2016-05-16T22:00:51-05:00 2015-06-30 861065772 Deloitte Tax LLP 555 E Wells St Suite 1400 Milwaukee WI 53202 990 2014-07-01 390806315 Columbia St Mary's Hospital Milwaukee 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 462296956 false 0928 X columbia-stmarys.org X 1859 WI Full-service hospital with medical, surgical, advanced clinical and other community services. 13 11 2954 379 4186218 -916746 877679 1013945 439990837 456559605 89747 141043 6089591 4582363 447047854 462296956 97163 74469 0 0 183448279 220346256 0 0 0 291697776 277061584 475243218 497482309 -28195364 -35185353 599538910 586813683 398885042 160281470 200653868 426532213 Columbia St. Mary's Hospital Milwaukee ("CSM-M") is part of Columbia St. Mary's Inc. ("CSM"), a healthcare provider 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. CSM-M'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 421528683 74469 456209621 CSM-M OPERATES A FULL-SERVICE 336-BED HOSPITAL, WHICH OFFERS A COMPLETE RANGE OF MEDICAL, SURGICAL AND ADVANCED CLINICAL SPECIALTIES. CSM-M OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. DURING FISCAL 2015, CSM-M 'S HOSPITAL PROVIDED CARE TO 99,302 PATIENTS. CSM-M 'S ESTIMATED UNREIMBURSED COSTS OF SERVICES TO THE ELDERLY, UNINSURED, AND UNDERINSURED TOTALED $112,168,426. CSM-M 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 CSM-M MAKES A POSITIVE DIFFERENCE IN THE HEALTH STATUS OF ITS COMMUNITY, FOCUSING ON THOSE WHO ARE VULNERABLE. 421528683 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 253 0 true 2954 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 Rd Ste 301 Glendale WI 53212 TRAVIS ANDERSEN CSM PRESIDENT/CEO (Start Date 8/4/14) 25.00 37.00 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 0.20 40.80 X 0 510213 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 5.00 45.30 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 30.00 20.00 X 0 451606 13625 SANJAY S DESHPANDE MD PHYSICIAN 40.00 0 X 1466061 0 46125 ANTHONY D LINN MD PHYSICIAN 40.00 0 X 837677 0 33071 EMAD BOTROS PHYSICIAN 40.00 0 X 1000090 0 36374 JOSHUA LIBERMAN PHYSICIAN 40.00 0 X 1246868 0 40443 RICHARD PIRCON PHYSICIAN 40.00 0 X 1125168 0 44798 MARK TAYLOR Former PRESIDENT / CEO (END 6/30/14) 0.00 0.00 X 0 1332208 14876 5675864 6258044 515081 243 true true false Metropolitan Anesthesiologists SC 2323 N Lake Drive Milwaukee WI 53211 Physician Services 14447496 Morrison Management Specialists 400 Northridge Road Suite 600 Atlanta GA 30350 Food services and environmental services 12651803 Heathcare Services Inc 3220 Tillman Drive Suite 300 Bensalem PA 19020 Revenue cycle management 7627890 The Medical College of Wisconsin Affiliated 9200 W Wisconsin Avenue Milwaukee WI 53226 Residency Program 3456738 Medical College of Wisconsin 8701 W Waterown Plank Rd Milwaukee WI 53226 Residency Program 2558265 44 X 817375 196570 1013945 Net Patient Services 621990 446996267 446996267 Retail Pharmacy Revenue 446110 6096051 4389157 1706894 Diagnostic Lab Revenue 621500 2218614 2218614 MSA Revenue 541200 521420 260710 260710 Seton Dental Clinic 531120 277793 277793 449460 449460 0 0 456559605 71843 71843 815329 815329 0 815329 815329 69200 0 69200 69200 69200 128 128 128 Contract Services 900099 1895759 1895759 Service Fees 900099 685380 685380 Food & Nutrition 722210 866002 866002 319765 319765 0 0 3766906 462296956 456209621 4186218 887172 X 74469 74469 5284342 5284342 181946324 169009766 12936558 22883844 20580088 2303756 10231746 9988571 243175 826094 826094 9653 9653 522448 522448 56155556 56198422 -42866 0 466269 448490 17779 10910 10910 19885069 19792561 92508 356046 349339 6707 215067 214784 283 25764976 25608752 156224 3201054 3201054 Overhead Allocations 58471754 3727912 54743842 Patient Care Supplies 53145418 53029183 116235 Loss on Joint Venture 13858929 13858929 Hospital tax Assessment 12309255 12309255 31863086 31768003 95083 0 497482309 421528683 75953626 0 15007 537833 62215854 67730114 0 0 7405152 7004626 3631400 3044303 771450202 282116847 508393804 489333355 0 0 373178 253965 17504515 18909487 599538910 586813683 24660383 23282824 374224659 136998646 398885042 160281470 X 200653868 426532213 200653868 426532213 599538910 586813683 X -35185353 0 0 0 0 261063698 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 14709 14709 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. CSMM does not participate or intervene in (including the publishing or distribution of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 11856580 11856580 472959410 117752634 355206776 4532955 3116086 1416869 280302608 160737502 119565106 1798649 510625 1288024 489333355 Payable to third parties 398601 Payable to Affiliates 7881031 Pension/Deferred Compensation 17271229 Other Miscellaneous Liabilities 4010445 Intercompany Debt to Ascension 107437340 Total 136998646 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 Milwaukee, 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 X true X true X true true true false true true 6021332 0 6021332 0.0121 117227985 84472147 32755838 0.0658 0 0 0 0.0 0 0 123249317 84472147 38777170 0.0779 4125301 916206 3209095 0.0065 14471629 5825489 8646140 0.0174 0 0 0 0.0 0 0 0 0.0 495077 495077 0.0010 0 0 19092007 6741695 12350312 0.0248 0 0 142341324 91213842 51127482 0.1028 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 5635 5635 0.0000 0 0.0 91882 91882 0.0002 0 0.0 0 0 97517 0 97517 0.0002 false 24245778 484916 500078881 523153748 -23074867 X true true 1 1 Columbia St Mary's Hospital Milwaukee www.columbia-stmarys.org 53 X X X Columbia St Mary's Hospital Milwaukee 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=DOC100356 X true 12 true http://www.columbia-stmarys.org/doc/Page.asp?PageID=DOC100356 false false true X 2.0 3.0 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 MILWAUKEE. 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 Milwaukee County Health Department and representatives from health departments in Milwaukee County. The Milwaukee Health Care Partnership developed a Community Health Needs Assessment (CHNA) team process as a collaboration between health systems and local health departments. 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. JKV Research LLC 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 1,900 people were interviewed. The second level of data gathering was performed by the Center for Urban Population 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 MHCP members had agreed upon those diverse people who represented key aspects of the community. A survey tool was developed by the group and interviews were scheduled by MHCP members and by public health students working with the City of Milwaukee Health Department. In all, 35 individual interviews and five group interviews were conducted by team members. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE. 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 improve access to health care. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Milwaukee, Inc.. The CHNA was conducted with the Center for Urban Population Health. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Columbia St. Mary's Hospital Milwaukee, Inc.. The Milwaukee CHNA identified seven key issues: Infant Mortality, Children's Dental Needs, Breast Cancer, Access to Care in general, Access to Care regarding medical specialists, Inappropriate Use of Emergency Departments and Behavioral Health. Infant mortality, particularly among the African American community in Milwaukee, is a particular health issue needing improvement. CSM has been an important collaborator in city and state efforts to improve birth outcomes and reduce infant mortality rates in Milwaukee. CSM has supported the Lifecourse Initiative for Healthy Families as a community/academic partnership for initiation of a five year funded plan for mortality improvement. A particular CSM focus has been that of Safe Sleep initiatives to assure that infants have a safe place to sleep by providing Pack and Play cribs for mothers without a dedicated infant sleep space. Additionally, parents are educated about the importance of an infant sleeping on his back through a "Back to Sleep" campaign of infant apparel with that message imprinted. Prenatal education is delivered in a community setting through the CSM Blanket of Love Program. Lack of access to oral health care has also been identified in the Needs Assessment. CSM Milwaukee sponsored the Smart Smiles program of school-based oral health care to serve 6,800 children in fiscal 2015. Dentist assessment, oral hygiene care, dental sealants and fluoride treatments are provided in more than 40 schools to meet these needs. The St. Elizabeth Ann Seton Dental Clinic serves as the urgent dental care provider for uninsured people in Milwaukee, both children and adults. Access to primary care has been improved in Milwaukee through the work of St. Bens Clinic for the Homeless and the Community Chronic Disease Management (CCDM) Clinic to treat hypertension and diabetes through church partnerships. Additionally CSM sponsors medical residency programs through CSM Family Health Center and the CSM OB/GYN Clinic. The Columbia College of Nursing sponsors El Centro de Salud to provide health education screening and service through a primary education system in an impoverished area of Milwaukee. Specialty care access has been improved through the work of the Milwaukee Health Care Partnership, (MHCP) a collaboration of Milwaukee's five health systems and four Federally Qualified Health Centers. One program targets uninsured people from the FQHCs. and from area free clinics for access to specialty care. The Specialty Access for Uninsured Program (SAUP) pairs hospitals with FQHCs and free clinics to deliver specialty care for primary care patients. Additionally, the MHCP collaborates with state and county resources to plan for improvement in behavioral health delivery in Milwaukee County. This advisory work continues through participation by CSM vice-presidents and directors. A highlight of cancer screening is the use of a mobile mammography digital coach to deliver breast screening within community settings. This is particularly important for partnership with central city churches to identify women who otherwise would not access traditional hospital based screening. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE. All patients eligible for financial assistance receive a minimum discount of 44% off gross charges for services provided to them. 30 Airport Medical Clinic 4848 S 6th Street Milwaukee WI 53221 Clinic Babbitz Burnstein & Nash 2350 N Lake Drive Suite 201 Milwaukee WI 53221 Clinic Bay View Family Health Center 3056 S Kinnickinnic Ave Milwaukee WI 53207 Clinic CSMCP Pulmonology 2311 N Prospect Ave Milwaukee WI 53211 Clinic Cardiac Rhythm Specialists 2350 N Lake Drive Suite 206 Milwaukee WI 53211 Clinic Cardiac & Vascular Inter Specialists 2350 N Lake Drive Suite 206 Milwaukee WI 53211 Clinic Cathedral Square Urgent Care Center 734 N Jackson St Milwaukee WI 53202 Clinic Columbia West Clinic 10950 W Capitol Drive Wauwatosa WI 53222 Clinic ENT Associates 2350 N Lake Drive Suite 406 Milwaukee WI 53211 Clinic Family Health Center 1121 E North Ave Milwaukee WI 53212 Clinic PMC Neurology 2311 N Prospect Ave Milwaukee WI 53211 Clinic Gateway Medical Center 801 S 70th st West Allis WI 53214 Clinic Glendale Green Bay Clinic 9233 N Green Bay Road Brown Deer WI 53209 Clinic Glendale Port Washington Clinic 6900 N Port Washington Road Glendale WI 53217 Clinic CSM Gyn-Oncology 2350 N Lake Drive Suite 501 Milwaukee WI 53211 Clinic Medical Oncology 2350 N Lake Drive Suite 100 Milwaukee WI 53211 Clinic OBGYN Residency Clinic 2320 N Lake Drive Milwaukee WI 53211 Clinic Perinatal Assessment Center 2323 N Lake Drive Milwaukee WI 53211 Clinic Prospect Medical Commons 2311 N Prospect Ave Milwaukee WI 53211 Clinic Radiation Oncology 2350 N Lake Drive Suite G01 Milwaukee WI 53211 Clinic River Woods Urgent Care 375 W Riverwoods PKWY Glendale WI 53212 Clinic Shorewood Family Physicians 1901 E Capitol Drive Shorewood WI 53211 Clinic West Allis Medical Clinic 2323 S 102ND St West Allis WI 53227 Clinic Westgate Medical Group 2727 N Mayfair Road Wauwatosa WI 53222 Clinic Plastic Surgery 2350 N Lake Drive Suite 501 Milwaukee WI 53211 Clinic Wisconsin Cardiovascular Group 2350 N Lake Drive Suite 400 Milwaukee WI 53211 Clinic CSM Cancer Center 2350 N Lake Drive Suite 100 Milwaukee WI 53211 Clinic Cardiac Rhythm Specialists - Mayfair 2727 N Mayfair Road Wauwatosa WI 53222 Clinic Center For Pain Management 2323 N Lake Drive Milwaukee WI 53211 Clinic CSM Cathedral Square 788 N Jefferson St Milwaukee WI 53202 Clinic Schedule H, Part I, Line 6a Community benefit report prepared by related organization CSM Hospital Milwaukee 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 Milwaukee 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. Schedule H, Part II Community Building Activities Other community programs and services are delivered on a proactive basis from the Community Benefit Plan goals. Highlights of Plan goals include work to improve infant mortality; programs at Seton Dental Clinic to support oral health access, particularly for children; improvement in access to primary and secondary care; improved education and access regarding cancer screening and collaboration with the Milwaukee Health Care partnership. Infant mortality, particularly among the African American community in Milwaukee, is a particular health issue needing improvement. CSM has been an important collaborator in city and state efforts to improve birth outcomes and reduce infant mortality rates in Milwaukee. CSM has supported the Lifecourse Initiative for Healthy Families as a community/academic partnership for initiation of a five year funded plan for mortality improvement. A particular CSM focus has been that of a Safe Sleep initiatives to assure that infants have a safe place to sleep by providing Pack and Play cribs for mothers without a dedicated infant sleep space. Additionally, parents are educated about the importance of an infant sleeping on his back through a "Back to Sleep" campaign of infant apparel with that message imprinted. Prenatal education is delivered in a community setting through the CSM Blanket of Love Program. 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 expenses at cost within Schedule J. Schedule H, Part III, Line 3 Bad Debt Expense Methodology CSMM has a very robust financial assistance program; however, when comparing CSMM's percentage of charity care to its total expenses against the poverty levels in the greater Milwaukee community that CSMM serves, CSMM 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. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is included as part of the Ascension Healthconsolidated audited financials. The footnote that references bad debt expense in the fiscal 2015 consolidated audited financials 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 no 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 Milwaukee: 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 Milwaukee Community Benefit process is coordinated through the work of the Milwaukee Community Benefit Committee (MCBC). The MCBC 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. Two representatives of the CSM Patient Family Advisory Committee participate in the MCBC. The MCBC roles include the following: - Develop Community Health Needs Assessment (CHNA) to determine Milwaukee 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 involved the gathering of secondary information about Milwaukee County from varied public sources including state data, Milwaukee County data and City of Milwaukee data. The most remarkable needs for the service area included addressing infant mortality issues, improving access to oral health care, particularly for children, improving access to primary and specialty care, and improving health disparities, particularly regarding cancer screening. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance CSM Hospital Milwaukee 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 Milwaukee 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 Milwaukee serves a primary service area of eastern Milwaukee County, from the near South Side of Milwaukee north through Ozaukee County. CSM Hospital Milwaukee is located in an urban community within Milwaukee County. The population of Milwaukee County is approximately 953,000, with over 20% of the households living at or below federal poverty guidelines. The median income is approximately $43,000, over 46% of the population is a minority, and approximately 16% of the population speak a language other than English. The service area is varied, with some sectors having high incomes and many health resources while other high admission zip codes are located in the impoverished central city and in medically underserved areas. Several high admitting zip codes for CSM have a high proportion of African American people and two high admitting zip codes have high proportions of people of Hispanic background. Addressing the health disparity issues of these populations is an important part of the Community Benefit service of CSM Hospital Milwaukee. In fiscal 2015, CSM Hospital Milwaukee served 99,302 patients and provided $17,096,849 in traditional charity care (at cost), $6,021,332 in unpaid costs of public programs, $5,084,967 in uninsured discounts and $12,447,830 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 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 6 Affiliated health care system CSM Hospital Milwaukee is part of the CSM Inc., 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 Center, 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. Schedule H, Part VI, Line 7 State filing of community benefit report WI true Milwaukee Area Technical College 700 W State Street Milwaukee WI 53233 396003459 501(c)(3) 6182 Book Expired lab suppies Classroom training supplies Lutheran Mission Attic Workshop 12800 N Lake Shore Drive 12455 W Janesville Rd Muskego WI 53150 391577994 501 (c)(3) 0 62860 Book Medical Supplies and Equipment Support Mission Workshop 2 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 Date 8/4/14) 0 224785 0 75000 0 908 0 0 0 7878 0 308571 0 0 KEVIN GONIU MD BOARD MEMBER /CSM PHYSICIAN 0 388456 0 0 0 121757 0 7800 0 35618 0 553631 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 SANJAY S DESHPANDE MD PHYSICIAN 1443661 0 0 0 22400 0 7800 0 38325 0 1512186 0 0 0 ANTHONY D LINN MD PHYSICIAN 712787 0 0 0 124890 0 7800 0 25271 0 870748 0 0 0 EMAD BOTROS PHYSICIAN 998298 0 0 0 1792 0 7800 0 28574 0 1036464 0 0 0 JOSHUA LIBERMAN PHYSICIAN 1228230 0 0 0 18638 0 7800 0 32643 0 1287311 0 0 0 RICHARD PIRCON PHYSICIAN 1120266 0 0 0 4902 0 7800 0 36998 0 1169966 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Ascension Health, a related organization of Columbia St. Mary's Hospital Milwaukee 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: Anthony J Linn - $101,000 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 SERVE, BASED ON ESTABLISHED GUIDELINES. OFFICERS AND KEY EMPLOYEES PARTICIPATE IN A MANAGEMENT INCENTIVE PLAN, 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 MANY OF THE PERSONS LISTED IN PART VII, SECTION A HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF EMPLOYMENT FOR ASCENSION HEALTH ALLIANCE 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 MILWAUKEE, 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 CSM-M has a single corporate member, CSM. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body CSM-M has a sole member, has a single corporate member, CSM, who has the ability to elect members to the governing body of CSM-M. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders All decisions that have a material impact to CSM-M'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 key employees, 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 CSM 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. 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. CSM does publish an annual report and fact sheets on the external website, which is available for public viewing. Form 990, Part VII, Section B, Line 1 Independent Contractor Reporting Explanation Independent Contractor Reporting Explanation: Compensation of independent contractors is paid by and reported on the Form 1096, Annual Summary and Transmittal of U.S. Information Returns, of Ascension Health EIN 31-1662309. Expenses are allocated to and reimbursed by the filing organization to Ascension Health. As such, the organization has not reported independent contractors paid on Form 990, Part VII, Section B. Form 990, Part VIII, Line 2f Other Program Service Revenue Community Education - Total Revenue: 90847, Related or Exempt Function Revenue: 90847, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; H&M Ins Revenue - Total Revenue: 358613, Related or Exempt Function Revenue: 358613, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Misc Revenue - Total Revenue: 319765, Related or Exempt Function Revenue: 319765, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Payroll RCM Fees - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; Revenue Enhancement - Total Expense: 33438369, Program Service Expense: 33438369, Management and General Expenses: , Fundraising Expenses: ; Contract labor - Total Expense: 3874307, Program Service Expense: 3856964, Management and General Expenses: 17343, Fundraising Expenses: ; Professional Fees - Total Expense: 18842880, Program Service Expense: 18903089, Management and General Expenses: -60209, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Intercompany Loan Adjustment - XXX-XX-XXXX; COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC 4425 NORTH PORT WASHINGTON ROAD MILWAUKEE WI 53212 390807063 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 Columbia Health System true 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 Related SLEEP SERVICES OF WISCONSIN LLC 111 E KILBOURN AVE STE 1300 MILWAUKEE WI 53202 273148310 SLEEP SERVICES WI NA Related COLUMBIA ST MARY'S STRATEGIC ALLIANCE 4425 N PORT WASHINGTON RD GLENDALE WI 53212 HEALTHCARE WI NA C Corporation true MADISON MEDICAL AFFILIATES 4425 N PORT WASHINGTON RD GLENDALE WI 53212 391855720 HEALTHCARE WI NA C Corporation true PROSPECT MEDICAL COMMONS CONDO ASSOCIATION 4425 N PORT WASHINGTON RD GLENDALE WI 53212 208042108 CONDO ASSOCIATION WI NA C Corporation true false false true false true false false false false false false true true false false true false false false Columbia St Mary's Inc M 65887891 Book Sacred Rehabilitation Institute Inc L 1254383 Book Ascension Health E 107437340 Book Columbia St Mary's Inc C 817375 Book Columbia St Mary's Hospital Ozaukee Inc L 2092580 Book Sacred Heart Rehabilitiation Insititue Inc L 55768 Book Madison Medical Affiilates L 3953623 Book IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST NAME OF RELATED ORGANIZATION: MADISON MEDICAL AFFILIATES, INC DIRECT CONTROLLING ENTITY: COLUMBIA ST. MARY'S HOSPITAL, INC.