptsEvent1Amt
Charitable Contri Event1$34,545CharitableContriEvent1Amt
Gross Revenue Event1$47,523GrossRevenueEvent1Amt
Non Cash Prizes Event1$4,361NonCashPrizesEvent1Amt
Other Direct Expenses Event1$12,281OtherDirectExpensesEvent1Amt
Event2SIP SAVOREvent2Nm
Gross Receipts Event2$71,173GrossReceiptsEvent2Amt
Charitable Contri Event2$31,584CharitableContriEvent2Amt
Gross Revenue Event2$39,589GrossRevenueEvent2Amt
Other Direct Expenses Event2$4,153OtherDirectExpensesEvent2Amt
Other Events Total1OtherEventsTotalCnt
Gross Receipts Other Events$30,059GrossReceiptsOtherEventsAmt
Gross Revenue Other Events$30,059GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$1,376OthDirectExpnssOtherEventsAmt
Gross Receipts Total$183,300GrossReceiptsTotalAmt
Charitable Contributions Tot$66,129CharitableContributionsTotAmt
Gross Revenue Total Events$117,171GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$4,361NonCashPrizesTotalEventsAmt
Oth Direct Expnss Total Events$17,810OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$22,171DirectExpenseSummaryEventsAmt
Net Income Summary$95,000NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served651PersonsServedCnt
Total Community Benefit Expns$431,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$431,000NetCommunityBenefitExpnsAmt
Total Expense0.00330TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served33726PersonsServedCnt
Total Community Benefit Expns$12,649,595TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,974,636DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,674,959NetCommunityBenefitExpnsAmt
Total Expense0.05930TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served34377PersonsServedCnt
Total Community Benefit Expns$13,080,595TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,974,636DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,105,959NetCommunityBenefitExpnsAmt
Total Expense0.06260TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served18892PersonsServedCnt
Total Community Benefit Expns$104,339TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$104,339NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served3392PersonsServedCnt
Total Community Benefit Expns$307,748TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$307,748NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served19549PersonsServedCnt
Total Community Benefit Expns$79,788TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$79,788NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served41833PersonsServedCnt
Total Community Benefit Expns$491,875TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$491,875NetCommunityBenefitExpnsAmt
Total Expense0.00380TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served76210PersonsServedCnt
Total Community Benefit Expns$13,572,470TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,974,636DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,597,834NetCommunityBenefitExpnsAmt
Total Expense0.06640TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Persons Served13775PersonsServedCnt
Total Community Benefit Expns$14,719TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$14,719NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Persons Served300PersonsServedCnt
Total Community Benefit Expns$62TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$62NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Persons Served3930PersonsServedCnt
Total Community Benefit Expns$5,527TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,527NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Persons Served3250PersonsServedCnt
Total Community Benefit Expns$1,033TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,033NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Persons Served992PersonsServedCnt
Total Community Benefit Expns$9,961TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$9,961NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Persons Served22247PersonsServedCnt
Total Community Benefit Expns$31,302TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$31,302NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,112,142BadDebtExpenseAmt
Bad Debt Expense Attributable$234,662BadDebtExpenseAttributableAmt
Reimbursed By Medicare$47,300,616ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$65,909,190CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$18,608,574MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.HFMHEALTH.ORGWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.HFMHEALTH.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART V PAGE 8OtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V PAGE 8StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.HFMHEALTH.ORG/COMMUNITY-CARE/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2018/04/COMMCAREWEB.PDFFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLHTTPS://WWW.HFMHEALTH.ORG/WP-CONTENT/UPLOADS/2018/04/PLAIN-LANGUAGE-SUMMARYFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 5: ADHERING TO THE TAKE ACTION CYCLE FROM COUNTYHEALTHRANKINGS.ORG, HOLY FAMILY MEMORIAL PARTNERED WITH COMMUNITY LEADERS AND OTHER ORGANIZATIONS TO COLLABORATIVELY PLAN, ASSESS, AND ANALYZE COMMUNITY HEALTH NEEDS. THE PARTNERSHIP GROUP AGREED TO POOL THEIR PERSONNEL RESOURCES AND SHARE THE COSTS OF SURVEY ANALYSIS AND RESULTS TO ACCOMPLISH A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT FOR MANITOWOC COUNTY.THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM CONDUCTED 30 PERSONAL ONE ON ONE INPUT SESSIONS WITH THE PUBLIC HEALTH OFFICER AND PUBLIC HEALTH MANAGER FROM THE MANITOWOC COUNTY HEALTH DEPARTMENT, AS WELL AS THE DIRECTOR OF NORTHEAST WISCONSIN AREA HEALTH AND EDUCATION CENTER, AND THE EXECUTIVE DIRECTOR OF THE UNITED WAY - MANITOWOC COUNTY. ALSO INVOLVED WERE 26 OTHER BUSINESS, COMMUNITY, LEGISLATIVE, AND SOCIAL SERVICE LEADERS, INCLUDING LEADERS FROM THE HMONG AND HISPANIC COMMUNITIES. WE CONDUCTED A COMMUNITY HEALTH TELEPHONE SURVEY WITH 419 RESPONSES FROM COMMUNITY MEMBERS AND A YOUTH RISK BEHAVIOR SURVEY TAKEN BY 1,826 LOCAL HIGH SCHOOL STUDENTS.RESULTS OF THE ASSESSMENT HAVE BEEN UTILIZED BY HEALTHIEST MANITOWOC COUNTY TO DEVELOP A STRATEGIC PLAN AND ACTIONS STEPS TO ADDRESS THE IDENTIFIED HEALTH NEEDS. HOLY FAMILY MEMORIAL PARTICIPATED IN THE DEVELOPMENT OF THE STRATEGIC PLAN AND WILL PARTICIPATE IN THE ACTION STEPS.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 6A: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED COLLABORATIVELY WITH AURORA MEDICAL CENTER - MANITOWOC COUNTY.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED COLLABORATIVELY WITH COMMUNITY LEADERS FROM MANITOWOC COUNTY COMING FROM: HOLY FAMILY MEMORIAL, AURORA MEDICAL CENTER - MANITOWOC COUNTY, MANITOWOC COUNTY PUBLIC HEALTH DEPARTMENT, UNITED WAY MANITOWOC COUNTY, LAKESHORE COMMUNITY ACTION PROGRAM, AND LAKESHORE COMMUNITY HEALTH.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 11: HFM IDENTIFIED THREE SIGNIFICANT NEEDS IN THE CHNA AND HAS CREATED TEAMS WITH AN ASSIGNED LEADER AND OTHER MULTI-DISCIPLINARY PERSONNEL TO OWN, LEAD, AND MONITOR PROGRESS ON THE THREE MAIN GOALS. THE GOALS ARE: 1) IMPROVE SUBSTANCE ABUSE CARE AND SERVICES FOR OUR COMMUNITY; 2) IMPROVE MENTAL HEALTH CARE ACCESS AND SERVICES AT HOLY FAMILY MEMORIAL; AND 3) BE AN ORGANIZATIONAL ROLE MODEL AND COMMUNITY CHAMPION TO IMPROVE NUTRITION AND EXERCISE OPPORTUNITIES. ACTIVITIES AND PROGRESS ARE MONITORED ON A QUARTERLY BASIS. OTHER HEALTH NEEDS WHICH SURFACED IN THE CHNA ARE BEING ADDRESSED BY PARTNERSHIPS WITH OTHER COMMUNITY GROUPS SUCH AS HEALTHIEST MANITOWOC COUNTY AND OTHERS. IDENTIFIED NEEDS INCLUDE: 1) CHRONIC DISEASE MANAGEMENT; 2) TOBACCO CONTROL; 3) SOCIO-ECONOMIC IMPROVEMENTS; 4) INJURY AND FALLS PREVENTION; AND 5) INVESTING EARLY- PARENTAL TRAINING AND HEALTHY BABIES. COMMUNITY COALITIONS AS WELL AS HFM STAFF AND LEADERS ARE WORKING HARD ON COMMUNITY HEALTH ISSUES. OUR MISSION IS TO IMPROVE THE HEALTH OF OUR COMMUNITY. WE ARE ACTIVELY WORKING TOWARDS HEALTHY SOLUTIONS TO IDENTIFIED HEALTH NEEDS.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 20E: PAYMENT GUIDELINES AND THE FINANCIAL ASSISTANCE POLICY ARE POSTED IN PATIENT ROOMS AND LOBBIES, ADMISSION AND REGISTRATION AREAS, AND ARE GIVEN TO ALL SURGERY PATIENTS. IN ADDITION, INFORMATION IS PUBLISHED ON THE BACK OF ALL PATIENT STATEMENTS.
SCHEDULE H, PART V SECTION B, LINE 22DHOLY FAMILY MEMORIAL USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED.
SCHEDULE H, PART V SECTION B, LINE 7BHEALTHIESTMC.ORG; CO.MANITOWOC.WI.US/DEPARTMENTS/HEALTH-DEPARTMENT/
SCHEDULE H, PART V SECTION B, LINE 10AHFMHEALTH.ORG; HEALTHIESTMC.ORG; CO.MANITOWOC.WI.US/DEPARTMENTS/HEALTH-DEPARTMENT/
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line11 - HOLY FAMILY HEALTH SERVICES INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
FacilityRETAIL PHARMACYFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 6A:HOLY FAMILY MEMORIAL (HFM) PREPARED A COMMUNITY BENEFIT REPORT FOR THE CURRENT YEAR AND MADE IT AVAILABLE TO LOCAL CHURCH, POLITICAL, AND BUSINESS LEADERS, AS WELL AS OTHERS IN THE COMMUNITY IN EARLY SPRING 2017. IT WAS ALSO POSTED ON OUR WEBSITE.
PART I, LINE 7:COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HFM'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CAN NOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATES THAT ITS PREFERENTIAL TAX STATUS IS DESERVED.
SCHEDULE H, PART I, LINE 7, COLUMN FTHE PERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL EXPENSES REPORTED ON FORM 990 FOR HFM.
PART II, COMMUNITY BUILDING ACTIVITIES:HFM LEADS AND PARTICIPATES IN NUMEROUS INITIATIVES ALL AIMED AT IMPROVING THE OVERALL HEALTH OF THE COMMUNITY. WE BELIEVE THERE ARE SEVERAL MAJOR AREAS THAT CONTRIBUTE TO TRUE COMMUNITY HEALTH. HFM DEDICATES RESOURCES TO ENHANCE THE OVERALL VIBRANCY OF OUR COMMUNITY, MAKING IT AN OVERALL IMPROVED COMMUNITY IN WHICH TO LIVE, LEARN, WORK, AND PLAY. INITIATIVES INCLUDE: 1) HEALTH BEHAVIORS - PROVIDING SMOKING CESSATION CLASSES, COMMUNITY EXERCISE CHALLENGES, A MEDICALLY BASED WELLNESS CENTER, AND PROVIDING PRACTICAL AIDS TO ENCOURAGE GOOD NUTRITION PRACTICES; 2) SOCIAL AND ECONOMIC FACTORS - PROVIDING LEADERSHIP ON LOCAL ECONOMIC DEVELOPMENT, CHAMBER OF COMMERCE, AND STABLE WAGES AND BENEFITS TO OUR EMPLOYEES SINCE HFM IS THE LARGEST EMPLOYER IN THE COUNTY; 3) ENVIRONMENTAL FACTORS - REDUCING ENERGY USAGE, PROMOTING AN ACTIVE RECYCLING PROGRAM, AND BEAUTIFICATION OF GROUNDS.
PART III, LINE 2:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING HFM'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
PART III, LINE 3:ANY PERSON APPROVED FOR COMMUNITY CARE UNDER HFM'S COMMUNITY CARE PROGRAM HAS UP TO 10 MONTHS (FROM THE FIRST STATEMENT) TO PAY THE REMAINING BALANCE IN FULL. IF THERE IS A BALANCE AT THE END OF THE 10 MONTHS, THE PATIENT WILL RECEIVE A FINAL NOTICE. IF THE BALANCE IS NOT PAID WITHIN 30 DAYS, THE BALANCE WILL BE SENT TO BAD DEBT COLLECTIONS. A HINDSIGHT ANALYSIS IS USED TO ESTIMATE THE PERCENT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER HFM'S FINANCIAL ASSISTANCE POLICY.
PART III, LINE 4:AUDIT STATEMENT NOTE 2, SIGNIFICANT ACCOUNTING POLICIES HAS A SECTION LABELED "ACCOUNTS RECEIVABLE" THAT DESCRIBES BAD DEBT AND ITS EVALUATION.
PART III, LINE 8:HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH 53.2% OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HFM RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES. THE COST METHODOLOGY USED TO DETERMINE THE ALLOWABLE COSTS OF CARE WAS THE COST TO CHARGE RATIO.
PART III, LINE 9B:PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, CT SCAN, AND EMERGENCY SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, THE ELIGIBILITY SPECIALIST WILL HELP THEM COMPLETE THE APPLICATION PROCESS, AND FOLLOW UP ON THEIR APPLICATION THROUGH TO APPROVAL OR DISAPPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON HOW TO APPLY FOR THOSE PROGRAMS. THE ELIGIBILITY SPECIALIST WILL ALSO PROVIDE SUCH ASSISTANCE.
PART VI, LINE 2:HFM UTILIZES VARIOUS PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF MANITOWOC COUNTY. AS PART OF OUR STRATEGIC PLANNING PROCESS, WE OBTAIN INPUT FROM HUNDREDS OF PEOPLE REGARDING THEIR OPINIONS AND PERCEPTIONS OF THE GREATEST HEALTH CARE NEEDS. THIS DATA IS COLLECTED AND CONSIDERED AS WE EVALUATE ANNUAL TACTICS TO ADDRESS OUR STRATEGIES. ON A TRI-ANNUAL BASIS, HFM IS A KEY PARTICIPANT IN A VERY BROAD CHNA WHICH INCLUDES PRIMARY INPUT FROM THE COMMUNITY MEMBERS, LEADERS AND THOUGHT LEADERS IN ADDITION TO SECONDARY DATA FROM THE URBAN INSTITUTE FOR POPULATION HEALTH AND COUNTY HEALTH RANKINGS AND ROADMAPS. HFM CONDUCTS REGULAR FACE TO FACE AND GROUP SESSIONS WITH AREA EMPLOYERS TO ASCERTAIN HEALTH NEEDS WITHIN INDUSTRY AND BUSINESS. HFM REGULARLY ANALYZES AND REVIEWS DIRECT CUSTOMER INPUT FROM INPATIENT, OUTPATIENT AND RETAIL SURVEYS TO DETERMINE UNMET NEEDS. HFM HOSTS A PATIENT AND FAMILY ADVISORY COUNCIL WHICH MEETS REGULARLY AND PROVIDES INPUT ON CURRENT SERVICES, IDEAS FOR NEW SERVICES, AND HAS OPEN DIALOGUE AND INPUT ON MEMBERS IDEAS FOR COMMUNITY HEALTH NEEDS.
PART VI, LINE 3:INFORMATION ON ELIGIBILITY FOR ASSISTANCE IS AVAILABLE FROM HFM'S WEBSITE, BROCHURES, ADMISSIONS STAFF, COLLECTION CORRESPONDENTS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, AND CT SCANS. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST COMMUNICATES TO SELF PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR, INCLUDING, BUT NOT LIMITED TO, MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM IN COMPLETING THE APPLICATION AND FOLLOW UP ON THE APPLICATION THROUGH APPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CONTACT FOR ASSISTANCE FOR APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR OR ELIGIBILITY SPECIALIST IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL ASSIST THOSE PATIENTS TO APPLY FOR THOSE PROGRAMS.
PART VI, LINE 4:HOLY FAMILY MEMORIAL SERVES MANITOWOC COUNTY, A COUNTY LOCATED IN NORTHEAST WISCONSIN ALONG BEAUTIFUL LAKE MICHIGAN, WITH A POPULATION OF APPROXIMATELY 80,000 AS OF 2017. OF THESE, ROUGHLY 34% ARE 25 OR UNDER, 47% ARE 26-60, AND 19% ARE OVER AGE 60. 49.7% OF THE POPULATION IS MALE WHILE 50.3% IS FEMALE. ROUGHLY 93% IDENTIFY AS WHITE, 3% HISPANIC, 2% ASIAN, 1% EACH OF OTHER RACE, AND TWO OR MORE RACES. ROUGHLY 51% HAVE HOUSEHOLD INCOME $50,000 OR BELOW PER YEAR, 20% HAVE FROM $50,000 TO $75,000; 14% HAVE FROM $75,000 TO $100,000, AND 15% HAVE OVER $100,000. APPROXIMATELY 70% DO NOT HAVE A COLLEGE DEGREE, 10% HAVE AN ASSOCIATES DEGREE, 14% HAVE A BACHELORS DEGREE, AND 6% HOLD A GRADUATE, PROFESSIONAL, OR DOCTORATE DEGREE. THE PREDOMINANT INDUSTRY IN MANITOWOC COUNTY IS MANUFACTURING, COMPRISING ROUGHLY 30% OF OCCUPATIONS FOR INDIVIDUALS OVER AGE 16. HEALTH CARE AND SALES/OFFICE ARE ALSO PROMINENT, MAKING UP ROUGHLY 14% AND 12%, RESPECTIVELY. SMALLER SECTORS MAKING UP APPROXIMATELY 4-6% EACH INCLUDE FOOD SERVICE, AGRICULTURE, CONSTRUCTION, EDUCATION, FINANCE, TRANSPORTATION, AND OTHER.
PART VI, LINE 5:HOLY FAMILY MEMORIAL PROMOTES THE HEALTH OF THE COMMUNITY BY ENGAGING COMMUNITY MEMBERS INTO THE INPUT AND DECISION MAKING PROCESS. HFM'S BOARD OF DIRECTORS IS COMPRISED OF 100% LOCAL PEOPLE WHO HAVE A VESTED INTEREST IN ASSURING THAT HFM DOES ITS PART IN CREATING A HEALTHIER COMMUNITY. OUR MEDICAL AND DENTAL STAFF IS OPEN TO ANY PROVIDER WHO MEETS ESTABLISHED CRITERIA AND COMMITS TO PROVIDE CARE FOR ALL WHO SEEK HELP. HFM HOSTS VARIOUS COMMUNITY GROUPS IN OUR FACILITIES AND PROVIDES THEM WITH MEETING SPACE AND RELATED MEETING SUPPLIES. HFM REGULARLY PARTICIPATES IN THE LOCAL FARMERS MARKET AND A HOST OF COMMUNITY SPONSORED HEALTH AND WELLNESS EVENTS, PROVIDING COMPLIMENTARY SCREENS, AND INFORMATION ON HOW TO ACHIEVE BETTER HEALTH.
PART VI, LINE 6:THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR APPROXIMATELY 250 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH, AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES -- WISCONSIN, NEBRASKA, AND OHIO -- AND HAS EXISTED FOR OVER 125 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR IN THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGH THE PROVISION OF QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF GOD IN OUR COMMUNITIES.
PART VI, LINE 7, REPORTS FILED WITH STATESWI,NE,OH

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
SCHOLARSHIPS10$13,000ACTUAL TUITION COSTSNOT APPLICABLE
SCHOLARSHIPS - EDUCATION9$21,650ACTUAL TUITION COSTSNOT APPLICABLE

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART III:FormAndLineReferenceDesc
ExplanationHOLY FAMILY MEMORIAL'S SCHOLARSHIP PROGRAM IS DESIGNED AS A RECRUITMENT TOOL FOR EMPLOYMENT OF CANDIDATES IN SPECIFIED POSITIONS CONSIDERED DIFFICULT TO FILL. THE SCHOLARSHIP PROGRAM ASSISTS STUDENTS IN THEIR PURSUIT OF A HEALTHCARE RELATED DEGREE. AREAS OF STUDY INCLUDE NURSING, PHARMACY, PHYSICAL THERAPY, AND OTHERS. IN RETURN FOR THE SCHOLARSHIP, AN EMPLOYMENT SERVICE COMMITMENT IS MADE. IN ORDER TO BE ELIGIBLE, STUDENTS MUST: 1)BE ACCEPTED INTO AN ACCREDITED PROGRAM; 2)BE ATTENDING SCHOOL AS A FULL OR PART TIME STUDENT AND REMAIN IN THAT STATUS; 3)HAVE AND MAINTAIN A 3.0 CUMULATIVE GRADE POINT AVERAGE (GPA). SCHOLARSHIPS ARE AWARDED ON THE BASIS OF GPA, VERIFIED WITH AN OFFICIAL TRANSCRIPT OF GRADES, COMPLETION OF AN EMPLOYMENT APPLICATION, AND PERSONAL INTERVIEW. THE SCHOLARSHIP IS USED FOR TUITION COST. THE SCHOLARSHIPS ARE DISBURSED EACH SEMESTER AND ARE PAID DIRECTLY TO THE SCHOOL THE STUDENT ATTENDS. APPLICANTS WHO ARE AWARDED THE SCHOLARSHIP MUST MAKE A SIX MONTH COMMITMENT TO WORK AT HOLY FAMILY MEMORIAL FOR EACH SEMESTER THE SCHOLARSHIP IS AWARDED. THE SCHOLARSHIP RECIPIENT MUST REPAY THE FULL AMOUNT OF THE SCHOLARSHIP IF HE/SHE: 1)DROPS OUT OF SCHOOL; 2)FAILS TO MAINTAIN AT LEAST A 3.0 CUMULATIVE GPA; 3)DOES NOT ACCEPT EMPLOYMENT AT HOLY FAMILY MEMORIAL; 4)DOES NOT COMPLETE THE FULL LENGTH OF EMPLOYMENT COMMITMENT; OR 5)DOES NOT OBTAIN WISCONSIN LICENSURE, AS REQUIRED.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DEREK R BOWN DC
DIRECTOR$113,033$0$10,940$0$9,251$0$0$0$26,912$0$160,136$0$0$0
MATTHEW L CAMPBELL MD
DIRECTOR$296,244$0$0$0$2,308$0$0$0$25,621$0$324,173$0$0$0
MARK P HERZOG
DIRECTOR, PRESIDENT, CEO$525,960$0$180,999$0$29,795$0$0$0$29,353$0$766,107$0$0$0
WILLIAM C LEACH JR DO
DIRECTOR$346,225$0$0$0$0$0$0$0$25,934$0$372,159$0$0$0
ANNETTE M KAMINSKY APNP
DIRECTOR$105,178$0$35,347$0$102$0$0$0$9,594$0$150,221$0$0$0
JANE CURRAN-MEULI
EXECUTIVE VP, COO$250,774$0$74,618$0$3,000$0$0$0$27,762$0$356,154$0$0$0
STEVEN D DRIGGERS MD
EXECUTIVE VP, CMO$78,025$0$40,425$0$17,865$0$0$0$0$0$136,315$0$0$0
LAURA FIELDING
VP ORG ENGAGEMENT, CAO$150,451$0$11,126$0$1,513$0$0$0$4,393$0$167,483$0$0$0
MARY MAURER
VP COMMUNITY ENGAGEMENT, CIO$155,377$0$66,986$0$4,582$0$0$0$2,926$0$229,871$0$0$0
BRETT NORELL
VP FINANCE, CFO$228,263$0$31,320$0$19,257$0$0$0$19,892$0$298,732$0$0$0
DEAN POLLNOW MD
EXECUTIVE VP, CMO$376,102$0$3,553$0$3,000$0$0$0$22,361$0$405,016$0$0$0
JEREMY R ANCLAM MD
PHYSICIAN PROVIDER$483,890$0$454,193$0$1,923$0$0$0$23,334$0$963,340$0$0$0
KIRK DIMITRIS MD
PHYSICIAN PROVIDER$691,503$0$608,423$0$26,923$0$0$0$28,407$0$1,355,256$0$0$0
RYAN M DOPIRAK MD
PHYSICIAN PROVIDER$740,997$0$299,582$0$15,817$0$0$0$28,488$0$1,084,884$0$0$0
DAVID MIKOLYZK MD
PHYSICIAN PROVIDER$690,496$0$67,988$0$13,461$0$0$0$28,422$0$800,367$0$0$0
THOMAS SYLVESTER MD
PHYSICIAN PROVIDER$658,965$0$55,731$0$13,462$0$0$0$8,900$0$737,058$0$0$0
XA XIONG MD
FORMER DIRECTOR$33,744$0$12,015$0$0$0$0$0$4,972$0$50,731$0$0$0
WILLIAM D HAMPTON DO
FORMER DIRECTOR$312,686$0$17,480$0$0$0$0$0$30,194$0$360,360$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATHE FILING ORGANIZATION PROVIDED CIVIC PAY FOR SIX OFFICERS (CEO, COO, CMO, CIO, CFO, AND CAO) TOTALING $12,500. THIS BENEFIT WAS TREATED AS TAXABLE INCOME.
PART I, LINE 6DURING THE CURRENT YEAR, A BONUS APPRECIATION PROGRAM WAS APPROVED BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD OF DIRECTORS. THE BONUS WAS PAID OUT TO EMPLOYEES, INCLUDING OFFICERS, FOR FINANCIAL ACCOMPLISHMENTS THAT WERE MET BY THE ORGANIZATION.
PART I, LINE 7A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION OF PERSONALLY RENDERED SERVICES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATION FACILITIES
A39133785597712D4N02017-08-11$32,431,768SEE SCHEDULE K, PART VI000
WISCONSIN HEALTH AND EDUCATION FACILITIES
B3913378552016-10-19$7,830,000SEE SCHEDULE K, PART VI000
WISCONSIN HEALTH AND EDUCATION FACILITIES
C3913378552014-12-19$10,000,000SEE SCHEDULE K, PART VI000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndRetiredRetiredAmt
A$32,431,768$438,557$5,051,7392017Yes (1)0Yes (1)Yes (1)
B$7,830,000$18,0002006Yes (1)0Yes (1)Yes (1)$953,000
C$10,000,000$39,050$9,960,950201700Yes (1)Yes (1)$1,250,000

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A000000Yes (1)
B000000Yes (1)
C000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A00Yes (1)00000Yes (1)
B00Yes (1)0Yes (1)000Yes (1)
C00Yes (1)0Yes (1)000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)
CYes (1)

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, ROW B, COLUMN F:THE PURPOSE OF THE 2014 BOND ISSUE WAS TO REFUND SERIES 2003B, ISSUED ON 09/09/2003.
PART I, ROW A, COLUMN F:THE PURPOSE OF THE 2017 BOND ISSUE WAS TO REFUND SERIES 2007 AND TO PROVIDE NEW MONEY FOR CONSTRUCTION OF A CLINIC.
PART I, ROW C, COLUMN F:THE PURPOSE OF THE 2016 BOND ISSUE WAS TO 1) REPLACE THE ELECTRONIC HEALTH RECORD SYSTEM, INCLUDING THE ACQUISITION OF HARDWARE AND SOFTWARE; AND 2)FINANCE ELIGIBLE FINANCING-RELATED EXPENSES.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (5 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
HOLY FAMILY HEALTH SERVICES
HFM DIRECTORS SERVE BOTH ORGANIZATIONS$77,248INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED0
LINDSAY FROELICH
DAUGHTER OF FORMER DIRECTOR, DONALD BRISCH$42,643EMPLOYMENT BY ORGANIZATION0
KATHARINE CASEY
DAUGHTER OF FORMER DIRECTOR, WILLIAM CASEY$39,523EMPLOYMENT BY ORGANIZATION0
SUSAN BOWN
SPOUSE OF DIRECTOR, DEREK BOWN$57,423EMPLOYMENT BY ORGANIZATION0
LISA SCHUELER
SISTER OF OFFICER, LAURA FIELDING$34,708EMPLOYMENT BY ORGANIZATION0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM.
FORM 990, PART VI, SECTION A, LINE 7AHOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF HFM. FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PROVIDERS.
FORM 990, PART VI, SECTION A, LINE 7BSOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE BUDGET, MORTGAGE, PHILOSOPHY, MISSION AND VISION, LEASE OR SALE OF REAL ESTATE MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDIT MUST BE APPROVED BY THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11BTHE CHAIR OF THE GOVERNING BOARD REVIEWS FORM 990 PRIOR TO ITS FILING. AN OVERVIEW OF FORM 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, AND CONFLICT OF INTEREST IS PRESENTED TO THE BOARD OR BOARD COMMITTEE. THE COMPENSATION AND EVALUATION SUB-COMMITTEE REVIEWS FORM 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES OF FORM 990 ARE AVAILABLE TO ALL BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, GOVERNING BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND SIGN THE CERTIFICATION ON WHICH THEY DISCLOSE ANY CONFLICTS. AT EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION AND VOTING. ALL PHYSICIANS, LEADERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. CONFLICT OF INTEREST IS MONITORED THROUGH HFM'S COMPLIANCE DEPARTMENT.
FORM 990, PART VI, SECTION B, LINE 15LINES 15 A & B - HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES IS GOVERNED BY THE COMPENSATION AND EVALUATION SUB-COMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, AND CHIEF INNOVATION OFFICER. SENIOR LEADER SALARY DATA IS EVALUATED ANNUALLY BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM. TOTAL COMPENSATION FOR SENIOR LEADERS (SALARY, BENEFITS, AND INCENTIVE) IS EVALUATED EVERY THREE YEARS BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM (LAST DONE IN OCTOBER 2017). ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS AND MARKET COMPETITIVENESS. THE POLICY REFLECTS HFM'S MISSION AND VALUES AND THE LOCAL COMMUNITY EXPERIENCE BY EMPHASIZING REWARDS BASED ON WELL-ROUNDED ACCOMPLISHMENTS IN THE AREAS OF MISSION AND RELATIONSHIPS, KEY STRATEGIES, AND OPERATIONS, INCLUDING FINANCE.
FORM 990, PART VI, SECTION C, LINE 19HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION IS PUBLICLY AVAILABLE FROM THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE. IN ADDITION, HFM SUBMITS ITS FINANCIAL INFORMATION TO THE STATE OF WISCONSIN ANNUALLY. FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE OBTAINED FROM THE GUIDESTAR WEBSITE.
FORM 990, PART VII, SECTION A, PART 1A LINES 1 THROUGH 5:HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS INCLUDES FIVE EMPLOYED PROVIDERS. THE COMPENSATION REPORTED FOR THESE DIRECTORS IS FOR THEIR SERVICES AS A PROVIDER.
FORM 990, PART XI, LINE 9:RESTRICTED CONTRIBUTIONS NET OF ASSETS RELEASED 349,115. GAIN ON EXTINGUISHMENT OF DEBT 78,547.
FORM 990, PART XII, LINE 2C:THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE FISCAL YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
FRANCISCAN SISTERS OF CHRISTIAN CHARITY
1415 SOUTH RAPIDS ROADMANITOWOCWI54220391530622HOLDING CO.WI501(C)(3)LINE 1N/A0
ST PAUL ELDER SERVICES INC
316 EAST 14TH STREETKAUKAUNAWI54130391029149ELDER CAREWI501(C)(3)LINE 1N/A0
GOOD SAMARITAN MEDICAL CENTER
800 FOREST AVENUEZANESVILLEOH43701314379479HEALTHCAREOH501(C)(3)LINE 3N/A0
FRANCISCAN CARE SERVICES INC
430 N MONITOR STWEST POINTNE68788470486026HEALTHCARENE501(C)(3)LINE 3N/A0
SILVER LAKE COLLEGE OF THE HOLY FAMILY INC
2406 SOUTH ALVERNO ROADMANITOWOCWI54220390980974HIGHER EDUCATIONWI501(C)(3)LINE 2N/A0
FSCC HOLY FAMILY CONVENT
2409 SOUTH ALVERNO ROADMANITOWOCWI54220390808523RELIGIOUSWI501(C)(3)LINE 1N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
EIN391572253EIN
Primary ActivitiesPHARMACYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HFM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income$63,793ShareOfTotalIncomeAmt
Share Of EOY Assets$1,461,655ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other OrgYes (1)AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (8 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT
J$56,100ACTUAL REVENUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES
P$118,300ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES
P$859,152ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC
P$1,128,000ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS
P$10,471,897ACTUAL EXPENSE
HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSSUPPLIES
Q$1,174,558ACTUAL REVENUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - PURCHASE OF ASSETS
H$231,516APPRAISED VALUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - EXPENSE REIMBURSEMENT
P$298,500ACTUAL EXPENSE