HOLY FAMILY MEMORIAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
HOLY FAMILY MEMORIAL INC (EIN 39-0806395)
Tax period
2014-01-01 to 2014-12-31
Filed
2015-12-14
IRS object ID
201533489349300213
Schema version
2014v5.0
Note
A later return for the same period supersedes this one.
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)
Return2015-12-14T08:51:31-06:00ReturnTs
Tax Period End2014-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN391173131PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SCHENCK SCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1100 MARITIME DRIVE SUITE 2BAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN390806395EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOLYBusinessNameControlTxt
Phone9203202011PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARK HERZOGPersonNm
Person TitlePRESIDENT / CEOPersonTitleTxt
Phone9203203470PhoneNum
Signature2015-12-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKELLY BLOCK CPAPreparerPersonNm
PTINP00199509PTIN
Phone9206845500PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnYes (X)AmendedReturnInd
Principal OfficerMARK HERZOGPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$132,980,139GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HFMHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1899FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionHEALTH CARE SERVICESSEE SCHEDULE O HOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES. HFM PROVIDES ACUTE, OUTPATIENT, CLINIC, HOME CARE AND HOSPICE SERVICES FOR MANITOWOC COUNTY, STRIVING FOR MEDICIAL EXCELLENCE AND VALUED OUTCOMES WITHIN A COMPASSIONATE, VALUES BASED, CHRISTIAN ENVIRONMENT.ActivityOrMissionDesc
Voting Members Governing Body18VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee1277TotalEmployeeCnt
Total Volunteers312TotalVolunteersCnt
Total Gross UBI$38,323TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$14,580NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$596,002PYContributionsGrantsAmt
CY Contributions Grants$151,025CYContributionsGrantsAmt
PY Program Service Revenue$132,958,817PYProgramServiceRevenueAmt
CY Program Service Revenue$128,259,931CYProgramServiceRevenueAmt
PY Investment Income$3,202,328PYInvestmentIncomeAmt
CY Investment Income$3,632,177CYInvestmentIncomeAmt
PY Other Revenue$179,589PYOtherRevenueAmt
CY Other Revenue$1,993CYOtherRevenueAmt
PY Total Revenue$136,936,736PYTotalRevenueAmt
CY Total Revenue$132,045,126CYTotalRevenueAmt
PY Grants And Similar Paid$65,719PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$60,800CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$78,978,708PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$76,650,015CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$240,200CYTotalFundraisingExpenseAmt
PY Other Expenses$53,410,505PYOtherExpensesAmt
CY Other Expenses$50,847,874CYOtherExpensesAmt
PY Total Expenses$132,454,932PYTotalExpensesAmt
CY Total Expenses$127,558,689CYTotalExpensesAmt
PY Revenues Less Expenses$4,481,804PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,486,437CYRevenuesLessExpensesAmt
Total Assets BOY$176,647,204TotalAssetsBOYAmt
Total Assets EOY$176,983,319TotalAssetsEOYAmt
Total Liabilities BOY$64,072,941TotalLiabilitiesBOYAmt
Total Liabilities EOY$60,795,601TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$112,574,263NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$116,187,718NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHOLY FAMILY MEMORIAL IS A NETWORK OF HEALTH PROFESSIONALS WHO, ROOTED IN THE HEALING MINISTRY OF JESUS CHRIST, PROVIDE SERVICES TO HELP INDIVIDUALS AND OUR COMMUNITIES ACHIEVE HEALTHIER LIVES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$115,442,567ExpenseAmt
Grant$60,800GrantAmt
Revenue$131,896,273RevenueAmt
DescHOLY FAMILY MEMORIAL IS AN INTEGRATED NETWORK PROVIDING HEALTH CARE SERVICES INTENDED TO BENEFIT THE HEALTH AND WELLBEING OF THE COMMUNITIES IT SERVES. THESE SERVICES INCLUDE PRIMARY AND SPECIALTY CLINIC CARE, PREVENTIVE CARE SUCH AS HEALTH SCREENINGS, VACCINATION CLINICS AND HEALTH EDUCATION CLASSES, 24/7 EMERGENCY CARE, WALK-IN, INPATIENT ACUTE CARE, OUTPATIENT CARE, HOME CARE AND HOSPICE, HOME MEDICAL EQUIPMENT, PRESCRIPTIONS, OCCUPATIONAL HEALTH SERVICES, AND MEDICALLY BASED FITNESS AND WELLNESS. HOLY FAMILY MEMORIAL HAS BEEN ABLE TO ACHIEVE A GREATER IMPACT IN THE COMMUNITY BY PARTNERING FINANCIAL, HUMAN AND PROGRAMMATIC RESOURCES WITH OTHER ORGANIZATIONS. (CONTINUED ON SCHEDULE O)THESE PARTNERSHIPS INCLUDE A COMMITMENT TO COLLABORATE WITH OTHER HEALTH AND SOCIAL SERVICE AGENCIES TO IMPROVE ACCESS TO CARE, FOCUS ON PREVENTIVE SERVICES, REDUCE COMMUNITY HEALTH RISKS AND CONTRIBUTE TO A HEALTHIER, VIBRANT COMMUNITY.HOLY FAMILY MEMORIAL PROVIDES MEDICALLY NECESSARY SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICIES. IN ASSESSING A PATIENT'S ABILITY TO PAY, HOLY FAMILY MEMORIAL UTILIZES GENERALLY RECOGNIZED POVERTY INCOME LEVELS OF THE COMMUNITIES IT SERVES AND CONSIDERS SITUATIONS WHERE INCURRED CHARGES ARE SIGNIFICANT WHEN COMPARED TO THE PATIENT'S FINANCIAL RESOURCES. BECAUSE HOLY FAMILY MEMORIAL DOES NOT EXPECT TO RECEIVE PAYMENT OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT INCLUDED IN NET PATIENT SERVICE REVENUES. HOLY FAMILY MEMORIAL'S TOTAL COMMUNITY BENEFIT INCLUDES THE COST OF CHARITY CARE AND UNPAID COST OF PUBLIC PROGRAMS (MEDICARE AND MEDICAID) AS WELL AS THOSE DISCUSSED ABOVE. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT WAS APPROXIMATELY $23,957,000 FOR THE YEAR ENDED DECEMBER 2014. THIS AMOUNT INCLUDES THE NET COST OF CHARITY CARE OF APPROXIMATELY $985,000. MORE INFORMATION AVAILABLE FROM OUR COMMUNITY BENEFIT REPORT WHICH CAN BE LOCATED ON OUR WEBSITE AT WWW.HFMHEALTH.ORG.Desc
Total Program Service Expenses$115,442,567TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
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 ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
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 Document34IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1277EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
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 ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind0Form8899Filedind
Form1098 C Filed0Form1098CFiledInd
DAF Excess Business Holdings0DAFExcessBusinessHoldingsInd
Taxable Distributions0TaxableDistributionsInd
Distribution To Donor0DistributionToDonorInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members18GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
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 Body0Form990ProvidedToGvrnBodyInd
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 CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARK HERZOG PRESIDENT CEOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9203203470PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
RYAN M DOPIRAK MD
PHYSICIAN COUNCIL CHAIR40.00Yes (X)$1,139,160$0$31,808
MATTHEW L CAMPBELL MD
PHYSICIAN COUNCIL CHAIR40.00Yes (X)$322,699$0$29,000
XA XIONG MD
DIRECTOR40.00Yes (X)$189,733$0$26,278
MARY A GOVIER MD
DIRECTOR40.00Yes (X)$92,653$0$14,318
DEREK R BOWN DC
DIRECTOR40.00Yes (X)$126,916$0$26,938
DONALD R BRISCH
TREASURER2.00Yes (X)$0$0$0Yes (X)
WILLIAM R CASEY
CHAIR2.00Yes (X)$0$0$0Yes (X)
LAURIE CRAWFORD
SECRETARY2.00Yes (X)$0$0$0Yes (X)
JEFFREY S DUNN
DIRECTOR2.00Yes (X)$0$0$0
SISTER LORITA M GAFFNEY
DIRECTOR2.00Yes (X)$0$0$0
MARILYN KAUFMANN
DIRECTOR2.00Yes (X)$0$0$0
SISTER MARLITA HENSELER
DIRECTOR2.00Yes (X)$0$0$0
DENISE KITZEROW
DIRECTOR2.00Yes (X)$0$0$0
JANE L PFEFFER
VICE CHAIR2.00Yes (X)$0$0$0Yes (X)
SISTER JAN VILLEMURE
DIRECTOR2.00Yes (X)$0$0$0
SISTER ELAINE TURBA
DIRECTOR2.00Yes (X)$0$0$0
KATHLEEN A ZUCCHI
DIRECTOR2.00Yes (X)$0$0$0
SISTER LAURA WOLF
DIRECTOR2.00Yes (X)$0$0$0
MARK P HERZOG
DIRECTOR, PRESIDENT, CEO40.00Yes (X)$875,557$0$133,477Yes (X)
PATRICIA HUETTL
CHIEF FINANCIAL OFFICER40.00$273,628$0$69,523Yes (X)
STEVEN D DRIGGERS MD
CHIEF MEDICAL OFFICER40.00$531,886$0$84,903Yes (X)
MARY MAURER
CHIEF INNOVATION OFFICER40.00$364,956$0$44,517Yes (X)
KIRK DIMITRIS MD
PHYSICIAN40.00$1,201,017$0$26,324Yes (X)
DAVID MIKOLYZK MD
PHYSICIAN40.00$982,468$0$31,278Yes (X)
MICHAEL ROSENBERG MD
PHYSICIAN40.00$570,245$0$26,579Yes (X)
NANCY N BUTLER MD
PHYSICIAN40.00$606,802$0$13,323Yes (X)
JEFFREY A JACOBY MD
PHYSICIAN40.00$619,756$0$16,189Yes (X)
JANE CURRAN-MEULI
EXECUTIVE VP, COO40.00$144,198$0$12,237Yes (X)
WILLIAM D HAMPTON MD
FORMER DIRECTOR40.00$292,173$0$29,079Yes (X)
WILLIAM C CENSKY
FORMER CHAIR2.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$8,333,847TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$615,771TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K82IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CARETECH SOLUTIONS
901 WILSHIRE DRIVE STE 250TROYMI48084IT SERVICES$6,120,575
COMPLETERX LTD
3100 S GESSNER STE 640HOUSTONTX77063PHARMACY SERVICES$5,665,114
PATRIOT MEDICAL TECH
PO BOX 415000NASHVILLETN372415000BIO-MED SERVICES$1,161,463
SCHAUS ROOFING & MECHANICAL
2901 CALUMET AVENUEMANITOWOCWI54220MAINTENANCE SERVICES$766,123
RADIATION ONCOLOGY SPECIALISTS
PO BOX 678STURGEON BAYWI54235CANCER CARE SERVICES$589,085
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K15CntrctRcvdGreaterThan100KCnt
Fundraising$39,054FundraisingAmt
Government Grants$55,225GovernmentGrantsAmt
All Other Contributions$56,746AllOtherContributionsAmt
Noncash Contributions$15,008NoncashContributionsAmt
Total Contributions$151,025TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
INTEGRATED HEALTH CARE900099$110,996,173$110,996,173
LAB621500$10,988,609$10,958,384$30,225
PHARMACY446110$6,275,149$6,275,149
FieldValueIRS element (for citing)
Total Program Service Revenue$128,259,931TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,631,801TotalRevenueColumnAmt
Related Or Exempt Func Income$3,631,801RelatedOrExemptFuncIncomeAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$255,663RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$744,732RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$489,069RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$489,069TotalRevenueColumnAmt
Exclusion-$489,069ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$35,620OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$35,244OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$376OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$376TotalRevenueColumnAmt
Exclusion$376ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$134,259FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$39,054ContriRptFundraisingEventAmt
Fundraising Direct Expenses$22,823FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$111,436TotalRevenueColumnAmt
Exclusion$111,436ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$5,347GamingGrossIncomeAmt
Gaming Direct Expenses$2,945GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,402TotalRevenueColumnAmt
Exclusion$2,402ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$162,381GrossSalesOfInventoryAmt
Cost Of Goods Sold$129,269CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,112TotalRevenueColumnAmt
Unrelated Business Revenue$33,112UnrelatedBusinessRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
MISCELLANEOUS900003$452,885$143,539-$25,014$334,360
INVESTMENT HFHS & DME446110-$108,773-$108,773
FieldValueIRS element (for citing)
Other Revenue Total$344,112OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$132,045,126TotalRevenueColumnAmt
Related Or Exempt Func Income$131,896,273RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$38,323UnrelatedBusinessRevenueAmt
Exclusion-$40,495ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$60,800TotalAmt
Program Services$60,800ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$5,041,106TotalAmt
Program Services$2,427,048ProgramServicesAmt
Management And General$2,614,058ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$58,381,997TotalAmt
Program Services$53,972,065ProgramServicesAmt
Management And General$4,257,671ManagementAndGeneralAmt
Fundraising$152,261FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,376,214TotalAmt
Program Services$1,232,619ProgramServicesAmt
Management And General$139,139ManagementAndGeneralAmt
Fundraising$4,456FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,317,444TotalAmt
Program Services$8,189,868ProgramServicesAmt
Management And General$106,936ManagementAndGeneralAmt
Fundraising$20,640FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,533,254TotalAmt
Program Services$3,201,338ProgramServicesAmt
Management And General$321,384ManagementAndGeneralAmt
Fundraising$10,532FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$305,778TotalAmt
Program Services$20,017ProgramServicesAmt
Management And General$262,241ManagementAndGeneralAmt
Fundraising$23,520FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$38,897TotalAmt
Management And General$38,897ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$140,930TotalAmt
Management And General$140,930ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,456,112TotalAmt
Program Services$1,456,112ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$476,444TotalAmt
Program Services$31,032ProgramServicesAmt
Management And General$445,412ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$423,057TotalAmt
Program Services$309,408ProgramServicesAmt
Management And General$108,859ManagementAndGeneralAmt
Fundraising$4,790FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,953,461TotalAmt
Program Services$4,953,461ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,236,974TotalAmt
Program Services$1,460,242ProgramServicesAmt
Management And General$759,512ManagementAndGeneralAmt
Fundraising$17,220FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$384,211TotalAmt
Program Services$248,220ProgramServicesAmt
Management And General$135,500ManagementAndGeneralAmt
Fundraising$491FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$312,803TotalAmt
Program Services$180,106ProgramServicesAmt
Management And General$132,697ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,041,125TotalAmt
Program Services$2,041,125ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,162,632TotalAmt
Program Services$7,018,498ProgramServicesAmt
Management And General$143,403ManagementAndGeneralAmt
Fundraising$731FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$827,003TotalAmt
Program Services$826,006ProgramServicesAmt
Management And General$997ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL/SURGICAL SUPPLI$16,153,480$16,153,480
PURCHASED SERVICES$6,495,988$4,543,629$1,946,928$5,431
STATE PROVIDER ASSESSME$2,943,244$2,943,244
MAINTENANCE$2,866,548$2,784,474$82,074

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,629,187TotalAmt
Program Services$1,389,775ProgramServicesAmt
Management And General$239,284ManagementAndGeneralAmt
Fundraising$128FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$127,558,689TotalAmt
Program Services$115,442,567ProgramServicesAmt
Management And General$11,875,922ManagementAndGeneralAmt
Fundraising$240,200FundraisingAmt
FieldValueIRS element (for citing)
Joint CostsYes (X)JointCostsInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,531,070BOYAmt
EOY$12,353,542EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,555,671BOYAmt
EOY$4,793,820EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$20,269BOYAmt
EOY$17,668EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$21,930,752BOYAmt
EOY$19,541,149EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$300,000BOYAmt
EOY$300,000EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,251,697BOYAmt
EOY$2,229,888EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$7,393,728BOYAmt
EOY$6,769,043EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$174,544,160LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$110,831,132LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$66,469,229BOYAmt
EOY$63,713,028EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$41,497,975BOYAmt
EOY$46,012,548EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$19,892,686BOYAmt
EOY$17,728,459EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$3,381,711BOYAmt
EOY$3,356,697EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$422,416BOYAmt
EOY$167,477EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$176,647,204BOYAmt
EOY$176,983,319EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$14,813,355BOYAmt
EOY$14,093,992EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$30,639BOYAmt
EOY$33,691EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$48,806,531BOYAmt
EOY$46,500,241EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$422,416BOYAmt
EOY$167,477EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$200EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$64,072,941BOYAmt
EOY$60,795,601EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$110,297,499BOYAmt
EOY$113,656,774EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$350,024BOYAmt
EOY$519,926EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,926,740BOYAmt
EOY$2,011,018EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$112,574,263BOYAmt
EOY$116,187,718EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$176,647,204BOYAmt
EOY$176,983,319EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$4,486,437ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,127,161NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$254,179OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
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)
HospitalYes (X)HospitalInd

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$1,894DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$8,672OtherActivitiesAmt
Total Lobbying Expenditures$10,566TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationEXPLANATION: PART II-B, LINES 1B & 1G: HOLY FAMILY MEMORIAL SENT A REPRESENTATIVE TO WASHINGTON D.C. TWICE IN 2014, IN PART, TO DISCUSS SPECIFIC LEGISLATIVE MATTERS WITH THEIR FEDERAL REPRESENTATIVES. HOLY FAMILY MEMORIAL ALSO SENT A REPRESENTATIVE TO THE CAPITAL TO EDUCATE THEIR LEGISLATORS ON VARIOUS HEALTHCARE TOPICS. EXPLANATION: PART II-B, LINE 1I, OTHER ACTIVITIES: HOLY FAMILY MEMORIAL BELONGS TO THE WISCONSIN HEALTHCARE ASSOCIATION AND THE AMERICAN HEALTHCARE ASSOCIATION, WHICH USE A PERCENTAGE OF DUES FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct Liab0InclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,276,763BeginningYearBalanceAmt
Contributions$428,510ContributionsAmt
Investment Earnings Or Losses$61,207InvestmentEarningsOrLossesAmt
Other Expenditures$235,539OtherExpendituresAmt
End Year Balance$2,530,941EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915,567BeginningYearBalanceAmt
Contributions$374,287ContributionsAmt
Investment Earnings Or Losses$179,201InvestmentEarningsOrLossesAmt
Other Expenditures$192,292OtherExpendituresAmt
End Year Balance$2,276,763EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,637,918BeginningYearBalanceAmt
Contributions$514,026ContributionsAmt
Other Expenditures$236,377OtherExpendituresAmt
End Year Balance$1,915,567EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,602,667BeginningYearBalanceAmt
Contributions$202,680ContributionsAmt
Investment Earnings Or Losses-$9,775InvestmentEarningsOrLossesAmt
Grants Or Scholarships$500GrantsOrScholarshipsAmt
Other Expenditures$157,154OtherExpendituresAmt
End Year Balance$1,637,918EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,429,395BeginningYearBalanceAmt
Contributions$240,013ContributionsAmt
Investment Earnings Or Losses$162,063InvestmentEarningsOrLossesAmt
Grants Or Scholarships$500GrantsOrScholarshipsAmt
Other Expenditures$228,304OtherExpendituresAmt
End Year Balance$1,602,667EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.94000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.06000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,915,540OtherCostOrOtherBasisAmt
Book Value$4,915,540BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$101,808,660OtherCostOrOtherBasisAmt
Depreciation$58,117,028DepreciationAmt
Book Value$43,691,632BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,229,767OtherCostOrOtherBasisAmt
Depreciation$4,819,977DepreciationAmt
Book Value$409,790BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,661,463OtherCostOrOtherBasisAmt
Depreciation$47,025,748DepreciationAmt
Book Value$13,635,715BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,928,730OtherCostOrOtherBasisAmt
Depreciation$868,379DepreciationAmt
Book Value$1,060,351BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$63,713,028TotalBookValueLandBuildingsAmt

Financial Derivatives FinancialDerivativesGrp

FieldValueIRS element (for citing)
Book Value$17,728,459BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$17,728,459TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescSECURITY DEPOSITDesc
Amt$200Amt
FieldValueIRS element (for citing)
Total Liability$200TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$130,902,912TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$1,127,161NetUnrealizedGainsInvstAmt
Other Revenue-$45OtherRevenueAmt
Revenue Not Reported-$1,127,206RevenueNotReportedAmt
Revenue Subtotal$132,030,118RevenueSubtotalAmt
Other Revenues Not Included$15,008OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$15,008RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$132,045,126TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$127,543,636TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included-$45OtherExpensesIncludedAmt
Expenses Not Reported-$45ExpensesNotReportedAmt
Expenses Subtotal$127,543,681ExpensesSubtotalAmt
Other Expenses Not Included$15,008OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$15,008ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$127,558,689TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:HOLY FAMILY MEMORIAL'S ENDOWMENT FUNDS WERE ESTABLISHED TO PROVIDE FINANCIAL SUPPORT ON AN ONGOING BASIS TO MEET THE CURRENT AND FUTURE NEEDS OF HOLY FAMILY MEMORIAL AND THE PEOPLE IT SERVES. FUNDS ARE USED FOR CAPITAL EQUIPMENT, MAJOR BUILDING IMPROVEMENTS, PROGRAM DEVELOPMENT, AND OPERATIONS.
PART XI, LINE 2D - OTHER ADJUSTMENTS:AUDITOR RECLASS OF PURCHASED SERVICES FOR HOLY FAMILY HEALTH SERVICES -45.
PART XI, LINE 4B - OTHER ADJUSTMENTS:NON-CASH CONTRIBUTIONS (NON-SERVICE RELATED) 15,008.
PART XII, LINE 2D - OTHER ADJUSTMENTS:AUDITOR RECLASS OF PURCHASED SERVICES FOR HOLY FAMILY HEALTH SERVICES -45.
PART XII, LINE 4B - OTHER ADJUSTMENTS:NON-CASH CONTRIBUTIONS (NON-SERVICE RELATED) 15,008.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1SAMARITAN DAYEvent1Nm
Gross Receipts Event1$94,228GrossReceiptsEvent1Amt
Charitable Contri Event1$27,777CharitableContriEvent1Amt
Gross Revenue Event1$66,451GrossRevenueEvent1Amt
Other Direct Expenses Event1$9,304OtherDirectExpensesEvent1Amt
Event2MARITIME MARATHONEvent2Nm
Gross Receipts Event2$37,259GrossReceiptsEvent2Amt
Charitable Contri Event2$5,600CharitableContriEvent2Amt
Gross Revenue Event2$31,659GrossRevenueEvent2Amt
Other Direct Expenses Event2$12,114OtherDirectExpensesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$41,826GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$5,677CharitableContriOtherEventsAmt
Gross Revenue Other Events$36,149GrossRevenueOtherEventsAmt
Non Cash Prizes Other Events$100NonCashPrizesOtherEventsAmt
Oth Direct Expnss Other Events$1,305OthDirectExpnssOtherEventsAmt
Gross Receipts Total$173,313GrossReceiptsTotalAmt
Charitable Contributions Tot$39,054CharitableContributionsTotAmt
Gross Revenue Total Events$134,259GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$100NonCashPrizesTotalEventsAmt
Oth Direct Expnss Total Events$22,723OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$22,823DirectExpenseSummaryEventsAmt
Net Income Summary$111,436NetIncomeSummaryAmt
FieldValueIRS element (for citing)
LicensedYes (1)LicensedInd
Gaming Own Facility1.00000GamingOwnFacilityPct
Gaming Other Facility0.00000GamingOtherFacilityPct

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
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)
Persons Served1639PersonsServedCnt
Total Community Benefit Expns$984,967TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$984,967NetCommunityBenefitExpnsAmt
Total Expense0.00770TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served36596PersonsServedCnt
Total Community Benefit Expns$12,971,279TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,929,267DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,042,012NetCommunityBenefitExpnsAmt
Total Expense0.07090TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served38235PersonsServedCnt
Total Community Benefit Expns$13,956,246TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$3,929,267DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,026,979NetCommunityBenefitExpnsAmt
Total Expense0.07860TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served5131PersonsServedCnt
Total Community Benefit Expns$123,524TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$123,524NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served482PersonsServedCnt
Total Community Benefit Expns$130,104TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$130,104NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$192,480TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$151,983DirectOffsettingRevenueAmt
Net Community Benefit Expns$40,497NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served485PersonsServedCnt
Total Community Benefit Expns$93,346TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$93,346NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served6098PersonsServedCnt
Total Community Benefit Expns$539,454TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$151,983DirectOffsettingRevenueAmt
Net Community Benefit Expns$387,471NetCommunityBenefitExpnsAmt
Total Expense0.00300TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served44333PersonsServedCnt
Total Community Benefit Expns$14,495,700TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,081,250DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,414,450NetCommunityBenefitExpnsAmt
Total Expense0.08160TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Persons Served50PersonsServedCnt
Total Community Benefit Expns$7,890TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$7,890NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$27,655TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$27,655NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$907TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$907NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Persons Served659PersonsServedCnt
Total Community Benefit Expns$3,499TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$3,499NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Persons Served709PersonsServedCnt
Total Community Benefit Expns$39,951TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$39,951NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$1,354,947BadDebtExpenseAmt
Bad Debt Expense Attributable$285,894BadDebtExpenseAttributableAmt
Reimbursed By Medicare$44,492,004ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$58,034,855CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$13,542,851MedicareSurplusOrShortfallAmt

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 YORK STREET PROPERTIES LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesREAL ESTATEPrimaryActivitiesTxt
Org Profit Or Ownership0.36000OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership0.00000OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership0.00000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12300 WESTERN AVE PO BOX 1450AddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP542211450ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY MEMORIAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
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
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.HFMHEALTH.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLHEALTHIESTMC.ORG; MANITOWOCHEALTHDEPT.INFOOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHFMHEALTH.ORG;HEALTHIESTMC.ORG;MANITOWOCHEALTHDEPT.INFOStrategyWebsiteURLTxt
Strategy Attached0StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 5: THE COMMUNITY HEALTH ASSESSMENT CONDUCTED PERSONAL FACE TO FACE INPUT SESSIONS WITH THE DIRECTOR AND MANAGER OF PUBLIC HEALTH FROM THE MANITOWOC COUNTY HEALTH DEPARTMENT, THE DIRECTOR OF NORTHEASTERN WI AREA HEALTH AND EDUCATION CENTER AND THE DIRECTOR OF THE UNITED WAY - MANITOWOC COUNTY. WE CONDUCTED A COMMUNITY HEALTH TELEPHONE AND ONLINE SURVEY WITH 400 INPUTS FROM CITIZENS, A PHYSICIAN SURVEY WITH 25 INPUTS, A SOCIAL SERVICE AGENCY SURVEY WITH 25 INPUTS, FACE TO FACE INTERVIEWS WITH 20 BUSINESS LEADERS IN OUR COMMUNITY, AND A FOCUS GROUP WITH REPRESENTATIVES FROM THE HMONG COMMUNITY.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED COLLABORATIVELY WITH AURORA MEDICAL CENTER - MANITOWOC COUNTY.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 11: HFM IDENTIFIED FOUR SIGNIFICANT NEEDS IN OUR CHNA AND HAVE IMPLEMENTED A MULTIDISCIPLINARY COMMUNITY BENEFIT TEAM TO OWN, LEAD AND MONITOR PROGRESS ON THE 4 MAIN GOALS, WHICH INCLUDE: REDUCE DEATH RATE IN MANITOWOC COUNTY FROM FALLS; IMPROVE HEALTH LITERACY; INCREASE IMMUNIZATION RATES IN ADOLESCENTS INCLUDING COLLEGE-AGE FRESHMEN; INCREASE PHYSICAL ACTIVITY AND GOOD NUTRITION. THE TEAMS HAVE ALL FORMED COLLABORATIVE COMMUNITY COALITIONS TO ADDRESS THE SPECIFIC MEASURES FOR EACH GOAL AND REPORT ACTIVITY AND PROGRESS ON A QUARTERLY BASIS. OTHER HEALTH NEEDS WHICH SURFACED IN THE CHNA, WHILE NOT SPECIFICALLY OWNED AND LED BY HFM, ARE BEING ADDRESSED BY PARTNERSHIPS WITH OTHER COMMUNITY GROUPS OF WHICH AN HFM LEADER IS AN ACTIVE, ENGAGED PARTICIPANT. THESE GOALS INCLUDE: ACCESS TO PRIMARY CARE; CHRONIC DISEASE MANAGEMENT; ADULT OBESITY AND POOR NUTRITION; ACCESS TO MENTAL HEALTH CARE AND TOBACCO, ALCOHOL AND OTHER SUBSTANCE ABUSE. COMMUNITY COALITIONS ARE WORKING HARD ON THESE COMMUNITY HEALTH NEEDS AS WELL AS HFM STAFF MEMBERS.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 16I: HOLY FAMILY MEMORIAL'S COMMUNITY CARE PROGRAM IS COMMUNICATED ON THE WEBSITE SUMMARIZING THE ELIGIBILITY REQUIREMENTS TO INCLUDE SERVICES COVERED, INCOME GUIDELINES, APPLICATION FORM, AND OTHER DOCUMENTS NEEDED FOR COMPLETION OF THE APPLICATION. THE COMMUNITY CARE PROGRAM IS ALSO COMMUNICATED VIA PAYMENT GUIDELINE BROCHURES AVAILABLE IN THE REGISTRATION AREAS AT ALL HFM LOCATIONS THROUGHOUT THE COMMUNITY, AND TO PATIENTS IN COMMUNICATION WITH PRICE ESTIMATIONS AND COLLECTIONS, BOTH VERBAL AND WRITTEN. THE POLICY IS ALSO AVAILABLE UPON REQUEST.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 20E: PAYMENT GUIDELINES AND FINANCIAL ASSISTANCE POLICY IS POSTED IN PATIENT ROOMS AND LOBBIES, ADMISSION/REGISTRATION AREAS, GIVEN TO ALL SURGERY PATIENTS, AND PUBLISHED ON THE BACK OF ALL PATIENT STATEMENTS.
HOLY FAMILY MEMORIAL, INCPART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE AVERAGE OF ITS FIVE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
HOLY FAMILY HEALTH SERVICES INC
3310 CALUMET AVENUEMANITOWOCWI54220RETAIL PHARMACY
NORTH END HOME MEDICAL SERVICES LLC
3310 CALUMET AVENUEMANITOWOCWI54220DURABLE MEDICAL EQUIPMENT

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:COMMUNITY BENEFITS ARE PROGRAMS OR ACTIVITIES THAT PROVIDE CARE AND/OR PROMOTE HEALTH AND HEALING AS A RESPONSE TO IDENTIFIED COMMUNITY NEEDS. HOLY FAMILY MEMORIAL'S COMMUNITY BENEFIT PROGRAMS INCLUDE SERVICES FOR THOSE WHO CAN NOT AFFORD HEALTH CARE AND INITIATIVES FOR IMPROVING HEALTH IN THE BROADER COMMUNITY. PROVIDING COMMUNITY BENEFITS DEMONSTRATES THAT HOLY FAMILY MEMORIAL IS FULFILLING ITS CHARITABLE MISSION AND DEMONSTRATING ITS PREFERENTIAL TAX STATUS IS DESERVED.
SCHEDULE H, PART I, LINE 7, COLUMN FPERCENTAGE OF COMMUNITY BENEFIT EXPENSE TO OVERALL ENTITY'S EXPENSES.
PART II, COMMUNITY BUILDING ACTIVITIES:COMMUNITY BUILDING ACTIVITIES INDICATED IN PART II PROMOTE THE HEALTH OF THE MANITOWOC COMMUNITY BY ACTIVELY ADDRESSING EXPRESSED AND REPORTED ISSUES. SPECIFICALLY, THROUGH THE PROGRAMS INDICATED, HOLY FAMILY MEMORIAL AND IN PARTNERSHIP WITH OTHERS, WORKS DILIGENTLY TO ACHIEVE AN OVERALL HEALTHIER COMMUNITY. MAJOR INITIATIVES WITH POSITIVE RESULTS INCLUDE: IMPROVED ACCESS TO HEALTH CARE, IMPROVED MENTAL HEALTH ACCESS AND CARE, INCREASED EXERCISE FOR ADULTS AND CHILDREN, HEALTHY FOOD OPTIONS IN SCHOOLS, AND ACCESS TO FRESH FRUITS AND VEGETABLES FOR THE POOR.
PART III, LINE 4:AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE ORGANIZATION'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE.
PART III, LINE 8:HOLY FAMILY MEMORIAL IS A LICENSED MEDICARE PROVIDER WITH APPROXIMATLEY 47 PERCENT OF ITS PATIENT BASE QUALIFYING FOR THIS PROGRAM. AT PRESENT, THE REIMBURSEMENT RATE FOR THE MEDICARE PROGRAM DOES NOT FULLY COVER THE COST OF CARE TO THESE PATIENTS. THIS REPRESENTS THE ESTIMATED SHORTFALL CREATED WHEN HOLY FAMILY MEMORIAL RECEIVES PAYMENTS BELOW THE COSTS OF TREATING MEDICARE AND OTHER PUBLIC PROGRAM BENEFICIARIES.COST METHODOLOGY = COST TO CHARGE RATIO
PART III, LINE 9B:PAYMENT OPTIONS AS WELL AS COMMUNITY CARE ASSISTANCE IS NOTED ON ALL COLLECTION LETTERS, AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, CT SCAN, ER SERVICES. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES SELF-PAY INPATIENTS TO INTERVIEW & ADVISE PATIENTS OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION, OR OUR OWN CHARITY CARE PROGRAM. IF THEY MAY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, THE ELIGIBILITY SPECIALIST WILL HELP THEM COMPLETE THE APPLICATION PROCESS AND FOLLOW UP ON THEIR APPLICATION THROUGH TO APPROVAL/DISAPPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL DIRECT THOSE PATIENTS ON WHERE TO GO TO APPLY FOR THOSE PROGRAMS. THE ELIGIBILITY SPECIALIST WILL ASSIST AS WELL.
SCHEDULE H, PART III, LINE 3:THROUGH ANALYTICAL TOOLS, A COLLECTION PREDICTION SCORE IS APPLIED TO ALL ACCOUNTS WRITTEN OFF TO BAD DEBT THROUGH A COLLECTION AGENCY. THOSE SCORING LOW/UNCOLLECTIBLE ARE ASSUMED CHARITY/COMMUNITY BENEFIT.
PART VI, LINE 2:HOLY FAMILY MEMORIAL UTILIZES FOUR DISTINCT PROCESSES TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE. FIRST, AS A PART OF THE ANNUAL STRATEGIC PLANNING PROCESS, AN ENVIRONMENTAL ASSESSMENT IS DONE. INCLUDED IN THAT REPORT AND ANALYSIS IS CURRENT POPULATION DATA, COMMUNITY INPUT AND INPUT FROM VARIOUS CONSTITUENCIES RELATIVE TO PERCEIVED MET AND UNMET COMMUNITY HEALTH NEEDS. SECOND, HOLY FAMILY MEMORIAL PARTICIPATES IN A TRI-ANNUAL FULL COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS IN PARTNERSHIP WITH HEALTHIEST MANITOWOC COUNTY, AURORA MEDICAL CENTER, MANITOWOC COUNTY PUBLIC HEALTH DEPT AND THE UNITED WAY. THIS ASSESSMENT CONSISTS OF INPUT OBTAINED FROM HUNDREDS OF COMMUNITY RESIDENTS, LEADERS, BUSINESSES; INCLUDING ALL AGE GROUPS, BEGINNING FROM HIGH SCHOOL AGE. THE INFORMATION IS TABULATED, ANALYZED AND UTILIZED TO DETERMINE PRIORITIZED HEALTH NEEDS. HOLY FAMILY MEMORIAL USES THIS INFORMATION IN ITS COMMUNITY IMPLEMENTATION PLAN. THIRD, HOLY FAMILY MEMORIAL CONDUCTS REGULAR INPUT SESSSIONS WITH LOCAL EMPLOYERS TO ASCERTAIN HEALTH NEEDS FROM AN OCCUPATIONAL HEALTH PERSPECTIVE. THIS INFORMATION IS THEN UTILIZED TO DEVELOP AND PROVIDE NEEDED EMPLOYER/EMPLOYEE HEALTH SERVICES THROUGHOUT THE BUSINESS COMMUNITY. LASTLY, HOLY FAMILY MEMORIAL UTILIZES A COMBINATION OF PATIENT FEEDBACK FROM ONGOING PATIENT SATISFACTION SURVEYS (CONDUCTED POST PROVISION OF SERVICES) AND COMMUNITY RESEARCH STUDIES COMMISSIONED BY HOLY FAMILY MEMORIAL, TO ASSESS PROGRAM AND SERVICE HEALTH CARE NEEDS OF THE COMMUNITY.
PART VI, LINE 3:PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE AREAS / WEBSITE / BROCHURES / ADMISSIONS STAFF / COLLECTION CORRESPONDENTS AS WELL AS INSURANCE BENEFIT PAPERWORK THAT IS SENT TO PATIENTS FOR INPATIENT, SAME DAY SURGERY, MRI, AND CT SCANS. A PATIENT FINANCIAL ADVISOR AND/OR ELIGIBILITY SPECIALIST SEES/COMMUNICATES TO SELF-PAY INPATIENTS TO INTERVIEW AND ADVISE PATIENT OF ANY PROGRAMS THEY MAY QUALIFY FOR INCLUDING, BUT NOT LIMITED TO MEDICAID, VETERANS ADMINISTRATION OR OUR OWN CHARITY PROGRAM. IF THEY QUALIFY FOR MEDICAID OR VETERANS ADMINISTRATION, WE ASSIST THEM IN COMPLETING THE APPLICATION AND FOLLOW UP ON THE APPLICATION THROUGH APPROVAL. FOR THE NETWORK CHARITY PROGRAM, AN APPLICATION IS PROVIDED AND THE PATIENT IS INSTRUCTED ON WHOM TO CALL FOR ASSISTANCE IN APPLYING. WHEN CONTACTING PATIENTS BY PHONE, THE PATIENT FINANCIAL ADVISOR OR ELIGIBILITY SPECIALIST IS TRAINED TO IDENTIFY PATIENTS WHO MAY QUALIFY FOR OUTSIDE STATE OR FEDERAL ASSISTANCE AND WILL ASSIST THOSE PATIENTS ON APPLYING FOR THOSE PROGRAMS.
PART VI, LINE 4:THE COMMUNITY THAT HOLY FAMILY MEMORIAL SERVICES IS CONSIDERED TO BE LOCATED IN THE RURAL LAKESHORE REGION OF NORTHEAST WISCONSIN. THE PRIMARY SERVICE AREA IS MANITOWOC COUNTY WITH SECONDARY NEIGHBORING COUNTIES; BROWN, KEWAUNEE, CALUMET AND SHEBOYGAN. SPECIFICALLY, THE COMMUNITY SERVED IS AN OLDER POPULATION WITH 18.1% OF THE PEOPLE AGE 65 OR OLDER WITH MEDIAN HOUSEHOLD INCOME OF APPROXIMATELY $50,000. 14.3% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICAID AND SELF-PAY PATIENTS. THE 2014 SERVICE AREA IS EXPECTED TO REMAIN AT 2013 LEVELS WITH A SLIGHT GROWTH TOWARD THE 65+ AGE AND RETRACTION OF THOSE 18-44. REFLECTIVE OF THIS NUMBER IS THAT OVER 47% OF OUR SERVICES ARE DEDICATED TO PROVIDING CARE TO MEDICARE PATIENTS. THE COMMUNITY IS MAINLY CAUCASIAN WITH SEVERAL OTHER NATIONALITIES INCLUDING AFRICAN AMERICAN, ASIAN AND HISPANIC. OTHER PROVIDERS IN THE AREA CONSIST OF THE AURORA MEDICAL GROUP, MANITOWOC SURGERY CENTER, AND SEVERAL OTHER INDEPENDENT PROVIDERS.
PART VI, LINE 5:ALL OF HOLY FAMILY MEMORIAL'S BOARD MEMBERS RESIDE IN THE PRIMARY SERVICE AREA. THE BOARD CONSISTS OF COMMUNITY REPRESENTATIVES, PHYSICIANS AND REPRESENTATIVES OF THE SPONSOR ORGANIZATION. THE MEDICAL/DENTAL STAFF IS OPEN TO ALL QUALIFIED PROVIDERS WHO MEET THE REQUIREMENTS OF MEDICAL/DENTAL STAFF MEMBERSHIP. THE NETWORK OF PHYSICIANS AND OTHER PROVIDERS ARE COMMITTED TO PROVIDING EACH PATIENT WITH THE HIGHEST LEVEL OF PERSONAL CARE, RESPECT AND COMPASSION TO ENHANCE THE PATIENT'S QUALITY OF LIFE AND HEALTH STATUS. ALL SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION TO PURCHASE NECESSARY MEDICAL EQUIPMENT, COMPENSATE EMPLOYEES, AND PLAN FOR FUTURE NEEDS. NONE OF THE SURPLUS EARNINGS BENEFIT ANY INDIVIDUALS OR OTHER CORPORATE ENTITIES.
PART VI, LINE 6:THE HEALTH CARE NETWORK IS SPONSORED BY THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY, LOCATED AT HOLY FAMILY CONVENT, MANITOWOC, WISCONSIN. THE CONVENT, SITUATED ON SILVER LAKE, THREE MILES WEST OF LAKE MICHIGAN, IS HOME FOR OVER 350 CONGREGATION MEMBERS WHO SERVE THROUGHOUT THE UNITED STATES AND ARE PRIMARILY ENGAGED IN EDUCATION, PARISH AND HEALTH MINISTRIES. THE HEALTHCARE MINISTRY SPANS THREE STATES - WISCONSIN, NEBRASKA AND OHIO - AND HAS EXISTED FOR OVER 100 YEARS. THE MISSION OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY HEALTHCARE MINISTRY IS TO CARRY OUT THE COMMITMENT OF THE SPONSOR IN THE HEALING MISSION OF THE CATHOLIC CHURCH THROUGH THE PROVISION OF QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF GOD IN OUR COMMUNITIES.
PART VI, LINE 7, REPORTS FILED WITH STATESWI,NE

Schedule I IRS990ScheduleI

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

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDesc
SCHOLARSHIPS10$10,500ACTUAL TUITION COST
SCHOLARSHIPS - EDUCATION12$34,300ACTUAL TUITION COST

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART III:FormAndLineReferenceDesc
ExplanationHOLY FAMILY MEMORIAL'S SCHOLARSHIP PROGRAM IS DESIGNED AS A RECRUITMENT TOOL FOR EMPLOYMENT OF CANDIDATES IN SPECIFIED POSITIONS, CONSIDERED DIFFICULT TO FILL AND TO ASSIST STUDENTS IN THEIR PURSUIT OF A HEALTH CARE RELATED DEGREE. AREAS OF STUDY INCLUDE NURSING, PHARMACY, PHYSICAL THERAPY AND OTHERS. IN RETURN FOR THE SCHOLARSHIP, AN EMPLOYMENT SERVICE COMMITMENT IS MADE. IN ORDER TO BE ELIGIBLE: 1) STUDENTS MUST BE ACCEPTED INTO AN ACCREDITED PROGRAM 2) CANDIDATES MUST BE ATTENDING SCHOOL AS A FULL OR PART TIME STUDENT AND REMAIN IN THAT STATUS 3) STUDENTS MUST HAVE AND MAINTAIN A 3.0 CUMULATIVE GRADE POINT AVERAGE. SCHOLARSHIPS ARE AWARDED ON THE BASIS OF GRADE POINT AVERAGE, VERIFIED WITH OFFICIAL TRANSCRIPT OF GRADES, COMPLETION OF EMPLOYMENT APPLICATION AND PERSONAL INTERVIEW. THE SCHOLARSHIP IS USED FOR TUITION COST. THE SCHOLARSHIPS ARE GIVEN OUT EACH SEMESTER AND ARE PAID DIRECTLY TO THE SCHOOL THE STUDENT ATTENDS. APPLICANTS WHO ARE AWARDED THE SCHOLARSHIP MUST MAKE A SIX-MONTH COMMITMENT TO WORK AT HOLY FAMILY MEMORIAL FOR EACH SEMESTER THE SCHOLARSHIP IS AWARDED. THE SCHOLARSHIP RECIPIENT MUST REPAY THE FULL AMOUNT OF THE SCHOLARSHIP IF HE/SHE: 1) DROPS OUT OF SCHOOL 2) FALLS BELOW A 3.0 CUMULATIVE GRADE POINT AVERAGE 3) DOES NOT ACCEPT EMPLOYMENT 4) DOES NOT COMPLETE FULL LENGTH OF EMPLOYMENT COMMITMENT 5) DOES NOT OBTAIN WISCONSIN LICENSURE, AS REQUIRED. THE SCHOLARSHIP AWARD THROUGH EDUCATION ARE USED TO PROMOTE HEALTH CARE CAREERS. THE REQUIREMENTS FOR THE MEDICAL/DENTAL ENDOWMENT INCLUDE ACCEPTANCE AT AN ACCREDITED COLLEGE, UNIVERSITY, OR TECHNICAL SCHOOL, A MANITOWOC COUNTY RESIDENT, A GRADE POINT AVERAGE OF 3.0 OR ABOVE IS DESIRED, DEMONSTRATE HEALTH CAREER INTEREST AND FINANCIAL NEED. THESE SCHOLARSHIPS ARE OFFERED FOR ONE YEAR WITH POSSIBLE CONTINUATION BASED ON MEETING CRITERIA. THE CRITERIA FOR THE RONCALLI SCHOLARSHIP INCLUDES ACCEPTANCE AT AN ACCREDITED COLLEGE, UNIVERSITY, OR TECHNICAL SCHOOL, A MANITOWOC COUNTY RESIDENT, A GRADE POINT AVERAGE OF 3.0 OR ABOVE IS DESIRED, AND DEMONSTRATED HEALTH CAREER INTEREST. THESE SCHOLARSHIPS ARE PROVIDED FOR ONE YEAR.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 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
RYAN M DOPIRAK MD
PHYSICIAN COUNCIL CHAIR$697,915$0$380,705$0$60,540$0$5,646$0$28,411$0$1,173,217$0$0$0
MATTHEW L CAMPBELL MD
PHYSICIAN COUNCIL CHAIR$316,213$0$0$0$6,486$0$5,646$0$25,603$0$353,948$0$0$0
XA XIONG MD
DIRECTOR$177,175$0$12,000$0$558$0$1,623$0$26,617$0$217,973$0$0$0
DEREK R BOWN DC
DIRECTOR$117,811$0$8,738$0$367$0$2,284$0$26,015$0$155,215$0$0$0
MARK P HERZOG
DIRECTOR, PRESIDENT, CEO$497,586$0$69,455$0$308,516$0$108,172$0$27,553$0$1,011,282$0$0$0
PATRICIA HUETTL
CHIEF FINANCIAL OFFICER$238,727$0$30,125$0$4,776$0$42,581$0$29,191$0$345,400$0$0$0
STEVEN D DRIGGERS MD
CHIEF MEDICAL OFFICER$419,553$0$54,217$0$58,116$0$58,811$0$27,309$0$618,006$0$0$0
MARY MAURER
CHIEF INNOVATION OFFICER$183,018$0$26,468$0$155,470$0$43,217$0$3,415$0$411,588$0$0$0
KIRK DIMITRIS MD
PHYSICIAN$714,570$0$485,961$0$486$0$5,646$0$22,927$0$1,229,590$0$0$0
DAVID MIKOLYZK MD
PHYSICIAN$699,707$0$268,813$0$13,948$0$5,646$0$27,881$0$1,015,995$0$0$0
MICHAEL ROSENBERG MD
PHYSICIAN$508,682$0$8,000$0$53,563$0$5,646$0$23,182$0$599,073$0$0$0
NANCY N BUTLER MD
PHYSICIAN$348,904$0$156,088$0$101,810$0$5,646$0$9,926$0$622,374$0$0$0
JEFFREY A JACOBY MD
PHYSICIAN$273,742$0$345,422$0$592$0$5,646$0$11,668$0$637,070$0$0$0
JANE CURRAN-MEULI
EXECUTIVE VP, COO$133,586$0$8,740$0$1,872$0$2,654$0$10,848$0$157,700$0$0$0
WILLIAM D HAMPTON MD
FORMER DIRECTOR$246,183$0$23,217$0$22,773$0$5,646$0$25,682$0$323,501$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ACIVIC PAY, CEO, CFO, KEY EMPLOYEES (5 EMPLOYEES - $1,650-$5,776), BENEFIT TREATED AS TAXABLE INCOME
PART I, LINE 6THE SENIOR SUCCESSSHARE PROGRAM IS AN AT RISK COMPENSATION PROGRAM WHICH IS BASED ON BALANCED STRATEGIC ACCOMPLISHMENTS AS APPROVED ANNUALLY BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD OF DIRECTORS. ELIGIBLE PERSONS INCLUDE THE PRESIDENT/CEO, CHIEF MEDICAL OFFICER, CHIEF FINANCIAL OFFICER, AND CHIEF INNOVATION OFFICER.
PART I, LINE 7A PORTION OF PHYSICIAN SALARY IS BASED ON INDIVIDUAL PRODUCTION FOR PERSONALLY RENDERED SERVICES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
WISCONSIN HEALTH AND EDUCATION FACILITIES
A39133785597710V2S62007-04-26$45,170,000SEE SCHEDULE K, PART V000
WISCONSIN HEALTH AND EDUCATION FACILITIES
B3913378552014-12-19$7,830,000SEE SCHEDULE K, PART V000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$6,702,000$45,170,000$3,555,000$485,000$4,990,0002009Yes (1)Yes (1)Yes (1)Yes (1)
B$7,830,000$18,0002006Yes (1)0Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A000000Yes (1)
B000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A00000000Yes (1)
B00Yes (1)00000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE B, COLUMN F:THE PURPOSE OF THE BOND ISSUE WAS TO REFUND SERIES 2003B, ISSUED ON 09/09/2003.
PART I, LINE A, COLUMN F:THE PURPOSE OF THE BOND ISSUE WERE 1) THE ACQUISITION, CONSTRUCTION, RENOVATION, REMODELING AND EQUIPPING OF CERTAIN HOSPITAL AND OTHER HEALTHCARE FACILITIES AS IDENTIFIED IN A NOTICE OF PUBLIC HEARING PUBLISHED IN CONNECTION WITH THE ISSUANCE OF THE BONDS INCLUDING THE ACQUISITION OF TELEMETRY MONITORS AND AN MRI SYSTEM 2) THE CURRENT REFUNDING OF ALL THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY REVENUE (WHEFA) BONDS, SERIES 1995, 3) THE ADVANCE REFUNDING OF ALL OF THE WHEFA BONDS, SERIES 1998A, AND 4) THE ADVANCE REFUNDING OF A PORTION OF THE WHEFA BONDS, SERIES 2003A.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
NORTH END HOME MED SVC LLC
SERVE AS DIRECTORS ON BOTH ORGANIZATIONS-$182,418INCOME FROM CONTINUOUS OPS - 100% OWNED0
HOLY FAMILY HEALTH SERVICES
SERVE AS DIRECTORS ON BOTH ORGANIZATIONS$232,037INCOME FROM CONTINUOUS OPERATIONS - 100% OWNED0
LINDSAY FROELICH
DAUGHTER OF DIRECTOR$45,821EMPLOYMENT BY ORGANIZATION0
KATHERINE CASEY
DAUGHTER OF DIRECTOR$27,712EMPLOYMENT BY ORGANIZATION0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6HOLY FAMILY MEMORIAL IS SPONSORED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AHOLY FAMILY MEMORIAL OPERATES AN INTEGRATED HEALTHCARE DELIVERY SYSTEM, PRIMARILY TO THE RESIDENTS OF MANITOWOC COUNTY, WISCONSIN. HOLY FAMILY MEMORIAL IS OPERATED BY FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC., WHICH IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. FRANCISCAN SISTERS OF CHRISTIAN CHARITY SPONSORED MINISTRIES, INC. IS A NOT-FOR-PROFIT HEALTHCARE HOLDING COMPANY INCORPORATED TO MONITOR AND MANAGE HEALTHCARE OPERATIONS. THE BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN EIGHTEEN INDIVIDUALS. THE PRESIDENT OF THE CORPORATION AND CHAIR OF THE PHYSICIAN COUNCIL SHALL BE EX-OFFICIO MEMBERS WITH FULL VOTING PRIVILEGES. IN ADDITION TO THE EX-OFFICIO BOARD POSITIONS, THE BOARD OF DIRECTORS SHALL INCLUDE FOUR MEMBERS OF FRANCISCAN SISTERS OF CHRISTIAN CHARITY AND AT LEAST FOUR PHYSICIANS.
FORM 990, PART VI, SECTION A, LINE 7BSOME DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER AS OUTLINED IN THE CORPORATE BYLAWS. FOR EXAMPLE, THE GOVERNING BOARD SUBMITS NAMES OF NEW BOARD MEMBERS TO THE MEMBER AND THE MEMBER APPOINTS THEM. APPROVAL OF THE BUDGET, MORTGAGE, PHILOSOPHY, MISSION & VISION, LEASE OR SALE OF REAL ESTATE MUST BE APPROVED BY THE MEMBER. A CERTIFIED AUDIT OF CORPORATE FUNDS OR THE ANNUAL FISCAL AUDIT MUST BE APPROVED BY THE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11THE CHAIR OF THE GOVERNING BOARD REVIEWS THE 990 PRIOR TO FILING. AN OVERVIEW OF THE 990 ALONG WITH SPECIFIC SECTIONS ON GOVERNANCE, COMMUNITY BENEFITS, AND CONFLICT OF INTEREST IS PRESENTED TO THE BOARD OR BOARD COMMITTEE. THE COMPENSATION AND EVALUATION SUBCOMMITTEE REVIEWS THE 990 SECTIONS RELATED TO COMPENSATION PRIOR TO FILING. COPIES ARE AVAILABLE TO ALL BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, GOVERNING BOARD MEMBERS ARE PROVIDED A COPY OF THE CONFLICT OF INTEREST POLICY TO REVIEW AND SIGN THE CERTIFICATION ON WHICH THEY DISCLOSE ANY CONFLICTS. AT EACH BOARD OR COMMITTEE MEETING WHERE THERE WILL BE A VOTE, THE CHAIRPERSON ASKS IF THERE ARE ANY CONFLICTS TO THE PARTICULAR ISSUE. IF THERE IS A CONFLICT, THAT PERSON ABSTAINS FROM DISCUSSION & VOTING. ALL PHYSICIANS, LEADERS, AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST ANNUALLY. CONFLICT OF INTEREST IS MONITORED THROUGH HOLY FAMILY MEMORIAL'S COMPLIANCE DEPARTMENT.
FORM 990, PART VI, SECTION B, LINE 15LINES 15 A & B - HOLY FAMILY MEMORIAL HAS A SENIOR LEADER COMPENSATION POLICY. THE PROCESS OF DETERMINING THESE SALARIES IS GOVERNED BY THE COMPENSATION AND EVALUATION SUBCOMMITTEE OF THE BOARD. THE POLICY COVERS THE FOLLOWING POSITIONS: PRESIDENT AND CEO, CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER AND CHIEF INNOVATION OFFICER. SENIOR LEADER SALARY DATA IS EVALUATED ANNUALLY BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM. TOTAL COMPENSATION FOR SENIOR LEADERS (SALARY, BENEFITS AND INCENTIVE) IS EVALUATED EVERY THREE YEARS BY AN EXTERNAL EXECUTIVE COMPENSATION FIRM (LAST DONE OCT 2014). ALSO CONSIDERED ARE CURRENT MARKET CONDITIONS AND MARKET COMPETITIVENESS. THE POLICY REFLECTS HOLY FAMILY MEMORIAL'S MISSION AND VALUES AND THE LOCAL COMMUNITY EXPERIENCE BY EMPHASIZING REWARDS BASED ON WELL ROUNDED ACCOMPLISHMENTS IN THE AREAS OF MISSION AND RELATIONSHIPS, KEY STRATEGIES AND OPERATIONS, INCLUDING FINANCE.
FORM 990, PART VI, SECTION C, LINE 19HOLY FAMILY MEMORIAL'S ARTICLES OF INCORPORATION ARE PUBLICLY AVAILABLE FROM THE WI DEPARTMENT OF FINANCIAL INSTITUTIONS. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. HOLY FAMILY MEMORIAL'S FINANCIAL STATEMENTS ARE AVAILABLE ON THE DACBOND.COM WEBSITE AND HOLY FAMILY MEMORIAL SUBMITS FINANCIAL INFORMATION TO THE STATE OF WI ANNUALLY. FORM 990 IS AVAILABLE UPON REQUEST AND CAN BE SEEN ON THE GUIDESTAR WEBSITE.
FORM 990, PART VII, SECTION A, PART 1A LINES 1 THROUGH 5:HOLY FAMILY MEMORIAL'S BOARD OF DIRECTORS INCLUDES SIX EMPLOYED PROVIDERS. THE COMPENSATION REPORTED FOR THESE DIRECTORS IS FOR THEIR SERVICES AS A PROVIDER.
FORM 990, PART XI, LINE 9:RESTRICTED CONTRIBUTIONS NET OF ASSETS RELEASED 254,179.
FORM 990, PART XII, LINE 2C:THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX PROCESS.
FORM 990, B, AMENDED RETURN EXPLANATION:THE RETURN WAS AMENDED TO CORRECT THE FOLLOWING: -FORM 990, PART VII, SECTION A: NAMES AND/OR TITLES FOR TWO BOARD MEMBERS -SCHEDULE L, PART IV AND V: CORRECT SPELLING OF RELATED PARTY NAME.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTH END HOME MED SCS LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
EIN391868808EIN
Primary ActivitiesMEDICAL EQUIPMENTPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Total Income-$181,554TotalIncomeAmt
End Of Year Assets$1,815,867EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HFM INCBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
FRANCISCAN SISTERS OF CHRISTIAN CHARITY
1415 SOUTH RAPIDS ROADMANITOWOCWI54220391530622HEALTHCAREWI501(C)(3)LINE 1N/A0
ST PAUL ELDER SERVICES INC
316 EAST 14TH STREETKAUKAUNAWI54130391029149ELDER CAREWI501(C)(3)LINE 1N/A0
GOOD SAMARITAN MEDICAL CENTER
800 FOREST AVENUEZANESVILLEOH43701314379479HOLDING CO.OH501(C)(3)LINE 3N/A0
FRANCISCAN CARE SERVICES INC
430 N MONITOR STWEST POINTNE68788470486026HEALTHCARENE501(C)(3)LINE 3N/A0
SILVER LAKE COLLEGE OF THE HOLY FAMILY INC
2406 SOUTH ALVERNO ROADMANITOWOCWI54220390980974HIGHER EDUCATIONWI501(C)(3)LINE 2N/A0
HOLY FAMILY CONVENT OF THE FRANCISCAN SISTERS OF CHRISTIAN CHARITY
2409 SOUTH ALVERNO ROADMANITOWOCWI54220390808523RELIGIOUSWI501(C)(3)LINE 1N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOLY FAMILY HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line13310 CALUMET AVENUEAddressLine1Txt
CityMANITOWOCCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54220ZIPCd
FieldValueIRS element (for citing)
EIN391572253EIN
Primary ActivitiesPHARMACYPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HFM INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income$156,540ShareOfTotalIncomeAmt
Share Of EOY Assets$1,900,185ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
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 Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (6 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
HOLY FAMILY HEALTH SERVICES - REIMBURSEMENT OF SALARYBENEFITSUPPLIESRENT
Q$973,255ACTUAL REVENUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - BUILDING RENT
J$56,100ACTUAL REVENUE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - AUDIT FEES
P$95,000ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - ADMINISTRATIVE SERVICES
P$740,000ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY-LIABBUILDINGWORKERS COMP INSURANC
P$1,392,265ACTUAL EXPENSE
FRANCISCAN SISTERS OF CHRISTIAN CHARITY - HEALTH INSURANCE PREMIUMS
P$9,821,000ACTUAL EXPENSE

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