2016-05-16T22:01:23-05:00 2015-06-30 861065772 Deloitte Tax LLP 555 East Wells Street Suite 1400 Milwaukee WI 53202 990 2014-07-01 390807063 Columbia St Mary's Hospital Ozaukee Inc COLU 4143262230 4425 N Port Washington Road Glendale WI 53212 Timothy Waldoch Interim CFO 2016-05-16 true Rachel J Becker P00966076 4142713000 2014 2016-08-17 19:52:53Z Travis Andersen 4425 N Port Washington Road Glendale WI 53212 169468715 false 0928 X Columbia-stmarys.org X 1955 WI Full-service hospital providing medical, surgical, advanced clinical, and other community services 13 11 1100 199 857375 -43343 136385 76220 156032311 167658641 16251 10900 2191994 1722954 158376941 169468715 29233 114311 0 0 62672076 71174896 0 0 0 90779084 84063756 153480393 155352963 4896548 14115752 594739553 125385143 293924213 58344293 300815340 67040850 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. false false 121097822 114311 167876569 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 2015, CSMO PROVIDED CARE TO 39,959 PATIENTS. CSMO'S ESTIMATED UNREIMBURSED COSTS OF SERVICES TO THE ELDERLY, UNINSURED, AND UNDERINSURED TOTALED $50,619,022. 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. 121097822 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 116 0 true 1100 true true true false false false false false false false false false X 13 11 true false false false true true true true true false false true true true true true true false true false X Timothy Waldoch 4143262230 4425 N Port Washington Road Glendale WI 53212 TRAVIS ANDERSEN CSM PRESIDENT/CEO (START 8/4/14) 16.00 46.00 X X 0 300693 7878 TINA CHANG BOARD MEMBER 0.20 0.80 X 0 0 0 PATRICIA J DOLHUN MD BOARD MEMBER 0.20 0.80 X 0 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 40.20 0.80 X 510213 0 43418 MICHAEL GREBE BOARD MEMBER 0.20 0.80 X 0 0 0 GEORGE H HOFF CHAIR 0.20 0.80 X 0 0 0 ROBERT LYON MD BOARD MEMBER 0.20 0.80 X 0 0 0 R BRUCE MCDONALD BOARD MEMBER 0.20 0.80 X 0 0 0 CHRISTINE NUERNBERG BOARD MEMBER 0.20 0.80 X 0 0 0 RANDALL PERRY SECRETARY/TREASURER 0.20 0.80 X 0 0 0 STEPHEN ROBBINS MD BOARD MEMBER 0.20 0.80 X 0 0 0 SISTER THERESA SULLIVAN DC BOARD MEMBER 0.20 0.80 X 0 0 0 ROBERT J VENABLE VICE CHAIR 0.20 0.80 X 0 0 0 RHONDA ANDERSON CSM PRESIDENT/CFO (End Date 10/11/14) 5.00 45.00 X 0 734942 42333 TIMOTHY WALDOCH INTERIM CFO 18.00 33.00 X 0 213345 37363 CHERYL HILL VP HUMAN RESOURCES (End date 8/26/14) 20.00 33.00 X 0 308377 19917 GERRI LIETZ-STAFFILENO VP HOSP OPERATIONS 39.00 11.30 X 0 378557 29218 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 20.00 30.00 X 0 1034205 45369 SUZANNE SANICOLA VP CSM COMM PHYSICIANS 20.00 30.00 X 0 313443 32866 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION 20.00 30.00 X 0 680455 27407 WILLIAM HART VP/COO 10.00 40.00 X 0 451606 13625 JANET GOLDMAN MD PHYSICIAN 40.00 0 X 381576 0 23684 ROBERT M HORTH MD PHYSICIAN 40.00 0 X 550397 0 28677 DIRK STEINERT MD PHYSICIAN 40.00 0 X 432431 0 50357 FREDERICK G WESTREICH MD PHYSICIAN 40.00 0 X 394738 0 38565 JOHN YOUSIF MD PHYSICIAN 40.00 0 X 539284 0 20246 MARK TAYLOR Former PRESIDENT / CEO (END 6/30/14) 0.00 0.00 X 0 1332208 14876 2808639 5747831 475799 13 true true false MORRISON MANAGEMENT SPECIALISTS INC 400 Northridge Road Suite 600 Atlanta GA 30350 Food Services and Environmental Services 3562563 AMERICAN LANDSCAPE & AMERICAN SNOW PRO N60 W16073 Kohler Ln Menomonee Falls WI 53051 Landscaping and Snow Removal Services 266789 M A MORTENSON COMPANY 700 N Meadow Ln Minneapolis MN 55422 Construction 246016 WI CARDIOVASCULAR SERVICES LLC W129 N7055 Northfield Dr Menomonee Fallss WI 53051 Medical Purchased Services 181349 CG SCHMIDT INC 11777 West Lake Park Dr Milwaukee WI 53224 Construction 153804 0 76220 76220 Net Patient Services 621990 166040192 166040192 Retail Pharmacy Revenue 446110 1617449 1132214 485235 Community Education 900099 1000 1000 0 0 0 0 167658641 658551 658551 0 658551 658551 10900 0 10900 10900 10900 Contract Services 900099 655713 655713 Food & Nutrition 722210 372140 372140 Miscellaneous Revenue 900099 36550 36550 0 0 0 0 1064403 169468715 167876569 857375 658551 114311 114311 618805 618805 59018628 52579560 6439068 8086305 7789919 296386 3451158 3438087 13071 119496 119496 13496 13496 6357 6357 12671157 8987991 3683166 0 2938 2938 157500 150712 6788 500 500 6222887 6245619 -22732 66257 63278 2979 52263 51864 399 7599452 7594336 5116 940558 62300 878258 Overhead Allocation 23741614 1495664 22245950 Patient Care Supplies 19121278 19119768 1510 Purchased Servies 5355144 5285824 69320 Hospital Assessment Tax 4663161 4663161 3329698 3318998 10700 0 155352963 121097822 34255141 0 254494 254496 21841496 23376431 0 0 3979200 3846733 621218 708352 198879941 101955691 98567381 96924250 0 0 347552 274881 469128212 0 594739553 125385143 8643053 7040075 285281160 51304218 293924213 58344293 X 300815340 67040850 300815340 67040850 594739553 125385143 14115752 -247890242 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8277 8277 false Schedule C, Part II-B, Line 1 Lobbying Activities Lobbying Expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. CSMO does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 29290 29290 114662183 39386867 75275316 1600051 773968 826083 81874739 61477130 20397609 713678 317726 395952 96924250 Intercompany A/P 2862866 Misc Noncurrent Liabilities 1253865 Intercompany Debt to Ascension Health Alliance 47187487 51304218 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2015. true true true X true X true true true false true true 712995 0 712995 0.0046 16192643 14193662 1998981 0.0129 0 0.0 0 0 16905638 14193662 2711976 0.0175 246220 12184 234036 0.0015 563299 0 563299 0.0036 0 0 0 0.0 0 0 0 0.0 2000 0 2000 0.0000 0 0 811519 12184 799335 0.0051 0 0 17717157 14205846 3511311 0.0226 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 2691772 53835 249100257 288322370 -39222113 X true true 1 1 Columbia St Mary's Hospital Ozaukee 13111 N Port Washington Road Mequon WI 53097 www.columbia-stmarys.org 246 X X X Columbia St Mary's Hospital Ozaukee 1 false false true X X X X X X X X X 12 true true true true X http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100361 X true 12 true http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100365 false false true X 2.0 3.0 X X X X X true true X X X true X http://www.columbia-stmarys.org/oth/Page.asp?PageID=OTH000946 X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Ozaukee. The hospital facility took into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health. The collaboration included participation by the Ozaukee County Health Department. CSM participated with the Aurora Community Benefit staff in developing a CHNA Team to conduct the assessment. The CHNA team developed a multi-level assessment process. The first level consisted of a survey of county residents regarding their health status, health access and the perception of community needs. Working together, survey questions were developed and approved. A consultant was contracted to perform the survey using techniques that the consultant had used in similar surveys over ten years. The survey was conducted over the telephone to cell phone owners and "land line" telephone owners. More than 400 people were interviewed. The second level of data gathering was performed by the Center for Urban Popluation Health (CUPH) as secondary data gathering about community needs based on public health and other publicly available information. The third level of data was gathered through a key stakeholder interview process. The CSM and Aurora leaders had agreed upon key stakeholders in the community. A survey tool that had been developed by the MHCP members was used for the Ozaukee interviews. Five interviews were conducted of public health, academic and community leaders. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Ozaukee. The other hospital facilities with which the reporting hospital facility conducted its CHNA, include Aurora Health Care, Children's Hospital of Wisconsin, Froedtert Health and Wheaton Franciscan Healthcare. Columbia St. Mary's Community Benefit staff collaborated with the Community Benefit staff of Aurora Health Care as the only other hospital located in Ozaukee County. The two facilities have partnership experience in CHNA from Milwaukee County and have a good relationship in the CHNA process. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Columbia St. Mary's Hopsital Ozaukee. The CHNA was conducted with Center for Urban Population Health. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Ozaukee, Inc.. 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 13 Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Ozaukee. The other hospital facilities with which the reporting hospital facility conducted its CHNA, include Aurora Health Care, Children's Hospital of Wisconsin, Froedtert Health and Wheaton Franciscan Healthcare. These five hospital systems have developed the Milwaukee Health Care Partnership (MHCP) to collaborate efforts to improve understanding of health care needs in Milwaukee and to impr 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. 21 Marsho Family Medical Group 1703 N Taylor Drive Sheboygan WI 53081 Clinic Marsho Family Medical Group 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 Cardiac Rhythm Specialists - Ozaukee 13133 N Port Washington Road Mequon WI 53097 Clinic CSM Neurology 13133 N Port Washington Road Mequon WI 53097 Clinic Cancer Center - Ozaukee OncologyHEMA 13133 N Port Washington Road Mequon WI 53097 Clinic Radiation Oncology 13133 N Port Washington Road Mequon WI 53097 Clinic ENT Associates - Ozaukee 13133 N Port Washington Road Mequon WI 53097 Clinic 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 Wisconsin Cardiovascular Group - Mequon 13133 N Port Washington Road Mequon WI 53097 Clinic Cardiac Rhythm Specialists - Oshkosh 2700 W 9th Ave Oshkosh WI 54904 Clinic Port Washington Family Medical Group 1317 W Grand Ave Port Washington WI 53074 Clinic Genesis Chiropractic Clinic 830 E Green Bany Ave Suite 103 Saukville WI 53080 Clinic Greenlane Family Practice 830 E Green Bay Ave Saukville WI 53080 Clinic Cardiac Rhythm Specialists - Sheboygan 1414 N Taylor Drive 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 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 2015, 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 $6,792,342. 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 2015 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/oth/Page.asp?PageID=OTH000946; 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 2015, CSM Hospital Ozaukee served 39,959 patients and provided $712,995 in traditional charity care (at cost), $1,998,981 in unpaid costs of public programs, $1,093,255 in uninsured discounts and $799,335 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 FY 15. 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 2015, the CSM system provided $153,589,389 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 true City of Mequon 1133 N Cedarburg Rd Mequon WI 53092 29582 Fire Truck Lutheran Mission Attic Workshop 12455 W Janesville Rd Muskego WI 53150 391577994 501(c)(3) 0 84199 Book Donated Medical Supplies and Equipment Medical Supplies and Equipment for Missions 2 0 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds 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. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. 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. false true false false false false false true false MARK TAYLOR Former PRESIDENT / CEO (END 6/30/14) 0 347993 0 934720 0 49495 0 7800 0 7076 0 1347084 0 0 TRAVIS ANDERSEN CSM PRESIDENT/CEO (START 8/4/14) 0 224785 0 75000 0 908 0 0 0 7878 0 308571 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 388456 0 0 0 121757 0 7800 0 35618 0 553631 0 0 0 RHONDA ANDERSON CSM PRESIDENT/CFO (End Date 10/11/14) 0 444599 0 217783 0 72560 0 33467 0 8866 0 777275 0 0 TIMOTHY WALDOCH INTERIM CFO 0 194618 0 18446 0 281 0 6337 0 31026 0 250708 0 0 CHERYL HILL VP HUMAN RESOURCES (End date 8/26/14) 0 186822 0 105600 0 15955 0 5742 0 14175 0 328294 0 0 GERRI LIETZ-STAFFILENO VP HOSP OPERATIONS 0 230943 0 123237 0 24377 0 7501 0 21717 0 407775 0 0 BRUCE MCCARTHY PRESIDENT PHYSICIAN DIVISION 0 698420 0 306588 0 29197 0 7800 0 37569 0 1079574 0 0 SUZANNE SANICOLA VP CSM COMM PHYSICIANS 0 187055 0 106686 0 19702 0 6558 0 26308 0 346309 0 0 ALLAN SPOONER PRESIDENT HOSPITAL DIVISION 0 478474 0 180971 0 21010 0 7800 0 19607 0 707862 0 0 WILLIAM HART VP/COO 0 297519 0 150910 0 3177 0 7800 0 5825 0 465231 0 0 JANET GOLDMAN MD PHYSICIAN 363246 0 0 0 18330 0 7800 0 15884 0 405260 0 0 0 ROBERT M HORTH MD PHYSICIAN 532151 0 0 0 18246 0 0 0 28677 0 579074 0 0 0 DIRK STEINERT MD PHYSICIAN 431213 0 0 0 1218 0 15600 0 34757 0 482788 0 0 0 FREDERICK G WESTREICH MD PHYSICIAN 381091 0 0 0 13647 0 7800 0 30765 0 433303 0 0 0 JOHN YOUSIF MD PHYSICIAN 535063 0 0 0 4221 0 0 0 20246 0 559530 0 0 0 Schedule J, Part I, Line 3 EXPLANATION 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 4b Supplemental nonqualified retirement plan Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The organization that paid the salaries of the individuals listed in Schedule H, Part II paid out of the supplemental nonqualified retirement plan in the amounts as noted: Mark R. Taylor - $21,269 Kevin J. Goniu, MD - $100,100 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. Form 990, Part VI, Line 2 EXPLANATION ANY OF THE PERSONS LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT FOR COLUMBIA ST. MARY'S, INC. RELATED ENTITIES. 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. 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 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 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 true ASCENSION HEALTH 4600 EDMUNDSON ROAD ST LOUIS MO 63136 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I 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 Type I ASCENSION HEALTH ALLIANCE COLUMBIA HEALTH SYSTEM true COLUMBIA HEALTH SYSTEM 4425 NORTH PORT WASHINGTON ROAD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(c)(3 Type I 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 Type I NA false ORTHOPEDIC HOSPITAL OF WISCONSIN LLC 575 RIVERWOODS PARKWAY GLENDALE WI 53212 392015655 HEALTHCARE - HOSPITAL WI NA N/A SLEEP SERVICES OF WISCONSIN LLC 111 E KILBOURN AVE STE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI NA N/A 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 false false true false false false false false false false false false true false false false false false false Columbia St Mary's Inc M 22277280 Book Ascension Health E 47187487 Book Columbia St Mary's Foundation Inc C 76220 Book Columbia St Mary's Hospital Milwaukee Inc M 2092580 Book