2015-05-14T10:46:13-05:00 2014-06-30 861065772 Deloitte Tax LLP 555 East Wells Street Suite 1400 Milwaukee WI 53202 990 2013-07-01 390816818 St Elizabeth Hospital Inc STEL 9207382000 1506 South Onedia Street Appleton WI 549151397 Jeffrey Francis Ministry Health Care CAFO 9207382000 2015-05-13 1 Rachel Becker P00966076 4142703000 2015-05-07 2013 2016-02-25 16:41:14Z Jeffrey Francis 1506 South Onedia Street Appleton WI 549151397 191724614 0 0928 X www.affinityhealth.org X 1899 WI To further the healing ministry of Jesus by improving the health and well-being of all people. 18 10 1354 412 172652 -49396 1887720 1469503 134504858 184284906 39454 235141 1379149 4584388 137811181 190573938 58500 613381 0 0 56762320 78437985 0 0 0 56461378 74601315 113282198 153652681 24528983 36921257 147885810 195528987 118972312 126076497 28913498 69452490 The mission of St. Elizabeth Hospital, Inc. is to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor. 0 0 122523300 613381 186133500 St. Elizabeth Hospital, Inc. provides inpatient, outpatient, emergency room, and ancillary services regardless of an individual's ability to pay. The Hospital also provides educational programs and services on health care issues to the community it serves. See Schedule H for further details. 122523300 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 71 0 1 1354 1 1 1 0 0 0 0 0 0 0 0 0 X 18 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X Jeffrey Francis 4143593145 222 W College Avenue 3rd Floor Appleton WI 54911 William Calhoun President at MMC 10.00 31.60 X X 0 392457 47205 Stephen C Morton Chairman 0.30 1.20 X X 0 0 0 Daniel Neufelder Sr. VP Hosp Ops/Vice Chair 10.00 46.10 X X 0 896266 89267 John Russo end 1213 Vice Chairman 0.30 1.20 X X 0 0 0 Wayne Trembly Secretary 0.30 1.20 X X 0 0 0 Kathryn Sieman Treasurer 0.30 1.20 X X 0 0 0 Lane Earns Board Member 0.30 1.20 X 0 0 0 Mark Faustich MD Board Member 0.30 40.80 X 0 409546 24567 Mary Harp-Jirschele Board Member 0.30 1.20 X 0 0 0 Frederick Klein MD Board Member 0.30 1.20 X 0 0 0 Joseph McCormick MD Board Member 0.30 40.80 X 0 906132 54733 Kevin Ralofsky start 114 Board Member 0.30 1.50 X 0 0 0 Jay Sauter Board Member 0.30 1.20 X 0 0 0 Stacey Sensor DO Board Member 0.30 41.10 X 0 582436 36897 Sudeep Sodhi MD Board Member 0.30 40.80 X 0 851724 54749 Barbara J Strand MD Board Member 0.30 40.80 X 0 313912 29366 Catherine Tierney Board Member 0.30 1.20 X 0 0 0 Monica Vomastic Board Member 0.30 1.20 X 0 0 0 Nicholas Desien Ministry Health Care CEO 1.00 55.30 X 0 2061606 41974 Jeffrey Francis Ministry Health Care CAFO 1.00 64.90 X 0 522252 124025 Travis Andersen Hospital Pres - STE App 40.00 1.30 X 0 355671 48793 Mark Kehrberg Chief Medical Officer AHS 10.00 30.60 X 0 394415 54779 Lawrence Donatelle Vice President of Medical Affairs 40.00 0.00 X 308458 0 46816 Jennie Rebecca Gaurkee Pharmacy Director 40.00 0.00 X 170491 0 33346 Debra Lastofka Pharmacist 40.00 0.00 X 149291 0 30772 Annette Siedschlag Pharmacist 40.00 0.00 X 139884 0 25518 Brian G Humphrey Senior Ultrasound Technologist 40.00 0.00 X 139993 0 12903 Jeanne Maurer Pharmacist 40.00 0.00 X 138825 0 38831 Jeff Badger Former Officer 0.00 52.00 X 0 497813 62987 1046942 8184230 857528 35 1 1 0 The Boldt Company 2525 N Roemer Rd PO Box 419 Appleton WI 54912 Purchased Services 21242873 Boldt Procurement LLC 2525 N Roemer Rd PO Box 419 Appleton WI 54912 Purchased Services 7985017 Hammel Green & Abrahamson Inc 333 East Erie Street Milwaukee WI 53202 Consulting & Design Services 3051068 GE Healthcare PO Box 96483 Chicago IL 60693 Equipment Repairs 963231 Outagamie Department of Solid Waste 1419 Holland Road Appleton WI 54911 Construction Bed Tower 881817 36 1469503 1469503 Net Patient Revenue 622110 184315801 184315801 Misc. Hospital Revenue 622000 1054842 1054842 Outpatient Lab Revenue 621500 168702 168702 Genetic Services 900099 3950 3950 Equity Int. in Catalpa 621500 -1258389 -1258389 184284906 188868 188868 2637046 1092625 1544421 1544421 1544421 104324 58051 46273 46273 46273 EHR Incentive Pymnt 900099 1902077 1902077 Cafeteria Income 722210 1018721 1018721 Other Non-Op. Revenue 900099 119169 119169 3039967 190573938 186133500 172652 2798283 613381 613381 62422653 51852955 10569698 1530409 1530409 10579402 7571425 3007977 3905521 3905521 4989172 1128315 3860857 25824848 24937811 887037 4126976 3424844 702132 443251 36213 407038 2926656 2926656 6421765 5788273 633492 632017 617461 14556 Purchased Services 15003704 9411042 5592662 Pharmaceuticals 7348003 7329235 18768 Food 1120198 1033018 87180 Dues 203432 27935 175497 5561293 388806 5172487 153652681 122523300 31129381 0 14212352 3280970 864442 660107 23780846 27070582 2892284 3145705 459390 169831 161289910 7632800 100453087 153657110 5223409 7544682 147885810 195528987 25777492 36770693 79640825 79236726 13553995 10069078 118972312 126076497 X 28865122 68434029 48376 1018461 28913498 69452490 147885810 195528987 X 36921257 47122 3570613 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10845 10845 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. St. Elizabeth Hospital, Inc. 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. 4117424 4117424 56899329 3427080 53472249 415308 66895 348413 29841760 4091700 25750060 70016089 47125 69968964 153657110 Pension Liability 7809592 Due to Third Party Payors 753950 457(b) Plan 581198 Unspecified Revenue 520000 Deferred Tax Liability 404338 10069078 X Part X, Line 2: From the consolidated audited financial statements of Ministry Health Care, Inc. which include the activity of St. Elizabeth Hospital, Inc.: The Health Ministry accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position or expected to be taken in a tax returns. 1 1 1 X 1 X 1 1 1 0 1 1 2115640 2115640 0.01380 3458733 3458733 0.02250 86153 86153 0.00060 5660526 5660526 0.03690 15 2959 523716 838 522878 0.00340 3 43 1023770 167765 856005 0.00560 2 4700933 4149610 551323 0.00360 11 5351 667886 667886 0.00430 31 8353 6916305 4318213 2598092 0.01690 31 8353 12576831 4318213 8258618 0.05380 1 170 569 569 0.00000 2 15966 15966 0.00010 2 44 983 983 0.00000 3 87 1214 1214 0.00000 8 301 18732 18732 0.00010 0 7898641 0 65953283 63403017 2550266 X 1 1 1 1 St Elizabeth Hospital Inc 1506 South Oneida Street Appleton WI 54915 www.affinityhealth.org 88 X X X X St Elizabeth Hospital Inc 1 1 X X X X X X X X X 12 1 1 1 X See Part v, Section B X X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 St. Elizabeth Hospital, Inc. Part V, Section B, Line 3: St. Elizabeth Hospital, Inc. participated in the assessment processes that gathered input from both private and public Outagamie, Calumet and Winnebago County organization members including: medical staff, nurses and administrators; clinic personnel; public health nurses and educators; behavioral health staff and leaders; health insurance-health management staff, elementary, high school and post high school educators, nurses and administrators; police and emergency personnel; child, women's, family and senior social services; as well as community members interested in the health needs assessment process. Several Affinity representatives participated as a member of the Fox Valley L.I.F.E. Study and/or Fox Valley Regional Community Health Coalition throughout the assessment process. Ernesto Gonzalez, CASA Hispana was consulted about the Latino community health needs. As part of the Fox Cities L.I.F.E. Study, Kristene Stacker, Fox Cities Community Health Clinic was consulted about the medically underserved community health needs.Outagamie County Public Health Experts:- Mary Dorn, Public Health Manager of Outagamie County, Department of Health and Human Services, Division of Public Health BSN and Master's in Public Health (MPH).- Fifteen years of public health experience in tribal and local health department settings focusing on population based health.- Sue Kamien, Health Officer/Maternal Child Health Supervisor of Outagamie County Health and Human Services.- More than 30 years of public health experience with a focus on nutrition, maternal and child health.- Ellen Koski, Community Health Educator of Outagamie County, Department of Health and Human Services, Division of Public Health, Master's in Public Health (MPH).- Nine years of academic and community programming through the University of Minnesota School of Public Health.- City of Appleton Health Experts:Kurt Eggebrecht, Public Health Officer, Appleton Health Department, Master's in Education (M.Ed).- Thirteen years of experience as City of Appleton Health Officer conducting and overseeing community health needs assessments; has more than 34 years health promotion/disease prevention experience.City of Menasha Health Experts:- Sue Nett, Public Health Director, City of Menasha Health Department BSN and Master in Public Administration.- About 28 years of experience as City of Menasha Public Health Director overseeing the health of the community with 10 years of experience conducting and overseeing community needs assessments (as part of the Fox Cities L.I.F.E. Study). St. Elizabeth Hospital, Inc. Part V, Section B, Line 4: Conducted with Calumet Medical Center, Mercy Medical Center, Thedacare, and Aurora Health. St. Elizabeth Hospital, Inc. Part V, Section B, Line 5d: http://www.affinityhealth.org/Affinity-Files/Community- Health-Needs-Assessments/FY2013-STE-CHNA_FINAL4.pdf St. Elizabeth Hospital, Inc. Part V, Section B, Line 7: Three other broad health categories were identified by the Community Health Needs Assessment process. While individual segments within our system are addressing specific health needs within these broad categories (i.e. COPD, hypertension, palliative care, etc.), the following will not be a priority of St. Elizabeth Hospital, Inc.:- Chronic Disease Management - already being addressed by others in the community and system (with the exception of obesity, which is a priority need for St. Elizabeth Hospital, Inc.);- Sexual Activity, Pregnancy and Parenting - already being addressed by others in the community;- Preventive Care Services - already being addressed by others in the community;Fourteen other health issues were identified by the Community Health Needs Assessment process. Given the reasons indicated below, St. Elizabeth Hospital, Inc. will not be focusing on these health needs at this time.- Access to dental care - already being addressed by others in the community- Low birth weights - already being addressed by others in the community.- Teen birth rate up - already being addressed by others in the community.- High cost of child care - Hospital does not have the expertise to effectively address the need.- Increased gaps in care management for people with disabilities of all ages - already being addressed by others in the community.- Increase in low income students - Hospital does not have the expertise to effectively address the need.- Decreased water quality - Hospital does not have the expertise to effectively address the need.- Increased elder abuse - already being addressed by others in the community.- Increase in violent crime esp. drug-related - Hospital does not have the expertise to effectively address the need.- Increased homelessness related to unemployment (more children) - insufficient resources (financial and personnel) to address the need.- Increased FoodShare recipients - insufficient resources (financial and personnel) to address the need.- Increased food insecurity and hunger - Hospital does not have the expertise to effectively address the need.- Transportation challenges - Hospital does not have the expertise to effectively address the need.- Availability of jobs with health care benefits - insufficient resources (financial and personnel) to address the need. St. Elizabeth Hospital, Inc. Part V, Section B, Line 14g: A plain language summary of the financial assistance policy is available in the following locations:- The Hospital facility's website- Attachment to billing invoices- Posted to the Hospital facility's emergency rooms and waiting rooms- Posted in the Hospital facility's admission offices- Provided, in writing, to patients on admission to the Hospital facility. Part I, Line 3c: It is the policy of St. Elizabeth Hospital, Inc. to provide medically necessary health care services to people in the communities it serves, regardless of their ability to pay. Affinity Care financial assistance is granted based upon the patient's inability to pay and to individuals who are uninsured, underinsured or medically indigent. Affinity Care works in collaboration with other financial (both public and private) assistance programs. This is to ensure holistic wellness of patients by facilitating knowledge of available services and programs for health while practicing good stewardship of funds. Key criteria utilized to determine eligibility for Affinity Care financial assistance includes family size, federal poverty income guidelines and available assets. The available asset test includes consideration of the amount of equity in a home, automobiles, and savings accounts which are considered part of total allowable income when assessing against the federal poverty income guidelines. Part I, Line 6a: St. Elizabeth's Hospital, Inc. is included in the annual community benefit report which is published by Ministry Health Care (EIN: 39-1490371) and available to the public on its website, www.ministryhealth.org. This report includes all of the related entities within the Ministry Health Care network of hospitals, clinics and other health-related organizations. Part I, Line 7: Amounts calculated in Part I, Line 7 are determined both on a cost accounting system and a cost-to-charge ratio. Other benefits are determined based on the direct and indirect costs (where allocated) associated with a program net of earned revenue. Detail for each program/activity is maintained and determined at the department level. Charity care and means-tested programs are determined based on a cost-to-charge ratio consistent with Worksheet 2, Ratio of Patient Care Cost to Charges. Prior year cost report settlements are excluded from the shortfall calculation in order to get a true fiscal year shortfall amount. Part II, Community Building Activities: Community-building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the organization. Costs for these activities include cash, in-kind donations, and expenditures for the development of a variety of community health programs and partnerships.Some examples include: Rebuilding Together in which managers from St. Elizabeth Hospital went out to help low-income elderly members of the community with remodeling projects to improve safety or condition of their homes. Another example is the Health Career Experience Day in which professionals from St. Elizabeth Hospital, Inc. highlighted a variety of healthcare careers and talk about their professions (i.e. nursing, surgery, laboratory and radiology). Part III, Line 2: Accounts are written off to bad debt after all internal collection efforts have been exhausted. Attempts to resolve these outstanding balances can include, but are not limited to statements being sent, phone calls and letters being sent. Account follow up protocol is based on personal pay balance size owed. Part III, Line 3: St. Elizabeth Hospital, Inc. has a very robust financial assistance program; therefore, no estimate is made for bad debt attributed to financial assistance eligible patients. Part III, Line 4: From the consolidated audited financial statements of Ministry Health Care, Inc. (which includes the activity of St. Elizabeth Hospital, Inc.):The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful 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 doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Ministry 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 Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Ministry's policies.The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. The Health Ministry has not experienced material changes in write-off trends and has not materially changed its charity care policy in the current year. Part III, Line 8: 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. Part III, Line 9b: St. Elizabeth Hospital, Inc. has a debt collection policy which sets forth collection practices for patients who are known to qualify or may qualify for financial assistance under the charity care program. Sufficient financial counseling support is made available to patients so they can easily access patient financial service representatives and have their questions answered, and gain an understanding of the reasons why they owe a balance. Accounts are designated as charity care in the business offices so no additional time is spent on collection efforts. Part VI, Line 2: St. Elizabeth Hospital, Inc. performs community health needs assessments as needed. Planning workgroups consisting of community partners are formed to define the community and its health needs through review of United Way Life Study results, Healthy People Initiatives, census documents, and local government health and welfare agencies. Considering other community resources/assets, data collection methods are used to identify particular problems or subgroups and areas known to have high poverty rates and to be underserved. The data is analyzed and priorities are set based on trending information which may target a specific need. When a need is identified, the Hospital develops a plan to implement a program either through community collaboration or individually. Outcomes from the programs are measured and considered in subsequent community health needs assessments. The leadership at Affinity takes their commitment to the health and well-bring of the community it serves very seriously. In fact, it is core to the Organization's mission, "to live out the healing ministry of Christ by providing services that promote the health and well-being of the communities we serve, especially the poor." Senior leaders and management are also highly encouraged to provide direct service to the poor in their communities. St. Elizabeth and the leadership also subscribe to publications like the Advisory Board to compare national trends to local trends to ensure the hospital is resourcing areas to meet patient needs. Part VI, Line 3: St. Elizabeth Hospital, Inc. goes to great lengths in order to inform and educate patients/persons who may be billed for patient care about their eligibility for assistance under federal, state or local government programs and under the organizations Affinity Care Policy. The Affinity Care Policy and application is posted on the Organization's website. Admissions and other key areas contain summary information of the Affinity Care Policy. As part of the intake/discharge process, patients are provided with a copy of the policy and other information for financial assistance. If during the course of the patient registration process, care encounter, treatment, or upon discharge it becomes evident that a patient may need financial assistance, the patient shall be referred to the organizations Affinity Care Program. Patients may be identified as needing financial assistance at any time during the course of an encounter. A referral for consideration of Affinity Care financial assistance can be initiated by any member of the Hospital's workforce, including medical staff members, who become aware of the patients potential need for Affinity Care financial assistance. The Affinity Care brochure was also translated into dialects prevalent in the community in order to reach out to those that may speak another language (Spanish and Hmong). Patient registration staff and financial counselors are provided with guidelines to follow when interacting with patients. As part of the Affinity Care process, patients must register with the county public assistance to see if they may qualify under any other federal or state programs. Part VI, Line 4: While there is growing agreement in the United States about what constitutes a non-profit hospitals "community benefit," this is a work in progress. St. Elizabeth Hospital, Inc. provided significant charity care and other community benefits as defined by the IRS. But in addition, we believe that we provide a critically important community benefit, which is not quantified. St. Elizabeth Hospital, Inc., like most community hospitals, was created and is maintained in order to provide care locally, care that without our hospital, may not be available locally.Certain specialized services available include: I/P adult behavioral health services, I/P adolescent behavioral health services and neonatal intensive care services.The City of Appleton is located in Outagamie, Calumet, and Winnebago counties. According to the 2008-2012 American Community Survey 5-Year Estimates, there were 72,575 people living in Appleton, consisting of 28,428 households and 18,074 families. The population density of Appleton was 2,984.9 people per square mile. The population consisted of 86.0% White, 4.7% Hispanic, 1.6% African American, 0.5% Native American, 5.3% Asian, and 1.9% Other.Of the 28,428 households in Appleton, 32.8% of those had children under the age of 18, living at home. The 28,428 households are categorized as 49% married couples living together, 4.1% had a male head of household with no wife present, 10.5% had a female head of household with no husband present, and 47% were non-families. 29.6% of the households consisted of individuals and 10.1% had someone 65 and older living alone.The age population is widely spread. 28.9% were under 18, 6.5% were 19-24, 26.8% were 25-44, 26.3% were 45-64, and 11.5% were 65+. The median income for a household was $52,605 and the median income for a family was $66,781. The per capita income for the city was $27,106. The largest industry in Appleton is educational, health and social services (21.5%). Manufacturing (20.4%) and retail trade (11.4%) are the next largest industries in Appleton.Roughly 8% of families and 10.5% of the population were below the poverty line. That includes 13.5% of those under 18 years old and 7.4% of those 65 and older.The unadjusted seasonal unemployment rate for Outagamie, Calumet, and Winnebago Counties was 4.0%, 3.7%, and 4.3%, respectively, compared to a state unemployment rate of 5.1% and a national unemployment rate of 7.9%. Part VI, Line 5: The Organization strives to further its exempt purposes by the following:(1) The Organization's governing board consists primarily of persons who reside within the primary service area who are not employees of the Organization.(2) As mentioned, the Organization provides several services which are not otherwise available being in a rural setting.(3) Based on the Organization's mission, emergency rooms are made available to all patients regardless of the ability to pay.(4) The Organization also participates in the education and training of healthcare professionals through internship programs.Certain specialized services available include: dental services to primarily the indegent, fertility clinic services and WIC home visits to new mothers and infants. Part VI, Line 6: Ministry Health Care, Inc. ("Ministry" or "the Health Ministry") is a member of Ascension Health. Ascension Health Alliance, d/b/a Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporations that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. Ascension and its member organizations are hereafter referred to collectively as the System.Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; the Congregation of Alexian Brothers of the Immaculate Conception Province, Inc. American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System, which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi US/Caribbean Province, became part of Ascension Health on April 1, 2013.The Health Ministry is a Wisconsin non-stock, tax-exempt corporation that manages, promotes, and supports health care and related ministries in Wisconsin and Minnesota. The Health Ministry provides inpatient, outpatient, and emergency care services for the residents of Wisconsin and Minnesota. Admitting physicians are primarily practitioners in the local area. The Health Ministry is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of the Health Ministry are related to providing health care services.The consolidated financial statements include the following affiliates in which Ministry has a controlling interest or is the sole sponsor.Affiliate Organization LocationAffinity Health System, Inc. (Affinity)Calumet Medical Center, Inc. (CMC) Chilton, WINetwork Health System, Inc. (NHS)Affinity Medical Group (AMG) Fox Valley of WisconsinTwin Med, LLC Fox Valley of WisconsinMercy Medical Center, Inc. Oshkosh, WIMercy Health Foundation Oshkosh, WISt. Elizabeth Hospital Appleton, WICatalpa Health Appleton, WISt. Elizabeth Foundation Appleton, WIAgape Community Center of Milwaukee, Inc. Milwaukee, WIDoor County Memorial Hospital (Door County) Sturgeon Bay, WIGood Samaritan Health Center of Merrill Merrill, WIGood Samaritan Health Center Foundation Merrill, WIHoward Young Health Care, Inc. (Howard Young)Dr. Kate Newcomb Convalescent Center Woodruff, WIHoward Young Medical Center, Inc. Woodruff, WIHoward Young Foundation Woodruff, WIEagle River Memorial Hospital, Inc. Eagle River, WIMinistry Holdings, Inc.Network Health (NH) Fox Valley of WisconsinNetwork Health Insurance Corporation (NHIC) Fox Valley of WisconsinMinistry Home Care, Inc.Ministry Home Care Services Various in WisconsinMinistry Medical Group, Inc.Our Lady of Victory Hospital Stanley, WISacred Heart Hospital- Tomahawk, WI/Rhine-St. Mary's Hospital, Inc. -lander, WISaint Clare's Hospital of Weston, Inc. Weston, WIFoundation of St. Clare's Hospital of Weston, Inc. Weston, WISt. Elizabeth's Hospital of Wabasha, Inc. Wabasha, MNSt. Joseph's Hospital of Marshfield, Inc. Marshfield, WIFoundation of St. Joseph's Hospital of Marshfield, Inc. Marshfield, WISt. Michael's Hospital of Stevens Point, Inc. Stevens Point, WISt. Michael's Foundation of Stevens Point, Inc. Stevens Point, WIMission:The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:- Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured.- Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.- Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.- Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and other community benefit programs. The cost of providing care to persons living in poverty and other community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.The amount of traditional charity care provided, determined on the basis of cost, was approximately $18,380,000 for the year ended June 30, 2014. The amount of unpaid cost of public programs, cost of other programs for persons living in poverty and other vulnerable persons, and community benefit cost are reported in the accompanying supplementary information. 1 Partnership Community Health Center Inc 5337 Grande Market Drive Appleton WI 54913 202090446 Section 501(c)(3) 613381 Provide Medical Care For the Uninsured In Our Community 1 0 Part I, Line 2: Each year St. Elizabeth Hospital provides a grant based on an integration agreement. The integration agreement substantiates the amount and the recipient of the grant. 0 1 0 0 0 0 0 0 0 William Calhoun President at MMC 0 330620 0 44429 0 17408 0 29514 0 17691 0 439662 0 0 Daniel Neufelder Sr. VP Hosp Ops/Vice Chair 0 770217 0 95952 0 30097 0 70286 0 18981 0 985533 0 0 Mark Faustich MD Board Member 0 387296 0 0 0 22250 0 20384 0 4183 0 434113 0 0 Joseph McCormick MD Board Member 0 891235 0 0 0 14897 0 35000 0 19733 0 960865 0 0 Stacey Sensor DO Board Member 0 567140 0 0 0 15296 0 17500 0 19397 0 619333 0 0 Sudeep Sodhi MD Board Member 0 834731 0 0 0 16993 0 35000 0 19749 0 906473 0 0 Barbara J Strand MD Board Member 0 246953 0 40532 0 26427 0 21723 0 7643 0 343278 0 0 Nicholas Desien Ministry Health Care CEO 0 1004953 0 329299 0 727354 0 15000 0 26974 0 2103580 0 0 Jeffrey Francis Ministry Health Care CAFO 0 427032 0 63804 0 31416 0 101523 0 22502 0 646277 0 0 Travis Andersen Hospital Pres - STE App 0 281005 0 45452 0 29214 0 31388 0 17405 0 404464 0 0 Mark Kehrberg Chief Medical Officer AHS 0 333905 0 25071 0 35439 0 39160 0 15619 0 449194 0 0 Lawrence Donatelle Vice President of Medical Affairs 257910 0 24454 0 26094 0 29525 0 17291 0 355274 0 0 0 Jennie Rebecca Gaurkee Pharmacy Director 160656 0 0 0 9835 0 17275 0 16071 0 203837 0 0 0 Debra Lastofka Pharmacist 126959 0 0 0 22332 0 22405 0 8367 0 180063 0 0 0 Annette Siedschlag Pharmacist 122283 0 0 0 17601 0 23000 0 2518 0 165402 0 0 0 Brian G Humphrey Senior Ultrasound Technologist 133518 0 0 0 6475 0 6686 0 6217 0 152896 0 0 0 Jeanne Maurer Pharmacist 117818 0 0 0 21007 0 23000 0 15831 0 177656 0 0 0 Jeff Badger Former Officer 0 405962 0 56934 0 34917 0 44888 0 18099 0 560800 0 0 Part I, Line 3 Ministry Health Care, Inc., a related organization of St. Elizabeth Hospital, Inc., uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Part I, Line 4b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. No distributions were made from the plan during the year. Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of employment by Ministry Healthcare, Inc. related entities. Form 990, Part VI, Section A, line 6 St. Elizabeth Hospital, Inc. has a two corporate members, Ministry Healthcare, Inc. and Affinity Health System. Form 990, Part VI, Section A, line 7a St. Elizabeth Hospital, Inc. has a two corporate members, Ministry Healthcare, Inc. and Affinity Health System, who has the ability to elect members to the governing body of St. Elizabeth Hospital Inc. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to St. Elizabeth Hospital, Inc. financial information or corporation as a whole are subject to approval by its two corporate members, Ministry Healthcare, Inc. and Affinity Health System. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. 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, Section B, line 12c The Organization regularly and consistently monitors and enforces compliance with the Conflict of Interest 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 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 Conflict 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, Section B, line 15 In determining compensation of the organization's CEO, the process, performed by Ministry Health Care, Inc., a related organization of St. Elizabeth Hospital, 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 board minutes. The individual was not present when his compensation was decided. In determining compensation of other officers and key employees of the organization, the process, performed by Ministry Health Care, Inc., a related organization of St. Elizabeth Hospital, 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 other officers and key employees of the organization were 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 board minutes. Form 990, Part VI, Section C, line 19 The Ministry web page is available to the public for inspection with a good deal of information regarding whom Ministry Health Care is and the entities included along with our mission. The Articles of Incorporation, Bylaws, Conflicts of Interest Policy, and financial statements are not included on any web page. However, if an inquiry is made for any documents, they are shared as appropriate. Form 990, Part XI, line 9: FASB 136 Elimination - St. Elizabeth Hospital Foundation 970,085. Pension Adjustment 2,600,528. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 631453806 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Ministry Health Care Inc 10925 W Lake Park Dr Ste 100 Milwaukee WI 53224 391490371 Parent Corporation WI Section 501(c)(3) Schedule A, Line 11b Ascension Health 0 Affinity Health System Inc 1570 Midway Place Menasha WI 54952 391568866 Support related healthcare organziations IL Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 0 Agape Community Center of Milwaukee Inc 6100 North 42nd Street Milwaukee WI 532093560 391461846 Community Center WI Section 501(c)(3) Schedule A, Line 1 Ministry Health Care Inc 1 Calumet Medical Center Inc 614 Memorial Drive Chilton WI 53014 390905385 Hospital WI Section 501(c)(3) Schedule A, Line 3 Affinity Health System Inc 1 Catalpa Health Inc N4642 County N Appleton WI 54914 454681563 Mental Health Facility WI Section 501(c)(3) Schedule A, Line 3 St Elizabeth Hospital Inc 1 Saint Michael's Foundation of Stevens Point Inc 900 Illinois Avenue Stevens Point WI 54481 391657410 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 11a St Michael's Hospital of Stevens Point Inc 1 Door County Memorial Hospital 323 South 18th Avenue Sturgeon Bay WI 54235 390806324 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Dr Kate Newcomb Convalescent Center Inc PO Box 829 Woodruff WI 54568 391357365 LTC Facility WI Section 501(c)(3) Schedule A, Line 3 Howard Young Health Care Inc 1 Eagle River Memorial Hospital Incorporated 201 Hospital Road Eagle River WI 54521 390985690 Hospital WI Section 501(c)(3) Schedule A, Line 3 Howard Young Medical Center 1 Foundation of Saint Clare's Hospital of Weston Inc 3400 Ministry Parkway Weston WI 54476 733193633 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 11a St Clare's Hospital of Weston Inc 1 Foundation of Saint Joseph's Hospital of Marshfield Inc 611 Saint Joseph Avenue Marshfield WI 54449 391684957 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 11a St Joseph's Hospital of Marshfield Inc 1 Good Samaritan Health Center of Merrill Wisconsin Inc 601 South Center Avenue Merrill WI 54452 390808503 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Good Samaritan Hlth Cntr Foundation of Merrill Wisconsin Inc 601 South Center Avenue Merrill WI 54452 391627755 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 11a Ministry Health Care Inc 1 Howard Young Foundation Inc 240 Maple Street Woodruff WI 54568 391521169 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 7 Ministry Health Care Inc 1 Howard Young Health Care Inc 240 Maple Street Woodruff WI 54568 391499115 Home Office WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Howard Young Medical Center Inc 240 Maple Street Woodruff WI 54568 390873606 Hospital WI Section 501(c)(3) Schedule A, Line 3 Howard Young Health Care Inc 1 Mercy Health Foundation Inc PO Box 3370 Oshkosh WI 54903 237140261 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 9 Affinity Health System Inc 1 Mercy Medical Center of Oshkosh Inc 500 S Oakwood Road Oshkosh WI 54904 390806268 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Ministry Home Care Inc 611 St Joseph Avenue 4S Marshfield WI 54449 391936201 Home Care/Hospice WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Ministry Medical Group Inc 824 Illinois Avenue Stevens Point WI 54481 391965593 Clinics WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Ministry Weight Management Inc 2251 North Shore Drive Rhinelander WI 54501 391829015 Health Services WI Section 501(c)(3) Schedule A, Line 3 Sacred Heart-St Mary's Hospital Inc 1 Network Health System Inc 1570 Appleton Rd Menasha WI 54952 391127163 Clinical Healthcare Services WI Section 501(c)(3) Schedule A, Line 3 Affinity Health System Inc 1 Our Lady of Victory Hospital Inc 1120 Pine Street Stanley WI 54768 390807065 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Sacred Heart-St Mary's Hospitals Inc PO Box 347 Stevens Point WI 54481 391390638 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Saint Clare's Hospital of Weston Inc 3400 Ministry Parkway Weston WI 54476 721531917 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Saint Elizabeth's Hospital of Wabasha Inc 1200 Grant Blvd West Wabasha MN 55981 410693877 Hospital MN Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 St Elizabeth Hospital Foundation Inc 1506 S Oneida Street Appleton WI 54915 391256677 Charitable Foundation WI Section 501(c)(3) Schedule A, Line 7 Affinity Health System Inc 1 Saint Joseph's Hospital of Marshfield Inc 611 Saint Joseph Avenue Marshfield WI 54449 390847631 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Saint Michael's Hospital of Stevens Points Inc 900 Illinois Avenue Stevens Point WI 54481 390808443 Hospital WI Section 501(c)(3) Schedule A, Line 3 Ministry Health Care Inc 1 Twin Med LLP PO Box 8005 Menasha WI 54952 391180341 Rental Property WI N/A Network Health Plan Inc 1570 Midway Place Menasha WI 54952 391442058 Insurance WI N/A C 0 Ministry Holdings Inc 1570 Midway Place Menasha WI 54952 422966177 Insurance Holding Company WI N/A C 0 1 0 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 Network Health System Inc A 2476612 FMV Network Health System Inc A 161609 FMV St Elizabeth Hospital Foundation Inc C 1469497 FMV Ministry Health Care Inc E 86609853 FMV Mercy Medical Center of Oshkosh Inc L 448350 FMV Mercy Medical Center of Oshkosh Inc M 324316 FMV Network Health System Inc O 231896 FMV Affinity Health System Inc O 133518 FMV Ministry Health Care Inc O 13455445 FMV Network Health Plan Inc O 58170 FMV Calumet Medical Center Inc O 187803 FMV Mercy Medical Center of Oshkosh Inc O 761270 FMV Ministry Health Care Inc P 10769605 FMV Network Health Systems Inc Q 890747 FMV Ministry Health Care Inc R 4270893 FMV Network Health System Inc S 167750 FMV