2016-05-16T13:43:42-05:00 2015-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2014-07-01 392016396 COLUMBIA CENTER INC COLU 4143262230 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 KAREN J CASEY PRESIDENT & CEO 4143262230 2016-05-16 1 TERRI REXRODE CPA MST P00096513 9206620016 2016-05-16 2014 2016-12-15 16:53:06Z KAREN J CASEY 4425 N PORT WASHINGTON ROAD GLENDALE WI 53212 6927402 0 X THEBIRTHHOSPITAL.ORG X 2001 WI TO PROVIDE HIGH QUALITY BIRTHING SERVICES, OUTPATIENT ELECTIVE STERILIZATION, AND CONTRACEPTIVE SERVICES TO FAMILIES IN OZAUKEE AND WASHINGTON COUNTIES, AS WELL AS THE NORTHERN REGION OF MILWAUKEE COUNTY. 12 12 70 12 0 0 0 202500 5566845 6099797 5668 6508 25707 618597 5598220 6927402 0 0 0 0 3378252 3458055 0 0 0 2678016 2973374 6056268 6431429 -458048 495973 17821101 18277813 462931 559873 17358170 17717940 X TO PROVIDE HIGH QUALITY BIRTHING SERVICES, OUTPATIENT ELECTIVE STERILIZATION, AND CONTRACEPTIVE SERVICES TO FAMILIES IN THE METRO AND NORTHERN MILWAUKEE AREAS. 0 0 3862164 0 6718394 COLUMBIA CENTER IS AN INDEPENDENT, STATE-OF-THE-ART, BIRTHING HOSPITAL LOCATED ON THE CAMPUS OF COLUMBIA ST. MARY'S HOSPITAL OZAUKEE IN MEQUON, WISCONSIN. COLUMBIA CENTER STRIVES TO MAINTAIN HIGHER-THAN-AVERAGE STAFF-TO-PATIENT RATIOS, ALLOWING ITS SKILLED LABOR AND DELIVERY NURSING STAFF TO PROVIDE A HIGH LEVEL OF PERSONALIZED ATTENTION TO ITS NEW MOTHERS-TO-BE. COLUMBIA CENTER STAFF MEMBERS HAVE AN AVERAGE OF 19 YEARS EXPERIENCE, AND IN 2015, ASSISTED IN OVER 519 CHILDBIRTHS. COLUMBIA CENTER OFFERS WISCONSIN'S ONLY HOSPITAL-BASED DOULA PROGRAM. A DOULA PROVIDES NON-MEDICAL EMOTIONAL AND PHYSICAL SUPPORT TO WOMEN DURING LABOR AND BIRTH. IN ADDITION TO INPATIENT CHILDBIRTH SERVICES, COLUMBIA CENTER OFFERS A COMPREHENSIVE RANGE OF PREGNANCY, CHILDBIRTH AND EARLY PARENTING EDUCATIONAL CLASSES. COLUMBIA CENTER ALSO PROVIDES REPRODUCTIVE PLANNING AND ELECTIVE STERILIZATION SERVICES, INCLUDING OUTPATIENT TUBAL LIGATIONS AND VASECTOMIES. 3862164 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 70 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 X KAREN J CASEY 4143262230 4425 N PORT WASHINGTON RD GLENDALE WI 53212 PATRICIA J DOLHUN MD CHAIR 1.00 X X 0 0 0 ROBERTA M DREWS SECRETARY 1.00 X X 0 0 0 POLLY W BEAL TREASURER 1.00 X X 0 0 0 DANIEL F MCKEITHAN BOARD MEMBER 1.00 X 0 0 0 DON S SCHOONENBERG BOARD MEMBER 1.00 X 0 0 0 ELIZABETH R HAGEN MD BOARD MEMBER 1.00 X 0 0 0 JILL G PELISEK BOARD MEMBER 1.00 X 0 0 0 LINDA T MELLOWES BOARD MEMBER 1.00 X 0 0 0 LORI J LANGHOLZ BOARD MEMBER 1.00 X 0 0 0 PATRICK T REGAN MD BOARD MEMBER 1.00 X 0 0 0 POLLY H VAN DYKE END 092014 BOARD MEMBER 1.00 X 0 0 0 TERRANCE J WILKINS MD BOARD MEMBER 1.00 X 0 0 0 WARNER C FRAZIER BOARD MEMBER 1.00 X 0 0 0 KAREN J CASEY PRESIDENT & CEO 1.00 40.00 X 0 263376 17229 VICKI PHILIPS CRNA 40.00 X 198761 0 9161 JAMES TALLEY CRNA 36.00 X 155611 0 24846 JEFFREY TUSHAUS CRNA 36.00 X 169812 0 547 524184 263376 51783 3 0 1 0 TRIMEDX LLC 5451 LAKEVIEW PARKWAY S DRIVE INDIANAPOLIS IN 46268 EQUIPMENT REPAIR SERVICES 111099 MCDILL DESIGN 626 N WATER STREET MILWAUKEE WI 53202 MARKETING SERVICES 102371 2 200000 2500 202500 NET PATIENT REVENUE 621990 6098917 6098917 INSTRUCTIONAL CLASSES 900099 880 880 6099797 6508 6508 OTHER REVENUE 900099 618597 618597 618597 6927402 6718394 0 6508 X 2759320 2646953 112367 92982 89893 3089 422053 408030 14023 183700 177257 6443 8208 8208 203646 203646 1236177 1236177 262186 262186 7905 7905 93627 93627 48 48 5233 5233 524575 524575 79981 79981 PATIENT CARE SUPPLIES 259474 259474 BAD DEBT EXPENSE 169629 169629 HOSPITAL ASSESSMENT TAX 110928 110928 11757 11757 6431429 3862164 2569265 0 5631297 7128902 661365 882013 9625 3500 8684 35976 14899210 4749344 10611041 10149866 67956 77556 831133 0 17821101 18277813 462931 389223 0 170650 462931 559873 X 17290214 17640384 67956 77556 17358170 17717940 17821101 18277813 X 495973 -136203 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 283200 283200 10085462 1918726 8166736 4530548 2830618 1699930 10149866 DUE TO AFFILIATE 170650 170650 6982059 360489 -169629 190860 6791199 136203 136203 6927402 6622289 360489 -169629 190860 6431429 0 6431429 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -169,629. PART XI, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE TRANSFER COLUMBIA HEALTH SYSTEM 145,803. CHANGE IN INTEREST IN NET ASSETS -9,600. PART XII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -169,629. 1 1 1 X 1 X 1 1 0 1 1 6409 6409 0.00100 1434895 414289 1020606 0.16300 1441304 414289 1027015 0.16400 12829 12829 0.00200 3728 3728 0.00060 16557 16557 0.00260 1457861 414289 1043572 0.16660 34725 34725 0.00550 34725 34725 0.00550 1 120097 0 11381 19273 -7892 X 1 1 1 1 COLUMBIA CENTER INC 13125 N PORT WASHINGTON RD MEQUON WI 53097 THEBIRTHHOSPITAL.ORG 300 X BIRTHING HOSPITAL COLUMBIA CENTER INC 1 0 0 1 X X X X X X 12 1 0 0 1 X THEBIRTHHOSPITAL.ORG/RESOURCES/COMMUNITY-NEEDS-ASSESSMENT X 1 12 1 THEBIRTHHOSPITAL.ORG/RESOURCES/COMMUNITY-NEEDS-ASSESSMENT 1 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTP://THEBIRTHHOSPITAL.ORG/RESOURCES/FINANCIAL-ASSISTANCE/ X X X 1 0 X X 1 X 0 0 COLUMBIA CENTER, INC. PART V, SECTION B, LINE 5: COLUMBIA CENTER PARTNERED WITH KIRSTEN JOHNSON, MPH, OZAUKEE COUNTY DEPARTMENT OF HEALTH; JENNIFER DOERRING, RN, PHD, UNIVERSITY OF WISCONSIN-MILWAUKEE; AND MS. ROSE EICHENHOEFER, CSW, MEQUON-BASED LICENSED SOCIAL WORKER. COLUMBIA CENTER, INC. PART V, SECTION B, LINE 11: COLUMBIA CENTER ACTIVELY PARTICIPATES IN COMMUNITY HEALTH DISCUSSIONS. THE EMPLOYEES AND MANAGEMENT ARE CONTINUALLY LOOKING FOR WAYS TO IMPROVE HEALTH CARE AND ITS AVAILABILITY IN THE LOCAL COMMUNITY. MANAGEMENT ALSO WORKS WITH THE LOCAL HEALTH DEPARTMENT TO LOCATE GAPS WITHIN HEALTH CARE OFFERINGS TO FILL THE HEALTH CARE NEEDS OF THE COMMUNITY. ANNUALLY, A COMMUNITY BENEFIT REPORT IS SUBMITTED TO THE STATE COMPILING COMMUNITY BENEFIT INFORMATION AS REQUESTED.DURING FY15, COLUMBIA CENTER DONATED $10,000 TO THE MOM'S MENTAL HEALTH INITIATIVE THROUGH MCDILL DESIGN TO BUILD A WEBSITE TO PROVIDE GREATER ACCESS AND HELP ADDRESS THE ISSUE OF MOTHERS SUFFERING FROM POSTPARTUM DEPRESSION. COLUMBIA CENTER, INC. PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME BETWEEN 200-300% OF THE POVERTY LEVEL QUALIFY FOR REDUCED PATIENT FINANCIAL RESPONSIBILTY BASED ON A TIERED SCALE - THE MOST THEY WOULD BE RESPONSIBLE FOR IS 60% (I.E. A 40% DISCOUNT), WITH A MAX AMOUNT OF 10% OF THEIR INCOME. PATIENTS WITH INCOME LESS THAN 300% OF THE POVERTY LEVEL QUALIFY FOR 100% FINANCIAL ASSISTANCE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY COLUMBIA CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE: HTTP://THEBIRTHHOSPITAL.ORG/RESOURCES/FINANCIAL-ASSISTANCE/ PART I, LINE 7: THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA. THE ORGANIZATION USES A COST ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, 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. PART I, LN 7 COL(F): 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 EXPENSES AT COST WITHIN SCHEDULE H. TOTAL BAD DEBT EXPENSE FROM THE INCOME STATEMENT TO WHICH THE COST TO CHARGE RATIO IS APPLIED IS $169,629. PART II, COMMUNITY BUILDING ACTIVITIES: COLUMBIA CENTER SUPPORTS HEALTHY BABIES, HEALTHY MOTHERS, AND HEALTHY FAMILIES IN THE COUNTIES THEY SERVE. ANNUAL SUPPORT IS PROVIDED THROUGH EDUCATIONAL CLASSES FOCUSED ON HEALTHY PREGNANCIES, HEALTHY NUTRITION, AND POSTPARTUM SUPPORT FOR MOTHERS. THESE CLASSES ARE OFFERED FREE OF CHARGE TO ANYONE INTERESTED. DURING FISCAL YEAR 2015 COLUMBIA CENTER SPONSORED AN INFANT CPR AND SAFETY CLASS TO EDUCATE PARENTS AND CAREGIVERS ON THE CPR AS PROMOTED BY THE AMERICAN HEART ASSOCIATION. PART III, LINE 2: 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 EXPENSES AT COST WITHIN SCHEDULE H. TOTAL BAD DEBT EXPENSE FROM THE INCOME STATEMENT TO WHICH THE COST TO CHARGE RATIO IS APPLIED IS $169,629. PART III, LINE 4: THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE REGARDING BAD DEBTS. WE HAVE ADDED OUR PATIENT RECEIVABLES AND CREDIT POLICY BELOW AS AN EXPLANATION:PATIENT RECEIVABLES AND CREDIT POLICYPATIENT ACCOUNTS RECEIVABLE ARE UNCOLLATERALIZED PATIENT OBLIGATIONS THAT ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. THESE OBLIGATIONS ARE PRIMARILY FROM LOCAL RESIDENTS, MOST OF WHOM ARE INSURED UNDER THIRD-PARTY PAYER AGREEMENTS. THE CENTER BILLS THIRD-PARTY PAYORS ON THE PATIENTS' BEHALF, OR IF A PATIENT IS UNINSURED, THE PATIENT IS BILLED DIRECTLY. ONCE CLAIMS ARE SETTLED WITH THE PRIMARY PAYER, ANY SECONDARY INSURANCE IS BILLED, AND PATIENTS ARE BILLED FOR COPAY AND DEDUCTIBLE AMOUNTS THAT ARE THE PATIENTS' RESPONSIBILITY. PAYMENTS ON PATIENT ACCOUNTS RECEIVABLE ARE APPLIED TO THE SPECIFIC CLAIM IDENTIFIED ON THE REMITTANCE ADVICE OR STATEMENT.THE CARRYING AMOUNTS OF PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.COLUMBIA CENTER USES HFMA STATEMENT #15 AND THEREFORE NO AMOUNTS OF OUR BAD DEBT EXPENSE SHOULD BE ATTRIBUTABLE TO PATIENTS UNDER OUR FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: COLUMBIA CENTER DOES NOT TREAT MEDICARE SHORTFALLS AS COMMUNITY BENEFIT. PART III, LINE 9B: 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. PART VI, LINE 2: COLUMBIA CENTER ACTIVELY PARTICIPATES IN COMMUNITY HEALTH CARE DISCUSSIONS. THE EMPLOYEES AND MANAGEMENT ARE CONTINUALLY LOOKING FOR WAYS TO IMPROVE HEALTH CARE AND IT'S AVAILABILITY IN THE LOCAL COMMUNITY. MANAGEMENT ALSO WORKS WITH THE LOCAL HEALTH DEPARTMENT TO LOCATE GAPS WITHIN HEALTH CARE OFFERINGS TO FILL THE HEALTH CARE NEEDS OF THE COMMUNITY. ANNUALLY, A COMMUNITY BENEFIT REPORT IS SUBMITTED TO THE STATE COMPILING COMMUNITY BENEFIT INFORMATION AS REQUESTED. PART VI, LINE 3: PATIENTS AND THEIR FAMILIES ARE ADVISED OF THE HOSPITAL'S POLICIES, INCLUDING THE FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF NEED-BASED FINANCIAL ASSISTANCE IN EASILY UNDERSTOOD TERMS, AS WELL AS IN ANY LANGUAGE COMMONLY USED BY PATIENTS IN OUR COMMUNITY. FINANCIAL COUNSELORS ARE AVAILABLE TO ALL PATIENTS.FINANCIAL ASSISTANCE AND CHARITY CARE INFORMATION IS ALSO AVAILABLE ON COLUMBIA CENTER'S WEBSITE FOR EASY ACCESSIBILITY. PART VI, LINE 4: COLUMBIA CENTER SERVES OZAUKEE AND WASHINGTON COUNTIES, AS WELL AS THE NORTHERN REGION OF MILWAUKEE COUNTY, BUT PATIENTS COME FROM OUTSIDE THESE AREAS FOR THE EXCEPTIONAL CARE OFFERED TO PATIENTS. PART VI, LINE 5: COLUMBIA CENTER ACTIVELY PARTICIPATES IN NURSE INTERNSHIP TRAINING. OVER 400 HOURS OF COLUMBIA CENTER STAFF TIME WAS USED PROVIDING PRACTICAL TRAINING FOR NURSES FINISHING THEIR EDUCATION. ALSO, DONATIONS ARE MADE TO LOCAL CHARITIES TO ASSIST THEM IN PROVIDING BENEFITS WITHIN OZAUKEE COUNTY. PART VI, LINE 7, REPORTS FILED WITH STATES WI 0 0 0 0 0 0 0 0 0 KAREN J CASEY PRESIDENT & CEO 0 191226 0 72150 0 0 0 4329 0 12900 0 280605 0 0 VICKI PHILIPS CRNA 174610 0 0 0 24151 0 0 0 9161 0 207922 0 0 0 JAMES TALLEY CRNA 149447 0 0 0 6164 0 0 0 24846 0 180457 0 0 0 JEFFREY TUSHAUS CRNA 155786 0 0 0 14026 0 0 0 547 0 170359 0 0 0 PART I, LINE 3 COLUMBIA HEALTH SYSTEM, INC., THE SPONSORING ORGANIZATION OF COLUMBIA CENTER, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT AND CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 6 COLUMBIA CENTER (CC) HAS A SOLE CORPORATE MEMBER, COLUMBIA HEALTH SYSTEM, INC. (CHS) FORM 990, PART VI, SECTION A, LINE 7A CHS, THE SOLE MEMBER, HAS THE ABILITY TO ELECT MEMBERS/INDIVIDUALS TO THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO COLUMBIA CENTER'S FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, COLUMBIA HEALTH SYSTEM. COLUMBIA HEALTH SYSTEM HAS THE POWER TO APPROVE NEW MEMBERS AND IMPORTANT BUSINESS DECISIONS, SUCH AS THE SALE, LEASE OR DISPOSAL OF ASSETS IN EXCESS OF A PRE-DETERMINED AMOUNT, OR THE SALE, TRANSFER, EXCHANGE OR OTHER DISPOSAL OF ALL OR SUBSTANTIALLY ALL OF THE COLUMBIA CENTER ASSETS, AND THE COMBINATION, DISSOLUTION, MERGER OR CONSOLIDATION INVOLVING COLUMBIA CENTER OR ANY OTHER STRUCTURAL CHANGES. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS TO REVIEW AND ANSWER ANY QUESTIONS. PRIOR TO FILING THE RETURN, COMMITTEE MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C COLUMBIA CENTER HAS A WRITTEN CONFLICT OF INTEREST POLICY. THE ORGANIZATION 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. IF A CONFLICT OF INTEREST ARISES, THE BOARD MEMBER WILL RECUSE THEMSELVES FROM THE MEETING DURING THE DISCUSSION, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 15A & B. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS 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 OTHER HOSPITALS OF SIMILAR SIZE AND SCOPE IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN A MEMO FROM THE BOARD CHAIR TO THE CEO. THE CEO WAS NOT PRESENT WHEN HER COMPENSATION WAS DECIDED. NO OTHER INDIVIDUALS ARE CONSIDERED KEY EMPLOYEES OR OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIALS OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 32,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,872. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 534,308. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 534,308. ENVIRONMENTAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 91,320. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,320. MATERIALS MANAGEMENT/LINENS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,986. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,986. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 488,493. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 488,493. DIETARY SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 53,198. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,198. FORM 990, PART XI, LINE 9: CHANGE IN TEMP RESTRICTED NET ASSETS - INTEREST IN COLUMBIA ST MARYS FDN 9,600. AFFILATE TRANSFER COLUMBIA HEALTH SYSTEM -145,803. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S FINANCIAL STATEMENTS HAVE BEEN AUDITED BY AN INDEPENDENT AUDIT FIRM. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT AUDITORS. NO CHANGES HAVE OCCURRED SINCE THE PRIOR YEAR. COLUMBIA ST MARY'S FOUNDATION 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391494981 FOUNDATION WI 501(C)(3) 7 COLUMBIA HEALTH SYSTEM INC 1 COLUMBIA HEALTH SYSTEM INC 4425 NORTH PORT WASHINGTON RD GLENDALE WI 53212 391494977 HEALTH SYSTEM WI 501(C)(3) 11 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COLUMBIA ST MARY'S FOUNDATION INC C 200000 ACTUAL COST COLUMBIA HEALTH SYSTEM INC C 360489 FAIR MARKET VALUE