2013-05-14T15:10:04-05:00 2012-06-30 KPMG LLP 191 West Nationwide Blvd Ste 500 Columbus OH 432152568 990 2011-07-01 370661244 ST MARY'S HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS % REBECCA COLKER STMA 2174642966 1800 E LAKE SHORE DRIVE DECATUR IL 62521 Rebecca Colker 2174642970 2013-05-12 true KPMG LLP 6142492300 2011 2016-03-07 17:11:31Z kevin f kast 1800 E LAKE SHORE DRIVE DECATUR IL 62521 151815786 false 0928 X WWW.STMARYSDECATUR.COM X 1878 IL To participate in the health care ministry of the church and provide a family-centered approach in meeting the community's health care needs regardless of ability to pay. 11 8 1362 263 72358 2458455 8923897 127410553 138284968 2938286 617634 35166 1219232 132842460 149045731 0 0 0 0 57394166 57551408 0 0 0 79804522 81667446 137198688 139218854 -4356228 9826877 139522997 136158575 72395048 84818413 67127949 51340162 X TO PARTICIPATE IN THE HEALTH CARE MINISTRY OF THE CHURCH AND PROVIDE A FAMILY-CENTERED APPROACH IN MEETING THE COMMUNITY'S HEALTH CARE NEEDS REGARDLESS OF ABILITY TO PAY. true false 90928390 138284968 SEE SCHEDULE O - Statement of Program Service Accomplishments 90928390 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false true false true false false false false true true false false false false true 75 0 true 1362 true true true false false false false false false false false false X 11 8 false true false false true true true true true false false true true true true true true true true false X REBECCA COLKER 2174642970 1800 E LAKE SHORE DRIVE DECATUR IL 62521 X SR HELEN MARIE PLUMMER OSF 1.0 X SR MARYBETH CULNAN OSF 1.0 X 0 0 0 KEVIN KAST 60.0 X X 0 403490 180530 JOHN SKEFFINGTON 1.0 X X 0 0 0 KEVIN BREHENY 1.0 X X 0 0 0 JON ROBINSON 1.0 X X 0 0 0 MARK CHEVIRON 1.0 X 0 0 0 PAT DAWSON 1.0 X 0 0 0 Fr JOE MOLLOY 1.0 X 0 0 0 BOB WIESEMANN 1.0 X 0 0 0 CLAUDIA MADDING 1.0 X 0 0 0 THERESA J RUTHERFORD 60.0 X 193218 0 67784 ANN M CARR 0.25 X 0 225813 215561 REBECCA COLKER 60.0 X 249415 0 55116 MARIA GRANZOTTI 20.0 X 402647 0 45023 MARK DABBS 40.0 X 172777 0 12006 MARY HARTMAN 40.0 X 214043 0 103558 BETH MCCOY 40.0 X 199714 0 95590 ROBERTA MCBRIDE 40.0 X 198425 0 191360 SARAH STAMBAUGH 40.0 X 193646 0 90687 sheila hollinden 40.0 X 197743 0 0 2021628 629303 1057215 9 false true false WALSH CONSTRUCTION 929 WEST ADAMS CHICAGO IL 60607 CONTRACTOR 15837085 sodexo 488 paysphere circle DECATUR IL 60674 cafeteria management 1450964 Central IL Emergency Physicians PO Box 793 TRAVERSE CITY MI 496850793 Emergency Dept Mgmt 1022559 REHAB CARE 7733 FORSYTH BOULEVARD ST LOUIS MO 63105 CONTRACTOR 787692 central il associates 1800 e lake shore dr DECATUR IL 62521 anesthesia phy serv 775345 19 8923897 8923897 NET PATIENT SERVICE REVENUE 900099 138284968 138284968 138284968 185678 185678 0 0 1438943 2768796 -1329853 -1329853 -1329853 431705 1510 1259 431705 251 431956 431956 0 0 0 CAFETERA/CAFE 722210 31165 31165 REFERENCE LAB 621500 38482 38482 PHYSICIAN ANSWERING SERVICES 900099 33876 33876 2445562 2445562 2549085 149045731 138284968 72358 1764508 0 0 0 0 449855 449855 0 43328883 38661637 4667246 2508307 2303623 204684 8058102 7097576 960526 3206261 2799452 406809 181615 52243 129372 974840 625 974215 238 238 36000 36000 0 25668 25668 27860989 18164489 9696500 621757 621757 433531 306537 126994 0 0 1693701 1422286 271415 49458 24133 25325 0 156209 116185 40024 342362 5124 337238 0 7448276 177024 7271252 2147410 168682 1978728 SUPPLIES 18716795 18624261 92534 BAD DEBTS 15177828 15177828 MEDICAID TAX ASSESSMENT 3817944 3817944 OTHER 1982825 1004513 978312 139218854 90928390 48290464 0 284136 1461109 660147 0 0 0 19847632 24231183 0 0 0 0 0 0 3133264 3180631 1006726 1089972 221373719 123950348 78623403 97423371 35519441 8461915 0 0 0 0 0 0 448248 310394 139522997 136158575 21288344 30968876 0 0 95538 97809 28956551 0 0 0 0 0 0 0 0 0 22054615 53751728 72395048 84818413 X 53667061 45135891 12259905 5003264 1200983 1201007 67127949 51340162 139522997 136158575 X 9826877 -25614664 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 60610 60610 false DESCRIPTION OF OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II B, QUESTION 1I ST. MARY'S HOSPITAL ("THE HOSPITAL") IS A MEMBER OF THE CATHOLIC HEALTH, ILL ASSOCIATION ("CHA"), THE ILLINOIS HEALTH ASSOCIATION ("IHA"), THE NATIONAL ASSOCIATION FOR HOME CARE AND HOSPICE, AND THE AMERICAN HEALTH ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES. A PART OF THESE DUES IS ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. $24,610 of THE AMOUNT LISTED ABOVE IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. The hospital paid $36,000 during the year to Julie Curry, a professional lobbyist through its legal counsel. 3295160 3295160 82818377 29526259 53292118 87345616 69532350 17813266 40892927 24891739 16001188 7021639 0 7021639 97423371 0 ACCRUED BENEFIT LIABILITY 28582708 ABSETOS LONG TERM DEBT 22169193 RETIRE OBLIGATION - ASBESTOS 1662923 ESTIMATED SELF INSURANCE LIAB 1336904 53751728 ASC SUBTOPIC 740-10 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, the Obligated Group 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, and accounting in interim periods, and requires increased disclosures. As of June 30, 2012 and 2011, the Obligated Group does not have a liability for unrecognized tax benefits. true true true X true X true true true false true true 1 6152 3574563 0 3574563 0.02990 1 24250 8187934 8187934 0.06850 1 2008 336770 265478 71292 0.00060 3 32410 12099267 265478 11833789 0.09900 60 650730 2181 648549 0.00540 5 1975 165124 24731 140393 0.00120 44959031 43681864 1277167 0.01070 5 10363 163060 163060 0.00140 70 12338 45937945 43708776 2229169 0.01870 73 44748 58037212 43974254 14062958 0.11770 3 3778 56835 56835 0.00050 3 3778 56835 56835 0.00050 true 15177828 5061806 47018572 43879830 3138742 X true true 1 1 ST MARY'S HOSPITAL

1700 E LAKE SHORE DR DECATUR IL 62521

X X X ST MARY'S HOSPITAL 1 X X X X X X X X X X 11 true false true X X X X X X X X false true true 150. true 300. true X X X X X X X true true X X X true true X false false PART I, LINE 3C The organization does follow FPG to determine eligibility for providing charity and discounted care to low-income uninsured and underinsured individuals. PART I, LINE 6A The hospitals community benefit report can be accessed at www.stmarysdecatur.com. PART I, LINE 7G The organization provides numerous clinical services despite the fact services yield a net financial loss to the organization. Subsidized health services provided by the organization include the service lines of emergency services, obstetrics/nursery, observation, and behavioral health. 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 11.77%. The amount of bad debt expense removed when calculating the percentages in Part I, Line 7, column (F) was $15,177,828. PART I, LINE 7 Costing methodology for amounts reported in table: The common method for estimating the true economic cost of medical services is to adjust the charges through the use of cost-to-charge ratios. Cost-to-charge ratios convert charges for medical services to their true economic costs. Applying cost-to-charge ratios to medical service charges produces average estimates of true costs. The cost-to-charge ratio represents total hospital operating costs divided by total gross billed charges. The exception to the costing methodology described in the preceding paragraph is for the amount for subsidized services on line 7g, for which a costing information system was utilized. More accurate allocations of direct costs are available through the use of that system, and were applied for the subsidized health services. a. For FY2012, total charity care written off was $10,716,961 as reported on the income statement. The net community benefit cost, after applying the cost-to-charge ratio of 33.35%, was $3,574,564 b. For FY2012, estimated cost of Medicaid was $21,373,640. The net community benefit cost, after applying the cost-to-charge ratio of 33.35%, was $8,187,935. c. The estimated cost is calculated using the cost -to -charge ratio. Actual cost can be traced directly to (or identified with) a specific cost center or cost object such as a department, process, or product. The following other benefits are calculated from the income statement. For FY2012, unreimbursed cost from other means tested government programs realized revenue of $265,478 and expenses $336,770. The net community benefit expense was $71,292. d. Total of line 7a through 7c. e. For FY2012, community health improvement services and benefit operations realized revenue of $2,181 and expenses $650,730. The net community benefit expense was $648,549. f. For FY2012, health professions education realized revenues of $24,731 and expense of $165,124. The net community benefit expense was $140,393. g. For FY2012 there were no subsidized health services costs attributed to community benefit. h. For FY2012, there was no research costs attributed to community benefit. i. For FY2012, cash and in-kind contributions realized expenses of $163,060. The net community benefit expense was $163,060. Actual cash contributions of $160,393 are included and consist of charitable contributions made to organizations in the community. j. Total of lines 7e through 7i. k. Total of lines 7d and 7j. NHLBI Partnership and Decatur Health Coalition: St. Mary's Hospital partners with the National Heart, Lung and Blood Institute (NHLBI) on the Learn More Breathe Better campaign to educate the community about COPD and other breathing issues, and promote behaviors that improve health. On a local level, Decatur Health Coalition is working toward the same goals. It is made up of representatives from American Lung Association, Community Health Improvement Center, Decatur Memorial Hospital, Decatur Community Partnership, Macon County Health Department and St. Mary's Hospital and its creation was a result of our organization reaching out to the community as part of the COPD Project. This group is responsible for organizing two major community health events each year that provides free community health education and screenings. Due to the large manufacturing industry in Macon County and the poor air quality that results from the toxic agents released, breathing issues are prevalent in our community. St. Mary's has researched admissions data related to COPD and has increased education and changed processes within the hospital to promote improved health of community members with breathing issues and reduce readmissions. The model for COPD core measures was shared at national best-practice seminars in order to benefit other communities as well. Obesity Coalition: St. Mary's staff participates on the local Obesity Coalition to help raise awareness and take action in lowering the number of Illinoisans that are considered obese. The Obesity Prevention Coalition began in 2008 through a grant from the American Academy of Pediatrics to focus on the issue of childhood obesity in Decatur. Since its inception, the group has grown in members, scope and area. The mission of the OPC is to decrease and prevent obesity in both children and adults throughout Macon County. In 2011, the OPC sponsored community-wide wellness events including the Macon County Wellness Challenge, the Decatur Celebration Fun Run and Healthfest 2011. Obesity has reached epidemic proportions in Illinois - 62% of Illinois adults are overweight or obese. One in five children are obese, the fourth worst rate in the nation. Given that obesity and overweight are primary determinants of cardiovascular diseases, cancer, respiratory diseases, and diabetes - already leading causes of death in Illinois - the implications of this epidemic for the health of our state are staggering. Eisenhower High School HUB Initiative: Eisenhower High School is located adjacent to the St. Mary's Hospital Campus. The majority of students attending the school are low-income, minority students. The school received a HUB Grant to assist not only in renovating the school, but to help build a strong neighborhood hub. St. Mary's staff has been involved in the planning phases and has identified opportunities to contribute our expertise and resources by providing various health, behavioral, and health career education. An example of planned services are family workshops which focus on substance abuse issues. The goal of this initiative is to improve the neighborhood community by providing safe and fun evening activities, offer events that promote family involvement, and offer education on healthy habits and career choices for the children and families who live there. PART II The organization provides a senior center and language translation service to the community. The Lake Shore Connection program is focused on individuals age 55 and over. Participants in the program can obtain courtesy transportation to and from any health related appointments in the community. The organization also offers participants free quarterly health screenings, discounts on monthly lunch and learn programs, and other resources to assist participants in staying productive, healthy and independent. Spectra Corp and Language Service: The language translation service provides assistance to patients who do not speak English. Language Service provides assistance to patients who are unable to hear. The organization believes that providing this service is essential to making sure that all members of the community have access to excellent health care. PART III, LINE 4 The footnote text related to bad debt expense from the audited financial statements reads as follows: "The Obligated Group also provides a significant amount of uncompensated care for patients, which is not included above, but is reported in the consolidated statements of operations as a provision for uncollectible accounts. Many of those patients are uninsured or underinsured, but did not apply for, or qualify for, charity care." Please note that reference is made to the "Obligated Group", of which this organization is a member. The organization 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 organization's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. The organization is in the process of implementing processes, procedures, and systems to more effectively determine charity care that will reduce a patient's documentation requirements when applying for charity care. This will provide a more accurate reporting of charity care services provided by the organization. Actual bad debt expense was $15,177,828 as reported on the income statement. After applying the cost-to-charge ratio of 33.35%, the estimated cost of accounts turned to bad debt was $5,061,806. There were patients who qualified under the Hospital's Charity Care Policy and also had accounts written off to bad debt expense. The amount that was written off to bad debt expense for these patients was $222,760. After applying the cost-to-charge ratio of 33.35%, the cost of bad debt was $74,290. A system report was created showing patient accounts written off to bad debt. A second report was created that showed accounts with charity adjustments during fiscal year ended June 30, 2012. The two reports were compared to determine if any patients who qualified to charity had accounts written off to bad debt. 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. The hospital Medicare shortfall at cost for fiscal year 2012 was $3,138,742. The shortfall is figured by netting reimbursement against cost. The information is taken from the FY12 cost report. For FY12, reimbursement totaled $47,018,572 and cost totaled $43,879,830 for Inpatient Hospital, Outpatient Hospital, Rehab, and Skilled. PART III, LINE 9(B) 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 QUALIFIED 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 QUALIFIED 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 PAYER 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. FOR ADDITIONAL INFORMATION, SEE RESPONSE TO QUESTION VI, 3. PART V The organization does not have any healthcare facilities that are not registered as a healthcare facility under State law. Part V, Section B, Line 1 During fiscal year 2012, St. Mary's Hospital conducted a health needs assessment of the facility's service area. Macon County makes up the majority of the St. Mary's Hospital primary service area, with surrounding counties comprising much of the secondary and tertiary areas. St. Mary's Hospital, which is affiliated with Hospital Sisters Health Systems, is one of two acute care hospitals serving this area. St. Mary's Hospital first participated with the Macon County Health Department and other community health providers as part of the Community Health Committee for completion of the Illinois Project for Local Assessment of Needs (IPLAN). St. Mary's Hospital then supplemented the IPLAN data with primary data from 400 telephone surveys, conducted by Leede Research, to the primary service area. Part V, Section B, LINE 3 Assessing the health needs of the community began with the collaboration of health professionals on the Community Health Committee, which was organized by the Macon County Health Department. This committee of 19 members was led by Brandi Binkley, Director of Health Promotion. In addition to 8 representatives from St. Mary's Hospital, members of this committee include representatives from United Way, Decatur Memorial Hospital, Macon County Mental Health Board, Decatur Housing Authority, Decatur Community Partnership, Community Health Improvement Center, Dove Retired Senior Volunteer Program, American Cancer Society, and a Parish Nurse. These community partners bring special knowledge and expertise in the areas of public health, underserved, low-income and minority populations, and chronic disease. The Community Health Plan (IPLAN) for Macon County was created as a result of this group's research. To supplement the work of the Community Health Committee, St. Mary's Hospital sought additional primary data. In November 2011, along with other hospitals in the Hospital Sisters Health System, St. Mary's Hospital contracted with Leede Research to conduct telephone interviews in each local service area. The study consisted of 400 completed telephone interviews utilizing a questionnaire designed by Leede in cooperation with hospital leadership. A proportionate stratified sample was used to provide equal input from all geographic areas. Weighting by age and income was used to more accurately represent the actual population in the area. The goal was to give the survey an accurate representation of the actual service area. Analysis showed that results from Leede survey process aligned with IPLAN data. Since the data was mutually supportive with similar findings, St. Mary's chose to utilize the primary data set for our prioritization process and implementation planning. The facility's parent organization, Hospital Systems Health Systems, has formed a Community Benefit Planning Team that has developed guidelines for consistency in community health needs assessments, implementation planning and guidelines for reporting community benefit. St. Mary's Hospital formed an internal Community Benefit Team consisting of hospital colleagues. The purpose of this group is to provide input, monitor the progress of our community benefit initiative and implementation plan, as well as assist in identifying additional opportunities for addressing the needs of the community. Since December 2009, the St. Mary's Strategic Planning Committee, comprised of hospital leadership, local physicians, community leaders and local Board Members, has been instrumental in examining the St. Mary's Ministry from every vantage point. They provide valuable input on an ongoing basis on the community's healthcare needs. The hospital's Strategic Plan is built from the work of this group, and is updated yearly based on the identified service gaps and needs of our community. Members of our community-based Strategic Planning Committee, hospital volunteers, and our Community Benefit Team were asked to participate in the prioritization process for identified health needs from the Community Health Needs Assessment. In addition, St. Mary's participation in Grow Decatur, a community-based group working toward building a healthier community, lends further perspective into the needs of the community and presents further opportunities for service collaboration among local businesses and service providers. St. Mary's Hospital Representative worked with the group to analyze and prioritize the data gleaned from the group's community assessment and will continue to participate in the improvement process. Input is continuously obtained from the patients we serve through patient satisfaction surveys. Input provided through some of these surveys was taken into consideration in the development of the hospital's master facility plan, which resulted in the major Emergency Room capital project. Part V, Section B, LINE 7 The Hospital's Community Health Needs Assessment and associated implementation strategy were completed in FY2012, the reporting year. However, the implementation strategy had not yet been executed, so this question will need to be answered in the filing for FY2013. Access to Healthcare * Increase access to medication and effective discharge instructions through partnership with local Pharmacist * Increase access to home health infusion through partnership with a local home health infusion company. * Improve access to mental health services through collaboration with other health providers to establish the Macon County Care Coordination to build an integrated health care delivery system for residents with behavioral needs. Cardiovascular/Women's Health * In partnership with Prairie Cardiovascular on St. Mary's campus, we will be developing programs that focus on education, awareness and screenings for women's cardiovascular health. Women's Health * St. Mary's nurses will receive Sexual Assault Nurse Examiner (SANE) certification training in order to preserve the dignity of and be attentive to the emotional needs of women who have been the victim of an assault. * Through our support and participation in the Come Together Let's Walk Event, St. Mary's Hospital was awarded a grant for expanded programs in cancer diagnosis and/or treatment. With the high instances of breast, cervical, and ovarian cancer in our area, we plan to focus these funds on women's health. Obesity * St. Mary's Dieticians designed a Nutrition Fair for at-risk Decatur Public School students to provide education on eating healthy, encourage healthy food and exercise choices, and provide a fun summer learning opportunity for community youth. This aligns with the education efforts of the Obesity Coalition. While the issue of affordable housing was identified in the Community Health Needs Assessment, St. Mary's Hospital is not directly involved in addressing that issue, as this is outside our area of focus or expertise. The Decatur Housing Authority, Energy Assistance Foundation, and Community Investment Corporation of Decatur are all offices in Macon County that offer housing assistance. Previously implemented and ongoing programs that address the areas of focus from the Community Health Needs Assessment are: * Access to Healthcare: Through our mission to serve all regardless of ability to pay, we continue to address this need. St. Mary's Hospital is dedicated to another aspect of affordable healthcare, which is acquiring employment that offers health insurance. As one of the largest employers in the city, we are pleased to partner with the local high schools to offer job preparation training and job fairs for students. * Women's Health: St. Mary's Hospital is committed to promoting women's health through our Prenatal Clinic which provides early and adequate prenatal care to new mothers who may not otherwise get the proper care. Through our Baby-Friendly Initiative, St. Mary's Hospital aims to improve the care of pregnant mothers and newborns by protecting, promoting and supporting breastfeeding. Studies have shown that breastfed babies are less likely to suffer from serious illnesses and as adults, are less likely to develop risk factors for heart disease such as obesity and high blood pressure. Benefits for mothers are a lower risk of developing breast or ovarian cancer. * Obesity: St. Mary's Hospital has two representatives on the Obesity Coalition: a Dietician and our Director of Maternal Child Services. Through this group, we will assist in building programs and activities in our community to address this health concern. This will allow us to combine resources and potentially make a greater difference. St. Mary's Hospital will also continue to partner with other local service providers in addressing the top concerns for our community. part v, section b, line 19(d) WE ASK EACH PATIENT TO FILL OUT A FORM IN ORDER TO DETERMINE THEIR ELIGIBILITY UNDER THE ILLINOIS UNINSURED ACT. IF THE PATIENT FAILS TO FILL OUT THE FORM, FINANCIAL COUNSELORS WILL SEEK TO DETERMINE PATIENT ELIGIBILITY BY SEEKING APPROPRIATE INFORMATION IN THE SEARCH AMERICA PROGRAM. WE ALSO REVIEW THE PATIENTS' ACCOUNTS TO ENSURE THEY ARE NOT CHARGED MORE THAN 25% OF THEIR ANNUAL GROSS INCOME. ONCE THE CHARGES FOR A SELF-PAY BALANCE EXCEED 25% OF THE PATIENTS' ANNUAL GROSS INCOME, THE REMAINING BALANCE IS ADJUSTED OFF TO CHRISTIAN CARE. Needs Assessment An integral part of the mission of St. Mary's Hospital is the commitment to meet the health care needs of all in the community, regardless of the ability to pay. St. Mary's participated in a Needs Assessment process during FY2012 that culminated in on Implementation Strategy approved by the St. Mary's Board at the end of the fiscal year. The Community Health Needs and associated implementation strategy will be used to guide our efforts in 2013. For prior years, we collaborated with the Macon County Health Department in their Health Needs Assessment and the creation of their Community Health Plan. We have also collaborated with United Way, other non-profit organizations, and local community groups in conducting a community health needs assessment survey. In addition, we listened to the voice of our community through patient surveys and our community-based councils to identify community needs. the community needs assessment is available online at https://www.stmarysdecatur.com/About/Community.aspx Patient education of eligibility for assistance The Registration Department provides brochures to patients upon registration regarding the payment assistance programs available to them at St. Mary's Hospital. The brochures are also supplied in waiting and ancillary areas for easy access by the patient. Contact numbers for several agencies are listed in the brochure, as well as information about how to read and understand the bill. Information on payment assistance, billing procedures and explanations of Medicare forms are available on the organization's website. The organization has a representative on site to assist patients who may be eligible for Medicaid assistance through the Illinois Department of Public Assistance. They work with patients to determine if they may be eligible, and if so, assist in pulling together the necessary application for submission. Patients are also provided a Fair Billing Act Notification at the point of registration regarding separate physician billing they can expect to receive, plus information about the patient's financial responsibility if their insurance plan is out of network. One on one conversation to educate patients about financial assistance often stem from patients receiving a statement or a pre-collection letter. At that point, the customer service representative or cashier, or other qualified staff, will inform/educate the caller about financial assistance options. The first pre-collection letter reminds the patient their account is in delinquent status. It also informs them they may be eligible for financial assistance through the organization's Charity Care program. The letter provides direct contact information to begin the application process for Charity Care. A system called Search America is now being utilized after failed attempts made by the hospital and by our law firm to work out payment arrangements. That system accesses credit and other information and allows us to see the probability of a patient being able to pay their bill. After assessing that information, the hospital makes a determination whether to grant charity or continue collection efforts. Community Information Community Served The population of Macon County, based on the 2010 U.S. Census Bureau, is 110,768, which represents a decrease of 3.4% since the 2000 census. The county median household income, as reported in 2010 is $44,337, with a poverty rate for the same period at 15.7%. Decatur's median family income is $49,562, which is the lowest compared to the surrounding major cities. The racial makeup of the county in 2010 was 79.3% White, 16.3% African American, with other races comprising the remaining 4.4%. 15.7% of the county lives in poverty, which is 3.1% above the Illinois figure and 1.9% above the national figure. 69% of children in Decatur Public Schools live in poverty. Macon County's adult obesity rate, at 33%, greatly exceeds the Illinois rate of 20%, and the national rate of 14%. The unemployment rate (not seasonally adjusted) as of February 2012 was 11.0%, up from a rate of 10.1% in December 2011. In 2010, educational services/ health care/social assistance was the largest major sector, representing 23.1% of all jobs in the county. Manufacturing comprised the next largest sector, representing 17.3%. Macon County has 580 square miles in land area and a population density of 190.8 per square mile. The town of Decatur, which is where St. Mary's Hospital is located, is the county seat and also the largest city in Macon County. Promotion of Community health St. Mary's Hospital 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 135 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 Macon County and surrounding areas. The hospital is governed by a Board of Directors, the majority of which is comprised of persons who 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 Hospital 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. 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. St. Mary's also devotes significant resources to access for patients who cannot afford care, along with other community benefits. In fiscal year 2012, St. Mary's provided over $12 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. Additionally, during this period, St. Mary's provided $4.6 million (at cost) in uncompensated care to patients that did not qualify for charity care or public assistance and over $15 million (at cost) in excess of Medicare payment for health care services. The range of benefits provided by St. Mary's flows 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. Based on the assessment of community needs described under #2 above, St. Mary's has focused on the following priorities. Access to Services Prenatal Clinic: The prenatal clinic serves uninsured and underinsured mothers. It provides both prenatal and postnatal care. Each year, the clinic cares for approximately 250 women and babies, with an estimated 3,500 visits. The clinic is unique in that each woman has her own physician, ensuring comprehensive and consistent prenatal care. In addition, community resources are invited to participate in the clinic, giving patients full exposure to options available to them. Adult Day Services: The organization operates an adult day care program for adults unable to totally care for themselves and who do not have home assistance during the day. This program provides a safe, caring environment for participants, while providing respite for caregivers. To increase accessibility, transportation is available. Lakeshore Connection: Keeping Seniors in a Healthy State of Mind One of the defining characteristics of St. Mary's Hospital is its emphasis on holistic care-serving the physical, spiritual and emotional needs of the Deca AFFILIATED HEALTH CARE SYSTEM ST. MARY'S HOSPITAL DECATUR 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 Christs healing love for all people through our high quality Franciscan health care ministry. We live our Mission by healing those who seek our care, as well as through our Community Benefit initiatives. Working collaboratively with othersin the 12 communities we serve, our Community Benefit efforts are successfully expanding access to care, improving the health status of residents, and furthering medical education and knowledge. Across HSHS, we collectively provided $174.2 million in Community Benefits (or 9.7% of total hospital expenses) in FY2012. Included in this amount was $43.1 million provided for Charity Care and $97.9 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 $168.4 million. HSHS hospitals also recorded $106.6 million in uncollectible accounts. Beyond 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 U.S. 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 FY2012, 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 the individual. Our efforts to ensure residents in the communities we serve receive the right care at the right time 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. In western Wisconsin, St. Josephs 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 2,216 patient visits, a 25% increase from the prior year. With more than 150 individuals volunteering, the clinic provided over 6,500 hours (including 700 physician hours and 1,500 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 northeastern Wisconsin, St. Vincent Hospital in Green Bay supports patient care for the uninsured at the NEW Community Clinic by paying a nurses salary and offering free and discounted laboratory and radiology services. More than 70% of patients who use the clinic report the care they received helped keep them out of the Emergency Department. St. Nicholas Hospital in Sheboygan proactively reaches out to local Hmong and Hispanic organizations toensure these populations can participate in free screenings and health education programs. Through this ongoing outreach initiative, St. Nicholas engaged more than 350 people last year, and in many cases was able to identify critical health conditions early and provide appropriate follow-up care. A Woman's Place at St. Mary's Hospital Medical Center in Green Bay reaches out to Hispanic neighbors to provide health and wellness education, health screenings, resources and referral services. Last year A Woman's Place touched the lives of more than 7,000 women through health screenings, educational events, classes and its resource center. In southeast Illinois, area residents can get help filling a prescription through the long-term collaboration between St. Anthonys Memorial Hospital in Effingham and Catholic Charities. Last year, St. Anthonys helped underwrite the cost of prescription medications for more than 430 residents. In southwest Illinois, St. Joseph's Hospital in Highland recognized many rural residents did not have a reliable means of transportation and partnered with generous individuals in the community to offer a free transportation service. The Friends Van, fully supported by the Friends of St. Joseph's Hospital, provides free rides to medical, dental and other personal appointments within a 20-mile radius of Highland. In FY2012, the Friends Van transported 2,050 individuals for a total of 12,561 miles. In addition to programs such as these, HSHS makes sure that those who need financial assistance for care receive it. Our Charity Care program covers 100% of hospital charges for individuals and families who earn less than 200% of the federal poverty level. HSHS Charity Care 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 charity care 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 Christs 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. To address metabolic disease management, St. Francis Hospital in Litchfield, Illinois, partners with Montgomery County Health Department to provide screening for diabetes and renal disease. St. Francis Hospital teams up with Macoupin County Health Department to provide Diabetes Self-Management classes. St. Josephs Hospital in Breese, Illinois coordinates several community education seminars and health fairs on cardiovascular disease and healthy eating each year. Over 3,000 residents participated in these health events last year. Recognizing the importance of proper food and nutrition to overall health, St. Johns Hospital in Springfield initiated the Destination Dinner program which teaches families how to cook healthy, from-scratch meals, and eat together as a family. Families meet quarterly to learn new cooking skills. They also learn how to prepare a meal for a family of four on a budget of $8.00. In addition to raising awareness about how to eat healthy on a limited budget, the program brings families together around the dinner table, which research shows promotes healthy relationships, increased academic performance and decreased risk for substance abuse and risky sexual behavior. Sacred Heart Hospital in Eau Claire, Wisconsin addressed the need for access to mental health services for children and adolescents by opening an outpatient behavioral health clinic. Sacred Heart has also adopted screening tools for behavioral and mental health risk factors for use at affiliated clinics. The goal is to better identify mental health issues and provide earlier intervention. Sacred Heart Hospital is also working with the Chippewa Valley Free Clinic(CVFC) to develop expanded provider coverage for CVFC patients who require mental health services. St. Mary's Hospital in STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI IL, X X X X X X false true false false false false false false false KEVIN KAST 0 368854 0 0 0 34636 0 158181 0 23169 0 584840 0 40460 THERESA J RUTHERFORD 192434 0 0 0 784 0 53902 0 13925 0 261045 0 0 0 ANN M CARR 0 180383 0 0 0 45430 0 197622 0 18662 0 442097 0 15440 REBECCA COLKER 249306 0 0 0 109 0 41234 0 14702 0 305351 0 254463 0 MARY HARTMAN 212064 0 0 0 1979 0 89676 0 14633 0 318352 0 242419 0 BETH MCCOY 190896 0 0 0 8818 0 76925 0 19415 0 296054 0 220380 0 ROBERTA MCBRIDE 198425 0 0 0 0 0 0 0 0 0 198425 0 216113 0 MARIA GRANZOTTI 386866 0 15480 0 301 0 38416 0 7410 0 448473 0 351938 0 SARAH STAMBAUGH 188980 0 0 0 4666 0 72185 0 19252 0 285083 0 0 0 MARK DABBS 164172 0 8415 0 190 0 0 0 12693 0 185470 0 0 0 sheila hollinden 197403 0 0 0 340 0 0 0 0 0 197743 0 0 0 ANN M. CARR SCHEDULE J, PART I, LINE 4B ANN M. CARR PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $33,655. KEVIN KAST SCHEDULE J, PART I, LINE 4B KEVIN KAST PARTICIPATED IN A SERP PLAN DURING THE YEAR IN THE AMOUNT OF $79,410. 0 Bolen Robinson Ellis Board Member 261958 legal services false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS FORM 990 SCHEDULE L, PART IV BOARD MEMBER, JON ROBINSON, IS A 50% PARTNER IN THE BOLEN, ROBINSON LAW FIRM. THE FIRM PROVIDES LEGAL SERVICES TO THE ORGANIZATION AND ALL SERVICES WERE CONSIDERED TO BE ARMS-LENGTH TRANSACTIONS. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ST. MARY'S HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF ST. MARY'S HOSPITAL, IT IS RECONGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE NECESSARY MEDICAL SERVICES. INHERENT TO OUR MISSION, WE PROVIDE CARE TO THE POOR, THE ELDERLY, AND THE NEEDY OF THE COMMUNITY THROUGH VARIOUS PROGRAMS AND SERVICES. THESE ACTIVITIES INCLUDE COMMUNITY EDUCATION PROGRAMS, WELLNESS PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF BROAD COMMUNITY SUPPORT ACTIVITIES. DURING FICAL YEAR 2012, ST. MARY'S HOSPITAL PROVIDED 43,452 ADULT AND PEDIATRIC DAYS OF CARE AND 166,148 OUTPATIENT VISITS DURING THE SAME TIME PERIOD. ST. MARY'S HOSPITAL PROVIDES BOTH BENEFITS TO THE POOR AND TO THE BROADER COMMUNITY. BENEFITS TO THE POOR ARE PROVIDED ON THE FORM OF TRADITIONAL CHARITY CARE FOR THOSE WHO CANNOT AFFORD TO PAY, UNPAID COSTS Of PUBLIC PROGRAMS SUCH AS MEDICAID AND GENERAL RELIEF, NONBILLED SERVICES FOR THE POOR AND MANY IN-KIND DONATIONS. THE TOTAL VALUES OF THESE UNREIMBURSED BENEFITS FOR THE POOR WERE $11,836,333 IN FISCAL YEAR 2012. ST. MARY'S HOSPITAL PROVIDES NUMEROUS BENEFITS TO THE BROADER COMMUNITY. THIS IS CARRIED OUT THROUGH OUR PARTICIPATION IN THE MEDICARE PROGRAM, PROVIDING MANY PROGRAMS AND SERVICES FREE OR AT A REDUCED PRICE, AND PROVIDING SERVICES THAT BENEFIT THE COMMUNITY BUT HAVE A NEGATIVE MARGIN TOTALED $15,293,725 DURING FISCAL YEAR 2012. ALL OTHER NONBILLED SERVICES PROVIDED TO THE COMMUNITY AND SERVICES PROVIDED AT LOW OR NEGATIVE MARGINS TOTALED $908,038 FOR THE YEAR ENDED 6/30/2012. BELOW ARE SPECIFIC EXAMPLES OF SERVICES INCLUDED IN THE ABOVE FIGURES: THROUGH THE OPERATION OF ITS PRENATAL CLINIC, THE HOSPITAL PROVIDES BOTH PRE AND POST NATAL CARE TO THE POOR. THE HOSPITAL ROUTINELY DONATES FOOD TO LOCAL FOOD PANTRIES. OBSOLETE EQUIPMENT IS ALSO OCCASIONALLY DONATED TO LOCAL AGENCIES. PROVIDE TRAINING TO THE LOCAL PARAMEDICS, FIRST RESPONDER GROUPS, AND FIRE DEPARTMENTS. IN ADDITIONA, AREA ORGANIZATIONS RECEIVE CPR TRAINING THROUGH THE HOSPITAL'S EMS DEPARTMENT. the HOSPITAL PARTICIPATES IN THE SECONDARY TRANSITIONAL EXPERIENCE PROGRAM BY PROVIDING EMPLOYMENT OPPORTUNITIES TO HANDICAPPED STUDENTS. PASTORAL CARE AND SOCIAL SERVICE DEPARTMENTS PROVIDE ASSISTANCE FOR PATIENT AND FAMILY NEEDS. PROVIDED LIFELINE VOICE COMMUNICATORS TO ELDERLY PATIENTS WITH SPECIAL NEEDS. EMPLOYEES SERVE AS SPEAKERS AT HEALTH FAIRS, SCHOOLS, AND A VARIETY OF AREA ORGANIZATIONS. ASSIST THE UNITED WAY CAMPAIGN BY HAVING STAFF MEMBERS ORGANIZE THE HOSPITAL'S ANNUAL FUND DRIVE. PROVIDE A VARIETY OF HEALTH SCREENINGS TO THE PUBLIC IN DIFFERENT LOCATIONS THROUGHOUT THE COMMUNITY. TAX EXEMPT BONDS FORM 990, PART IV, QUESTION 24 St. Mary's Decatur 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. Delegation of management Form 990, Part VI, Line 2 St. Mary's Hospital outsources management of the Rehab department to better facilitate the health needs of its patients. In doing so, St. Mary's hospital is able to focus its efforts in other areas, improving the already exceptional quality provided in those areas. RIGHTS OF MEMBERS TO ELECT GOVERNING BODY FORM 990, PART VI, LINES 6 & 7A THE SENIOR GOVERNING BODY OF ST. Mary's HOSPITAL (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 (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 15 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 St. Mary's Hospital's cash reserves are invested in a pooled investment account. Participation in the pooled fund is limited to the 501(C)(3) Hospitals and related health services organizations sponsored by the Hospital Sisters Health System. The pooled account consists of cash, and equity and debt securities that are publicly traded. In accordance with the provisions of SFAS No. 124 "Accounting for certain investments held by Not-For-Profit Organizations," investments in equity securities with readily determinable 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 participants. other changes in net assets Form 990, Part XI, Line 5 transfer to affiliates (5,923,000) change in pension funded status (10,030,338) gain on sale of assets (251) change in temporarily restricted net assets (7,256,641) change in permanently restricted net assets 24 other change in net assets 434,635 change in swap agreements (1,903,744) unreal. loss on investments not held at Foundation (935,600) ------------- total (25,614,664) ============= HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANN M. CARR TITLE:TREASURER HOURS:60 Springfield Health Partners LLC 4936 Laverna Road springfield IL 62707 371364419 healthcare IL 0 0 hshs mg Kiara Clinical Integration Network LLC 4936 Laverna Rd springfield IL 62707 261417684 healthcare IL 0 0 HSSI PHYSICIAN CLINICAL INTERGRATION NETWORK 4936 LAVERNA RD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 0 0 KCIN 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 NA false HOSPITAL SISTERS OF ST FRANCIS FDTN 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(C)(3) 11A NA false HSHS SELF INSURANCE TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371120626 INSURANCE IL 501(C)(3) 11A NA false HSHS HEALTH CARE PLAN TRUST FUND 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371137724 HEALTHCARE IL 501(C)(3) N/A NA false Hospital Sisters Healthcare West Inc 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(C)(3) 11A NA false SACRED HEART HOSPITAL 900 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(C)(3) 3 NA false ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(C)(3) 3 NA false ST ELIZABETH'S HOSPITAL 211 SOUTH THIRD STREET BELLEVILLE IL 62220 370663567 HEALTHCARE IL 501(C)(3) 3 NA false ST NICHOLAS HOSPITAL 3100 SUPERIOR AVENUE SHEBOYGAN WI 53081 390808480 HEALTHCARE WI 501(C)(3) 3 NA false ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(C)(3) 3 NA false ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(C)(3) 3 NA false ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(C)(3) 3 NA false ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(C)(3) 3 NA false ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(C)(3) 3 NA false ST MARY'S MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(C)(3) 3 NA false ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 54301 390817529 HEALTHCARE WI 501(C)(3) 3 NA false ST JOSEPH'S HOSPITAL 1515 MAIN STREET HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(C)(3) 3 NA false HSHS MEDICAL GROUP INC 3215 Executive Park Drive Springfield IL 62703 263956318 HEALTHCARE IL 501(C)(3) 11A NA false HSHS WISCONSIN MEDICAL GROUP INC 3215 Executive Park Drive Springfield IL 62703 264515959 HEALTHCARE WI 501(C)(3) 11A NA false Orange Cross Ambulance inc 919 Ashland Ave Sheboygan WI 53081 391860942 Healthcare WI 501(C)(3) 9 St Nicholas false Wisconsin Upper Peninsula Onc Mngmt Svcs 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) 9 HSSI false Memorial and St Elizabeth's Healthcare 4000 North Illinois Street Swansea IL 62226 371312961 HealthCare IL St Elizabeth's NONE 0 0 false 0 false Prairie Heart Institute - Carbondale 800 East Carpenter Street Springfield IL 62769 371321197 HealthCare IL St John's NONE 0 0 false 0 false Northeast Wisconsin Radiation Therapy Se 1821 S Webster Avenue STE 300 Green Bay WI 543079047 263749065 HealthCare WI HSSI NONE 0 0 false 0 false Pain Center of Wisconsin 4131 W Loomis Road STE 300 Greenfield WI 53221 263155343 HealthCare WI St Vincent NONE 0 0 false 0 false Surgery Center of Sheboygan LLC 3141 Saemann Ave Sheboygan WI 53081 260822209 HealthCare WI St Nicholas NONE 0 0 false 0 false Prevea Ventures LLC 2710 EXECUTIVE DR Green Bay WI 54304 203775127 HealthCare WI HSSI NONE 0 0 false 0 false CARPENTER STREET HOTEL LLC 36- HOTEL IL LASANTE INC NONE 0 0 false 0 false SPRINGFIELD URGENT CARE REAL E RENT. REAL ES IL LASANTE INC NONE 0 0 false 0 false Kiara Inc 4936 Laverna Rd Springfield IL 62707 371163401 HealthCare IL HSHS C Corp 0 0 LaSante Wisconsin Inc 4936 Laverna Rd Springfield IL 62707 391572196 HealthCare IL Kiara Inc C Corp 0 0 LaSante Inc 4936 Laverna Rd Springfield IL 62707 371163400 HealthCare IL Kiara Inc C Corp 0 0 Prairie Cardiovascular 619 East Mason STE 4P57 Springfield IL 62701 371071858 HealthCare IL Kiara Inc C Corp 0 0 Prevea Health Services 2710 EXECUTIVE DR Green Bay WI 54304 391839351 HealthCare WI HSSI C Corp 0 0 Prevea Clinic Inc 2710 EXECUTIVE DR Green Bay WI 54304 391839349 HealthCare WI HSSI C Corp 0 0 Prevea Health Network 2710 EXECUTIVE DR Green Bay WI 54304 392000537 HealthCare WI HSSI C Corp 0 0 Renaissance Quality Insurance PO Box 1159 Grand Caymans CJ KY1-1102 980669953 Insurance CJ HSSI c corp 0 0 false false false false false false false false true false true false false true true true true true Prairie Cardiovascular q 520342 FMV transactions with related organizations schedule r, part v, line 2 The transactions reported on line 1 and not specifically identified on line 2 are between related 501(c)(3) public charities. accordingly they are not reported in this section.