COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC (EIN 39-0807063)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-13
- IRS object ID
- 201701339349300725
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-13T10:03:50-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390807063 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Columbia St Mary's Hospital Ozaukee Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COLU | BusinessNameControlTxt |
| Phone | 4143262230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N Port Washington Road 301 | AddressLine1Txt |
| City | Glendale | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53212 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Timothy Waldoch | PersonNm |
| Person Title | Interim CFO | PersonTitleTxt |
| Signature | 2017-05-13 | SignatureDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Travis Andersen | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N Port Washington Road | AddressLine1Txt |
| City | Glendale | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53212 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $171,980,480 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 0928 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | Columbia-stmarys.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Full-service hospital providing medical, surgical, advanced clinical, and other community services | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 1114 | TotalEmployeeCnt |
| Total Volunteers | 219 | TotalVolunteersCnt |
| Total Gross UBI | $479,302 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$90,575 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $76,220 | PYContributionsGrantsAmt |
| CY Contributions Grants | $59,416 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $167,658,641 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $169,693,333 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,900 | PYInvestmentIncomeAmt |
| CY Investment Income | $998 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,722,954 | PYOtherRevenueAmt |
| CY Other Revenue | $2,226,733 | CYOtherRevenueAmt |
| PY Total Revenue | $169,468,715 | PYTotalRevenueAmt |
| CY Total Revenue | $171,980,480 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $114,311 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $175,747 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $71,174,896 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $64,674,938 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $84,063,756 | PYOtherExpensesAmt |
| CY Other Expenses | $87,848,810 | CYOtherExpensesAmt |
| PY Total Expenses | $155,352,963 | PYTotalExpensesAmt |
| CY Total Expenses | $152,699,495 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $14,115,752 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $19,280,985 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $125,385,143 | TotalAssetsBOYAmt |
| Total Assets EOY | $284,975,902 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $58,344,293 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $198,654,067 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $67,040,850 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $86,321,835 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Columbia St. Mary's Hospital Ozaukee, Inc. ("CSMO") is part of Columbia St. Mary's Inc ("CSM"), a healthcare provided founded in response to identified community needs, which is sponsored by Ascension Health, a Catholic National Health System, and Columbia Health System, a non-sectarian community health system. CSMO'S governing body has adopted the mission of CSM. CSM exists to make a positive difference in the health status and lives of individuals and our community, with special concern for those who are vulnerable. CSM and its affiliates are committed to providing high-quality, accessible, values-driven programs and services with equal attention to the physical, spiritual, and emotional dimensions of health. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $144,338,966 | ExpenseAmt |
| Grant | $175,747 | GrantAmt |
| Revenue | $170,799,324 | RevenueAmt |
| Desc | CSMO OPERATES A FULL-SERVICE 152-BED HOSPITAL, WHICH OFFERS A COMPLETE RANGE OF MEDICAL, SURGICAL, AND ADVANCED CLINICAL SPECIALTIES. CSMO OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. DURING FISCAL 2016, CSMO PROVIDED CARE TO 30,041 PATIENTS. CSMO'S ESTIMATED UNREIMBURSED COSTS OF SERVICES TO THE ELDERLY, UNINSURED, AND UNDERINSURED TOTALED $8,515,191. CSMO ALSO SPONSORS A NUMBER OF PROGRAMS DESIGNED TO IMPROVE THE HEALTH CARE IN ITS COMMUNITY. REFER TO THE COMMUNITY BENEFIT INFORMATION IN SCHEDULE H FOR DISCUSSION OF HOW CSMO MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE. | Desc |
| Total Program Service Expenses | $144,338,966 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 118 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1114 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Timothy Waldoch | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4143262230 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4425 N Port Washington Road | AddressLine1Txt |
| City | Glendale | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53212 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (29 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| TRAVIS D ANDERSEN | ||||||||||
| PRESIDENT/CEO | 15.0 | 31.0 | Yes (X) | Yes (X) | $0 | $1,068,528 | $61,462 | |||
| TINA CHANG | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| PATRICIA J DOLHUN MD | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| KEVIN GONIU MD | ||||||||||
| BOARD MEMBER /CSM PHYSICIAN | 40.0 | 5.6 | Yes (X) | $540,814 | $0 | $189,305 | ||||
| MICHAEL GREBE | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| GEORGE H HOFF | ||||||||||
| CHAIR | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT LYON MD | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| R BRUCE MCDONALD | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| CHRISTINE NUERNBERG | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| RANDALL PERRY | ||||||||||
| SECRETARY/TREASURER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| STEPHEN ROBBINS MD | ||||||||||
| BOARD MEMBER | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT J VENABLE | ||||||||||
| VICE CHAIR | 0.2 | 0.8 | Yes (X) | $0 | $0 | $0 | ||||
| TIMOTHY WALDOCH | ||||||||||
| INTERIM CFO | 15.0 | 31.0 | Yes (X) | $0 | $273,038 | $65,995 | ||||
| CLARISSA COX | ||||||||||
| VP QUALITY & CLINICAL INTEGRATION | 15.0 | 30.0 | $0 | $237,460 | $25,297 | Yes (X) | ||||
| WILLIAM HART | ||||||||||
| VP/COO | 20.0 | 30.0 | $0 | $356,332 | $38,138 | Yes (X) | ||||
| KEVIN KLUESNER | ||||||||||
| VP CLINICAL SERVICES | 20.0 | 30.0 | $0 | $269,517 | $65,711 | Yes (X) | ||||
| GERRI LIETZ-STAFFILENO | ||||||||||
| VP/CNO | 20.0 | 30.3 | $0 | $299,518 | $77,515 | Yes (X) | ||||
| BRUCE MCCARTHY | ||||||||||
| PRESIDENT PHYSICIAN DIVISION | 20.0 | 30.0 | $0 | $761,964 | $116,261 | Yes (X) | ||||
| MICHAEL SANDERL | ||||||||||
| VP MISSION INTEGRATION & ADVOC | 15.0 | 30.0 | $0 | $252,916 | $66,494 | Yes (X) | ||||
| SUZANNE SANICOLA | ||||||||||
| VP PHYSICIAN SVCS | 15.0 | 25.0 | $0 | $247,248 | $76,596 | Yes (X) | ||||
| JO ANN HANKWITZ | ||||||||||
| INTERIM CHRO | 15.0 | 30.0 | $0 | $148,146 | $48,658 | Yes (X) | ||||
| RICHARD SHIMP MD | ||||||||||
| CHIEF MEDICAL OFFICER | 15.0 | 25.0 | $0 | $422,475 | $59,695 | Yes (X) | ||||
| ROBERT M HORTH MD | ||||||||||
| CSM PHYSICIAN | 40.0 | 0 | $605,944 | $0 | $75,135 | Yes (X) | ||||
| DIRK STEINERT MD | ||||||||||
| CSM PHYSICIAN | 40.0 | 0 | $489,261 | $0 | $43,700 | Yes (X) | ||||
| FREDERICK G WESTREICH MD | ||||||||||
| CSM PHYSICIAN | 40.0 | 0 | $451,462 | $0 | $65,150 | Yes (X) | ||||
| JOHN YOUSIF MD | ||||||||||
| CSM PHYSICIAN | 40.0 | 0 | $503,612 | $0 | $24,018 | Yes (X) | ||||
| JANET GOLDMAN MD | ||||||||||
| CSM PHYSICIAN | 40.0 | 0 | $420,457 | $0 | $75,991 | Yes (X) | ||||
| ALLAN SPOONER | ||||||||||
| PRESIDENT HOSPITAL DIVISION (END 08/31/15) | 15.0 | 25.0 | $0 | $741,627 | $49,902 | Yes (X) | ||||
| MARK TAYLOR | ||||||||||
| FORMER PRESIDENT / CEO (END 6/30/14) | 0.0 | 0.0 | $0 | $31,490 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,011,550 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,110,257 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,225,022 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 63 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MORRISON MANAGEMENT SPECIALISTS | |||||
| 5801 Peachtree Dunwoody Road | Atlanta | GA | 30342 | Food Services and Environmental Services | $3,883,319 |
| METROPOLITAN ANESTHESIOLOGISTS | |||||
| 2025 E Newport Ave | Milwaukee | WI | 53211 | Physician Contracted Services | $2,421,166 |
| GENERAL ELECTRIC COMPANY | |||||
| PO Box 96483 | Chicago | IL | 60693 | Construction | $1,383,421 |
| M A MORTENSEN COMPANY | |||||
| 17975 W Sarah Lance | Brookfield | WI | 53045 | Construction | $1,022,399 |
| GRUNAU COMPANY INC | |||||
| 1100 W Anderson Road | Oak Creek | WI | 53154 | Construction | $401,127 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Related Organizations | $59,416 | RelatedOrganizationsAmt |
| Total Contributions | $59,416 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net Patient Services | 621990 | $168,087,628 | $168,087,628 | |
| Retail Pharmacy Revenue | 446110 | $1,597,673 | $1,118,371 | $479,302 |
| Community Education | 900099 | $8,032 | $8,032 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $169,693,333 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $998 | TotalRevenueColumnAmt |
| Exclusion | $998 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $641,440 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $641,440 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $641,440 | TotalRevenueColumnAmt |
| Exclusion | $641,440 | ExclusionAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Contract Services | 900099 | $554,479 | $554,479 |
| Food & Nutrition | 722210 | $421,508 | $421,508 |
| Service Fees Revenue | 900099 | $600,661 | $600,661 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,645 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,645 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,585,293 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $171,980,480 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $170,799,324 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $479,302 | UnrelatedBusinessRevenueAmt |
| Exclusion | $642,438 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175,747 | TotalAmt |
| Program Services | $175,747 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,602,753 | TotalAmt |
| Program Services | $2,602,753 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,485,851 | TotalAmt |
| Program Services | $51,143,261 | ProgramServicesAmt |
| Management And General | $342,590 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,067,898 | TotalAmt |
| Program Services | $7,067,898 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,518,436 | TotalAmt |
| Program Services | $3,499,421 | ProgramServicesAmt |
| Management And General | $19,015 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,496 | TotalAmt |
| Program Services | $119,496 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,740 | TotalAmt |
| Program Services | $1,740 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,593,307 | TotalAmt |
| Program Services | $10,879,759 | ProgramServicesAmt |
| Management And General | $7,713,548 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,426 | TotalAmt |
| Program Services | $1,426 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,865 | TotalAmt |
| Program Services | $203,087 | ProgramServicesAmt |
| Management And General | $12,778 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,484 | TotalAmt |
| Program Services | $652 | ProgramServicesAmt |
| Management And General | $76,832 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,777,346 | TotalAmt |
| Program Services | $4,777,346 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,022 | TotalAmt |
| Program Services | $85,022 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,262 | TotalAmt |
| Program Services | $99,016 | ProgramServicesAmt |
| Management And General | $4,246 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,287,906 | TotalAmt |
| Program Services | $8,131,492 | ProgramServicesAmt |
| Management And General | $156,414 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $585,566 | TotalAmt |
| Program Services | $585,566 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Service Fee Expense | $27,609,735 | $27,609,735 | |
| Patient Care Supplies | $19,638,080 | $19,637,367 | $713 |
| Repairs and Maintenance | $765,387 | $765,371 | $16 |
| Hospital Assessment Tax | $4,487,295 | $4,487,295 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,499,893 | TotalAmt |
| Program Services | $2,465,516 | ProgramServicesAmt |
| Management And General | $34,377 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,699,495 | TotalAmt |
| Program Services | $144,338,966 | ProgramServicesAmt |
| Management And General | $8,360,529 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $254,496 | BOYAmt |
| EOY | $110,365 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,376,431 | BOYAmt |
| EOY | $25,294,364 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,846,733 | BOYAmt |
| EOY | $3,539,633 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $708,352 | BOYAmt |
| EOY | $995,169 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $203,693,613 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $108,456,187 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,924,250 | BOYAmt |
| EOY | $95,237,426 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $274,881 | BOYAmt |
| EOY | $208,975 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $159,589,970 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,385,143 | BOYAmt |
| EOY | $284,975,902 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,040,075 | BOYAmt |
| EOY | $7,127,144 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,304,218 | BOYAmt |
| EOY | $191,526,923 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,344,293 | BOYAmt |
| EOY | $198,654,067 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,040,850 | BOYAmt |
| EOY | $86,321,835 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,040,850 | BOYAmt |
| EOY | $86,321,835 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,385,143 | BOYAmt |
| EOY | $284,975,902 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $19,280,985 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $29,290 | OtherCostOrOtherBasisAmt |
| Book Value | $29,290 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $114,812,711 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,544,860 | DepreciationAmt |
| Book Value | $72,267,851 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,600,051 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,017,933 | DepreciationAmt |
| Book Value | $582,118 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,588,501 | OtherCostOrOtherBasisAmt |
| Depreciation | $64,243,272 | DepreciationAmt |
| Book Value | $19,345,229 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,663,060 | OtherCostOrOtherBasisAmt |
| Depreciation | $650,122 | DepreciationAmt |
| Book Value | $3,012,938 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $95,237,426 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Intercompany Receivables | Desc |
| Book Value | $159,589,970 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $159,589,970 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Intercompany A/P | $143,270,479 |
| Misc Current Liabilities | $1,277,255 |
| Intercompany Debt to Ascension Health Alliance | $46,600,638 |
| Misc NonCurrent Liabilities | $378,551 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $191,526,923 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote | FormAndLineReferenceDesc |
| Explanation | From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Columbia St. Mary's Hospital Ozaukee, Inc.: The System accounts for uncertainty in income tax provisions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2016. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $591,523 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $591,523 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0039 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,922,311 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,503,695 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,418,616 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0420 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $15,513,834 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,503,695 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,010,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0459 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $223,504 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,284 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $216,220 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0014 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $439,750 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $439,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0029 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $664,254 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,284 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $656,970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0043 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $16,178,088 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,510,979 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,667,109 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0502 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $6,141,405 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $122,828 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $260,706,828 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $298,996,573 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$38,289,745 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Columbia St Mary's Hospital Ozaukee | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13111 N Port Washington Road | AddressLine1Txt |
| City | Mequon | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53097 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.columbia-stmarys.org | WebsiteAddressTxt |
| State License | 246 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Columbia St Mary's Hospital Ozaukee | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100365 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100365 | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.0 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC102812 | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - Columbia St. Mary's Hospital Ozaukee, Inc.. The Community Health Improvement Committee reviewed the CHNA to determine those needs most appropriate to be addressed by CSM Ozaukee by considering attributes of the Community Service Philosophy and history of programs serving the community. Community Services Department staff prepared a set of plans and metrics to assist in tracking progress of community health improvement work. The Community Health Improvement Committee made edits to the draft and approved a Community Health Improvement Plan (CHIP) for submission to the CSM Board. A combined report was developed to show the connection between the community needs and community health improvement plan and metrics. The Community Health Improvement Strategy, containing the CHNA and CHIP, was approved by the CSM Board on April 16, 2016. |
| Schedule H, Part V, Section B, Line 5 Facility , 2 | Facility , 2 - Columbia St. Mary's Hospital Ozaukee, 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. - Aurora Health Grafton - Cedarburg Chamber of Commerce - Feith Family Ozaukee YMCA T,TT,TTT - Mequon Thiensville School District - Newcastle Place Retirement Community - Ozaukee Economic Development Corp (OED) - Ozaukee Family Services T - Ozaukee County Human Services - Ozaukee County Public Health Department - Port Washington-Saukville School District T - Starting Point Ozaukee - United Way Ozaukee County - Village of Grafton |
| Schedule H, Part V, Section B, Line 6a Facility , 1 | Facility , 1 - Columbia St. Mary's Hospital Ozaukee, Inc.. Aurora Health Care |
| Schedule H, Part V, Section B, Line 6b Facility , 1 | Facility , 1 - Columbia St. Mary's Hospital Ozaukee, Inc.. Ozaukee County Public Health Department |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - Columbia St. Mary's Hospital Ozaukee, Inc.. How CSMO is addressing the needs: Using the CHNA completed in June 2013, the hospital developed, adopted, and worked on executing a three-year Implementation Strategy to address priority community health needs. In Fiscal Year 2016, the hospital implemented the following plan to address the priority needs: THE CHNA CSM OZAUKEE EXECUTIVE SUMMARY IDENTIFIED FOUR KEY ISSUES: CANCER SCREENING, CHRONIC ILLNESS, ADULT MENTAL HEALTH AND SUBSTANCE ABUSE. CSMO DEVELOPED A SPECIFIC RESPONSE TO EACH OF THESE AREAS AS DEVELOPED IN ITS OZAUKEE COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN. ADDITIONALLY, THE OZAUKEE COUNTY PUBLIC HEALTH DEPARTMENT HAD DEVELOPED AN INITIATIVE ENTITLED INVEST TO FOSTER PARTNERSHIP IN THE COUNTY REGARDING HEALTH IMPROVEMENT EFFORTS. INVEST HAS THREE WORKGROUPS WITH WHICH CSM PARTICIPATES: SUBSTANCE ABUSE IMPROVEMENT, MENTAL HEALTH IMPROVEMENT AND OBESITY IMPROVEMENT. CSM OZAUKEE ADDRESSED COMMUNITY NEEDS THROUGH CHARITY CARE, UNPAID COSTS OF PUBLIC PROGRAMS, AND SPONSORSHIP OF COMMUNITY PROGRAMS AND SERVICES. OZAUKEE PROVIDED CHARITY CARE AND SUPPORT OF PUBLIC PROGRAMS SUCH AS MEDICAL ASSISTANCE AND BADGERCARE AT SIGNIFICANT LEVELS AS SHOWN IN SCHEDULE H CATEGORIES. ADDITIONALLY, A COMMUNITY BENEFIT PLAN ADDRESSED COMMUNITY HEALTH NEEDS. HIGHLIGHTS INCLUDED SUPPORT OF THE HUIRAS FAMILY COMMUNITY HEALTH CLINIC THROUGH ADOPTION OF A CHRONIC DISEASE MANAGEMENT MODEL OF CARE, DEVELOPMENT OF CANCER SCREENING ACTIVITY AND PARTICIPATION IN INVEST PROGRAM SUPPORT. |
| Schedule H, Part V, Section B, Line 11 Facility , 2 | Facility , 2 - Columbia St. Mary's Hospital Ozaukee, Inc.. How CSMO will address the needs as identified in the most recent CHNA: Using the CHNA completed in June 2016, the hospital developed and adopted FY17-FY19 Implementation Strategy. The following summarizes the strategies the hospital will implement during that time period to address the priority needs. AODA - Increase availability of suboxone clinics - Participate in INVEST Alcohol team to modify Ozaukee alcohol culture Youth Substance Abuse - Collaborate with physician clinics for better assessment of teens within the clinical setting - Establish a partnership with school districts to screen and refer at-risk youth for ongoing education. Mental Health Access - Expand mental health availability through hiring of staff into existing CSM programming - Support INVEST Coalition Access to Primary & Oral Health Care - Increase the number of children receiving dental sealants through Smart Smiles - Evaluate and improve services at Huiras Clinic. - Participate in community efforts to document transportation needs and develop a response. Breast Cancer - Become a Wisconsin Well Women provider - Expand outreach through CSM mammography outreach strategy Obesity & Nutrition - Support INVEST - Link local farmers to institutional cooks and kitchens |
| Schedule H, Part V, Section B, Line 11 Facility , 3 | Facility , 3 - Columbia St. Mary's Hospital Ozaukee, Inc.. Needs not being addressed and why: TOBACCO USE INVEST continues to have a committee devoted to minimizing tobacco use in Ozaukee County. Currently the focus of the committee is educating multi-unit property owners on the benefits of smoke free policies and on creating an awareness of the health impact of other tobacco products. The manager of respiratory services represents CSM on the committee and will keep the Community Benefit Committee apprised if a program or project is developed that would call for CSM involvement. VIOLENCE & BULLYING CSM has not had particular connections to schools and educational systems from which to work in this regard. CSM will focus community health efforts in other areas. Common Ground Ozaukee is the lead organization in this work |
| Schedule H, Part V, Section B, Line 22 Facility , 1 | Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL OZAUKEE. ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE RECEIVE A MINIMUM DISOCUNT OF 44% OFF GROSS CHARGES FOR SERVICES PROVIDED TO THEM. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 21 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (23 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|
| Marsho Family Medical Group - Sheboygan | |||||
| 1703 N Taylor Drive | Sheboygan | WI | 53081 | Clinic | |
| Marsho Family Medical Group - Plymouth | |||||
| 515 E Mill St | Plymouth | WI | 53073 | Clinic | |
| Cedar Mills Medical Group | |||||
| N143 W6515 Pioneer Road | Cedarburg | WI | 53012 | Clinic | |
| Family Practice Associates of Cedarburg | |||||
| W62 N179 Washington Ave | Cedarburg | WI | 53012 | Clinic | |
| Germantown Clinic | |||||
| N112 W15415 Mequon Road | Germantown | WI | 53022 | Clinic | |
| Grafton Medical Center | |||||
| 2061 Cheyenne CT | Grafton | WI | 53024 | Clinic | |
| CSM Cardiovascular Specialists - Electrophysiology - Mequon | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | |
| CSM Hospital Ozaukee Neurology | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite G06 |
| Van Dyke Cancer Center - Ozaukee | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | |
| ENT Associates - Ozaukee | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite 226 |
| Highland Family Health Center | |||||
| 12800 N Port Washington Road | Mequon | WI | 53097 | Clinic | |
| Meadowview Obstetrics & Gynecology | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite 118 |
| CSM Cardiovascular Specialists - Mequon | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite 116 |
| CSM Cardiovascular Specialists - Electrophysiology - Oshkosh | |||||
| 2700 W 9th Ave | Oshkosh | WI | 54904 | Clinic | |
| CSM Cardiovascular Specialists - Electrophysiology - Appleton | |||||
| 1506 S Oneida St | Appleton | WI | 54915 | Clinic | |
| Genesis Chiropractic Clinic | |||||
| 830 E Green Bany Ave | Saukville | WI | 53080 | Clinic | Suite 106 |
| Greenlane Family Practice | |||||
| 830 E Green Bay Ave | Saukville | WI | 53080 | Clinic | |
| CSM Cardiovascular Specialists - Electrophysiology - Sheboygan | |||||
| 1414 N Taylor Dr | Sheboygan | WI | 53081 | Clinic | |
| Coulis Cardiology | |||||
| 1414 N Taylor Dr | Sheboygan | WI | 53081 | Clinic | |
| CSM Hospital Ozaukee Suite 206 | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite 206 |
| Sheboygan Outpatient Center | |||||
| 1414 N Taylor Dr | Sheboygan | WI | 53081 | Clinic | |
| Cosmetic Surgery and Skin Care Center | |||||
| 10554 N Port Washington Rd | Mequon | WI | 53092 | Clinic | |
| CSM Reflux Center - Ozaukee | |||||
| 13133 N Port Washington Road | Mequon | WI | 53097 | Clinic | Suite 110 |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 6a Community benefit report prepared by related organization | CSM Hospital Ozaukee prepares and files an annual Community Benefit Plan report with the Wisconsin Hospital Association ("WHA"). The information on this report includes information only for CSM Hospital Ozaukee and not any of its affiliated hospitals. |
| Schedule H, Part I, Line 7g Subsidized Health Services | THE ORGANIZATION EMPLOYS ITS PHYSICIANS AT ITS HOSPITALS AND PHYSICIAN CLINICS, SO THE ASSOCIATED COSTS AND CHARGES RELATING TO THOSE PHYSICIAN SERVICES ARE INCLUDED IN ALL RELEVANT CATEGORIES IN PART I. |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND 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 CERTAIN CATEGORIES IN THE TABLE, THIS WAS A COST ACCOUNTING SYSTEM; IN OTHER CATEGORIES, A SPECIFIC COST-TO-CHARGE RATIO WAS APPLIED.AMOUNT AS REPORTED IN THE ANNUAL COMMUNITY BENEFIT REPORT. |
| Schedule H, Part II Community Building Activities | REGARDING COMMUNITY BUILDING ACTIVITY, SUPPORT OF NON-PROFIT HEALTH AND CULTURAL PROGRAMS IS SIGNIFICANT TO CSM HOSPITAL OZAUKEE. AS A SIGNIFICANT EMPLOYER AND A SIGNIFICANT ECONOMIC RESOURCE IN THE COUNTY, THE OZAUKEE CAMPUS SUPPORTS NON-PROFIT PROGRAMS IN THEIR PROVISION OF IMPORTANT COMMUNITY SERVICES AND CULTURAL ACTIVITIES. DURING FISCAL YEAR 2016, CSM HOSPITAL OZAUKEE CONTINUED TO SUPPORT THE SCHOOL TO WORK PROGRAM, A YOUTH PROGRAM WHICH PROVIDES WORKFORCE DEVELOPMENT IN COLLABORATION WITH LOCAL HIGH SCHOOLS. STUDENTS SPEND TIME WORKING WITH PROFESSIONALS TO UNDERSTAND THE VALUES AND ROLES OF DIFFERENT PROFESSIONS. THIS PROGRAM IS SUPPORTED BY THE VOLUNTEER DEPARTMENT OF CSM OZAUKEE AND PROFESSIONALS WITHIN THE INTERNSHIP SETTINGS. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Bad debt is calculated from the audited financial statements using an average cost to charge ratio. The same ratio is used to calculate all of the expense at cost within Schedule H. Total bad debt expense from the income statement to which the cost to charge ration is applied is $6,141,405. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | CSMO has a very robust financial assistance program; however, when comparing CSMO's percentage of charity care to its total expenses against the poverty levels in the greater Milwaukee community that CSMO serves, CSMO estimates that approximately 2% of its total bad debt expense relates to patients who might otherwise qualify for financial assistance under its policies but choose not to apply. This amount is not included in the community benefit reported on Part I. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The organization is a part of the Columbia St. Mary's Inc. consolidated audit and further included as part of the Ascension Health consolidated audited financials. The footnote that references bad debt expense in the 2016 consolidated audit is as follows: "The provision for bad debts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of allowance for uncollectible 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 bad debts to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the organization follows established guidelines for placing certain past due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the organization. Accounts receivable are written off after collection efforts have been followed in accordance with the Organization's policies." |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. |
| Schedule H, Part V, Section B, Line 16a FAP website | - Columbia St. Mary's Hospital Ozaukee: Line 16a URL: http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC102812; |
| Schedule H, Part VI, Line 2 Needs assessment | The Columbia St. Mary's Hospital Ozaukee Community Benefit Process is coordinated through the work of the Ozaukee Community Benefit Committee (OCBC). The OCBC is guided by the mission statement of CSM and a Community Benefit Philosophy statement. The committee is comprised of administrative leadership, managers, and staff involved in direct service to vulnerable people. The OCBC roles include the following: - Develop Community Health Needs Assessment (CHNA) to determine Ozaukee County needs - Review CHNA and create Community Benefit Plan to address needs - Incorporate Community Benefit Plan goals in the CSM Integrated Strategic, Operational and Financial Plan (ISOFP) for Board level approval and submission to Ascension Health System - Develop a strategy to measure and increase the impact of Community Benefit Plan elements The Needs Assessment in FY13 involved the gathering of secondary information about Ozaukee County from varied public sources including state data and Ozaukee County data. CSM Hospital Ozaukee serves a primary service area of Ozaukee County. Although the County is one of the healthiest in the state according to University of Wisconsin Population Health records, it does have important needs in terms of access to primary care, breast cancer screening and behavioral health issues. Additionally, the Ozaukee County Public Health Department had developed an initiative entitled INVEST to foster partnership in the county regarding health improvement efforts. INVEST has three workgroups with which CSM participates: Substance Abuse Improvement, Mental Health Improvement and Obesity Improvement. CSM Ozaukee addressed community needs through charity care, unpaid costs of public programs, and sponsorship of community programs and services. Ozaukee provided charity care and support of public programs such as Medical Assistance and BadgerCare at significant levels as shown in Schedule H categories. Additionally, a Community Benefit Plan addressed community health needs. Highlights included support of the Huiras Family Community Health Clinic through adoption of a chronic disease management model of care, development of cancer screening activity and participation in INVEST program support. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | CSM Hospital Ozaukee attempts to identify patients who may be eligible for charity or discounted care as outlined in the charity care policy during the pre-registration, registration, admissions and discharge processes. A copy of the charity care policy is posted in the emergency room, and a summary of the policy is provided to patients with admission and discharge paperwork. CSM Hospital Ozaukee has trained financial counselors available to discuss payment options to the patients. Upon making an appointment, the financial counselors will meet with the patient to determine what other financial assistance programs for which the patient may qualify. |
| Schedule H, Part VI, Line 4 Community information | CSM Hospital Ozaukee primarily serves the healthcare needs of those living in the Ozaukee County, as well as those living in the Sheboygan and Washington communities. The population of Ozaukee County is approximately 330,000, with median income in each county ranging from $53,000 to $76,000, and poverty levels ranging between 4.7% and 8.2%. In fiscal 2016, CSM Hospital Ozaukee served 30,041 patients and provided $591,523 in traditional charity care (at cost), $6,418,616 in unpaid costs of public programs, $845,979 in uninsured discounts and $659,073 in other community programs and services, which are reported on Part I, Line 7j and Part II. Discounts for the uninsured and underinsured are not included in Parts I or II of Schedule H. |
| Schedule H, Part VI, Line 5 Promotion of community health | The Huiras Family Community Health Clinic is a free clinic approach to improving access to care. Volunteer physicians work with paid nursing and nurse practitioner staff to provide episodic care to uninsured people in poverty. The Clinic served patients through more than 600 clinical encounters in FY16. The model of allowing chronic disease patients to schedule appointments and receive ongoing support as in the Milwaukee chronic disease model was initiated this year and will improve consistent care for the patients. CSM Ozaukee leaders participated in INVEST programming, taking leadership positions in the Mental Health and Obesity committee work. The Ozaukee County Public Health Office participates on the Ozaukee Community Benefit Committee, further fostering collaboration in INVEST goals. The Community Benefit Plan also focused on cancer screening and fostered specific work in mammography screening in collaboration with community non-profit organizations. |
| Schedule H, Part VI, Line 6 Affiliated health care system | CSM Hospital Ozaukee is part of the CSM Health System, which contributes to the positive health status of the communities it serves. CSM is an organization comprised of three hospitals, 61 community clinics, The Columbia College of Nursing, a partnership with the Orthopaedic Hospital of Wisconsin, a partnership with the Sleep Wellness Institute, a partnership with Horizon Home Care & Hospice, and five Urgent Care Centers. CSM provides care for individuals and families throughout Milwaukee, Ozaukee, Washington, and Sheboygan counties - with more than 160 years of service to individuals and families in these communities. As a member of Ascension Health, the nation's largest Catholic healthcare system, CSM continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of CSM is to perpetuate the health mission of the church. CSM furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. CSM employs a Community Benefit Philosophy in program planning and implementation. CSM provides for the health of the community through financial support provided to patients by financial discounts and contracts, by developing clinics and services for specific vulnerable groups, by sponsoring community education and training and by collaborating with government programs. During fiscal 2016, the CSM system provided $86,306,151 in community health benefit services, including subsidized health care, professional education, financial contributions and community building activities. In addition, the organization's governing body is comprised of local community leaders and physicians, the majority of whom reside within the communities CSM serves and are neither employees nor contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community; however, the clinics within the organization are served by physicians affiliated with CSM. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | WI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|---|
| City of Mequon | ||||||||||
| 1133 N Cedarburg Rd | Mequon | WI | 53092 | $30,748 | FIRE TRUCK | |||||
| Lutheran Mission Attic Workshop | ||||||||||
| 12455 W Janesville Rd | Muskego | WI | 53150 | Medical Supplies and Equipment for Mission | 391577994 | 501(c)(3) | $144,999 | BOOK | Medical Supplies and Equipment for Mission | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. | FormAndLineReferenceDesc |
| Explanation | Contributions to governments and organizations in the United States are approved by the board of directors and/or the president & CEO. All records of outgoing contributions are retained for a period of 10 years, plus the current fiscal year, and can be located at the office center at 4425 North Port Washington Rd, Glendale, WI 53212. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (19 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK TAYLOR | ||||||||||||||
| FORMER PRESIDENT / CEO (END 6/30/14) | $0 | $0 | $0 | $0 | $0 | $31,490 | $0 | $0 | $0 | $0 | $0 | $31,490 | $0 | $0 |
| TRAVIS D ANDERSEN | ||||||||||||||
| PRESIDENT/CEO | $0 | $563,273 | $0 | $433,518 | $0 | $71,737 | $0 | $25,800 | $0 | $35,662 | $0 | $1,129,991 | $0 | $0 |
| KEVIN GONIU MD | ||||||||||||||
| BOARD MEMBER /CSM PHYSICIAN | $536,211 | $0 | $500 | $0 | $4,103 | $0 | $150,050 | $0 | $39,255 | $0 | $730,118 | $0 | $0 | $0 |
| TIMOTHY WALDOCH | ||||||||||||||
| INTERIM CFO | $0 | $225,973 | $0 | $46,540 | $0 | $524 | $0 | $31,276 | $0 | $34,719 | $0 | $339,033 | $0 | $0 |
| ALLAN SPOONER | ||||||||||||||
| PRESIDENT HOSPITAL DIVISION (END 08/31/15) | $0 | $343,147 | $0 | $104,852 | $0 | $293,627 | $0 | $30,006 | $0 | $19,895 | $0 | $791,528 | $0 | $0 |
| CLARISSA COX | ||||||||||||||
| VP QUALITY & CLINICAL INTEGRATION | $0 | $189,874 | $0 | $33,533 | $0 | $14,054 | $0 | $20,221 | $0 | $5,076 | $0 | $262,757 | $0 | $0 |
| WILLIAM HART | ||||||||||||||
| VP/COO | $0 | $300,173 | $0 | $52,953 | $0 | $3,206 | $0 | $31,950 | $0 | $6,188 | $0 | $394,469 | $0 | $0 |
| KEVIN KLUESNER | ||||||||||||||
| VP CLINICAL SERVICES | $0 | $223,639 | $0 | $41,285 | $0 | $4,593 | $0 | $31,950 | $0 | $33,761 | $0 | $335,228 | $0 | $0 |
| GERRI LIETZ-STAFFILENO | ||||||||||||||
| VP/CNO | $0 | $238,684 | $0 | $43,671 | $0 | $17,163 | $0 | $48,399 | $0 | $29,115 | $0 | $377,033 | $0 | $0 |
| BRUCE MCCARTHY | ||||||||||||||
| PRESIDENT PHYSICIAN DIVISION | $0 | $557,979 | $0 | $125,883 | $0 | $78,102 | $0 | $74,375 | $0 | $41,886 | $0 | $878,225 | $0 | $0 |
| MICHAEL SANDERL | ||||||||||||||
| VP MISSION INTEGRATION & ADVOC | $0 | $206,127 | $0 | $34,541 | $0 | $12,249 | $0 | $39,914 | $0 | $26,580 | $0 | $319,409 | $0 | $0 |
| SUZANNE SANICOLA | ||||||||||||||
| VP PHYSICIAN SVCS | $0 | $207,588 | $0 | $37,435 | $0 | $2,225 | $0 | $48,418 | $0 | $28,177 | $0 | $323,844 | $0 | $0 |
| JO ANN HANKWITZ | ||||||||||||||
| INTERIM CHRO | $0 | $121,866 | $0 | $25,630 | $0 | $649 | $0 | $26,265 | $0 | $22,393 | $0 | $196,804 | $0 | $0 |
| RICHARD SHIMP MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $0 | $357,632 | $0 | $62,276 | $0 | $2,567 | $0 | $25,650 | $0 | $34,045 | $0 | $482,170 | $0 | $0 |
| ROBERT M HORTH MD | ||||||||||||||
| CSM PHYSICIAN | $604,547 | $0 | $500 | $0 | $896 | $0 | $43,800 | $0 | $31,335 | $0 | $681,079 | $0 | $0 | $0 |
| DIRK STEINERT MD | ||||||||||||||
| CSM PHYSICIAN | $488,090 | $0 | $500 | $0 | $671 | $0 | $25,285 | $0 | $18,415 | $0 | $532,961 | $0 | $0 | $0 |
| FREDERICK G WESTREICH MD | ||||||||||||||
| CSM PHYSICIAN | $450,307 | $0 | $500 | $0 | $655 | $0 | $32,263 | $0 | $32,888 | $0 | $516,612 | $0 | $0 | $0 |
| JOHN YOUSIF MD | ||||||||||||||
| CSM PHYSICIAN | $494,563 | $0 | $500 | $0 | $8,550 | $0 | $0 | $0 | $24,018 | $0 | $527,630 | $0 | $0 | $0 |
| JANET GOLDMAN MD | ||||||||||||||
| CSM PHYSICIAN | $419,054 | $0 | $500 | $0 | $902 | $0 | $49,275 | $0 | $26,716 | $0 | $496,447 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation | ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S HOSPITAL OZAUKEE, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| Schedule J, Part I, Line 4a Severance or change-of-control payment | Severance payments for executives were made by a related organization (CSM, Inc.) as follows: Allan Spooner: $151,926 Michael Sanderl: $11,271 |
| Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan | Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. NO DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WERE MADE IN THE CURRENT YEAR. |
| 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 served, based on established guidelines. Officers and Key Employees participate in a management incentive place, whereby certain financial triggers of the CSM System as approved by the Board must be met before any eligible employee may receive payment of the incentive. Once the trigger is met, the incentive is measured based on various established goals, including operating margin, patient satisfaction, quality and productivity. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 15a EXPLANATION | IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF COLUMBIA ST. MARY'S HOSPITAL OZAUKEE, 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 CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | CSMO has a single corporate member, CSM. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | CSMO has a single corporate member, CSM, who has the ability to elect members to the governing body of CSMO. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | All decisions that have a material impact to CSMO's financial information or corporation as a whole are subject to approval by its sole corporate member, CSM. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the form to the board, or a designated committee, to review and answer any questions. Prior to filing the return, all board members are provided the Form 990 and management team members are available to answer any board members questions. |
| Form 990, Part VI, Line 12c Conflict of interest policy | As an affiliate of CSM, CSMO has adopted the CSM conflict of interest policy. CSM regularly and consistently monitors and enforces compliance with the 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 meeting will decide if conflicts of interest exist. Each director, principal officer, and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax exempt purpose. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | In determining compensation of other officers and key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensations, the other officers and key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. |
| 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 VIII, Line 11d Other Miscellaneous Revenue | Other Misc Revenue - Total Revenue: 8645, Related or Exempt Function Revenue: 8645, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | Contract Labor - Total Expense: 445806, Program Service Expense: 445806, Management and General Expenses: , Fundraising Expenses: ; Physician Contracted Services - Total Expense: 5099150, Program Service Expense: 5099150, Management and General Expenses: , Fundraising Expenses: ; Professional Fees - Total Expense: 162883, Program Service Expense: 162883, Management and General Expenses: , Fundraising Expenses: ; Dietary Services - Total Expense: 1831772, Program Service Expense: 1831772, Management and General Expenses: , Fundraising Expenses: ; Environmental Services - Total Expense: 1850310, Program Service Expense: 1850310, Management and General Expenses: , Fundraising Expenses: ; Lab Services - Total Expense: 450287, Program Service Expense: 450287, Management and General Expenses: , Fundraising Expenses: ; Laundry Services - Total Expense: 405480, Program Service Expense: 405480, Management and General Expenses: , Fundraising Expenses: ; Medical Purchased Services - Total Expense: 472204, Program Service Expense: 472204, Management and General Expenses: , Fundraising Expenses: ; Billing - Total Expense: 7705774, Program Service Expense: , Management and General Expenses: 7705774, Fundraising Expenses: ; Other Purchased Services - Total Expense: 169641, Program Service Expense: 161867, Management and General Expenses: 7774, Fundraising Expenses: ; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 390806315 | HOSPITAL | WI | 501(c)(3 | 3 | COLUMBIA ST MARY'S INC | Yes (true) |
| SACRED HEART REHABILITATION INSTITUTE | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 390902199 | REHAB FACILITY | WI | 501(c)(3 | 3 | COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC | Yes (true) |
| COLUMBIA COLLEGE OF NURSING | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | MILWAUKEE | WI | 53212 | 391596986 | COLLEGE | WI | 501(c)(3 | 2 | COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC | Yes (true) |
| ASCENSION HEALTH | ||||||||||
| 4600 EDMUNDSON ROAD | ST LOUIS | MO | 63136 | 311662309 | NATIONAL HEALTH SYSTEM | MO | 501(c)(3 | ASCENSION HEALTH ALLIANCE | false | |
| HORIZON HOME CARE & HOSPICE INC | ||||||||||
| 8949 N DEERBROOK TRL | MILWAUKEE | WI | 53223 | 391171298 | HOME CARE / HOSPICE | WI | 501(c)(3 | 3 | NA | false |
| COLUMBIA ST MARY'S INC | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | GLENDALE | WI | 53212 | 391834639 | HEALTH SYSTEM | WI | 501(c)(3 | ASCENSION HEALTH ALLIANCE COLUMBIA HEALTH SYSTEM | Yes (true) | |
| COLUMBIA HEALTH SYSTEM | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | GLENDALE | WI | 53212 | 391494977 | HEALTH SYSTEM | WI | 501(c)(3 | NA | false | |
| COLUMBIA ST MARY'S FOUNDATION INC | ||||||||||
| 4425 NORTH PORT WASHINGTON ROAD | GLENDALE | WI | 53212 | 391494981 | FOUNDATION | WI | 501(c)(3 | 7 | NA | false |
| ASCENSION HEALTH ALLIANCE | ||||||||||
| PO BOX 45998 | ST LOUIS | MO | 563145599 | 453358926 | NATIONAL HEALTH SYSTEM | MO | 501(c)(3 | NA | false | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|
| ORTHOPEDIC HOSPITAL OF WISCONSIN LLC | |||||||||
| 575 RIVERWOODS PARKWAY | GLENDALE | WI | 53212 | 392015655 | HEALTHCARE - HOSPITAL | WI | NA | N/A | 0 |
| SLEEP SERVICES OF WISCONSIN LLC | |||||||||
| 111 E KILBOURN AVE STE 1300 | MILWAUKEE | WI | 53202 | 273148310 | SLEEP SERVICES | WI | NA | N/A | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| COLUMBIA ST MARY'S STRATEGIC ALLIANCE | |||||||||
| 4425 N PORT WASHINGTON RD | GLENDALE | WI | 53212 | 391871856 | HEALTHCARE | WI | NA | C Corporation | false |
| MADISON MEDICAL AFFILIATES | |||||||||
| 4425 N PORT WASHINGTON RD | GLENDALE | WI | 53212 | 391855720 | HEALTHCARE | WI | NA | C Corporation | false |
| PROSPECT MEDICAL COMMONS CONDO ASSOCIATION | |||||||||
| 4425 N PORT WASHINGTON RD | GLENDALE | WI | 53212 | 208042108 | CONDO ASSOCIATION | WI | NA | C Corporation | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Ascension Health | ||
| E | $46,600,638 | BOOK |
| Columbia St Mary's Foundation Inc | ||
| C | $59,416 | FMV |
| Columbia St Mary's Inc | ||
| M | $25,533,276 | BOOK |
| Columbia St Mary's Hospital Milwaukee Inc | ||
| M | $2,065,809 | BOOK |
| Orthopaedic Hospital of Wisconsin | ||
| L | $113,179 | BOOK |
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