ASCENSION WISCONSIN INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
ASCENSION WISCONSIN INC (EIN 39-1834639)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-15
IRS object ID
201501359349308865
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-15T17:35:48-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1555 E Wells St Suite 1400AddressLine1
CityMilwaukeeCity
StateWIState
ZIP Code53202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391834639EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Columbia St Mary's IncBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCOLUBusinessNameControlTxt
Phone4143262230PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14425 North Port Washington RoadAddressLine1
Address Line2Suite 301AddressLine2
CityGlendaleCity
StateWIState
ZIP Code53212ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRhonda AndersnPersonNm
Person TitleInterim CFOPersonTitleTxt
Phone4143262230PhoneNum
Signature2015-05-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonRachel J BeckerPreparerPersonNm
PTINP00966076PTIN
Phone4142713000PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTravis AndersenPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14425 North Port Washington RoadAddressLine1
Address Line2Suite 301AddressLine2
CityGlendaleCity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$151,208,194GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresscolumbia-stmarys.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionHealth care system dedicated to making a positive difference in individuals and our community.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee540TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$49,417TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$3,118NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$376,402PYContributionsGrantsAmt
CY Contributions Grants$364,187CYContributionsGrantsAmt
PY Program Service Revenue$116,024,234PYProgramServiceRevenueAmt
CY Program Service Revenue$141,309,835CYProgramServiceRevenueAmt
PY Investment Income$4,455,324PYInvestmentIncomeAmt
CY Investment Income$4,596,687CYInvestmentIncomeAmt
PY Other Revenue$5,398,028PYOtherRevenueAmt
CY Other Revenue$4,937,485CYOtherRevenueAmt
PY Total Revenue$126,253,988PYTotalRevenueAmt
CY Total Revenue$151,208,194CYTotalRevenueAmt
PY Grants And Similar Paid$429,175PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$428,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$38,555,157PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$18,951,026CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$97,433,085PYOtherExpensesAmt
CY Other Expenses$87,298,238CYOtherExpensesAmt
PY Total Expenses$136,417,417PYTotalExpensesAmt
CY Total Expenses$106,677,264CYTotalExpensesAmt
PY Revenues Less Expenses-$10,163,429PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$44,530,930CYRevenuesLessExpensesAmt
Total Assets BOY$493,691,681TotalAssetsBOYAmt
Total Assets EOY$235,812,966TotalAssetsEOYAmt
Total Liabilities BOY$482,096,928TotalLiabilitiesBOYAmt
Total Liabilities EOY$186,671,608TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$11,594,753NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$49,141,358NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionColumbia St. Mary's, Inc. ("CSM") is a health care 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 exists to make a positive difference in the health status and lives of individuals and our community, with special concern for those who are vulnerable. CSM and its affiliates are committed to providing high-quality, accessible, values-driven programs and services with equal attention to the physical, spiritual, and emotional dimensions of health.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$64,503,520ExpenseAmt
Grant$428,000GrantAmt
Revenue$146,199,053RevenueAmt
DescCSM, Inc exists as the parent corporation in the CSM system, which is comprised of three hospitals, (Columbia St. Mary's Hospital Milwaukee Inc, Columbia St. Mary's Hospital Ozaukee Inc, and Sacred Heart Rehabilitation Institute Inc.), 61 community clinics, the Columbia College of Nursing, a partnership with the Orthopedic Hospital of Wisconsin, a partnership with the Sleep Wellness Institute, and five urgent care centers. During fiscal 2014, CSM'S health system (Sacred Heart Rehabilitation, Columbia St. Mary's Milwaukee, Columbia St. Mary's Ozaukee) provided care to 332,115 patients. The estimated unreimbursed cost of services provided to the elderly, uninsured and underinsured totaled $164,585,590. Refer to the community benefit information in Schedule H for discussion of how CSM makes a positive difference in the health status of its community, focusing on those who are vulnerable.Desc
Total Program Service Expenses$64,503,520TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related InvstYes (1)ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee540EmployeeCnt
Employment Tax Returns Filed0EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Excess Business Holdings0ExcessBusinessHoldingsInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Timothy WaldochBusinessNameLine1
FieldValueIRS element (for citing)
Phone4143262230PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14425 N Port Washington Road STE 301AddressLine1
CityGlendaleCity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
R Bruce McDonald
Chair0.200.80Yes (X)$0$0$0
George H Hoff
Vice Chair0.200.80Yes (X)$0$0$0
Robert J Venable
Vice Chair0.200.80Yes (X)$0$0$0
Randall Perry
Secretary/Treasurer0.200.80Yes (X)$0$0$0
Tina Chang
Board Member0.200.80Yes (X)$0$0$0
Patricia J Dolhun MD
Board Member0.200.80Yes (X)$0$0$0
Kevin Goniu MD
Board Member/CSM Physician0.2040.80Yes (X)$0$459,309$140,438
Michael Grebe
Board Member0.200.80Yes (X)$0$0$0
Robert Lyon MD
Board Member0.200.80Yes (X)$0$0$0
Christine Nuernberg
Board Member0.200.80Yes (X)$0$0$0
Stephen Robbins MD
Board Member (Start 7/1/13)0.200.80Yes (X)$0$0$0
Mason G Ross
Board Member0.200.80Yes (X)$0$0$0
Sister Theresa Sullivan DC
Board Member0.200.80Yes (X)$0$0$0
Mark R Taylor End 63014
President/CEO1.0049.00Yes (X)$1,384,590$0$113,707Yes (X)
Rhonda Anderson
CSM President/CFO5.0045.00$442,055$0$15,038Yes (X)
Cheryl Hill
VP/CHRO5.0045.00$320,704$0$28,397Yes (X)
Gerri Lietz-Staffileno
VP Hosp Operations5.0045.00$0$320,213$30,058Yes (X)
David H Shapiro MD End 413
Chief Medical Officer5.0045.00$294,585$0$356,173Yes (X)
Suzanne Sanicola
VP Physician Services5.0045.00$221,994$0$32,430Yes (X)
William Hart
VP / COO6.0044.00$338,325$0$13,276Yes (X)
Bruce McCarthy MD
President Hosp Div5.0045.00$598,035$0$39,781Yes (X)
Constance Bradley End 413
VP Hosp Operations7.0043.00$0$187,443$9,777Yes (X)
Allan Spooner
President Hospital Division5.0045.00$605,560$0$39,781Yes (X)
Jeffrey C Squier
Payor Relations & Strategy Officer40.000.00$216,979$0$36,249Yes (X)
Michael E Sanderl
VP Mission Integration and Advocacy40.000.00$301,366$0$29,145Yes (X)
Clarissa L Cox
VP Quality & Clinical40.000.00$202,175$0$9,129Yes (X)
David Mannes
Controller5.0045.00$176,981$0$29,139Yes (X)
Patricia L Allen
Chief Financial Advsr-Hosp Dev40.000.00$169,568$0$16,490Yes (X)
Marian Purdue End 1012
Former Interim Pres Hosp Div0.000.00$153,750$0$0Yes (X)
Deborah Friberg End 612
Former President Hosp Div0.000.00$232,993$0$5,671Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$5,659,660TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$966,965TotReportableCompRltdOrgAmt
Total Other Compensation$944,679TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K34IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$114,241RelatedOrganizationsAmt
Government Grants$249,946GovernmentGrantsAmt
Total Contributions$364,187TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
Service Fees541610$127,287,440$127,287,440
Joint Venture Income622110$13,628,000$13,628,000
Medical Staff Dues561499$194,075$194,075
Health & Med Ins Rev611710$119,663$119,663
Management Fee Income541610$49,417$49,417

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,240TotalRevenueColumnAmt
Related Or Exempt Func Income$31,240RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$141,309,835TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,595,537TotalRevenueColumnAmt
Exclusion$4,595,537ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$67,671RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$67,671RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$67,671TotalRevenueColumnAmt
Related Or Exempt Func Income$67,671RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$1,150OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$1,150OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,150TotalRevenueColumnAmt
Related Or Exempt Func Income$1,150RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER OPERATING REVENUDesc
Business561499BusinessCd
Total Revenue Column$4,869,814TotalRevenueColumnAmt
Related Or Exempt Func Income$4,869,814RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,869,814OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$151,208,194TotalRevenueColumnAmt
Related Or Exempt Func Income$146,199,053RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$49,417UnrelatedBusinessRevenueAmt
Exclusion$4,595,537ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$428,000TotalAmt
Program Services$428,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$3,790,370TotalAmt
Program Services$1,913,557ProgramServicesAmt
Management And General$1,876,813ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$2,493,605TotalAmt
Program Services$954,041ProgramServicesAmt
Management And General$1,539,564ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$10,632,899TotalAmt
Program Services$4,282,812ProgramServicesAmt
Management And General$6,350,087ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,034,152TotalAmt
Program Services$733,194ProgramServicesAmt
Management And General$1,300,958ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$69,629TotalAmt
Program Services$69,629ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$893,799TotalAmt
Program Services$106ProgramServicesAmt
Management And General$893,693ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$454,945TotalAmt
Program Services$298,053ProgramServicesAmt
Management And General$156,892ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,088,613TotalAmt
Program Services$408,392ProgramServicesAmt
Management And General$3,680,221ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$4,090,563TotalAmt
Program Services$117,027ProgramServicesAmt
Management And General$3,973,536ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$188,460TotalAmt
Program Services$30,160ProgramServicesAmt
Management And General$158,300ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$2,673,170TotalAmt
Program Services$2,495,739ProgramServicesAmt
Management And General$177,431ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,167,081TotalAmt
Program Services$4,502,240ProgramServicesAmt
Management And General$664,841ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$198,224TotalAmt
Program Services$40,697ProgramServicesAmt
Management And General$157,527ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$133,133TotalAmt
Program Services$87,762ProgramServicesAmt
Management And General$45,371ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$10,188,837TotalAmt
Management And General$10,188,837ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$8,145,578TotalAmt
Program Services$7,686,569ProgramServicesAmt
Management And General$459,009ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$289,833TotalAmt
Program Services$3,647ProgramServicesAmt
Management And General$286,186ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Service Fees$32,652,183$28,679,959$3,972,224
purchased services$11,016,119$9,845,785$1,170,334
PATIENT CARE SUPPLIES$701,805$136,061$565,744
Minor Equipment$680,911$250,902$430,009

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,665,355TotalAmt
Program Services$1,539,188ProgramServicesAmt
Management And General$4,126,167ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$106,677,264TotalAmt
Program Services$64,503,520ProgramServicesAmt
Management And General$42,173,744ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,092,514BOYAmt
EOY$2,097,433EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$60,700,134BOYAmt
EOY$17,388,157EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$18,608,148BOYAmt
EOY$10,008,698EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$35,603,002BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$81,822BOYAmt
EOY$52,151EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,246,515BOYAmt
EOY$2,793,220EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$38,930,626LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$33,894,830LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,841,272BOYAmt
EOY$5,035,796EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$24,690,729BOYAmt
EOY$42,873,188EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$32,490,405BOYAmt
EOY$31,296,567EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$310,337,140BOYAmt
EOY$124,267,756EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$493,691,681BOYAmt
EOY$235,812,966EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$19,764,210BOYAmt
EOY$11,789,287EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$462,332,718BOYAmt
EOY$174,882,321EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$482,096,928BOYAmt
EOY$186,671,608EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$5,081,670BOYAmt
EOY$32,044,715EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$11,548,826BOYAmt
EOY$11,969,046EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,127,597BOYAmt
EOY$5,127,597EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$11,594,753BOYAmt
EOY$49,141,358EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$493,691,681BOYAmt
EOY$235,812,966EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$44,530,930ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$7,591,288NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$14,575,613OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
CertificationYes (X)CertificationInd
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Supported Org Information SupportedOrgInformationGrp (4 entries)

EINEINOrganization TypeOrganizationTypeDescGoverning Document ListedGoverningDocumentListedIndSupported Org NotifiedSupportedOrgNotifiedIndUS OrganizedUSOrganizedIndSupportSupportAmt
CSM HOSPITAL MILWAUKEE
3908063153Yes (1)Yes (1)Yes (1)$0
CSM HOSPITAL OZAUKEE
3908070633Yes (1)Yes (1)Yes (1)$0
SACRED HEART REHABILITATION INSTITUTE
3909021993Yes (1)Yes (1)Yes (1)$0
COLUMBIA COLLEGE OF NURSING INC
3915969862Yes (1)Yes (1)Yes (1)$0
FieldValueIRS element (for citing)
Supported Organizations Total4SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt

Form990 Schedule A Part IV Form990ScheduleAPartIVGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Line 11FormAndLineReferenceDesc
ExplanationColumbia St. Mary's Inc. supports the provision of healthcare services at the corporations to which it is a member by the provision of centralized administrative support, including billing and collections, IT, managed care contracting, financial services, business development, medical library, CME, property management, administrative costs for clinical institutes (including oncology, cardiology, bariatrics, pediatrics, stroke and neurosciences), research (including oncology, neurosciences and general research), marketing, logistics, external affairs, public relations, and construction. Costs of certain of these departments are charged to the members through a management fee. Transactions with each member are delineated on Schedule R.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$764,011OtherCostOrOtherBasisAmt
Book Value$764,011BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,241,740OtherCostOrOtherBasisAmt
Depreciation$12,891,460DepreciationAmt
Book Value$1,350,280BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,836,550OtherCostOrOtherBasisAmt
Depreciation$1,812,020DepreciationAmt
Book Value$24,530BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,596,388OtherCostOrOtherBasisAmt
Depreciation$18,975,531DepreciationAmt
Book Value$2,620,857BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$491,937OtherCostOrOtherBasisAmt
Depreciation$215,819DepreciationAmt
Book Value$276,118BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$5,035,796TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
Investments in Unconsolidated Entities$25,776,545C
Investments in CSM Foundation - Perm Rest$5,127,597C
INvestments in CSM Foundation - Temp Rest$11,969,046C
FieldValueIRS element (for citing)
Total Book Value Program Rltd$42,873,188TotalBookValueProgramRltdAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
Deferred Compensation$220,254
Pension Prefunding$53,458,089
Interest in Investments held by Ascension Health Alliance$70,589,413
FieldValueIRS element (for citing)
Total Book Value Other Assets$124,267,756TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)

DescDescAmtAmt
Intercompany Debt to Ascension Health Alliance$159,774,672
Accrued Pension$3,102,722
Deferred Compensation$1,297,983
Misc Noncurrent Liabilities$2,200,963
Misc Current Liabilities$2,321,151
Due to Affiliates$6,184,830
FieldValueIRS element (for citing)
Total Liability$174,882,321TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
ExplanationFrom the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Columbia St. Mary's 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, 2014.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$312,925TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$312,925NetCommunityBenefitExpnsAmt
Total Expense0.01820TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$952,850TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$729,229DirectOffsettingRevenueAmt
Net Community Benefit Expns$223,621NetCommunityBenefitExpnsAmt
Total Expense0.01310TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,265,775TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$729,229DirectOffsettingRevenueAmt
Net Community Benefit Expns$536,546NetCommunityBenefitExpnsAmt
Total Expense0.03130TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,702TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,702NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,702TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,702NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,272,477TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$729,229DirectOffsettingRevenueAmt
Net Community Benefit Expns$543,248NetCommunityBenefitExpnsAmt
Total Expense0.03170TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,792TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10,792NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$500TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$500NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,100TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,100NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,392TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$12,392NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$633,555BadDebtExpenseAmt
Bad Debt Expense Attributable$12,671BadDebtExpenseAttributableAmt
Reimbursed By Medicare$5,222,751ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$3,816,188CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,406,563MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line11 Orthopaedic Hospital of Wisconsin LLCBusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivitiesOrthopedic SurgeriesPrimaryActivitiesTxt
Org Profit Or Ownership0.50000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.50000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Orthopaedic Hospital of Wisconsin LLCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1475 West River Woods ParkwayAddressLine1
CityGlendaleCity
StateWIState
ZIP Code53212ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.ohow.comWebsiteAddressTxt
State License1006StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
OtherSpecialty Orthopedic HospitalOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Orthopaedic Hospital of WisconsinBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Own Website URLSee Section C Line 5d for websiteOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Medicaid MedicareYes (X)MedicaidMedicareInd
State RegulationYes (X)StateRegulationInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted In Emergency RoomYes (X)PostedInEmergencyRoomInd
Posted In Admission OfficeYes (X)PostedInAdmissionOfficeInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Orthopaedic Hospital of WisconsinPart V, Section B, Line 3: 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 CHNA team developed a multi-level assessment process. The first level consisted of a survey of county residents regarding their health status, health access and the perception of community needs. Working together, survey questions were developed and approved. A consultant was contracted to perform the survey using techniques that the consultant had used in similar surveys over ten years. The survey was conducted over the telephone to cell phone owners and "land line" telephone owners. More than 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.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 4: 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.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 5d: WWW.COLUMBIA-STMARYS.ORG/SERVINGOURCOMMUNITY
Orthopaedic Hospital of WisconsinPart V, Section B, Line 7: 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 Behavior Health. In the case of OHOW, only access to care was focused on because it is a specialty hospital focusing on orthopedics. Columbia St. Mary's does not have the scope and capacity to address the other identified OHOW needs.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 10: All patients with income less than 200% of the federal poverty level will be eligible for 100% charity care write-off of the charges for services that have been provided. Eligibility may be determined at any point in the revenue cycle. Financial counselors provide assistance to the patients to determine if they are eligible for Medicaid or other public assistance in order to qualify for charity care. Credit reports or other similar reports may be run to verify information provided.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 11: Patients with incomes above 300% of the poverty level may be eligible for some level of discount based on a substantive assessment of their ability to pay. The assessment considers total income and dollar amount of patient responsibility on a sliding scale. A means test is performed that considers income, total medical bill obligations, mortgage payments, utility payments, number of family members, and any disability considerations. Patients who do not qualify for charity care, but are in need of financial assistance, will be offered appropriate extended payment terms or other payment options that take into account the patient's financial status.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 16e: The following steps were followed and considered reasonable efforts for purposes of Question 16:- Notified each individual of the facility's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- Individuals were notified of the FAP by methods as noted in Question 14. This includes, but is not limited to, providing the following: - A brief description of eligibility requirements and assistance provided - Directions on how to access the FAP and application on our website and physical location of application forms - Instructions to obtain free copy of FAP and application by mail - Contact information for an individual/nonprofit organization to assist if the individual has questions - Statement of translations of FAP as well as plain language summaries - Statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB - For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP.- For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP- We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12).
Orthopaedic Hospital of WisconsinPart V, Section B, Line 17e: The following steps were followed and considered reasonable efforts for purposes of Question 17:- Notified each individual of the facility's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- Individuals were notified of the FAP by methods as noted in Question 14. This includes, but is not limited to, providing the following: - A brief description of eligibility requirements and assistance provided - Directions on how to access the FAP and application on our website and physical location of application forms - Instructions to obtain free copy of FAP and application by mail - Contact information for an individual/nonprofit organization to assist if the individual has questions - Statement of translations of FAP as well as plain language summaries - Statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB - For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP.- For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP- We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12).
Orthopaedic Hospital of WisconsinPart V, Section B, Line 20d: All patients eligible for financial assistancec receive a minimum discount of 40% off gross charges for services provided to them.
Orthopaedic Hospital of WisconsinPart V, Section B, Line 21: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- Individuals were notified of the FAP as noted in Question 14. This includes, but is not limited to,the following: - Brief description of eligibility requirements and assistance provided. - Direct individuals to our website and physical location of application forms - Provided instructions to obtain free copy of FAP and application by mail - Provided contact information for an individual/nonprofit organization to assist if the individual has questions - Provided statement of translations of FAP as well as plain language summaries - Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP- For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.- We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12).
Orthopaedic Hospital of WisconsinPart V, Section B, Line 22: The following steps were followed and considered reasonable efforts followed for purposes of identifying patients eligible for assistance under the facility's FAP:- Notified each individual of the Hospital's Financial Assistance Policy (FAP). This notification began on the date care was provided and ended on the 120th day after the first billing statement was provided to the individual.- Individuals were notified of the FAP as noted in Question 14. This includes, but is not limited to, the following: - Brief description of eligibility requirements and assistance provided. - Direct individuals to our website and physical location of application forms - Provided instructions to obtain free copy of FAP and application by mail - Provided contact information for an individual/nonprofit organization to assist if the individual has questions - Provided statement of translations of FAP as well as plain language summaries - Provided statement that no FAP-eligible individual will be charged more for emergency/medically necessary care than AGB- For individuals who submitted an incomplete FAP, we provided that individual with information relevant to assist them with completion of the FAP- For individuals who submitted a complete FAP, we made and documented a determination as to whether that person was eligible under the facility's FAP.- We determined eligibility based on other means such as establishing that the individual is eligible under one or more means tested programs (as noted in Question 12).

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3c:The hospitals of CSM provide medically necessary care to all patients, regardless of race, color, creed, ethnic origin, gender, disability or economic status. OHOW's specific policy uses a percentage of Federal Poverty Level (FPL) to determine free and discounted care. At a minimum, patients with income less than or equal to 200% of the FPL, which may be adjusted for cost of living utilizing the local wage index compared to national wage index, will be eligible for 100% charity care write off of charges for services that have been provided to them.
Part I, Line 6a:OHOW files an annual community benefit report with the Wisconsin Hospital Association ("WHA"). CSM does not file a community benefit report with the WHA since CSM does not have any patient care revenue. However, CSM is the parent entity of 3 hospitals, Columbia St. Mary's Hospital Milwaukee, Inc., Columbia St. Mary's Hospital Ozaukee, Sacred Heart Rehabilitation, Inc., each of which file community benefit reports with WHA. CSM does, however, describe the benefits that the CSM organization provides to the community on its website.
Part I, Line 7: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.Part I, Line 7g: The organization has not included costs attributable to a physician clinic as part of subsidized health services.
Part I, Ln 7 Col(f):CSM's share of the amount of bad debt expense reported by OHOW in 2013 but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $633,555.
Part II, Community Building Activities:During 2013, OHOW made a number contributions to organizations that encourage youth fitness and overall health education. Further, in order to accomplish the collaborative work in the community and to oversee access clinics and outreach programs, CSM has a Community Services Department which oversees the CSM Community Benefit Process. CSM, Inc. participates in Community Building activities through programs such as INROADS, which is an opportunity for culturally diverse college students to serve an internship over summer break to familiarize themselves with the challenges and opportunities in health care and gain real world experience. INROADS is reflected in the Community Building section of the report. CSM is a founding member of the Milwaukee Health Care Partnership (MHCP), which is a collaboration between the five Milwaukee health systems and Federally Qualified Health Centers to improve access to health care in the community. The partnership has worked with County health officials to improve behavioral access and Partnership funding supports mental health respite beds in the community. CSM's CEO and VP of Mission Services each spend significant time in MHCP collaborative work. Access to health education and screening in many areas of the city is best accomplished through church collaboration. CSM employs nurses to work in collaboration with churches and community organizations to offer health education, health screening, and care management support to parishioners and community members in a variety of outreach programs affiliated with churches. CSM developed the beginning stages of a collaboration with 44 Church of God in Christ churches in Milwaukee to accomplish better health awareness and improve screening rates.
Part III, Line 4:OHOW, which files financial statements separate from CSM, includes the following footnote related to accounts receivables: "The majority of the Hospital's accounts receivables are due from third-party payors under reimbursement agreements and from patients for services provided. Accounts receivable are due upon receipt of invoice. Receivables are stated net of any allowance for contractual discounts and uncollectible accounts by considering the number of days past due, collection history, and the general economy and industry as a whole. Contractual adjustments are based on expected payment rates in accordance with third-party payor agreements. The Hospital writes off accounts receivable when they are determined to be uncollectible. Payments subsequently received are credited to the allowance for doubtful accounts."
Part III, Line 8:OHOW follows 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:OHOW 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 St. Mary's, Inc. serves the Milwaukee and Ozaukee communities through a Community Benefit Process overseen by the Milwaukee Community Benefit Committee and the Ozaukee Community Benefit Committee. The process of understanding community needs through a Community Health Needs Assessment and interpreted through the work of Community Benefit Committees to lead to a Community Benefit Plan for Milwaukee and Ozaukee communities is consistent across the organization. Although the Community Benefit Plan occurs primarily in the Milwaukee, Ozaukee and Sacred Heart Rehabilitation Institute settings, the work is also supported by departments behind the scenes across CSM, including accounting, human resources, purchasing, legal counsel and other administrative functions. Programs such as the Orthopaedic Hospital of Wisconsin have also contributed to support of Community Benefit programming. Community Benefit Committees at CSM have consistent roles to support the Community Benefit functions. The roles include the following: - Develop Community Health Needs Assessment (CHNA) to determine community 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 elementsThe Community Health Needs Assessments are specific to the demographics and health issues to the community. The Needs Assessments in FY13 involved the gathering of secondary information about the communities from varied public sources including state data, and county data. The most remarkable needs for the service were addressed through Community Benefit Plans for each community.
Part VI, Line 3:CSM 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 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 the patient may qualify for.
Part VI, Line 4:CSM primarily serves the Milwaukee and Ozaukee counties in southeastern Wisconsin. OHOW 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. Discounts for the uninsured and underinsured are not included in Parts I or II of Schedule H.
Part VI, Line 5:A hallmark of CSM, Inc. is the ability to proactively meet health needs through preventive programs and programs to allow access to primary and specialty care. The programs are most often delivered through partnership with other non-profit organizations in health and social services. Each hospital has access improvement programs including: St. Bens Clinic for the Homeless, Seton Dental Clinic, Community Chronic Disease Management Clinic, Huiras Family Community Health Center, El Centro de Salude Clinic sponsored by the Columbia College of Nursing, the CSM OB/Clinic and the CSM Family Health Center. A particularly strong partner in these activities has been the Medical College of Wisconsin in sponsorship of programs: - The Family Health Center, a residency-based Family Medicine clinic that provides primary care to more than 9,000 individuals in the community.- The OB/GYN Clinic, a residency-based program that serves over 150 patients, 250 OB appointments per month, and 325 deliveries per year.- The Chronic Disease Management Clinic, which screens and manages hypertension, diabetes, obesity, and smoking for low income adults through a clinic based in a food pantry. In turn, CSM across the hospital settings hosts residents for their training growth and development. All of these services are reported as part of the Community Benefit expenses in Section H of the appropriate hospital report.
Part VI, Line 6:The CSM health system focuses on contributing 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 Sleep Services of Wisconsin, and four 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.OHOW itself is a specialty hospital which performs more than 5,000 surgical procedures each year and offers the complete range of orthopaedic services, including joint replacements and spine procedures, rehabilitation, diagnostic testing and pain management services. 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 2014, the CSM system provided $69,252,511 in unreimbursed services, including $14,778,518 in traditional charity care, $12,524,287 in discounts to the uninsured, $14,687,238 in community benefit programs, and $27,262,467 in other unpaid public programs, including subsidized health care, professional education, financial contributions and community building activities.In addition, the organization's governing body is comprised of local community leaders and physicians, the majority of whom reside within the communities CSM serves and are neither employees nor contractors of the organization, nor family members thereof. The hospital extends medical staff privileges to all qualified physicians in its community; however, the clinics within the organization are served by physicians affiliated with CSM.
Part VI, Line 7CSM does not file a community benefit report since it does not have any patient care revenue. However, CSM's three hospital organizations, Columbia St. Mary's Hospital, Milwaukee, Inc., Columbia St. Mary's Hospital Ozaukee, Inc. and Sacred Heart Rehabilitation Institute, Inc. each file community benefit reports with the Wisconsin Hospital Association.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
United Way of Greater Milwaukee
225 W Vine StreetMilwaukeeWI53212390806190501(c)(3)$400,000Federally Qualified Health Centers Funding
Milwaukee Development Corporation
756 N Milwaukee StreetMilwaukeeWI53202501(c)(3)$15,000Fund general operations
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationCONTRIBUTIONS TO GOVERNMENTS AND ORGANIZATIONS IN THE UNITED STATES ARE APPROVED BY THE BOARD OF DIRECTORS AND/OR THE PRESIDENT & CEO. ALL RECORDS OF OUTGOING CONTRIBUTIONS ARE RETAINED FOR A PERIOD OF 10 YEARS, PLUS THE CURRENT FISCAL YEAR, AND CAN BE LOCATED AT THE OFFICE CENTER AT 4425 NORTH PORT WASHINGTON RD, GLENDALE, WI 53212.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceYes (X)HousingAllowanceOrResidenceInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (18 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Kevin Goniu MD
Board Member/CSM Physician$0$450,755$0$0$0$8,554$0$107,750$0$32,688$0$599,747$0$0
Mark R Taylor End 63014
President/CEO$584,435$0$673,131$0$127,024$0$85,650$0$28,057$0$1,498,297$0$107,104$0
Rhonda Anderson
CSM President/CFO$417,774$0$20,000$0$4,281$0$7,650$0$7,388$0$457,093$0$0$0
Cheryl Hill
VP/CHRO$294,224$0$15,000$0$11,480$0$7,650$0$20,747$0$349,101$0$6,093$0
Gerri Lietz-Staffileno
VP Hosp Operations$0$283,405$0$15,000$0$21,808$0$7,501$0$22,557$0$350,271$0$5,366
David H Shapiro MD End 413
Chief Medical Officer$122,544$0$500$0$171,541$0$347,002$0$9,171$0$650,758$0$3,623$0
Suzanne Sanicola
VP Physician Services$187,313$0$15,000$0$19,681$0$6,501$0$25,929$0$254,424$0$0$0
William Hart
VP / COO$320,148$0$15,000$0$3,177$0$7,650$0$5,626$0$351,601$0$0$0
Bruce McCarthy MD
President Hosp Div$541,696$0$20,000$0$36,339$0$7,650$0$32,131$0$637,816$0$0$0
Constance Bradley End 413
VP Hosp Operations$0$68,422$0$0$0$119,021$0$1,949$0$7,828$0$197,220$0$0
Allan Spooner
President Hospital Division$480,119$0$90,366$0$35,075$0$7,650$0$32,131$0$645,341$0$0$0
Jeffrey C Squier
Payor Relations & Strategy Officer$215,460$0$1,204$0$315$0$6,786$0$29,463$0$253,228$0$0$0
Michael E Sanderl
VP Mission Integration and Advocacy$181,095$0$52,727$0$67,544$0$5,553$0$23,592$0$330,511$0$0$0
Clarissa L Cox
VP Quality & Clinical$178,937$0$15,000$0$8,238$0$5,850$0$3,279$0$211,304$0$5,019$0
David Mannes
Controller$145,204$0$31,668$0$109$0$4,570$0$24,569$0$206,120$0$0$0
Patricia L Allen
Chief Financial Advsr-Hosp Dev$167,922$0$1,500$0$146$0$5,179$0$11,311$0$186,058$0$0$0
Marian Purdue End 1012
Former Interim Pres Hosp Div$153,750$0$0$0$0$0$0$0$0$0$153,750$0$0$0
Deborah Friberg End 612
Former President Hosp Div$0$0$232,993$0$0$0$0$0$5,671$0$238,664$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aPayments were made to new president hospital division to assist with moving expenses and the sale of his home in calendar year 2013.
Part I, Line 3Ascension Health, a related organization of Columbia St. Mary's, 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.
Part I, Lines 4a-bPart I, Line 4a: Severance Payments: Deborah Friberg - $232,993 Constance J. Bradley: $118,575 David H. Shapiro, MD: $156,925 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. The organization that paid the salaries of the individuals listed in Schedule H, Part II paid out of the supplemental nonqualified retirement plan in the amounts as noted: Mark R. Taylor - $107,104 Gerri G. Lietz-Staffileno - $5,366 Chery L. Hill - $6,093 Constance J. Bradley - $2,391 David H. Shapiro, MD - $3,623
Part I, Line 7Part I, Line 7: Board Members, Officers, Key Employees and Highest Compensated Employees who are employed by the CSM Organizations and are medical doctors are eligible to receive a percentage of the revenue generated from patients they served, based on established guidelines. Officers and Key Employees participate in a management incentive place, whereby certain financial triggers of the CSM System as approved by the Board must be met before any eligible employee may receive payment of the incentive. Once the trigger is met, the incentive is measured based on various established goals, including operating margin, patient satisfaction, quality and productivity.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 2Many of the persons listed in Part VII, Section A have a "business relationship" with each other by virture of employment for Columbia St. Mary's Inc. related entities.
Form 990, Part VI, Section A, line 6CSM has two corporate members: Ascension Health and Columbia Health System.
Form 990, Part VI, Section A, line 7aOne of CSM'S corporate members, Ascension Health, has the ability to elect members to the governing body of CSM.
Form 990, Part VI, Section A, line 7bAscension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Columbia Health System has the authority to approve any changes to the governing documents which would affect its interest or rights in CSM, the mission and vision statements of CSM, and any major corporate structural transactions of CSM.
Form 990, Part VI, Section B, line 11Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review and answer any questions. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions.
Form 990, Part VI, Section B, line 12cCSM 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, Section B, line 15b15a. In determining the compensation of the organization's CEO, the process, performed by Ascension Health, a related organization of Columbia St. Mary's, 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 her compensation was decided. 15b. 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 compensation committee of the board of directors 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, Section C, line 19The organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section B: Independent Contractor ReportingCompensation 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 XI, line 9:DEFERRED PENSION COSTS 1,679,051. Equity Transfer - Temporarily Restricted 420,220. TRANSFER -A FFILIATES -16,056,484. TRANSFER - SPONSOR -618,400.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390806315HOSPITALWI501(c)(3)3COLUMBIA ST MARY'S INCYes (1)
COLUMBIA ST MARY'S HOSPITAL OZAUKEE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390807063HOSPITALWI501(c)(3)3COLUMBIA ST MARY'S INCYes (1)
SACRED HEART REHABILITATION INSTITUTE INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212390902199REHAB FACILITYWI501(c)(3)3COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INCYes (1)
COLUMBIA COLLEGE OF NURSING INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391596986COLLEGEWI501(c)(3)2COLUMBIA ST MARY'S HOSPITAL MILWAUKEE INCYes (1)
ASCENSION HEALTH
PO BOX 45998ST LOUISMO631455998311662309National Health SystemMO501(c)(3)11Ascension Health AllianceYes (1)
HORIZON HOME CARE & HOSPICE INC
8949 N DEERBROOK TRLMILWAUKEEWI53223391171298HOME CARE/HOSPICEWI501(c)(3)30N/A
COLUMBIA HEALTH SYSTEM
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391494977Health SystemWI501(c)(3)110N/A
COLUMBIA ST MARY'S FOUNDATION INC
4425 NORTH PORT WASHINGTON ROADGLENDALEWI53212391494981FOUNDATIONWI501(C)(3)70N/A
ASCENSION HEALTH ALLIANCE
PO BOX 45998ST LOUISMO631455998453358926NATIONAL HEALTH SYSTEMMO501(c)(3)11A0N/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
ORTHOPAEDIC HOSPITAL OF WISCONSIN LLC
575 RIVERWOODS PKWYGLENDALEWI53212392015655HEALTH CAREWICOLUMBIA ST MARY'S INCRELATED$14,052,074$28,030,3480Yes (1)0.50000
SLEEP SERVICES OF WISCONSIN LLC
111 E KILBOURN AVE STE 1300MILWAUKEEWI53202273148310SLEEP SERVICESWIcOLUMBIA ST MARY'S INCRELATED-$142,654$1,067,7890Yes (1)0.50000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Entity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
CSM STRATEGIC ALLIANCE
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391871856HEALTHCAREWICOLUMBIA ST MARY'S INCC-$2,000$424,0000.500000
MADISON MEDICAL AFFILIATES INC
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212391855720HEALTHCAREWICOLUMBIA ST MARY'S HOSPITAL MILWAUKEE INCC1.00000Yes (1)
PROSPECT MEDICAL COMMONS CONDO ASSOCIATION
4425 NORTH PORT WASHINGTON RDGLENDALEWI53212208042108CONDO ASSOCWICOLUMBIA ST MARY'S INCC$134,0420.70000Yes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (26 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
Columbia St Mary's Hospital Milwaukee Inc
L$90,776,749
Columbia St Mary's Hospital Ozaukee
L$30,251,387
Sacred Heart Rehabilitation Institute
L$2,823,792
Madison Medical Affiliates
L$1,376,604
Ascension Health
E$2,285,921
Ascension Health
E$157,488,751
Ascension Health
M$882,000
Ascension Health
M$1,419,795
AScension Health
M$6,827,509
AScension Health
M$250,887
AScension Health
M$6,615,000
Ascension Health
M$298,384
Ascension Health
M$2,922,000
AScension Health
M$1,007,381
Ascension Health
M$31,842,033
Orthopaedic Hospital of Wisconsin
O$11,708,468
Ascension Health
K$73,733
Madison Medical Affiliates
R$8,500,000
Columbia Health System
R$320,016
Columbia St Mary's Foundation inc
C$114,241
Madison Medical Affiliates
J$50,821
Madison Medical Affiliates
L$1,319,417
Madison Medical Affiliates
L$2,389,248
Columbia Center
L$126,648
Orthopaedic Hospital of Wisconsin
L$1,105,666
Columbia College of Nursing
J$1,111,171

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