ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ST MARYS HOSPITAL MEDICAL CENTER OF GREEN BAY INC (EIN 39-0818682)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-12
- IRS object ID
- 201431329349302783
- Schema version
- 2012v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-12T14:10:06-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 191 West Nationwide Blvd Ste 500 | AddressLine1 |
| City | Columbus | City |
| State | OH | State |
| ZIP Code | 432152568 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390818682 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL MEDICAL CENTER OF | BusinessNameLine1 |
| Business Name Line2 | GREEN BAY INC - HOSPITAL SISTERS | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % GREG SIMIA | InCareOfName |
| Name Control | STMA | NameControl |
| Phone | 9204984200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 54303 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THERESE PANDL | Name |
| Title | CHIEF EXECUTIVE OFFICER | Title |
| Phone | 9204984200 | Phone |
| Date Signed | 2014-05-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KPMG LLP | Name |
| Phone | 6142492300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | THERESE PANDL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 54303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 131557241 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.STMGB.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1900 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 803 | TotalNbrEmployees |
| Total Nbr Volunteers | 101 | TotalNbrVolunteers |
| Total Gross UBI | 942371 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -1012374 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 969249 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 494039 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 115430881 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 123523457 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 774768 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2321127 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1580363 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2354989 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 118755261 | TotalRevenuePriorYear |
| Total Revenue Current Year | 128693612 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 47352045 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 47687677 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 63374287 | OtherExpensePriorYear |
| Other Expenses Current Year | 66414928 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 110726332 | TotalExpensesPriorYear |
| Total Expenses Current Year | 114102605 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 8028929 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 14591007 | RevenuesLessExpensesCY |
| Total Assets BOY | 163199187 | TotalAssetsBOY |
| Total Assets EOY | 172358746 | TotalAssetsEOY |
| Total Liabilities BOY | 76275384 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 58631707 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 86923803 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 113727039 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 14639827 | Expense |
| Revenue | 26914163 | Revenue |
| Description | SURGERY - see schedule O | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5542035 | Expense |
| Revenue | 18923123 | Revenue |
| Description | RADIOLOGY SERVICES - see schedule O | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6327786 | Expense |
| Revenue | 14862100 | Revenue |
| Description | HEART & VASCULAR CENTER - see schedule O | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 66083861 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 62436869 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 92593509 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | true | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 38 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 803 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GREG SIMIA | NamePerson |
| Telephone Number | 9208845595 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 54303 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| THERESE PANDL | ||||||||
| PRESIDENT/CEO | 20.0 | 40.0 | X | X | 0 | 663886 | 124666 | |
| JUDY NAGEL | ||||||||
| Vice Chair | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| SISTER BERNADINE GUTOWSKI OSF | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| ROBERT BURNS | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| JOHN HAGER | ||||||||
| SECRETARY | 1.0 | 0.0 | X | X | 0 | 0 | 0 | |
| KENNETH JOHNSON MD | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| DJ LONG | ||||||||
| CHAIR PERSON | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| Daniel J Platkowski | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| FRANK MIKELL | ||||||||
| DIRECTOR | 1.0 | 59.0 | X | 0 | 841930 | 132140 | ||
| DR KEN HUJET | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| BETSY MITCHELL | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| Jules Blank MD | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| ANN M CARR | ||||||||
| TREASURER | 0.25 | 59.75 | X | 0 | 272146 | 138031 | ||
| LAWRENCE J CONNORS | ||||||||
| COO | 40.0 | 0.0 | X | 233191 | 0 | 24438 | ||
| greg simia | ||||||||
| division cfo | 20.0 | 20.0 | X | 0 | 339812 | 24098 | ||
| JOHN DAUL | ||||||||
| CRNA | 40.0 | 0.0 | 204528 | 0 | 22213 | X | ||
| STEPHEN KORDIYAK | ||||||||
| CRNA | 40.0 | 0.0 | 202146 | 0 | 22219 | X | ||
| GABRIEL LEIS | ||||||||
| CRNA | 40.0 | 0.0 | 213733 | 0 | 23175 | X | ||
| Robert Kelly | ||||||||
| CRNA | 40.0 | 0.0 | 202104 | 0 | 20339 | X | ||
| Molly Condit | ||||||||
| CRNA | 40.0 | 0.0 | 194977 | 0 | 24800 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1250679 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2117774 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 556119 | TotalOtherCompensation |
| Number Individuals GT100 K | 25 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ST VINCENT HOSPITAL | |||||
| 835 S VAN BUREN STREET | GREEN BAY | WI | 54303 | SHARED SERVICES | 32801616 |
| CARDINAL HEALTH | |||||
| PO BOX 70539 | CHICAGO | IL | 60673 | MEDICAL SUPPLIES | 5487141 |
| PREVEA CLINIC | |||||
| PO BOX 19070 | GREEN BAY | WI | 54307 | SHARED LABOR | 3338137 |
| MEDTRONIC USA INC | |||||
| 710 MEDTRONIC PARKWAY | MINNEAPOLIS | MN | 55432 | MEDICAL SUPPLIES | 1652586 |
| ZIMMER US INC | |||||
| W165 N5815 RIDGEWOOD DR | MENOMONEE FALLS | WI | 53051 | MEDICAL SUPPLIES | 1460776 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 52 | NumberOfContractorsGT100K |
| Related Organizations | 494039 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| Total Contributions | 494039 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 900099 | 122504011 | 122504011 | |
| LABORATORY SERVICES | 621500 | 632244 | 632244 | |
| PREVEA INVESTMENT GAIN/LOSS | 900099 | 387202 | 387202 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 123523457 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 865312 | TotalRevenueColumn |
| Exclusion | $865,312 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2933941 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2863629 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 70312 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 70312 | TotalRevenueColumn |
| Exclusion | $70,312 | ExclusionAmount |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1455815 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1455815 | TotalRevenueColumn |
| Exclusion | $1,455,815 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| OTHER REVENUE | 900099 | 1554044 | $1,554,044 | ||
| CHILDCARE REVENUE | 624410 | 730633 | 420506 | 310127 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2284677 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 128693612 | TotalRevenueColumn |
| Related Or Exempt Function Income | 123311719 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 942371 | UnrelatedBusinessRevenue |
| Exclusion | $3,945,483 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 271717 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 271717 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33751683 | Total |
| Program Services | 31122881 | ProgramServices |
| Management And General | 2628802 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3536146 | Total |
| Program Services | 3234513 | ProgramServices |
| Management And General | 301633 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8006250 | Total |
| Program Services | 7323317 | ProgramServices |
| Management And General | 682933 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2121881 | Total |
| Program Services | 1940885 | ProgramServices |
| Management And General | 180996 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7998223 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 7998223 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68850 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 68850 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9659977 | Total |
| Program Services | 6956603 | ProgramServices |
| Management And General | 2703374 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93256 | Total |
| Program Services | 768 | ProgramServices |
| Management And General | 92488 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239542 | Total |
| Program Services | 232095 | ProgramServices |
| Management And General | 7447 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3165944 | Total |
| Program Services | 3143124 | ProgramServices |
| Management And General | 22820 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42013 | Total |
| Program Services | 36361 | ProgramServices |
| Management And General | 5652 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67258 | Total |
| Program Services | 57516 | ProgramServices |
| Management And General | 9742 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 582909 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 582909 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5103340 | Total |
| Program Services | 4159221 | ProgramServices |
| Management And General | 944119 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 302491 | Total |
| Program Services | 88688 | ProgramServices |
| Management And General | 213803 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES - MED/SURG/O2/DRUGS | 18123665 | 18123665 | |
| PREVEA INVESTMENT AND LEASE | 9357538 | 9357538 | |
| BAD DEBT EXPENSE | 4912324 | 4912324 | |
| MEDICAID TAX ASSESSMENT | 3577388 | 3577388 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3120210 | Total |
| Program Services | 1904010 | ProgramServices |
| Management And General | 1216200 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114102605 | Total |
| Program Services | 92593509 | ProgramServices |
| Management And General | 21509096 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | X | InfoInScheduleOPartX |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2579 | BOY |
| EOY | 2432 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6691890 | BOY |
| EOY | 6595224 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12784813 | BOY |
| EOY | 11838898 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 465724 | BOY |
| EOY | 454209 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2479268 | BOY |
| EOY | 2780133 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 421457 | BOY |
| EOY | 204574 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 158699466 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 83705145 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77538239 | BOY |
| EOY | 74994321 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51620725 | BOY |
| EOY | 64680197 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9578157 | BOY |
| EOY | 9889497 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1616335 | BOY |
| EOY | 919261 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 163199187 | BOY |
| EOY | 172358746 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17161138 | BOY |
| EOY | 9237418 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32993547 | BOY |
| EOY | 33143218 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26120699 | BOY |
| EOY | 16251071 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76275384 | BOY |
| EOY | 58631707 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79921595 | BOY |
| EOY | 106744812 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4704337 | BOY |
| EOY | 4683657 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2297871 | BOY |
| EOY | 2298570 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86923803 | BOY |
| EOY | 113727039 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 163199187 | BOY |
| EOY | 172358746 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 14591007 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 2382735 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 9829494 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $13,806 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 13806 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of other lobbying activities | Identifier |
| Return Reference | schedule C, Part II-B, Question 1I | ReturnReference |
| Explanation | ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, with PART OF THESE DUES being ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 2276732 | OtherCostOrOtherBasis |
| Book Value | 2276732 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 63791000 | OtherCostOrOtherBasis |
| Depreciation | 24870403 | Depreciation |
| Book Value | 38920597 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 648418 | OtherCostOrOtherBasis |
| Depreciation | 321382 | Depreciation |
| Book Value | 327036 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 39111185 | OtherCostOrOtherBasis |
| Depreciation | 26341959 | Depreciation |
| Book Value | 12769226 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 52872131 | OtherCostOrOtherBasis |
| Depreciation | 32171401 | Depreciation |
| Book Value | 20700730 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 74994321 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (6 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN PREVEA | 6826470 | C |
| INV. IN COMM MEMORIAL HOSPITAL | 1216202 | C |
| INVESTMENT IN UNITY | 1387020 | C |
| INV. IN ONCOLOGY JOINT VENTURE | 235761 | C |
| INV. IN CATHOLIC FOUNDATION | 28762 | F |
| UNAMORT BOND ISSUE-MTI | 195282 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 9889497 | TotalOfBookValueProgramRelated |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED PENSION LIABILITY | $15,923,520 |
| RETIRE OBLIGATION ASBESTOS | $230,601 |
| ESTIMATED SELF-INSURANCE | $96,950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 16251071 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ASC SUBTOPIC 740-10 | Identifier |
| Explanation | HSHS HAS ADOPTED ASC SUBTOPIC 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES - AN INTERPRETATION OF FASB STATEMENT NO.109. ASC SUBTOPIC 740-10 ADDRESSES THE DETERMINATION OF HOW TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. UNDER ASC SUBTOPIC 740-10, HSHS MUST RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. ASC SUBTOPIC 740-10 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, ACCOUNTING IN INTERIM PERIODS, AND REQUIRES INCREASED DISCLOSURES. AS OF JUNE 30, 2013 AND 2012, HSHS DOES NOT HAVE AN ASSET OR LIABILITY FOR UNRECOGNIZED TAX BENEFITS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 225. | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 2797 | PersonsServed |
| Total Community Benefit Expense | 2617843 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2617843 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02400 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 19340 | PersonsServed |
| Total Community Benefit Expense | 16620231 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11160060 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5460171 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05000 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 671 | PersonsServed |
| Total Community Benefit Expense | 1068267 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 684707 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 383560 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 22808 | PersonsServed |
| Total Community Benefit Expense | 20306341 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11844767 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8461574 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07750 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 61 | NumberOfActivitiesOrPrograms |
| Persons Served | 6544 | PersonsServed |
| Total Community Benefit Expense | 324227 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11398 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 312829 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00280 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 13 | NumberOfActivitiesOrPrograms |
| Persons Served | 49 | PersonsServed |
| Total Community Benefit Expense | 267721 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 267721 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00250 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Total Community Benefit Expense | 686605 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 90887 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 595718 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00550 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 9 | NumberOfActivitiesOrPrograms |
| Persons Served | 575 | PersonsServed |
| Total Community Benefit Expense | 114375 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 114375 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 85 | NumberOfActivitiesOrPrograms |
| Persons Served | 7168 | PersonsServed |
| Total Community Benefit Expense | 1392928 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 102285 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1290643 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01180 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 88 | NumberOfActivitiesOrPrograms |
| Persons Served | 29976 | PersonsServed |
| Total Community Benefit Expense | 21699269 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11947052 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9752217 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08930 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 25 | PersonsServed |
| Total Community Building Expense | 87 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 87 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 41 | PersonsServed |
| Total Community Building Expense | 211 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 211 | NetCommunityBuildingExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 33282 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 33282 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 66 | PersonsServed |
| Total Community Building Expense | 33580 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 33580 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,871,759 | BadDebtExpenseAmount |
| Amount Attributable To | 896168 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 35260682 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 46333796 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -11073114 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (7 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| Prevea Clinic - PHS | |||
| HEALTHCARE | 0.25000 | 0.00000 | 0.50000 |
| Prevea Health Ntwrk | |||
| healthcare | 0.25000 | 0.00000 | 0.50000 |
| Prevea Ventures | |||
| healthcare | 0.25000 | 0.00000 | 0.50000 |
| Prevea health srvcs | |||
| healthcare | 0.25000 | 0.00000 | 0.50000 |
| unity limited pship | |||
| healthcare | 0.10000 | 0.00000 | 0.00000 |
| NE WI RAD THERAPY | |||
| healthcare | 0.25000 | 0.00000 | 0.50000 |
| community mem hospit | |||
| healthcare | 0.07200 | 0.00000 | 0.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1726 SHAWANO AVENUE | AddressLine1 |
| City | GREEN BAY | City |
| State | WI | State |
| ZIP Code | 54303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST MARY'S HOSPITAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 225. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| SCHEDULE H, PART I, LINE 3C | Not applicable. The organization follows FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. |
| SCHEDULE H, PART I, LINE 6A | Yes. The hospital's community benefit report can be accessed at www.stmgb.org. |
| SCHEDULE H, PART I, LINE 7, COLUMN (F) | THE PERCENT OF CHARITY CARE AND CERTAIN OTHER BENEFITS AT COST AS A PERCENT OF TOTAL EXPENSES LESS BAD DEBT IS 8.93%. THE AMOUNT OF BAD DEBT EXPENSE REMOVED WHEN CALCULATING THE PERCENTAGES IN PART I, LINE 7, COLUMN F WAS $4,912,324. |
| SCHEDULE H, PART I, LINE 7 | CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FISCAL YEAR ENDING 2013 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET J. |
| SCHEDULE H, PART II | The community building activities that we have tracked and reported in our community benefit report are a minor portion of our total community benefit efforts. They consist primarily of actively participating in and supporting the work of community groups to advance community awareness about health issues such as leading the Oral Health Community Task Force and serving on the NEW Community Clinic board. |
| SCHEDULE H, PART III, LINE 3 | THE HOSPITAL STRONGLY BELIEVES THAT ITS CHARITY CARE, AND THE RELATED COMMUNITY BENEFIT OBTAINED FROM SUCH CARE, IS UNDERSTATED BECAUSE OF THOSE PATIENTS THAT POTENTIALLY QUALIFY FOR CHARITY CARE BUT DO NOT WISH TO APPLY FOR IT. IN ADDITION, SOME CARE IS NOT CLASSIFIED AS CHARITY DUE TO MISSING DOCUMENTATION ON PATIENT RESOURCES. THUS, THE HOSPITAL'S BAD DEBT MAY INCLUDE A PORTION THAT COULD BE CLASSIFIED AS CHARITY CARE IF APPLICATION FOR SUCH CARE WAS SOUGHT AND/OR COMPLETED. CURRENTLY, THE HOSPITAL IS IMPLEMENTING PROCESSES, PROCEDURES, AND SYSTEMS TO MORE EFFECTIVELY DETERMINE CHARITY CARE THAT WILL REDUCE A PATIENT'S DOCUMENTATION REQUIREMENTS AND EASE THE PATIENT'S EMOTIONAL BURDEN IN APPLYING FOR CHARITY CARE. THIS WILL PROVIDE A MORE ACCURATE REPORTING OF CHARITY CARE SERVICES PROVIDED BY THE HOSPITAL. THE HOSPITAL COMPUTES THE COST OF BAD DEBT BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE TOTAL CHARGES WRITTEN OFF AS BAD DEBT EXPENSE. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY THE BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES, AND COMMUNITY BENEFIT EXPENSE. THE ADJUSTED OPERATING COST IS THEN DIVIDED BY THE TOTAL GROSS PATIENT CHARGES TO CALCULATE THE RATIO OF PATIENT CARE COST TO CHARGES. PART III, LINE 4 BAD DEBT EXPENSE OF HSHS IS DISCUSSED AT PAGES 18 AND 19 OF THE AUDITED FINANCIAL STATEMENTS, A COPY OF WHICH IS ATTACHED TO THIS RETURN. |
| SCHEDULE H, PART III, LINE 8 | THE HOSPITAL CONTINUALLY STRIVES TO PROVIDE EXCELLENT PATIENT CARE IN THE MOST COST EFFECTIVE FASHION. NONETHELESS, THE MEDICARE PROGRAM, IN MANY CASES, DOES NOT PROVIDE PAYMENT THAT COVERS THE FULL COST OF THE CARE PROVIDED. SINCE IT IS THE MISSION OF THE HOSPITAL TO RESPOND TO COMMUNITY NEED, HOSPITAL MANAGEMENT CONTINUALLY ADVOCATES FOR IMPROVED MEDICARE PAYMENT SO THAT THE COST OF QUALITY CARE TO THOSE PATIENTS THAT ARE NOT ABLE TO AFFORD IT IS NOT COMPROMISED AND IS FAIRLY SUBSIDIZED BY ALL PAYERS. WHILE THIS SHORTFALL IN MEDICARE PAYMENTS IS NOT CLASSIFIED AS COMMUNITY BENEFIT BY THE IRS, WE NONETHELESS BELIEVE IT IS AN IMPORTANT CONTRIBUTION MADE BY THE HOSPITAL TO THE HEALTH AND WELL-BEING OF THE COMMUNITY. OUR MISSION CALLS US TO SERVE ALL PATIENTS WITH THE HIGHEST POSSIBLE QUALITY AND EFFICIENCY, EVEN IF WE ARE NOT PAID FULLY FOR DOING SO. THE HOSPITAL COMPUTES THE UNPAID COSTS OF PROVIDING CARE TO MEDICARE PATIENTS BY COMPARING THE COST OF THE SERVICES TO THE REIMBURSEMENT RECEIVED FROM MEDICARE DURING THE YEAR. THE COST OF MEDICARE SERVICES IS CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE ANNUAL MEDICARE CHARGES. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES, AND COMMUNITY BENEFIT EXPENSE. THE DIFFERENCE BETWEEN THE REIMBURSEMENT RECEIVED AND THE CALCULATED COST OF THE SERVICES IS REPORTED AS THE MEDICARE SHORTFALL. The hospital Medicare shortfall at cost for FY 2013 was $11,073,414. |
| SCHEDULE H, PART III, LINE 9B | EVERY EFFORT IS MADE PRIOR TO, DURING, AND AFTER PROVISION OF MEDICAL SERVICES TO DETERMINE WHETHER A PATIENT IS ELIGIBLE FOR CHARITY/COMMUNITY CARE AND TO ASSIST THE PATIENT IN COMPLETING THE APPLICATION AND PROVIDING ADEQUATE DOCUMENTATION. IF THE PATIENT QUALIFIES FOR CHARITY/COMMUNITY CARE FOR THE FULL BALANCE OF THEIR ACCOUNT, THE ENTIRE AMOUNT IS WRITTEN OFF TO CHARITY/COMMUNITY CARE AND HENCE NO DEBT COLLECTION IS PURSUED. IF THE PATIENT QUALIFIES FOR CHARITY/COMMUNITY CARE FOR A PORTION OF THEIR ACCOUNT BALANCE, THAT PORTION IS WRITTEN OFF TO CHARITY/COMMUNITY CARE, WITH THE PATIENT BEING RESPONSIBLE FOR THE REMAINDER OF THE BALANCE. ADDITIONALLY, REASONABLE EFFORT WILL BE MADE TO OBTAIN THIRD-PARTY OR GOVERNMENT PAYOR REIMBURSEMENT ON BEHALF OF THE PATIENT. IF THOSE EFFORTS ARE NOT FRUITFUL, AN OFFER WILL BE EXTENDED TO THE PATIENT TO MAKE INSTALLMENT PAYMENTS ON THEIR BALANCE. ONLY AT SUCH POINT THAT THE PATIENT DEFAULTS ON INSTALLMENT PAYMENTS OR REFUSES TO COOPERATE WITH THE HOSPITAL'S EFFORTS TO BE REIMBURSED WILL THE ACCOUNT BE SENT TO COLLECTIONS. |
| Part V, Section B, Line 3 | Yes. The hospital's CHNA involved people broadly representative of the community. The Community Health Needs Assessment was truly a collaborative effort. In Wisconsin, public health departments conduct community health needs assessments every five years. The Brown County and City of DePere Public Health Departments collaborate on the one for Brown County, the county in which Green Bay is located. When a leader from St. Mary's approached the health departments about possible opportunities to collaborate, they not only willingly agreed to find ways to do so, they also agreed to modify their every-five-year process to meet the hospitals' every- three-year time frame and to begin to conduct the local needs assessment immediately. In the past, the Brown County/City of DePere health departments would themselves convene the community wide planning team and the subsequent action planning teams. Once contacted about opportunities to collaborate, they instead convened a community health needs assessment steering committee that included representatives of St. Mary's and its sister hospital St. Vincent Hospital in Green Bay, the local United Way, the other not for profit hospital in Green Bay, and representatives of the regional office of Wisconsin's Department of Health. This steering committee then worked to identify representatives who could broadly represent the community in actually conducting the needs assessment and setting priorities. These individuals were referred to as our community "partners". All steering committee members were assigned people to contact to invite them into the process as partners. This resulted in a community partner group that was broadly representative of the community: many community service agencies, educational institutions, government, health care, low income and minority population representatives, public health experts, and others (see partner listing at the end of this narrative). The steering committee also set the format for each meeting, evaluated the effectiveness of each meeting after it occurred, developed the prioritization process, and evaluated the effectiveness of the entire process. Steering committee members all assumed responsibilities for tasks related to the process during the course of the needs assessment. The report entitled Healthy Wisconsin 2020 and the health focus areas contained within served as the basis for the health needs assessment. An epidemiologist from the Wisconsin Department of Health gathered data from secondary sources (such as public health statistics) on how Brown County and the City of De Pere compares with the state-wide data. St. Mary's Hospital also provided additional data when available. Meetings of all the partners were held once a month for six months. A profile of each health needs area was developed, and the "partners" reviewed the data at these meeting where the information was presented. They discussed key data points and assessed what is currently being done. Before the meeting concluded, they then rated the health focus area on three criteria-magnitude (number of people impacted), seriousness (level of impact of the problem), and feasibility (whether there are known interventions to address the problem). These ratings were combined, and based on the ratings, the health focus areas were narrowed to the top eight. At a final meeting of the partners group, a multi-vote approach was used to narrow the top eight to the top three. The top three needs were: o oral health o adequate and appropriate food and nutrition, and o alcohol and other drug abuse (AODA) Throughout this process, St. Mary's leaders were actively engaged. The progress of the needs assessment was regularly reviewed by an internal community benefit committee. The findings of the needs assessment were also shared with our hospital's community advisory committee for their reaction and comment. The community advisory committee is a group of over 25 community members representing business, education, not for profit agencies, low income and minority populations, clergy, and others who serve as advisors to the hospital. The internal Community Benefit Committee and the Community Advisory Committee serve both St. Mary's and St. Vincent because the two hospitals provide coordinated services to the Green Bay area as part of the Hospital Sisters Health System's Eastern Wisconsin Division. Adequacy of the Data and Information for Community Needs Assessment There were no serious defects in the data used for this needs assessment process. The only limitation is because of the nature of public health data, some indicators were a year or more old. Brown Community Health Needs Assessment Partner Listing Aging & Disability Resource Center, Sunny Archambault Aurora Health System, Julie Pomasl Bay Area Community Council, Pat Finder-Stone Bellin College, Kathie DeMuth Bellin Health, Jody Wilmet* Bellin Health, Linda Roethle Boys & Girls Club, John Benberg Brown County Board, Mike Fleck Brown County Board of Health (board member), Audrey Murphy** Brown County Community Treatment Center, Mary Johnson Brown County Cooperative Extension, Judy Knudsen Brown County Health Department, Judy Friederichs (Director, Brown County Health Department)* ** Brown County Human Services, Kevin Lunog Brown County Planning, Chuck Lamine Brown County United Way, Stephanie Foley*# Center for Childhood Safety/ Safe Kids Greater Green Bay, Justine Lodl City of De Pere Board of Health (board member), Pat Finder-Stone ** City of De Pere Health Department, Mary Dorn, Health Director* ** De Pere Area Chamber of Commerce, Cheryl Detrick Division of Public Health Northeast Regional Office, Rebecca Hovarter, Regional Public Health Nursing Consultant* ** Division of Public Health Northeast Regional Office, Lynn Hrabik, Epidemiologist* ** Family Services-Crisis Center, Tana Koss # Greater Green Bay Community Foundation, Martha Ahrendt Greater Green Bay YMCA, Sandy Atkins Green Bay Chamber of Commerce, Nan Nelson, CCE Homeless Population Representative, Seth Moore # N.E.W. Community Clinic, Bonnie Kuhr # NWTC Health Science, Kay Tupala, Dean Oneida Tribe of Indians, Michelle Myers # Parish Nurse, Katie Dykes # Brown County Sheriff Representation-Chief's group, Randy Schultz Prevea Health, Dr. Ashok Rai St. Mary's Hospital Medical Center, Heidi Selberg* St Vincent Hospital, Heidi Selberg* St Willebroad Catholic Parish, Maria Plascencia School Representation-Superintendent's group, Barb Natelle The Salvation Army, Rebecca Lesperance # United Hmong and Asian American Community Center, Staryoung Thao # UWGB-Environmental Sciences, Thomas Erdman UW-Green Bay Nursing Program, Chris Vandenhouten Women, Infant and Children (WIC), Bonnie Kuhr # * signifies steering committee member ** signifies person with special knowledge of public health, including public health department leadership staff and members of governance bodies for public health departments # signifies representatives of underserved, low income, minority, chronic disease |
| Part V, Section B, Line 4 | Bellin Health was actively involved in the community health needs assessment. |
| Part V, Section B, Line 7 | The St. Mary's board of directors approved an implementation strategy based on the CHNA from the prior reporting year. Based on the CHNA, three priority needs for the community were identified in FY2013: oral health, alcohol and other drug abuse (AODA) and adequate and appropriate food and nutrition. Oral Health In partnership with sister hospital St. Vincent, St. Mary's Hospital supported the NEW Dental Clinic on the campus of Northeast Wisconsin Technical College (NWTC) to expand its services to accommodate up to 6,000 patients. St. Mary's actively supported the efforts of the NEW Community Clinic to apply for FQHC (federally qualified health center) status, which allows them to provide dental services more easily and effectively than had been the case in the past; they were awarded this status at the end of June 2012. St. Mary's support of NEW Clinic's application included donations to the current clinic location that were cited as part of the required matching funds, providing grant writing expertise and providing access to data to support the application. Most importantly, St. Mary's provided funds to purchase the capital equipment needed to open a dental clinic for low income uninsured and Medicaid patients at NEW Community Clinic's location at Northeast Wisconsin Technical College; this enabled them to open a six-chair operatory in spring 2013. The NEW Community Clinic's FQHC status enabled them to be reimbursed for Medicaid patients' dental care. This program provides a viable alternative other than the ED for Medicaid and uninsured patients. Alcohol and Other Drug Abuse (AODA) Work began to address the AODA needs by initiating discussions with local agencies on how medical clearance for alcohol intoxication is currently working. These discussions led to efforts to develop a telemedicine approach for medical clearance for patients needing psychiatric clearance; these collaborative discussions continue. Adequate and Appropriate Food and Nutrition St. Mary's did not address this identified need as the other health system that participated in the community health needs assessment took the lead on addressing this need. St. Mary's Hospital focused its efforts on oral health and AODA. Part V, Section B, Line 12h Yes, the Financial Assistance Policy contains a detailed description of the Purpose, Definitions and Guidelines for financial assistance. |
| Part V, Section B, Line 14G | St. Mary's posts its charity care policy and application on our website. In addition, charity care applications are available and prominently displayed in our waiting and registration areas. Our financial counselors are available to meet with patients on site before or at the time of service to assist them in identifying whether they are eligible for government aid or financial assistance, and to assist them in applying for programs for which they may be eligible. After patients receive service, our customer service representatives are also trained to assist them to apply for various government programs or for our charity care program. Our collectors are trained to provide this assistance as well. Last but not least, we have contracted with an outside firm to do active outreach with patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. Yes, section I of the Financial Assistance Policy describes the "Communication of the Financial Assistance Program to Patients" in detail. |
| Part V, Section B, Line 20D | The hospital sets the rate for billing individuals without insurance covering emergency or other medically necessary care at the hospitals lowest commercial rate. |
| Needs assessment | As indicated in Part V, Section B, St. Mary's conducted a Community Health Needs Assessment in our FY2012. Prior to completing the CHNA with our community partners, we employed a number of methods to assess health care needs: 1) we have a community advisory committee broadly representative of the community, which meets regularly to discuss hospital services and advise the hospital on how well it is meeting community needs. As terms expire, committee members assist in identifying new members. We include representatives from the neighboring communities we serve, as well as some potentially underserved groups such as Hmong and Native American leaders. 2) Hospital leadership meets with individual committee members each year to learn more about their opinions about community needs. 3) We examine the reasons that self-pay and medical assistance patients come to our ED for care. 4) Hospital leaders serve on local social service agency boards, such as NEW Community Clinic. 5) Our Hispanic health educator/cultural liaisons assist in identifying the needs of special subgroups of patients. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | OUR HOSPITAL POSTS ITS CHARITY CARE POLICY AND APPLICATION ON OUR WEBSITE. IN ADDITION, CHARITY CARE APPLICATIONS ARE AVAILABLE AND PROMINENTLY DISPLAYED IN OUR WAITING AND REGISTRATION AREAS. OUR FINANCIAL COUNSELORS ARE AVAILABLE TO MEET WITH PATIENTS ON SITE BEFORE, OR AT, THE TIME OF SERVICE TO ASSIST THEM IN IDENTIFYING WHETHER THEY ARE ELIGIBLE FOR GOVERNMENT AID OR FINANCIAL ASSISTANCE, AND TO ASSIST THEM IN APPLYING FOR PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. AFTER PATIENTS RECEIVE SERVICE, OUR CUSTOMER SERVICE REPRESENTATIVES ARE ALSO TRAINED TO ASSIST THEM TO APPLY FOR VARIOUS GOVERNMENT PROGRAMS OR FOR OUR CHARITY CARE PROGRAM. OUR COLLECTORS ARE TRAINED TO PROVIDE THIS ASSISTANCE AS WELL. THE HOSPITAL HAS ALSO CONTRACTED WITH AN OUTSIDE FIRM TO DO ACTIVE OUTREACH WITH PATIENTS WHO MAY NEED ADDITIONAL ASSISTANCE OR ADVOCACY TO APPLY FOR BENEFITS, APPEAL DENIALS, OR WHO NEED TRANSPORTATION TO GOVERNMENT AGENCIES TO APPLY FOR BENEFITS. |
| Community Information | Brown County, Wisconsin is a primarily urban county, one of 72 Wisconsin counties, and is located in the northeastern part of the state. Brown Countys population is predominantly Caucasian (85%), but there is a sizeable Hispanic population comprising about 7% of the population. The balance is made up almost equally of Asian, Native American and African Americans. There are approximately 250,000 residents, of which about 41,000 are covered by Medicaid/Badger Care Plus. About 11% of Brown County Residents live at or below the federal poverty level, (Source: WI DHS Public Health Profiles). According to the Wisconsin Department of Health Services, 6% of Brown Countys population is uninsured. Brown County contains a dental care HPSA (health professional shortage area) and the metro area is a MUA (medically underserved area), per maps on the Wisconsin DHS website. There are three not-for-profit general medical surgical hospitals and one for-profit general medical surgical hospital serving Brown County and the surrounding area. In addition, there is one not-for-profit psychiatric hospital and one county operated psychiatric hospital. Since most of the population resides in the Green Bay metro area, plans and services focus on this area. |
| PROMOTION OF COMMUNITY HEALTH | St. Mary's Hospital Medical Center offers hope to our community in the tradition of the Hospital Sisters of St. Francis. As a healing ministry of the Catholic Church and an affiliate of the Hospital Sisters Health System (HSHS), St. Mary's is committed to delivering high quality, compassionate, and cost-effective health care services to all. The hospital was founded over 100 years ago to bring a healing presence and improve the health of our community, especially for people who are sick, poor, and disadvantaged. Because of the hospital's purpose and tradition, it is organized to promote the health of Brown County, Wisconsin, and surrounding areas. The hospital is governed by a Board of Directors, the majority of whom reside in the organization's primary service area and who are neither employees nor contractors of the hospital (nor family members thereof). The Board ensures that St. Mary's is responding to community need. During the last year, for example, the Board reviewed the Community Health Needs Assessment and approved an implementation strategy for addressing selected needs. In addition our hospital Advisory Council, Friends of St. Mary's Foundation and volunteers who assist in many areas of the hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Also consistent with its exempt purpose, St. Mary's has an open medical staff with privileges available to all qualified physicians in the area. In addition, the hospital operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, St. Mary's reinvests surplus funds into the mission of the organization and health of the community rather than distributing them as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. For example, St. Mary's is currently working with its parent organization, Hospital Sisters Health System, to continuously enhance quality and improve coordination of care both inside the hospital and with a growing number of physician partners. Supported by investments in information technology, this "care integration" strategy is designed to better coordinate care, improve health outcomes, create new efficiencies, and help ensure that patients (especially those with chronic conditions) get well and stay well. For example, the Epic electronic medical record system enables providers to connect with their patients' medical records from wherever they are and allows emergency physicians access to patient medical records from any facility that has Epic. This reduces duplicate testing, puts critical health information at providers' fingertips, helps better manage chronic conditions, and improves patient safety. A Heart Failure Clinic has been established to assist heart failure patients to maintain good health and to stay out of the hospital by incorporating diet, exercise and other wellness information into the long-term care plan. This growing program has shown success in reducing readmissions, something that is also especially helpful for those with limited financial resources. St. Mary's Hospital Medical Center dedicates significant resources to provide access for patients who cannot afford care, along with other community benefits. In Fiscal Year 2013, St. Mary's provided over $9.7 million in community benefit services, including charity care at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. During this period, St. Mary's provided over $11 million (at cost) in excess of Medicare payment for health care services. Responding to Community Need St. Mary's Hospital provides a range of community benefits that flow from our mission and long-standing commitment to our community. In many cases, these programs would be unlikely to exist without the leadership role played by St. Mary's, and they often relieve a burden that would otherwise be carried by government. An example of our community benefit initiatives is the support we provide to patients that pass each year through the doors of the NEW Community Clinic, a 38-year-old free health center for the uninsured and underinsured. St Mary's provides free and discounted laboratory and radiology services to the clinic. More than 70 percent of patients say the clinic's care prevented a trip to the emergency department. This year, St. Mary's Hospital, along with sister hospital St. Vincent Hospital, provided funds to purchase the equipment necessary to operate a six-chair dental operatory at the NEW Clinic's Northeast Wisconsin Technical College site. This donation will provide the facilities for as many as 6000 additional patient visits for basic restorative and hygiene care for uninsured and Medicaid patients. Professionals at the hospital assisted in excess of 2,200 people to apply for the appropriate assistance, such as Social Security or Medical Assistance when they came to the hospital in a time of medical need. A Woman's Place at St. Mary's Hospital Medical Center is a valued and trusted outreach center for women and their families throughout our area. Through A Woman's Place we reach out to our Hispanic neighbors and provide health and wellness education, health screenings, resources and referral services, facilitated by a Hispanic Health Educator. Last year A Woman's Place touched the lives of more than 5,400 women through its Resource Center and consumer lending library; screenings for cardiovascular disease, osteoporosis and reproductive cancer; and educational events and classes on a variety of health topics. Hospital employees provide information at educational and public forums, such as the YMCA Healthy Kids Day, A Day Just for Women, Brown County Aging Resource Center, the Big Event for Little Kids, a series of events during National Women's Health Week and the Einstein Project. Many underserved and uninsured of our community attend these events. St. Mary's staff, along with staff from our sister hospital, St. Vincent, collected one truckload of home medical supplies for the annual Community Medical Collection to support Hospital Sisters Mission Outreach. Hospital Sisters Mission Outreach is a medical surplus recovery organization focused on meeting the health care needs of individuals in developing nations. Collection included wheelchairs, walker, canes, bandages, ace wraps, and other home medical supplies. The American Cancer Society Loan Closet - located at A Woman's Place - provides wigs, scarves, turbans, hats and breast prostheses for women living with the side effects of cancer treatments. Additionally, the Look Good, Feel Better program offers information and guidance to cancer patients looking to enhance their appearance. This gives patients a sense of control over physical changes they may experience. St. Mary's Hospital along with St. Vincent Hospital and Bellin Health supports Unity Hospice, a provider of appropriate and compassionate care for the terminally ill. These efforts to serve the needs of our community result in real benefits for the people of Green Bay. |
| Affiliated health care system | St. Mary's Hospital Medical Center in Green Bay, Wisconsin is an affiliate of Hospital Sisters Health System (HSHS), a health care ministry that includes 13 hospitals, scores of community-based health centers and clinics, and hundreds of physician partners across Illinois and Wisconsin. The Mission of HSHS is "to reveal and embody Christ's healing love for all people through our high quality Franciscan health care ministry." We live our Mission by providing holistic healing to all who seek our care, as well as through Community Benefit. Working collaboratively with others in the communities we serve, our Community Benefit initiatives are strategically and successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. In FY2013, our 13 hospitals responded to needs identified in each of their Community Health Needs Assessments (CHNAs) completed in FY2012. The information gathered from these assessments was used to develop new and enhance existing Community Benefit programs and services that best addressed community needs. Included among the many priority needs identified in our CHNAs were chronic disease prevention and management, obesity, adequate food and nutrition, mental health, and access to health care services. HSHS hospitals are proactively addressing these and other needs through patient, provider and community education, preventative screenings, self-management classes, and new or enhanced clinical services. Across HSHS, we collectively provided $185.6 million in Community Benefit (or 10.2% of total hospital expenses) in FY2013. Included in this amount was $45.9 million provided for Financial Assistance (i.e. Charity Care) and $104.2 million for unreimbursed care provided under the Medicaid program. In addition, HSHS hospitals committed significant resources to care for Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $152.3 million. HSHS hospitals also recorded $107.1 million in uncollectible accounts. In addition to the dollars invested in our Community Benefit programs, HSHS also continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing do, we ensure we are able to meet the ongoing demand for high quality, efficient and easily accessible health care. Recognizing that the health care delivery model in the United States is evolving, HSHS remains focused on implementing our Care Integration strategy. Care Integration coordinates the delivery of care around the needs of each patient. During FY2013, we made significant progress with this strategy as we further implemented interoperable health information technologies, expanded the number of Medical Homes, and strengthened our alignment with physicians. Greater access to care As a Franciscan health care ministry, HSHS is deeply committed to serving those who are most in need. We not only provide care to every patient who walks through our doors, but also reach out beyond the walls of our hospitals and clinics to care for those in our communities. Our efforts to ensure residents in the communities we serve receive the right care at the right time in the right setting often involve partnering with others to achieve this goal. Across our two-state System, there are numerous examples of HSHS collaborating with other organizations to enhance access to care for those in need. From 2006 to 2009, the United States saw a 16% increase in individuals seeking dental care at hospital emergency rooms. With the support of St. Mary's Hospital Medical Center and St. Vincent Hospital in Green Bay, Wisconsin, the NEW Dental Clinic on the campus of Northeast Wisconsin Technical College expanded in FY2013 and was able to accommodate up to 6,000 visits. The clinic provides dental services to low-income and uninsured persons including the homeless in Brown County. St. Francis Hospital in Litchfield, Illinois partnered with Lewis & Clark Community College to bring their mobile health unit to the Litchfield area; the unit provides dental exams and screenings, x-rays and dental hygiene to those in need. In western Wisconsin, St. Joseph's Hospital in Chippewa Falls works closely with the Chippewa Health Improvement Partnership (CHIP) to support the Open Door Clinic. The free medical clinic provides health care for those without insurance coverage. This past year, the clinic received a total of 2,672 patient visits, an 11% increase from the prior year. With more than 166 individuals volunteering, the clinic provided more than 6,751 hours (including 753 provider hours and 675 nursing hours) of service to individuals. The Open Door Clinic is an example of HSHS providing leadership and support to a community-based program designed to meet the needs of those less fortunate. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthony's Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthony's helped underwrite the cost of prescription medications for more than 280 residents. In southwest Illinois, St. Joseph's Hospital in Highland enhanced their offerings to their senior population based on their CHNA. "Senior Renewal" is an outpatient counseling program for senior adults who may be facing emotional and physical problems unique to the aging process such as feelings of loneliness, isolation and anxiety. Clients receive an intensive level of treatment without inpatient hospitalization through counseling strategies and education. In addition, in collaboration with the Illinois Department of Insurance, St. Joseph's Hospital participates in the Senior Health Insurance Program (SHIP), a free health insurance counseling service for Medicare beneficiaries and their caregivers. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Financial Assistance (i.e. Charity Care) program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Financial Assistance programs have a sliding scale, in some instances providing up to a 60% discount on charges for those earning up to 600% of the federal poverty level. Counselors are available in our hospitals to explain our financial assistance policies to patients, provide them with assistance in filling out a simple application form, or help them enroll in publicly funded health care programs. Better community health As part of our Mission to embody Christ's healing love, we understand that we have a responsibility to improve the overall quality of life in our communities by supporting initiatives that promote health and wellness. We recognize we are most successful when we work together with a wide array of public and private organizations that share our commitment to improving lives. By doing so, we maximize our efforts and reduce the duplication of services. HSHS hospitals also understand we need to listen closely to the residents of the communities we serve to ensure the health care needs of all are being met. To that end, each of our 13 hospitals completed Community Health Needs Assessments (CHNA) during FY2012. The information gathered from these assessments is being used to help us develop new, and enhance existing, programs and services that best address the needs of the community. Among the many priority needs identified from the CHNAs include metabolic and cardiovascular disease management, adequate food and nutrition, and mental health. HSHS hospitals are addressing these and other needs by proactively offering educational opportunities, preventative screenings, and new or enhanced clinical services. In partnership with the Sangamon County Health Department (SCDH) and local farmers, St. John's Hospital in Springfield, Illinois took a lead role in bringing a Farmers Market to the east side of Springfield. The East Side Farmers Market addresses three community needs: childhood obesity, childhood poverty (26% of children in Sangamon County live in poverty vs. 18% in the state) and providing fresh produce to persons living in a known "food desert." WIC Cooking Classes are also offered in tandem with the East Side Farmers Market to teach participants how to prepare fresh produce. The Farmers Market and cooking classes are hosted at the SCDH. St. Mary's Hospital in Streator, Illinois teamed up with the Streator YMCA to offer a 12 week weight loss program - Healthy You - to motivate 282 participants (nearly double the participants from last year) to lose weight and maintain a healthy lifestyle. The program included aerobics classes, cooking classes, and a maintenance program to encourage participants to weigh in monthly. A total of 191 participa |
| STATE FILING OF COMMUNITY BENEFIT REPORT | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THERESE PANDL | ||||||||||||||
| PRESIDENT/CEO | 0 | 565288 | 0 | 77968 | 0 | 20630 | 0 | 100815 | 0 | 28586 | 0 | 793287 | 0 | 0 |
| FRANK MIKELL | ||||||||||||||
| DIRECTOR | 0 | 602758 | 0 | 110977 | 0 | 128195 | 0 | 112963 | 0 | 20070 | 0 | 974963 | 0 | 59328 |
| ANN M CARR | ||||||||||||||
| TREASURER | 0 | 193454 | 0 | 29440 | 0 | 49252 | 0 | 121170 | 0 | 17686 | 0 | 411002 | 0 | 18215 |
| LAWRENCE J CONNORS | ||||||||||||||
| COO | 233191 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25329 | 0 | 258520 | 0 | 0 | 0 |
| greg simia | ||||||||||||||
| division cfo | 0 | 339812 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25043 | 0 | 364855 | 0 | 0 |
| JOHN DAUL | ||||||||||||||
| CRNA | 204528 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 23093 | 0 | 227621 | 0 | 0 | 0 |
| STEPHEN KORDIYAK | ||||||||||||||
| CRNA | 202146 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 23099 | 0 | 225245 | 0 | 0 | 0 |
| GABRIEL LEIS | ||||||||||||||
| CRNA | 213733 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 24056 | 0 | 237789 | 0 | 0 | 0 |
| Robert Kelly | ||||||||||||||
| CRNA | 202104 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 20423 | 0 | 222527 | 0 | 0 | 0 |
| Molly Condit | ||||||||||||||
| CRNA | 194977 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25637 | 0 | 220614 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| THERESE PANDL | SCHEDULE J, PART I, LINE 4B | THERESE PANDL PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $64,900. |
| ANN M. CARR | SCHEDULE J, PART I, LINE 4B | ANN M. CARR PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $42,817. |
| FRANK MIKELL | SCHEDULE J, PART I, LINE 4B | FRANK MIKELL PARTICIPATED IN A SERP DURING THE YEAR IN THE AMOUNT OF $133,006. |
Schedule L IRS990ScheduleL
Loan Table LoanTable (2 entries)
| Relationship With OrganizationRelationshipWithOrganization | Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|---|
| THERESE PANDL | |||||||
| OFF/TRUSTEE | MORT EXT | X | $250,000 | 251973 | false | true | true |
| THERESE PANDL | |||||||
| OFF/TRUSTEE | STOCK PURCH | X | $4,125 | 4125 | false | true | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 256098 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PREVEA CLINIC | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | OFFICER | Relationship |
| Amount Of Transaction | 3338137 | AmountOfTransaction |
| Description Of Transaction | PHYSICIAN SERVICES | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| LOANS TO/FROM INTERESTED PERSONS | SCHEDULE L, PART II | ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. |
| BUSINESS TRANSACTIONS WITH INTERESTED PERSONS | SCHEDULE L, PART IV | Therese Pandl, President of SVGB, is a board member of Prevea Clinic. ALL TRANSACTIONS INVOLVING INTERESTED PERSONS ARE DETERMINED TO BE CONSISTENT WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY TRANSACTIONS REQUIRING BOARD APPROVAL ARE APPROVED BY AN INDEPENDENT BOARD PRIOR TO OCCURRING. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 PART III, LINE 1 | TO CONTINUE CHRIST'S HEALING LOVE THROUGH DELIVERY OF COMPETENT & COMPASSIONATE HEALTHCARE IN AN ENVIRONMENT SENSITIVE TO THE NEEDS OF ALL PEOPLE. THE HOSPITAL IS COMMITTED TO PROVIDING A BROAD RANGE OF QUALITY INPATIENT AND OUTPATIENT SERVICES WITHOUT REGARD TO THE INDIVIDUAL'S RACE, CREED, HANDICAPS, OR FINANCIAL STATUS. PROGRAM SERVICE REVENUE - SURGERY FORM 990 PART III, LINE 4A SURGERY St. Mary's Hospital Medical Center Surgical Services Surgical Services at St. Mary's Hospital Medical Center are comprised of Central Processing, Anesthesia, Surgery and Recovery. This includes eight OR Suites, a C-Section Room and two minor treatment rooms, Services are available 24/7 and include both inpatient and outpatient procedures. In fiscal year 2013, over 5,500 surgical procedures were performed. Surgical procedures include General, Orthopedic, Urology, Gynecology, Oral - Maxillofacial, and Organ procurement. Anesthesia and Central Processing also provide Hospital-wide services to Inpatient Nursing, Labor and Delivery and the Emergency Department. The Anesthesia department is comprised of nine employed Nurse Anesthetists and three Anesthesiologists on campus daily. |
| PROGRAM SERVICE REVENUE - RADIOLOGY SERVICES | FORM 990, PART III, LINE 4B | RADIOLOGY St. Mary's Hospital Medical Center Imaging Services: The Imaging services department at St. Mary's Hospital Medical Center provides Inpatient, Outpatient, and Emergency care. Overall, the department performs more than 50,000 inpatient and outpatient exams and procedures annually. Patients have access to the latest technology in Digital Mammography, Computed Tomography, MRI, Nuclear Medicine, and Ultrasound. Four Interventional Radiologists provide minimally invasive procedures using image guidance. The staff consists of Board Certified radiologists as well as licensed and certified technologists, nurses, and sonographers. The modalities are accredited and utilize state-of-the-art equipment to afford the radiologists optimal images for interpretation. The department and hospital are accredited by the Joint Commission. During FY2012 the department began using a new state of the art MRI wide bore scanner. |
| PROGRAM SERVICE REVENUE - HEART & VASCULAR CENTER | FORM 990, PART III, LINE 4C | HEART & VASCULAR CENTER St. Mary's Hospital Medical Center Cath Lab: The Cath Lab offers a complete array of catheterization laboratory procedures and noninvasive cardiovascular diagnostic procedures, doing over 1,300 cardiac catheterizations in FY2013. If needed, a state-of-the-art Cardiovascular operating center (CVOR) is available nearby at our sister facility, St. Vincent Hospital, for cutting-edge open heart procedures by our highly-skilled cardiothoracic surgeons. CVICU suites are also offered there. For those patients who need follow-up, a Cardio-Pulmonary Rehabilitation Program is offered on site at St. Mary's. A new program was offered at St. Mary's Hospital beginning in FY2013, Electrophysiology, which led to some of the increase in statistics this year. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES St. Mary's Hospital Medical Center Other Program Services at St. Mary's Hospital Medical Center is comprised of Family Birthing Center, Intensive Care, Emergency, Center for Digestive Health, Pharmacy, Laboratory, Respiratory Therapy, Rehabilitation Services and other services. In FY2013 the hospital had over 114,000 outpatient visits, over 5,100 admissions, over 15,000 patient days, over 700 births and over 31,000 emergency room visits. |
| TAX EXEMPT BONDS | FORM 990, PART IV, LINE 24 | ST MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY, INC. HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HOSPITAL SISTERS SERVICES, INC. FORM 990. |
| RIGHTS OF MEMBERS TO ELECT GOVERNING BODY | FORM 990, PART VI, LINE 6 & 7A | THE SENIOR GOVERNING BODY OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC (THE "CORPORATION") IS THE MEMBER OF THE CORPORATION, WHICH IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, HSSI HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS, CHAIRPERSON OF THE BOARD, AND PRESIDENT. |
| MEMBER RESERVED POWERS | FORM 990, PART VI, LINE 7B | RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. MARY'S HOSPITAL MEDICAL CENTER OF GREEN BAY INC. (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEMBERS OF HSHS ARE THE INDIVIDUAL SISTERS WHO, FROM TIME TO TIME, ARE THE DULY ELECTED PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS, RESPECTIVELY OF THE AMERICAN PROVINCE OF THE HOSPITAL SISTERS OF ST. FRANCIS ("AMERICAN PROVINCE"). THE AMERICAN PROVINCE IS THE UNITED STATES ORGANIZATION OF THE CONGREGATION OF THE HOSPITAL SISTERS OF THE THIRD ORDER REGULAR OF ST. FRANCIS, A RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMEND ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHANGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILIATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRATEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORATION OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, LINE 11B | The hospital employs KPMG to assist in the overall review and electroNIC SUBMISSION OF ITS FORM 990. KPMG PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION, AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, LINE 12C | THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. |
| WHISTLEBLOWER POLICY | FORM 990, PART VI, LINE 13 | PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. |
| COMPENSATION PROCESS | FORM 990, PART VI, LINE 15a and 15b | THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL DISQUALIFIED INDIVIDUALS. INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES, AND BENEFITS FOR THE DISQUALIFIED INDIVIDUALS. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION FOR THE DISQUALIFIED INDIVIDUALS. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. |
| DOCUMENTS AVAILABLE TO THE PUBLIC | FORM 990, PART VI, LINE 19 | BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. |
| POOLED INVESTMENT ACCOUNT | FORM 990, PART X, LINE 11 | THE HOSPITALS CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT MAINTAINED BY HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"). PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND HEALTH SERVICES ORGANIZATIONS SPONSORED BY HSHS. THE POOLED ACCOUNT CONSISTS OF CASH, EQUITY, AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF STATEMENT OF FINANCIAL ACCOUNTING STANDARDS ("SFAS") NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS", INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE FAIR VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE INDIVIDUAL HOSPITAL PARTICIPANTS. |
| Other Changes in net assets or fund balances | Form 990, Part XI, Line 5 | Temporarily Restricted Assets (19,982) Change in Fair Value of Interest Rate Swaps 2,446,389 Loss on Early Extinguishment of Debt (420,978) Transfers to Affiliates (1,096,819) Changes in Pension Funded Status 9,367,702 Swap Payments (446,818) ----------- Total 9,829,494 =========== |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 261417684 | HEALTHCARE | IL | 0 | 0 | HSSI |
| PHYSICIAN CLINICAL INTEGRATION NTWRK LLC | |||||||||
| 4936 Laverna ROAd | Springfield | IL | 62707 | 371668647 | HealthCare | IL | 0 | 0 | KCIN |
| KIARA CLINICAL INTEGRATION NETWORK LLC | |||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371364419 | HEALTHCARE | IL | 0 | 0 | HSHS MG |
Form990 Schedule R Part II Form990ScheduleRPartII (23 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| HOSPITAL SISTERS HEALTH SYSTEM | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371058692 | HEALTHCARE | IL | 501(c)(3) | 11A | NA | false |
| HOSPITAL SISTERS SERVICES INC | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371163402 | HEALTHCARE | IL | 501(c)(3) | 11A | HSHS | false |
| HOSPITAL SISTERS OF ST FRANCIS FDTN | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371186514 | HEALTHCARE | IL | 501(c)(3) | 11A | HSHS | false |
| HSHS SELF INSURANCE TRUST FUND | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371120626 | INSURANCE | IL | 501(c)(3) | 11A | HSHS | false |
| HSHS HEALTH CARE PLAN TRUST FUND | ||||||||||
| 4936 LAVERNA ROAD | SPRINGFIELD | IL | 62707 | 371137724 | HEALTHCARE | IL | 501(c)(3) | N/A | HSHS | false |
| ST ELIZABETH'S HOSPITAL | ||||||||||
| 2661 COUNTY HIGHWAY I | CHIPPEWA FALLS | WI | 54729 | 510157933 | HEALTHCARE | WI | 501(c)(3) | 11A | HSSI | false |
| SACRED HEART HOSPITAL | ||||||||||
| 900 WEST CLAIREMONT AVENUE | EAU CLAIRE | WI | 54701 | 390807060 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | false |
| ST ANTHONY'S HOSPITAL | ||||||||||
| 503 N MAPLE STREET | EFFINGHAM | IL | 62401 | 370661233 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST ELIZABETH'S HOSPITAL | ||||||||||
| 211 SOUTH THIRD STREET | BELLEVILE | IL | 62220 | 370663567 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST NICHOLAS HOSPITAL | ||||||||||
| 3100 SUPERIOR AVENUE | SHEBOYGAN | WI | 53081 | 390808480 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | false |
| ST JOHN'S HOSPITAL | ||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 370661238 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 1800 E LAKE SHORE DRIVE | BREESE | IL | 62230 | 371208459 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 2661 COUNTY HIGHWAY 1 | CHIPPEWA FALLS | WI | 54729 | 390810545 | healthcare | WI | 501(c)(3) | 3 | HSSI | false |
| ST MARY'S HOSPITAL | ||||||||||
| 1800 E LAKE SHORE DRIVE | DECATUR | IL | 62521 | 370661244 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST MARY'S HOSPITAL | ||||||||||
| 111 SPRING STREET | STREATOR | IL | 61364 | 362169181 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| STFRANCIS HOSPITAL | ||||||||||
| 1215 FRANCISCAN DRIVE | LITCHFIELD | IL | 62056 | 370661236 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| ST VINCENT HOSPITAL | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 54301 | 390817529 | HEALTHCARE | WI | 501(c)(3) | 3 | HSSI | false |
| ST JOSEPH'S HOSPITAL | ||||||||||
| 1515 MAIN STREET | HIGHLAND | IL | 62249 | 370663568 | HEALTHCARE | IL | 501(c)(3) | 3 | HSSI | false |
| HSHS MEDICAL GROUP INC | ||||||||||
| 3215 Executive Park Drive | SPRINGFIELD | IL | 62703 | 263956318 | HEALTHCARE | IL | 501(c)(3) | 11A | HSSI | false |
| HSHS WISCONSIN MEDICAL GROUP INC | ||||||||||
| 3215 Executive Park Drive | Springfield | IL | 62703 | 264515959 | HEALTHCARE | WI | 501(c)(3) | 11A | HSSI | false |
| ORANGE CROSS AMBULANCE INC | ||||||||||
| 919 ASHLAND AVE | SHEBOYGAN | WI | 53081 | 391860942 | HEALTHCARE | WI | 501(c)(3) | 9 | STNICHOLAS | false |
| WISCONSIN UPPER PEN OCN MNGMT SERVICES | ||||||||||
| 835 S VAN BUREN | GREEN BAY | WI | 54301 | 391677100 | HEALTHCARE | WI | 501(c)(3) | 3 | ST VINCENT | false |
| UNITY LIMITED PARTNERSHIP | ||||||||||
| 2366 OAK RIDGE CIRCLE | DE PERE | WI | 54115 | 391750729 | HEALTHCARE | WI | 501(c)(3) | 11A | HSSI | false |
Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | Code VCodeVAmount | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARPENTER STREET HOTEL LLC | ||||||||||||||
| 525 NORTH SIXTH STREET HOTEL | SPRINGFIELD | IL | 62707 | 371312961 | Hotel | IL | LASANTE INC | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| NORTHEAST WISCONSIN RADIATION | ||||||||||||||
| 800 East Carpenter Street | GREEN BAY | WI | 54301 | 371321197 | HEALTHCARE | WI | HSSI | RELATED | 47426 | 238253 | false | $0 | false | 0.50000 |
| PRAIRIE HEART INSTITUTE - CARB | ||||||||||||||
| 800 EAST CARPENTER STREET | SPRINGFIELD | IL | 62769 | 263749065 | HEALTHCARE | IL | ST JOHN'S | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| MEMORIAL AND ST ELIZABETH'S HOSPITAL | ||||||||||||||
| 400 NORTH ILLINOIS STREET | SWANSEA | IL | 62226 | 263155343 | HEALTHCARE | IL | ST ELIZABETH'S | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| PAIN CENTER OF WISCONSIN | ||||||||||||||
| 3141 Saemann AveNUE | MILWAUKEE | WI | 53221 | 260822209 | HEALTHCARE | WI | ST VINCENT | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| SURGERY CENTER OF SHEBOYGAN | ||||||||||||||
| 3141 SAEMANN AVE | SHEBOYGAN | WI | 53081 | 203775127 | HEALTHCARE | WI | ST NICHOLAS | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| PREVEA VENTURES LLC | ||||||||||||||
| 2710 EXECUTIVE DR | GREEN BAY | WI | 54304 | 203775127 | HEALTHCARE | WI | HSSI | RELATED | 0 | 0 | false | $0 | false | 0.00000 |
| SPRINGFIELD URGENT CARE REAL ESTATE | ||||||||||||||
| PO BOX 19456 | SPRINGFIELD | IL | 62794 | RENT. REAL ES | IL | LASANTE INC | RELATED | 0 | 0 | false | $0 | false | 0.00000 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kiara Inc | ||||||||||||||||
| 4936 Laverna ROAd | Springfield | IL | 62707 | 371163401 | HealthCare | IL | HSHS | C Corp | 0 | 0 | 0.00000 | false | ||||
| LASANTE INC | ||||||||||||||||
| 4936 Laverna ROAd | Springfield | IL | 62707 | 371163400 | HEALTHCARE | IL | Kiara Inc | C Corp | 0 | 0 | 0.00000 | false | ||||
| LaSante Wisconsin INC | ||||||||||||||||
| 4936 Laverna ROAd | Springfield | IL | 62707 | 391572196 | HealthCare | IL | Kiara Inc | C Corp | 0 | 0 | 0.00000 | false | ||||
| Prairie Cardiovascular | ||||||||||||||||
| 619 East Mason STE 4P57 | Springfield | IL | 62701 | 371071858 | HealthCare | IL | Kiara Inc | C Corp | 0 | 0 | 0.00000 | false | ||||
| PREVEA HEALTH SERVICES | ||||||||||||||||
| 2710 EXECUTIVE DR | GREEN BAY | WI | 54304 | 391839351 | HEALTHCARE | WI | HSSI | C CORP | 0 | 0 | 0.00000 | false | ||||
| PREVEA CLINIC INC | ||||||||||||||||
| 2710 EXECUTIVE DR | GREEN BAY | WI | 54304 | 391839349 | HEALTHCARE | WI | HSSI | C CORP | 0 | 0 | 0.00000 | false | ||||
| PREVEA HEALTH NETWORK | ||||||||||||||||
| 2710 EXECUTIVE DR | GREEN BAY | WI | 54304 | 392000537 | HEALTHCARE | WI | HSSI | C CORP | 0 | 0 | 0.00000 | false | ||||
| RENAISSANCE QUALITY INSURANCE | ||||||||||||||||
| 980669953 | INSURANCE | CA | HSSI | C CORP | 0 | 0 | 0.00000 | false | PO BOX 1159 KY1-1102 | GRAND CAYMANS | CAYMAN ISLANDS | CJ | ||||
| OJV INC | ||||||||||||||||
| 4936 Laverna Rd | Springfield | IL | 62707 | 460873384 | Healthcare | IL | Lasante Inc | C Corp | 0 | 0 | false | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | true | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | TRANSACTIONS WITH RELATED ORGANIZATIONS | Identifier |
| Return Reference | SCHEDULE R, PART V, LINE 2 | ReturnReference |
| Explanation | ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION. | Explanation |